Search Results (630)

Objectives: To investigate the reliability and validity of the Singer Reflux Symptom Score (sRSS), a new patient-reported outcome questionnaire documenting the severity of reflux symptoms in singing voice is proposed. Methods: Amateur and professional singers consulting the European Reflux Clinic for laryngopharyngeal reflux disease (LPRD) symptoms and findings were prospectively recruited from January 2022 to February 2023. The diagnosis was based on a Reflux Symptom Score (RSS) > 13 and Reflux Sign Assessment (RSA) > 14. A control group of asymptomatic singer subjects was recruited from the University of Mons. The sRSS was rated within a 7-day period to assess test–retest reliability. Internal consistency was measured using Cronbach’s α in patients and controls. A correlation analysis was performed between sRSS and Singing Voice Handicap Index (sVHI) to evaluate convergent validity. Responsiveness to change was evaluated through pre- to post-treatment sRSS changes. The sRSS threshold for suggesting a significant impact of LPRD on singing voice was determined by receiver operating characteristic (ROC) analysis. Results: Thirty-three singers with suspected LPRD (51.5% female; mean age: 51.8 ± 17.2 years) were consecutively recruited. Difficulty reaching high notes and vocal fatigue were the most prevalent LPRD-related singing complaints. The sRSS demonstrated high internal consistency (Cronbach-α = 0.832), test–retest reliability, and external validity (correlation with sVHI: r = 0.654; p = 0.015). Singers with suspected LPRD reported a significant higher sRSS compared to 68 controls. sRSS item and total scores significantly reduced from pre-treatment to 3 months post-treatment except for the abnormal voice breathiness item. ROC analysis revealed superior diagnostic accuracy for sRSS (AUC = 0.971) compared to sRSS-quality of life (AUC = 0.926), with an optimal cutoff at sRSS > 38.5 (sensitivity: 90.3%; specificity: 85.0%). Conclusions: The sRSS is a reliable and valid singer-reported outcome questionnaire for documenting singing symptoms associated with LPRD leading to personalized management of Singers. Future large-cohort studies are needed to evaluate its specificity for LPRD compared to other vocal fold disorders in singers. Full article

The rapid evolution of Industry 4.0 technologies has resulted in a scenario in which collaborative networks are essential to overcome the challenges related to their implementation. However, the frameworks to guide such collaborations remain underexplored. This study addresses this gap by proposing Business Rules and Goals Models to operationalize Industry 4.0 solutions through enterprise collaboration. Using the For Enterprise Modeling (4EM) method, the research integrates qualitative insights from expert opinions, including interviews with 12 professionals (academics, industry professionals, and consultants) from Brazilian manufacturing sectors. The Goals Model identifies five main objectives—competitiveness, efficiency, flexibility, interoperability, and real-time collaboration—while the Business Rules Model outlines 18 actionable recommendations, such as investing in digital infrastructure, upskilling employees, and standardizing information technology systems. The results reveal that cultural resistance, limited resources, and knowledge gaps are critical barriers, while interoperability and stakeholder integration emerge as enablers of digital transformation. The study concludes that successfully adopting Industry 4.0 requires technological investments, organizational alignment, structured governance, and collaborative ecosystems. These models provide a practical roadmap for companies navigating the complexities of Industry 4.0, emphasizing adaptability and cross-functional synergy. The research contributes to the literature on collaborative networks by connecting theoretical frameworks with actionable enterprise-level strategies. Full article

Background: Mental health issues among medical students have gained increasing attention globally, with studies indicating a high prevalence of psychological disorders within this population. The use of antidepressants and anti-anxiety medications has become a common response to these mental health challenges. However, it is crucial to understand the extent of their usage and associated effects on students’ mental health and academic performance. This cross-sectional study explored the use of antidepressants and anti-anxiety drugs and their impact on the mental health of medical students in Saudi Arabia. Methods: A cross-sectional survey of 561 medical students from 34 universities was conducted between March and July 2024. An anonymous online questionnaire was used to collect sociodemographic, mental health, and medication usage-related information. Results: Most of the participants were female (71.5%) and aged 21–25 years (62.7%). Approximately 23.8% of them used antidepressants, 5.6% reported using anti-anxiety medications, and 14.0% used both types of medication. Among the medication users, 71.7% were using selective serotonin reuptake inhibitors (SSRIs), and 28.3% were using other medications. Adverse drug reactions were reported by 58.8% of the participants, and 39.6% changed drugs with inadequate efficacy. Notably, 49.0% of the respondents who have ever used medications discontinued their medication without consulting a healthcare professional. Despite these challenges, 62.0% of the participants felt that their medications had a positive impact on their academic performance, 73.4% believed that the benefits outweighed the drawbacks, and 76.2% expressed a willingness to continue taking their medication. In particular, 77.6% agreed that treatment with these drugs could prevent mental breakdowns. Sleep duration, physical activity, and family history of psychiatric disorders were significantly associated with medication use, with p values of 0.002, 0.014, and 0.042, respectively. Conclusions: These results shed light on the need to understand the prescribing practices of antidepressant and anti-anxiety drugs among medical students while promoting the appropriate use of these medications among the students. There is a need to incorporate mental health interventions into counseling services and awareness programs to support students. Future longitudinal studies are needed to explore long-term trends. Full article

High-rise construction presents heightened safety risks due to vertical complexity, spatial constraints, and workforce variability. Conventional safety management often proves insufficient, especially in rapidly urbanizing or resource-limited settings. This study proposes a hybrid methodological framework to systematically identify and prioritize the critical factors influencing occupational safety in Vietnamese high-rise construction projects. Based on 181 valid survey responses from construction professionals, 23 observed variables were developed through extensive literature review and expert consultation. Exploratory Factor Analysis (EFA) was employed to empirically group 23 validated indicators into five key latent dimensions: (1) Safety Training and Inspection, (2) Employer’s Knowledge and Responsibility, (3) Worker’s Competence and Compliance, (4) Working Conditions and Environment, and (5) Safety Equipment and Signage. These dimensions were then structured into an Analytic Hierarchy Process (AHP) model, with pairwise comparisons conducted by industry experts to calculate consistency ratios and derive factor weights across three high-rise project case studies. The findings provide actionable insights for construction managers, safety professionals, and policymakers in developing and underdeveloped countries, supporting data-driven decision-making for safer and more sustainable urban development. Full article

Background/Objectives: This study explores the perspectives of mental health professionals on tailoring the Mentis Plus intervention to enhance positive mental health (PMH) in individuals experiencing First-Episode Psychosis (FEP). Although the Mentis Plus Program has been previously implemented in other contexts, it has not yet been applied to FEP care. Therefore, this study aimed to adapt the intervention for future implementation through expert consultation. Methods: A qualitative exploratory-descriptive design was employed. Data were collected via three focus groups comprising multidisciplinary professionals experienced in FEP care. Qualitative content analysis was used to examine the data. Results: Participants viewed the tailored Mentis Plus intervention as a valuable, recovery-oriented tool. Key recommendations included a flexible, group-based format with eight weekly sessions. Suggested intervention components encompassed gratitude journaling, emotional regulation techniques, and collaborative problem-solving exercises. Group delivery was highlighted as essential for mitigating isolation and promoting peer support. Practical implementation strategies included phased session structures and routine emotional check-ins. Identified barriers to implementation included the need for specialized training, limited therapeutic spaces, and the heterogeneity of participant needs. Facilitators included a person-centered approach, institutional backing, and sufficient resources. Conclusions: The findings support the feasibility and clinical relevance of a tailored Mentis Plus FEP Program—Brief Version. Expert-informed insights provide a foundation for adapting mental health interventions to early-psychosis care and inform future research and implementation strategies. Full article

Background: Psychological problems post-stroke can negatively impact stroke survivors. Although general psychological services exist (e.g., NHS Talking Therapies), access remains limited, particularly for individuals with post-stroke communication and cognitive impairments. Stroke service staff report low confidence in managing psychological distress. This study is the first to explore the barriers and facilitators to implementing a novel intervention package comprising a cross-service care pathway and staff training to enhance post-stroke psychological provision. Methods: Staff from stroke and mental health services in four UK regions, recruited through purposive sampling to ensure diversity of services and professional roles, participated in semi-structured interviews or focus groups, guided by the Theoretical Domains Framework (TDF), before and after implementation of the intervention package. Pre-implementation interviews/groups identified anticipated barriers and facilitators to implementation and training needs, informing the development of site-specific intervention packages; post-implementation interviews/groups explored experienced barriers, facilitators and perceptions of the intervention. Interviews underwent thematic analysis using the TDF. Results: Fifty-five staff participated pre-implementation and seventeen post-implementation, representing stroke (e.g., nurse, physiotherapist, consultant) and psychology (e.g., counsellor, psychological therapist) roles across acute, rehabilitation, community, and voluntary services. Challenges anticipated pre-implementation included: limited specialist post-stroke psychological support; low staff confidence; and fragmented service pathways. Post-implementation findings indicated increased staff knowledge and confidence, enhanced screening and referral processes, and stronger inter-service collaboration. Implementation success varied across sites (with some sites showing greater ownership and sustainability of the intervention) and across staff roles (with therapy staff more likely than nursing staff to have received training). Conclusions: Effective implementation of an intervention package to increase psychological provision post-stroke requires staff engagement at all levels across all services. Staff investment influenced ownership of the intervention package, beliefs about priorities and overall enhancement of service capability. Full article

Despite advances in cancer care, disparities persist. The collection of the social determinants of health (SDOH) is fundamental to addressing disparities. However, SDOH are inconsistently collected in many regions of the world. This two-phase multiple methods study examined patient and community perspectives regarding SDOH data collection in Canada. In phase 1, a survey was administered to patients at a cancer centre (n = 549) to assess perspectives on an SDOH data collection tool. In phase 2, broader perspectives were sought through a community consultation with patient partners experiencing structural inequality (n = 15). Most participants were comfortable with SDOH data collection. Of survey respondents, 95% were comfortable with the collection of language, birthplace, sex, gender, education, and disability, and 82% to 94% were comfortable with SES, sexual orientation, social support, and race/ethnicity. Discomfort levels did not differ across subgroups, except women were more uncomfortable disclosing SES (OR: 2.00; 95%CI: 1.26, 3.19). Most (71%) preferred face-to-face data collection with a healthcare professional and only half were comfortable with storage of SDOH in electronic health records. Open-ended survey responses (n = 1533) and the community consultation revealed concerns about privacy, discrimination, relevance to care, and data accuracy. SDOH data collection efforts should include a clear rationale for patients, training for providers, strong data privacy and security measures, and actionable strategies to address needs. Full article

Botulism is a severe muscle paralysis disease mediated by the botulinum toxin. Here, we reported a foodborne botulism case caused by Clostridium botulinum subtype A5(b3) from self-packaged vacuum spicy rabbit heads. Treatment for this case was delayed due to misdiagnosis and insufficient diagnostic capacity in three hospitals, which resulted in progressive clinical deterioration, and eventually, the patient was transferred to Shandong Public Health Clinical Center for specialized therapy. The case was suspected as foodborne botulism by the Qilu Medical-Prevention Innovation Integration pathway and multi-disciplinary consultation. An epidemiological investigation and laboratory confirmation revealed that the botulinum neurotoxin originated from vacuum-packaged spicy rabbit heads distributed via interprovincial cold chain logistics. After treatment with botulism antiserum, the patient’s condition significantly improved, and they were discharged after recovery. We revealed that this foodborne botulism outbreak was caused by the Clostridium botulinum A5(b3) subtype from food by whole-genome sequencing and SNP typing. All the strains belonged to Group I carrying the botulinum neurotoxin gene classified as the ha cluster. Toxin A was confirmed by MBA and other methods, while toxin B was non-functional due to the truncated bont/B gene. Other virulence genes and antibiotic resistance genes were also detected. Our findings indicate that self-packaged vacuum meat products represent an emerging risk factor for botulism transmission when stored improperly. Importantly, the recurrent misdiagnosis in this case underscored the urgent need to enhance the training of healthcare professionals in medical institutions to improve the diagnostic accuracy and clinical management of botulism. Full article

Background: Caregivers of children often encounter barriers when accessing pediatric healthcare services. These challenges highlight the need for digital innovations to improve accessibility and efficiency in pediatric outpatient care. Objectives: This study aimed to design, implement, and pilot evaluate the Smart Well Child Center application in conjunction with enhancements to the Pediatric Outpatient Department. Methods: This study employs a mixed-methods research approach. The application was developed following the system development life cycle (SDLC) process, and its performance was subsequently evaluated. Additionally, its effectiveness in real-world settings was assessed through a satisfaction survey completed by 85 child caregivers. The results were summarized using the mean and standard deviation, and satisfaction levels were compared using paired t-test and repeated measures ANOVA. Results: The findings reveal that caregivers face significant challenges, including financial burdens related to travel, prolonged wait times, and difficulties accessing healthcare services. In response, the application was designed to incorporate key functionalities. Within the pre-consultation self-assessment module, caregivers can complete evaluations and receive recommendations directly through the application. Furthermore, the service procedure flowchart was restructured to seamlessly integrate these digital innovations, thereby enhancing the overall healthcare experience. The evaluation results indicate that the application achieved high performance ratings across all assessed dimensions (4.06 ± 0.77). Additionally, caregivers reported a substantial increase in satisfaction levels both immediately after implementation (4.58 ± 0.57) and one month afterward (4.59 ± 0.33). Conclusions: Given these findings, it is recommended that the hospital fully adopt the Smart Well Child Center application to improve healthcare accessibility and reduce patient wait times. Future research should assess the long-term impact of the intervention on both caregiver outcomes and healthcare professional workflow, satisfaction, and system usability, to inform broader implementation strategies. Full article

Construction delays are a repeated problem in government buildings projects in Kuwait, always leading to increased costs and schedule slippage. This pilot study investigates key delay factors and corresponding solutions strategies by analyzing the responses from 60 construction professionals representing project management consultants (PMCs), contractors, and consultants. Using a structured questionnaire and confirmatory factor analysis (CFA), the study identifies and validates critical delay constructs and explores useful solutions measures from stakeholders’ perspectives. The findings provide foundational data to refine the main study and enhance model validity for structural equation modeling (SEM). The top of the delay factors are poor contractor monitoring, weakness of consultant project management team, and design faults. Recommended solutions strategies include establishing a monitoring system to track subcontractor progress and addressing potential delays proactively, ensuring timely approval for the required workforce, and establishing clear delivery schedules. The results validate the questionnaire’s reliability (Cronbach’s alpha = 0.920) and provide insights into urgency areas for delay mitigation in the Kuwaiti governmental building construction sector. Full article

Background/Objectives: The pediatric mental health crisis in the United States has reached unprecedented levels. Severe shortages in specialized health care professionals, particularly child and adolescent psychiatrists (CAPs), exacerbate the challenge of delivering timely and quality mental health care, especially in rural areas like Kansas. Innovative models such as Pediatric Mental Health Care Access (PMHCA) programs and School-Based Health Clinics (SBHCs) aim to integrate mental health expertise into primary care settings to address this gap. Methods: This paper examines an integrated care model to support SBHCs developed by the Kansas PMHCA. The Interprofessional Child-Centered Integrated Care Model (ICX2) was implemented within an SBHC in Haysville, KS. ICX2 utilizes biweekly collaborative team meetings (CTMs) via zoom involving primary care, psychology, child psychiatry, social work, and school resource coordinators to discuss patient cases and enhance the primary care management of pediatric mental health. This descriptive study analyzes data from January 2023 to June 2023, focusing on patient demographics, case characteristics discussed during CTMs, and recommendations made by the interprofessional team. Results: Findings illustrate the complex biopsychosocial needs of patients seen and define themes of case consultation and recommendations. Conclusions: Integrated care programs like ICX2 can be feasibly implemented through PMHCA programs and may be an efficient intervention to bridge resource gaps. Full article

Emergency department overcrowding disproportionately affects complex patients, such as older adults and those with comorbidities, who consume significant resources and experience prolonged delays. This study integrates process mining and predictive simulation to identify key factors influencing length of stay and to propose a data-driven solution: a tailored fast-track pathway for high-risk patients. Using data from 94,489 emergency episodes, a predictive formula was developed based on clinically relevant variables, including age (>65 years); triage levels (II and III); frequent emergency department visits; need for mobility aids; and specific reasons for consultation such as dyspnea, abdominal pain, and poor general condition. Simulation results demonstrated that implementing this fast-track pathway reduces length of stay by up to 21% and emergency department saturation by 35%, even with minimal resource allocation (five beds). The manual predictive formula showed comparable prediction performance to machine learning models while maintaining transparency and traceability, ensuring greater acceptability among healthcare professionals. This approach represents a paradigm shift in emergency department management, offering a scalable tool to optimise resource allocation, improve patient outcomes, and reduce operational inefficiencies. Future multicenter validations could establish this model as an essential component of emergency department management strategies. Full article

Background/Objectives: The economic impact of adverse events following COVID-19 immunisation (AEFIs) in Australia is underexplored. This study aimed to assess the economic burden of AEFIs on both healthcare systems and societal productivity. Methods: A cross-sectional survey was conducted in Queensland residents aged ≥18 years who had received at least one dose of a COVID-19 vaccine in the preceding 12 months. Overall, 6964 participants were recruited from July to September 2022 via email and broad social media campaigns. The survey collected data on the incidence, type and duration of AEFIs; healthcare utilisation; and work-related absenteeism. Healthcare costs were estimated using national healthcare reimbursement data, and productivity costs were estimated using Australian Bureau of Statistics Average Weekly Earnings. Results: Of the 6797 eligible respondents (predominantly female [62%]; median age: 52 years), AEFIs were reported by 53.4%, 44.1%, 40.7%, and 40.9% following doses 1 to 4, respectively. Pain and tenderness were predominant local AEFIs, while tiredness and headaches were the most frequent systemic AEFIs, generally resolving within three days. Relatively few participants reporting AEFIs consulted medical professionals: 7.0%, 7.3%, 5.1%, and 1.9% following each dose, respectively. The mean healthcare cost per person reporting AEFIs was AUD 24, AUD 88, AUD 22, and AUD 4 following each respective dose. Work absenteeism was recorded in 16.5%, 18.2%, 15.2%, and 11.2% following each dose with mean absenteeism days per person of 4.7, 7.4, 3.6 and 2.1, respectively, and mean productivity costs per person reporting AEFIs amounting to AUD 1494, AUD 2388, AUD 1136, and AUD 690, respectively. Conclusions: Participants reported mostly mild AEFIs with only a small proportion of individuals seeking medical services. Productivity costs attributable to these AEFIs exceeded direct healthcare expenses incurred. Full article

The purpose of this study is to compare the accuracy and readability of Coronavirus Disease 2019 (COVID-19)-prevention and control knowledge texts generated by four current generative artificial intelligence (AI) models—two international models (ChatGPT and Gemini) and two domestic models (Kimi and Ernie Bot)—and to evaluate the other performance characteristics of texts generated by domestic and international models. This paper uses the questions and answers in the COVID-19 prevention guidelines issued by the U.S. Centers for Disease Control and Prevention (CDC) as the evaluation criteria. The accuracy, readability, and comprehensibility of the texts generated by each model are scored against the CDC standards. Then the neural network model in the intelligent algorithms is used to identify the factors that affect readability. Then the medical topics of the generated text are analyzed using text analysis technology. Finally, a questionnaire-based manual scoring approach was used to evaluate the AI-generated texts, which was then compared to automated machine scoring. Accuracy: domestic models have higher textual accuracy, while international models have higher reliability. Readability: domestic models produced more fluent and publicly accessible language; international models generated more standardized and formally structured texts with greater consistency. Comprehensibility: domestic models offered superior readability, while international models were more stable in output. Readability factors: the average words per sentence (AWPS) emerged as the most significant factor influencing readability across all models. Topic analysis: ChatGPT emphasized epidemiological knowledge; Gemini focused on general medical and health topics; Kimi provided more multidisciplinary content; and Ernie Bot concentrated on clinical medicine. From the empirical results, it can be found that the manual and machine scoring are highly consistent in the indicators SimHash and FKGL, which proves the effectiveness of the evaluation method proposed in this paper. Conclusion: Texts generated by domestic models are more accessible and better suited for public education, clinical communication, and health consultations. In contrast, the international model has a higher accuracy in generating expertise, especially in epidemiological studies and assessing knowledge literature on disease severity. The inclusion of manual evaluations confirms the reliability of the proposed assessment framework. It is therefore recommended that future AI-generated knowledge systems for infectious disease control balance professional rigor with public comprehensibility, in order to provide reliable and accessible reference materials during major infectious disease outbreaks. Full article

Background: The UK Department for Digital, Culture, Media, and Sport (DCMS) grassroots concussion guidance, May 2023, advised that all community-based sport-related concussions (SRCs) be diagnosed by a healthcare practitioner. This may require that general practitioners (GPs) diagnose and manage SRCs. Diagnosing SRCs in primary care settings in the United Kingdom (UK) presents significant challenges, primarily due to the lack of validated tools specifically designed for general practitioners (GPs). This scoping review aims to identify diagnostic and management tools for SRCs in grassroots sports and primary care settings. Aims: To identify tools that can be used by GPs to diagnose and manage concussions in primary care, both adult and paediatric populations. Design and Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScRs). Five databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, Google Scholar) were searched from 1946 to April 2025. Search terms included “concussion”, “primary care”, and “diagnosis”. Studies that discussed SRCs in community or primary care settings were included. Those that exclusively discussed secondary care and elite sports were excluded, as well as non-English studies. Two reviewers independently screened titles, abstracts, and full texts, with a third resolving any disagreements. Data were extracted into Microsoft Excel. Studies were assessed for quality using the Joanna Briggs critical appraisal tools and AGREE II checklist. Results: Of 727 studies, 12 met the inclusion criteria. Identified tools included Sport Concussion Assessment Tool 6 (SCAT6, 10–15 min, adolescent/adults), Sport Concussion Office Assessment Tool 6 (SCOAT6, 45–60 min, multidisciplinary), the Buffalo Concussion Physical Examination (BCPE, 5–6 min, adolescent-focused), and the Brain Injury Screening Tool (BIST, 6 min, ages 8+). As part of BCPE, a separate Telehealth version was developed for remote consultations. SCAT6 and SCOAT6 are designed for healthcare professionals, including GPs, but require additional training and time beyond typical UK consultation lengths (9.2 min). BIST and BCPE show promise but require UK validation. Conclusions: SCAT6, SCOAT6, BIST, and BCPE could enhance SRC care, but their feasibility in UK primary care requires adaptation (e.g., integration with GP IT systems and alignment with NICE guidelines). Further research is required to validate these tools and assess additional training needs. Full article