Search Results (6,809)

Background/Objectives: Safe disposal of unused medicines represents an increasing public health and environmental concern. Until 2024, Romanian community pharmacies collected expired medicines from the public, though implementation was inconsistent. Using a knowledge–attitude–practice (KAP) framework, this study assessed community pharmacists’ self-reported involvement in pharmaceutical waste prevention in Bihor County, Romania, one year after new legislation transferred collection responsibilities to hospital-based centers. Methods: A cross-sectional survey was conducted in May 2025 using a self-administered questionnaire comprising 22 items covering socio-demographics, professional practices, knowledge, and attitudes. Eligible participants were community pharmacists (N = 285). Results: Respondents reported high awareness and favourable attitudes toward pharmaceutical waste management: 98.2% indicated awareness of current legislation, 94.4% reported receiving training on the new regulations, 99.6% acknowledged health and environmental risks, and 98.9% expressed agreement that patient education is important. However, 55.4% reported providing disposal information only when patients requested it, while 89.8% indicated that patients rarely asked about medicine disposal. Self-reported proactive counseling increased with patient request frequency (χ²(3) = 7.914, p = 0.048), with pharmacists in the high-request group reporting substantially higher proactive counseling than those in the low-request group (83.3% vs. 42.9%). In an adjusted logistic regression, low request frequency was associated with lower odds of proactive counseling (aOR = 0.21, 95% CI: 0.05–0.98, p = 0.047). Most respondents (94.6%) perceived waste-related responsibilities, though these perceptions were only weakly related to reported counseling behaviors. Conclusions: Pharmacists reported high awareness and positive attitudes toward pharmaceutical waste management, but counseling remained reactive. Patient demand was a key correlate of counseling proactivity, underscoring the need for structured education within Romania’s hospital-based take-back system. Full article

Background: Traumatic brain injury (TBI) imposes a substantial public health burden through long-term physical, cognitive, and psychiatric effects. This includes substance use disorders (SUDs) for which TBI is a demonstrated risk factor; however, prior studies have not comprehensively compared relative incidences of SUD subtypes post-TBI or differences between intracranial hemorrhage (ICH) and non-ICH TBI in patients without prior SUD history. This global retrospective analysis using the TriNetX database aims to quantify new-onset SUD incidence post-TBI in the largest cohort of patients evaluated to date, with cohorts stratified by SUD subtype and ICH versus non-ICH TBI, to highlight opportunities for post-injury care models to mitigate SUD risk. Methods: De-identified data from the TriNetX Research Network were used to select patients with TBI (n = 1,889,112) and define distinct cohorts based upon the presence (n = 420,868) or absence (n = 1,471,592) of ICH. Patients with previously diagnosed SUD before the date of TBI were excluded. Patient demographics and medical comorbidities were calculated for each group. The incidence of new SUD diagnosis over the lifetime and at 1-, 3-, and 5-years post-TBI were calculated and compared. Subtypes of SUD were defined and calculated based on the specific substance used. Propensity scores were calculated to create balanced matched ICH and non-ICH cohorts (n = 331,812 each) were used for comparisons of 5-year SUD incidence. Results: In the full TBI cohort, 5-year new SUD incidence was 4.2% overall, with nicotine (2.4%) and alcohol (1.1%) predominating, followed by cannabis (0.9%) and opioids (0.4%). Rates of SUDs increased over time, but attenuated beyond 5 years, with approximately 50% of those who would ultimately be diagnosed with SUD manifesting (lifetime) by 3 years post-TBI. After propensity matching, non-ICH TBI showed higher 5-year risk for any SUD (4.2% vs. 3.6%; risk difference −0.65%, p < 0.0001) and all subtypes (p < 0.05) except inhalants (p = 0.53). Conclusions: This largest-to-date analysis of new-onset SUD post-TBI demonstrates significantly higher rates of SUD in TBI patients; rates of nicotine, alcohol, cannabis, and opioid use disorders were most common. Non-ICH TBI patients demonstrated greater rates of SUD after injury than patients with ICH-associated TBI. Of patients suffering from TBI without ICH who would eventually be diagnosed with SUD, approximately 50% had obtained that diagnosis within 3 years of the injury. Taken together, these findings demonstrate the clinical need for routine SUD screening in post-TBI care, especially for 3 years post-injury. Such an intervention has the potential to significantly alleviate the public health burden and associated cost of care for TBI-associated substance use disorder patients. Full article

Background/Objectives: Challenging behaviour post-stroke can complicate care and disrupt rehabilitation, yet its presentation and management are underreported. This study explored how such behaviours were documented in clinical records and managed in stroke settings, and how care delivery and discharge outcomes were documented in this context. Methods: A retrospective chart review was conducted across two NHS stroke units, covering all admissions between March and April 2022. Patient records were reviewed to capture demographic, clinical, and behavioural information, together with details relating to management and discharge. Challenging behaviour was identified retrospectively from clinical documentation during routine care. Descriptive statistics were used to summarise the data. Results: Forty-eight stroke admissions were examined, with challenging behaviour documented in thirteen patients (27%). Eleven had ischaemic stroke, with moderate severity common (n = 6), while inattention/neglect (n = 5) and infection (n = 4) were also documented. Behaviours were commonly recorded as confusion or agitation, and predominantly by nursing staff. Challenges to care delivery were documented in six of these patients, and additional professional input was provided for seven. Discharge delays were documented in patients with challenging behaviour, and the median length of stay was notably longer for this group (19 days compared with 7). Documentation of cognitive or delirium screening was uncommon. Conclusions: Challenging behaviour was documented in over a quarter of acute stroke admissions and was documented alongside greater care complexity and longer hospital stays. These preliminary descriptive findings from a small sample indicate a need for further exploration to better characterise challenging behaviour following stroke and its implications for care. Full article

Background/Objectives: Health Promotion Centres (HPCs) in Slovenia represent a European best practice for integrated prevention and health promotion. This study explores the feasibility of adapting the Slovenian HPC model to Bergamo Province, Lombardy, considering local population needs and health system characteristics. Methods: We conducted a qualitative feasibility and policy analysis based primarily on documentary review, complemented by a webinar, a study visit to Slovenia, and expert consultations (conducted in two group discussions) with professionals from ATS (Agenzia Tutela della Salute) Bergamo and local ASST (Azienda Socio-Sanitaria Territoriale) providers. Data were analysed using the PIET-T framework (Population–Intervention–Environment–Transfer). Results: Eight key elements define the Slovenian model: (1) governance and stewardship; (2) structural financing; (3) standardized service portfolio; (4) systematic preventive referrals; (5) integration with primary care and screening; (6) multidisciplinary teams with codified training; (7) community outreach and equity orientation; and (8) information systems and reporting. While Bergamo shares similar demographic and epidemiological profiles, differences in behavioral risk factors, project-based financing, fragmented initiatives, and limited digital integration necessitate adaptation. The comparative assessment highlighted key areas requiring contextual adaptation, including financing mechanisms, organisational coordination, workforce capacity, digital interoperability, and approaches to equity. Conclusions: The Slovenian HPC experience demonstrates the potential of integrated, community-based health promotion. Its adaptation to Lombardy appears feasible if core components are preserved and tailored to local governance, population, and health system conditions. These organisational features may be particularly relevant for time-dependent conditions, such as acute cardiovascular and cerebrovascular events, by potentially supporting more timely risk-factor management and coordination across diagnostic and emergency pathways. Rather than a blueprint for reform, this experience offers useful insights to reinforce prevention and health promotion within the ongoing territorial care reform in Lombardy. Full article

Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case–control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (β = −0.005, p = 0.03) and treatment modality (β = −0.0026, p = 0.05). In comprehensive conservative management, body mass index (β = −0.007, p = 0.02) and urine urea excretion (β = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (β = 0.16, p = 0.05), potassium levels (β = −0.046, p = 0.04) and allopurinol therapy (β = −0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = −0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake. Full article

Objective: Due to the increasing prevalence of rheumatological conditions worldwide, especially among women, and their known negative impact on body image, there is a growing demand for cosmetic procedures. Therefore, it is imperative to develop an evidence-based understanding of the safety of these procedures and their potential effects on the disease course to prevent undesirable exacerbations. Methods: An observational cross-sectional survey was conducted among adult patients diagnosed with rheumatic diseases. Data were collected using an electronic questionnaire that addressed demographics, disease characteristics, comorbidities, and perceptions of cosmetic procedures. Ethical approval was obtained from the Institutional Review Board of King Saud University and King Saud University Medical City. Appropriate descriptive and inferential statistical analyses were performed. Results: A total of 212 participants were included; among them, 92 participants considered or underwent cosmetic procedures, while 120 did not. A significant difference was observed between groups regarding disease-related impact on self-confidence (p = 0.01). Factors associated with undergoing cosmetic procedures included gender (female sex) (OR 12.02; 95% CI: 1.55–93.17; p = 0.017), higher educational level (OR 14.00; 95% CI: 1.32–147.42; p = 0.028), a monthly income of SAR 1000–5000 (OR 2.39; 95% CI: 1.03–5.53; p = 0.041) or SAR 5000–10,000 (OR 2.75; 95% CI: 1.19–6.33; p = 0.017), and employment status (OR 1.81; 95% CI: 1.03–3.18; p = 0.038). Conclusions: A substantial proportion of patients with rheumatic diseases considered or had undergone cosmetic procedures, primarily driven by appearance-related concerns and reduced self-confidence. Female sex, higher education, higher income, and employment status were significant predictors. Fear of disease flare-ups and potential side effects were the most common reasons for avoiding cosmetic procedures. Full article

Objectives: The main objective of the present study was to evaluate the outcomes of patients referred for colposcopy due to human papillomavirus (HPV) positivity and/or abnormal cytology. Methods: A retrospective analysis was conducted on women who underwent colposcopy between January 2015 and December 2023. Demographic data and results of the colposcopy result were obtained from the patient files and the electronic gynecologic oncology clinic database. Results: A total of 2682 patients were included in the analysis. A cervical biopsy identified a cervical intraepithelial neoplasia (CIN)2+ (CIN2, CIN3, and invasive cancer) lesions in 361 patients (13.5%), while endocervical curettage (ECC) identified a CIN2+ lesions in 148 patients (5.6%). A total of 74 patients exhibited CIN2+ lesions in both cervical biopsy and ECC samples, while 74 patients displayed CIN2+ lesions exclusively in ECC samples. The distribution of high-risk HPV positivity in 435 patients with CIN2+ lesions revealed that 47.5% of patients were positive for HPV type 16, while 8.9% were positive for HPV type 18. A total of 50% of all patients diagnosed with CIN2+ lesions by ECC alone were found to be positive for HPV type 16 (37/74). Of the 116 patients with high-risk HPV positivity and normal cytology, 34 (29.3%) were high-risk HPV other-positive. Conclusion: HPV type 16 and 18 positivity represents the highest-risk groups in terms of CIN2+ lesion development. ECC should be considered, in particular, in women with HPV 16 positivity. Colposcopy should be performed immediately, rather than after one year, in women with high-risk HPV other-positivity and normal cervical cytology, in order to increase the detection rate of CIN2+ lesions. Full article

Rapid urbanization and global warming are amplifying heat-related health risks, particularly for vulnerable age groups. This study develops an open-source risk assessment framework that uses big data from remote sensing, land use, and population datasets to evaluate heat-related health risks. The framework integrates indicators of green infrastructure, Land Surface Temperature (LST), and demographic vulnerability to identify areas of increased health risk. Milan (Italy) was used as the case study for the application to test the methodology and validate its capacity to detect spatial correlations between Surface Urban Heat Island (Surface UHI) intensity and concentrations of sensitive population groups (children aged 0–5 and elderly aged 65+). The results highlight distinct spatial inequalities in heat exposure and health vulnerability, confirming the method’s potential to support climate adaptation and public health planning. By relying entirely on open-access data and tools, this approach offers a replicable and scalable model for assessing climate-related health risks and informing evidence-based strategies that can support public administrations to visualize risk, prioritize interventions, and enhance urban resilience. Full article

Background: Health literacy and eHealth literacy are core competencies for nursing students, yet their distribution across training pathways remains insufficiently explored. Objective: This study aimed to examine HL and eHL levels among nursing students across different years of the educational programme and identify distinct subgroups of students. Methods: A cross-sectional study was conducted among undergraduate nursing students enrolled in all years of a single Italian university programme. Literacy profiles were assessed using validated questionnaires. A Two-Step Cluster Analysis was applied to identify homogeneous literacy profiles. Group differences were examined using appropriate statistical tests. Results: Four distinct clusters were identified, showing heterogeneous patterns of literacy profiles across the training course. Significant differences emerged in demographic and educational variables across clusters. Conclusions: The findings highlight the coexistence of diverse literacy profiles among nursing students and suggest the need for tailored educational strategies. Due to the cross-sectional design, causal inferences cannot be drawn. Full article

Immigrants from Latin America’s Indigenous and rural communities in New York City are likely to break the cycle of poverty by improving language proficiency, acculturation, and education. Their well-being has received poor attention in the economic literature, and little is known about the needs, financial welfare, health status, or education among Indigenous-origin migrants from Latin American households. This study used primary data from a non-probabilistic sample of 121 self-identified Indigenous migrants living in New York City (NYC), a demographic cohort presenting challenges in terms of research access. National-level data usually aggregates all Spanish-speaking individuals as Hispanics and fails to acknowledge the presence of these pre-Hispanic groups. Integrating low-skilled Latin American Indigenous migrants into labor markets remains a challenge. We examined the link between the household income of Indigenous migrants from Latin America in NYC and education, acculturation, and discrimination. Using a logistic regression, we substantiated that education retains its prominence as the primary determinant of income for Indigenous migrants, but perceptions of discrimination based on skin color undermined this progress. This study highlights the need for interventions to promote language proficiency, acculturation, and education among Indigenous immigrant communities and implement culturally tailored policies to encourage the upward mobility of this population. Full article

(1) Background: Hot pot bases are susceptible to phthalate (PAE) contamination due to their high lipid content. Standard risk models often fail to capture extreme values, leading to biased exposure estimates. This study characterized dibutyl phthalate (DBP) and bis(2-ethylhexyl) phthalate (DEHP) contamination using a hybrid modeling framework to ensure precise risk profiling. (2) Methods: A total of 91 samples were analyzed via GC-MS. Concentration data were fitted using traditional parametric, extreme value mixture (EVMM), and finite mixture models. Probabilistic dietary risks were assessed for Chinese demographic groups using 10,000-iteration Monte Carlo simulations. (3) Results: DEHP (detection rate: 55%) and DBP (32%) were best modeled by a two-component Gamma mixture and a Lognormal–Generalized Pareto distribution, respectively. These advanced models significantly outperformed conventional distributions in capturing upper-tail extremes. Crucially, all hazard quotients (HQs) remained below the safety threshold of 1, indicating acceptable risk, although children aged 7–13 exhibited the highest calculated risk (Max DEHP HQ = 0.68). (4) Conclusions: Although current exposure levels are within safe limits, the heavy-tailed distributions identify potential sporadic high-exposure events that traditional models overlook, specifically highlighting the relative vulnerability of children aged 7–13. This study validates that hybrid statistical approaches offer superior precision for analyzing skewed contamination data. Consequently, these findings provide a critical scientific basis for refining regulatory monitoring and implementing targeted source-tracking measures to mitigate long-tail food safety risks. Full article

Past literature on mental health has extensively discussed the effect of interpersonal relationships on mental health, but studies have yet to systematically investigate the meaning and influence of group membership. This study thereby focuses on the influence of group membership that individuals form through private groups on mental health. We particularly explore the possibility that the positive influence of the number of memberships on mental conditions turns negative when individuals suffer from excessive obligations and requirements from the groups they engage. Using data from the 2023 Korea Social Integration Survey, results from ordered logistic regression analyses suggest that the relationship between group membership and mental distress shows a U-shape. While one’s membership in private groups is negatively associated with anxiety, depressive symptoms, and suicidal thoughts even after controlling for interpersonal contact network as well as other socio-demographic characteristics, the association becomes positive when one engages in an excessive number of groups. Furthermore, we find this U-shape relationship to be significant only in urban communities, not smaller local communities. Our study provides implications for understanding how and under which social conditions membership in social groups shape one’s mental health. Full article

Background: Minimally invasive hysterectomy with sentinel lymph node (SLN) mapping is standard for early-stage endometrial cancer, but comparative real-world data on robot-assisted (RAH) versus conventional laparoscopy (TLH) remain limited. This study aimed to compare the two techniques in a real-world clinical setting. Methods: We retrospectively reviewed medical records of 140 patients with FIGO stage I endometrial cancer who underwent RAH or TLH at Semmelweis University between January 2022 and December 2024. We analyzed patient demographics, sentinel lymph node (SLN) detection rates, conversion rates, operative time, pathological characteristics. Results: Baseline demographic and oncologic characteristics were comparable. SLN detection was significantly higher in the RAH group compared to TLH (98% vs. 90.2%, p = 0.04). Conversion to laparotomy occurred in 0% of RAH cases versus 11.5% of TLH cases (p = 0.0024). Conclusions: In a standardized ICG-guided SLN mapping setting, RAH achieved higher SLN detection and markedly lower conversion rates than TLH, without differences in operative time or key pathological parameters. Full article

Background and Objectives: Cementless total knee arthroplasty (TKA) with two-pegged Trabecular Metal (TM) tibial components composed of porous tantalum was introduced to improve fixation and reduce aseptic implant failure, particularly in younger, more active patients. Despite these theoretical advantages, mid-term outcomes remain uncertain. This retrospective study compares the survival of consecutive cementless TKAs with TM posterior-stabilized (PS) and cruciate-retaining (CR) modular tibial components with cemented PS and CR components from the same implant system, using revision for aseptic causes as the primary endpoint. Materials and Methods: Institutional review board approval was obtained, and a minimum follow-up of two years was required. Between January 2017 and November 2021, a total of 1202 TKAs of a single implant design were performed at a high-volume academic center by five board-certified orthopedic surgeons, predominantly for primary osteoarthritis. Of these, 826 (68.7%) procedures were cemented, and 376 (31.3%) were cementless. Demographic data and revision outcomes were collected for all patients. Results: There was no statistically significant difference between cohorts in the 7-year survival rate for all causes of revision (97.4%, 95% CI 95.6–99.2 for cementless vs. 97.8%, 95% CI 96.6–99.0 for cemented; p = 0.63). However, the 7-year survival rate for aseptic causes was significantly lower (p < 0.05) in the cementless TKA group (97.9%, 95% CI 96.3–99.5) compared with the cemented group (99.4%, 95% CI 98.8–100). Revisions for aseptic causes occurred in 7 cementless (1.86%) and 4 cemented (0.84%) TKAs (p < 0.05), most commonly due to loosening of the tibial TM component (6 [1.59%] vs. 2 [0.24%], respectively; p < 0.05). During follow-up, 94 patients (8.7%) died of causes unrelated to TKA. Conclusions: Cementless TM PS and CR modular TKAs demonstrated inferior mid-term performance compared with their cemented counterparts for aseptic reasons. These findings raise concerns regarding the durability of this cementless design and underscore the need for cautious use and further investigation. Full article

This study examines the effectiveness and implementation fidelity of the Mind–Grit Pathways framework, a blended and personalized learning intervention integrating academic instruction with growth mindset and grit development in alignment with Sustainable Development Goal 4 (Quality Education). Using a quasi-experimental pretest–posttest control group design, the study analyzed Grade 11 students from two demographically comparable urban high schools (n = 933). Treatment students (n = 491) participated in the intervention across mathematics, science, and English/reading for one academic year, while control students received traditional instruction. Multivariate analyses indicated significantly greater academic gains for treatment students across all subject areas and total achievement (p < 0.001). Within the treatment group, substantial teacher- and homeroom-level variation was observed, with large effects in mathematics and moderate effects in science and English/reading, highlighting the role of instructional enactment. Teacher professional development hours were positively associated with student engagement and achievement gains, and student platform usage demonstrated a strong relationship with academic growth, providing objective evidence of implementation fidelity. The results suggest that blended learning frameworks can produce meaningful and equitable academic gains when supported by sustained professional development and high-quality classroom implementation. Full article