Care Issues Research Articles

Exploring the Discriminant Validity of the Modified Arm Care Screen (MACS), Designed for Overhead Athletes, in Detecting Musculoskeletal Risk Factors in the General Population

Background: Shoulder pain is the third most common musculoskeletal issue in primary care, affecting up to 50% of patients six months post-consultation, leading to significant functional impairments and societal costs, especially due to sick leave. Shoulder injuries are particularly prevalent among ‘overhead athletes’ in sports like swimming, volleyball, and handball, with high injury rates reported annually. Screening tools like the Arm Care Screen (ACS) have been used to effectively identify athletes at risk of shoulder injuries. However, their applicability to the general population is less understood. This study aimed to assess the discriminant validity of a modified ACS (MACS) in detecting musculoskeletal risk factors among non-athletes. Methods: A prospective cross-sectional study was conducted with 30 asymptomatic subjects over 18, excluding those with a history of shoulder injuries or surgeries. The MACS, comprising four tests, was administered, and its diagnostic performance was evaluated through sensitivity, specificity, predictive values, and likelihood ratios. Results: The results indicated low sensitivity (0–47.62%) and variable specificity (55.56–100%), suggesting that the MACS may not effectively identify risk factors in the general population. Positive and negative predictive values were inconsistent (ranging from 0 to 100), as well as positive and negative likelihood ratios (ranging from 0 to 3.47), highlighting the need for non-athlete-specific screening tools. Conclusion: While the MACS shows promise in athletes, its application in the general population requires further refinement. This study underscores the necessity for tailored screening methods to enhance the early detection and prevention of musculoskeletal issues in diverse populations.

Implications of Big Data Analytics, AI, Machine Learning, and Deep Learning in the Health Care System of Bangladesh: Scoping Review.

The rapid advancement of digital technologies, particularly in big data analytics (BDA), artificial intelligence (AI), machine learning (ML), and deep learning (DL), is reshaping the global health care system, including in Bangladesh. The increased adoption of these technologies in health care delivery within Bangladesh has sparked their integration into health care and public health research, resulting in a noticeable surge in related studies. However, a critical gap exists, as there is a lack of comprehensive evidence regarding the research landscape; regulatory challenges; use cases; and the application and adoption of BDA, AI, ML, and DL in the health care system of Bangladesh. This gap impedes the attainment of optimal results. As Bangladesh is a leading implementer of digital technologies, bridging this gap is urgent for the effective use of these advancing technologies. This scoping review aims to collate (1) the existing research in Bangladesh's health care system, using the aforementioned technologies and synthesizing their findings, and (2) the limitations faced by researchers in integrating the aforementioned technologies into health care research. MEDLINE (via PubMed), IEEE Xplore, Scopus, and Embase databases were searched to identify published research articles between January 1, 2000, and September 10, 2023, meeting the following inclusion criteria: (1) any study using any of the BDA, AI, ML, and DL technologies and health care and public health datasets for predicting health issues and forecasting any kind of outbreak; (2) studies primarily focusing on health care and public health issues in Bangladesh; and (3) original research articles published in peer-reviewed journals and conference proceedings written in English. With the initial search, we identified 1653 studies. Following the inclusion and exclusion criteria and full-text review, 4.66% (77/1653) of the articles were finally included in this review. There was a substantial increase in studies over the last 5 years (2017-2023). Among the 77 studies, the majority (n=65, 84%) used ML models. A smaller proportion of studies incorporated AI (4/77, 5%), DL (7/77, 9%), and BDA (1/77, 1%) technologies. Among the reviewed articles, 52% (40/77) relied on primary data, while the remaining 48% (37/77) used secondary data. The primary research areas of focus were infectious diseases (15/77, 19%), noncommunicable diseases (23/77, 30%), child health (11/77, 14%), and mental health (9/77, 12%). This scoping review highlights remarkable progress in leveraging BDA, AI, ML, and DL within Bangladesh's health care system. The observed surge in studies over the last 5 years underscores the increasing significance of AI and related technologies in health care research. Notably, most (65/77, 84%) studies focused on ML models, unveiling opportunities for advancements in predictive modeling. This review encapsulates the current state of technological integration and propels us into a promising era for the future of digital Bangladesh.

Cardiovascular mortality rate between 2018 and 2022 in Kyrgyz Republic

Abstract Background Cardiovascular diseases (CVD) are the number one cause of death in low- and middle-income countries (LMICs), including Kyrgyz Republic. According to official statistics, CVD ranks first in the structure of overall mortality, accounting for more than half (52.1% according to 2022 data) of all deaths. Purpose to analyze the cardiovascular mortality rate in the Kyrgyz Republic, from 2018 to 2022. Methods Medical and statistical information on mortality from CVD in the population was obtained from the Centre for Electronic Health (CEH) of the Ministry of Health. To conduct a comparative analysis, relative indicators per 100 thousand population were calculated. A retrospective epidemiological study of mortality from CVD including different nosological forms over period for 2018–2022 was conducted, calculating the rate of increase (decrease). An analysis of the epidemiological situation of the disease in nine administrative-territorial units of the Kyrgyz Republic was also carried out with the calculation of the average 5-year mortality ratefor the period from 2018 to 2022. Results Despite the decrease in morbidity, a high proportion of mortality from CVD remains in all years, more than 50%. In terms of the percentage indicator for recent years, all this time it has maintained the highest position, in contrast to diseases of other organs and systems. In the last decade, from 2012 until 2020, there was a gradual decrease in the mortality rate. Since 2020, we have seen a sharp increase in the CVD mortality rate per 100 thousand population by 19.6% compared to 2018, by 19.4% since 2019, which is associated with the influence of Covid-19 pandemic, in 2021 this indicator amounted to 297.6 cases, in 2022 - 234.5. The main contribution to population death from CVD is made by coronary heart disease (65.90%), including acute myocardial infarction, cerebrovascular diseases (21.4%), arterial hypertension (5.9%). If we analyze the mortality rate from CVD by nine administrative-territorial units, the highest rates in 2022 are observed in the Chui and Talas regions, 291.9 and 266.3 per 100 thousand population respectively; the lowest in the Osh region (207.3), Osh city (196.1) and Bishkek (208.6), which is explained by the better organization of health services in these areas. Conclusion CVD remains the main cause of mortality in the population of the Kyrgyz Republic. Although over the past year there has been a good decline in this indicator, in almost all regions, particularly the greatest successes have been achieved in Naryn and Issyk-Kul regions. In connection with the above, there is requirement for a clear identification of priorities when determining the strategy of treatment and preventive interventions. It is necessary to create an effective National system of care for patients with CVD with a focus on emergency cardiac care and prevention issues.

The hidden costs: a qualitative analysis exploring the experience of prostate cancer treatment-related side effects on sexual function and urinary incontinence among Black survivors and their caregivers.

Prostate cancer (PCa) disproportionately affects Black men in the U.S., leading to high incidence and mortality rates. Post-treatment challenges, such as sexual dysfunction and urinary incontinence, significantly impact quality of life yet are frequently overlooked. The purpose of this study was to characterize the experience of treatment-related side effects around sexual function and urinary incontinence among Black survivors of PCa and their caregivers. We conducted semi-structured virtual interviews with 11 Black survivors of PCa and 11 caregivers (22 total participants). Survivors were eligible if they were diagnosed and treated for PCa within the last decade and caregivers were eligible if they self-identified as a caregiver for a Black survivor. Interviews were transcribed verbatim and analyzed using a qualitative descriptive approach. During interviews, participants spontaneously discussed topics covering sexual dysfunction and urinary incontinence. Key themes identified from interview discussions included the physical experience of PCa treatment, knowledge of the impact of PCa treatment on life quality, and the process of navigating survivorship care. Although they received peer and familial support, survivors expressed a desire for clinicians to initiate discussions on sexual dysfunction and urinary incontinence. Caregivers recounted their experiences while providing support to the survivor. The findings underscore the need for clinicians to prioritize discussions on sexual dysfunction and urinary incontinence with patients, and for enhancement of care pathways and resources for these issues in survivorship care. Trained professionals, such as occupational and physical therapists, social workers, genetic counselors, and psychologists, have the potential to fill this survivorship care gap.

Community Provider Perspectives on an Autism Learning Health Network: A Qualitative Study.

Although autism is highly prevalent, no single care center has enough patients to produce generalizable knowledge of optimal care; this slows the pace of quality improvement research. The Autism Care Network (ACNet) is a learning health network (LHN) dedicated to developing the most effective approach to care for autistic children and adolescents through integrating clinical and research data. Given that most autistic patients receive care in the community, expanding ACNet to include community providers is essential to improve autism care. Our objectives were to: (1) understand the current data collection practices, learning needs, capacity, and overall interest of community clinicians in participating in an autism LHN; (2) identify their perspectives on participating in a LHN and ways in which their engagement and interest can be cultivated. Participants were purposively sampled from community physicians who participated in ASD-focused educational programming. In-depth semi-structured interviews were conducted. Analysis of 29 participant interviews yielded five primary themes: Navigating Administrative Challenges, Improving Data Collection Practices, Increasing Provider Confidence and Competence, Breaking Down Silos, and System and Societal Barriers to Achieving Best Practices. This study provides a rich and nuanced understanding of the experiences of community providers regarding the challenges of ASD care provision in the community. Overall, these findings suggest that LHNs have the potential to address several of the issues in community autism care highlighted by community providers.

04 Care for adolescents with substance use: A national survey of paediatric hospitals

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

Tabular review of contemporary open surgical repair experiences for treatment of thoracoabdominal aortic aneurysms.

Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) is one of the most challenging operations due to extensive surgical dissection and exposure, risk of complications and need for reconstruction of the aorta and its branches. In the last two decades, endovascular techniques have evolved and now are considered a viable alternative to open surgical repair in patients with suitable anatomy. Regardless of which technique is selected, open or endovascular, reduction of postoperative morbidity and mortality requires large clinical volume, optimal patient selection and a multidisciplinary team that can take care of the surgical, anesthetic, critical care and postoperative issues that occur after these operations. The aim of this article is to summarize the clinical data on open surgical repair of thoracoabdominal aortic aneurysms in a schematic tabular format.

Rethinking Intergenerational Living as the Ideal Form of Senior Care: Life Course Research with Immigrant Families in Toronto

Canada’s care systems are ill-equipped to support its aging population, and this crisis intertwines with an acute shortage of affordable housing. Immigrants to Canada have a higher propensity to cohabitate multi-generationally, an arrangement that is sometimes romanticized as an ideal form of senior care. This article contributes to scholarship exploring intergenerational cohabitation as a practice of care, using life course research to consider how class and migration timing shape experiences of intergenerational living and senior care. Based on 19 in-depth interviews with immigrant seniors from Latin America and the Caribbean (n=10) and family caregivers (n=9) living in the Greater Toronto Area, this study uncovers two central findings. First, intergenerational living should not be viewed as an ideal form of senior care since (1a) some seniors resist intergenerational living, preferring independence and downtown residence nearer to culturally relevant communities and (1b) cohabitation does not always provide sufficient or better care. Second, access to smooth multigenerational cohabitation is inequitable, as housing arrangements are structured by class and migration timing, with middle-class families who have been in Canada longer facing fewer barriers to positive experiences of intergenerational living, compared to more recent migrants with lower incomes. This article challenges culturally essentializing assumptions about immigrant intergenerational cohabitation and argues that access to affordable housing is a senior care issue.

A Study Of Accreditation Status Synchronization And Regional Public Service Agency As A Model Of Public Health Service (Puskesmas) Management Improvement

Indonesia still has public health centre (Puskesmas) health care issues. The data from Bengkulu is comparable to those from the national level. It shows that Puskesmas has not maximised gatekeeping. We need responsible Puskesmas management and high-quality, sustainable health care to address these problems. Pushesmas' accreditation and Regional Public Service Agency status help the government improve Puskesmas administration. We need a synchronization model because we implement accreditation and BLUD separately. Given the current situation, this study explores potential synchronization strategies between accreditation and BLUD to enhance Puskesmas management. The study describes the condition of accredited and BLUD Puskesmas, identifies the problems, investigates the role capabilities of the parties involved, seeks to synchronise Puskesmas management, and formulates a strategy to improve management. This qualitative descriptive research uses a case study approach with purposive sampling to examine Puskesmas, an accredited and BLUD school in Bengkulu Province. Researchers conduct in-depth interviews, observations, library studies, and documentation. Researchers analyse data through collection, reduction, presentation, and verification or conclusion. They also triangulate data, sources, and procedures for data validity analysis. This research created a Puskesmas Management Improvement Strategy Model as a Novelty

Anatomy of the uterus of sheep of the Edilbaev breed in the age aspect

Sheep farming is one of the key branches of animal husbandry in the Russian Federation. Various measures aimed at further increasing the useful qualities in sheep breeding are based not only on breeding principles, but also on the achievements of veterinary sciences. It is quite understandable that the special attention of biological science and agricultural practice to the breed, age, and species characteristics of animals, namely to the reproduction system, allows us to scientifically and correctly raise issues in breeding, care, feeding, exploitation and reproduction. Not knowing the issues of anatomical topography, the structure of organs in animals of different age groups, it is difficult to carry out various medical manipulations in surgical or obstetric and gynecological practice. The study was conducted at the Department of Animal Anatomy of the St. Petersburg State University of Veterinary Medicine. Cadaveric material for the study was delivered to the Department of Animal Anatomy of the St. Petersburg State University of Veterinary Medicine from a farm in the Leningrad Region. Female sheep of the Edilbaev breed served as the object of the study. Three age groups were selected for the study. The study established the anatomical features of the uterus in the age aspect in sheep of the Edilbaev breed, and morphometric measurements were carried out in three age-related physiological groups (fetuses, newborns, young). Skeleto- and syntopia of all parts of the uterus was determined in different age groups. It was established that the uterus of sheep of the Edilbaevsky breed belongs to mobile organs, that is, depending on physiological conditions, it can change its topographic location points. Morphometry has determined that there is an uneven increase in the components of all parts of the uterus from the fetal period to the age stage of the young. The results of the study can be used by veterinary specialists, in particular obstetricians, surgeons to establish operative access to the uterus and in obstetric and gynecological practice in sheep breeding.

Survey of GP registrars' training experience and confidence in managing children and adolescents with mental health conditions in primary care.

The aim of thisstudy is to assess General Practitioner (GP) trainees' training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland. An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants' training experiences and confidence levels in key areas of child and adolescent mental health in primary care. Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders. The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.

Struggling with studying and earning – realities of the UK's cost-of-living crisis on students on social work programmes

ABSTRACT The UK has been experiencing an extended cost-of-living crisis since 2021 and students attending universities have struggled with the impacts of rising prices. This article reports on findings from a study to explore local recruitment and retention issues in adult social care from the perspective of different populations of interest in the South of England. A mixed methods approach was undertaken. One group of participants were students enrolled in social work undergraduate and postgraduate programmes. They completed an online questionnaire (n = 20), with a subsample (n = 11) being interviewed. Comments relating to the wide-ranging effects of cost-of-living issues discussed by the participants were themed together and are described. The findings offer suggestions to evaluate student support mechanisms and reduce the potential impacts of ongoing financial difficulties caused by the need to juggle course, placement and financial demands across this and other applicable undergraduate sectors and their programmes. They also reflect risks to future workforce recruitment alongside the potential of ‘earn and learn’ programmes, such as apprenticeship routes – which may offer a viable alternative to qualification for those at particular risk of financial hardship whilst studying.

Addressing Rural Health Issues through Policy Storytelling

Police officers, teachers, and social (vocational) workers (SLBs) interact the most with citizens and can implement policy. The citizens being mentioned end up being our patients in these rural areas. We need to learn about who the patients and citizens are through a medical front-line lens the same way SLBs do. Interviews, focus groups, observations and other qualitative methods will help surgical administrative professionals who want to address the access to care issue in underserved and rural areas. In return, this can help retain staff and prevent staff burnout by addressing the problems of potential patients before they occur.

From classroom to collaboration: how pre-graduation interprofessional learning shapes health professional graduates’ interactions in practice

ABSTRACT Interprofessional education (IPE) aims to prepare health professional students with the knowledge, attitudes and skills required for collaborative healthcare practice. Although positive outcomes have been documented at the completion of university-based IPE experiences, or longitudinally across health care degrees, the literature is unclear on how university-based IPE influences graduate practice. This study therefore explores how health professional graduates experience interprofessional interactions in practice and how these may be connected to their university-based IPE experiences. Interviews with seven health professional graduates who had participated in an 11-week IPE course as part of their pre-licensure degrees were analyzed using interpretative phenomenological analysis. The participants were able to articulate instances of effective and less effective collaboration from their professional experiences, making sense of these experiences with explicit reference to the themes of role understanding, collaborative working relationships, interprofessional communication, patient-centered care and contextual influences; all ideas introduced in their university-based IPE. They connected their understanding of roles, collaborative working relationships and interprofessional communication explicitly to their prior university-based IPE, identifying these learnings as foundational knowledge. This connection was not as explicit for patient-centered care and contextual issues. These findings highlight the critical importance of IPE in preparing health professionals for high-quality contemporary practice.

Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention

BackgroundInterventions targeting healthcare professionals’ confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy.MethodsUsing a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis.ResultsWhile no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention.ConclusionsThe CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.

Medical students’ knowledge on palliative care – a survey of teaching in Finland

Background Most studies on palliative medicine (PM) undergraduate education have focused on contents and organizational issues but not the outcome. Students’ learning outcomes should be studied to improve teaching in medical schools. Methods A questionnaire about perceived PM education and attitudes on palliative care (PC) was sent to 543 last year students in all five Finnish medical schools in 2018–2019. In total, 175 (32 %) responses were received from four universities. The students evaluated both the quantity and quality of their PM teaching, implementation of European Association for Palliative Care (EAPC) guidelines and their satisfaction to the training. There were two palliative case scenarios, and the students were asked to find the best treatment option. In addition, students´ attitudes towards end-of-life (EOL) care issues were examined. Results In the Finnish universities, PM education was available mainly integrated with oncology, geriatrics, and general medicine. A total of two universities also offered a specific PM course. In average, 50–70% of the EAPC curriculum was covered by lectures, small-group teaching, seminars, and bedside teaching with significant differences between faculties. Only 30–60 % of students were satisfied with the education received. The highest rankings were given in the universities with a special PM course. Students from these universities expressed less anxiety in facing EOL issues. Conclusions In Finland, the coverage of EAPC curriculum is satisfactory, but the PM education is mainly given integrated with other specialties. The dedicated course on PM was associated with increased perceived knowledge and satisfaction of PM education. However, PM training was not associated with students’ attitudes on PC.

Painting workshops for people living with dementia as a means of expression and communication: revelations from our elders

Purpose This study aims to explore art workshops for people living with dementia as a process enabling creative expression and fostering communication with others. Design/methodology/approach To enable detailed exploration of the expressive powers of painting and drawing, the authors draw several examples from a series of painting workshops for people living with dementia, which formed part of the PPI for research into experiences of restraint within care. Findings Artwork enabled personal expression, facilitated conversation with others and revealed hidden knowledge and abilities, but also revealed dangers of miscommunication, specifically here related to technological changes and spirituality. Research limitations/implications Individual differences in responses to painting will exist meaning that the specific findings outlined here are unique to individuals and not always generalisable. This follows from the quality of the individual communication that may be enabled by painting, meaning that close attention to each person is both fostered and required. Practical implications Art activities can provide a means to enable deep personal expression and agency in people living with dementia, which can contribute to countering dehumanisation. Social implications Attention to the process of painting can be beneficial in fostering verbal and non-verbal communication with individuals who have difficulties in communication. Attention to cultural issues in care needs to incorporate understanding of spiritual and religious issues and take note of gaps in understanding related to technological as well as cultural changes between generations. Originality/value Much work in this area explores art activities for people living with dementia in terms of beneficial outcomes. This work explores the creative process inherent in painting, drawing upon insights from art theory and providing in-depth individual insights through case studies. Both researchers in this study are artists and the work drew upon their understanding of the processes of painting.

The relationship between positive end-expiratory pressure (PEEP) and intra-abdominal pressure (IAP) in mechanically ventilated patients: A prospective observational study.

Positive end-expiratory pressure is a crucial mechanical breathing parameter. Intra-abdominal hypertension is well defined as a sustained increase in the intra-abdominal pressure ≥12 mmHg. There are still controversies about mechanical ventilation's effect and use of positive end-expiratory pressure on intra-abdominal pressure. We aimed to delineate the relationship between positive end-expiratory pressure and intra-abdominal pressure in mechanically ventilated patients admitted to the intensive care units of a large tertiary hospital in Upper Egypt. This study was a prospective observational study. The study was conducted at a university hospital from October 2023 to February 2024. The enrolled adult patients were allocated into two groups based on their positive end-expiratory pressure: group I, low pressure (<8 cm H2O) and group II, high pressure (8-10 cm H2O). A total of 120 patients were enrolled, 60 patients in each group. The most commonly encountered diagnoses were pneumonia (32/120, 26.7%) and acute respiratory distress syndrome (ARDS) (31/120, 25.8%), respectively. There was a significant difference between the intra-abdominal pressure mean values of the two patient groups, 18.9 ± 3.3 versus 24.4 ± 5.9 mmHg in the group of low versus high pressure (correlation value of .454, p < .001), respectively. There were highly significant correlations between intra-abdominal pressure categories and the patient groups (correlation value of .495, p < .001). There were 24 (40%) versus 0 (0%) patients of high pressure versus low pressure within the category IV group of intra-abdominal hypertension (>25 mmHg). We observed a significant relationship between positive end-expiratory pressure and intra-abdominal pressure in mechanically ventilated patients. The patient group with high pressure had higher mean values compared with the group with low pressure. The study highlights the importance of closely monitoring intra-abdominal pressure in mechanically ventilated patients who receive positive end-expiratory pressure. Further studies are warranted. The relationship between positive end-expiratory pressure and intra-abdominal pressure is an essential issue in daily critical care nursing clinical practice. Considering the occurrence of multiple organ dysfunction as a result of a non-detected increase in intra-abdominal pressure, critical care nurses should pay attention to measuring this pressure to maintain intra-abdominal pressures that are safe for mechanically ventilated and critically ill intensive care unit patients, thereby preventing these undue effects.

Reflections on the Challenges of Old-age Security and Policy Options for an Ageing Population

The global phenomenon of population aging is advancing at an unprecedented pace, particularly in China, where the accelerating aging process poses substantial challenges to the existing pension security system. The issue of elderly care has emerged as a critical topic in the realms of society, economy, and politics, impacting national sustainability and social stability. The challenges brought about by an aging society extend beyond the pressures of pension payments and insufficient elderly care services, encompassing risks related to funding sources and management, as well as concerns over the fairness of the security system. In the face of these challenges, there is an urgent need to optimize pension policies, advance pension system reforms, enhance the elderly care service system, and strengthen the coordination between social and medical security to construct a more equitable and sustainable pension security framework. Measures must be collaboratively advanced through top-level institutional design, policy execution efficiency, and societal involvement to provide robust support in addressing the challenges of aging. This paper will delve into the impact of population aging on the pension security system, analyze the current state and shortcomings of policies, and propose strategies to enhance the system's resilience, offering insights and recommendations for strengthening the pension security framework.

EJS-1 Economic issues for health care: patients', doctors' and payers' perspectives

EJS-1 Economic issues for health care: patients', doctors' and payers' perspectives