Health Care Centers Research Articles

Assaults against pandemic heroes: an observational study in the Metropolitan City of Genoa in Italy

Abstract Background Escalating violence against healthcare workers is a significant public health issue that undermines care quality and workers’ health. This descriptive study aims to examine trends in aggression across different pandemic phases. Methods The study analysed reported violence among healthcare workers from 2018 to 2023 within a Local Health Authority in Genoa, Italy. Variables of interest included the severity of aggression, the professionals affected, and the locations of incidents. Data was analysed using appropriate statistical methods, including multinomial logistic regression, to assess relationships across pandemic phases. Results Reported aggressions rose from 48 incidents in 2018 to 103 in 2023, totaling 463. Pre-pandemic physical violence was at 39%, dropping to 27% during and after the pandemic (χ²=7.4, df = 2, p < 0.025). Nurses experienced the highest violence rates, with an average of 72% pre-pandemic and 74% post-pandemic, reducing to 51% during the pandemic if compared with doctors (Coef -0.80; 95%CI -1.45|-0.15). Over half of incidents occurred in Emergency and Psychiatric Services, from 77% before to 51% after pandemic. Conversely, violence in Local Services rose from 7% before to 24% during and 28% after pandemic (χ²=56.9, df = 6, p < 0.000). If compared to Hospitals, violence in Local Services increased during (Coef 1.44; 95%CI 0.40|2.48) and post-pandemic (Coef 1.001; 95%CI 0.13|1.87), and in Psychiatric Services decreased post-pandemic (Coef -0.98; 95%CI -1.67|-0.29). Conclusions Violence against healthcare workers shifted during and post-pandemic, mirroring the decentralisation of healthcare due to pandemic. The urgent development and implementation of effective violence prevention strategies are imperative. These should include training, psychological support, security enhancements, and a strong organisational culture that prioritises safety and respect. Protecting healthcare workers is crucial for their well-being and to ensure high healthcare quality. Key messages • Escalating violence undermines care quality and healthcare worker well-being. Effective prevention strategies are essential, including training, support, and an organisation that prioritises safety. • Nurses are the main victims of violence. Violence is higher in Emergency Departments, but incidents are increasing in Local Health Services, due to organisational changes during and post-pandemic.

“We want to get out” – A qualitative study on reasons for nurses’ early retirement intentions

Abstract Background Nurses, the largest workforce in healthcare, play a central role in health systems. There is a severe global shortage of nurses, which is expected to worsen as a significant portion approaches retirement age. Early retirements can harm care quality and healthcare access, thus significantly impacting public health. Identifying reasons is crucial to prevent this trend. This study examined factors behind nurses’ early retirement intentions. Methods A descriptive qualitative study was conducted in an Irish hospital (July to September 2023) including individual interviews with 10 nurses aged 55 and over. A thematic analysis was conducted collaboratively by three researchers to identify key factors influencing nurses’ intentions to retire early. Results Five main themes emerged: 1) Health concerns, encompassing physical strain and psychological stress, significantly influencing early retirement intentions; 2) Struggling to balance job demands with personal responsibilities such as caring for ageing parents due to inflexible work schedules; 3) Need for more support from senior leaders to address staffing shortages and investment in aging nurses’ career and retirement planning to make staying more desirable and easier; 4) Feelings about nurses’ experience being undervalued in the evolving healthcare; and 5) Facing constant heavy responsibility in guiding new nurses, while simultaneously fearing patient safety risks and encountering generational differences. Conclusions Developing support systems for ageing nurses, encompassing strategies to ease workload strain, enhancing career opportunities, and promoting intergenerational collaboration are critical for reducing early retirement trends and sustaining a resilient healthcare workforce. By implementing tailored approaches, such as flexible scheduling and mentorship programs for ageing nurses, healthcare organisations can promote workforce longevity and enhance public health outcomes through improved care delivery. Key messages • Health challenges and struggles in work-life balance influence early retirement intentions among nurses, urging flexible work arrangements and improved recognition and leadership in healthcare. • To extend work careers, organisations must invest in ageing nurses’ career and retirement planning, value experience, and acknowledge potential challenges and benefits in intergenerational nursing.

PD-L1 Expression Varies in Thyroid Cancer Types and Is Associated with Decreased Progression Free Survival (PFS) in Patients with Anaplastic Thyroid Cancer.

Thyroid cancer (TC) remains a significant clinical challenge worldwide, with a subset of patients facing aggressive disease progression and therapeutic resistance. Immune checkpoint inhibitors targeting programmed death-ligand 1 (PD-L1) have emerged as promising therapeutic approaches for various malignancies, yet their efficacy in TC remains uncertain. The objective of this study was to investigate PD-L1 expression in aggressive TC and its association with histological subtypes, molecular mutation, and progression-free survival. This is a retrospective study of patients with advanced TC seen in two tertiary health care centers. Included in this study were patients with advanced TC with recurrence or progression on therapy for whom tumor molecular profiling and PD-L1 status were available. Kaplan-Meier estimators were utilized to analyze the progression-free survival (PFS) between patients with PD-L1 positive and negative status in Anaplastic TC (ATC) subgroup. A total of 176 patients with advanced thyroid cancer were included (48.9% female). Of the patients, 13 had ATC, 11 Medullary TC (MTC), 81 Papillary TC Classic Variant (PTCCV), 20 Follicular TC (FTC), 8 Oncocytic TC (OTC), 10 Poorly Differentiated TC (PDTC), and 30 had the Papillary TC Follicular Variant (PTCFV). BRAF mutation was present in 41%, TERT in 30%, RAS in 19%, TP53 in 10%, and RET in 8.6% of patients. PD-L1 positivity was significantly different across different TC types and histological subtypes (p < 0.01): Patients with OTC had the highest frequency of PD-L1 positivity (71%), followed by ATC (69%), PTCCV (28.5%), and FTC (11%). Patients with MTC and PTCFV did not exhibit any PD-L1 positivity. TP53 mutation was positively associated with PD-L1 expression (21.6% vs. 7.5%, p = 0.03), and RAS mutation was negatively associated with PD-L1 expression (8.1% vs. 24.2% p = 0.04). Among patients with ATC, positive PD-L1 expression was associated with lower PFS (p = 0.002). PD-L1 expression varies across different TC types and histological subtypes and may be modulated by the mutational landscape. PD-L1 expression in ATC is associated with shorter PFS. Follow up studies are warranted to elucidate the molecular mechanism driving the observed differences in immune pathways, potentially paving the way for the development of more effective and personalized immune therapies for patients with aggressive TC.

An intersectional approach on menstrual inequity as lived by women in circumstances of socioeconomic vulnerability in an urban and rural setting in Spain: a qualitative study

Since menstrual health and menstrual inequity are determined by social power structures, this study proposes to analyse, from an intersectional perspective, the experiences of menstrual inequity of women and people who menstruate (PWM) (≥18 years) under circumstances of socioeconomic vulnerability in an urban and rural setting in Catalonia (Spain), focusing on menstrual poverty, menstrual management and access to health care for menstrual health. An exploratory and interpretative qualitative study was conducted. Venue-based convenience sampling was carried out, recruiting women from a non-governmental organisation and a primary health care centre. Eighteen individual semi-structured interviews were conducted between October 2022 and February 2023. Data were analysed through reflexive thematic analysis. Analysis revealed that menstrual care was generally a distant preoccupation that revolved around circumstances of socioeconomic vulnerability, housing, and productive/reproductive work. Menstrual poverty, menstrual management and menstrual self-care challenges, barriers to accessing health care for menstrual health, and menstrual taboo, stigma and discrimination were commonplace and deepened by socioeconomic vulnerability. In this way, women’s menstrual experiences were rooted in intersecting axes of inequity, based on gender, race and class. Intersectional and critical participatory research, policy and practice are imperative to develop counter mechanisms that confront systems of privilege-oppression to modulate menstrual experience, health and equity.

Real world data after the implementation of coronary computed tomography angiography in Swedish primary care to rule out coronary artery disease, a cross-sectional study based on pre-test probability

Abstract Background In primary care, most patients with of non-acute chest pain will neither receive a heart related diagnosis nor be referred to a cardiologist. Studies indicate a better cardiovascular prognosis in chest pain patients referred to Coronary Computed Tomography Angiography (CCTA) as compared to risk stratification solely based on risk prediction instruments(1). CCTA is recommended since 2019 for low to intermediate cardiovascular (CV) risk patients(2). In the study setting, the primary care has implemented CCTA as first line test for patients with suspected obstructive coronary artery disease (CAD) and a Pre-Test Probability (PTP) of &amp;lt;15% and any CV risk factor, with PTP mandatorily entered in the referral letters. Purpose To study the outcome of CCTA based on referred PTP values categorised into &amp;lt;5%, 5-15% and &amp;gt;15%. We hypothesized that the presence of significant stenosis would be on par with the mean PTP. Methods In this cross-sectional retrospective cohort study, all consecutive clinical referrals for a CCTA from primary health care centres with a catchment area of ~470 000 inhabitants in the country of Sweden between 1 June 2021 and 7 Dec. 2022, with PTP estimates and completed CCTA were included. CCTA findings were stratified as normal, atheromatosis, or significant stenosis (≥50% coronary lumen obstruction). Patient baseline characteristics routinely registered on the day of CCTA was retrieved from a nationwide quality registry, SWEDEHEART(3). Pearsons’s Chi2 and one-way ANOVA was used to test differences in group distributions. Results During the study period, 381 patients with a PTP had obtained CCTA, of which 75% (n=286) had PTP &amp;lt;15%. The mean age was 60 years (standard deviation [SD] 11), 70% were female, 30% were prescribed lipid-lowering medication and 47% anti-hypertensives (Table 1). In total, the mean PTP was 12.4% (SD 8.7) and in 18% a suspected significant stenosis was identified. (Figure 1). Among patients referred with PTP 5-15%, the presence of suspected significant stenosis was 12% and cardiology consultation was less frequently described than for PTP &amp;lt;5 or ≥15% (14% vs 33% vs 44%, p &amp;lt; 0.001). Conclusions This study indicates that PTP is an efficient means to select patients for CCTA in primary care. In total, about 1/5 had a suspected significant stenosis, which often requires further investigations, and about 4/5 could be reassured that symptoms were not due to coronary artery disease. In 31% atheromatosis was identified, potentially facilitating counselling on CV prevention. We conclude that CCTA is a clinically effective option for primary care physicians to rule out CAD in patients with low PTP.Figure 1Table 1

Evaluating the psychological antecedents of vaccination in applicants to primary health care centers

Abstract Background Vaccine acceptance can be enhanced by understanding the psychological antecedents of vaccination. The 5C model identifies relevant factors: confidence, complacency, constraints, calculation, and collective responsibility. This study aims to evaluate these factors among primary health care center applicants in Ankara. Methods A total of 1712 individuals aged 18 and over, who visited primary health care centers, participated in the study. The face-to-face survey included questions about sociodemographic characteristics, Vaccination Psychological Antecedents Scale, individuals’ attitudes and behaviors towards vaccination, and internet usage. Factors with a significance level of p &amp;lt; 0.20 from previous analyses were assessed using multivariate logistic regression analysis. The factors influencing the decision to get vaccinated without hesitation when necessary were investigated. Results The likelihood of getting vaccinated without hesitation in necessary situations is higher among those with higher income than expenditure(OR:1,517, 95%CI=1,094-2,104), those without chronic diseases in their family(OR:1,411, 95%CI=1,109-1,795), and those who do not actively use social media(OR:1,380, 95%CI=1,051-1,813). Additionally, an increase in the confidence score(OR:1,276, 95%CI=1,239-1,315) and the collective responsibility score(OR:1,096, 95%CI=1,058-1,134), was associated with an increased likelihood, while an increase in the calculation dimension(OR:0,928, 95%CI=0,895-0,962) was associated with a decreased likelihood. Conclusions Income status, presence of chronic illness in the family, active social media usage, confidence, collective responsibility, and calculation are factors influencing vaccine acceptance without hesitation. Communication strategies based on trust and collective responsibility should be developed to improve vaccine acceptance. The risk factors causing vaccine hesitancy among social media users should be investigated, and measures should be taken. Key messages • Develop trust-based, collective responsibility-focused communication to boost vaccine acceptance. • Investigate and address social media-driven vaccine hesitancy.

Mammography screening among women attending primary healthcare centers in Monastir, Tunisia

Abstract Background Breast cancer is the leading cancer among women worldwide. Early detection through mammography screening improves prognosis and enhances survival rate for this disease. The aim of this study was to identify the factors associated with mammography screening utilization among women attending primary healthcare centers. Methods A cross-sectional study was conducted in four primary healthcare centers in Monastir governorate in October 2023 using a pre-tested questionnaire. Women aged over 45 years-old were included as they were the target group in the breast cancer screening strategy. Univariate then multivariate analyses were performed in order to identify the factors associated with mammography screening utilization. Data was analyzed by SPSS 21.0. Results A total of 192 women were included in the study with a mean age of 56.7±8.8 years-old. Among them, 79.7 % (n = 153) were married and 51.6% (n = 98) had three children and less. A total of 55.3 % (n = 94) had a primary education level. Regarding participants’ practices of breast cancer screening, 35% of our participants have had mammogram. Univariate analysis showed that the knowledge about breast cancer symptoms (p = 0.015), practicing Breast self-examination (BSE) (p = 0.002), being aware about mammography (p = 0.001) and the recommended age of the screening at 45 years-old (p = 0.001) were significantly associated with adherence to breast cancer screening. Multivariate analysis revealed that practicing BSE (ORa=2.60 [95%CI: 1.22-5.55] and knowing the recommended age of mammography screening (ORa=2.28 [95%CI: 1.17-4.45] were significant (P &amp;lt; 0.05) predictors of mammography screening utilization. Conclusions Mammography screening rate is low. This study had provided some informations about factors influencing mammography screening. Policymakers and public health practitioners should consider the identified factors when developing intervention programs to improve breast cancer screening. Key messages • There is a need to conduct education sessions in schools to raise awareness about breast cancer screening at an early age. • Social media can be a tool for health education on mammography screening.

Cardiometabolic multimorbidity and associated risk factors in a cohort identified through community-based screening in Eastern Nepal

Abstract Background Cardiometabolic multimorbidity constitutes a major cause of premature mortality and morbidity in low- and middle-income countries like Nepal. Early detection of associated risk factors and timely management at primary care centres can significantly reduce the impact at individual level. Lack of quality research data in resource poor setting often pose a challenge to plan for efficient delivery of health services. Purpose This analysis of secondary data from a cohort identified through a community based NCD intervention program intends to explore the distribution of cardiometabolic multimorbidity and associated risk factors in adult population of Eastern Nepal. Methods This report is a part of integrated NCD management strategy, a KHDC (Kidney, Hypertension, Diabetes, and Cardiovascular disease) program, implemented through community-based screening and interventions focused on primary level healthcare centres. The KHDC program involved screening of 14,517 individuals aged 18 years and above at baseline during a period of 2019-2023 for selected NCDs, including, cardiovascular diseases, hypertension, diabetes, and kidney disease. Individual level data was collected through anthropometric measurements, participants’ self-report, vitals assessment, laboratory parameters and diagnostic adjuncts including ECG and Echocardiography. Outcome of cardiometabolic multimorbidity1 was defined as presence of two or more of diabetes mellitus, and cardiovascular diseases including myocardial infarction and stroke. Results About 12.8% (n=1862) of the participants had at least one cardiometabolic multimorbidity, while less than one per cent (n=47) had two or more multimorbidity. Presence of at least one multimorbidity was associated with older age ≥ 40 years [OR: 3.870 (95% CI: 3.285-4.558)], male gender [OR: 1.326 (95% CI: 1.202-1.463)], BMI ≥ 23 kg/cm2 [OR: 1.348 (95% CI: 1.208-1.503)], current tobacco consumption [OR: 1.164 (95% CI: 1.038-1.305)] and co-occurrence of hypertension [OR: 1.736 (95% CI: 1.550-1.943)]. The presence of both diabetes mellitus and cardiovascular disease was associated with age ≥ 40 years [OR: 7.612 (95% CI: 1.846-31.395)] and co-occurrence of hypertension [OR: 2.544 (95% CI: 1.401-4.620)]. Conclusion Disproportionate burden of cardiometabolic multimorbidity was apparent among adult population screened in our program. Older age and co-occurrence of hypertension was identified as contributing factors for the presence of such multimorbidity. A baseline information on the distribution and risk factors for the same among general population can provide a valuable insight into understanding the disease progression and prognostic outcomes.Table of Outcomes

Culture for Health – Example from Serbia

Abstract Using the possibility of social prescribing at the community level integrates several sectors, primarily the health sector and the culture sector. The goal of this project was to strengthen intersectoral cooperation (culture and health) and consider the possibility of providing conditions in the local community for continuous prescribing of the culture ‘on prescription’. Institute for Public Health of Vojvodina invited Matica Srpska Gallery to participate together with the Novi Sad Healthcare Center in a unique project that connects culture and health. The ‘Culture on prescription - culture for health’ consisted of two phases: curatorial guidance and group workshops. Curatorial guidance means the selection of individual works of art whose narration is planned and methodologically adapted to different groups of participants and which evokes different feelings related to quality of life and health. The second part of the program consisted of workshops in the Museum, enriched with works of art and a pleasant atmosphere.The workshops are based on group analytical methods and participants had the opportunity to reflect their observations, experiences and feelings on individual works of art, and they often reflected with personal life experiences that were not only aesthetic, but also pleasant and therapeutic. Participants came in two sessions, with two different curatorial guides, carefully thematically prepared, and which were later the source for substantive reflection. The positive outcomes of these innovative workshops was confirmed through written and oral facts, through which the participants emphasized that the stay in the museum space was therapeutic in itself. The possibility of the so-called ‘depot’ or prolonged effect of the unique prescription was observed, emphasizing that the participation in the workshops left an impression on the participants and that they will stay with a positive feeling and pleasantness after receiving a ‘dose’ of culture for health.

Psychometric Properties of the Arabic Version of Interactive Breastfeeding Scale

Objective: To assess factors influencing mother-child interaction during breastfeeding and validate the Arabic version of the Interactive Breastfeeding Scale (IBfS). Methods: A descriptive (cross- sectional study design) was carried out to evaluate the factors that interfere with the mother-child interaction during breastfeeding. A non-probability 'purposive sample' consists of (377) mothers who attending primary health care centers in Baghdad City. The study was started at January/2024 to July / 2024. Results: The Arabic version of the Interactive Breastfeeding Scale reveals strong psychometric properties with Cronbach’s Alpha values ranging from 0.71 to 0.86. Significant correlations were found between the scale and factors like Mother’s Perspective (r = .886) and Child Perspective (r = .661). The findings highlight the importance of mother and child-related factors in breastfeeding experiences. Conclusions: The Arabic version of the Interactive Breastfeeding Scale (IBfS) demonstrates strong reliability and validity, making it a robust tool for assessing breastfeeding dynamics. Key factors such as Mother’s Perspective and Child Perspective show significant correlations with IBfS, underscoring their critical role in the breastfeeding experience. The scale’s psychometric properties support its use in diverse settings, providing valuable insights into mother-child interactions during breastfeeding.

Intestinal Parasites and Hematological Parameters in Children Living in Ambatoboeny District, Madagascar

Madagascar is one of the poorest countries in the world. The country’s extreme weather conditions, poor sanitation, and weak economy facilitate the spread of parasitic diseases. Infections with intestinal parasites are particularly dangerous for children because they can cause malnutrition and anemia, which, in turn, have a negative effect on children’s cognitive functions and physical development. The aim of the present study was to analyze the prevalence of intestinal parasites and to assess hematological parameters in a group of children living in northern Madagascar. The screening was conducted in May 2024 in the Clinique Medicale Beyzym in Manerinerina, the Ambatoboeny district. It involved a sample of 208 children aged 0–17 years. Single stool samples were collected from all study participants. The samples were fixed in SAF fixative and then transported from Africa to Europe for further diagnostics at the Department of Epidemiology and Tropical Medicine, the Military Institute of Medicine–the National Research Institute in Poland. First, the samples were analyzed by light microscopy methods using three different diagnostic techniques (direct smear, decantation with distilled water, and the Fülleborn method). Next, they were tested by molecular biology methods (real-time PCR). Blood samples for the assessment of hematological parameters were collected at the healthcare center in Madagascar. The prevalence of intestinal parasites in the study sample was 61.5%. Helminths were found in 15.2% of the investigated children, and Giardia intestinalis (20.5%) was found to be the most prevalent parasite in the study population. Most infections were caused by potentially pathogenic stramenopila Blastocystis spp. (32.0%). Mean Hb, HCT, MCV, MCH, and MCHC levels in the study participants were below normal values. However, no correlation was found between the presence of a parasitic infection and low hematological parameters, which are a clinical sign of anemia. High rates of infections with intestinal parasites in children living in northern Madagascar support the necessity to introduce long-term preventive measures, which would limit the spread of parasitic diseases in the Malagasy population. Low hematological parameters in non-infected children may be indicative of persistent malnutrition or infection with other parasites, e.g., malaria or schistosomiasis.

Oral Health Status among Postmenopausal Women Attending Tertiary Hospital of Bharatpur, Nepal

Introduction: Menopause is a biological process occurring in middle aged women causing changes in the level of circulating hormones. Changes in the oral flora, oral mucosa and decrease in bone mineral density leads to many menopauses related oral findings. Objective: This study was conducted with the objective to assess the oral health status of postmenopausal women visiting tertiary health care centre in Bharatpur, Chitwan. Methods: Analytical cross-sectional study was conducted among 224 postmenopausal women attending dental OPD in a tertiary health care centre. Comprehensive oral examination was done where CPITN index was used to record periodontal health and DMFT index was used to record caries experience of the patient. Data entry was done in Microsoft Excel and statistical analysis was done using SPSS version 20. Results: Total 224 patients were examined with age range of 45 to 78 years and the mean age of 56.71 years. 113 study participants comprising 50.4%, showed supra or subgingival calculus followed by gingival bleeding in 54 (24.1%). Mean decayed score among study participants was found to be 2.71±2.85, mean missing score was found to be 4.29±7.83. Conclusion: Mean score for missing teeth suggestive of sequel of dental caries and periodontitis was found higher among the post-menopausal women followed by mean decayed score. Dental caries score was high probably due to dryness of mouth and other predisposing factors.

Work engagement in public primary healthcare centers: psychometric analysis of a scale for its evaluation

PurposeThis study aims to validate the 17-item Utrecht Work Engagement Scale (UWES-17) within Public Primary Healthcare Centers, addressing the need for a reliable measure of work engagement among health workers.Design/methodology/approachThis study conducted a validity and reliability analysis of the UWES-17 among community health workers in Chile, exploring its psychometric properties and structure, focusing on its three-factor structure and examining the causal relationships between work engagement dimensions.FindingsThe UWES-17 demonstrated a valid and reliable three-factor structure among Chilean health workers, with a significant construct dependence among its dimensions –vigor, dedication and absorption – highlighting their interrelated nature.Research limitations/implicationsWhile validated for community health workers in Chile, the UWES-17’s applicability across healthcare settings and professions warrants further investigation.Practical implicationsThe validated UWES-17 can guide human resource practices in assessing and enhancing work engagement among health workers, potentially improving employee well-being and performance.Social implicationsAddressing work engagement and burnout among health workers is vital for a resilient healthcare system. This validated measure contributes to efforts to improve health worker well-being and healthcare service quality.Originality/valueThis study contributes a validated measure of work engagement specifically tailored to public primary healthcare centers, offering valuable insights for future research on health workers' well-being and performance. This research enhances the understanding of organizational dynamics within public healthcare settings.

Prediction of physical activity and nutritional behaviors based on social cognitive theory in middle-aged population at risk of coronary artery disease in Bandar Abbas

AbstractCoronary artery disease (CAD) is the most common cardiovascular disease and the main cause of mortality in developing countries. Since physical activity and nutritional behaviors are modifiable risk factors in people at risk of CAD, the present study aims to explore the effect of an intervention based on the social cognitive theory (SCT) on physical activity and nutritional behaviors in middle-aged population at risk of CAD in the city of Bandar Abbas. The present cross-sectional study was conducted on 519 middle-aged subjects who visited the healthcare centers in Bandar Abbas, southern Iran, in 2023. The sampling was simple randomization. The data were collected using the general physical activity questionnaire, nutritional behavior questionnaire and a questionnaire based on the social cognitive theory (SCT). Descriptive statistics were used to describe the demographic features of the sample. Pearson correlation coefficient was used to test the relationship between the variables of study. Multiple linear regression was used to test the effect of the SCT constructs on physical activity and nutrition behaviors. All statistical analyses and hypothesis testing were done in SPSS 21, at a significance level of 0.05. A total number of 519 subjects participated in this study, whose average age was 44.23 ± 7.14 years. The results of Pearson correlation test showed a statistically significant positive correlation between nutritional behaviors and the constructs of self-efficacy, collective efficacy, outcome expectations, observational learning, normative beliefs, barriers and opportunities, reinforcement and punishment, and behavioral intention. There was also a significant positive correlation between physical activity and self-efficacy, normative beliefs, social support and behavioral intention. Social support, self-efficacy, normative beliefs, observational learning, behavioral skills and knowledge were found to be the predictors of physical activity. Reinforcement and punishment, normative beliefs, collective efficacy, social support and barriers and opportunities were the predictors of nutritional behaviors in the middle-aged population. As the results of the study showed, it is suggested to increase physical activity in the middle-aged population at risk of CAD using appropriate strategies to strengthen social support through family and friends, improve self-efficacy, identify positive and negative normative beliefs. Plans should be made to improve observational learning, increase behavioral skills, and increase knowledge to improve nutritional behaviors, use appropriate strategies to provide timely and appropriate rewards and punishments, identify and strengthen positive normative beliefs, improve collective efficacy, and increase social support. To this aim, families and other individuals around the middle-aged population can help remove barriers and create opportunities.

Application of zero trust model in preventing medical errors.

Medical errors can occur in many areas of healthcare, including hospitals, clinics, and surgery centers. They can result in negative consequences for patients and their loved ones. Over the years, different methods have been used to reduce medical errors. Zero Trust is an information security model that denies access to applications and data by default. Other industries have successfully used Zero Trust Model (ZTM), and it has been shown to improve outcomes. This editorial analyzes how the ZTM can be introduced to prevent medical errors in healthcare settings. ZTM application in healthcare could potentially revolutionize patient safety by tightly controlling and monitoring access to sensitive patient data and critical systems. By enhancing security measures, the ZTM could address the paramount concerns of patient data privacy and safety in healthcare. The zero-trust approach offers a potential solution by identifying consistent causes of errors and providing viable solutions to prevent their recurrence. In the era of worsening ransomware attacks on healthcare systems, the ZTM could also have enormous implications in other cybersecurity aspects. With this manuscript, the authors advocate for the broader application of ZTM across other facets of healthcare cybersecurity.

Missing Medical Data in Neurological Emergency Care Compromise Patient Safety and Healthcare Resources.

Background: Acute care of patients in the emergency department (ED) can be very challenging when patients attend EDs without their important medical information. This is especially problematic for multimorbid patients under polypharmacy. The aim of this study was to assess systematically the frequency and clinical relevance of incomplete medical data upon ED admission. Methods: The study was conducted in the neurological ED of a German tertiary hospital. The availability and accuracy of medical data of all neurological patients in the ED were assessed upon arrival. Treating ED physicians were asked about the acute care of the patients to clarify whether missing data resulted in delays or complications in the emergency treatment. Additionally, doctors responsible for the inpatient care of patients who were admitted to a ward via the ED were questioned about the course of the inpatient stay to monitor how initially missing data might have influenced the hospital stay. Results: Medical data of 27% of the 272 included patients were missing or incomplete upon admission in the ED. The ED physicians had to make additional phone calls to gather information in 57% of these cases (vs. 22% in patients with complete data, p < 0.0001). Delays between 5 and 240 min were documented due to initially missing data. Unnecessary diagnostic procedures (e.g., lumbar puncture) were performed in 5% of these patients, thus compromising patient safety. Even the inpatient stay was complicated by initially missing data, as doctors still had to spend time (between 10 and 180 min) to gain relevant information. Retrospectively, 5% of hospitalizations could have been avoided if all medical information had been available upon ED admission. Conclusions: Missing medical data caused complications and delays in acute as well as inpatient care of patients admitted to the neurological ED. This compromised patient safety and led to a waste of medical resources and valuable time of the responsible medical team. Therefore, a comprehensive, digital data management system is urgently needed to improve patient safety and facilitate efficient patient care in the ED and beyond.

Management of Disseminated Rhinosporidiosis: Experience From a Single Tertiary Institution.

This study aims to present a series of patients with disseminated rhinosporidosis with diagnostic and therapeutic features. A retrospective study was conducted in a tertiary health care centre in South India from 2007 to 2020 with disseminated rhinosporidiosis. Twelve patients with multiple sites of involvement like the nose, nasopharynx, oropharynx, larynx, lacrimal sac and skin were included in the study. All patients underwent surgical excision, followed by peroral dapsone for one year. The age group was around 30-55 years, with male predominance (11:1). Pond bathing history was present in 50% (n=6). The most common site of lesion was the nose (100%), oropharynx (83.3%), skin (75%), larynx (50%) and less commonly, nasopharynx (41.6%) and lacrimal sac (25%). One patient underwent surgery four times (8.3%), followed by thrice and twice by five (41.6%) and six (50%) patients, respectively. On two years of follow-up, two patients (16.6%) had a recurrence in the nose and larynx whereas eight patients (66.6%) had no recurrence and two patients (16.6%) were lost to follow-up. This original article highlights the rare occurrence of disseminated rhinosporidiosis, the possibility of which should be kept in mind, mainly when two or more sites are involved. The most significant number of disseminated rhinosporidiosis cases in the literature is reported here. Dissemination with the cutaneous and multisite disease is rarely reported and poses difficulty in management. Early diagnosis and intervention prevent the dissemination of spores into various parts of the body.

Profile Of Opportunistic Infections Among HIV Patients On ART Attending At Tertiary Health Care Center

Profile Of Opportunistic Infections Among HIV Patients On ART Attending At Tertiary Health Care Center

Utilizing laser therapy to manage oral potentially malignant disorders in older adults at the primary care level.

Oral lesions are a significant concern among older adults because they can progress to oral cancer if not diagnosed and treated promptly and effectively. Transportation to the hospital is a major barrier to oral healthcare for many older adults. The purpose of this editorial is to address the challenges of managing oral potentially malignant disorders in the older population, highlighting the barriers they face in accessing healthcare services, the potential use of laser therapy for management, and the direction of research in this area. Due to the limited access of the older to healthcare services, primary healthcare facilities within communities serve as their primary providers. Laser therapy is recommended for the management of oral potentially malignant disorders due to its favorable outcomes. This approach has been tested in several primary healthcare centers in Thailand. In our project, laser therapy was used to treat oral potentially malignant disorders in primary and secondary healthcare services. This includes photodynamic therapy for older patients with extensive lesions, as well as individuals with oral leukoplakia and erythroplakia who have declined curative surgery. It has also been used in cases of recalcitrant lichen planus to steroid or photobiomodulation therapy. This approach has been well accepted by both oral healthcare providers and patients. To expand access to these treatment options in such settings, it is critical to empower healthcare professionals, particularly dentists and dental nurses, to integrate laser techniques into geriatric care and oral cancer screening. Establishing a network foundation for orofacial laserology would also enhance the potential of such settings.

A Feature-Fusion Technique-Based Alzheimer's Disease Classification Using Magnetic Resonance Imaging.

Early identification of Alzheimer's disease (AD) is essential for optimal treatment and management. Deep learning (DL) technologies, including convolutional neural networks (CNNs) and vision transformers (ViTs) can provide promising outcomes in AD diagnosis. However, these technologies lack model interpretability and demand substantial computational resources, causing challenges in the resource-constrained environment. Hybrid ViTs can outperform individual ViTs by visualizing key features with limited computational power. This synergy enhances feature extraction and promotes model interpretability. Thus, the authors present an innovative model for classifying AD using MRI images with limited computational resources. The authors improved the AD feature-extraction process by modifying the existing ViTs. A CatBoost-based classifier was used to classify the extracted features into multiple classes. The proposed model was generalized using the OASIS dataset. The model obtained an exceptional classification accuracy of 98.8% with a minimal loss of 0.12. The findings highlight the potential of the proposed AD classification model in providing an interpretable and resource-efficient solution for healthcare centers. To improve model robustness and applicability, subsequent research can include genetic and clinical data.