Search Results (502)

Background/Objectives: The social importance of health literacy (HL) is widely understood, and its measurement is the subject of various studies. Due to the recent pandemic, several instruments for measuring HL about COVID-19 have been proposed in different countries, including the HLS-COVID-Q22 questionnaire. The diversity of cultures and languages necessitates the cross-cultural adaptation of this instrument. Thus, the present study translates, adapts, and validates the psychometric properties of the HLS-COVID-Q22 questionnaire to provide its cross-cultural adaptation from English to Spanish (Peru). Methods: As part of ensuring that the final questionnaire accommodates the cultural nuances and idiosyncrasies of the target language, the following activities were carried out: (a) a survey of 40 respondents; and (b) a focus group with 10 participants, followed by expert approval. In addition, the validity and reliability of the health instrument have been ascertained through a further pilot test administered to 490 people in the city of Tacna in southern Peru. Results: The resulting questionnaire helps measure HL in Peru, aiding better-informed decision-making for individual health choices. Conclusions: The presence of such a tool is advantageous in case of similar global health emergencies, when the questionnaire can be made readily available to support a promotion of strategies towards better self-care. Moreover, it encourages other Latin American stakeholders to adjust the instrument to their own cultural, language, and socio-economic contexts, thus invigorating the regional and global expansion of the HL study network. Full article

Introduction: Cystic fibrosis (CF) is a genetic condition affecting several organs and systems, including the pancreas, colon, respiratory system, and reproductive system. The detection of a growing number of CFTR variants and genotypes has contributed to an increase in the CF population which, in turn, has had an impact on the overall statistics regarding the prognosis and outcome of the condition. Given the increase in life expectancy, it is critical to better predict outcomes and prognosticate in CF. Thus, each person’s choice to aggressively treat specific disease components can be more appropriate and tailored, further increasing survival. The objective of our narrative review is to summarize the most recent information concerning the value and significance of clinical parameters in predicting outcomes, such as gender, diabetes, liver and pancreatic status, lung function, radiography, bacteriology, and blood and sputum biomarkers of inflammation and disease, and how variations in these parameters affect prognosis from the prenatal stage to maturity. Materials and methods: A methodological search of the available data was performed with regard to prognostic factors in the evolution of CF in children and young adults. We evaluated articles from the PubMed academic search engine using the following search terms: prognostic factors AND children AND cystic fibrosis OR mucoviscidosis. Results: We found that it is crucial to customize CF patients’ care based on their unique clinical and biological parameters, genetics, and related comorbidities. Conclusions: The predictive significance of more dynamic clinical condition markers provides more realistic future objectives to center treatment and targets for each patient. Over the past ten years, improvements in care, diagnostics, and treatment have impacted the prognosis for CF. Although genotyping offers a way to categorize CF to direct research and treatment, it is crucial to understand that a variety of other factors, such as epigenetics, genetic modifiers, environmental factors, and socioeconomic status, can affect CF outcomes. The long-term management of this complicated multisystem condition has been made easier for patients, their families, and physicians by earlier and more accurate identification techniques, evidence-based research, and centralized expert multidisciplinary care. Full article

As veganism becomes more popular, the number of vegan pregnant women and children is steadily increasing. During vegan pregnancy and early childhood, there is a high risk for nutrient deficiencies that may impair child development. External factors, such as healthcare advice, social networks, and social environments, that affect the diet of vegan pregnant women, parents, and their children, as well as their approach towards dietary supplementation, have not yet been investigated. Various sources of information, combined with a lack of expertise, sparse food and nutritional health literacy, and qualitatively heterogeneous information provision by medical experts, unsettle vegan pregnant women and parents and affect their dietary choices and potentially the health of their children. The VedieS study aims to investigate potential connections between external influences and associated impacts on a vegan diet and the intake of dietary supplements (DS) of pregnant women and children. Two surveys are being conducted within the study: one targeting 1000 vegan pregnant women and parents, and another targeting 60 experts in each of five healthcare groups: gynecologists, pediatricians, general practitioners, pharmacists, and dietitians. This study is the first to examine how socio-economic, social, and further informational factors influence dietary practices during vegan pregnancy and childhood. It highlights the need for reliable, expert-led guidance, as current information sources are often inconsistent and may put these vulnerable groups at risk. Full article

Background: Cefiderocol (FDC) presents challenges in antimicrobial susceptibility testing (AST). The reference standard is the broth microdilution (BMD) method with iron-depleted cation-adjusted Mueller-Hinton broth (ID-CAMHB). Still, it is cumbersome for routine clinical laboratory use, while variable accuracy has been reported with available commercial systems. Variability in interpretive criteria and areas of technical uncertainty (ATUs) further complicate assessments. Methods: This review and expert opinion presents: (1) an overview of non-susceptibility to FDC and then delves into the performance of current FDC AST methods for Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii complex; (2) a practical decision framework to guide clinical microbiologists in making informed choices. Results and Conclusions: For Enterobacterales, including carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa, we propose disk diffusion (DD) as a preliminary screening tool to classify isolates as susceptible (S) or resistant (R). Confirmatory testing using the UMIC^® FDC system or the ID-CAMHB BMD method is recommended for R isolates. In cases of discrepancy, repeating the test with ID-CAMHB BMD is advised. Additionally, isolates falling within the ATU during DD testing should be retested using the UMIC^® system or ID-CAMHB BMD. For A. baumannii complex, since EUCAST breakpoints have not been defined yet, we propose a stepwise framework based on the first DD result: isolates with inhibition zones < 17 mm are considered non-susceptible and should be confirmed with standard BMD. Those between 17 and 22 mm require retesting with a commercial BMD method, with further confirmation recommended if S isolates with zones ≥ 23 mm may be considered S without additional testing. Full article

Veterinarians are not just animal health professionals; they are also considered animal welfare experts. Animal-directed empathy, the ability to understand and match an animal’s emotional state, is essential for recognizing animal welfare issues. It is therefore a vital competency for veterinarians. The factors that play a role in shaping this empathy are animal, personal, and cultural influences, as well as the categorization of animals based on their benefit or harm to people: pet, pest or profit (used for economic purposes). We conducted a survey among veterinary students in the Netherlands to assess their levels of animal-directed empathy by scoring their attitude toward animals with the “Pet, Pest, Profit Scale”. Analysis of 321 completed surveys revealed that students showed the highest empathy for pets, the second-highest levels for pest animals, and the lowest levels for profit animals. Empathy levels also differed depending on career choice, background, and diet. These findings indicate that categorizing animals influences veterinary students’ empathy levels, which can lead to unrecognized welfare issues, especially for pest and profit animals. It is important to enhance empathy for these categories through targeted educational interventions to help prepare veterinary students for their responsibility as veterinarians, ensuring the welfare of all animals, whether pet, pest or profit. Full article

Cystinosis is a rare systemic disease characterized by the accumulation of cystine in tissues, leading to multi-organ damage. Infantile nephropathic cystinosis is the dominant and severe form of cystinosis with critical renal manifestations that require kidney transplantation at an early age if left untreated. Cysteamine, the lifelong cystine-depleting therapy, is the mainstay treatment of nephropathic cystinosis. Cysteamine prevents cystine crystal formation and delays disease progression. While the initially introduced cysteamine consists of an immediate-release (IR) formulation, a delayed-release (DR) formulation has been developed with a simplified dosing regimen (Q12H instead of Q6H) and an improved quality of life while maintaining comparable efficacy. Due to the rare incidence of the disease and lack of international guidelines, diagnosis and treatment initiation are oftentimes delayed, leading to a poor prognosis. Pediatric and adult nephrologists from Kuwait, Saudi Arabia, the United Arab Emirates (UAE), and Qatar, in addition to one international expert from Amsterdam, convened to share their clinical experience, reflecting on the challenges encountered and therapeutic approaches followed in the management of nephropathic cystinosis in the Gulf Cooperation Council (GCC) region. Experts completed a multiple-choice questionnaire and engaged in structured discussions, where they shed light on gaps and limitations with regard to diagnostic tests and criteria to ensure early diagnosis and timely treatment initiation. Based on available literature, experts suggested an algorithm to help guide nephropathic cystinosis management in the GCC. It is highly recommended for patients who do not tolerate IR-cysteamine and do not adhere to IR-cysteamine treatment to switch to DR-cysteamine. Given the systemic nature of the disease, a multi-disciplinary approach is required for optimal disease management. Full article

Background/Objectives: Otolaryngologists are increasingly using head and neck ultrasound (HNUS). Determining whether a practitioner of HNUS has achieved adequate theoretical knowledge remains a challenge. This study assesses the performance of two large language models (LLMs) in generating multiple-choice questions (MCQs) for head and neck ultrasound, compared with MCQs generated by physicians. Methods: Physicians and LLMs (ChatGPT, GPT4o, and Google Gemini, Gemini Advanced) created a total of 90 MCQs that covered the topics of lymph nodes, thyroid, and salivary glands. Experts in HNUS additionally evaluated all physician-drafted MCQs using a Delphi-like process. The MCQs were assessed by an international panel of experts in HNUS, who were blinded to the source of the questions. Using a Likert scale, the evaluation was based on an overall assessment including six assessment criteria: clarity, relevance, suitability, quality of distractors, adequate rationale of the answer, and an assessment of the level of difficulty. Results: Four experts in the clinical field of HNUS assessed the 90 MCQs. No significant differences were observed between the two LLMs. Physician-drafted questions (n = 30) had significant differences with Google Gemini in terms of relevance, suitability, and adequate rationale of the answer, but only significant differences in terms of suitability compared with ChatGPT. Compared to MCQ items (n = 16) validated by medical experts, LLM-constructed MCQ items scored significantly lower across all criteria. The difficulty level of the MCQs was the same. Conclusions: Our study demonstrates that both LLMs could be used to generate MCQ items with a quality comparable to drafts from physicians. However, the quality of LLM-generated MCQ items was still significantly lower than MCQs validated by ultrasound experts. LLMs are therefore cost-effective to generate a quick draft for MCQ items that afterward should be validated by experts before being used for assessment purposes. In this way, the value of LLM is not the elimination of humans, but rather vastly superior time management. Full article

Objective: This proof-of-concept study aimed to evaluate and compare the clinical performance of two AI language models (ChatGPT-3.5 and OpenAI o3) in answering clinical pharmacy multiple-choice questions (MCQs), benchmarked against responses from specialist clinical pharmacists in Jordan, including academic preceptors and hospital-based clinicians. Methods: A total of 60 clinical pharmacy MCQs were developed based on current guidelines across four therapeutic areas: cardiovascular, endocrine, infectious, and respiratory diseases. Each item was reviewed by academic and clinical experts and then pilot-tested with five pharmacists to determine clarity and difficulty. Two ChatGPT models—GPT-3.5 and OpenAI o3—were tested using a standardized prompt for each MCQ, entered in separate sessions to avoid memory retention. Their answers were classified as true/false positives or negatives and retested after two weeks to assess reproducibility. Simultaneously, 25 licensed pharmacists (primarily from one academic institution and several hospitals in Amman) completed the same MCQs using validated references (excluding AI tools). Accuracy, sensitivity, specificity, and Cohen’s Kappa were used to compare AI and human performance, with statistical analysis conducted using appropriate tests at a significance level of p ≤ 0.05. Results: OpenAI o3 achieved the highest accuracy (83.3%), sensitivity (90.0%), and specificity (70.0%), outperforming GPT-3.5 (70.0%, 77.5%, 55.0%) and pharmacists (69.7%, 77.0%, 55.0%). AI performance declined significantly with increasing question difficulty. OpenAI o3 showed the highest accuracy in the cardiovascular domain (93.3%), while GPT-3.5 performed best in infectious diseases (80.0%). Reproducibility was higher for GPT-3.5 (81.6%, κ = 0.556) than OpenAI o3 (76.7%, κ = 0.364). Over two test rounds, GPT-3.5’s accuracy remained stable, whereas OpenAI o3’s accuracy decreased from 83.3% to 70.0%, indicating some variability. Conclusions: OpenAI o3 shows strong promise as a clinical decision-support tool in pharmacy, especially for low- to moderate-difficulty questions. However, inconsistencies in reproducibility and limitations in complex cases highlight the importance of cautious, supervised integration alongside human expertise. Full article

Dietary choices and patterns have enormous consequences along the lines of individual, community, and planetary health. Excess meat consumption has been linked to chronic disease risk, and at large scales, the underlying industries maintain a massive environmental footprint. For these reasons, public and planetary health experts are unified in emphasizing a whole or minimally processed plant-based diet. In response, the purveyors of ultra-processed foods have added “meat alternatives” to their ultra-processed commercial portfolios; multinational corporations have been joined by “start-ups” with new ultra-processed meat analogues. Here, in our Viewpoint, we revisit the 1990s food industry rhetoric and product innovation, a time in which multinational corporations pushed a great “low-fat transition.” We focus on the McLean Deluxe burger, a carrageenan-rich product introduced by the McDonald’s Corporation in 1991. Propelled by a marketing and media-driven fear of dietary fats, the lower-fat burger was presented with great fanfare. We reflect this history off the current “great protein transition,” a period once again rich in rhetoric, with similar displays of industry detachment from concerns about the health consequences of innovation. We scrutinize the safety of carrageenan and argue that the McLean burger should serve as a cautionary tale for planetary health and 21st century food innovation. Full article

This study explores modernization strategies for existing district heating (DH) networks to enhance their efficiency and sustainability, focusing on achieving net-zero emissions in urban heating systems. Building upon a literature review and expert interviews, we developed a strategic decision-support framework that outlines distinct strategies for retrofitting district heating grids and includes a portfolio analysis. This framework serves as a tool to guide DH operators and stakeholders in selecting well-founded modernization pathways by considering technical, economic, and social dimensions. The review identifies several promising measures, such as reducing operational temperatures at substations, implementing optimized substations, integrating renewable and waste heat sources, implementing thermal energy storage (TES), deploying smart metering and monitoring infrastructure, and expanding networks while addressing public concerns. Additionally, the review highlights the importance of stakeholder engagement and policy support in successfully implementing these strategies. The developed strategic decision-support framework helps practitioners select a tailored modernization strategy aligned with the local context. Furthermore, the findings show the necessity of adopting a comprehensive approach that combines technical upgrades with robust stakeholder involvement and supportive policy measures to facilitate the transition to sustainable urban heating solutions. For example, the development of decision-support tools enables stakeholders to systematically evaluate and select grid modernization strategies, directly helping to reduce transmission losses and lower greenhouse gas (GHG) emissions contributing to climate goals and enhancing energy security. Indeed, as shown in the reviewed literature, retrofitting high-temperature district heating networks with low-temperature distribution and integrating renewables can lead to near-complete decarbonization of the supplied heat. Additionally, integrating advanced digital technologies, such as smart grid systems, can enhance grid efficiency and enable a greater share of variable renewable energy thus supporting national decarbonization targets. Further investigation could point to the most determining context factors for best choices to improve the sustainability and efficiency of existing DH systems. Full article

Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service for much-needed community-based healthcare. To support this expanded role, targeted, competency-based training is essential; however, this can pose challenges, especially in coordinating synchronous learning across geographically dispersed teams and in ensuring engagement using an online format. Methods: A nationwide, online training program was developed to improve the knowledge of the personnel members of the Hellenic National Public Health Organization’s MHUs. This program was structured focusing on four core themes: (i) prevention–health promotion; (ii) provision of care; (iii) social welfare and solidarity initiatives; and (iv) digital health skill enhancement. The program was implemented by the University of Crete’s Center for Training and Lifelong Learning from 16 January to 24 February 2025. A multidisciplinary team of 64 experts delivered 250 h of live and on-demand educational content, including health screenings, vaccination protocols, biomarker monitoring, chronic disease management, treatment adherence, organ donation awareness, counseling on social violence, and eHealth applications. Knowledge acquisition was assessed through a pre- and post-training multiple-choice test related to the core themes. Trainees’ and trainers’ qualitative feedback was evaluated using a 0–10 numerical rating scale (Likert-type). Results: A total of 873 MHU members participated in the study, including both healthcare professionals and administrative staff. The attendance rate was consistently above 90% on a daily basis. The average assessment score increased from 52.8% (pre-training) to 69.8% (post-training), indicating 17% knowledge acquisition. The paired t-test analysis demonstrated that this improvement was statistically significant (t = −8.52, p < 0.001), confirming the program’s effectiveness in enhancing knowledge. As part of the evaluation of qualitative feedback, the program was positively evaluated, with 75–80% of trainees rating key components such as content, structure, and trainer effectiveness as “Very Good” or “Excellent.” In addition, using a 0–10 scale, trainers rated the program relative to organization (9.4/10), content (8.8), and trainee engagement (8.9), confirming the program’s strength and scalability in primary care education. Conclusions: This initiative highlights the effectiveness of a structured, online training program in enhancing MHU knowledge, ensuring standardized, high-quality education that supports current primary healthcare needs. Future studies evaluating whether the increase in knowledge acquisition may also result in an improvement in the personnel’s competencies, and clinical practice will further contribute to assessing whether additional training programs may be helpful. Full article

Various activities, whether economic, social, or environmental, exert pressure on a coastal area. The extent of economic activities taking place in coastal regions is continuously increasing, particularly in tourism, maritime transport, port operations, and fisheries and aquaculture. Therefore, the decision to establish activities in a coastal area is complex and requires careful consideration by all stakeholders who use this space, which is potentially one of the most important natural resources for the development of any coastal country. This research is focused on assessing the justification for establishing economic activities in a coastal area, taking into account the interconnection of spatial, safety, environmental, and social factors. Therefore, three possible scenarios have been proposed: the location of the communal port, the location of the nautical port-marina, and the location of the marine entertainment and recreation centre. The goal was to develop a model that would enable the objective assessment and selection of the most suitable activity that would simultaneously benefit society and have the least harmful impact on the environment. Therefore, a multi-criteria analysis was conducted using the AHP (Analytic Hierarchy Process) method. The decision-making process was based on the expert validation of criteria, sub-criteria, and alternatives. An analytical tool called Expert Choice was used to synthesise the results and select the optimal activity. The sensitivity analysis confirmed the stability and reliability of the obtained results, with the AHP method proving to be an effective tool in structuring the decision-making process regarding the establishment of activities in the coastal area. Based on the results of the multi-criteria assessment, planning the establishment of activities is an important precondition for the long-term and sustainable development of coastal activities in an area. Full article

Cat owners are involved in their cats’ healthcare, including the prevention of parasitic diseases. However, a comprehensive understanding of their preferences for feline antiparasitics is lacking. This study addresses this gap through a multifaceted methodology comprising three phases. In Phase 1, the physical properties and usability aspects of seven topical antiparasitic formulations were assessed. Within Phase 2, an ease-of-use study was conducted to evaluate the cat owners’ application experience with deidentified products representing three topical antiparasitics. Phase 3 included the identification and validation of product attributes most valued by pet owners through interviews with cat owners and veterinary experts. The product attributes identified informed the subsequent quantitative discrete choice experiment (DCE), which involved 1040 cat owners from different countries (Australia/New Zealand, Canada, Greece/Spain, and the UK) and aimed to analyze their preferences based on choices among product profiles mirroring four topical antiparasitics: selamectin–sarolaner, moxidectin–fluralaner, moxidectin–imidacloprid, and eprinomectin–esafoxolaner–praziquantel. Phase 1 showed that the selamectin–sarolaner formulation exhibits minimal odor, less stickiness, and less drying time. The ease-of-use study (Phase 2) showed that the blinded product representing the selamectin–sarolaner formulation was characterized by seamless application, rapid dispensing, and a sense of control during application. The quantitative DCE study (Phase 3) indicated a preference for the product profile mirroring the selamectin–sarolaner formulation among a global sample of cat owners. Demographic characteristics such as gender, age, and insurance status influenced their preferences. Key predictors for preferring the selamectin–sarolaner formulation over at least one comparator treatment included the ability to confirm successful administration, age restrictions, ease of application, and the time before the cat could sit on furniture following administration. These findings suggest that cat owners prioritize ease of use, safety, and overall user experience, providing valuable guidance for veterinary practitioners to make informed treatment recommendations. Full article

California’s SB 1014 (Clean Miles Standard) mandates ridehailing fleet electrification to reduce emissions from vehicle miles traveled, posing financial and infrastructure challenges for drivers. This study employs a mixed-methods approach, including expert interviews (n = 10), group discussions (n = 8), and a survey of full- and part-time drivers (n = 436), to examine electric vehicle (EV) adoption attitudes and policy preferences. Access to home charging and prior EV experience emerged as the most statistically significant predictors of EV acquisition. Socio-demographic variables, particularly income and age, could also influence the EV choice and sensitivity to policy design. Full-time drivers, though confident in the EV range, were concerned about income loss from the charging downtime and access to urban fast chargers. They showed a greater interest in EVs than part-time drivers and favored an income-based instant rebate at the point of sale. In contrast, part-time drivers showed greater hesitancy and were more responsive to vehicle purchase discounts (price reductions or instant rebates at the point of sale available to all customers) and charging credits (monetary incentive or prepaid allowance to offset the cost of EV charging equipment). Policymakers might target low-income full-time drivers with greater price reductions and offer charging credits (USD 500 to USD 1500) to part-time drivers needing operational and infrastructure support. Full article

The intersection of digitalization and innovation has emerged as the most vital strategy to spur economic development and shape consumer choice. The study examines sustainable development, digital economic governance, and sustainable consumption, emphasizing the role of consumer awareness, tariff policy, and managerial practice in aligning business strategy with sustainable goals. Amidst global environmental challenges, a suitable tariff policy is of utmost significance to propel the digital economy and encourage sustainable development. This paper investigates how emerging tariff policies can advance trade competitiveness and environmental impacts and draws on a literature review and data collection for the period between 2000 and 2025. The article examines the disruptive function of digital technologies, AI, and big data in driving sustainable business practices and digitalization. It also discusses how such technologies can simplify tariff implementation, compliance, and stakeholder trust through behavioral insights drawn from secondary data analysis on a cross-country basis and official reports. The study identifies best practices in the coordination of tariff policy with international governance institutions. Empirical observation shows that innovative tariff approaches in digital economic governance can support long-term growth, increase international coordination, and guide global governance efforts in environmental sustainability and SDGs. The implications of the findings are relevant to policymakers, business leaders, and legal experts working on fast-paced global changes. Full article