Search Results (310)

Background: Poor adherence to home exercise programs is a persistent challenge in physical rehabilitation and beyond. Data suggest that follow-up telehealth visits featuring behavior change techniques can improve adherence. However, the optimal frequency of behavioral support for effective self-management of technology-enabled home exercise programs remains unclear. This paper investigates how adherence to home exercise varies with the number of follow-up visits holding the type of exercise constant and measuring adherence objectively. Methods: A secondary analysis of adherence was conducted on participants from the VIGOROUS five-site, single-blind, and randomized controlled trial. Chronic (>6 months) community-resident stroke survivors with mild-to-moderate upper extremity hemiparesis (n = 111) were assigned 15 h of asynchronous video game-based home exercise over 3 weeks. Participants received behavioral support during (a) one single in-person session, (b) four in-person sessions, or (c) four in-person sessions plus six remote teleconsultations. Each consultation incorporated standardized behavior change techniques—contracting, feedback, self-monitoring, action planning, and guided problem solving—to promote increased paretic arm use during daily activities. The primary outcome was adherence (minutes exercising), objectively captured by the gaming system for 87 participants. Results: Six telehealth visits with remote therapeutic monitoring (RTM) increased home exercise completion by 3.3 h [95% CI: 0.008, 6.60]; each remote or in-person consultation was associated with an estimated 34 min of additional asynchronous home exercise. Conclusions: RTM, which does not require travel to a healthcare facility, is a time-efficient modality to enhance therapeutic engagement. Behaviorally focused telehealth visits boost stroke survivors’ adherence to a structured home exercise program. Full article

(1) Background: Lead exposure is an important preventable environmental health concern among children, especially in low- and middle-income countries. In Indonesia, evidence from routine health service settings remains limited. (2) Methods: This cross-sectional study assessed blood lead levels (BLLs) and associated factors among children aged 1–5 years attending 12 primary health care facilities in Bogor City and Bogor Regency between December 2025 and January 2026. A total of 420 children were recruited consecutively during routine services. Environmental and household risk factors were collected using structured questionnaires, and venous blood samples were analyzed using inductively coupled plasma mass spectrometry. Elevated BLL was defined as ≥5 µg/dL. (3) Results: The mean BLL was 2.24 µg/dL, and 21.9% of children had elevated BLLs. Prevalence was higher in Bogor Regency than in Bogor City (41.2% vs. 2.4%; p < 0.001) and among children residing near lead-processing activities (44.2% vs. 16.2%; p < 0.001). One child had a BLL of 66.82 µg/dL. Results were returned to caregivers and facilities; children with BLL ≥ 5 µg/dL received counselling, exposure-reduction advice, nutritional support, and follow-up planning, while the child with BLL > 45 µg/dL was urgently referred for confirmatory assessment and specialist management. (4) Conclusions: Primary healthcare–based screening can identify vulnerable children and trigger clinical, nutritional, environmental, and referral responses, although longitudinal follow-up and environmental source testing are needed. Full article

Background: Effective HIV prevention in South Africa requires implementing pre-exposure prophylaxis (PrEP) service delivery options responsive to adolescents and young people (AYP) with diverse characteristics and needs. We aimed to identify characteristics associated with AYP’s choice of PrEP initiation setting. Methods: Fast-PrEP is an ongoing phase 4 HIV prevention programme in Cape Town, South Africa. Oral PrEP (TDF/FTC) is offered to AYP (15–29 years) within sexual and reproductive health services from four community-based mobile clinics and 12 public primary healthcare facilities. Descriptive statistics and logistic regression models evaluated sociodemographic, behavioural, and clinical factors associated with PrEP initiation from mobile clinics and public health facilities in 13,807 AYP between Aug’22 and Dec’24. Results: Most AYP (70.7%; n = 9760) initiated PrEP from mobile clinics. AYP with more complex healthcare needs, such as pregnancy, parenthood, known sero-different relationships, or currently having STI symptoms, were significantly more likely to use the public health facilities. Both male and female AYP initiating PrEP at mobile clinics had four times the odds of moderate-to-severe depression. Previous PrEP experience was not associated with the choice of PrEP service delivery platform. Conclusions: Our results indicate that offering community-based PrEP alongside public sector facilities increases the reach of a diverse group of AYP who may benefit from PrEP. Full article

The coexistence of undernutrition and excess weight is an important child public health challenge. This study described temporal trends and departmental spatial configurations of wasting, stunting, overweight, and obesity among children under five years of age in Peru during 2014–2024. Analyses used anthropometric assessment records from the Nutritional Status Information System (SIEN), collected in public healthcare facilities and aggregated by department and year. Annual Percentage Change summarized average temporal trends, while observed prevalence maps, Global Moran’s I, Local Indicators of Spatial Association (LISA), and a median-based bivariate classification were applied independently to 2014, 2019, and 2024. Queen contiguity was the primary spatial specification, along with KNN-4 sensitivity analysis. Wasting and obesity increased on average, stunting decreased, and overweight showed no significant long-term trend. Global autocorrelation was most consistent for wasting, whereas findings for excess-weight indicators were sensitive to the weights matrix. LISA identified local spatial classifications at nominal p < 0.05; however, these findings were exploratory because no multiple-testing correction was applied. The bivariate classification identified two, four, and three departments with concurrent high relative undernutrition and excess-weight scores in 2014, 2019, and 2024, respectively. These record-based findings show territorial heterogeneity within SIEN but do not represent population prevalence, causal geographic effects, or an integrated spatiotemporal process. Full article

Saturated steam remains the primary sterilization modality in healthcare facilities globally; however, superheated steam may compromise sterile barrier integrity. Limited data characterize how superheated steam affects peel-pouch sterile barriers under controlled conditions. This pilot study evaluated peel-pouch performance under saturated steam control and experimental superheated steam conditions. Seventy-two samples were exposed to four exposure scenarios using an ISO 18472:2018 compliant BIER vessel: control and experimental treatment at both 121 °C and 132 °C (N = 18 per group). Outcomes included visual inspection (cracking, discoloration, peel-off), bubble emission testing and peel strength testing. Fisher exact tests with Bonferroni correction evaluated categorical outcomes; two-way ANOVA evaluated peel force data. Visual damage showed no statistically significant difference across conditions (Fisher–Freeman–Halton exact test, p = 0.422), ranging from 5.6% in controls to 22.2% at 121 °C experimental conditions (OR = 4.85, p = 0.038). Pairwise odds ratio estimates suggested a possible increase in visible damage under experimental conditions; however, the overall comparison was not statistically significant. Bubble emission testing revealed highly significant differences (p = 0.0014), with experimental conditions showing 71.43% failure at 121 °C versus 11.11% in controls. Peel strength was dramatically reduced in experimental samples (47.4% reduction; F = 154.83, p < 0.0001), independent of temperature. Visual inspection failed to detect barrier compromises evident through functional and mechanical testing. In controlled laboratory conditions using a single peel-pouch brand, exposure to controlled superheated steam conditions was associated with significant barrier damage. These findings underscore the need for comprehensive barrier testing beyond visual inspection in sterilization validation. Full article

Background: Oral cancer remains a major global health concern, with increasing incidence and mortality, especially in developing countries. Public awareness is crucial for early detection and improved outcomes. Objective: To assess oral cancer awareness, recognition of risk factors and early signs, screening behavior, and care-seeking preferences among patients attending a university dental hospital in Türkiye. Methods: This cross-sectional, facility-based survey included 1360 volunteer patients who attended the Faculty of Dentistry between January and December 2025. Consecutive sampling was used to include all eligible and consenting individuals. A structured questionnaire assessed participants’ sociodemographic characteristics, oral cancer awareness, knowledge of symptoms and risk factors, screening history, and lifestyle habits. Data were analyzed using IBM SPSS Statistics 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed. Statistical significance was set at p < 0.05. Main outcomes and measures: The primary outcome was oral cancer awareness (measured by the question “Have you ever heard of oral cancer?”). Secondary outcomes included knowledge of risk factors and early clinical signs, screening history, preferred healthcare contact for suspected oral cancer, and lifestyle factors (tobacco and alcohol). Associations between sociodemographic variables and oral cancer awareness were also evaluated. Results: The sample consisted of 1360 participants (56.4% female; mean age: 33.44 ± 14.60 years; range: 18–70). Of the 1377 questionnaires collected, 1360 were complete and included in the final analysis (questionnaire completion rate: 98.8%). Breast cancer was the most recognized cancer (96.9%), whereas only 50.8% of participants had heard of oral cancer. Dentists (39.4%) were the primary source of information. Tobacco use (92.2%) and alcohol consumption (80.3%) were the most frequently identified risk factors, whereas only 58.3% recognized human papillomavirus as a risk factor for oral cancer. In univariate analyses, oral cancer awareness was significantly associated with age, marital status, education level, monthly income, occupation, alcohol use, and the timing of the most recent dental visit (p < 0.05). In multivariable logistic regression, undergraduate education (OR = 2.008, 95% CI: 1.135–3.553), higher monthly income (>100,000 TRY vs. <25,000 TRY, OR = 2.398, 95% CI: 1.571–3.658), alcohol use (OR = 1.521, 95% CI: 1.082–2.139), and a dental visit within the previous year (OR = 4.130, 95% CI: 1.590–10.730) remained independently associated with oral cancer awareness. Conclusions: Oral cancer awareness in this study population was limited. The findings suggest that targeted educational strategies may be beneficial for improving oral cancer awareness. Strengthening dentists’ preventive role and promoting education through social media may help improve oral cancer awareness and facilitate earlier detection. Full article

Background: Equitable and adequate access to primary care services is essential for reducing healthcare disparities and advancing social justice. In developing countries like China, achieving a balanced primary care provision across urban–rural divides, regions, and population groups represents a critical strategy for improving public health outcomes. Methods: This study integrates high-resolution population data, nationwide point of interest (POI) data, and aggregated individual survey data to analyze the spatial distribution of primary care facilities in China, evaluate their accessibility and equity, and examine the relationships among primary care accessibility, socioeconomic factors, and public health outcomes using geographic analysis and machine-learning methods. Results: (1) Primary care facilities in China exhibit significant spatial clustering and pronounced urban–rural disparities, with 23% of the urban population having access within walking distance; (2) while horizontal equity in primary care accessibility is relatively well-maintained for China’s aging population, vertical equity requires substantial improvement; and (3) primary care accessibility demonstrates significant but nonlinear associations with key socioeconomic indicators, including urban population size, GDP, built-up area, health insurance coverage, and public expenditure. Conclusions: These findings provide valuable insights for health resource allocation and urban planning policies aimed at achieving equitable primary care access. Full article

Objectives: To identify factors influencing influenza vaccination willingness and uptake among adults aged ≥60 years in Henan Province and to evaluate the effect of a brief educational intervention on vaccination willingness and behavior. Methods: In September 2024, a cross-sectional survey based on the Behavioral and Social Drivers (BeSD) framework was conducted among adults aged ≥60 years across five counties in Henan. For participants without baseline willingness, a 3 min one-on-one educational intervention was delivered. In May 2025, following the end of the 2024–2025 influenza vaccination season (which runs from 1 October to 31 March in Henan Province), we retrieved vaccination records for all participants from the Henan Provincial Immunization Information System. This system captures all influenza vaccinations administered at designated vaccination clinics across the province. To ensure completeness for doses administered outside the provincial system (e.g., in other provinces or at private healthcare facilities), we conducted telephone follow-up interviews with all participants whose baseline vaccination intention was inconsistent with their actual vaccination behavior (i.e., willing but unvaccinated or unwilling but vaccinated). During these interviews, for those who reported receiving the vaccine outside Henan Province or at private facilities, we inquired about the specific date and location of vaccination to supplement the registry data. We also explored the reasons behind the intention–behavior discrepancy. For these participants, we requested vaccination certificates or other supporting documentation to confirm their vaccination status. Results: Baseline vaccination willingness was 68.20% (1630/2390), whereas the actual vaccination rate was only 6.95% (166/2390), yielding a willingness-to-behavior conversion rate of 9.51% (155/1630) among those with baseline willingness. Of the 760 participants without baseline willingness, 543 (71.45%) completed the 3 min one-on-one instant educational intervention and the follow-up assessment; the remaining 217 were excluded due to refusal or loss to follow-up. Among these 543 completers, 46 (8.47%) became willing to vaccinate, and eight (1.47%) were subsequently vaccinated. Multivariate analysis identified the social processes dimension as the strongest correlate of both willingness (OR = 1.38 per 1-point increase, 95% CI: 1.33–1.44) and uptake (OR = 1.12, 95% CI: 1.03–1.22). Urban residence was associated with higher willingness (OR = 1.41, 95% CI: 1.12–1.78) and higher uptake (OR = 1.64, 95% CI: 1.11–2.42). Current smokers had a significantly lower uptake than never smokers (OR = 0.43, 95% CI: 0.22–0.85). Among the 11 participants without baseline willingness who were eventually vaccinated (eight from the intervention group and three from the non-intervention group), family/friend influence (63.64%, 7/11) and physician recommendation (36.36%, 4/11) were the primary drivers. For those with willingness but no action (n = 1475), the main barriers were perceived good health (33.29%), high vaccine cost (27.12%), and lack of time (26.31%). Conclusions: Influenza vaccination among older adults in Henan exhibits a “high willingness, low conversion” pattern, with social processes as the strongest driver bridging the intention–behavior gap. A brief educational intervention improved willingness but failed to translate into meaningful uptake, underscoring that knowledge transfer alone is insufficient. We recommend a multi-component strategy that (1) mobilizes family members and community doctors as trusted vaccine advocates; (2) leverages family and village doctor networks to reduce urban–rural disparities; (3) counters the “perceived good health” barrier with age-specific risk communication; and (4) integrates vaccine recommendations into routine care for high-risk groups, particularly frequent outpatient attendees and smokers. Full article

Background: Effective nurse–patient communication is fundamental to quality care delivery, yet language barriers pose significant challenges in multicultural healthcare environments. In Saudi Arabia’s diverse healthcare landscape, nurses frequently encounter patients who do not speak Arabic, potentially compromising care quality and patient safety. Objective: To explore multilevel factors influencing communication between Saudi nurses and non-Arabic-speaking patients, using Bronfenbrenner’s ecological systems theory as a conceptual framework. Design: A qualitative descriptive study employing semi-structured interviews analyzed through reflexive thematic analysis. Setting: Four healthcare facilities (two governmental and two private hospitals) across Saudi Arabia. Participants: Eighteen Saudi registered nurses with experience caring for non-Arabic-speaking patients, recruited through purposive sampling. Methods: Semi-structured interviews (n = 18) were conducted in Arabic or English between November 2025 and February 2026. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, organized within Bronfenbrenner’s ecological levels. Collaborative reflexive coding and member-checking with six participants supported analytical rigor. Results: Five main themes emerged: (1) Individual-level competencies and preparedness (microsystem), (2) Interpersonal dynamics and cultural sensitivity (microsystem), (3) Unit-level resources and organizational support (mesosystem), (4) Institutional policies and language services (exosystem), and (5) Healthcare system and societal influences (macrosystem). Participants identified language proficiency gaps, cultural misunderstandings, inadequate interpreter services, and systemic barriers as primary challenges affecting communication quality. Conclusions: Communication between Saudi nurses and non-Arabic-speaking patients is influenced by complex, interconnected factors across multiple ecological levels. Interventions should address individual competency development, organizational support systems, and policy-level changes to ensure equitable, safe, and effective communication for all patients. Full article

Background/Objectives: Refugee populations face significant barriers in accessing healthcare services, particularly in sexual and reproductive health (SRH), with important implications for menstrual health. Limited access to adequate menstrual products, safe sanitation facilities, and appropriate information contributes to period poverty among migrant and refugee women, exacerbating conditions of vulnerability and discrimination. The present study aims to explore the lived experiences, barriers, and facilitating factors in the management of menstrual health and menarche among refugee women and girls. Methods: A systematic meta-synthesis was carried out between January and May 2026 using the PubMed, Cochrane Library, Scopus and LILACS databases and grey literature sources. The SPIDER framework was applied to guide the research question and search strategy. Qualitative and mixed-method primary studies and grey literature reports containing qualitative findings describing experiences of menstruation among refugee women and girls were included. Studies published in English, Italian, Spanish, and Portuguese were eligible. Study quality was appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist. Data were analysed using a thematic synthesis approach as described by Thomas and Harden. Results: A total of 24 studies were included. Six analytical themes were identified: (1) structural constraints affecting access to resources and services; (2) context-dependent menstrual management practices; (3) female support networks; (4) menstruation as a socially constructed and learned experience; (5) constrained agency and compromised dignity under conditions of stigma; and (6) physical and psychological impacts. Overall, menstrual health was shaped by the interaction of structural barriers and socio-cultural norms, which limited safe and dignified management. Significant gaps in knowledge and preparedness were observed, particularly prior to menarche. Women and girls relied on coping strategies and informal support networks despite associated trade-offs for health and dignity. Conclusions: Menstrual health among refugee women and girls is shaped by structural inequalities, socio-cultural norms, and conditions of displacement. Addressing these challenges requires integrated, multisectoral approaches that go beyond product provision to tackle underlying determinants. Strengthening menstrual health literacy, engaging communities, and supporting the role of healthcare professionals such as midwives is essential to support more equitable and sustainable menstrual health interventions. Findings should be interpreted in light of the heterogeneity of study contexts and methodological quality. Full article

Background/Objectives: Remote islands in Japan constitute a unique medical environment in which physicians often manage a broad spectrum of clinical conditions. However, physicians practicing on remote islands have diverse medical backgrounds, and disease-level community-based care patterns in these settings have not been systematically described. This study aimed to characterize community-based care patterns across diseases in clinics on remote islands in Japan using an exploratory conceptual framework and to examine whether facility- and physician-related attributes were associated with these patterns. Methods: We conducted a questionnaire survey in February 2023 involving rural clinics on remote islands in Japan. For each disease, respondents reported community involvement at three clinical stages—initial consultation, follow-up, and completion of care—yielding eight possible care patterns (000–111). Primary community completeness was defined as the proportion of clinics reporting community-based involvement in initial consultation and completion of care (P111 + P101). Diseases were ranked according to this metric and stratified into three predefined conceptual zones (upper, middle, and lower). Subgroup analyses examined differences in primary community completeness according to facility- and physician-related attributes, including deployment duration, prior rural practice experience, career length, and specialty composition. Results: We analyzed data from 23 clinics covering 167 diseases. Diseases formed a continuous gradient ranging from community-completable to specialist-dependent conditions. Differences in community-based care patterns were most pronounced in the middle zone. Deployment duration was associated with directional differences in community-based care patterns, whereas specialty composition was associated with larger subgroup differences. In contrast, diseases in the lower zone demonstrated relatively stable specialist-dependent patterns regardless of facility- or physician-related attributes. Conclusions: This exploratory study proposed a conceptual framework for characterizing community-based care patterns across diseases in clinics on remote islands in Japan. The findings suggest that community-based care patterns on remote islands may reflect differences in disease-related care structures as well as contextual factors. The proposed framework may support future discussions regarding education, workforce planning, and healthcare systems in remote island settings in Japan. Full article

Reducing carbon emissions from daily travel has become an important goal of 15-minute living-circle planning, yet it remains unclear which facility configurations are most supportive of green travel. Using 634 living circles and 20 million mobile-phone travel records and point-of-interest (POI) data, this study examines how facility layout within a 15-minute cycling circle influences residents’ walking and cycling travel behavior. Extreme Gradient Boosting (XGBoost) models and Shapley Additive Explanations (SHAP) suggest that low accessibility is generally associated with lower green travel shares, while moderate facility density promotes green travel, yet for some facility types, high density may show diminishing marginal benefits. Vegetable markets and primary schools emerge as key facilities, with education facilities driven mainly by accessibility, entertainment facilities by density, and commercial and healthcare facilities by both. K-means clustering identifies three types of low-green-travel-performing living circles—characterized by low density and poor accessibility—concentrated in peripheral and newly developed areas. The methodology is transferable, and the derived numerical ranges and living-circle typologies offer context-specific implications for Tangshan, and identified differences in facility importance and diminishing marginal benefits enrich 15-minute city theory. Full article

Background/Objectives: Hypertension contributes to almost 5 million deaths annually, exacerbated by poor quality of care. Currently in South Africa, the quality of care for patients with hypertension is unknown, and there have been no agreed-upon quality indicators to measure this at the primary healthcare (PHC) level. Quality indicators have previously been developed to address this although their acceptability in PHC facilities in South Africa has not been established. Consequently, we aimed to explore the acceptability of these indicators, and their subsequent use for monitoring adherence to hypertension guidelines, as well as assess their availability and accessibility. Subsequently, identify recommendations for service-delivery changes to improve the uptake of evidence-based indicators into routine practice and the quality of hypertension care in South Africa. Methods: Questionnaire survey during semi-structured interviews with one key informant from 12 PHC clinics where the indicators had previously been tested. Results: Most facilities accepted hypertension quality indicators to improve hypertension management and patient outcomes. Ten clinics had assessed the facility’s quality of care, and all had access to hypertension guidelines. However, only two clinics had a hypertension-specific patient register. Concerns also included a manual data management system and nurse shortages. Conclusions: Large-scale application of quality indicators would facilitate evidence-based decisions for future use at PHC clinics to improve monitoring of adherence to hypertension guidelines and patient outcomes. However, this needs investing in electronic information management to improve data accuracy and management alongside a nursing workforce strategy. Replicating this study in other LMICs can provide comparable preliminary data within the region. Full article

Background: Early management of adult burn injuries in resource-constrained environments—such as battlefields and primary care facilities—remains hindered by the absence of standardized, evidence-based protocols. This study aimed to systematically synthesize existing evidence and develop an integrated framework of actionable recommendations to optimize prehospital and early emergency care. Methods: A comprehensive evidence synthesis was conducted across 14 international and domestic bibliographic databases and authoritative repositories. Eligible sources included clinical practice guidelines, expert consensus statements, evidence summaries, and systematic reviews. Literature quality was appraised using validated instruments, and best-practice recommendations were extracted and thematically synthesized across the continuum of early burn care. Results: Fifty-nine high-quality studies yielded 77 recommendations across 13 domains, spanning from scene safety and burn process cessation through airway, breathing, and circulatory management to wound care, infection control, and transfer preparation. An integrated, context-adaptive framework was established to guide resource-calibrated interventions rather than rigid protocol adherence. Conclusions: These findings provide tiered guidance for frontline healthcare providers and inform the development of emergency care standards in resource-limited settings. Future research should prioritize field validation and contextual implementation to address barriers to evidence translation and enhance real-world applicability. Full article

Healthcare facilities are among the most energy-intensive public infrastructures due to their continuous operations, complex systems, and critical service requirements. In this context, Energy Performance Contracts (EPCs) have gained increasing attention as a strategic tool for enhancing energy efficiency and sustainability in healthcare facilities. This paper investigates the potential and implementation of EPCs in the hospital sector, with a particular focus on their integration within Public–Private Partnership (PPP) frameworks. The study addresses that gap through a cross-case analysis of fourteen hospital EPC projects implemented in Italy, the United Kingdom, the Nordic countries and Central-Eastern Europe, mapping their technical scope against a three-family taxonomy (envelope, plant systems, regulation and monitoring) and benchmarking their energy and economic performance. All figures reported derive from project documentation and contractual monitoring records. The results show that envelope-led configurations deliver the deepest reductions in primary and final energy consumption (up to 50% on the baseline), while plant-side measures, and trigeneration in particular, generate the largest absolute CO₂ savings (from approximately 500 to 17,000 tCO₂eq/yr); lighting, and building management systems (BMS) retrofits, although ubiquitous, account for a 20–25% band when deployed in isolation. The findings reframe EPCs as a configurable contract for decarbonization in healthcare environments and offer practitioners a reading grid for scoping future hospital retrofits under this framework. Full article