Search Results (214)

Climate change poses growing challenges to youth sports participation, but adolescent girls face disproportionate and compounding vulnerabilities. These arise from sex-specific physiological factors, sociocultural constraints, and institutional inequities that uniquely and disproportionately impact girls. These challenges are especially concerning considering the numerous health and well-being benefits of sports participation. However, there is a notable lack of research examining the specific impacts of climate change on adolescent girls’ sports participation, as well as evidence-informed strategies to mitigate these effects. The aim of this study is to (1) conduct a scoping review to better understand the impacts of climate change on adolescent girls’ sports participation and (2) examine the relationship between climate change and adolescent girls’ involvement in sports by integrating Ecologism and the Individual × Environment (I×E) frameworks. A search was conducted using four databases (PubMed, Scopus, SPORTDiscus and Web of Science), and a gray literature search was performed on Google. The search was limited to studies focusing on how climate change or weather variables impacted adolescent girls’ physical activity levels or sports participation. Studies must have been written in English, and all geographical regions were included. In total, 26 studies met the inclusion criteria. These findings were then analyzed by integrating Ecologism, which promotes sustainable infrastructure, and the Individual × Environment (I×E) framework, which highlights interventions tailored to individual and environmental interaction. Recommended strategies include climate-resilient facility design, equity-focused funding models, participatory research, and coordinated efforts from public health units and urban planning stakeholders. By integrating these frameworks, the paper proposes a comprehensive set of interventions that address both systemic ecological challenges and individual-level barriers, aiming to foster climate-resilient sports environments for adolescent girls. Full article

Background and Objectives: Blood flow is critical for tissue oxygenation, and alterations in cerebrovascular and peripheral circulation have important health implications. This study aimed to examine the impact of distinct mechanisms for increasing intra-cavity pressure through the abdominal bracing (AB) and Valsalva maneuver (VM) on central and peripheral hemodynamics. Materials and Methods: A randomized crossover design was used, and thirty healthy young adults (age 21.9 ± 1.5 years; BMI 20.9 ± 1.8 kg/m²) performed AB and VM in a randomized order. All participants provided written informed consent, and the study protocol was approved by the Clinical Research Information Service (KCT0009742; registered on 30 August 2024). Hemodynamic responses were measured before and after each intervention, including heart rate, blood pressure, pulse wave velocity, carotid artery diameter, pulsatility index, resistive index, peripheral oxygen saturation, and cerebral oxygenation. Repeated-measures analysis of variance and paired t-tests were conducted on the datasets. Results: Both the VM and AB significantly increased heart rate (p < 0.001) and systolic blood pressure (VM: p = 0.015; AB: p < 0.001). Cerebral oxygen saturation decreased significantly (VM: p < 0.05; AB: p < 0.05), whereas oxyhemoglobin increased during both interventions, suggesting higher cerebral oxygen demand. The VM specifically increased the carotid pulsatility index (pre = 1.76 ± 0.28; post2 = 1.87 ± 0.33; p = 0.008), reflecting elevated central vascular resistance. In contrast, AB decreased peripheral oxygen saturation (pre = 98.43 ± 0.71; post1 = 97.49 ± 1.76; p < 0.001) and increased peripheral (heart–finger) pulse wave velocity (Lt: p = 0.026; Rt: p = 0.010), indicating greater stimulation of peripheral circulation. Conclusions: Distinct mechanisms that elevate intra-cavity pressure differentially influence central and peripheral hemodynamics. These findings suggest that intra-cavity pressure can selectively modulate hemodynamic responses, with potential applications in both clinical and exercise settings. Full article

Breast cancer is a leading cause of mortality among women, disproportionately affecting Hispanic populations in the U.S., particularly those with limited health literacy and language access. To address these disparities, we present a bilingual, web-based educational platform tailored to low-literacy Hispanic users. The platform supports full navigation in English and Spanish, with seamless language switching and both written and spoken input options. It incorporates automatic speech recognition (ASR) capable of handling code-switching, enhancing accessibility for bilingual users. Educational content is delivered through culturally sensitive videos organized into four categories: prevention, detection, diagnosis, and treatment. Each video includes embedded and post-video assessment questions aligned with Bloom’s Taxonomy to foster active learning. Users can monitor their progress and quiz performance via a personalized dashboard. An integrated chatbot, powered by large language models (LLMs), allows users to ask foundational breast cancer questions in natural language. The platform also recommends relevant resources, including nearby treatment centers, and support groups. LLMs are further used for ASR, question generation, and semantic response evaluation. Combining language technologies and LLMs reduces disparities in cancer education and supports informed decision-making among underserved populations, playing a pivotal role in reducing information gaps and promoting informed healthcare decisions. Full article

Large language models (LLMs) are increasingly explored as chatbots for patient education, including applications in urooncology. Since only 12% of adults have proficient health literacy and most patient information materials exceed recommended reading levels, improving readability is crucial. Although LLMs could potentially increase the readability of medical information, evidence is mixed, underscoring the need to assess chatbot outputs in clinical settings. Therefore, this study evaluates the measured and perceived readability of chatbot responses in speech-based interactions with urological patients. Urological patients engaged in unscripted conversations with a GPT-4-based chatbot. Transcripts were analyzed using three readability indices: Flesch–Reading-Ease (FRE), Lesbarkeitsindex (LIX) and Wiener-Sachtextformel (WSF). Perceived readability was assessed using a survey covering technical language, clarity and explainability. Associations between measured and perceived readability were analyzed. Knowledge retention was not assessed in this study. A total of 231 conversations were evaluated. The most frequently addressed topics were prostate cancer (22.5%), robotic-assisted prostatectomy (19.9%) and follow-up (18.6%). Objectively, responses were classified as difficult to read (FRE 43.1 ± 9.1; LIX 52.8 ± 6.2; WSF 11.2 ± 1.6). In contrast, perceived readability was rated highly for technical language, clarity and explainability (83–90%). Correlation analyses revealed no association between objective and perceived readability. Chatbot responses were objectively written at a difficult reading level, exceeding recommendations for optimized health literacy. Nevertheless, most patients perceived the information as clear and understandable. This discrepancy suggests that perceived comprehensibility is influenced by factors beyond measurable linguistic complexity. Full article

This pilot study examined how sociodemographic factors (age, education, internet usage) influence patients’ comprehension of written healthcare communications, and their understanding of patient rights as articulated in appointment letters. A cross-sectional study was conducted among in-clinic patients at three Danish hospitals. Participants completed a self-administered questionnaire, assessing health literacy through four domains: assessing, understanding, appraising, and applying information from appointment letters. The questionnaire included sociodemographic data, Internet usage, IT competencies, and self-assessed health. Overall, 364 patients participated, with the majority being female and aged between 35 and 74 years. The mean scores for the domains of understanding and applying information were higher compared to assessing and appraising. Multiple linear regression analysis revealed that higher education levels positively correlated with the ability to appraise legal information, while frequent internet usage also enhanced appraisal skills. Findings highlight a concerning gap in patients’ ability to understand and appraise their patient rights within written healthcare communications. While patients demonstrate reasonable skills in understanding basic information, critical legal aspects remain challenging. Enhancing education and digital literacy may improve comprehension, emphasizing the need for simplified language and alternative formats in appointment letters. Further research is warranted to optimize communication strategies for patient rights. Full article

Introduction: Tuberculosis (TB) remains a public health concern, and people at risk for TB are hesitant to seek care. The first South African National TB prevalence survey, conducted in 2017–2019, found that most participants with TB symptoms did not seek care for TB. In 2022, an estimated 23% of people with TB in South Africa were undiagnosed, contributing to the country’s burden of “missing” TB cases. This study explores health-seeking behaviour among people with TB (PwTB) in South Africa, focussing on barriers and facilitators to care-seeking and the quantification of TB-related stigma from a patient and community perspective. Methods: We conducted a mixed-method study in the City of Johannesburg (COJ) Metropolitan Municipality from February to March 2022. PwTB aged 18 and older initiating TB treatment for microbiologically confirmed pulmonary TB were recruited from three primary healthcare facilities in the COJ. After providing written informed consent, they participated in a one-time, in-depth, face-to-face interview. The interviews were digitally recorded and conducted by trained facilitators. We used thematic analysis with deductive approaches to develop themes. We used the Van Rie TB stigma assessment scale to quantify perceived stigma. Results: We interviewed 23 PwTB with an overall median age of 39 years and 14 (61%) males. Patient-level barriers to accessing TB care included visiting traditional healers and pharmacists before their TB diagnosis; wrong or missed diagnosis by private doctors; work commitments; scarcity of resources to attend the clinic or walk long distances; perceived and experienced stigma; and a lack of TB knowledge. Facility-level barriers included long clinic queues and uncertainty about where to receive TB care in the clinic. Facilitators for TB care-seeking included being in contact with someone who had TB, receiving encouragement from family, or having knowledge about TB transmission and early diagnosis. The overall median total stigma score among 21 PwTB was 53 (IQR: 46–63), with median community and patient stigma scores of 25 (IQR: 22–30) and 31 (IQR: 21–36), respectively. Conclusions: We found important considerations for the TB programme to improve the uptake of services. Since PwTB consult elsewhere before visiting a facility for TB care, TB programmes could establish private–public partnerships. TB programmes could also increase TB awareness in the community, especially among males, and mobile clinics could be considered to assist with TB case detection and treatment provision. Applying behavioural design techniques and co-designing interventions with patients and providers could improve TB health-seeking behaviours. Full article

Background/Objectives: The maintenance of peri-implant soft tissue health is critical for the long-term success of implant therapy, particularly in edentulous patients rehabilitated with mandibular overdentures. Leukocyte- and platelet-rich fibrin (L-PRF) has been proposed as an autologous biomaterial to enhance peri-implant tissue quality. This randomized controlled clinical trial evaluated the effect of L-PRF on peri-implant mucosal thickness in edentulous patients treated with mandibular implant-retained overdentures. Methods: Edentulous patients received two interforaminal implants to retain a mandibular overdenture and were randomly assigned to a test group (L-PRF applied during surgery) or a control group (standard protocol without L-PRF). Clinical measurements of keratinized mucosal thickness and width were recorded at baseline, 12 weeks, and 24 weeks. Volumetric analyses of soft and hard tissue changes were performed using digital superimposition of STL models. The trial was conducted in accordance with the Declaration of Helsinki and approved by the Scientific Ethics Committee of the Aconcagua Health Service. All participants provided written informed consent. Results: A significant increase in keratinized mucosal thickness was observed in the L-PRF group at 12 and 24 weeks compared with baseline (p < 0.01). No significant differences were detected between the groups in soft tissue volume (p = 0.12) or bone volume (p = 0.45). Mucosal width remained stable in both groups throughout follow-up. Conclusions: The application of L-PRF at implant placement resulted in a significant gain in peri-implant mucosal thickness, suggesting a soft tissue modulating effect. Enhancing keratinized mucosal thickness during implant surgery may improve peri-implant tissue quality and support long-term stability of mandibular overdentures. Full article

Due to the burdens of critical operations, firefighters are at occupational risk of developing mental health problems such as post-traumatic stress symptoms (PTSS) or anger. In this study, we assessed the impact of a firefighting operation with two fatalities and eleven injuries among colleagues on the mental health of those involved. Aims: The study hypothesizes that firefighters who were acquainted with the wounded or deceased show more PTSS and score higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to those who were not. The second hypothesis assumes that the deployed group shows more PTSS and scores higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to the grouping of non-deployed colleagues. Methods: A total of N = 138 firefighters were included, of which n = 32 were deployed and n = 106 were not (n = 26 acquainted with wounded or injured; n = 107 not acquainted with wounded or injured; n = 5 not specified). Both groups completed a standardized questionnaire voluntarily and after providing written informed consent ten months after the incident. The questionnaire consisted of the Posttraumatic Stress Checklist for DSM-5 (PCL-5) and the State-Trait Anger Inventory (STAXI-2) questionnaire. Results: Firefighters who knew the injured or deceased colleagues had significantly higher PTSS [T(23.7) = −2.5; p = 0.019; d = 0.67; 95% CI = (−10.8, −1.0)], state anger [T(74.2) = 2.4; p = 0.021; d = 0.41; 95% CI = (0.2, 2.0)], and anger control scores [T(124) = −2.7; p = 0.008; d = 0.71; 95% CI = (−5.9, −0.9)]. In addition, the deployed group showed higher anger control [T(134) = 2.0; p = 0.046; d = 0.42; 95% CI = (0.0, 4.2)] and outward anger expression [T(73.5) = −2.2; p = 0.032; d = 0.40; 95% CI = (−2.3, −0.1)] scores compared to their non-deployed colleagues. Discussion: Future psychological pre- and post-deployment interventions should place more focus on the increased vulnerability of those acquainted with wounded or deceased colleagues. Full article

Background/objectives: Aging is associated with a decline in physiological and cognitive functions. Periodontitis, a disease affecting the periodontal tissues, increases in prevalence with age. Bacteria and inflammatory mediators resulting from periodontitis can trigger neuroinflammation and potentially accelerate the progression of neurodegenerative diseases. This study aimed to evaluate the association between periodontal status, salivary flow rate, salivary cortisol levels, and cytokine levels with cognitive status in elderly Indonesian subjects. Methods: This cross-sectional study involved 70 participants aged ≥ 60 years from several social institutions in Jakarta and the Dental Hospital, Faculty of Dentistry, Universitas Indonesia. All participants provided written informed consent before the examination. Periodontal parameters, including plaque score, calculus index, bleeding on probing, number of remaining teeth, and functional tooth units, were assessed. Unstimulated salivary flow was collected over five minutes, and salivary cortisol levels were measured. Gingival crevicular fluid samples from the deepest periodontal pockets were collected to measure cytokine levels (TNF-α and IL-1β). Both cortisol and cytokine levels were analyzed using ELISA. Cognitive function was evaluated using the Hopkins Verbal Learning Test. Results: Plaque score, calculus index, and bleeding on probing were moderately associated with cognitive scores (p < 0.05). In contrast, the number of remaining teeth, functional tooth units, periodontitis severity, salivary flow rate, salivary cortisol, and cytokine levels were not significantly associated with cognitive scores (p > 0.05). Conclusions: These findings suggest that elderly individuals with cognitive impairment tend to have poorer periodontal health than those with normal cognitive function. Full article

Background: Indonesia launched a nationwide school-based HPV immunization program in August 2023. Despite this, regional disparities in vaccine uptake persist. Therefore, we undertook a study in North Sumatra Province to assess HPV vaccination coverage and analyze the main factors affecting the uptake of HPV vaccination. Methods: This study employed a mixed-methods approach and was carried out in Medan and Deli Serdang of North Sumatra Province. Quantitative data were used to examine HPV coverage rates among school-aged girls in 2024, while qualitative interviews with parents, teachers, and health officers explored administrative, social, and behavioral barriers and facilitators. Results: In 2024, HPV vaccine coverage in Deli Serdang reached 62.09%, while Kota Medan lagged behind at just 27.20%. High-coverage schools in the Galang subdistrict benefited from proactive engagement between Puskesmas (community health clinics) and parents. In contrast, lower-coverage areas experienced logistical and communication challenges. Parents expressed a preference for face-to-face communication over written consent forms and emphasized the importance of clear, empathetic messaging. Conclusions: The stark contrast in coverage—particularly the low uptake in urban Kota Medan—highlights the need for more responsive and localized implementation strategies. Strengthening direct communication, addressing administrative inefficiencies, and fostering trust through tailored community engagement are critical. These findings suggest a need for targeted improvements in urban settings and further research across diverse regions to inform policy development and strategies for improved coverage of HPV vaccinations. Full article

Background: During the global outbreak of coronavirus disease 2019 (COVID-19), the Kingdom of Saudi Arabia (KSA) ranked second in terms of the highest rate of confirmed cases among the Arab Gulf countries. This situation significantly impacted its population, economy, and healthcare system, especially the psychological well-being of frontline healthcare workers, including frontline nurses. However, there is lack of studies on this topic, particularly on the experiences of frontline expatriate nurses in the KSA, necessitating the utilization of descriptive phenomenological design. Objective: This study aimed to explore the experiences of frontline expatriate nurses and their influence on psychological well-being while delivering care to patients with COVID-19. Methods: The study employed a qualitative, descriptive phenomenological design that adhered to the key features of Husserl’s phenomenological approach and purposive sampling to select 17 frontline expatriate nurses. They participated in face-to-face semi-structured interviews. Prior to the 17 semi-structured interviews, written consent was obtained from each of the frontline expatriate nurses. The qualitative data collected were analyzed through thematic analysis and rigor was ensured in this qualitative investigation. Results: Two primary themes were identified from the interviews: (1) psychological effects due to fear of contracting the corona virus, which included two sub-themes pertaining to organizational stressors resulting in having anxiety, depression, fear, mental stress, and stigmatization; and (2) resilience to cope with the challenges brought by the pandemic, which was characterized by three sub-themes focusing on the importance of accurate information, presence of family and social support, and maintaining good health. The expatriate status of frontline nurses is a key factor influencing in their psychological well-being and resilience. Conclusions: Findings indicated that the psychological well-being of frontline expatriate nurses was adversely affected during the pandemic while caring for COVID-19 patients. Consequently, targeted interventions aimed at alleviating the negative psychological impacts of the pandemic are urgently needed to bolster the resilience of frontline expatriate nurses in emergency situations such as the COVID-19 crisis to cope with the associated psychological challenges during the peak of the pandemic, particularly among expatriate nurses. Full article

Informed consent is a fundamental component of both the right to health and self-determination. Its violation, which occurs when the acquisition process is absent or flawed, can also lead to legal proceedings for isolated harm, regardless of the simultaneous existence of those related to biological and psychological harm. Across Europe, this remains a legal and ethical cornerstone, increasingly important in the context of cross-border care and culturally diverse healthcare settings. Many countries have enacted specific laws to ensure patients receive adequate information, while courts continue to refine its interpretation—often highlighting the inadequacy of informed consent in daily clinical practice. In Italy, in particular, recent rulings underscore the need for clear, comprehensive, and properly documented consent formats for health treatments. This review synthesizes rulings, regulations, and the scientific literature to offer practical guidance for improving informed consent practices in Italy, valuing the role of forensic experts in the integration in healthcare settings of the different interests at stake. The aim is to support both legal compliance and the delivery of high-quality, patient-centred care. Courts and legislation in Italy demand clear and tailored informative disclosure for health treatments, with indications of the treatment and outcomes, to be in written form. Yet, foreseeable risks, more common complications, and alternative treatment options are often poorly communicated in practice—frequently forming the basis of claims for compensation. Integrating team-based consultations and multimedia tools can significantly enhance patient understanding and secure the informed consent process. Those key points are summarized in a brief table, ideally suggesting the minimal requirements for an informed consent form. Investing in standardizing informed consent protocols, and also fostering the sharing of best practices with forensic medicine experts, are crucial steps in ensuring shared decision-making in healthcare and trying to reduce legal disputes. Full article

Background/Objectives: Patients with an ileoanal pouch change their diet to manage their symptoms and will often resort to the internet for nutrition advice. Currently, no evidence-based dietary guidelines exist to inform online resources. Hence, this study aims to assess the quality of online nutrition information directed towards patients with an ileoanal pouch. Methods: A systematic Google search was conducted to identify consumer websites including information on nutrition for those with ileoanal pouches. Quality was assessed using the DISCERN instrument, and the readability of written content was assessed using the Flesch–Kincaid score. A summative content analysis was used to identify the frequency of particular topics. Websites were also assessed against standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision-making support tools. Results: A total of 12 websites met the inclusion criteria. Mean total DISCERN scores across all websites are 33 out of 75, indicating that overall, the websites were of poor quality. The mean Flesch–Kincaid score was 57 out of 100, or “fairly difficult” in terms of readability. The main themes according to the content analysis were “general dietary advice for pouch”, “dietary strategies for symptom management”, “addressing risks associated with having a pouch”, and “optimisation of nutritional intake”. Overall, websites did not meet the standards for shared decision-making. Conclusions: Online nutrition information for patients with an ileoanal pouch is of poor quality and difficult to understand. There is a need for higher quality online resources for these patients, ideally co-produced with a multidisciplinary team and patient, to provide patients with good quality, understandable, and accessible nutrition information. Full article

Aims: To systematically review and synthesize qualitative research exploring the Breast Cancer Survivors (BCSs)’ perception of health promotion interventions and informing strategies to mitigate recurrence risk within five years post-treatment and improve clinical outcomes. Specifically, this study addresses the question: “How do women diagnosed with breast cancer perceive health promotion interventions for recurrence prevention?” Design: A systematic review and qualitative meta-synthesis were performed. Data Sources: A systematic search of scientific databases (CINAHL, MEDLINE, and Scopus) was undertaken in November 2024. The reference list was cross-referenced and hand-searched to identify additional articles. Review Methods: Studies were included if they met the following criteria: they were primary qualitative studies focusing on BCSs within five years post-treatment, involving participants who had completed surgery, radiotherapy, or chemotherapy in the same time frame, as this period is critical for monitoring recurrence and implementing health promotion interventions. Only studies published in peer-reviewed journals and written in Italian, English, French, or Spanish were considered, provided that an abstract and the full text were available. Moreover, eligible studies had to be conducted in high-income or middle-income countries. Studies were excluded if they focused exclusively on advanced or metastatic breast cancer, if they involved mixed cancer populations without reporting separate data for BCSs, or if they were non-qualitative studies or gray literature. The review study protocol was registered in the PROSPERO database (CRD42024626033). Results: The literature search identified 490 records, 13 articles from databases, and 3 articles identified via other methods (web and citation searching) that met inclusion criteria. A narrative synthesis approach allowed the emerging five themes: (I) Challenges, (II) Self-motivation and empowerment, (III) The relationships as a facilitator, (IV) Barriers to change, and (V) Proactive support strategies. Conclusions: Addressing internal and external factors that influence health behaviors is essential to improve adherence, reduce recurrence risk, and enhance quality of life. Tailored interventions, social support, and healthcare engagement are crucial in this effort. Impact: Our meta-synthesis highlighted significant challenges as well as valuable resources for health promotion among BCSs, suggesting practical and tailored approaches to improving the adoption of healthy behaviors, supported by relationships and targeted support strategies. Full article

Background: The aim of this scoping review is to analyze the health status of Roma and Sinti in Europe, highlighting the issues faced by children and women. In addition, we want to examine the access of these groups to health care services and to identify possible interventions to increase their use. Methods: Our research was conducted on Pubmed, Google Scholar, and the Trip Database. We selected articles written in English, Spanish, and Italian published since 2015. Results: Studies have shown that the health status of Roma and Sinti populations is generally worse than that of the rest of the population. Limited access to care is due to several specific factors, such as beliefs, traditions, and the lack of awareness of widespread direct and indirect discrimination against these groups by healthcare professionals. The studies reviewed have shown how mistrust can be broken down through multi-centered interventions linked to information, education, and communication through mediators able to interact with these populations, as well as through appropriate training of the health workers in charge. Conclusions: The health of the Roma and Sinti populations is commonly worse than that of the rest of the population. This is particularly true for the large proportion of people confined to suburban camps. However, the available evidence signals the low quality of life they experience and the need for interventions involving the communities and the establishment of ad hoc orientation or initial care contact points in the segregated areas. This could lead to an improvement in the integration of this population into the National Health Systems’ activities. Full article