Search Results (2,112)

Background: Respiratory syncytial virus (RSV) bronchiolitis remains a leading cause of hospitalization in infants, particularly those with risk factors such as prematurity or chronic diseases. Nirsevimab, a long-acting monoclonal antibody, has recently been approved for RSV prevention. However, parental acceptance of this novel immunoprophylaxis is crucial for effective implementation. The aim of this study was to investigate parental acceptance of nirsevimab prophylaxis for RSV among eligible neonates in Emilia-Romagna, Italy, and to identify factors influencing decision making. Methods: A prospective, multicenter observational study enrolled 1042 parents of neonates eligible for nirsevimab prophylaxis according to regional criteria. Parents completed a semi-structured questionnaire during pre-immunization counseling, exploring knowledge, attitudes, perceived risks, information sources, and willingness to accept prophylaxis. Statistical analysis assessed associations between parental characteristics and acceptance rates. Results: Among the 1042 respondents, 87.0% (n = 907) expressed willingness to administer nirsevimab to their child, while 2.2% (n = 23) refused and 8.8% (n = 92) were undecided. Higher acceptance was significantly associated with awareness of RSV risks (72.1% vs. 41.7%, p < 0.01), belief in nirsevimab’s high efficacy (46.2% vs. 18.3%, p < 0.01), and lower concern over side effects (10.6% vs. 27.8%, p < 0.01). Trust in primary care pediatricians and the healthcare system was also notably higher among accepting parents (p < 0.001). Willingness to pay declined with a hypothetical EUR 250 cost but remained higher among the acceptance group (71.0% vs. 50.4%, p < 0.001). Conclusions: Parental acceptance of nirsevimab in Emilia-Romagna was high, though significant gaps in knowledge and concerns about safety persist. Targeted educational strategies that clarify the nature, efficacy, and safety of nirsevimab—alongside maintaining cost-free access—are essential to support the successful implementation of RSV prophylaxis programs. Full article

(1) Background: Violence against healthcare professionals is becoming a growing concern for healthcare systems and a public health issue, and in Portugal it remains undocumented at a national level, leaving a critical knowledge gap. This scenario compromises the development of effective public policies and evidence-based institutional strategies, which are essential for guiding policymakers in the implementation of preventive measures and appropriate safety protocols to assess the nature, frequency, and key factors contributing to violence against healthcare professionals (doctors and nurses) in clinical settings. (2) Methods: This is a quantitative, descriptive, and cross-sectional study. The sample size was 440 professionals (n = 440). Between January and May 2024, healthcare professionals (physicians and nurses) working in four local health units located in the south of Portugal were invited to participate in this study via institutional e-mail. Data was collected using a structured questionnaire on the healthcare professional’s sociodemographic and work-related characteristics and aspects related to violence towards healthcare professionals in the workplace. Unconditional logistic regression models were fitted to compute crude odds ratios (ORs) and 95% confidence intervals (95%CIs) for the association between sociodemographic and work-related characteristics and violence at work. (3) Results: Nearly 40% of the healthcare professionals sampled reported having been victims of violence in the workplace, and, among these, the majority reported experiencing psychological violence (94.2%), followed by physical violence (46.2%), another type of violence (39.1%), and sexual violence (4.1%). Incidents were mostly occasional (65.5%), occurring during the daytime (51.5%) and on weekdays (84.8%). Healthcare professionals aged between 34 and 55 years old were approximately twice as likely to experience violence compared to those who were 56 years old or older (OR = 2.28; 95%CI 1.33–3.90). Also, those who had been with the organization for more than 4 years (5–7 years: OR = 2.37; 95%CI 1.05–5.37. ≥8 years: OR = 1.87; 95%CI 1.00–3.50), as well as those who worked shifts (OR = 1.84; 95%CI 1.25–2.72), reported incidents of violence more frequently. (4) Conclusions: The low response rate (12.5%) and cross-sectional design limit the generalizability of the results, which should be interpreted considering these methodological limitations. Workplace violence in Portugal is a reality, and it requires solutions. Information related to violent incidents must be comprehensively gathered to understand the full extent of the problem and develop prevention strategies based on potentially changeable risk factors to minimize the negative effects of workplace violence. Full article

This study aims to develop, implement, and evaluate an Early Warning System (EWS) to alert communities and government agencies in KwaZulu-Natal, South Africa, about extreme weather events (EWEs) and related disease outbreaks. The project focuses on eThekwini and Ugu municipalities, using a participatory, co-creation approach with communities and health providers. A systematic review will be undertaken to understand the impact of climate change on disease outbreaks and design an EWS that integrates data from rural and urban healthcare and environmental contexts. It will assess disease burden at primary healthcare clinics, examine health needs and community experiences during EWEs, and evaluate health system resilience. The project will also evaluate the design, development, and performance of the EWS intervention, including its implementation costs. Ethical approval will be sought, and informed consent obtained from participants. Based on the findings, recommendations will be made to the Department of Health to enhance early warning systems and health system resilience in response to EWEs and disease outbreaks. Full article

Cultural and religious norms significantly influence reproductive decisions, including prenatal testing and pregnancy termination. We conducted a cross-sectional study among Muslim women living in mixed Jewish-Arab cities compared to those in predominantly Arab cities in Israel. Data for all co-variates were obtained through participants’ self-reports by an online questionnaire of 36 items for adequate content validity between July 2022 and June 2023. In total, 1081 Israeli Muslim women aged 18–49 years were enrolled. Religious affiliation has been shown to influence individuals’ attitudes toward abortion, with members of religious communities often holding more restrictive or negative views on the subject. Muslim women residing in mixed Jewish-Arab cities demonstrate significantly higher uptake of both non-invasive and invasive prenatal testing, as well as pregnancy terminations following abnormal diagnoses, compared to those in predominantly Arab cities (p < 0.001), which indicates that proximity to Jewish communities, greater availability of health services, and exposure to more permissive social norms in mixed cities may reduce religious and cultural barriers, thereby facilitating more informed reproductive decisions. Older women (≥35) in mixed cities had a higher tendency to birth a child with abnormalities in the past than Arab cities (80.9% vs. 70.0%, respectively), However, women who lived in mixed cities underwent more non-invasive (87.2% vs. 64.8%, respectively), invasive prenatal tests (85.1% vs. 69.7%, respectively), and pregnancy termination (88.3% vs. 64.1%, respectively) than those in Arab cities, p < 0.001. Our findings indicate the importance of gaining a deeper understanding of the relations between religious convictions, cultural standards, and medical practices that should contribute to reducing the prevalence of genetic disorders with their associated adverse impact on families, communities, and healthcare systems. Full article

Despite its positive impact on household income, parental labour migration negatively affects left-behind children (LBC) and their caregivers. Studies in various settings have reported different impacts on LBC, but less is known about the consequences faced by their caregivers. This qualitative study used in-depth interviews to collect data from caregivers of LBC whose parents migrated for employment. Participants were recruited using the snowball sampling technique, starting with the distribution of study information sheets through village offices in Belu and Malacca districts, Indonesia. Data analysis was guided by a qualitative data analysis framework, which involved several steps, including familiarisation with the data or transcripts, identification of a thematic framework, indexing the data, charting the data, and mapping and interpreting the entire data. The findings showed that despite some benefits, including monthly remittances and positive feelings of living with and receiving support from LBC experienced by some caregivers, parental labour migration negatively impacted most caregivers due to their caregiving roles and responsibilities. These challenges included (i) mental and physical health issues, (ii) impacts on daily food and healthcare needs, and (iii) difficulties in their social lives and overall well-being. The findings underscore the need for comprehensive support systems and interventions to address these challenges and improve caregiver well-being. Such support systems should include access to mental and physical health services, financial assistance, employment opportunities, and social support networks. Future large-scale studies are recommended to explore the various impacts of parental migration and caregiving roles and responsibilities on caregivers of LBC, as the findings can better inform the development of policies and interventions to support them. Full article

Modeling drug-induced transcriptional responses at the single-cell level is essential for advancing human healthcare, particularly in understanding disease mechanisms, assessing therapeutic efficacy, and anticipating adverse effects. However, existing approaches often impose a rigid constraint by enforcing pointwise alignment of latent representations to a standard normal prior, which limits expressiveness and results in biologically uninformative embeddings, especially in complex biological systems. Additionally, many methods inadequately address the challenges of unpaired data, typically relying on naive averaging strategies that ignore cell-type specificity and intercellular heterogeneity. To overcome these limitations, we propose scOTM, a deep learning framework designed to predict single-cell perturbation responses from unpaired data, focusing on generalization to unseen cell types. scOTM integrates prior biological knowledge of perturbations and cellular states, derived from large language models specialized for molecular and single-cell corpora. These informative representations are incorporated into a variational autoencoder with maximum mean discrepancy regularization, allowing flexible modeling of transcriptional shifts without imposing a strict constraint of alignment to a standard normal prior. scOTM further employs optimal transport to establish an efficient and interpretable mapping between control and perturbed distributions, effectively capturing the transcriptional shifts underlying response variation. Extensive experiments demonstrate that scOTM outperforms existing methods in predicting whole-transcriptome responses and identifying top differentially expressed genes. Furthermore, scOTM exhibits superior robustness in data-limited settings and strong generalization capabilities across cell types. Full article

Background and Aim: In 2021, healthcare expenditure in Italy represented 7.3% of the national gross domestic product, with approximately 80% attributed to the management of chronic diseases—an increasing burden associated with population aging. Population stratification tools have emerged as critical instruments for the efficient allocation of healthcare resources, particularly for high-need, high-cost individuals. This systematic review aimed to identify, classify, and evaluate existing population stratification tools based on their characteristics, validation status, and practical applications. Methods: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines to examine adult population stratification models grounded in healthcare needs. The review encompassed studies retrieved from major scientific databases and included both national and international implementations. Results: The initial search yielded 140,111 records, from which 17 distinct stratification tools were identified. Of these, nine had undergone validation through peer-reviewed studies. Within the Italian context, only six tools were in active use—three of which were developed as region-specific algorithms, while the remaining three employed internationally established software platforms. Conclusions: Population stratification tools provide a robust framework for assessing both clinical complexity and resource utilization, thereby facilitating the design of integrated care pathways and evidence-based policy decisions. In the context of proactive and personalized healthcare delivery, such tools play a pivotal role in enhancing system efficiency, informing strategic planning, and promoting equitable access to care. Full article

Introduction: Healthcare service utilisation for type 2 diabetes (T2D) is suboptimal among people from culturally and linguistically diverse (CALD) backgrounds. Synthesised evidence on drivers influencing their healthcare access and utilisation across the continuum of care (CoC) is scarce. This review synthesised drivers of accessing and utilising healthcare services across the CoC for T2D from the perspectives of people from CALD backgrounds and their healthcare service providers (HSPs). Methods: Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched from inception to November 2023. This review was prospectively registered with PROSPERO (ID: CRD42023491560). The McGill Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of articles included in this systematic review. Studies were included if they were primary research involving people from CALD backgrounds and/or their HSPs, and reported data related to access to and utilisation of services across the CoC. The CoC framework was used to conduct a guided thematic analysis for qualitative findings and narrative synthesis was used to summarise quantitative findings. Results: Thirty-five studies were included: 31 qualitative, 3 quantitative, and 1 mixed-method. Psychosocial (e.g., fear of treatment) and sociocultural barriers (e.g., stigma) were reportedly encountered at diagnosis and initiation of treatment. Language and cultural barriers were expressed by most people with T2D and their HSPs, especially at the monitoring and adherence stages of the CoC. Trusted relationships with HSPs and the cultural competency of the HSPs were facilitators of continued monitoring and adherence and long-term care and management. No barriers or facilitators were identified for decision-making to enter the healthcare systems, screening, and first point of contact aspects of the CoC from the perspectives of either patients or HSPs. Conclusions: Although included articles were heavily skewed towards qualitative studies, the synthesised evidence on factors influencing access to and utilisation of healthcare services for T2D can inform policymaking by highlighting pathways to improved use of healthcare services among these groups. Full article

Background and Rationale: Visceral disorders, both functional and organic, significantly impact health-related quality of life and pose a challenge for healthcare systems. Osteopathy offers manual, systemic, and patient-centered approaches for their management, yet these remain controversial due to limited scientific support and methodological inconsistencies. In the evolving landscape of healthcare regulation in Europe, and particularly in Italy, exploring clinical reasoning and operational models in visceral osteopathy is essential. This study aimed to explore the beliefs, clinical reasoning, and management strategies of experienced Italian osteopaths in the treatment of visceral disorders using a Constructivist Grounded Theory approach. Methods: This qualitative study applied a Constructivist Grounded Theory approach to explore the beliefs and clinical practices of 10 experienced Italian osteopaths. Semi-structured interviews were transcribed, coded, and thematically analyzed, integrating literature comparisons to support theory generation. Results: Four core themes emerged: (1) education and professional development, (2) definition and identification of visceral disorders, (3) clinical management strategies, and (4) multidisciplinary collaboration. The findings reveal marked heterogeneity in diagnostic frameworks and treatment rationales, often driven by tradition and subjective interpretation rather than empirical evidence. Palpatory assessments were frequently prioritized over patient-reported outcomes. Conclusion: The study highlights substantial fragmentation in Italian visceral osteopathic practice, echoing challenges across Europe. Promoting a shift towards critical thinking, evidence-based models, shared terminology, and interprofessional integration is essential for contextualising osteopathic contributions to the care of individuals presenting with visceral-related problems. These findings provide insights into the fragmented clinical practices of Italian osteopaths and may contribute to shaping a more critical and evidence-informed approach within Italian osteopathic practice and professional development, which is now more relevant than ever, given the recent integration of osteopathy into the Italian higher education system. Full article

The World Health Organization (WHO) declared snakebite envenoming (SBE) as a neglected tropical disease in 2017. Antivenom is the gold standard of treatment, but many healthcare barriers exist, and hence, affected populations are often unable to access it. The challenge is further perpetuated by the lack of attention from national health authorities, poor regulatory systems and policies, and mismanagement of antivenom. This study aims to map the evidence regarding snake antivenom regulations globally and identify gaps in the literature to inform future research and policy. This review was conducted using the original Arksey and O’Malley framework by three independent reviewers, and the results were reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). A search strategy was developed with assistance from a librarian, and six databases were searched: PubMed, SCOPUS, ProQuest Central, Africa Wide Web, Academic Search Output, and Web of Science. Screening was conducted independently by the reviewers, using Rayyan, and conflicts were resolved with discussions. A total of 84 articles were included for data extraction. The major themes that emerged from the included studies were regarding antivenom availability, accessibility, manufacturing, and regulations. The study revealed massive gaps in terms of policies governing antivenom management, especially in Asia and Africa. The literature does not offer sufficient evidence on management guidelines for antivenom in the endemic regions, despite identifying the challenges in supply. However, significant information from Latin America revealed self-sufficient production, involvement of national health bodies in establishing efficient regulations, effective distribution nationally and regionally, and technology sharing to reduce SBE-related mortality. Full article

A review was conducted on snakebites in Central America. Information was extracted using the databases of PubMed, SciELO, and LILACS. Information included retrospective studies, case reports, and case series; in this way, valuable information was retrieved from limited sources. The identified studies comprised those discussing envenoming snakebites. Several species were identified, but three of them had major epidemiological features impacting envenoming by snakebites: Bothrops asper, Crotalus simus, and Micrurus sp. Adolescents and young adult males living in rural areas and engaged in agricultural activities were identified as the main victims of snakebites by clinical records. Symptoms of local damage in the bite sites included edema and skin and muscle necrosis. In addition, the cardiovascular system was affected, with symptoms like hypotension, bleeding, and coagulation disorders. Neurotoxicity causing sensitivity and motricity problems was also reported. For El Salvador, accidents caused by Crotalus simus and Micrurus spp. were given more attention due to their greater relevance. The role of Bothrops species was more relevant in the envenoming reported by other countries. Treatment was found to be provided based on antivenoms produced in Costa Rica, and the recovery of the patients depended on the time elapsed between the accident and the initial treatment in the healthcare system. Full article

As cyber threats such as phishing and ransomware continue to escalate, healthcare systems are facing significant challenges in protecting sensitive data and ensuring operational continuity. This study explores how email communication practices influence cybersecurity in Saudi Arabia’s healthcare sector, particularly within the framework of rapid digitalisation under Vision 2030. The research employs a qualitative approach, with semi-structured interviews conducted with 40 healthcare professionals across various hospitals. A phenomenological analysis of the data revealed several key vulnerabilities, including inconsistent cybersecurity training, a reliance on informal messaging apps, and limited awareness of phishing tactics. The inconsistent cybersecurity training across regions emerged as a major weakness affecting overall resilience. These findings, grounded in rich qualitative data, offer a significant standalone contribution to understanding cybersecurity in healthcare settings. The findings highlight the need for mandatory training and awareness programmes and policy reforms to enhance cyber resilience within healthcare settings. Full article

As the Metaverse continues to evolve as a transformative digital ecosystem, its environmental implications remain insufficiently examined within academic discourse. Despite growing interest in its technological and societal impacts, there is a lack of comprehensive evaluations that synthesize existing knowledge on its sustainability potential. This interdisciplinary narrative review addresses this gap by critically exploring how Metaverse technologies intersect with environmental sustainability across key sectors, including education, healthcare, tourism, e-commerce, manufacturing, and urban development. Employing a narrative review methodology informed by a systematic selection of scholarly and industry sources, the study consolidates current practices, emerging opportunities, and notable trade-offs. While the Metaverse presents promising avenues for reducing material consumption, optimizing urban planning through digital twins, and lowering emissions via virtual alternatives to physical travel, it also raises pressing environmental concerns, particularly related to high energy consumption, short hardware lifespans, and the rebound effects of intensified digital engagement. The findings suggest that environmental sustainability within the Metaverse is not inherent to its virtual nature but hinges on deliberate design, regulatory foresight, and the broader energy systems it depends on. This review offers timely insights for policymakers, technology developers, and sustainability advocates seeking to align immersive digital innovation with ecological responsibility and long-term planetary health. Full article

The experience of main informal caregivers during a loved one’s terminal phase and in the bereavement process involves significant emotional and physical challenges, affecting their adaptation after caregiving ends. These challenges highlight the need for support in transitioning to life post-caregiving. Health professionals play a crucial role in providing compassionate support, facilitating a dignified farewell, and connecting caregivers with bereavement support networks. To understand the experiences informal caregivers after the death of the individual they cared for, and their perspectives on nursing care, a combination of qualitative and quantitative studies was conducted based on Grounded Theory. The findings aimed to promote effective adaptive responses and multisectoral support, assisting in bereavement reorganization and improving caregivers’ health after their role concludes. A model emerged for end-of-life care and support for caregivers after their caregiving tasks end, framed within a systemic approach to healthcare. This model emphasizes the interconnectedness of the terminally ill person, their family, and the caregiver as stakeholders in care. Recognizing and supporting informal caregivers is essential to ensuring the quality of care provided during the caregiving process. Continuous support throughout the caregiving period and during the transition to post-care is vital for facilitating adaptation and recovery. Full article

Background: Gastrointestinal (GI) disorders present significant healthcare challenges, requiring rapid, accurate, and effective diagnostic methods to improve treatment outcomes and prevent complications. Wireless capsule endoscopy (WCE) is an effective tool for diagnosing GI abnormalities; however, precisely identifying diverse lesions with similar visual patterns remains difficult. Methods: Many existing computer-aided diagnostic (CAD) systems rely on manually crafted features or single deep learning (DL) models, which often fail to capture the complex and varied characteristics of GI diseases. In this study, we proposed “EndoNet,” a multi-stage hybrid DL framework for eight-class GI disease classification using WCE images. Features were extracted from two different layers of three pre-trained convolutional neural networks (CNNs) (Inception, Xception, ResNet101), with both inter-layer and inter-model feature fusion performed. Dimensionality reduction was achieved using Non-Negative Matrix Factorization (NNMF), followed by selection of the most informative features via the Minimum Redundancy Maximum Relevance (mRMR) method. Results: Two datasets were used to evaluate the performance of EndoNer, including Kvasir v2 and HyperKvasir. Classification using seven different Machine Learning algorithms achieved a maximum accuracy of 97.8% and 98.4% for Kvasir v2 and HyperKvasir datasets, respectively. Conclusions: By integrating transfer learning with feature engineering, dimensionality reduction, and feature selection, EndoNet provides high accuracy, flexibility, and interpretability. This framework offers a powerful and generalizable artificial intelligence solution suitable for clinical decision support systems. Full article