Telephone Interviews Research Articles

Exploring the long-term disability outcomes in Trauma patients: study protocol

ObjectivesTrauma registries are essential tools for improving trauma care quality and efficiency, but many fail to capture long-term patient-reported outcome measures (PROMs). Focusing on these outcomes is crucial for understanding the extent of disability patients experience and identifying potential post-discharge interventions to optimize recovery. Studies reflecting the experience from low- and middle-income countries in this area are limited. Therefore, we aim to develop a digital trauma registry in Pakistan to prospectively capture patient-reported outcome measures at one, three, six, and twelve months post-injury.MethodsWe will develop and implement a digital trauma registry at two tertiary care facilities in Karachi, Pakistan: Aga Khan University Hospital and Jinnah Postgraduate Medical Center. The registry will include all admitted adult trauma patients (≥ 18 years). Data collection will be conducted digitally using tablets, with mortality, level of disability, functional status, and quality of life as primary outcomes. Follow-up data will be collected through telephone interviews with patients and caregivers. We will employ descriptive statistics to summarize participant’s socio-demographic and clinical characteristics. Additionally, we will perform survival analysis using Kaplan-Meier curves and Cox proportional hazard models and utilize mixed-effects linear regression to adjust for potential confounders for primary outcomes.DiscussionThe trauma registry will fill the current gap in knowledge regarding long-term outcomes among trauma patients in low- and middle-income countries (LMICs). This study will delineate future direction for capturing post-discharge data, enhancing our understanding of recovery, and informing the design of interventions aimed at improving long-term outcomes.

Rasch analysis of the new general self efficacy scale: an evaluation of its psychometric properties in older adults with low vision

BackgroundWhile general self-efficacy is known to relate to achievement in many areas, it has rarely been evaluated in individuals with low vision. Here we explore the psychometric properties and targeting of the New General Self Efficacy Scale (NGSES) using Rasch analysis in data collected from older adult clinical trial participants with low vision.MethodsParticipants (n = 121) completed pre-intervention telephone questionnaires (i.e., NGSES, Activity Inventory (AI), Beck Depression Inventory (BDI), SF-36, and the Telephone Interview for Cognitive Status (TICS). Rasch analysis using the Method of Successive Dichotomizations (MSD) was applied to NGSES, AI, and BDI datasets to estimate person and item measures, and ordered rating category thresholds.NGSES infit mean square statistics and standard errors were analyzed to test whether data fit Rasch model requirements, and targeting was assessed by comparing distributions of person and item measures. Multiple linear regression evaluated the influence of participant characteristics on NGSES person measures.ResultsThere was a significant difference (p = 0.01) in the distributions of NGSES person measures (mean = 0.85, range -2.1-3.2) and item measures (mean = 0, range -1.0-0.72). Infit mean square statistics and standard errors for item and person measures conformed to expectations of the Rasch model.Greater NGSES person measure was related to lower BDI person measure (β = -0.48, p < 0.0005, 95% CI -0.67—-0.28) and higher AI person measure (β = 0.11, p = 0.047, 95% CI 0.0013 – 0.22) after controlling for cognitive status (TICS). Other variables including SF-36, visual acuity, and patient demographics were not related to NGSES person measure.ConclusionsWhile NGSES person measures estimated from a low vision patient population conformed to basic Rasch model requirements, the significant differences in the person and item measure distributions indicate poor NGSES targeting, specifically a ceiling effect. Therefore, there is limited discrimination between persons at the upper end of the scale. While further work can evaluate how self-efficacy may be associated with other factors in the low vision patient population, the ceiling effect found in this study cautions interpretation of NGSES results for those with high general self-efficacy.Trial registrationPre-registered on clinicaltrials.gov, identifier NCT04926974.

Patient Perspectives on Blended Internet-Based and Face-to-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study.

Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from alcohol use disorder (AUD), but a low proportion seek treatment due to person- and treatment-related barriers. Internet-based cognitive behavioral therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended cognitive behavioral therapy (bCBT), which combines face-to-face CBT (FtF CBT) and iCBT for AUD. This study aims to investigate user experiences of bCBT. More specifically, it seeks to explore the advantages and disadvantages that users have experienced with bCBT for AUD, as well as their motivations for choosing this treatment format. A total of 30 patients who had participated in the Blend-A (Blending Internet Treatment into Conventional Face-to-Face Treatment for AUD) study and received the intervention were contacted and offered the opportunity to participate in semistructured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual FtF interview. Thus, the final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data were anonymized and securely stored. We found that users experienced several advantages of iCBT over a larger part of the treatment course, including increased anonymity and privacy. Most importantly, it offered flexibility, allowing patients to focus on their rehabilitation process at their own pace. Patients appreciated the availability of written text in the online program, finding it helpful for gaining knowledge and understanding of AUD and its impact on the individual with the condition. They emphasized how the assignments helped them fully engage in treatment by first acknowledging their problem with alcohol and then dedicating time to self-reflection before FtF sessions, allowing for more in-depth discussions with the therapist. They also appreciated the reminders, which motivated them to complete their assignments. Overall, patients perceived more benefits than disadvantages in using bCBT. Essentially, bCBT offers a form of assisted autonomy that cannot be fully achieved through iCBT or FtF CBT alone. It is only through their combination that patients can fully appreciate the benefits of the treatment, as they have time for self-reflection, with guidance from the therapist between FtF CBT sessions. ClinicalTrials.gov NCT04535258; https://clinicaltrials.gov/ct2/show/NCT04535258.

Influence of Leadership Styles on Performance of Local Government Agencies: Case of Central Equatoria State Local Government in South Sudan

An organization's success depends on successful leadership and good organizational culture. This study investigates the influence of various leadership styles on the performance of local government agencies in Central Equatoria State, Juba, South Sudan. It explores how transformational, transactional, and laissez-faire leadership styles influence the performance of the central Equatoria state local government. The general objective of the study was to examine the influence of various leadership styles under the long-range leadership model on the performance of the central Equatoria state local government. The specific objectives of the study include the following: To assess the influence of transformational leadership style on performance of the central Equatoria state Local Government, to establish the influence of transactional leadership style on performance of the Central Equatoria state Local Government and to examine influence of laisses-faire leadership style on performance of the Central Equatoria state Local Government. The research employed a descriptive design, targeting 791 individuals, including local government officers and leaders from public institutions. A sample of 138 respondents was selected through stratified random sampling, and data was collected via questionnaires, interviews, and document analysis. To ensure validity of the finding, the researcher performed a pilot study on the data collection and analysis instruments in Juba County. This was done to guarantee the instrument's content coverage and authenticity by enhancing problems, the format, and the measuring scales. the researcher ensured protection of the research process to ensure reduction of anomalies, inaccuracy and scoring in the measurements to guarantee reliability of the data obtained. This research was focused on both primary and secondary data. Questionnaires was used as the main tool of data collection supported by both physical and telephone interview. Analysis of reports published on newspapers and internet was as well done. The study utilized the full range leadership model by James MacGregor Burns (1985) and Bernard M. Bass (1985), which encompasses transformational, transactional, and laissez-faire leadership styles. The findings revealed that both transformational and transactional leadership styles are not widely practiced by the CESLG Leaders and had limited impact on performance of the central Equatoria state local government while laissez-faire leadership being the most practiced style, significantly influenced poor performance outcomes of the central Equatoria state local government and it’s one of the reasons for the poor performance of the CESLG institutions. As such the researcher recommend among others, the following to both the CESLG leaders and other stake holders for implementation; The CESLG leaders need to consider recruiting young and well-educated local government officer as the study revealed that majority 48.8% of the local government officials are aged between 51 to 60 years whose performance are average , the local government leaders need to consider initiating executive training and development Programme for local government officers, The CESLG leadership is advised to conduct regular performance review for its institutions and staff. the CESLG leaders and other stakeholders/institutions are encouraged to adopt modern leadership styles such as transformational and transactional in their management styles.

German general practitioners' experiences of managing post-COVID-19 syndrome: A qualitative interview study.

The management of the long-term sequelae of coronavirus disease 2019 (COVID-19) infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely owing to a significant gap in the understanding of its aetiology, diagnosis and effective treatment. To examine general practitioners' (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement. This study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs (N = 31) from across Germany. Interviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. GPs reported that they were often the first point of contact for patients with persistent symptoms following SARS-CoV-2 infection, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients' functioning, social participation and the substantial time required for patient care. GPs coordinate diagnosis and treatment but face challenges because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care. The findings confirm the high functional limitations and psychosocial burden of PCS on patients, and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments.

Mapping Obesity Trends in Saudi Arabia: A Four-Year Description Study.

Our study aims to map the trends in obesity prevalence over the past four years and to describe the health, behavior, and psychological factors of people living with obesity in Saudi. This is a secondary data analysis using the Sharik Health Indicators Surveillance System (SHISS) from 2020 to 2023. The SHISS dataset comprises cross-sectional telephone interviews carried out quarterly across all administrative regions of Saudi Arabia. Recruitment of participants was restricted to Saudi resident adults only. The study analyzed data from 92,137 participants, with a balanced region and gender distribution. The average age of participants was 36.83 ± 13.68 years. The prevalence of obesity showed minor fluctuations over four years, with the highest at 22.2% in 2020 and lowest at 21.4% in 2023. This study showed that a slight decline in daily smoking rates was observed from 2020 to 2023 across all categories. Participants living with obesity reported a higher consumption of fruits and vegetables compared to their not with obesity counterparts. In addition, participants living with obesity engaged less frequently in physical activities compared to those without obesity. Moreover, people living with obesity have higher incidence rates of depression and anxiety, as well as various of chronic diseases. This study highlights the complex factors affecting obesity prevalence in Saudi Arabia. Despite progress, ongoing health promotion and disease prevention are crucial to address the persistent challenges driven by behavioral and socio-economic factors. Continued surveillance and longitudinal studies are essential to track trends in obesity, smoking, and physical activity, ensuring that health initiatives align with population needs.

Patient Experience of Living With Hemophilia A: A Conceptual Model of Humanistic and Symptomatic Experience in Adolescents, Adults, and Children

Background: People living with hemophilia A face challenges impacting their daily lives despite treatment innovations. Previous studies have explored perceptions and treatment experiences; however, there is a lack of an evidence-based, comprehensive model to identify concepts (clinical, physical, and psychological functioning) relevant for people with hemophilia A (PwHA). Objectives: The aim of this qualitative study was to address the question: What is the humanistic and symptomatic experience of adolescents, adults, and children living with hemophilia A and what is the impact of hemophilia A on their quality of life? Methods: Participants, identified through patient associations in the UK, were male PwHA and caregivers of male PwHA receiving prophylactic treatment. Qualitative research was conducted involving semistructured telephone interviews with PwHA and caregivers between April 2020 and September 2020 in the UK. Standard analytical techniques of conceptual model development were used. Results: Of 30 participants, 23 were PwHA and 7 were caregivers. A conceptual model was produced describing patient experience of symptoms, physical functioning, treatment experiences, and the impact of symptoms and treatment on daily lives. Participants reported hemophilia-related symptoms, including bleeding, pain, and joint stiffness, as well as difficulties engaging with social and leisure activities. They also reported protection from bleeds provided by their treatment, relief from symptoms, and the resultant sense of normality. Concepts were broadly relevant across all age groups; however, psychological impacts were reported only by adult PwHA, and caregivers reported impacts related to outdoor activities, play, and education. Participants indicated that their ideal treatment would be delivered orally. Discussion: This study highlights the range of symptoms experienced by PwHA across a broad range of age groups, thus enabling the evaluation of relevant concepts across different stages of life. The research supports development of a conceptual model documenting symptoms, impacts, and treatment experience relevant to PwHA. Conclusion: Insights gathered through the interviews and resulting conceptual model support development of new therapies to address the physical and social challenges identified by PwHA and highlight a need for novel hemophilia A treatments that can ease treatment administration, provide adequate level of protection, and enable life to be lived normally.

Effect of small dose esketamine on perioperative neurocognitive disorder and postoperative depressive symptoms in elderly patients undergoing major elective noncardiac surgery for malignant tumors: A randomized clinical trial.

Perioperative neurocognitive disorder and postoperative depressive symptoms are significant complications after surgery. Studies have indicated that esketamine possesses neuroprotective and antidepressant qualities. This trial included 209 patients aged 60 to 86 years undergoing tumor resection who received esketamine (Group E) or not (Group C) during and after surgery. In group E, patients were given an intravenous dose of 0.5 mg/kg of esketamine 10 minutes after induction of general anaesthesia. In addition, esketamine (2 mg/kg) in combination with sufentanil was used for PCIA during 48 hours postoperatively. On the other hand, saline was used as a substitute for esketamine in group C. Cognitive function was evaluated using neuropsychological tests and telephone interview for cognitive status-modified, and symptoms of depression were assessed using Hamilton Depression Rating Scale 17. Compared to Group C, patients in Group E exhibited lower rates of depressive symptoms at 3, 7, and 90 days post-surgery (53.9% vs 67.7%, 26.3% vs 47.9%, and 13.3% vs 28.4%). Group E also showed decreased time for Trail Making Test on days 7 and 90. However, there were no significant differences in the incidence of delirium 1 to 5 days post-surgery or cognitive impairment 90 days post-surgery between the 2 groups (12.1% vs 10.9% and 8.4% vs 9.7%). Intraoperative low-dose esketamine and postoperative low-dose esketamine combined with sufentanil for patient-controlled intravenous analgesia has been shown to improve postoperative analgesia, alleviate postoperative depressive symptoms, and aid in the recovery of social executive ability. However, this approach did not reduce the incidence of postoperative delirium or postoperative cognitive dysfunction.

Patient Experience of Living With Hemophilia A: A Conceptual Model of Humanistic and Symptomatic Experience in Adolescents, Adults, and Children.

Background: People living with hemophilia A face challenges impacting their daily lives despite treatment innovations. Previous studies have explored perceptions and treatment experiences; however, there is a lack of an evidence-based, comprehensive model to identify concepts (clinical, physical, and psychological functioning) relevant for people with hemophilia A (PwHA). Objectives: The aim of this qualitative study was to address the question: What is the humanistic and symptomatic experience of adolescents, adults, and children living with hemophilia A and what is the impact of hemophilia A on their quality of life? Methods: Participants, identified through patient associations in the UK, were male PwHA and caregivers of male PwHA receiving prophylactic treatment. Qualitative research was conducted involving semistructured telephone interviews with PwHA and caregivers between April 2020 and September 2020 in the UK. Standard analytical techniques of conceptual model development were used. Results: Of 30 participants, 23 were PwHA and 7 were caregivers. A conceptual model was produced describing patient experience of symptoms, physical functioning, treatment experiences, and the impact of symptoms and treatment on daily lives. Participants reported hemophilia-related symptoms, including bleeding, pain, and joint stiffness, as well as difficulties engaging with social and leisure activities. They also reported protection from bleeds provided by their treatment, relief from symptoms, and the resultant sense of normality. Concepts were broadly relevant across all age groups; however, psychological impacts were reported only by adult PwHA, and caregivers reported impacts related to outdoor activities, play, and education. Participants indicated that their ideal treatment would be delivered orally. Discussion: This study highlights the range of symptoms experienced by PwHA across a broad range of age groups, thus enabling the evaluation of relevant concepts across different stages of life. The research supports development of a conceptual model documenting symptoms, impacts, and treatment experience relevant to PwHA. Conclusion: Insights gathered through the interviews and resulting conceptual model support development of new therapies to address the physical and social challenges identified by PwHA and highlight a need for novel hemophilia A treatments that can ease treatment administration, provide adequate level of protection, and enable life to be lived normally.

Equestrian-associated injuries of the hand: a retrospective analysis of injury mechanisms and patterns.

Hand injuries are frequently caused by sports and are associated with long periods of inability to work and high economic health costs. After ball sports and cycling, the most common cause of hand injuries is horseback riding. Therefore, measures should be taken to prevent these risks and increase safety in sports, however data characterizing equestrian sports-associated injuries are limited. A retrospective monocentric cohort study was performed including 39 patients (mean age: 35 ± 2.6 (range 9-65) years, female 89.7% who sustained an injury to the hand while practicing equestrian sports during 2016-2021 and presented to our hand surgery center. Data analysis was performed to characterize the trauma mechanism and injury patterns by evaluating the clinical information system and conducting telephone interviews. Overall, 53.8% of the injuries occurred while leading the horse owing to traction by bridles or a lead rope on the fingers, whereas only 33.3% were caused by a fall and 12.8% by a bite injury. The majority (87.2%) of cases were injuries to the phalanges (metacarpus: 7.7%; carpus: 5.1%). Fractures were present in 51.3% of cases. The most serious injuries included avulsion amputations in 23.1% of patients (10.3% subtotal; 12.8% total amputation). Equestrian-associated injuries occur more frequently during horse handling than riding, resulting in severe avulsion amputations due to traction of the lunge or bridle, requiring complex microsurgical treatment. We recommend that appropriate protective gloves are worn for prevention of hand injuries. Additionally, the use of self-opening panic hooks with overload protection can prevent excessive traction. III.

Identification of psychosocially stressed families by practice pediatricians : Results on the effectiveness of the PATH (Pediatric Attention To Help) intervention

In Germany, about afifth of families with young children live under psychosocially stressful conditions that can threaten the healthy development of the child. In order to improve the referral of these families from pediatric practices to early childhood intervention services ("Frühe Hilfen"), the PATH intervention was developed and implemented in Baden-Württemberg. The first step in the referral process is to identify psychosocially stressed families. This study investigated whether the PATH intervention increases the proportion of identified families with psychosocial stress by pediatricians. In aquasi-experimental study, atotal of 293 psychosocially stressed families who were cared for by 29pediatricians from established pediatric practices were examined. The intervention group (IG) consisted of families with pediatricians from Baden-Württemberg who took part in the PATH intervention. The control group (CG) consisted of families with pediatricians from Bavaria who did not take part in the PATH intervention. Additional qualitative telephone interviews were conducted with 10pediatricians from the IG and 20families from the IG with psychosocial stress. Asignificantly higher proportion of psychosocially stressed families was identified in the IG than in the CG. The difference was about 20percentage points and was similar regardless of the family's level of stress. The results show that the PATH intervention improves the identification of psychosocially stressed families by pediatricians. This improved identification of psychosocially stressed families is an important prerequisite for referring families to tailored early childhood intervention services such as those provided by the "Frühe Hilfen".

КОПІНГ-СТРАТЕГІЇ В КОНТЕКСТІ КРИЗОВОГО УПРАВЛІННЯ

The ongoing humanitarian crisis in Ukraine, intensified by the conflict that began in February 2022, has resulted in 14.7 million individuals requiring humanitarian aid by 2024. This crisis has led to significant socioeconomic challenges, with households adopting various coping strategies to manage economic stress. Understanding these strategies and their regional variations is crucial for effective crisis response and resource allocation. The purpose of the article. To analyze and present findings on the coping strategies adopted by Ukrainian households in response to the ongoing humanitarian crisis and conflict, with a particular focus on regional differences and the most severely affected areas. The object of the research. Household coping strategies across different regions of Ukraine, including selling assets, spending savings, purchasing food on credit, seeking additional employment, reducing health and education expenditures, and using degrading income sources. The methods of the research. The study employed a quantitative data collection methodology developed by REACH, utilizing both face-to-face household surveys and computer-assisted telephone interviews. The dataset encompassed 10,434 interviews conducted at the household level across 23 oblasts, targeting a 95% confidence level and an 8% margin of error. The hypothesis of the research. The research appears to hypothesize that there are significant regional variations in the adoption of coping strategies, with areas closer to the conflict zone experiencing more severe economic stress and resorting to more extreme coping measures. The statement of basic materials. The research identified ten distinct coping strategies and analyzed their adoption rates across different regions of Ukraine. Eastern and southern regions, particularly Donetska, Kharkivska, Zaporizka, Khersonska, and Sumska oblasts, consistently demonstrated higher adoption rates of various coping strategies. Donetska oblast emerged as the epicenter of economic stress, with 50% of households reporting the sale of assets or spending of savings. Zaporizka oblast led in purchasing food on credit (18.63%) and reducing health expenditures (55.28%). Significant regional disparities were observed, with some oblasts showing coping strategy adoption rates far exceeding national averages. The originality and practical significance of the research. This study provides a comprehensive, region-specific analysis of household coping strategies in Ukraine during an ongoing crisis, offering valuable insights for targeted interventions. The research's practical significance lies in its potential applications for socio-economic management, including informing the design of targeted social safety nets and economic support programs, guiding efficient resource allocation based on region-specific needs, and supporting the development of tailored healthcare and education policies. Conclusions and prospects for further research. It provides a baseline for monitoring and evaluating the effectiveness of future interventions and informs long-term regional development strategies and crisis response planning. By offering a nuanced understanding of how different regions are coping with the crisis, this research enables policymakers to develop more effective, localized approaches to addressing Ukraine's complex humanitarian challenges.

Evaluating the impact of the Health Access for Refugees Project on people who are refugees or seeking asylum in Northern England.

Evidence demonstrates that people who are seeking asylum and refugees face individual, institutional and system-level barriers when accessing health services. Health Access for Refugees' Project (HARP) is a UK initiative increasing access to health care within this community through a series of interventions. This study explored the impact of HARP on health service access, experiences and outcomes for clients, and how volunteers and staff addressed institutional and system-level barriers. In summer 2020, we conducted qualitative telephone interviews with four HARP clients, eight clients who became volunteers, seven further volunteers and three staff members. The educational aspect of the interventions supported clients navigating the complex UK health care system while promoting independence in accessing health care. Advocacy by volunteers and staff was important in challenging barriers at individual and institutional levels. Staff challenged the asylum system, by improving information around entitlement to health care and addressing barriers to registering with a General Practitioner (GP). Interventions such as those provided by HARP can address different levels of barriers to support people accessing health care provision. This can be achieved through training health professionals and working with peers to support access to care and to develop self-advocacy. However, stable long-term funding is essential to ensure the sustainability of these initiative.

Long COVID-19 and Coexistence of Fatigue and Depression: A Cross-sectional Study from Saudi Arabia.

Coronavirus disease 2019 (COVID-19) is associated with various manifestations even after infection resolution. This study aimed to assess the prevalence of post-COVID-19 fatigue and its predictors. We conducted a nationwide cross-sectional study among Polymerase Chain Reaction test confirmed COVID-19 cases in Saudi Arabia from July 2021 to February 2022. We collected data through telephonic interviews covering socio-demographics, comorbidities, body mass index, smoking, illness severity, and COVID-19 vaccination status. We assessed fatigue using Fatigue Severity Scale while depression was assessed using Patient Health Questionnaire-2. Logistic regression was employed to analyze the relationship between post-COVID-19 fatigue and depression. The analysis included 361 participants with a mean age of 37 ± 10.5 years, among whom 43% were female. Approximately 10% had comorbidities, and 21% were current smokers. Nearly two-thirds (68%) of the participants reported mild illness. The prevalence of perceived fatigue was 22.7%, while fatigue measured by the Fatigue Severity Scale was 14.4%. The multivariable logistic regression model revealed that COVID-19 severity and depression were significant predictors of post-COVID-19 fatigue; adjusted odds ratio 1.87 (95% CI: 1.10 to 3.18) and 14.3 (95% CI: 4.55 to 45.0), respectively. Our findings suggest a higher prevalence of perceived fatigue compared to that measured by the Fatigue Severity Scale, underscoring the importance of using a valid assessment tool for fatigue among COVID-19 patients to ensure proper management. The significant association between post-COVID-19 fatigue and depression highlights the need for psychological assessment of COVID-19 patients to enhance their post-infection quality of life.

Analyzing Changes in Attitudes and Behaviors towards Seasonal Influenza Vaccination in Spain’s Adult Population over Three Seasons

Background/Objectives: The experience of the COVID-19 pandemic has turned the spotlight on the importance of public health measures and disease prevention. Despite this, the acceptance of influenza vaccination has remained low in most countries (and far from the 75% target set by the World Health Organization). The objective of this study has been to investigate how attitudes and behaviors regarding influenza vaccination in the Spanish adult population have changed over the last three years (from 2021 to 2024) in order to analyze trends in influenza vaccination. Methods: To this end, a cross-sectional study was conducted through 2206 telephone interviews, and the results were compared with those obtained in previous campaigns. Results: The findings indicate a significant decline in overall vaccination intent. Healthcare professionals remain the most influential factor in encouraging vaccination, yet there is a notable increase in the lack of vaccine recommendations, contributing to the decision not to vaccinate. This study also reveals low awareness of the influenza vaccine campaign, emphasizing the need for improved public health communication. Conclusions: To counteract these trends, this study recommends intensifying awareness campaigns, strengthening the role of healthcare providers in vaccine advocacy, and tailoring communication strategies. These efforts are crucial to enhancing vaccination coverage and protecting vulnerable populations against influenza.

Navigating post-ICU care: understanding family members’ experiences - a qualitative study

ABSTRACT Background: Comprehending and addressing the needs of caregivers during the post-intensive care unit (ICU) phase is vital for establishing sustainable support systems and improving the overall quality of life (QoL) for both patients and caregivers. Objective: To explore the experiences of family members (FMs) caring for loved ones three-months after ICU discharge and their related QoL. Methods and measures: A qualitative, descriptive research was conducted. Participants were recruited from two general ICUs in an Italian Academic Hospital. Data collection lasted two months and was performed with telephonic interviews led by ICU nurses. Thematic analysis was conducted using a hybrid approach, incorporating both deductive and inductive coding strategies. This process has been facilitated by Atlas.ti software. Results: Twenty-four FMs participated, representing a diverse range of familial relationships with the patients. Thematic analysis revealed four overarching themes: 1) QoL underwent transformations; 2) Positive emotions laden with significance; 3) Supporting role taken on by a caregiver; and 4) Life’s transience through the meaning-making of the illness event. These themes highlighted the multifaceted nature of the caregiving experience. Conclusions: This study provides valuable insights into the challenges and dynamics faced by FMs following ICU discharge. Findings underscore the importance of addressing environmental challenges, cultivating positive emotions, and strengthening caregiver-patient relationships to enhance the caregiving experience and promote overall QoL. FMs can adapt their personal concepts and reach their full potential by learning to coexist with the demanding role of caregiver and achieve a new level of resilience and fulfillment.

Complications and morbidity of the extended delto-pectoral approach in treating complex humeral shaft fractures with proximal metaphyseal extension using a long locking plate for internal fixation

Background Humeral shaft fractures account for up to 3% of all fractures, but complex forms of those fractures (type AO/OTA B or higher) are rare. Plate and screw fixation of the fracture are rated as consolidated from 80 to 97%. Reported complications include non-union, secondary radial nerve palsy and infection. Minimally invasive plate osteosynthesis (MIPO) should provide the same union rate as open reduction and internal fixation (ORIF) but potentially with fewer complications. The aim of our study was to review patients treated for complex humeral fractures with ORIF through an extended delto-pectoral approach using a long pre-contoured locking plate. The morbidity of the open approach, complication rates, union rate and clinical outcomes were assessed.Methods We performed a retrospective analysis of 26 consecutive complex humeral shaft fractures (7 males, mean age 59 years; 19 females, mean age 67 years) treated in our institution with a long pre-contoured locking plate between June/2011 and December/2017. Fracture healing was evaluated with standard radiographs. Eventual complications and the morbidity of the approach were assessed through chart review. The final clinical outcome and quality of life were assessed via telephone interview with DASH score and EQ-5D-3 L in 25 of the 26 patients included.Results There were no complications related to the open approach with uneventful wound healing in all cases without any infections. Mechanical complications occurred in 3 cases (11%): one tuberosity dislocation (revised) and two plate failures (one revised). Postoperative radial nerve palsy was observed in two patients (7%), of which one was transient, the other was persistent. The plate was removed in 4 cases (15%). The average radiological and clinical follow-up was 21 months (range: 12–56). At 12 months follow-up complete fracture healing was confirmed in 22 out of 26 cases and in three more patients after 18 months. After an average of 44 months, the mean DASH score was 35 (SD ± 15.83) points; the EQ-5D-3 L score 0.7 (SD ± 0.31).Conclusion ORIF with a long locking plate though an extended delto-pectoral approach is certainly still a viable option to treat complex humeral shaft fractures with good soft tissue and bone healing as well as good functional recovery. No increased morbidity was attributed to the open surgical approach. In our series, radial nerve palsy could not be completely avoided, accentuating the potential risk of this specific fracture in close proximity to the radial nerve.Trial registrationEthics Committee: Ethikkommission Ostschweiz (EKOS), Project ID: 2019-00323.

Validation of a sports nutrition knowledge questionnaire for Sri Lankan track and field athletes

BackgroundWhile several validated sports nutrition knowledge questionnaires exist, none are specifically designed to assess the sports nutrition knowledge (SNK) of Sri Lankan track and field athletes. This study aims to validate the Sri Lankan Sports Nutrition Knowledge Questionnaire (SLn-SNKQ), tailored for this athlete group, to provide more accurate and meaningful insights for research and practice. This will enable health professionals and coaches to confidently assess athletes’ nutrition knowledge, which directly influences their food choices.MethodsThe validity of the questionnaire was established through a multi-step approach. Content validity was achieved via ratings from nutrition experts, all of whom had specialized training in human nutrition and experience of working with athletes. Face validity was evaluated through in-depth telephone interviews with elite or highly trained athletes, using a retrospective think-out-loud protocol to gather feedback on the clarity and relevance of the questions. Construct validity involved nutrition-trained doctors (NTG), non-nutrition-trained professionals (NNTG), and elite-level athletes’ groups (AG). Internal consistency was assessed using Cronbach’s alpha, and test-retest reliability was evaluated.ResultsThe final tool comprised 123 individual statements or prompts (items) that were organized into 32 broader questions, spanning 12 sub-sections. Content validity was confirmed by fully integrating 49 out of 70 comments and partially integrating four comments received from nutrition experts for each sub-section. Face validity was established by fully integrating 33 out of 40 comments received from 16 elite and highly trained athletes. Construct validity was confirmed, indicating significant differences in the total scores achieved as a percentage of the SLn-SNKQ among the NTG (462.5, 92.5%), NNTG (223.5, 44.7%), and AG (235, 47.0%; p < 0.001). Reproducibility was established by strong test-retest reliability between individuals’ scores on two test attempts, three weeks apart (spearman’s correlation; ρ = 0.99, p < 0.05). Internal reliability for each sub-section met psychometric reliability requirements (Cronbach’s α > 0.7).ConclusionsThe SLn-SNKQ has been validated and demonstrates robust psychometric properties, offering a reliable tool for assessing SNK among Sri Lankan track and field athletes.

Meeting Men Where they are: Motivators and Barriers to Accessing Health Services through a Men's Mobile Wellness Clinic, October 2019 to March 2020, Blantyre, Malawi.

In Malawi approximately, 88.3% people living with HIV are aware of their HIV status. Significant gaps are among men aged 15-34 years; only 72% know their HIV status. To reach men, Jhpiego, in collaboration with the Ministry of Health (MOH), implemented the Men's Mobile Wellness Clinic (MMWC) at workplace settings in Blantyre, Malawi between October 2019 and March 2020. We conducted a descriptive qualitative study to understand motivators and barriers to MMWC service uptake by employees and employers. Primary data was drawn from in-depth telephone interviews from four study populations: employers who accepted or declined to host the MMWC at their worksite, and employees who accessed or did not access the services. We performed a thematic analysis using Nvivo 12 software to identify patterns and themes across the dataset. Main reasons given for using the service among male employees were a desire to know their health status, availability of free health services at the workplace, and good quality services offered by MMWC staff, and support from their supervisor. Men who did not access services stated reasons such as work-clinic scheduling conflicts, lack of adequate promotion of the service, and miscommunication on the criteria about who should attend the MMWC. Employers who accepted to host the MMWC stated convenience and employee's rights to know their health status. Those who declined either stated that employees did not want the services or COVID-19 preventive measures by the MOH between October 2019 and March 2020 restricted participation. This study underscores the potential utility of MMWC services including HIV testing among men. The desire to know their health status, availability of free MMWC services at the workplace, good quality services offered by MMWC staff, and the endorsement of MMWC by supervisors were main motivators to access the MMWC services. Sensitizing supervisors and employees about the benefits of the MMWC services, strengthening demand creation, and clarifying eligibility are important to facilitate MMWC uptake among men in Malawi.

Survey self-report of rheumatoid arthritis and treatments versus specialist clinician confirmation

ObjectiveTo assess agreement between patient survey report and physician recorded arthritic conditions and medication use in order to validate population-based epidemiologic approaches to auto-immune arthritic conditions.MethodsRheumatologists in the U.S. Appalachian region recruited men 50 years or older with a confirmed rheumatoid arthritis (RA) diagnosis. For each participating patient, the treating specialist completed a brief chart abstraction that included rheumatic diagnosis and corresponding treatment. Patients participated in a telephone interview using the same questionnaire as applied in a larger random digit dial survey that queried arthritis diagnosis and treatment. We assessed patient-clinician agreement with the Prevalence Adjusted and Biased Adjusted Kappa (PABAK) statistic.ResultsWe included 36 patient-clinician dyads in this analysis. All clinicians and patients concurred in the RA diagnosis (PABAK = 1). For concomitant systemic lupus and scleroderma, we observed generally concordant responses (PABAK 0.89 and 1, respectively). For medication use, for hydroxychloroquine or sulfasalazine was associated with the lowest PABAK (0.39), intermediate values for methotrexate and for the “other conventional synthetic DMARDs” category (0.67), and with the highest agreement PABAK value for the “biologic DMARD or JAK 2 inhibitor” category (0.89).ConclusionSurvey-based self-report of RA offers a useful approach in epidemiological investigation. This is particularly relevant to population-based approaches to autoimmune arthritis related to occupational and environmental factors.