Search Results (2,464)

Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived stress levels, occupational stress, and sleep quality among Hungarian nurses, while identifying key demographic, occupational, and behavioral predictors. Materials and Methods: A cross-sectional, quantitative study was conducted from April to July 2022 among nurses employed in Hungarian general hospitals (N = 418). Data were collected via an online self-administered questionnaire. Stress and sleep quality were measured using the Perceived Stress Scale (PSS-14), Expanded Nursing Stress Scale (ENSS), and Groningen Sleep Quality Scale (GSQS). Statistical analysis included descriptive statistics, ANOVA, post hoc tests, t-tests, and Pearson’s correlation (p < 0.05). Results: The mean PSS-14 score was 27.82 (SD = 7.82), indicating moderate stress. Sleep quality was poor (mean GSQS = 7.29, SD = 4.28), with significant positive correlation with perceived stress (r = 0.442, p < 0.001). Low income, lower education, and high coffee or alcohol consumption, and multiple night shifts were significantly associated with higher stress and poorer sleep quality. Occupational stress and mental workload, as measured by ENSS, was highest in internal medicine (mean = 122.16, SD = 37.09; p = 0.033). The most burdensome ENSS subscale was “workload” (mean = 2.30, SD = 0.92), with “not enough staff to adequately cover the unit” identified as the most stressful item. Additional cognitive and emotional workload components included dealing with violent patients and a lack of emotional preparedness in supporting families. Conclusions: Post-COVID nurses in Hungary experience moderate stress and impaired sleep. Excessive workload, emotional demands, and shift patterns significantly contribute to psychological and cognitive strain. Institutional and policy-level interventions are needed to reduce occupational stress and promote workforce resilience. Full article

Background/Objectives: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general hospital wards. We aimed to evaluate the MINI’s feasibility in facilitating an earlier identification of terminally ill patients and improving patient reported outcomes in a hospital setting. Methods: This prospective, two-arm pre-post intervention study at a university hospital evaluated the MINI alongside usual care. Patient-reported outcomes, including quality of life (SF-12), palliative care needs (IPOS), and functional status (ECOG), were collected at baseline and every three months over 12 months. Participants were allocated to a control or intervention group. Results: Of 188 patients identified using the Surprise Question, 58 completed the baseline assessment. While physical functioning (SF-12 PCS) remained comparable, the intervention group experienced clinically meaningful improvements in mental health (SF-12 MCS) at three months, with positive trends at six months. This group also showed a decline in palliative care needs, reduced emotional symptoms, and improved performance status, evidenced by significant differences in non-parametric analyses. These findings underscore the MINI’s potential to significantly improve patient well-being. Conclusions: This pilot study demonstrated the feasibility of the MINI and suggests it may foster meaningful system-wide change in patient-centred care within acute hospital settings, leading to improved patient outcomes and more confident healthcare staff in identifying terminally ill patients. However, given the small sample size, these findings should be interpreted with caution. Future research with larger cohorts and extended intervention periods is warranted to fully elucidate the MINI’s impact and refine strategies for improving care for terminally ill patients. Full article

Background and objectives: Overweight and obesity are global public health problems, as they increase the risk of chronic diseases, reduce quality of life, and generate a significant economic and healthcare burden. This study evaluates the capacity of nutritional patterns and psychological status to predict the presence of cardiometabolic risk among overweight and obese young adults, from a neural network approach. Method: The study included N = 188 overweight or obese students, who provided measures on their dietary intake, physical and psychological state, and sociodemographic profile. Neural networks were used to predict their metabolic status, classified into two categories based on anthropometric, biochemical, and cardiometabolic risk factors: metabolically unhealthy obesity (MUO) versus metabolically healthy obesity (MHO). Results: The predictive models demonstrated differences in specificity and sensitivity capacity depending on the criteria employed for the classification of MUO/MHO and gender. Among the female subsample, MUO was predicted by poor diet (low consumption of mineral and vitamins, and high consumption of fats and sodium) and high levels of depression and stress, while among the male subsample high body mass index (BMI), depression, and anxiety were the key factors. Protective factors associated to MHO were lower BMI, lower psychopathology distress and more balanced diets. Predictive models based on the HOMA-IR criterion yielded very high specificity and low sensibility (high capacity to identify MHO but low accuracy to identify MUO). The models based on the IDF criterion achieved excellent discriminative capacity for men (specificity and sensitivity around 92.5%), while the model for women obtained excellent sensitivity and low specificity. Conclusions: The results provide empirical support for personalized prevention and treatment programs, accounting for individual differences with the aim of promoting healthy habits among young adults, especially during university education. Full article

Physical and mental health are intrinsically linked. However, healthcare systems, training programs, and clinical practice often operate in silos, creating structural disincentives that exacerbate morbidity, mortality, and economic burden. Integrated care models have consistently demonstrated improved outcomes, enhanced quality of life, and greater cost-effectiveness across a range of neuropsychiatric and chronic disorders. With the launch of the World Health Organization Brain Health Framework (2022) and the Swiss Brain Health Plan (2023–2033), important progress has been made toward integrating mental and brain health. However, current brain health concepts could be further strengthened by more explicitly incorporating the role of the body and physical health, including psychosomatic and social aspects, particularly in terms of their dynamic, bidirectional interactions with the brain. This article further outlines the health-related and economic benefits of integrated care, key challenges to the systematic implementation of mind–body integration within healthcare systems, and proposes strategic directions for embedding body–brain dynamics into research, education, and policy. This includes interdisciplinary teaching, harmonized conceptual models, composite clinical metrics, transferable interventions, and the removal of systemic barriers to establish integrated care pathways and reduce stigma through patient-centered empowerment. Ultimately, the “no health without brain health” ethos demands the conceptual and practical integration of dynamic, bidirectional body–brain interactions. Full article

Particulate matter (PM), a complex mixture of solid particles and liquid droplets, originates from both natural sources, such as sand, pollen, and marine salts, and anthropogenic activities, including vehicle emissions and industrial processes. While PM itself is not inherently toxic in all its forms, it often acts as a carrier of xenobiotic toxicants, such as heavy metals and organic pollutants, which adhere to its surface. This combination can result in synergistic toxic effects, significantly enhancing the potential harm to biological systems. Due to its small size and composition, PM can penetrate deep into the respiratory tract, acting as a physical “shuttle” that facilitates the distribution and bioavailability of toxic substances to distant organs. The omnipresence of PM in the environment leads to unavoidable and constant exposure, contributing to increased morbidity and mortality rates, particularly among vulnerable populations like the elderly, children, and individuals with pre-existing health conditions. This exposure also imposes a substantial financial burden on healthcare systems, as treating PM-related illnesses requires significant medical resources and leads to higher healthcare costs. Addressing these challenges necessitates effective mitigation strategies, including reducing PM exposure, improving air quality, and exploring novel approaches such as AI-based exposure prediction and nutritional interventions to protect public health and minimize the adverse effects of PM pollution. Full article

Background: Healthcare professionals experience high levels of stress due to demanding work, especially in metropolitan areas. Nature-based interventions offer potential mental health benefits. This randomized intervention study aimed to evaluate the effects of nature immersion therapies on mental health outcomes in healthcare workers with different psychological risk in Bogota, Colombia. Methods: During a period of 6 months, a total of 82 healthcare workers from two institutions were assigned to three groups: two exposed weekly to nature (parks and forests) and one control group with monthly conventional interventions. Psychological assessments of stress, anxiety, fatigue, and sleep quality were conducted at three time points (baseline, three, and six months of intervention). Cortisol Awakening Response (CAR) was measured monthly using immunoassay. Results: A decrease in the proportion of participants reporting high levels of perceived stress was observed in both intervention groups. Both forest and parks interventions significantly reduced anxiety and fatigue, while sleep quality improved only in the forest group. Multivariate analysis found a negative association between fatigue and forest intervention, as well as significant differences in CAR concentrations across groups over time. Conclusions: This study provides evidence that nature immersion therapy, particularly urban forests, positively impact mental and physical health, reducing stress, anxiety, fatigue, and CAR levels, and could be considered as an effective intervention to enhance workers’ resilience to stress, benefiting their overall health and well-being. 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

Moral injury is a discrete form of harm affecting individuals as a potentially avoidable consequence of exposure to a morally injurious event. That injury (independent of psychological injury or illness) has been identified as a cause of physical symptoms, suicide and suicidality. Originally identified within military and veteran cohorts, it is observable in emergency responders, healthcare providers, human rights advocates and others. Its aetiology suggests that other groups where the potential for tensions between personal morals, professional ethics and occupational activities arises (such as whistleblowers, law enforcement personnel and lawyers) may be at risk. Despite increasingly diverse evidence identifying moral injury as a substantive harm with significant consequences, the legal options for redress are unclear. This article explores whether requirements for establishing a duty of care as a precursor to a negligence claim are likely to pose an insurmountable obstacle for plaintiffs, including in the context of employer–employee duty relationships. It concludes that despite popular perceptions that negligence law is unlikely to be able to accommodate moral injury claims, a closer reading of key judgments indicates that there are opportunities for it to potentially be recognised as a harm on a principled basis—consistent with existing jurisprudence and legislation—for the purposes of establishing a duty of care. In the event that normative claims for its recognition are resisted, the justification for that resistance must be found outside historical development of legal principles from case law. Full article

The integration of robotics and mobile networks (5G/6G) through the Internet of Robotic Things (IoRT) is revolutionizing telemedicine, enabling remote physician participation in scenarios where specialists are scarce, where there is a high risk to them, such as in conflicts or natural disasters, or where access to a medical facility is not possible. Nevertheless, touching a human safely with a robotic arm in non-engineered or even out-of-hospital environments presents substantial challenges. This article presents a novel IoRT approach for healthcare in or from remote areas, enabling interaction between a specialist’s hand and a robotic hand. We introduce the IoRT-in-hand: a smart, lightweight end-effector that extends the specialist’s hand, integrating a medical instrument, an RGB camera with servos, a force/torque sensor, and a mini-PC with Internet connectivity. Additionally, we propose an open-source Android app combining MQTT and ROS for real-time remote manipulation, alongside an Edge–Cloud architecture that links the physical robot with its Digital Twin (DT), enabling precise control and 3D visual feedback of the robot’s environment. A proof of concept is presented for the proposed tele-robotic system, using a 6-DOF manipulator with the IoRT-in-hand to perform an ultrasound scan. Teleoperation was conducted over 2300 km via a 5G NSA network on the operator side and a wired network in a laboratory on the robot side. Performance was assessed through human subject feedback, sensory data, and latency measurements, demonstrating the system’s potential for remote healthcare and emergency applications. The source code and CAD models of the IoRT-in-hand prototype are publicly available in an open-access repository to encourage reproducibility and facilitate further developments in robotic telemedicine. 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

According to the WHO, health problems in Somalia are reported to be at an alarming level today and in the future. Objective: The aim of this study was to determine the relationship between healthy lifestyle behaviours and the levels of health literacy of university students receiving health sciences education in Mogadishu, Somalia. Methods: This descriptive, cross-sectional study was conducted in April 2024 in a university delivering education in Turkish in Mogadishu. The study sample comprised 219 health sciences students. The data collection tools used were a demographic data form, the Healthy Lifestyle Behaviours Scale II (HLBS-II) and the Turkish version of the European Health Literacy Scale (HLS-EU-TR). Results: A total of 219 students participated, with 86.3% identifying as female and 13.7% as male, and the average age was 20.91 ± 2.2 years. The mean of the total scores obtained for the HLBS II was found to be 127.54 ± 23.46 and the mean of the total scores obtained for HLS-EU-TR was 30.33 ± 8.17, while scores across all dimensions of the HLS-EU-TR indicated a problematic−borderline level. Analysis showed that with each advancing year of study, there was a statistically significant increase in health responsibility, physical activity, nutrition and total HLBS scores (p < 0.05). A positive correlation was observed between healthy lifestyle behaviours and HLS-EU-TR total scores, with correlation coefficients as follows: r = 0.230, p = 0.001; r = 0.215, p = 0.001; r = 0.193, p = 0.004; r = 0.308, p < 0.001; r = 0.247, p < 0.001; r = 0.284, p < 0.001; r = 0.313, p < 0.001. Furthermore, 13.1% of the change in healthy lifestyle behaviours was explained by the HLS-EU-TR Treatment and Services subdimension and grade level (R² = 0.131). The HLS-EU-TR Treatment and Services subdimension and grade level positively contributed to the level of healthy lifestyle behaviours (ß = 0.373; ß = 0.164). Conclusion: It can be concluded that the identification of a positive correlation between health literacy and healthy lifestyle behaviours indicates that health literacy significantly influences healthy lifestyle choices. This correlation suggests that as students progress through their educational journey, their knowledge and behaviours toward health improve, highlighting that increased educational attainment equips individuals with the skills necessary to engage more effectively in the healthcare system and to translate acquired knowledge into behaviour. These findings underscore the critical role of ongoing health education initiated from an early age. Full article

Background: Refractory epilepsy refers to a type of epilepsy in which anti-epileptic medications do not yield results, necessitating alternative medical interventions. The ketogenic diet (KD) is utilized as a non-pharmacologic treatment for refractory epilepsy. This study aims to assess details regarding caregivers’ awareness and practices, challenges faced, and other details regarding the KD as a treatment option for children with refractory epilepsy. Methods: A cross-sectional study included 15 caregivers of children with refractory epilepsy who adhere to the KD. Data were collected using an online, self-administered questionnaire including socio-demographic characteristics and descriptive aspects of KD on 15 caregivers. Results: Caregivers’ awareness scores varied, over half of the caregivers (53.3%) demonstrated low awareness levels, scoring below the midpoint on the awareness scale, while both caregivers’ adherence (t value = 31.5; p < 0.001) and patients’ adherence levels (t value = 26.1; p < 0.001) significantly exceeded the minimum expected thresholds, indicating effective implementation of the diet protocols. Challenges faced by caregivers were categorized as follow: logistical challenges (e.g., issues related to KD availability, cost, and weighing (15.6%)), behavioral challenges (e.g., avoiding prohibited foods (18.8%), feelings of hunger, the social environment, and never eating without caregivers), and medical challenges (e.g., frequent blood glucose monitoring (25%)). The most common side effects of the KD were gastrointestinal symptoms, including constipation (33.3%) and gastroesophageal reflux disease (GERD). Physical symptoms such as dyslipidemia were also reported by 13.3% of participants. In terms of neurological and behavioral improvements, the three most reduced symptoms following KD adoption were hyperactive attention deficit (25%), tremors (20%), and insomnia (20%). Conclusions: This study reveals a significant gap between high adherence and low awareness of the KD among caregivers of children with refractory epilepsy. While adherence is crucial for the success of KD, this discrepancy highlights the need for comprehensive caregiver education that not only focuses on practical implementation but also on the underlying rationale of the diet. This study underscores the importance of multidisciplinary support, by including dietitians, to bridge the knowledge gap. These findings suggest that dietary education programs should aim to improve caregivers’ understanding, ultimately enhancing adherence and long-term outcomes. Future research should explore the psychosocial factors influencing adherence and the role of trust in healthcare professionals in shaping caregiver behaviors. The findings also call for further exploration into the impact of caregiver education on child health outcomes in the long term. The varied knowledge among caregivers indicates a need for further educational interventions or increased visits from dietitians. Strategies need to be framed to overcome the challenges faced and improve adherence. Full article

Background/Objectives: School-age children with food allergies (FAs) face substantial psychosocial challenges. Herein, we aimed to synthesize the experiences of such children. Methods: A systematic review of qualitative studies was conducted using the Joanna Briggs Institute methodology. The protocol was registered in PROSPERO (CRD42022359854). A systematic search was conducted of eight databases. Thirteen studies met the inclusion criteria. The data were synthesized through meta-aggregation, and the confidence in the findings was assessed using the ConQual approach. Results: Seventy-three unequivocal findings were extracted and synthesized into three integrated findings. (1) Children with FAs live with daily fear, social restrictions, and emotional stress. To ensure their safety and foster self-management skills, the trusted adults in their lives must be well-informed about allergy management. (2) Children with FAs experience isolation, teasing, and exclusion from peers, whereas peer communication can foster understanding and acceptance. To address this, schools must promote peer empathy, provide allergy education, and build inclusive environments that empower children to express their needs safely. (3) Motivated by curiosity and personal goals, some children engage in oral immunotherapy or allergen reintroduction, leading to meaningful outcomes, such as increased food choices, social inclusion, and reduced anxiety. At the same time, they face emotional and physical burdens, highlighting the need for safety-focused, informed, supported care that considers both the benefits and burdens. Conclusions: This review highlights the need for child-centered, emotionally supportive, and inclusive care involving families, schools, and healthcare providers. However, the moderate ConQual score of the synthesized findings indicates that the recommendations should be considered with caution. Full article

Workplace violence (WPV) against healthcare workers (HCWs) in infectious disease hospitals, particularly in high-risk settings, remains a critical yet understudied occupational hazard. A mixed-methods study was conducted at a Chinese infectious disease hospital, combining quantitative surveys (N = 675) and semi-structured interviews (28 HCWs, 17 patients/families). Logistic regression was used to analyze WPV incidence and predictors, while a thematic analysis of interview data identified contextual drivers. Psychological violence (34.1%) was significantly more prevalent than physical violence (2.2%), with outpatient departments (44.1%) and temporary staff (OR = 1.72) at the highest risk. Qualitative themes revealed systemic triggers, including communication breakdowns, environmental stressors, and organizational gaps in safety protocols and reporting. This study addressed a critical gap by incorporating the perspectives of HCWs and patients, revealing that WPV perceptions vary due to differing expectations and experiences. From these results, the CARE (Communication, Advocacy, Respect, Education) framework proposes actionable strategies: standardized SBAR communication protocols, enhanced security protocols in high-risk units, and mandatory anti-violence training. These findings underscore the need to strengthen the occupational health system to mitigate WPV and to improve healthcare quality. Full article

Background: The growing challenge of multimorbidity for healthcare systems worldwide demands a dual prevention framework, targeting both primary and secondary prevention. Multimorbidity–multibehaviours can provide such a theoretical and clinical framework to explore new aetiological evidence for multimorbidity risk. While the role of single health risk behaviours, such as smoking, nutrition, alcohol, and physical activity (SNAP), in chronic disease prevention is well-documented, their synergistic effect on multimorbidity has received relatively little attention. Methods: Using retrospective observational data from electronic health records of 21,079 patients from a convenience sample of three general practices in Staffordshire, UK (2015–2018), we examined the association between SNAP-multibehaviours and multimorbidity risk, defined as follows: MM2+ (≥2 morbidities), MM3+ (≥3 morbidities), and complex multimorbidity (accumulated morbidities affecting ≥3 body systems). Multiple logistic regression models, stratified by sex and adjusted for age and area, were applied to analyse the associations between both combined and accumulative SNAP-health risk behaviours (HRBs) and all multimorbidity operational definitions. Results: A dose–response association was observed, indicating increased multimorbidity risk with greater accumulation of SNAP-HRBs. Additionally, sex-specific patterns were identified, which varied according to the operational definitions of multimorbidity. These findings underscored both the clinical significance of the identified outcomes for promoting tailored multimorbidity guidelines and the need for further sex-sensitive research. Conclusion: These findings support the importance of transcending traditional silos in healthcare and public health research by integrating preventive and curative medicines under a multimorbidity–multibehaviour framework. Embracing the complexity of coexisting morbidities and health risk behaviours, healthcare systems can move beyond disease-specific and behaviour-specific paradigms. This approach has the potential to enhance clinical outcomes and to address the complex needs of individuals with multimorbidity in real-world healthcare settings. Full article