Healthcare最新文献

Background: Turnover intention among healthcare workers represents a growing challenge for chronic care institutions, particularly in resource-constrained healthcare systems. Organizational and ethical factors have been increasingly recognized as relevant correlates of workforce retention. Methods: This exploratory cross-sectional study was conducted in a Romanian chronic care hospital between January 2023 and September 2024. A total of 62 healthcare workers were included using a census-based recruitment approach. Organizational climate, ethical work environment, job satisfaction, and turnover intention were assessed using adapted and composite self-report measures. Correlation, multivariate regression, and exploratory mediation analyses were performed. Results: Job satisfaction and ethical work environment were inversely associated with turnover intention in both correlation and multivariate analyses. Organizational climate did not retain an independent association with turnover intention after adjustment. Exploratory mediation analysis suggested that job satisfaction may partially account for the association between an ethical work environment and turnover intention. Higher turnover intention and less favorable organizational perceptions were observed among nursing and auxiliary healthcare staff compared to physicians. Conclusions: The findings suggest that organizational and ethical conditions, particularly those influencing job satisfaction, are relevant correlates of turnover intention in chronic care settings. Given the exploratory design and limited sample size, these results should be interpreted cautiously. Organizational strategies targeting ethical practices and everyday work satisfaction may represent feasible approaches to workforce retention in similar healthcare contexts.

Background/Objectives: Geographic Information Systems (GIS) offer essential capabilities for identifying spatial concentrations of vulnerability and strengthening context-aware prevention strategies. This manuscript describes a geospatial architecture designed to generate anticipatory, place-based risk identification applicable across diverse community and institutional environments. Interpersonal Violence (IPV), one of several preventable harms that benefit from this spatially informed analysis, remains a critical public health challenge shaped by structural, ecological, and situational factors. Methods: The conceptual framework presented integrates de-identified surveillance data, ecological indicators, environmental and temporal dynamics into a unified spatial epidemiological model. Multilevel data layers are geocoded, spatially matched, and analyzed using clustering (e.g., Getis-Ord Gi*), spatial dependence metrics (e.g., Moran's I), and contextual modeling to support anticipatory identification of elevated vulnerability. Framework Outputs: The model is designed to identify spatial clustering, mobility-linked risk patterns, and emerging escalation zones using neighborhood disadvantage, built-environment factors, and situational markers. Outputs are intended to support both clinical decision-making (e.g., geocoded trauma screening, and context-aware discharge planning), and community-level prevention (e.g., targeted environmental interventions and cross-sector resource coordination). Conclusions: This framework synthesizes behavioral theory, spatial epidemiology, and prevention science into an integrative architecture for coordinated public health response. As a conceptual foundation for future empirical research, it advances the development of more dynamic, spatially informed, and equity-focused prevention systems.

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical patients with chronic conditions is a priority for healthcare. Methods: This meta-analysis summarized data from 39,493 medical patients across 14 non-randomized trials that had been identified by a prior review of the survival benefits of social support interventions. Results: Across four studies reporting hazard ratio data, the results failed to reach statistical significance (HR = 2.10, 95% CI = 0.99 to 4.48, p = 0.0546), and the results of ten studies reporting odds ratio data were of smaller magnitude (OR = 1.27, 95% CI [0.72, 2.23], p > 0.05). Heterogeneity characterized both the odds ratio data (I² = 53%; Q = 18.1, p = 0.03) and hazard ratio data (I² = 89%, Q = 23, p < 0.001). A notable finding was that studies with longer periods of data collection showed longer survival among medical patients receiving social support. Conclusions: Long-term observations may be necessary for the survival benefits of social support interventions to become apparent. Further research with a larger pool of data from long-term follow-up studies will be needed to establish firm conclusions.

Background: Assistive technologies (ATs) for individuals with tetraplegia have evolved from mechanical aids to complex neurotechnological, digital, and psychosocial systems. However, the evidence base remains fragmented, with heterogeneous methodologies and limited integration across domains. This review synthesizes recent review-level evidence to clarify current trends, gaps, and directions in ATs for tetraplegia. Methods: A narrative review of reviews was conducted following the ANDJ checklist. PubMed and Scopus were searched for systematic, scoping, and narrative reviews addressing assistive technologies relevant to tetraplegia. After screening, de-duplication, and quality appraisal, 20 reviews were included and synthesized narratively. Results: The included reviews clustered into four main domains: neural and regenerative interfaces, motor and biomechanical assistive systems, digital and adaptive rehabilitation ecosystems, and psychosocial and integrative frameworks. Across domains, evidence highlights a shift toward personalized, adaptive, and interoperable systems, supported by neurotechnologies, robotics, mobile health, and virtual reality. Common limitations include heterogeneous outcome measures, scarcity of longitudinal evidence, limited system interoperability, and persistent inequities in access and adoption. Emerging applications of artificial intelligence support adaptive control, monitoring, and personalization, though robust clinical validation remains limited. Conclusions: This synthesis provides a structured overview of review-level evidence on assistive technologies for tetraplegia. The findings underscore the need for coordinated, multidisciplinary approaches and more rigorous, longitudinal evaluation to support the development of inclusive, human-centered, and interoperable assistive ecosystems.

Background: Discogenic low back pain (LBP) is a significant therapeutic and social problem. Discopathy is associated with neurological symptoms that severely disrupt the patient's functional status. Regardless of the choice of neurosurgical procedure for discopathy, its effectiveness highly varies. Aims: This study aimed to assess the effectiveness of neurosurgical treatment and neurorehabilitation procedures based on a comprehensive analysis of a number of neurological symptoms and the functional status of patients with chronic discogenic LBP. Material and Methods: This study involved 110 patients (56 women and 54 men) who underwent first-ever lumbar spine surgery. Before the surgery and 3 months after the hospital discharge, all patients were subjected to neurological examination and comprehensive assessment of neurological symptoms. Results: After the procedure, improvement was shown in sensory disturbance (p < 0.0001), pain (p < 0.0001), and sexual dysfunction (p < 0.0001). The results of lower limb paresis, monoplegia, and sphincter complications remained non-significant. A reduction in scoliosis (p = 0.0040) and lumbar pain (p < 0.0001) was observed. There was a reduction in pain in the lower leg (p = 0.0136) and foot (p = 0.0122) during movements. Improvement in passive and active mobility as well as pain reduction in the lumbar spine area were demonstrated (p < 0.0001). There was significant improvement in the knee and ankle reflexes (p < 0.0001). There were no significant changes in the superficial sensation. In the functional assessment, an improvement in the toe-to-floor test of 13.3 cm was confirmed (p < 0.0001), while there was no difference in the Lasègue's test. Conclusions: The general and neurological condition of patients with LBP significantly improved after the spine surgery. The improvement included mainly a reduction in pain and sensory disturbances, return of deep reflexes, and increased mobility of the lower limbs and spine.

Background/objectives: Screening instruments are relevant for assessing the mental health of older adults, favoring clinical practice and research. However, there is a need for instruments with sufficient evidence of validity for use in Latin America and the Caribbean (LAC), where they are growing. This scoping review aims to evaluate the existing evidence regarding the psychometric properties of mental health measurement instruments used with older adults from LAC.

Methods: Eight databases (PubMed, CINAHL, Medline, Embase, Scielo, Scopus, Web of Science, PsycINFO) were searched to extract relevant articles about instruments to measure mental health outcomes in older adults in English, Spanish, and Portuguese. After the first screening and duplicate removal, 6307 were retrieved.

Results: The full-text screening identified 312 articles for inclusion in the review. Most of the articles were from Brazil (49.04%). One hundred eighty instruments (52.79%) assessed cognition, mainly using the Mini-Mental State Examination (MMSE), followed by 11.14% for depression, most commonly with the Yesavage Depression Scale (GDS). The assessment of validity was predominantly based on two criteria (34%), and 56% of the evidence was published in the last 10 years. To improve usability, we have provided a practical guide to help LAC clinicians and researchers identify and select robustly validated and contextually appropriate assessment instruments.

Conclusions: There is still little evidence of the validity of instruments that measure other aspects of mental health beyond cognitive functioning. There seems to be no unified set of criteria in Latin America for determining whether an instrument has sufficient valid evidence. More work is needed on cross-cultural validity evidence within the region.

Background/Objectives: Veterinarians are among the most stressed of all professional groups. Their work is characterised by long working hours, high emotional demands and an increased risk of anxiety, depression, suicide and burnout. The aim of this cross-sectional study that examines retrospective records of experienced violence was to analyse the frequency of violent acts and their connection to certain factors (age, gender, place of work, and specialist area according to animal species). Methods: This nationwide, cross-sectional, online survey of veterinarians in Germany was conducted between July 2021 and February 2023. A total of 1053 veterinarians were included in the analysis, which was conducted according to the respondents' age, (<35 years, 35-45 years and >45 years), gender, workplace and veterinary specialisation. Sociodemographic and work-related data were collected, as were responses to questions regarding experiences of violence, which were differentiated between verbal abuse and physical violence. The data were analysed using descriptive statistics and non-parametric group comparisons (Kruskal-Wallis test with Bonferroni correction, Mann-Whitney U test and Pearson's chi-squared test). Results: Overall, 52.7% of veterinarians reported experiencing verbal abuse or physical violence at the hands of animal owners. Verbal abuse occurred, on average, more than three times per month, whereas physical violence was rare. Physical violence occurred significantly more frequently among middle-aged veterinarians (p < 0.001). The highest prevalence of verbal abuse or violence (72.5%, p < 0.001) was reported by veterinarians working in public authorities, while the lowest was reported by those working in laboratories. Conclusions: Workplace violence against veterinarians is a frequent occupational burden in Germany and highlights the urgent need for targeted prevention, de-escalation training and organisational support across veterinary settings.

Introduction: Timely access to healthcare is essential for improving population health and reducing inequities. Immigrants often experience unique cultural, linguistic, and systemic barriers that delay care-seeking and service utilization. Despite the rapid growth of the Nepalese community in Canada, there is limited empirical evidence examining their healthcare access. This study aimed to assess the prevalence and determinants of delays in accessing healthcare among Nepalese immigrants. Methods: A community-based participatory research (CBPR) framework guided a cross-sectional survey conducted between January and June 2019. The research process was co-led by academic investigators, community scholars, and local Nepalese organizations to ensure cultural and contextual relevance. A snowball sampling strategy was used to recruit 401 Nepalese adults. Data were analyzed using descriptive statistics and multivariable logistic regression to examine sociodemographic and health-related factors associated with delayed healthcare access. Results: Of the 401 respondents, 66.3% (n = 266) reported experiencing a delay in accessing healthcare within the preceding 12 months. Delays were more common among participants aged 26-45 years, those who were married, employed, or had an undergraduate degree or lower. After adjusting for covariates, older age, lower education, having a family doctor, higher income (≥$26,000), and one or more chronic conditions were associated with increased odds of delay. Family size and the number of years living in Canada have had little effect on care delay. Conclusions: Delays in accessing healthcare are common among Nepalese immigrants in Calgary, reflecting the intersection of individual, cultural, and systemic determinants. These findings underscore the importance of community-engaged, culturally responsive strategies to address barriers and promote equitable healthcare access for immigrant populations. Strengthening partnerships between health systems and immigrant communities may enhance trust, navigation, and continuity of care.

Background. Rheumatoid arthritis (RA) is a chronic autoimmune disease frequently accompanied by cardiovascular, respiratory, skeletal, psychiatric, and neoplastic comorbidities that are associated with higher morbidity and poorer health-related quality of life (HRQoL). This study evaluated the associations between comorbidities and patient-reported physical health, emotional distress, daily functioning, and social relationships in adults with RA and explored patient-reported unmet needs relevant to integrated care. Methods. We conducted a cross-sectional survey among 286 adults with physician-confirmed RA, using a structured questionnaire (ICRA-Q) administered between June and July 2025 via online platforms and in-hospital supervised completion. The survey captured demographics, patient-reported physician-diagnosed comorbidities (current and/or past), perceived disease impact, functional limitations, emotional and social consequences, access to treatment, financial burden, and support needs. Analyses included descriptive statistics, χ² tests, t-tests/ANOVA, effect sizes (Cramer's V and standardized mean differences), and multivariable logistic regression to explore predictors of high HRQoL impact and high difficulty in disease management. An exploratory classification into high-risk phenotypes was performed using predefined clinical, psychological, and socioeconomic criteria. Results. Most participants (98.6%) reported at least one comorbidity, most commonly hypertension, osteoporosis, and cardiovascular disease. Higher comorbidity burden and depression/anxiety were strongly associated with higher pain, reduced mobility, emotional distress, and financial strain. Exploratory high-risk phenotypes (severe somatic multimorbidity, high psychological vulnerability, high socioeconomic burden, and a composite very high-risk profile) were associated with poorer HRQoL indicators. Younger age, shorter disease duration, and higher perceived social support were associated with lower perceived burden. Conclusions. In this cross-sectional, patient-reported study, comorbidity burden-particularly psychological comorbidity-was strongly associated with poorer HRQoL and greater management difficulty in RA. These findings support the need for multidisciplinary, integrated care pathways; however, subgroup phenotypes should be considered exploratory and require external validation.

Frontline workers across health, emergency, and social care sectors are repeatedly exposed to distressing events and chronic stressors as part of their occupational roles. Unlike single-event trauma, these cumulative exposures accrue over time, generating persistent psychological and physiological strain. Traditional diagnostic frameworks, particularly post-traumatic stress disorder (PTSD), were not designed to capture the layered and ongoing nature of this occupational trauma. This commentary introduces the concept of Persistent Traumatic Stress Exposure (PTSE), a framework that reframes trauma among frontline workers as an exposure arising from organisational and systemic conditions rather than solely an individual disorder. It aims to reorient understanding, responsibility, and intervention from a purely clinical lens toward systems, cultures, and organisational duties of care. PTSE is presented as an integrative paradigm informed by contemporary theory and evidence on trauma, moral injury, organisational stress, and trauma-informed systems. The framework synthesises findings from health, emergency, and social care settings, illustrating how repeated exposure, ethical conflict, and institutional pressures contribute to cumulative psychological harm. PTSE highlights that psychological injury may build across shifts, careers, and lifetimes, requiring preventive, real-time, and sustained responses. The framework emphasises that effective support is dependent on both organisational readiness, the structural conditions that enable trauma-informed work, and organisational preparedness, the practical capability to enact safe, predictable, and stigma-free responses to trauma exposure. PTSE challenges prevailing stigma by framing trauma as a predictable occupational hazard rather than a personal weakness. It aligns with modern occupational health perspectives by advocating for systems that strengthen psychological safety, leadership capability and access to support. By adopting PTSE, organisations can shift from reactive treatment models toward proactive cultural and structural protection, honouring the lived realities of frontline workers and promoting long-term wellbeing and resilience.