Search Results (677)

Women with disabilities often face unique barriers to accessing healthcare, potentially increasing their vulnerability and reducing engagement with vital health services, including human immunodeficiency virus (HIV) testing. This study assessed the prevalence and associated factors of HIV-testing among women with disabilities in Ghana. Cross-sectional data from the 2017–2018 Ghana Multiple Indicator Cluster Survey, encompassing 819 women with disabilities, were analysed both descriptively and inferentially. The overall prevalence of HIV testing was 48.0% (95%CI = 44.6–51.4). Educational attainment, marital status, and geographical region were key determinants of HIV testing uptake. Women possessing a Senior High School or Tertiary level education demonstrated higher odds of HIV testing compared to those with no formal education. Women residing in Greater Accra, Volta, Brong Ahafo, and Upper West regions were more likely to have undergone HIV testing than those in the Western Region. Never-married women exhibited lower odds of HIV testing uptake than their married counterparts. No statistically significant association was found between various disability types and HIV testing uptake. Less than half of women with disabilities in Ghana had ever tested for HIV, highlighting a substantial unmet need and underscoring the urgent need for targeted interventions, including enhanced, region-specific educational and health promotion initiatives, and tailored support for never-married women with disabilities. Full article

Background/Objectives: Long-term follow up of pediatric radiotherapy survivors referred to tertiary and quaternary centers is difficult, limiting outcome monitoring. We implemented an electronic Health Status Survey (HSS) to capture survivorship data. Methods: The Health Status Survey (HSS) was distributed to survivors aged 1 month–25 years treated with curative-intent radiotherapy at our institution. Eligibility required confirmed survival and valid email contact. Survey responses and demographics were summarized with descriptive statistics and comparative tests. Surveys were sent to 876 eligible participants, with 322 responses received (36.8%) between December 2023 and March 2024. Results: Survey completion extended follow up by a median of 18.3 months (about 1.5 years), improving monitoring beyond the last chart-documented visit. Respondents reported 12 recurrences, 5 s malignancies, and 7 deaths not captured in prior records, altering event-free survival statistics by as much as 7.5%. Most respondents (90.1%) reported a medical visit in the past year, and many provided updates on ongoing health issues, provider contact, and social outcomes. Conclusions: The HSS is a replicable method for extended follow up of tertiary and quaternary care center patients, capturing previously unreported clinical, social, and educational outcomes. By supplementing chart data with patient-reported information, this cost-effective tool supports targeted annual follow up and the identification of trends for long-term survivorship care. Full article

Background/Objectives: Youth-onset type 2 diabetes (Y-T2D) incidence and severity rose during the COVID-19 pandemic, particularly during periods of widespread public health restrictions—including, but not limited to, virtual learning, stay-at-home orders, closure of recreational facilities, and limitations on in-person healthcare access. This study assessed incidence, severity, and remission rates of Y-T2D following the return to in-person education, focusing on cases diagnosed while such restrictions were in place. Methods: A retrospective chart review was conducted at a pediatric tertiary care center (2018–2024) to identify new Y-T2D diagnoses. We compared incidence rates, disease severity at diagnosis, and remission outcomes before and after the period of comprehensive public health restrictions, defined locally as March 2020–August 2021, during which virtual learning was implemented. Results: Incidence declined from 13.2 to 6.3 cases/month after the major restrictions were lifted. Youth diagnosed after the restrictions period had lower rates of diabetic ketoacidosis (7.1% vs. 20.9%, p < 0.001) and severe hyperglycemia (HbA1c 9.1 ± 2.5% vs. 10.1 ± 2.3%, p < 0.001). Among those diagnosed during the restriction period, 11.1% achieved remission within three years. Remission was associated with lower baseline HbA1c (OR = 9.52, 95% CI: 2.2–41.7, p = 0.003), metformin use (OR = 7.0, CI: 1.9–26.3, p = 0.004), GLP-1 receptor agonist use (OR = 5.8, CI: 1.3–24.4, p = 0.018), and lower likelihood of insulin therapy (OR = 19.5, CI: 2.3–166.7, p = 0.007). Conclusions: The reduction in Y-T2D cases after the lifting of pandemic-related restrictions highlights the impact of pandemic-related environmental changes. Low remission rates—especially among underserved youth—underscore the urgency of early screening, prompt intervention, and equitable access to pediatric diabetes care, and highlight the need to consider the metabolic health impacts of future prolonged public health measures. Full article

Health and social care professionals are important for fostering behaviour change to improve population health. Behaviour change education is varied across university curricula, impacting practitioner preparedness to promote engagement in health behaviours. This study examined health and social care professionals’ perceptions of behaviour change education and training in their university course and the factors influencing their preparedness to engage in behaviour change conversations, guided by the Theoretical Domains Framework (TDF). Australian health and social care professionals (N = 153, M_age = 33.4, SD = 10.5) were surveyed on their perceptions of behaviour change training, knowledge, confidence, and six TDF domains. Sixty-one percent of participants reported that communication skills were highly integrated (‘a lot’ to ‘a great deal’) throughout their course, compared to behaviour change techniques (45.8%), behaviour change theories (45.8%), and counselling therapies (39.9%). Mental health/social care professionals differed significantly from primary care and allied health professionals in skills (p < 0.05) and beliefs about capabilities (p < 0.05 primary care only). Findings demonstrated strong professional identity and intentions for behaviour change but lower confidence in their own capability to deliver behaviour change interventions. University curricula should expand behaviour change content beyond current communication skills training, using discipline-specific approaches for improved graduate preparedness. Full article

Tuberculosis continues to represent a major occupational risk in healthcare environments, particularly for healthcare workers who have persistent contact with patients who may be infectious. Despite the high occupational burden of tuberculosis among healthcare workers, there remains a lack of focused reviews that comprehensively evaluate preventive interventions across all levels of prevention within healthcare settings. In this literature review, effective preventive interventions relevant to tuberculosis transmission have been examined. Primary preventive interventions seek to diminish exposure through protective interventions such as respirators, improvements in ventilation systems, and implementation of educational programs regarding infection control protocols. Secondary preventive interventions target early diagnosis and routine screening with efforts to detect cases and latent infections early, before they progress to active disease. Enhancements in diagnostic technology have improved both the accuracy and speed of detection, further aiding the efforts of controlling nosocomial transmission. Tertiary preventive interventions target enhancing compliance with treatment protocols, managing complications of active infection, and controlling resistant strains through individualized follow-up and interventions. Barriers like stigma and lack of resources, however, often impede such interventions’ effectiveness in many cases. This narrative literature review highlights the imperative for strengthened workplace policies, an expansion of educational programs, and continued research in new and emerging interventions like new vaccine and diagnostics technology development. All these factors aim to optimize intervention effectiveness for tuberculosis and protect the health and welfare of workers in the medical field. Full article

Background/Objectives: Heart transplantation substantially improves survival and quality of life in patients with advanced heart failure; however, many heart transplantation patients fail to recover normal physical activity levels. Persistent inactivity compromises secondary prevention and long-term outcomes. Kinesiophobia—an excessive and irrational fear of movement—may act as a central barrier limiting physical activity after heart transplantation. This study aimed to explore how kinesiophobia develops and interacts with physical and psychological factors that influence adherence to an active lifestyle after heart transplantation. Methods: A qualitative study was conducted in 24 adult heart transplantation patients (mean age 62.1 years; 83% male) at a tertiary hospital in Spain. Semi-structured interviews lasting 35–60 min were transcribed verbatim and analysed using reflexive thematic analysis. Methodological rigour was ensured through triangulation, reflexivity, and transparent documentation of analytic decisions. Results: Three interrelated themes were identified: (1) Kinesiophobia, characterised by fear of overexertion and avoidance of performing physical activity; (2) physical limitations, including fatigue, muscle weakness, treatment side effects, and intensified perceptions of vulnerability; and (3) psychological distress, encompassing anxiety, demotivation, and frustration, which intensified inactivity. These domains formed a self-perpetuating cycle that restricted participation in physical activity. Some participants reported simple adaptive strategies, such as pacing, walking and social support that enhanced their sense of safety and confidence. Conclusions: Kinesiophobia, physical limitations, and psychological distress interact to restrict physical activity in heart transplantation patients. Our findings suggest that rehabilitation should integrate psychological support, cognitive-behavioural strategies, and tailored education to reduce fear, enhance self-efficacy, and promote sustainable physical activity engagement. Full article

Chronic hepatitis B virus (HBV) and Occult HBV infection (OBI) remain a health burden in sub-Saharan Africa. This study investigated HBV prevalence, circulating genotypes, and associated risk factors with HBV exposure among HIV-positive adults on antiretroviral therapy and pregnant women in southwestern Cameroon. A total of 233 HIV patients and 190 third-trimester pregnant women were screened for HBV DNA, viral load, serological markers (HBsAg, anti-HBc, and anti-HBs), and HBV genotypes were determined by partial sequencing of the S gene. HBV DNA was detected in 10% of HIV-positive patients and 4% of pregnant women, with an overall prevalence of 7%. OBI accounted for 9% and 3%, respectively. Anti-HBc seroprevalence was high (75% in HIV, 46% in pregnant women), while self-reported vaccination coverage was low (1% and 11%). Genotypes A, B, D, and E were identified, with genotype B reported for the first time in Cameroon. Immune escape mutations and the adefovir resistance mutation rtA181V were detected. Self-reported alcohol use was associated with HBV exposure in HIV patients (aOR = 2.08; p = 0.028) and inversely associated with tertiary education in pregnant women (aOR = 0.18; p = 0.038). This study highlights a significant burden of HBV and OBI among vulnerable populations in Cameroon. Full article

An innovative, STEAM-based educational approach uses LEGO^® robots to improve the visualisation and understanding of trochoid curves in tertiary mathematics education. The method involves a two-step process: first, the curves are drawn based on the classical definition of trochoids using a custom-designed LEGO^® robot that employs LED light to trace the shapes. Then, the same process is replicated with a marker, with the robot controlling the movement of the drawing head to reproduce the curves accurately. To deepen students’ comprehension and visualisation, Desmos dynamic geometry software was used in parallel to draw all three types of trochoids (prolate, curtate, and cusped). This hands-on technique aims to make these motion curves more tangible and engaging within a classroom setting. A quantitative experiment involving 94 first-year IT BSc students was conducted during the spring semester of the 2024/2025 academic year using a quasi-experimental design. We had one control group and two experimental groups. One of the experimental groups did not use educational robotics; participants could only see how the robots worked via video. The other experimental group gained first-hand experience by building and testing LEGO^® drawing robots. The aim was to evaluate the effectiveness of an innovative teaching method that used educational robotics to improve understanding of the mathematical properties of trochoids, compared to traditional teaching methods and presentations containing short videos. The Mann–Whitney U test was used in all cases during hypothesis testing. Only watching videos of drawing robots does not have a statistically significant effect on learning outcomes. In this case, the effect size was only 0.12. However, the results of the group performing educational robotics activities showed a statistically significant difference compared to the other two groups, with large effect sizes (0.68 and 0.7). Our results suggest that visualisation using LEGO^® robots significantly improves students’ knowledge of parametric curves. Educational robotics offers promising opportunities because it is an attractive and interactive teaching tool. Its great advantage is that it combines abstract mathematical concepts with modern technology, thus creating an effective learning environment. Full article

Background and Objectives: Parental beliefs strongly influence treatment adherence in pediatric allergic diseases. Concerns about corticosteroid therapy—known as corticophobia—may disrupt disease control and compromise child well-being. This study aimed to evaluate parental knowledge, beliefs, and concerns regarding topical, inhaled, and intranasal corticosteroid use in children, and to identify sociodemographic factors associated with corticophobia. Materials and Methods: This prospective survey was conducted in a tertiary pediatric allergy and immunology clinic. A structured questionnaire was anonymously completed by 110 parents of children receiving corticosteroid therapy. The survey assessed demographics, family history of atopy, corticosteroid use, perceived disease severity, knowledge level, concerns, and sources of information. Descriptive statistics and chi-square tests were applied (p < 0.05 significant). Results: The most frequent concerns were growth retardation, hormonal imbalance, and long-term side effects. Corticophobia was significantly more prevalent among university-educated parents (p = 0.043) and those with a family history of atopy (p = 0.017). Despite generally high adherence to prescribed regimens, nearly 60% of parents sought additional information, highlighting the impact of knowledge gaps on health-related parenting practices. Conclusions: Corticophobia remains a common parental concern in pediatric allergy care, with implications for adherence, family decision-making, and child well-being. Addressing misinformation and providing family-centered, tailored educational strategies—particularly for highly educated parents and those with an atopic background—may reduce fears, strengthen trust, and promote sustainable healthy behaviors. Full article

Implementation of universal antiretroviral treatment (ART) in pregnancy has improved maternal health and reduced vertical transmission. However, women living with HIV (WLHIV) still experience worse perinatal outcomes. This retrospective study compared demographic, virological factors, ART regimens and perinatal outcomes in pregnant WLHIV between 2000–2010 (n = 318) and 2011–2021 (n = 140) at a tertiary center in Barcelona. Significant demographic shifts included changes in ethnic distribution, substance use, educational attainment, and maternal BMI. Significant progress in infection control was observed, with increased ART coverage up to 97%, improved viral suppression (80% to 91.3%, p = 0.002), and enhanced immunological status. ART regimens shifted significantly, with an increase in integrase strand transfer inhibitors (INSTI)-based regimens (0.7% to 39.2%, p < 0.001). Obstetric management evolved, with a rise in vaginal deliveries (24.8% to 44.3%, p < 0.001) and a decline in intrapartum zidovudine (93.7% to 54.7%, p < 0.001). Notably, preterm birth rates sharply declined, yet small-for-gestational-age (SGA) infants (26.4% vs. 20%, p = 0.323) and preeclampsia rates remained unchanged and higher than in the general population. All statistical analyses were performed in IBM SPSS statistics 23. In conclusion, although maternal and perinatal outcomes in pregnant WLHIV have improved over the past two decades, a high rate of adverse perinatal outcomes related to placental dysfunction (SGA, preeclampsia) persist. Our findings highlight the need for optimized prenatal care and further research to develop targeted interventions for WLHIV. Full article

This study investigates how enterprises in the service (tertiary) sector in Vojvodina, Serbia, integrate and prioritize Sustainable Development Goals (SDGs), with a focus on ecological sustainability, under crisis conditions. Based on a questionnaire survey and factor analysis of 150 respondents, which identified four key sustainability dimensions explained 59.75% of total variance, were identified: Education and Energy (including SDG4—Quality Education and SDG7—Affordable and Clean Energy), Health and Social Well-being (including SDG3—Good Health and Well-being and SDG2—Zero Hunger), Ecological Sustainability and Nature Protection (including SDG6—Clean Water and Sanitation and SDG14—Life Below Water), and Economy and Climate Change (including SDG8—Decent Work and Economic Growth, SDG13—Climate Action, and SDG17—Partnerships for the Goals). The findings emphasize the multidimensional and interconnected nature of these dimensions and their role in enhancing organizational resilience. By linking crisis management strategies with SDG integration, the study provides both theoretical contributions and practical insights for managers aiming to improve sustainability performance in turbulent environments. Full article

The Educational Competition Optimizer (ECO) formulates search as a three-stage didactic process—primary, secondary and tertiary learning—but the original framework suffers from scarce information exchange, sluggish late-stage convergence and an unstable exploration–exploitation ratio. We present EECO, which introduces three synergistic mechanisms: a regenerative population strategy that uses the covariance matrix of elite solutions to maintain diversity, a Powell mechanism that accelerates exploitation within promising regions, and a trend-driven update that adaptively balances exploration and exploitation. EECO was evaluated on the 29 benchmark functions of CEC-2017 and nine real-world constrained engineering problems. Results show that EECO delivers higher solution accuracy and markedly smaller standard deviations than eight recent algorithms, including EDECO, ISGTOA, APSM-jSO, LSHADE-SPACMA, EOSMA, GLSRIME, EPSCA, and ESLPSO. Across the entire experimental battery, EECO consistently occupied the first place in the Friedman hierarchy: it attained average ranks of 2.138 in 10-D, 1.438 in 30-D, 1.207 in 50-D, and 1.345 in 100-D CEC-2017 benchmarks, together with 1.722 on the nine real-world engineering problems, corroborating its superior and dimension-scalable performance. The Wilcoxon rank sum test confirms the statistical significance of these improvements. With its remarkable convergence accuracy and reliable stability, EECO emerges as a promising variant of the ECO algorithm. Full article

Background: Parent-reported experience in neonatal units is a key but under-measured dimension of family-centred care in Poland. We piloted a brief parent-experience questionnaire informed by the Neonatal Satisfaction Survey (NSS-8) and communication constructs from the Parents’ Experiences of Communication in Neonatal Care (PEC) to describe in-hospital experience and identify actionable targets for improvement. Methods: Observational, cross-sectional pilot at a Polish tertiary centre (September–November 2021). Parents of hospitalized neonates completed a 21-item survey covering educational materials, medical care/communication, parental stress/confidence, hospitalization details, and sociodemographics. Analyses were descriptive with item-wise denominators (n = 32–46). Results: Forty-six parents participated. Educational materials were rated very highly: parental guide 9.8/10 (n = 46); brochure readability 10/10 (n = 46), indicating ceiling effects. Perceptions of care and communication were favourable: overall care 4.47/5, physician concern 4.62/5, ward conditions 4.47/5, explanation of test indications 4.23/5, and adequacy/understandability of information 4.35/5 (each n = 35; medians = 5). Despite this, parental stress/anger/insomnia was moderate (3.00/5; n = 35), while confidence in basic home care remained high (4.10/5; n = 35). Following discharge, 17/46 (37.0%) sought specialist consultations. Length of stay (n = 34) had a median of 1 day (0–4). Reasons for admission most frequently included multisymptom presentations (20/46, 43.5%); respiratory (8.7%) and infectious (6.5%) causes were less common. Conclusions: Parents reported very positive care and communication alongside persistent emotional burden and substantial post-discharge information needs. Findings support pairing a broad experience framework with a focused communication module, standardizing discharge communication (including a 48–72 h “bridging” contact), and progressing to a multicentre psychometric validation. This exploratory pilot was not a formal validation study; mixed scales and item-wise missingness should guide instrument refinement. Full article

Background: Periodontally accelerated osteogenic orthodontics (PAOO) is a surgical procedure to accelerate orthodontic tooth movement and minimize periodontal complications. This study surveyed U.S. periodontists to assess various aspects of the procedure as regards prevalence, training, and execution. Methods: The authors developed a unique questionnaire, the first national study of this type, housed on the Qualtrics^® survey platform, to analyze trends in PAOO training and use. Unique recruitment emails were sent to 3154 members of the American Academy of Periodontology. 449 U.S. periodontists/3154 surveyed (14.2%) responded to this web-based, anonymized survey. IBM statistical software (SPSS V28) was used for data analysis. Results: Among respondents, PAOO training was received during residency (32.7%) and by continuing education (CE) (50.8%), with higher CE (57.3%) by those who did not receive PAOO residency training (p < 0.001). 38.5% of periodontists perform PAOO, and those most likely to perform PAOO had both PAOO residency training and CE, with 78.5% performing 1–5 cases/year. Most (87.7%) received 1–2 PAOO referrals/year from orthodontists or general dentists. Differences in techniques and materials were the type of bone graft or membrane used, the position of corticotomies, and the timing of orthodontic movement. The primary PAOO goal was “rapid tooth movement” (41.1%) and to “increase the alveolar housing” (37.2%). The secondary (38%) and tertiary (37.2%) ranked goals were “augment dehiscence or fenestration”, with the “prevention of apical root resorption” ranked as their quaternary goal. Conclusions: The results of this survey provide data on the trends, training, and use of PAOO among U.S. periodontists. This information may aid in developing residency curriculum and performing PAOO research. Full article

Despite notable progress in HIV prevention and treatment, men who have sex with men (MSM) continue to bear a disproportionate burden of HIV, particularly in sub-Saharan Africa, where systemic barriers restrict access to HIV testing. This study draws on data from the 2017 Ghana Men’s Study II (GMS II), to examine the socio-demographic, behavioural, and structural factors influencing HIV testing among MSM. The Ghana Men’s Study II dataset, involving 4095 MSM, was de-identified and analysed using STATA (software version 17). Before the analysis, missing information for categorical variables were treated using the mode imputation technique. Chi-square test was done to describe relevant characteristics of the study population, such as socio-demographic/socio-economic variables and behavioural practices. Multivariable logistic regression analysis was performed for variables with p < 0.05 to determine significant predictors of HIV testing among MSM. All the statistical analyses were performed at a 95% confidence interval, with significant differences at p < 0.05. In multivariable logistic regression analysis, age 25–34 (AOR: 1.43; 95% CI: 1.18–1.74, p < 0.001), having a senior high school education (AOR: 1.69; 95% CI: 1.02–2.80, p = 0.040), tertiary education (AOR: 2.03; 95% CI: 1.17–3.55, p = 0.012), being a light drinker of alcohol (AOR: 1.28; 95% CI: 1.04–1.58, p = 0.020), and having a comprehensive knowledge of HIV (AOR: 1.50; 95% CI: 1.26–1.78, p < 0.001) had higher odds for HIV testing. Other factors such as being a Muslim (AOR: 0.69; 95% CI: 0.54–0.90, p = 0.005) and sold sex to other males (AOR: 0.67; 95% CI: 0.50–0.90, p = 0.007) were also positively associated with HIV testing among Ghanaian MSM. The findings revealed a number of socio-demographic and behavioural factors associated with HIV testing among the MSM population in Ghana. Full article