Search Results (447)

Background: Intimate partner violence (IPV) represents a major public health problem in Europe, with significant physical, psychological, and social consequences. Nurses are often the first professionals capable of detecting early signs of IPV, yet they lack validated instruments to assess their clinical competency in detection, evaluation, documentation, and intervention. This study aimed to develop and validate the Intimate Partner Violence Nursing Competency Scale (IPVNCS), aligned with the Nursing Intervention Classification (NIC 6403). Methods: A cross-sectional psychometric study was conducted among registered nurses in the Community of Madrid. A 30-item Likert-type self-administered instrument (1–5 scale) was developed based on NANDA, NIC 6403, and NOC frameworks. A total of 202 nurses participated. Reliability was assessed through Cronbach’s alpha. Construct validity was examined using exploratory factor analysis (EFA) with Promax rotation and confirmatory factor analysis (CFA) using AMOS 26. Ethical approval was obtained (CEU San Pablo, code 843/24/104). Results: After item refinement, 26 items remained across four dimensions: (1) Intervention and Referral, (2) Detection and Assessment, (3) Documentation and Recording-keeping, (4) Psychosocial Support. The instrument showed excellent reliability ($\alpha$ = 0.97). KMO was 0.947 and Bartlett’s test was significant (p < 0.001). CFA demonstrated satisfactory fit: ${\chi }^2$/df = 2.066, RMSEA = 0.073, CFI = 0.92, TLI = 0.91, NFI = 0.86. The final model adequately represented the latent structure. After debugging, its psychometric properties were significantly improved. Four redundant items were eliminated, achieving internal consistency ($\alpha$ = 0.97), a KMO value of 0.947 and a significant Bartlett’s test of sphericity. It showed a better fit, according to ${\chi }^2$/df = (2.066); Parsimony = (720.736); RMR (0.0529; RMSEA (0.073); NFI (0.860); TLI (0.910) and CFI (0.920). The final model provides an adequate representation of the latent structure of the data. This study provides initial evidence of construct validity and internal consistency reliability of the IPVNCS. Conclusions: The IPVNCS is a valid and reliable tool to assess nursing competencies for clinical management of IPV. It supports structured evaluation across four core nursing domains, enabling improved educational planning, clinical decision-making, and quality of care for victims. The scale fills a gap in clinical nursing assessment tools and can support protocol development in emergency, primary care, and hospital settings. Full article

Background/Objectives: Patient-level factors strongly influence antimicrobial resistance (AMR) through the pressure applied to healthcare professionals to prescribe antibiotics even for self-limiting viral infections, enhanced by knowledge and attitude concerns. This includes Africa, with high levels of AMR. However, validated measurement tools for African primary healthcare (PHC) are scarce. This study evaluated the reliability, structural validity, and interpretability of the Community Antimicrobial Use Scale (CAMUS) in South Africa. Methods: A cross-sectional survey was conducted with 1283 adults across 25 diverse public PHC facilities across two provinces. The 30-item theory-based tool underwent exploratory and confirmatory factor analysis (EFA/CFA), reliability, and validity testing. Results: EFA identified a coherent five-factor structure: (F1) Understanding antibiotics; (F2) Social and behavioural norms; (F3) Non-prescribed use; (F4) Understanding of AMR; and (F5) Attitudes. Internal consistency was strongest for knowledge and misuse domains (alpha approximation 0.80). Test–retest reliability was good-to-excellent (ICC: 0.72–0.89). CFA confirmed acceptable composite reliability (CR ≥ 0.63). Although average variance extracted (AVE) was low for broader behavioural constructs, indicating conceptual breadth, it was high for AMR knowledge (0.737). Construct validity was supported by positive correlations with health literacy (r = 0.48) and appropriate use intentions (r = 0.42). Measurement error metrics (SEM = 1.59; SDC = 4.40) indicated good precision for group-level comparisons. Conclusions: CAMUS demonstrated a theoretically grounded structure with robust performance in knowledge and misuse domains. While social and attitudinal domains require refinement, we believe the tool is psychometrically suitable for group-level antimicrobial use surveillance and programme evaluation in South African PHC settings and wider to help with targeting future educational programmes among patients. Full article

The rapid adoption of generative artificial intelligence (AI) in higher education has intensified a pedagogical dilemma: while AI tools can increase immediate classroom engagement, they do not necessarily foster the self-regulated learning (SRL) capacities required for ethical and reflective professional practice, particularly in human-service fields. In this two-time-point, pre-post cohort-level (repeated cross-sectional) evaluation, we examined a six-week AI-integrated curriculum incorporating explicit SRL scaffolding among social work undergraduates at a Taiwanese university (pre-test N = 37; post-test N = 35). Because the surveys were administered anonymously and individual responses could not be linked across time, pre-post comparisons were conducted at the cohort level using independent samples. The participating students completed the AI-Enhanced Learning Attitude Scale (AILAS); this is a 30-item instrument grounded in the Technology Acceptance Model, Attitude Theory and SRL frameworks, assessing six dimensions of AI-related learning attitudes. Prior pilot evidence suggested an engagement regulation gap, characterized by relatively strong learning process engagement but weaker learning planning and learning habits. Accordingly, the curriculum incorporated weekly goal-setting activities, structured reflection tasks, peer accountability mechanisms, explicit instructor modeling of SRL strategies and simple progress tracking tools. The conducted psychometric analyses demonstrated excellent internal consistency for the total scale at the post-test stage (Cronbach’s α = 0.95). The independent-samples t-tests indicated that, at the post-test stage, the cohorts reported higher mean scores across most dimensions, with the largest cohort-level differences in Learning Habits (Cohen’s d = 0.75, p = 0.003) and Learning Process (Cohen’s d = 0.79, p = 0.002). After Bonferroni adjustment, improvements in the Learning Desire, Learning Habits and Learning Process dimensions and the Overall Attitude scores remained statistically robust. In contrast, the Learning Planning dimension demonstrated only marginal improvement (d = 0.46, p = 0.064), suggesting that higher-order planning skills may require longer or more sustained instructional support. No statistically significant gender differences were identified at the post-test stage. Taken together, the findings presented in this study offer preliminary, design-consistent evidence that SRL-oriented pedagogical scaffolding, rather than AI technology itself, may help narrow the engagement regulation gap, while the consolidation of autonomous planning capacities remains an ongoing instructional challenge. Full article

Background and Objectives: Chronic low back pain (CLBP) is a prevalent condition that impairs quality of life, functionality, and work productivity. While most acute episodes of back pain resolve, 4–25% become chronic due to factors such as high pain intensity, psychological distress, and maladaptive behaviors. Nonspecific CLBP is best understood through the biopsychosocial model, encompassing biological, psychological, and social influences, including kinesiophobia. Management relies on physical activity, pain education, and psychological interventions, with therapist knowledge and attitudes affecting outcomes. This study aimed to assess the prevalence of CLBP among healthcare workers, examine their knowledge of pain neurophysiology, evaluate kinesiophobia, and explore how personal experience with CLBP influences their beliefs, attitudes, and interactions with patients. Materials and Methods: A cross-sectional observational study was conducted from January to May 2025 among healthcare professionals. A total of 50 participants completed an online questionnaire, of which 42 were valid and included in the analysis. The questionnaire collected demographic and professional data, determined the presence of CLBP, and included three standardized instruments: the Revised Neurophysiology of Pain Questionnaire (rNPQ) to assess knowledge of pain mechanisms, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) to evaluate beliefs about pain and disability, and the Tampa Scale of Kinesiophobia (TSK-11) to measure fear of movement. Data were analyzed using SPSS and Microsoft Excel. Results: Among the 42 participants, 11 demonstrated low, 28 moderate, and 3 high knowledge of pain neurophysiology (rNPQ), with a mean score of 5.66. On the HC-PAIRS, the majority (30 participants) scored above 60, indicating beliefs that pain leads to disability, while 12 scored below 60, reflecting a biopsychosocial perspective; gender did not significantly affect HC-PAIRS scores (p = 0.213). As for kinesiophobia (TSK-11), 24 participants had low, 17 moderate, and 1 clinically significant fear of movement. Correlation analysis revealed that younger participants had higher rNPQ scores (r = −0.358, p = 0.020) and lower TSK-11 scores (r = −0.389, p = 0.011). TSK-11 scores increased with age (r = 0.432, p = 0.004), while HC-PAIRS scores showed no significant correlations. Conclusions: Healthcare professionals, particularly physiotherapists, show gaps in knowledge of pain neurophysiology and a tendency toward biomedical beliefs regarding chronic low back pain. This cross-sectional study indicates that a greater understanding of pain mechanisms is associated with lower kinesiophobia, emphasizing the importance of education. Integrating the biopsychosocial model into undergraduate and continuing professional training, through interdisciplinary and practical modules, may improve knowledge, reduce maladaptive fear-avoidance behaviors, and enhance patient care. Future studies should include larger, more diverse samples and assess the long-term impact of educational interventions on clinical practice. Full article

Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37–91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1–4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5–14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm²) at a rate of 9.3 cm²/h in 121 min. Tutored beginners achieved a 75% [25–100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers. Full article

Background/Objectives: Medication incidents remain a significant concern in hospital settings. Integrated medication systems, regarding organized processes, policies, technologies and professional practices are designed to enhance patient safety; however, their safety performance is still suboptimal. The use of valid and reliable instruments to assess hospital medication system safety can be a valuable resource for health care management. The aim of this study was to describe the development and psychometric validation of the Hospital Medication System Safety Assessment Questionnaire (HMSSA-Q) for assessing the safety of hospital medication systems and its processes in Portugal. Methods: The HMSSA-Q was developed through a literature review and two rounds of expert panel consultation. Following consensus, a pilot methodological study was conducted in 95 Portuguese hospitals. Construct validity was assessed using principal component factor analysis, and reliability was evaluated through internal consistency (Cronbach’s alpha). Results: The instrument is theoretically structured into five predefined domains/subscales: Organizational Environment, Safe Medication Prescribing, Safe Medication in Hospital Pharmacy, Safe Medication Preparation and Administration, and Information and Patient Education. Principal component analyses performed separately for each domain supported their internal structure. The overall scale showed excellent internal consistency (Cronbach’s α = 0.97), with Cronbach’s alpha values for the domains ranging from 0.86 to 0.94. Conclusions: The HMSSA-Q is a valid and reliable instrument for assessing the safety of hospital medication systems and has the potential to serve as an innovative management tool for improving patient safety. Full article

Purpose: This study assessed the adaptations resulting from implementing an experimental, integrated training program tailored to sex-specific traits. The aim was to enhance motor abilities, aerobic capacity, and metabolic variables in female and male rugby sevens athletes. Methods: Employing a combined observational and experimental design, initial and post-intervention assessments were conducted over three months (March–June 2023) with 24 elite professional players, divided equally by sex (12 females, 12 males). The protocol consisted of 12 micro-cycles, each lasting 7 days and comprising 12 training sessions. The evaluations included sprint and jumping tests, as well as functional assessments such as resting metabolic rate and cardiopulmonary exercise testing. Results: Using one-way repeated measures ANOVA, significant improvements were noted across all performance parameters (p < 0.001), with effect sizes ranging from small to very large. Sex-specific differences were evident, with females demonstrating consistent improvements in aerobic capacity and jumping ability, while males excelled in explosive power and longer sprints. Despite initial performance disparities, both sexes improved in short-distance sprints (10 m and 40 m). Cardiovascular efficiency improved as indicated by reduced maximum heart rates and lower respiratory quotients. Conclusions: Males showed superior progress in strength and explosive power tests, reflecting distinct physiological traits. These findings underscore the need for individualized and sex-specific training programs to optimize performance in high-intensity sports, such as rugby sevens. Full article

In medical diagnostics and decision-making, particularly in dentistry where structural interpretation of radiographs plays a crucial role, accurate image segmentation is a fundamental step. One established approach to segmentation is the use of clustering techniques. This study evaluates the performance of five clustering algorithms, namely, K-Means, Fuzzy C-Means, DBSCAN, Gaussian Mixture Models (GMM), and Agglomerative Hierarchical Clustering for image segmentation. Our study uses two sets of real-world dental data comprising 140 adult tooth images and 70 children’s tooth images, including professionally annotated ground truth masks. Preprocessing involved grayscale conversion, normalization, and image downscaling to accommodate computational constraints for complex algorithms. The algorithms were accessed using a variety of metrics including Rand Index, Fowlkes-Mallows Index, Recall, Precision, F1-Score, and Jaccard Index. DBSCAN achieved the highest performance on adult data in terms of structural fidelity and cluster compactness, while Fuzzy C-Means excelled on the children dataset, capturing soft tissue boundaries more effectively. The results highlight distinct performance behaviours tied to morphological differences between adult and pediatric dental anatomy. This study offers practical insights for selecting clustering algorithms tailored to dental imaging challenges, advancing efforts in automated, label-free medical image analysis. Full article

Background: Telemedicine can improve early symptom detection using medical devices and applications. It can also help identify barriers to patient adherence and enhance communication with healthcare professionals. This study aimed to evaluate the applicability, usability, and patient satisfaction with telemonitoring devices and apps for individuals with heart failure and type 2 diabetes. Methods: In a randomized study, patients in the Intervention Group received six months of nursing teleassistance and telemonitoring using a wearable electrocardiograph, a step tracker, and an App for recording clinical information and conducting video calls. Usability was measured using the System Usability Scale (SUS) and satisfaction with a six-item questionnaire. Results: A total of 43 patients (71 ± 8 years) were enrolled in the intervention group. A total of 41 (95%) of patients utilized the App daily, entering 13,048 information, 53 ± 59 per patient. The nurses performed 896 video-calls, 22 ± 21 per patient. The mean number of walking sessions recorded was 6.1 ± 0.9 per week (159 ± 24 per patient). Thirty-five patients (81%) used a 3-lead ECG and recorded 942 traces, 27 ± 14 per patient. At the end, 40 SUS were collected from patients: 15 (38%, 71 ± 7 years) considered the system excellent or good, 20 (50%, 71 ± 8 years) thought it fair, and 5 (13%, 74 ± 7 years) considered the system offered poor. The overall assessment of patient satisfaction with the service was 22 ± 3.3. Conclusions: This study provides evidence that, although technology can be complex for older adults, it is broadly accepted by most patients, especially when the benefits are understood. The support offered by nurses is essential for significantly enhancing the overall patient experience. Full article

Background: This study aimed to validate the Ambivalence and Uncertainty Scale (AUS), developed to measure dispositional ambivalence, ambivalence intolerance, and decision-making difficulties, particularly among healthcare professionals during high-stress situations such as the COVID-19 pandemic. Method: Cross-sectional data from 1240 German healthcare professionals were analyzed. Exploratory factor analysis (EFA) was employed to evaluate the scale’s dimensionality, while internal consistency and construct validity, including convergent and divergent validity, were assessed using correlations with relevant psychological constructs. Results: The EFA revealed a unidimensional structure explaining 64.33% of variance, indicating a single underlying trait. The AUS demonstrated excellent internal consistency (Cronbach’s α = 0.86) and strong convergent validity, evidenced by significant positive correlations with anxiety and depressive symptoms (r = 0.63) and burnout (r = 0.48), and a negative correlation with sense of coherence (r = −0.60). Divergent validity was supported through minimal correlation with unrelated constructs such as fatigue (r = −0.02) and a moderate correlation with work–family conflict (r = 0.31). The AUS effectively captures dispositional ambivalence and uncertainty tolerance, highlighting its relevance in psychological adaptation and resilience among professionals in stressful environments. Full article

Background/Objectives: Aphasia screening tools help healthcare professionals detect aphasia after a stroke. To date, there is no standardized and validated aphasia screening tool available for use in Cyprus. The Cyprus Aphasia Screening Test (CAST) is a newly developed tool for detecting post-stroke aphasia. This study aims to present the main characteristics of the CAST and evaluate its psychometric properties and diagnostic accuracy. Methods: A cross-sectional study was conducted, involving 99 participants divided into three groups as follows: 43 people with stroke-aphasia, 21 with strokes but without aphasia, and 35 healthy controls. Results: The CAST demonstrated excellent internal consistency (Cronbach’s α > 0.967), high test–retest (ICC ≥ 0.983) and interrater (ICC = 0.979) reliability, and verified known-groups validity (p< 0.001). A significant correlation between the total scores of the CAST and the Greek version of the Boston Diagnostic Aphasia Examination (Short Form) confirmed a linear relationship across the two measures (p < 0.001). A ROC curve analysis (AUC = 0.97) identified 36/40 as the cut-off for detecting aphasia. Conclusions: The CAST is a reliable, clinician-administered aphasia screening tool with strong psychometric properties. It is designed to identify post-stroke aphasia and distinguish between stroke patients with and without aphasia. It consists of 10 subtests that assess both language comprehension and production. The CAST is designed for easy scoring and requires minimal equipment, making it well-suited for quick and efficient administration at the bedside. The CAST represents a step forward in aphasia screening for Greek-speaking populations in Cyprus. Full article

Background: Steel box girders are widely employed in bridge engineering due to their excellent mechanical properties and construction convenience, yet their modular design still encounters bottlenecks such as knowledge reuse difficulties and information silos. This study proposes a BIM-driven framework based on knowledge graphs and data fusion. By constructing a professional knowledge graph comprising 85 core entity types and 150 semantic relationships (integrated with over 15,000 knowledge units), systematic management of design knowledge is achieved. The developed BIM reverse modeling technology improves parametric modeling efficiency by 30–40%, while the data fusion mechanism supports over 90% accuracy in design conflict detection. The intelligent decision-making system built upon this framework meets 75% of business scenario requirements while effectively assisting critical decisions such as module selection. Results demonstrate that this framework significantly enhances design collaboration efficiency and intelligence through knowledge structuring and deep data integration. Although some achievements were validated via simulation due to limited field measurement data, the approach demonstrates strong engineering applicability and provides novel technical pathways and methodological support for advancing digital transformation in bridge engineering. Full article

Medical textiles have gained significant attention for their ability to prevent the transmission of infectious diseases while ensuring the safety and comfort of healthcare professionals. This study focuses on modifying the surfaces of polyethylene terephthalate (PET) fabrics with titanium dioxide (TiO₂) nanoparticles (NPs) to enhance their antibacterial properties, thermophysiological comfort, and thermal insulation. The effects of varying volumes of the tetraisopropyl orthotitanate precursor on the functional properties of the coated PET fabrics were systematically investigated. The surface morphology was characterized using scanning electron microscopy (SEM). At the same time, the elemental and chemical properties were analyzed through Energy-dispersive spectroscopy (EDS), Raman spectroscopy, and Fourier-transform infrared spectroscopy (FTIR). The TiO₂ NPs-coated PET fabrics demonstrated exceptional antibacterial activity against Gram-negative and Gram-positive bacteria and significantly improved thermophysiological comfort. Specifically, thermal resistance increased with a higher density of TiO₂ nanoparticles, leading to a decrease in thermal conductivity. Notably, only minimal reductions were observed in relative water vapor permeability (RWVP) and air permeability (AP), indicating that the fabric’s porosity was maintained. Furthermore, the presence of the TiO₂ nanolayer on the PET fabric significantly enhanced its thermal stability, providing excellent thermal insulation properties. These findings underscore the potential of TiO₂ NPs-coated PET fabrics as promising candidates for advanced medical textile applications, where a balance of protection, comfort, and thermal insulation is essential. Full article

Background: Evidence on HAIs in Africa is fairly common. Objectives: The main objective was to identify the surveillance tools used for healthcare–associated infections (HAIs) in countries in the WHO African Region. Secondary objectives focused on the organization of surveillance, the pathogens involved, and the frequency of multidrug–resistant species. Inclusion and exclusion criteria: Observational or interventional studies on healthcare–associated infections in humans, published between January 2011 and December 2024, in French or English, were included. However, the following publications were not included: animal studies, healthcare–associated infections not related to healthcare, literature reviews, studies outside the period or geographical area, and studies in languages other than French or English. Sources of information and search date: The databases consulted were PubMed, Web of Science, EMBASE, Cochrane, African Index Medicus, Google Scholar, and AJOL. The search was conducted between January and March 2025. Risk of bias assessment: The risk of bias was assessed using a specific grid (eleven criteria), scored from one (low) to three (high). The studies were classified into three levels of methodological quality. The results of the bias assessment showed that the publications were excellent (strong and moderate) with a cumulative rate of 99.9%. Methods of synthesizing results: Data were extracted using a standardized grid and synthesized narratively. No meta–analysis was performed. Number of studies and characteristics: 95 studies were included, mostly cross–sectional studies (82.1%), cohorts (10.4%), and a few case reports. Most were from West Africa (60.0%), particularly Nigeria (16.8%) and South Africa (14.7%). Main results: • Most common pathogens: Staphylococcus aureus (53.7%), Escherichia coli (43.2%), Klebsiella pneumoniae (32.6%). • Resistance profile: ESBL (27.4%), MRSA (21.1%), multidrug resistance (13.7%). • Sources of HAIs: mainly exogenous (83.2%). • Laboratory methods: phenotypic (70.5%), genotypic or genomic rare (3.1%). • Scope of studies: local (96.8%), national (3.2%). Limitations of evidence: Risk of bias due to underreporting of HAIs, methodological heterogeneity, predominance of cross–sectional studies, low use of molecular methods, lack of modeling, and uneven geographical coverage. Overall interpretation and implications: surveillance of HAIs in Africa remains fragmented and poorly standardized. There is a need to strengthen national systems, integrate molecular methods, train professionals, and promote interventional research. The WHO GLASS program can serve as a framework for harmonizing surveillance. Full article

Background/Objectives: Metabolic syndrome (MetS) and even closely related metabolic and anthropometric alterations require timely intervention to reduce associated risks. Neo-Policaptil^® Gel Retard has shown potential in managing both established MetS and early imbalances. To further characterize its real-world impact, a large post-marketing survey was conducted to assess perceived effectiveness, safety, quality of life (QoL), and patterns of use. Methods: Between December 2021 and May 2025, patients/child caregivers, pharmacists, and physicians completed online questionnaires via a dedicated web platform. Patients reported their direct experience, while healthcare professionals (HCPs) provided observations on patient use. Results: The survey included 2204 patients, 57 child caregivers, 455 physicians, and 387 pharmacists. Overall, 97.7% of patients reported an improvement in their condition. Most physicians (94.3%) and pharmacists (89.1%) rated the overall effectiveness of the product as “good” or “excellent”. The safety profile was judged “good” or “excellent” by 84.4% of patients and by over 93% of HCPs. The product was mainly used as monotherapy or in combination with dietary measures and/or physical exercise. Conclusions: These findings underscore the product’s effectiveness, safety, tolerability, and positive influence on QoL in both adults and children affected by MetS or by related metabolic and anthropometric imbalances. Full article