Search Results (158)

Background: Since quality of life encompasses social, psychological, and physical well-being, it is a crucial component of overall health and well-being. The quality of life has a significant impact on both the mother and the unborn child throughout the perinatal period. Both parties suffer when a threat, such as an illness, materialises because it lowers the quality of life. Using the SCL-90-R and SF-36, the current study aims to investigate variations in anxiety levels and health-related quality of life (HRQoL) between pregnant women with and without relevant medical conditions. Methods: We carried out a cross-sectional study between April 2023 and December 2024. Eligibility criteria were: (a) pregnant women; (b) at least 18 years old; (c) of Romanian nationality residing in Romania; and (d) who signed informed consent and agreed to participate. A Personal Information Form (PIF), the SF-36 Health Survey, and the SCL-90-R questionnaire were used to collect data. Statistical analyses were performed with SPSS v26, using non-parametric tests (Mann–Whitney U, Spearman correlations). Results: Ninety-five of the 212 patients in the study reported having related medical conditions. There were no statistically significant differences between the groups in the physical or mental components of the SF-36. Nonetheless, the pathological group’s anxiety scores were noticeably higher. Particularly in the pathological group, Spearman correlation revealed an inverse relationship between anxiety and SF-36 physical component scores. Conclusions: The findings highlight the importance of integrating psychological screening into prenatal care, particularly for women with medical comorbidities. Early identification and management of elevated anxiety may help preserve maternal HRQoL and contribute to better perinatal outcomes. Full article

Few studies provide insights on how to incorporate community members’ perspectives of genomic research during the early phases of study development. Engaging with community members early and consistently throughout the research lifecycle could help identify and mitigate barriers to genomic research participation, particularly among groups with rare and understudied cancers. Methods: The Washington University Participant Engagement and Cancer Genome Sequencing (WU-PE-CGS) study formed a Participant Engagement Advisory Board (PEAB) consisting of patients, patient advocates, and patient advocacy organizations who represented the three understudied cancer populations: cholangiocarcinoma, early-onset colorectal cancer in Black Americans, and multiple myeloma in Black Americans. PEAB members were involved in PE-CGS from the time of the grant submission and provided input on key study procedures by participating in monthly project meetings and serving on the leadership team. PEAB recommendations are described in this process paper. Results: The PEAB provided key feedback on recruitment, consent, and survey development. Recruitment optimization focused on making the script more concise, tailoring to participant’s locale, and providing clearer participation expectations. Consent improvements prioritized key information, addressed data protection, and clarified the process of returning genetic results. Survey enhancements included refining scientific terminology and ensuring inclusivity across the cancer continuum. Conclusions: The PEAB provided valuable feedback that improved the development and implementation of WU-PE-CGS research processes. Incorporating the PEAB’s suggestions helped ensure that patients with rare and understudied cancers were successfully enrolled into the WU-PE-CGS. The PEAB will continue to contribute throughout all study phases. Full article

Background: Research shows that experiences of sexual violence and the use of substances hurt mental health, predisposing individuals to the development of psychological symptoms of somatization, depression, and anxiety. Objective: The main objective of this study is to assess substance use, sexual violence, and psychological symptoms (BSI-18) in a community sample of Portuguese college students. Participants: 459 college students aged 18 to 50 years participated in this study (mean = 21.55; SD = 3.15). Methods: A survey was created online and disseminated via mailing lists and social networks, and the measurement instruments used were an informed consent form, a sociodemographic questionnaire, the Brief Symptom Inventory-18 (BSI-18), a Sexual Violence Questionnaire, and a Substance Use Questionnaire. Results: We found that men consume more substances, but women report more sexual victimization and psychological symptoms. Non-heterosexuals report significantly more sexual violence experiences and higher substance consumption and psychological symptoms than heterosexuals. Sexual victimization showed strong correlations with both substance use and psychological symptoms, while only some substances correlated with psychological symptoms. Age, gender, sexual orientation, sexual violence, and the substance “Hashish/Marijuana” were shown to be significant and strong predictors of psychological symptoms. Conclusions: As shown in previous studies, sexual and gender minorities are more at risk of experiencing sexual victimization and are more prone to consuming substances and developing psychological symptoms, except for men, who tend to consume more substances. Sexual violence and psychological symptoms are highly correlated, while the relation between substance use and psychological symptoms is not entirely clear. Our findings highlight the need for stronger educational and clinical interventions and increased mental health resources, with training on topics involving sexual violence, substance use, and addressing the specific challenges faced by minority groups, to create safer, inclusive, and more supportive Portuguese universities. Full article

Background: Indonesia launched a nationwide school-based HPV immunization program in August 2023. Despite this, regional disparities in vaccine uptake persist. Therefore, we undertook a study in North Sumatra Province to assess HPV vaccination coverage and analyze the main factors affecting the uptake of HPV vaccination. Methods: This study employed a mixed-methods approach and was carried out in Medan and Deli Serdang of North Sumatra Province. Quantitative data were used to examine HPV coverage rates among school-aged girls in 2024, while qualitative interviews with parents, teachers, and health officers explored administrative, social, and behavioral barriers and facilitators. Results: In 2024, HPV vaccine coverage in Deli Serdang reached 62.09%, while Kota Medan lagged behind at just 27.20%. High-coverage schools in the Galang subdistrict benefited from proactive engagement between Puskesmas (community health clinics) and parents. In contrast, lower-coverage areas experienced logistical and communication challenges. Parents expressed a preference for face-to-face communication over written consent forms and emphasized the importance of clear, empathetic messaging. Conclusions: The stark contrast in coverage—particularly the low uptake in urban Kota Medan—highlights the need for more responsive and localized implementation strategies. Strengthening direct communication, addressing administrative inefficiencies, and fostering trust through tailored community engagement are critical. These findings suggest a need for targeted improvements in urban settings and further research across diverse regions to inform policy development and strategies for improved coverage of HPV vaccinations. Full article

Informed consent is a fundamental component of both the right to health and self-determination. Its violation, which occurs when the acquisition process is absent or flawed, can also lead to legal proceedings for isolated harm, regardless of the simultaneous existence of those related to biological and psychological harm. Across Europe, this remains a legal and ethical cornerstone, increasingly important in the context of cross-border care and culturally diverse healthcare settings. Many countries have enacted specific laws to ensure patients receive adequate information, while courts continue to refine its interpretation—often highlighting the inadequacy of informed consent in daily clinical practice. In Italy, in particular, recent rulings underscore the need for clear, comprehensive, and properly documented consent formats for health treatments. This review synthesizes rulings, regulations, and the scientific literature to offer practical guidance for improving informed consent practices in Italy, valuing the role of forensic experts in the integration in healthcare settings of the different interests at stake. The aim is to support both legal compliance and the delivery of high-quality, patient-centred care. Courts and legislation in Italy demand clear and tailored informative disclosure for health treatments, with indications of the treatment and outcomes, to be in written form. Yet, foreseeable risks, more common complications, and alternative treatment options are often poorly communicated in practice—frequently forming the basis of claims for compensation. Integrating team-based consultations and multimedia tools can significantly enhance patient understanding and secure the informed consent process. Those key points are summarized in a brief table, ideally suggesting the minimal requirements for an informed consent form. Investing in standardizing informed consent protocols, and also fostering the sharing of best practices with forensic medicine experts, are crucial steps in ensuring shared decision-making in healthcare and trying to reduce legal disputes. Full article

Background: Electronic monitoring adherence devices (EAMDs) are increasingly being utilized in various healthcare settings to track medication adherence. Objective: To determine the accuracy of the Sensal Health MyAide™ Smart Doc in capturing dose removal from the vial, specifically the time of dose removal and the number of pills removed for each actuation of the device. Methods: This validation study compares the device’s recording of dose withdrawals from a prescription vial by simulated patients against reference documentation reported using MS Forms by the participants. Three participants completed a 4-day study consisting of two non-consecutive 1 h sessions per day encompassing six actuations from the prescription vial to be captured by the Sensal Health MyAide™ Smart Dock after their informed consent was obtained. Statistical analysis included percent agreement and Cohen’s kappa assessing agreement between user-reported data and electronic measurement data recorded by the MyAide™ Smart Dock. Outcome measures included confirmation of the specific user, time of dose removal (±1 min), and the number of pills withdrawn. Results: Three subjects were recruited to provide data for a total of 144 actuations. The study found perfect 100% agreement across the number of pills withdrawn and specific users withdrawing the pills and 99% agreement for the time of administration. The Cohen’s kappa values for the outcome measures were 1.00 (95%CI [1.00, 1.00]) for the number of pills dispensed and specific user and 0.993 (95%CI [0.990, 0.996]) for the time of administration. Conclusions: This study found that the Sensal Health MyAide™ Smart Dock can accurately record the time of administration, the number of pills dispensed, and the identity of the user dispensing the pills. Full article

This paper addresses issues around the viral safety of plasma derivatives, which have led to a spate of public inquiries over the past thirty years. These inquiries have ensued following the infection of recipients of plasma derivatives and have focused on identifying which, if any, parties were responsible for these events. The most recent of these inquiries—the Infected Blood Inquiry in the United Kingdom—ran between 2018 and 2022, and has reached conclusions regarding the allocation of responsibility, some of which are discussed in this review. The published reports of the inquiries, supplemented by evidence sourced from the peer-reviewed literature, the policies of government agencies, and public reactions to these processes, form the basis of this review. In addition, the perspective of the author, who has a background in plasma fractionation science as well as being a recipient of plasma products during the period covered by these various inquiries, is offered as a way of augmenting the issues covered. The benefits arising from these, occasionally controversial, inquiries are described, including the heightened commitment to blood safety by policymakers, the embedment of precautionism as a safety principle, and the need for transparency and informed consent in patient management. Full article

Perineuriomas are a rare form of peripheral nerve sheath tumors, with occurrences in the oral cavity being exceptionally uncommon. This scarcity underscores the clinical significance of each documented case, as it facilitates enhanced diagnostic precision among oral health professionals. We hereby present a case involving a 68-year-old female patient with an extraneural perineurioma (EPN) located on the mandibular region. A laser-assisted excisional biopsy was performed, and the diagnosis of EPN was confirmed through histopathological examination complemented by immunohistochemical analysis. The lesion was surgically excised, and no recurrence was observed during a one-year follow-up period. Accurate recognition of EPNs in the oral cavity is crucial to prevent unnecessary aggressive surgical interventions. Misdiagnoses may occur in cases of fibromas, neurofibromas, schwannomas, ossifying fibromas, or low-grade malignancies, which can potentially result in overtreatment that may compromise both function and aesthetics. Given the rarity of oral EPN, precise diagnosis and appropriate management are essential to avoid unwarranted invasive procedures and to mitigate potential medico-legal implications originating from misdiagnosis or suboptimal treatment. Ensuring comprehensive informed consent and meticulous documentation is also vital in minimizing medico-legal risks. Full article

Background/Objectives: Health education plays a vital role in training health professionals and caregivers, supporting both prevention and the promotion of self-care. In this context, technology serves as a valuable ally by enabling continuous and flexible learning. Among the various domains of health education, nutrition stands out as a key element in the management of Amyotrophic Lateral Sclerosis (ALS), helping to prevent malnutrition and enhance patient well-being. Accordingly, this study aimed to evaluate the effectiveness of the teaching and learning processes within a learning pathway focused on food and nutrition in the context of ALS. Methods: This study adopted a longitudinal, quantitative design. The learning pathway, titled “Food and Nutrition in ALS,” consisted of four self-paced and self-instructional Massive Open Online Courses (MOOCs), offered through the Virtual Learning Environment of the Brazilian Health System (AVASUS). Participants included health professionals, caregivers, and patients from all five regions of Brazil. Participants had the autonomy to complete the courses in any order, with no prerequisites for enrollment. Results: Out of 14,263 participants enrolled nationwide, 182 were included in this study after signing the Informed Consent Form. Of these, 142 (78%) completed at least one course and participated in the educational intervention. A significant increase in knowledge was observed, with mean pre-test scores rising from 7.3 (SD = 1.8) to 9.6 (SD = 0.9) on the post-test across all courses (p < 0.001). Conclusions: The self-instructional, technology-mediated continuing education model proved effective in improving participants’ knowledge about nutrition in ALS. Future studies should explore knowledge retention, behavior change, and the impact of such interventions on clinical outcomes, especially in multidisciplinary care settings. Full article

Artificial Intelligence (AI) is reshaping mental healthcare by enabling new forms of diagnosis, therapy, and patient monitoring. Yet this digital transformation raises complex policy and ethical questions that remain insufficiently addressed. In this paper, we critically examine how AI-driven innovations are being integrated into mental health systems across different global contexts, with particular attention to governance, regulation, and social justice. The study follows the PRISMA-ScR methodology to ensure transparency and methodological rigor, while also acknowledging its inherent limitations, such as the emphasis on breadth over depth and the exclusion of non-English sources. Drawing on international guidelines, academic literature, and emerging national strategies, it identifies both opportunities, such as improved access and personalized care, and threats, including algorithmic bias, data privacy risks, and diminished human oversight. Special attention is given to underrepresented populations and the risks of digital exclusion. The paper argues for a value-driven approach that centers equity, transparency, and informed consent in the deployment of AI tools. It concludes with actionable policy recommendations to support the ethical implementation of AI in mental health, emphasizing the need for cross-sectoral collaboration and global accountability mechanisms. Full article

Background/Objectives: In Mexico, there is very little data on the prevalence of metabolic syndrome in people living with human immunodeficiency virus (HIV) receiving antiretroviral therapy (ART), so, determining the number of people with this condition will help to establish measures to treat it promptly. Methods: A descriptive, observational, prospective, cross-sectional study was conducted in a cohort of people living with HIV who signed the informed consent form and were stratified according to the criteria established by the Adult Treatment Panel III (ATP-III) and the Latin American Diabetes Association (ALAD) for the diagnosis of metabolic syndrome. Results: According to the ATP-III and ALAD criteria, 26.5% and 36.3% of people living with HIV receiving ART were diagnosed with metabolic syndrome, respectively. Metabolic syndrome was more prevalent in men than in women, using both classification criteria (ATP-III: 58 men [67.4%] vs. 28 women [32.6%]; ALAD: 84 men [71.2%] vs. 34 women [28.8%]). The median time since HIV diagnosis of the participants with metabolic syndrome was longer than for the participants without metabolic syndrome, using the ALAD criteria (p = 0.023). The time spent on ART among participants with metabolic syndrome was longer than among those without, using the ATP-III criteria (p = 0.011). The CD4+ T-cell count and HIV-RNA detection showed no significant difference between participants with and without metabolic syndrome (p > 0.05). No statistical significance was found concerning ART and metabolic syndrome; it is noteworthy that for participants with dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), the frequency was similar regardless of the criteria used, and different for those who were taking bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) or were in other schemes (etravirine, darunavir/ritonavir, raltegravir). Conclusions: Our results suggested that 26.5% and 36.3% of the people living with HIV receiving ART included in this study had metabolic syndrome according to ATP-III and ALAD criteria, respectively. These results are consistent with results reported in the Latin American population. Interestingly, both criteria showed a higher frequency of metabolic syndrome in men living with HIV compared to women. Full article

Background/Objectives: Colorectal cancer is a significant health problem worldwide. Surgery is the primary curative treatment for most colorectal cancers. Cardiopulmonary exercise testing is now performed widely before surgery, and it is the most objective and precise means of evaluating pre-surgical physical fitness. Also, we can use the 6 min walk test to measure cardiorespiratory fitness before surgery. Methods: We included colorectal patients who were awaiting open abdominal or laparoscopic surgery. After admission to the hospital, patients who signed informed consent forms fulfilled a short questionnaire about health and physical status, preoperative physical activities, and quality of life questionnaire (EORTC QLQ-C30). Patients performed a 6 min walk test (6MWT) 2 days before surgery and 7 days after surgery. 6MWT is a tool for measuring the functional status of fitness. Also, they fulfilled the quality of recovery questionnaire (QoR 15) 7 days after surgery. Results: In a final analysis, we included 72 patients with a mean age of 62.48. We compared the number of steps, walk distance, average and maximal walk speed, and average and maximal heart rate before and after surgery, overall, and by group. Our findings show a statistically significant difference between men and women in the walk distance (F = 4.99, p = 0.02) The number of steps showed a statistically significant difference according to patients’ ages (F = 2.90, p = 0.02). Also, we detected differences in the average and maximum heart rate during walking when comparing body mass index (average heart rate F = 5.72, p = 0.00, maximum heart rate F = 2.52, p = 0.04). Conclusions: Our study provides evidence that average and maximal heart rate during the 6 min walk test was higher in the postoperative period, especially in overweight and obese participants. Full article

Stealthing, the nonconsensual removal of a condom during sexual intercourse, is a prevalent yet underreported form of sexual misconduct, particularly among college students. This white paper examines the legal landscape, gaps in responses, and the burden of stealthing on college students. It presents actionable strategies for college campuses to combat stealthing, including updating policies, enforcing a zero-tolerance policy, training staff, providing survivor-centered support services, integrating cultural competency, and ensuring transparent enforcement of processes. These strategies aim to empower college campuses to prevent and reduce stealthing, promote informed consent, and enhance survivor support. Full article

Background/Objectives: Violence in healthcare settings, especially in emergency departments (ED), remains an important public health issue worldwide. Thus, additional insight into the effect of these incidents into nurses’ professional attitudes, their work life and related implications to patient safety issues may be valuable. We investigated ED nurses’ living experience of exposure to workplace violence by healthcare service users, with focus on the impact on them. Methods: Following a qualitative study design, data were collected (January–June 2024) through semi-structured interviews with open-ended questions and were analyzed according to an inductive, content analysis approach. Participants provided informed consent, and data collection continued until theoretical saturation was reached. Results: The sample included six nurses. Various forms of workplace violence and its psychological, social, and professional consequences were identified. Violence was more frequently perpetrated by patients’ relatives, with verbal aggression being the most common form. A fundamental divergence in needs and expectation between patients and their family members/caregivers, on one side, and participants, on the other, revealed a pronounced empathy gap. Each group remained focused on its own priorities while struggling to recognize or accommodate others’ perspectives. This lack of mutual understanding contributed to tension that, in some cases, escalated even into physically violent incidents against the participants. A similar gap was identified between the participants’ needs and administrators’ attitudes and related policies. The failure of administrative measures to bridge this gap was described as a crucial factor in further escalating conflicts and tension in the ED. Conclusions: Further research on quality improvement projects, including all stakeholders, aiming to enhance empathy in all parties involved is proposed. Full article

Preoperative anxiety affects approximately 80% of adult patients; thus, identifying patients with excessive anxiety and implementing appropriate interventions can significantly reduce the risk of deterioration during the perioperative period. This narrative review presents current knowledge about pharmacological and nonpharmacological methods for reducing preoperative anxiety. Commonly used pharmacological options include benzodiazepines, ketamine, or fentanyl. Antidepressants have also been shown to be effective in alleviating symptoms, but they typically require four weeks to take effect. Establishment of supportive relationships with medical staff to help patients express their feelings have been shown to have a positive impact on anxiety reduction. Other nonpharmacological methods include the provision of information through informed consent forms, video materials, virtual reality, or the use of psychotherapeutic interventions such as breathing techniques, music therapy, or cognitive–behavioural therapy. Some studies suggest that essential oils may have a role in reducing perioperative anxiety. Nonpharmacological interventions can be used in patients of different ages. An increasing number of researchers advocate for a holistic approach that integrates less invasive and cost-effective interventions with conventional medicine. While various interventions have been proposed to manage preoperative anxiety, more research is needed to establish the most effective and feasible interventions for different patient populations. Full article