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Introduction: Using the essential reproductive care services such as antenatal care (ANC) and skilled birth services are vital for ensuring safe motherhood and controlling maternal and child mortality. There is no recent evidence on the state of using reproductive care services in Pakistan women. The purpose of the cross-sectional study is to explore the timing and frequency of ANC, the hospital and other institutional delivery, the cesarean section (C-section) services and to identify the sociodemographic factors that are associated with the use of these services.

Methodology: Using the latest Pakistan Demographic and Health Survey (2017-18 PDHS) for this analysis, the data were collected by face-to-face interviews by trained interviewers, which included 8287 women aged 15-49 years. The data on reproductive services were defined by standard guidelines by the World Health Organization (WHO). Data analyses involved univariate tests and multivariate regression techniques.

Results: The percentage of women who attended ANC visits in the first trimester was 62.59%, and those who attended the minimum recommended number of four visits was 49.46%. The percentages of using hospital and C-section services were, respectively, 76.20% and 19.63%. In the regression analysis, place of residence, education, household wealth status, access to using electronic media and learning about family planning from electronic media and before marriage were found to significantly predict the use of ANC and facility delivery services. However, educational and household wealth status stood out as the strongest predictors of all. About half of the women were not having adequate ANC visits and about one-third not making timely ANC contact. More than three-quarters reported choosing to deliver at hospital/other facility, and about one-fifth preferred C-section.

Conclusions: The results indicated that, among the predictor of using these services, education and household wealth status were found to have the strongest association, highlighting the role of women's socioeconomic well-being in availing the basic reproductive healthcare services. Hence, this study suggests that the government and medical institutions should further pay attention to the ANC visits and reduce infant birth mortality rates. Simultaneously, increasing women's educational opportunities, enhancing women's socioeconomic well-being and social status, can help improve their health awareness and promote healthy behaviors.

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a debilitating disease with significant morbidity and decreased quality of life (QoL). The introduction of biologics in its management has allowed new therapeutic options, and Dupilumab represents the first approved biologic. This study aims to evaluate a possible relationship between the clinical response to biological therapy and mental health in patients with severe CRSwNP. Methods: This is a multicenter study conducted at the Otolaryngology departments of three major Italian health institutions. Participants were patients with CRSwNP treated with Dupilumab. Patients were assessed at baseline and during treatment by submitting them to a survey consisting of a dedicated questionnaire focused on psychological health and two patient-reported outcome measures (PROMs): the 22-item Sino-Nasal Outcome Test (SNOT-22) and a Visual Analogue Scale (VAS) for nasal symptoms. Results: 86 patients were included in the study (58 males and 28 females; mean age: 58.2 years). There was a significant improvement in both symptoms and QoL, with an enhanced psychological state observed in patients after the first administration and within the first months of therapy. Conclusions: This study evaluated the possible correlations between Dupilumab treatment and improvements in mental health in patients with CRSwNP, as assessed through a survey, and clinical conditions, assessed through SNOT-22 and VAS. Our findings showed that Dupilumab not only improved clinical symptoms but also had a positive impact on patients' mental health, with benefits observed already after the first administration and the first months of therapy. This survey highlights the relevance of psychological well-being and its implications for patients with chronic diseases such as CRSwNP.

Background/objectives: Individuals with autism spectrum disorder (ASD) are at increased risk of developing cardiometabolic diseases. Although physical exercise (PE) has emerged in the literature as an important modulator for reducing such risk, evidence remains unclear. This systematic review aimed to investigate the effects of PE on cardiometabolic health in individuals with ASD.

Methods: A systematic review was carried out according to the PRISMA guidelines, from their inception until 18 July 2023, in the following electronic databases: Scopus, Medline, and Web of Science. Studies were included if they focused on ASD patients undergoing physical exercise, assessing cardiometabolic risk, exercise tolerance, and QoL. The following were excluded: non-exercise interventions, additional therapies, non-English studies, and reviews. The methodological quality of the included studies was assessed through the Downs and Black scale.

Results: A total of four studies (149 participants) were included in this review, with the average methodological quality being rated as "fair". Interventions had mixed effects on cardiometabolic health. The BMI (↓2.8 kg/m²), waist circumference (↓1.86 cm), and lipid profiles improved in some cases. VO₂max and HR_baseline showed moderate gains. Secondary outcomes included enhanced endurance, strength, and calorie expenditure, especially in mild ASD. Autistic traits and quality of life improved post-intervention, with better results in the experimental groups.

Conclusions: This review indicates that aerobic and functional training improves cardiometabolic health, autistic traits, and QoL in individuals with ASD, particularly in mild cases. Further research is needed to explore the impact of ASD severity on these outcomes.

Background/Objectives: Digital health technologies show promise in improving rheumatic disease management and reducing healthcare access disparities globally. This paper examines how electronic health records, telemedicine, apps, and wearable devices are used in rheumatic care across different economic settings. Methods: The study evaluates digital health technology implementation and outcomes in high-income versus low- and middle-income countries (LMICs). Results: Digital health technologies demonstrate improvements in disease monitoring, treatment adherence, and doctor-patient communication, though impact varies by region. Key barriers include poor infrastructure, limited tech literacy, and the digital divide, particularly affecting LMICs. The proposed evidence-based framework recommends strategic investments in digital infrastructure, healthcare system integration, and professional training to address these challenges. Conclusions: Implementation of digital health technologies, guided by targeted interventions and regional adaptations, can effectively reduce global disparities in rheumatic care. Success requires sustained commitment to addressing infrastructure and literacy barriers while ensuring equitable access across all economic settings.

Background: Major trauma is a leading cause of severe disability and mortality. The influence of patient sex on outcome after severe trauma is a topic of ongoing discussion. We present a prospective multicenter study on the effects of trauma severity on health-related quality of life (HRQoL) of female patients. We hypothesized that the impairment of HRQoL after major trauma between the sexes depends not only on sex itself but also on age. Methods: This multicenter prospective registry-based observational study compared sex-based differences in HRQoL of patients who sustained major trauma Injury Severity Score (ISS ≥ 16). The HRQoL was assessed using the EQ-5D-3L (European Quality of Life 5-Dimension 3-Level Version) score over 2 years post-trauma. Results: We included 416 patients (116 female/300 male) with an ISS > 16 (median ISS 22 IQR 18/30). All patients had a lower HRQoL after trauma than the population norm. Increased AIS (Abbreviated Injury Scale) face and extremity scores and ASA (American Society of Anesthesiologists) scores showed a significant decrease in HRQoL. Even though the groups of female and male patients were comparable in injury severity, female patients reported significantly more problems on the anxiety and depression scales than male patients 6 months (p = 0.003) and 24 months (p = 0.044) after trauma (6 months: female 46% vs. male 30%; 24 months: female 44% vs. male 32%). We observed the greatest improvement in the EQ Index over time in patients between 16 and 39 years of age, especially female patients (0.78 to 0.87 in females under 39 years of age, compared to males in the same age group 0.76 to 0.81). Females over 65 years of age initially presented the lowest EQ Index of 0.62. It remained significantly lower over time and was lower compared to male patients of the same age group (female EQ Index after 24 months was 0.68 compared to men over the age of 65 who presented an EQ Index of 0.75). Conclusions: All patients included in this study presented a lower HRQoL after trauma than the population norm. Female patients under 39 years of age reported the most improvement. Females over 65 years of age showed a limited HRQoL, which remained significantly lower over time. Female patients reported significantly more anxiety and depression after major trauma than male patients. Thus, further development and methodologically rigorous testing of ortho-geriatric initiatives, psychosocial support, and prevention measures are required to improve the care after major trauma, particularly for the female elderly.

Background: Spirituality is significantly associated with the quality of life of patients suffering from rheumatic diseases, helping them to cope with pain and improve emotional well-being. There is a gap in the literature regarding the relationship between spirituality, quality of life and treatment adherence in patients with rheumatic diseases, especially rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), as relevant studies, especially in the Greek population, are limited. Aims: The present study aimed to evaluate the effect of medication adherence and spirituality on the quality of life of patients with rheumatic diseases. Methods: This was a cross-sectional study conducted in adult patients with rheumatoid arthritis and systemic lupus erythematosus from the region of Crete. Data were collected via a self-administrated questionnaire consisting of four parts, including questions regarding demographic and clinical information; the WHOQoL-BREF, 3, FACIT-Sp-12, and SMAQ questionnaires were used. The level of statistical significance was set at α = 0.05 for all analyses. Results: The study sample consisted of 115 participants, with the majority being women (90%). The majority of the participants suffered from RA (62%), while 38% suffered from SLE. The mean age of the participants was 49.15 years (SD = 11.7), and 46% described their health as good. We found that the dimensions of spirituality are positively related to the dimensions of quality of life. The peace dimension has a strong correlation with psychological health (r = 0.679, p < 0.001) and overall quality of life (QOL Global, r = 0.671, p < 0.001). Meaning also shows a positive correlation with psychological health (r = 0.563, p < 0.001) and overall quality of life (r = 0.506, p < 0.001), whereas adherence to medication shows a low but positive correlation with overall spirituality (r = 0.192, p = 0.040). Conclusions: The findings support that spirituality can be a protective mechanism, improving the mental resilience and adaptability of patients. This study has the potential to contribute to the development of evidence-based guidelines for the integration of spiritual care into clinical practice, with the objective of enhancing the psychological well-being and overall quality of life of patients with rheumatic diseases.

Background/Objectives: Difficulties in emotion regulation (DER) serve as a transdiagnostic risk factor for a wide range of emotion-based psychopathologies, including anxiety and depression disorders. This study presents a report on the psychometrics of the eight-item Difficulties in Emotion Regulation Scale-8 (DERS-8) and the development of its Polish norms. Methods: The sample comprised 1329 Polish adults aged 18-73, with 907 females, 384 males, 36 non-binary, and 2 people with an unidentifiable gender. The participants filled out a series of self-report questionnaires on DER, anxiety and depression symptoms, and well-being. Factor structure and measurement invariance, as well as discriminant validity of the DERS-8, were tested with confirmatory factor analysis. Convergent and divergent validity was assessed via relationships with negative and positive mental health outcomes. Internal consistency reliability was evaluated with alpha and omega coefficients. Demographic differences were also examined. Results: Our empirical evidence supported the strong psychometrics of the Polish DERS-8, including its good level of internal consistency reliability (i.e., 0.89) and strong validity. The one-factor DERS-8 model had a good fit, with its supported scalar invariance between a set of demographic variables and levels of mental health outcomes. DERS-8 scores were strong positive predictors of anxiety and depression symptoms and negative predictors of well-being, emphasizing the potential detrimental effects of DER on the dual continuum of mental health and mental illness. Conclusions: The Polish DERS-8 has strong psychometric properties. Given the development of its percentile rank norms, the scale can be used as a good screening measure of DER in the Polish adult sample.

Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry's role in misrepresenting opioid risks-leading to over USD 50 billion in legal settlements-has included targeted marketing to vulnerable populations. This study examines Janssen Pharmaceuticals' "Imagine the Possibilities Pain Coalition" (IPPC), which aimed to increase opioid use among veterans with chronic non-cancer pain. Insights from this public health industry document analysis offer guidance for military medicine and healthcare policymaking. Methods: Using the Opioid Industry Document Archive (OIDA), housed at Johns Hopkins University and the University of California, San Francisco, researchers conducted retrospective content analysis. Documents referencing veterans were identified through keyword searches on Johns Hopkins' SciServer portal and reviewed using CoCounsel, an AI-based legal document platform using a human-in-the-loop approach. Relevant documents were examined by the authors to extract material aligned with the research focus. Results: The IPPC employed strategies to influence opioid prescribing for veterans. These included educational materials that minimized addiction risks and exaggerated long-term benefits and empathy-driven narratives prioritizing immediate pain relief over potential harms. Ghostwriting ensured favorable perspectives on opioids in scientific literature, aligning with broader industry strategies to promote opioids for chronic pain. Conclusions: The targeted marketing of opioids to veterans has exacerbated the opioid crisis, as documented in government reports and litigation. Rigorous oversight of industry-funded coalitions and evidence-based practices are critical to insulating military healthcare from corporate influence and addressing the opioid crisis among veterans.

Background: Health behavior consultations support self-management if delivered by skilled practitioners. We summarize here the results of a collaborative training intervention program delivered to health and care practitioners working in a remote-island context. The program was designed to build confidence in the implementation of communication and behavior change skills and to sustain their use in work settings. The setting for the behavior change training program was the South Atlantic island of St. Helena, a remote low-middle-income country which has a population with high levels of obesity and a prevalence of long-term conditions. Objectives: We aimed to increase knowledge, confidence, and implementation of behavior change techniques (BCTs) and communication skills of health and social care staff through delivering and evaluating training using the MAP (Motivation, Action, Prompt) behavior change framework. A successful training intervention could ultimately improve self-management and patient health outcomes. Methods: Co-production with onsite representatives adapted the program for local delivery. A two-day training program was delivered face-to-face to 32 multidisciplinary staff. Pre- and post-intervention and 18-month follow-up evaluation assessed reactions, learning and implementation using multiple methods, including participant feedback and primary care patient reports. Results: Positive reactions to training and significant improvement in confidence, perceived importance, intention to use and implementation of BCTs and communication skills immediately post-training and at long-term follow-up were observed. Patient reports suggested some techniques became routinely used. Methodological difficulties arose due to staff retention and disruption through the COVID-19 pandemic. Conclusions: The delivery of health behavior change training can be effective in remote contexts with sustainable impacts on healthcare. There are challenges working in this context including staff continuity and technological reliability.

Background/Objectives: Increased time and adherence to physical activity, as well as increased intensity of physical activity, is one of the determining factors in improving survival and avoiding disease recurrence in female breast cancer survivors. The study aims to determine the effect of a 12-session concurrent training program on increasing moderate/vigorous physical activity time in this population. Methods: A total of (N = 72) female breast cancer survivors were randomized into an intervention group and a control group to perform a 12-session concurrent training program. The GPAQ questionnaire measured the time and intensity of physical activity and work they performed before starting the program and three months after completion of the program. Results: A total of (N = 15) women in the intervention group and (N = 22) women in the control group completed the questionnaire before and three months after completing the program. A significant increase in moderate, vigorous, and combined physical activity (PA) was observed in the intervention group (IG) in comparison to the control group (CG) at three months following the intervention. While these results are promising, it is important to note that the observed improvements in PA adherence reflect associations rather than direct causal relationships. While these changes are statistically significant, they also reflect meaningful improvements in clinical outcomes. A notable finding was the significant decrease in sedentary time observed in the IG, which is likely to have contributed to the observed improvement in adherence. Conclusions: Concurrent training shows an increment in the time and intensity of daily physical activity performed by breast cancer survivors, which is a determining aspect of the survival and non-relapse of the disease in this population.