Health Care Research Articles

Days at Home After Cancer Surgery: Impact of Area Deprivation and Association with Long-Term Outcomes.

Poor infrastructure in deprivedareas may hinder access to health care, and a lack of socioeconomic resources can prevent patients from remaining at home after discharge. This study sought to assess the association between the Area Deprivation Index (ADI) and days at home within 90days (DAH-90) after a complex operative procedure. Patients who underwent an elective operation for a gastrointestinal cancer between 2016 and 2020 were identified from the Medicare Standard Analytic Files. County-level ADI was calculated using a weighted average of ADI percentiles for each census block within a county. The association between ADI and DAH-90 and the impact of DAH-90 on 1-year expenditures and 1-year mortality were evaluated. Among 72,452 patients who underwent a surgical procedure, median patient age was 75years (interquartile range [IQR] 71-81) and 54.3% of patients had a Charlson Comorbidity Index higher than 2. A +0.2 increase in ADI was associated with 12.6% lower odds of achieving high DAH-90 (adjusted odds ratio [aOR], 0.874; 95% confidence interval [CI], 0.845-0.903) compared with low DAH-90. Notably, high DAH-90 (mean difference, -55,614$; 95% CI, -56,540$ to -54,687$) and medium DAH-90 (mean difference, -39,538$; 95% CI, -40,194$ to -38,882$) were associated with markedly decreased 1-year total expenditures, as well as lower 1-year mortality compared with patients who spent fewer days at home after surgery. Increasing area deprivation was associated with higher likelihood of spending fewer days at home after a complex cancer surgical procedure. Patients spending fewer days at home were far more likely to die within 1 year and experienced higher health care costs.

Dimensions and Subcategories of Digital Maturity in General Practice: Qualitative Study.

The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework. The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice. An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH). In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice. The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed.

Impact of artificial intelligence in transforming and replacing traditional learning and development of employees

Purpose The purpose of this study was to examine the impact of artificial intelligence interventions in transforming learning and development of organizations and to investigate whether artificial intelligence can replace traditional learning methods. Design/methodology/approach Mixed method approach was adopted to conduct the study. The sample size for quantitative study was 300 employees belonging to domains of technology, finance, health care and manufacturing. Structural equation modeling was done to arrive at the results. The qualitative study was done on 25 employees by conducting in-depth interviews followed by thematic analysis. Findings The findings of quantitative study revealed that perceived usefulness, perceived experience and learning effectiveness significantly contributed to transformation of traditional learning. The same was validated by qualitative study, and it also indicated that respondents preferred blended learning and artificial intelligence cannot replace traditional learning. Originality/value The study contributes to research by highlighting the impact of artificial intelligence in transformation of traditional learning and development based on departmental and job-specific roles as well as sectors that require physical training in addition to knowledge-based training.

Networks of care for the modern adolescent.

At a time of increased demand for specialist mental health services, a more nuanced understanding of how adolescents navigate systems of care and support is essential. We mapped 'networks of care' to explore patterns of mental health help-seeking alongside the perceived helpfulness of support accessed. We examined data from 23 927 adolescents aged 11-18 years who participated in the 2023 OxWell Student Survey, an English school-based, repeated cross-sectional survey of mental health and wellbeing. Students self-reported past-year access to 18 types of support across informal (e.g. friends and family), semi-formal (e.g. school and charities), and formal (e.g. health and social care) domains, alongside how helpful they found the support. We used a network approach to explore interconnections between sources of support accessed and perceived helpfulness. One in four (27.0%, 6449/23927) adolescents reported past-year access to mental health support, of which 56.7% (3658/6449) reported accessing multiple types. Informal networks were the most commonly accessed (23.1%, 5523/23927), followed by semi-formal (9.7%, 2317/23927) and formal (6.8%, 1623/23927) supports. Informal sources had high acceptability, with around 80-90% reporting them as helpful, whereas child and adolescent mental health services (CAMHS), helplines, and online supports were perceived to be the least helpful. The networks also identified groups who might not be optimally served by current systems, including gender diverse adolescents and adolescents who found mental health support from their parents unhelpful. Adolescents are accessing mental health support across informal, semi-formal, and formal sources of care. Services can no longer be developed, delivered, or evaluated in isolation from these networks.

A prognostic model for predicting functional impairment in youth mental health services.

Functional impairment is a major concern among those presenting to youth mental health services and can have a profound impact on long-term outcomes. Early recognition and prevention for those at risk of functional impairment is essential to guide effective youth mental health care. Yet, identifying those at risk is challenging and impacts the appropriate allocation of indicated prevention and early intervention strategies. We developed a prognostic model to predict a young person's social and occupational functional impairment trajectory over 3 months. The sample included 718 young people (12-25years) engaged in youth mental health care. A Bayesian random effects model was designed using demographic and clinical factors and model performance was evaluated on held-out test data via 5-fold cross-validation. Eight factors were identified as the optimal set for prediction: employment, education, or training status; self-harm; psychotic-like experiences; physical health comorbidity; childhood-onset syndrome; illness type; clinical stage; and circadian disturbances. The model had an acceptable area under the curve (AUC) of 0.70 (95% CI, 0.56-0.81) overall, indicating its utility for predicting functional impairment over 3 months. For those with good baseline functioning, it showed excellent performance (AUC=0.80, 0.67-0.79) for identifying individuals at risk of deterioration. We developed and validated a prognostic model for youth mental health services to predict functional impairment trajectories over a 3-month period. This model serves as a foundation for further tool development and demonstrates its potential to guide indicated prevention and early intervention for enhancing functional outcomes or preventing functional decline.

Inequities in Access to Mental Health Services Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees.

Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) people are often aggregated into a monolithic group, but when they are disaggregated into ethnic groups (e.g., Chinese), inequities can be identified. Using a representative sample of adult Medicaid enrollees (N=55,215), the authors assessed inequities in self-reported access to mental or behavioral health services between non-Hispanic AA and NHPI Medicaid enrollees and non-Hispanic White Medicaid enrollees, both by racial group and across 10 disaggregated ethnic groups. AA and NHPI enrollees, by race and all 10 ethnicities, reported significantly worse mental health care access than did White enrollees. The magnitude of disparities also differed between ethnic groups, ranging from -14.6 percentage points for Native Hawaiian enrollees to -43.6 percentage points for Vietnamese enrollees.

Electroceuticals: Unlocking the promise of therapies.

Electroceuticals refers to the constantly growing disciplines of bioelectric and bioelectronic medication. These include a broad variety of devices that have been invented and are now being utilized in medical implants, wearable medical electronics, and bioelectronics. The primary aim of this study is to encompass several facets of electroceuticals, their applications, and recent advancements in the field of medical challenges. A complete literature study was conducted, which included a comprehensive review of globally recognized scientific research databases. The progressive refinement and diminution of technology, in conjunction with swift advancements in comprehending the role of electrical pathways in the human body, have rendered it progressively viable to manipulate these pathways for therapeutic purposes. Electrical stimulation impacts and modifies biological functioning and pathological processes in the body. In the contemporary era of medicine, health care practitioners from a variety of fields utilize electricity to cure disease or injury or to assess and diagnose using a variety of electrically driven medical tools.

Canada's First National Oral Health Research Strategy (2024-2030).

Recent years have seen significant positive changes and developments in oral health-related policy and data on oral health and oral health care in Canada. Simultaneously, on the international stage, the momentum for oral health and related research continues to build. These changes have led to an initiative to create Canada's first National Oral Health Research Strategy (NOHRS), which was recently published by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis (Allison and Rock 2024). In this communication, we describe the process that was used to undertake this work. We present the resulting guiding principles, the research priority areas, and the framework that emerged, which included 6 strategic priorities grouped into 3 themes: (A) Leading Issues: (1) access to care, (2) inequities, identities, and oral health; (B) Emerging Methods: (3) artificial intelligence, (4) omics; and (C) Overarching Approaches: (5) environmental sustainability, (6) knowledge mobilization and implementation science. In addition, NOHRS includes a series of proposed goals and a timeline over the coming years. The point is to encourage a broad range of individuals and groups of people to engage with this high-level strategy and create plans to implement it. This strategy directly answers the call by the World Health Organization for countries to establish a national oral health research strategy (World Health Organization 2024). We have engaged in an extensive, broad consultative process, resulting in a Canadian NOHRS that is tailored to the needs of our community. Its aim is to galvanize our community into action to address the priorities we have identified. By engaging in this process, we build upon multiple oral health-related initiatives in Canada and on the international stage. We hope to inspire and facilitate similar, much-needed work elsewhere.

Dietitian-nutritionist intern resident (D-NIR) - A need light years away from occurring in Spain

The dietitian-nutritionist (D-N) is a health professional with a university degree in human nutrition and dietetics in charge of the correct nutrition according to the physiological and pathological needs of people, as stated in the Law on the Regulation of Healthcare Professions since 2003. Various national and international societies, supported by numerous studies, point to the need to incorporate the D-N in the National Health System (NHS) to improve healthcare in the context of multidisciplinary teams. However, despite the importance of the functions of the D-N within the NHS portfolio, and unlike the rest of the health professions, there are many regions in Spain that still do not have the figure of this professional. Likewise, there is no specific system of Specialized Health Care Training (SHCT) for this professional, which is a need that impedes his or her own official training and specialization. Therefore, the creation of an SHCT for the dietitian-nutritionist intern resident (D-NIR) is proposed with the aim of improving their comprehensive training, competencies and responsibilities, thus improving the quality of care in the NHS in the context of multidisciplinary teams.

Subnational mapping of anemia and etiologic factors in the West and Central African Region.

Despite bold commitments to reduce anemia, little change in prevalence was observed over the past decade. We aimed to generate subnational maps of anemia among women of reproductive age (WRA), malaria transmission, and hemoglobinopathies to identify priority areas, but also explore their geographical overlap. Using the most recent Demographic and Health Surveys (DHS), we first mapped anemia clusters across Sub-Sahara Africa (SSA) and identified the WCA as a major cluster. Geographic clusters with high anemia and related etiologic factors were identified using spatial statistics. Multilevel regression models were run to identify factors associated with any, moderate and severe anemia. West and Central African countries (n=17). WRA (n= 112,024) residing in 17 WCA countries. There was a significant overlap in geographical clusters of anemia, malaria, and hemoglobinopathies, particularly in the coastal areas of the WCA region. Low birth interval (0.86 [0.77, 0.97]), number of childbirth (1.12 [1.02, 1.23]), being in the 15-19 age range (1.47 [1.09, 1.98])) were associated with increased odds of any anemia. Unimproved toilet facility and open defecation were associated with any anemia, whereas the use of unclean cooking fuel was associated with moderate/severe anemia (P<0.05). Access to health care facility, living in malaria prone areas, and hemoglobinopathies (HbC and HbS) were all associated with any, moderate or severe anemia. Interlinkages between infection, hemoglobinopathies, and nutritional deficiencies complicate the etiology of anemia in the WCA region. Without renewed efforts to integrate activities and align various sectors in the prevention of anemia, progress is likely to remain elusive.

Cumulative incidence of chronic pain after visiting a Dutch emergency department with acute pain

BackgroundChronic pain is a substantial problem in modern healthcare resulting in health care overutilization. The cumulative incidence of developing chronic pain after visiting the emergency department with acute pain has been determined for specific patient groups only. If the cumulative incidence of chronic pain in emergency department patients with acute pain is high, more proactive measures are justified to limit development of chronic pain. The primary objective was to study the cumulative incidence of chronic pain in patients visiting Dutch emergency departments with acute pain. In addition, we compared the Health-Related Quality of Life (HRQOL) and pain related interference with work.MethodsIn this prospective multicenter cohort study data was collected from adult patients visiting the emergency department with acute pain. Chronic pain was defined by means of a numeric rating scale (NRS) of ≥ 1 measured 90 days after the initial visit. HRQOL was measured with European Quality of Life (EQ-5D-5 L) and Short Form (SF-36) questionnaires.Results1906 patients were included of which 825 had complete data. Of these, 559 patients (67.8%; 95%CI: 64.5 − 70.9%) scored an NRS ≥ 1 after 90 days. Incidence with completed analyses (with imputed data) was similar. Patients with chronic pain reported a significantly lower HRQOL; EQ-5D-5 L index (median 0.82 vs. 1.00) and significantly more pain related hindrance (median 1.00 vs. 0.00).Conclusions67.8% of the responders scored NRS ≥ 1 90 days after ED-visit with acute pain. Regardless of the used definition, chronic pain is associated with a lower HRQOL and more pain related hindrance.

Histologic and immunologic factors associated with response to immune checkpoint inhibitors in advanced sarcoma.

To characterize factors associated with response to immune checkpoint inhibitors (ICIs) in advanced sarcoma. This is a retrospective study with a cohort of 216 patients with advanced sarcoma treated with ICIs between 2016-2023 at Stanford Health Care. Overall survival (OS), progression free survival (PFS), objective response rates per RECIST criteria (ORR), and reason for ICI discontinuation were analyzed across histologic subtypes, ICI regimens, tumor mutational burden (TMB), and PD-L1 expression. The overall ORR in the cohort was 16.7%. The histologic subtypes with the highest ORR were Kaposi sarcoma (KS, 66.7%), alveolar soft part sarcoma (ASPS, 50%), angiosarcoma (AS, 33.3%), myxofibrosarcoma (MFS, 28.6%), and undifferentiated pleomorphic sarcoma (UPS, 27.8%). The subtypes with the lowest ORR were osteosarcoma (0%), synovial sarcoma (SS, 0%), and liposarcoma (LPS, 3.7%). The subtypes with the highest median PFS were KS (median not reached, NR), ASPS (NR), MFS (27.4 months), and UPS (11.3 months). The ORR for sarcomas with PD-L1 ≥ 1% was 27.8% (p=0.02), while the ORR for sarcomas with TMB ≥ 10 mutations per megabase of DNA (mut/MB) was 28.6% (p=0.20). ORR and PFS were highly variable across sarcoma histologic subtype. In this large analysis, KS, ASPS, AS, MFS, and UPS demonstrated the highest ORR and longest PFS while osteosarcoma, SS, and LPS had the lowest ORR and shortest PFS. PD-L1 expression was also associated with increased ORR. Our findings provide further insight into understanding the sarcoma histologic and immunologic factors that correspond with response to ICIs.

The Political Economy of Priority Setting and Resource Allocation in European Oral Health Policy.

Pressing oral health care challenges pose prioritization dilemmas for governments. This study aimed to identify key determinants of prioritization in oral health policy in Denmark, Germany, the Netherlands, and the United Kingdom, as part of a series of the DELIVER project. A literature review based on a search of PubMed and Google Scholar articles related to these countries from January 1, 2000, to October 17, 2023, and key informant interviews with policy makers were conducted to identify key trends in oral health policy choices and determinants of priority setting and resource allocation processes. A total of 249 articles were included, and 6 key informants were interviewed. The overarching focus identified was the accessibility of dental care, primarily characterized by incremental and localized programs for vulnerable groups. Supply-side arrangements consisted of adaptations to population needs, including financial incentives for providers and adjusted service delivery models such as task shifting. Several interventions of quality management were found, particularly in Germany. A funnel was produced to illustrate 3 stages driving oral health policy choices. These were political accountability to address population demand, stakeholder influence through negotiations and lobbying, and bureaucratic justification of policy innovations. While findings highlighted political attention on oral health care through public outcry, complex negotiations and limited data formed bottlenecks of prioritization. Prioritization in oral health policy seems to be dominated by fragmented investments in incremental services of delivery rather than synergized reforms such as granular package designs. While some contexts showed political traction for oral health policy, complex negotiations strained by interests of private professionals and challenges of limited evidence result in difficulties in constraining oral health care within public spending targets. This has placed oral health policy in a state of inertia, where insufficient public resources meet the force of content exerted by the private sector. This study can inform policy makers and researchers to understand the various stakeholder roles in maintaining the status quo of oral health policy and the processes creating the bottlenecks preventing progression in improving oral health care systems. This understanding could lead to novel approaches to oral health policy making and the appropriate data acquisition and analysis to aid oral health policy.

Risk factors for Clonorchis sinensis infections and control measures reinforced with focused interviews.

Clonorchiosis, a disease that develops following the consumption of raw freshwater fish that harbors Clonorchis sinensis metacercariae, seriously threatens the health of residents in endemic areas. We aimed to assess the level of awareness of liver fluke infections among infected residents and restaurant workers in liver fluke infection-endemic areas. To identify and provide a more realistic description of C. sinensis infections, we conducted a focused interview and questionnaire survey of local residents in endemic areas in Korea. Most residents knew that freshwater fish are a source of C. sinensis infection. Nevertheless, the consumption of raw freshwater fish was the main risk factor for their infection with C. sinensis. The residents had little knowledge regarding their residential area being endemic to C. sinensis or about the symptoms and complications of C. sinensis infection. Although the participants had no experience with C. sinensis prevention or health education, they preferred on-site education during visits to village halls. The in-depth interviewees had a high level of knowledge about C. sinensis infection but were unaware that eating raw freshwater fish was its cause. Family and social gatherings encourage the habit of eating raw freshwater fish, which is a risk factor for repetitive infections. Based on these findings, to eliminate clonorchiosis, we propose strengthening the capacity of public health care personnel, giving C. sinensis prevention education, and screening educational videos during visits to village halls. Furthermore, intensive education is recommended for reinfected people and community opinion leaders, as well as reservoir host control.

Airway management and ventilation strategy among obese adult patients: a comprehensive review and analysis

Background: Difficulties with mask ventilation and intubation are more prevalent in obese patients. Hence, health care practitioners engaged in airway management of obese individuals must exercise particular vigilance and care. Ventilation strategies can potentially have a detrimental impact on postoperative pulmonary function, prolong hospital stays, and increase costs. As a result, the aim of this review was to investigate airway management technique and ventilation strategies in obese adult patients. Methods: The PubMed, HINARI, Google Scholar, and Cochrane Review databases were searched using appropriate keywords and search engines for adequate evidence from studies meeting the inclusion criteria to reveal the endpoint, which was ventilation strategy and airway management in adult obese patients. Duplicate entries were eliminated through EndNote software. Screening of literature was conducted with proper appraisal checklist. This review was reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 statement. Results: The included literature covers a wide range of topics, including preoxygenation, making the patient in a 25° head-up position, use of 10–12cmH2O of positive end-expiratory pressure (PEEP) and continuous positive airway pressure (CPAP) during induction, placing the patient in a ramping posture during intubation, high-flow oxygenation (15 L/min) through the nasopharyngeal airway or nasal cannula during laryngoscopy, using low tidal volume during surgery, a 1:1/1.5:1 I:E ratio, PEEP of 10–20 cmH2O, Fio2 reduced to make SpO2 &gt; 90, pressure-controlled (PC)/volume-controlled (VC) ventilation mode, and recruitment maneuver (RM). Following surgery, it was essential to provide oxygen therapy to maintain preoperative levels, provide CPAP/non-invasive positive pressure ventilation, place patients in semi-sitting positions, and provide thorough postanesthesia care unit monitoring in order to enhance patient outcomes with regard to morbidity and mortality among obese patients. To safely manage and overcome airway challenges in severely obese patients with a suspected difficult airway, awake fiberoptic intubation is recommended. Conclusions: Positioning the patient in a head-up position (semi-sitting), utilizing CPAP during preoxygenation, and administering oxygen via nasal cannula during intubation to prolong apnoea time and awake fibrotic for suspected difficult airway. Additionally, selecting appropriate ventilation modes (PC/VC), PEEP + RM, and positions during the intraoperative phase is crucial to improving outcomes in obese surgical patients.

Knowledge Acquisition and Audience Retention in Stroke Education: Results From a Global Study by the World Stroke Organization.

The World Stroke Academy (WSA), the educational platform of the WSO, provides high-quality stroke education to health care professionals worldwide. Understanding the learning needs and preferences of WSA members is crucial for effective knowledge translation. This study aims to (1) assess demographics and professional backgrounds of WSA members, (2) identify preferences in knowledge acquisition, and (3) evaluate audience retention during WSA webinars. A survey was developed using Qualtrics and distributed via email to all WSA members from May 8 to May 23, 2023. The survey included multiple-choice, rating scale, and ranking questions. Audience retention data were obtained from the latest 6 WSA webinars (May 2023-December 2023). Descriptive variables were reported, and χ2 analysis and multinomial regression models were used. A random sample of 1065 WSO members received the survey; 327 initiated it (participation rate, 30.7%), and 236 completed it (completion rate, 72.2%). The mean age (SD) of participants was 46.7 (±11.6) years; 57.2% identified as male. Most respondents were stroke specialist physicians (65.3%) and were based in Europe (35.2%). Online journal articles represented 41.6% of the total time allocated for stroke education, with 17% allocated to webinars. Social media usage patterns showed X (formerly Twitter) as the top choice (34.7%). Age, profession, and location significantly influenced social media platform use. Audience retention was at 50% at the 57-minute mark and 44.3% at the end of webinars. Tailoring WSA webinar content to meet health care professionals' needs and enhancing interactive components can improve audience retention. These insights will guide the future development of the WSA portfolio.

Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study.

The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales-people of South Asian, Black African, and Caribbean backgrounds-in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services.

User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study.

The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients' abilities and health status on the adoption of these interventions. This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM). The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM. We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness (β=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage. This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care.

Norwegian adaptation of the Quality in Psychiatric Care – In-Patient instrument: psychometric properties and factor structure

BackgroundValidated instruments measuring the quality of mental healthcare from patients’ perspectives are scarce, and available instruments have been requested. One of the few instruments measuring the quality of care from a patient’s perspective is the Swedish Quality in Psychiatric Care–In–Patient (QPC-IP). This cross-sectional study aimed to translate and adapt the QPC-IP instrument for a Norwegian context and assess its psychometric properties.MethodsThe QPC-IP was translated and adapted to a Norwegian context using a translation back-translation process model. A total of 169 inpatients from specialised mental health services responded to the questionnaire. The QPC-IP comprises six dimensions: Encounter (eight items), Participation (eight items), Discharge (four items), Support (four items), Secluded Environment (three items), and Secure Environment (three items), totalling 30 items. Confirmatory factor analysis was conducted to assess the instrument’s factor structure. Additionally, Cronbach’s alpha was used to establish the instrument's internal consistency.ResultsThe results indicated that the Norwegian adaptation of the QPC-IP possesses good psychometric properties, including internal consistency, content, and construct validity, as confirmed by the confirmatory factor analysis results. The confirmatory factor analysis demonstrated an adequate fit for the six-factor structure, consistent with the original Swedish instrument.ConclusionsThe QPC-IP is a user-friendly and easily implementable tool that assesses various dimensions of the quality of inpatient mental healthcare from a patient’s perspective. Moreover, the Norwegian QPC-IP holds potential for use in comparative, cross-cultural studies within mental healthcare services to monitor the quality of the provided services.

The association between social anxiety disorder and parenting style among nursing students

BackgroundSocial anxiety disorder (SAD) is a common mental health concern affecting students globally and in Saudi Arabia. This study aimed to assess the prevalence of SAD among nursing students and examine its association with various parenting styles.MethodsThis cross-sectional study included 141 female nursing students at the College of Nursing at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). Participants completed the Parental Authority Questionnaire (PAQ) and Social Phobia Inventory (SPIN). The study data were collected using Microsoft Forms. An ordinal logistic regression analysis was performed to examine the association between SAD and parenting styles.ResultsThe prevalence of SAD among the nursing students was 47.5%, with 6.4% having severe SAD and 2.8% having very severe SAD. The authoritative parenting style was the most frequently reported, with 58.2% of the students reporting having an authoritative mother and 44.7% reporting having an authoritative father. Maternal (odds ratio [OR] = 0.181, 95% confidence interval [CI] = 0.062, 0.527, p = 0.001) and paternal (OR = 0.186, 95% CI = 0.060, 0.574, p = 0.003) authoritative parenting styles were associated with a decrease in the odds of experiencing symptoms of SAD among nursing students. Additionally, a paternal authoritarian parenting style (OR = 2.816, 95% CI = 1.011, 8.218, p = 0.048) was associated with an increase in the odds of experiencing SAD symptoms. However, maternal authoritarian parenting style was not significantly associated with SAD symptoms among students (p > 0.05).ConclusionsThe parenting style is an influential factor contributing to the experience of SAD in nursing students. In this study, both authoritative and authoritarian parenting styles were significantly associated with the symptoms of SAD. Nursing educators and mental health professionals must establish appropriate strategies to help students cope with SAD. Moreover, educational programs targeting parents must be implemented to increase their awareness of the impact of parental practices on their children’s mental health.