Search Results (90)

(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

By leveraging Internet of Things (IoT) technology, patients can utilize medical devices to upload their collected personal health records (PHRs) to the cloud for analytical processing or transmission to doctors, which embodies smart health systems and greatly enhances the efficiency and accessibility of healthcare management. However, the highly sensitive nature of PHRs necessitates efficient and secure transmission mechanisms. Revocable and verifiable attribute-based encryption (ABE) enables dynamic fine-grained access control and can verify the integrity of outsourced computation results via a verification tag. However, most existing schemes have two vital issues. First, in order to achieve the verifiable function, they need to execute the secret sharing operation twice during the encryption process, which significantly increases the computational overhead. Second, during the revocation operation, the verification tag is not updated simultaneously, so revoked users can infer plaintext through the unchanged tag. To address these challenges, we propose a revocable ABE scheme with efficient and secure verification, which not only reduces local computational load by optimizing the encryption algorithm and outsourcing complex operations to the cloud server, but also updates the tag when revocation operation occurs. We present a rigorous security analysis of our proposed scheme, and show that the verification tag retains its verifiability even after being dynamically updated. Experimental results demonstrate that local encryption and decryption costs are stable and low, which fully meets the real-time and security requirements of smart health systems. Full article

This study explores the perception of (Austrian) standard German and Austro-Bavarian dialect varieties by 111 adult speakers of German as a second language (L2) in Austria, tested through ‘smart’ and ‘friendly’ judgements in a matched-guise task. Our goal was to determine whether L2 speakers, both at the group level and as a function of individual differences in standard German and dialect proficiency, reflect the attitudes of Austrian speakers by (a) judging the dialect higher in terms of friendliness in solidarity-stressing situations (e.g., in a bakery) and (b) attributing the standard variety a higher indexical value in terms of intelligence in status-stressing settings (e.g., at the doctor’s office), a phenomenon in Austrian-centered sociolinguistics known as ‘functional prestige’. Bayesian multilevel modeling revealed that L2 speakers do not adopt attitudinal patterns suggestive of functional prestige and even appear to reallocate certain constraints on sociolinguistic perception, which seems to depend on individual differences in varietal proficiency. Full article

People who suffer from body integrity dysphoria (BID) feel a strong need to be disabled. The most common desire is for amputation or paralysis. Objectives: This study aims to gather the opinion of experts on which types of disabilities are included in BID, which therapies are useful and whether those affected should be supported in obtaining a disability. Methods: A questionnaire with 62 items and a flow chart were developed and sent to experts who have published work with regard to BID. Participants: 22 experts from 11 countries, mostly with an academic title and with an average age of 48.5 years, responded. Results: As expected, amputations and paralysis were clearly attributed to BID, other disabilities (toothlessness, incontinence, diabetes) received rather uncertain or negative scores. On average, those affected were not classified as mentally or psychiatrically ill. Neurological misconnection was considered the most likely cause. Experts did not think it was helpful to inform the health system or even the police about the desire to be disabled. Almost all experts supported the surgical solution of amputation by doctors. All participants believed that BID patients are aware of the limitations imposed by the desired disability. Finally, a flow chart is presented for diagnosis and therapy. Conclusions: The experts assume that the surgical solution is currently acceptable if it has been proven that the BID-affected person does not suffer from another mental disorder, there is a high level of suffering due to BID, other therapies have not been of any use and it is clear that the quality of life will actually increase as a result of achieving the disability. Full article

Conflict-related sexual violence remains a systematic tool employed in warfare and terrorism to undermine communities, as recognized by the UN Security Council in Resolutions 1820 (2008) and 2242 (2015). Sexual violence has been a persistent issue throughout the history of conflict, war, and human existence. However, the victimization of men and boys remains insufficiently acknowledged and reported. This under-recognition can be attributed to several factors, such as societal stigma, the topic’s sensitive nature, prevailing stereotypes, and cultural influences. Male sexual violence is recognized as a critical public health concern because of its profound, immediate, and lasting effects on the victims, their loved ones, the community, and society at large. This paper examines the social and relational consequences of such violence on the individual victims, their significant others, and the wider society. The analysis will draw upon data gathered from the author’s doctoral thesis conducted in the Eastern region of the Democratic Republic of the Congo in 2021, as well as recent research on this critical issue to enrich the discussion. Full article

Heart failure functions as one of the leading global causes of death because it falls under the cardiovascular disease categories. Cardiac tissue engineering advances by developing new tissues to rebuild heart functions in individuals with damaged heart structures as it gives medical treatment possibilities to patients reaching their final stage. Most of the heart tissue consists of cardiomyocytes which make up between 80 to 90 percent of the total organ space. The cardiomyocytes retain their specialized cell structure which includes elongation, but they align to produce contractions as they span into length. After myocardial infarction, doctors need elastic soft platforms to heal the heart tissue because they mimic its natural attributes. Special consideration must be paid to the material selection for appropriate mechanical properties, given that different substances have separate qualities. Stem cell survival becomes higher, and cell differentiation develops more efficiently when a proper scaffold design is implemented, thus enabling tissue repair. Conductive biomaterials demonstrate the best candidate status for cardiac tissue engineering due to their ability to both convey electrical signals and boost biological actions as well as promote cellular communication. Scientists conduct life science research on stem cells because the cells present unique characteristics. Biomaterials with conductive properties within cardiac tissue engineering help the body recover heart tissue while improving the functionality of damaged structures in the myocardium. This article analyzes various conductive biomaterials used in biomedical practices for cardiac tissue healing applications. Full article

Most drugs excreted in urine are not filtered by wastewater treatment plants and end up in aquatic systems. At concentrations measured in waters, toxic effects on species have been described. Second, most of the drug consumption is attributable to primary care prescriptions. We thus present here, an ecotoxicity classification of the most sold drugs in primary care in Switzerland. Three datasets were combined: (1) surveyed ecotoxic drugs by the Swiss National Surface Water Quality Monitoring Programme and its European equivalent, (2) the top 50 drugs by sale in primary care in Switzerland, and (3) active pharmaceutical ingredient (API) concentrations in Lake Geneva and the rivers of the canton of Vaud between 2017 and 2022. We classified APIs into five categories from the safest to the least safe: (1) APIs found in concentrations (C) <10× their environmental quality standard (EQS·10⁻¹), (2) EQS·10⁻¹ < C < EQS and not listed by the Swiss or the EU Watch List, (3) EQS·10⁻¹ < C < EQS and listed, (4) C > EQS and not listed, and (5) C > EQS and listed. We obtained full ecotoxicological data for 35 APIs. Fifteen APIs were designated as safe (category (1):paracetamol, tramadol, amisulpride, citalopram, mirtazapine, metformin, gabapentin, lamotrigine, primidone, candesartan, irbesartan, atenolol, hydrochlorothiazide, ofloxacin, sulfadiazine), eleven as intermediately safe, and nine were of concern (azithromycin, ciprofloxacin, clarithromycin, sulfamethoxazole, carbamazepine, diclofenac, ibuprofen, iomeprol, iopromide). Full data were available for only one-third of the drugs most sold in primary care. Where data do exist, we observed significant differences in environmental impact among the same class of drugs. Our classification could therefore help guide doctors to adopt more eco-friendly prescriptions. Full article

Searchable encryption (SE) allows users to efficiently retrieve data from encrypted cloud data, but most of the existing SE solutions only support precise keyword search. Fuzzy searchable encryption agrees with practical situations well in the cloud environment, as search keywords that are misspelled to some extent can still generate search trapdoors that are as effective as correct keywords. In scenarios where multiple users can search for ciphertext, most fuzzy searchable encryption schemes ignore the security issues associated with malicious cloud services and are inflexible in multi-user scenarios. For example, in medical application scenarios where malicious cloud servers may exist, diverse types of files need to correspond to doctors in the corresponding departments, and there is a lack of fine-grained access control for sharing decryption keys for different types of files. In the application of medical cloud storage, malicious cloud servers may return incorrect ciphertext files. Since diverse types of files need to be guaranteed to be accessible by doctors in the corresponding departments, sharing decryption keys with the corresponding doctors for different types of files is an issue. To solve these problems, a verifiable fuzzy searchable encryption with blockchain-assisted multi-user scenarios is proposed. Locality-sensitive hashing and bloom filters are used to realize multi-keyword fuzzy search, and the bigram segmentation algorithm is optimized for keyword conversion to improve search accuracy. To realize fine-grained access control in multi-user scenarios, ciphertext-policy attribute-based encryption (CP-ABE) is used to distribute the shared keys. In response to the possibility of malicious servers tampering with or falsifying users’ search results, the scheme leverages the blockchain’s technical features of decentralization, non-tamperability, and traceability, and uses smart contracts as a trusted third party to carry out the search work, which not only prevents keyword-guessing attacks within the cloud server, but also solves the verification work of search results. The security analysis leads to the conclusion that the scheme is secure under the adaptively chosen-keyword attack. Full article

A comprehensive system for automated medical data analysis and diagnosis of non-alcoholic fatty liver disease using artificial intelligence has been developed. The system consists of several modules: medical data aggregation, AI model training using advanced machine learning algorithms, Explainable AI generating reports, and patient diagnosis by ensemble model. Those models have achieved diagnostic accuracy higher than 95%, and the system is designed for continuous improvement by aggregating more data and automatically retraining models. It is a modern, flexible, and scalable tool designed to support medical diagnosis. It can make doctors’ work easier and faster, and the discovered biomarkers of a disease can increase the quality of its diagnosis. The ensemble model generating diagnoses achieved nearly perfect quality and, using explainable artificial intelligence, it was possible to determine attributes and their values that constitute non-alcoholic-fatty-liver-disease (NAFLD) biomarkers. Full article

Aims: This study aims to assess the perspective of doctors and nurses regarding the clinical settings and barriers to implementing opportunistic diabetic retinopathy screening with handheld fundus cameras. Design: This study was a cross-sectional, online questionnaire study. Methods: An online survey was distributed to doctors and nurses working in Portuguese primary care units and hospitals between October and November 2021. The survey assessed current fundus observation practices, potential contexts, and barriers to using handheld fundus cameras. Results: We received 299 eligible responses. About 87% of respondents (n = 255) believe in the clinical utility of handheld fundus cameras to increase patients’ access to diabetes-related retinopathy screening, and 74% (n = 218) attribute utility to identify other eye or systemic diseases. More than a third of participants (37%, n = 111) envisioned using such devices multiple times per week. The main potential barriers identified included limited time (n = 90), equipment cost (n = 48), or the lack of skills in retinal image acquisition (n = 47). Most respondents (94%, n = 275) expected a follow-up recommendation to accompany the telemedicine diagnosis. Conclusions: Doctors and nurses support the use of handheld fundus cameras. However, to optimize their implementation, some strategies should be considered, including training, telemedicine-based diagnosis, and support for follow-up through accessible, user-friendly, and efficient information systems. Full article

Hemobiologic reactions associated with the hemoincompatibility of extracorporeal circuit material are an undesirable and inevitable consequence of all blood-contacting medical devices, typically considered only from a clinical perspective. In hemodialysis (HD), the blood of patients undergoes repetitive (at least thrice weekly for 4 h and lifelong) exposure to different polymeric materials that activate plasmatic pathways and blood cells. There is a general agreement that hemoincompatibility reactions, although unavoidable during extracorporeal therapies, are unphysiological contributors to non-hemodynamic dialysis-induced systemic stress and need to be curtailed. Strategies to lessen the periodic and direct effects of blood interacting with artificial surfaces to stimulate numerous biological pathways have focused mainly on the development of ‘more passive’ materials to decrease intradialytic morbidity. The indirect implications of this phenomenon, such as its impact on the overall delivery of care, have not been considered in detail. In this article, we explore, for the first time, the potential clinical and economic consequences of hemoincompatibility from a value-based healthcare (VBHC) perspective. As the fundamental tenet of VBHC is achieving the best clinical outcomes at the lowest cost, we examine the equation from the individual perspectives of the three key stakeholders of the dialysis care delivery processes: the patient, the provider, and the payer. For the patient, sub-optimal therapy caused by hemoincompatibility results in poor quality of life and various dialysis-associated conditions involving cost-impacting adjustments to lifestyles. For the provider, the decrease in income is attributed to factors such as an increase in workload and use of resources, dissatisfaction of the patient from the services provided, loss of reimbursement and direct revenue, or an increase in doctor–nurse turnover due to the complexity of managing care (nephrology encounters a chronic workforce shortage). The payer and healthcare system incur additional costs, e.g., increased hospitalization rates, including intensive care unit admissions, and increased medications and diagnostics to counteract adverse events and complications. Thus, hemoincompatibility reactions may be relevant from a socioeconomic perspective and may need to be addressed beyond just its clinical relevance to streamline the delivery of HD in terms of payability, future sustainability, and societal repercussions. Strategies to mitigate the economic impact and address the cost-effectiveness of the hemoincompatibility of extracorporeal kidney replacement therapy are proposed to conclude this comprehensive approach. Full article