Search Results (719)

Background: Radiology and ultrasound technologists are exposed to sustained static postures, repetitive movements, equipment handling, and patient-positioning tasks that increase the risk of work-related musculoskeletal disorders (WRMSDs). During Ramadan, increased healthcare demand associated with Umrah may further increase occupational workload in Madinah. Objective: To estimate the 7-day prevalence of WRMSDs and identify occupational factors associated with pain intensity among radiology and ultrasound technologists working during Ramadan in Madinah. Methods: A cross-sectional online survey was conducted among 237 radiology and ultrasound technologists working in Madinah during Ramadan 1447/2026. Participants were recruited using online convenience and snowball sampling through professional networks and social-media platforms. The survey included the Nordic Musculoskeletal Questionnaire (NMQ), a 0–10 Numeric Pain Rating Scale (NPRS), and demographic and occupational variables. Bivariate analyses and multivariable linear regression with robust standard errors were used to examine factors associated with pain intensity. Results: Overall, 89.5% of participants reported WRMSDs during the preceding 7 days. The lower back (56.5%) and neck (40.5%) were the most affected regions. Mean pain intensity was 5.55 ± 2.28. Higher pain intensity was associated, after adjustment for the variables included in the model, with older age, working as an ultrasound technologist, managing 11–20 or more than 30 patients per shift, and frequent night-shifts, with the strongest association observed among participants working at least three-night-shifts per week (B = 3.27, 95% CI 2.43–4.10). BMI, sex, years of experience and shift duration were not independently associated with pain intensity after adjustment. Conclusions: WRMSDs were highly prevalent among radiology and ultrasound technologists working during Ramadan in Madinah. Night-shift frequency and very high patient workload showed the largest occupational associations with pain intensity. These findings identify workload distribution and night-shift scheduling as potential areas for occupational health evaluation during periods of increased healthcare demand. Because of the cross-sectional design, the findings should be interpreted as associations rather than causal effects. Full article

Limited inclusion of ethnically diverse and socioeconomically disadvantaged populations in pain research undermines external validity, generalizability, and equity. This comprehensive review synthesized evidence on effective strategies to recruit and retain these populations in pain studies. We searched Medline, Web of Science, Embase, Scopus, and CENTRAL (12 April 2025) and included studies in which ethnically diverse and socioeconomically disadvantaged participants comprised ≥75% of the sample. Quantitative data were pooled using random-effects meta-analyses of proportions, with prespecified subgroup analyses, and qualitative findings were integrated through thematic synthesis. Certainty of evidence was evaluated using GRADE. Eighteen studies (n = 4611; 11 experimental, 5 observational, 2 qualitative), primarily from the United States and involving chronic pain, met inclusion criteria. Overall enrollment among ethnically diverse and socioeconomically disadvantaged groups was 37% (95% CI 18–58%), with significantly higher enrollment in observational studies (84%, 95% CI 78–90%) than in experimental trials (22%, 95% CI 10–36%; p < 0.001). Overall retention was 77% (95% CI 64–88%) and did not differ significantly by study design. Statewide disease-clinic networks, purposive community-leader engagement, and snowball sampling produced the highest enrollment, whereas medical-record screening yielded the lowest enrollment but the highest retention. Compensation and reminder strategies were similarly effective for retention. Thematic synthesis highlighted trust, culturally and linguistically tailored communication, hybrid and flexible visit schedules, transportation assistance, and clinician engagement as key facilitators. GRADE certainty was low for enrollment and moderate for retention. Community-engaged recruitment strategies, clinician referrals, culturally tailored materials, hybrid procedures, and modest incentives can substantially improve participation of ethnically diverse and socioeconomically disadvantaged populations in pain research. Standardized CONSORT-style reporting of recruitment/retention flowcharts according to strategy and ethnicity/socioeconomic status is essential to refine evidence-based strategies in the future. Full article

Background: Healthcare access in Vietnam confronts regional disparities and rising demand, requiring collaborative policies and strong workforce performance to guarantee effective and affordable services. This study scrutinises how organisational culture shapes healthcare workforce performance within Vietnam’s public healthcare organisations, with particular emphasis on organisational commitment, knowledge-sharing behaviour, and digital health transformation. Methods: This study employed a quantitative, cross-sectional survey design. Data were collected from 450 healthcare professionals in public healthcare facilities in southern Vietnam through convenience and snowball sampling, using a structured questionnaire measuring organisational culture (Denison model), organisational commitment, knowledge-sharing behaviour, digital health transformation and job performance on a six-point Likert scale. Data were analysed using partial least squares structural equation modelling (PLS-SEM) in SmartPLS 3.0. Results: The findings indicate that organisational culture is directly and substantively associated with healthcare workforce performance. In addition, knowledge sharing and digital health transformation operate as mediating mechanisms, with knowledge sharing showing a notably stronger indirect association. Notably, the relationship between organisational commitment and healthcare workforce performance was indicated to be not statistically significant. Conclusions: This study offers important practical and healthcare policy implications for healthcare administrators, human resource practitioners, public-sector leaders, and health policy stakeholders, predominantly in designing and employing targeted, culture-driven interventions aimed at improving healthcare workforce performance. Specifically, fostering a culture that encourages knowledge exchange and supports digital health transformation emerges as a critical pathway for organisational advancement. Such initiatives are instrumental in nurturing a motivated, engaged, and high-performing workforce, thereby underlining the sustainable development of public healthcare organisations. Full article

Background/Objectives: Job satisfaction is important for high-quality healthcare delivery. This study aimed to explore family medicine physicians’ (FMPs’) opinions and beliefs regarding job satisfaction, factors influencing their satisfaction, and intentions to transition to other institutions. Methods: This qualitative descriptive study was conducted in the Al-Qassim region in 2024, using thematic analysis (Braun & Clarke) to analyze data. Eleven FMPs working within the health cluster of the Ministry of Health (MOH) were recruited using purposive sampling supplemented by the snowball technique. FMPs who were specialists and consultants were included. In-depth interviews were conducted, the interview content was transcribed, and thematic analysis was performed. Results: Four major themes were identified. The first theme was role ambiguity and workload burden; the second, resource gaps and operational limitations; the third, organizational barriers and professional stability; and the fourth, workplace dissatisfaction and intent to leave. Most of the FMPs reported being nearly satisfied with their job, and all agreed that dissatisfaction may lead physicians to consider leaving their institution. Job security within the MOH had a positive impact on job satisfaction, while concerns about changes associated with the health transformation process were noted. Conclusions: Physicians expressed varying degrees of satisfaction despite different challenges and limitations. Some physicians were open to changing their workplace, whereas one physician had already applied to other institutions. It is recommended to reassure physicians regarding job security during the health transformation process, clearly define job roles and responsibilities, and ensure the availability of necessary resources to improve physician satisfaction, provide better alignment with career expectations and maintain workforce stability in the MOH-affiliated PHC centers of the Al-Qassim region of Saudi Arabia. Full article

Underutilised indigenous crops (UICs) are increasingly recognised for their potential to contribute to climate-resilient agriculture, dietary diversification, and household food security among smallholder farmers in South Africa. However, evidence regarding farmers’ knowledge, attitudes, and practices (KAP) toward these crops remains limited. This study examined the KAP of smallholder farmers toward UICs and assessed factors associated with their adoption in selected municipalities of South Africa. A quantitative cross-sectional survey was conducted among 205 smallholder farming households using a structured questionnaire. Respondents were selected through a multi-stage sampling procedure involving purposive, snowball, and stratified sampling. Data were analysed using descriptive statistics, Ordinary Least Squares (OLS) regression, binary logistic regression, and bootstrap mediation analysis. Results showed that smallholder farmers generally possessed positive knowledge and attitudes toward UICs, particularly regarding their nutritional value, adaptability to local climatic conditions, and contribution to household food security. However, utilisation practices remained uneven across households. Age, farming experience, water availability, extension support, and market access were significantly associated with adoption. Formal bootstrap mediation analysis (1000 simulations) did not support attitudinal mediation of the knowledge-adoption relationship (ACME = −0.007, 95% CI: −0.079 to 0.059, p = 0.802), suggesting that knowledge operates through mechanisms other than attitudinal change. The study concludes that UICs possess significant potential to contribute to food security and climate adaptation in the study areas, but stronger institutional support, extension services, and market development are required for wider adoption. Full article

On-site digital human guide systems, which integrate intelligent interactive technologies with guidance, interpretation, and information services, are emerging as an important form of intelligent on-site service. However, existing knowledge remains largely fragmented across technological configurations, interaction modalities, application contexts, and user experience objectives, lacking an integrated cross-dimensional analytical perspective that explains how these systems create and deliver value. To address this gap, this paper aims to adopt a Product–Service Systems (PSS) perspective to systematically examine the development of on-site digital human guide systems. Specifically, it explores their product–service configurations, service delivery modes and user participation, and artificial intelligence (AI) capability integration pathways, while identifying the value creation opportunities and challenges associated with system development and continuous optimization. The PSS paradigm offers such an integrative lens, which has gained renewed relevance as the Fourth Industrial Revolution (Industry 4.0) accelerates the servitization and digital transformation of traditional services. This paper conducts a scoping review employing content analysis based on a structured cross-database search across Google Scholar, Scopus, and Web of Science, supplemented by snowball sampling, covering 40 studies, including 34 deployed projects. The findings reveal that: (1) on-site digital human guide systems can be categorized into four product–service configurations: fixed terminal (stationary dialogue); mobile terminal (location-aware guidance); Head-Mounted Display/Mixed Reality (immersive experience); and robot (full-process mobile service). The selection of these configurations is shaped by spatial characteristics, target user group, and institutional operational conditions; (2) a user behavior taxonomy of nine active and five passive types was developed, demonstrating that user participation patterns are jointly shaped by control allocation in service delivery and the social behavior design of digital humans, with users showing a preference for controllable and interruptible engagement; (3) AI integration has evolved from rule-and-script-driven approaches to modular AI integration, and subsequently to large language model (LLM)/Retrieval-Augmented Generation (RAG)-driven architectures, with corresponding design implications proposed; and (4) challenges were classified into four major categories and 26 subcategories across three digital transformation stages. The contribution of this paper lies in the development of an integrated PSS analytical framework for on-site digital human guide systems, spanning product, service, and AI integration layers. The framework provides a multi-layer analytical lens for understanding system configurations, user participation, technological evolution, and implementation challenges, while offering structured guidance for configuration and service selection, system design, and continuous optimization across diverse deployment contexts. These findings provide practical implications for researchers and practitioners seeking to design, deploy, and optimize on-site digital human guide systems across diverse service environments. Full article

Background/Objectives: The concomitant use of conventional medicines with foods, food supplements, and herbal products has increased, raising concerns about interactions. Despite this, healthcare professionals’ knowledge and clinical practices in this domain remain incompletely characterised. This study aimed to assess knowledge, attitudes, and clinical practices regarding food–drug, herb–drug, and supplement–drug interactions among healthcare professionals (HPs) in Portugal. Methods: A cross-sectional pilot study was conducted among 311 HPs using an online questionnaire; participants were recruited through convenience and snowball sampling. The instrument evaluated perceptions, practices, and knowledge (22 items; score 0–22). Descriptive statistics and non-parametric tests were used for group comparisons. Results: Most participants (90.6%) recognised the clinical relevance of herb–drug interactions; however, only 57.6% reported routinely asking patients about food supplements or herbal product use, and 46.0% about teas or infusions. The median knowledge score was 9.00 (interquartile range 9.00), with a mean of 9.34 ± 5.91. Significant differences were observed between professions (p < 0.001): pharmacists achieved the highest scores and nurses the lowest. In exploratory analyses, academic training and continuing education were associated with higher knowledge, whereas professional experience was not. Conclusions: Among the professionals studied, a discrepancy exists between perceived clinical relevance and actual practice, with important gaps in technical knowledge. Within the limits of this sample, the findings point to a need for improved education and structured clinical approaches to enhance patient safety when medicines and natural products are used concomitantly. Full article

Antiretroviral therapy (ART) is essential for preventing HIV transmission and improving the health outcomes of people living with HIV (PLHIV). However, many barriers limit PLHIV from starting and adhering to ART, which explains why HIV responses in many settings, including Indonesia, have produced limited gains. This qualitative phenomenological study explored multilevel barriers to ART adherence in urban Yogyakarta (locally known as Jogja) and rural Belu, Indonesia, from the perspectives of PLHIV and healthcare professionals (HCPs). Data were collected through one-on-one in-depth interviews with 92 PLHIV and 20 HCPs. Participants were recruited using the snowball sampling technique. Data were analysed using framework analysis informed by the Access to Healthcare Framework. The findings showed that PLHIV in Belu and Jogja had different experiences in terms of the provision of and ability to access and adhere to ART or HIV treatment. In rural Belu, ART was less available and visible, harder to approach, often unaffordable, less aligned with patients’ needs, and strongly influenced by the widespread use of traditional medicine. PLHIV in Belu also reported a more limited ability to perceive the need for ART, reach services, pay costs, engage in care, and seek ART than those in urban Jogja. Personal, psychological, and social barriers were also reported to hinder PLHIV’s ART adherence in both settings. These findings highlight the need for HIV policies that promote the equitable distribution of ART services and targeted interventions to improve understanding and acceptance of HIV care among PLHIV and the wider community. Full article

Background/Objectives: Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain, fatigue, sleep disturbances, and psychosocial challenges. Although physiotherapists play a key role in FM management, little is known about how biopsychosocial principles are applied in clinical practice. This study explored physiotherapists’ clinical reasoning, therapeutic strategies, and approaches to promoting adherence and functional recovery in FM. Methods: A qualitative study was conducted within a constructivist–interpretative paradigm. Thirteen physiotherapists with experience in FM management across different healthcare settings in Spain participated in semi-structured interviews. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s framework. Methodological rigor was ensured through reflexive engagement among researchers with differing backgrounds, reflexive practice, and adherence to COREQ guidelines. Results: Three overarching themes and seven sub-themes were identified. Clinical validation emerged as a key strategy to reduce uncertainty and facilitate engagement. Therapeutic goals were progressively shifted from pain reduction toward function, autonomy, and participation. Pain neuroscience education and individualized exercise were identified as the main therapeutic strategies, while group-based interventions promoted social support, motivation, and adherence. Lifestyle recommendations, including stable routines, social participation, and work adaptation, complemented treatment. Conclusions: Physiotherapists perceive FM management as a multidimensional process extending beyond symptom reduction. Validation, pain neuroscience education, individualized exercise, and group-based support appear to facilitate adherence, self-management, and functional recovery within a biopsychosocial framework. Full article

Background: Empathy is essential for supportive nursing work environments, yet little is known about Generation Z (Gen Z) nurses’ experiences of empathy from colleagues and nurse managers. Aim: To examine Gen Z nurses’ experiences of empathy in workplace relationships with colleagues and nurse managers and the individual, generational, and institutional factors shaping these experiences. Methods: A qualitative descriptive study design was employed. Data were collected between October 2025 and March 2026 through semi-structured, in-depth interviews with 20 Gen Z nurses working in diverse clinical settings in Turkey. Participants were recruited using purposive and snowball sampling. Interviews were conducted via Zoom, audio-recorded with consent, and transcribed verbatim. Data were analyzed using Braun and Clarke’s reflexive thematic analysis framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the study reporting. Results: Four main themes were identified: (1) perceptions of empathy among Gen Z nurses, (2) empathy experiences in workplace relationships, (3) factors influencing empathy experiences, and (4) expectations for building an empathic work environment. Empathy was experienced through feeling understood, non-judgmental listening, and emotional and practical support, particularly in peer relationships. Hierarchical communication, perceived intergenerational differences, workload, and time pressure were key factors influencing workplace empathy experiences. Conclusions: Participants described empathy as a relational and context-dependent experience embedded in everyday workplace interactions. Their accounts suggest that supportive, non-hierarchical relationships may facilitate empathic engagement, whereas rigid communication styles and heavy workloads may act as barriers. These findings represent the experiences and interpretations of the Gen Z nurses interviewed and should not be read as objective comparisons between generations. Organizational strategies that support empathic communication and psychologically safe teamwork may help strengthen team cohesion and nurse retention. Full article

Suicidal ideation among college students is a multicausal public health concern shaped by individual, family, social, and academic factors. Although prior research has consistently documented associations between psychological distress and suicide risk in this population, most studies analyze risk factors in isolation, leaving the joint contribution of variables across ecological levels insufficiently understood. The present study, framed within Bronfenbrenner’s ecological model of human development and Joiner’s interpersonal theory of suicide, examined the simultaneous influence of clinical, protective, academic, and victimization variables on suicidal ideation in college students. A cross-sectional design was employed with a sample of 553 undergraduate and graduate students (68.9% women; mean age = 20.93 years, SD = 3.81) from the University of Málaga (Spain), recruited through snowball and convenience sampling. Participants completed validated self-report measures of suicidal ideation (Paykel Suicide Scale), depression and anxiety (HADS), eating disorders (CBCAR), self-esteem (RSE), academic stress (SISCO), academic procrastination (APS-SF), bullying, cyberbullying, and social exclusion (QAEU), social support (QFSSS), family satisfaction, healthy habits, and family history of mental illness. Data were analyzed through Pearson and Spearman correlations and a robust multiple linear regression (ordinary least squares with HC3 robust standard errors and bias-corrected and accelerated bootstrap confidence intervals from 5000 resamples), complemented by an ordinal regression as a sensitivity analysis. The regression model accounted for 44.1% of the variance in suicidal ideation, with depression, anxiety, eating disorders, family history of mental illness, and bullying showing significant positive associations and self-esteem the strongest protective association. An ordinal regression sensitivity analysis yielded a consistent pattern, supporting the robustness of these findings. Family and social support, although correlated with lower ideation, lost statistical weight in the multivariate models, suggesting that their contribution operates indirectly, mainly through depression and self-esteem. Findings support the integration of clinical, social, and personal-resource components into college prevention programs, prioritizing early detection of psychopathology, anti-bullying protocols, interventions to strengthen self-esteem, and greater visibility of campus psychological services. Full article

Agro-food processing activities are increasingly recognized as important levers of sustainable rural development, contributing to territorial attractiveness, local economic diversification, and more resilient rural livelihoods. However, despite growing recognition of their contribution to sustainable rural transformation, the territorial implications of agro-food processing remain insufficiently documented and quantified in Sub-Saharan Africa, a gap that is particularly pressing in the current context of Benin’s ongoing decentralization reforms, which increasingly call for territorially grounded evidence to inform local development policy. This study addresses this gap by assessing the contribution of agro-food processing to territorial attractiveness in central Benin, as a pathway toward more sustainable and spatially balanced local economic development. Data were collected from 204 individual and cooperative processing units surveyed via KoboCollect (version 2025.3.3) using snowball sampling. As the data are cross-sectional, the reported associations should be interpreted as descriptive rather than causal. A Territorial Attractiveness Index (TAI), combining indicators of investment, business creation, and agglomeration effects, was developed as a quantitative tool to measure and monitor this contribution. Data were analyzed using descriptive statistics and, following verification of ANOVA assumptions, the non-parametric Kruskal–Wallis test with Bonferroni-adjusted pairwise comparisons. The results show that 74% of surveyed units made investments (mean CFAF 248,919.5), 76% reported an association with local business creation, and 90.7% reported agglomeration effects linked to economic concentration. The mean TAI was 4.559 out of 7, indicating a substantial association with territorial attractiveness. Significant differences were observed among municipalities (Kruskal–Wallis χ² = 43.27, df = 5, p < 0.001), with Bantè exhibiting markedly lower attractiveness than the other five municipalities, which did not differ among themselves, a pattern that appears more closely linked to structural deficits in collective coordination than to a general absence of processing activity. These findings suggest that sustainable rural development policies should promote context-specific, territorially anchored agro-industrial clusters to reduce spatial disparities and strengthen the long-term economic sustainability of rural territories. Full article

Background: Healthcare workers play a critical role in parental vaccine decision-making and the uptake of non-routine childhood vaccines. This study aimed to evaluate healthcare workers’ knowledge, attitudes and behaviors regarding non-routine childhood vaccines, including rotavirus, meningococcal, human papillomavirus (HPV) and influenza vaccines. Methods: This cross-sectional study was conducted between October 2025 and March 2026 among healthcare workers in Türkiye. Data were collected using a structured questionnaire and the Attitudes Towards Vaccine Scale (ATVS), distributed through convenience and snowball sampling methods. Results: A total of 345 healthcare workers participated in the study. Recommendation behaviors differed significantly according to vaccine type (p < 0.001). Rotavirus and meningococcal vaccines were more frequently recommended than HPV and influenza vaccines. Although influenza vaccine had the highest awareness rate, it demonstrated the lowest recommendation rate and the lowest support for inclusion in the national immunization schedule. Physicians had significantly higher knowledge levels and vaccination attitude scores than non-physician healthcare workers (p < 0.001). ATVS scores were positively correlated with recommendation behaviors (ρ = 0.35, p < 0.001) and self-vaccination tendency (ρ = 0.34, p < 0.001). In multivariable analyses, higher vaccination attitude scores independently predicted greater self-vaccination tendency (OR = 1.07, 95% CI: 1.04–1.11, p < 0.001). Cost was the most commonly reported barrier to vaccine implementation. Conclusions: Positive attitudes toward non-routine childhood vaccines among healthcare workers do not necessarily translate into consistent recommendation behaviors across all vaccine types. Strategies targeting healthcare worker education, equitable vaccine access and standardized vaccine counseling practices may improve uptake and recommendation of optional childhood vaccines in Türkiye. Full article

Background/Objectives: Enteral nutrition is an essential component of care for critically ill patients, and nurses play a key role in its assessment, delivery, and monitoring. Although the Spanish version of the Persenius Scale has previously undergone translation, cross-cultural adaptation, and content validation, its structural validity has not yet been evaluated. Therefore, this study aimed to evaluate the structural validity of the Spanish version of the Persenius Scale in a sample of intensive care unit nurses in Spain. Methods: A cross-sectional study was conducted using an online questionnaire administered to intensive care unit nurses. The analytical sample included 329 participants recruited through non-probability snowball sampling. Sampling adequacy was assessed using the Kaiser–Meyer–Olkin index and Bartlett’s test of sphericity. Principal component analysis with Varimax rotation was performed to evaluate the structural validity of the instrument. Hierarchical cluster analysis was also used to examine the coherence of item grouping. Results: The Kaiser–Meyer–Olkin value was 0.88, and Bartlett’s test of sphericity was significant, supporting the suitability of the data for component analysis. A five-component solution was retained, explaining approximately 58% of the total variance. The components were organizational resources, specialized training, professional responsibility, perceived competence, and technical modality of enteral administration. Organizational resources and professional responsibility showed the most homogeneous loading patterns, whereas several technical practice items demonstrated higher uniqueness and weaker structural integration. Conclusions: The present study provides preliminary evidence regarding the internal structure of the Spanish version of the Persenius Scale by demonstrating a clinically interpretable five-component structure. The instrument may support the assessment of educational, organizational, and professional aspects of enteral nutrition practice among intensive care unit nurses. Full article

Background/Objectives: Non-communicable diseases (NCDs), including cardiovascular disease and diabetes, present an increasing challenge in humanitarian settings. While healthcare services in refugee camps have traditionally prioritised acute and communicable diseases, the long-term management of chronic conditions remains difficult, particularly among older adults. This study explored healthcare providers’ perspectives on barriers to cardiovascular disease and diabetes care among elderly Rohingya refugees living in Cox’s Bazar, Bangladesh. Methods: A qualitative study was conducted using semi-structured interviews with six physicians working in Rohingya refugee camps in Cox’s Bazar, Bangladesh. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Three overarching categories of barriers were identified: service delivery barriers, physical and environmental barriers, and socio-cultural barriers. Healthcare providers described limited diagnostic capacity, restricted medication availability, fragmented continuity of care, transport difficulties, challenging camp terrain, language barriers, low health literacy, and reliance on informal healthcare providers as key challenges affecting long-term management of cardiovascular disease and diabetes. These interconnected barriers were perceived to reduce healthcare access and continuity of care for elderly Rohingya refugees. Conclusions: The findings suggest that humanitarian healthcare systems should strengthen long-term management of non-communicable diseases among ageing refugee populations. Improving diagnostic capacity, ensuring reliable access to essential medicines, enhancing continuity of care, and supporting culturally appropriate health education and outreach services may improve chronic disease management in humanitarian settings. Further research exploring the perspectives of elderly Rohingya refugees is needed to complement healthcare provider perspectives. Full article