Search Results (73)

Background: Emotional safety is increasingly recognized as crucial for high-quality patient care, encompassing a patient’s sense of security, courteous treatment, being heard, and a peaceful environment. Purpose: The purpose of this study was to explore the perceptions of patients and providers (doctors and nurses) regarding emotional harm and safety in relation to hospitalized patients. Methods: We conducted a qualitative study in public-sector teaching hospitals in Peshawar, Pakistan. Data were collected after we obtained informed consent using individual interviews with 15 providers, namely, doctors (n = 7) and nurses (n = 8), and five focus group discussions (FGDs) with 25 hospitalized patients. Data from both the interviews and FGDs were analyzed using Braun and Clarke’s six-phase approach to thematic analysis. Results: The key themes revealed by the providers’ perspectives were factors contributing to emotional harm, staff-related factors, coping mechanisms and solutions, and the impact of prior experiences and involvement. The main themes that emerged from the patients’ perspectives were anxiety upon admission, the impact of communication, emotional stress due to treatment delays, systemic/bureaucratic challenges, financial burden, a lack of emotional support, and post-hospitalization concerns. The consistent perspectives shared by both patients and providers included the impact of systemic factors, communication issues, the role of staff attitude/behavior, financial concerns, and the influence of prior experiences. Conclusions: This study highlights the complex interplay of systemic, staff-related, and patient-specific factors. It suggests a need to improve communication, staff support, administrative processes, financial counseling, emotional support integration, and discharge planning to minimize harm and create a patient-centered environment. Full article

Background/Objectives: Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. Methods: A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. Results: Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. Conclusions: BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes. Full article

Background: Cochlear implants (CIs) are the gold standard intervention for severe-to-profound sensorineural hearing loss. Their success depends not only on technological advancements but also on the knowledge, attitudes, and practices (KAP) of otolaryngologists responsible for patient selection, counselling, and postoperative management. Objective: This study aimed to evaluate the KAP of otolaryngologists in the UAE towards CIs, identify gaps in training and decision-making, and assess adherence to global CI protocols. Methods: A cross-sectional study was conducted using a self-administered online questionnaire distributed to otolaryngologists across public and private healthcare institutions in the UAE. The survey assessed demographics, clinical knowledge, attitudes towards CIs, and clinical practices. Descriptive and inferential statistical analyses were performed to assess the relationships among knowledge levels, referral frequency, and institutional factors. Results: A total of 31 otolaryngologists participated. While 74% demonstrated moderate-to-high knowledge of CIs, 39% had low awareness of national guidelines. Most (61%) strongly supported CI integration into treatment protocols, but financial and institutional barriers were frequently cited as challenges. Knowledge levels significantly correlated with referral frequency (p < 0.001), indicating a gap between awareness and practice. Conclusions: This is the first study in the UAE assessing otolaryngologists’ KAP regarding CIs. Despite favourable attitudes, limited guideline awareness, financial barriers, and inconsistent multidisciplinary collaboration remain challenges. Targeted clinician education, standardised CI guidelines aligned with international benchmarks, and improved funding mechanisms are essential to enhance CI accessibility and optimise patient outcomes in the region. Full article

Background: Early Hearing Detection and Intervention (EHDI) is essential for minimising the negative impact of childhood hearing loss on speech, language, and cognitive development. However, in low- and middle-income countries such as South Africa, various challenges hinder the implementation of EHDI services, leading to delayed diagnosis and intervention. Aim: This study explores caregivers’ experiences with EHDI services, identifying key challenges and facilitators affecting access and timely intervention. Methods: A narrative inquiry approach was used as part of a broader research initiative on family-centred EHDI. Nine caregivers of children who are deaf or hard of hearing (DHH) were purposively sampled, and data were collected through semi-structured interviews. Results: Thematic analysis revealed systemic and structural challenges, logistical and financial constraints, and caregiver-related factors that hindered access to EHDI services. Key facilitators included caregiver knowledge and advocacy, family support services such as counselling and South African Sign Language training, and high-quality audiological and educational services. Conclusions: Findings emphasise the need for policy-driven reforms, including expanding newborn hearing screening programmes, improving financial assistance mechanisms, and increasing public awareness. Addressing these challenges and leveraging facilitators can help South Africa align with global EHDI benchmarks and improve outcomes for DHH children. Full article

Many patients with head-and-neck cancer (HNC) suffer from speech or swallowing disorders. We investigated the impact of dysphagia on health-related quality of life (HRQOL), functioning, and distress in HNC survivors, and whether cancer rehabilitation can alleviate these conditions. Before admission (T0) and at discharge (T1) of three-week inpatient cancer rehabilitation, patient-reported outcomes were collected. HRQOL, symptoms, functioning, and psychological distress were assessed with EORTC QLQ-C30 and Hospital Anxiety and Depression Scale (HADS) questionnaires. Of 63 HNC patients, 22 had dysphagia, 23 needed no speech therapy (Control-1), and 18 needed speech therapy, but showed no symptoms of dysphagia (Control-2). Before rehabilitation, HRQOL, physical, social, and emotional functioning were significantly lower in dysphagia patients than in controls. Dysphagia patients reported more severe general symptoms including fatigue, pain, sleep disturbances, nausea/vomiting, diarrhea, and financial worries. Furthermore, the emotional and social functioning of Control-2 was significantly worse than Control-1. For all HNC patients, social, emotional, and role functioning, fatigue, nausea/vomiting, insomnia, and appetite loss significantly improved at T1. Improvements in HRQOL were most noticeable in dysphagia patients. Psychooncological counseling reduced depression in dysphagia and Control-2 patients to levels seen in the general population. In conclusion, dysphagia patients suffer severely from impaired functioning and systemic symptoms but benefit substantially from rehabilitation. Full article

Background: Cochlear implants (CIs) have become a widely used intervention for Deaf and hard-of-hearing (DHH) children, particularly for developing spoken language. However, parental decision-making regarding CIs is influenced by a range of factors, including socio-economic status, healthcare accessibility, cultural beliefs, and societal attitudes. While extensive research on parental perceptions of CIs exists in high-income countries (HICs), there is limited research on these perspectives in low- and middle-income countries (LMICs), like South Africa, where disparities in healthcare access significantly impact CI uptake. Objectives: This study aimed to explore the views and perceptions of South African parents regarding CIs for their DHH children, with a specific focus on how financial, cultural, and informational barriers influence decision-making. Methods: A mixed-methods approach was used, combining Q-methodology for quantitative data and thematic analysis for qualitative insights. Nine parents of DHH children participated. The Q-set survey ranked parental attitudes toward CI risks, benefits, and accessibility, while semi-structured interviews provided deeper insights into decision-making processes. Factor analysis grouped participants into clusters based on their perceptions, and qualitative data were analysed using a thematic framework approach. Results: Findings revealed two distinct parental clusters: (a) Cluster 1 parents viewed CIs as essential for speech development and strongly supported implantation, and (b) Cluster 2 parents recognized CI benefits but emphasized that outcomes vary based on individual circumstances. Three overarching themes emerged from thematic analysis: (1) financial barriers restricting CI access, (2) parental reliance on medical professionals for decision-making, and (3) persistent stigma and cultural beliefs influencing CI perceptions. Conclusions: This study highlights critical barriers to CI access in South Africa, including socio-economic inequities, limited healthcare infrastructure, and persistent stigma. While parents largely recognized the benefits of CIs, their decisions were shaped by financial constraints and concerns about Deaf identity and societal acceptance. This study calls for the expansion of publicly funded CI programmes, the development of culturally tailored parental counselling protocols, and targeted public awareness campaigns to reduce stigma surrounding hearing restoration devices. These interventions can help mitigate financial and cultural barriers to CI adoption in South Africa. Full article

Background: Smoking during pregnancy is a significant issue because of its impact on maternal and fetal health. This study aimed to ascertain the effects of smoking cessation programs on the smoking abstinence rate and pregnancy outcomes. Methods: A meta-analysis of twenty-one RCTs was carried out in accordance with PRISMA standards. The meta-analysis comprised 8149 pregnant smokers. With RevMan (version 5.4), the pooled effect of RR for different smoking cessation interventions was determined. Using the GRADE approach, the certainty was evaluated. I² statistics and sensitivity analysis were utilized to measure heterogeneity. Egger’s test and funnel plot analysis were used to assess publication bias. Results: The pregnant women who received cognitive-behavioral counseling and financial incentives recognized a significant rise in their smoking abstinence rate (RR: 1.14, 95% CI: 1.02–1.28, p = 0.03 and RR: 2.37, 95% CI: 1.92–2.93, p < 0.001), but there was no significant difference observed among other behavioral approaches or pharmaceutical therapy. Fetuses born to women in the intervention group had significantly larger birth weights (MD = 94.73, 95% CI = (41.18–58.27), p < 0.001. Conclusions: Pregnant women respond well to cognitive-behavioral counseling and financial incentives for quitting smoking, which improve pregnancy outcomes like birth weight. Full article

This study analyzes the relationship between financial education, financial attitude, financial advice, financial knowledge, and behavior and its influence on financial capabilities, as well as their impact on financial well-being. The population consists of individuals over 18 years of age, who are primarily higher education students. A non-probabilistic self-selection sampling method was used, and data were collected through an electronic form on Google Forms. The design is quantitative, non-experimental, and cross-sectional. The instrument includes sections on sociodemographic profiles, financial education, financial attitudes, financial advice, financial knowledge and behavior, financial capabilities, and financial well-being using a 1 to 5 Likert scale. To ensure validity and reliability, statistical indices such as Cronbach’s alpha and McDonald’s omega were applied. Data normality was assessed, and exploratory and confirmatory factor analyses were conducted using structural equation modeling (SEM). The findings from the results of this study largely align with the existing literature regarding the relationship between financial knowledge and financial capabilities, as well as between financial capabilities and financial well-being. However, a discrepancy is observed in the hypotheses related to financial education, financial attitudes, and financial counseling, suggesting that although these factors are important, their influence may depend on other contextual elements or mediators not considered in this study. This opens the possibility for further investigation into how these factors interact in the development of financial capabilities. Full article

Introduction: Chronic obstructive pulmonary disease (COPD) has a diverse negative impact on patients, affecting them both physically and mentally. Psychosocial factors such as anxiety, depression, social isolation, and financial stress have been found to be positively associated with more exacerbations, hospital readmissions, poor adherence to medication, and lower quality of life among patients with COPD. However, healthcare professionals, who have a crucial role in diagnosing and managing COPD, often overlook these psychosocial factors of the disease, despite growing evidence suggesting their crucial role in improving disease outcomes. Consequently, this study will evaluate the effectiveness of a personalized individualized informational intervention on the quality of life, adherence, and psychosocial economic status of patients with COPD in healthcare settings of Greece. Methods: A prospective, mixed-methods design will be used, incorporating both quantitative data through questionnaires, including the Short Form (SF-12), Clinical COPD Questionnaire (CCQ), Test of Adherence to Inhalers (TAI), Patient Health Questionnaire (PHQ-4), Multidimensional Scale of Perceived Social Support (MSPSS), and Financial Ability Scale (FAS), alongside qualitative data with questions exploring themes such as general health perception, treatment adherence, mental status, socioeconomic status, and disease management. Participants will consist of patients receiving care at primary healthcare facilities and respiratory hospital departments in Crete, Greece. The intervention will involve providing structured information on social, financial, and psychological support services, along with psychosocial counseling over a six-month period. The impact of the intervention will be measured using validated tools to assess health status, quality of life, treatment adherence, mental health, and socioeconomic status before and after the intervention. Conversely, qualitative interviews will be conducted to gain deeper insights into the impact of the intervention. Finally, when the analyses of both data types are finalized, they will be triangulated to achieve convergence. This procedure entails the creation of a figure or illustration that demonstrates the convergence or divergence of both data types. Conclusions: The findings of this study are expected to highlight the importance of integrating an individualized informational intervention into the management of COPD. Thus, this study could guide healthcare professionals and policymakers in improving COPD care and patient outcomes. Full article

Background/Objectives: Patients requiring haemodialysis often perceive the cost of their travels to the dialysis centres as a significant burden. The study aimed to collect a first Swiss national data set on transport costs and assess their impact on patients and their relatives. Methods: In addition to interviews with patients, a quantitative survey was developed and distributed online using a voluntary sampling strategy. Data were analysed by means of descriptive statistics. A Sounding Board of patients, relatives, and healthcare professionals accompanied all steps of the project. Results: A total of 6 dialysis patients were interviewed; 437 respondents of the national survey met the inclusion criteria. Patients travel a median distance of 7.5 km to their dialysis centres. For 78% of them, the journey takes up to 30 min, and nearly half use their private car as their main mode of transport. The median annual transport costs are CHF 2925 (mean = CHF 5041). Approximately half of the patients perceive transport costs as a burden or limitation, yet only about 30% receive financial support, for which there is no standard process. Patients requiring financial support reported difficulties navigating the system. Conclusions: This study highlighted that many dialysis patients are burdened by transport costs and receive limited financial support and counselling services. Implementation of a standardised process for financial support should be explored. Full article

Background/Objectives: This study investigates the challenges faced by family caregivers of individuals with dementia in Japan, particularly in the context of the COVID-19 pandemic. Methods: We conducted a cross-sectional survey of 500 family caregivers of patients with dementia. Results: 56.4% of caregivers reported an increased caregiving burden, primarily due to extended caregiving hours, reduced access to public services, and restrictions on social interactions. This study found a strong preference for formal support, with 75.4% of caregivers desiring access to more comprehensive services. However, 19.4% of dementia patients were not utilizing any public services, largely due to a mismatch between available services and caregivers’ actual needs, as well as societal resistance to inviting formal support into the home. Informal support systems, such as dementia family groups and cafes, were well-known, but participation rates remained low (5.4% and 5.8%, respectively), despite the potential benefits for reducing stress and providing emotional support. Key barriers included privacy concerns, reluctance to engage, and logistical challenges such as inconvenient access and time constraints. Conclusions: To mitigate the above challenges, this study recommends expanding telemedicine and remote support services, improving awareness of available resources, and offering flexible, tailored solutions to meet diverse caregiving needs. Additionally, increasing financial support, enhancing public recognition of caregiver roles, and providing psychological counseling and stress management programs are essential to alleviating both the emotional and economic burdens placed on family caregivers during the pandemic. Full article

Background/Objectives: Non-obstructive azoospermia (NOA) is a severe form of male infertility characterized by the absence of sperm in the ejaculate due to impaired spermatogenesis. Testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection is the primary treatment, but success rates are unpredictable, causing significant emotional and financial burdens. Traditional clinical and hormonal predictors have shown inconsistent reliability. This review aims to evaluate current and emerging non-invasive preoperative predictors of successful sperm retrieval in men with NOA, highlighting promising biomarkers and their potential clinical applications. Methods: A comprehensive literature review was conducted, examining studies on clinical and hormonal factors, imaging techniques, molecular biology biomarkers, and genetic testing related to TESE outcomes in NOA patients. The potential role of artificial intelligence and machine learning in enhancing predictive models was also explored. Results: Traditional predictors such as patient age, body mass index, infertility duration, testicular volume, and serum hormone levels (follicle-stimulating hormone, luteinizing hormone, inhibin B) have limited predictive value for TESE success. Emerging non-invasive biomarkers—including anti-Müllerian hormone levels, inhibin B to anti-Müllerian hormone ratio, specific microRNAs, long non-coding RNAs, circular RNAs, and germ-cell-specific proteins like TEX101—show promise in predicting successful sperm retrieval. Advanced imaging techniques like high-frequency ultrasound and functional magnetic resonance imaging offer potential but require further validation. Integrating molecular biomarkers with artificial intelligence and machine learning algorithms may enhance predictive accuracy. Conclusions: Predicting TESE outcomes in men with NOA remains challenging using conventional clinical and hormonal parameters. Emerging non-invasive biomarkers offer significant potential to improve predictive models but require validation through large-scale studies. Incorporating artificial intelligence and machine learning could further refine predictive accuracy, aiding clinical decision-making and improving patient counseling and treatment strategies in NOA. Full article

Background: Kidney stone disease (KSD) is characterized by an increasing prevalence worldwide, representing an important clinical issue and a financial burden for healthcare systems. A KSD-causing monogenic variant is traditionally expected in up to 30% of children and 1–5% of adults forming stones, confirmed by a strong connection between a positive family history and KSD. The insufficient use of genetic testing in these patients is associated with a lack of perceived benefit and a scarce awareness of inherited kidney diseases. Genetic testing has important practical implications, such as the possibility of earlier diagnoses, familial counseling, and tailored therapy, based on the evaluation of fine-mapped pathogenic variants. Our aim is to analyze the current evidence on genetic testing in KSD patients to whom genetic tests were applied without strict a priori selection criteria, to provide an overview of its diagnostic yield and factors potentially affecting it (such as the age of KSD onset, a familial history of KSD, consanguinity, and extrarenal features). Methods: A literature review was performed, selecting original articles published in the last 10 years concerning genetic investigations in patients affected by nephrolithiasis or nephrocalcinosis. Available data were subsequently extracted and analyzed. Results: In total, 13 studies on 1675 patients (77% pediatric populations) were included; 333 patients were determined to be affected by a monogenic disorder, with an overall yield of about 20%. The likelihood of a positive genetic finding was much higher in pediatric (26%) than adult populations (8%). Cystinuria was the most common diagnosis in both populations. After the removal of conditions that could be identified with a stone composition analysis or urinary chemistry investigation, the diagnostic yield dropped to 19% among pediatric patients and below 5% for adults. Conclusions: Genetic testing should be considered in KSD pediatric patients and in selected subgroups of adults with suggestive features when a diagnosis is not established after stone examination and blood as well as urine metabolic profiling. Full article

Background: Insulin resistance, a key factor in developing type 2 diabetes mellitus, is linked to various health conditions. The basis of its treatment is lifestyle modification. However, adherence to nutritional and other medical recommendations can be challenging for chronic disease patients due to many factors, including demographics, social context, gender, age, and the patient’s baseline health condition. This study aims to evaluate the impact of online support group members on the diet quality of women with insulin resistance. Methods: This study was conducted as an online survey consisting of KomPAN (validated food frequency questionnaire) augmented with questions regarding using professional counseling and membership in support groups. The study covered 1565 women with insulin resistance, 1011 of whom were associated with the online support group. Results: The mean pHDI (pro-health diet index) was 5.18 ± 2.69 in the support groups and 4.86 ± 2.69 in the control group (p = 0.0319. There were no significant differences in the nHDI (non-health diet index). We found that the pHDI is associated with financial situations, the household’s situation, occupation education level, and medical or dietitian care, whereas occupation, medical, and dietitian care affect the nHDI. Membership in support groups is related to a higher pHDI and state of self-assessment of nutritional knowledge. Conclusions: Our study indicates a relationship between participation in online support groups and dietary behaviors and the subjective assessment of nutrition knowledge. Future research should focus on elucidating the mechanisms behind these influences and exploring how these communities can be optimized for broader public health initiatives. Full article

Understanding the frequency of abuse suffered by older individuals proves challenging when attempting to link it to everyday social issues due to variations in the interpretation and comprehension of this form of mistreatment. This cross-sectional study conducted in May and June of 2023 aimed to investigate the perceptions and attitudes of the general population in the Republic of Croatia regarding the abuse of older individuals. The research included 822 volunteers aged from 18 to 64 who actively engaged in social media. A self-developed, structured questionnaire (based on an exhaustive review of the relevant literature) that underwent a thorough pilot testing phase to confirm clarity, coherence, and respondent comprehension was used to collect the study data. The data analysis included descriptive statistics, chi-square tests for associations between variables, and Mann–Whitney U and Kruskal–Wallis tests to assess the relationships between correct answers and observed indicators, with a significance level set at p < 0.05 (two-tailed). It can be concluded that there was a statistically significant difference in knowledge of possible causes of abuse depending on the age groups of the respondents (p = 0.001) and their present employment within the health or social system (p < 0.001). A prevailing neutral stance was observed among the majority of the surveyed population regarding the attribution of responsibility to older individuals themselves for any mistreatment they face. When confronted with scenarios illustrating abusive behaviour towards older individuals, the participants exhibited nuanced recognition across different forms of abuse, with the exception of financial abuse, where most participants indicated that there was no abuse or possible abuse. These findings underscore the need for enhanced public education initiatives concerning the diverse manifestations of abuse and neglect within the community of older individuals in the Republic of Croatia. Additionally, there is a pressing need for counselling services aimed at fostering a deeper understanding of the unique needs of older individuals and the underlying factors contributing to abusive behaviour. Through such measures, societal awareness and support mechanisms can be fortified, fostering a culture of respect, empathy, and protection for older adults. Full article