Search Results (482)

Background: Chronic Obstructive Pulmonary Disease (COPD) affects over 400 million people worldwide. Ireland reports the highest COPD-related mortality and hospitalizations in Europe. Dysphagia impacts approximately 50% of people with COPD (PwCOPD) and contributes to COPD exacerbations, hospitalizations, and mortality. Expiratory Muscle Strength Training (EMST) improves respiration and swallowing for PwCOPD; however, little is known about its clinical use by Speech-Language Pathologists (SLPs). Methods: A cross-sectional online survey, developed in accordance with CHERRIES and CROSS guidelines, aimed to explore SLPs awareness, assessment approaches, treatment protocols, training, and confidence in EMST delivery. It was distributed to SLPs working with adults with dysphagia in Ireland. Purposive and snowball sampling were used, with a target sample size of n = 258. Results: The response rate was 36% (n = 92). Awareness of EMST was high (99%, n = 91). 53% (n = 49) reported using EMST. Among EMST users, 20% employed objective assessments of maximal expiratory pressure (MEP), while most calibrated devices to 75% of MEP and followed the “rule of fives” treatment protocol. 29% had formal training in EMST. SLPs with ≤10 years’ clinical experience and those working in acute hospitals used EMST most often. Confidence was influenced by training, experience, access to specialized respiratory equipment, and interdisciplinary team members. Conclusions: SLPs EMST awareness is high, but implementation practices remains variable, with low uptake of formal training and limited use of objective MEP assessment. Findings highlight the need for structured training and population-specific protocols to support consistent and confident EMST delivery for PwCOPD. Full article

Background/Objectives: Adults with intellectual disability (ID) experience high rates of psychiatric comorbidity but often face diagnostic challenges and treatment barriers, leading to inappropriate psychotropic medication use. This study examined the extent to which specialized psychiatric assessment and improved diagnostic accuracy had an impact on medication management and clinical outcomes in adults with ID and co-occurring psychiatric disorders. Methods: This observational retrospective study analyzed medical records from 25 adults with ID who underwent specialized psychiatric assessment at a community-based service in Italy between January 2023 and January 2024. Psychopathological diagnoses were established according to Diagnostic Manual—Intellectual Disability, Second Edition (DM-ID2) criteria, based on clinical observation and a comprehensive assessment using validated instruments. Clinical outcomes were assessed using a psychometric tool encompassing multiple psychopathological and behavioral dimensions. Data on psychotropic prescriptions and side effects were also collected. Non-parametric analyses were performed, with significance set at α = 0.05. Results: The proportion of patients with a psychiatric diagnosis increased from 32% to 96% after specialized assessment (p < 0.001), with notable rises in depressive (0% to 32%), bipolar (8% to 36%), anxiety (4% to 24%), and impulse control (0% to 16%) disorders. First-generation antipsychotic prescriptions decreased (from 36% to 8%, p = 0.023), while antidepressant use increased (from 12% to 52%, p = 0.004). The mean number of side effects per patient declined from 1.6 to 0.5 (p < 0.001), particularly the elevated prolactin level and psychomotor retardation. Significant improvements were observed in symptom intensity and frequency across multiple domains, including aggression, mood disturbances, and compulsions (p < 0.001). Conclusions: In this single-center retrospective study, specialized psychiatric assessment was associated with improved diagnostic accuracy, medication management, and clinical outcomes in adults with ID. The increase in psychiatric diagnoses likely reflects improved identification, addressing key challenges in precision diagnosis for people with neurodevelopmental disorders. Although the overall number of prescribed medications remained stable, optimization of treatment regimens reduced first-generation antipsychotic use and related adverse effects. These findings indicates that access to specialized assessment and precision diagnosis could improve psychopharmacological interventions and outcomes for this vulnerable population, but larger, multi-center and longer-term studies are needed to confirm these results. Full article

Background: Hepatocellular carcinoma (HCC) is a major global health burden, with poor outcomes largely due to diagnosis at an advanced stage and the limited performance of current surveillance tools. Ultrasound with alpha fetoprotein (AFP) provides insufficient sensitivity for early-stage detection, highlighting the need to better identify the at-risk population. Focus of the review: Many HCC risk scores have been proposed; however, some depend on specialized laboratory data that are not widely available. This review summarizes risk scores that show reliable discrimination and rely on demographic, clinical, or molecular information that can be readily obtained in routine care. Conclusions: Advances in HCC risk scores support the move toward surveillance approaches based on individual risk. These tools can improve risk stratification, increase the likelihood of early detection, and potentially support better outcomes for people who belong to the at-risk population for HCC. Full article

Background and Objectives: There is a worldwide increase in the demand for gender-affirming surgical treatments among transgender and gender-diverse (TGD) adults and adolescents. In Poland, transgender people generally lack trust in healthcare providers, which makes it more difficult for them to begin their transition process. This patient population is not well understood by many of the specialists who may potentially be involved in their care, in some way, reinforcing their concerns. The aim of this study is to present the sociodemographic characteristics of a group of female-to-male transgender patients who were admitted to a privately based plastic surgery center to undergo chest wall reconstruction. Materials and Methods: This study comprises a statistical analysis of data retrospectively obtained from the medical records of 100 patients from across the country undergoing female-to-male transition, who were operated on between 2021 and 2025 at a specialized private clinic in Poland. All individuals had already started gender-affirming medical treatment with testosterone at the time of first consultation. Results: The results show a trend toward a decreasing age at the time of the decision to undergo gender-affirming surgery. In the study group, 100% of patients were already undergoing hormone therapy. In our group of transgender individuals, we did not observe a correlation between cultural or social background, religion, and gender dysphoria. It is encouraging that more than half of the patients reported no longer needing psychiatric support, and that those who were still under specialist supervision stated that they experienced a significant improvement in their overall well-being. Conclusions: The rising demand for transgender healthcare highlights the need for studying and analyzing this group of patients in order to provide the best patient-centered care throughout the gender transition process by all specialists involved. Gender-affirming mastectomy, when combined with testosterone therapy, has a positive mental health impact on transgender individuals. Full article

Off-road vehicles, including those intended for mountain tourism, are also designed for people with special needs. These designs primarily concern the design of the drive of the vehicle, which can be manual, foot-powered, electric or a combination of these. Unusual forms of controlling these vehicles are also used, which use various parts of the body for this purpose, including the torso. In addition to using specific parts of the body to control the vehicle, an alternative is to use vision for this purpose, such as through eye tracking and similar techniques. The problem with these applications is the high prices of the devices and software used. They are mainly implemented in military solutions. The cost of these forms of vehicle control is too high; often higher than the price of the vehicle. This article presents an overview of the broad concept and technical solutions used to control various vehicles using hardware that can interact with the organ of vision. An extremely cheap prototype of this type of solution for several dozen EUR is also proposed in this article. The device uses methods based on vision techniques using the OpenCV 4_11 library. The research results in this area are presented, stating that such control is efficient. Full article

This research study addresses the critical contradiction within global food systems: unsustainable consumption patterns and persistent food insecurity coexist and are exacerbated by food waste, which deepens socioeconomic inequalities and generates negative environmental externalities. In this scenario, higher education plays a central role in adopting comprehensive strategic frameworks to develop specialized human capital and influence society. This study analyzes a Service Learning model that integrates the CFS-IRA Principles to promote the SDGs and ensure responsible consumption. Based on a case study of the Food Bank Chair spanning 10 years and 212 projects, the implementation of this model was evaluated using the Working with People (WWP) method, which combines the development of postgraduate students’ skills with community service to address social problems. The results demonstrated the effectiveness of the SL-WWP model in strengthening students’ technical, social, and ethical competencies while reducing food waste. The evaluation showed strong alignment with key SDGs, with outstanding performance in governance, although the need to strengthen environmental and social criteria was identified. The originality lies in integrating the CFS-IRA Principles into an SL model that encourages innovative cooperation among universities, civil society, and public–private sectors, offering a replicable proposal for higher education institutions to establish themselves as agents of change towards sustainability. Full article

Organizational climate (OC) and job satisfaction (JS) are constructs that have been studied for more than five decades. However, the results to date are not sufficient to generalize conclusions across cultures, countries and sectors. To contribute to the development of theory and practice, this study analyzes publication trends through a bibliographic review of publications indexed in the Web of Science (WoS) database between 1975 and 2023, using bibliometric and scientometric techniques. This review synthesizes the accumulated knowledge and reveals significant gaps that need to be addressed, highlighting the weak articulation of research in general; the low scientific production in regions such as India, Southeast Asia, Latin America; the overrepresentation of the health sector in the specialized literature. These findings seek to motivate researchers to fill gaps in scientific production and help managers and administrators to strengthen practices that improve the environmental conditions of workers. The limitations of this study are related to the characteristics of quantitative bibliographic studies and the inclusion of only two constructs related to people’s well-being at work, which suggests that future research could incorporate other variables such as emotional intelligence, leadership or organizational citizenship behavior. Full article

Background: Chemsex, the intentional use of psychoactive substances to enhance sexual experiences, is an emerging public health issue in Brazil, associated with increased risks of sexually transmitted infections and complex psychosocial vulnerabilities. Despite the universal coverage provided by the Unified Health System (SUS), individuals who practice chemsex often encounter barriers to healthcare, including stigma, discrimination, and a lack of specialized services. To date, no comprehensive reviews appear to synthesize evidence on how this population accesses healthcare in the Brazilian context; existing knowledge remains fragmented across individual studies. Objectives: The aim is to map and synthesize the available evidence regarding access to health services among people who engage in chemsex in Brazil, identifying health needs, professional demands, barriers, and facilitators. Methods: The protocol follows the Joanna Briggs Institute methodology for scoping reviews and PRISMA-ScR guidelines. A systematic search will be conducted in MEDLINE (PubMed), Embase, Scopus, SciELO, and LILACS for studies published between 2014 and 2024 in Portuguese, English, or Spanish. Data will be summarized using descriptive and narrative synthesis, presented in tables and thematic categories. Studies will be included if they address chemsex or sexualized drug use in Brazil and report on healthcare access, regardless of gender identity, sexual orientation, or drug type. Studies that do not address chemsex, focus on drug use outside a sexual context, or are unrelated to Brazil will be excluded. Expected results: The review is expected to identify key barriers and facilitators to healthcare access, highlight knowledge gaps for underrepresented groups, and support recommendations for research, policy, and practice to improve care for people engaging in chemsex in Brazil. By focusing on an underexplored intersection of drug use, sexuality, and healthcare access in Latin America, this study aims to provide an innovative contribution to public health literature. Full article

In this article, I argue that the state creates legal advice deserts in immigration and asylum by designing law and policy which drive up legal need, driving down provision through unfavourable conditions for providers, and by placing people in need into areas from which they have no realistic prospect of accessing legal advice and representation. I draw on frameworks of spatial justice and of demand to analyse the impact of the legislative and policy developments in the Special Issue’s focal period of 2022–24 on legal aid in each of the UK’s three legal aid systems: England and Wales, Scotland, and Northern Ireland. The legislative changes included introducing new stages into asylum law, which created new legal needs. Policy changes drove a wholesale geographical shift in demand as all local authorities in the UK (except Scilly) now host people in the asylum process. The changes depended upon the involvement of legal aid lawyers in order to be workable, but the marketised model of legal aid provision in England and Wales, and the low-paid laissez faire model in Northern Ireland, are fundamentally incompatible with that demand. I conclude by arguing that legal aid cannot be an afterthought. Asylum policy should be shaped to reduce failure demand, while legal aid policy should be funded and designed so as to pay for the necessary provision, with interventions to remove the spatial inequalities in access to (legal) justice. Full article

The aim of this study was to develop a scientifically substantiated recipe for the functional food granola using plant-derived ingredients selected for their nutritional value and functional properties. The proposed multi-component granola, comprised of a variety of cereals, fruits, and vegetables local to Kazakhstan, comprises ingredients including oats (Syrgalym variety), corn (Tatti-2012), rice (Barakat), buckwheat (Shortandinskaya 3), pumpkin (Karina), apple (Zailiyskiy), and cranberry (Ben Lear). The research methodology included an analysis of the chemical composition of ingredients, the development and testing of ten granola recipes, and an assessment of their nutritional and sensory value. Optimal formula No. 4 provided the following nutritional values per 100 g: protein—12.4 g; dietary fibre—6.8 g; vitamin C—22.3 mg; potassium—617.4 mg; and iron—4.7 mg. Statistical data processing was performed using the Pearson correlation coefficient and Student’s t-test (p < 0.05). The obtained correlation dependencies allowed the contribution of each component to the nutrient profiles to be determined. Sensory evaluation showed favourable taste and organoleptic characteristics of the recipes using fruit and berry components, especially apples and cranberries. The developed recipe can be recommended for inclusion in the diet of athletes, the elderly, and people with insufficient intake of vitamins and minerals. The results have practical value and contribute to the expansion of the range of healthy food products based on the agricultural potential of Kazakhstan. Prospects for further research include the development of specialised formulas for baby food and people with special dietary needs. Full article

This study focuses on the current service/care difficulties and challenges that social institutions in Hungary are facing during their daily operations; how they can react to them utilizing their internal resources, mechanisms, and capacities; and what concrete, tangible needs and demands are emerging in terms of methodological professional support, potential forms, interventions, and direction for professional development. A total of 24 general and 55 specific service and operational problems were identified and assessed in eight different service areas (family and child welfare services, family and child welfare centers, respite care for children, care for the homeless, addiction intervention, care for people with disabilities, care for psychiatric patients, specialized care for the elderly, and basic services for the elderly). The empirical base of the study uses a database of 201 online questionnaires completed by a professional target group working for social service providers in two counties (Győr-Moson-Sopron and Veszprém), representing 166 social service providers. The questionnaires were completed between November and December of 2022. The findings will be used to develop a professional support and development problem map. Social institutions face complex and serious service/care difficulties and challenges in their daily operations. Three distinctive basic problems clearly stand out in both severity and significance from the complex set of factors assessed. The biggest problem in the social care system is clearly the complex challenge of low wages, followed by the administrative burdens in the ranking of operational difficulties, and the third key factor was the psycho-mental workload of staff. Full article

Forest mushrooms, due to their taste and smell, have been a component of people’s diets since the beginning of time. Unfortunately, there are many inedible or poisonous species of mushrooms that are similar to those that are eaten. For example, the highly valued Boletus edulis is similar to the inedible bitter bolete and the poisonous bolete. In the case of mushrooms of the genus Lactarius, such similarities are demonstrated by the delicious tasting L. deliciosus, the inedible downy L. pubescens and the poisonous cottony L. torminosus. This study presents an attempt to classify these three species based on studies of the emission of volatile organic compounds from the volatile headspace using proton-transfer reaction mass spectrometry (PTR-MS). The conducted statistical tests, principal component analysis (PCA) and discriminant analysis revealed significant differences in the concentration of 20 selected protonated VOC molecules for the tested mushroom species. The clear advantages of the PTR-MS technique are that there is no need for special sample preparation and it has rapid measurement capability and high analytical sensitivity. This allows for a quick comparative analysis of VOCs, for example, from different species of forest mushrooms. Full article

About 8% of Ghanaians, including adolescents, have various types of disabilities. Although many legal and constitutional protections for people with disabilities, including adolescents, exist in Ghana, it is widely known that these persons face a variety of psychosocial issues. Several factors have been identified as contributing to the unremitting marginalisation of people with disabilities in general, but the extent to which these can be generalised to adolescents with disabilities is unknown. This study, therefore, sought to document the determinants, manifestations, and consequences of disability-related stigma among differently abled adolescents in three special schools in northern, middle, and southern Ghana. An exploratory descriptive qualitative design was used. Overall, 54 participants were purposively selected for a semi-structured interview and focus group discussions. Braun and Clarke’s procedure for thematic analysis was followed. The findings showed a variety of stigmatising experiences by adolescents with disabilities in their sociocultural context. More broadly, the cause of disability was linked to the ramifications of parental sins against the gods, being a descendant of river gods, and the consequences of bewitchment/curses by family members. Others included the perceived transmissibility of the disability and disability as a visible condition. Stigma manifested in the form of pejorative labelling, ableism, and social exclusion. The consequences of this stigma included negative psychological and emotional effects (i.e., depression, low self-esteem, and a lack of confidence) and suicidal ideation. There is an urgent need for stigma reduction interventions for adolescents with disabilities in Ghana as part of an effort to improve their wellbeing. Full article

The aim of the study is to identify research on inclusive tourism and its links with related research directions. For this purpose, a review of the literature available in the Scopus database was carried out using the VOSviewer bibliometric tool. The analysis included titles and abstracts of a selected group of articles that were assessed directly by the researchers. This process enabled the identification and characterisation of thematic clusters reflecting the most frequently undertaken research issues, and also allowed for the indication of research gaps and changes occurring over time. The results of the analysis are presented in the form of graphs and tables. In the discussion and final conclusions, significant connections of inclusive tourism are indicated. Although inclusiveness is an important objective of sustainable development, these terms were clearly linked in scientific research only in 2002, and since 2020, there has been a noticeable increase in these connections. The vast majority of studies are focused on the needs of people with mobility disabilities and seniors, but it has been noted that research is beginning to increasingly pay attention to other groups of individuals with special needs as well as the inclusion of marginalised social groups in tourism planning. Full article

Spinal cord injury (SCI) represents a complex pathological event, which requires continuous and highly specialized territorial interventions. The literature highlights disadvantages faced by people with SCI in accessing local services. This study aimed to investigate the concept of territorial continuity for SCI, reconstructing patients and healthcare professionals’ perspectives, to identify facilitators, barriers and opportunities. Methods: a Focus Group (FG) qualitative study was conducted at Piacenza Ausl; four FGs were carried out; a research team member moderated FGs using thematic guides, while an observer was responsible for noting non-verbal aspects. Meetings lasted between 90 and 120 min and were audio-recorded. Transcript analysis involved the identification of units of meaning, which were grouped into general themes. Results: Final analysis highlighted 435 verbatim, grouped into 21 initial themes, that converged into 5 emerging themes: “SCI continuity as multidisciplinary teamwork”; “The need for rehabilitation as a driver of territorial continuity”; “Reinventing everyday life after SCI”; “Barriers and facilitators”; and “The future of territorial care”. Discussion: Patients and healthcare professionals highlighted the absence of a defined treatment path and the lack of reference points, thus generating disorientation and need for information. Among the proposals, telemedicine, empowering the case manager’s role, promoting specific training courses and rethinking community hospitals were supported. Full article