Search Results (419)

Background/Objectives: The COVID-19 pandemic accelerated the shift toward community- and home-based care models. Within this transformation, Family and Community Nurses (FCNs) have become key in bridging hospital and primary care, supporting continuity, self-care, and quality of life (QoL). Despite increasing recognition, evidence on FCN-led interventions remains fragmented. This systematic review and meta-analysis aimed to synthesize evidence on the impact of FCN interventions on QoL and clinical outcomes in post-COVID and people living with chronic conditions managed in community and home settings. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, CINAHL, PsycINFO, Embase, and Cochrane Library (January 2020–November 2024). Eligible studies were randomized controlled trials evaluating FCN-led interventions. Primary outcomes were QoL (measured with validated tools) and glycemic control (HbA1c). Secondary outcomes included hospital readmissions, anxiety, depression, and self-care abilities. Risk of bias was assessed using the Cochrane RoB2 tool for randomized controlled trials. Random-effects meta-analyses were performed, with heterogeneity evaluated by I². The protocol was prospectively registered in PROSPERO (CRD42024567890) before data extraction. Results: Seventy-one studies (n = 19,390) were included. Interventions comprised home visits, telehealth, patient education, and case management. Pooled analyses demonstrated significant improvement in QoL (SMD 0.34, 95% CI 0.18–0.50) and reduction in HbA1c (−0.47%, 95% CI −0.69 to −0.25). FCN interventions also reduced hospital readmissions (RR 0.74, 95% CI 0.62–0.89) and improved mental health outcomes. Most studies were judged at low to moderate risk of bias. Conclusions: FCN-led interventions significantly enhance QoL, mental health, and clinical outcomes while reducing hospital readmissions. These findings highlight the strategic importance of integrating FCNs into community-based healthcare models. Full article

Background: Forced displacement is a significant public health challenge associated with deteriorated mental and physical health outcomes. Following the outbreak of Israel’s ‘Iron Swords’ war on 7 October 2023, more than 250,000 citizens were evacuated from their homes. Previous research has consistently documented elevated anxiety and poor health perception among displaced populations; however, the extent to which displacement itself contributes to anxiety has not been directly examined or established. Objective: The objective was to compare levels of anxiety and health perception between internally displaced and non-displaced Israeli adults and examine the mediating roles of emotional well-being and emotional functioning within the framework of Hobfoll’s Conservation of Resources (COR) theory. Methods: A cross-sectional, comparative quantitative study was conducted using validated self-report questionnaires to assess health perception (SF-36) and anxiety (GAD-7). The study sample comprised 98 adults, including 46 displaced individuals and 52 participants from the general population. Differences in health dimensions and anxiety levels were analyzed using t-tests, correlation analyses, and regression models. To advance understanding beyond previous research, mediation analysis based on the Conservation of Resources (COR) theory was employed, enabling identification of the psychological mechanisms through which displacement influences anxiety. Results: Displaced participants reported significantly lower scores across all SF-36 dimensions and significantly higher anxiety levels compared to the general population. Regression analyses indicated that emotional well-being and emotional functioning were significant predictors of anxiety, whereas displacement status alone was not a direct predictor once mediators were included. Mediation analysis further demonstrated that both emotional well-being and emotional functioning fully mediated the relationship between displacement and anxiety Conclusions: Forced displacement has lasting negative effects on mental health, primarily through the erosion of emotional and functional resources. These findings highlight the importance of interventions aimed at strengthening psychological resilience and continuity of care. Study limitations include a cross-sectional design, reliance on self-reported data, and relatively small sample, which may limit generalizability. Full article

This study presents the development and validation of an unobtrusive automatic sleep quality assessment index (ASQI) designed for elderly individuals. The proposed method utilizes features such as sleep duration, sleep latency, and sleep efficiency, calculated from physiological data—heart rate, respiratory rate, body movements, and bed-exit behavior—captured by a non-contact bed sensor system installed in home environments. Based on these parameters, a six-component sleep quality index was constructed to objectively evaluate nightly sleep. To assess the reliability and validity of ASQI, sleep data were collected from eleven elderly participants over a one-year period. Results showed strong test–retest reliability ($r=0.91$, $p<0.001$) and moderate correlation with the widely used Pittsburgh Sleep Quality Index (PSQI) ($r=0.52$, $p<0.05$). Furthermore, ASQI successfully differentiated between self-reported good and poor sleepers, achieving a classification accuracy of 85.7%, with a sensitivity of 66.7% and specificity of 93.3%. These findings demonstrate that the ASQI system is a practical and scalable tool for continuous, home-based sleep monitoring in older populations. Its non-intrusive design and objective scoring make it well-suited for personalized sleep management and early detection of sleep-related issues. This work contributes to the growing field of unobtrusive health monitoring and highlights the potential of sensor-based systems in elderly care. Full article

Background: This study was conducted within the Qassim Health Cluster as part of efforts to operationalize the Saudi Model of Care (SMoC). It aims to evaluate the outcomes and value of palliative care services in alignment with SMoC by applying patient-centered measurement tools. In Saudi Arabia, Vision 2030 has spurred significant expansion in palliative care, yet challenges persist in home-based care and consistent outcome measurement. Current Quality-Adjusted Life Year (QALY) methodologies often fail to capture patient-centered dimensions (emotional, spiritual, and social support), leading to gaps in outcome assessments. Methods: This cross-sectional descriptive study characterized 147 oncology palliative care patients in Qassim, Saudi Arabia, from January to December 2024. Data on demographics, diagnoses, care duration, health-related quality of life (EQ-5D-5L), and patient experiences were collected via face-to-face interviews. Although QALY was conceptually referenced, the study utilized EQ-5D-5L as a proxy measure for patient-perceived health status. Results: The cohort was predominantly older females (64.63%) with various cancer diagnoses, primarily breast cancer (29.25%), and a long duration of palliative care. Patients reported significant impairments in mobility (21.77%), self-care, daily activities, and a high prevalence of pain and anxiety/depression. However, most felt respected by their care team (85.71%), experienced effective symptom management (68.03%), and were consistently involved in decision-making (68.03%). Conclusions: This study provides baseline data on oncology palliative care in Qassim, highlighting complex patient needs alongside positive perceptions of care. QALY methodologies must be refined to better capture patient-centered benefits and inform resource allocation, contributing to more responsive and effective palliative care services. However, due to the cross-sectional design, causal relationships between care exposure and outcomes cannot be inferred; hence, the findings should be interpreted as descriptive rather than causal. Full article

Background: School-age children with cochlear implants (CIs) navigate academic and social settings by adopting varied communication strategies. Understanding these preferences and their determinants is essential for inclusive education and equitable public health. Evidence from multilingual contexts remains limited. Objective: The aim of this study was to investigate the communication preferences among school-age children with CI and the influence of social adaptability, home language, and CI duration. Methods: A cross-sectional study was conducted with 32 CI user school-age children (mean age = 13.4 years) at Sharjah City for Humanitarian Services. A structured questionnaire assessed communication mode, adaptability, comfort, and effectiveness. Quantitative associations were tested with Chi-square or Fisher’s exact tests; Pearson’s correlation examined links with CI duration. Qualitative responses were thematically analysed. Results: Most school-age children with CI preferred bimodal communication (spoken and sign). The primary spoken language used in the household was associated with communication preferences across settings (p ≤ 0.031). Gender differences appeared in family communication (p = 0.036). Longer CI duration correlated with greater spoken-language comfort (r = 0.32; p = 0.038). Self-reported adaptability was high but not significantly associated with preferences. Conclusions: School-age children with CI in multilingual environments predominantly adopt bimodal communication, shaped by sociocultural and linguistic contexts. Recognising bimodal use as normative supports bilingual education, family-centred care and public health strategies promoting equity and participation. Full article

Background/Objectives: Permanent colostomy requires significant physical and psychological adaptation. Patients often experience reduced physical activity, impaired quality of life, and fear of movement. Current exercise recommendations are inconsistent, and no consensus exists on safe return to activity. This study aims to evaluate the effect of a 12-week home-based graded exercise programme on physical activity, quality of life, kinesiophobia, exercise capacity, and self-efficacy in patients with permanent colostomies. Methods: This randomized controlled trial will recruit 51 adults with permanent colostomies, beginning six weeks post-surgery. Participants will be randomized (1:1) to an intervention or control group. The intervention group will receive a 12-week home-based exercise programme including patient education, resistance and core training, and progressive aerobic walking. The control group will receive standard medical care and an informational leaflet. Primary outcomes include physical activity (steps/day), quality of life (Stoma-QoL), kinesiophobia (Tampa Scale), exercise capacity (6-Minute Walk Test), and self-efficacy (General Self-Efficacy Questionnaire). Follow-up will be conducted at baseline, post-intervention, and six months. Data will be analyzed using intention-to-treat principles with a significance threshold of p < 0.05. Conclusions: This trial will be the first to assess the effects of a structured, home-based graded exercise programme in individuals with permanent colostomies. The findings are expected to provide evidence on the efficacy of exercise for improving physical and psychological outcomes in this population and to inform clinical guidelines for safe, individualized activity resumption. Full article

Background/Objectives: Family members who provide care play a central but often underestimated role in the healthcare system and are frequently exposed to considerable physical, emotional, and social stress. To better understand and support their needs, a structured self-assessment tool (SSA-PA) was developed. This development addresses the current lack of practical, validated instruments that enable caregivers to systematically reflect on their own stress levels and resources, which is becoming increasingly important in view of the growing demand for care and the risk of caregiver burnout. This tool aims to promote self-reflection, identify individual stresses and resources, and enable more targeted support for family caregivers. Methods: The development process (September–December 2024) followed a multi-phase design that integrated theoretical foundations from nursing, health, and psychology, in particular Orem’s theory of self-care deficit, Lazarus and Folkman’s stress and coping model, and Engel’s biopsychosocial model. Four core dimensions were defined: (1) health and self-care, (2) burden and stress, (3) support and resources, and (4) satisfaction and quality of life. The final tool comprises 37 items (mostly 5-point Likert scales), supplemented by multiple-choice and open-ended questions. Content validity was ensured through expert review and testing with nine family caregivers. Internal consistency was assessed using Cronbach’s alpha (α = 0.998), indicating very high reliability, although possible item redundancies were identified. The evaluation took place in January 2025 with 33 family caregivers to assess user-friendliness, relevance, and perceived usefulness. Results: The majority of participants rated the tool as user-friendly and clearly structured. Around 80% reported a high level of comprehensibility, and over half stated that the tool provided new insights into their own health and care burden. Qualitative feedback highlighted the value of the tool for self-reflection and motivation to seek external support. Suggestions for improvement included shorter item formulations, improved visual feedback (e.g., progress bars or charts), and expanded question areas on financial burdens and digital support options. Conclusions: The SSA-PA is a theoretically grounded and user-centered tool for assessing and reflecting on the situation of family caregivers. It not only enables systematic self-assessments but also promotes awareness and proactive coping strategies. Future research should focus on conducting factor analyses to further validate the construct, testing the tool in larger samples, and exploring its integration into structured care consultations to improve the quality of home care. Full article

Inactivity and increases in psychological and behavioral symptoms are common for people with dementia, and current assessment relies on proxy-rated tools. We investigate the feasibility and adherence of the use of sensor technology by exploring the relationship between daytime activity and sleep quality. For a total of 42 day–night data pairs in nursing home residents with dementia (N = 11), Garmin Vivoactive5 and Somnofy monitored continuous physical activity levels, sleep efficiency (SE), sleep score, sleep regularity index (SRI), and wake after sleep onset (WASO). Using the Spearman coefficient, we explored correlations between digital and proxy-rated tools (Personal Self Maintenance Scale (PSMS) and Neuropsychiatric Inventory–Nursing Home version (NPI-NH)) and the relationships between the digital biomarkers (SE, SRI, WASO, sleep score, physical activity). Participants (mean age 84 years) had moderate to severe degrees of dementia. Daytime activity levels correlated to sleep quality parameters WASO (−0.34, p = 0.03), and SRI (0.43, p = 0.01), and traditional sleep measures were associated with digital biomarkers (WASO/NPI-NH-K, p = 0.03). We found a relationship between daytime activity and sleep quality; however, the bidirectional relationship remains ambiguous and should be further investigated. The use of sensing technologies for people with dementia residing in a nursing home is feasible, although not without limitations, and has the potential to identify subtle changes, improving clinical assessment and the corresponding care recommendations. Full article

Toxocariasis, a geohelminthiasis caused by Toxocara canis and Toxocara cati nematodes, has an estimated 19% seroprevalence worldwide. Although children have been considered more prone to infection, adults and the elderly may also be considered at risk. Accordingly, the present study aimed to assess the associated risk factors for Toxocara spp. seropositivity in a population of 290 individuals over 50 years old, attended by the Public Health System in western São Paulo state. Socioepidemiological information was obtained by a semi-structured questionnaire, a blood (serum) sample, and a neurocognitive function assessment by the 10-point cognitive screener (10-CS). Overall, 89/290 (30.7%; 95% CI: 25.7–36.2%) individuals presented anti-Toxocara spp. IgG antibodies by ELISA. Multivariate analysis revealed that individuals raising both dogs and cats were 3-fold more likely to be seropositive than the ones without any pet (p = 0.002), while educational level resulted in an associated protective factor (p = 0.001). No seropositivity influence was observed for the other evaluated variables, including age, gender, monthly income, consumption of drinkable water or raw/undercooked meat, having a dirty floor at home, contact with soil, washing vegetables and hands before meals, and onychophagy. Although seropositivity was not statistically associated with dementia (p = 0.198) and neuropsychiatric disorder (p = 0.440), results herein indicated toxocariasis as a likely under-reported and neglected infection in the older human population. As an immunosenescence risk group that should be continuously monitored, elderly pet owners may be at risk and should be extra careful with self-hygiene and pet deworming, particularly when owning multiple pet species, to reduce the risk of toxocariasis infection. Full article

This study explores patients’ experiences participating in a home-based remote patient monitoring program for chronic disease management. Using a mixed-methods approach, data was collected through semi-structured interviews and surveys from participants with Chronic Obstructive Pulmonary Disease (COPD) and diabetes. Two key themes emerged: “knowing” and “relationship.” The “knowing” theme encompassed data-driven awareness and contextualized education that empowered patients in their health management. The “relationship” theme highlighted the importance of interpersonal connections with healthcare providers and the sense of security from clinical oversight. Technology served as a communication platform supporting patient-clinician interactions rather than replacing them. The findings demonstrate that remote monitoring programs enhance chronic disease self-management through two interconnected mechanisms: the development of ‘situated health literacy’ through real-time, personalized data interpretation, and strengthened therapeutic relationships enabled by technology-mediated clinical oversight. Rather than replacing human interaction, technology serves as a platform for meaningful patient-provider communication that supports both immediate health management and long-term self-management capability development. These exploratory findings suggest potential design considerations for patient-centered telehealth services that integrate health literacy enhancement with relationship-centered care. Full article

The present study aimed to evaluate the effect of maternal involvement in children’s home-based learning activities during the COVID-19 lockdown on mothers’ parenting stress, the quality of maternal care perceived by offspring, and the level of children’s internalizing/externalizing symptoms. This study recruited 415 subjects from the general population. To assess parenting stress, mothers were administered the Parenting Stress Index–Short Form; to assess children’s perceived quality of maternal care, this study used the Parental Bonding Inventory; and the Child Behavior Checklist/6–18 was used to assess internalizing/externalizing symptoms in children. Correlations showed that the amount of time spent by the mother supervising children’s self-study was highly and positively correlated with parental stress and offspring’s externalizing (but not internalizing) symptoms, and highly and positively correlated with the subscale of maternal overprotection in the children’s perceived quality of maternal care. Moreover, the multiple regression analyses conducted based on the above significant correlations showed that the amount of time spent by the mother overseeing children’s study was associated with parental stress, children’s externalizing symptoms, and maternal overprotection. Overall, the current study contributes to showing the burden families had to face as a result of school closures and accompanying distance learning during the COVID-19 epidemic. Full article

Background/Objectives: Systemic lupus erythematosus (SLE) is associated with impaired functional capacity, persistent fatigue, and poor health-related quality of life despite advances in pharmacological therapy. Exercise training has been proposed as a non-pharmacological intervention, but its efficacy and safety remain incompletely defined. This systematic review aimed to evaluate the effects of exercise training on functional aerobic capacity and quality of life in adults with SLE. Methods: A comprehensive search of PubMed, EMBASE, Cochrane Library, and PEDro was conducted to identify randomized controlled trials published up to October 2022, in accordance with the PRISMA guidelines. Results: Twelve randomized controlled trials involving 619 participants were included. Exercise interventions were heterogeneous and comprised aerobics, resistance, combined programs, vibration training, home-based protocols, and counseling strategies, with durations ranging from 6 weeks to 12 months. Supervised aerobic and combined interventions consistently improved functional aerobic capacity, while quality of life benefits were reported across several domains, particularly physical health, vitality, and fatigue. Additional positive effects were observed on fatigue, depression, pain, sleep, insulin sensitivity, and self-care ability, without evidence of increased disease activity. Conclusions: Structured exercise is safe and can meaningfully enhance functional capacity and quality of life in patients with SLE, supporting its incorporation into multidisciplinary clinical management. Full article

Primary Care Pharmacy (PCP) plays a vital role in healthcare systems. This study evaluated the competencies of pharmacy graduates from a community-focused curriculum, emphasizing their skills and personal traits. A structured questionnaire assessed four domains: general characteristics (11 items), PCP skills (16 items: 13 home visit and 3 community engagement skills), PCP personal traits (7 items), and readiness for PCP practice. Two sets of questionnaires were distributed in 2018 to recent pharmacy graduates: one for self-assessment and the other for evaluation by supervisors or co-workers. A 5-point scale (1 = least competent, 5 = most competent) was used. Co-workers gave higher scores than the graduates themselves. In home visit skills, “providing medicine advice” scored highest (4.4 ± 0.6 by graduates; 4.5 ± 0.2 by co-workers), while “performing essential physical exams” scored the lowest (3.5 ± 0.7). For co-workers, the lowest score was “working with a multidisciplinary team” (3.9 ± 0.9). Among community engagement skills, “solving health-related problems” rated highest (3.4 ± 0.7), and “identifying community health needs” rated lowest (3.2 ± 0.7). “Being friendly” and “responsibility” were top-rated personal traits by graduates and co-workers, respectively. The lowest was “coordinating with local organizations.” Graduates showed strong PCP traits and home visit skills but moderate community engagement. Community-based exposure is recommended to enhance these competencies. Full article

Background: Pain is a prevalent and distressing symptom for children with cancer, negatively affecting quality of life and family functioning. While most research focuses on hospital-based care, many pain episodes occur at home, where parents act as primary caregivers with limited access to evidence-based symptom management. Young children are particularly vulnerable due to limited self-reporting capacity and reliance on parental assessment. We aimed to explore parent experiences and pediatric oncology clinician perceptions of young children’s cancer pain at home, its impact on families, and recommended supports. Methods: Using an interpretive descriptive qualitative design, we conducted semi-structured interviews with parents of children aged 2–11 years undergoing outpatient cancer treatment and clinicians at two hospitals in Canada and the United States. Data were analyzed using thematic analysis. Results: In total, 21 parents and 21 clinicians participated. Three themes were developed: (1) the multifaceted experience of young children’s cancer pain at home, (2) the ripple effects of a young child’s cancer pain on the family unit, and (3) assessing and treating children’s cancer pain at home. Conclusion: Managing cancer pain at home places substantial emotional and practical demands on the families of young children. Our findings highlight that structured supports providing parents and clinicians with education, effective communication pathways, and collaboration opportunities may optimize home-based pain care, reduce caregiving burden, and improve outcomes for children and their families. Full article

Objectives: Despite the implementation of additional safety measures, motor vehicle collisions (MVCs) still result in significant injuries and fatalities. This study aims to explore the severity of these injuries and the length of hospital stays (LOS) following MVCs. Furthermore, this study will assess how helmet use and alcohol influence trauma outcomes. Methods: This retrospective study from a single center includes 604 patients from 1 January 2016, to 31 December 2024. Patients were identified based on the Abbreviated Injury Scale (AIS) body regions. Descriptive statistics and ANOVA were performed on helmet use and blood alcohol concentration, with significance set at p < 0.01. Results: Mean LOS at the hospital (H) was 13 days, 10.53 h in the ED, and 113.32 h in the ICU. In total, 74.5% of patients were male and 25.5% were female. The mean injury severity score (ISS) was 22.58, with 99.83% representing blunt trauma. The majority of patients (94.21%) arrived with signs of life, with 50.99% patients discharged to home or self-care (routine discharge). A noticeable trend following 2020 showed an increase in ED discharges, and thus ED admissions, compared to years before 2020. Helmet use showed a non-significant trend toward reduced ISS and length of stay. ETOH level and primary payor source were not significantly associated with outcome variables in regression models, though patterns suggest a potential relationship between payor source and ED discharge disposition. Conclusions: This study identifies important clinical trends that merit further investigation. Helmet use may be associated with reduced injury severity and shorter hospital stays, while differences in primary payor source suggest disparities in ED discharge outcomes. These findings underscore the need for further research on payor disposition, helmet use, and ETOH level in MVCs. Full article