Search Results (4,244)

Against the background of traffic conflicts arising due to the highly concentrated population in high-density cities, this study aims to systematically identify the core transport needs of patients awaiting medical treatment; based on the theory of the Kano model, we construct a measurement system relating to patient transport needs when awaiting medical treatment that encompasses multiple levels. Taking 10 large general hospitals in Guangzhou as samples, this study collected data through questionnaires and auxiliary interviews, using the importance–sensitivity analysis method to accurately measure the degree of patient needs for each influencing factor of the transport environment for medical treatment. The study found that, among the primary needs (core basic needs), the perfection of public transport (which directly affects the convenience of medical care) is the core need with the highest degree of demand. Among the second-level needs (refined categorised demand levels), specifically relating to important attributes (essential needs), priority attention should be given to patient diversion, hospital–city connection, and corridor settings. As concerns the high value-added one-dimensional attributes (desired needs), focus should be placed on controlling health and safety distances and guiding the flow of medical treatment, while for high glamour attributes (glamour needs), primary consideration should be given to crowd distribution, stopping and resting, and direct access to the ground floor. The group difference analysis (grouped by emotional state, transport mode, and group type) showed that the first-level demand sensitivity ranking was highly consistent, and the second-level demand for urban connectivity, convenient transfer, and direct underground access were also common priorities. This study is the first to introduce the Kano model into the analysis of high-density urban healthcare transport systems, providing a clear basis for the grading of demand for the design of the transport environment for patients’ medical care. This is of great practical value for alleviating congestion and improving the resilience of emergency response in mega-cities in relation to medical care. Full article

Background: Vaccine hesitancy is a major threat to public health. As part of efforts to increase vaccine uptake, the focus is on optimizing the quality of communication among healthcare workers. Physician shortages and workloads create time constraints, making communication interventions in primary care challenging. This study aimed to propose strategies to improve communication between general practitioners and vaccine-hesitant individuals. This narrative review addresses the specific needs of general practitioners for effective communication and proposes strategies to combat vaccine hesitancy in culturally and linguistically diverse regions. Methods: Systematic searches of EMBASE and PubMed were performed using terms related to vaccine hesitancy, communication strategies, primary care, and cultural diversity. Additionally, the websites of major health organizations were searched for relevant reports and guidelines. Selection criteria were based on the relevance and quality of the selected studies. Results: The findings highlight the importance of empathy, transparency, and personalized information in communication strategies. The need for communication training and addressing policy and workload barriers for healthcare providers is significant. The proposed strategy includes regular communication skills and cultural competency workshops, language training, the development of multilingual resources, implementation of telemedicine services, and active community engagement. Conclusions: Policy recommendations advocate for increased primary care resources, support from general practitioner unions, and the integration of digital tools. These strategies are essential to improve vaccine uptake and public health outcomes by enhancing the capacity of general practitioners to effectively engage with vaccine-hesitant patients. Full article

Background/Objectives: This study examined the relationship between nutritional status and muscle strength in the upper and lower large muscles, with a specific focus on shoulder, hip, and knee muscle strength in community-dwelling older adults. It also investigated the relationship between nutritional status and functional performance as measured by the Timed Up and Go (TUG) test. Methods: A secondary analysis of a cross-sectional study involving 2045 older adults (aged 60 years or older) from 15 randomly selected primary health care centers in Riyadh was conducted between January 2015 and April 2017. After excluding participants with specific medical conditions, 1741 individuals were included in the analysis. Nutritional status was assessed using the Arabic version of the Mini-Nutritional Assessment (MNA). Handgrip strength (HGS) and large muscle strength (shoulder, hip, knee) were measured using a hydraulic hand dynamometer and the Nicholas Manual Muscle Tester, respectively. The TUG test was also assessed to evaluate physical performance. Results: The study revealed that well-nourished older adults had significantly greater upper and lower muscle strength than those who were malnourished or at risk (p ≤ 0.001), with males generally exhibiting stronger muscle strength than females. Furthermore, in both genders, older adults showed significant positive correlations between MNA scores and upper and lower muscle strength. Additionally, longer times on the TUG test indicated a higher risk of malnutrition (OR: 1.135, CI: 1.087–1.186; p ≤ 0.001). Conclusions: this study breaks new ground by being the first to explore the relationship between nutritional status and the muscular strength in the shoulder and hip regions. Findings indicate that muscle strength and physical performance were associated with malnutrition. Full article

Background: As means of addressing ongoing challenges in accessing publicly funded specialist care, new models of care have been trialled. One such approach is using physiotherapists in advance practice roles, who in collaboration with other health professionals, act as an initial orthopedic point of contact and coordinate care. This research investigated the impact of a model of care, the Spinal Virtual Clinic Model, implemented for the first time in South Australia, using advanced practice physiotherapists in a large metropolitan hospital in South Australia. Although formally named the “Spinal Virtual Clinic” by the health service, this model does not involve direct patient contact and differs from traditional virtual or telehealth clinics. Instead, it is best understood as a physiotherapy-led referral triage and management service. Methods: This research was conducted in two stages. Stage 1 was a retrospective clinical audit of sequential patients triaged to the Spinal Virtual Clinic, as well as a follow up audit to capture any subsequent engagement with the Orthopaedic Spinal Service following the initial Spinal Virtual Clinic correspondence. Data were descriptively analysed. In Stage 2, semi-structured interviews were conducted with patients from the Spinal Virtual Clinic to explore their perspectives on this model of care. The interviews were transcribed verbatim and independently analysed using thematic analysis. The sequential use of quantitative and qualitative approaches enabled us to both describe engagement with this model of care and better understand the underlying perspectives. Results: Three hundred and nine referrals were triaged to the physiotherapy-led spinal virtual clinic over a six-month period from 1 January 2021 to 30 June 2021. Majority of referrals were triaged as low acuity did not need formal spinal specialist review and could be managed safely in primary care. Therapist-led active management strategies (80.8%), trial of neuropathic medication (35.6%) closely followed by advice regarding targeted spinal injections (foraminal and epidural), were the most common conservative management strategies recommended. Only a small proportion needed surgical review. Interviews with eleven patients revealed that while many valued the convenience, timely advice, and reassurance offered by the service, others expressed confusion about the referral process and disappointment at not seeing a specialist. A key recommendation identified was improved communication, including providing patients with direct feedback alongside general practitioner correspondence. Conclusions: This research, underpinned by quantitative and qualitative research, has showcased the potential of this model of care, the spinal virtual clinic, to have a positive impact on improving access and reducing the burden on the health system for low acuity patients. As historical models of care become unsustainable and obsolete, alternative models of care can be implemented in health care settings where outpatient demand significantly exceeds capacity. Full article

Background/Objectives: Adolescent idiopathic scoliosis (AIS) often requires prolonged brace use to prevent curve progression. However, adherence is challenging due to discomfort, mobility restrictions, and psychosocial stressors. This study evaluated the feasibility and clinical utility of a mobile health (mHealth) system for real-time tracking of brace adherence and treatment-related experiences in adolescents with AIS. Methods: Thirty adolescents with AIS (mean age = 12.9, SD = 1.8) undergoing brace treatment at a tertiary care center used a custom app for 90 days. The app collected daily self-reports on brace wear duration, discomfort, movement limitations, emotional distress, and social challenges. A clinical alarm system alerted providers when patient input indicated potential concerns. Primary outcomes were feasibility (adherence to daily use and usability ratings) and brace adherence. Secondary outcomes included the app’s capacity to identify treatment-related challenges and its association with changes in stress, quality of life, anxiety, and depression. Results: Participants reported meeting recommended brace wear time (≥16 h/day) on 84.8% of days. The app triggered 186 clinical alarms, with the most frequent related to emotional distress (23.1%) and pain (15.6%). Alarm frequency declined over time. Improvements of ≥20% in psychological outcomes were observed in 20–26.7% of participants, while group-level changes were nonsignificant. Conclusions: mHealth-based monitoring appears feasible and acceptable for digitally engaged adolescents with AIS. The app supported early detection of treatment barriers and prompted timely clinical responses. Despite limitations, it shows promise as a tool to improve treatment engagement and address psychosocial challenges in scoliosis care. Full article

Background: Weekend presentation to the emergency department (ED) has been associated with increased morbidity and mortality in various clinical settings. However, the literature is scant whether such an effect exists for patients presenting with COVID-19 infection. Additionally, comparative analyses of mortality predictors in COVID-19 patients evaluated at the emergency department need further exploration. Methods: This retrospective cohort study examined factors associated with mortality among adult patients (aged ≥ 18 years) who presented with COVID-19 to the emergency departments of five hospitals within the Johns Hopkins Health System (combined capacity: 2513 beds) between March 1 and 4 May 2020. Data were extracted from electronic health records. Multivariable logistic regression was utilized to assess the relationship between mortality and a range of variables, including sociodemographic characteristics, clinical presentation, laboratory parameters, pre-existing comorbidities, and weekend versus weekday presentation. Results: Of the 2767 patients, 685 (25%) presented to the emergency department on weekends. Compared to weekday presenters, weekend patients were more likely to be hospitalized (64%), and these patients had a mean symptom duration of 5 days (SD ± 6). Weekend presenters also exhibited higher rates of clinical frailty, dehydration, hypoxia, and respiratory distress upon arrival. In multivariable logistic regression analysis adjusting for sociodemographic characteristics, clinical risk factors, and laboratory findings, independent predictors of increased mortality included absence of a primary care provider (OR 3.47; 95% CI: 2.37–5.07), peripheral oxygen saturation (SpO₂) < 95% at presentation (OR 1.46; 95% CI: 1.001–2.12), and hyperglycemia (OR 2.13; 95% CI: 1.25–3.65). Notably, the presence of crackles on physical examination demonstrated a trend toward reduced mortality (OR 0.47; 95% CI: 0.24–0.92). Conclusions: While weekend presentation was associated with higher hospitalization rates among patients with COVID-19, it did not independently predict increased mortality. Absence of a primary care provider, hypoxia, and hyperglycemia at presentation emerged as strong, independent predictors of mortality in the ED setting. Race, gender, and obesity were not significantly associated with mortality in this cohort, warranting further investigation. These findings may support more effective triage and risk stratification strategies in current and future public health emergencies. Full article

The iron and steel industries globally have a high prevalence of occupational injuries, which need to be reduced. Obtaining safety climate information from workers assists in understanding the safety status at the workplace. This study aimed to assess the safety climate in the iron and steel industries and its association with occupational injuries. A cross-sectional study was conducted in four iron and steel industrial sites in Tanzania. Three hundred and twenty-one workers from the production lines and 50 managers/supervisors participated. The data were collected by interviews using the Kiswahili version of the Nordic Safety Climate Questionnaire (NOSACQ-50) and the modified International Labor Organization (ILO) manual on methods for occupational injuries. The managers/supervisors scored higher than the workers in five of the NOSACQ-50 dimensions. Most workers with low scores on safety climate had experienced occupational injuries. Analyses of the workers who had been injured at work showed that the dimensions ‘management safety priority and ability’, and ‘management safety justice’ were significant predictors of occupational injuries in the iron and steel industries, when adjusting for working years and working hours per day. This indicates that safety climate is a predictor of occupational injuries, and it is important to improve the safety priorities and commitments among the employees. Full article

Objective: The objective of this retrospective cross-sectional study is to explore how caregiver social determinants of health, appraisal of healthcare provider effectiveness, and insurance coverage influence caregiver ability to have their adolescent child access vision care, including completion of annual vision screening, visiting an ophthalmologist or optometrist, and completion of recommended additional screenings. Study Design: We used National Survey of Children’s Health (NSCH) data for 12–17-year-old adolescents for the years 2022 and 2023 (n = 37,425). Summary statistics for the selected sample were generated and binary logistic regressions were conducted. Outcome variables were the type of vision screening that occurred or not. Covariates were socioeconomic and demographic data of the adolescent’s primary caregiver. Independent variables were insurance coverage and healthcare provider’s skill and effectiveness. Results: Significant associations were reported between visiting an ophthalmologist or optometrist and each of spending enough time with patients; listening carefully to patients; and making patients feel like care is a partnership. Additionally, significant associations were reported between insurance coverage and both successful completion of vision screening and visiting an eye doctor. Conclusions: This study underscores the substantial impact of effectiveness of eye doctors in delivering annual vision exams and insurance adequacy on adolescent vision care engagement. Our results will inform the development of future evidence-based educational interventions to raise awareness on the importance of annual vision screenings in US adolescents and emphasize the need for screening mandates to advocate for this important public health issue. Full article

Background: The prevalence of dental caries has increased among children, largely due to nutritional habits or inadequate access to dental care. The present study aimed to investigate the prevalence of dental caries associated with various factors that lead to their appearance, such as food intake and body composition, among Romanian school-age children from two counties, Bistriţa Năsăud and Mureş. Methods: This cross-sectional study included 1100 children aged 6–10 years from two Romanian counties. Dental caries experience was assessed using the DMFT and dmft indices based on WHO criteria. Dietary intake and oral health behaviors were evaluated through a food frequency questionnaire completed by parents. Associations between dietary variables and dental caries were assessed using independent sample t-tests and Mann–Whitney U tests. A binary logistic regression model was used to estimate the likelihood of caries in the permanent dentition (DMFT > 0), with covariates including county, parental education, daily sugar intake, consumption of dairy products, body mass index (BMI), and waist-to-height ratio. Results: It was found that the children who daily consume cheese recorded a DMFT value lower than the children who did not consume (p < 0.05). Moreover, those who consume sugary foods recorded higher values of DMFT as compared with those who did not (p < 0.05). The body weight, BMI, and waist circumference are positively correlated with DMFT, but negatively with dmft (p < 0.05). The overall prevalence of caries was 79.8% in primary dentition and 63.6% in permanent dentition, with slightly higher rates observed in Bistriţa-Năsăud County compared to Mureş. It seems that the predictors of the caries’s presence among children include the mother’s education level, sugar intake frequency, and body fat ratio. Conclusions: Based on significant associations found, one can affirm that the dental caries of the Romanian school-age children is due to sugary food intake and body composition. In addition, the direct relationship between dental caries and childhood obesity showed through the correlation of BMI and dental health indices denotes that school-age children should reduce sugary foods and increase dairy products. Full article

Background/Objectives: The child and adolescent mental health service (CAMHS) hand-over to adult mental health service (AMHS) remains an ongoing shortfall in eating disorder (ED) treatment, typically in tandem with diagnostic drift, heightened suicide risk, and carer burn-out. We created one 14-to-25 Transition—ED track within our own unit, where a single multidisciplinary team continuously follows each patient and family across the CAMHS–AMHS boundary (via weekly joint paediatric and adult clinician meeting) without changing the individual psychotherapist, family therapist, or dietitian at the age 18 transition. We investigated the manner in which patients and parents perceive this model. Methods: A survey of two naturalistic parent cohorts—CAMHS (n = 16) and Transition—Adult arm (n = 15)—also joined, alongside the original group of young adults who had entered the programme during its set-up phase (n = 9). Here, the 14–25 pathway denotes one unified route of care across adolescence and young adulthood; the Transition—Adult arm is its ≥ 18-years component. All index patients had a primary DSM-5-TR diagnosis of restricting-type anorexia nervosa. Participants completed the Client Satisfaction Questionnaire-8 (CSQ-8; range 8–32) and four bespoke Continuity-of-Care items (1–4 Likert). Results: Overall, the caregivers in both cohorts were pleased (median CSQ-8 = 28.5 [CAMHS] vs. 27.0 [Transition]; p = 0.75). Continuity items were universally well rated across cohorts. Cohort parents reported a median of two unchanged core clinicians (i.e., the individual psychotherapist, the family therapist, or the dietitian), which was nonsignificantly positively correlated with CSQ-8 scores (ρ = 0.22). Early-group patients mirrored caregiver impressions (mean CSQ-8 = 27.0 ± 3.9). Conclusions: It is feasible and highly acceptable to both caregivers and anorexia nervosa young adults to have the same key staff and family-centred sessions over the 14-to-25 age span. Constrained by single-site study and small sample size, these preliminary data provide a rationale for wider implementation and controlled follow-up studies. Full article

Background and Objectives: Musculoskeletal pain is a global public health issue. Eight Constitution Medicine (ECM), a type of East Asian Traditional Medicine, offers personalized, minimally invasive treatment through Eight Constitution Acupuncture (ECA) and Eight Constitution Lifestyle Intervention (ECLI). Despite its clinical use, scientific evidence supporting ECM’s effectiveness remains limited. This study aimed to evaluate the effectiveness in treating musculoskeletal pain in primary care settings. Materials and Methods: This retrospective study analyzed medical records from three ECM clinics (Gangnam-Shingwang, Yeson, and Yebon) between January 2018 and August 2023. A total of 163 patients were included, with 44 providing follow-up data. Pain intensity, quality of life, and functional outcomes were assessed using validated instruments including the PainDETECT questionnaire, Korean Cancer Pain Assessment Tool (KCPAT) somatic pain scores, EuroQol 5-Dimension 5-Level (EQ-5D-5L), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oswestry Disability Index (ODI), Neck Disability Index (NDI), and Shoulder Pain and Disability Index (SPADI). Pre- and post-treatment scores were statistically analyzed. Results: Significant decreases were observed in KCPAT somatic pain scores (11.77 ± 4.77 to 9.77 ± 5.32) and significant improvements in EQ-5D-5L scores (0.74 ± 0.12 to 0.80 ± 0.07). WOMAC and ODI scores also showed significant improvements. However, the changes in the NDI, SPADI, and PainDETECT scores were not statistically significant. No adverse events were reported. Conclusions: ECM, through ECA and ECLI, may offer effective personalized treatment for musculoskeletal pain, improving both pain intensity and quality of life. Despite its small sample size and retrospective design, this study offers valuable preliminary evidence for ECM. Further large-scale prospective studies are needed to confirm these findings. Full article

Background: Hyperventilation Syndrome (HVS) is a well-recognized physiological consequence of acute anxiety, often resulting in respiratory alkalosis and subsequent electrolyte imbalances. Among these, a reduction in ionized calcium levels can lead to neuromuscular irritability and electrocardiographic abnormalities such as QTc prolongation. Although well-documented in specific settings, including autism spectrum disorders and drug-induced crises, such complications are rarely described in otherwise healthy pediatric patients presenting with isolated anxiety episodes. This report aims to raise awareness of anxiety-driven somatic manifestations, particularly in the context of the rising prevalence of mental health disorders among children and adolescents. Methods: We report the case of a previously healthy 10-year-old girl presenting to the emergency department with acute agitation and hyperventilation. Clinical examination revealed neuromuscular symptoms, including Trousseau’s sign and flexion posture. Initial laboratory testing and arterial blood gas analysis indicated respiratory alkalosis with decreased ionized calcium levels, and a resting ECG showed QTc prolongation (510 ms). Treatment included intravenous midazolam, a balanced electrolyte solution, and oral bromazepam during intensive observation with cardiac monitoring. Results: The patient’s symptoms progressively improved following anxiolytic and supportive therapy. Electrolyte abnormalities normalized within 48 h, with complete resolution of the prolonged QTc (430 ms). No arrhythmias or other complications occurred. Outpatient psychological follow-up was arranged upon discharge. Conclusions: This case underscores the importance of considering anxiety as a primary etiology in pediatric patients with apparent metabolic or cardiac abnormalities. Early psychiatric recognition and targeted supportive care can prevent overtreatment and reduce the burden on emergency and cardiologic resources. Full article

Primary ovarian insufficiency (POI) in adolescents and young women is a rare but serious endocrine disorder with far-reaching reproductive, metabolic, and psychological implications. This study aimed to evaluate diagnostic timelines, treatment patterns, and psychosocial outcomes among affected individuals in a secondary care setting in Saudi Arabia. A retrospective observational analysis was conducted on 96 patients aged 13–39 years diagnosed with POI between 2018 and 2024. Data were extracted from electronic medical records and assessed using validated clinical and psychological tools, including the MENQOL and HADS. The mean age at diagnosis was 22.9 years, with one-third of patients experiencing diagnostic delays exceeding 18 months. Hormone replacement therapy was initiated in 69.8% of cases, while fertility counselling and bone mineral density screening were provided to 61.5% and 74.0% of patients, respectively. Over 60% exhibited clinically significant symptoms of anxiety or depression. Multivariate analysis revealed that delayed diagnosis, absence of hormone therapy, and lack of fertility counselling significantly increased the risk of psychological distress. These findings underscore the importance of timely diagnosis, multidisciplinary intervention, and integrated mental health support in the management of POI. Comprehensive, culturally responsive care models are essential to improving quality of life and long-term outcomes in this vulnerable population. Full article

In pharmacy, theoretical and methodological approaches from anthropology and the social sciences have been increasingly used to understand the complexity of health–disease processes and their relationship with medicines and social practices. Ethnography offers a critical and in-depth lens for analyzing phenomena in Primary Health Care (PHC), bridging persistent gaps between theory and method in health research. This article presents the theoretical and methodological trajectory of an ethnographic study on pharmaceutical services in PHC, conducted through participant observation in three Units in São Paulo, totaling 166 h of fieldwork. Data were recorded in field diaries and analyzed using a thematic inductive approach, leading to the development of conceptual categories and an analytical framework. Reflections on the method enabled interpretive analyses based on assumptions that were confronted with national and international trends in pharmacy literature. Constructing the method in a non-isolated, context-sensitive way was essential to understanding how pharmacists actively shape their practices in PHC. The study reinforces the relevance of participant observation as both a methodological and interpretive strategy, revealing that pharmaceutical services are being constructed through culturally situated practices that respond to health needs with the pharmacist’s active involvement. Full article

Medicaid enrollees often face barriers to care due to inconsistent clinician participation. This study investigates how primary care clinicians’ engagement with Medicaid evolved from 2016 to 2019, focusing on those already serving Medicaid patients at baseline. Using longitudinal data from the Transformed Medicaid Statistical Information System Analytic Files (TAFs), we analyzed changes in the number of unique Medicaid enrollees served annually by 220,665 clinicians across 40 states. We defined major increases or decreases as changes exceeding 90% of baseline enrollee volume and examined associations with clinician, practice, and state-level characteristics. The results show that while about 60% of clinicians maintained stable enrollee volumes, nearly 20% experienced substantial increases or decreases. Higher baseline enrollee volume and affiliation with community health centers were associated with greater stability, while rural practice settings were linked to higher odds of major decreases. These findings underscore the dynamic nature of Medicaid participation and highlight the need for policies that support consistent clinician engagement. As Medicaid programs face potential funding cuts and eligibility changes, tracking participation trends and reinforcing stable provider networks will be critical to safeguarding access to care. Full article