Quality Health Research Articles

Artificial Intelligence-Prompted Explanations of Common Primary Care Diagnoses

Background: Artificial intelligence (AI)-generated explanations about medical topics may be clearer and more accessible than traditional evidence-based sources, enhancing patient understanding and autonomy. We evaluated different AI explanations for patients about common diagnoses to aid in patient care. Methods: We prompted ChatGPT 3.5 , Google Bard, HuggingChat, and Claude 2 separately to generate a short patient education paragraph about seven common diagnoses. We used the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) to evaluate the readability and grade level of the responses. We used the Agency for Healthcare Research and Quality’s Patient Education Materials Assessment Tool (PEMAT) grading rubric to evaluate the understandability and actionability of responses. Results: Claude 2 demonstrated scores of FRE (67.0), FKGL (7.4), and PEMAT, 69% for understandability, and 34% for actionability. ChatGPT scores were FRE (58.5), FKGL (9.3), PEMAT (69% and 31%, respectively). Google Bard scores were FRE (50.1), FKGL (9.9), PEMAT (52% and 23%). HuggingChat scores were FRE (48.7) and FKGL (11.6), PEMAT (57% and 29%). Conclusion: Claude 2 and ChatGPT demonstrated superior readability and understandability, but practical application and patient outcomes need further exploration. This study is limited by the rapid development of these tools with newer improved models replacing the older ones. Additionally, the accuracy and clarity of AI responses is based on that of the user-generated response. The PEMAT grading rubric is also mainly used for patient information leaflets that include visual aids and may contain subjective evaluations.

Diagnosis and management of bruxism. A literature review

Bruxism, characterized by involuntary grinding or clenching of teeth, is a widespread condition with multifaceted implications for oral health, physical well-being, and quality of life. This comprehensive review aims to provide an in-depth study of bruxism, encompassing its definition, classification, etiology, pathophysiology, clinical manifestations, and consequences. Bruxism is classified based on its timing (sleep bruxism or awake bruxism). The etiology of bruxism is multifactorial, involving physiological factors such as central nervous system (CNS) pathways, sleep disorders, and occlusal factors, as well as psychological factors like stress, anxiety, personality traits and environmental factors including medications, substances, and stressors. Clinically, bruxism can result in various dental consequences, including tooth wear, fractures and damage to restorations, as well as temporomandibular disorders (TMDs) such as myofascial pain. These manifestations can negatively impact individual's oral health, physical well-being, and overall quality of life. Management strategies include behavioral and lifestyle changes, oral appliances, dental treatments for tooth damage, and, in certain instances, pharmacological interventions. While the current understanding of bruxism has advanced, further research is needed to fully elucidate its etiology, pathophysiology, and effective management strategies.

A 10-week multicomponent outdoor exercise program improves hemodynamic parameters and physical fitness in cardiovascular disease adult and elderly patients

AbstractThis study aimed to assess the effects of a 10-week multicomponent outdoor exercise program on hemodynamic, physical fitness and psychological variables in subjects with CVDs. Twenty participants (12 M and 8 F; age 68.5 ± 8.6 years; BMI 28.49 ± 4.98 kg/m2) suffering from CVDs participated in this randomized controlled study and were allocated into two groups: an experimental group (EG; 6 M, 5 F) who underwent a multicomponent training (i.e., cardiorespiratory, resistance, mobility and breathing exercises; 60’, 2d·wk-1), or a wait-list control group (CG; 6 M, 3 F) who did not engage in any PA. Hemodynamic parameters were assessed through resting heart rate (RHR) and peripheral blood pressure (P-SBP/P-DBP). Physical fitness was assessed via a 30″ chair stand test (30CST), timed up and go (TUG) test, handgrip strength (HGS) test, and 2’ step test (TMST). The health status and quality of life (QoL) were evaluated with short form-12 (SF-12) and World Health Organization QoL (WHOQoL-bref), respectively. After the intervention, EG showed significant reduction in hemodynamic parameters (RHR p < 0.001, ES = 0.98; P-SBP p < 0.001, ES = 0.53; P-DBP: p < 0.001, ES = 0.78), physical fitness (30CST p < 0.001, ES = 0.92; TUG p = 0.001, ES = 0.67; TMST p < 0.05, ES = 0.79) and physical component of SF-12 (PSC-12 p < 0.05, ES = 0.42) compared to CG; no significant changes were observed in HGS, QoL and mental health component of the SF-12 (p > 0.05). The findings showed significant improvements in hemodynamic parameters and physical fitness suggesting the effectiveness of the multicomponent outdoor exercise program in adults and elderly with stabilized CVDs.

Measuring the transition to regenerative agriculture in the UK with a co-designed experiment: design, methods and expected outcomes

Abstract Regenerative agriculture is promoted as a farming system that can improve agricultural sustainability, address soil degradation, and provide ecosystem service benefits. However, there remains limited evidence for the quantifiable benefits of a widespread transition to regenerative agriculture on soil, biodiversity, and crop quality, particularly at the landscape scale, and poor integration of findings across disciplines. Social and cultural aspects of the transition, such as the positioning of regenerative agriculture as a grassroots movement, farmers’ perspectives on defining regenerative practices, and social or political barriers to implementation, are harder to quantify and often overlooked in evidence-based approaches. 
Here, we present the detailed methodology for our interdisciplinary, co-designed landscape-scale experiment measuring changes in soil health, biodiversity, yield, and grain quality, as well as social and political dimensions of the implementation of regenerative practices. Our unique approach, through the co-production process, the landscape-scale, and the focus on a systemic transition instead of individual practices, will bring strong evidence of the benefits of regenerative agriculture for sustained agricultural productivity, the mitigation of climate change and biodiversity depletion in agroecosystems. Our research aims to guide future studies transforming theoretical ecology into testable hypotheses in real-world systems and provide actionable evidence to inform agricultural policies in the UK and beyond.

Lived experiences of diabetes self-management among persons with disabilities in rural Tamil Nadu – a case study approach

BackgroundPeople with disabilities have numerous challenges in diabetes self-management. Poor self-management leads to the worsening of disability and secondary complications of diabetes. This study was conducted to explore the challenges in diabetes self-management and the factors influencing diabetes self-management among people with disabilities.MethodsWe conducted 16 case studies among people with physical, neurological, visual, hearing, and multiple disabilities who were affected by diabetes. We adopted a thematic content analysis approach to analyse the data.ResultsPeople with disabilities have challenges in adopting healthy diets as they are unable to purchase and consume fruits and vegetables which are costly, unavailable, and inaccessible. They have difficulty in doing physical activity due to lack of inclusive public spaces which are inaccessible, lack of motivation, and dependence on others for their mobility. Irregular drug supply in the public health system and unaffordable cost of drugs hamper adherence to medications. Laboratories are inaccessible to people with disabilities thus preventing monitoring of blood sugars. They have poor quality of life, life with pain and mental health issues, which prevent adoption of self-management behaviors. The intersectionality of age and gender with disability worsens self-management behaviors. Inaccessible health system, poor quality of health care and insensitive health care providers further complicate self-management.ConclusionThis study documents the challenges faced by persons with disabilities in practicing diabetes self management. There is a need for public health policy and planning that is inclusive of persons with disabilities to make access to diabetes care universal.

The risk factors and predictors of injury among collegiate rugby players under the age of 20.

The risk of injury in rugby is high, due to the contact nature of the game. Players are constantly exposed to impact and collision during training and match-play. Rugby union consists of various risk factors that predispose players to injury. The aim of the study was to determine the risk factors of injury and to predict the risk of injury per playing position during match-play. The study followed a quantitative, non-experimental, and cross-sectional research design. A total of 252 male rugby players, aged 18 to 20 years, who played in a collegiate rugby competition in South Africa (SA) for the 2022 season were conveniently sampled for the study. The playing position, time of injury (whether during a match or training), use of protective equipment, and phase of play in which the injury occurred were recorded. Injury data was captured by qualified healthcare professionals using an adapted injury surveillance questionnaire. The study found that potential risk factors for injury included illegal or dangerous play, playing in the second half of the match (more specifically the third quarter of the match), and playing in the offensive part of the field (more specifically between the opposition-22 and halfway line). Contact events were the most common cause of match injury (91.1%). The half of the match in which an injury was sustained was significantly different between forwards and backs (P=0.011). A statistically significant association was found between playing position and the phase of play in which injury was sustained (P=0.021). Regression analysis showed that playing between the opposition-22 m line and the halfway line was a significant predictor of injury for both forwards and backs (P=0.035). In conclusion, potential risk factors for injury were related to dangerous play, time during the match (specifically the third quarter of the match), and location of play (specifically between the opposition-22 m line and halfway line). The area of play was a significant predictor of injury for all players. It is recommended that greater efforts in collecting epidemiological data need to be made to broaden the knowledge base on injuries and provide strategies to coaches and players to reduce the risk of injury in rugby.

Patient-Centered Care as an Optimal Solution for Enhancing the Quality of Healthcare Delivery

The measurement of patients' satisfaction with the quality of treatment hinges on the extent to which their intended expectations, objectives, and preferences are met through interactions with healthcare professionals, including nurses. The paradigm of patient-centered care is increasingly recognized as pivotal for delivering high- quality nursing services. Evolving health information, technological advancements, shifting perceptions of care, greater patient engagement, and heightened competition within healthcare drive the pursuit of enhanced care quality. Assessing patients' perspectives is integral to improving healthcare quality, ensuring that services effectively align with patients' needs. This paper explores factors influencing patient-centered care and delves into the concept's tenets and implications for nursing practice.

Electronic health records model to improve the quality of patients’ healthcare

Background: Electronic health records (EHR) has been acknowledged for bringing down healthcare costs and enhancing hospital service standards.Aim: The aim of this study was to develop an EHR model to lower patient treatment costs and enhance healthcare quality in South African public healthcare.Methods: In this study, a cross-sectional quantitative methodology was used. The research data for this study were provided by medical healthcare professionals, at Dr. George Mukhari Academic Hospital (DGMAH). This included doctors, nurses, pharmacists, radiologists, and radiographers who completed a semi-structured questionnaire.Results: The final model’s findings show that the use of EHR significantly improves information quality (IQ) and positively influences medical errors reduction (MER). Knowledge quality (KQ) has a positive significant impact on MER, whereas IQ has a considerable negative impact on MER. Furthermore, cost reduction in patient treatment (CRPT) has a positive significant influence on MER.Conclusion: Patients obtain better medical care when medical professionals have access to complete and accurate information. Medical errors can be reduced or even prevented with the use of EHRs, which can lead to better patient outcomes.Contribution: The quality of patient care at South African public hospitals and in other developing countries can be enhanced by using this framework as a guide to reduce treatment costs.

The effect of health facility ownership on perceived healthcare quality: evidence from Ghana.

Whether private healthcare providers should be encouraged over public providers remains unclear. On the one hand, because private providers are profit-driven, they are more motivated to compete for demand by enhancing quality if demand is elastic. However, because they are more motivated to maximize revenue, they may sacrifice quality to maximize profit. A crucial factor in determining whether private providers should be encouraged is the extent to which their quality exceeds or falls short of that of the public provider. This study, therefore, investigates whether the public and private differ in providing quality healthcare services using the 2014 Ghana Demographic and Health Survey. Our measure of healthcare quality is based on patient satisfaction level with nine healthcare services (cleanliness, waiting time, comfort and safety, consultation time, privacy, listening, explanation, treatment advice and confidentiality) provided by public and private healthcare facilities. We applied an instrumental variable approach to account for endogeneity issues related to the patient's choice of healthcare provider. We find that private facility users have a higher probability of being very satisfied with "waiting time", "consultation time", "listening", "cleanliness", "comfort and safety", "confidentiality", and "privacy" than public users, thus suggesting that private facilities provide better service than public. We thus recommend encouraging the private sector to enter the healthcare market. We also find that failing to account for endogeneity in provider choice when estimating the effect of healthcare facility ownership on healthcare service quality underestimates the effects.

Moving beyond biology: the critical role of social and structural determinants in atopic dermatitis.

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease with a substantial global burden and negative impact on quality of life. While genetics and pathophysiology are key to understanding AD, emerging evidence indicates that social and structural determinants of health (SDOH and StDOH) strongly influence the condition's onset, severity, and outcomes. SDOH, such as economic stability, education quality and access, healthcare quality and access, neighborhood environment, and social/community context, shape individual risk and disease experience. StDOH, including government processes, economic policies, social/public policies, and cultural/societal values, further act as upstream forces that directly and indirectly influence AD outcomes. In this review, we synthesize current knowledge on the impacts of SDOH and StDOH on AD incidence, severity, and disparities. Embracing a biopsychosocial model is crucial to elucidate the etiology, epidemiology, and optimal management of AD. Future research should adopt a holistic approach, moving beyond a purely biological perspective to consider the intricate interplay of social and structural determinants in understanding and managing AD.

Transformation of Modern Urban Park Based on User’s Spatial Perceived Preferences: A Case Study of Kowloon Walled City Park in Hong Kong

Urban parks enhance residents’ quality of life and health by fostering a harmonious relationship between people and nature, so effective park design needs to prioritize ecological protection, sustainable landscapes, and practical spatial structures to achieve these benefits. This study takes the typical case of urban park renovation and reconstruction—Kowloon Walled City Park—as an example to conduct research and divides the interior of the park into four types of areas: contemporary built-up area; historical relic area; natural–folk custom area; and ecological conservation area. Based on 405 valid questionnaire data for respondents, this study conducts empirical research using a combination of the Semantic Differential (SD) method, Importance Performance Analysis (IPA) model, and unordered multivariate logit choice model, comprehensively describes and analyzes individual spatial perception and preferences, and further discusses the potential factors affecting individual perception preferences. The results show that there are differences in many characteristics between different areas in Kowloon Walled City Park. At the same time, people generally prefer park areas that integrate modern and traditional elements, natural and cultural environments, and pay attention to the balance between naturalness and sociality in park design. These results provide useful information for planners, developers, and others, as well as data for designing urban park construction with higher practical value and natural benefits.

Spinal deformity surgery in Scheuermann's kyphosis versus adolescent idiopathic scoliosis: meta-analysis of complications and clinical outcomes.

Surgical management of adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) may be associated with several complications including extended length of stay and unplanned reoperations. Several studies have previously compared postoperative complications and functional outcomes for AIS and SK patients with mixed results. However, a meta-analysis compiling the literature on this topic is lacking. Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until April 2024. The extracted data consisted of complications (overall and surgical-site infections [SSI]), readmissions, reoperations, and Scoliosis Research Society-22 (SRS-22) score. Mean differences (MD) with 95% CI were used for continuous data and odds ratio (OR) was utilized for dichotomous data were calculated across studies. Seven retrospective articles were included in the meta-analysis, including 4866 patients, with 399 in the SK group and 4467 in the AIS group. SK patients were found to have statistically significantly higher rates of overall complications (OR = 5.41; 95% CI 3.69-7.93, p < .001), SSI (OR = 11.30; 95% CI 6.14-20.82, p < .001), readmissions (OR = 2.81; 95% CI 1.21-6.53, p = 0.02), and reoperations (OR = 7.40; 95% CI 4.76-11.51, p < .001) than AIS patients. However, they had similar SRS-22 scores postoperatively (MD = -0.06; 95% CI -0.16 to 0.04, p = 0.26) despite the SK group having lower SRS-22 scores preoperatively (MD = -0.30; 95% CI -0.42 to -0.18, p < .001). In this meta-analysis of studies comparing spinal deformity surgery outcomes in AIS and SK patients, SK was associated with more complications, readmissions, and reoperations. SK did have equivalent SRS-22 scores postoperatively to AIS patients, highlighting the benefit of surgical treatment despite higher complication rates. This data may help inform healthcare institutions, payors, and quality monitoring organizations who examine outcomes of pediatric and adult spinal deformity surgery.

A research agenda to advance the study of implementation mechanisms

BackgroundImplementation science scholars have made significant progress identifying factors that enable or obstruct the implementation of evidence-based interventions, and testing strategies that may modify those factors. However, little research sheds light on how or why strategies work, in what contexts, and for whom. Studying implementation mechanisms—the processes responsible for change—is crucial for advancing the field of implementation science and enhancing its value in facilitating equitable policy and practice change. The Agency for Healthcare Research and Quality funded a conference series to achieve two aims: (1) develop a research agenda on implementation mechanisms, and (2) actively disseminate the research agenda to research, policy, and practice audiences. This article presents the resulting research agenda, including priorities and actions to encourage its execution.MethodBuilding on prior concept mapping work, in a semi-structured, 3-day, in-person working meeting, 23 US-based researchers used a modified nominal group process to generate priorities and actions for addressing challenges to studying implementation mechanisms. During each of the three 120-min sessions, small groups responded to the prompt: “What actions need to be taken to move this research forward?” The groups brainstormed actions, which were then shared with the full group and discussed with the support of facilitators trained in structured group processes. Facilitators grouped critical and novel ideas into themes. Attendees voted on six themes they prioritized to discuss in a fourth, 120-min session, during which small groups operationalized prioritized actions. Subsequently, all ideas were collated, combined, and revised for clarity by a subset of the authorship team.ResultsFrom this multistep process, 150 actions emerged across 10 priority areas, which together constitute the research agenda. Actions included discrete activities, projects, or products, and ways to shift how research is conducted to strengthen the study of implementation mechanisms.ConclusionsThis research agenda elevates actions to guide the selection, design, and evaluation of implementation mechanisms. By delineating recommended actions to address the challenges of studying implementation mechanisms, this research agenda facilitates expanding the field of implementation science, beyond studying what works to how and why strategies work, in what contexts, for whom, and with which interventions.

A community health-coaching referral program following discharge from treatment for chronic low back pain – a qualitative study of the patient’s perspective

BackgroundGlobal policy and guidelines for low back pain (LBP) management promote physical activity and self-management yet adherence is poor and a decline in outcomes is common following discharge from treatment. Health coaching is effective at improving exercise adherence, self-efficacy, and social support in individuals with chronic conditions, and may be an acceptable, cost-effective way to support people in the community following discharge from treatment for LBP.AimThis qualitative study aimed to understand which aspects of a community over-the-phone health-coaching program, were liked and disliked by patients as well as their perceived outcomes of the service after being discharged from LBP treatment.MethodsA purposive sampling approach was used to recruit 12 participants with chronic LBP, from a large randomised controlled trial, who were randomly allocated to receive a health coaching program from the Get Healthy Service® in Australia. Semi-structured interviews were conducted, and a general inductive thematic analysis approach was taken.ResultsThe main themes uncovered regarding the intervention included the positive and negative aspects of the health coaching service and the relationship between the participant and health coach. Specifically, the participants spoke of the importance of the health coach, the value of goal setting, the quality of the advice received, the benefits of feeling supported, the format of the coaching service, and LBP-specific knowledge. They also reported the health coach and the coaching relationship to be the primary factors influencing the program outcomes and the qualities of the coaching relationship they valued most were connection, communication, care, and competence. The sub-themes uncovered regarding the outcomes of the intervention included positive impacts (a greater capacity to cope, increased confidence, increased motivation and increased satisfaction) and negative impacts (receiving no personal benefit).Clinical implicationsIn an environment where self-management and self-care are becoming increasingly important, understanding the patient’s experience as part of a coaching program is likely to lead to improved quality of health coaching care, more tailored service delivery and potentially more effective and cost-effective community-based care for individuals with chronic LBP in the community after being discharged from treatment.Trial RegistrationThe GBTH trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/9/2020. Ethical approval was prospectively granted by the Western Sydney Local Health District Human Research and Ethics Committee (2020/ETH00115). Written informed consent was obtained from all participants. The relevant sponsor has reviewed the study protocol and consent form.

A comparison between robotic-assisted and open approaches for large ventral hernia repair-a multicenter analysis of 30days outcomes using the ACHQC database.

Over the last few decades, there has been an increase in the use of a minimally invasive (MIS) approach for complex hernias involving component separation. A robotic platform provides better visualization and mobilization of tissues for component separation. We aim to assess the outcomes of open and robotic-assisted approaches for large VHR utilizing the ACHQC national database. A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who had primary and incisional midline ventral hernias larger than 10cm and underwent elective open and robotic hernia repairs with mesh from January 2013 to March 2023. Univariate and multivariate analyses were performed comparing Open and Robotic approaches. The ACHQC database identified 5,516 patients with midline hernias larger than 10cm who underwent VHR. The open group (OG) had 4,978 patients, and the robotic group (RG) had 538. The RG had a higher median BMI (33.3kg/m2 (IQR 29.8-38.1) vs 32.7 (IQR 28.7-36.6) (p < 0.001). Median hernia width was 15cm (IQR 12-18) in the OG and 12cm in the RG (10-14) (p < 0.001). Sublay positioning of the mesh was the most common. The fascial closure was higher in the RG (524; 97% versus 4,708; 95%-p = 0.005). Median Length of Stay (LOS) was 5days (IQR 4-7) in the OG and 2days (IQR 1-3) in the RG (p < 0.001). The readmission rate was higher in the OG (n = 374; 7.5% vs n = 16; 3%; p < 0.001). 30-day SSI were higher in the OG (343; 6.9%% vs 14; 2.6%; p < 0.001). Logistic regression analysis identified diabetes (OR 1.6; CI 1.1-2.1; p = 0.006) and BMI (OR 1.04, CI 1.02-1.06; p < 0.001) as predictors of SSIs, while the robotic approach was protective (OR 0.35, CI 0.17-0.64; p = 0.002). For SSO, logistic regression showed BMI (OR 1.04, CI 1.03-1.06; p < 0.001) and smoking (OR 1.8, CI 1.3-2.4; p < 0.001) as predictors Robotic approach was associated with lower readmission rates (OR .04, CI 0.2-0.6; p < 0.001). A robotic approach improves early 30-day outcomes compared to an open technique for large VHR. There was no difference in SSO at 30days.

Assessment of the level of patient satisfaction in Homoeopathy using 12 Item Japanese Short-form Satisfaction Questionnaire: A cross-sectional study

To strengthen the health care services, it is important to know the patients’ satisfaction about the quality of health care they are getting exposed to, in different modes of treatment. There are a few studies on the topic but are mostly related to modern medicine. It is desirable to make such efforts in other systems of medicine in view of recent emphasis of the Govt of India for the use of AYUSH. The present paper aims to present findings of a pilot study examining the usefulness of 12-item Japanese short-term self-administered questionnaire and the level of patient satisfaction following homoeopathic healthcare encounters. The pilot study was conducted in the OPD (out-patient department) of Bakson Homoeopathic Medical College &amp; Hospital, Greater Noida (BHMC&amp;H) to understand and estimate patients’ satisfaction related to health care service. The study was cross-sectional of 81 newly enrolled patients in the Hospital’s OPDs by using a bilingual 12-Item Japanese short form self-administered consultation questionnaire. The questionnaire appeared to be reliable and valid. The internal consistency scores of Cronbach’s Alpha range between 0.62 – 0.93. Most of the patients have given positive feedback against all the dimensions/ subscales related to patient’s care. It is recommended to conduct further longitudinal surveys with greater sample size in an AYUSH health care set up as being emphasized by the present national programme effort.

Addressing Sleep Disturbances: Blood Transfusions and Improved Sleep Patterns in HIV Patients

Sleep disturbances are prevalent among individuals living with HIV, significantly impacting their quality of life and overall health. This review explores the relationship between anemia, fatigue, and sleep quality in HIV patients, highlighting the potential role of blood transfusions as an effective intervention for mitigating sleep disturbances. Blood transfusions improve hemoglobin levels, enhance oxygen delivery, and alleviate fatigue, which may contribute to better sleep patterns in this population. The mechanisms through which blood transfusions can improve sleep quality include enhanced oxygenation, reduction of inflammation, and modulation of immune responses. By addressing anemia and its associated symptoms, blood transfusions may foster an environment conducive to restful sleep, ultimately supporting the physical and mental well-being of individuals living with HIV. Integrating blood transfusions into comprehensive HIV care strategies is crucial for optimizing health outcomes. A multidisciplinary approach that includes ongoing assessment and tailored interventions can help manage anemia, improve sleep quality, and enhance overall quality of life for patients. Keywords: anemia, blood transfusions, fatigue, HIV, sleep disturbances,

Internet addiction, sleeping habits and psychological distress in Brazilian adolescents and young adults.

The internet is widespread in modern society and has raised concerns about excessive usage and its consequences for different aging groups. This study explores the relationships between internet addiction, sleep patterns, and psychological distress in adolescents and young adults. In order to assess this phenomenon, an exploratory cross-sectional study was conducted in southern Brazil from October to December 2023. A questionnaire, administered via Google Forms, collected data from 618 participants aged 15-36. The participants consisted of a non-probabilistic community sample selected based on convenience criteria. Instruments included a sociodemographic questionnaire, the Internet Addiction Test, Depression, Anxiety, and Stress Scale, and Social Media Engagement Questionnaire. It was categorized 48.1% as having moderate internet addiction, and classified 0.8% as having severe internet addiction. Correlation analysis revealed positive associations between internet addiction and depression, anxiety, and stress. Logistic regression identified internet addiction and overall psychological distress as predictors of sleep difficulties, along with unemployment status. The findings highlight the detrimental impact of excessive internet use on sleep quality and mental health. The bidirectional relationship between internet addiction and psychological distress underscores the complex interplay between these variables. This study underscores the urgent need for interventions targeting internet addiction and its associated consequences in adolescents and young adults. Addressing internet addiction levels and promoting healthy internet usage habits are crucial steps in mitigating the adverse effects on mental health and sleep quality. There is a need for targeted interventions, protocols, and preventive measures to mitigate the adverse effects of excessive internet use on mental health and sleep quality. Public health strategies should include IA and its consequences in health programs with multidisciplinary approaches and protocols for treatments for behavioral addictions. The study emphasizes the multifaceted nature of internet addiction and its implications for mental health and sleep patterns.

Pediatric Burn Unit Admission is Associated with School Holidays and Lower Home Childhood Opportunity Level.

Burn injury can have profound detrimental effects on quality of life and mental health of children. We collected demographics, burn etiology, burn date, and home zip code for pediatric patients admitted to our burn unit from 2016-2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for pre-school-age and school-age children. Home zip code was used to determine each child's home Childhood Opportunity Index score, which is composed of sub-domains for Education, Health & Environment, and Social & Economic. We calculated the odds-ratio for odds of pediatric burn admission for each COI sub-domain quintile, using very high opportunity neighborhoods as the reference. Scald was the prevailing burn etiology (64%). In school-age children, July was the month with the most burn injuries (19%), attributable to firework injuries. School-age children were also more likely to be injured in a week without classroom instruction (p<0.001). There was a dose-response relationship between Childhood Opportunity Index and odds of burn admission, with the greatest odds of burn admission observed for children from very low educational opportunity areas (OR 5.21, 95% CI 3.67-7.39). These findings support interventions for burn prevention such as increased education about the dangers of fireworks, addressing inequities in access to childcare and extracurricular activities, and reducing the default water heater temperatures in multi-unit dwellings.

Changing practice in cystic fibrosis: Implementing objective medication adherence data at every consultation, a learning health system and quality improvement collaborative

AbstractBackgroundMedication adherence data are an important quality indicator in cystic fibrosis (CF) care, yet real‐time objective data are not routinely available. An online application (CFHealthHub) has been designed to deliver these data to people with CF and their clinical team. Adoption of this innovation is the focus of an National Health Service England‐funded learning health system and Quality Improvement Collaborative (QIC). This study applies the capability, opportunity, and motivation model of behavior change to assess whether the QIC had supported healthcare professionals' uptake of accessing patient adherence data.MethodThis was a mixed‐method study, treating each multidisciplinary team as an individual case. Click analytic data from CFHealthHub were collected between January 1, 2018, and September 22, 2019. Thirteen healthcare practitioners participated in semi‐structured interviews, before and after establishing the QIC. Qualitative data were analyzed using the behavior change model.ResultsThe cases showed varied improvement trajectories. While two cases reported reduced barriers, one faced persistent challenges. Participation in the QIC led to enhanced confidence in the platform's utility. Reduced capability, opportunity, and motivation barriers correlated with increased uptake, demonstrating value in integrating behavior change theory into QICs.ConclusionQICs can successfully reduce barriers and enable uptake of e‐health innovations such as adherence monitoring technology. However, ongoing multi‐level strategies are needed to embed changes. Further research should explore sustainability mechanisms and their impact on patient outcomes.