Exploratory Cross-sectional Study Research Articles

Alterations of functional brain activity and connectivity in female nurses working on long-term shift.

To investigate the alterations of functional brain activity and connectivity in female nurses working on long-term shifts and explore their correlations with work-related psychological traits. An exploratory cross-sectional study. Thirty-five female nurses working on long-term shifts (shift nurses) and 35 female nurses working on fixed days (fixed nurses) were enrolled. After assessing the work-related psychological traits, including burnout, perceived stress, anxiety, and depression of nurses, the fractional amplitude of low-frequency fluctuations (fALFF) and region of interest (ROI)-based functional connectivity (FC) analyses were performed to investigate the differences of brain spontaneous activity and functional connectivity between these two groups of nurses. Thereafter, correlations between the functional brain parameters (fALFF and FC) and clinical metrics were investigated among the shift nurses. Compared to fixed nurses, shift nurses had higher burnout, perceived stress and depression scores, lower fALFF in the right dorsolateral prefrontal cortex (dlPFC), left and right superior parietal lobule (SPL), bilateral anterior cingulate cortex (ACC), and higher fALFF in the right superior/middle temporal gyrus, as well as decreased FC between the right dlPFC (the selected ROI) and bilateral ACC, left and right inferior frontal/orbitofrontal gyrus (IFG/IOFG), right SPL, and left middle occipital gyrus (voxel-level p < 0.001, cluster level p < 0.05, GRF correction). Correlation analyses demonstrated that the fALFF value of the right dlPFC was significantly correlated with the burnout and anxiety scores, the FC value of the right dlPFC-right SPL was correlated with the perceived stress and burnout scores, the FC value of the right dlPFC-right IFG/IOFG was correlated with the burnout score in shift nurses (p < 0.05). Shift nurses had work-related altered functional activity and connectivity in the right frontoparietal network, which provided objective and visualised evidence to clarify the hazards of long-term shift work on female nurses. Seventy nurses participated deeply as subjects in this study. These findings are expected to draw managers' attention to the harmful influences of shift work on nurses.

Identifying and Prioritizing the Indicators Influencing the Performance of the Permit-to-work System Using Hybrid Fuzzy Delphi Method - Improve Analytic Hierarchy Process Methods: An Exploratory Cross-sectional Study

Abstract Aim: This study aimed to identify and prioritize the main indicators that influence the performance of the permit-to-work (PTW) using hybrid fuzzy Delphi-improve analytic hierarchy process (IAHP) methods. Materials and Methods: By the fuzzy Delphi method, indicators that affect PTW are classified into seven main groups and 41 subindicators based on experts’ opinions; in the final stage, indicators and subindicators were weighted and prioritized using the IAHP methods. Results: The results of the IAHP method showed that accountability (0.178), preventive measures and risk avoidance (0.165), and training and qualification (0.141) are the most important ingredients also; the results revealed that identification of work-related hazards (0.221), preformation of gas test (0.173), signature of responsible person for safety (0.232), the record of the work steps (0.213), period of permit validity (0.153), and period of training courses (0.351) had most important among the subindicators. Conclusion: The results of this study can be used as a practical guide to plan the implementation of corrective measures for improving the performance of the PTW system and conduct an audit to identify the strengths and weaknesses of the PTW system in process industries.

The Relationships between Caregiver Burden, Physical Frailty, Race, Behavioral and Psychological Symptoms (BPSD), and Other Associated Variables: An Exploratory Study.

Background and Objectives: For persons with dementia, the relationships between caregiver burden, physical frailty, race, behavioral and psychological symptoms (BPSD), and other associated variables are poorly understood. Only one prior study examined the relationships among these variables but did not include race, which is an important social determinant of health outcomes in the United States. To examine these interactions, we conducted a cross-sectional exploratory study based on a model by Sugimoto and colleagues. Materials and Methods: The sample comprised 85 patient-caregiver dyads (58% White) seen in four centers in diverse regions of New York State. All patients met DSM5 criteria for a major neurocognitive disorder, had a Clinical Dementia Rating sum score of ≥3, and Mini-Mental State Examination (MMSE) score of 10 to 26. Other measures included the SHARE-Frailty Instrument(FI), the Neuropsychiatric Inventory (NPI) to assess BPSD, Zarit's Caregiver Burden Interview (CBI), Lawton's Activities of Daily Living (ADL) Scale, the MMSE, the Cumulative Illness Rating Scale for Geriatrics (CIRSG), age, and gender. Results: In our sample, 59% met the criteria for prefrail/subsyndromal or frail/syndromal (SSF) on the SHARE-FI. SSF had significant direct effects on the NPI and significant indirect effects on the CBI mediated through the NPI; the NPI had significant direct effects on the CBI. Race (White) had significant direct effects on the CBI (higher) and SSF (lower) but did not have significant indirect effects on the CBI. MMSE, ADL, and CIRSG were not significantly associated with the NPI or the CBI. Conclusions: Our analysis demonstrated that frailty, race, BPSD, and caregiver burden may directly or indirectly influence one another, and therefore should be considered essential elements of dementia assessment, care, and research. These results must be viewed as provisional and should be replicated longitudinally with larger samples.

Morphosyntactic Abilities and Cognitive Performance in Multiple Sclerosis.

While cognitive abilities in people with multiple sclerosis (PwMS) have been studied in detail, little is known about linguistic abilities in PwMS and their relation to cognitive impairment. In this cross-sectional explorative study, we aim to investigate the morphosyntactic abilities of PwMS alongside their cognitive performance. Furthermore, we explore the effect of clinical factors, namely, the disease duration and MS type, on the linguistic and cognitive performance of PwMS. By so doing, we aim to shed light on neurocognitive and clinical correlates of linguistic performance in PwMS. We included 78 patients and 78 age-, sex- and education-matched healthy individuals. All participants were additionally administered the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, a verbal short-term memory task (non-word repetition) and questionnaires about mood, fatigue and quality of life. In addition, they underwent examinations with morphology and syntax tasks. PwMS were found to be impaired in morphology (past tense) and selectively impaired in syntax alongside cognitive impairments. Disease duration had the main impact on cognitive abilities. The MS type selectively impacted linguistic abilities, as shown by the remarkably deficient performance of the MS individuals with the progressive disease subtype. Linguistic impairments were predicted by only one measure of the BICAM test, namely, the Symbol Digit Modalities Test (SDMT), a measure of cognitive processing speed. Overall, this study contributes to the better understanding of the linguistic profile of PwMS by reporting selective deficits in their morphological and syntactical abilities. Furthermore, it provides insights into the clinical and cognitive correlates of linguistic performance. By so doing, it suggests clinical implications for the development of intervention programs for PwMS.

Unveiling the unseen toll: exploring the impact of the Lebanese economic crisis on the health-seeking behaviors in a sample of patients with diabetes and hypertension.

Against the backdrop of Lebanon's escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis- its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus. An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26. The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4th Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05). Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.

Do Mindful Eating and Intuitive Eating Affect Beverage Preferences? A Cross-Sectional Survey.

Intuitive eating involves following body signals to guide eating decisions and avoiding restrictive diets. Mindful eating is paying full attention to sensory experiences and fostering nonjudgmental awareness. We aimed to elucidate potential relationships between beverage intake and intuitive and mindful eating scores. This cross-sectional exploratory study (October 2021-December 2022) enrolled adult male and female participants who provided sociodemographic and health-related information and subsequently completed the Beverage Intake Questionnaire, the Mindful Eating Questionnaire (MEQ-30), and the Intuitive Eating Scale (IES-2). Bidirectional relationships were observed between beverage intake and intuitive and mindful eating scores. The total beverage intake of males was double compared with that of females, with the intake being mainly derived from sugar-sweetened beverages (p = 0.000). Increased total water intake was positively correlated with IES-2 and its subscale scores and was negatively correlated with MEQ-30 scores in both sexes (p < 0.05). Alcoholic beverage intake was associated with reductions in IES-2 and MEQ-30 scores, whereas unconditional permission to eat increased by 18.3% in males. In females, the consumption of milk-based beverages decreased the IES-2 scores. Understanding the complex relationships between beverage intake and intuitive and mindful eating may deepen our understanding of individual dietary behaviors and inform dietary interventions.

Is menstrual cycle misunderstanding a bias for ergogenic AIDS use? A cross sectional study

The complex process of hormonal release and interaction of the Menstrual Cycle (MC) seems to impact the athlete's physical and psychological state. Objective: 1) investigate female athletes' understanding of MC, including its various phases and their potential effects on sports performance, 2) analyze the athletes' self-perception of sports performance during the different phases of MC and 3) identify possible ergogenic strategies (nutritional, mechanical, pharmacological, and/or psychological) adopted by athletes for alleviating premenstrual and menstrual symptoms in order to improve sports performance. Design: This exploratory cross-sectional study involved 105 competitive athletes, from 12 different sport modalities, from regional to international competitive level. Setting: Participants completed a survey assessing contraceptive use, knowledge regarding MC phases and perceptions of sports performance at different phases of MC as well as the adopted strategies to alleviate pre and menstrual symptoms to enhance sport performance. Results: Although 65.8% of the athletes reported knowing the MC phases, only 53.5% were able to identify them. Also, 60% of the athletes feel unmotivated or unwilling to exercise and 72.4% feel tired, indisposed, or self-reported worse sports performance during a certain phase of the MC, being follicular phase the most cited. Conclusions: The use of hormonal contraceptive methods, fatigue/discomfort and the number of weekly workouts seem to influence the use of nutritional aids. Competitive athletes have a limited understanding of MC, even considering that it has a detrimental effect on sports performance, especially during follicular phase. Feelings of tiredness, indisposition, or worse sports performance are the most common reasons for nutritional aids use.

The Use of Simulation in Nursing Education Programs: A Cross-Sectional Interuniversity Study

Background. Simulation-based education has been incorporated into nursing curricula as an educational strategy. However, its implementation has not yet been standardized in different regions. Purpose. The aim of this study is to describe simulation-based education in the nursing curricula in Catalonia and Andorra. Methods. An exploratory cross-sectional study was conducted in 2019 in which 16 universities participated. Results. The median dedication to clinical simulation in the nursing studies was 287.5 hours, with variations between universities (ranging from 24 to 516 hours). The dedication for the low-medium fidelity simulation was 89.4 hours (SD ± 58.3) and 26 hours (SD ± 17) for the high-fidelity simulation. All the universities had qualified teaching staff and facilities. Conclusions. There is variability in the implementation and use of simulation-based education among universities. However, there is consensus on its usefulness in nursing curricula. To integrate simulation training into the nursing curriculum, it is necessary to establish convergent simulation standards in higher education.

Occupational therapy practitioners’ experiences with interprofessional collaborative practice

ABSTRACT Although occupational therapists engage as part of interprofessional healthcare teams, explicit investigation into their experiences of interprofessional collaborative practice (IPCP) has not been explored. This study evaluated occupational therapists in the United States experiences of IPCP with additional inquiry into which healthcare professionals occupational therapy practitioners interact with and how they engage in collaboration, during IPCP. An exploratory cross-sectional study was conducted using an online survey; 142 occupational therapy practitioners responded. Quantitative data were analyzed using descriptive and bivariate analyses; open-ended responses underwent consensual qualitative analysis. Participants reported most often engaging in IPCP with physical therapists, speech-language pathologists, nurses, physicians, and case managers, although variations in the top five professions were evident between practice settings. In addition, 82% of the respondents reported either feeling prepared or very prepared for IPCP after completing their pre-licensed educational programs. Two qualitative themes have emerged to describe key education-oriented and practice-oriented interprofessional experiences. To further enhance engagement in and preparedness for IPCP, occupational therapy professionals, and students may benefit from interprofessional training that involves the professions most often encountered during clinical practice. This type of learning could foster an understanding of communication and teamwork, thus enhancing readiness to participate in the IPCP team upon transition to practice.

Internalized stigma related to COVID-19 and its psychosocial and mental health correlates: a multicentric health facility based observational study from Nepal.

The COVID-19 pandemic has led to physical and psychological complications and social consequences in the form of illness-related stigma. This study aimed (1) to assess the sociodemographic and clinical variable, as well as COVID-19 related knowledge and perception of persons admitted for COVID-19/Suspected COVID-19 in Nepal, (2) to determine their levels of COVID-19- related internalized stigma, depression, and anxiety symptoms, and (3) to evaluate the correlates of COVID-19- related internalized stigma. It was a cross-sectional exploratory study with a convenience sample of 395 participants (306 confirmed cases, 89 suspected cases) conducted between July-October 2020 in four health facilities in Madhesh and Lumbini provinces of Nepal. We used a semi-structured questionnaire to assess sociodemographic details, clinical information, COVID-19-related knowledge, perception, COVID-19-related internalized stigma, and the Hamilton Anxiety Depression Scale (HADS) in Nepali language. Descriptive statistics, correlation analyses, and linear regression analyses were performed. The level of statistical significance was considered at p < 0.05. Around 23.3% of the patients had anxiety symptoms, 32.9% had depressive symptoms, and 20.3% had high COVID-19-related internalized stigma (mean ISMI score: 2.51-4.00). Linear regression analyses showed a significant positive association of COVID-19-related internalized stigma total score, with the following eight factors, i.e., no income in the past one month (p = 0.013), below average socioeconomic status (p = 0.004), anxiety symptoms (p = <0.001), depressive symptoms (p = <0.001), recent testing positive for COVID-19 (p = <0.001), involuntary admission (p = <0.001), prior experience of being in isolation and quarantine (p = 0.045), and those who blame others for COVID-19 (p = 0.025). COVID-19 survivors and suspects are vulnerable to symptoms of depression, anxiety, and COVID-19-related internalized stigma. For the first time from Nepal, our data suggests that COVID-19-related internalized stigma is associated with anxiety and depression symptoms, perceived below-average socioeconomic status, involuntary admission, prior experience of being in isolation and quarantine, recent COVID-19 positive report, self-blame, below-average socioeconomic status and no income in the past one month. Mitigating and preventing internalized stigma associated with a public health crisis such as COVID-19 is imperative by diagnosing and treating such mental health issues early and designing interventions and policies especially targeting vulnerable populations focusing on their economic background and socio-cultural beliefs.

Routine Outcome Monitoring from Psychotherapists' Perspectives: A Framework Analysis Study of Expected Benefits and Difficulties.

Psychotherapists' attitudes and expectations towards routine outcome monitoring can impact the likelihood of its fruitful implementation. While existing studies have predominantly focused on Europe and North America, research in Latin America remains limited. The aim of this study is to explore therapists' expected benefits and difficulties prior to implementing a routine outcome monitoring system in a university psychotherapy service in Ecuador. An exploratory and descriptive cross-sectional qualitative study was carried out with 20 participants aged 21 to 47. Semi-structured interviews were conducted to explore participants' knowledge about routine outcome monitoring, their expectations of the difficulties, benefits, usability and risks of using a monitoring system, as well as their expectations about their role in the process. The data analysis adhered to the framework analysis methodology, leading to the identification of six overarching themes, 36 specific themes and 82 subthemes. The interviews highlighted a spectrum of positive and negative expectations at several levels: institutional/general, therapeutic process, therapists, and clients. Perceived benefits encompassed various aspects, including the availability of supplementary information, continuous adaptation of the therapeutic process, facilitation of organization and treatment planning, opportunities for professional development, and fostering patient trust and empowerment. On the other hand, anticipated difficulties comprised concerns such as discomfort among therapists and clients, increased workload, system usage and technical difficulties, and the risk of excessive quantification. Overall, participants expressed more anticipated benefits than difficulties. We present recommendations that can support and optimize the current local implementation efforts of routine outcome monitoring, both within this service and in other settings. These recommendations consider ways to meet positive expectations and address or mitigate negative ones.

Adherence to the National Tobacco-Free School Policy in Selected Schools of Puducherry District in India: A Cross-Sectional Exploratory Study.

The objective of this study was to estimate the level of compliance and the factors associated with high adherence to the Tobacco-Free Educational Institutions (ToFEI) guidelines of the Government of India among schools in the district of Puducherry, India. This cross-sectional study was conducted among schools (N=50) in the Puducherry district in 2021-2022 using a "Self-Evaluation Scorecard" of the ToFEI guidelines. The assessment was done through in-person interviews with the schools' heads/representatives. The level of compliance to indicators was presented as proportions, and factors associated with high compliance were assessed using the chi-square test. No school met all the ToFEI indicators. The majority (88%) showed no evidence of the use of tobacco products inside the premises. More than half of the schools (58%) adhered to the criteria of not having tobacco shops within 100 yards and 56% reported the inclusion of the "No Use of Tobacco" norm in their guidelines. Schools located in rural areas (p-value <0.01) and those with teachers who attended any tobacco-related workshop were more likely to comply with the ToFEI indicators (p-value 0.05). After relaxing the criteria for 'High Adherence' to at least four indicators, we found that 20% of schools showed high adherence to the ToFEI indicators. Overall compliance of schools to the ToFEI guidelines is low in Puducherry. Sensitizing the relevant stakeholders in the district for implementing ToFEI guidelines and institutionalizing tobacco control activities in the school are the needs of the hour.

Knowledge, practice and communication barriers for oncology doctors in Chile when addressing the sexuality of their patients.

Communication in a doctor-patient relationship constitutes a crucial aspect in medicine, and its multiple dimensions encompass a wide variety of ethical issues. Communication is particularly relevant in oncology, because it requires continually dealing with sensitive topics in one of the most highly vulnerable situations as a human: illness and proximity to death. Sexuality is one of these topics because it constitutes an area that is frequently affected by cancer and cancer treatment, which may include causing significant distress, the reinforcement of a negative self-image, relationship conflicts and a permanent memory of having cancer. The objective of this research is to describe the perception of knowledge and communications practices used by oncology doctors with respect to sexual health in the care of their patients, as well as the barriers found when it comes to confronting the topic. An exploratory quantitative, descriptive and cross-sectional study was carried out, in which a self-administered questionnaire was given to oncology doctors who practise in Chile. This questionnaire had 41 closed questions with answers on a Likert scale and was previously validated by being reviewed and applied to a pilot group of five professionals (one medical bioethics expert and four doctors in the field of oncology). The data were analysed with the SPSS statistical program v. 20, using descriptive statistics. The main results show that the surveyed doctors consider sexuality to be an important part of patients' quality of life. However, this finding does not align with the practices given for including it as part of clinical care. The professionals refer as the main barriers those that are attributed to the structural functioning of the institution, giving little value to those barriers related to personal aspects or those associated with patient characteristics and/or behaviors. The results of this study show that, despite oncology doctors seeing sexuality as an important aspect of the quality of life of their patients, they do not include the topic in clinical care. Given that one of the main barriers is obstacles relating to the institution, it is necessary to create political institutions that create the conditions for including this area as a relevant part of cancer patient care.

Perceived social support mediates the effect of COVID-19 pandemic on job adaptation disorders of workers: An exploratory cross-sectional study.

COVID-19 lockdown can lead to job adaptation disorders, which are heterogeneous among individuals. The purpose of this study was to explore the association between perceived social support and job adaptation disorders among workers in China during the COVID-19 pandemic. The questionnaires of Psychological Questionnaire for Public Health Emergencies, Multidimensional Scale of Perceived Social Support, Work Attitude Scale were used for this cross-section study via an online survey. The study included 626 employees. Hierarchical regression analysis and Bootstrap method were used to investigate the mediation effect of perceived social support between the emergency and job adaptation disorders. The percentages of the 5 dimensions of depression, neurasthenia, fear, compulsion-anxiety, and hypochondria in workers were 59.7%, 56.1%, 92.3%, 42.0%, and 18.7%, respectively. Social support mediated the relationship between depression, neurasthenia, obsessive-compulsive anxiety and job adaptation disorder, accounting for 18.1%, 16.1%, and 17.5% of the total effect (ab/c), respectively. Perceived social support could alleviate COVID-19 pandemic-related depression, neurasthenia, compulsion-anxiety, and job adaptation disorder in Chinese workers. Improving their perception of social support, workers may better adapt themselves to work in the challenging of the public health emergency during COVID-19 pandemic.

Cancer-Related Fatigue and Its Influencing Factors Among Colorectal Cancer Patients: A Generalized Linear Modeling Approach.

This study aimed to improve cancer-related fatigue (CRF) and health outcomes of colorectal cancer patients by understanding the status quo of CRF, exploring the relations of coping, anxiety symptoms, depressive symptoms, body image perception and CRF, and also identifying the factors affecting CRF based on a generalized linear modeling approach. An exploratory cross-sectional study was conducted on 370 colorectal cancer patients at two hospitals in Anhui Province, China, from July 2020 to February 2021. The data were collected by using general information questionnaire, cancer fatigue scale, simplified coping style questionnaire, generalized anxiety disorder-7 scale, patient health questionnaire-9, and body image scale. Descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analyses, and generalized linear model analyses were applied to analyze the data. The average CRF score of the patients was 21.612 (SD=6.160), with a prevalence rate of 69.4% for clinically relevant fatigue. The generalized linear model revealed that: In step 1, gender (female) (B=1.799, Waldχ2=7.506, p=0.006), per capita monthly income (1001-3000 RMB) (B=-1.673, Waldχ2=5.536, p=0.019) and treatment modalities (chemotherapy+others) (B=2.425, Waldχ2=8.211, p=0.004) were related to CRF. In step 2, depressive symptoms (B=1.223, Waldχ2=129.019, p<0.001) and negative coping strategies (B=0.215, Waldχ2=11.347, p=0.001) exhibited significant positive correlations with CRF, positive coping strategies (B=-0.319, Waldχ2=59.175, p<0.001) showed significant negative correlations with CRF; While anxiety symptoms (B=0.162, Waldχ2=1.840, p=0.175) and body image perception (B=0.013, Waldχ2=0.048, p=0.826) had no correlations with CRF. The prevalence of CRF was relatively high among colorectal cancer patients. Coping and depressive symptoms were the modifiable influencing factors of CRF. Tailored interventions dedicated to promoting positive coping behavior, diminishing negative coping behavior and reducing depressive symptoms may improve the CRF of patients with colorectal cancer. Healthcare providers working with these patients should receive corresponding education and training in these complementary treatments. Additionally, when developing non-pharmacological interventions, appropriate consideration of the patients' gender, income condition and the type of anticancer treatment is also necessary.

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach: Exploratory Cross-Sectional Study of Patients' Views on Quality of Care.

The purpose of this study was to evaluate patients' perception and quality of diabetic foot ulcer (DFU) care delivered by an interdisciplinary team approach (ITA). Exploratory cross-sectional study. Twenty patients with a healed plantar DFU were recruited from an interdisciplinary Wound Care clinic of a Canadian University affiliated hospital. Their mean age was 64years (75% were males [n=15]), 18 (90%) were living with type 2 diabetes, and 45% (n=9) had osteomyelitis in the previous year of their enrollment in the study. The validated short form of the Quality From the Patient's Perspective questionnaire was used to evaluate quality of care dimensions (medical-technical competence of the caregivers; physical-technical conditions of the care organization; degree of identity-orientation in the attitudes and actions of the caregivers; and sociocultural atmosphere of the care organization). Respondents reported experiencing a high level of quality care with an ITA. All indicators of patient-perceived reality of care delivered were superior or equal related to their subjective importance in all dimensions of quality care (with scores ranging from 3.85 to 4.00 on a 4-Point Likert scale). Patients' satisfaction regarding the ITA was high. Study findings suggest that an ITA model provided high quality of care for treating DFUs for all quality dimensions judged important for patients.

Physicians' Perspectives on the Impact of Insurance Status on Clinical Decision-Making in Saudi Arabia.

Background The decision-making process in clinical practice depends heavily on collaboration and information sharing. Physicians' decision-making processes are profoundly influenced by the patient's insurance status, which warrants focused investigation. Hence, this study aimed to investigate how physicians perceive the influence of insurance status on treatment options and medical interventions and to explore the extent to which physicians discuss insurance-related considerations with patients during the shared decision-making process. Methodology This was a cross-sectional exploratory study conducted in various healthcare facilities all over Saudi Arabia. The electronic questionnaire was the primary tool for data collection. Data were then coded, entered, and analyzed using both descriptive and inferential statistical methods. Results The study involved 430 physicians, primarily male (n= 230, 53.5%), aged 31-40 years (n= 215, 50%), and mostly non-Saudi (n= 285, 66.3%). Medical officers constituted the majority of the study population (n= 258, 60%), with one to five years of experience (n= 187, 43.5%), and engaged in private practice (n= 230, 70%). Concerning insurance, 287 (66.7%) physicians considered patient's insurance when discussing treatment options, while 318 (74%) physicians discussed the financial implications of different treatment options with the patients. Regarding outcomes, 373 (86.7%) physicians believed that insurance status affected patient outcomes and treatment modalities. Significant factors, such as age between 31 and 40 years (P < 0.001), over 10 years of clinical experience (P = 0.002), engagement in both governmental and private practice (P = 0.012), and being a medical officer (P = 0.005), demonstrated a high impact on the insurance status influencing clinical decision-making. Overall, recognizing the influence of insurance on decision-making is crucial for equitable healthcare. Conclusions More than half of the physicians demonstrated high scores indicating the impact of insurance status on the clinical decision-making process. This impact was influenced by specific physician parameters such as age, experience, specialty, and type of practice. Moreover, the financial situation and insurance status of the patients significantly affected treatment and patient outcomes.

The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses

IntroductionMoral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses. MethodsA cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience. ResultsFour distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams. DiscussionOur study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.

Noise-induced hearing loss and hearing protection: Attitudes at a South African coal mine.

Negative attitudes and beliefs are major contributing factors to the rising numbers of noise-induced hearing loss (NIHL) cases in coal mines both locally and internationally. International literature confirms limited knowledge surrounding employees' attitudes and beliefs regarding NIHL and hearing protection devices (HPDs), hence the need for the study. To ascertain the attitudes and beliefs about NIHL and HPD use among employees at a large scale underground coal mine in Mpumalanga. A descriptive and exploratory cross-sectional study was conducted using a self-administered questionnaire, developed by the National Institute for Occupational Safety and Health (NIOSH) on Beliefs about Hearing Protection and Hearing Loss (BHPHL). Participants (n= 241) included employees from a coal mine in Mpumalanga, South Africa. Out of 241 completed surveys, this study found that 84% were aware of when to replace earmuffs; 95% believed wearing HPDs could prevent hearing loss in noisy environments; 83% felt their hearing was impacted by loud noise. Additionally, 86% mentioned discomfort from earmuff pressure; 95% emphasised HPD importance; and 95% used HPDs around loud sounds. Moreover, 98% knew how to properly wear earplugs, while lower education levels were linked to higher susceptibility to NIHL. The study identified positive attitudes towards NIHL and HPD use, but existing NIHL cases must be acknowledged. Organisations can use the findings to develop tailored hearing conservation programmes (HCP), including education, involving employees in protection decisions and promoting diligent HPD usage.Contribution:This study contributes to the limited literature on noise perceptions, NIHL, and HPD use in mining, emphasising the impact attitude has on HPD use and assessing the effect of miners NIHL knowledge on compliance. The findings, unique to coal mining, hold significance for enhancing hearing conservation and reducing NIHL.

Bariatric surgery patients in AUD treatment in Norway-an exploratory cross-sectional study.

Patients who have undergone some forms of bariatric surgery have increased risk of developing alcohol use disorder (AUD). In the present observational study, we compared patients with AUD who themselves reported to having undergone bariatric surgery with other patients in treatment for AUD. One-hundred-and-six consecutively enrolled patients in residential treatment for AUD were asked if they had undergone bariatric surgery. Sociodemographics, mental health-related, and alcohol use-related parameters were compared between those who had and those who had not undergone bariatric surgery. Of the 106 patients with AUD, seven (6.6%; 95% confidence interval, 2.7%-13.1%) had undergone bariatric surgery. Six of seven patients had undergone such surgery were women (P < .001). The patients with AUD who had undergone bariatric surgery were similar to other patients with AUD on most other parameters, the exception being a larger number of alcohol units ingested to feel an effect of alcohol (adjusted odds ratio 7.1; 95% confidence interval 2.0-12.2; P = .007). The high number of patients with AUD that reported having undergone bariatric surgery emphasizes the risks following such a procedure. The overrepresentation of women may reflect than more women undergo such procedures. The unexpected finding that patients with AUD having undergone bariatric surgery seemed to need more alcohol to feel intoxicated warrants further research.