Cross-sectional Survey Study Research Articles

Correlation between illness perceptions and self-reported degree-of-worry in somatic ill patients in emergency care: a Danish cross-sectional study.

The study aimed to investigate the correlation between illness perceptions and self-reported degree-of-worry (DOW) in patients presenting to the emergency department with acute somatic illness. A cross-sectional survey study collected data from a survey on DOW, the Brief-illness Perception Questionnaire (B-IPQ) and demographics. An emergency department at a university hospital in the Capital Region of Denmark. 944 patients (≥18 years) presenting to the emergency department with acute somatic illness. Data collection was conducted during day and evening shifts on weekdays from 13 January to 19 December 2020. Correlations between B-IPQ scores and DOW, including (1) the total B-IPQ score, (2) emotional representations (emotion and illness concern combined) and (3) the single items, respectively. Secondary analysis: linear relationships between the single B-IPQ items and DOW. Analyses included the variables sex, age, reason for contact, self-reported comorbidity, employment, highest educational attainment, cohabitation status and region of origin. The study found moderate correlations between the total illness perceptions score and DOW of 0.47 (95% CI 0.42 to 0.52) and emotional representations and DOW of 0.57 (95% CI 0.52 to 0.61). Linear regression showed the largest and most significant changes in DOW with an increasing score of the B-IPQ items for consequence, illness concern and emotion. Illness perceptions overall and perceptions of consequences of symptoms, illness concern and emotional representations are correlated with patients' DOW, with increasing DOW related to more negative illness perceptions. This finding contributes to insight into how illness perceptions are related to illness worry when presenting to the emergency department. Incorporating the novel DOW scale may aid triage and clinical encounters in the emergency department. ClinicalTrails.gov reference: NCT04226040.

Views of research ethics committee members on end-of-participation communications for trial participants who stop taking part: a cross-sectional survey study

BackgroundGiving information to trial participants who stop taking part could support them through what can be a difficult process. We previously developed guidance around the ethical acceptability of such information provision, and about how trialists can develop suitable communication materials. There is limited evidence about what research ethics committees think of this issue, and limited guidance about what level of oversight they should have over the proposed communications, or post-consent participant communications generally. We conducted a survey of UK ethics committee members to address these points.MethodsThe survey was co-developed by public contributors and trialists who had previously worked together on the communications guidance. We asked respondents if they agreed with the general idea of informing participants who stop taking part, if they had ever been requested to review similar communications, and what level of ethics committee review they might recommend. The survey was primarily conducted online. It was reviewed by three ethics committee members before finalisation and shared directly with all UK ethics committee members. We analysed quantitative questions descriptively and used inductive analysis for open questions to identify common themes.ResultsNinety-one ethics committee members participated (nearly 10% of all UK members). The sample was similar to reported data about all members in terms of several personal characteristics. Most respondents (83%) agreed with our project’s rationale. Only 23% of respondents reported having been asked to review an end-of-participation information sheet before. Respondents gave various answers about the level of ethics committee review required, but most supported a relatively proportionate review process. Common concerns were about the risk of coercion or making participants feel pressured.ConclusionsOur survey suggests that ethics committee members generally support providing information to trial participants who stop taking part, if risks to participants are mitigated. We believe our guidance already addresses the main concerns raised. Our respondents’ lack of prior experience with end-of-participation information sheets suggests that participants are not getting information they want or need when they stop participating. Our results help clarify how ethics committee should oversee post-consent participant communications, but further guidance from research regulators could be helpful.

Health Maintenance Organization-mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study.

Health maintenance organization-mobile health (HMO-mHealth) services have a direct impact on patients' daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them. This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction. Israeli adults aged ≥18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model. A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68%; male: 2025/6321, 32%). Approximately 80.9% (5115/6321) to 88.2% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3% (3498/6321), 52.2% (3301/6321), and 46.9% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95% CI 0.67-0.83; P<.001 and OR 0.82, 95% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95% CI 1.02-1.22; P<.02 to OR 1.38, 95% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services. HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups.

Coping in crisis: The role of sense of coherence, life satisfaction, and resilience in the relationship between depression, social support, fear of COVID-19, and perceived vulnerability to disease among nurses in South Africa

In the context of the formidable challenges posed by the COVID-19 pandemic, healthcare professionals coped in various ways. This cross-sectional survey study sought to examine the protective role of satisfaction with life, sense of coherence, and resilience in the relationship between depression, social support, fear of COVID-19, and perceived vulnerability to disease among nurses in South Africa. Participants were a convenience sample of nurses ( n = 264) working at four South African hospitals in the Western Cape. Data were collected by means of an electronic survey and analysed using structural equation modelling. Participants completed a comprehensive battery of psychological measures. We found that while higher levels of fear of COVID-19 robustly predicted depressive symptomology among nurses, factors such as sense of coherence, and social support emerged as protective resources. These protective factors have the potential to alleviate the mental health impacts of pandemic-related stressors among nurses.

Registered Nurses' Digital Client Work and Associating Factors: A Cross-Sectional Study.

To describe the frequency of digital client work among Finnish registered nurses, including video consultations, secured messaging and digital promotion of care without direct contact with the client. In addition, the study examines the association between various factors related to nurses' characteristics and work environment with digital client work and its frequency. A cross-sectional survey study. A total of 2970 nurses responded to a nationwide survey in spring 2023. Descriptive statistics were used to characterise the frequency of different types of digital client work. Binary logistic regression analyses were used to examine the associations. One-third of the respondents reported digital client work during the last 6 months. The majority had worked digitally with their clients daily or weekly. Secured messaging was the most frequently used type of digital client work, whereas video consultations were less frequent. Nurses working in acute care, home-based care or other environments worked more frequently digitally with their clients than those working in inpatient care. Nurses with higher digital dedication and collegial support had greater odds of digital client work than those with lower dedication. Among those who reported frequent digital client work, lower skills in information security were observed. Given the significant variation in the frequency of digital client work among nurses across different environments, assessing broader digitalisation adoption opportunities is essential. Organisations must ensure that nurses have sufficient skills for secure handling of client data, and efforts should be made in creating motivational and supportive work environments to facilitate digital client work. By understanding the factors influencing nurses' digital client work, organisations can create stronger structures to support their work. Enhancing digital service availability across different healthcare settings would offer clients more care options, thereby potentially improving their access to healthcare. This research addresses a knowledge gap regarding the current extent of nurses' digital client work in various healthcare environments and explores potential influencing factors. As governments aim to significantly expand the provision of digital healthcare services, understanding the variation in nurses' digital client work is crucial. This information can guide targeted interventions, such as continuous education, and organisational and collegial support, facilitating dedication to use digital technologies and ensuring secure and impactful advancements in digital healthcare. Our research will benefit healthcare organisations, decision-makers, nursing professionals and educational institutions. Our study adheres to the relevant EQUATOR guidelines and follows the STROBE checklist for cross-sectional studies. No patient or public contribution.

Exploring the Correlation Between Occupational Well-Being and Burnout: An Analysis of Bhutanese Teachers` Data

Aims: This study examined the relationship between teachers` occupational well-being and burnout as well as challenges faced by teachers, key drivers of their job satisfaction, factors contributing to their burnout, and suggestion for improving their well-being at school. The well-being of teachers was assessed focusing on affective, behavioral, and health components. Methodology: A cross-sectional survey study design was used to collect data from the teachers. The target population consists of all primary, middle, and secondary school teachers across the country. To ensure a representative sample, 402 Bhutanese teachers (primary, middle, and secondary school) across the country were selected by employing stratified random sampling method. Different teachers from different grades, schools, and years of experience were selected proportionately. A self-created structured questionnaire was applied to 402 Bhutanese teachers across the country, selected through stratified random sampling method. The instrument demonstrated strong internal consistency reliability, with Cronbach`s alpha coefficient 0.85, 0.78, 0.70, and 0.77 for affective, behavioral, and health well-being, as well as burnout constructs, respectively. Data were analyzed using descriptive statistics and inferential statistics (correlation analysis and two sample independent t-test) in RStudio. Results: Among the dimensions of occupational well-being, affective components like anxiety, depression, and emotional exhaustion require significant attention, with emotional exhaustion being notably high. Regarding potential stressors, high workload, paperwork, students` behavioral and disciplinary issues, and insufficient resources are the most pressing issues for most of the teachers. The most satisfying aspects of the job for teachers are having supportive colleagues, experiencing positive interactions with students, and receiving competitive salary and benefits. Conclusion: For policy makers and school administrators, the findings of this study underscore the importance of implementing strategies to mitigate emotional exhaustion, such as providing mental health resources, fostering a supportive work environment, offering professional development opportunities focused on stress management, and improving students` behavioral and disciplinary issues. Addressing the foregoing issues can lead to a decrease in burnout rates, ultimately improving teacher retention and the overall quality of education.

ASPEN international survey on ethical competencies dealing with decision-making in the use of artificially administered nutrition and hydration and competency application in clinical practice.

Ethical competencies dealing with decision-making for clinicians involved in artificially administered nutrition and hydration (AANH) have not been defined in the literature. Although clinical assessments identify nutrition needs and appropriate routes of nutrition administration, an assessment of the ethical, cultural, and spiritual implications of the medical nutrition therapy may be overlooked. Eleven competency statements were developed by members of two international sections of the American Society for Parenteral and Enteral Nutrition. This descriptive cross-sectional survey study was conducted to measure the importance of the competency statements to the membership of two sections using a five-point Likert scale of 1-5 (1-low to 5-high). A total of 113 responses (12.5% response rate) were obtained predominantly from physicians and dietitians from 25 countries. There was a wide range of world regions of the 49% respondents outside of the United States. Means and SDs were calculated for agreement with the 11 competency statements with overall means ranging from 4.32 to 4.67. Most of the participants cared for adult/older adult patients (63.7%) exclusively, and 12.4% cared for pediatric/neonate patients exclusively; the remainder (23.9%) cared for both populations. Respondents reported they were either experienced, competent, or expert (88.6%) in dealing with ethical issues related to AANH. This international interdisciplinary group agreed that the integration of ethical, cultural, and spiritual competencies into clinical decision-making regarding artificially AANH is important.

Patient Perspectives on AI for Mental Health Care: Cross-Sectional Survey Study.

The application of artificial intelligence (AI) to health and health care is rapidly increasing. Several studies have assessed the attitudes of health professionals, but far fewer studies have explored the perspectives of patients or the general public. Studies investigating patient perspectives have focused on somatic issues, including those related to radiology, perinatal health, and general applications. Patient feedback has been elicited in the development of specific mental health care solutions, but broader perspectives toward AI for mental health care have been underexplored. This study aims to understand public perceptions regarding potential benefits of AI, concerns about AI, comfort with AI accomplishing various tasks, and values related to AI, all pertaining to mental health care. We conducted a 1-time cross-sectional survey with a nationally representative sample of 500 US-based adults. Participants provided structured responses on their perceived benefits, concerns, comfort, and values regarding AI for mental health care. They could also add free-text responses to elaborate on their concerns and values. A plurality of participants (245/497, 49.3%) believed AI may be beneficial for mental health care, but this perspective differed based on sociodemographic variables (all P<.05). Specifically, Black participants (odds ratio [OR] 1.76, 95% CI 1.03-3.05) and those with lower health literacy (OR 2.16, 95% CI 1.29-3.78) perceived AI to be more beneficial, and women (OR 0.68, 95% CI 0.46-0.99) perceived AI to be less beneficial. Participants endorsed concerns about accuracy, possible unintended consequences such as misdiagnosis, the confidentiality of their information, and the loss of connection with their health professional when AI is used for mental health care. A majority of participants (80.4%, 402/500) valued being able to understand individual factors driving their risk, confidentiality, and autonomy as it pertained to the use of AI for their mental health. When asked who was responsible for the misdiagnosis of mental health conditions using AI, 81.6% (408/500) of participants found the health professional to be responsible. Qualitative results revealed similar concerns related to the accuracy of AI and how its use may impact the confidentiality of patients' information. Future work involving the use of AI for mental health care should investigate strategies for conveying the level of AI's accuracy, factors that drive patients' mental health risks, and how data are used confidentially so that patients can determine with their health professionals when AI may be beneficial. It will also be important in a mental health care context to ensure the patient-health professional relationship is preserved when AI is used.

Cross-sectional survey of 43,517 dogs in the Dog Aging Project identifies owner-reported lifetime prevalence and characteristics of gastrointestinal disease.

To evaluate the prevalence of and characteristics associated with owner-reported gastrointestinal (GI) disease in companion dogs within the US. Cross-sectional owner-reported survey study of 43,517 dogs enrolled in the DAP between December 26, 2019, and December 31, 2022. Dogs were grouped on the basis of having an owner-reported GI disorder (ORGID) versus not having that ORGID at any point in their history (control group). Multivariable logistic regression analysis was used to estimate the association between dog characteristics and ORGIDs with prevalence ORs (PORs). Of the 43,517 dogs in the DAP Pack, 30,677 (70%) had no history of ORGIDs and 12,840 (30%) had at least 1 ORGID. The most common ORGIDs included infectious diseases (7,580 of 43,517 [17%]), chronic diarrhea (1,316 [3%]), foreign bodies (1,086 [2%]), anal sac impactions (1,031 [2%]), pancreatitis (857 [2%]), inflammatory GI disease (615 [1%]), chronic vomiting (519 [1%]), and acute hemorrhagic diarrhea syndrome (388 [1%]). Compared to controls, dogs with noninfectious ORGIDs had greater odds of having a history of being castrated (POR, 2.55; 95% CI, 2.29 to 2.85), underweight (POR, 1.58; 95% CI, 1.47 to 1.70), or fed primarily canned food (POR, 2.51; 95% CI, 2.21 to 2.85) or receiving probiotics (POR, 1.69; 95% CI, 1.58 to 1.81) or nonprescription GI medications (POR, 4.06; 95% CI, 3.80 to 4.33). Dog owners in the US recruited from the general public reported a high prevalence of GI disorders in their dogs. Infectious and noninfectious ORGIDs were reported with approximately equal frequency. Dogs with ORGIDs were more likely to have a history of receiving probiotics or nonprescription GI medications, which may indicate that owners are changing lifestyle practices to accommodate these GI disorders, although future longitudinal research is needed.

Pain and Discomfort Among Mohs Surgeons: An Ergonomic Model of Procedural Dermatologists

Background: Dermatologic surgeons are at risk for work-related injuries and chronic pain. Objectives: To investigate the prevalence and characteristics of pain and discomfort among fellowship trained Mohs surgeons across the United States Methods: A cross-sectional survey study was conducted of members of the American College of Mohs Surgery (ACMS).Participants reported the continuous variables of hours spent working, standing versus sitting while operating, typing to the electronic medical record, and exercising per week. Results: 107 male and female respondents participated. 88.7% of respondents reported chronic pain; the most common anatomic locations for pain were the neck (54.2%), upper back (38.2%), and lower back (33.6%). At these anatomic locations, male respondents less frequently complained of upper back pain (odds ratio (OR) 0.349, 95% confidence interval (CI) 0.155 to 0.787; P = 0.010) but more frequently complained of lower back pain (OR 2.462, 95% CI 1.606 to 13.320; P = 0.044), than female respondents. Respondents were significantly more likely to report regular pain-relieving medication use when suffering from pain at the neck (OR 4.665, 95% CI 1.450 to 15.007; P = 0.006) or upper back (OR 3.366, 95% CI 1.251 to 9.054; P = 0.013). Respondents regularly using sit-stand stools were less likely to report neck pain (OR 0.326, 95% CI 0.105 to 1.015; P = 0.046). Conclusions: Pain is prevalent among Mohs surgeons. Adopting and training in an ergonomically-friendly environment and incorporating an ergonomically aware mindset early in a surgeon’s career may decrease one’s risk for job-related injury and pain.

Knowledge and Awareness of Risk Factors for HIV Infection and about HIV Testing among Medical Students in Warsaw.

The number of late diagnoses of HIV remains very high in Poland, leading to a high proportion of patients developing and dying of HIV-related diseases. The main reason for this is the very low utilization of HIV testing. Our analyses aimed to investigate knowledge about the indications for HIV testing among medical university students, as well as identify their own HIV testing experiences. A cross-sectional survey study was designed to collect information on the students' demographics and their experiences of HIV testing, as well as their knowledge of virus transmission and the indications for testing. Data were collected as part of the HIV_week@WUM project conducted at the Medical University of Warsaw in parallel with the 18th European AIDS Conference, which took place in Warsaw between 18 and 21 October 2023. In total, 545 questionnaires were collected. The median age of the study participants was 20 (interquartile range (IQR): 19-22 years). The majority of respondents were as follows: women (67.5%), born in Poland (97.8%), and were attending the medical faculty (56.7%). Only 114 (21.43%) participants had ever been tested for HIV. For all modes of HIV transmission, most of the respondents overestimated the risk of acquiring HIV, but, at the same time, they had never been tested for HIV. Only one in five health sciences students has ever had a test for HIV, which is less than estimates for the general population of Warsaw. There is an ongoing need to popularize testing among future health care providers in order to address both the indications for testing for individuals and the better use of HIV testing in clinical practice.

Attitudes and preferences about retention: A survey study of nursing home employees

ObjectiveThere is an anticipated surge in demand for nursing home staff associated with the doubling of Americans aged 65 and older by 2060. Nursing homes face alarming turnover rates, exacerbated by the COVID-19 pandemic. This study explores the attitudes and preferences of nursing home staff toward non-monetary perks to better understand perks’ impact on employee retention. MethodsThis cross-sectional survey study, conducted in a 115-bed nursing home in Pittsburgh area, assessed employee preferences toward non-monetary workplace incentives. Descriptive statistics were used to analyze multiple choice questions and thematic analysis was used to assess open-ended questions. ResultsA total of 59 employees completed the survey. Participants indicated preferences for perks with monetary benefit, such as extra PTO for good work, gift cards, and classes. Thematic analysis revealed preferences for incentives such as equitable treatment. DiscussionThese preliminary findings offer insights on increasing nursing home employee retention using non-monetary incentives.

Health status and disability in persons with spinal cord injuries in South Africa and Kenya

Background: There is a lack of understanding regarding the nature of disabilities and functioning limitations associated with spinal cord injuries (SCI) in developing economies given limited healthcare resources.Aim: Our purpose was to assess and compare SCI-related disability among individuals with SCI in South Africa and Kenya to inform rehabilitation service planning.Settings: Two hundred individuals from South Africa and 90 from Kenya with SCI took part in this cross-sectional survey study, examining the comprehensive functioning of individuals with long-term SCI.Methods: This study utilised the International SCI (InSCI) Community Survey questionnaire. Subsections of the questionnaire were used to investigate the differences in the period-prevalence of secondary medical conditions, activity limitations and participation restrictions in persons with SCI.Results: In both countries, sexual dysfunction (55% – 57%), pain (48% – 49%), spasticity (41% – 42%) and bladder dysfunction (27% – 60%) emerged as the predominant secondary medical complications, with sexual dysfunction and pain showing overlap. There was no notable superiority in terms of treatment rates for secondary medical conditions between countries; however, exceptions were found. Both countries experienced similar overlaps in prevalent activity limitations and participation restrictions, including standing unsupported, using the toilet, bladder and bowel impairments, using public transport and reaching destinations. However, the Kenyan cohort showed significantly higher prevalence rates compared to the South African cohort for challenges related to carrying out daily routines, getting to destinations and using public transportation, while maintaining intimate relationships was more prevalent in South Africa.Conclusion: This study provides insight into the similarities and differences in both the nature and prevalence of disability in two developing economies. It appears that universal functioning patterns after SCI exist in the two countries, and a further need emerged to examine these functioning problems on other major life areas.Contribution: While some functioning problems could be addressed through healthcare and rehabilitation alone, others will require improved coordination and a whole-of-government approach, namely issues related to participation, community integration and inclusion.

Evaluation of Ambulance Healthcare Personnel’s Knowledge and Experience About Prone CPR: A Survey Study

Abstract Aim: Prone cardiopulmonary resuscitation (CPR) (CPR performed in the prone position) is an important intervention for managing cardiopulmonary arrest in patients that experience cardiopulmonary arrest in the prone position. It is important for pre-hospital healthcare personnel to learn and practice this technique when necessary. This study aims to determine the knowledge level of pre-hospital healthcare personnel on this prone CPR. Material and Method: Our study is a cross-sectional survey study conducted at a single center. Pre-hospital healthcare personnel who transferred patients by ambulance to Ankara City Hospital between July 1-31, 2021, were included in the study. Participants were given a total of 31 questions, 24 of which aimed to determine demographic information and educational status, and 7 of which assessed theoretical knowledge about prone CPR. Data analysis was performed using IBM SPSS 16.0 for Windows, with a significance level of p

Perspectives on virtual interviews and emerging technologies integration in family medicine residency programs: a cross-sectional survey study

BackgroundDuring the coronavirus disease of 2019 (COVID-19) pandemic, in-person interviews for the recruitment of family medicine residents shifted to online (virtual) interviews. The purpose of this study was twofold: (1) to gather the ideas about virtual interviews of family medicine applicants (interviewees), and faculty and staff who interviewed these applicants (interviewers), and (2) to describe interviewers’ and interviewees’ opinions of use of emerging technologies such as artificial intelligence (AI) and virtual reality (VR) in the recruitment process as well as during clinical practice.MethodsThis was a cross-sectional survey study. Participants were both interviewers and candidates who applied to the McGill University Family Medicine Residency Program for the 2020–2021 and 2021–2022 cycles.ResultsThe study population was constituted by N = 132 applicants and N = 60 interviewers. The response rate was 91.7% (55/60) for interviewers and 43.2% (57/132) for interviewees. Both interviewers (43.7%) and interviewees (68.5%) were satisfied with connecting through virtual interviews. Interviewers (43.75%) and interviewees (55.5%) would prefer for both options to be available. Both interviewers (50%) and interviewees (72%) were interested in emerging technologies. Almost all interviewees (95.8%) were interested in learning about AI and VR and its application in clinical practice with the majority (60.8%) agreeing that it should be taught within medical training.ConclusionAlthough experience of virtual interviewing during the COVID-19 pandemic has been positive for both interviewees and interviewers, the findings of this study suggest that it will be unlikely that virtual interviews completely replace in-person interviews for selecting candidates for family medicine residency programs in the long term as participants value aspects of in-person interviews and would want a choice in format. Since incoming family medicine physicians seem to be eager to learn and utilize emerging technologies such as AI and VR, educators and institutions should consider family physicians’ needs due to the changing technological landscape in family medicine education.

Long-term results and patient-reported outcomes after vascularized fibular graft use in the treatment of post-traumatic bone defects of femur shaft and tibia: A retrospective cohort and cross-sectional survey study

Post-traumatic critical-sized bone defects pose a reconstructive challenge for reconstructive surgeons. The vascularized fibula graft is a well-described treatment for osseous defects of the femur and tibia. This study aimed to assess long-term patient-reported quality of life, the success-, and complication rates in lower extremity reconstruction with vascularized fibula grafts. A retrospective cohort of 29 patients who underwent fibula graft reconstruction for critical-sized bone defects after post-traumatic tibial and femoral bone loss between 1990 and 2021 was included. To assess the health-related quality of life and return to work and satisfaction, a cross-sectional survey was performed using the short-form-36, lower extremity functional scale, and a self-made questionnaire including the DN4, satisfaction, and subjective ankle function. The median bone defect size was 8cm (IQR 9-7cm). The mental component scores were comparable to the Dutch population norm, whereas the impaired physical function scores were associated with pain (r 0.849, p<0.001). Neuropathic symptoms were reported in 7 out of 19 patients, and 11 out of 19 patients returned to normal daily activity. All respondents reported positive or neutral scores on overall satisfaction with the recovery. Bone healing was uneventful in 19 out of 29 patients. Union was achieved in 25 out of 29 patients. Persistent nonunion was observed in 4 patients, leading to amputation in 2 patients. Vascularized fibula graft use led to high union rates and limb salvage in patients with post-traumatic segmental bone loss of the tibia and femur. Patient satisfaction with the overall recovery was positive; however, functional outcomes remained impaired.

A Comprehensive Analysis of Skin Cancer Concerns and Protective Practices in Manitoba, Canada, Highlights Lack of Skin Cancer Awareness and Predominance of High-Risk Sun Exposure Behaviors.

The rapidly increasing skin cancer rates in Canada are alarming, with current data estimating that 1/3 of Canadians will be affected in their lifetime. Thus, deeper understanding of high-risk sun exposure behaviors is needed to help counter this trend. Only limited action has been taken by federal/provincial governments to reduce skin cancer incidence. A cross-sectional survey study was conducted in Manitoba, with frequency counts, means, and percentages used to encapsulate responses. Age- and gender-adjusted odds ratios were calculated using logistic regression analyses. Our study identified worrying inadequacies in sun protective behaviors and attitudes, with the threat of such high-risk behaviors amplified by a lack of skin cancer awareness. Alarming elements were noted in participants' sun exposure history (>65% reported a history of sunburns, >50% previously used a tanning bed, and >75% recently tanned for pleasure), beliefs and attitudes (>50% believe that they look better/healthier with a tan, and >40% believe that having a base tan is protective against further sun damage), and sun protection efforts (sun protective clothing was used <60% of the time, sunscreen was used by <50%, and there was a lack of knowledge about sunscreen characteristics in ~30% of respondents), in addition to significant differences being established between demographic subgroups (based on gender, age, skin phototype, income, and education attained). This study provides worrisome insight onto the grim landscape of sun protective behaviors and attitudes in Manitoba, which will inevitably translate into higher skin cancer rates and should serve as a call to action to promote targeted public health messaging in this jurisdiction and beyond.

Investigation of Mother-to-Child Transmission of Hepatitis B in Yinchuan, China: Cross-Sectional Survey Study.

Hepatitis B poses a significant global public health challenge, with mother-to-child transmission (MTCT) being the primary method of hepatitis B virus (HBV) transmission. The prevalence of HBV infection in China is the highest in Asia, and it carries the greatest burden globally. This study aims to critically evaluate the existing local strategies for preventing MTCT and the proposed potential enhancements by analyzing the prevalence of hepatitis B among pregnant women and their neonates in Yinchuan. From January 2017 to December 2021, 37,557 prenatal screening records were collected. Among them, 947 pregnant women who tested positive for hepatitis B surface antigen (HBsAg) near delivery and their 960 neonates were included in an HBV-exposed group, while 29 pregnant women who tested negative and their 30 neonates were included in an HBV-nonexposed group. HBV markers in maternal peripheral blood and neonatal cord blood were analyzed using the least absolute shrinkage and selection operator (LASSO) regression, logistic regression, chi-square test, t-test, and U-test. Additionally, to further evaluate the diagnostic value of HBsAg positivity in cord blood, we conducted an additional follow-up study on 103 infants who tested positive for HBsAg in their cord blood. The prevalence of HBV among pregnant women was 2.5% (947/37,557), with a declining trend every year (χ²4=19.7; P=.001). From 2018 to 2020, only 33.0% (35/106) of eligible pregnant women received antiviral medication treatment. Using LASSO regression to screen risk factors correlated with HBsAg positivity in cord blood (when log [λ] reached a minimum value of -5.02), 5 variables with nonzero coefficients were selected, including maternal hepatitis B e-antigen (HBeAg) status, maternal hepatitis B core antibody (HBcAb) status, maternal HBV DNA load, delivery method, and neonatal birth weight. Through univariate and multivariate logistic regression, delivery by cesarean section (adjusted odds ratio [aOR] 0.52, 95% CI 0.31-0.87), maternal HBeAg positivity (aOR 2.05, 95% CI 1.27-3.33), low maternal viral load (aOR 2.69, 95% CI 1.33-5.46), and high maternal viral load (aOR 2.69, 95% CI 1.32-5.51) were found to be strongly associated with cord blood HBsAg positivity. In the additional follow-up study, 61 infants successfully completed the follow-up, and only 2 were found to be infected with HBV. The mothers of both these infants had detectable HBV DNA levels and should have received standard antiviral therapy. The results of the hepatitis B surface antibody (HBsAb) positivity rate and titer test indicated a gradual decline in the immunity of vaccinated infants as the interval after vaccination increased. The clinical relevance of HBV marker detection in cord blood is restricted within the current prevention measures for MTCT. There is an emphasis on the significance of public education regarding hepatitis B and the reinforcement of postnatal follow-up for the prevention of MTCT.

The Impact of Scars After DIEP-Flap Breast Reconstruction on Satisfaction and HR-QoL: A Cross-Sectional Study Comparing BREAST-Q Scores.

Although deep inferior epigastric perforator (DIEP) flap breast reconstruction is the most widely used technique for autologous breast reconstruction, this technique leads to large scars in visible areas on breast and abdomen. So far, limited studies have thoroughly addressed the impact of breast and abdominal scars on satisfaction and Health-related Quality of Life (HR-QoL). This research aimed to determine whether women with no/minor scar symptoms after undergoing DIEP-flap breast reconstruction differ in satisfaction and perceived HR-QoL from women with symptomatic scars. In this cross-sectional survey study, women who had previously undergone DIEP-flap breast reconstruction completed an online survey. Patient-reported scar quality was assessed with the Patient and Observer Scar Assessment Scale (POSAS), and satisfaction and HR-QoL with BREAST-Q. Independent-samples t-tests were conducted to compare BREAST-Q scores between women with no/minor scar symptoms (POSAS overall opinion score 1-3) and women with symptomatic scars (POSAS overall opinion score 4-10). A total of 248 women completed the survey. Women with scar symptoms had significantly worse BREAST-Q scores on 'Satisfaction with breasts,' 'Physical well-being,' 'Psychosocial well-being' and, 'Sexual well-being' compared to women with no/minor scar symptoms (p ≤ 0.001). After DIEP-flap breast reconstructions, women with symptomatic breast and abdominal scars had a clinically relevant and statistically significant lower degree of satisfaction and HR-QoL compared to women who had no/minor scar symptoms. We therefore recommend to explicitly and repeatedly address inevitability of visible scars after DIEP-flap breast reconstruction, aiming to improve preoperative patient selection and post-operative expectation management. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Leadership support and satisfaction of healthcare professionals in China’s leading hospitals: a cross-sectional study

BackgroundHealthcare professionals’ job satisfaction is a critical indicator of healthcare performance, pivotal in addressing challenges such as hospital quality outcomes, patient satisfaction, and staff retention rates. Existing evidence underscores the significant influence of healthcare leadership on job satisfaction. Our study aims to assess the impact of leadership support on the satisfaction of healthcare professionals, including physicians, nurses, and administrative staff, in China’s leading hospitals.MethodsA cross-sectional survey study was conducted on healthcare professionals in three leading hospitals in China from July to December 2021. These hospitals represent three regions in China with varying levels of social and economic development, one in the eastern region, one in the central region, and the third in the western region. Within each hospital, we employed a convenience sampling method to conduct a questionnaire survey involving 487 healthcare professionals. We assessed perceived leadership support across five dimensions: resource support, environmental support, decision support, research support, and innovation encouragement. Simultaneously, we measured satisfaction using the MSQ among healthcare professionals.ResultsThe overall satisfaction rate among surveyed healthcare professionals was 74.33%. Our study revealed significant support from senior leadership in hospitals for encouraging research (96.92%), inspiring innovation (96.30%), and fostering a positive work environment (93.63%). However, lower levels of support were perceived in decision-making (81.72%) and resource allocation (80.08%). Using binary logistic regression with satisfaction as the dependent variable and healthcare professionals’ perceived leadership support, hospital origin, job role, department, gender, age, education level, and professional designation as independent variables, the results indicated that support in resource provision (OR: 4.312, 95% CI: 2.412 ∼ 7.710) and environmental facilitation (OR: 4.052, 95% CI: 1.134 ∼ 14.471) significantly enhances healthcare personnel satisfaction.ConclusionThe findings underscore the critical role of leadership support in enhancing job satisfaction among healthcare professionals. For hospital administrators and policymakers, the study highlights the need to focus on three key dimensions: providing adequate resources, creating a supportive environment, and involving healthcare professionals in decision-making processes.