Insufficient Care Research Articles

Dignity in people with dementia: A concept analysis.

Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer's disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL).Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD.Research Design: We conducted a concept analysis using Walker and Avant's eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords "dignity," "dementia," "Alzheimer's disease," and "dementia care."Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person's sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced.Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression.

Provider Education to Increase Sexually Transmitted Infections Screening Rates Among Older Adults Seen in Primary Care Practice

Sexually transmitted infection (STI) rates among older adults have increased significantly due to insufficient sexual health care. To address this, a quality improvement project educated providers at a primary care site using American Academy of Family Physicians guidelines. In a pre-/post-implementation design, 10 providers attended a 45-minute session. STI screening and positivity rates were assessed 8 weeks before and after the intervention. Screening rates increased from 2% to 10% (P < .0001), and positivity rates rose from 7% to 8% (P = .0035), indicating the effectiveness of provider education in enhancing STI screening and identifying more cases.

Unveiling the True Price: Assessing the Economic Impact of Cosmetic Surgery Tourism on a Single Tertiary Center in Bahrain

Abstract Background In light of the escalating cost of cosmetic surgery in Bahrain, the burgeoning “Cosmetic Surgery Tourism” sector has captured the attention of many Bahrainis. Neighboring countries aggressively promote affordable packages on numerous social media platforms, luring individuals with the allure of a vacation experience. However, insufficient postoperative care abroad has far-reaching implications that jeopardize both patient well-being and the integrity of the healthcare system. Objectives This study aims to assess the present patterns of complications related to cosmetic surgery tourism and the resulting financial burden on the Bahraini healthcare system. Methods A retrospective cost analysis and chart review were performed for all patients who presented with complaints associated with cosmetic surgeries between January 2018 and September 2023. After identifying patient demographics, procedure characteristics, admission data, length of stay, and intervention needs, a comprehensive cost analysis was conducted. Results A total of thirty patients manifested complications. Complications associated with abdominoplasty were the most prevalent. Iran emerged as the most frequented destination, with Egypt and Turkey following in order of prevalence. Surgical-site infections constituted the most common complications. Required interventions included admission for intravenous antibiotics, hyperbaric wound care, implant removal, and critical care admission. The projected expense to the hospital was 65,970 BHD (175,000 USD), equating to an average expenditure of 2,200 BHD (5,852 USD) per patient. Conclusions The allure of cost-effective cosmetic treatments often leads to complications that impose substantial economic burdens. The study concludes with policy recommendations to balance individuals’ freedom to seek healthcare abroad with long-term sustainability and equitable access to Bahrain's healthcare system.

Pregnancy care experiences for adults with congenital heart disease in the United States

BackgroundResearch to reduce maternal morbidity due to cardiovascular disease is vitally important in the United States, especially for the growing number of individuals with congenital heart disease (CHD) reaching childbearing age. Understanding patient experiences through patient engagement is critical to designing research that is aligned with the needs of adults with CHD undergoing pregnancy. MethodsThis patient engagement project, grounded in human centered design, focuses on the discovering patient and healthcare provider priorities for reducing maternal morbidity in CHD through patient centered outcomes research (PCOR). In this first stage, a capacity building consortium of over 90 key partners, including patients, advocates, healthcare providers, and researchers, was assembled. Baseline education on patient engagement, PCOR, and survey instrument design was delivered virtually. Two questionnaires were designed to elicit tacit knowledge – one for patients and one for providers – regarding gaps and needs across four key pillars: access to clinical care, patient and provider education, mental health, and research opportunities. The pillars were determined through thematic summaries from consortium discussions. ResultsThe patient questionnaire received 828 responses (age range: 18-60 years) from 48 U.S. states. The provider questionnaire garnered 218 responses from professionals. Several common themes for areas of research were observed across all pillars including improved access to specialized cardio-obstetric care and improved education about the need for specialized care. Healthcare providers cited insufficient care coordination models and resources as a major barrier to providing effective clinical care. Both patients and providers expressed a need for improved access to mental health care. While only 28% of patient respondents who underwent a pregnancy reported a pre-existing mental health diagnosis, nearly 2/3 reported having significant anxiety symptoms related to their pregnancy. Of those with significant symptoms, 44% were unable to access mental health services. Additionally, only 55% of healthcare providers reported referral for assessment and treatment if mental health concerns arose during or after pregnancy. ConclusionThe results provide valuable insights into the unique challenges faced by patients with CHD and their providers during pregnancy. By addressing the identified gaps through PCOR, we can work towards a goal to improve maternal care for women with CHD.

Sex-differences in the clinical features, managements and outcomes of early-onset atherosclerotic coronary artery disease in China

Abstract Background/Introduction There is an alarming rise in the incidence of atherosclerotic coronary artery disease (CAD) among young adults, particularly in young women. Sex disparities of early-onset CAD in the context of contemporary cardiovascular practice are not well understood. Purpose We aimed to delineate the differences in clinical profiles and prognosis between young men and women with established early-onset CAD. Methods This is a nationwide, hospital-based, longitudinal prospective cohort study. Young patients (aged ≥18 years and ≤ 45 years) with angiographically confirmed severe atherosclerotic obstructive coronary arteries (luminal narrowing ≥ 70%) were included from 38 hospitals across China between May 2017 and May 2020. Coronary risk factors, clinical features and treatments were compared between men and women at baseline. Participants were followed for 3 years. The outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, non-fatal myocardial infarction (MI), unplanned revascularization, and ischemic stroke. The Cox regression analyses were used to estimate hazard ratios (HR) with 95% confidence intervals (CIs) for outcome. Results There were 1524 patients (female: 4.4%) included in this study. The female patients were older than the male patients (41.1±4.0 years for females vs. 39.6±4.4 years for males, p=0.006). They showed a lower prevalence of hypertension, lipid disorders, and smoking or drinking (all p&amp;lt;0.01). The female patients were less likely to have at least 1 modifiable risk factors (female: n=45 (67.2%) vs. male: n=1382 [94.6 %], p&amp;lt;0.001); they showed more favorable laboratory results at baseline, including lipids, serum creatinine and uric acid (all p&amp;lt;0.05) as compared to male patients. Besides, young females presented more often with stable angina on admission, whereas young males tended to present with acute MI (p&amp;lt;0.001). There was no significant sex difference in Gensini Score (p=0.15). Female patients were less likely to undergo revascularization procedures than male patients (73.1% vs. 85.3%, p=0.01). During the 3 years of follow-up, female patients were at a significantly higher risk of MACE compared to their male counterparts (13.4% vs. 5.8%, adjusted HR: 3.07, 95% CI:1.36–6.94, p=0.007) after adjusting for age, smoking, drinking, body mass index, hypertension, diabetes, dyslipidemia, diagnosis and revascularization. Conclusions Distinct sex disparities, unfavorable to young females, were documented among patients with early-onset CAD, with the largest gaps noted in the treatment and prognosis. Despite more favorable baseline profiles, young female patients had insufficient care and 3-fold greater risk for MACE compared to young males. These results highlight the need for strengthening the treatment strategies for this vulnerable disease entity.Figure 1

Post-operative Mortality Trends for Complicated Appendicitis: Adults with and without Disabilities

Abstract Background Even for the same complicated appendicitis, the prognosis may vary if appropriate post-operative care and follow-up are not provided. We aimed to investigate the 10-year trend of complicated appendicitis mortality among disabilities and non-disabilities peoples in Korea, recognizing potential disparities in post-surgical outcomes and the importance of adequate post-operative care. Methods Patients with complicated appendicitis were classified by severity using DRG codes. Causes of death were categorized into infectious, respiratory, cardiovascular, and digestive diseases using ICD-10 data. Age-adjusted mortality rates were calculated annually from 2008 to 2017 based on disability presence, severity, and type. Factors associated complicated appendicitis mortality were analyzed using multivariate logistic regression models. Results The mortality of complicated appendicitis was 10.2 times (40.8% vs. 413.9%) higher in people with disabilities, especially those with severe disabilities. This difference was more evident in patients with a severe disability (aOR=2.12, 95% CI:1.58-2.86), intellectual or psychological disability (aOR=2.95, 95% CI:1.49-5.85) and internal organ problems (aOR=2.05, 95% CI:1.28-3.28). Conclusions Our findings suggest that insufficient post-operative care among disabled peoples, especially those with severe disabilities, internal organ problems, and intellectual or psychological disabilities, may impact outcomes. This is exacerbated by poor healthcare facilities and limited disability awareness among healthcare workers. Additionally, further research is required to uncover unexplained mortality causes. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health &amp; Welfare, Republic of Korea (grant number: HC23C0165). Key messages • Complicated appendicitis mortality rates show a stark 10.2-fold disparity between people with and without disabilities. • Severe disabilities, intellectual or psychological disabilities, and internal organ problems heighten the risk, emphasizing the importance of disability-inclusive healthcare practices.

Exploring the Factors Related to Knowledge of Palliative Care for Patients with Terminal Cancer Among Nursing Students: A Cross-Sectional Study

Introduction: The inadequate knowledge is the main obstacle of provision of palliative care. This study attempted to examine the association between related factors and knowledge about palliative care for patients with terminal cancer among nursing students in Bangkok, Thailand. Methods: This study was cross-sectional, conducted in June 2024 at Saint Louis College, Bangkok, Thailand. Data were collected through self-administered questionnaires measuring sociodemographic characteristics. We employed the Palliative Care Quiz for Nursing (PCQN) and the Frommelt Attitude Toward Care of the Dying (FATCOD), form B. Descriptive statistics and multiple linear regression were selected to use for analysis. Results: The participants were 111 third-year nursing students. The mean score of knowledge about palliative care for patients with terminal cancer was 8.52 (SD = 1.84. The significant predictors of knowledge about palliative care for patient with terminal cancer were experience of losing close relatives or beloved ones from cancer within 1 year (β = 1.083, p &lt; 0.05), and attitude toward dying (β = 0.041, p &lt; 0.05). Conclusion: This study highlights that nursing students had insufficient palliative care knowledge for patient with end-stage cancer. These findings implies that better attitude toward caring for end-of-life patient associated with improved palliative care knowledge. Therefore, to develop educational program of palliative care for nursing students with psychological and spiritual care training should be embedded in the program for optimum palliative care for patients with terminal cancer.

Social Determinants of Preterm Birth amongst Non-Hispanic Black Individuals.

Non-Hispanic Black individuals are disproportionately affected by preterm birth (PTB), a major driver of the racial disparity in infant mortality in the United States. The objective of this study is to identify indicators of social determinants of health (SDoH) that contribute to preterm birth amongst non-Hispanic Black individuals. Population-based retrospective case-control study of U.S. birth records (2012-2016). Factors potentially associated with PTB and considered indicators of SDoH were compared between singleton live births of non-Hispanic Black individuals delivering preterm (<37 weeks of gestation) and term (≥37 weeks of gestation). Logistic regression quantified the association between SDoH and PTB such as insurance, education, and prenatal care visits and reported as odds ratios (ORs; 95% confidence interval, CI). Of 2,763,235 live births to Black individuals, 340,480 (12%) occurred <37 weeks of gestation. Factors most strongly associated with PTB (p < 0.001), presented as OR (95% CI), included no prenatal care 3.0 (95% CI: 2.9-3.1) or insufficient prenatal care 2.7 (95% CI: 2.7-2.8), smoking during pregnancy 1.4 (95% CI: 1.43-1.47), unmarried 1.18 (95% CI: 1.17-1.19), lack of high school diploma 1.1 (95% CI: 1.12-1.40), lack of father of baby listed on birth certificate 1.22 (1.21-1.23), and Black paternal race 1.10 (1.08-1.12). Receipt of WIC (women, infants, and children) during the pregnancy had a protective effect on PTB risk in Black individuals, OR 0.83 (0.83-0.84). Pregnancies in Black individuals who are ≥35 years old, smoke tobacco, utilize Medicaid insurance, have less than a high school education, are unmarried, have little to no prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Understanding the lived experience of Black pregnant people and these selected indicators of SDoH that contribute to the risk of PTB may inform development of interventions to address the racial disparity in PTB in the United States. · Preterm birth disproportionately affects Black individuals.. · SDoH are contributors to preterm birth.. · This study investigates social determinant influences on preterm birth among Black individuals..

Challenges Afflicting Prisons – A First-hand Observation

Prisons encounter numerous challenges stemming from systemic, social, and administrative shortcomings. Overcrowding stands out as a significant problem, with facilities operating well beyond their intended capacities, leading to strained resources, increased tensions, and substandard living conditions. The high volume of pretrial detainees exacerbates overcrowding, prolongs the wait for justice, and creates excessive difficulties for those who are imprisoned. Deficiencies in infrastructure, a lack of initiatives to build new prisons or expand the capacity of current facilities, insufficient medical care - particularly in mental health services - and shortages of staff all jeopardize the well-being and safety of inmates. Additionally, gender-specific issues, such as insufficient facilities for women and the absence of open prisons, underscore the system's failure to support marginalized groups. Furthermore, the scarcity of rehabilitation programs hinders the reintegration of prisoners into society. Malpractices, gang activity, and substance abuse in prisons worsen these conditions, leading to violence and fatalities that hinder reform initiatives. Addressing these interconnected challenges requires extensive reforms that involve robust administrative commitment, investments in infrastructure and workforce, improvements to the legal framework, and the creation of rehabilitation programs aimed at cultivating a more humane and efficient prison system.

Reflections on the Challenges of Old-age Security and Policy Options for an Ageing Population

The global phenomenon of population aging is advancing at an unprecedented pace, particularly in China, where the accelerating aging process poses substantial challenges to the existing pension security system. The issue of elderly care has emerged as a critical topic in the realms of society, economy, and politics, impacting national sustainability and social stability. The challenges brought about by an aging society extend beyond the pressures of pension payments and insufficient elderly care services, encompassing risks related to funding sources and management, as well as concerns over the fairness of the security system. In the face of these challenges, there is an urgent need to optimize pension policies, advance pension system reforms, enhance the elderly care service system, and strengthen the coordination between social and medical security to construct a more equitable and sustainable pension security framework. Measures must be collaboratively advanced through top-level institutional design, policy execution efficiency, and societal involvement to provide robust support in addressing the challenges of aging. This paper will delve into the impact of population aging on the pension security system, analyze the current state and shortcomings of policies, and propose strategies to enhance the system's resilience, offering insights and recommendations for strengthening the pension security framework.

Unplanned births and their effects on maternal Health: Findings from the Constances Cohort

Unplanned births remain relatively common, even in regions with high contraceptive prevalence and accessible abortion services, such as contemporary France. Previous studies have shown that unplanned births can have numerous negative consequences for the well-being of mothers and children, including poorer maternal health behaviors, delayed and insufficient prenatal care, and depression during or immediately after pregnancy. However, these studies do not provide conclusive evidence on whether the observed outcomes are a consequence of unplanned births or of the conditions in which they likely occur. Furthermore, scant attention has been given to other dimensions of maternal well-being, such as physical health.This study uses longitudinal data from the French Constances Cohort and applies fixed-effects event study models to examine how women's self-rated general health and risk of depressive symptoms are affected in the years following an unplanned birth. Results show that women who had an unplanned birth reported a sudden, significant drop in their general health in the year following the birth, particularly among the youngest, while health outcomes following planned births showed a gradual, slight decrease over the time-period considered. The risk of depressive symptoms increased similarly after birth for both unplanned and planned births. This study contributes to the literature by using a longitudinally constructed measure of unplanned births based on pre-birth fertility intentions, rather than commonly used retrospective measures prone to ex post rationalization. It also distinguishes between unwanted and mistimed births while further examining their consequences on medium-term maternal health.

The Application, Limitations, and Improvement Measures of MOOCs in Education in the New Era

MOOCs (Massive Open Online Courses) are an internet-based online education model that provides teaching resources and services to global users via web platforms. The development of MOOCs can be traced back to 2002, with significant acceleration in recent years. In education, MOOCs have been widely applied, such as in flipped classrooms and teacher training. They offer high flexibility and rich learning resources, significantly improving students' learning efficiency and reducing learning costs. However, MOOCs also face challenges, such as uneven teaching quality, lack of learner self-discipline, and insufficient humanistic care. For the sustainable development of MOOCs, there is a need to strengthen teacher training, improve teaching quality, enhance teaching evaluation and feedback, and perfect online education regulation. With the rapid development of information technology and the internet, MOOC education has become a prominent educational model. This paper aims to discuss the application of MOOCs in education in the new era, analyze the existing problems, and propose effective improvement measures to more effectively promote the development of MOOC education.

Midwifery assessment and interventions protocol for adolescent pregnancy: a Delphi method approach

Background: Adolescence pregnancy poses risks for both mothers and infants, often due to insufficient prenatal care resulting from societal stigmatization and lack of awareness. Around 16 million adolescents aged 15-19 years in the world give birth each year; in Indonesia, the first pregnant women aged &lt;20 years are 45.10%, while in West Sumatra, it is 33.7%. To address this issue, integrated programs and midwifery care have been implemented. However, providing such care to adolescent mothers comes with its own set of challenges.Purpose: This study aims to conduct a midwifery assessment and intervention protocol for adolescent pregnancy.Method: Qualitative approach The Delphi method involved two rounds of evaluation, with twenty-one participants who were independent practice midwives, six midwives involved in the mother and child health program, and nine midwifery lecturers from accredited educational institutions A (excellent). Participants had at least five years of clinical experience and were selected using purposive non-probability sampling. Participants evaluated statements related to midwifery care during the Delphi process. The validity of these statements was determined by participants providing a minimum score of 3, and the Content Validity Ratio (CVR) was calculated. Statements with a CVR greater than 0.8 were considered valid.Results: Based on expert consensus, important assessments for adolescent pregnant women include addressing issues of gender equality and domestic violence, reproductive and sexual health, risks associated with smoking and substance abuse, maintaining a healthy pregnancy, and adequately preparing for labor and parenthood.Conclusion: Midwifery management and midwifery information were deemed valid dimensions of midwifery care; relational care had one invalid item.

Microbial Contamination in Contact Lenses, Lens Care Solutions, and Accessories Among Asymptomatic Soft Contact Lens Users.

Objective This study aimed to evaluate microbial contamination of contact lenses (CL) and their accessories among asymptomatic lens users and identify behavioral risk factors that might exacerbate the said contamination. Methodology Ninety-five asymptomatic soft CL users were recruited. In total, 380 samples were collected from the inner surface of lenses, the base of lens cases, the tip of the multipurpose solution bottle, and the solution itself. All swabs with samples were inoculated onto Columbia 5% sheep blood agar, MacConkey agar, Pseudomonas agar with cetrimide, and Sabouraud dextrose agar. Blood agar, MacConkey agar, and Pseudomonas agar with cetrimide were incubated at 37 °C for 24-48 hours. Fungal growth was investigated on Sabouraud dextrose agar, incubated at 25 °C, and examined daily for three weeks. Microscopic examination, culture-based methods, and biochemical tests were used to identify isolated microorganisms. A self-administered questionnaire on compliance with care and hygiene procedures was completed by each participant. Results The overall microbial contamination of tested samples was 38.7%. The most frequently contaminated items were lens cases (59, 62.1%), followed by bottles (44, 46.3%) and lenses (35, 36.8%). Meanwhile, the lowest incidence of contamination was seen in lens multipurpose solutions (9, 9.5%). The predominant microorganisms recovered were Coagulase-negative Staphylococci (CoNS) (94, 64%) and Gram-positive rods (29, 19.7%). Other identified potential pathogens were Staphylococcus aureus(11, 7.5%), Pseudomonas aeruginosa(5, 3.4%), Escherichia coli(1, 0.7%), andCandida albicans(2, 1.4%). The questionnaire revealed that contact lens users aged 18 to 20 showed a lack of compliance with proper hygienic care for contact lens maintenance. Risk factors such as male gender, smoking, showering, or swimming while wearing CL were related to microbiological contamination in at least one of the samples (P > 0.05). Conclusions The highest degree of contamination with highly virulent pathogens was determined in lens cases owing to insufficient lens care practices among study participants. Noncompliance with the lens cleaning procedures can lead to microbial colonization of the lens and its accessories, prompting inflammatory events in the eyes in the future.

Nursing role in the care of a patient with threatened abortion in the obstetrics and gynecology service of a hospital

The threat of abortion is an alert with vaginal bleeding in the first twenty weeks, accompanied by physical and emotional suffering. The common complication is mild to severe anemia. There are no preventive measures to avoid it, so prenatal control is important so that the pregnancy is viable. In order to know the role of nursing in the care of patients with threatened abortion, a qualitative study was carried out, with a single clinical case design based on the Nursing Care Process method, applying as an instrument the evaluation guide of Marjory Gordon to a 22-year-old patient. 10 nursing diagnoses were identified, prioritizing the diagnosis: (00221) Ineffective maternity process r/c with insufficient prenatal care and inadequate maternal nutrition m/p inadequate prenatal management, ineffective management of bothersome symptoms during pregnancy and prenatal lifestyle inappropriate. The interventions carried out were satisfactory, since the patient improved the maternity process. Given the problem of hemorrhage complication, the results are still indefinite due to the few hours of intervention and evaluation. It is concluded that the role of nursing is essential in the assessment of pregnant women with threatened abortion; Knowing its evolution allowed administering care to resolve the process of ineffective motherhood and prioritizing individualized nursing care in the prevention of hemorrhage in the first 20 weeks of pregnancy. In addition, in order to improve the skills of the nursing professional, NANDA I, NOC, NIC, and collaboration problems were used.

Exploring pain management practices among nurses in a provincial city of Vietnam: A cross-sectional investigation of influential factors

Background &amp; Aim: There is limited evidence regarding pain management practice and its associated factors among nurses in Vietnam. Therefore, the study aimed 1) To examine the current state of pain management practices among nurses at Hai Duong Provincial General Hospital, Vietnam; and 2) to identify its associated factors. Methods &amp; Materials: A cross-sectional study design was performed on 200 nurses and 200 medical records needed to be reviewed to match the number of nursing samples. The data collection was conducted from May to June 2022. The modified Cancer Pain Practice Index included 13 evidence-based pain management Indicators applied to measure nurses’ pain management practice by reviewing medical records, and the Knowledge and Attitudes Survey Regarding Pain tool was used to assess the pain management knowledge and attitude of nurses by self-completed questionnaire. Results: A significant majority, comprising 146 nurses (73%), demonstrated inadequate pain management practices. Several crucial indicators of pain management were suboptimally performed by the majority of nurses. These included failure to document the execution of pain assessments for new patients, inadequate monitoring for side effects of opioid analgesics, and insufficient assessment and care for bowel status when opioids were prescribed. Additionally, participation in prior pain management training courses, along with knowledge and attitude toward pain management, emerged as significant variables associated with pain management practices (p&lt;0.001). Conclusion: The study highlighted widespread poor pain management practices among nurses. Participation in training courses and good knowledge and attitude correlate with better practices.

Psychosocial and mental health challenges facing perinatally HIV-infected adolescents along the Kenyan coast: a qualitative inquiry using the socioecological model.

The advent of antiretroviral therapy has led perinatally HIV-infected (PHI) adolescents to live long, fulfilling lives through lifelong treatment. However, there is limited knowledge about the lived experiences and psychosocial and mental health challenges faced by PHI adolescents in sub-Saharan Africa, where 80% of PHI adolescents reside. To address this gap, we adapted the socioecological model to investigate the challenges and lived experiences of PHI adolescents in rural coastal Kenya. Between October and November 2018, a sample of 40 participants (20 PHI adolescents and their 20 primary caregivers) participated in a qualitative study using an H-assessment data collection approach for adolescents and focus group discussions with caregivers. Data analysis was conducted using a framework approach on NVIVO 11 software. PHI adolescents from this setting experience many challenges across various levels of the ecosystem. At the individual level, challenges include living in denial, HIV status disclosure, antiretroviral adherence, internalized stigma, and mental health issues. Within the family, challenges such as parental loss, insufficient care from parents, and unacceptance lead to threats of harm. In the broader community, key challenges such as gossip, unsupportive community members, long waiting times at the health facility, isolation, rejection, and an unresponsive school system fail to address the needs of PHI adolescents. Finally, HIV-related stigma and discrimination manifested across different levels of the socioecological framework. To cope with these challenges, PHI adolescents often rely on privacy and social support from their families. The findings underscore the need to develop and implement multi-level adolescent-friendly interventions to address PHI adolescent challenges and guide future investment in adolescent's health. Furthermore, there is a need to address internalized and interpersonal stigmas through individual-level interventions that promote resilience and the active involvement of adolescents, their caregivers, peers, and teachers who are their social support system.

Perceptions of social rejection, emotional exhaustion, and substance consumption of sex workers in Ciudad Juarez

In Ciudad Juárez Mexico, sex workers present indicators of imbalance in their mental health in the face of a culture of social rejection and insufficient government comprehensive health care strategies. The objective of the study was to analyze the influence of social rejection on emotional exhaustion and substance consumption. With cross-sectional exploratory qualitative methodology, a guide of 12 questions validated by experts with 10 sex workers was used. The findings indicated that the majority suffer from social rejection that generates emotional exhaustion with a depersonalized attitude, since substance consumption alters reality to minimize the psychoemotional effects.

ORAL HEALTH CARE IN PATIENTS OF THE INTENSIVE CARE UNITS.

Introduction: oral hygiene is considered a basic need to protect the health and well-being of the population, with more emphasis for patients under intensive care support. Objective: shortly review the literature about effective role of well-trained professional teams while performing oral care in patients managed in the Intensive Care Unity. Methods: scientific review article, taking as a source of information the current literature published in the PubMed database between 2004 and 2024 including, systematic reviews, meta-analysis, and review studies related with the buccal care procedures, and their relationships with the outcomes of critical ill patients under the infection risks. Results: 28 articles were analyzed, with data of children or adult patients of diverse continents who needed mechanical ventilation, enteral or parenteral feeding, or some invasive procedure favoring the hospital acquired infections, mainly the pneumonias. The reviewed literature most frequently described the lack or insufficient specialized care for the oral cavity of patient with very limited autonomy during hospitalizations. Conclusion: as a whole, there is a need for the dental specialists in the hospital team to personally perform, besides to train in service the nurse staffs and their assistants to carry on the correct methods for the patient daily buccal hygiene, with improvement of general health care and avoiding the worsening during the hospitalization period.

Epidemiology of Candidemia in Mashhad, Northeast Iran: A Prospective Multicenter Study (2019-2021).

Candidemia is a major cause of morbidity and mortality in health care settings, and its epidemiology is changing. In the last two decades, the proportion of non-albicans Candida (NAC) yeasts in candidemia has increased. These yeasts more often display resistance to common antifungals. In many western countries, candidemia is mainly caused by susceptible C. albicans, while in resource-limited countries, including Iran, the candidemia species distribution is studied less often. Here, we investigated the species distribution, resistance levels, and characteristics of patients with candidemia in five hospitals in Mashhad (northeast Iran) for two years (2019-2021). Yeast isolates from blood were identified with MALDI-TOF MS and subjected to antifungal susceptibility testing (AFST) using the broth microdilution method, while molecular genotyping was applied to Candida parapsilosis isolates. In total, 160 yeast isolates were recovered from 160 patients, of which the majority were adults (60%). Candidemia was almost equally detected in men (48%) and women (52%). Almost half of patients (n = 67, 49%) were from intensive care units (ICUs). C. parapsilosis (n = 58, 36%) was the most common causative agent, surpassing C. albicans (n = 52, 33%). The all-cause mortality rate was 53%, with C. albicans candidemia displaying the lowest mortality with 39%, in contrast to a mortality rate of 59% for NAC candidemia. With microbroth AFST, nearly all tested isolates were found to be susceptible, except for one C. albicans isolate that was resistant to anidulafungin. By applying short tandem repeat (STR) genotyping to C. parapsilosis, multiple clusters were found. To summarize, candidemia in Mashhad, Iran, from 2019 to 2021, is characterized by common yeast species, in particular C. parapsilosis, for which STR typing indicates potential nosocomial transmission. The overall mortality is high, while resistance rates were found to be low, suggesting that the high mortality is linked to limited diagnostic options and insufficient medical care, including the restricted use of echinocandins as the first treatment option.