Search Results (36,753)

Background: Worldwide, around 400,000 children are diagnosed with cancer every year. Understanding survivors’ social and stigma-related experiences may help address their needs and improve their outcomes. Objectives: To explore the social and stigma-related experiences, coping strategies, and support needs of pediatric cancer survivors in Newfoundland and Labrador, a province of Canada. Methods: This is a qualitative, cross-sectional study focusing on retrospective participant experiences. Eligibility criteria included being diagnosed with cancer before the age of 18 and being diagnosed or treated in the province. Extensive recruitment activities were employed. Data collection occurred through semi-structured virtual interviews and completion of a sociodemographic survey. Participant interviews were transcribed verbatim, and themes were identified iteratively through inductive thematic analysis. Descriptive statistics were used to define the participants’ sociodemographic characteristics. Results: Seven participants were recruited. Thematic analysis identified five major themes: (i) isolation and being treated differently; (ii) support received, coping mechanisms, and support needs; (iii) resilience and interest to give back; (iv) workplace and disability related experiences; and (v) additional impacts of cancer. Our results showed that participants received substantial social support in various ways but inadequate professional mental health support. School was a significant setting for cancer-related stigmatization. Discrimination in the workplace was rare and was disability-related rather than cancer-related. Conclusions: Our results show that there are significant issues to address, such as stigma and isolation experienced by pediatric cancer survivors as well as the need to improve the psychosocial support programs offered to them. Our results also show that the participants had distinct lived experiences compared to adult-onset cancer populations. Overall, the findings presented are expected to inform further studies and healthcare-education policies to help address these issues and improve the experiences of pediatric cancer survivors. Full article

Background: Postoperative admission to critical care facilities is frequently employed following complex abdominal and gynecologic oncology surgery; however, the clinical value of routine short-stay (≤24 h) high-acuity care remains uncertain as the existing evidence is limited, heterogeneous and derived primarily from non-randomized studies. Consequently, the present critical narrative review aims to discuss the rationale for planned short-duration postoperative high-acuity care, summarize the contemporary evidence, and identify priorities for future research. Methods: Relevant studies evaluating planned postoperative admission to critical care facilities for ≤24 h following major abdominal surgery were identified through a targeted review of contemporary literature using a structured search of MEDLINE, Scopus, Google Scholar, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Evidence from observational studies investigating intensive care units, high-dependency units, post-anesthesia care units, and advanced recovery pathways was critically synthesized, with particular attention to clinical outcomes, healthcare utilization, and current knowledge gaps. Results: Nine primary studies were included, predominantly observational in design, with the majority lacking a comparative study design, thereby limiting direct evaluation of the clinical effectiveness of planned short-stay postoperative high-acuity care. None of the studies were designed to evaluate a gynecologic oncology population, limiting the direct applicability of the available evidence to this setting. As such, the current evidence is better suited to critical clinical interpretation of the rationale, patient selection, and potential role of postoperative high-acuity care than to drawing definitive conclusions regarding intervention effectiveness. Overall, the available data suggest that planned short-stay high-acuity postoperative care is not consistently associated with reductions in postoperative mortality or overall morbidity but may decrease unplanned intensive care unit admissions in selected patient populations. Most studies reported little or no effect on overall hospital length of stay, whereas increased healthcare costs were primarily observed in capacity-driven or unplanned postoperative critical care pathways. Interpretation of the available literature remains limited by the predominance of observational studies, heterogeneous patient populations, variability in critical care models, and inconsistent outcome reporting. Conclusions: Current evidence does not support routine postoperative admission to critical care facilities following major abdominal surgery, while evidence specifically addressing gynecologic oncology remains insufficient to establish specialty-specific effectiveness. However, planned, time-limited high-acuity postoperative care was not associated with an observed increase in adverse clinical outcomes in the available observational studies and may offer clinical and system-level benefits in selected high-risk patients; these findings should be interpreted cautiously given the limitations of the available evidence. Prospective studies with standardized outcome reporting and clearly defined populations are needed to inform evidence-based perioperative care strategies. Full article

Background/Objectives: Cutaneous melanoma prognosis is largely determined at diagnosis, with Breslow thickness, subtype and other histopathological aspects being key prognostic indicators. Variations in healthcare organization and environmental factors may influence melanoma presentation. This study aimed to compare epidemiological, clinical, and histopathological characteristics of primary cutaneous melanoma between two national referral centers in Southeastern Europe. Methods: A multicenter retrospective cohort study was conducted at the University Clinical Center of Serbia (Belgrade) and the Clinical Center of Montenegro (Podgorica). Consecutive patients treated for primary cutaneous melanoma between January 2018 and December 2022 were included. Data of interest were extracted from medical records. Annual regional sunshine hours were obtained from publicly available climatological databases. Group comparisons were performed using appropriate parametric and non-parametric tests, followed by a multivariable ordinal logistic regression analysis. Results: A total of 412 patients were analyzed. Age and sex distributions were comparable between cohorts. Nodular melanoma predominated in Montenegro, whereas superficial spreading melanoma was most common in Belgrade (p < 0.001). Median Breslow thickness was significantly higher in Montenegro (p = 0.001), with a greater proportion of tumors >4 mm (p = 0.001). In multivariable analysis, increasing age (p < 0.001), male sex (p = 0.027), and treatment in Montenegro (p = 0.001) were independently associated with higher Breslow thickness categories. Conclusions: Patients treated in Montenegro presented with thicker melanomas and a higher proportion of nodular subtype. These differences may reflect multifactorial influences, including healthcare accessibility and diagnostic pathways. Further prospective studies incorporating other histopathological aspects, time-to-diagnosis and survival outcomes are warranted. Full article

Background: Pakistan is one of only two countries where wild poliovirus type 1 (WPV1) continues to persist. Vaccine refusals challenge efforts to end the virus, especially in high-risk communities. Methods: A qualitative exploratory study took place from September to November 2025 in three High-Risk Union Councils (HRUCs) of Karachi, Pakistan. The study examined reasons for refusing the polio vaccine and identified specific communication and operational strategies to improve vaccine acceptance. A total of 23 in-depth interviews and 10 focus group discussions were conducted with 71 participants, including parents who refuse the vaccine, polio program staff, physicians, and government stakeholders. Data were analyzed using a sequential inductive and deductive thematic approach, mapping findings onto the Socio-Ecological Model (SEM) with NVivo 15 (Lumivero, Denver, CO, USA). Results: Factors influencing polio vaccine refusals were interconnected and spanned multiple levels. At the intrapersonal level, campaign fatigue, a lack of knowledge about poliomyelitis, concerns about side effects, and rumors about infertility were common. Community-level factors included household gatekeepers, local influencers, and digital misinformation. Institutional barriers included weak communication from the frontline, inadequate supervision, workforce shortages, poor tracking of refusals, and limited involvement of physicians. At the policy level, refusals were linked to distrust in governance, poor municipal services, and dissatisfaction with vertical campaign methods. Recommended strategies included integrating polio services with routine immunization and primary healthcare, strengthening counseling by physicians, engaging trusted local influencers and community leaders, expanding targeted social media campaigns to counter misinformation, implementing quick responses to rumors, enhancing workforce capacity, and using data-driven microplanning, including targeted SNIDs and focused interventions in areas with chronic refusals. Conclusions: Polio vaccine refusals are shaped by social, communication, operational, and structural factors. Improving communication and operational guidelines by reducing the number of campaigns, increasing active engagement at the frontline, integrating polio activities into routine health services, and addressing misinformation with a dynamic communication strategy may enhance vaccine acceptance and support polio eradication efforts. Full article

Background/Objectives: Dietary supplements (DSs) and over-the-counter (OTC) medications for mood improvement and stress relief are widely used, but little is known about how their use relates to coping preferences, trust in physicians, and communication with doctors. This exploratory cross-sectional study compared users and non-users of such products in Poland. Methods: Data were collected between October 2024 and May 2025 and included 798 adults recruited through a mixed-mode convenience sampling strategy (636 online and 162 in person). Participants were classified as current users (CUs; n = 184), past users (PUs; n = 297), or never-users (NUs; n = 317). The outcomes included hypothetical future coping strategies (under an assumption of unlimited resources), trust in physicians using an author-translated adaptation of the Trust in Doctors in General (T-DiG) scale and three-category communication-related attitudes. Multivariable models were adjusted for age, gender, education, medical or health science background, and recruitment mode. Results: Overall, 60.3% of respondents reported current or past use. Compared with NUs, both CUs and PUs had higher adjusted odds of selecting future DS/OTC use (CUs: aOR = 5.60, 95% CI 3.44–9.14, p < 0.001; PUs: aOR = 2.44, 95% CI 1.52–3.93, p < 0.001). PUs also had higher adjusted odds of selecting psychotherapy (aOR = 1.50, 95% CI 1.04–2.17, p = 0.031; overall p = 0.018). Product-use status was associated with selected items of T-DiG: communication competency (overall p = 0.031) and global trust (overall p < 0.001). Compared with NUs, CUs had lower adjusted scores on both subscales (aMD = −0.19, 95% CI −0.33 to −0.04, p = 0.010 and aMD = −0.40, 95% CI −0.59 to −0.21, p < 0.001, respectively). Overall product-group effects were also observed for the first two communication items: CUs had lower relative risk ratios than NUs for discussing product-related doubts first with their physician (RRR = 0.52, 95% CI 0.35–0.78, p = 0.001) and for feeling free to raise such doubts (RRR = 0.57, 95% CI 0.36–0.92, p = 0.022). Conclusions: Product-use status showed selective associations with hypothetical coping preferences, physician trust, and communication-related attitudes rather than a uniform pattern of reluctance to seek professional support. Current use was most strongly associated with lower trust and less favorable product-related communication attitudes. Given the cross-sectional design and hypothetical nature of the coping outcomes, these findings do not establish causality, temporal ordering, or actual healthcare-seeking behavior. Full article

The agricultural sector in Greece heavily relies on migrant workers, particularly from South Asian countries, such as Bangladesh, Pakistan, and India. Research has shown that these workers face numerous challenges, including unsanitary living conditions, exposure to hazardous working conditions, harmful chemicals, a lack of safety equipment, accidents, abuse, violence, and exploitative conduct from employers. Drawing on 45 in-depth interviews, this article analyzes the experiences of Bangladeshi migrant farmworkers employed as strawberry pickers in Nea Manolada, Greece. This study specifically examines how precarious and harsh working conditions in the agricultural sector affect the health, quality of life, and social integration of these unskilled workers. Evidence from the empirical sample reveals that Bangladeshi workers experience hazardous working environments, a lack of labor rights and contracts, chronic job insecurity, and exposure to harmful chemicals and are particularly vulnerable to injury, exploitation, and poverty due to the ethnic–racial division of labor, legal uncertainty, threats of deportation, overcrowded and unsanitary housing, poor nutrition, persistent job insecurity, health risks, and limited access to healthcare. These challenges and inequalities, both in employment and health, are seen as situations akin to modern slavery. This study underscores the urgent need for legislative, labor, and public health interventions to address the specific conditions faced by Bangladeshi migrant workers in the agricultural sector. While this research provides an in-depth insight into this group, it also acknowledges limitations regarding gender, sector, and wider representativeness. The results contribute to a nuanced understanding of the intersection between legal status, the ethnic–racial division of labor, working conditions, health, and quality of life among South Asian migrant agricultural workers in Southern Europe. Full article

The global shift toward an aging population presents significant challenges for healthcare systems. This is compounded by rising disability rates, fragmented care models that struggle to meet complex needs, and a digital divide caused by the emergence of smart technologies. This work aims to evaluate how the digital divide affects the adoption, usability, and perceived benefits of smart home technologies designed to support activities of daily living and health monitoring. The influences of socioeconomic status and geographic location (urban versus rural) on the digital divide are considered. Four databases (Web of Science™, Scopus^®, PubMed^®, and IEEE Xplore^®) were searched between 2014 and 2026, resulting in 71 studies that examined older adults, smart home technologies for daily living or health monitoring, and factors related to the digital divide. Findings were synthesized using the Technology Acceptance Model, Van Dijk’s Digital Divide Framework, and Health Behavior Models. Three key barriers were identified—economic, technical, and social—which disproportionately affected vulnerable groups. Smart Home Health Technologies (SH2Techs) present adoption challenges distinct from standalone devices because they require integrated infrastructure and sustained engagement. Limited research addressing the usability of non-clinical SH2Techs has identified the need for co-design, simplified interfaces, targeted training, and policy reforms to support equitable aging in place. Full article

Flexible pressure sensors featuring high sensitivity, a broad detection range, and excellent stability are pivotal components for high-precision electronic skins and human health monitoring. To circumvent the limitations of existing sensors in maintaining high responsiveness across extensive pressure ranges, herein, a novel flexible capacitive pressure sensor is developed based on a 3D porous ionogel foam composite (IL/EG/PVA@MF) coupled with a planar electrode array. This device leverages the synergistic structural engineering of the 3D hyperelastic melamine foam (MF) skeleton and the pressure-regulated fringe-field distribution and iontronic interfacial polarization of the porous ionogel. Experimental evaluations demonstrate that the sensor achieves a high normalized sensitivity of 62.45 kPa⁻¹ (2–10 kPa) and maintains reliable piecewise linear sensing performance across a broad working range of 0–50 kPa, accompanied by a rapid response time of within 8 ms. Furthermore, the sensor exhibits outstanding performance consistency after 6000 compression-release cycles at 50 kPa, verifying its good mechanical durability. In practical applications, the device can monitor diverse physiological signals with high fidelity, ranging from subtle radial artery pulses to large-scale joint movements and specific coughing patterns, underscoring its broad potential for integrated wearable systems and intelligent healthcare. Full article

India is the most populous country in the world, with a rising urban population and witnessing a surge in noncommunicable diseases such as cancer that impose significant pressure on healthcare professionals, hospitals, and city planners. Over the last decade, India has pursued a vision to transform urban areas into smart cities and roll out digital infrastructure. Rapid urbanization coupled with an ageing population has accelerated demand for precision cancer care (PCC) solutions using advanced technologies such as digital twins (DT), leveraging the developing digital infrastructure in urban India. The fast evolution of e-health technologies and digital infrastructure outstrips healthcare professional readiness, creating challenges for DT adoption for PCC. Past studies on DT adoption primarily focused on organizational adoption and technical implementation challenges. This study addresses this research gap by leveraging the Unified Theory of Acceptance and Use of Technology (UTAUT) framework to investigate the factors that influence the adoption intention of DT for PCC in urban India. The article reports actionable insights and implications for researchers, healthcare professionals, top management of hospitals, smart city planners, government agencies, and urban policymakers. The study will assist stakeholders such as cancer care organizations, technology service providers, and city planners in planning, designing, and implementing DT for PCC. Full article

Background/Objectives: Oral diseases are among the most prevalent non-communicable diseases and impose a substantial public health burden across Europe. Although general total health expenditure may reflect health-system capacity, it does not specifically measure oral healthcare financing, and evidence regarding its association with population-level oral health remains limited. The objective of this study was to assess the association between total health expenditure and oral health outcomes in European countries. The primary focus was on dental caries prevalence, while a secondary exploratory analysis examined edentulism. Methods: Using publicly available international databases, an ecological, unbalanced country-level panel dataset was constructed. The main caries model included 153 country-year observations from 25 European countries during 2015–2021. An extended model incorporating practicing dentist density included 109 observations from 20 countries. Two-way fixed-effects regression models with country and year effects and country-clustered standard errors were applied. Edentulism was examined using exploratory cross-sectional OLS models for 2019. Results: In the main model, higher total health expenditure (β = −0.00305, p = 0.027) and GDP per capita (β = −0.00024, p = 0.021) were associated with lower caries prevalence. In the extended model, only GDP per capita remained statistically significant (β = −0.00028, p = 0.021), whereas total health expenditure, tertiary educational attainment, and practicing dentist density were not significantly associated with caries prevalence. No statistically significant associations were observed in the exploratory edentulism analyses. Conclusions: Total health expenditure and GDP per capita were negatively associated with caries prevalence in the main country-level model, although the expenditure association was not maintained in the restricted extended sample. These ecological findings do not establish causality and require confirmation using more complete, oral-health-specific data. Full article

Background: The rapid integration of Artificial Intelligence (AI), specifically Clinical Decision Support Systems (CDSS), into healthcare offers substantial efficiency but introduces critical ethical and legal challenges, particularly the perpetuation of systemic bias against older adults (“Digital Ageism”). While technological advances may improve care, they can violate fundamental bioethical principles when models are trained on unrepresentative data. Aim: This article argues that traditional clinical risk-management models are structurally insufficient to address opaque algorithmic bias and presents a conceptual, multidimensional governance framework designed to prevent the codification of human ageism into AI infrastructure. Methods: Drawing on systemic failures observed during the COVID-19 pandemic, the normative model integrates legal and governance standards aligned with the EU AI Act, Explainable AI (XAI) tools, and a three-phase implementation protocol. Results: To illustrate potential application without overburdening medical staff, the article introduces a theoretical Targeted Escalation Protocol and an Autonomous High-Load Safety Mode. The latter applies deterministic hardcoded constraints to contain age-dominant outputs during acute surges while preserving attending-clinician authority. The framework is explored through an Intensive Care Unit (ICU) thought experiment. Conclusions: The framework provides a structured roadmap for policymakers, ethicists, and healthcare administrators to move from reactive defensive medicine toward proactive ethical safety, safeguarding the dignity of the aging population while aiming to mitigate institutional legal exposure. Full article

Background/Objectives: Healthcare workforce shortages and the challenges facing healthcare professionals are among the most pressing issues confronting contemporary health systems. This study examines the social representations of public, private, and public–private partnership (PPP) healthcare organisational models and professional practice elicited from public-sector physicians and nurses in Portugal. Methods: A cross-sectional survey was conducted between October 2022 and May 2023 using a non-probability sample of 308 physicians and nurses classified as public-sector professionals. Participants completed a free-association task concerning the public, private, and PPP healthcare models and their professional practice. The evoked terms were examined using prototypical analysis within the structural approach to Social Representations Theory. The representation of the public healthcare sector included elements such as accessibility, universality, equity, slowness, disorganisation, and resource limitations. The private healthcare sector was characterised by elements including cost, profit, speed, organisation, inaccessibility, and service quality. Results: The representation of PPPs included better management, efficiency, profit, interests, and quality, alongside a relatively frequent “No opinion” response. Professional practice was characterised by elements including caring, dedication, empathy, resilience, exhaustion, perceived undervaluation, and remuneration. Conclusions: These findings describe the social representations elicited from the present sample of public-sector physicians and nurses and should not be interpreted as evidence of objective differences between healthcare organisational models or as direct measures of motivation, resilience, burnout, sector preference, or working conditions. The findings are exploratory and hypothesis-generating and may inform future comparative research involving professionals working across different healthcare settings, as well as studies using dedicated measures of professional and occupational outcomes. Full article

Background: Adoption of surgical robotic systems is accelerating globally, driven by advances in clinical capability, ergonomics, and workflow efficiency. However, robotic surgery programs introduce complex organizational challenges related to patient safety, workforce capability, infrastructure readiness, governance, vendor dependency, procurement, and long-term sustainability. Hospitals often lack structured, leadership-oriented frameworks to support systematic, context-appropriate evaluation, adoption, and governance of these technologies. Objective: To develop a multidisciplinary, consensus-based framework to support leadership-level evaluation, organizational readiness assessment, adoption, and governance of surgical robotic systems. Methods: A two-round modified Delphi study was conducted at Singapore General Hospital involving eleven stakeholder groups spanning clinical, perioperative, technical, operational, governance, and executive domains. Department-level consensus responses were generated. In Round 1, stakeholders completed role-specific questionnaires comprising Likert-scale items and open-ended questions. Items rated as low importance were excluded, while items of moderate importance were refined through thematic analysis. In Round 2, refined and newly generated items were re-evaluated. Items achieving ≥70% agreement for high importance within each stakeholder group were retained. Results: A total of 417 consensus-derived items were identified and organized into nine thematic domains encompassing patient safety and risk management, technical capability and surgical performance, workflow integration, training and credentialing, governance and sustainability, vendor support, infrastructure, logistics, and operational readiness. The framework was operationalized through category-specific interpretive scoring rubrics and three domain-weighted decision models reflecting clinician, safety, and procurement perspectives. Conclusions: This study presents a leadership-oriented, multi-stakeholder framework to support the risk-aware evaluation, adoption, implementation, and governance of surgical robotic systems. By integrating considerations across institutional readiness, comparative robotic platform assessment, and program governance, the framework provides a structured approach to decision-making throughout the robotic surgery lifecycle. While it may serve as a useful starting point for institutions seeking to establish or expand robotic surgery programs, the framework was developed and evaluated within a single academic tertiary healthcare institution. Further validation across diverse healthcare settings, including community hospitals, non-academic institutions, specialty centers, and resource-constrained environments, is required before broader adoption can be recommended. Full article

Background: Composite anthropometric and cardiometabolic indices have emerged as practical tools for identifying metabolic syndrome (MetS), but their comparative classification performance against ALAD-defined MetS has not been comprehensively evaluated in Panamanian adults. This study compared the classification performance of selected anthropometric, body composition, and cardiometabolic indices for identifying metabolic syndrome defined according to the Latin American Diabetes Association (Asociación Latinoamericana de Diabetes [ALAD]) criteria in non-diabetic Panamanian adults. Methods: This cross-sectional study included 262 adults without diabetes (110 men and 152 women). Clinical and laboratory measurements were used to calculate the body mass index (BMI), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic index of plasma (AIP), cardiometabolic index (CMI), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Classification performance was evaluated using receiver operating characteristic (ROC) curve analysis, optimal cut-off values, and DeLong’s test. Age-adjusted logistic regression assessed associations between each index and ALAD-defined MetS. Results: Composite indices integrating anthropometric and metabolic parameters showed high classification performance. CMI had the highest observed AUC in men (AUC = 0.933; 95% CI: 0.887–0.979), whereas LAP had the highest observed AUC in women (AUC = 0.854; 95% CI: 0.778–0.931). Conclusions: CMI and LAP showed high classification performance for identifying ALAD-defined MetS in Panamanian adults without diabetes, with the highest observed AUCs in men and women, respectively. These simple, inexpensive indices may have potential utility as screening tools for identifying ALAD-defined MetS in primary healthcare settings. The proposed cut-off values are exploratory and require external validation in independent Panamanian and Latin American populations before clinical implementation. Full article