Healthcare最新文献

Invasive lobular carcinoma (ILC) accounts for approximately 15% of breast cancers and the most common neoplasm in the female population. Cervical involvement is exceptionally rare and often underrecognized. This relationship is well-defined in the context of breast and ovarian cancer syndrome related to BRCA gene mutations. However, it is also observed in rare but underreported cases of cervical metastases originating from breast cancer. The objective of this manuscript is to describe a rare case of cervical recurrence of invasive lobular carcinoma and summarize comparable case to guide future gynecologic follow-up strategies. Therefore, we report the case of a 60-year-old woman who developed a late cervical recurrence of ILC ten years after her initial breast cancer diagnosis. The patient had previously undergone mastectomy for ER-positive, PR-positive, HER2-negative ILC, followed by five years of adjuvant endocrine therapy. She remained disease-free until presenting with post-menopausal bleeding, urinary symptoms, and acute renal failure. Pelvic examination and ultrasonography revealed an enlarged, indurated cervix with bilateral hydroureteronephrosis. Biopsy demonstrated a discohesive infiltrate consistent with metastatic lobular carcinoma, confirmed by immunohistochemistry (GATA3+, CK7+, ER/PR+, E-cadherin-, CK20-, CDX2-). Staging PET-CT showed additional metastases involving bone, peritoneum, and lymph nodes. The patient began systemic therapy with ribociclib plus letrozole, achieving radiologic improvement of the cervical lesion and abdominal disease. After a follow-up of several months, she maintains stable disease but has persistent chronic renal impairment secondary to obstructive uropathy. This case highlights the ability of ILC to recur after long latency and to metastasize to unusual gynecologic sites such as the cervix. We also review the literature on cervical recurrence from lobular carcinoma to emphasize the importance of gynecologic surveillance in breast cancer survivors and to identify areas that require further investigation.

Background/Objectives: The present exploratory study evaluates the feasibility and psychological effects of a structured Qigong intervention implemented in an Italian university setting. Qigong is a traditional Chinese mind-body practice combining gentle movements, breathwork, and mindful attention, aimed at enhancing mind-body integration and interoceptive awareness. Methods: A total of 332 undergraduate students voluntarily enrolled in a 12-week Qigong program. The intervention was based on Neidan Qigong and integrated both static and dynamic exercises. Psychological functioning was assessed through several self-report measures evaluating a range of constructs, including mindfulness (FFMQ), interoceptive ability (MAIA), perceived stress (PSS), depression, anxiety, and stress (BDI; DASS-21; STAI Y), emotion regulation (DERS), alexithymia (TAS), and sleep quality (PSQI). Results: A total of 114 students completed the intervention. The protocol was well received by participants and demonstrated high feasibility in the academic context, with good attendance rates and overall engagement. Preliminary findings indicate consistent improvements across several psychological domains. Conclusions: The results suggest that Qigong may be associated with improvements in mental health and well-being in young adults and may represent a promising, low-cost intervention. The findings should be interpreted as preliminary. Further research using controlled and methodologically rigorous designs is needed to assess the stability of these effects over time, incorporate physiological measures, and clarify the specific therapeutic contribution of spontaneous movement within Qigong practice.

Background: Incarcerated men experience disproportionately high levels of health inequities shaped by social determinants, including poverty, violence, family adversity, trauma, and limited access to healthcare. These long-standing disadvantages, added to the adverse conditions experienced in prisons, may be associated with elevated rates of suicidality in this population. This study examined the prevalence of suicidal ideation and lifetime suicide attempts among men deprived of liberty in Southern Brazil and investigated the role of cumulative adversities and current protective factors in these outcomes. Methods: A cross-sectional study was conducted with 496 incarcerated men. Participants completed a sociodemographic and background questionnaire assessing lifetime adversity (e.g., hunger, homelessness, sexual abuse, domestic violence, family substance dependence) and current protective factors in prison (e.g., family visits, education, leisure, physical activity, religion, positive self-perception). Cumulative adversity and protective factors were operationalized as composite indices. Logistic regression models tested whether cumulative adversities and protective factors were independently associated with suicidal ideation and suicide attempts. Results: Lifetime prevalence was 9.6% for suicidal ideation and 10.8% for suicide attempts. Cumulative adversities were associated with higher odds of both suicidal ideation (OR = 1.43; 95% CI = 1.11-1.84; p = 0.006) and suicide attempts (OR = 1.94; 95% CI = 1.50-2.52; p < 0.001). Protective factors were associated with lower likelihood of suicidal ideation (OR = 0.74; 95% CI = 0.58-0.96; p = 0.020) but were not significantly associated with suicide attempts. No significant interaction effects were observed, indicating that protective factors did not moderate the impact of adversity. Conclusions: Suicidal tendencies among incarcerated men were associated with cumulative structural and psychosocial adversities. Protective factors in prison were associated with lower odds of ideation but not attempts. These associations may inform person-centered and equity-oriented approaches and are consistent with the relevance of social determinants to mental health, although causal inferences are not supported by this project.

The rapid expansion of mindfulness research has generated both enthusiasm and controversy regarding its actual clinical value. While meditation is often regarded as the central mechanism of mindfulness-based interventions, other components such as psychoeducation and informal practice may play an equally significant role in improving mental health outcomes. This critical review examines the relative contributions of these elements to the therapeutic impact of mindfulness and clarifies the extent to which its effects are comparable to established treatments, particularly Cognitive Behavioral Therapy (CBT). Evidence from meta-analyses and high-quality trials indicates that mindfulness programs achieve moderate efficacy in reducing symptoms of anxiety, depression, and stress, but effect sizes are frequently inflated by methodological limitations. Importantly, cognitive and emotional regulation skills, especially acceptance and non-judgment, appear to sustain long-term benefits more consistently than meditation alone. These findings highlight the need for rigorous longitudinal studies and component-focused designs to identify the mechanisms that drive clinical change. By distinguishing between evidence-based applications and overstated claims, this review contributes to a more balanced understanding of mindfulness and its appropriate integration into healthcare.

Background: Managing chronic conditions can overwhelm patients and reduce their confidence in self-management. Patient activation (PA) is a concept that reflects patients' knowledge, skills, and confidence in managing their health and self-care. In Jordan, PA has not been explicitly studied, particularly among patients with chronic conditions. Therefore, this study explores PA and its determinants in individuals with chronic conditions in Jordan. Methods: A cross-sectional study was conducted using a convenience sample of outpatients recruited from a tertiary hospital in Jordan. Participants completed a questionnaire including sociodemographic and clinical data, the Single Item Literacy Screener, and the 13-item Patient Activation Measure (PAM). Bivariate and regression analyses were conducted to explore the factors associated with PAM scores. Results: Among a total of 666 participants, the mean PAM score was 57.1 ± 9.17, indicating a moderate activation level overall. Regression analysis revealed that being female (p = 0.14), adequate health literacy (p = 0.002), and post-secondary education (p = 0.004) were significantly associated with higher PAM scores, and older age (p = 0.004) and polypharmacy (p = 0.010) with lower scores. An additional regression model showed that the negative association between polypharmacy and PA scores did not differ by health literacy level, with no significant interaction between polypharmacy and health literacy (p = 0.555). Conclusions: This study showed that individuals with chronic illnesses in Jordan had moderate to high patient activation levels. Several sociodemographic and clinical factors were significantly associated with patient activation. Polypharmacy was independently associated with lower patient activation scores, regardless of health literacy levels. However, given the study's exploratory nature, the results should be interpreted as preliminary evidence warranting further research.

Backgrounds/Objectives: Mindfulness-based stress reduction (MBSR) programs may have applications for adults with cerebral palsy (CP), particularly as this population is at increased risk of mental health challenges relative to the general population. However, little is known about the experiences of adults with CP participating in these programs. The aim of this study was to explore the experiences of adults with CP, and a facilitator, who participated in a 9-week MBSR telehealth program. Methods: Adults who attended an MBSR telehealth program were invited to participate in focus groups. If a participant was unable to attend a focus group, they were offered a semi-structured interview. The facilitator participated in a semi-structured interview. Focus groups and interviews were recorded, transcribed verbatim, and inductively thematically analyzed using Framework Analysis. Results: Ten adults with CP and one facilitator participated. Feedback on the program spanned across three themes: (i) learning and creating my mindfulness toolbox; (ii) applying mindfulness to everyday life; and (iii) online together with expert facilitation. Participants appreciated having access to a variety of mindfulness techniques to accommodate individual preferences. Peer-learning in a facilitated, online group context was also valued. Participants recalled implementing mindfulness strategies in everyday life and provided recommendations of how to improve the program. These included incorporating a group orientation, shortening group sessions to reduce fatigue, and follow-up sessions to maintain mindfulness skills after program completion. Conclusions: This study provides new knowledge about the perspectives of adults with CP regarding MBSR delivered via telehealth. Participant recommendations should inform future implementation of group mindfulness telehealth programs for adults with CP.

Objectives: Clinical decision-support systems are computer-based tools to improve healthcare decision-making. However, their effectiveness depends on being positively perceived and well understood by healthcare professionals. Qualitative research is particularly valuable for exploring related behaviors and attitudes. This study aims to explore experiences of family physicians and nurses concerning the visualization, utility and understanding of the non-valvular atrial fibrillation clinical decision-support system (CDS-NVAF) tool in primary care in Catalonia, Spain. Methods: We performed a qualitative study, taking a pragmatic utilitarian approach, comprising focus groups with healthcare professionals from primary care centers in the intervention arm of the CDS-NVAF tool randomized clinical trial. A thematic content analysis was performed. Results: Thirty-three healthcare professionals participated in three focus groups. We identified three key themes: (1) barriers to tool adherence, encompassing problems related to understanding the CDS-NVAF tool, alert fatigue, and workload; (2) using the CDS-NVAF tool: differences in interpretations of Time in Therapeutic Range (TTR) assessments, and the value of TTR for assessing patient risk; (3) participants' suggestions: improvements in workflow, technical aspects, and training in non-valvular atrial fibrillation management. Conclusions: Healthcare professionals endorsed a clinical decision-support system for managing oral anticoagulation in non-valvular atrial fibrillation patients in primary care. However, they emphasized the view that the CDS-NVAF requires technical changes related to its visualization and better integration in their workflow, as well as continuing training to reinforce their theoretical and practical knowledge for better TTR interpretation.

Background: This study investigated the relationships between hematological and bone metabolism variables in 35 elite female trail runners, focusing on identifying key hematological correlates of bone health. Methods: Forty-four hematological variables, including biochemical, hormonal, metabolic, liver enzyme, and iron profiles, as well as complete blood count and platelet indices, were analyzed. Bone mineral density (BMD) and bone mineral content (BMC) were assessed at multiple skeletal regions via dual-energy X-ray absorptiometry (DXA). A cross-sectional design was employed, utilizing descriptive statistics, correlation analyses, and multiple linear regression to analyze the associations between hematological markers and BMC and BMD. Results: Significant but moderate associations were identified: magnesium consistently emerged as a negatively associated factor, particularly associated with BMC and BMD in the lumbar spine (L1-L4) and whole-body, potentially reflecting hypothesized mineral mobilization during chronic physical stress. Follicle-stimulating hormone showed positive associations with BMD, suggesting a potential protective association in bone turnover regulation. Additionally, calcium and thyroid hormones were linked to regional bone properties, highlighting site-specific skeletal vulnerabilities. Conclusions: These findings suggest a complex interplay between mineral homeostasis and hormonal balance that may be related to skeletal integrity in elite female trail runners. This work provides a foundation for developing evidence-based guidelines to support the health and performance of female endurance athletes. Further research is warranted to confirm these results through longitudinal evaluations.

Objective. The aim of this study was to define a structured competence model for nurses working in gastrointestinal endoscopy in Italy and to assess nurses' perceptions of the number of procedural repetitions required to acquire and maintain competence across different endoscopic procedures. Methods. A cross-sectional online survey targeted registered nurses working in Italian gastrointestinal endoscopy units. The questionnaire, developed from guidelines and expert consensus, covered demographics, organizational context, and perceived repetition thresholds for 30 procedures. Partial Credit Models (PCMs) estimated acquisition and maintenance thresholds; Differential Item Functioning (DIF) tested differences by self-reported experience level. Results. A total of 332 nurses participated (68.4% female; mean age 47.1 years; mean endoscopy experience 10.1 years). For competence acquisition, most procedures were placed in the 11-30 or 31-50 repetition range, with higher values for complex techniques. Competence maintenance generally required fewer repetitions, but thresholds varied by procedure. Advanced or infrequently performed techniques were perceived as more demanding. More experienced nurses reported higher thresholds, reflecting stricter internal standards. Conclusions. Acquisition and maintenance of gastrointestinal endoscopy competences differ in intensity and frequency requirements, supporting the need for tailored, modular training pathways. Findings highlight the importance of national competence standards, adaptive learning technologies, and structured mentorship to enhance skill development, reduce variability, and promote consistent, high-quality patient care across Italy.

Background/Objectives: Healthcare workers at the frontline of managing pandemics are at increased risk for adverse physical and mental health outcomes, which has been shown to result in burnout. The relationship between personal resilience and burnout among clinical and non-clinical healthcare staff working in an acute care setting was assessed at the start of the COVID-19 pandemic. Methods: A prospective cross-sectional survey design with electronic questionnaires was used to measure resilience (Connor-Davidson Resilience Scale,) and burnout (Maslach Burnout Inventory-Human Services Survey). Linear regression analyses were conducted to examine the relationship between resilience and emotional exhaustion, depersonalization, and personal accomplishment. Results: A significant inverse relationship between resilience and both emotional exhaustion and depersonalization, and a positive relationship between resilience and personal accomplishment were identified. Higher resilience scores were significantly associated with lower emotional exhaustion and depersonalization and higher personal accomplishment under pandemic conditions. Conclusions: Strategies to boost resilience organization-wide amongst healthcare staff providing patient care are critical for providing skills to reduce the onset of burnout and support employee mental health. From a pandemic preparedness lens, organizational-level emergency management should consider the importance of resilience-building among staff to proactively prevent burnout and its subsequent effects on patient-care and general hospital functioning.