Search Results (173)

Background: Childhood hearing loss is a public health problem of critical importance associated with speech development, academic achievement, and quality of life. Parents’ awareness and knowledge about risk factors contribute to early detection and timely intervention.  Objective: This study aims to examine Jordanian mothers’ knowledge of childhood hearing loss risk factors and investigate the impact of education level and socioeconomic status (SES) on the accuracy and comprehensiveness of this knowledge with the moderating effect of health literacy. Material and Methods: The approach employed an embedded mixed-methods design with a dominant quantitative strand supported by qualitative data, utilizing quantitative surveys (n = 250), analyzed using structural equation modeling (SEM) in SmartPLS, and qualitative interviews (n = 10), analyzed thematically to expand upon the quantitative findings by exploring barriers to awareness and healthcare-seeking behaviors. Results: The accuracy and comprehensiveness of knowledge of hearing loss risk factors were also positively influenced by maternal knowledge of hearing loss risk factors. Maternal knowledge was significantly associated with both education level and socioeconomic status (SES). Furthermore, maternal knowledge and accuracy were significantly moderated by health literacy, such that mothers with higher health literacy exhibited a stronger relationship between knowledge and accuracy. Qualitative findings revealed that individuals encountered barriers to accessing reliable information and comprehending medical advice and faced financial difficulties due to limited options for healthcare services. Conclusions: These results underscore the need for maternal education programs that address specific issues, provide simplified healthcare communication, and enhance access to pediatric audiology services. Future research should explore longitudinal assessments and intervention-based strategies to enhance mothers’ awareness and detect early childhood hearing loss. Full article

Background: Breastfeeding is essential for preventing non-communicable diseases. However, mothers with chronic illnesses tend to breastfeed less, increasing the likelihood of abandoning breastfeeding, especially if they experience gestational complications. Objective: To analyze the association between factors such as prepregnancy maternal characteristics, gestational complications, food security, barriers, and facilitators with the practice of exclusive breastfeeding. Methods: Cross-sectional study with 566 women who had prenatal care and gave birth at the National Institute of Perinatology (Mexico City) between 2021 and 2024. Surveys were administered on breastfeeding practices, food insecurity, barriers, and facilitators of exclusive breastfeeding in mothers. In addition, sociodemographic information, medical history (prepregnancy conditions and complications), gestational weight gain, and neonatal outcomes were recorded. Results: Of the 566 women, only 43.6% practiced exclusive breastfeeding, with a median duration of 4 months. Exclusive breastfeeding was more frequent in young, stay-at-home mothers with lower educational attainment and in those with food insecurity, who also tended to delay the introduction of complementary foods until after six months. Prepregnancy risk conditions (OR 1.56, 95% CI 1.06–2.30) and multiparity (OR 1.64, 95% CI 1.08–2.49) increased the risk of non-exclusive breastfeeding. Conversely, food insecurity (OR 0.40, 95% CI 0.20–0.78) and counseling from healthcare personnel (OR 0.09, 95% CI 0.01–0.51) showed a protective effect. The analysis also showed that paid employment (OR 4.68, 95% CI 1.65–13.21), the perception of low milk production (OR 6.45, 95% CI 2.95–14.10), maternal illness/medication (OR 3.91, 95% CI 1.36–11.28), and fatigue (OR 4.67, 95% CI 1.36–11.28) increased the probability of non-exclusive breastfeeding. Conclusions: In Mexico, the promotion of exclusive breastfeeding faces challenges, especially in mothers who begin pregnancy with significant chronic conditions such as diabetes, hypertension, obesity, advanced maternal age, and hypothyroidism, among others. Healthcare personnel should provide personalized advice to each woman from the prenatal stage on strategies to achieve and maintain exclusive breastfeeding. Full article

Access to high-quality, culturally responsive nutrition advice during pregnancy is necessary for optimal health outcomes for mothers and babies. Evidence indicates that age, education and access to trained healthcare practitioners have a positive correlation with healthy food intake and positive outcomes. There are limited studies that discuss the importance of providing culturally responsive nutrition advice to pregnant Indigenous women. Therefore, this paper investigates the sources from which Indigenous women access nutrition information, assesses its adequacy in meeting needs, and identifies the effective ways to deliver this information. This study took place in Queensland (QLD), New South Wales (NSW), and Western Australia (WA), which were chosen to represent diverse cultural communities. A total of 103 participants were recruited, including Indigenous women and healthcare practitioners. Focus groups were audio-recorded, transcribed and analysed. Participants indicated that pregnant women are highly interested in improving their nutrition knowledge during pregnancy and actively seek information from their healthcare practitioners and dietitians. Findings suggested dissatisfaction with the information received, as it failed to address their needs. Results of this paper call for an urgent increased presence of community dietitians in antenatal clinics dedicated to Indigenous pregnant women as an additional way to provide families with the information they need for healthy pregnancies. Full article

Background/Objectives: The availability of accessible health information outside of traditional healthcare settings has transformed patient engagement in shared decision-making (SDM) with healthcare providers. However, the challenge of navigating misinformation complicates SDM, highlighting the critical role of trust, especially when patient-achieved information conflicts with professional advice. This study examines the association between patients’ health information behavior (HIB) and SDM, emphasizing the role of patients’ trust in healthcare providers. Methods: Utilizing data from the Health Information National Trends Survey (HINTS), this research explores how trust mediates the relationship between HIB and SDM. We conducted factor analysis, mediation analysis, and moderated mediation analysis to assess our hypotheses. Results: Factor analysis identified two main HIB dimensions: emotional responses and utilization of social media. Emotional responses positively influenced SDM, enhancing trust and decision-making involvement. In contrast, utilization of social media negatively influenced SDM through decreased trust. Mediation analysis confirmed trust in physicians as a crucial mediator, particularly when emotional responses foster trust and engagement. Moderated mediation showed that high healthcare quality amplified the positive mediation effects of trust, underscoring its role in effective SDM. Conclusions: This study highlights the significant role of trust in enhancing patient engagement in SDM through HIB. High perceived healthcare quality also strengthens trust, improving SDM outcomes. The study contributes to the literature by providing a comprehensive analysis of the interplay between HIB, trust, and SDM, suggesting that enhancing patient-centered care requires fostering trusted patient–physician relationships. Full article

Background/Objective: Patients have historically trusted healthcare providers to be a reliable source of health information. However, with the recent pandemic and subsequent recovery, understanding and developing patients’ trust has become even more important, especially regarding vaccine acceptance. The objective of this work is to explore the current level of trust that rural patients have in their healthcare providers concerning influenza vaccination and related recommendations and its impact on vaccine uptake in a rural county in Washington State. Methods: An anonymous survey was conducted by a survey research center using a random sampling of 3000 addresses for people living in Yakima County in Washington State. Yakima County has a high percentage of people who identify as Hispanic or Latino/a and is a medically underserved area. The survey was designed to evaluate factors influencing the decision to be vaccinated against influenza and the level of trust in information from healthcare providers. Results: Results showed that participants who had been vaccinated against influenza in the previous five years were more likely to trust the advice of their primary care provider (p < 0.001), specialty care provider (p < 0.001), pharmacist (p = 0.02), and nurse (p = 0.002). People who were not vaccinated against influenza in the last five years were statistically more likely to report that a recommendation from a healthcare provider would not make a difference in their decision (p < 0.001). People who were vaccinated were more likely to utilize healthcare providers as a source of information about the influenza vaccine (p < 0.001) and people who were unvaccinated were more likely to use their own personal research as a trusted information source (p = 0.04). Conclusions: Healthcare providers continue to be well regarded and trusted by their patients, especially in rurally located counties, though work still needs to be carried out around influenza vaccination importance messaging. This work identified that all healthcare providers need to work collaboratively to reinforce vaccination guideline recommendations and to both provide education and continue successful access-to-vaccination strategies to promote influenza prevention. Full article

Musculoskeletal disorders represent one of the most pervasive health concerns that drive frequent medical consultations and pharmacy encounters. Community pharmacies are well placed to help address this demand as they are accessible settings for healthcare advice and support for patients with musculoskeletal disorders complaining of pain. Heat therapy stands as a valuable component of a multimodal approach to the management of musculoskeletal pain by virtue of multiple effects: pain relief, reduction of muscle spasms and stiffness, and enhanced muscle flexibility and range of motion. However, there is limited guidance on heat therapy use in routine practice, particularly on indications and contraindications, mode of application, and precautions. Such an educational gap has been documented among pharmacists. Therefore, it is paramount that pharmacists gain knowledge about when and how to effectively integrate superficial heat therapy with both pharmacological and physical therapy, to provide patients with a comprehensive, multimodal approach to alleviating musculoskeletal pain. A multidisciplinary panel of experts gathered to develop practical guidance on heat therapy-appropriate application in patients with musculoskeletal pain. In this work, we provide actionable suggestions to build pharmacists’ competency in managing musculoskeletal pain and empower them in effectively using heat therapy as a single therapeutic option or in combination with over-the-counter analgesics. Full article

Background/Objectives: This study identifies barriers to maternal and child healthcare access in Afghanistan under the Taliban and proposes solutions using the WHO Health System Building Blocks Framework. Methods: Midwives and mothers were recruited via chain-referral sampling. After obtaining IRB and the participants’ informed consent, in-depth virtual interviews, guided by Social Cognitive Theory, were recorded, transcribed, and analyzed using content analysis in MAXQDA 2020. Results: Data analysis revealed four primary consequences of the political unrest in Afghanistan that have exacerbated barriers to accessing maternal and child healthcare: (a) Taliban-imposed restrictions on women’s education and mobility, reducing female healthcare providers and limiting mothers’ access to care; (b) increased poverty, preventing women from attending perinatal visits due to out-of-pocket costs; (c) the deterioration of healthcare services, including medicine shortages, weakened health financing due to donor withdrawals, lack of insurance, and poor governance; and (d) the increased perpetuation of misinformation and harmful practices, such as the use of clergymen for medical advice instead of doctors. Using the WHO Health Systems Framework, we recommend solutions that address issues in service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. Conclusions: This is the first qualitative study capturing Afghan mothers’ and healthcare providers’ experiences under Taliban rule. Our findings can inform international efforts to advocate for women’s healthcare and education rights and guide global aid programs in strengthening Afghanistan’s healthcare system in alignment with Sustainable Development Goal 5. Full article

Introduction: Cognitive impairment (CI) is recognized as a very frequent feature of persons with multiple sclerosis (pwMSs). Multiple studies have demonstrated the effectiveness of cognitive rehabilitation (CR) in improving CI linked to cerebral functional connectivity facilitation and increased strategies to cope with daily living activities. Nevertheless, there is considerable heterogeneity in the methodologies and protocols proposed to pwMSs. Aim: This study aimed to establish a current state of CR for pwMSs, among different types of healthcare providers (HCPs) in France. Methods: A Web-based survey was conducted between March and September 2024 among HCPs involved in the care of pwMSs. Results: One hundred and one HCPs involved in the care of pwMSs participated in this survey. CR was considered efficient by 97% of HCPs, especially when multimodal. Based on the responses, CR is proposed mainly following cognitive complaints, for moderate or severe cognitive disorders, and at the onset of the disease (45%). HCPs mentioned several obstacles to the implementation of CR, notably the cost of remediation (37%), and the lack of availability of both professionals (58%) and patients (51%). Conclusions: This rehabilitation requires specific tools combined with psychoeducative advice provided by multidisciplinary HCPs. Full article

Objectives: Prolonged disorders of consciousness (DoC) present complex diagnostic and therapeutic challenges. This study aimed to evaluate the accuracy of two ChatGPT models (ChatGPT 4o and ChatGPT o1) in answering questions about prolonged DoC, framed as if they were posed by a patient’s relative. Secondary objectives included comparing performance across languages (English vs. Italian) and assessing whether responses conveyed an empathetic tone. Methods: Fifty-seven open-ended questions reflecting common caregiver concerns were generated in both English and Italian, each categorized into one of three domains: clinical data, instrumental diagnostics, or therapy. Each question contained a background context followed by a specific query and was submitted once to both models. Two reviewers evaluated the responses on a four-point scale, ranging from “incorrect and potentially misleading” to “correct and complete”. Discrepancies were resolved by a third reviewer. Accuracy, language differences, empathy, and recommendation to consult a healthcare professional were analyzed using absolute frequencies, percentages, the Mann–Whitney U test, and Chi-squared tests. Results: A total of 228 responses were analyzed. Both models provided predominantly correct answers (80.7–96.8%), with English responses achieving higher accuracy only for ChatGPT 4o on clinical data. ChatGPT 4o exhibited greater empathy in its responses, whereas ChatGPT o1 more frequently recommended consulting a healthcare professional in Italian. Conclusions: Both ChatGPT models demonstrated high accuracy in addressing prolonged DoC queries, highlighting their potential usefulness for caregiver support. However, occasional inaccuracies emphasize the importance of verifying chatbot-generated information with professional medical advice. Full article

Background: This study aims to evaluate the vaccination status of children with rheumatic diseases (RD) compared to healthy controls (HC) and immunization barriers, as studies examining the vaccination status and factors promoting or hindering vaccination among children RD remain limited. Methods: A cross-sectional study was conducted on children with RD (in a rheumatology clinic) and HC (in a fracture clinic) at a tertiary care center in Canada. Demographics, diagnosis, treatments, and vaccine status were obtained from health records and a provincial electronic vaccine database. A patient/caregiver questionnaire was used to capture perceived immunization barriers, concerns, and satisfaction. Descriptive statistical methods were used for analysis. Results: The study involved 144 children with RD and 111 HC. Data from 94 children with RD and 86 HC, all lifelong Alberta residents, were analyzed for objective vaccination status. Most vaccines were received at rates of 80% or higher, except the influenza vaccine, which had the lowest adherence (34% in RD vs. 21% in HC). In 31% of RD children, vaccinations were withheld due to active disease, healthcare provider advice, or caregiver concerns about side effects. In 27% HC, vaccinations were withheld due to side effects. Both groups primarily relied on their family doctor for vaccination information, and 85% or more expressed satisfaction with the information received. Conclusions: Most children with RD and HC received recommended vaccines, but influenza vaccination gaps were identified. Knowledge about vaccine contraindications in RD is well understood, but perceived safety concerns limit vaccination completeness. Healthcare providers, especially family doctors, pediatricians, and rheumatologists, should be providing education resources for vaccines and be proactive in discussing the safety and necessity of vaccinations. Full article

Background: A significant concern for patients with Inflammatory Bowel Disease (IBD) is predicting and managing disease flares. While healthcare providers rely on biomarkers, providing conclusive patient advice remains challenging. This review explores the role of lifestyle, psychological health, and environmental exposures in the prediction and management of IBD flares. Methods: This review followed PRISMA guidelines (2020). A structured search was conducted in PubMed for articles published between 2012 and 2024, using free and Medical Subject Heading (MeSH) terms for predicting factors in IBD. Inclusion criteria included studies reporting primary data on modifiable clinical or environmental predictors of IBD relapse, excluding studies on post-operative investigations, treatment cessation, and pediatric or pregnant populations. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the studies. Results: Out of 2287 identified citations, 58 articles were included. Several modifiable factors influencing disease flares were identified, including psychological stress, sleep disturbances, smoking, and nutrition. Poor sleep quality and mental health were linked to increased flare risks, while smoking was associated with higher relapse rates in Crohn’s disease. Environmental exposures, such as heat waves and high-altitude regions, also contributed. Predictive models integrating clinical, lifestyle, and psychological factors showed promising accuracy but require further refinement. Limitations of this review include the potential for publication bias, variability in flare definitions, and limited sample sizes Conclusions: Key predictors of IBD flares include dietary factors, psychological stress, poor sleep quality, and pharmacological influences. Personalized approaches integrating these predictors can optimize disease control and improve patient outcomes. Full article

Citizens Advice on Prescription (CAP), a Liverpool (UK)-based service, provides welfare advice and link worker social prescription support to people experiencing and at risk of experiencing financial or social hardship. CAP, which receives referrals from healthcare and third-sector services, aims to improve service users’ financial security, health, and wellbeing. A mixed-methods social return on-investment (SROI) analysis was used to evaluate this service. Between May 2022 and November 2023, a subset of service users (n = 538) completed the Short Warwick–Edinburgh Mental Wellbeing Survey (SWEMWBS) at baseline and a 2-month follow-up. Supporting quantitative and qualitative economic data were also collected (February 2023–February 2024) through semi-structured interviews (n = 16). Changes in social value were determined by comparing pre- and post-SWEMWBS scores. These scores were then mapped to monetary values using the Mental Health Social Value Bank (MHSVB). SROI ratios were then calculated by dividing the change in social value by the associated service provision costs. The mean social value change per person ranged from GBP 505.70 to GBP 697.52, and the mean service provision cost was GBP 148.66 per person. The overall study reported a positive SROI return range of GBP 1: GBP 3.40–GBP 4.69. The results indicate that non-clinical support services, like CAP, may be an effective intervention for addressing the wider determinants of health and wellbeing. Full article

Background/Objectives: Registered dietitian nutritionists (RDNs) are allied healthcare professionals who can help people with multiple sclerosis (MS) incorporate healthy eating, but little is known about their involvement in MS care. Thus, the objective of this survey was to investigate the perceptions and utilization of RDNs in MS care among multidisciplinary MS providers in the United States and Canada. Methods: An online survey was disseminated via the Consortium of MS Centers email listserv and MS-specific scientific conferences. The survey queried practitioner type, RDN referrals, the perceived benefits of RDNs in MS care, and the proportion of their patients who follow ‘MS diets’ or have nutrition-related issues. Reasons for or against RDN referral and beneficial resources were also queried. Results: Of the 60 completed surveys, respondents were primarily neurologists (n = 27, 45.0%). Most (n = 43, 71.7%) indicated that half or more of their patients inquire about diet, but n = 32 (53.3%) indicated that very few follow an ‘MS diet’ and n = 47 (78.3%) indicated that very few decline disease-modifying therapies to follow an ‘MS diet’. Most (n = 45, 77.6%) respondents indicated referring their patients to a RDN with lack of nutrition knowledge/general healthy eating advice (n = 34, 73.9%) and overweight/obesity (n = 31, 67.4%) as being the most common reasons for referral. RDNs were reported as being helpful or extremely helpful by n = 38 (84.4%) of respondents who reported referring to RDNs. Most (n = 46, 79.3%) indicated that their patients would benefit from having an RDN with MS-specialized training as a member of staff. Conclusions: MS care providers support the need for RDNs with specialized training in MS care. Full article

Objective: Malocclusion affects oral health and quality of life, emphasizing the critical need to assess the knowledge and practices of healthcare providers in the prevention and treatment of malocclusion. The aim of this cross-sectional study was to investigate the knowledge and practice of Croatian pediatricians and family physicians regarding malocclusion, its causes and its impact on children’s health. Methods: An online self-structured questionnaire with 34 closed-ended questions was distributed to pediatricians and general practitioners throughout Croatia. The questionnaire addressed demographic data, knowledge of the causes of malocclusion, impact on children’s health and referral practices. Data were summarized in descriptive statistics, and a generalized linear model (GLM) examined the relationships between knowledge, referral practices and sociodemographic factors (p < 0.05). Results: Of 446 participants, including 364 general practitioners and 82 pediatricians (77.8% women), the mean knowledge score was 12.77 ± 3.41 out of 18, with 54.9% scoring at or above the median (Md = 13.00). Pediatricians had a higher mean score (13.77 ± 1.19) than family physicians (12.54 ± 3.60, p = 0.042). A higher level of knowledge was found among physicians working in community health centers (p ≤ 0.001) and among those recommending orthodontic examinations (p = 0.042). Over 90% of pediatricians and family physicians recognized hereditary factors, pacifier use, thumb and finger sucking, bottle feeding, trauma and accidents as causes of malocclusion. In addition, over 80% of respondents reported informing parents about harmful habits that can lead to misaligned teeth, with 100% of pediatricians giving such advice. Conclusions: Pediatricians have better knowledge about malocclusion compared to family physicians, and physicians in community health centers have the highest level of knowledge. It is recommended to improve the training of general practitioners and to promote early orthodontic examinations to improve preventive care. Full article

Background/Objectives: Low- and no-calorie sweeteners (LNCSs) provide sweetness in food applications that are suggested to support consumers’ reduced consumption of caloric sweeteners and added sugar intake. Consumers seek guidance and advice on using LNCSs from healthcare providers, including dietitians and nutritionists. However, prior research suggests there may be inconsistent guidance on the use of LNCSs. The main goal is to assess dietitians’ and nutritionists’ perceptions and knowledge of LNCSs. We also evaluate the impact of educational intervention on the perceptions and knowledge of low- and no-calorie sweeteners (LNCSs) among healthcare professionals. Methods: Participants completed an online questionnaire on their perceptions of LNCSs before and after viewing a webinar given by a member of the FDA on the safety and approval process of LNCSs. A total of 187 participants completed the pre-questionnaire, and 58 participants completed the post-questionnaire. Results: The LNCSs most familiar to participants was aspartame, followed by stevia, with thaumatin, advantame, and neotame being the least familiar sweeteners. While all sweeteners were FDA-approved, there were differences in perceived safety and suitability for dietary use. Following the intervention, there was a significant improvement in the participant’s knowledge, understanding, and confidence in the safety and approval process of LNCSs and reduced negative perceptions of LNCSs on health. Conclusions: With nutritionists and dietitians being the primary sources of nutritional guidance, consumers may seek their recommendations regarding using LNCSs. However, this study revealed differences in suitability across FDA-approved LNCSs and a lack of confidence regarding the safety and approval process. Education programs regarding the safety and approval process of LNCSs increase confidence in advising patients and clients on the use of LNCSs. Full article