Healthcare最新文献

Background/Objectives: Healthcare workers have faced increasing emotional strain driven by organizational constraints, rising workload, and accumulated post-pandemic pressure. To support emotional well-being in primary care professionals, the Catalan Health Institute implemented a large-scale psychoeducational group program in its primary care centers. This study explored its feasibility, acceptability, and the factors shaping real-world implementation from the perspectives of participating professionals and community psychologists who taught it. Methods: A qualitative study was conducted involving five online focus groups held with community psychologists (two groups) and primary care professionals who participated in the program (three groups), selected through purposive sampling. Additional qualitative material was obtained from implementation-related field notes. Session transcripts were analyzed using inductive thematic analysis. The study is registered at ClinicalTrials.gov (NCT05720429). Results: Participants described a context of sustained emotional strain that increased motivation to engage with the program. The sessions were perceived as a valuable protected space for emotional expression, interpersonal connection, and learning self-care strategies. Community psychologists were regarded as key facilitators due to their embedded role and contextual knowledge. However, inconsistent managerial engagement, lack of protected time, competing workloads, and inadequate physical spaces were barriers to successful implementation. Participants proposed strengthening institutional support and offering follow-up sessions to consolidate benefits. Conclusions: The program was positively valued and was perceived to provide individual and team-level benefits. Its sustainability requires stronger organizational commitment and integration into routine practice. Findings underscore the need to complement individual-focused interventions with systemic actions addressing workload, staffing, and organizational culture.

Background/Objectives: Post-COVID-19 muscle weakness is common even after mild or moderate infection, driven by systemic inflammation, prolonged inactivity, and reduced functional reserve. This study aimed to describe changes in global muscle strength assessed using the Medical Research Council (MRC) scale in adults recovering from mild or moderate COVID-19 who participated in a structured two-week rehabilitation program, and to compare these changes with those observed under standard medical follow-up. Methods: This retrospective study included 193 adults recovering from mild or moderate COVID-19: 160 who completed a structured inpatient rehabilitation program (study group) and 33 who received no supervised rehabilitation (control group). Muscle strength was assessed using the MRC scale at baseline and at follow-up. Non-parametric analyses (Wilcoxon signed-rank test, Mann-Whitney U test, and Spearman correlation) were used to evaluate within-group changes, between-group differences, and associations with age and sex. Results: Both groups showed significant within-group improvements in muscle strength. In the study group, median MRC scores increased from 50 (IQR 40-56) to 52 (IQR 50-56), with a mean ΔMRC of 2.76 ± 8.72 (p < 0.001). In the control group, MRC scores rose from 50 (40-56) to 52 (43-56), corresponding to a mean ΔMRC of 1.00 ± 2.09 (p = 0.005). The between-group comparison of ΔMRC did not reach statistical significance overall; however, age-stratified analyses indicated greater muscle strength gains in the rehabilitation group among participants aged ≥60 years. Conclusions: Short-term improvements in global muscle strength were observed both after structured rehabilitation and under standard medical follow-up, indicating a substantial contribution of natural recovery. Although participants in the rehabilitation group showed numerically larger gains-most notably in the ≥60-year subgroup-between-group differences in ΔMRC were not statistically significant. Overall, these findings support the feasibility and potential functional value of early, individualized rehabilitation while underscoring the need for adequately powered prospective studies to clarify its incremental benefit beyond spontaneous recovery.

Background/Objectives: Blood biomarkers for estimating alcohol consumption are useful for preventing alcohol-related harms. Although there are conventional blood biomarkers of heavy alcohol drinkers, it remains to be clarified whether their combination is useful for estimation of excessive alcohol consumption from the viewpoint of preventing hypertension. Methods: Participants included 8172 men aged from 31 to 70 years who had undergone health checkups. Overall, participants were classified into three groups of nondrinkers, occasional drinkers, and regular drinkers by frequency; regular drinkers were further classified into four groups of light (<22 g/day), moderate (≥22 and <44 g/day), heavy (≥44 and <66 g/day), and very heavy drinkers (≥66 g/day) according to the amount of average daily alcohol consumption. The relationships of blood biomarkers (mean corpuscular volume [MCV], gamma glutamyl transferase [GGT], and HDL cholesterol [HDL-C]) and their products with alcohol consumption were investigated by using correlation analysis and receiver-operating characteristics (ROC) analysis. Results: Seven variables of blood biomarkers and their products were significantly correlated with frequency and amount of alcohol consumption, and the degrees of the correlations were stronger in the following order: HDL-C alone < product of MCV and HDL-C < MCV alone < GGT alone < product of MCV and GGT < product of GGT and HDL-C < product of MCV, HDL-C and GGT. In the ROC analysis, the area under the ROC curve for the relationship between the product of MCV, HDL-C, and GGT (named the alcohol consumption index [ACI]) and excessive alcohol intake (22 g/day or more) was 0.819 (95% confidence interval: 0.809-0.830), and the cutoff of this index was 194,863 with a sensitivity and specificity of 0.745 and 0.751, respectively. The positive predictive value was 69.2%. Conclusions: Among the three conventional blood biomarkers and their combinations, ACI demonstrated the strongest associations with alcohol consumption and excessive alcohol intake in men. Although the combined biomarkers are unlikely to be useful as a diagnostic tool, there is a possibility of future application by integrating ACI with recent biomarkers including carbohydrate-deficient transferrin for estimation of alcohol consumption.

Background: In today's dynamic healthcare environment, Changi General Hospital (CGH) has positioned staff wellbeing and engagement as fundamental priorities that underpin workforce sustainability and quality care delivery. Recognizing that allied health professionals (AHPs) face unique emotional demands and potential empathy fatigue, the CGH Allied Health Division (AHD) uses three strategic pillars: individual empowerment, leaders as key stewards and institutional support systems to address staff wellbeing and engagement. This paper will evaluate the outcomes of implementing the programs and identifying the barriers and enablers to achieving staff wellbeing and engagement. Methods: It adopts a mixed-methods approach using both quantitative survey data and qualitative feedback. Results: A total of 314 AHPs participated with a mean employment duration of 8.89 years. While 95% agreed that their work was meaningful and 76.8% reported happiness at work, 40.8% did not experience being recognized by the organization and approximately 30% did not find higher management responsive to their needs or transparent in their communication. Qualitative analysis revealed concerns about psychological safety of sharing one's opinions and concerns, and a desire for better renumeration and career progression. Conclusions: AHPs reported happiness and meaningfulness in their clinical work. However, issues with organizational recognition, higher management responsiveness and transparency, as well as psychological safety were elicited. Working towards addressing fostering psychological safety and enhancing recognition and communication with management are important in order to develop and sustain a thriving healthcare workforce capable of high-quality patient care. Overall, the findings reinforced AHD direction of putting employee wellbeing and engagement as a strategic priority.

Aim: As the global population is aging rapidly, promoting physical activity in later life is increasingly seen as a good strategy to enhance and sustain the social and psychological well-being of older adults from a positive aging perspective. This study explored how social capital influences the relationship between playing football and happiness in veteran footballers. Specifically, it aimed to understand if social capital acts as a mediator between these two factors. Materials and Methods: This cross-sectional study was performed on a convenience sample of 423 veteran footballers aged from 38 to 59 years who completed a survey at 35th Sakarya Veterans Football Tournament in Sakarya in north-west Turkey. Football participation was assessed using the Serious Leisure Inventory. Social capital was assessed in both cognitive and structural aspects. A single-item scale assessed general happiness. Data were analyzed with Pearson correlation coefficients and were calculated using SPSS (version 24) to assess the direction and strength of the links between the investigated variables. Path coefficients were calculated through regression analyses. For testing mediation effects, the study utilized Hayes' bootstrapping method, executed with the Version 4.2 Beta of the PROCESS macro. Results: According to the research findings, the direct effect of football participation on happiness was determined to be 0.43 (p < 0.01). While community involvement played a significant mediating role with a coefficient of 0.11 (95% CI [0.05, 0.15]), the social trust and neighborhood dimensions of social capital did not yield statistically significant effects. Collectively, the model explains 24% of the variance in happiness (R² = 0.24), with a total effect of football participation calculated at 0.57 (p = 0.000). Conclusions: it is believed that social environments that include participation in sport can contribute to successful and comfortable aging by greatly enhancing the overall well-being and happiness of older athletes/adults.

Background/Objectives: Medication-related safety incidents rank among the most prevalent patient safety concerns globally. In addition to healthcare professionals, patients also play a vital role in ensuring safe medication practices. To effectively engage them, it is essential to gain a deeper understanding of their knowledge and perspectives. Methods: We conducted a netnography-based mixed-method content analysis study within the Hungarian online environment to identify key patient concerns. A total of 5174 relevant comments and discussions were analyzed (from 14 August 2020 to 14 August 2023), utilizing a medication safety framework based on Glies et al. The analysis was confined to publicly accessible online content related to oral medications and did not include demographic information about commenters. Results: The framework was applicable, though its representation was uneven. Patients predominantly focused on issues related to Access to services and Communication. Online discussions were primarily dominated by patients, with contributions from relatives and healthcare professionals being comparatively limited. The majority of concerns pertained to prescription medications, particularly in the fields of gynecology, internal medicine, and gastroenterology. ATC codes G and A were most frequently referenced, corresponding to the healthcare domains discussed. Conclusions: Initiatives aimed at enhancing medication safety should prioritize improving access and communication. Patients must be empowered as active agents in safety efforts; they can aid in preventing errors, reporting incidents, and offering feedback. Their engagement supports organizational learning and promotes safer healthcare delivery.

Background/Objectives: Iron-deficiency anemia (IDA) is a common extraintestinal complication of inflammatory bowel disease (IBD). Among high-dose intravenous (IV) iron options, ferric carboxymaltose (FCM) carries a higher risk of treatment-emergent hypophosphatemia than ferric derisomaltose (FDI), with potential clinical consequences. Slovenia's healthcare setting, characterized by very low IV iron infusion tariffs and recent pricing in which FCM is substantially less expensive than FDI, warrants a setting-specific cost effectiveness evaluation. Methods: We integrated two methodological components: (i) a payer-perspective cost-effectiveness analysis using a patient-level microsimulation model with (ii) an umbrella review of systematic reviews and a targeted search of expert consensus statements on IV-iron-associated hypophosphatemia. Results: In the base case, FDI required fewer infusions than FCM (11.1 vs. 14.2 over 10 years) but generated only €95 in IV iron administration savings due to low tariffs, while drug procurement was €1166 higher with FDI than FCM. When incorporating the clinical impact of hypophosphatemia, incremental quality-adjusted life years (QALYs) were 0.136, yielding an incremental cost-effectiveness ratio (ICER) of €6590/QALY. The umbrella review consistently showed higher hypophosphatemia incidence with FCM (up to 92%) compared with other IV iron formulations (<10%), with recent recommendations emphasizing phosphate monitoring and risk mitigation through alternative formulations. Conclusions: Despite Slovenia's low IV iron infusion tariffs and lower FCM price, FDI remained cost-effective in this model, largely due to its more favorable hypophosphatemia profile within the model. These findings suggest that hypophosphatemia risk should be considered when selecting IV iron therapy in routine IBD care.

Background: Clinical Ethics Consultation (CEC) helps healthcare professionals, patients, and families address ethically complex situations in clinical practice. Since 2016, requests for CEC at the Fondazione Policlinico Universitario "A. Gemelli" IRCCS (FPG) have been entered into the hospital IT system like other consulting services. This has increased both the number of requests and the need to monitor and evaluate the service. Aims: This qualitative study investigates how the CEC service at FPG is perceived in terms of its value, role, and impact, and further aims to identify appropriate strategies for evaluating the service. Methods: Semi-structured interviews were conducted with 28 healthcare professionals who had used or taken part in the service within the previous two years. Data were examined using reflective thematic analysis, leading to the development of codes and themes. Results: Five main themes emerged: (1) Role and identity of the clinical ethics consultant the, (2) Benefits of CEC for clinical practice, (3) How to evaluate the CEC Service, (4) HCPs' Evaluation, and (5) CEC Service Improvement Strategies. Participants saw the consultant as an "active third party" who combines ethical, clinical, and communication skills to mediate conflicts, support teamwork, and guide shared care planning. The service was viewed as strengthening patient-centered care by improving communication with patients and families, clarifying treatment proportionality, and reducing clinicians' decisional isolation. Interviewees emphasized the need for structured evaluation tools that include both quantitative indicators and qualitative feedback. Satisfaction with the service was consistently high, with recommendations to expand consultant availability, improve timeliness, and enhance training. Conclusions: CEC appears to serve as a clinical, relational, and training resource that fosters ethically grounded, collaborative, and person-centered care.

Background: Excess body fat during growth has been associated with impaired bone development; however, evidence on the influence of total and regional body fat on bone mineral content (BMC) in physically active youth remains limited.

Objective: This study aimed to analyze the association between total and regional body fat and BMC in children and adolescent athletes.

Methods: This cross-sectional study included 109 children and adolescents aged 9 to 18 years participating in different sports (indoor volleyball, beach volleyball, swimming, track and field, and basketball). Bone mineral content assessed by DXA and normalized by height (BMC/Height) for the total body less head (TBLH), lumbar spine (L1-L4), and femoral neck was considered the dependent variable. Total and regional (android and gynoid) body fat percentages obtained by dual-energy X-ray absorptiometry (DXA) were treated as independent variables. Associations were examined using multivariable linear regression adjusted for biological and training-related covariates.

Results: Total body fat (β = -0.014; p < 0.05), android fat (β = -0.011; p < 0.05), and gynoid fat (β = -0.014; p < 0.05) were significantly and inversely associated with lumbar spine BMC/Height. No associations were observed between total, android, or gynoid fat percentage and TBLH or femoral neck BMC/Height (p > 0.05).

Conclusions: The inverse and site-specific association of total, android, and gynoid fat with lumbar spine BMC/Height highlights the greater susceptibility of this skeletal site to adiposity-related detriments, underscoring the importance of site-specific monitoring of bone mineral content, even among physically active youth.

Background: This systematic review aims to identify modifiable and non-modifiable predictors of exercise capacity (VO₂peak level or change) in stroke survivors. These insights may further optimize rehabilitation treatment and improve long-term health outcomes.

Methods: PubMed (PubMed.gov), EMBASE (Elsevier), CINAHL (EBSCO), and Web of Science (Clarivate) were searched (last search on 7 October 2025). Inclusion criteria were: (1) adults (>18 years) who survived a stroke (ischemic and hemorrhagic), (2) outcome was a measurement of maximum exercise capacity (VO₂peak) measured with CPET (or equivalent), (3) predictors of exercise capacity were measured (e.g., personal factors, disease-related factors, components of rehabilitation), (4) predictors of exercise capacity were analyzed in multivariate regression models, (5) primary research, and (6) full-text available. During the data extraction phase, predictors were categorized into modifiable and non-modifiable predictors. Risk of bias was assessed with the McMaster Critical Review Form for Quantitative Studies.

Results: Of 919 unique articles, seventeen were included. Modifiable factors such as BMI (4/8 articles) and fat mass (1/1), lower limb strength (3/3), cardiorespiratory fitness (e.g., baseline VO₂peak (2/4)), training intensity (2/2) and perceived fatigue (1/1) significantly predicted VO₂peak (level or change). Significant non-modifiable predictors were age (3/11), sex (1/8), diabetes (1/2), and stroke-specific (4/8) factors.

Conclusions: This systematic review highlights the significant role of modifiable and non-modifiable predictors in optimizing exercise capacity (VO₂peak) for stroke survivors. In addition, considering modifiable and non-modifiable predictors allows for more personalized treatment planning. The findings can guide healthcare professionals in tailoring rehabilitation programs, though further research is needed to develop a comprehensive prediction model.