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Background: The postpartum period represents a critical transitional phase in which women experience profound changes in identity, meaning, and social roles. This process is often shaped by social vulnerability and existential transformation, yet remains insufficiently explored from a phenomenological perspective. This study aimed to explore how women reconstruct identity and meaning during the postpartum period within the context of social vulnerability and existential transition. Methods: This qualitative study em-ployed an descriptive phenomenological approach in accordance with the COREQ guidelines. Data saturation was achieved with 20 mothers of infants aged 0-12 months who were purposively selected from a province in eastern Türkiye. Data were collected through semi-structured face-to-face interviews and analyzed using Colaizzi's phenomenological method. Credibility was ensured through participant validation, reflexivity, and team-based analysis. Results: Four themes emerged. Fracturing of Existence indicated an ontological shift from "I" to "we," reflecting a metaphorical rebirth of the self. Invisible Burdens revealed that societal expectations and insufficient social support intensify psychosocial vulnerability. Re-Tailoring the Self demonstrated that maternal identity is dynamic and continuously negotiated between the past and emerging self. Construction of Silent Resilience showed that women develop strength alongside vulnerability through internal resources, spirituality, and everyday practices of hope. Conclusions: The postpartum period involves a multilayered reconstruction of identity and meaning beyond role adaptation. During this existential transition, women not only give birth to a child but also reconstruct their own existence, metaphorically giving birth to themselves.

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Background: Vascular access is a core component of hemodialysis and may influence both clinical outcomes and patient-reported quality of life. This study examined the association between vascular access type and quality of life among patients receiving maintenance hemodialysis in multiple nephrology centers. Methods: We conducted a multicenter, cross-sectional observational study of 152 adults with end-stage kidney disease undergoing hemodialysis in public and private dialysis units in the Attica region, Greece (January-May 2022). Data were collected using a demographic/clinical questionnaire, the 36-Item Short Form Health Survey (SF-36), the Dialysis Patient Satisfaction Questionnaire (SDIALOR), and the Missoula VITAS Quality of Life Index (MVQOLI). Multivariable linear regression models were fitted for SF-36 and MVQOLI domain scores. Results: Most participants reported being very (40.8%) or quite (53.3%) satisfied with their current vascular access, and 69.5% considered an arteriovenous fistula (AVF) the most appropriate option. SF-36 scores were generally lower than those reported for the general population, except for the mental health domain. Compared with AVF, permanent catheter use was associated with lower SF-36 physical functioning scores, and graft use was associated with lower vitality scores. Lower vascular access satisfaction was consistently associated with lower HRQoL: compared with being "very" satisfied, being "quite" satisfied was associated with lower general health, vitality, social functioning, mental health, and lower PCS/MCS scores, while being "a little/not at all" satisfied was associated with lower general health and worse bodily pain scores. On MVQOLI, living alone and lower access satisfaction were associated with lower interpersonal relationships, transcendence/spirituality, and overall quality-of-life scores, while obesity was associated with lower function scores. Conclusions: Vascular access type, particularly AVF versus catheter, is associated with meaningful differences in quality of life among hemodialysis patients. Patient satisfaction with access and sociodemographic characteristics should be considered in patient-centered access planning and follow-up.

Background/objectives: Children with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently rely on pharmacological treatment to manage core symptoms. This study examined how Medicaid expansion and the COVID-19 pandemic influenced medication use among children with ASD or ADHD, including those with comorbid diagnoses.

Methods: We analyzed 2016-2023 data from the National Survey of Children's Health (NSCH) for children aged 3-17 years with caregiver-reported diagnoses. Logistic regression models assessed the association between Medicaid expansion, the pandemic period, and current medication use, including an interaction between expansion and pandemic period. Analyses were conducted for the full sample (N = 35,198) and a subgroup with comorbid ASD and ADHD (N = 4298).

Results: Current Medicaid expansion was associated with significantly lower odds of medication use in the full sample (aOR = 0.68, p < 0.001) but not the comorbid group (aOR = 0.98, p = 0.9). Medication use showed no significant change during the COVID-19 period in either the full sample (aOR = 0.99; p > 0.90) or the comorbid subgroup (aOR = 1.22; p = 0.4). A significant interaction indicating increased odds of medication use during the pandemic in expansion states was observed only in the full sample, although a similar but non-significant pattern appeared in the comorbid group. Age, race, and insurance-related differences were significant across groups, with coverage consistency playing a larger role in the full sample. Sensitivity analyses, excluding the 2020 survey year and modeling pre/post pandemic periods, supported the robustness of findings.

Conclusions: Medicaid expansion was associated with patterns consistent with buffering pandemic-related disruptions in medication use among children with ASD or ADHD overall, but those with co-occurring conditions remain especially vulnerable.

Background: The use of physical restraints in hospital settings remains a controversial practice due to its ethical, legal, and safety implications. Although restraints are intended to prevent falls or manage agitation, their inappropriate use may compromise patient dignity, autonomy, and quality of care. Current healthcare policies emphasize restraint reduction, appropriate documentation, and professional training as key elements of humanized and safe care. Methods: A descriptive cross-sectional study based on an anonymous self-administered survey was conducted in a tertiary university hospital as the diagnostic phase of a quality improvement project aimed at evaluating healthcare professionals' knowledge, perceptions, and documentation practices related to physical restraint use. A structured ad hoc questionnaire was distributed to registered nurses and nursing assistants working in adult inpatient units using a non-probabilistic convenience sampling strategy. The survey explored training, clinical decision-making, communication with patients and families, awareness of institutional protocols, and use of the electronic health record (EHR). Descriptive analyses and Pearson's chi-square tests were performed using IBM SPSS Statistics. Results: A total of 241 professionals participated. More than half of respondents (54.8%) reported no formal training in physical restraint use, and only 27.4% considered their training sufficient. Although 86.3% stated they were familiar with restraint indications, only 53.5% were aware of the existence of a structured EHR restraint registry, and just 31.0% consistently completed it. Documentation of restraint removal was particularly low (32.9%). Furthermore, significant discrepancies were observed between regulatory definitions of restraints and professionals' perceptions regarding practices requiring formal documentation. Statistically significant associations were identified between professional category, perceived training adequacy, and knowledge of physical restraint indications. Conclusions: This diagnostic phase identified substantial gaps between regulatory requirements, professional knowledge, and real-world documentation practices related to physical restraint use. The findings highlight the need for competency-based training strategies, standardized documentation processes, and strengthened institutional leadership to promote patient safety, regulatory compliance, and the humanization of hospital care.

Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson's disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson's disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long-term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of APs for PDP is common, with up to 35% of PD patients prescribed at least one AP within 7 years of PD diagnosis.

Methods: Four electronic databases (Ovid MEDLINE, Embase, PsycINFO, PubMed) were systematically searched for double-blind, randomised, placebo-controlled clinical trials for the use of APs in the treatment of PDP and their effects on PD motor symptoms, according to PRISMA guidelines.

Results: Eleven studies from ten publications were identified and included in this review. Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Quetiapine showed no significant improvement for PDP over placebo in three of the four studies, with both olanzapine studies also showing no improvement. Olanzapine studies also showed significant motor worsening compared to placebo. Clozapine significantly improved psychosis compared with placebo in both studies, with large effect sizes in primary outcome measures; (-0.82, 95% CI -1.37 to -0.26), -0.89 (95% CI -1.42 to -0.36). Pimavanserin also showed significant improvement (-0.48, 95% CI -0.77 to -0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores compared with placebo groups.

Conclusions: Data from the studies included in this review suggest that the use of quetiapine for the management of PDP may not be evidence based. Clozapine may improve PDP symptoms with low doses however significant side-effects may limit usability. The findings from this review support the use of clozapine as an alternative AP for the management of PDP when clinically appropriate.

Background/Objectives: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Electrolyte disturbances are common in this patient cohort, with serum chloride frequently elevated. Chloride dysregulation may be associated with poor neurological outcomes through mechanisms including paradoxical gamma amino butyric acid receptor excitation, cytotoxic edema, and ferroptosis. The aim of this review was to evaluate the relationship between serum chloride levels and outcomes in patients with TBI. Methods: A literature review was performed to identify all potential studies that reported on serum chloride levels and TBI. All study types and patient groups were included. Studies were included if they reported on serum chloride measurements as well as outcomes such as mortality, surgical intervention, intracranial pressure, and neurological/functional outcome scores in patients with TBI. References and citations were also reviewed. Results: A small number of mostly retrospective studies with modest patient numbers demonstrate an association between high chloride levels and increased mortality in patients with TBI, with this relationship persisting independent of hypernatremia. Recent large, randomized trials showed that balanced crystalloid solutions, despite lower chloride content, may be associated with worse outcomes in TBI patients compared to saline. No studies directly correlated chloride levels with intracranial pressure measurements. Chloride level rather than total chloride load appears more strongly associated with adverse outcomes, with non-hypertonic saline sources contributing substantially to chloride burden. Mechanistic evidence links chloride channel dysregulation to ferroptosis and cytotoxic edema, with sex-specific patterns of transporter expression. Conclusions: Limited available evidence suggests that hyperchloremia is independently associated with increased mortality in TBI though causality remains unestablished. The findings regarding balanced solutions challenge conventional fluid management assumptions and highlight the complexity of chloride's role in TBI pathophysiology. The absence of studies directly correlating chloride with intracranial pressure represents a critical evidence gap. Future studies with larger patient numbers, prospective designs, and multimodal neuromonitoring should further define these relationships to inform evidence-based chloride management strategies.

Introduction: Religious practices can shape lifestyles, influence health choices, and help individuals cope with illness and suffering. Understanding which aspects of religiosity support health-promoting attitudes is particularly important. This study explores how belonging to a religious community affects health and well-being among religious sisters.

Materials and methods: An anonymous survey was conducted among 463 women from international, apostolic Catholic congregations in Poland and 33 other countries. The questionnaire included questions on lifestyle, physical health (including diet, physical activity, sleep, chronic conditions, and medication use), and perceptions of how community life influences health and encourages health-conscious behaviors.

Results: Overall, 57% of participants reported following a healthy lifestyle, most commonly sisters aged 65 and older (73%). Non-Polish sisters and those living outside Poland were more likely to report healthy habits. Among sisters who saw their community as beneficial for health, 69% led a healthy lifestyle. Retreats, a sense of belonging, communal prayers, and vacations were consistently rated as having the most positive impact on well-being, particularly among older sisters and missionaries.

Conclusions: Life in a religious community appears to support health both directly, through structured daily routines and shared responsibilities, and indirectly, by providing social support and fostering a sense of purpose. Spiritual practices, rest, and close interpersonal relationships emerge as the most influential factors for well-being, while formal obligations such as wearing religious attire or attending formation meetings were rated as less impactful. These findings highlight the important role of communal life in promoting both physical and spiritual health among religious sisters.

Background: Exercise interventions are commonly considered as non-pharmacological approaches to support cognitive and functional outcomes in older adults with dementia. However, the effects reported in the literature remain heterogeneous, and commonly used time-based dose markers may be insufficient to explain variability across trials. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020 guidelines. Eligible trials described benefits with cognitive, functional or behavioral changes associated with structured exercise interventions in older adults with dementia. Random-effects meta-analysis and meta-regression models were used to derive pooled effects and assess if linear dose indicators (e.g., duration of intervention, session length, frequency and total cumulative dose) reflected heterogeneity. Results: Twenty-two studies were analyzed. Based on our pooled analyses, a small but statistically significant improvement was observed under the fixed-effects model (g = 0.106, 95% CI 0.015-0.197; p = 0.023), but this was not significant for random-effects models (g = 0.117, 95% CI -0.021-0.254; p = 0.097), while suggesting moderate between-study heterogeneity (Q(21) = 43.530, p = 0.003; I² = 51.757%; τ² = 0.052). For the main random-effects meta-regression, standard linear dose indicators did not significantly explain between-study heterogeneity (Qm(3) = 1.06, p = 0.7867; R²_analog ≈ 0), while significant residual heterogeneity remained (I² ≈ 56.03%). Conclusions: In the literature so far, there are limited and heterogeneous effects of exercise interventions on cognition and functions in older adults with dementia. These findings in all literature suggest that the current evidence does not support a consistent linear dose-response relationship but rather will likely depend to some extent on feasibility and supervision (again, quality of the interventions), thus emphasizing that exercise strategies must be contextually sensitive rather than dose-dependent.

Background/objectives: Psychiatric inpatient care emphasizes pharmacological stabilization, yet psychosocial interventions remain essential for addressing complex emotional, interpersonal, and behavioral needs. While talk-based psychotherapy (TBP) is standard inpatient psychosocial care, some patients face barriers to exclusively verbal engagement during acute crises. This study examined the feasibility and implementation of psychodrama as a pragmatic add-on to routine inpatient TBP under real-world ward conditions.

Methods: A quasi-experimental pragmatic add-on design was used (N = 84). All participants received routine TBP; the experimental group (n = 47) additionally participated in psychodrama co-facilitated by a multidisciplinary team (MDT). Outcomes were assessed using the ASEBA-ASR. Non-parametric tests with effect sizes and 95% confidence intervals were used to evaluate pre-post symptom changes over four weeks, and between-group differences were assessed using change-score comparisons.

Results: Both groups demonstrated significant within-group symptom reductions following the intervention. However, between-group comparisons of change scores showed no statistically significant differences (all p > 0.05), with small effect sizes and confidence intervals including zero.

Conclusions: Psychodrama appears feasible to implement as an action-based psychosocial add-on in acute inpatient settings. Although statistical superiority over TBP alone was not demonstrated, the intervention allowed for the characterization of symptom trajectories under real-world constraints, suggesting that psychodrama may represent an action-based option to diversify psychosocial pathways within MDT-delivered care. Future adequately powered studies are needed to examine how action-based modalities may fit within multidimensional, complexity-informed inpatient care pathways.