Long-term patient outcomes for people with HIV (PWH) are largely dependent upon provision of quality healthcare. Bias or misinformation influencing care may be present before healthcare workers begin formal training. There are no known studies profiling attitudes of Australian medical students towards PWH. This descriptive study gauged medical students' opinions regarding PWH and their understanding of HIV/AIDS and its transmission. A REDCap-based self-administered survey was disseminated to undergraduate and postgraduate Monash University medical students over a 7-week period. The survey closed in March 2024. Of an estimated 1900 enrolled students, we received 136 responses. Of those, 54 identified as male, 81 identified as female, and 1 identified as another gender. The median age was 21 years (range 17-31). There were 48 (35.3%) preclinical and 88 (64.7%) clinical year students.Most preclinical (87.5%) and clinical year (67.0%) students had at least one inaccuracy in their HIV/AIDS knowledge. The majority (107/136, 78.7%) had inaccurate knowledge about HIV transmission. Only 6.8% clinical year students were confident in their ability to counsel a PWH on all relevant aspects of management. Insufficient education was cited by 41.2% of students and 88% felt that further education regarding HIV/AIDS would be beneficial.HIV/AIDS knowledge improved as students progressed through medical school. Bias against PWH was rare. While bias against PWH was low, this highlighted a crucial gap in students' knowledge and confidence regarding HIV management. These findings underscore a critical need for targeted HIV/AIDS education and training to ensure sustained delivery of quality HIV care.

Background: The use of physical restraints in hospital settings remains a controversial practice due to its ethical, legal, and safety implications. Although restraints are intended to prevent falls or manage agitation, their inappropriate use may compromise patient dignity, autonomy, and quality of care. Current healthcare policies emphasize restraint reduction, appropriate documentation, and professional training as key elements of humanized and safe care. Methods: A descriptive cross-sectional study based on an anonymous self-administered survey was conducted in a tertiary university hospital as the diagnostic phase of a quality improvement project aimed at evaluating healthcare professionals' knowledge, perceptions, and documentation practices related to physical restraint use. A structured ad hoc questionnaire was distributed to registered nurses and nursing assistants working in adult inpatient units using a non-probabilistic convenience sampling strategy. The survey explored training, clinical decision-making, communication with patients and families, awareness of institutional protocols, and use of the electronic health record (EHR). Descriptive analyses and Pearson's chi-square tests were performed using IBM SPSS Statistics. Results: A total of 241 professionals participated. More than half of respondents (54.8%) reported no formal training in physical restraint use, and only 27.4% considered their training sufficient. Although 86.3% stated they were familiar with restraint indications, only 53.5% were aware of the existence of a structured EHR restraint registry, and just 31.0% consistently completed it. Documentation of restraint removal was particularly low (32.9%). Furthermore, significant discrepancies were observed between regulatory definitions of restraints and professionals' perceptions regarding practices requiring formal documentation. Statistically significant associations were identified between professional category, perceived training adequacy, and knowledge of physical restraint indications. Conclusions: This diagnostic phase identified substantial gaps between regulatory requirements, professional knowledge, and real-world documentation practices related to physical restraint use. The findings highlight the need for competency-based training strategies, standardized documentation processes, and strengthened institutional leadership to promote patient safety, regulatory compliance, and the humanization of hospital care.

This study aimed to evaluate the levels of depression, anxiety, and stress (DAS) experienced by 4th and 5th-year dental interns at Kahramanmaras Sutcu Imam University Faculty of Dentistry, and to investigate the relationship of these psychological conditions with demographic factors. A cross-sectional study was conducted among 126 dental interns during the 2024-2025 academic year. Data were collected using self-administered survey forms, which included basic demographic information, perceived internship challenges, and their mental health status, assessed over the previous week using the Depression Anxiety Stress Scale-21 (DASS-21). The gender distribution of the 126 students in the study was 61.1% female and 38.9% male. Among the students, 55.6% identified dentistry as their first choice. The overall mean DASS-21 scores for the entire sample were Depression: 18.68 ± 11.40, Anxiety: 17.20 ± 10.19, and Stress: 20.40 ± 10.83. The prevalence of extremely severe levels of depression, anxiety, and stress were found to be 29.4%, 39.7%, and 15.9%, respectively. 4th-year students (Depression: 22.20 ± 12.18; Anxiety: 21.21 ± 11.62; Stress: 23.97 ± 12.20) exhibited statistically higher DASS scores across all subscales compared to 5th-year students (Depression: 15.38 ± 10.62; Anxiety: 13.42 ± 8.64; Stress: 17.05 ± 9.37) (p < 0.05). Significant differences were also identified between mental health and sources of financial support, as well as peer relationships (p < 0.05). Positive significant correlations were found between the perceived difficulty levels during the Prosthodontics internship and DASS scores (r = 0.271-0.329, p < 0.05). Identifying effective strategies to support the mental health of dentistry students is critically important not only for safeguarding the well-being of individuals but also for enhancing the overall quality of healthcare services. Therefore, integration of structured psychological support programs into clinical dental curricula is recommended.

State-level abortion restrictions in the US enforced after the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision have worsened geographic, racial, and socioeconomic inequities in abortion access, warranting investigation of experiences for individuals who travel out of state to seek abortion care. To highlight the obstacles abortion seekers must overcome to obtain care, to identify common barriers and facilitators of interstate abortion travel, and to offer recommendations for abortion organizations, policymakers, and advocates to expand access for individuals living in states with abortion bans. This qualitative study analyzed data obtained from out-of-state participants collected as part of a larger cross-sectional, mixed-methods study. All English- and Spanish-speaking patients from out of state who were at least 16 years of age and medically cleared for research attending 2 abortion clinics in Illinois between September and November 2023 were eligible. Participants completed a self-administered survey and a semistructured interview. Directed content analysis was used to identify emergent and crosscutting themes. In total, 33 individuals (all self-identified as female or a woman) completed the survey and interview. Most participants were between 20 and 24 years of age (n = 12 [36%]) or 30 years or older (n = 12 [36%]), and from southern US states with a total abortion ban (n = 25 [76%]). From the time participants decided to terminate their pregnancy to the day of the abortion appointment, they experienced a median of 14.0 days of delay, with a mean (SD) of 29.6 (36.5) days of delay. Patient journeys of seeking abortion were categorized into 3 phases: information gathering, planning finances and travel, and traveling and completing the appointment. Participants reflected on how restrictive policies in their home states deepened abortion stigma and stifled access to accurate information. Most participants encountered their longest delays in the information-gathering phase, as they had to find legitimate clinics, often without any referrals, and navigate the complex web of laws between states. When patients had personal financial security, strong social support, or were in geographic proximity to a state in which abortion was legal, their journeys were facilitated. In this cross-sectional qualitative study of participants traveling across state lines for abortion, the policy landscape and abortion stigma of the home state, information and resource availability, and interpersonal support shaped their journeys in the post-Dobbs landscape. To improve cross-state abortion access for individuals in states with abortion restrictions or bans, policy change should be coupled with increased visibility of accurate information, charitable funding, and abortion stigma reduction. Abortion support organizations and the public should continue to enable access through social support services, such as volunteer drivers and abortion doulas.

BackgroundFor any organization, it is crucial to understand that its internal CSR practices should be perceived positively and enhance satisfaction and happiness, ultimately leading to its employees' long-term intention to stay and improved job performance.ObjectiveDrawing on social exchange theory and social identity theory, the study examines the role of internal CSR in promoting employee happiness, intention to stay, and job performance through top management support.MethodsThe data were collected using a self-administered survey and convenience sampling. Initially, 450 questionnaires were distributed among hotel staff at various levels; however, only 293 questionnaires were used for further analysis. Notably, 70.30% of the respondents were male and 29.70% female, with the majority being young adults aged 20-30 (53.24%) and 30-40 (25.94%). PLS-SEM using Smart PLS (4.0) was used to test the proposed hypotheses.ResultsTop management support moderates the relationship between internal CSR and happiness at work. The findings also show that happiness at work mediates the relationship between internal CSR and employee intention to stay. Intention to stay mediates the relationship between happiness at work and employee job performance. Finally, the study results indicate that happiness at work and intention to stay sequentially mediate the relationship between internal CSR and employee job performance.ConclusionsInternal CSR practices such as work-life balance initiatives, fair treatment, employee development, and inclusive policies are essential for promoting well-being. Organizations that focus on these practices are better able to improve employee satisfaction, happiness, their long-term stay, and job performance.

IntroductionGlobally, trauma patients suffer from high rates of preventable deaths, in part driven by low rates of access to and application of resource-relevant evidence-informed clinical guidance. This mixed-methods study assessed the accessibility (barriers to attempting to use guidance), clarity (ease of comprehension), utility (based on resources and time), and implementation of trauma guidance for Peruvian injury providers.MethodsSemistructured qualitative interviews were conducted in Spanish at three hospitals in Lima, Peru. Interviews were analyzed in Dedoose V.9.1.12 using an iteratively developed codebook; quantitative self-administered surveys were then developed and distributed at the Pan American Trauma Society Conference. Surveys were analyzed using descriptive statistics and frequencies.Results38 interviews and 83 surveys were conducted with surgical attendings, emergency physicians, and surgical and emergency residents across all years of training. Access barriers included paywalls, language barriers, low user-friendliness, and technology limits (poor internet, few computers). A mobile app and portable physical guidance are preferred potential solutions. Utility barriers included low equipment maintenance and high patient volumes. Resource-based guidance, conciseness (eg, flowcharts), and standardization are perceived to potentially increase utility. Implementation barriers included limited training time, reliance on more experienced colleagues rather than guidance, low enforcement, and low funding. Potential facilitators are increased administrative support and staff willingness to use guidance improving patient mortality, clinical errors, and length of stay. No barriers to clarity were reported.ConclusionBarriers to using clinical guidance included low user-friendliness, low local applicability, and an unsupportive culture. Mobile apps, resource stratification, and administrative involvement are priorities to address these needs. Trauma guidance adapted to local realities may reduce preventable deaths in acute care. Further work is needed to identify how to create and distribute updated clinical guidance to better serve trauma providers worldwide.Level of evidenceEconomic and Value-based Evaluations Level 2.

Purpose This study aims to analyze the influence of attitudes and perceived behavioral control on the intention to consume halal and environment-friendly products, and to explore the role of intention as a mediator in bridging these linkages by considering the differences in marital status between married and unmarried groups. Design/methodology/approach The quantitative approach with a self-administered survey was performed through an online survey to 323 respondents who consume halal and environment-friendly products. Data were analyzed using the structural equation modeling technique based on partial least squares (PLS) with the help of SmartPLS version 3.0 to estimate direct and indirect relationships between variables. Findings The findings reveal the contradictory results for married and unmarried groups for the role of attitude and perceived behavioral control in promoting intention to consume halal and environment-friendly products. The consensus exists in the linkage between intention and consumption behavior among these groups. This study also shows that intention cannot mediate between variables for the married group, while it can fully mediate for the unmarried group. Research limitations/implications The unbalanced composition of respondents based on marital status is dominated by the group of unmarried respondents. The result can affect the generalizability of the results to married and unmarried groups. Further investigation is suggested to involve more proportional samples and consider additional variables such as social norms and religiosity in understanding intention and consumption behavior. Practical implications The study shows that marital status can shape the pathways to halal and environment-friendly consumption. This refines the theory of planned behavior (TPB) by showing the life-stage differences and supports integration with the value–attitude–behavior (VAB) framework. For practical matters, it informs differentiated strategies for unmarried consumers to respond to personal attitudes and ethical values, while married consumers prioritize household welfare and affordability. Businesses operating in the halal and environment-friendly sectors are required to align their strategies with Islamic principles to enhance the wider market for both married and unmarried groups. Originality/value This study provides a new approach by integrating TPB and VAB in the context of halal and environment-friendly product consumption and considering marital status as a predictor, which has been overlooked by preliminary studies in this theme.

Attitudes, knowledge and training needs in chronic pain: national survey of family doctors members of semfyc

Multiple sclerosis (MS) is a chronic demyelinating disease that often leads to disability in young adults. Among its various phenotypes, highly active MS (HA-MS) presents with frequent relapses, incomplete recovery, and a high burden of MRI lesions. Despite its clinical importance, there is no universally accepted definition of HA-MS, which complicates early identification and treatment decisions. This study aimed to evaluate whether Brazilian neurologists can recognize HA-MS and whether there is agreement regarding its defining characteristics. It also explored how this recognition influences treatment choices. A cross-sectional, self-administered online survey was distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN). The questionnaire was open from March to September 2023. Responses were analyzed using descriptive statistics and chi-square or Fisher's exact tests. A total of 206 neurologists completed the survey. Most respondents agreed that signs of high disease activity influence therapeutic decisions (98.1%). The most frequently cited indicators of HA-MS were annualized relapse rate (37.4%) and the number of gadolinium-enhancing lesions on MRI (32.0%). The Rush et al. definition was most commonly endorsed (53.9%), while Tintoré's was least favored (85.9%). High-efficacy therapies-particularly Natalizumab, Ocrelizumab, and Alemtuzumab-were the preferred treatment options. Neuroimmunologists were significantly more likely to prescribe advanced therapies and less likely to use first-line agents compared to general neurologists. Brazilian neurologists show substantial agreement in identifying clinical and radiological signs of HA-MS and favor early, high-efficacy treatment strategies. These findings highlight the need for clear, standardized criteria to guide consistent diagnosis and timely therapeutic intervention, ultimately improving patient care in MS.

Validity and Reliability of the Arabic Version of the Glottal Function Index in Dysphonic Patients.

This study aims to empirically examine the effect of ESG management of cosmetics companies on relationship continuity intention, focusing on the mediating role of customer trust. ESG management was classified into eco-friendly management, social responsibility, and governance improvement, while relationship continuity intention was divided into intention to continue using and intention to expand relationships. Data were collected through a self-administered survey from consumers aged 20 to 40 who had experience using cosmetics companies engaged in ESG activities. A total of 338 valid responses were analyzed using SPSS 25.0. The results showed that all dimensions of ESG management had significant positive effects on customer trust. In addition, ESG management was found to have significant positive effects on both intention to continue using and intention to expand relationships. Customer trust also had a significant positive influence on both dimensions of relationship continuity intention. Mediation analysis indicated that customer trust played a significant mediating role in the relationship between ESG management and relationship continuity intention. Specifically, eco-friendly management and social responsibility showed full mediation through customer trust in relation to intention to continue using, while governance improvement demonstrated partial mediation. For intention to expand relationships, social responsibility and governance improvement exhibited full mediation, whereas eco-friendly management showed partial mediation. These findings suggest that ESG management in cosmetics companies influences consumers’ relationship behaviors primarily through the formation of customer trust, highlighting the importance of trust-based ESG strategies for sustainable customer relationship management.

OBJECTIVE:Inadequate wound management can lead to increased complications, costs, and risks, highlighting the importance of health care professionals’ knowledge in wound and peri-wound care. Although previous studies have identified knowledge gaps among nurses, national data on Canadian nurses’ understanding of wound cleansing remain limited. This study aimed to evaluate Canadian nurses’ knowledge and practices regarding wound and peri-wound cleansing and assess their alignment with evidence-informed recommendations.METHODS:A descriptive, cross-sectional, self-administered online survey was conducted from June to August 2024 to gather data on current practices. Research ethics board exemption was obtained from the Joint West Park Healthcare Centre-Toronto Central LHIN-Toronto Grace Health Centre Research Ethics Board (JREB).RESULTS:Survey results revealed that 91% (n=180) of nurses recognize the role of regular wound cleansing in promoting healing, whereas 90% (n=178) believe it helps reduce biofilm and prevent infection. In addition, 99% (n=196) support routine peri-wound cleansing, and 94% (n=186) emphasize the use of nondamaging cleansers. Despite this knowledge, gaps persist between belief and practice. For example, 68% (n=135) support gauze soaking, yet only 30% (n=59) use this method routinely. Only 54% (n=107) correctly identified the need for antiseptics on peri-wound areas, and just 34% (n=67) consider hypochlorous acid and sodium hypochlorite equally safe.CONCLUSIONS:The findings underscore the need for enhanced education to bridge the gap between knowledge and practice. Aligning wound care practices with current evidence is essential to improving outcomes, preventing infection, and ensuring patient safety across Canadian health care settings.

Latino men who have sex with men (LMSM) account for a disproportionate and growing number of HIV diagnoses in the United States. Intersectional stigma remains a key driver of HIV inequities; however, most quantitative intersectional stigma measures are limited and do not consider the larger social context. NEXUS is a longitudinal cohort study that will use social network methods and theory to rigorously measure intersectional stigma among LMSM and quantify the longitudinal association between intersectional stigma and HIV prevention outcomes. We will prospectively enroll 500 HIV-negative LMSM in San Diego, California, and follow participants over 1 year. At baseline and every 6 months thereafter (Month 0, Month 6, and Month 12), participants will complete an interviewer-administered social network inventory and a self-administered survey to collect information on their social networks (alter types, size, and characteristics) and HIV prevention engagement (HIV testing and pre-exposure prophylaxis use), respectively. Information on HIV prevention engagement will also be abstracted from medical records. Intersectional stigma will be operationalized as a multilevel latent variable comprised of observed measures of anticipated and enacted stigma experienced by a participant from an alter toward the participant's Latino, masculine, and sexual identities. Multilevel structural equation modeling will be used to estimate the longitudinal association between intersectional stigma, HIV testing, and pre-exposure prophylaxis use, considering potential mediators and moderators. NEXUS recruitment began in June 2021, and as of March 11, 2025, a total of 482 participants had been enrolled. Enrollment is planned to end by May 2025, with baseline results expected late 2025 and through the following year. Data collection for our prospective study aims is expected to be complete in June 2026, with data analysis and expected results published later that year. NEXUS will advance quantitative intersectional stigma measurement using a novel social network approach. This study will identify intervention targets to reduce HIV inequities among LMSM and mitigate the harms of intersectional stigma in this population.

Parental involvement plays a crucial role in shaping students’ academic outcomes. The study investigates the relationships between SES, parental involvements, parental self-efficacy, expectations, beliefs, and student academic achievement in Cambodian lower secondary schools. Using quantitative research design, data were collected from 351 parents through self-administered surveys. A mediation analysis was conducted to assess the direct and indirect effects of parental involvement. Findings indicate that home-based parental involvement positively predicts student achievement, while school-based involvement has a negative effect. Parental expectations emerged as a significant mediator, reinforcing the role of parental aspirations in academic success. However, self-efficacy exhibited a negative effect on achievement. SES was the strongest predictor of student achievement, highlighting its critical influence on access to educational resources. The study contributes to the growing literature on parental involvement in developing countries and highlights the need for context-specific strategies that align with Cambodia’s educational landscape.

ABSTRACT Across North America, nearly 350 public libraries employ social workers or have social service office hours. With public libraries’ mandate of welcoming all members of the public through their doors, having social workers as part of library staff does appear, on its face, to make sense. But does it? This study explores public library leaders’ perceptions through the southeastern United States about the opportunities social workers in their libraries bring to their communities using a self-administered survey. Most respondents believed that this was an excellent idea and could prove helpful to their patrons but with caveats.

Purpose: To assess the nature of COVID-19 vaccine side effects in Jordan, addressing public concerns and vaccine hesitancy. Methods: A total of 405 participants were surveyed, having received one to four doses of the COVID-19 vaccines approved in Jordan. Data were collected via a self-administered online survey created with Google Forms and shared through social media platforms. Results: Of these, 355 participants met the inclusion criteria - primarily female (57.7 %) and educated to a bachelor’s level (53.5 %). Most had no serious medical conditions (75.5 %) and had received two doses (71.3 %), with Pfizer-BioNTech being the most common (56.9 %). Side effects were reported by 68.1 %, mostly minor, such as injection site pain (45.8 %) and fatigue (42.7 %). Severe effects (10.7 %), including anaphylaxis and dyspnea, were infrequent and non-hospitalized. Conclusion: This study affirms the high safety profile of COVID-19 vaccines, with most side effects being mild and short-lived. The rarity of severe adverse events underscores the vaccines’ overall benefits, supporting their continued use in public health efforts. Transparent communication and ongoing safety monitoring remain essential to enhance public confidence and combat vaccine hesitancy.

Abstract How should we measure “pure” or “true” independents? For years, the respective item required a respondent to volunteer that answer. Recent surveys have moved toward presenting it explicitly. Those that do produce estimates of pure independents that are much larger than in past surveys. We present evidence of this phenomenon across multiple surveys and ask: Are self-administered surveys overcounting independents, or are traditional live-interviewer surveys undercounting independents? We answer that question by comparing live-interview and self-administered samples from the 2012 and 2016 American National Election Studies, by undertaking tests to rule out mode effects (including an experiment), and by seeing which question wording correlates more strongly with measures of latent ideology, vote choice, and ratings of the parties. Our findings suggest that surveys that include an explicit response option, allowing Americans to self-identify easily as “(pure) independent,” offer a more precise measurement of the concept of party identification. This has implications for the study of independents, as well as for discussions about polarization and party-system dealignment.

Sepsis is a life-threatening condition, characterized by a dysregulated response to infection; however, the understanding in the general population is low or lacking, especially in regions such as Saudi Arabia where such situations are sparse. The present study strives to assess the general awareness and knowledge of sepsis among the adult Saudi population and aims to identify the potential determinants of such awareness. It is a cross-sectional research study. The present study was able to solicit the data with a time frame from July to November 2024 through an online and self-administered survey instrument that can be circulated over social media sites. Sample criteria included participants that were over 18 years of age and resided in Saudi Arabia. The data were analyzed with reference to sociodemographic, level of prevalence, and knowledge about sepsis using e-SPSS. Out of 544 respondents, only 32% reported prior awareness of sepsis, with 19.8% indicating good knowledge. The most well-known symptoms were fever (58.6%) and pain (44.3%), but little was known about other symptoms and their causes. Age, educational attainment, and work in healthcare were among the demographic variables that were substantially linked to increased awareness. The research provides evidence that a substantial number of the adult population in Saudi Arabia are not aware and do not have sufficient knowledge of sepsis. The data points to the fact that people in Saudi Arabia are in dire need of education on sepsis to improve recognition of this diagnosis and understanding of its significance, aiming at bettering the outcomes and emergence.

Objectives: This study aimed to determine the prevalence of voiding dysfunction and its impact on quality of life among women diagnosed with rheumatoid arthritis, a chronic autoimmune condition known for joint inflammation and systemic manifestations. Methods: A cross-sectional observational design was employed at two tertiary care centers in Saudi Arabia. Over an 8-week period, 144 female patients with rheumatoid arthritis completed a self-administered online survey. The questionnaire included demographic data and the International Prostate Symptom Score (IPSS), a validated tool used to assess urinary symptoms and their effect on quality of life. Patients under 18 or with known urological disorders were excluded. Results: Participants had a mean age of 47.2 years, and 72.9% were married. The average IPSS was 11.2, with 41.7% classified as moderately symptomatic, 40.4% mildly symptomatic, and 17.9% severely symptomatic. Only 16.7% discussed urinary issues with family or partners, and 15.3% with physicians. Notably, 35.4% planned to consult a specialist, and this intent was significantly associated with higher IPSS scores (p < 0.03). Conclusions: Voiding dysfunction is highly prevalent among women with rheumatoid arthritis and significantly affects quality of life. Despite moderate to severe symptoms, many patients do not seek medical help. Routine screening and increased awareness are recommended to improve management and outcomes for this population. Further research is needed to explore regional differences and incorporate objective diagnostic tools.

This study was conducted following a time of rapid change in the U.S. refugee resettlement program to advance empirical understanding of compassion satisfaction, secondary traumatic stress (STS), and burnout in the U.S. refugee resettlement workforce in 2023. With approval from Institutional Review Boards, data were collected using a self-administered online survey based on a cross-sectional design. Univariate analyses produced rates and levels of compassion satisfaction, STS, and burnout, and structural equation modeling examined associations between socio-demographic, personal, and work-related factors and the three outcomes. The sample comprised 472 respondents, predominantly female (83.3%). Nearly all (99%) of survey respondents reported moderate and high levels of compassion satisfaction, while 56 and 58% of scores fell into the categories of moderate STS and burnout, respectively. Being in a management role, resilient coping, compassion, turnover intention, and client connection were all associated with compassion satisfaction; while self-efficacy, quality of work-life, and client connection were significantly associated with both burnout and STS. Study results reiterate the importance of examining both demands and resources, as well as positive and adverse outcomes, in the refugee resettlement workforce. Implications for policy, practice, and future research are discussed.