Search Results (102)

Objective: To investigate the occurrence trends, distribution characteristics, and contributing factors of medical damage liability disputes in Chongqing from 2012 to 2024, thereby providing data support for risk prevention and control in regional medical institutions and for health policy formulation. Methods: A retrospective study design was employed. Adjudication documents pertaining to medical damage liability disputes in Chongqing, spanning from January 2012 to December 2024, were retrieved from the China Judgments Online database. A total of 1761 eligible cases were selected based on standardized criteria. Statistical analysis was conducted on core case variables. Results: The number of cases exhibited a fluctuating upward trend from 2012 to 2024, peaking in 2019 (276 cases) before subsequently declining. The average actual compensation amount demonstrated a steady increase, reaching its highest level in 2023 (259,200 ± 53,900 CNY). Deficiencies in diagnostic and therapeutic procedures constituted the predominant cause of disputes (50.37%). Surgical departments (46.05%) and orthopedics departments (22.60%) were identified as high-risk specialties. Tertiary public hospitals accounted for the highest proportion of disputes (48.89%) and the highest average actual compensation (216,100 ± 10,600 CNY). Regarding the apportionment of liability, secondary liability attributed to the medical provider was the most frequent (29.59%). Patient death was the most common adverse outcome (37.14%). The highest average compensation amount was associated with persistent vegetative state outcomes (777,500 ± 157,200 CNY). Statistically significant differences in actual compensation amounts were observed across all outcome categories (all p < 0.05). Conclusions: The situation concerning medical damage disputes in Chongqing remains severe. The etiologies of disputes are predominantly attributable to medical technical factors—particularly deficiencies in diagnostic and therapeutic procedures—and failure to fulfill a duty of care, both of which are associated with elevated compensation amounts. Given that this study employed a retrospective descriptive design, the aforementioned findings reflect associations among variables rather than causal relationships. Based on the identified risk hierarchy, it is recommended that priority be given to strengthening perioperative safety verification and re-certification of critical procedural skills in high-incidence departments, such as surgery and obstetrics and gynecology, enhancing informed consent and medical record quality management, and advancing the tiered healthcare delivery system, with a view to reducing medical risks and mitigating doctor–patient conflicts. Full article

Price spikes are rare but economically significant events observed across electricity, financial, commodity, and cryptocurrency markets. Their abrupt magnitude, heavy-tailed distributions, and severe class imbalance make them difficult to forecast using conventional time-series methods. This systematic literature review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, synthesises recent deep learning approaches to forward-looking price-spike prediction and classification. Searches of Scopus, Web of Science, and IEEE Xplore identified studies published between 2020 and 2026. Following screening and full-text eligibility assessment of approximately 300 studies, only 20 met the inclusion criteria and were included in the final synthesis, comprising 19 peer-reviewed papers and one doctoral thesis. The review develops a structured taxonomy spanning spike definitions, task formulations, model architectures, input design, and evaluation practices. A central finding is that predictive performance is driven more by problem formulation, label construction, and evaluation design than by model architecture. While architectures have diversified to include recurrent networks, transformers, graph neural networks, and hybrid frameworks, improvements are often attributable to differences in how the prediction problem is defined rather than the models themselves. Key limitations stem from inconsistent spike definitions and insufficient treatment of class imbalance, leading to a misalignment between modelling objectives and evaluation practices, further exacerbated by the absence of standardised benchmarks. These issues hinder comparability and can lead to overstated model performance by masking poor detection of rare but economically critical spike events. The review therefore identifies clear directions for future research, including standardised spike labelling, adoption of rare-event-appropriate evaluation frameworks, and problem formulations that explicitly target extreme-event prediction. Full article

Background: Doctors have made increasing use of artificial intelligence-based clinical decision support systems in recent years in eastern China, but far less so in poorer western China, where hospitals with less access to specialized expert services might be expected to make greater use of such aids. Methods: This study of the reasons for lower uptake in the western hospitals focused on a tertiary referral hospital in the capital city of the poorest province in China. Drawing on UTAUT (unified theory of acceptance and use of technology) theoretical literature and previous studies, seven variables most likely to explain the limited adoption of the technology were identified and tested by means of an explanatory sequential mixed-methods study. Results: Initial bivariate tests revealed no significant differences across variables; however, multivariate logistic regression identified social influence as the sole statistically significant predictor of adoption willingness. Follow-up structured interviews revealed a surprisingly low awareness of the technology by medical personnel, with very limited deployment. Conclusions: The failure to adopt AI diagnosis technology is attributable not to the variables usually cited as factors inhibiting technology adoption but rather the failure of hospital and medical faculty administrators to acquire the technology and train doctors and medical students. Full article

Objective: The aim of this thesis was to externally validate a predictive model of suboptimal surgery in advanced ovarian cancer, developed by doctors Escrig and Llueca. The model classifies patients pre-surgically to estimate the likelihood of incomplete cytoreductive surgery. Methods: A retrospective cohort comparison between two time periods was performed. Validation used a new cohort of 83 patients with advanced ovarian cancer, prospectively collected between 2017 and 2023 across five hospitals (experimental group). This group was compared with the original control cohort (2013–2016), which had served for model development. The predictive models (R3 and R4) are based on the Peritoneal Carcinomatosis Index (PCI) assessed by CT, laparoscopic PCI, and the presence of intestinal sub-obstruction. For model R4, intraoperative PCI was also included. Results: The experimental group had a lower rate of suboptimal cytoreduction compared with the control group (4.8% vs. 13.8%; p = 0.049). Significant differences were observed in ascites (49.4% vs. 27.5%; p = 0.002), and no patient in the experimental group presented intestinal sub-obstruction (0% vs. 8%; p = 0.002). Although at least 13 suboptimal surgeries were expected for validation, only four occurred. The predictive models did not classify any of these four cases as high risk, instead categorizing them as low or intermediate risk. Conclusions: Statistical external validation could not be performed due to event scarcity. This reduced incidence is attributed to selection bias: highly experienced surgical teams from participating centres likely applied criteria similar to those of the model, referring high risk patients (e.g., with intestinal sub-obstruction) to neoadjuvant therapy and thus avoiding suboptimal primary surgeries. Although direct validation was not possible, the findings indirectly suggest that the model is effective in guiding patient selection and improving surgical outcomes. Full article

Background: Overweight and obesity frequently occur as comorbid conditions in people with asthma, particularly among those with poor disease control or more severe clinical profiles. However, the extent to which exposure to grey spaces may influence the link between overweight/obesity and asthma remains insufficiently explored. Aim: To assess the association between overweight/obesity and asthma in an Italian general population sample and the influence of residential grey space on such relationship. Methods: A total of 2841 individuals (54.7% women; age range 8–97 years) residing in Pisa, Italy, were surveyed in 1991–1993 using a standardised questionnaire on health conditions and relevant risk factors. The proportion of grey space within a 1000 m buffer around each participant’s home was quantified using the CORINE Land Cover database. Multinomial logistic regression models were applied to assess the association between asthma status (1. asthma symptoms without doctor diagnosis, 2. diagnosis ± symptoms, 3. no diagnosis/symptoms − reference category) and overweight/obesity, adjusting for sex, age, educational level, smoking, physical activity and grey space exposure. Analyses were further stratified according to high vs. low grey space exposure (above vs. below 63%, corresponding to the second tertile). Mediation and interaction analyses were also performed. Results: The prevalence of asthma diagnosis ± symptoms, overweight and obesity was 18.7%, 35.8% and 12.8%, respectively. In the full sample, asthma symptoms without medical diagnosis were positively associated with overweight (Odds Ratio—OR 1.43; 95% Confidence Interval—CI 1.08–1.88), obesity (OR 1.99; 95% CI 1.38–2.88) and residential grey space (OR 1.06; 95% CI 1.01–1.13). Stratified models showed that, among participants with high exposure to grey areas, asthma symptoms were linked to both overweight (OR 2.03; 95% CI 1.29–3.19) and obesity (OR 2.57; 95% CI 1.36–4.86). In individuals with low grey space exposure, an association was observed only with obesity (OR 1.80; 95% CI 1.15–2.82). Mediation analysis did not reveal any weight-related effect modification. Measures of additive interaction indicated that 32% of asthma symptoms were attributable to the interaction between excess body weight and high grey space exposure. Conclusions: This study showed that overweight/obesity and grey space exposure are factors associated with asthma symptoms. These findings advocate for an early identification of overweight/obese-asthma symptom phenotype since it may help prevent the onset or worsening of asthma, particularly in urban environments. These insights highlight the need for integrated public health and urban planning strategies to promote more sustainable, health-supportive environments. Full article

Objectives: The objective of this study was to explore the views expressed online by COPD patients regarding adherence to inhaled therapy. Methods: This study applied a qualitative, exploratory-interpretive design and an inductive methodology. Sources analyzed included COPD websites, patient forums, and social networks. Units of analysis were videos, stories, questions and answers, and conversation threads. Saturation criteria were applied. Applying a constant comparative methodology, analyses were conducted at textual (quotes, initial and focused coding, families) and conceptual (categories, networks, meta-network, provisional and final model) levels using ATLAS.ti 7.5. Reports were returned to patients. Results: There were 248 patients (51 men, 148 women, 49 unidentified) corresponding to 29 testimonies (6 narratives, 11 videos, 10 conversation threads, 2 questions collections). Adherence to inhalers is based on their perception of effectiveness to enable a normal life, and benefits should outweigh adverse effects. Adherence facilitators included mutual support between patients encouraging adherence and effective doctor-patient communication. Adherence barriers included (1) side effects; (2) mistaken beliefs about inhalers (habituation, attribution of non-existent side effects, fear of corticosteroids); (3) poor doctor-patient relationship (lack of listening, failure to consider patient’s preferences, communication iatrogenesis); (4) considering natural remedies as substitutes for treatment. Conclusions: Adherence to inhalers as reported in online testimony from COPD patients depends on the balance between efficacy and side effects. Adherence is influenced by peer support and doctor-patient communication. Doubts, erroneous beliefs, and iatrogenic effects of poor communication can hinder adherence. Full article

The aim of this article was to identify factors influencing the purchasing decisions of individual buyers represented by Polish doctors on the dairy product market, taking into account the demographic variable of the respondents’ age. This article is based on a survey conducted among 201 Polish doctors using the CAPI (Computer-Assisted Personal Interview) method. The collected primary data was subjected to quantitative analysis, including both a description of general trends and the identification of differences in responses between distinct age categories of respondents, as well as the identification of hidden factor structures. Conducting a study with a group of doctors perceived as experts fills a research gap in the literature and makes an important contribution to the discussion on the factors shaping the purchasing behaviour of doctors as buyers. The research revealed differences in the assessment of the importance of motivators influencing purchasing decisions for dairy products between groups of doctors separated by age. Younger respondents (aged 27–44) attach greater importance to the influence of marketing activities at the point of sale and the health attributes of dairy products, while older respondents (aged 45 and over) attach greater importance to aspects related to trust and safety as well as consumer trends. Hidden (latent) factors influencing purchasing decisions in the surveyed age-based groups of doctors were also identified in comparison with the total number of respondents, and consumer segments were identified based on the similarity of factor profiles. The results of this study can be used both by companies in the dairy sector in the process of designing marketing strategies for dairy products and by institutions influencing public health. Full article

Background/Objectives: Chronic medical conditions are comorbid with psychological disorders, often attributed to the weight of managing persistent demands associated with debilitating illness. Lifestyle adjustments, physical pain, and costs of health care can impose impairment of functioning, exacerbated by the onset of a chronic disease. While cause-and-effect directionality is difficult to ascertain, it is widely assumed that psychological stress can exacerbate the ability of patients to manage chronic medical conditions. Methods: The current study examined a novel model comprising five psychological factors which might explain variations in patients’ level of adherence, satisfaction, and quality of life. The sample consisted primarily of 124 low-income, female Hispanic patients, who were patients diagnosed with rheumatic and endocrine medical diagnoses. Results: Psychological distress and the lingering psychological effects of the COVID-19 pandemic were negatively associated with patient adherence, satisfaction, and quality of life, and that patients’ reports of the working alliances with their doctors moderated (i.e., significantly lessened) the negative association between the lingering impact of the COVID-19 pandemic and their satisfaction with care. Patients’ self-efficacy, resilience, and working alliance were all positively and significantly associated with adherence, satisfaction, and QOL. The association between working alliance and satisfaction represents a very large effect (r = 0.77, p < 0.001). Path analysis found a direct effect between psychological distress (stand. est. = 0.28, p = 0.05) and treatment adherence and a direct effect between COVID-19 impact and adherence (stand. est. = −0.19, p = 0.05). Conclusions: This study provides evidence of the role that both psychological stress and psychological strengths play in the experience of receiving medical care for low-income patients with rheumatic and endocrine conditions. Psychological stress inhibits adherence, and the physician–patient working alliance moderates the negative correlation between COVID impact and treatment satisfaction. Full article

The aim of this study is to provide a systematic account of structural discourse markers operating at a conversational macro-level in German Palliative Care interactions, focusing on their frequency, distribution, co-occurrence, and speaker-group-specific usage. By combining qualitative approaches from conversation analysis and interactional linguistics with quantitative methods from corpus linguistics, discourse markers are analyzed together as a functional category from multiple analytical perspectives to enhance the overall understanding of the use of discourse markers. The analysis reveals a functional distribution across different transition points in conversation: Whereas the German so most frequently appears in openings and transitions to non-verbal activities, gut and okay predominate in topic shifts and conversation closings. However, gut and okay differ in their composition of discursive functions, although discourse structuring emerges as the second most frequent function in both cases, an observation that stands in contrast to the continued neglect of this function in standard dictionary entries. The institutional asymmetries inherent in medical interactions are reflected in the finding that both doctors and caregivers use significantly more structural discourse markers than patients and their relatives. Differences between physicians’ and caregivers’ use of discourse markers can be attributed to their different professional roles and communicative responsibilities. Full article

Low uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black women has been partly attributed to barriers related to patient-provider communication. The goal of this paper was to investigate the association between exposure to the #ShesWell campaign and Black women’s communication about PrEP with a healthcare provider (HCP). We conducted a cross-sectional survey of 403 sexually active, Black women after the initial phase of #ShesWell and used multivariable regression models to analyze whether exposure to #ShesWell was associated with talking to an HCP about PrEP or intention to discuss PrEP with an HCP in the future. Approximately 33% of women surveyed reported exposure to #ShesWell. Campaign exposure was significantly associated with talking to an HCP in the past year about PrEP (OR = 4.96, p = 0.001) and intention to discuss PrEP with an HCP in the next six months (B = 0.29, p = 0.038). Stronger beliefs that doctors should initiate sexual health conversations were positively associated with past PrEP conversations (OR = 2.32, p < 0.001) and future intention (B = 0.11, p = 0.029). Greater comfort discussing prevention (B = 0.35, p < 0.001), self-efficacy discussing PrEP (B = 0.29, p = 0.001), and concern about getting HIV (B = 0.51, p < 0.001) were also associated with intention to discuss PrEP with an HCP. Findings highlight the potential for communication campaigns to motivate patient-provider communication about PrEP, addressing a reported barrier to PrEP uptake among Black women. Full article

(1) Background: After receiving an abnormal Papanicolaou smear result, very often women fail to adhere to further procedures due to depression. Using a neural network approach, this research aimed to predict pre- and post-diagnostic depressive symptoms in women with abnormal Pap screening tests. (2) Methods: The study was conducted at the Clinical Center of Kragujevac, Serbia, among 172 women with a positive Pap screening result before and after diagnostic procedures (colposcopy/biopsy/endocervical curettage). Just before and 2 to 4 weeks after the diagnostic procedures, women filled out a socio-demographic questionnaire and the Hospital Anxiety and Depression Scale (HADS). Multilayer perceptron neural networks were modeled. (3) Results: Depression was present in 37.2% of women before diagnostic procedures and in 48.3% after. Feature selection showed four variables that correlated with depression before diagnostic procedures—anxiety (according to the HADS), depression according to the CESD scale, worry score on the POSM scale and use of sedatives. Model for predicting pre-diagnostic depression yielded an accuracy of 79.41%, with a value of 0.842 for area under the receiver operating characteristic curve (AUROC). The HADS anxiety score, place of residence and CESD score were the most important attributes for predicting post-diagnostic depression, with an ANN model accuracy of 88.24% and AUROC 0.939. (4) Conclusions: This research revealed a possible way of predicting depression occurrence in those women who received a positive Pap screening test and who are undergoing follow-up diagnostics, aiding medical doctors in the provision of successful and on-time psychological assistance. Full article

Pregnancy and birth are biological processes shaped by social factors, requiring sociological approaches to explain reproductive behaviour. This narrative review outlines the importance of health sociology against the background that health and illness behaviour is influenced by the social environment. The aim of this paper is to summarize the current state of research on the influence of social systems and social milieu behaviour on reproduction, pregnancy, and childbirth in order to make it easier for midwives and doctors to take these factors into account in their everyday clinical and outpatient work. First, the paper lays out the basics of how health and illness are socially constructed, looking at it from both a structural and action-oriented perspective. It then goes on to explain what this means for pregnancy and childbirth as social processes, how women’s health is related to the social construction of gender roles, that breastfeeding is also a social process, and what conclusions can be drawn for the work of midwives. Pregnancy and birth are social processes based on norms and role attributions: “Decisions” regarding one’s own reproductivity are usually only “self-determined” to a limited extent and tend to occur in the context of social norms and milieu-specific role expectations. The promotion of women’s health depends on how milieu-specific norms and logics of action are understood. For all the professions involved in obstetrics, this results in the need for a critical examination of the sociological aspects of health. This implies the necessity for all obstetric professions to critically examine aspects of the sociology of health in order to provide women and their families with appropriate, evidence-based and client-centred care in the context of pregnancy, birth and the postpartum period, against the background of constant social change. Full article

Addressing climate change requires deeper insight into the psychological drivers of pro-environmental behavior. This study investigates how personality traits, climate-related emotions, and demographic factors can predict sustainable consumption and climate action participation using a Bayesian regression approach. Drawing from the HEXACO personality model and key emotional predictors—Climate Change Worry (CCW) and environmental empathy (EE)—we analyzed data from 604 adults in Greece to assess both private and public climate-related behaviors. This research is novel in its integrative approach, combining dispositional traits and affective states within a Bayesian analytical framework to simultaneously predict both sustainable consumption and climate action. Bayesian model testing highlighted education as the most powerful and reliable predictor of sustainable consumption, with increasing levels—namely Doctoral education—linked to more environmentally responsible action. CCW produced small but reliable effects, supporting hypotheses that moderate emotional concern will lead to sustainable behavior when linked to efficacy belief. The majority of HEXACO traits, e.g., Honesty–Humility and Conscientiousness, produced limited predictive power. This indicates in this case that structural and emotional considerations were stronger than dispositional personality traits. For climate action involvement, Bayesian logistic models found no considerable evidence of any predictor, corroborating the perspective that public participation in high effort action is most likely to rely on contextual enablers instead of internal sentiments or attributes. A significant interaction effect between education and gender also indicated that the sustainability effect of education is moderated by sociocultural identity. Methodologically, this research demonstrates the strengths of Bayesian analysis in sustainability science to make sensitive inference and model comparison possible. The results highlight the importance of affect-related structural variables in behavioral models and have applied implications for theory-informed and targeted climate education and communication interventions to enable different populations to act sustainably. Full article

Background: Physician attributes significantly impact patient outcomes, satisfaction, and trust. Various attribute frameworks have been developed to help structure and guide undergraduate medical education and subsequent clinician practice; however, prioritization of these attributes vary by stakeholder (patients, physicians, medical students). Based on findings from two previous studies completed by the research team, we sought to understand the context in which individuals in these stakeholder groups prioritize particular physician attributes. We adopted a qualitative approach, conducting semi-structured interviews with patients (N = 11), doctors (N = 11), and medical students (N = 12), for a total sample of 34. Results: Thematic analysis of data resulted in the following five themes: caring, communicator, expert, professional, curiosity and open-mindedness. Central to our findings was the need for a positive, trusting provider–patient relationship, which was framed as the conduit to quality patient care (both receiving and providing). The attributes believed to support this central finding differed, noting that “caring”, “curiosity and open-mindedness” are not typical in physician attribute frameworks. Findings suggest there is a central guiding philosophy shaping what medical students, physicians and patients alike, need in the context of the provider–patient relationship, which transcends particular attributes. The guiding philosophy of relational inquiry is used to further situate study findings. Conclusions: Integrating a central guiding philosophy can add additional depth and nuance to attribute frameworks, ensuring considerations for qualities that transcend particular attribute characteristics, such as “caring” and “curiosity and open-mindedness” are also explicitly used to help structure and guide undergraduate medical education and subsequent clinician practice. Full article

Background: In the Democratic Republic of Congo (DRC), the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in 2011 through a three-dose schedule, targeting infants as part of the Expanded Program on Immunization (EPI), to reduce pneumococcal-related morbidity and mortality. The aim of this study was to determine the proportion of pneumonia and meningitis cases and deaths prevented in children under five following the introduction of this vaccine. Methods: This is a systematic review. We synthesized findings from studies carried out in the DRC between 2011 and 2023. We searched scientific articles, published and unpublished doctoral theses and conference proceedings. Only papers written in French or English and those reporting the results of original analytical studies were selected. We assessed the direct effect of PCV13 by calculating the proportion of infections avoided, using Odds Ratios or prevalence ratios related to infection or pneumococcal carriage. Results: Four studies were included in this review. Regarding pneumococcal carriage, when children received three PCV13 doses, the prevalence of carriage was reduced by 93.3% (95% CI: 86.3 to 96.6%), while a single dose did not significantly reduce the prevalence of carriage compared with children who had not received any dose. Concerning pneumonia prevention, three doses of PCV13 prevented 66.7% (95% CI: 37.2 to 82.2) of cases among vaccinated children. The proportion of meningitis attributable to S. pneumoniae prevented was 75.0% (95% CI: 6% to 93.3%) among children vaccinated with PCV13. S. pneumoniae serotypes 19F and 23F were the most frequent causes of invasive pneumonia in children. Serotypes 35B/35C, 15B/C, 10A and 11A/D were the most frequently identified causes of morbidity in Congolese children. In 2022, with PCV13 vaccination coverage at 79.0%, an estimated 113,359 cases of severe pneumonia and 17,255 pneumonia-related deaths were prevented in the DRC, with 3313 cases and 1544 deaths attributable to pneumococcal meningitis prevented. Conclusions: There is clear, but scattered, evidence of reduced colonization by S. pneumoniae and hospital admissions due to pneumococcal pneumonia and meningitis. The results also show that S. pneumoniae serotypes 35B/35C, 15B/C, 10A and 11A/D not included in PCV13 were the main cause of pneumococcal disease in unvaccinated or under-vaccinated children. These data support the need to continue improving vaccination coverage among children who are unvaccinated or incompletely vaccinated with PCV13 to reduce the burden of pneumococcal infections in the DRC. Full article