Search Results (111)

Background: Childhood vaccination remains the cornerstone of public health strategies, substantially reducing global morbidity and mortality, yet suboptimal uptake persists in many settings. In South Africa, the challenge is evident, with persistent outbreaks of vaccine-preventable diseases. Addressing localised immunisation shortfalls requires elucidating the complex interplay of factors beyond conventional access barriers. This qualitative study provides context-specific insights into the behavioural and social drivers influencing childhood vaccination uptake among caregivers in Cape Town, South Africa. Methods: Utilising an exploratory qualitative research design, thematic analysis was applied to interview data (n = 25 caregivers) collected via a purposive sampling strategy designed to capture maximum variation in experiences within targeted low-uptake subdistricts. Interpretation of the data was systematically guided by the World Health Organization’s Behavioural and Social Drivers (BeSD) framework. The latter consists of four domains, namely, “Thinking and Feeling”, “Social Processes”, “Motivation”, and “Practical Factors”. Findings: Analysis across BeSD domains reflected a pattern of the intention–behaviour gap, where caregivers are motivated for vaccination but face structural and practical barriers affecting timely uptake. In the Thinking and Feeling domain, widespread conviction regarding the vital benefits of vaccination co-existed with significant anxiety concerning minor side effects (e.g., pain and fever), which sometimes precipitated missed subsequent appointments. Caregivers frequently accept immunisation as a social routine despite having limited knowledge of the diseases it prevents. Social Processes demonstrated that while decision-making authority rested primarily with mothers, compliance relied on the delegation of logistical responsibilities to extended family members. Critically, reports of poor communication, judgment, or negative attitudes among healthcare workers undermined trust and acted as barriers to sustained engagement. Within the Practical Factors domain, structural constraints frequently overshadowed high intent, with pervasive issues such as long waiting times and financial costs cited as the main reasons for missed appointments. Conclusions: Participants generally expressed strong acceptance of vaccination, but attainment of optimal coverage is constrained by systemic failures in patient–provider communication and persistent logistical barriers within the public healthcare delivery system. Strategic public health interventions must therefore move beyond addressing only attitudinal opposition to prioritise targeted efforts that mitigate structural constraints and reinforce personalised, empathetic communication to sustain caregiver confidence and adherence. Full article

In Taiwan, some cases charge high diagnostic fees based merely on manual visual inspection or other simple checks, which has severely undermined public trust and delayed judicial resolutions, forcing courts to repeatedly appoint alternative evaluators and prolonging dispute timelines. Based on convenient sampling under a 95% confidence level with a 10% margin of error and a 10–90% category proportion, this study analyzes 83 leakage identification cases collected through convenience sampling, covering diverse building types, leakage causes, and detection techniques such as infrared imaging, borescopes, and moisture meters. A clustering-based pricing framework was applied to classify cases by inspection methods and leakage causes and to link them with cost intervals. After rigorous filtering, cost categorization, one-hot encoding, and normalization, the model revealed three distinct cost groups and achieved an overall classification accuracy of 86.75%, with particularly high precision in the medium-cost range. The findings confirm that advanced methods (e.g., borescopes, high-pressure cleaning) correspond to higher fees, while simpler approaches (e.g., infrared imaging) remain in lower cost brackets. This framework supports transparent and standardized fee estimation, addresses long-standing pricing controversies, and enhances consumer trust in leakage diagnostics. Full article

Background: Missed primary care appointments disrupt continuity, reduce care quality, and increase healthcare costs. Despite numerous studies, global patterns and predictors of appointment non-adherence remain inconsistently reported. Objective: To identify, categorize, and evaluate the consistency of predictors of appointment non-adherence in primary care across diverse populations and healthcare systems. Methods: A systematic review was conducted following PRISMA guidelines (PROSPERO ID: CRD420251121963). PubMed/MEDLINE, Scopus, Web of Science, and Cochrane were searched in August 2025 for observational studies examining predictors of missed, canceled, or rescheduled primary care appointments. Study quality was appraised using the MINORS tool. Results: Twenty-seven observational studies (1982–2025) across eight countries were included, representing a total of more than 13 million appointments analyzed. Reported non-attendance varied widely (~5–31%). Predictors clustered into: patient-level (younger age, socioeconomic disadvantage, minority status in North American studies, mental health burden, and lower literacy/greater social needs), appointment-level (prior non-attendance and longer time between booking and visit), and clinic/system-level (access barriers such as transportation and scheduling friction). Telemedicine and continuity with the same clinician were associated with lower non-attendance in more recent studies. Due to heterogeneity in definitions and analyses, the results were synthesized narratively; overall study quality was modest–moderate by MINORS. Conclusions: Missed appointments reflect interacting patient- and system-level determinants, with the highest risk among younger and socioeconomically disadvantaged patients and those with mental health conditions. Interventions that reduce access friction (e.g., reminders, flexible scheduling/shorter lead times, transportation support) and equity-focused hybrid telemedicine may reduce non-adherence. Full article

Performance management systems (PMSs) in private secondary education are vital, and although several tried and tested public sector performance measurement models exist, limited private secondary school performance measurement models exist in South Africa. This study aims to empirically validate a South African tailor-made theoretical performance measurement model (developed from a systematic literature review of 220 articles) and determine the relationships between its key antecedents (Academic Excellence, Internal Processes, Learning and Growth, and Resources) and their respective sub-antecedents. Data were collected by distributing a hard-copy questionnaire to appointed coworkers at 12 schools in the eThekwini Municipality of KwaZulu-Natal, in Durban, South Africa. The schoolmaster’s permission and blessing were obtained, and a coworker was appointed to assist with the distribution and collection of the structured 5-point Likert-scale questionnaires. A high response rate of 89% (N = 274; n = 244) was realised. The data were tested for normality and reliability (Cronbach’s alpha coefficients consistently exceeded 0.70), and investigated for evidence of model validity using an exploratory factor analysis. The data were normally distributed and not skewed, and the antecedents could be validated. The model showed evidence of validity, and the respective relationships between the antecedents were determined. Learning and Growth (16.46%) was the most critical antecedent, followed by Student perspective (15.51%), and Resource perspective (12.20%). The Internal perspective for academic excellence was, surprisingly, the least important (7.94%). The results show that all four antecedents are valid and should be used in the performance measurement of private secondary schools. Full article

Objective: The objective of this study is to synthesize and critically appraise how artificial intelligence (AI) is being integrated into oral and maxillofacial surgery (OMFS). This review’s novel contribution is to jointly map clinical applications (diagnostics, virtual surgical planning, intraoperative guidance) and operational uses (triage, scheduling, documentation, patient communication), quantifying evidence and validation status to provide practice-oriented guidance for adoption. Study Design: A narrative review of the recent literature and expert analysis, supplemented by illustrative multicenter implementation data from OMFS practice, was carried out. Results: AI demonstrates high performance in radiographic analysis and virtual planning (up to 96% predictive accuracy and sub-millimeter soft-tissue simulation error), with clinical reports of shorter planning times and more efficient patient communication. Early deployments in OMFS clinics have increased appointment bookings, while maintaining high patient satisfaction, and reduced the administrative burden. Remaining challenges include data quality, explainability, and limited multicenter and pediatric validation, which constrain generalizability and require clinician oversight. Conclusions: AI offers substantive benefits across the OMFS care continuum—improving diagnostic accuracy, surgical planning, and patient engagement while streamlining workflows. Responsible adoption depends on transparent validation, data governance, and targeted training, with attention to cost-effectiveness. Immediate priorities include standardized reporting of quantitative outcomes (e.g., sensitivity, specificity, time saved) and prospective multicenter studies, ensuring that AI augments—rather than replaces—human-centered care. Full article

Background: AMR causes a large global health burden, with approximately 4.95 million deaths linked to bacterial AMR in 2019, 1.27 million due to AMR directly. Although Brazil mandated prescriptions for systemic antibiotics in 2010/2011, self-medication and access without prescriptions continue, with community pharmacists playing a vital part in antimicrobial stewardship (AMS). This study examined antibiotic misuse and AMR in Brazil through community pharmacists’ perspectives, emphasising their dual role as professional actors and frontline observers of public behaviour. Methods: We conducted 20 semi-structured interviews with community pharmacists and performed reflexive thematic analysis of their accounts, repeating five independent analytic cycles to confirm thematic robustness. Results: Six themes were consistently identified as recounted by pharmacists in their practice contexts: Access and Self-Medication; Relationships with Healthcare Professionals; Knowledge and Beliefs about Antibiotics; Use and Adherence; Healthcare System Barriers; and Regulation and Enforcement. Pharmacists mentioned regular requests for antibiotics without prescriptions, drug reuse, and significant impact from community, i.e., from relatives, and peers. The common misunderstanding was that antibiotics treat viral illnesses. Structural issues, for instance GP appointment costs and long waits, made patients seek help from pharmacies. Due to regulation being applied inconsistently, pharmacies struggled to refuse unsuitable requests. Conclusions: Framed through pharmacists’ dual vantage as professionals and frontline observers, the findings highlight intertwined factors underpinning inappropriate antibiotic use in Brazil and support a multi-pronged intervention spanning health system strengthening, professional education, economic considerations, and community engagement. Full article

Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ², ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article

Background/Objectives: Saudi Arabia implemented the Saudi Medical Appointments and Referrals Centre (SMARC) e-referral system to coordinate patient transfers and enhance healthcare access across the country. This nationwide system was established to improve coordination between healthcare facilities and provide timely access to specialized services. SMARC operates as a centralized coordination hub connecting secondary and tertiary care facilities across all specialties nationwide. This study evaluates SMARC’s evolution since 2020–2021 and efficiency improvements through 2023–2024 after major expansion efforts. Methods: This retrospective analysis examined 755,145 e-referrals across all 13 administrative regions of Saudi Arabia during 2023–2024. The study analyzed data extracted from the SMARC database covering two consecutive years. Outcomes assessed included acceptance rates, referral destinations (internal within the same region vs. external to other regions), and factors associated with system performance. Results: The total volume of e-referrals through SMARC increased substantially by 19.34% to 755,145 in 2023–2024. Acceptance rates for referrals improved markedly from 74.13% to 90.19% over this period. The proportion of internal referrals increased from 80.13% of total referrals to 87.52%. In contrast, external referrals to other regions declined from 19.87% to 12.48% of the total. Critical care referrals (ICU, CCU, NICU, PICU) decreased from 12.39% to 9.91%. Referrals for life-saving emergency conditions showed a noticeable decrease from 6.65% to 2.18%. Referrals to hospital outpatient departments (OPD) also showed an increase from 48.07% to 66.66% of total referrals. Conclusions: SMARC demonstrated considerable improvements in key metrics including referral acceptance rates and growth in regional self-sufficiency. This progress is associated with the Kingdom’s goals for advancing its healthcare system under Vision 2030 initiatives. The system has enabled more effective care coordination and access to specialized services across regions. These achievements were observed during a period of significant healthcare infrastructure expansion documented during this period, including growth in specialized centers, increased ICU bed capacity following governmental regulation after the COVID-19 pandemic, and expansion of trained medical subspecialists. Full article

Introduction: Adolescents and young adults (AYAs), especially those from underserved communities, often face barriers to sexual and reproductive health (SRH). This pilot study evaluated the implementation of mobile health technologies to promote SRH care, including the integration of the Rapid Adolescent Prevention Screening^TM (RAAPS) and the Health-E You/Salud iTu^TM (Health-E You) app at a School-Based Health Center (SBHC) in Los Angeles using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: This multi-method pilot study included the implementation of an integrated tool with two components, the RAAPS electronic health screening tool and the Health-E You app, which delivers tailored SRH education and contraceptive decision support to patients (who were sex-assigned as female at birth) and provides an electronic summary to clinicians to better prepare them for the visit with their patient. Quantitative data on tool usage were collected directly from the back-end data storage for the apps, and qualitative data were obtained through semi-structured interviews and in-clinic observations. Thematic analysis was conducted to identify implementation barriers and facilitators. Results: Between April 2024 and June 2024, 60 unique patients (14–19 years of age) had a healthcare visit. Of these, 35.00% used the integrated RAAPS/Health-E You app, and 88.33% completed the Health-E You app only. All five clinic staff were interviewed and expressed that they valued the tools for their educational impact, noting that they enhanced SRH discussions and helped uncover sensitive information that students might not disclose face-to-face. However, the tools affected clinic workflows and caused rooming delays due to the time-intensive setup process and lack of integration with the clinic’s primary electronic medical record system. In addition, they also reported that the time to complete the screener and app within the context of a 30-min appointment limited the time available for direct patient care. Additionally, staff reported that some students struggled with the two-step process and did not complete all components of the tool. Despite these challenges, clinic staff strongly supported renewing the RAAPS license and continued use of the Health-E You app, emphasizing the platform’s potential for improving SRH care and its educational value. Conclusions: The integrated RAAPS and Health-E You app platform demonstrated educational value and improved SRH care but faced operational and technical barriers in implementing the tool. These findings emphasize the potential of such tools to address SRH disparities among vulnerable AYAs while providing a framework for future implementations in SBHCs. Full article

Background/Objectives: Nonattendance at healthcare appointments remains a major challenge, particularly in chronic diseases like diabetes. Dietary therapy is essential in diabetes care, yet nonattendance at dietitian appointments persists. This study aimed to identify key drivers of nonattendance at dietitian appointments, explore prior experiences with dietary counseling, and determine factors motivating attendance. Methods: A mixed-methods approach was used in this quality improvement project, drawing on multiple data sources to explore nonattendance at dietitian appointments. This included combining a retrospective analysis of clinical and attendance data from patient records at a Danish outpatient diabetes clinic with semi-structured interviews with 25 individuals who had recently missed a dietitian appointment. Quantitative and qualitative data were analyzed separately and then integrated to characterize overall nonattendance patterns. Interview data were analyzed using systematic text condensation. Results: Individuals who missed dietitian appointments were also more likely to miss other healthcare appointments. Vulnerable individuals (i.e., those with complex health conditions or mental health issues) were more likely to miss appointments. Four principal barriers to attendance were identified: administrative, digital, and logistical challenges; competing health concerns; personal priorities; and unclear referral communication and patient involvement. Conclusions: Improving attendance at dietitian appointments requires a multifaceted approach. Key recommendations include optimizing scheduling practices, implementing digital reminders, offering continuity of care and virtual consultation options. Referring clinicians should improve patient communication by clearly explaining the purpose of the dietitian consultation and involving patients in shared decision-making prior to referral. Dietitians should collaborate with patients to establish realistic, personalized goals to foster engagement in their diabetes management. Full article

Background: Bronchiolitis accounts for a substantial number of pediatric hospitalizations and its epidemiology closely parallels that of respiratory syncytial virus (RSV), its principal etiological agent. International guidelines recommend supportive therapy based primarily on oxygen supplementation and hydration. Methods: This study aimed to assess, across three pediatric wards, the impact of internal monitoring and targeted educational interventions on adherence to bronchiolitis management guidelines. Focus was placed on evaluating the effectiveness of tailored strategies in enhancing the appropriateness of treatment practices. Each center independently developed an audit and feedback strategy aligned with local practices and available resources. In Center 1, monthly staff meetings included guideline refreshers throughout the epidemic season. Center 2 appointed two attending physicians to monitor treatment prescriptions and report deviations. Center 3 established an internal protocol through staff consensus, followed by monthly review sessions. In this retrospective analysis, all consecutive patients admitted with bronchiolitis during the winter seasons of 2022–2023 and 2023–2024 (Period 2) were compared with those admitted in 2021–2022 (Period 1). Results: A total of 623 infants under 24 months of age were included, 451 (72%) of whom tested positive for RSV. Their median length of hospital stay was 6 days; 26 infants (4%) required intensive care, and no deaths were recorded. A comparative analysis of the treatment modalities used—high-flow nasal cannula (HFNC) oxygen therapy, inhaled medications, corticosteroids, and antibiotics—revealed a reduced use of non-recommended therapies (e.g., nebulized β2-agonists, steroids, and antibiotics) in Period 2, alongside heterogeneous patterns in HFNC use. Center-specific strategies, tailored to team dynamics and resource availability, effectively promoted greater adherence to evidence-based guidelines. Conclusions: Our findings suggest that structured internal interventions can lead to more appropriate bronchiolitis management and the improved standardization of care. Full article

While outside chief executive officers (CEOs) are often viewed as catalysts for strategic change compared to their inside counterparts, this study reveals their potential to undermine firms’ environmental responsibility. Integrating agency theory with social capital theory, we investigate whether and how board-level social capital can moderate the sustainability risks associated with outside CEO succession. Using a panel dataset of 989 pollution-intensive Chinese firms from 2010 to 2022, we apply propensity score matching (PSM) to reduce endogeneity in CEO succession decisions, followed by fixed-effects regressions. The empirical results show that outside CEOs, particularly during their early tenure, are more likely to prioritize short-term financial performance over environmental goals—due to limited firm-specific knowledge and heightened external pressure. However, external board social capital (e.g., ties to government and industry associations) enhances resource access and post-appointment accountability, while internal social capital (e.g., co-working experience among directors) establishes common norms that facilitate strategic continuity. This study positions board social capital as a relational governance mechanism that complements formal oversight. The findings contribute to succession and environmental research by linking executive origin to sustainability outcomes and provide practical guidance on leveraging board networks to support leadership transitions. Full article

Background/Objectives: Children with Down syndrome (DS) have distinct oral care needs and challenges, yet research on their care experiences, exploring caregiver and provider perspectives, is limited. Therefore, this study aimed to describe the barriers and facilitators to oral care for children with DS, as reported by caregivers and dental professionals. Methods: In this qualitative inquiry, semi-structured questions were used to elicit narratives describing oral care experiences from one caregiver focus group (n = 5), individual caregiver interviews (n = 9), and individual dentist interviews (n = 8). The transcripts were coded and thematically analyzed. Results: Three themes emerged in both groups. The first theme, Access, described the challenges in locating a dentist willing and knowledgeable about how to treat children with DS, and the variability in experiences between different contexts (i.e., community-based vs. specialty clinics). The second theme, Pre-visit Preparation, noted the potential impact of dental trauma on dental visits and recommended the use of preparation strategies, such as desensitization appointments, strategic scheduling, and visual or verbal scripts or social stories, to introduce dental encounters. The final theme, Dental Encounters, dealt with the importance of communication and interpersonal connection, as well as concerns about and support for active/passive immobilization techniques and pharmacological intervention. Sensory strategies for auditory, tactile, and vestibular input were discussed, in addition to distraction techniques, the timing and pacing of dental encounters, and parental presence/absence. Conclusions: Tailoring dental care around the unique sensory and behavioral needs of children with DS and building effective partnerships between children, parents, and dentists were emphasized for optimizing the dental care experiences of children with DS. Full article

Background/Objectives: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves the health of nutritionally at-risk populations. However, engagement challenges, such as missed appointments and unredeemed food benefits, may limit program efficacy. Barriers to engagement are heightened among American Indian populations, who often experience disproportionately high levels of participation-related challenges. This study assessed whether newly developed health communication theory-based text messages incorporating persuasive language and different message framing (i.e., gain-framed and loss-framed) improved WIC appointment attendance and food benefit redemption rates, above and beyond standard information-based reminders. Methods: The sample included participants served by the Inter Tribal Council of Arizona WIC between the months of September 2022 and February 2023 who (a) had an appointment during the intervention period (n = 7584) or (b) were eligible to receive a reminder text about unused food benefits during the intervention period (n = 2177). A three-phase intervention design was used, with each phase lasting six weeks. During the baseline phase, participants received standard information-based text messages, while during the two intervention phases, participants received newly developed messages using (1) gain-framed and (2) loss-framed persuasive language. Difference-in-difference regression analyses compared whether differences in outcomes (i.e., appointment attendance and monthly food benefit redemption rates) between participants who received reminder messages and those who did not differed over intervention phases. Results: Receipt of both gain-framed and loss-framed theory-based messages was associated with higher appointment attendance, when compared to receipt of standard information-based messages during baseline (p = 0.003 and p = 0.01, respectively). Neither the gain-framed nor loss-framed messages were associated with higher food benefit redemption rates than standard messages. Conclusions: Results indicated that persuasive communication theory-based text reminders may be an effective, low-cost strategy to boost WIC appointment attendance among American Indians. Full article

A macular hole is a defect of the neurosensory retina at the fovea. Post-traumatic holes can occur immediately after blunt trauma, causing severe non-penetrating retinal contusion or after sudden detachment of the vitreous from the retina. Post-traumatic macular holes can close spontaneously or may require vitreoretinal surgery. This paper aims to present the case of an 11-year-old boy with a macular hole following a ball injury. The child reported deterioration of visual acuity. Ophthalmic examination, ocular ultrasound, optical coherence tomography (OCT), perimetry, and a pattern visual evoked potential (VEP) test were performed. On the day of injury, the visual acuity of the right eye was 0.04 and intraocular pressure was 28 mmHg; the eyelid skin was reddened, and superficial conjunctival injection was observed. A fundus examination revealed oedema, pre-retinal haemorrhages, and a macular hole; peripheral retinal oedema in the superior temporal quadrant with pre-retinal haemorrhages was also seen. At the follow-up appointment scheduled 5 months following hospital discharge, visual acuity of the right eye was 0.3 and intraocular pressure was 20 mmHg. Follow-up OCT images of the OD macula were comparable to the findings obtained on the day of hospital discharge, i.e., 10 days after blunt trauma to the right eye. The left-eye OCT did not reveal any abnormalities. Full article