Search Results (4,302)

Background/Objectives: Despite legal progress and achievements regarding trans* rights in Portugal over recent decades, trans* individuals still face high levels of violence and discrimination, especially within family and intimate relationships. This qualitative study aimed to explore the experiences and perspectives of professionals working in the domestic violence field with the trans* population and service provision within the National Support Network for Victims of Domestic Violence (RNAVVD). Methods: Semi-structured interviews were conducted with eight participants, including psychologists, social workers, and program directors from organizations supporting victims of domestic violence in Portugal. Data were analyzed using Codebook Thematic Analysis to identify themes, resulting in two main themes: (1) Experiences in Working with Victimized Trans* Individuals; and (2) Framework of Portugal’s National Support Network. Results: The results showed that trans* individuals face significant vulnerabilities due to family and intimate partner violence, systemic discrimination, and inequalities in essential services. Young trans* individuals are seen as being particularly at risk due to the impacts of violence and lack of family support on their autonomy, and additional barriers to entering the labor market. Participants also identified barriers faced by this population when trying to access victim support services (e.g., lack of specialized training and low availability of specialized and culturally competent services), while highlighting efforts by LGBTQIA+ services to meet their psychosocial needs. Conclusions: In conclusion, public institutions must address the specific needs of trans* individuals by developing policies and services that adopt a cross-sectoral, intersectional approach across society. Full article

Background: Arterial hypertension is one of the most prevalent chronic non-communicable diseases and a leading cause of cardiovascular morbidity and mortality worldwide. Its burden remains particularly high in rural and resource-limited settings, where access to healthcare is often constrained by shortages of healthcare professionals, geographical barriers, and underdeveloped infrastructure. These factors may contribute to delayed diagnosis, suboptimal disease control, and increased risk of complications. In this context, telemedicine has emerged as a useful approach to supporting hypertension management and improving access to care in rural populations. Methods: This study presents a narrative review of the literature focusing on the application of telemedicine in the management of arterial hypertension in rural populations. A structured literature search of PubMed, Scopus, and Web of Science databases was conducted for studies published between 2015 and 2025. The review included randomized controlled trials, systematic reviews, meta-analyses, and observational studies evaluating telemedicine interventions, including remote blood pressure monitoring, mobile health applications, and teleconsultations. Study selection was guided by relevance to the research objective, with particular attention to rural and resource-limited contexts. Results: Telemedicine interventions have been associated with improvements in blood pressure control, treatment adherence, and access to healthcare services. Evidence from randomized controlled trials and meta-analyses suggests modest reductions in systolic and diastolic blood pressure compared with standard care. However, a substantial proportion of the available evidence originates from studies conducted in general or mixed populations rather than exclusively rural settings. Therefore, the applicability of these findings to rural contexts remains limited and should be interpreted with caution. The effectiveness of telemedicine may vary depending on differences in healthcare infrastructure, resource availability, digital accessibility, and organizational models across healthcare systems. Integrated care approaches involving primary healthcare providers and specialist support may contribute to improved continuity of care, although their impact appears to be context-dependent. Key barriers include limited telecommunication infrastructure, digital literacy challenges, and difficulties in integrating telemedicine into routine clinical practice. Conclusions: Telemedicine may represent a useful approach to supporting hypertension management in rural populations. However, its implementation requires careful consideration of local healthcare systems, patient characteristics, and organizational context. Telemedicine should be viewed as a context-dependent strategy rather than a uniform solution. Further context-specific research is needed to evaluate the long-term clinical, organizational, and economic impact of telemedicine interventions in rural hypertension management. Full article

The pharmaceutical development of cannabis-based medicinal products is challenged by significant variability in the quality, composition, and standardization of plant-derived active pharmaceutical ingredients (APIs). In Ukraine, despite recent legislative liberalization, a substantial shortage of standardized raw materials continues to limit the development of innovative dosage forms. This study analyses international practices among API manufacturers to identify technological parameters necessary to overcome domestic market barriers and support the implementation of advanced drug delivery systems. Content analysis was conducted on regulatory documentation, professional literature, and manufacturers’ technical specifications. Candidate evaluation followed predefined inclusion and exclusion criteria. The study assessed compliance with Good Manufacturing Practice (GMP) requirements, extraction and purification technologies, the extent of analytical characterization, and batch-to-batch reproducibility. Purposive sampling enabled a comparative analysis of various technological approaches. Marked heterogeneity was observed in API standardization and analytical control indicators among manufacturers. Possession of a GMP certificate was found necessary but may be insufficient to ensure the pharmaceutical equivalence of materials. Differences in extraction methods and purification levels may affect stability profiles, pharmaceutical development strategies, and risk management related to final product quality. The findings demonstrate that manufacturer selection is a critical decision point in pharmaceutical development, with substantiated supplier choice directly influencing dosage form development and regulatory compliance. Full article

The management of retinopathy of prematurity (ROP) has evolved alongside advances in neonatal medicine, shaped by both scientific progress and medico-legal influences. ROP-related medical malpractice lawsuits provide a unique perspective on how standards of care are defined and evaluated. This review comprises two complementary components: a narrative medico-historical review of ROP management and a structured descriptive comparison of judicial cases identified in publicly accessible legal databases in Japan. The aim was to clarify how evolving clinical practice, dissemination of knowledge, and institutional capacity have influenced judicial interpretations of the standard of care. The findings indicate that standards of care in ROP management have been determined not solely by established evidence but by a broader assessment of contemporaneous professional knowledge and clinical practice. A marked shift in judicial outcomes after the mid-1970s corresponded to the widespread adoption of systematic screening and photocoagulation therapy. These results suggest that medico-legal evaluation reflects system-level maturity in neonatal care. In the current era of anti-vascular endothelial growth factor therapy, litigation is likely to focus less on specific interventions and more on the appropriateness of clinical decision-making, consideration of alternatives, and adequacy of informed consent procedures. This review provides a medico-historical framework for improving patient safety, risk management, and quality of care in neonatal practice. Full article

Financial reporting standards aim to increase transparency; however, the expansion in disclosure volume may also create an information overload paradox for investors, an issue that remains underexplored in the context of institutional investors. Excess information beyond mandatory requirements may complicate decision environments and create cognitive burden. When information exceeds cognitive processing capacities, attention may become fragmented, making it more difficult to distinguish signal from noise and potentially leading to analysis paralysis and changes in risk perception. Drawing on bounded rationality and cognitive load theory, this study conceptualizes information overload as a behavioral constraint associated with perceived limitations in decision quality and speed and, accordingly, examines its influence on institutional investors’ decision processes through a phenomenological approach. The study employs thematic analysis based on in-depth interviews with 19 professionals in institutional investment organizations in Türkiye. The findings suggest that information overload is experienced as cognitive strain that may prolong decision processes, may be associated with analysis paralysis and perceived changes in decision quality, and may be associated with increased uncertainty and potential challenges in interpreting risk. These findings provide exploratory insight into how information density may influence risk interpretation and portfolio assessment, and how institutional investors perceive decision-making efficiency. Full article

Background/Objectives: Dog tethering remains a common containment practice in several regions despite increasing concerns about its implications for animal welfare. This study aimed to assess veterinary professionals’ perceptions in Portugal about the impact of dog tethering on canine health, behavior, and welfare, as well as their views on its regulation. Methods: An anonymous, structured questionnaire was distributed online to veterinary professionals to collect data on clinical exposure to chained dogs, observed health and behavioral outcomes, and attitudes toward criminalizing the practice. Results: A total of 331 veterinarians participated, of whom 71.9% reported encountering chained dogs during their professional activities, particularly in rural areas. Most respondents perceived the tethering conditions as inadequate, particularly regarding freedom of movement and the fulfillment of behavioral needs. Frequently reported consequences included alopecia at the restraint site, poor muscle condition, physical injuries, fear-related behaviors, reduced socialization, and increased aggression. Preventing escape was identified as the primary perceived motivation for tethering. The majority of veterinarians supported some degree of criminalization, particularly when welfare impairment was evident. Conclusions: These findings reflect veterinary professionals’ perceptions of the welfare risks associated with prolonged tethering and underscore the need for integrated strategies combining regulation, education, and accessible, humane containment alternatives. Full article

Recent reports indicate that employees are being subjected to harassment on social media. However, research in this area is highly interdisciplinary, often existing in disciplines that cater to occupational groups, such as politicians, journalists, or education professionals. We therefore conducted a scoping review to synthesize research in this area. Our scoping review sought to identify (1) the nature of social media harassment towards employees, (2) specific risk factors, and (3) how organizations manage the problem. We conducted searches of the Web of Science and Scopus databases, alongside keyword searches of Google Scholar. Our approach aligned with PRISMA recommendations for conducting scoping reviews, and the searches produced 47 studies, of which 35 met the inclusion criteria. Analyses revealed the varied nature of social media harassment towards employees, reflected in the use of 14 different labels to describe social media harassment. Only five studies addressed risk factors for experiencing harassment, which included greater prominence and visibility, more active use of social media, and working in an organization where offline harassment occurs. Moreover, just six studies have examined organizational responses to the problem, and were largely seen as ineffective, although thirteen studies addressed how individuals coped with social media harassment. This is the first paper that reviews research on social media harassment directed at employees. To consolidate this research area, we offer suggestions aimed at reducing construct proliferation and promoting a more coherent research agenda. Full article

Background: The nursing profession is recognized as a high-risk occupation, with the emotional toll on healthcare workers reaching a critical point. A complex interplay of anger and cynicism, often stemming from systemic pressures and chronic moral injury, seems to increasingly affect nurses’ professional and personal lives. This psychological strain does not end when the shift ends; rather, it often manifests as insomnia and nightmare distress, creating a vicious cycle of exhaustion and emotional instability. This article explores how anger, cynical distrust, nightmare distress and insomnia are interrelated and jeopardize the well-being of nursing staff and what these “invisible” symptoms reveal about the current state of healthcare by confirming their prevalence rates. Methods: This cross-sectional study was conducted online in October 2025 and included 441 hospital nurses who completed the Dimensions of Anger Reactions-5 (DAR-5), the 8-item Cynical Distrust scale (CDS-8), the Nightmare Distress Questionnaire (NDQ) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of anger, nightmare distress and insomnia were 41.5%, 6.6%, and 62.1%, respectively. Based on the CDS-8 scores, a notable proportion (20.9%) of nurses fell within the highest quartile of CDS-8 scores (CDS-8 > 29), indicating relatively elevated cynical distrust within this sample; this threshold is sample-derived and does not correspond to a validated clinical cut-off. Hierarchical multiple regression analysis indicated that the DAR-5 explained 22.1% of the variance in AIS, while an additional 10.2% was explained by NDQ and another 1.5% by the CDS-8. Both cynical distrust and nightmare distress displayed a chain mediation pattern in the association between anger and insomnia; however, given the cross-sectional design, the temporal order of these variables cannot be confirmed. Conclusions: Anger exhibited significant direct and indirect associations with insomnia, with cynical distrust and nightmare distress acting as serial mediators in this cross-sectional model. Findings from this cross-sectional study tentatively suggest that future intervention efforts targeting insomnia in nurses might benefit from addressing anger alongside nightmare distress and cynical attitudes; however, experimental studies are needed to confirm whether such interventions would be effective. Full article

Severe early childhood caries (SECC) in preschool children is a progressive, multifactorial disease with far-reaching consequences for child health, family functioning, and health systems. Minimally invasive dentistry (MID), particularly 38% silver diamine fluoride (SDF), is increasingly used to arrest lesions and “buy time” when definitive restorative care is delayed. This narrative review synthesizes current evidence-based guidelines and real-world utilization data to clarify the appropriate role and limits of SDF in SECC management. Professional guidance supports SDF for lesion arrest within an ongoing caries management plan, but does not endorse it as a universal long-term substitute for durable restorative care. Observational studies show that many SDF-treated primary teeth receive additional intervention within approximately 2 years, and any delay in sedation/general anesthesia is typically measured in weeks to months. A large recent private practice study found that 35% of children with caries progressed to higher-intensity treatment (restoration or extraction) over a median of 547 days, reinforcing the time-limited nature of interim stabilization. We propose a “preservation-to-precision” framework that prioritizes child-centered outcomes—freedom from pain and infection, durable function, and acceptable psychosocial impact—through risk-based, tooth- and child-specific planning, realistic follow-up assessment, and clear exit criteria for transition to definitive care. In high-income settings, the ethical value of “buying time” depends on whether systems use that time to advance children toward timely, definitive care rather than normalizing prolonged temporization as routine practice. Full article

Background/Objectives: Telemedicine-enabled medication dispensing and delivery was formally regulated in Jordan in 2025, but the Jordan Pharmacists Association publicly rejected the pharmacy-related provisions because of concerns about safety, liability, and the pharmacist’s professional role. This study evaluated community pharmacists’ acceptance of the regulated model and identified perceived patient safety risks, implementation barriers, and required safeguards. Methods: A convergent mixed-methods design was used. A cross-sectional online survey was completed by 350 licensed community pharmacists (response rate 83.3%). The questionnaire assessed willingness to participate, perceived patient safety risks, implementation barriers, and facilitators using 5-point Likert scales. Multivariable logistic regression examined predictors of willingness. Semi-structured interviews were conducted with 22 purposively sampled pharmacists until thematic saturation. Quantitative and qualitative findings were integrated using joint displays. Results: Only 28.3% of pharmacists were willing to participate under current conditions, 46.9% were unwilling, and 24.9% expressed conditional acceptance; 52.0% opposed national implementation. Patient safety concerns were great (mean 4.4 ± 0.6/5), especially regarding remote patient assessment (91.4%) and medication errors (88.9%). Implementation barriers were severe (mean 4.5 ± 0.5/5), mainly regulatory ambiguity (92.0%) and unclear liability (89.7%). Facilitators were strongly endorsed (mean 4.7 ± 0.4/5), particularly mandatory pharmacist verification (94.6%) and clear legal protections (93.4%). Qualitative findings reinforced pharmacists’ role as the “final safety checkpoint” and showed acceptance depended on strong safeguards. Conclusions: Jordanian pharmacists showed principled resistance to the current model. Acceptance depends on pharmacist oversight, legal clarity, and infrastructure readiness. Full article

Background: Sports-related concussion (SRC) is associated with elevated subsequent musculoskeletal (MSK) injury risk, yet no study has examined whether a mandatory post-concussion rest period mitigates this risk in professional Australian rules football. The aim of this study was to compare subsequent injury risk following SRC in Australian Football League (AFL) male athletes across two periods: a discretionary return-to-play period (2016 to 2019) and a mandatory 12-day non-competition period (2021 to 2024). Methods: Injury data were extracted from publicly available AFL injury reports across eight seasons (n = 4351 players). Risk ratios (RRs) with 95% confidence intervals were calculated using log-binomial methods, with pooled estimates derived via the Mantel–Haenszel approach. Results: Across both periods, SRC significantly increased overall MSK injury risk compared to MSK-first injury risk (2016 to 2019: RR:1.59 [95%CI:1.31 to 1.92]; p < 0.001; 2021 to 2024: RR:1.56 [95%CI:1.28 to 1.91]; p < 0.001). Upper and lower limb injury risks were similarly elevated across both eras. Notably, the risk of subsequent concussion was significantly elevated during 2016 to 2019 (RR:3.14, p < 0.001), whereas no statistically significant elevation was demonstrated during 2021 to 2024 (RR:1.30, p = 0.324). Conclusions: During the 12-day rest period, subsequent concussion risk was no longer significantly elevated, while MSK injury risk remained increased, suggesting longer recovery periods may be warranted for full neuromuscular recovery following SRC. Full article

The prevalence of plastics in the environment raises concerns about their complex and poorly understood effects on human health. Research continues to uncover more sources of exposure and wider ranges of plastics within the body. Adverse health effects have been observed in animals, but their relevance to humans remains unclear. To address the growing need for reliable toxicity assessment resources and tools to aid in the synthesis of findings and the identification of data gaps and needs, we have developed a data visualization tool to provide streamlined access to the evaluated data on the chemical impacts of plastics on human health. The Plastics-Related Toxicology Profiles Tool uses Tableau Public to organize the extracted chemical-specific information from ATSDR Toxicological Profiles, the United Nations Environmental Program’s 2023 Chemicals in Plastics Technical Report, and a literature review of relevant research in Google Scholar and PubMed. The tool organizes extracted data from 98 ATSDR Toxicological Profiles representing over 476 substances related to plastics production in 16 tabulated health outcome categories associated with plastics exposure. The chemicals are organized into four categories based on their role in plastics manufacturing. The top four health endpoints impacted by all listed substance profiles are respiratory, neurologic, hepatic, and developmental effects. More than 30% of the substance profiles affected these systems as well as other non-cancer endpoints involving the immunological, renal, and reproductive systems, as well as increased cancer risk in respiratory and hepatic systems. Most monomers negatively impact development and the respiratory system, and most metal additives affect the respiratory system. We explain how this data visualization tool combined with ATSDR’s framework for assessing health impacts from multiple chemicals could be applied to identify the target organs impacted by components of the common plastic polyvinyl chloride. Hazard quotients and index show low toxicity and health risk of components in the cured product. This data provide a valuable resource for prioritizing health risk assessments. Use of this interactive tool can enhance the ability of public health professionals to navigate the expanding literature, synthesize findings, and identify future health risk assessment and research priorities. Full article

Background/Objectives: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is common in dentistry, mainly for pain and inflammation. However, their coadministration with warfarin may lead to serious potential drug-drug interactions (PDDIs), increasing the risk of bleeding. This study aimed to identify and describe the frequency of PDDIs between warfarin and NSAIDs prescribed by dentists and dispensed by the Unified Health System (SUS) in Minas Gerais, Brazil, from January 2011 to December 2021. Methods: A descriptive analysis was conducted using data from Integrated Pharmaceutical Services Management System (Sigaf), considering prescriptions of warfarin and NSAIDs issued during the same period. Results: The prescribed NSAIDs were diclofenac sodium 50 mg, diclofenac potassium 50 mg, ibuprofen 600 mg, nimesulide 100 mg, and nimesulide 50 mg/mL oral suspension. Warfarin sodium 5 mg is the prescribed oral anticoagulants. The results showed a marked increase in both warfarin (from 6017 to 59,945 prescriptions; +896%) and NSAID use (from 2644 to 84,408 prescriptions; +3093%), paralleling the rise in PDDIs, which grew from 2 in 2011 to 62 in 2021. Despite this 3000% relative increase, the absolute frequency of PDDIs remained low, corresponding to approximately 0.7 interactions per 1000 NSAID prescriptions in 2021. Conclusions: Although these PDDIs are low, they are clinically significant and may have important implications for patients and the healthcare system. In conclusion, PDDIs between NSAIDs and warfarin, though low in absolute numbers, have increased over the years, reinforcing the need for greater awareness among dental professionals and for the implementation of clinical decision support strategies to promote safe care. Full article

Increased flight volumes necessitate urgent reforms in Airspace Management (ASM) to mitigate risks of fatalities and near-misses. In order to enhance aviation system safety, the International Civil Aviation Organization (ICAO) mandates that state parties must conduct the Universal Safety Oversight Audit Program (USOAP) to continuously monitor civil aviation. This research aims to identify critical factors influencing Thailand’s ASM by employing experimental design and Structural Equation Modeling (SEM) to analyze influences and relationships among communication, surveillance, navigation, Air Traffic Management (ATM), and ASM. The methodology includes stimulation and a questionnaire-based survey conducted with aviation professionals and mapping out their answers to find the influences, relationships, and importance of the different factors. The results were validated using various statistical tools. The findings indicate signi1ficant direct and indirect effects on ASM, emphasizing that effective communication and robust surveillance are essential for safety and operational efficiency. This study highlights the need to increase the ASM framework, providing actionable insights for optimizing air traffic control in response to the growing air traffic demand. Furthermore, SEM for Airspace optimization can be applied internationally to significantly reduce accidents and incidents in the future. Full article

This study aims to identify key health and safety challenges and examine root causes while developing a conceptual framework to improve safety. Results of the study will be useful for policy makers, regulatory authorities, construction managers, safety professionals and researchers to improve regulations, safety practices, training programs and policy development. The emerging construction industry in Sri Lanka is facing significant safety challenges for workers, including poor practices, inappropriate conduct, and negative attitudes. The construction industry was selected for this study due to its labor-intensive nature and its consistently high exposure to occupational hazards compared to other industrial sectors. The underlying root causes of these health and safety challenges remain unclear, primarily due to a lack of comprehensive government regulations, which are currently limited to the outdated Factories Ordinance of 1942. Sri Lanka was chosen as the focus of this study because of its rapidly expanding construction sector and outdated regulatory framework; it is also a representative of underdeveloped countries. Several studies have identified contributing factors such as outdated legislation, a shortage of qualified officers, poor attitudes, lack of funding, negligence, and limited awareness. To address this research gap, the safety aspects of the Sri Lankan construction industry have been examined, revealing emerging challenges such as poor safety practices, the presence of foreign workers, and the inadequate use of personal protective equipment (PPE) by staff. A deeper examination of these challenges indicates that sufficient safety budgets reflect leadership attitudes toward preventing injuries, and that targeted safety training for different roles can help mitigate these issues. Accordingly, a conceptual safety framework has been developed. A qualitative, semi-structured interview comprising both open- and closed-ended questions was conducted to gain insights from 26 experts (including engineers, architects, human resource personnel, safety officers, and managers) regarding workplace safety challenges. The interview data was thematically categorized based on the identified safety challenges using NVivo analysis, to determine their root causes and develop strategies to improve workplace safety. To evaluate the emotional tone of participants’ response, sentiment analysis was conducted. Results highlighted participants’ optimism when discussing proactive or successful safety measures, neutrality in objective assessments, and concern or dissatisfaction when addressing safety challenges and organizational shortcomings. Experts recommended that safety education should be introduced in universities and vocational institutes. Firms can incorporate safety training through toolbox talks and induction sessions, and they can allocate a safety budget in their contracts. The study suggests developing a certificate-level safety training module for the construction industry and provides fresh insights into the underlying causes of safety issues in the Sri Lankan construction sector. Furthermore, the study has implications for delivering a health and safety framework for project risk management in developing countries that face budget constraints and limited training and development opportunities for enhancing construction skill sets. Full article