Healthcare最新文献

Background/Objectives: Internationally, breast cancer incidence and survivorship are increasing. As the number of breast cancer survivors continues to rise, so does the demand for supportive care. This study aimed to explore how treatment experiences of breast cancer survivors in Hong Kong (HK) affect their unmet care needs, with a focus on how Chinese culture influences their journey. Methods: This phenomenological qualitative study engaged a purposive sample of 28 breast cancer survivors in HK through semi-structured interviews. Data were analyzed using Colaizzi's seven-step method to interpret their lived experiences. Results: Four key themes emerged: (i) carrying the burden in silence: the isolation of self-preservation; (ii) beyond the clinic: making medical advice fit into everyday routine; (iii) bridging two worlds: resilience through the integration of Traditional Chinese Medicine and Western Care; and (iv) reclaiming femininity: women helping women heal. Conclusions: This study provides an understanding of breast cancer survivors' experiences and offers insights into delivering more realistic services. Basically, it extends survivorship knowledge by demonstrating how integrating cultural values into clinical care bridges the gap between medical treatment and holistic well-being.

Background: The majority of the funding for the New Rural Cooperative Medical System (NCMS) is derived from fiscal subsidies, comprising central transfer payments and local fiscal matching subsidies. Local governments' strategic behavior in response to central transfer payments may further impact NCMS compensation spending and medical economic risks. Methodology: Accordingly, this paper investigates, from both theoretical and empirical perspectives, the impact pathways through which local fiscal matching subsidies influence the medical economic risks faced by insured rural households, with central transfer payments serving as a moderating factor. This paper constructs a dynamic game framework involving the central government, local governments, and household sectors. It further applies a mediation effect model and related econometric methods to conduct empirical analysis using 87,630 observations from the China Family Panel Studies (CFPS). Results: The results show that, first, local fiscal matching subsidies significantly reduce catastrophic health expenditures for rural households under the income effect of central transfer payments. However, under the substitution effect, the opposite occurs, as local governments adopt non-cooperative strategies in response to central transfer payments. Second, these impacts exhibit regional heterogeneity, with stronger effects in eastern regions, regions with more developed secondary industries, and regions with higher fiscal self-sufficiency rates. Third, local fiscal matching subsidies influence medical economic risks through compensation spending, under the moderating role of central transfer payments. Conclusions: This paper provides a novel perspective on why the NCMS struggles to provide effective protection, thereby enriching the existing literature. Furthermore, it provides policy guidance for fiscal and healthcare reforms in countries with similar contexts to China. Based on these insights, we argue that, during the future integration process of the Basic Medical Insurance for Urban and Rural Residents, clear boundaries should be defined for local fiscal matching subsidies, and the moderating role of central transfer payments should be strategically leveraged.

Background/Objectives: Little research has examined changes over time in mental health within end-stage liver disease (ESLD) patient-care partner dyads. Therefore, the aim of this observational study was to identify patterns of dyadic mental health over time in a sample of ESLD dyads and associations with individual- and dyadic-level characteristics. Methods: Adult men and women with ESLD and their care partners were recruited at liver clinics at two healthcare centers in the U.S. Pacific Northwest. Survey data were collected at the time of study enrollment and at 3, 6, 9, and 12 months. Patients and care partners completed the Mishel Uncertainty in Illness Scale, the Multidimensional Perceived Social Support Scale, the Mutuality Scale, the Short-Form Health Survey, and one religiosity item. Standard summary statistics and multilevel and latent growth mixture modeling were used to analyze the data. Results: In total, 186 dyads were included in the analyses, which revealed three distinct patterns of dyadic mental health: "disparate: patient better" (n = 47 [25.3%]), "shared mental health" (n = 76 [40.86%]), and "disparate: care partner better" (n = 63 [33.87%]). Significant characteristics associated with the patterns included care-related strain, uncertainty, relationship quality, and social support. Conclusions: Clinical implications include greater attention to both members of the dyad, with particular attention to low levels of mental health in patients or care partners as identified by the different patterns. Future research should employ a dyadic approach to address the prevalence of characteristics and identify others to improve the mental health of both members of the dyad.

Background: The Temporomandibular Joint Ankylosis Quality of Life Questionnaire (TMJAQoL) is a disease-specific instrument designed to assess quality of life in patients with temporomandibular joint (TMJ) ankylosis. No validated Turkish version of this scale existed prior to this study. The aim of this study was to translate, culturally adapt, and evaluate the Turkish version of the TMJAQoL (TMJAQoL-TR) in patients with severe temporomandibular disorders, including a predefined ankylosis subgroup.

Materials and methods: A total of 120 patients with temporomandibular complaints were included. Test-retest reliability was evaluated in a clinically stable subsample of 72 participants with a one-week interval. Following forward-backward translation and cultural adaptation procedures, the TMJAQoL-TR was administered together with the Oral Health Impact Profile Short Form-14 (OHIP-14), the Short Form-36 (SF-36), and Visual Analog Scale (VAS) pain scores. Reliability was assessed using Cronbach's α, item-level Weighted Cohen's Kappa, and test-retest Intraclass Correlation Coefficients (ICC), supported by measurement error indices (Standard Error of Measurement [SEM] and Minimal Detectable Change at 95% confidence [MDC₉₅]). Construct validity was examined using Spearman correlation coefficients. Structural validity was investigated through exploratory factor analysis, followed by a confirmatory structural model in AMOS to evaluate preliminary model consistency. Floor and ceiling effects were analyzed using the 15% criterion.

Results: The TMJAQoL-TR demonstrated excellent internal consistency (Cronbach's α = 0.879) and very high test-retest reliability (ICC = 0.995; 95% CI: 0.992-0.997). Strong correlations were observed with OHIP-14 (r = 0.772, p < 0.01), and moderate correlations with VAS pain scores (r = 0.312, p < 0.01). No significant floor or ceiling effects were detected. A weak but significant negative correlation with the SF-36 physical role subscale suggests that TMJ-related quality of life impairment is associated with role limitations in daily activities, although the magnitude of this association was modest. Exploratory factor analysis supported a clinically coherent two-factor structure, and the AMOS structural model demonstrated acceptable consistency with this framework.

Conclusions: The TMJAQoL-TR appears to be a valid and reliable instrument for assessing quality of life in patients with severe TMJ-related functional limitations. Findings from the ankylosis subgroup support potential applicability within the instrument's original target population; however, further validation in larger ankylosis-specific samples is warranted.

Background/Objectives: Dialysis-induced hypotension (DIH) affects 10-30% of hemodialysis sessions and increases mortality. Sertraline may stabilize blood pressure by modulating the Bezold-Jarisch reflex. We aimed to evaluate the efficacy and safety of sertraline for preventing DIH. Methods: We searched PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov through December 2025. Random-effects meta-analysis was performed using standardized mean differences (SMD). Results: Nine studies (140 patients) met inclusion criteria. Sertraline significantly increased mean arterial pressure (SMD: 0.87; 95% CI: 0.52-1.22; p < 0.001), corresponding to approximately 8.5 mmHg. DIH episodes decreased by 35% (RR: 0.65; 95% CI: 0.48-0.88). Heterogeneity was moderate (I² = 42%). Among studies reporting safety data (n = 106), adverse events were mild (14%) with no serious events. No publication bias was detected (Egger's p = 0.21). Conclusions: Sertraline significantly improves hemodynamic stability during hemodialysis with a favorable safety profile. It represents a promising option for DIH, particularly in patients with comorbid depression or contraindications to midodrine.

Background: This study explores how healthcare staff perceptions of their physical work environment influence their satisfaction.

Methods: A qualitative research design involving semi-structured interviews was adopted. The study sample comprised ten healthcare staff, including both clinical and nonclinical employees, working in a healthcare facility. The participants represented a range of professional roles and work areas, allowing for diverse perspectives on the physical environment. The data were analyzed using thematic analysis. The interview transcripts were systematically coded, and recurring patterns and themes were identified through an iterative analytical process reflecting participants' perceptions and experiences of the physical work environment.

Results: The analysis revealed seven main themes: impact of spatial layout on workflow; need for relaxation and break spaces; connection to nature, furniture and comfort; influence of color on mood; ambient features and environmental control; and natural light and well-being.

Conclusions: This study highlights the critical role of the healthcare physical environment in shaping employee satisfaction and offers practical recommendations for healthcare facility design, emphasizing the need for ergonomic workspaces, greenspaces, and safe workplaces. This study contributes to a deeper understanding of how the physical environment can be optimized to support employees in healthcare settings.

Kefir is a traditional fermented milk beverage characterized by a complex community of lactic acid bacteria, acetic acid bacteria and yeasts that contributes to its unique sensory and nutritional properties. Regular consumption of kefir has been associated with a wide range of potential health benefits. This review aimed to evaluate the available clinical evidence on kefir consumption and its impact on human health. A literature search of the databases PubMed, Web of Science, and Scopus was conducted up to 30 August 2025. Eligible studies were human clinical trials investigating kefir as a fermented milk beverage without the addition of defined probiotic strains, prebiotics, or synbiotics. A total of 28 clinical studies were identified and included diverse study designs, such as crossover trials, parallel-group randomized controlled trials, multi-arm trials, early-phase exploratory studies, and pilot studies. Kefir intake showed potential benefits for gut microbiota modulation, metabolic parameters, inflammatory markers, immune function, and gastrointestinal health. However, interpretation of these findings is limited due to substantial heterogeneity in kefir preparation, microbial composition, dosage, intervention duration, study populations, and outcome measures. Consequently, although kefir may offer multiple health benefits, the overall strength of evidence remains limited. Larger, well-designed clinical trials with standardized kefir interventions are needed to better define kefir's efficacy in specific populations and health conditions.

Background: Feasibility studies enable the refinement of complex interventions and procedures prior to definitive trials. To establish robust evidence for clinical applications, this study evaluated the feasibility, acceptability and safety of an evidence-based breathing exercise (BE) intervention protocol among breast cancer survivors experiencing chronic pain. Methods: In an open-label pilot randomised controlled trial with a nested qualitative evaluation, 72 women were randomised into a BE plus routine care group (n = 36) or a routine care alone group (n = 36). Feasibility and acceptability outcomes included recruitment, retention, instrument completeness and suitability, intervention adherence, safety, and participants' perceived experience of practicing BE and participating in this study. Outcome assessments occurred at baseline (week 0), post-intervention (week 5), and follow-up (week 9). Quantitative data were analysed descriptively. Qualitative interviews (n = 20) explored participant experiences, and the data were analysed thematically. Results: The feasibility was high, with an 84% recruitment (72/86) and 94% retention (68/72), and the recruitment process took 19 weeks. The overall BE intervention adherence was 82.4%. Questionnaire completion was satisfactory, with minimal missing values reported in the questionnaire. No serious adverse events occurred. Evidence from qualitative evaluation reinforced the feasibility from quantitative data. Conclusions: The BE protocol and study procedures were feasible, acceptable, and safe in this population. A fully powered RCT is warranted to determine the effectiveness and durability of the outcomes.

Chronic diseases-including diabetes mellitus, cardiovascular disease, chronic kidney disease, and autoimmune disorders-remain the leading causes of global morbidity and mortality. While biomedical pathophysiology defines the etiology and progression of these conditions, cultural factors significantly modulate how patients perceive illness, engage in treatment, and adhere to medical recommendations. This review synthesizes evidence from cross-cultural studies, with a specific focus on medical manifestations and therapeutic challenges, to examine how sociocultural determinants intersect with biological disease processes. We highlight nuanced case comparisons between South Asian, East Asian, Middle Eastern, African, Latinx, and Indigenous populations, illustrating how cultural constructs such as collectivism, fatalism, stigma, reliance on traditional medicine, and health literacy directly influence outcomes in chronic disease management. Importantly, we integrate evidence-based recommendations for healthcare professionals, emphasizing culturally tailored interventions, precision medicine approaches, and the role of interdisciplinary care teams.

This narrative literature review explores the clinical use of Ketamine as part of an untested hypothetical model framework for bridge therapy for acute suicidality. Long-term suicide rates continue to increase in the United States and in many other countries, creating a pressing public health challenge with a variety of treatment considerations. Existing standard-of-care SSRI therapeutics have a delay between administration and symptom relief at 2-6 weeks, leaving a so-called danger zone of about 1-3 months of risk for suicidal follow-through behaviors. Ketamine, a potent NMDA (N-methyl-D-aspartate) receptor antagonist, has recently seen widespread interest in both regulatory and clinical settings for increasing neuroplasticity and alleviating depressive symptoms. Ketamine's mechanism-of-action through mTORC1 is much faster than SSRI's downstream transcriptional regulation, leading to quicker relief of suicidal symptoms and the removal of the danger zone lag period. The current literature suggests that a controlled, supervised subanesthetic dose of Ketamine in a clinical setting has low risks of addiction or abuse, distinguishing therapeutic uses of Ketamine from recreational uses. While the biological efficacy of Ketamine is established, this conceptual review focuses on a possible initial hypothetical framework of a "Bridge Protocol." We searched PubMed, Google Scholar, The Cochrane Library, and PsycINFO (January 2000-December 2025) to synthesize evidence regarding SSRI latency, acute Ketamine protocols, and post-discharge safety. We conclude that while promising, the proposed Ketamine Bridge Therapy requires rigorous longitudinal validation and sustained clinical studies before it can be safely used and experience widespread adoption.