Healthcare最新文献

Background/Objectives: The common heart failure (HF) symptoms-dyspnea, fatigue, and edema-often prompt emergency visits. Dyspnea notably affects activities of daily living (ADLs), making its assessment crucial for evaluating therapeutic success. This study assesses the reliability and validity of the European Portuguese version of the London Chest Activity of Daily Living (LCADL) scale, originally validated in 2010, to evaluate ADL limitations in patients with HF. Methods: Following international guidelines for translation and cultural adaptation, 46 patients with HF from two cardiology departments were enrolled. The Six Minute Walk Test (6MWT) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used for construct validity. Results: A significant correlation was found between the results of the 6MWT and the LCADL total score (r = -0.504; p < 0.001) and the LCADL scale and the MLHFQ (r = 0.703; p < 0.001), except for the domestic activities dimension (r = 0.278; p = 0.062). Reliability revealed an α of 0.917. Conclusions: The study presents the validation of the European Portuguese version of the LCADL scale in patients with HF, emphasizing its reliability and cultural appropriateness. The LCADL scale has proven effective in assessing dyspnea-induced limitations in ADLs, and this study expands its utility by suggesting broader clinical setting applications. Future research should explore its adaptability in diverse healthcare settings, potentially enhancing personalized care strategies and patient outcomes. This work underscores the LCADL scale's role in facilitating more targeted and effective interventions for managing ADL limitations in patients with HF, suggesting a significant impact on clinical practices and patient care management.

Background/Objectives: Access to health services is a fundamental element of social welfare and individual quality of life. This study aimed to fill gaps in the Turkish literature regarding the assessment and perception of access to health services and to introduce a valid and reliable measurement tool for this purpose. Methods: This methodological cross-sectional study was conducted in Istanbul with 639 adults aged 18-65 years. Linguistic and cultural appropriateness were evaluated, and validation was assessed through known group validity using sociodemographic factors. Convergent and divergent validity analyses were performed. Reliability was examined using alpha coefficients and 27% percentile discrimination. A secondary confirmatory factor analysis provided the overall score for the scale. Results: The scale was validated on four factors, and seven items were removed during refinement, resulting in a final twenty-three-item scale. Internal consistency was robust, with alpha coefficients of 0.899 for acceptability and affordability, 0.825 for availability, 0.773 for accommodation, 0.892 for awareness, and 0.943 for overall access. Perceived access to health services was significantly correlated with age, beliefs in easy access to health, and satisfaction with outpatient care. Conclusions: The validated scale provides a reliable tool for measuring perceptions of access to health services, which is essential for shaping health policies and practices. Comprehensive assessments using such tools can help discern nuanced distinctions between perceived and actual access.

Objectives: To study the prevalence of injuries among padel players in Madinah and investigate potential causes. This study makes an attempt to add to the gaps in the literature regarding injury risks and preventive strategies in this fast-growing sport.

Methods: Retrospective cross-sectional study on 305 padel players who come from Madinah, consisting of 193 men and 112 women aged 18-40 years. Data were collected using an online Google Forms questionnaire, including descriptive statistics and non-parametric tests, among which the chi-square test was performed, aiming for the assessment of demographic and injury-related variables.

Results: There were significantly different incidences of injuries with regard to gender at the p = 0.001 level. A 44.6% prevalence was recorded among women, while men had a prevalence of 8.2%. With respect to the severity of injuries from moderate to severe, there are higher percentages in women that comprised 40.4% and 5.6%, respectively. The most frequent types of upper body injuries among women were ligament sprains and muscle strains. Stress and poor warm-up practices were some of the lifestyle factors identified to increase the risk of sustaining an injury.

Conclusions: This study highlights gender-specific injury patterns among padel players in Madinah, emphasizing the need for targeted injury prevention programs, including structured warm-ups and strength training. The findings contribute valuable insights for enhancing player safety and aligning with public health objectives under Saudi Vision 2030.

Objective: The aim of this scoping review was to evaluate whether artificial intelligence integrated into breast cancer screening work strategies could help resolve some diagnostic issues that still remain. Methods: PubMed, Web of Science, and Scopus were consulted. The literature research was updated to 28 May 2024. The PRISMA method of selecting articles was used. The articles were classified according to the type of publication (meta-analysis, trial, prospective, and retrospective studies); moreover, retrospective studies were based on citizen recruitment (organized screening vs. spontaneous screening and a combination of both). Results: Meta-analyses showed that AI had an effective reduction in the radiologists' reading time of radiological images, with a variation from 17 to 91%. Furthermore, they highlighted how the use of artificial intelligence software improved the diagnostic accuracy. Systematic review speculated that AI could reduce false negatives and positives and detect subtle abnormalities missed by human observers. DR with AI results from organized screening showed a higher recall rate, specificity, and PPV. Data from opportunistic screening found that AI could reduce interval cancer with a corresponding reduction in serious outcome. Nevertheless, the analysis of this review suggests that the study of breast density and interval cancer still requires numerous applications. Conclusions: Artificial intelligence appears to be a promising technology for health, with consequences that can have a major impact on healthcare systems. Where screening is opportunistic and involves only one human reader, the use of AI can increase diagnostic performance enough to equal that of double human reading.

Objectives: This study assessed associations of total and mental-activity-based sedentary behavior (SB) with the risk of being overweight or obese in adults. The role of sex and SB patterns and the effects of statistically exchanging different mental-activity-based SBs on body mass index (BMI) were explored. Methods: Participants (n = 1154) from the Saudi Post-COVID-19 Sedentary Behavior Survey self-reported demographics, health-related variables, and last-measured body height and weight. BMI was calculated to classify adults as normal weight or overweight/obese. The Sedentary Behavior Questionnaire estimated total and mentally active and passive SB per day, during weekdays, and on weekends. Adjusted logistic regression and isotemporal substitution models assessed the associations of SBs with the risk of being overweight or obese and the effects of displacing mental-activity-based SBs on BMI, respectively. Results: No significant relationships were observed in the overall sample (p > 0.05). Once sex was considered, the risk of being overweight or obese increased between 5.2% and 10.7% for each hour increase in total and mentally active SBs per day and on weekends in men only (p < 0.05 for all). Replacing one hour of mentally active SB with mentally passive SB resulted in non-significant effects on BMI (p > 0.05). Conclusions: These findings reveal the importance of distinguishing between SBs based on mental activity for more optimal obesity outcomes, particularly in men. Importantly, exchanging mental-activity-based SBs does not appear to be an effective behavioral strategy to reduce obesity. Obesity prevention and management plans should target reducing total and mentally active SBs daily and on weekends.

Migration generates changes in the quality of life (QoL) of immigrants. One of the difficulties that the process of migrating can entail is discrimination, which is the set of negative attitudes towards a person, in this case, because of their nationality. Objective: To analyze the effect that the sense of coherence (SOC) has on the relationship that discrimination by national origin has on quality of life. Method: The WHOQOL-BREF questionnaire was used to assess QoL, and Krieger's Perceived Discrimination Experiences scale and Antonovsky's SOC-13 scale were applied to 2144 participants (49.9% women), aged between 18 and 82 years, from Venezuela, Colombia and Peru, all of them being first generation migrants living in Chile. Results: In all the national groups evaluated, discrimination has an inverse relationship with both QoL and SOC, while the latter has a positive relationship with QoL. The direct effect of discrimination on QoL life is found to be smaller when this relationship is mediated by the presence of the SOC. This proposed model has good goodness-of-fit indicators in the three national groups evaluated. Conclusions: A strong and well-defined life purpose, a perception of greater control over surrounding events and situations, and perceiving life events as understandable and consistent can be an effective tools to diminish the effect of discrimination on quality of life in the migrant population.

Background/Objectives: New nurses often face challenges in adapting to clinical environments, particularly in mastering electronic medical record (EMR) systems, which are critical for effective patient care and communication. This study aimed to evaluate the effectiveness of a practice-oriented EMR education program designed to improve new nurses' EMR competencies. Methods: A quasi-experimental pretest-post-test design with a non-equivalent control group was employed. Fifty-four new nurses employed for less than a year participated, with 25 in the intervention group and 29 in the comparison group. The intervention group underwent five weekly sessions focused on core EMR tasks, including admission nursing, operation/procedure documentation, patient transfer/discharge, night duties, and SBAR handovers. The program, led by clinical nurse educators, incorporated lectures, practical exercises, and Q&A sessions. EMR competencies were assessed using a validated 5-point Likert scale. Results: The intervention group showed significant improvements across all assessed domains, with post-program scores significantly higher than those of the comparison group. The most notable improvements were in operation/procedure documentation and patient transfer/discharge tasks. The comparison group's gains were limited, likely reflecting natural skill acquisition through clinical experience. Conclusions: The practice-oriented EMR education program effectively enhanced new nurses' EMR competencies. The program's structured approach, which combined theoretical instruction with extensive hands-on practice and department-specific adaptations, proved particularly effective in improving complex documentation tasks. The integration of comprehensive EMR training into nursing curricula and the expansion of such programs to other institutions are recommended for broader implementation.

Background/Objectives: This study assessed the association among perceived stress, anxiety, and depression with both the metabolic syndrome (MetS) risk and diagnostic status among young adults in the Deep South. Methods: Participants included 132 young adults aged 18-39 (M_age = 27.73, SD = 11.11; M_BMI = 27.6, SD = 6.8; 56.5% female; 55.7% White) living in Mississippi. In addition to completing self-report measures of perceived stress, anxiety, and depression, all of the participants underwent anthropometric, blood pressure, and fasting blood glucose and lipid assessments to ascertain the MetS status. The participants were provided with both a MetS diagnosis (defined as a dichotomous yes/no variable) as well as a continuous MetS risk severity score determined using existing equations. The risk scores ranged from -1 to +1, with positive scores indicating an increased risk for MetS. Results: After controlling for age, biological sex, race, medication use, and education level, multiple regression models revealed significant positive relationships between perceived stress (b = 0.03; p = 0.017) and anxiety symptoms (b = 0.01; p = 0.039) with the MetS severity. Perceived stress (p = 0.017) and anxiety symptoms (p = 0.043) were also significantly higher among participants with MetS compared to those without. There were no significant associations between the MetS severity and depressive symptoms, and no differences in depressive symptoms in participants with versus without MetS. Conclusions: The results highlight the role of stress and anxiety not only in MetS but in the overall metabolic risk among young adults living in the Deep South. The results highlight the importance of intervening on stress and anxiety early in adulthood to help mitigate cardiometabolic health risk.

Background/Objectives: Patient safety is fundamental to primary healthcare, and medical errors impose a considerable burden on patients globally. However, the impact of medical errors on primary healthcare physicians remains understudied, especially in developing countries. This study aimed to examine the associations between self-reported medical errors and physicians' performance and confidence in Chinese primary care practice. Methods: A cross-sectional survey was conducted from November 2021 to May 2022 with 224 primary care physicians from 38 community health centers (CHCs) across four large cities in China. The quality of clinical and preventative care, and confidence in managing commonly occurring diseases, multimorbidity, and common mental health disorders served as indicators of performance and confidence, respectively. Hierarchical linear regression and linear regression with cluster-robust standard errors were employed. Results: Clinical care quality (β = -0.159, SE = 0.075, p < 0.05), preventive care quality (β = -0.165, SE = 0.068, p < 0.05), confidence in managing multimorbidity (β = -0.175, SE = 0.074, p < 0.05), and confidence in managing common mental health disorders (β = -0.189, SE = 0.076, p < 0.05) were negatively associated with self-reported medical errors, with scores of 4.08 (SD 0.95), 3.59 (SD 0.87), 3.63 (SD 1.04), and 3.10 (SD 1.21) out of 5 (where 5 represents the best possible score), respectively. The association between self-reported medical errors and confidence in managing commonly occurring diseases (β = -0.063, SE = 0.075, p > 0.05) was not statistically significant, with a score of 3.81 (SD 1.00) out of 5 (where 5 represents the best possible score). Conclusions: This study offers new insight into the associations between self-reported medical errors and primary healthcare physicians' performance and confidence. It is crucial for CHCs to be aware of the impact of self-reported medical errors on physicians' performance in delivering clinic and preventative care, and confidence in managing multimorbidity and common mental health disorders. Strategies such as strengthening organizational support should be developed to maintain performance and rebuild confidence in delivering care for physicians who were involved in medical errors.

Background/Objectives: Increased mortality and poor post-discharge outcomes are common in malnourished inpatients. It is unknown whether post-discharge outcomes differ between patients with hospital-acquired malnutrition (HAM) or malnutrition present on admission (MPOA), which could impact nutrition processes within healthcare systems and hospital-acquired-complication policy. This retrospective matched case-control study compared mortality, discharge location and readmission at 3-, 12- and 36-months post-discharge between HAM and MPOA patients. Methods: The eligible patients were ≥18 years, malnourished and stayed in hospital for >14 days between 2015 and 2019. HAM patients were 1:1 matched with MPOA patients for age (±3 years), sex, facility and year of admission and further categorised by age group (18 < 65, ≥65 years). The data were obtained from medical records included demographics, mortality, discharge location and readmissions. Statistical tests were used to compare the groups. Results: There were 350 eligible patients (n = 175 HAM, 65 ± 18 years, 37%F, 88% moderately malnourished, 71% from hospitals with >500 beds). HAM and MPOA patients had similar post-discharge mortality (n = 51/175 (29%) vs. n = 64/175 (37%), p > 0.172) and discharge locations (n = 101/111 (81%) vs. n = 91/124 (82%) resided at home, p = 1.00) at 36 months. Of those readmitted to hospital (n= 268/350, 77%), days hospitalised post-discharge (HAM:17(6-40) vs. MPOA:19(8-39)) and number of readmissions (HAM:2(1-4) vs. MPOA:2(1-5)) were similar at 36 months (p > 0.05). However, older MPOA patients were more likely to readmit within 30 days (p = 0.007). Conclusions: Mortality was high but similar between MPOA and HAM patients up to 36 months post-discharge. Discharge location and readmissions were also similar between the groups, except that older MPOA patients were more likely to readmit to hospital within 30 days than older HAM patients. Mechanisms, such as nutrition policies and procedures, implementation of post-discharge nutrition interventions or allocation of post-discharge resources, should be explored further and should consider all long-stay malnourished patients, particularly those aged ≥ 65 years, to reduce preventable patient harm associated with malnutrition.