Search Results (1,470)

While there is extensive literature on the strengths of different supervisory models, we have limited understanding of how the relational capacity of front-line staff may impact how they receive and seek feedback from their supervisor. This study examines how mental health providers’ and front-line staff’s own rejection sensitivity may be associated with the supervisory relationship and the ways in which job feedback is sought and received in community-based mental health settings. Cross-sectional survey data were collected from 156 front-line staff of three mental health agencies. Staff were administered an original survey using validated measures related to supervision, feedback, and relational capacities. We found staff with a higher rejection sensitivity (RS) were less likely to actively seek feedback about their performance; and, when feedback was received, were more likely to rate its quality as poor. Staff with a higher RS were more likely to perceive their supervisor and their relationship negatively. This is the first study to examine whether workers’ relational capacities, as expressed through a higher RS, influence their perceptions of supervision and quality of feedback and their feedback-seeking behaviors. These findings build theory related to the important role that staff relational capacities play in influencing organizational dynamics and support. Full article

Biocontainment laboratories often have limited access to a range of instruments required for conducting standard assays on infected materials. Consequently, some of the protocols involving infected samples are conducted outside a biocontainment facility. To be compliant with regulatory requirements and minimize health and safety risks for scientific personnel, it is imperative to test procedures rigorously for safely removing infected samples from biocontainment areas. This study validated the chemical inactivation of Nipah virus (NiV), a representative member of the Henipavirus genus, in animal tissues and serum. Importantly, this work demonstrated successful NiV-spiking of non-human primate (NHP) tissues and their subsequent inactivation. This is important because NHP tissues contain unpredictable amounts of infectious virus. The primary objective was to establish standardized protocols that are compliant with regulations to permit safe retrieval of infected biological samples with high NiV infectious virus content from ABSL-4 laboratories for subsequent downstream processing under lower biocontainment conditions. Full article

Repeated exposure to low-level blast overpressure (BOP) during controlled detonations is an emerging occupational health concern for military breachers and Special Operations Forces personnel, given accumulating evidence that chronic exposure may produce subtle, subclinical neurotrauma. This study derived a latent neuroinjury construct integrating three complementary domains of brain health—post-concussive symptoms, working-memory performance, and circulating biomarkers—to determine whether breachers exhibit coherent patterns of neurobiological alteration. Symptom severity was assessed using the Rivermead Post-Concussion Questionnaire (RPQ), and working memory was assessed with the N-Back task and a panel of thirteen neuroproteomic biomarkers was measured reflecting astroglial activation, neuronal and axonal injury, oxidative stress, inflammatory signaling, and neurotrophic regulation. Experienced Canadian Armed Forces breachers with extensive occupational BOP exposure were compared with unexposed controls. Bayesian latent-variable modeling provided probabilistic evidence for a chronic, subclinical neurobiological signal, with the strongest contributions arising from self-reported symptoms and smaller but consistent contributions from the biomarker domain. Working-memory performance did not load substantively on the latent factor. Several RPQ items and circulating biomarkers showed robust loadings, and the latent neuroinjury factor was elevated in breachers relative to controls (97% posterior probability). The pattern is broadly consistent with subclinical neurobiological stress in the absence of measurable cognitive impairment, suggesting early or compensated physiological alterations rather than overt dysfunction. This multidomain, biomarker-informed framework provides a mechanistically grounded and scalable approach for identifying subtle neurobiological strain in military personnel routinely exposed to repetitive low-level blast. It may offer value for risk stratification, operational health surveillance, and the longitudinal monitoring of neurobiological change in high-risk occupations. Full article

Objectives: Intensive care units (ICUs) are characterised by high care complexity and nursing workload, which directly affects patient safety and staff sustainability. Latvia faces a chronic shortage of nurses, particularly in intensive care, yet systematic national data on nursing workload have been lacking. This study aimed to quantitatively assess nursing workload in Latvian ICUs using the Nursing Activities Score (NAS) and to evaluate its relationship with staffing adequacy. Methods: A prospective, multicentre observational study was conducted over six months (May–November 2025) in 14 Latvian ICUs representing all three levels of intensive care. Nursing workload was measured using the NAS during each 12 h shift. A total of 28,079 complete NAS observations were analysed using descriptive statistics, inferential tests (t-tests, ANOVA), mixed-effects modelling, regression analysis, and time-series forecasting. Results: The mean NAS was 65.45 (SD = 25.76), equivalent to an average of 15.71 nursing care hours per patient per day. Workload remained similarly high during day and night shifts. Significant differences were observed between ICUs and care levels, with level 2 units showing the highest workload. The average nursing shortage rate was 42.6% and was strongly predicted by NAS values (R² = 0.115), whereas shift type and unit level had minimal explanatory power. Conclusions: ICU nursing workload in Latvia is persistently high and unevenly distributed across units. Staffing levels are not adequately adjusted to actual care demands. Integrating NAS-based workload monitoring into staffing models is essential for evidence-based workforce planning, improving patient safety, and reducing nurse overburdening. Full article

Background/Objectives: Personal values shape appraisal of stress and life satisfaction. We examined the relationship between perceived stress and life satisfaction among uniformed personnel in outpatient mental health care, and the role of a personal values hierarchy in this context. Methods: Cross-sectional study of 183 uniformed personnel (34 females, 149 males, age 30–66 years, M = 44.72, SD = 5.84) diagnosed with bodily distress disorder or post-traumatic stress disorder at a mental health clinic. Participants completed standardized questionnaires assessing perceived stress, satisfaction with life, coping styles, and personal values. For the Personal Value List, each value not selected by a participant was coded as 0 to avoid missing data; scores regarding symbols of happiness were not used. Reliability was evaluated via repeated measurement; two parts of a key instrument showed test–retest correlations of approximately 0.78 and 0.76. For assessing statistical significance, the bootstrap method was used (1000 resamples). Analyses were conducted in jamovi 2.3.28 using snowLatent (latent profile analysis) and medmod 1.1.0 (moderation analysis). Results: Perceived stress was negatively associated with satisfaction with life (B = −0.36, 95% CI [−0.48; −0.24], p < 0.001). Latent profile analysis extracted two personal values hierarchy profiles (AIC = 4237; BIC = 4587). Profile membership was not a significant predictor of satisfaction with life (p = 0.595) and did not moderate the relationship between perceived stress and satisfaction with life (p = 0.907). Distraction seeking was significantly higher in profile 1 (p = 0.010). Conclusions: In treated uniformed personnel, higher perceived stress is linked to lower life satisfaction. The personal values hierarchy did not moderate this relationship and was not associated with satisfaction with life; however, the personal values hierarchy was related to coping, specifically distraction seeking. Full article

Background/Objectives: The Mediterranean diet (MD) constitutes one of the most broadly studied dietary patterns, which has been linked to the prevention of non-communicable diseases and mental health disorders. University students, a population exposed to significant psychosocial stressors and lifestyle changes, may particularly benefit from healthy eating patterns such as the MD. This study was designed to examine the potential associations of MD adherence with symptoms of depression and anxiety among Greek university students. Methods: A cross-sectional study was initially conducted among 7160 active university students from ten diverse geographic regions in Greece. After the enrollment procedure and the application of relevant exclusion criteria, 5191 university students (52.0% female; mean age: 21.3 ± 2.4 years) constituted the study population. MD adherence was assessed using the KIDMED index, while depressive and anxiety symptoms were evaluated using the Beck Depression Inventory-II (BDI-II) and State–Trait Anxiety Inventory (STAI-6), respectively. Sociodemographic and anthropometric data were collected for all the enrolled university students. All the questionnaires were completed by face-to-face interviews with expert personnel. Results: Students with low adherence to the MD were significantly more likely to report symptoms of depression (OR = 2.12; p ˂ 0.001) and anxiety (OR = 2.27; p ˂ 0.001) and to be overweight or obese (OR = 2.45; p ˂ 0.001) after adjustment for multiple confounding factors. Low MD adherence was also associated with male gender (OR = 0.73; p ˂ 0.01), living alone (OR = 0.78; p ˂ 0.01), smoking (OR = 0.75; p ˂ 0.01), low physical activity (OR = 1.84; p = 0.001), and poorer academic performance (OR = 0.83; p ˂ 0.01). Conclusions: Low adherence to the MD is significantly associated with increased likelihood of depression, anxiety, and excess body weight among university students in Greece. These findings underscore the importance of promoting healthy dietary habits and related lifestyle behaviors in young adult populations as a potential strategy for mental health prevention and intervention. Due to the presence of several limitations in the present study, future longitudinal and interventional studies should be performed to confirm the present findings. Full article

Background: Health literacy is increasingly recognized as an essential determinant of health, readiness, and safety in the military, especially as health systems become more digitalized. However, evidence on general and digital health literacy in the armed forces remains limited. This study examined levels of general health literacy and digital health literacy among Lithuanian soldiers and explored their associations with sociodemographic, service-related, and health characteristics. Methods: A cross-sectional survey was conducted among 603 military personnel serving in the national armed forces. General and digital health literacy were measured with HLS19-Q12 and HLS19-DIGI. Data on sociodemographic and military characteristics, self-rated health, and self-reported long-term illnesses were collected. Descriptive statistics, correlation analyses, and multivariable regression models were used to analyze the data. Results: The sample was predominantly male (81.9%) with a mean age of 39.08 years (SD = 8.89). The mean general health literacy score was 80.1 (SD = 19.17), whereas the mean digital health literacy score was 67.81 (SD = 30.05). Overall, 45.0% of soldiers had excellent general health literacy, and 12.0% had inadequate general health literacy; 42.1% had excellent digital health literacy, and 35% had inadequate digital health literacy. Higher levels of health literacy were positively associated with better self-rated health and social status. No statistically significant associations were found between health literacy and gender, age, education, length of service, type of military service, and self-reported long-term health complaints. Conclusions: Military personnel in this study displayed relatively high general health literacy, yet digital health literacy was lower and more unevenly distributed, indicating a potential vulnerability for health outcomes as access to information, communication, and care increasingly relies on digital platforms. Given the cross-sectional design, causal inferences cannot be drawn. Military health services may build on existing health literacy strengths while considering strategies to address digital health literacy gaps (e.g., targeted training, tailored support, and user-friendly digital solutions, including service design), acknowledging that feasibility and implementation depend on organizational context and resources. Full article

Background: The use of continuous glucose monitoring (CGM) offers several benefits. Compared to point-of-care (POC) capillary glucose tests, user acceptability is greater, and time in the target glucose range is improved. If these advantages can be transferred from outpatient to in-patient settings, CGM could assist clinicians in making timely, proactive treatment decisions. Scope of the review: This scoping review focuses on clinical studies of CGM use in hospital settings among non-pregnant adults, with a particular focus on studies from 2023 to 2025. It examines the latest evidence and guidelines and sets out the clinical and analytical considerations involved in implementing in-patient CGM. Main findings: In-hospital CGM facilitates hypoglycemia detection, especially asymptomatic and nocturnal episodes. Data on the impact of CGM use on clinical outcomes are scarce, and most studies focus on the reliability of CGM technology rather than clinical outcomes. Several factors affect CGM accuracy in hospitals, such as medications, fluid management, and hemodynamic disturbances. Despite between-device and settings-related variability, CGM devices generally show reasonable accuracy, with Mean Absolute Relative Differences (MARDs) ranging from 10% to 23%. In-hospital CGM has also improved workflows and reduced personnel exposure in infectious disease settings. Key implementation challenges: The MARD thresholds for safe in-hospital CGM use without confirmatory POC testing and evidence-based protocols for CGM application in ICU and non-ICU settings are not yet established. Despite challenges related to implementation, including personnel training, integrating diabetes technology with electronic health records, and costs, the benefits of improved monitoring and in-patient safety make CGM use worthwhile to pursue. Full article

The health and operational continuity of emergency responders are fundamental pillars of sustainable and resilient disaster management systems. These personnel operate in high-risk environments, exposed to intense physical, environmental, and psychological stress. This makes it crucial to monitor their health to safeguard their well-being and performance. Traditional methods, which rely on intermittent, voice-based check-ins, are reactive and create a dangerous information gap regarding a responder’s real-time health and safety. To address this sustainability challenge, the convergence of the Internet of Things (IoT) and wearable biosensors presents a transformative opportunity to shift from reactive to proactive safety monitoring, enabling the continuous capture of high-resolution physiological and environmental data. However, realizing a field-deployable system is a complex “system-of-systems” challenge. This review contributes to the field of sustainable emergency management by analyzing the complete technological chain required to build such a solution, structured along the data workflow from acquisition to action. It examines: (1) foundational health sensing technologies for bioelectrical, biophysical, and biochemical signals; (2) powering strategies, including low-power design and self-powering systems via energy harvesting; (3) ad hoc communication networks (terrestrial, aerial, and space-based) essential for infrastructure-denied disaster zones; (4) data processing architectures, comparing edge, fog, and cloud computing for real-time analytics; and (5) visualization tools, such as augmented reality (AR) and heads-up displays (HUDs), for decision support. The review synthesizes these components by discussing their integrated application in scenarios like firefighting and urban search and rescue. It concludes that a robust system depends not on a single component but on the seamless integration of this entire technological chain, and highlights future research directions crucial for quantifying and maximizing its impact on sustainable development goals (SDGs 3, 9, and 11) related to health, sustainable cities, and resilient infrastructure. Full article

Background: Pneumothorax (PTX) develops in 1–2% of neonates, leading to significant morbidity and mortality and requiring providers to be comfortable with management. Our objective was to evaluate whether radiographic measurements of PTX size can be used to predict the need for procedural intervention in neonates in order to help guide the need for the availability of specific personnel. Methods: With the help of a data analyst, 62 patients diagnosed with neonatal PTX between March 2016 and October 2024 were identified. Most babies (46) were born in 2023–2024 when our new electronic health record could more easily identify these infants. PTX size was evaluated using radiographs by calculating the ratio of the widest transverse measurement of the PTX on both anteroposterior (AP) and, when available, lateral decubitus (DECUB) divided by the widest transverse measurement of the hemithorax above the diaphragm. Clinical data were collected, and statistical analysis was performed using need for intervention (thoracentesis (TC), chest tube (CT), or both). Results: We found that a larger PTX size ratio, measured in the AP (p < 0.0001) or DECUB view (p < 0.008), was highly associated with need for intervention in this cohort of infants with PTX. Only 33% of PTXs required intervention. Also, 13/14 (93%) cases who underwent TC ultimately required a CT. PTX was more prevalent in males in general, but sex was not associated with needing intervention. The average gestational age (GA) of the cohort was 36 5/7 weeks, with only 12% being < 34 weeks GA. Univariate analysis indicated that lower GA and birth weight were risk factors for intervention. There was a trend (p = 0.075, by Fisher’s exact test) suggesting that infants with both respiratory distress syndrome (RDS) and PTX may be more likely (60%) to require intervention (no RDS, 29% intervention). Finally, a receiver operator characteristic curve was derived from the AP ratio based on the yes/no intervention which resulted in an area under the curve statistic of 0.902 and the optimal AP ratio cutoff of 0.184. Conclusions: The ratio of the transverse measurement of the PTX/hemithorax size from radiographs was highly predictive for need for intervention in a cohort of primarily term infants with PTX. Smaller and lower GA infants were at a higher risk for requiring procedural intervention. Nearly all infants who had TC also needed a CT. These findings could inform clinical strategies for managing neonatal PTXs, especially in identifying appropriate needed personnel availability if a TC occurs. Full article

High-altitude exposure poses significant health challenges to mountaineers, military personnel, travelers, and indigenous residents. Altitude-related illnesses encompass acute conditions such as acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), and chronic manifestations like chronic mountain sickness (CMS). Hypobaric hypoxia induces oxidative stress and inflammatory cascades, causing alterations in multiple organ systems through co-related amplification mechanisms. Therefore, this review aims to systematically discuss the injury mechanisms and comprehensive intervention strategies involved in high-altitude diseases. In summary, these pathologies involve key damage pathways: oxidative stress activates inflammatory pathways through NF-κB and NOD-like receptor thermal protein domain-associated protein 3 (NLRP3) inflammasomes; energy depletion impairs calcium homeostasis, leading to cellular calcium overload; mitochondrial dysfunction amplifies injury through mitochondrial permeability transition pore (mPTP) opening and apoptotic factor release. These mechanisms could be converged in organ-specific patterns—blood–brain barrier disruption in HACE, stress failure in HAPE, and right heart dysfunction in chronic exposure. Promising strategies include multi-level therapeutic approaches targeting oxygenation (supplemental oxygen, acetazolamide), specific pathway modulation (antioxidants, calcium channel blockers, HIF-1α regulators), and damage repair (glucocorticoids). Notably, functional foods show significant therapeutic potential: dietary nitrates (beetroot) enhance oxygen delivery, tea polyphenols and anthocyanins (black goji berry) provide antioxidant effects, and traditional herbal bioactives (astragaloside, ginsenosides) offer multi-targeted organ protection. Full article

Fishermen operating in pelagic fisheries often experience significant barriers to medical care due to geographic isolation, harsh environmental conditions, and the absence of onboard healthcare personnel. Telemedicine offers an effective approach to overcome these limitations by enabling remote diagnosis, monitoring, and treatment through satellite-based communication systems. This review summarizes the progress and applications of telemedicine in maritime and other austere environments, focusing on technological advancements, clinical implementations, and emerging trends in artificial intelligence-driven healthcare. Evidence from pilot and retrospective studies highlights the growing use of wearable devices, telementored ultrasound, digital photography, and cloud-based monitoring systems for managing acute and chronic medical conditions at sea. The integration of machine learning and deep learning algorithms has further improved fatigue, stress, and motion detection, enhancing early risk assessment among seafarers. Despite challenges such as limited connectivity, data privacy concerns, and training requirements, the adoption of telemedicine significantly improves health outcomes, reduces emergency evacuations, and promotes occupational safety. Future directions emphasize the development of 5G-enabled Internet of Medical Things networks and predictive AI tools to establish comprehensive maritime telehealth ecosystems for fishermen in pelagic operations. Full article

Wild birds are relevant reservoirs and sentinels for zoonotic pathogens such as Chlamydia psittaci and West Nile virus (WNV), both of which can affect animal and public health. Wildlife rehabilitation centers (WRCs) offer unique opportunities for passive surveillance of emerging and re-emerging infectious diseases, particularly in urban and peri-urban settings. From 2013 to 2022, a total of 1024 bird samples were collected upon admission to WRCs in the Community of Madrid, Spain. Oropharyngeal and cloacal swabs, as well as tissue samples, were tested using real-time PCR targeting the ompA gene of C. psittaci and the 3’NC region of WNV. One sample tested positive for C. psittaci by real-time PCR in 2021, yielding a positivity rate of 0.22% (95% CI: 0.01–1.19). No positive cases were detected during the remaining years of the study. All samples tested negative for WNV over the nine-year period. The low detection rate suggests limited circulation of these pathogens among wild birds in central Spain, though it may partly reflect the variability inherent to passive surveillance and sample-type heterogeneity. However, continued surveillance is warranted, especially in high-risk avian species and personnel occupationally exposed in avian rehabilitation facilities using expanded sample sizes and complementary diagnostic tools. Extending monitoring beyond the typical vector season and increasing testing of sensitive tissues, particularly for WNV, may further enhance detection sensitivity and strengthen early-warning capacity. These efforts are essential to improve early detection and risk assessment within a One Health framework. Full article

Religious plurality is an increasingly prevalent phenomenon in contemporary societies, and managing it within the healthcare sector presents significant challenges. In this regard, healthcare systems must strike a balance between religious freedom and the organisation of healthcare services. This paper will address the management and legal treatment of religious diversity in healthcare, focusing on the impact of artificial intelligence in this area. There is no doubt that Artificial Intelligence is transforming the management of religious diversity in healthcare. While many advances have been observed in this area in recent years, numerous ethical and privacy challenges have also emerged, which are undoubtedly leading to the need for a reconfiguration of the legal framework. Issues such as conscientious objection by healthcare personnel, access to treatments compatible with patients’ beliefs, and possible tensions between the right to health and religious freedom will be analysed. The influence of Artificial Intelligence on decision-making and the personalisation of treatments, along with the ethical and legal challenges this entails, will also be explored. Based on this analysis, we will reflect on current challenges and possible improvements in managing religious plurality in healthcare systems. Our aim is to promote a model that provides better medical care, adequately addresses ethical and privacy challenges, respects diversity, and guarantees fundamental rights. Full article

Background and Objectives: Healthcare-associated infections (HAIs) are a major cause of morbidity and mortality and can lead to serious long-term consequences, increased hospital length stay, higher rates of antibiotic resistance, and additional financial costs. The study aim was to highlight important aspects related to the level of knowledge of HAIs, risk factors for HAI and methods of preventing HAIs among nurses from urban hospitals in the North-East of Romania. Materials and Methods: We conducted a cross-sectional study on the level of knowledge of HAI problems among medical personnel (nurses). The study group consisted of 288 nurses who responded online to a questionnaire. Results: Multivariate analysis suggested that 45.5% of the value of the knowledge score of prevention and limitation of HAIs could be determined by the answers to the questions regarding the importance of the nurse role, professional experience, and training. Moreover 84.6% of the knowledge score could be determined by the answers to the questions regarding the assessment of the importance of factors related to lack of medical personnel, professional burnout, insufficient knowledge and staff training, inefficient team, poor collaboration within departments, stressful work environment, staff health status, multiple tasks at work (p = 0.038). While 50% of the knowledge score could be explained by responses regarding personal problems related to daily activity; physical and mental health status; and physical, psychological, and social components (p = 0.038). Conclusions: Our study highlighted aspects of the level of knowledge regarding HAIs among nurses, an issue that plays a key role in hospital management. Overall, the knowledge score for the prevention and limitation of HAIs was higher in nurses/females aged over 40 and in nurses with more than 15 years of experience. Full article