Search Results (9,860)

An ultrasound-assisted extraction method combined with response surface methodology was applied to optimize the extraction of phenolic compounds and evaluate the antioxidant capacity of Ferula communis inflorescence. Response surface methodology with a central composite design was used to optimize the process. As independent variables, ethanol concentration (40–80% v/v), solvent-to-sample ratio (10–40 mL/g), and extraction time (14–30 min) were assessed. A solid-to-liquid ratio of 19 mL/g, a 60% ethanol concentration, and a 23 min extraction duration were the ideal extraction parameters. The extraction yield, total phenolic content (TPC), total flavonoid content (TFC), and DPPH radical scavenging capacity (IC₅₀) were predicted to be 18.91%, 34.93 mg GAE/g, 18.03 mg QE/g, and 0.58 mg/mL, respectively, under these optimized conditions. The efficacy of the central composite design in optimizing polyphenol extraction from F. communis was validated by experimental results that closely matched the predicted values. Eleven phenolic compounds were identified by HPLC-DAD, with pyrogallol and kaempferol being the most prevalent components. These results suggest that F. communis may represent a promising source of bioactive compounds with potential antioxidant applications. Full article

Background: Menopause represents a critical physiological transition associated with hormonal changes that influence both metabolic health and quality of life (QoL). Metabolic dysfunction-associated steatotic liver disease (MASLD), a common metabolic condition, is closely linked to menopause; however, its independent contribution to QoL impairment remains unclear. This study aimed to investigate the interplay between menopausal status, metabolic dysfunction, MASLD, and QoL in midlife women. Methods: A cross-sectional observational study was conducted including 80 women aged 45–55 years, comprising both premenopausal and menopausal participants. Clinical, anthropometric, biochemical, and imaging data were collected. MASLD was diagnosed using magnetic resonance imaging in the presence of metabolic dysfunction. Metabolic assessment included glucose, insulin, liver enzymes, C-reactive protein, and indices of insulin resistance (HOMA-IR) and sensitivity (QUICKI). QoL was evaluated using the Utian Quality of Life (UQOL) scale. Associations were examined using univariate and multivariable linear regression models. Results: MASLD prevalence was significantly higher in menopausal women compared with non-menopausal women (61.9% vs. 15.8%, p < 0.001). Metabolic parameters, particularly insulin resistance and body mass index, were strongly associated with MASLD. The mean total UQOL score indicated moderate QoL. In multivariable analysis, menopausal status was the only independent predictor of reduced total QoL (b = −4.93, p = 0.01) and occupational health domain (b = −4.60, p = 0.001). MASLD and metabolic parameters were not independently associated with overall QoL. Correlation analyses revealed modest associations between metabolic markers and specific QoL domains, particularly occupational and physical health. Conclusions: Menopause is the primary determinant of reduced QoL in midlife women, particularly affecting functional domains, while MASLD does not independently impact QoL despite its strong association with metabolic dysfunction. These findings suggest that menopausal status may play a more prominent role in quality-of-life outcomes than MASLD in women undergoing the menopausal transition. However, the cross-sectional design does not allow conclusions regarding causal or mechanistic relationships. Full article

Background: Suicide is a major mental health concern, particularly among university students facing unique stressors. Understanding their attitudes toward suicide is essential for effective prevention, yet the existing literature lacks a systematic review on this population. This review synthesises and evaluates the literature on attitudes toward suicide among university students. Methods: A systematic search was conducted on four databases (MEDLINE, Web of Science, Scopus, and PubMed) using Medical Subject Headings terms and keywords identified from previous studies. The search, conducted in February 2024, included studies published between 2014 and 2024. One researcher screened the titles and abstracts, while two independent researchers extracted the data. Twenty-one articles (N participants = 13,424) were selected for further assessment. Quantitative designs were the most common (n = 18), followed by qualitative (n = 2) and mixed-method designs (n = 1), spanning multiple regions. Themes were derived by organising findings into thematic categories based on recurring patterns across the studies. Results: Two core themes emerged: Factors associated with attitudes toward suicide and their associations with suicide outcomes. Conclusions: The review underscores the need for culturally sensitive approaches to address negative attitudes toward suicide and promote help-seeking among university students, highlighting the importance of further research in this area. Full article

Background: Rosacea is a chronic inflammatory dermatosis characterized by vascular dysregulation, immune dysfunction, neurovascular alterations, and microbial involvement. Recent advances in understanding its pathophysiology have led to the development of targeted therapeutic strategies addressing multiple disease mechanisms. This systematic review aimed to evaluate contemporary evidence regarding emerging and established treatment approaches for rosacea. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2016 and 2025. Original human studies evaluating therapeutic interventions for rosacea were included. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate for each study design. Results: Fifteen studies involving 537 patients with rosacea and 77 controls (614 participants in total) met the eligibility criteria. Evaluated interventions included vascular-targeted therapies, topical anti-inflammatory agents, systemic and immunomodulatory treatments, and microbiome-oriented approaches. Oxymetazoline, pulsed-dye laser, platelet-rich plasma, ivermectin, azelaic acid, dapsone, sulfur preparations, and metronidazole demonstrated clinical benefits in reducing erythema, inflammatory lesions, or overall disease severity. Emerging therapies, including tofacitinib and oral ivermectin, showed promising results in refractory disease. Microbiome-related interventions, particularly Demodex-targeted therapies and Helicobacter pylori eradication, were also associated with clinical improvement. Risk-of-bias assessment identified two studies with low risk of bias, twelve with moderate risk of bias, and one study with high risk of bias. Conclusions: Current evidence supports a multimodal and mechanism-based approach to rosacea management, integrating vascular, inflammatory, immunological, and microbiological targets. However, the available evidence remains limited by small sample sizes, heterogeneous methodologies, short follow-up periods, and a predominance of non-randomized study designs. Large, well-designed randomized controlled trials are needed to establish optimal evidence-based treatment strategies and define the long-term efficacy and safety of emerging therapies. Full article

Background: Cognitive impairment (CI) may be overdiagnosed in individuals with vision impairment (VI) due to the vision-dependent design of current cognitive assessment tools. This cross-sectional study evaluated the acceptability and diagnostic accuracy (pilot) of the Visually Independent Test Battery of Neurocognition (VISION-Cog) protocol, against gold-standard neurologist diagnosis. Methods: Community-dwelling older adults with near binocular presenting VI (near visual acuity [NVA] ≥0.2 logarithm of the minimum angle of resolution [LogMAR] units) were recruited from the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study. Participants underwent VISION-Cog and the Singapore-validated Montreal Cognitive Assessment (MoCA-SG) testing and were referred for neurologist evaluation based on standardized referral protocols. The acceptability of the VISION-Cog was assessed through study completion rates, test duration, and the qualitative feedback. Vision-Cog’s diagnostic accuracy (pilot) against neurologist evaluation was analyzed using binary logistic regression and C-statistics to estimate area under the receiver operating curve (AUC) with corresponding sensitivity and specificity. Results: Out of forty-five participants (mean age [SD]: 73.8 [6.1 years]; mean NVA [SD]: 0.47 [0.14] LogMAR; and 54.1% female), 37 (82.2%) completed the protocol. The mean VISION-Cog completion time [SD] was 59 m 57 s (7 m 18 s). Qualitatively, participants found the testing time acceptable. The VISION-Cog achieved an AUC of 0.930 against neurologist diagnosis, with 100.0% sensitivity and 78.0% specificity. Conclusions:The VISION-Cog demonstrated satisfactory preliminary diagnostic accuracy and good acceptability indices in older Asian adults, supporting the need of larger studies to confirm its diagnostic accuracy of CI and clinical utility in those with VI.: Full article

Introduction/Objectives: Patient-centered communication is essential in oncology care, where healthcare professionals often manage emotionally demanding conversations, uncertainty, complex decisions, and patient involvement in care. However, the relationship between communication knowledge, empathic listening, and practical communication skills remains insufficiently examined. This study aimed to examine the associations between communication knowledge, empathic listening, and interpersonal communication skills among healthcare professionals involved in oncology care. Methods: A cross-sectional study was conducted in Croatia from May to November 2025 on a convenience sample of 138 healthcare professionals involved in oncology care. Communication knowledge was assessed using a study-specific questionnaire, empathic listening using an adapted Active Empathic Listening Scale, and interpersonal communication skills using an adapted Interpersonal Communication Skills Inventory. Because the instruments were adapted to the oncology care context, their dimensions were examined using exploratory factor analysis and interpreted as sample-specific exploratory constructs. Descriptive statistics, correlation analyses, and multiple linear regression analyses were performed. Results: Clear message delivery and assertiveness had the highest self-reported score, whereas emotional interaction management had the lowest. Communication knowledge was not an independent predictor of communication skills dimensions. Processing and responding positively predicted clear message delivery and assertiveness (β = 0.361; p = 0.001; R² = 13.4%), while noticing emotional and nonverbal cues negatively predicted emotional interaction management (β = −0.234; p = 0.032; R² = 7.6%). The explained variance of the models was low. Conclusions: The findings suggest limited but potentially relevant associations between selected dimensions of empathic listening and self-reported communication skills in oncology care. Communication knowledge, measured using a study-specific exploratory instrument, was not independently associated with communication skills. Because of the exploratory design, self-report measures, adapted instruments, and convenience sampling, the results should be interpreted with caution. Full article

Background: Intraoperative periprosthetic femoral fractures (IPFF) represent a concerning and often under-recognized complication in total hip arthroplasty (THA). Although several risk factors have been reported, their association with specific femoral morphology and stem geometry has not been fully addressed. This study aimed to identify the incidence and risk factors for IPFF in THA using cementless tapered stems. Methods: A retrospective review was conducted on 3137 primary THAs (2622 patients) performed with cementless tapered stems at a single institution between February 2011 and August 2018. Femoral morphology was classified according to the Dorr types; A (1425 hips, 45.4%), B (1542, 49.2%), and C (170, 5.4%). Femoral stems were categorized as flat, rectangular, or quadrangular tapered designs. The occurrence of IPFF was identified through surgical records and postoperative radiographs. Multivariate regression analysis was performed to identify independent risk factors for IPFF. The mean age at THA was 55 years (range, 15–96), and 52.9% of the patients were women. Results: The overall incidence of IPFF was 2.2% (69 hips). Non-displaced cracks in the proximal metaphysis (58 hips, 84.1%) were the most common type of fracture. The incidence of IPFF was significantly higher in Dorr type A (3.0%) and type C (4.7%) femurs compared with type B (1.2%) femurs. Multivariate regression revealed that female sex (odds ratio [OR], 1.752; p = 0.032) and Dorr type A (OR, 2.898; p < 0.001) and type C (OR, 4.530; p < 0.001) were significantly associated with IPFF. Additionally, the use of quadrangular tapered stems was associated with a higher risk compared with flat tapered stems (OR, 7.382; p < 0.001). Conclusions: Dorr type A and C femurs, along with female sex and the use of quadrangular tapered stems, were significant risk factors for IPFF. Our findings suggest that preoperative consideration of individual femoral morphology and careful selection of stem design are essential to mitigate the risk of IPFF in THA using cementless tapered stems. Full article

The transient heat-transfer behavior of hybrid natural-fiber-reinforced epoxy composites containing 0–5 wt% conch shell filler and 20–35 wt% combined banana–bagasse fiber reinforcement was evaluated using active infrared thermography. A standardized protocol comprising 30 s of convective heating with 100 °C hot air followed by 60 s of natural cooling was applied to seven composite configurations tested in triplicate. The transient response was analyzed in three phases: active heating (0–30 s), thermal lag (30–57 s), and natural cooling (57–90 s). Maximum temperature ($T_{max}$), heating rate ($R_h$), cooling rate ($R_c$), and a thermal retention ratio ($TR$) were extracted and statistically validated by one-way ANOVA with Bonferroni correction. For specimens exhibiting zero within-group variance at the camera display resolution, significance was confirmed using exact permutation tests. Filler incorporation (3–5 wt%) was the dominant factor governing peak-temperature reduction; F5B15S10 (5 wt% filler, 25 wt% total fiber) achieved the lowest $T_{max}$ (33.80 °C, 4.57 °C below neat epoxy). Cooling efficiency was primarily governed by fiber content; F3B15S20 (3 wt% filler, 35 wt% total fiber) demonstrated the most efficient heat dissipation ($TR=0.721$). These findings demonstrate that heating resistance and cooling efficiency are governed by partially independent mechanisms, enabling tailored material design. This study indicates that the proposed transient thermographic protocol provides a valuable reference to thermal management design of hybrid biocomposites in automotive interior and building envelope applications. Full article

End-to-end motion control of 7-degree-of-freedom (DOF) redundant manipulators under sparse reward signals presents a fundamental challenge in deep reinforcement learning (DRL) for robotics: the vast configuration space and absence of dense gradient information combine to produce severe cold-start failures and high cross-seed training variance. This paper proposes Curriculum-SAC-HER, a novel fusion framework integrating Soft Actor–Critic (SAC), Hindsight Experience Replay (HER), and a performance-driven three-stage Automatic Curriculum Learning (ACL) scheduler, designed to resolve the cold-start exploration bottleneck within a training budget of 300,000 environment interaction steps. The core methodology progressively expands the spatial target distribution across three stages of increasing difficulty, conditioning each stage transition on an 80% rolling success threshold to guarantee kinematic prior consolidation before advancing. A rigorous evaluation across 15 independent training runs (five seeds per group, all retained without filtering) demonstrates that the proposed framework achieves a final mean success rate of 84.8% (std: 11.0%), substantially surpassing the SAC + HER ablation (70.3%, Mann–Whitney U test, p = 0.028) and the DDPG baseline (22.3%, p = 0.008), while compressing cross-seed variance by 67% relative to the ablation. Zero-shot robustness evaluations under simulated domain perturbations further reveal that the learned policy maintains above 92% success across extreme friction variations and sustains 71.8% success under a 1.5× payload increase, demonstrating that the ACL module fosters generalized kinematic representations rather than over-fitting to specific contact mechanics. Full article

Across the world’s electrical substations, water-treatment plants, and manufacturing lines, a single engineer with valid credentials and a laptop can today push new control logic to a programmable logic controller (PLC) and change the physical behaviors of safety-critical equipment within minutes. Firmware and ladder-logic updates on SCADA and industrial IoT systems are privileged operations: an attacker installing a malicious update controls the physical process. Existing protections concentrate install authority in a single party with no externally verifiable record; compromise of the vendor key, the engineering workstation, or any operator credential suffices to deliver an attacker-chosen payload to a PLC. CertiFlash binds every update to four independent approvals: a vendor signature, a FROST-Ed25519 threshold signature from an operator quorum, a per-session nonce from the PLC, and a monotonic counter. Every decision is recorded in an append-only Merkle transparency log. The PLC verifies the aggregate with a standard RFC 8032 Ed25519 verifier, requiring no FROST-specific device code. Four security properties (authenticity, authorization, rollback resistance, auditability) are machine-checked in Tamarin under a Dolev–Yao adversary with up to t − 1 compromised operators and corroborated through ten attack scenarios. The implementation runs with concurrent Modbus TCP and Siemens S7 traffic, blocks all attacks, signs in 27–192 ms (k = 3–10), keeps ML-DSA-65 within 6% of Ed25519 from 1 KiB to 10 MiB, and sustains 30.1 updates/s on 100 PLCs. The operator-quorum signature remains FROST-Ed25519: the design is partially post-quantum in the evaluated version. The framework maps to IEC 62443-3-3 SR 3.4 and NIS2 Article 21(2)(d–e). Full article

High-dynamic amusement ride conditions involving impacts, rapid rotations, and abrupt posture changes introduce severe motion artifacts that degrade vital sign quality and destabilize physiological state recognition. This study aims to develop an engineering-ready closed-loop framework for robust passenger monitoring and intelligent diagnosis. A multimodal sensing and modeling pipeline was designed to jointly leverage physiological signals such as heart rate and SpO₂ and kinematic measurements, including acceleration, angular rate, velocity, and attitude. Inertial and PPG signals were preprocessed into supervised samples through wavelet multiresolution denoising and coordinate frame unification, while a strapdown inertial navigation system was used to propagate a 12-channel physical quantity sequence. To ensure interpretability and standards compliance, constraints from GB 8408-2018 were translated into executable threshold rules, enabling standards-driven auto-labeling and rule-based early warning. Building on this foundation, three learning modules were developed: a fusion model for high-dynamic heart rate estimation, a CNN–LSTM dynamic-threshold-enhanced network TAPNet for rapid kinematic anomaly screening, and an attention-augmented hybrid model HS-BANet integrating one-dimensional residual blocks, bidirectional LSTM, and multi-head attention for fine-grained arrhythmia classification. Experimental results demonstrated accurate and consistent heart rate estimation with RMSE of 1.18 bpm on HSSH-I and 1.24 bpm on the independent HSSH-II set, strong agreement with training and testing correlations of 0.9928 and 0.9865, and near-zero bias in Bland–Altman analysis. TAPNet achieved 96.9% validation accuracy and 98.2% test accuracy for kinematic anomaly recognition, maintaining robust generalization under class imbalance. HS-BANet enabled multi-class identification of PVC, PAC, VT, SVT, and AF, achieving an accuracy of 92.37%, an F1-score of 86.87%, a precision of 88.45%, a sensitivity of 88.14%, and a specificity of 89.42%. Overall, the proposed two-stage multimodal closed-loop—fast, interpretable early warning based on physical quantity thresholds followed by fine-grained diagnosis from physiological signals—supports stable feature extraction and reliable decision-making under strong motion artifacts and non-stationary dynamics, balancing responsiveness and diagnostic credibility, while showing potential for practical safety early warning and future deployment-oriented operational support in amusement ride scenarios. Full article

Background/Objectives: Pulses are nutrient-dense, low-glycaemic legumes rich in fibre and bioactive compounds that may modulate carcinogenesis through effects on diet quality, metabolism, and the gut microbiome. This scoping review mapped human evidence on pulses in relation to cancer risk reduction and related mechanistic and survivorship-relevant outcomes. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) Population, Concept and Context (PCC) guidance, we searched CENTRAL, Scopus and PubMed (2014–31 December 2025), supplemented by backward and forward citation tracking, for English-language human studies in which pulses were a defined exposure or intervention and cancer-specific clinical outcomes or biomarkers were reported. Exposures are described using the original ‘legume’ terminology, with pulse-specific interpretation restricted to FAO-defined pulses or clearly dry pulse forms and to pulse-dominant legume intake where the constituent items were predominantly pulses but preparation was not specified. Results: After screening 1244 records, 15 studies met the inclusion criteria, comprising five case–control studies, five 4-week randomised controlled trials (RCTs), one 8-week randomised crossover trial, one controlled feeding study, two prospective cohort studies, and one other prospective study. Observational data from a single pooled case–control study suggest that higher pulse-dominant legume intake is compatible with modestly lower colorectal cancer risk, although the findings are mixed and often attenuate after adjustment for lifestyle and dietary confounders. Evidence for breast and oesophageal cancer and all-cancer mortality is limited, frequently subgroup-specific or highly sensitive to confounder control, and survivorship endpoints are represented mainly by short-term mechanistic and feasibility trials in colorectal cancer survivors rather than by long-term clinical outcomes. Notably, five of these navy bean interventions were conducted by a single research group using similar protocols, which constrains the independence of replication. Conclusions: Pulses can be considered practical components of cancer-protective dietary patterns, especially for colorectal cancer, but the heterogeneity of study designs, short-term interventions, limited sample sizes, and lack of preparation-specific exposure data preclude firm causal inferences; longer-term, rigorously designed trials and detailed observational work are needed to refine pulse-based recommendations for cancer risk reduction and to clarify any role in survivorship care. Full article

Background: AI-supported game-based learning (AI-GBL) integrates artificial intelligence mechanisms, including adaptive difficulty adjustment, large language model (LLM) scaffolding, intelligent non-player characters (NPCs), and stealth assessment, into game-based educational environments. Objective: This systematic review synthesizes the empirical evidence on AI-GBL effectiveness, adaptive mechanisms, and intelligent assessment approaches across diverse educational contexts. Method: Following PRISMA 2020 guidelines, 55 peer-reviewed empirical studies (2021–2026) were identified from Web of Science and Scopus databases. Two independent reviewers screened records (κ = 0.89; 100% consensus on disagreements), extracted data using a standardized coding scheme, and assessed methodological quality using a five-criterion rubric. A thematic synthesis approach was adopted due to the heterogeneity of the evidence base. Results: The reviewed studies generally suggest promising positive effects of AI-GBL on knowledge acquisition, intrinsic motivation, and affective engagement under a range of educational conditions. LLM-based scaffolding reduces cognitive load but risks fostering passive dependency; adaptive difficulty adjustment benefits depend critically on the direction and magnitude of adaptation; AI NPCs function as credible instructional partners in both EFL and STEM contexts; stealth assessment achieves AUCs of 0.848–0.913. Challenges include algorithmic bias in assessment models, LLM latency, over-reliance risks, and a near absence of longitudinal evidence. Conclusions: AI-GBL’s effectiveness rests on principled alignment between AI mechanisms and learning theory rather than algorithmic sophistication per se. Equity-by-design approaches and longitudinal evidence constitute the field’s priority research needs. Full article

Background/Objectives: The rapid expansion of social media platforms has profoundly changed the way adolescents access reproductive health information. While digital environments increase accessibility to contraceptive content, they also facilitate the dissemination of misinformation, potentially influencing both contraceptive literacy and psychological well-being. The present study aimed to evaluate the relationship between sources of contraceptive information, contraceptive misinformation endorsement, contraceptive knowledge, and mental health indicators among Romanian adolescents and young adults. Methods: A cross-sectional observational study was conducted in a cohort of 210 Romanian adolescents and young adults. Participants completed a structured self-administered questionnaire assessing demographic characteristics, contraceptive information sources, digital health behaviors, contraceptive misconceptions, and contraceptive knowledge. Anxiety and depressive symptoms were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Correlation analyses and multivariable logistic regression models were performed to identify factors associated with poor contraceptive knowledge and moderate-to-severe anxiety. Results: Social media represented the primary source of contraceptive information for 58.1% of participants. Individuals relying predominantly on social media demonstrated significantly lower contraceptive knowledge questionnaire (CKQ) scores compared to those obtaining information from healthcare professionals (5.9 ± 1.8 vs. 8.1 ± 1.7, p < 0.001). Contraceptive misinformation endorsement was inversely correlated with CKQ scores (r = −0.44, p < 0.001) and positively associated with anxiety (r = 0.47, p < 0.001) and depressive symptoms (r = 0.41, p < 0.001). In multivariable analyses, primary reliance on social media (OR 2.21, 95% CI 1.12–4.34, p = 0.022) and low digital health literacy (OR 2.94, 95% CI 1.51–5.71, p = 0.001) were independently associated with poor contraceptive knowledge. Higher misinformation endorsement, infertility-related fears, and high social media exposure were independently associated with moderate-to-severe anxiety. Conclusions: Contraceptive misinformation endorsement was associated with lower contraceptive literacy and poorer psychological outcomes among adolescents and young adults. These findings highlight the growing importance of digital health literacy. However, given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects, and longitudinal studies are required to clarify their directionality. Full article

Background/Objectives: Standardised institutional patient satisfaction surveys are the primary quality-monitoring tool in Romanian public hospitals, but their ability to capture the full range of patient experiences remains uncertain. This study quantifies the discrepancy between institutional patient satisfaction scores and an independent, unmediated national feedback instrument, the Patient Feedback Mechanism (MFP), at Targoviste County Emergency Hospital (SJUT) over a six-year period (2019–2024), and examines item-level MFP results across eight dimensions of the patient experience, including dimensions not captured by the institutional indicators routinely reported by SMCSP. Methods: A sequential design combined six years of institutional satisfaction data (2019–2024) from SJUT (N = 32,176 questionnaires) with item-level MFP results for the same period, covering eight questions on medical services, cleanliness, out-of-pocket medication costs, staff involvement, communication, recommendation intent, self-reported health outcome, and willingness to report requests for money from staff. Hypotheses were tested using two-proportion z-tests with Wilson confidence intervals, Mann–Kendall trend analysis, and Cohen’s h for effect sizes. Results: Institutional satisfaction remained consistently high (96.88–97.45%), while MFP satisfaction with medical services ranged from 70.7% to 88.9% across the same years, yielding gaps of 7.9 to 26.7 percentage points, significant in every year (p < 0.001; Cohen’s h ranging from 0.32 to 0.82). The gap did not follow a monotonic trend (Mann–Kendall p = 0.469); instead, it widened to a peak in 2021 and narrowed progressively through 2024. A parallel comparison between the Quality and Patient Safety Management Service (SMCSP) overall impression item (exceeding 99%) and the MFP recommendation item (69.9–76.3%) showed even larger gaps, of 23.3 to 29.6 percentage points. The MFP item on willingness to report requests for money from staff, which is not part of SMCSP’s reported institutional indicators, remained in a narrow 4.0–5.5% range between 2019 and 2023 with no significant trend (Mann–Kendall p = 0.82); a higher 2024 value (6.9%) coincides with a national redesign of this item and is not directly comparable to earlier years. Conclusions: Institutional surveys and an independent national feedback instrument offer structurally distinct perspectives on hospital performance, reflecting differences in administration rather than equivalent estimates of patient satisfaction. The discrepancy between sources is significant and persistent, though not monotonic, widening sharply during 2021 before narrowing. One item with no institutional equivalent documents a measurable, non-trivial proportion of patients willing to report informal payment requests every year, although the available data do not establish whether this proportion is rising over time. Systematic use of existing MFP data, already collected nationally, can complement institutional surveys at minimal additional cost, provided the two instruments are interpreted as structurally different rather than as alternative estimates of the same quantity. Full article