Search Results (232)

Background/Objectives: A multivariable prediction model was developed and externally validated to estimate an individual’s current need to visit a dentist among young to middle-aged adults. The objective was to provide an accessible, non-invasive screening tool for independent home self-assessment or integration within routine healthcare workflows. Methods: A cross-sectional study utilised data from two National Health and Nutrition Examination Survey (NHANES) cycles (2011–2014). Logistic regression was applied to develop the prediction model among 1870 dentate adults aged 30–50, a critical onset period for oral diseases. The primary outcome was derived from objective oral examinations conducted by licensed dentists. The resulting questionnaire-based tool provides two recommendations: a visit to a dentist or continuation of routine oral care. Results: External validation using the independent NHANES 2013–2014 cohort (n = 2024) demonstrated robust and clinically relevant predictive capacity, with an AUC of 0.822 (95% CI 0.803–0.842). The model exhibited acceptable calibration (slope 0.85; intercept 0.04) and stable operation. Decision-curve analysis showed net benefit across thresholds; at Pt = 0.33, 14/100 unnecessary screenings were avoided compared with treat-all. Internal validation using a 10% hold-out partition (n = 184) supported these findings, indicating similarly strong discrimination (AUC 0.817, 95% CI 0.751–0.884). Conclusions: Early midlife is a consistent and informative period for oral health intervention. A scalable 14-predictor architecture using accessible indicators established high clinical utility, supporting integration into digital health and primary care. This approach enables efficient population-level prevention. Large-scale, nationally representative NHANES data allowed for the investigation of less-studied factors, including intermittent smoking, metabolic dysregulation, and elevated cholesterol levels. Full article

Acute aortic syndrome (AAS) comprises acute aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer, and limited intimal tear, conditions that require rapid recognition because mortality and resource use are strongly influenced by time to diagnosis, anatomical extent, malperfusion, and the need for emergency surgical or endovascular intervention. This revised narrative review synthesizes contemporary evidence on clinical, genetic, environmental, and health-system determinants of prolonged hospitalisation, intensive care unit (ICU) utilisation, bed occupancy, and costs in patients with AAS. Beyond summarising established risk factors, the review adds a resource-oriented framework that links hypertension, advanced age, female sex, smoking-related comorbidity, hereditary aortopathies, haemodynamic instability, malperfusion, delayed diagnosis, operative complexity, and postoperative complications to measurable downstream outcomes such as ICU length of stay, total hospital length of stay, reoperation, readmission, and longitudinal imaging surveillance. We searched PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for relevant studies, registries, guideline documents, and cost analyses published between January 2000 and May 2026, with particular emphasis on studies from the last five years. The review was not designed as a meta-analysis; therefore, effect estimates are interpreted according to study design and generalisability. AAS imposes a disproportionate burden on hospital systems because high-risk patients often require advanced imaging, prolonged haemodynamic monitoring, complex open or endovascular repair, ICU care, and lifelong follow-up. Earlier diagnosis, structured risk stratification, targeted genetic evaluation, aggressive control of modifiable risk factors, and system-level pathways such as dedicated aortic networks may shorten hospital stay and reduce avoidable costs. Full article

Background: Maternal postpartum hospital readmissions represent profound implications for maternal health outcomes and potential gaps in quality of maternal care. Objective: This study aims to synthesise evidence on risk factors for maternal postpartum hospital readmissions within 42 days of discharge following birth hospitalisation. Methods: An electronic database search utilised CINAHL, EMBASE (Ovid), and MEDLINE for relevant studies published from 1 January 2010 to 30 June 2024. The studies that investigated the prevalence and risk factors for 42-day postpartum maternal readmission and reported risk estimates, published in English, were included. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) for case-control studies and cohort studies. The PRISMA guidelines were followed in reporting this review. The review protocol was registered on PROSPERO (CRD42023442269). Results: A total of 7758 articles were retrieved, ultimately including 60 studies. The rate of maternal postpartum readmissions varied from 0.1236‰ to 26%. Significant risk factors were extracted and categorised into five groups: maternal demographic and socio-economic factors; behavioural and lifestyle factors; health institution structural factors; obstetric and delivery characteristics; as well as maternal morbidity The most frequently cited risk factors which contributed to maternal postpartum hospital readmissions were age, race/ethnicity, substance use, caesarean delivery, length of maternal hospital stay, premature birth, and all maternal morbidities, especially mental health disorders, severe maternal morbidity, and hypertensive disorders of pregnancy. Conclusions: This systematic review identified complex and diverse risk factors associated with maternal postpartum hospital readmissions within 42 days after discharge following birth hospitalisation. This helps our understanding of the risk factors and the strength of association with maternal postpartum hospital readmissions. Future research should develop a multidimensional risk assessment framework to guide clinical practice in adopting holistic individualised approaches for postpartum risk evaluation, thereby reducing readmission rates and improving maternal health outcomes. Full article

Background/Objectives: Alcohol-related frequent attenders (ARFAs) constitute a small but resource-intensive emergency department (ED) population. Methods: Following PRISMA-ScR guidelines, we searched MEDLINE, PsycINFO, CINAHL Complete, and EMBASE from inception to May 2025 for empirical studies examining ED frequent attendance with alcohol involvement. Definitions had high heterogeneity; therefore, narrative synthesis was conducted. Results: A total of 73 studies were included, most retrospective (57.5%), encompassing sample sizes from 14 to over 4.1 million participants: 59 frequent attender (FA) studies with alcohol subgroup analyses and 14 pure ARFA studies. Research was concentrated in North America and Europe (56/73, 76.7%), with limited Asia-Pacific representation (21.9%). Seven distinct definition threshold categories were identified (≥2 to ≥20 visits annually); 31.5% utilised different definitions. Qualitative studies (n = 6) identified push factors (dependence, mental health crises, housing instability, fragmented services) and pull factors (24/7 access, crisis care model, immediate service) driving frequent attendance. Eight studies evaluated interventions; all employed non-randomised designs examining case management, integrated pathways, and community-based treatments. Conclusions: Critical gaps include the absence of standardised definitions for comparison across studies, a concentration of research in Western settings limiting global applicability, and insufficient rigorous intervention evidence. Priorities include developing empirically validated definitions, expanding non-Western research, and conducting randomised controlled trials with adequate follow-up. Full article

Background: Hypotonic–hyporesponsive episode (HHE) is a recognised adverse event following immunisation (AEFI) in infants, characterised by sudden hypotonia, hyporesponsiveness, and pallor or cyanosis. Although considered benign, its abrupt and often dramatic presentation often leads to acute medical evaluation. Contemporary data on HHE are limited, and awareness among healthcare professionals needs attention. Methods: We conducted a retrospective analysis of all spontaneous reports of HHE submitted to the national pharmacovigilance centre Lareb between 1 January 2012 and 22 July 2025. Cases were included only when meeting Brighton Collaboration (BC) Level 1 criteria, requiring clear documentation of hypotonia, hyporesponsiveness, and pallor or cyanosis in children younger than 24 months. Demographic and clinical characteristics, vaccine combinations, latency, duration, seriousness, and medical care utilisation were described. Results: A total of 294 Level 1 HHE cases were identified. Most episodes followed combinations of hexavalent vaccines with pneumococcal conjugate vaccines. The median age at onset was 9 weeks, with slightly more reports involving boys. The median latency to onset was 5 h (range 4–8 h), and the median episode duration was 10 min (range 3–30 min), aligning with the historical literature. All children recovered fully, and no long-term sequelae were reported. Although HHE is clinically benign, 27% of cases were classified as serious, primarily due to hospital admission. Among non-serious cases, one third involved medical assessment or emergency services. Healthcare professionals submitted 44% of reports, notably community child health physicians. Conclusions: Contemporary Dutch pharmacovigilance data confirm that the clinical characteristics of HHE remain highly consistent with long-standig evidence. Despite its benign and self-limiting nature, HHE frequently triggers substantial medical care consumption. Improved awareness of the typical presentation, course, and prognosis, supported by the Brighton Collaboration criteria, may help clinicians recognise HHE more readily, reduce unnecessary medical consumption, and provide reassurance to caregivers. Full article

Intimate partner violence (IPV) affects individuals of all genders and can result in adverse physical, psychological, and social outcomes. Experiences of IPV in men remain understudied when compared with those of cisgender women, leading to considerable gaps in understanding of prevalence, experiences, disclosure, and outcomes. The Male Experiences of Intimate Partner Violence Study (ME-IPV Study) was designed to explore: nature of IPV experiences, physical and psychological impacts, barriers to reporting/disclosing, experiences of disclosure, experiences of support, and support needs in a Northern Ireland (NI) context. This mixed-method study utilised data from N = 10 qualitative interview participants (quantitative results reported separately), analysed using an Interpretative Phenomenological Analysis (IPA) framework. Participants described experiencing multiple forms of IPV, with coercive control, psychological and institutional abuse being highly prevalent. Detrimental effects of their experiences included diagnoses of anxiety, depression, and PTSD, physical symptomology, the advent/exacerbation of multiple health conditions, and suicidal ideation. Barriers to care were primarily a lack of dedicated care pathway, concerns over being believed, and stigmatic barriers. Experiences of disclosure were mixed: positive with family/friends and negative with police and institutions of state. Male experiences of IPV in NI are a significant public health issue and it is evident that the impacts of IPV on men’s physical/mental health and wellbeing are profound. Full article

Background/Objectives: One contemporary problem in health economics is the measurement and interpretation of socioeconomic inequalities in outcomes, utilisation, and resource distribution. This article aims to estimate socioeconomic inequality in the regional allocation of health resources in Bulgaria during 2019–2023. Methods: A year-by-year database was created. It includes regions (n = 28), population, GDP per capita, and the numbers of practicing physicians, dentists, nurses, midwives, hospital beds, and outpatient facilities. Income inequality is analysed using decile ratios, the Gini coefficient, the Generalised Entropy index, and the Atkinson index. Socioeconomic health inequality is quantified using the concentration index (CI) and the coefficient of variation (CV) of the absolute number and of resource density (per 1000 inhabitants). The socio-economic variable is a regional gross domestic product (GDP) per capita fractional rank and a frequency-weight approach to account for population size is used. The analysis is extended with the relative and slope indices of inequality. The CI of hospital beds, practicing physicians, and nurses is decomposed using the age dependency ratio and the number of hospitalisations by districts. Results: The Gini index levels remain stable, with no significant fluctuations, in the narrow range of 29.6–29.7. The highest inequality of the absolute resource’s quantity is among midwives (Mean CI = 0.498, CV = 0.018), and the lowest among nurses (Mean CI = 0.442, CV = 0.024). For material resources, a greater concentration of outpatient organisations in richer areas is observed (Mean CI = 0.481, CV = 0.035) than for hospital beds (Mean CI = 0.427, CV = 0.034). The dynamics and descriptives of inequality of resources’ density follow the same pattern, but with lower average rates, ranging from 0.045 to 0.112. The obtained estimates are statistically significant (p < 0.05). The analysis of the regression-based measures confirms, without any doubt, both the magnitude and the direction of the development of inequalities in the territorial distribution of health resources. Conclusions: Inequality measures vary by resource group. Significant inequality exists in the distribution of health resources between poorer and richer regions, particularly in material resources, in the outpatient sector. For most resource groups, a very slight decrease in inequality is observed midway through the analysed period. The most significant part of this inequality can be explained by differences in hospital care and income across richer and poorer regions. Full article

Background and Objectives: The COVID-19 pandemic was associated with major disruptions, not only at the environmental, social, and economic levels but also in the public health systems and, therefore, emergency care utilisation. Prior to the pandemic, one of the most significant issues in the ED was overcrowding, with a consequent percentage of people leaving the ED without being seen (LWBS). The aim of this study was to assess the association between the 2020 COVID-19 pandemic and the number of LWBS, compared with the rates recorded during the same period in 2019 and 2021. Materials and Methods: A retrospective comparative observational study of ED admissions was conducted in two university hospitals in Ancona (Italy) between 9 March and 3 May 2020 and in Gran Canaria (Spain) between 14 March and 10 May 2020, corresponding to the lockdown in the two countries, respectively. ED visits were assessed during the defined periods, separately for the Italian and Spanish contexts and between groups, comparing the two contexts for each year. Results: In Italy, during the 2019 timeframe, 597 (7.0%) of 8568 patients who arrived in the ED left before being seen; during the same period in 2020, 100 (3.2%) of 3100; and in 2021, 334 (6.0%) of 5555. In Spain, patients leaving the ED prior to medical consult in 2019 were 567 (4.0%) out of 14,034 visits; in 2020, they amounted to 185 (2.6%) out of 7208; and in 2021, they were 528 (4.0%) out of 13,214. The results of the logistic regression analysis for Italy and Spain showed that male sex [odds ratio (OR), 95% confidence interval (CI): 1.38 (1.24–1.53)], age group between 17 and 43 years compared to those subjects older than 74 years old [OR (95%CI): 4.04 (3.34–4.88)] and a lower priority code at triage were significantly associated with a higher odds of LWBS. Conclusions: The findings suggest that the COVID-19 pandemic was associated with changes in only some characteristics of the profiles and types of patients leaving the ED, while it had a strong impact on the number of patients who left the ED before medical examination. The observed decrease in ED visits and LWBS rates in 2020 suggests that the COVID-19 pandemic has changed the population’s use of the ED, highlighting the potential need for improved public and professional awareness of appropriate care pathways and the role of health professionals in them. Full article

Bovine Viral Diarrhoea (BVD) is an infectious disease caused by the Bovine Viral Diarrhoea Virus (BVDV), a member of the genus Orthopestivirus. The disease remains endemic across Australian beef and dairy production systems, imposing a multi-million-dollar annual burden on animal health, welfare, and industry sustainability. BVDV can be transmitted both horizontally and vertically, with persistently infected (PI) animals serving as the primary source of infection. Rapid identification and subsequent culling of PI animals are fundamental requirements for any successful eradication program. Currently, Australia’s decentralised, non-compulsory approach places the responsibility of biosecurity on individual producers, resulting in a fragmented national landscape. This review proposes that the strategic deployment of rapid, field-deployable point-of-care (POC) diagnostics serves as the transformative catalyst needed for a coordinated national eradication pathway. POC approaches utilising technologies such as lateral flow assays, nucleic acid amplification tests, and biosensors enable real-time, crush-side diagnosis and high-throughput surveillance, proving effective for early detection and control of infectious diseases. When integrated with robust biosecurity measures and optimised vaccination strategies, these POC advancements offer a scientifically sound and commercially viable pathway toward the systematic eradication of BVDV in the Australian cattle industry. Full article

Background: Patients described as high-need, high-cost (HNHC) represent a subset of individuals with complex multimorbidity whose healthcare trajectories are characterised by recurrent instability and intensive use of acute care services. Concepts such as trajectory disruption, resilience, and complex adaptive behaviour are widely discussed in health systems research, yet linking these ideas to longitudinal patient care remains limited. The PaJR (Patient Journey Record) relational system was designed using principles from complex adaptive systems theory, enabling longitudinal observation of patient trajectories in real-world care. Objective: This study develops a middle-range theory grounded in longitudinal relational monitoring data. Methods: Two datasets (MonashWatch and Irish cohorts) provide empirical grounding through descriptive analysis of signal clustering, distribution, and multi-domain patterns. Monitoring calls capture structured patient-reported signals across multiple domains, including illness, medication, healthcare utilisation, social support, environmental factors, and self-care. Results: Results demonstrate long-tail signal distributions, temporal clustering, and multi-domain instability preceding admission. Alerts frequently occurred in clusters across consecutive monitoring calls 88% of alert calls were part of a consecutive alert sequence, with approximately 64% of alert calls occurring immediately after a previous alert. Alerts were also commonly multi-domain, with approximately 64% involving disturbances across more than one domain simultaneously. Conclusions: Longitudinal relational monitoring reveals instability patterns in patient journeys that are not visible in episodic health-system data. Recognising these instability phases may enable earlier, more adaptive responses for patients with complex healthcare needs and provides empirical grounding for emerging theories of healthcare trajectories within complex adaptive systems. Although grounded in relational monitoring data, the instability–plasticity framework may extend to inform interpretation across physiological and connected health monitoring systems. Full article

Chronic obstructive pulmonary disease (COPD) imposes a substantial physical and psychosocial burden, yet the role of loneliness remains under-recognised in clinical practice. Loneliness, defined as a subjective discrepancy between desired and actual social relationships, has emerged as a clinically relevant determinant of patient outcomes. This narrative review synthesises current evidence on the epidemiology, mechanisms, and clinical consequences of loneliness in COPD, and evaluates its implications for disease management. Available evidence indicates that loneliness affects a considerable proportion of individuals with COPD, with prevalence estimates ranging from approximately 18% to over 30%, particularly among patients with greater symptom burden, functional limitation, and oxygen dependence. Dyspnoea and advancing disease severity reduce social participation and increase vulnerability to perceived social disconnection. Loneliness influences COPD outcomes through interconnected behavioural, biological, and healthcare engagement pathways, including systemic inflammation, neuroendocrine stress responses, physical inactivity, impaired self-management, and reduced engagement with healthcare services. These mechanisms contribute to poorer clinical trajectories, as loneliness is consistently associated with reduced health-related quality of life, increased exacerbations, higher healthcare utilisation, greater risk of hospitalisation, and elevated mortality, independent of depression and anxiety. Despite this, loneliness is rarely assessed in routine respiratory care, and targeted interventions remain limited. Emerging strategies, including pulmonary rehabilitation, peer support, and digital health interventions, show promise in reducing loneliness and improving outcomes. Loneliness represents a modifiable and clinically actionable risk factor in COPD, and its integration into routine assessment and management may enhance patient engagement, optimise treatment effectiveness, and reduce healthcare burden. Addressing loneliness represents a critical opportunity to advance more effective and comprehensive COPD care. Full article

Individuals with cystic fibrosis (CF) face significant treatment burdens, and as life expectancy has increased, there is growing emphasis on their psychosocial well-being. Prevalence data indicate that approximately one-quarter to one-third of individuals with CF and their caregivers experience clinically significant anxiety or depression. Specifically, pooled global estimates report an anxiety prevalence of 24.9% (95% CI: 20.8–28.9%) and depression prevalence of 13–33% in adults with CF, with caregivers experiencing even higher rates (anxiety: 35–38%; depression: 20–35%). Depression is independently associated with a nearly twofold increase in mortality risk and substantially higher healthcare costs, underscoring its prognostic significance. These mental health comorbidities are consistently associated with reduced treatment adherence, diminished quality of life, increased healthcare utilisation, and decreased survival. Accordingly, psychological well-being has emerged as a key patient outcome that directly shapes engagement with care and the effectiveness of long-term CF management. International CF guidelines now recommend routine mental health screening within multidisciplinary care frameworks. Evidence-based interventions include cognitive–behavioural therapy (CBT), which is endorsed as a primary treatment, although access remains limited, and stepped-care pharmacotherapy, primarily selective serotonin reuptake inhibitors (SSRIs), for moderate to severe symptoms. Telemedicine and other digital health approaches have expanded access to psychological support, with remote CBT and online programmes demonstrating feasibility and symptom improvement during the COVID-19 pandemic and beyond. The advent of CFTR modulator therapies has significantly altered clinical outcomes, enabling many patients to achieve improved lung function and daily functioning. Nevertheless, mental health challenges persist, as individuals navigate new identity shifts and anxieties despite enhanced physical health. The implementation of mental healthcare remains inconsistent; while screening rates have increased, timely follow-up and integrated psychosocial support are frequently insufficient across care centres. This narrative review highlights the ongoing need to integrate mental health management into CF care to optimise adherence, patient outcomes, and long-term survival in the current therapeutic landscape. Full article

Background/Objectives: Multiple impacted teeth are defined as the sequential impaction of more than two teeth in the alveolar bone, whether unilateral or multilateral. Multiple impactions are an uncommon and rare phenomenon demanding thorough treatment planning and careful execution, but data on the prevalence of multiple impactions is scarce in the literature. In cases of multiple impactions, clinicians generally perform a 3D assessment using CBCT to determine tooth positions, establish a sequence of surgical exposures, implement suitable traction, and utilise appropriate biomechanics. A multidisciplinary approach between orthodontists and oral surgeons is essential to achieve optimal results. Methods: This case report presents non-syndromic multiple impactions of three upper left permanent anterior teeth—21, 22, and 23—along with a retained supernumerary tooth preventing their eruption and a fused primary tooth. The primary teeth and the impacted supernumerary tooth were surgically removed. A digitally designed transpalatal arch was used to preserve the space and to act as anchorage for the orthodontic traction. After an 8-month observational period without spontaneous eruption, surgical exposure was carried out using the closed exposure technique. Subsequently, elastic traction was performed, guiding the impacted teeth into the dental arch. Results: The multiple impacted teeth were successfully aligned in the dental arch, achieving symmetry in the frontal segment while preserving periodontal health. In order to ensure stability during the retention period, thermoformed retainers were used. Conclusions: Each complex and rare clinical case poses a challenge to orthodontists and is important for the scientific literature as it provides valuable clinical experience. Full article

Background/Objectives: The digital transformation of healthcare has become a key component of building resilient and sustainable health systems. However, the long-term sustainability of digital health technologies depends not only on user acceptance but also on the institutional governance conditions that shape how these technologies are implemented and utilised in practice. This study examines how institutional factors shape the sustainable utilisation patterns of Internet of Things (IoT) technologies in regulated healthcare environments, with hospital IoT-based asset management systems, a mature and widely deployed use case in China’s public hospitals, providing the empirical context for the investigation. Methods: Drawing on institutional theory and the Technology Acceptance Model (TAM), we conceptualise user perceptions as behavioural micro-foundations through which institutional conditions influence technology utilisation. A survey of 293 healthcare professionals from two large public hospitals in China was analysed using Structural Equation Modelling (SEM), incorporating mediation and Multi-Group Analysis (MGA). Results: The results demonstrate that technical compatibility (TC) significantly enhances perceived ease of use (PEU) (β = 0.40), while organisational support (OS) positively influences both perceived usefulness (PU) (β = 0.35) and PEU (β = 0.30). Conversely, regulatory compliance (RC) negatively affects PU (β = −0.25) and PEU (β = −0.20), revealing a tension between accountability requirements and operational efficiency. The model explains between 58% and 67% of the variance in key constructs. Conclusions: Overall, the findings indicate that sustainable utilisation patterns depend on alignment between technological capabilities and institutional governance conditions, with user perceptions operating as behavioural micro-foundations through which institutional effects are transmitted. By integrating institutional theory with technology acceptance research, this study contributes a governance perspective for understanding sustainable digital transformation in healthcare systems and provides practical insights for designing interoperable, compliant, and supportive digital health infrastructures to enhance hospital operational efficiency and quality of care. Full article

Background: Lay counsellor-delivered psychosocial interventions are increasingly used to address workforce shortages in mental health care. While randomised trials commonly report mean improvements, explicit assessment of clinical deterioration is rare. This secondary analysis evaluated whether a lay counsellor intervention for early psychosis was associated with evidence of deterioration compared with usual care. Methods: Patient-level data from a randomised controlled trial in Thailand (n = 255) were analysed. Deterioration was defined as worsening between baseline and the 6-month follow-up across functional, behavioural, and service utilisation domains. Risk differences were estimated using Newcombe confidence intervals, and risk ratios were calculated using standard methods with the Haldane–Anscombe correction applied, where required. Analyses were conducted for the full sample (UC n = 125; LICM n = 130) and stratified by baseline severity (none/borderline: UC n = 103, LICM n = 103; mild-to-severe: UC n = 22, LICM n = 27). Results: In the full sample, deterioration rates were similar across most domains. A statistically significant reduction in deterioration related to disturbing or aggressive behaviour was observed in the LICM arm (risk difference −14.1%; 95% CI −26.8% to −0.6%; risk ratio 0.45; 95% CI 0.26 to 0.79). No statistically significant excess deterioration was observed in other domains. In severity-stratified analyses, no subgroup showed a statistically significant increase in deterioration attributable to the intervention. However, among participants with mild-to-severe baseline illness, although no statistically significant harm signal was detected, the adverse risk differences and risk ratios observed in socially useful activities, self-care, regular outpatient follow-up visits, and medication adherence among participants with greater baseline severity underscore the importance of careful monitoring in higher-risk subgroups. Conclusions: No statistically significant evidence of excess deterioration was observed in either the full sample or subgroup analyses between the intervention and control arms. However, the adverse absolute difference observed in multiple patient-related domains, among participants with mild-to-severe baseline illness, suggests that lay-counsellor interventions may require a stepped-care approach to safely address the mental health needs of patients with higher levels of severity. Psychosocial trials should routinely report deterioration and subgroup analyses alongside mean improvements. Full article