Search Results (421)

Background/Objectives: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector. University Departments of Rural Health (UDRH), academic centres based in regional, rural, and remote (RRR) locations across Australia, are uniquely positioned to foster a culturally safe rural health workforce through training, education, and engagement with Indigenous communities. This narrative review examines the contributions of UDRHs to health workforce issues through analysis of their publications focused on Indigenous health. Methods: Research articles relating to workforce were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Of 46 articles identified across the 12 years, 19 focused on developing the understanding and cultural safety skills of university students studying in a health field, including campus-based Indigenous health education and support for students undertaking rural clinical placements. Twelve articles investigated cultural safety skills and recruitment and retention of the rural health workforce. Fifteen articles focused on Indigenous people in the health workforce, examining clinical training and resources, and the enablers and barriers to retaining Indigenous students and workers. Conclusions: This analysis highlights the sustained efforts of UDRHs to improve Indigenous health through multiple areas within their influence, including curriculum design, health student training on campus, and rural placement opportunities to transform understanding of Indigenous strengths and disadvantages and rural health workforce development. A continuing effort is needed on ways UDRHs can support Indigenous health students during their studies and while on placement, how to improve cultural safety in the health workforce, and ways to better support Indigenous health professionals. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article

Burn injuries are complex and require effective wound management strategies. Traditional treatments, such as dermal templates, are limited by simplified extracellular matrix (ECM) composition (e.g., collagen-elastin or collagen-glycosaminoglycan), sheet-based formats, and frequent use of animal-derived materials. These limitations can reduce wound conformity, biocompatibility, and integration with host tissue. Functional hydrogels are being explored as alternatives due to properties such as high water content, biodegradability, adhesiveness, antimicrobial activity, and support for angiogenesis. Unlike standard templates, hydrogels can adapt to irregular wound shapes as in burn wounds and reach deeper tissue layers, supporting moisture retention, cell migration, and controlled drug delivery. These features may improve the wound environment and support healing in burns of varying severity. This review outlines recent developments in functional hydrogel technologies and compares them to current clinical treatments for burn care. Emphasis is placed on the structural and biological features that influence performance, including material composition, bioactivity, and integration capacity. Through an exploration of key mechanisms of action and clinical applications, this review highlights the benefits and challenges associated with hydrogel technology, providing insights into its future role in burn care. Full article

Background: Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR) is a minimally invasive alternative to conventional haemorrhoidectomy. While associated with reduced postoperative pain and quicker recovery, data on its safety, recurrence rates, and applicability across haemorrhoid grades remain limited, particularly in Australian settings. Methods: A retrospective review was conducted on 128 consecutive patients who underwent elective HAL-RAR at a single institution between February 2022 and December 2024. Data on demographics, operative details, postoperative outcomes, and recurrence were collected. Outcomes were stratified by haemorrhoid grade. Multivariate logistic regression was used to identify predictors of recurrence, day-case completion, and conversion to excisional surgery. Results: The median age was 49 years, and 77.3% had Grade II or III haemorrhoids. HAL-RAR was completed as a day case in 76.6% of patients. Postoperative urinary retention occurred in 3.9%, return to theatre in 0.8%, and 30-day readmission in 7.0%. The symptomatic recurrence rate was 17.6%. Grade IV haemorrhoids were independently associated with increased recurrence (aOR 3.64, 95% CI 1.03–12.84), reduced likelihood of day-case management (aOR 0.14, 95% CI 0.03–0.93), and higher conversion to excisional haemorrhoidectomy (aOR 7.23, 95% CI 1.13–46.40). Conclusions: HAL-RAR is a safe, effective, and low-morbidity option for the management of Grade II and III haemorrhoids, suitable for day-case surgery. In selected Grade IV cases, it may offer benefit, although with higher recurrence and conversion risk. Careful patient selection is essential, and longer-term prospective studies are needed to assess durability. Full article

Background: Type 2 diabetes (T2D) is a growing public health concern, particularly in low- and middle-income countries. Although prediabetes is a major risk factor for T2D, it remains largely underdiagnosed and untreated. Structured lifestyle interventions have proven effective in preventing diabetes, but their feasibility within the Brazilian public health system remains unclear. Methods: This multicenter pilot randomized controlled trial assessed the feasibility of a culturally adapted lifestyle intervention (PROVEN-DIA) across the five regions of Brazil. A total of 220 adults at high risk for T2D were randomized to an intervention group or a control group (usual care) and followed for three months. Both groups received similar educational content on healthy eating and physical activity, but the intervention group participated in a structured and personalized lifestyle program with regular follow-up sessions. The primary outcome was adherence to dietary recommendations, assessed using the BALANCE Index—a validated dietary score (range: 0–40) based on the Brazilian Cardioprotective Diet that classifies foods into color-coded groups according to nutritional quality—along with engagement in moderate-to-vigorous physical activity (MVPA). Secondary outcomes included diet quality (DQIR), anthropometric and metabolic parameters. Results: Feasibility was demonstrated by a 93.2% retention rate (n = 205). There was no significant difference in the primary outcome (simultaneous improvement in diet and MVPA). However, the PROVEN-DIA group exhibited significantly greater improvements in diet quality, with a 2.8-point increase in the BALANCE Index (vs. 0.5 in the control, p = 0.03), and a significant improvement in the DQIR (p < 0.001). No significant differences between groups were observed in MVPA, HbA1C, glycaemia, or body weight. Conclusions: The PROVEN-DIA intervention proved feasible within the Brazilian public health context, resulting in significant improvements in dietary quality among individuals at high risk for T2D. A larger trial with longer follow-up is warranted to evaluate its effectiveness in preventing the progression to diabetes. However, to enhance physical activity outcomes, specific adaptations and targeted strategies may be required to better support participant engagement in exercise. Full article

Background: In this work, we examine determinants of staff departure rates in the NHS, a critical issue for workforce stability and continuity of care. High turnover, particularly among clinical staff, undermines service delivery and incurs substantial replacement costs. Methods: Here, we analyse a unique dataset derived from Electronic Staff Records at Ashford and St. Peter’s NHS Foundation Trust, using a machine learning approach to move beyond traditional survey-based methods, to assess propensity to leave. Results: In addition to established predictors such as salary and length of service, we identify drivers of increased risks of staff exits, including the distance between home and workplace and, especially for medical staff, cost centre vacancy rates. Conclusions: These findings highlight the multifactorial nature of staff retention and suggest the potential of local administrative data to improve workforce planning, for example, through hyperlocal recruitment strategies. Whilst further work will be required to assess the generalisability of our findings beyond a single Trust, our analysis offers insights for NHS managers seeking to stabilise staffing levels and reduce attrition through targeted interventions beyond pay and tenure. Full article

Background/Objectives: This quantitative cross-sectional study examined the relationships between self-efficacy, compassion fatigue, and the quality of nursing work life (QNWL) in primary care nurses from the Dammam and Riyadh regions of Saudi Arabia. This study examined how these factors varied according to gender, education, income, and years of experience. Methods: A total of 158 primary care nurses completed validated survey instruments, including the General Self-Efficacy Scale, Professional Quality of Life Scale—Version 5, and Work-Related Quality of Life Scale-2. Descriptive statistics were used for data analysis. Results: The results indicated that participants experienced elevated self-efficacy (M = 29.53, SD = 0.52), moderate compassion fatigue (M = 54.62, SD = 10.16), and moderate overall quality of work life (QWL) (M = 3.26, SD = 0.52). Positive correlations were identified between self-efficacy and QWL (r = 0.250, p < 0.05) and compassion satisfaction (r = 0.533, p < 0.05). By contrast, compassion fatigue was negatively correlated with QWL (r = −0.259, p < 0.05). Notable disparities in QWL were identified according to education level and years of experience, with nurses possessing advanced degrees and those with less experience having elevated QNWL scores. Conclusions: This study highlights the significance of promoting self-efficacy and mitigating compassion fatigue to improve the quality of nursing. Administrators and nurse leaders should consider strategies such as continuous professional development, psychological support, and effective workload management to enhance the well-being and retention of primary care nurses. Full article

Background: Intravascular albumin mass represents the total quantity of albumin circulating within the bloodstream and may serve as a physiologically relevant marker of vascular integrity and fluid distribution in sepsis. While low serum albumin levels are acknowledged as prognostic indicators, dynamic assessments based on albumin mass remain insufficiently explored in patients outside the intensive care unit. Objectives: To describe the temporal changes in intravascular albumin mass in patients with community-acquired sepsis and to examine its relationship with fluid balance and thirty-day mortality. Methods: This prospective observational study encompassed 247 adults diagnosed with community-acquired sepsis who were admitted to a high-dependency hospital ward specializing in acute medical care. The intravascular albumin mass was calculated daily for a duration of up to five days, utilizing plasma albumin concentration and estimated plasma volume derived from anthropometric and hematologic data. Net albumin leakage was defined as the variation in intravascular albumin mass between consecutive days. Fluid administration and urine output were documented to ascertain cumulative fluid balance. Repeated-measures statistical models were employed to evaluate the associations between intravascular albumin mass, fluid balance, and mortality, with adjustments made for age, comorbidity, and clinical severity scores. Results: The intravascular albumin mass exhibited a significant decrease during the initial five days of hospitalization and demonstrated an inverse correlation with the cumulative fluid balance. A greater net leakage of albumin was associated with a positive fluid balance and elevated mortality rates. Furthermore, a reduced intravascular albumin mass independently predicted an increased risk of mortality at thirty days. Conclusions: A reduction in intravascular albumin mass may suggest ineffective fluid retention and the onset of capillary leak syndrome. This parameter holds promise as a clinically valuable, non-invasive indicator for guiding fluid resuscitation in cases of sepsis. Full article

Spinal cord injury (SCI) frequently leads to neurogenic lower urinary tract dysfunction, for which appropriate bladder management is essential. While clinical care relies on continuous low-pressure drainage in the acute phase, rat models commonly use twice-daily manual bladder expression—a method known to generate high intravesical pressures and retention. This study evaluated the impact of this standard practice on bladder tissue remodeling by comparing it to continuous drainage via high vesicostomy in a rat SCI model. 32 female Lewis rats underwent thoracic contusion SCI and were assigned to either manual expression or vesicostomy-based bladder management. Over eight weeks, locomotor recovery, wound healing, and bladder histology were assessed. Vesicostomy proved technically simple but required tailored wound care and calibration. Results showed significantly greater bladder wall thickness, detrusor muscle hypertrophy, urothelial thickening, collagen deposition, and mast cell infiltration in the manual expression group compared to both vesicostomy and controls. In contrast, vesicostomy animals exhibited near-control levels across most parameters. These findings highlight that commonly used bladder emptying protocols in rat SCI models may overestimate structural bladder changes and inflammatory responses. Refined drainage strategies such as vesicostomy can minimize secondary damage and improve the translational relevance of preclinical SCI research. Full article

Glucose-responsive insulin delivery systems that effectively regulate insulin retention and release in response to real-time fluctuation of glucose levels are highly desirable for diabetes care with minimized risk of hypoglycemia. Herein, we report a class of glucose-sensitive copolymer microgels, prepared from a simple one-pot precipitation copolymerization of 4-vinylphenylboronic acid (VPBA), 2-(dimethylamino) ethyl acrylate (DMAEA), and oligo(ethylene glycol) methyl ether methacrylate (M_w = 300, MEO₅MA), for gated glucose-responsive insulin release within the physiologically desirable glucose level range. The composition of the p(VPBA-DMAEA-MEO₅MA) copolymer microgels were analyzed using NMR and FTIR spectra. The cis-diols of glucose can reversibly bind with the −B(OH)₂ groups of the VPBA component in the microgels, resulting in the formation of negatively charged boronate esters that induce the volume phase transition of the microgels. The DMAEA component is incorporated to reduce the pK_a of VPBA, thus improving the glucose sensitivity of the microgels at physiological pH. The neutral hydrophilic MEO₅MA component is used to tune the onset of the glucose responsiveness of the microgels to the physiologically desirable levels. The more the MEO₅MA component copolymerized in the microgels, the greater the glucose concentration required to initiate the swelling of the microgels to trigger the release of insulin. When the onset of the glucose response was tuned to 4−5 mM, the copolymer microgels retained insulin effectively in the hypo-/normo-glycemic range but also released insulin efficiently in response to the elevation of glucose levels in the hyperglycemic range, which is essential for diabetes management. The copolymer microgels display no cytotoxicity in vitro. Full article

This study investigates the cybersecurity landscape of Aotearoa-New Zealand through a culturally grounded lens, focusing on the integration of Indigenous Māori values into cybersecurity frameworks. In response to escalating cyber threats, the research adopts a mixed-methods and interdisciplinary approach—combining surveys, focus groups, and case studies—to explore how cultural principles such as whanaungatanga (collective responsibility) and manaakitanga (care and respect) influence digital safety practices. The findings demonstrate that culturally informed strategies enhance trust, resilience, and community engagement, particularly in rural and underserved Māori communities. Quantitative analysis revealed that 63% of urban participants correctly identified phishing attempts compared to 38% of rural participants, highlighting a significant urban–rural awareness gap. Additionally, over 72% of Māori respondents indicated that cybersecurity messaging was more effective when delivered through familiar cultural channels, such as marae networks or iwi-led training programmes. Focus groups reinforced this, with participants noting stronger retention and behavioural change when cyber risks were communicated using Māori metaphors, language, or values-based analogies. The study also confirms that culturally grounded interventions—such as incorporating Māori motifs (e.g., koru, poutama) into secure interface design and using iwi structures to disseminate best practices—can align with international standards like NIST CSF and ISO 27001. This compatibility enhances stakeholder buy-in and demonstrates universal applicability in multicultural contexts. Key challenges identified include a cybersecurity talent shortage in remote areas, difficulties integrating Indigenous perspectives into mainstream policy, and persistent barriers from the digital divide. The research advocates for cross-sector collaboration among government, private industry, and Indigenous communities to co-develop inclusive, resilient cybersecurity ecosystems. Based on the UTAUT and New Zealand’s cybersecurity vision “Secure Together—Tō Tātou Korowai Manaaki 2023–2028,” this study provides a model for small nations and multicultural societies to create robust, inclusive cybersecurity frameworks. Full article

In higher education, the emotional intelligence (EI) of university professors, defined as the ability to perceive, understand, manage and utilize emotions effectively, is increasingly recognized as a pivotal factor in enhancing students’ academic achievement and psychological well-being. However, the scarcity of studies directly linking professors’ EI to students’ well-being highlights a critical research gap. This systematic review investigates how professors’ emotional competencies influence student outcomes—such as academic performance, engagement, motivation, and mental health—and identifies the factors that mediate or moderate these effects. Findings indicate that professors’ EI, particularly empathy, emotional regulation, and interpersonal skills, significantly enhances student engagement, motivation, and academic satisfaction, with indirect effects on psychological well-being. Cultural context, teaching modality (e.g., online vs. in-person), and professors’ age and experience moderate these effects and influence effect sizes. Qualitative synthesis further highlighted contextual gaps in the literature. The limited focus on well-being and outcomes and reliance on self-report measures underscore the need for longitudinal, culturally diverse studies and performance-based EI assessments. The value of this research lies in its potential to inform evidence-based educational practices and institutional policies. By elucidating the role of professors’ EI, the review lays the groundwork for developing faculty training programs aimed at strengthening emotional competencies and fostering inclusive, supportive learning environments that promote student growth and resilience. This is especially relevant given the growing prevalence of stress, anxiety, and disengagement among university students, exacerbated by post-pandemic challenges and academic pressures. Understanding the impact of EI can inform culturally responsive interventions, improve student retention, and enhance institutional effectiveness, thereby addressing a pressing need in contemporary higher education. In today’s rapidly evolving technological, social, and cultural landscape, universities have both the opportunity and the responsibility to act as catalysts for the creation of an educational culture that promotes social well-being. This requires adopting educational and organizational models that prioritize human care and the quality of interpersonal relationships. To be effective, these priorities must be integrated into all university operations, from governance to student support and talent development. Full article

Affecting millions of individuals each year, chronic wounds place a substantial strain on both the healthcare system and healthcare providers, becoming a global health issue that requires a rapid and efficient solution. Unlike acute wounds that heal naturally without any external intervention, chronic wounds necessitate proper medical treatment in order to promote the wound-healing process and avoid any arising complications. However, the traditional therapeutic strategies are often limited when it comes to treating chronic wounds, which is why new approaches that facilitate the timely and effective healing of skin have been explored. Due to their unique properties, collagen-based hydrogels have been widely investigated as potential candidates for the management of chronic skin wounds, owing to their good biocompatibility, high water retention capacity, which provides a moist microenvironment, and capacity to promote cell adhesion, proliferation, migration, and differentiation for optimal tissue repair. In this context, the current paper discusses the recent advancements in collagen-based hydrogels as wound dressings, thus highlighting their potential as a future therapeutic approach for skin chronic wound care. Full article

Background: Black sexual minority men (BSMM) are disproportionately affected by HIV incidence and have lower rates of HIV care engagement (e.g., retention in care, viral suppression), particularly in the US South. The COVID-19 pandemic exacerbated co-occurring psychosocial syndemic factors (e.g., depression, violence, substance use) that disproportionately impact BSMM living with HIV (BSMM+), but the impact of the pandemic on HIV care engagement among BSMM+ in the US South has not been explored in depth. Methods: BSMM+ (n = 27) were recruited from a longitudinal cohort in Dallas and Houston, Texas. Participants with less-than-optimal HIV care engagement, previous experiences of intimate partner violence (IPV), and prevalence of self-reported substance use were purposively selected for in-depth interviews from June 2022 to August 2023. Interviews lasted 54 min on average and were audio-recorded, transcribed, and de-identified before applying a thematic analysis approach. Results: Over half of participants experienced a relationship with IPV, used illicit substances in the past 60 days, and were depressed. Interviews highlighted that, during the COVID-19 pandemic, heightened levels of depression, substance use, and IPV individually and synergistically inhibited ART adherence and HIV care engagement. Participants described how IPV served to worsen their mental health and substance use, which, in turn, were the core drivers of poor HIV care engagement. Conclusions: The findings suggest that the COVID-19 pandemic exacerbated the syndemics of IPV, mental health, and substance use, and these acted as barriers to HIV care engagement. Future adherence interventions should synergistically address syndemic factors to maximize effectiveness. Full article

Introduction and Objectives: Bladder injuries are broadly classified based on anatomical location into two main categories: extraperitoneal and intraperitoneal. Traditionally, clinicians manage most extraperitoneal bladder ruptures conservatively with catheter drainage, while intraperitoneal ruptures are surgically repaired. This study aims to evaluate the feasibility of conservative management of intraperitoneal bladder rupture in the largest series to date. Methods: A retrospective review was performed of patients treated for intraperitoneal bladder perforations at two large tertiary care centers from 2015 to 2023. The charts of 290 patients with intraperitoneal perforations were reviewed to compile a list of those who underwent initial conservative management of their rupture via Foley catheter, of which there were 16. Demographic data was collected as well as variables related to patient characteristics, computed tomography (CT) measured size of perforation, management, complications, and follow-up. Data were analyzed using descriptive statistics, and comparative analyses (t-test and Fisher’s exact test) were performed. Results: Our final analysis identified 16 patients with intraperitoneal bladder rupture treated with initial conservative management. Of these patients, 15 (94%) were successfully managed with Foley catheter placement. Four patients (25%) experienced complications after conservative management, which included long-term urinary incontinence/retention, urinary tract infection (UTI), and pelvic abscess. For patients successfully managed conservatively, the median duration of catheterization was 18 days (IQR 21.75). Conclusions: For patients with small intraperitoneal bladder ruptures, conservative management with prolonged Foley catheterization is a suitable and successful strategy. Future studies evaluating outcomes in larger cohorts of patients will help determine whether this strategy should be considered more frequently in select patient populations. Full article