Search Results (1,562)

Surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in the environment is crucial for reducing its transmission, particularly in hospitals, nursing homes, and high-contact public areas. Rapid Point-of-Need (PON) tools at healthcare facilities, without involving prolonged bacterial culture in sophisticated laboratories, are needed for environmental surveillance of MRSA. We have developed a gold nanoparticle (AuNP)-based “Swab-and-Stain” assay for rapid and on-site detection of PBP2a-expressing MRSA from environmental surfaces. The assay utilizes anti-PBP2a antibody immobilized on cotton swabs to specifically capture PBP2a-expressing MRSA and anti-MRSA antibody conjugated on AuNPs to detect the captured MRSA on the swabs via sandwiched complex formation. In the presence of PBP2a-expressing MRSA, the swabs were stained in red, as seen with the naked eye. The color intensity of the stain can be quantified by smartphone image analysis for MRSA quantification. Using PBP2a-expressing MRSA samples spiked in real hospital sink and drain matrices, this pilot study demonstrated a “Swab-and-Stain” assay as a proof-of-concept method for detecting MRSA at a concentration as low as 12 CFU/mL. The assay was validated to specifically detect MRSA spiked in real hospital sink and drain matrices. This “Swab-and-Stain” assay provides a rapid, portable, and easy-to-use platform with potential application for PON environmental surveillance of MRSA. Full article

Background/objectives: This study aimed to identify and categorise the educational, training, and support needs of informal caregivers of stroke survivors in order to inform the development of an Immersive Virtual Reality (IVR) intervention within the European caregIVR project (Project No. 101129454; EU4Health Programme). Methods: A qualitative descriptive study was conducted using three focus groups involving informal caregivers, healthcare professionals and other stakeholders, and academics and healthcare students in Portugal (n = 33). Discussions explored everyday caregiving challenges, priority educational needs, and expectations regarding digital support tools. Data were analysed using qualitative content analysis with an inductive–deductive coding strategy supported by NVivo software (version 14). Results: Participants identified the transition from hospital to home as the most critical stage of the caregiving journey, characterised by poor continuity of care and insufficient preparation before hospital discharge. Major challenges included limited stroke-related health literacy, difficulties adapting the home environment, and substantial emotional, financial, and social burdens that frequently resulted in social isolation and caregiver burnout. Participants regarded IVR as a promising educational strategy for delivering practical, repetitive, and low-risk skills training. Conclusions: The findings suggest that caregiver empowerment should be promoted through progressive, person-centred, and non-judgemental educational programmes tailored to caregivers’ evolving needs. Caregivers should be supported by multidisciplinary teams capable of addressing the clinical, practical, and psychosocial complexity of post-stroke home care. Rather than replacing professional support, IVR should be considered a complementary educational tool with the potential to improve caregivers’ preparedness, confidence, and safety in the home-care setting. Full article

Background/objectives: Liver cirrhosis is a life-limiting, non-malignant condition with a high symptom burden, psychosocial challenges, and unpredictable disease trajectory. As such, patients with cirrhosis and their caregivers might benefit from palliative care (PC) interventions. However, in most clinical settings, PC is not yet an integral part of basic hepatology care. This scoping review aimed to map how patients with cirrhosis are identified for palliative care, which interventions are delivered, and which factors influence implementation. Methods: The review was conducted in accordance with Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. PubMed, CINAHL, and Scopus were searched. The initial search was conducted in November 2024 and updated in December 2025, June and August 2026. Quantitative, qualitative, and mixed-method studies involving adults (≥18 years) with liver cirrhosis, informal caregivers, and healthcare professionals were included. Data were charted descriptively and organized according to identification approaches, interventions, barriers, and facilitators. Results: In total, 39 studies were included. Patients were identified using identification tools, screening tools, clinical criteria, and prognostic scores. Interventions across inpatient, outpatient, and home-based settings included symptom management, prognostic communication, advance care planning, goals-of-care discussions, psychosocial support, and multidisciplinary collaboration. Overall, studies reported improvements in symptom management, communication, healthcare utilization, and informal caregiver outcomes. However, palliative care integration remained inconsistent and often occurred late. Key barriers included prognostic uncertainty, fragmented care pathways, limited training, and misconceptions about palliative care. Facilitators included education, structured assessment tools, and integration of palliative care into hepatology services. Conclusions: This review identified diverse approaches to patient identification and palliative care delivery, alongside key barriers and facilitators to implementation. Earlier integration of palliative care based on care needs, supported by communication, education, and interdisciplinary collaboration, may improve care for patients with cirrhosis. Full article

Background/Objectives: Complete postoperative recovery increasingly occurs after hospital discharge, particularly in the context of enhanced recovery after surgery (ERAS) programmes. However, patient-reported experience during the transition from hospital to home after digestive surgery remains poorly characterized. This study aimed to evaluate patient-reported experience and to explore its associations with perceived quality of recovery at discharge, surgical complexity, postoperative complications, and unplanned healthcare utilization. Methods: This study analyzed a prospective observational cohort of 361 adult patients undergoing elective digestive surgery at a tertiary care center. Patient-reported experience was assessed using an ad hoc structured questionnaire administered at discharge and 30 days later, covering discharge readiness, information, expectations, and support needs. Quality of recovery was assessed using the QoR-15 at discharge. Results: At discharge, 71% of patients reported feeling ready for discharge, whereas 41% agreed that they would have needed a longer hospital stay. At 30 days, 87% reported sufficient home-care information, 69% reported that recovery had met their expectations, 35% perceived discharge as premature, and 23% reported need to contact the hospital. Several ST-PREM domains assessed at discharge or during 30-day follow-up were associated with QoR-15 scores at discharge, with differences exceeding the 6-point minimal clinically important difference (MCID). No consistent differences in patient-reported experience were observed according to surgical complexity. Patients with postoperative complications or emergency department attendance reported less favorable recovery-related experience domains. Conclusions: Most patients reported favorable experiences during the hospital-to-home transition. However, a clinically relevant subgroup reported uncertainty, perceived premature discharge, or need for post-discharge support. Combining patient-reported experience measures with QoR-15 may help provide a more comprehensive evaluation of early postoperative recovery. Full article

Background/Objectives: Preterm birth remains a significant global public health challenge, associated with increased morbidity, rehospitalisation, and long-term vulnerability. The transition from the neonatal intensive care unit (NICU) to the home environment represents a critical phase. This practice-focused narrative review synthesises current evidence on community-based post-discharge follow-up for preterm infants, with particular emphasis on the complementary contribution of community health nursing and midwifery within multidisciplinary follow-up models, endocrine-metabolic surveillance and coordinated care for medically complex infants. Methods: A narrative synthesis of review articles, clinical guidelines, and empirical studies published between 2016 and 2026 was undertaken. Searches were performed in PubMed, Scopus, and CINAHL using terms related to preterm birth, NICU discharge, community follow-up, family-centred care, community health nursing, midwifery, and metabolic disorders. Results: Community-based, family-centred follow-up programmes are associated with improved continuity of care, increased parental confidence, enhanced breastfeeding outcomes, and reduced healthcare utilisation. Community health nurses, midwives and health visitors contribute complementary expertise within multidisciplinary follow-up by coordinating continuity of care, providing clinical surveillance of growth and feeding, supporting caregiver education, facilitating early identification of complications, and ensuring timely referral. However, endocrine and metabolic vulnerabilities remain underrepresented in many follow-up models, while infants with complex healthcare needs require individualised, risk-stratified surveillance. Conclusions: Community-based, interdisciplinary, and family-centred follow-up after NICU discharge is essential to enhance the quality and safety of care for preterm infants. Integrated, risk-stratified models of follow-up that combine preventive surveillance, family education, multidisciplinary coordination, and continuity of care may facilitate earlier recognition of complications and improve long-term outcomes. Full article

Background/Objectives: Human papillomavirus (HPV) causes several cancers in both females and males. In France, HPV vaccination coverage among adolescents remains suboptimal, particularly among boys, and knowledge about HPV infection and vaccination is limited. This study assessed HPV-related knowledge, attitudes, and vaccination uptake among adolescents attending Rural Family Homes (RFHs). Methods: A sequential mixed-methods study was conducted between September 2023 and June 2024 among 895 adolescents aged 15–19 years attending 19 RFHs in France. Participants completed an anonymous self-administered questionnaire assessing sociodemographic characteristics, general vaccination knowledge, HPV-related knowledge, vaccination status, and determinants of vaccine uptake. Focus groups involving 59 adolescents explored perceptions of, barriers to, and information needs regarding HPV vaccination. Quantitative data were analyzed using chi-square tests and multivariable logistic regression; qualitative data were analyzed thematically. Results: Overall, 44% of participants had received at least one HPV vaccine dose and 31% received at least two doses. Coverage was significantly higher among girls than boys (55% vs. 28%, p < 0.001). Only 35% demonstrated adequate HPV-related knowledge. Parents and general practitioners were the main information sources. Vaccination uptake was associated with favorable subjective norms, female sex, and the belief that vaccination reduces cancer risk. Qualitative findings revealed persistent misconceptions about HPV-related risks, particularly among boys, and a substantial need for reliable information. Conclusions: Adolescents attending RFHs showed limited HPV-related knowledge and suboptimal vaccination coverage, particularly boys. Parental support and healthcare professional recommendations were associated with vaccine uptake. Targeted educational interventions and catch-up vaccination strategies among this population are needed to improve coverage and reduce the burden of HPV-related diseases. Full article

Camera-based monitoring systems are increasingly adopted in healthcare settings for the continuous assessment of patient movement and activities. However, their technical performance under real-world indoor conditions remains insufficiently characterised, preventing appropriate selection when choosing cameras for clinical or home adoption and reproducibility. Existing validation studies typically assess either device metrological performance or algorithm accuracy in isolation, and often do not systematically account for practical deployment factors, such as lighting variability, occlusions, and camera positioning. To address this, we present two technical validation protocols that evaluate the same cameras at both the metrological and pose-estimation levels under systematically controlled deployment conditions rarely addressed together in prior work: the first evaluates the metrological performance of RGB and RGBD cameras, and the second assesses their use in supporting human pose estimation, validated using state-of-the-art pose estimators. The proposed protocols systematically assess five cameras (four RGBD and one RGB) under controlled variations in lighting, camera height, viewing angle, and occlusion level, within representative indoor scenarios. The experimental results show that metrological performance varies substantially across cameras, with depth bias at 5 m ranging from ∼10 mm to over 1400 mm depending on the device. For 2D pose estimation, all cameras achieve broadly comparable accuracy (mean mAP between ~78% and ~90%) across cameras and estimators, whereas 3D reconstruction error differs markedly across devices (MPJPE ranging from 104 mm to 365 mm), closely reflecting underlying depth sensing quality. Environmental factors have a camera- and estimator-dependent effect on 3D performance, while camera mounting height has minimal influence within the evaluated range. This work provides evidence-based guidance for the selection and deployment of cameras in healthcare monitoring applications, addressing an important gap in current technical validation practice. Full article

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) affects an estimated 6% of adults in the United States and contributes to a significant economic burden. Telehealth has emerged as a vital tool in the management of ADHD, offering improved access to care, especially for individuals in underserved communities. Despite its growing role, there remain critical gaps in understanding how social determinants of health (SDOH) are associated with disparities in telehealth utilization for ADHD treatment. Objectives and Methods: This study analyzed data from the National Center for Health Statistics (NCHS) Rapid Surveys System (RSS) Round 2: ADHD (October–November 2023), a nationally fielded survey of U.S. adults. Respondents were classified into three groups: never diagnosed, previously diagnosed, and currently diagnosed with ADHD. The study aimed to (1) compare the distribution of SDOH across ADHD status groups and the general adult population to identify factors associated with ADHD diagnosis; (2) assess the homogeneity of SDOH distributions across ADHD groups; (3) evaluate telehealth utilization among adults currently diagnosed with ADHD; and (4) examine the relationship between SDOH and telehealth use for ADHD treatment. Multivariable logistic regression (MVLR) served as a benchmark model, while machine learning (ML) models—including regularized linear regression, support vector machine (SVM), random forest (RF), LightGBM, multilayer perceptron (MLP), and Few-Shot Learning (FSL)—were trained to identify key predictors. Results: A total of 7009 survey responses were analyzed: 124 had a past diagnosis, 444 were currently diagnosed, and the remainder had never been diagnosed with ADHD, corresponding to a current ADHD prevalence of 6.3%. Adults with current ADHD were more likely to be male, single, younger, white, non-homeowners, and frequent users of online health resources. They also reported lower education, income, and financial security. About 70% used telehealth for counseling and prescriptions; insurance covered telehealth visits for 82.32% of users, yet 38.76% reported no coverage of ADHD-related diagnostic or treatment costs. Nineteen SDOH elements across four domains—demographic, socioeconomic, neighborhood/built environment, and healthcare access—were identified as predictors. ML models outperformed MVLR, with SVM and FSL achieving the highest F1 (both 0.63), and FSL the highest recall (0.69). Age, race, marital status, difficulty paying bills, home ownership, education, and household size were the most consistently important variables. Limitations: This study is limited by a cross-sectional design, reliance on self-reported ADHD diagnoses, and a lack of genetic or family-history measures. Additionally, the omission of complex sampling weights limits the national representativeness of these findings. Finally, the small effective sample size poses risks of model overfitting, and the generalizability of the models could not be externally validated due to the unavailability of comparable independent datasets. Conclusions: Despite widespread internet access, disparities in telehealth use for ADHD persist. Among 19 SDOH predictors, age (aOR = 0.56), difficulty paying medical bills (aOR = 2.52), and race (aOR = 1.37) were significantly associated with telehealth use, and all ML models outperformed the MVLR benchmark, though bootstrap CIs overlapped. Future research should incorporate inclusive data collection and stratified modeling to better represent disadvantaged populations and inform equitable access strategies. Full article

Background: Individuals with inflammatory bowel disease (IBD) are at substantially increased risk for Clostridioides difficile infection (CDI), which leads to significantly higher morbidity and mortality compared to the general population. However, comprehensive national-level analyses of long-term mortality trends in this population remain limited. This study examines mortality trends associated with IBD and CDI in the United States from 1999 to 2023. Methods: This descriptive study utilized the CDC WONDER Multiple Cause-of-Death database. Deaths involving IBD (ICD-10: K50, K51) and CDI (A04.7) were identified among adults aged 25 years and older. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated with 95% confidence intervals and stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was applied to estimate the annual percent change (APC) in mortality. Results: Between 1999 and 2023, 76,084 deaths were recorded. Medical facilities accounted for 46% of deaths, followed by decedents’ homes (28.3%) and nursing home/long-term care facilities (16.5%). Overall mortality declined gradually from 1999 to 2018 (APC: −0.23, p < 0.05), increased sharply through 2021 (APC: +12.75, p < 0.05), and was then followed by a non-significant change through 2023 (APC: −2.69; 95% CI: −8.24 to 3.19), consistent with a plateau. Men consistently exhibited higher AAMRs than women. Non-Hispanic White individuals had the highest AAMRs (1.844 in 2023), while Non-Hispanic Black individuals experienced a sustained increase from 2016 onward (APC: +7.11, p < 0.05). Hispanic mortality increased steadily throughout the study period (APC: +1.31, p < 0.05). Rural populations had higher overall AAMRs than urban populations. The Midwest recorded the highest regional AAMRs by 2023 (1.867). Conclusions: Mortality increased significantly between 2018 and 2021, coinciding with the COVID-19 pandemic, though our study design cannot prove causation. Disparities by race/ethnicity, urbanization, and region persisted. These findings underscore the need for ongoing antibiotic stewardship, equitable healthcare access, and targeted public health interventions for this vulnerable population. Full article

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse reactions to low-level environmental chemicals, often resulting in multisystem symptoms triggered by volatile organic compounds (VOCs) emitted from fragranced personal care and household products. The condition raises public health and accessibility concerns, as people with MCS may face barriers to accessing workplaces, healthcare settings, educational institutions, and other public environments. This descriptive cross-sectional study aimed to characterize the chemical exposures participants attributed to the onset of MCS and to subsequent symptom provocation, and to describe the associated symptom patterns. A cross-sectional survey was administered to Canadian residents aged 18 years or older, living with MCS for at least 1 year, with 18 questions assessing exposure history and onset of MCS and symptom provocation. A total of 119 participants completed the survey. Participants most frequently attributed the onset of MCS to the workplace (55%) or home (35%), with (61%) reporting ongoing exposures over time as the most frequently reported circumstance associated with onset. Fragranced products, including perfumes, air fresheners, cleaning products, disinfectants, construction materials, and laundry products, were the exposures most frequently reported in relation to both onset and subsequent symptom triggering. Symptoms involved multiple organ systems, with nearly one-third of participants reporting 11 or more symptoms; cognitive and respiratory symptoms were most prevalent. Nearly three-quarters of participants (74%) reported symptoms associated with third-hand exposure, and 51% reported discarding contaminated items, suggesting that third-hand exposure may represent an underrecognized pathway for symptom provocation. 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

Background: Poor adherence to home exercise programs is a persistent challenge in physical rehabilitation and beyond. Data suggest that follow-up telehealth visits featuring behavior change techniques can improve adherence. However, the optimal frequency of behavioral support for effective self-management of technology-enabled home exercise programs remains unclear. This paper investigates how adherence to home exercise varies with the number of follow-up visits holding the type of exercise constant and measuring adherence objectively. Methods: A secondary analysis of adherence was conducted on participants from the VIGOROUS five-site, single-blind, and randomized controlled trial. Chronic (>6 months) community-resident stroke survivors with mild-to-moderate upper extremity hemiparesis (n = 111) were assigned 15 h of asynchronous video game-based home exercise over 3 weeks. Participants received behavioral support during (a) one single in-person session, (b) four in-person sessions, or (c) four in-person sessions plus six remote teleconsultations. Each consultation incorporated standardized behavior change techniques—contracting, feedback, self-monitoring, action planning, and guided problem solving—to promote increased paretic arm use during daily activities. The primary outcome was adherence (minutes exercising), objectively captured by the gaming system for 87 participants. Results: Six telehealth visits with remote therapeutic monitoring (RTM) increased home exercise completion by 3.3 h [95% CI: 0.008, 6.60]; each remote or in-person consultation was associated with an estimated 34 min of additional asynchronous home exercise. Conclusions: RTM, which does not require travel to a healthcare facility, is a time-efficient modality to enhance therapeutic engagement. Behaviorally focused telehealth visits boost stroke survivors’ adherence to a structured home exercise program. Full article

Background: In line with international aging policies, most people with dementia receive care at home. Community-based respite services aim to relieve, support, or share caregiving responsibilities. More person-centered knowledge based on experiences from this group is needed to increase informed decisions about planning of qualitative respite care. The aim of this study is to describe how people with dementia experience respite care with alternating housing, i.e., living partly at home, partly in residential care, refer to their everyday life and well-being. Methods: A mixed-methods design was used. The qualitative approach focused on variations of dilemmas in interviews with people with dementia who were granted and received respite care (n = 8). Also, a quantitative approach focused on quality of life using behavioral and psychological symptom scores. Results: Everyday life at the respite care accommodation described by people with dementia included morning routines, variation in the environment, activities in the company of roommates, but also a lack of activities. Social belonging was described by people with dementia through living with roommates and through social contact with the healthcare staff. Quality of life and behavioral and psychological ratings varied between individuals and settings, but no consistent pattern was identified. Conclusions: Respite care appears to maintain a high quality of life and a low level of psychological symptoms for most of the people with dementia. Although the sample was small, these results are nevertheless an important contribution to the phenomenon, experiences of respite care by people with dementia, that need further research. Furthermore, these results can give decision-makers guidance for professional care efforts. Full article

Background: Acute kidney injury (AKI) is a common complication following cardiac surgery and is associated with increased morbidity and mortality. Contemporary national estimates of its clinical and economic burden in the United States remain limited. Methods: We conducted a retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS) for 2022–2023. Adult hospitalizations undergoing coronary artery bypass grafting (CABG), valve surgery, or combined CABG and valve surgery were identified using ICD-10-PCS codes. Hospitalizations with end-stage kidney disease were excluded. The primary exposure was AKI. Outcomes included in-hospital mortality, length of stay (LOS), non-home discharge, and hospitalization cost. Survey-weighted multivariable regression models were used to evaluate the independent association between AKI and study outcomes. Results: The final cohort included 133,801 hospitalizations, representing an estimated 669,005 cardiac surgery hospitalizations nationally. AKI occurred in 123,240 weighted hospitalizations (18.4%). Compared with hospitalizations without AKI, those with AKI had higher unadjusted mortality (7.21% vs. 0.71%), longer LOS (14.4 vs. 6.3 days), greater rates of non-home discharge (68.1% vs. 41.2%), and higher hospitalization costs ($97,452 vs. $56,253). After adjustment for demographic, socioeconomic, clinical, and procedural characteristics, AKI remained independently associated with in-hospital mortality (adjusted odds ratio [aOR] 9.91, 95% confidence interval [CI] 8.95–11.00), non-home discharge (aOR 2.52, 95% CI 2.42–2.63), prolonged LOS (adjusted rate ratio [aRR] 1.88, 95% CI 1.85–1.91), and increased hospitalization costs (cost ratio 1.59, 95% CI 1.56–1.61). AKI was associated with an adjusted incremental cost of $33,497 per hospitalization, corresponding to an estimated national attributable cost burden of $4.13 billion during the study period. Conclusions: AKI complicates nearly one in five cardiac surgery hospitalizations in the United States and is associated with substantially increased mortality, healthcare utilization, and hospitalization costs. These findings highlight the significant clinical and economic burden of cardiac surgery–associated AKI and support continued efforts to improve prevention, risk stratification, and perioperative management. Full article

Background: This single-site qualitative interview study sought the opinions of 15 stakeholders from a nursing home based in the United Kingdom (UK) about identification and management of comorbidities in residents with dementia. Methods: Stakeholders were recruited through one of the nursing home owners, who acted as the gatekeeper. No residents with dementia were interviewed. Semi structured interviews were conducted online via Microsoft Teams in 2024. Data was analyzed using thematic analysis. Results: Stakeholders comprised four care assistants; three well-being companions; two nurses; a general practitioner (GP); two informal caregivers; a chaplain; the manager; and the owner of the nursing home. Stakeholders perceived that the identification and management of comorbidities in residents with dementia were shaped by interacting factors across four domains: the wider healthcare context, nursing home organization, staff capability and care practices, and resident-related challenges. Perceived healthcare under-resourcing increased complexity, while coordinated teamwork, continuous improvement, staff well-being, geriatric expertise, and person-centred, inclusive care were viewed as key facilitators. Conclusions: Overall, the perspectives of stakeholders interviewed in this single-site case study suggest that improving the identification and management of comorbidities in residents with dementia requires multilevel interventions that strengthen staff capability, organizational practices, and integration between nursing homes and the wider healthcare system. Full article