Search Results (1,576)

Background/Objectives: Vitamin D deficiency is common in the Middle East, where it affects about 90% of the population. 25-hydroxyvitamin D [25(OH)D]. plays a key role in immune function and antimicrobial defense. Its deficiency has been implicated in surgical site infections (SSIs) also, which lead to increased healthcare costs and morbidity. Around 60% SSIs are preventable by addressing factors like 25(OH)D levels among others. In Qatar, 55.8% of the population is 25(OH)D deficient, but no direct link has been established between 25(OH)D deficiency and SSI risk. This study aims to investigate the relationship between deficient 25(OH)D levels and SSI development in surgical patients at Hamad Medical Corporation (HMC), Qatar. Methods: A retrospective chart review was conducted on adult patients who underwent surgery at HMC, Qatar, between January 2021 and December 2023, with known 25(OH)D levels measured within three months before surgery. A multivariate logistic regression analysis was conducted to evaluate the relationship between 25(OH)D levels and SSIs. Results: This retrospective chart review included 24,097 patients, with 3818 (15.8%) being 25(OH)D deficient. The mean age of the patients was 45 years, and 55% of them were female. The proportion of SSIs was highest in the 25(OH)D deficient group (2.7%) compared to the insufficient (1.8%) and sufficient (1.9%) groups, with a p-value of <0.01. The mean 25(OH)D level was 23 ng/mL in the SSI group, compared to 25 ng/mL in the no SSI group, with a p-value of <0.01. Multivariate logistic regression analysis identified several independent risk factors for SSIs, including 25(OH)D deficiency, male gender, intermediate and major case levels, longer operative times, lower preoperative serum albumin, and contaminated and dirty wounds, all with p-values of <0.05. Conclusions: Preoperative lower 25(OH)D levels increase the risk of SSIs. This study emphasizes the importance of optimizing 25(OH)D levels before surgery to reduce the occurrence of SSIs. Full article

Background/Objectives: Survey administration mode may significantly influence responses on polarizing health topics, yet this methodological factor remains understudied in vaccine hesitancy research. Understanding how data collection methods affect parental attitudes toward childhood vaccination is crucial for accurate public health surveillance and intervention design. Methods: This comparative cross-sectional study examined parental attitudes toward childhood vaccination using both paper-based (n = 487) and online (n = 386) survey administration among 873 parents. This study employed multivariate logistic regression analysis to assess differences between survey modes while controlling for demographic variables. Results: Key outcomes included general vaccination support, belief in vaccine–autism links, preference for natural immunity, and communication comfort with healthcare providers. Substantial differences emerged between survey modes. Online respondents showed significantly lower vaccination support (61.92% vs. 88.48%, p < 0.001), higher belief in the vaccine–autism link (37.31% vs. 16.77%, p < 0.001), and greater endorsement of natural immunity over vaccination (38.08% vs. 12.50%, p < 0.001). After adjusting for demographics, online respondents had 5 times lower odds of supporting childhood vaccination (OR = 0.20, 95% CI: 0.13–0.30) and nearly 5 times higher odds of preferring natural immunity (OR = 4.67, 95% CI: 3.19–6.95). Online respondents were also less likely to feel comfortable discussing vaccines with healthcare providers (51.0% vs. 72.7%, p < 0.001). Conclusions: Survey administration mode substantially influences measured parental vaccine attitudes, with online platforms capturing more vaccine-skeptical responses. These findings have critical implications for public health research methodology and suggest that mixed-mode survey designs or statistical adjustments may be necessary to obtain representative population estimates of vaccine hesitancy. 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: Delayed diagnosis of Chronic Obstructive Pulmonary Disease (COPD) in primary care is common and contributes to preventable morbidity. A deeper understanding of pre-diagnostic patterns is needed to develop targeted detection strategies. We aimed to characterize diagnostic delay and missed diagnostic opportunities (MDOs) and identify high-risk clinical profiles. Methods: We conducted a retrospective cohort study of 167 patients newly diagnosed with COPD in primary care centers in Madrid, Spain. Healthcare utilization in the 12 months preceding diagnosis was analyzed. Multivariable logistic regression was used to identify predictors of MDOs, and K-means clustering was used to identify patient phenotypes. Results: Diagnostic delay (>30 days) was present in 45.5% of patients, and MDOs in 47.3%. MDO-positive patients had significantly worse lung function (mean FEV₁: 1577 vs. 1898 mL, p = 0.008), greater symptom burden (CAT score ≥ 10: 79.7% vs. 59.1%, p = 0.003), and more frequent pre-diagnostic exacerbations (mean: 1.24 vs. 0.71, p = 0.032). After multivariable adjustment, diagnostic delay remained a powerful independent predictor of MDOs (OR 10.25, 95% CI 4.39–24.88; p < 0.001). Cluster analysis identified three distinct clinical phenotypes: ‘Paucisymptomatic–Preserved’, ‘Frequent Attenders/High-Risk’, and ‘Silent Decliners’. Conclusions: The pre-diagnostic period in COPD is a dynamic window of detectable, and potentially preventable, clinical deterioration driven by diagnostic inertia. The identification of distinct patient phenotypes suggests that a proactive, stratified, and personalized approach, rather than a one-size-fits-all strategy, is required to improve early diagnosis in primary care. Full article

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice. Full article

The effects of the COVID-19 pandemic restricted the availability of healthcare and social services. This retrospective study reports WIC enrollment rates and presents descriptive data on prenatal care access and selected maternal health conditions among pregnant women in Florida before and during the COVID-19 pandemic. Using birth data linking maternal and infant characteristics from the Florida Department of Health Bureau of Vital Statistics, we examined birth records from 1 January 2019 to 31 December 2020 related to women ranging from 11 to 59 years of age who received WIC. The descriptive results show that WIC recipients had higher rates of inadequate prenatal care and adverse maternal health outcomes during the pandemic. Logistic regression results show that the odds of receiving inadequate prenatal care increased by 24% (OR = 1.24, p < 0.001), the odds of experiencing gestational diabetes by 9% (OR = 1.09, p < 0.001), and the odds of experiencing gestational hypertension by 10% (OR = 1.10, p < 0.001). Further research is needed to evaluate how specific WIC services influence maternal outcomes, particularly during public health emergencies. Full article

Background/Objectives: This study examines individual perceptions of national healthcare system efficiency before and after the COVID-19 pandemic across 18 countries grouped into three clusters (the Anglo-world, Europe, East Asia). This paper aims to identify the demographic, socioeconomic, health-related, and macroeconomic healthcare drivers of public assessments, and explain changes in attitudes between 2011–2013 and 2021–2023. Methods: Using individual-level data from the International Social Survey Programme (ISSP) for 2011–2013 and 2021–2023, logistic regression models of perceived healthcare inefficiency are estimated. In addition, the Oaxaca–Blinder decomposition model is adopted in order to decompose the assessment gap between the two periods. Models include a range of individual demographic and socioeconomic characteristics and national healthcare controls (healthcare expenditure, potential years of life lost). Results: Health-related factors, especially self-assessed health and trust in doctors, consistently emerge as predictors of more favourable evaluations across regions and periods. Higher national healthcare expenditure is associated with more positive public views and is the single largest contributor to the improved assessments in 2021–2023. Demographic and socioeconomic variables show smaller regionally and temporally heterogeneous effects. Decomposition indicates that both changes in observed characteristics (notably, expenditure and trust) and unobserved behavioural, cultural, or institutional shifts account for the gap in public healthcare assessments between the two time periods. Conclusions: Public assessments of healthcare systems are primarily shaped by individual health status, trust in providers, and national spending rather than differential demographic and socioeconomic traits. Therefore, policymakers should couple targeted investments in the healthcare sector in order to address adequately public healthcare needs, and strengthen doctor–patient relationships in order to sustain public support. Future research should focus on disentangling the cultural and behavioural pathways influencing healthcare attitudes. Full article

Background: The increasing use of food supplements (FSs) and the knowledge gaps among healthcare professionals (HPs) and non-healthcare professionals (nHPs) in Portugal regarding their influence on dietary patterns and health need investigating. This study aimed to explore FS users’ lifestyle and dietary patterns, identifying differences and how professional background influences these patterns. Methods: A cross-sectional study was conducted among 1122 Portuguese adults aged 35 ± 14.0 yrs (between 18 and 85), via snowball sampling, collecting data on sociodemographic characteristics, dietary patterns, FS use, and health attitudes. Cluster analysis (k-means) revealed four patterns: (1) professional supplement users with a healthy diet (PSHD), (2) professional non-supplement users with a less healthy diet (PnSLHD), (3) non-professional supplement users with a healthy diet (nPSHD), and (4) non-professional non-supplement users with a less healthy diet (nPnSLHD). Logistic regression assessed associations with lifestyle traits. Results: Significant sociodemographic differences existed between HPs and nHPs. Higher nutritional knowledge and nutritionist recommendations were strongly associated with a healthier diet and FS use (PSHD, nPSHD). Smoking was associated with less healthy patterns (PnSLHD, nPnSLHD). Among nHPs, males were significantly more likely to belong to the nPSHD group (OR: 1.61) compared to females (OR: 0.61). Distinct dietary and lifestyle patterns among Portuguese FS users and non-users vary by background. Conclusions: The findings suggest that FS users often maintain healthier lifestyles, indicating that FSs typically supplement rather than compensate for poor habits. Full article

Objectives: Surgical site infection (SSI) is a demanding post-surgical complication. SSI has been linked to significant morbidity, mortality, and rising healthcare expenditure. Staples and sutures are the most utilized methods in orthopedic skin closure. The aim of this study was to compare the rate of SSI in sutured versus stapled wound closure after orthopedic limb surgeries. Methods: A prospective cohort study was conducted between September 2019 and March 2021. Patient demographics, method of wound closure, and potential risk factors associated with SSI were recorded. A multivariate logistic regression analysis was performed to identify independent risk factors associated with SSI. Results: A total of 775 patients were included. Eighteen patients (2.3%) acquired an SSI. 3.5% of the staples group and 1.1% of the suture group contracted an SSI (p = 0.028, univariate analysis). Length of hospital stay (LOS) was significantly higher in the staples group (p < 0.001). Use of antibiotics (AOR 5.938; 95%CI 1.693–20.820), LOS (AOR: 1.047, 95% CI:1.013–1.083), and duration of antibiotic prophylaxis (AOR:1.076, 95% CI: 1.010–1.147) were independent risk factors of SSI. Conclusions: The use of staples was associated with longer hospital stays. Use of antibiotics, prolonged hospital stays, and extended antibiotic prophylaxis were independent risk factors for SSI. These findings suggest that the choice of closure method may impact hospital stay, which could influence SSI risk. Full article

Introduction: Central line-associated bloodstream infections (CLABSIs) are a major cause of morbidity and mortality, yet health disparities in CLABSI incidence and outcomes remain understudied. This study evaluates these disparities and their impact on CLABSI rates, in-hospital mortality, hospital length of stay (LOS), and costs using the National Inpatient Sample (NIS) from 2016 to 2022. Methods: We conducted a retrospective analysis of adult hospitalizations using the NIS database that included central venous catheter placement and identified CLABSI using AHRQ’s Patient Safety Indicator 07. Primary outcomes included CLABSI incidence and in-hospital mortality; secondary outcomes were LOS and inflation-adjusted hospital costs. Outcomes were analyzed using logistic and lognormal regression models, focusing on demographic and clinical variables that included sex, race, socioeconomic status, and insurance type. Results: Among 11.5 million CVCs placed between 2016 and 2022, 6.56 million met CLABSI eligibility criteria, with 1 in 400 (0.25%) complicated by CLABSI. Blacks had 29.8% higher adjusted odds of CLABSI than Whites (p < 0.001), whereas Medicaid beneficiaries had 18.4% higher odds compared to those privately insured (p = 0.002). CLABSI was associated with a 97% increase in LOS and an 82% increase in hospital costs (both p < 0.001). In-hospital mortality was 13.3% and did not differ significantly by CLABSI status after adjustment. Discussion: Racial and socioeconomic disparities persist in CLABSI incidence and healthcare resource utilization, with Blacks and Medicaid beneficiaries at the highest risk. Although CLABSI rates returned to pre-pandemic levels in 2022, associated costs and LOS remained elevated. Further research and targeted prevention strategies are needed to reduce health disparities and improve patient outcomes. Full article

Background/Objectives: This study investigated how doctor visit(s), body image discrepancy, and perceived health status are associated with receiving a medical weight problem diagnosis. Methods: The sample included 458 Hispanic adults (366 women, 92 men) who completed a health survey at health fairs. Results: Descriptive analyses indicated that 51.4% of women and 54.3% of men were classified as overweight or obese, yet only 30% received a medical weight problem diagnosis. Most participants selected an ideal body shape that was thinner than their perceived body shape. Separate logistic regression analyses were conducted by gender to assess associations between body image discrepancy, perceived health status, and receiving a medical weight problem diagnosis, controlling for age. Findings revealed that women who had visited a doctor in the past year had 5.02 times the odds (95% CI:1.98–12.73) of receiving a medical weight problem diagnosis compared to those who had not. Each one-point increase in body image discrepancy was associated with a 1.88-fold increase in the odds of receiving a diagnosis (95% CI:1.49–2.37). Conversely, a one-point increase in perceived health status was associated with 1.59 times the odds (95% CI: 0.47–0.83) of not receiving a diagnosis. For men, those who had visited the doctor in the past year had 14.17 times the odds (95% CI:1.53–131.17) of receiving a medical weight problem diagnosis. Each one-point increase in body image discrepancy was associated with 1.60 times the odds of receiving a diagnosis (95% CI:1.01–2.54). However, perceived health status was not a significant predictor of diagnosis among men. Conclusions: Addressing healthcare access barriers and considering the roles of body image and perceived health status could improve obesity diagnosis and treatment in Hispanic populations. Full article

Background: Exposure to indoor air pollution (IAP), including particulate matter of size 2.5 µm/m³ (PM_2.5) and carbon monoxide (CO) resulting from the combustion of biomass fuels in homes, is an important risk factor associated with growth and developmental delays in neonates. We investigated the association between exposure to HAP and adverse birth outcomes in a birth cohort study of 594 pregnant females in Sri Lanka. Methods: Pregnant females between the ages of 18 and 40 years were enrolled in their first trimester and followed until delivery. Baseline assessments of fuel used for cooking were used to categorize the females into high-exposure (wood and kerosene) or low-exposure (liquid petroleum gas and electricity) groups. Indoor air quality measurements of PM_2.5 (n = 303) and CO (n = 258) were conducted in a subgroup of households. The outcomes at birth included the neonates’ appearance, pulse, grimace, activity, respiration (APGAR) score, Brazelton Neonatal Behavioural Assessment Scale (BNBAS) score, and birth weight. Linear and logistic regressions were used to evaluate the association between household air pollution (HAP) and birth outcomes. Results: Of the 526 neonates assessed at delivery, 55.7% were born to mothers with high HAP exposure and 44.3% with low HAP exposure, respectively. The results of the linear regression found an inverse association between higher exposure to HAP and birthweight in the adjusted and unadjusted models; the birth weight of children in the high-exposure group was lower by 107 g compared to that of the low-exposure group after adjusting for other variables (β = −106.8; 95% confidence intervals: −197.6, −16.0). Exposure status was not associated with birth length, gestational age, or the APGAR score; however, the BNBAS motor score was significantly lower in the neonates of the high-exposure group (6.41 vs. 6.55, p = 0.04), though it was not significant when adjusted for other variables. No correlation was found between the measured indoor PM_2.5 levels and birth weight, birth length, gestational age, APGAR score, or BNBAS score. Conclusions: Exposure to IAP due to emissions from combustion products from biomass fuels adversely affects birth weight. These effects may be more pronounced in vulnerable populations in settings where primary healthcare for pregnant women is limited. Full article

Background/Objectives: Ethical challenges in healthcare require awareness and adherence to professional codes of ethics, particularly in interdisciplinary settings such as tertiary hospitals. This study aimed to assess the attitudes and awareness of healthcare professionals regarding codes of ethics at the University Hospital of Split in Croatia, which did not have an institutional code at the time of the study. Methods: A cross-sectional survey using a structured, anonymous questionnaire was distributed both physically across hospital departments and online via email. Welch’s t-test, ANOVA, Kruskal–Wallis, and correlation tests were used to assess associations between favourability scores and participant characteristics. Linear and logistic regression analyses further examined predictors of favourable attitudes. Results: Of 442 returned questionnaires, 377 were complete and included in the analysis, mainly from nurses (56.5%) and physicians (42.7%). The median favourability score was 83.8% (88/105; IQR 78.1–88.6), with 87.0% scoring above the favourable threshold (≥75%). Female gender and higher education were significantly associated with more favourable attitudes. Participants strongly endorsed core principles such as patient confidentiality and autonomy, yet 57.6% considered ethics education during training inadequate, and only 36.3% viewed dual practices as a conflict of interest. Most respondents reported adherence to ethical standards (85.4%), while only over half were familiar with their professional ethics code (64.5%) and the hospital Ethics Committee (56.2%); a total of 66.3% supported introducing a hospital-specific code. Awareness and support for ethical structures were higher among women and those with more education. Conclusions: This study reveals a gap between personal ethical commitment and institutional ethical infrastructure. Strengthening ethics education and implementing a hospital-specific ethics code may enhance organisational ethical culture. Full article

Differentiated thyroid cancer (DTC) poses significant management challenges due to the variable risk of recurrence. This study uses a dataset comprising clinical, pathological, and treatment data from 383 patients to develop and validate machine learning models, combined with feature selection algorithms, for predicting differentiated thyroid cancer recurrence. We evaluated models based on a variety of machine learning technologies (light gradient boosting machine, random forest, k-nearest neighbor, logistic regression, stochastic gradient descent, and an emerging deep learner optimized for tabular data: Gandalf) combined with several feature selection methods. Our feature selection technologies include an emerging redundancy-aware wrapper-based feature selection technique, achieving thyroid cancer recurrence prediction accuracy of 94.8 to 95.9% across two validation methods, based only on whether the patient’s tumor’s response was structurally incomplete, whether their tumor’s stage was advanced (III, IVA, or IVB), and the patient’s age. The results underline the potential for machine learning to enhance the precision of recurrence prediction in DTC while developing technologies whose predictive capacity is more easily explained. Using the same dataset, machine learning and feature selection techniques, this study also provides an analysis on predicting American Thyroid Association (ATA) risk scores. The technologies developed as part of this study have potential for improving the personalization of healthcare through the creation of models based on detailed patient-specific clinical attributes. Full article

Blockchain’s decentralized, immutable, and transparent nature offers a promising solution to enhance security, trust, and efficiency in supply chains. While integrating blockchain into the SCM process poses significant challenges, including technical, operational, and regulatory issues, this review analyzes blockchain’s potential in SCM with a focus on the key challenges encountered when applying blockchain in this domain—such as scalability limitations, interoperability barriers, high implementation costs, and privacy as well as data security concerns. The key contributions are as follows: (1) applications of blockchain across major SCM domains—including pharmaceuticals, healthcare, logistics, and agri-food; (2) SCM functions that benefit from blockchain integration; (3) how blockchain’s properties is reshaping modern SCM processes; (4) the challenges faced by businesses while integrating blockchain into supply chains; (5) a critical evaluation of existing solutions and their limitations, categorized into three main domains; (6) unresolved issues highlighted in dedicated “Critical Issues to Consider” sections; (7) synergies with big data, IoT, and AI for secure and intelligent supply chains, along with challenges of emerging solutions; and (8) unexplored domains for blockchain in SCM. By synthesizing current research and industry insights, this study offers practical guidance and outlines future directions for building scalable and resilient global trade networks. Full article