Specific Health Care Research Articles

Exploring the Sociodemographic and Health-Related Determinants of Telehealth Use Among a Cohort of Older Australians During the COVID-19 Pandemic: Repeated Cross-Sectional Study.

During the COVID-19 pandemic, there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential health care. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to health care. Leveraging data collected by The Sax Institute's 45 and Up COVID Insights study between November 2020 and April 2022, the objective of this study was to identify and describe the sociodemographic and health-related determinants of telehealth adoption and use among a cohort of older Australians. We hypothesized that health-related factors would be key determinants of telehealth adoption for Australians aged ≥65 years during the COVID-19 pandemic. A repeated cross-sectional design was used. The relationships between telehealth use (classified as low, moderate, or high) and selected sociodemographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance, and the Use of Technology theoretical frameworks. Of the 21,830 participants aged ≥65 years, the proportion who indicated adopting telehealth ranged from 50.77% (11,082/21,830) at survey 1 in 2020 to 39.4% (7401/18,782) at survey 5 in 2022. High levels of telehealth use were associated with being female, aged <85 years, living in a major city, cohabiting with others, and being from the most socioeconomically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, and lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P<.001). A temporal association was observed, whereby participants who engaged with telehealth services before or early in the pandemic (as assessed in survey 1) were more likely to continue telehealth use when assessed in survey 5 in 2022 (P<.001). This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults, particularly those living with chronic diseases and multimorbidity, by using targeted strategies that overcome barriers to accessing specialized health care services.

Women’s experiences of risk-stratified breast cancer screening in the MyPeBS trial: a qualitative comparative study across two European countries

Objective Risk-stratification should improve the benefits-to-harms ratio for breast screening, whereby higher-risk women receive additional screening and low-risk women are screened less. This study investigated the effects of healthcare context by comparing how women in England and France experienced risk-based breast screening. Methods and measures Fifty-two women were purposively sampled from participants who underwent risk-based screening in the MyPeBS trial. Women received objectively-derived 5-year breast cancer risk estimates (low = < 1%, average = 1–1.66%, high = ≥ 1.67 to <6%, very-high-risk = ≥ 6%). This determined future trial-related screening schedules and prevention options. Semi-structured interviews were transcribed for thematic framework analysis. Results Two overarching themes were produced: the importance of supported risk communication and accessibility of risk management. Overall, risk-based breast screening was viewed positively. However, trial procedures, especially in risk estimate provision, differed across sites. Women at increased risk were more reassured when appointments were with specialist healthcare professionals (HCP). When absent, this resulted in reduced satisfaction with risk communication and greater uncertainty about its personal relevance. Low-risk women’s views on extended mammogram schedules seemed linked to how health services are organised differently. Conclusions Context is an important consideration regarding acceptability of healthcare innovations such as risk-stratified screening: it should not be assumed that findings from one country apply universally.

A Structured Approach to Involve Stakeholders in Prioritising Topics for Systematic Reviews in Public Health.

This study aimed to develop and apply a structured approach for prioritising topics for systematic reviews in public health, framed according to the readily applicable PICO format, which encourages the involvement of stakeholders' preferences in a transparent matter. We developed a multi-stage process, consisting of a scoping and two Delphi stages with web-based surveys and invited public health stakeholders in Switzerland to participate: First, respondents specified topics for different public health domains, which were reformulated in a PICO format by content analysis. Second, respondents rated the topics using five stakeholder-refined assessment criteria. Overall rankings were calculated to assess differences between stakeholder groups and rating criteria. In total, 215 respondents suggested 728 topics altogether. The response rate in the two Delphi stages was 91.6% and 77.6%, respectively. Most top-rated review topics focused on the effectiveness of interventions providing education to different target groups, followed by interventions to increase access to specific healthcare services. Our approach encourages involvement of stakeholders in identifying priorities for systematic reviews and highlights disparities between stakeholders and between individual criteria.

Widespread service fragmentation for patients and families with tuberous sclerosis complex (TSC) in the Republic of Ireland

BackgroundTuberous sclerosis complex (TSC) is a rare approximate 1:6000 birth incidence, a genetic disease with a wide variability of physical and neuropsychiatric symptoms. Patients require lifelong care from multiple healthcare specialities, for which International and United Kingdom (UK) TSC consensus recommendations exist. Personalised care delivered by a centralised coordinated team of TSC experts is recommended. There is no such service for the estimated 600 TSC patients in the Republic of Ireland (ROI) and there is a paucity of information regarding the healthcare of this group.PurposeEvaluate the baseline care of patients with TSC attending epilepsy services in the Republic of Ireland (ROI) against UK TSC consensus recommendations.MethodsPatients with a diagnosis of TSC attending 12 adult and paediatric epilepsy centres in the ROI were identified. Clinical audits measured the baseline care of a subset of these patients against UK, TSC clinical recommendations. Data was anonymised and analysed at Trinity College Dublin.ResultsOne hundred thirty-five TSC patients attending twelve epilepsy centres were identified. Adults (n = 67) paediatric (n = 68). The care of 83 patients was audited (n = 63 ≥ 18 years) and (n = 20 < 18 years). Many baseline tests were completed, however, they required intra or interhospital referral. Care appears fragmented and there was no evidence of formal disease surveillance plans.ConclusionsThe number of TSC patients attending epilepsy services is lower than expected (n = 135). Specialist services and treatments for TSC are available through informal referral pathways. Although UK, TSC consensus baseline recommendations are roughly adhered to, care is fragmented. Increased coordination of care could benefit disease management.

Sustainability of specialized healthcare in upper-middle-income economies: Innovations despite constraints

Countries such as Jamaica have had to be largely self-reliant in funding their health-care systems. The success of an early and sustained focus on primary healthcare, coupled with a change in the disease profile from infectious concerns to chronic non-communicable diseases associated with aging, has resulted in a marked rise in healthcare costs. Rapid technological advances in the diagnosis and treatment of many specialized conditions have further increased the cost of care. Funding these health-care costs sustainably is a challenge for Jamaica and other similarly developed economies due to competing demands for scarce funds. In addition to government health-care allocations, sources of sustainable funding from local public-private partnerships, through mechanisms such as philanthropy, may help address, at least in part, this chronic problem. This review examines strategies to create a framework for such funding, as well as proposes specific practical steps for their achievement. The author&amp;rsquo;s motivation to participate in the process of change stems from the stubbornly persistent inequalities of healthcare that people and health-care workers in Jamaica &amp;ndash; and similar lower- and middle-income countries &amp;ndash; routinely cope with. These inequalities must be addressed to truly achieve greater health egalitarianism, social stability, and ultimately, the developed country status they aspire to. The need to think innovatively to achieve this goal is self-evident, given the current inability of governments to achieve this goal.

Psychological factors and health-related quality of life in fibromyalgia patients

BackgroundFibromyalgia (FM) has been associated with decreased health-related quality of life (HRQoL), which has been linked to psychological variables such as anxiety, depression, coping, and social support. This study aimed to simultaneously analyse the association of these variables with HRQoL in FM patients and explore their mediating role in the relationship between somatic symptoms and HRQoL.Participants and procedureA cross-sectional sample of 134 FM patients (97% women) with no other rheumatologic diseases followed in specialized healthcare services completed self-report questionnaires to evaluate pain, fatigue, sleep, anxiety, depression, coping, social support, and HRQoL.ResultsThe results indicated that FM patients experienced a negative impact on all dimensions of HRQoL, with anxiety primarily affecting the mental dimensions, and depression and social support affecting both physical and mental dimensions. Anxiety, depression, dysfunctional coping, and low social support were independent predictors of HRQoL and mediated the effect of somatic symptoms in the mental component of HRQoL.ConclusionsFM patients experience a negative impact on HRQoL, and anxiety, depression, coping and social support play an important role as independent predictors of this decrease, and as mediators of the effect of somatic symptoms in the mental dimen-sions of HRQoL. This underscores the importance of considering these psychological variables in the therapeutic approach to FM and suggests the need for interventions targeting anxiety, depression, dysfunctional coping, and low social support to improve HRQoL in FM patients.

Mapping pharmacy deserts in North Carolina: a geospatial analysis and its implications for University of North Carolina Health’s catchment population

BackgroundPharmacy deserts represent areas where residents face notable challenges to accessing pharmacies. North Carolina (NC) presents an intriguing case study due to its diverse geographic landscape yet lacks extensive research regarding its pharmacy deserts. ObjectivesThis study aims to map pharmacy deserts in NC using pharmacy location and social determinants of health (SDOH) data measured using the social vulnerability index (SVI) and descriptively characterize health care utilization statistics for University of North Carolina (UNC) Health’s catchment population. MethodsPharmacy location data was compiled from the NC Board of Pharmacy. Pharmacy deserts were defined based on SVI > 0.75 and distance thresholds aligned to United States Department of Agriculture standards. Residential characteristics were retrieved from PolicyMap and Social Explorer databases. UNC Health patient utilization data were collected by UNC Pharmacy Data Analytics group for 3 NC counties. ResultsTwo thousand and two NC pharmacies met inclusion criteria. 17.2% urban tracts (1.3M residents) and 4.25% rural tracts (0.14M residents) were identified as pharmacy deserts (adj. P < 0.001). Those residing in deserts had significantly less internet access, annual medical cost per capita, and access to homeless relief services as well as significantly higher food insecurity rates and Medicare cost per capita (adj. P < 0.001). UNC-specific health care utilization statistics for the 3 assessed counties were all poorer in deserts compared to nondeserts within the same counties (P > 0.05). ConclusionA geospatial map with the location of pharmacy deserts in NC was created to highlight differences in patient health care utilization, affecting rural and urban areas. By incorporating SDOH predictors, this study provides a more nuanced map of NC pharmacy deserts compared to reviewing distance to pharmacies alone. Higher rates of emergency department and inpatient visits in counties with more residents in pharmacy deserts suggests potential health outcomes associated with limited pharmacy access.

Sustainability of specialized healthcare in economies like Jamaica: Overcoming historical constraints

Small island economies designated as upper-middle-income economies find themselves in the somewhat awkward position of not being viewed as in desperate need of financial support for their healthcare and thus receive severely limited external aid for healthcare. Consequently, countries like Jamaica have had to be self-reliant in funding their health-care systems. This challenge has prompted an early and sustained focus on primary healthcare, recognizing that prevention is better than cure. However, with the success of this strategy and the change in the disease profile from infectious concerns to chronic non-communicable diseases associated with aging, the cost of healthcare has markedly increased. Rapid technological advances in the diagnosis and treatment of specialized conditions have further escalated health-care costs. Funding these increasing health-care costs sustainably is a significant challenge for Jamaica and similarly developed smaller economies, especially given the numerous other demands for scarce funds. One potential solution to this chronic problem is to develop sustainable funding sources within the country, such as through local entrepreneurs and philanthropy. Partnerships for health can be forged, where philanthropic investments play a critical role. This article is the first in a series of two. It explores a relationship between the historical context and the current status of healthcare in Jamaica, which is evaluated in further detail, identifying the existing deficiencies that stem from chronic underinvestment. The second article will discuss the principles of giving, with a focus on philanthropy. Future endeavors will include a formal qualitative study of Jamaica&amp;rsquo;s wealthiest entrepreneurs to assess their interest in philanthropy and their potential to invest philanthropically in specialized healthcare in Jamaica.

Knowledge, skills, and confidence gaps impacting treatment decision making in relapsed/refractory chronic lymphocytic leukemia and mantle cell lymphoma: a quantitative survey study in France, Germany, and the United States

BackgroundWith recent advancements in the treatment of chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL), healthcare specialists may face challenges making treatment and management decisions based on latest evidence for the optimal care of patients with these conditions. This study aimed to identify specific knowledge, skills, and confidence gaps impacting the treatment of CLL and MCL, to inform future educational activities.MethodsHematologists and hemato-oncologists (HCPs, n = 224) from France (academic settings), Germany, and the United States (academic and community settings) responded to a 15-minute quantitative needs assessment survey that measured perceived knowledge, skills, and confidence levels regarding different aspects of treatment and management of CLL and MCL patients, as well as clinical case questions. Descriptive statistics (cross tabulations) and Chi-square tests were conducted.ResultsFour areas of educational need were identified: (1) sub-optimal knowledge of treatment guidelines; (2) sub-optimal knowledge of molecular testing to inform CLL/MCL treatment decisions; (3) sub-optimal skills when making treatment decisions according to patient profile (co-morbidities, molecular testing results); and (4) challenges balancing the risk of toxicities with benefits of treatment. Over one-third of the respondents reported skill gaps when selecting suitable treatment options and prescribing therapies and reported a lack in confidence to initiate and manage treatment. Larger gaps in knowledge of guidelines and skills in patient assessment were identified in MCL, compared to CLL.ConclusionsThis study suggests the need for continuing medical education specifically to improve knowledge of treatment guidelines, and to assist clinicians in developing skills and confidence when faced with clinical decision-making scenarios of patients with specific comorbidities and/or molecular test results, for example, through case-based learning activities.

The Effects of Recreational and Pharmaceutical Substance Use on Oral Microbiomes and Health

Oral health remains one of the most taken for granted parts of human body health, even though poor oral health has now been linked to various diseases, such as cancers, diabetes, autoimmune complications, neurological disorders, and cardiovascular disease, just to name a few. As we review in this paper, substance use or abuse, including alcohol, smoking, recreational drugs, and pharmaceutical drugs can have significant implications on oral health, which in turn can lead to more systemic diseases. In this paper, we show that oral microbiome dysbiosis and inflammatory cytokine pathways are two of the most significant mechanisms contributing to oral health complications from substance use. When substance use decreases beneficial oral species and increases periodontopathogenic strains, a subsequent cascade of oncogenic and inflammatory cytokines is triggered. In this review, we explore these mechanisms and others to determine the consequences of substance use on oral health. The findings are of significance clinically and in research fields as the substance-use-induced deterioration of oral health significantly reduces quality of life and daily functions. Overall, the studies in this review may provide valuable information for future personalized medicine and safer alternatives to legal and pharmaceutical substances. Furthermore, they can lead towards better rehabilitation or preventative initiatives and policies, as it is critical for healthcare and addiction aid specialists to have proper tools at their disposal.

2145 Physical and mental health needs of older transgender adults in the U.K.: a scoping review

Abstract Introduction The number of adults in the UK who identify as transgender is increasing, through greater recognition of trans identity and growing numbers of individuals transitioning in later life. The term ‘Transgender’ encompasses a diverse range of experiences and identities, including those who identify as non-binary, gender-fluid, and gender-queer. However, within this review, we use the shortened term ‘trans’ and the following broad definition: ‘people whose gender is different from the gender assigned to them at birth.’ We conducted this exploratory review to examine the literature regarding the specific health and social care needs of older trans adults. Methods We utilised scoping review methodology and thematic qualitative analysis to systematically search and map the literature related to the physical and mental health challenges related to the ageing experience among trans adults in the UK. Results We identified 22 relevant papers through combined systematic search and additional manual reference review. We recognised five key themes within the literature: Systems and Structural Factors, Health and Mental Health, Social Care, Diversity and The Future. The former three themes relate to limitations presented by current models of care, barriers within services and potential areas for development. Key areas identified include challenges related to the application of a binary gender model within healthcare systems as well as advanced care planning and ensuring gender-affirming care where capacity is lost including living with dementia. The latter two themes identify gaps in the current literature and provide examples of trans-inclusive positive practice. Conclusions There is an ongoing need for researchers, clinicians and policymakers to ensure that the needs of older trans adults are studied, understood and accommodated within policy and practice. Service providers delivering care to older adults must understand trans-specific needs, particularly around advanced care planning, to ensure that trans people are supported to age well.

Innovations in Biosensor Technologies for Healthcare Diagnostics and Therapeutic Drug Monitoring: Applications, Recent Progress, and Future Research Challenges.

This comprehensive review delves into the forefront of biosensor technologies and their critical roles in disease biomarker detection and therapeutic drug monitoring. It provides an in-depth analysis of various biosensor types and applications, including enzymatic sensors, immunosensors, and DNA sensors, elucidating their mechanisms and specific healthcare applications. The review highlights recent innovations such as integrating nanotechnology, developing wearable devices, and trends in miniaturisation, showcasing their transformative potential in healthcare. In addition, it addresses significant sensitivity, specificity, reproducibility, and data security challenges, proposing strategic solutions to overcome these obstacles. It is envisaged that it will inform strategic decision-making, drive technological innovation, and enhance global healthcare outcomes by synthesising multidisciplinary insights.

Needs and expectations of healthcare professionals regarding the topic of alcohology: Results of a survey conducted in France in 2022

ContextAlcohol-related health problems represent a significant public health concern, and it is imperative for the healthcare team to accurately perceive and detect these issues to provide appropriate care. The objective of this survey was to evaluate the knowledge, practices, and educational background of healthcare professionals in the field of alcohol-related health concerns, aiming to identify their information requirements. MethodsThis study employs a cross-sectional descriptive survey methodology, in which data were gathered through a digital questionnaire designed for healthcare professionals (including those in medical, paramedical, and medico-social professions) working in addictology services as well as other relevant services across France and its overseas departments. ResultsA total of 611 questionnaires were deemed usable for analysis. A considerable percentage of participants reported their knowledge and skills to be insufficient or very insufficient, with rates of 33 % and 36 %, respectively. Moreover, a significant proportion of respondents (≈ 28 %) stated that they had received no education in addictology. Our results highlight differences in levels of knowledge and competence among the various healthcare settings, notably with lower reported levels of satisfaction in hospital settings (public and private), private practice, and in Harm Reduction Centers. Furthermore, certain professions reported unsatisfactory levels of skills and knowledge in alcohol-related issues, particularly support staff, pharmacists, expert patients, administrative staff, and social workers. These findings suggest the need to enhance knowledge and skills by tailoring interventions according to the specific healthcare settings and professions. Additionally, the priority themes and channels for disseminating information varied depending on age, region, and professional category. ConclusionThis survey reveals a low level of knowledge, practice, and education in addictology, emphasizing the critical need for training. The importance of training extends not only to the priority topics addressed but also to the channels used for dissemination, all while customizing them to suit the age, professional category, structure, and region of healthcare professionals.

Cognitive impairment in patients awaiting kidney and liver transplantation-A clinically relevant problem?

Cognitive impairment (CI) is common in both end-stage kidney disease (ESKD) and alcohol-related liver cirrhosis. The aim of this study was to assess the prevalence and patterns of CI in patients awaiting kidney and liver transplantation, and to identify its determinants. In this cross-sectional, prospective study, 31 consecutive patients with ESKD and 31 consecutive patients with alcohol-related liver cirrhosis, all currently on transplant waiting lists, were screened for cognitive decline using the Addenbrooke's Cognitive Examination. Medical history, demographics, and laboratory test results were also collected. The prevalence of CI among patients with ESKD and alcohol-related liver cirrhosis was 26% and 90%, respectively. In both groups, memory was the most affected cognitive domain, along with verbal fluency in patients with ESKD, and visuospatial abilities in patients with alcoholic cirrhosis. The most statistically significant increase in the prevalence of CI was found in patients with lower educational attainment, in both alcohol-related liver cirrhosis and ESKD populations as well as in older patients with alcoholic cirrhosis. Furthermore, better cognitive functioning in ESKD patients was associated with higher levels of total lymphocyte count and alanine transaminase (ALT), and in alcohol-related liver cirrhosis patients with higher levels of ALT and aspartate transaminase. A nonsignificant trend toward lower memory domain scores was also observed with increasing ammonia levels and increasing severity of liver disease (higher Child-Pugh scores). Finally, suboptimal performance on the screening test was correlated with the severity of liver disease as assessed by the Model for End-Stage Liver Disease Sodium (MELD-Na), but not at the statistically significant level. The prevalence of CI, especially in patients with alcohol-related liver cirrhosis, is high and can be a significant clinical problem, negatively affecting the transplantation process. Routine screening tests in this group would contribute to the implementation of appropriate management, such as rehabilitation program or psychosocial treatments and facilitate the provision of specialized health care.

Nursing managers' perceptions of teamwork and collaboration in mining primary healthcare clinics in Gauteng.

Teamwork and collaboration among nursing managers, nurses, doctors and peripheral hospitals treating mining patients is pivotal. A case study of specific mining primary healthcare clinics revealed a lack of teamwork among the doctors and nursing managers, even on decisions that show productivity. The aim of this study was to explore and describe nursing managers' perceptions of teamwork and collaboration in mining primary healthcare clinics in Gauteng. A qualitative, exploratory, descriptive and contextual research design was adopted to conduct this study. Data were collected by conducting semi-structured individual interviews with 10 participants and thematically analysed. Data saturation was reached by the seventh participant and confirmed with three more interviews. Trustworthiness measures and ethical considerations were preserved as protocols because of the nature of the study. Three themes emanated from the study: (1) team coordination and support improve teamwork and collaboration in primary healthcare clinics, (2) there is a lack of involvement from the nursing team, negatively influencing teamwork and collaboration and (3) collaboration can improve the quality of healthcare services rendered in mining primary healthcare clinics. All mining primary healthcare clinic team members should be involved in operational activities to foster teamwork and collaboration.Contribution:This study revealed that teamwork and collaboration should be facilitated to improve the quality of healthcare service in mining primary healthcare clinics.

Healthcare practices among refugee older adults: A protocol for a scoping review

Background: Healthcare systems worldwide face the significant challenge of meeting the complex healthcare needs of refugee older adults. These individuals encounter numerous barriers at micro, meso, and macro levels in accessing and using healthcare in their host or resettled countries. Beyond these barriers, understanding their specific healthcare needs, healthcare-seeking behaviors, health practices, and the facilitators that enhance their access to and utilization of both formal and informal healthcare is crucial for improving their health outcomes. Objective: Our scoping review aims to capture the scope and range of evidence on refugee older adults’ healthcare needs, healthcare-seeking behaviors, health practices, and facilitators and barriers to access to and utilization of formal and informal healthcare. Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews along with the PRISMA-ScR framework will guide this scoping review. Literature written in English and published between 2011 and 2024 will be selected if they focused on refugee older adults who are 55 years of age and older. Scholarly literature will be searched using CINAHL, SocINDEX, Academic Search Complete, PsycINFO and MEDLINE, and gray literature will be captured by searching ProQuest’s Dissertations and Theses Global, Google, and Google Scholar. The extracted data will be synthesized, and narratively presented and supported by tables designed to align with the scoping review’s objective. Implications: The results of this scoping review will be used to offer actionable insights for healthcare providers, policymakers, and researchers. By mapping the existing landscape and identifying gaps, we also hope to inform the development of more inclusive and responsive healthcare models that address the specific needs of refugee older adults.

Infertility following trisomic pregnancies: A nationwide cohort study.

To study whether gynecologic or reproductive disorders show association with trisomic conceptions. This nationwide cohort study utilized the Registry of Congenital Malformations to identify women who had a trisomic pregnancy (n = 5784), either with trisomy 13 (T13; n = 351), trisomy 18 (T18; n = 1065) or trisomy 21 (T21; n = 4369) from 1987 to 2018. We used the Finnish Maternity cohort to match the cases to population controls (n = 34 422) on the age, residence, and timing of pregnancy. These data were cross-linked to the ICD-10 diagnoses of the national Care Registry for Health Care data on specialized health care in Finland during 1996 to 2019. Both inflammatory (ICD-10 diagnoses: N70-N77) and noninflammatory disorders of the genital tract (N80-N98) were studied. Crude odds ratios (ORs) with 95% CIs were calculated for associations between diagnoses and trisomic conceptions. The diagnosis of female infertility (N97) at any time was associated with trisomic conceptions (OR: 1.19, 95% CI: 1.08-1.32). In the subgroup analysis, this association was found for T18 (OR: 1.29, 95% CI: 1.03-1.61) and T21 (OR: 1.17, 95% CI: 1.04-1.32), but not for T13 (OR: 1.15, 95% CI: 0.75-1.72). When restricting the timing of the diagnosis of female infertility, an elevated OR was found only after the index pregnancy (OR: 1.81, 95% CI: 1.56-2.09). These increased odds for infertility after trisomic conceptions were observed both in women <35 years (T18 OR: 1.91, 95% CI: 1.21-3.00; T21 OR: 1.68, 95% CI: 1.31-2.14) and in women ≥35 years (T18 OR: 2.17, 95% CI: 1.40-3.33; T21 OR: 1.87; 95% CI: 1.47-2.39), but not after T13 conceptions. Our observational data suggest a link between trisomic conceptions and subsequent diagnoses of infertility but do not demonstrate causality. These data implicate that partially similar mechanisms might predispose to trisomy and infertility, regardless of maternal age.

Prevalence of Low Back Pain and Association Factors Among Operating Room Personnel of Ahvaz Hospitals: A Cross-Sectional Study

Background: Low back pain is a common musculoskeletal disorder among healthcare specialty nurses. Operating room staff are particularly susceptible to experiencing low back pain due to the nature of their work. Objectives: We conducted a study to investigate the prevalence of low back pain and the factors associated with it. Methods: A cross-sectional study was conducted on 323 operating room staff from five hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. Data was collected using a questionnaire developed by Tavakol et al. This questionnaire included demographic information and assessed the prevalence and dimensions of low back pain. The data was analyzed using IBM SPSS v.26. Results: The results showed that the prevalence of low back pain (LBP) was 74.3%. In this study, 64.8% of the personnel were women, 63.5% were married, and 72.4% had a bachelor's degree. Additionally, 87% had no history of smoking. The average age was 33.83 ± 7.02 years. There was a significant relationship between the prevalence of LBP and gender (P = 0.044), marital status (P = 0.0001), BMI (P = 0.008), age (P = 0.0001), shift work (P = 0.001), work experience (P = 0.0001), and the average number of shifts (P = 0.037). Conclusions: We found a high prevalence of LBP among operating room personnel, which is related to both individual and occupational factors. Our recommendations for nursing managers include modifying work shifts, allocating less physically demanding tasks to senior personnel and females, and implementing educational programs that focus on improving ergonomics and reducing physical strain.

Pediatric to adult transition care in neurogastroenterology and motility: A position paper from the American Neurogastroenterology and Motility Society and European Society of Neurogastroenterology and Motility.

Transition services-programs that support adolescents and young adults (AYAs) as they move from a child-centered to a more autonomous, adult-orientated healthcare system-have been associated with improved short- and long-term healthcare outcomes. Unfortunately, there is a paucity of evidence exploring transition services within the neurogastroenterology and motility (NGM) field. The overall aim of this article, endorsed by the American Neurogastroenterology and Motility Society and European Society of Neurogastroenterology and Motility, is to promote a discussion about the role of transition services for patients with NGM disorders. The AYAs addressed herein are those who have: (a) a ROME positive disorder of gut-brain interaction (DGBI), (b) a primary or secondary motility disorder (including those with motility disorders that have been surgically managed), or (c) an artificial feeding requirement (parenteral or enteral tube feeding) to manage malnutrition secondary to categories (a) or (b). The issues explored in this position paper include the specific physical and psychological healthcare needs of patients with NGM disorders; key healthcare professionals who should form part of a secondary care NGM transition service; the triadic relationship between healthcare professionals, caregivers, and patients; approaches to selecting patients who may benefit most from transition care; methods to assess transition readiness; and strategies with which to facilitate transfer of care between healthcare professionals. Key areas for future research are also addressed, including the construction of NGM-specific transition readiness questionnaires, tools to assess post-transfer healthcare outcomes, and educational programs to train healthcare professionals about transition care in NGM.

Comparison of Laws that Impact Volunteer Response in Three Disaster-Prone Southeastern States.

As natural disasters become more frequent and severe, the ability of impacted states to rapidly scale up their capacity to respond and facilitate recovery through volunteers is ever more crucial. However, the legal landscape that may facilitate or hamper augmentation through volunteers has yet to be fully explored. This study utilized policy surveillance methodology to code relevant laws identified in searches using the Emergency Law Inventory database and Westlaw. We assessed laws in three natural disaster-prone states: North Carolina, South Carolina, and Georgia. We assessed the presence of liability protection, license reciprocity, and scope of practice laws for health care volunteers. Of the three assessed legal domains, liability protection for health care volunteers across all states contained the most robust language. Liability protections apply unless the health care volunteers act with reckless disregard, willful misconduct, or gross negligence. However, nuance exists based on which organizations (state vs charitable) volunteers are affiliated with to qualify for coverage. License reciprocity for out-of-state specific health care professions entering the impacted states was available across all three states. However, only Georgia enacted federal model legislation that provides additional flexibility regarding credentialing and liability protections. Lastly, very few laws addressed the scope of practice in impacted states. Comparisons of laws that impact the ability of health care volunteers to respond and recover from disasters are scarce. More research needs to be performed to better understand the laws that impact volunteers in emergencies, particularly as the public health system is overtasked when providing services to impacted communities.