Search Results (133)

Background: Primary focal hyperhidrosis, characterized by excessive sweating primarily affecting the hands and axillae, can significantly impact quality of life. Bilateral thoracic sympathectomy is the gold standard treatment, providing permanent resolution of palmar hyperhidrosis. Most studies evaluating outcomes and patient satisfaction after sympathectomy focus on short- to medium-term follow-up, typically up to 5 years. This study aimed to assess anxiety, satisfaction, and sweat redistribution 20 years after bilateral endoscopic thoracic sympathectomy. Methods: Between January 2002 and December 2003, 106 patients with primary hyperhidrosis underwent bilateral endoscopic thoracic sympathectomy targeting ganglia T2–T3 at our center. The patients were contacted via telephone in 2023 and asked to complete the same survey they had filled out preoperatively and 12 months postoperatively. The survey evaluated sweat redistribution, anxiety, hyperhidrosis-related symptoms, and satisfaction. Anxiety, satisfaction, and perceived sweating were rated using a 5-point visual analog scale (VAS) ranging from 0 (unsatisfied/no symptoms) to 4 (very satisfied/severe symptoms). Results: Of the 106 eligible patients, 24 (22.6%) completed the survey. Most reported persistent anhidrosis (palmar or palmar–axillary) 20 years post-surgery. The survey results remained consistent with those at the 1-year follow-up. Significant sweat redistribution to the abdomen and back was observed. Patient satisfaction remained high, with no significant differences between the 1-year and 20-year assessments. Anxiety significantly decreased compared to preoperative levels (p < 0.001). Conclusions: Bilateral endoscopic thoracic sympathectomy is an effective long-term treatment for reducing excessive sweating. Patient satisfaction remains high over time, despite the persistence of compensatory sweating. Full article

Objectives: This study aimed to evaluate exclusive breastfeeding (EBF) rates and the duration of breastfeeding among mothers of twins and to identify the maternal, neonatal, and social factors associated with these outcomes. Methods: This retrospective cross-sectional study included 153 mothers of twin infants who were delivered at a tertiary hospital. Data were obtained from medical records and postnatal telephone interviews. Univariate analyses were performed to assess associations with EBF and breastfeeding duration, while multiple linear regression was performed to identify the independent predictors of breastfeeding. Results: The EBF rate within the first six months was 15%, and the mean breastfeeding duration was 10.5 ± 8.3 months. Tandem breastfeeding was positively associated with breastfeeding duration (β = 5.80; 95% CI: 3.51 to 8.10; p < 0.001), whereas bottle feeding showed a strong negative association (β = −9.49; 95% CI: −12.88 to −6.10; p < 0.001). Infants born before 34 weeks had significantly shorter breastfeeding durations, higher rates of NICU admission and respiratory support, and received less skin-to-skin contact and breastfeeding counselling compared to term infants (p < 0.05). Conclusions: Exclusive breastfeeding rates among mothers of twins remain low. Encouraging tandem breastfeeding, reducing bottle use, and providing tailored lactation support—particularly for mothers of preterm infants—may improve breastfeeding outcomes. Breastfeeding support should be adapted according to gestational age in neonatal care. Full article

This study examines how the Norwegian Child Welfare Tribunal justifies regulating telephone and digital communication between children in public care and their parents. The regulation of such contact represents a distinct form of state interference in family life and must adhere to principles of necessity, proportionality, and respect for children’s rights. Using a thematic analysis of 34 Tribunal decisions involving 44 children, the study identifies four central themes: ensuring stability and emotional security, addressing parental behavior, balancing proportionality and necessity, and considering the child’s view. The Tribunal’s reasoning often reflects a cautious, preventive approach, prioritizing emotional stability. However, the lack of transparent assessments of necessity and inconsistent inclusion of children’s perspectives raises concerns about proportionality and children’s autonomy. Additionally, the limited involvement of children in these decisions risks making restrictions difficult to implement in practice, as children may not understand or agree with them and instead seek unregulated contact. The findings underline the need for clearer justifications and more consistent consideration of a child’s view to ensure that decisions align with their best interests and remain feasible in practice. Full article

Borderline Personality Disorder (BPD) is a multifaceted mental illness characterized by a pervasive pattern of instability in interpersonal relationships, self-image, affect and marked impulsivity, beginning by early adulthood and presenting in a variety of contexts. The treatment of personality disorders is labeled as difficult, with various challenges identified in the literature, especially described in those with BPD. One of the challenges associated with BPD is treatment dropout, in which patients abandon their treatment schedules and protocols. The authors aim to explore the underlying motives for therapeutic abandonment in this population as well as discuss potential intervention methods to reduce this outcome during follow-up, whilst promoting regular adherence and active treatment participation. A cross-sectional study of patients that joined and subsequently dropped out of a specialized treatment program for Borderline Personality Disorder in a Portuguese hospital from 2014 to 2023 was realized utilizing data collected from surveys conducted through telephone interviews. Of the patients, 39 were identified as having dropped out of the program during the stipulated timeframe. Of these, five (12.8%) refused to participate, fourteen (35.8%) did not respond to contact attempts and two (0.05%) patients subsequently reintegrated into the program. Therefore, 18 (46.2%) agreed to respond to the questionnaire and were considered in the current study. The majority were female (94.4%) of single marital status and with secondary-level education. The main motivators for treatment dropout described by these patients included the large intervals between consultations, the loss of motivation and/or interest, as well as dissatisfaction with the program. Other variables were explored in the work, such as the desire to return to the program, the maintenance of other types of treatment, feelings after dropout and the evaluation of the usefulness of the program. Treatment dropout is an important problem in the treatment of BPD, as it stifles progress and therapeutic benefits through maintenance of the previous state, conditioned by impulsivity and marked instability. Although the current study attempts to clarify the motivating factors underlying abandonment in this population, further research is necessary in attempting to further reduce the lacuna regarding this common phenomenon and to develop interventions to promote positive outcomes. Full article

Background: Psychological parameters related to alcohol dependence (AD) affect patients’ behavioral and cognitive control, decision making, impulsivity and inhibitory control. People with AD often have a chronic course with a relapse to dependent substance use even after extensive treatment. This study investigated whether the psychological parameters of patients with AD predict (a) premature termination of treatment, and/or (b) relapse into consumption of alcohol from admission until 6 weeks after discharge from an inpatient rehabilitation treatment. Methods: Participants: Alcohol-dependent patients consecutively admitted for a duration of about three months to inpatient rehabilitation treatment in a hospital specialized in substance use disorders. Craving (OCDS-G) and impulsivity (BIS-11; UPPS) were assessed with computerized questionnaires. Attentional bias and inhibitory control were measured with two computer-based experiments (dot-probe task; stop-signal task (SST)). Investigations were conducted at entry (T1); after 6 weeks (T2); and during the last two weeks of the inpatient treatment (T3). Some N = 128 patients finished the first, N = 102 the second and N = 83 the third assessments. Outcome variables were discontinuation of treatment and abstinence or relapse until follow-up 6 weeks after discharge; participants were contacted via telephone. Results: None of the variables are associated with discontinuation of treatment. Poor inhibitory control (SST) and high craving (OCDS-5) levels, measured at T1, are significantly associated with relapse. Higher impulsivity (UPPS) measured at T2 and T3 is significantly associated with relapse. Exploratory analyses showed that older age, longer inpatient treatment duration and time spent in abstinence before rehabilitation treatment were significantly associated with a reduced risk of relapse. Conclusions: Psychological parameters, craving and impulsivity levels did not predict relapse to a high degree. It is assumed that discontinuation of treatment and relapse may be associated with different issues, such as social context, and individual motivation levels. In contrast, the length of both abstinence before admission and of inpatient treatment were significantly associated with abstinence; it is here suggested that recovery time duration may be an underestimated influencing factor regarding relapse in AD patients. Full article

With the improvement of the internet and the widespread adoption of digital communication devices such as smartphones, VoIP has largely replaced traditional telephone systems. Many companies are deploying VoIP systems due to their scalability and low cost. In this paper, we address the issue of remote clients or traveling employees being unable to contact business partners due to specific phone numbers. We propose a reference phone number mechanism that combines a set of related business partners’ phone numbers to enhance call availability. To ensure the confidentiality of calls, we also designed an algorithm to integrate key exchange protocols into the proposed mechanism. The mechanism can flexibly customize the required security protocols. A performance analysis was conducted by deploying the proposed mechanism in a medium-sized company. The results prove that the mechanism is feasible and the effect is satisfactory. Full article

Background/Objectives: The autologous arteriovenous fistula (AVF) is the preferred choice for vascular access in patients with end-stage kidney disease (ESKD) undergoing maintenance hemodialysis. However, in the long term, the primary patency of AVF is suboptimal, with an AVF failure of approximately 30% in one year. The aim of this study is to examine how the pre-operative baseline levels of interleukin-6 (IL-6) affect long-term AVF failure. Methods: This retrospective, observational study involves ESKD patients admitted to the Vascular Surgery Clinic for AVF creation from January 2020 to December 2023. Ultimately, a total of 91 patients whose AVFs matured and began dialysis were enrolled. Prior to surgery, each patient underwent a thorough blood sample collection, with IL-6 levels assessed. The patients were categorized into two groups: those with functioning AVFs and those with dysfunctional AVFs. Their progress was monitored via a review of medical records, telephone interviews, or direct contact. Following the surgery, patients were observed for an average of 1.53 ± 0.94 years. Results: During the follow-up, patients who experienced AVF failure had a higher incidence of diabetes mellitus (p = 0.019) and active smoking (p = 0.012), as well as higher levels of IL-6 (p < 0.001). At ROC analysis, we found a strong association between IL-6 value and AVF failure (AUC: 0.814, p < 0.001), with an optimal cut-off value of 7.08 (76.5% Sensitivity and 79.7% Specificity). Furthermore, at the survival curve Kaplan-Meier analysis, we observed a higher occurrence of AVF failure in patients with baseline IL-6 values above the median (p = 0.004), in tertile 3 (p = 0.002), and above the optimal cut-off value (p < 0.001). At cox-regression analysis, elevated baseline IL-6 levels are associated with AVF Failure (HR: 2.23, p < 0.001). Conclusions: In the current study, we demonstrated that elevated IL-6 levels at baseline are associated with long-term AVF failure, independent of age, sex, and cardiovascular risk factors. Full article

Objective: To assess the barriers to parental compliance with preschool vision screening tests and the recommended follow-up eye care. Methods: This prospective study included children aged 3–6 years attending 46 preschools. Parents were asked for consent for their children to participate in a vision screening test. Parents whose child did not participate due to lack of parental consent and parents whose child failed the screening test were contacted by telephone and given a standardized questionnaire to identify potential barriers to compliance. Results: A total of 1511 children (mean age 4.76 years ± 0.76, 51.3% boys) were eligible for vision screening. Consent was given by the parents of 1295 children (85.7%). Lack of consent in children who had never been examined by an ophthalmologist was primarily due to unawareness of the screening test or other logistical reasons (117 cases, 92.1%). Of the children screened, 140 (11.1%) failed the test and 80.0% of their parents adhered to the recommended follow-up eye care. Parents who followed the screening vision test recommendations were more likely to be native language speakers (82.8% vs. 58.8% mothers and 88.9% vs. 60.0% fathers; p = 0.049 and 0.015, respectively). There was a higher chance of at least one parent being native-born if recommendations were followed (90.6% vs. 58.8%, p = 0.004). All other factors tested were insignificant. Conclusions: Parental consent and cooperation with vision screening test and its recommendations were high. Migrant families are more likely to face challenges in following vision screening test recommendations, underscoring the need for tailored approaches for specific populations. Full article

The lifetime risk of breast and ovarian cancer increases substantially for individuals with mutations in BRCA1/2. The evidence indicates that BRCA1/2 mutation carriers benefit from early cancer detection and prevention strategies. However, data on the patterns of risk-reducing interventions are lacking. This study investigated the patterns of surveillance and risk-reducing interventions among unaffected BRCA1/2 mutation carriers. A cohort of unaffected BRCA1/2 mutation carriers was identified from the Korean Hereditary Breast cAncer (KOHBRA) study database, and a telephone survey was conducted. The survey included questions on the incidence of new cancers, patterns of cancer (breast, ovarian, prostate, other) surveillance, chemoprevention, risk-reducing surgery, and reasons for participating in risk-reducing strategies. Between November 2016 and November 2020, 192 BRCA1/2 mutation carriers were contacted, of which 83 responded. After excluding 37 responders who refused to participate, 46 participants (15 males, 31 females) were included in the analysis. The mean ± SD follow-up time was 103 ± 17 months (median 107, range 68~154), and the mean ± SD age was 31 ± 8 years. Ten BRCA1/2 mutation carriers developed breast cancer, one developed ovarian cancer, and three developed other cancers. Six BRCA1/2 mutation carriers (19.4%) underwent annual breast cancer surveillance as recommended by guidelines, while none underwent ovarian or prostate cancer surveillance. Three carriers (9.7%) used chemoprevention for breast cancer. Risk-reducing salpingo-oophorectomy was performed on only one BRCA1/2 mutation carrier. The rates of breast/ovarian cancer surveillance, chemoprevention, and risk-reducing surgery were low among unaffected Korean BRCA1/2 mutation carriers. Given this cohort’s relatively high risk of developing breast cancer, strategies to encourage active participation in risk reduction are needed. Full article

This study investigates the readiness of manufacturing industries in the Iraqi sector to adopt and implement Industry 4.0 (I4.0) technologies. The research focuses on manufacturing industries, including automotive, electronics, textiles, food processing, etc. The study’s main objective is to investigate the relationship between adopting I4.0 technologies and performance benefits in these sectors. A structured survey was conducted across 240 manufacturing companies, including specific I4.0 technologies (IoT, Big Data Analytics, Cloud Computing, Artificial Intelligence, etc.), usage levels, operations, products/services, and sustainability. Data were collected through telephone interviews and personal contacts, where the respondents rated the benefits of I4.0 technology adoption and performance benefit dimensions on a five-point Likert scale. The study utilized Partial Least Squares Structural Equation Modelling (PLS-SEM) using SmartPLS 3.2.9 software for data analysis. Findings show a positive relationship between I4.0 technology adoption and industrial performance benefits, emphasizing productivity and production efficiency improvements more than sustainability improvements and resource benefits. This research contributes to the understanding of I4.0 readiness in emerging economies and provides insight for policymakers and industry leaders in Iraq’s manufacturing sector. Full article

This study aims to describe the long-term changes in the knowledge of, and attitudes towards, COVID-19 and its preventive measures in northern Spain. A telephonic survey was performed among household contacts of COVID-19 cases in Catalonia and Navarre between May 2022 and December 2023. Knowledge and attitudes were assessed through 12 questions using a Likert scale, and responses were grouped as correct or incorrect. The change from baseline to the 6-month follow-up was evaluated with the absolute difference (AD) using the proportion of correct answers. At baseline, 299 subjects were contacted, of whom 63.2% (189) completed the 6-month follow-up. Correct knowledge of transmission (>85%) and the use of preventive measures (>92%) were observed at baseline and maintained over time. The attitudes towards face mask use remained adequate over the course of six months (>79%). However, attitudes regarding the use of face masks indoors (AD = −16.4%; p < 0.001) and those who thought that COVID-19 had a negative impact on their lives (AD = −16.5%; p < 0.001) decreased after 6 months. In the post-acute phase of the pandemic, household contacts maintained the correct level of knowledge towards COVID-19, while some attitudes decreased. These results should serve as a guide for health policy makers in decision-making in case of a new increase in the incidence of SARS-CoV-2. Full article

Background: Attendance to neonatal follow-up programs presents a significant factor associated with positive long-term outcomes of high-risk infants. Strategies to maximize participation benefit not only future interventions’ effectiveness but also healthcare systems and society. While a number of studies have focused on attrition or loss to follow-up, no studies have focused on the contributive risk factors to abstaining from neonatal follow-up programs specifically during the COVID-19 pandemic. This study aims to reveal the main factors linked to non-compliance in a neonatal follow-up program of a tertiary hospital. Methods: In this ambidirectional observational study, data from 1137 high-risk neonates who participated in a hospital follow-up program were collected (573 before and 564 after the COVID-19 pandemic). The study sample was grouped to three groups: G1 (N = 831), who maintained participation in the program; G2 (N = 196), who discontinued; and G3 (N = 110), who never visited the outpatient clinics. Data were obtained from the hospital’s Systems Applications and Products (SAP) Software and a structured questionnaire, answered by parents of newborns either discontinuing (G2) or not attending (G3) the follow-up program through a telephone contact. Results: The most frequently reported reason for discontinuance before the pandemic onset was the parents’ perception of no necessity to maintain participation (44.12%). During the COVID-19 pandemic, provider-related barriers to maintaining hospital access, inability to provide high-quality services (37.14%), and feelings of fear and insecurity (18.5%) emerged as factors for non-attendance. Citizenship and morbidity (respiratory distress syndrome, sepsis, necrotic enterocolitis, jaundice) acted as incentives to join the follow-up program during both study periods. Multiple regression analysis showed that multiple-gestation infants had higher odds of maintaining participation during the COVID-19 period (OR, 4.04; CI, 1.09–14.9). Conclusions: Understanding the potential impact of COVID-19 and the transformative changes in neonatal follow-up clinics is crucial for applying compliance strategies. Removing barriers to maintain family participation can lead to increased attendance rates. Full article

Background: Even though children after tonsil surgery experience pain and other limitations in their daily lives, nursing care is transferred to parents after tonsil surgery, and they might need some kind of support. The aim of the study was to test the design of a randomized controlled trial intended to evaluate a nurse-led telephone follow-up after tonsil surgery on postoperative symptoms and quality of life. Methods: Of the seventeen children aged 3–17 years scheduled to tonsil surgery, nine were randomized to the intervention group and eight to the control group using a randomization list. The parents in the intervention group were contacted by telephone on days 1, 3, 5, and 10 postoperatively for counseling by a nurse. The instruments Postoperative Recovery in Children (PRiC) and the health-related quality of life instrument (EQ-5 D-Y) were used to evaluate postoperative symptoms and quality of life, respectively. Results: Eight participants in the intervention group reported throat pain compared to five participants in the control group on the operation day and four days after, possibly due to an uneven distribution of the type of surgery between the study groups. The parents appreciated the telephone counseling, and there were no unplanned revisits in the intervention group. However, it was difficult to recruit participants and the assessment tools were not always fully completed. Conclusions: No explicit conclusions can be drawn from this feasibility study due to the low number of participants and the study design needs adjustments. Full article

Background and Objectives: There is little information on changes in the process and outcomes of intensive tobacco dependence treatment during the COVID-19 pandemic. The following characteristics were evaluated: interest in treatment, the number of face-to-face or telephone follow-ups, the duration of pharmacotherapy use, and the success rate. The aim of our study was to compare the number of patients who entered tobacco dependence treatment programmes and evaluate the one-year success rate in patients three years before and three years after the COVID-19 pandemic. Materials and Methods: A single-site retrospective cohort study using data from patients treated at the Centre for Tobacco Dependence in Prague, Czech Republic, between 2017 and 2022 (n = 2039) was performed. The one-year abstinence rate was validated by measuring carbon monoxide in exhaled air (6 ppm cut-off). Patients were divided into two groups: the group for which treatment was initiated in 2017–2019 (i.e., before the COVID-19 pandemic, BC; n= 1221) and the group for which treatment was initiated in 2020–2022 (i.e., during the COVID-19 pandemic, DC; n = 818). Results: No significant differences in the success rate of tobacco dependence treatment were found between the two groups (BC group, 40.5% (494/1221) vs. DC group, 42.2% (345/818)) (χ² (1, N = 2.039) = 0.6, p = 0.440). Furthermore, differences were not found in sex, education level, age at first cigarette, the duration of pharmacotherapy use, or the number of in-person visits. In contrast, there was an increase in the number of telephone contacts between the groups (18.7% (SD = 17.5%) vs. 32.9% (SD = 18.2%), p < 0.001). Conclusions: The number of patients who started treatment during the COVID-19 pandemic decreased by one-third compared to that during the 3-year period before the pandemic. The overall treatment success rate did not change significantly even with the increase in the number of telephone visits with the therapist. Full article

Payments for ecosystem services have recently been introduced into the ecosystem management landscape to counter ecosystem degradation. This study examines the experiences of sustainable use and management of watersheds using a compensation for ecosystem service model in the Koga watershed, Northern Ethiopia. The study primarily employed qualitative methods. Thirteen informants, chosen from a group of project implementers, were contacted for telephone interviews, and a document analysis was also conducted. Thematic approaches were employed to analysis the data. The study findings revealed that a project had been introduced to implement an innovative payment/compensation for ecosystem services (CES) scheme to manage watersheds and to alleviate poverty in the watershed. The scheme connected upstream and downstream communities and cooperatives through CES, earning praise for its effectiveness in combating dam siltation and watershed degradation. The initiative also established various enabling conditions, such as capacity building, bylaw formulation, and payment procedures for beneficiary communities. However, the CES scheme still has a long way to go to deliver the anticipated positive impacts on local livelihoods and watershed management. It is believed that a comprehensive legal framework, a stable political and social environment, and sustainable financing mechanisms are crucial for the success of any CES project. Therefore, Ethiopia should strive to meet these requirements to ensure that any future CES projects are designed and implemented sustainably. Full article