Search Results (115)

Student dropout remains a critical challenge in higher education, especially within public universities that serve diverse and vulnerable populations. This research presents the design and evaluation of an early warning system based on an XGBoost classifier, trained exclusively on data collected at the time of student enrollment. Using a retrospective dataset of nearly 40,000 first-year students (2014–2024) from a Mexican public university, the model incorporated academic, socioeconomic, demographic, and perceptual variables. The final XGBoost model achieved an AUC-ROC of 0.6902 and an F1-score of 0.6946 for the dropout class, with a sensitivity of 88%. XGBoost was chosen over Random Forest due to its superior ability to detect students at risk, a critical requirement for early intervention. The model flagged 59% of incoming students as high-risk, with considerable variability across academic programs. The most influential predictors included age, high school GPA, conditioned admission, and other family responsibilities and economic constraints. This research demonstrates that early warning systems can transform enrollment data into timely and actionable insights, enabling universities to identify vulnerable students earlier and respond more effectively, allocate support more efficiently, and enhance their efforts to reduce dropout rates and improve student retention. Full article

Background/Objective: Pregnancy-related acute kidney injury (PRAKI) remains a serious complication, with high rates of maternal morbidity and mortality, particularly in developing countries where delayed diagnosis and treatment are common. This study aimed to determine the proportion, associated risk factors, and maternal outcomes among pregnant and postpartum women at high risk of developing AKI. Methods: This cross-sectional analytical study was conducted at Bugando Medical Centre in Mwanza, Tanzania, from May 2023 to February 2024, targeting high-risk obstetric patients. Results: Out of 4588 admissions, 420 patients were identified as being at risk of developing PRAKI. Among them, 101 (24.22%) were diagnosed with PRAKI, while 316 (75.78%) did not develop the condition. The leading associated risk factors were pre-eclampsia (40.59%) and postpartum hemorrhage (PPH) (40.24%), followed by sepsis (11.8%) and abortion-related complications (5.94%). Multivariate analysis revealed that living in rural areas and having a lower level of education were significantly associated with PRAKI. Patients from rural areas had an adjusted odds ratio (AOR) of 5.37 (p < 0.001), while those with informal or primary education had an AOR of 4.21 (p = 0.048). Conclusions: The study also found that maternal mortality was significantly higher among patients with PRAKI, particularly those affected by PPH. These findings highlight the urgent need for improved management of obstetric emergencies to reduce PRAKI incidence and improve maternal outcomes in high-risk populations. Full article

Older adults, aged 65 years and older, develop and experience frailty at different rates. Yet, this heterogeneity is not well understood, nor are the factors, such as geographical residence, that influence different frailty trajectories and subsequent healthcare outcomes. We aim to identify factors that impact older adult frailty trajectories, skilled nursing facility (SNF) placement, and death. Medicare beneficiaries ≥ 65 years from the National Health and Aging Trend Study (2011–2021) with complete data using Fried’s frailty phenotype on ≥ 2 occasions (n = 6082) were included in the analysis. Rural/urban residence was defined using Office of Management and Budget criteria. Latent class growth analysis (LCGA) helped identify four frailty trajectories: improving, stable, mildly worsening, and drastically worsening. Cox proportional hazard analysis and logistic regression determined the association of social determinants of health (sex, race/ethnicity, education and income level, healthcare and transportation access, and social support) on death and SNF admission, respectively. The mean age was 75.12 years (SE 0.10); 56.4% female, 18.6% (n = 1133) rural residence. In the overall sample, 1094 (23.0%) older adults were classified as robust, 3242 (53.0%) as pre-frail, and 1746 (24.0%) as frail. Urban residence did not modify the relationship between frailty trajectories and SNF placement, nor did geographic residence on death. Higher income was associated with lower odds of a worse frailty trajectory, SNF admission, and a lower hazard of death, all reaching statistical significance. Future work should examine the factors that influence older adult participation in research and the impact of standardizing the definition of geographic rurality on older adult frailty and health outcomes. Full article

This research investigates higher education admission outcomes at Hungarian universities for ethnic Hungarian minority students residing in countries within the Carpathian Basin. The region is distinguished by a variety of national policies that impact minority education. By analyzing extensive data on the availability of mother tongue education, the status of minority rights, advanced level examination performance, and types of settlement using a wide range of statistical methods, our study reveals significant cross-national differences in the distribution of admission scores and central tendencies. Compared to lower and more varied scores for students from Ukraine and Romania, ethnic Hungarian students from Serbia and Slovakia achieved high average admission scores. Performance was notably more consistent among students from EU member states compared to non-EU regions, strongly linking outcomes to the more robust implementation of minority rights and better access to mother-tongue education within the EU framework. A critical finding is the strong positive correlation (Pearson r = 0.837) between admission scores and advanced level examination results, highlighting the pivotal role of these exams for the academic progression of these minority students. The Jonckheere-Terpstra test (p < 0.05) further confirmed significant performance differences between ranked country groups, with Serbian and Slovak students generally outperforming their Ukrainian and Romanian counterparts. Counterintuitively, settlement type (urban vs. rural) exhibited a negligible relationship with admission scores (r = 0.150), explaining only 2% of score variability. This challenges common assumptions and suggests other factors specific to the Hungarian minority context are more influential. This study provides crucial insights into the complex dynamics influencing Hungarian minority students’ access to higher education, underscoring cross-country educational inequalities, and informing the development of equitable minority rights and mother-tongue education policies in Central Europe for these often-marginalized communities. Full article

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and hospital-related variables in patients with TBI across two tertiary care centers in Eastern Europe, a region that remains underrepresented in the literature. Methods: A retrospective observational study was conducted using data from 119 TBI patients admitted between March 2020 and June 2023 at Cluj County Emergency Hospital (Romania) and Saint Vincent Hospital (Poland). GCS scores were analyzed as both categorical and continuous variables. Statistical analyses included Wilcoxon and Kruskal–Wallis tests for group comparisons and Spearman correlations for continuous variables. Results: Most patients included suffered a mild TBI (GCS score between 13 and 15). There were significant associations between GCS scores and post-traumatic amnesia (p < 0.05), discharge status (p < 0.01), discharge destination (p < 0.01), and education level (p < 0.01). GCS scores at admission were linked to survival, absence of post-traumatic amnesia, higher education levels, and home discharge. No significant differences observed across sex, residence, employment status, injury type, cause, or mechanism of injury. A weak but significant negative correlation was observed between GCS and length of hospital stay (rho = −0.229, p > 0.05), while age showed a non-significant correlation. Conclusions: The GCS score at admission is significantly associated with various clinical and socio-demographic outcomes in TBI patients, supporting the utility of the GCS score as a prognostic tool. The predominance of mild cases and the absence of radiological data, such as cerebral contusions or epidural or subdural hematomas, limit the generalizability of the findings. Further studies with larger samples and comprehensive imaging data are necessary to validate these findings. Full article

Background/Objectives: Diabetic foot (DF) is among the leading causes of diabetes-related disability. It is important to maintain regular follow-up and patient education in the prevention and treatment of DF ulcers. In extraordinary situations such as a pandemic, there are disruptions in regular clinical follow-up and patient education, and the effects of this disruption need to be investigated. The aim of this study was to investigate the impact of the pandemic on the clinical condition of patients hospitalised for DF. Methods: Patients were divided into two groups according to the date of admission to the clinic: the pre-pandemic (1 January 2019–11 March 2020) and the pandemic period (12 March 2020–1 June 2021). Comparisons were made between the two groups in terms of DF data and clinical parameters. Data were analysed with SPSS using chi-square, Student’s t-test and Mann–Whitney U analysis. Results: As a result of the screening, data from 125 DF patients (45 pre-pandemic and 80 pandemic) were collected. The DF stage, according to the Wagner classification, was significantly more advanced in patients during the pandemic period (p = 0.015). However, the time between the onset of symptoms and hospitalisation was longer for patients during the pandemic period (p = 0.035). When analysing treatment outcomes, the rate of wound healing was found to be lower (62.2% vs. 30%), and the rate of transtibial amputation was higher (11.2% vs. 20%) during the pandemic period (p = 0.002). Conclusions: This study found that the number of patients hospitalised for DF increased during the pandemic period, as did the severity of the wound, length of admission and radical treatment interventions. Full article

Background: This study investigated the prevalence and predictors of burnout among medical students at “Dunărea de Jos” University of Galați, Faculty of Medicine and Pharmacy. Methods: Burnout was measured using the School Burnout Inventory-U 9 (SBI-U 9), and potential predictors, including social media addiction (Bergen Social Media Addiction Scale—BSMAS), procrastination, age, gender, year of study, admission grade, last annual grade, hobbies, achievements, close friends, and relationship status, were assessed using appropriate instruments. Correlation and hierarchical multiple regression analyses identified predictors of burnout. Mediation analysis tested procrastination as a mediator between BSMAS and burnout, while moderation analysis examined whether procrastination moderated this relationship. Results: Social media addiction was an independent predictor of burnout. While younger age was correlated with higher burnout, it was not a significant predictor in the multivariate model. Procrastination did not significantly mediate the link between social media addiction and burnout but significantly moderated it. The effect of social media addiction on burnout was stronger for students with lower levels of procrastination. Conclusions: The study shows increased susceptibility to burnout among younger students and identifies social media addiction as a key risk factor. Procrastination moderates this relationship, indicating the need for interventions targeting both digital habits and time management in medical education. Full article

This study aims to explore the associations between menstrual health, lifestyle behaviors, biological traits, and coping strategies among female students at a Vietnamese medical university. A cross-sectional survey was conducted among 884 female students across five academic majors. Data on demographics, menstrual patterns, biological characteristics, lifestyle behaviors, and coping mechanisms were collected. Statistical analyses included descriptive statistics, correlation, and logistic regression to identify significant predictors of self-reported menstrual changes post university admission. Of the 884 participants, 49.8% reported menstrual changes after entering university. Among the lifestyle-related factors, increased daily electronic use (mean = 5.83 h) and later bedtimes (mean = 23:58) were associated with menstrual change (p < 0.01). Older age and higher academic year emerged as significant predictors of menstrual changes (p < 0.001). Additionally, students with blood groups A and B exhibited a higher risk compared to those with group O (p < 0.05), and Rh-positive status was also significantly associated with menstrual changes (p = 0.05). In terms of knowledge and coping practices, students who had premenstrual syndrome awareness since school were significantly less likely to report menstrual changes (p = 0.003). Although use of pain relief, particularly painkillers, correlated with higher reported pain severity, it was not directly linked to menstrual change. On the other hand, clinic consultations were positively associated with menstrual changes (p = 0.003), while students who relied on their mothers as counselors exhibited a protective association (p = 0.001). Menstrual health in university-aged women is influenced by a complex interplay of lifestyle behaviors, biological traits, and menstrual knowledge. Early education and structured coping support may serve as protective factors. The findings call for targeted menstrual health programs in university settings. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterised by frequent exacerbations, which contribute to increased healthcare utilisation and reduced quality of life. Knowledge about the disease is generally associated with better outcomes. This study examined the association between COPD knowledge levels and healthcare utilisation (including hospital readmissions) in patients hospitalised for acute exacerbations. Methods: This prospective observational study included 78 patients hospitalised for COPD exacerbations and classified as Group D according to the updated GOLD criteria 2021. The Bristol COPD Knowledge Questionnaire (BCKQ) was administered prior to discharge to evaluate patients’ knowledge levels. Data were collected about emergency department visits, hospitalisations, and intensive care unit (ICU) admissions for a six-month follow-up period. Statistical analyses assessed the relationships between BCKQ scores, patient outcomes, and risk factors influencing hospital readmissions. Results: The median BCKQ total score was 23 (6–40). A strong correlation was found between higher BCKQ scores and more visits to the emergency room (p = 0.005), especially in the subdomains of epidemiology (p = 0.010), aetiology (p = 0.033), and dyspnoea (p = 0.042). Higher antibiotic knowledge scores were associated with ICU admissions (p = 0.019). Logistic regression analysis revealed that domiciliary NIV use (OR = 2.60, p = 0.041) and higher BCKQ scores (OR = 1.10, p = 0.010) were significant predictors of hospital readmissions. However, no significant relationship was found between survival and BCKQ or mCCI scores (p > 0.05). Conclusions: This study indicates that while increased COPD knowledge is associated with greater healthcare utilisation, it does not directly translate into improved clinical outcomes. These findings underscore the importance of integrating practical skills and behaviour management into educational programmes to help patients effectively apply their knowledge. Further research is needed to explore long-term implications and strategies to optimise knowledge-based interventions. Full article

Background/Objectives: Multidisciplinary TAVI programs are focused on improving patient-centred care. We compared outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) within a multidisciplinary programme including a nurse with those of patients in the standard programme. Methods: This single-centre observational retrospective study includes patients with severe aortic valve disease and a TAVI indication, with the goal of comparing a nurse programme with standard practice. In the TAVI nursing programme, the nurse has several key roles: patient and family education, comprehensive assessment and procedure planification, patient and family accompaniment, complications detection during admission and follow-up, and patient experience evaluation in the post-procedure period. Results: 154 patients were included: 87 in the nurse programme and 67 in standard practice groups, respectively. Men comprised 52.6%, with an average age of 81 years. Both groups achieved high procedure success without differences in mortality during admission and follow-up (median 13.4 months). The nurse programme group showed better functional class more frequently and had significantly fewer emergency department visits (11.8% vs. 31.3%) and less frequency of readmission (1.2% vs. 23.4%). The TAVI nurse group reported significantly higher overall satisfaction with the process (9.8 vs. 8.9 scores), with the information received and the nurse treatment being the best rated items. Conclusions: A multidisciplinary programme for patients undergoing TAVI, coordinated by nurses and based on comprehensive attention that places the patients at the centre of the process, is feasible and shows high patient satisfaction. Full article

The medical profession is a prestigious position that requires very extensive higher education, to which only a small proportion of applicants are accepted. Changes in selection criteria can profoundly impact applicants’ pre-educational choices, early medical studies, and the characteristics of future medical professionals. This study assesses the impact of changing the admission requirements of medical schools in Finland. We examined two cohorts of students admitted to the University of Oulu’s medical school: 2009–2011 (n = 316) and 2013–2015 (n = 339). The first cohort prepared for the entrance exam with a field-specific book, while the second cohort focused on secondary school subjects such as biology, chemistry, and physics. We analysed the effects of the changes on accepted students’ profiles and the relationship between their prior performance, entrance exam success, and performance in medical studies. Changing the entrance exam content did not significantly alter accepted students’ profiles or ease access for recent matriculants. However, minor changes in correlations between prior performance, entrance exam performance, and medical study success were observed. The entrance exam’s predictive power for academic success was weak in both admission periods. This comparative study found that changing the entrance exam material did not notably influence the characteristics of accepted students. The changes to the selection criteria appear to have a minor impact on the actual success of students studying medicine. Regardless of the selection criteria, those who are accepted typically demonstrate strong learning capabilities. Despite modifications in the required entry-level knowledge, students with strong skills are admitted. Full article

Background/Introduction: Undernutrition’s impact on healthcare utilisation across age groups and care settings remains underexplored, particularly in Asian contexts. This study investigated the dynamic association between nutritional status and healthcare utilisation among community-dwelling adults in Singapore and assessed whether age modified this relationship. Methods: The study sampled 1703 adults enrolled in the Population Health Index study. Nutritional status was assessed annually using the Mini Nutritional Assessment, and healthcare utilisation data—across primary care, specialist outpatient clinics (SOCs), emergency departments (EDs), day surgeries, and inpatient admissions—were extracted from administrative databases. Negative binomial regressions with interaction terms using longitudinal panel data were conducted to examine age-modified effects. Results: At baseline, 9.7% of participants were classified as undernourished, with a higher prevalence in older adults (15.0%). Key risk factors for undernutrition included female sex, unemployment, financial inadequacy, currently smoking, lack of formal education, and multimorbidity. Undernutrition was associated with increased ED visits (IRR 1.41, AME: 0.35) and inpatient admissions (IRR 1.52, AME: 0.42). Among older adults, undernutrition was associated with less primary and specialist care (IRR: 0.72 and 0.57), while younger undernourished adults had more SOC visits (AME: 0.46). Older undernourished adults had 0.46 more ED visits and 0.47 more inpatient admissions on average in one year, though these increases did not differ from younger adults (interaction p > 0.05). Conclusions: Undernutrition is associated with increased ED visits and inpatient admissions, especially in older adults. Integrating nutritional screening and targeted interventions into community and primary care may help reduce preventable hospitalisations in high-risk populations. Full article

Background: Psychosis is one of the leading causes of disability worldwide. Individuals with early-onset psychosis (EOP) tend to experience a worse prognosis and shorter life expectancy. The etiology of EOP remains unclear, but epigenetic mechanisms are known to serve as the interface between environmental exposures and biological processes to better understand its etiology. Objectives: We characterized the sociodemographic and clinical characteristics, as well as genome-wide epigenetic markers, in Mexican patients with EOP. Methods: We estimated epigenetic age, performed an epigenome-wide association study, and finally developed an epigenetic risk score (MRS) to predict manifestations of psychosis. Results: We found that patients with EOP have a higher epigenetic age using Wu’s clock (p = 0.015). Moreover, accelerated epigenetic age was correlated with chronological age (PedBE clock, p = 0.046), global functioning (Wu’s clock, p = 0.027), and psychiatric admissions (DNAmTL, p = 0.038). In addition, we observed that a reduction in years of schooling is associated with an increase on epigenetic age (Levine’s clock, β = 5.07, p = 0.001). In our epigenome-wide association study, we identified eight CpGs associated with EOP. Noteworthy, a psychosis-methylation risk score (EOP-MRS) was associated with panic disorder (β = 1.36, p = 0.03), as well as auditory (β = 1.28, p = 0.04) and visual (β = 1.22, p = 0.04) hallucinations. Conclusions: Years of education have an impact on epigenetic age. Additionally, our study suggests associations of DNA methylation with EOP. Finally, we developed an MRS that associates clinical manifestations of psychosis. Full article

Background and Objectives: Priapism is a condition characterized by a prolonged erection lasting over four hours, either independent of or following sexual stimulation. The primary treatment goal for ischemic and non-ischemic priapism is timely and appropriate intervention in order to preserve erectile function and penile length. This study aims to evaluate the management of recurrent ischemic priapism in sickle cell disease (SCD) patients in an endemic region and compare it with ischemic priapism of other etiologies. Materials and Methods: Patients admitted to our hospital with a diagnosis of priapism between January 2010 and June 2024 were retrospectively reviewed. The patients were divided into two groups: ischemic priapism due to SCD and ischemic priapism due to other etiologies. Patient characteristics, treatment management, and the need for penile prosthesis (PP) were compared. Results: A total of 40 ischemic priapism patients were included in the study; 20 of them had SCD and the other 20 had priapism cases due to different etiologies. In the SCD priapism group, the rate of comorbidity and previous history of priapism were significantly (p < 0.05) higher than in the other etiologies of priapism group. Similarly, in the SCD priapism group, the hospital admission time and the rate of fibrosis findings in MRI (magnetic resonance imaging) were significantly (p < 0.05) higher than in the other priapism groups. The PP implantation rate in the SCD priapism group was found to be significantly (p < 0.05) higher than in the other priapism group. Conclusions: This study highlights the importance of early intervention and patient awareness in SCD-related ischemic priapism, recommending educational programs to improve symptom recognition and prevent complications. Full article

Background/Objective: To address the growing demand for mental health services, Nova Scotia Health introduced the Rapid Access Stabilization Program (RASP) through its Mental Health and Addictions Program (MHAP) in April 2023. RASP is designed to help reduce long wait times, frequent emergency department visits, and admissions to provide early intervention for individuals experiencing mental health problems. The RASP focuses on rapid access and early mental health intervention, aiming to prevent the worsening of patients’ symptoms, improve access to psychiatric care, and reduce service pressures on programs like the Community Mental Health Program (CMHP), which provide more extended, ongoing mental health support. This study compared participants’ sociodemographic and clinical profiles in the RASP and the CMHP. Methods: Data were collected from 1392 participants accessing mental health support either through the RASP or CMHP. A comparative analysis of sociodemographic factors (e.g., age, education, and income) and clinical characteristics (e.g., depression, anxiety, resilience, and substance use) was conducted. Chi-square tests and independent sample t-tests were used to evaluate the mean differences between the groups. Results: Significant sociodemographic and clinical differences emerged between the RASP and CMHP participants. The RASP group was older (M = 40.10 vs. 34.52 years) and more socioeconomically stable, with higher rates of employment (55.3% vs. 47.9%) and homeownership (36.5% vs. 17.7%). In contrast, the CMHP group had higher unemployment (25.7% vs. 16.5%) and lower income levels, with 47.5% earning <CAD 29,590 compared to 30.3% in the RASP group. Clinical profiles differed markedly: depression was more prevalent in the RASP (48.2% vs. 19.3%), whereas the CMHP had higher rates of psychosis (10.6% vs. 2.5%) and substance use disorder (7.8% vs. 1.9%). The RASP participants exhibited higher anxiety (GAD-7: M = 14.17 vs. 11.81) and depression symptoms (PHQ-9: M = 16.62 vs. 14.20) but lower resilience (BRS: M = 2.47 vs. 2.77). The CMHP participants had more adverse childhood experiences (ACE: M = 3.92 vs. 3.16) and lower suicidal intent (81.4% vs. 99.4% had no intention to act). Conclusions: The findings highlighted the unique profiles between the RASP and CMHP participants, suggesting the need for program-specific interventions. While the CMHP participants may benefit from integrated social support and trauma-informed care, the RASP participants may require cognitive behavioral therapy and resilience-building interventions. Tailoring mental health services to meet these unique needs could enhance program effectiveness and patient outcomes across both groups. Full article