Healthcare, Volume 12, Issue 22 (November-2 2024) – 120 articles

Background/Objectives: Tobacco use remains a significant public health issue, particularly among individuals with low incomes, including Medicaid recipients who often face multiple barriers to quitting. This study aimed to identify barriers, from the perspective of Medicaid managed care organizations (MCOs), influencing Medicaid recipient participation in tobacco cessation programs. Methods: Focus group interviews were conducted with Florida Medicaid MCOs to elicit processes for case identification, outreach, referral, program participation, and incentives. Answers were synthesized into themes. Results: Medicaid recipients were primarily identified through nicotine dependency claim codes or Health Risk Assessments (HRAs). Individuals were referred to state and local community tobacco cessation programs through text messaging and outreach by MCO case managers. The MCOs identified the following as barriers: primary care physicians (PCPs) with limited knowledge about cessation programs and pharmacologic treatments for nicotine dependence, low availability of health coaches, long wait times for entry into cessation programs, weak coordination between MCOs and cessation programs, and insufficient incentives for individuals for program participation. Suggested strategies to overcome barriers were continuing medical education (CME) for PCPs about tobacco cessation programs and prescription therapies, increasing the training of health coaches, more investment in quitlines, increasing data sharing between MCOs and cessation programs, and increasing incentives for individuals. Conclusions: These findings highlight the importance of engaging MCOs in discussions about policy and program improvements, as their insights can drive meaningful changes in how tobacco cessation and other preventive health programs are structured and implemented. Targeted interventions are needed to enhance tobacco cessation program participation among Medicaid recipients. Full article

Background/Objectives: Self-care has great potential to benefit consumers and health systems, but its mainstream adoption is hindered by a systemic lack of consumer health literacy (HL). Published data on consumer awareness of self-care and HL are limited for regions in Asia, and are needed to develop interventions to enhance HL and self-care for diverse populations in this region. The aim of this research was to describe and analyze patterns of HL and awareness of self-care among consumers in Asia. Methods: We conducted a mixed-methods study comprising qualitative focus group discussions (FGDs; 64 participants) followed by a quantitative online survey (1200 participants) among consumers in four Asian countries (India, Philippines, Malaysia, and Republic of Korea). We examined five dimensions of HL and self-care relevant to consumers: actively managing health; confidence/skills to find and access health information; confidence/skills to appraise information; support from social circle; and support from healthcare providers. From the quantitative survey, responses for 16 questions covering the five dimensions were used to calculate the Consumer Health Literacy Quotient (CHLQ; normalized range 0–100), an index we developed to assess HL in the context of personal wellness and self-treatable conditions. Latent class analysis (LCA) was applied to identify distinctive patterns of consumer HL within the sample. Results: The mean CHLQ was 75 out of 100 (SD ± 12.9), indicating ‘moderate’ levels of consumer HL across the countries. LCA identified five distinct consumer HL profiles, differing in their average CHLQ (overall score) and along the CHLQ dimensions. Consistent with CHLQ results, the profiles differed in their response patterns for common self-manageable ailments. Conclusions: This study identified distinct patterns of HL and awareness of self-care among consumers in four Asian countries through combined use of the CHLQ and quantitative profiling. This offers a promising approach for understanding self-care-related HL among consumers in Asia. Our findings on patterns of strengths and weakness in specific dimensions of HL and self-care in diverse populations can inform research, communications, and targeted interventions to empower consumers and foster self-care. Full article

Background/Objectives: Many women at risk for and surviving with breast/ovarian cancer are simultaneously raising children. These women often experience unique challenges due to concurrent demands as both parents and patients with cancer. Community-based cancer control organizations offer vital patient navigation (PN), including psychoeducational services. Yet, little is known about how PN addresses these mothers’ comprehensive care needs. Methods: We examined PN program data from N = 1758 women served by a national cancer organization. Results: Out of the 69% of navigated women who were mothers, most were raising adult children only (age ≥ 18; 56%); however, 31% were mothers with young children only (age < 18), and 13% were mothers with both adult and young children (χ² = 341.46, p < 0.001). While mothers with adult children reported poorer quality of life (QoL) than mothers with young children (physically unhealthy days, t = −2.2, df = 526, p < 0.05; total unhealthy days, t = −1.2, df = 533, p < 0.05), there were no significant differences in their PN experiences. For mothers with young children, a better QoL was associated with a lower genetic risk for cancer (r = −0.12) and a stronger sense of psychosocial empowerment (r = 0.10) (all p’s < 0.05). In an adjusted multivariate regression model of QoL, as empowerment increased, the influence of PN quality decreased (ß = −0.007, SE of ß = 0.00, p = 0.02), suggesting that strengthening mothers of young children’s sense of agency over their breast/ovarian cancer is critical to achieving overall well-being. Conclusions: CBO-led cancer control programming that supportively cares for mothers across their cancer journey can be essential to their QoL, especially for those who are raising minors. Full article

Background/Objectives: This study evaluates the perceptions of pharmacists in Romania regarding self-medication, a growing practice with significant implications for public health and sustainable development. The main objective is to analyze the role of pharmacists in managing self-medication and educating the public on rational medication use. Methods: A descriptive and exploratory methodology was employed, using a questionnaire administered to 300 pharmacists from various regions in Romania between March and April 2024. The data analysis included Chi-square tests and linear regression to identify predictive factors. Results: The findings reveal a direct correlation between the frequency of self-medication and the perceived severity of conditions, with self-medication being more common for minor ailments. Experienced pharmacists are less likely to encourage self-medication. Public education on the risks of self-medication significantly reduces the prevalence of this practice. Conclusions: Self-medication, without proper regulation and education, risks becoming unsustainable. Targeted informational campaigns and educational programs tailored to diverse demographic groups are essential. Pharmacists play a critical role in promoting safe and responsible medication use. Full article

Background: The effectiveness of pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) in preventing HIV is well-established, yet their use in clinical practice remains low. Healthcare providers, especially those in primary and emergency care settings, play a crucial role in adopting and implementing these prevention strategies. We conducted a statewide survey with 519 healthcare providers in Texas to assess their knowledge, practices, and barriers related to prescribing PrEP and nPEP. Methods: The survey collected data on demographics, clinical experience, practice type, awareness of recommended guidelines, knowledge of PrEP and nPEP, prescribing practices, and challenges encountered to prescribe these medications. We used multiple regression analysis to identify factors associated with PrEP and nPEP prescribing behavior. Results: While most providers were familiar with CDC and/or USPSTF-recommended PrEP guidelines, fewer had adequate knowledge of nPEP. Key challenges identified by providers included concerns about cost (48%), limited time (40% for PrEP and 51% for nPEP), and insufficient education or training (40% for PrEP and 35% for nPEP). Providers who were more familiar with the recommended guidelines and had greater experience in sexual health assessment were more likely to prescribe both PrEP and nPEP. Conclusions: This study highlights the need for enhanced education and training to boost providers’ knowledge and confidence in prescribing PrEP and nPEP. It also underscores the importance of addressing cost-related barriers and simplifying care processes to better integrate these HIV prevention strategies into primary and emergency care settings. Full article

The placebo effect can induce physiological or clinical neurological and organic responses despite the recipient receiving no active ingredients; these responses are based instead on the recipient’s perceptions. Placebo effects come from the rostral anterior cingulate cortex, pontine nucleus, and cerebellum of the brain; this information provides a better understanding of placebo effects and can also help us understand the mechanism of the modulation of neurotransmitters from the use of psychedelic substances, activity of selective serotonin reuptake inhibitors, the process of transcranial magnetic stimulation, and deep brain stimulation, as well as aid in developing novel therapies, challenging the validity of controlled clinical trials (RCTs) that the regulatory agencies now appreciate. Education about how placebo effects bring in social, political, and religious beliefs and whether these can be modulated may help reduce global confrontations. Full article

Background/Objectives: Spinal cord injury (SCI) is a disabling condition prevalent worldwide, requiring rehabilitation services from injury through community living. This study, conducted by representatives of the World Rehabilitation Alliance (WRA), aims to identify strategies for strengthening SCI rehabilitation services globally, with particular attention to settings where resources are limited. Methods: Three focus groups were held between 2023 and 2024 with WRA representatives specializing in SCI rehabilitation. Discussions focused on four key areas: workforce and education, health policy and systems research, primary care, and emergency response. Perspectives were developed taking into account frameworks from the World Health Organization (WHO). Results: Key insights into SCI rehabilitation services emphasize workforce and education as critical areas, underscoring the importance of specialized training, certification, and ongoing support to build capacity. In health systems and policy research, significant gaps in evidence-based practices were highlighted, emphasizing the need for comprehensive data collection and national registries to guide policy and align SCI care with global standards. The integration into primary care systems is recommended to improve access and address common complications in low- and middle-income countries (LMICs). For emergency response, this study stresses the importance of preparedness and establishing multi-disciplinary teams capable of managing SCI cases in resource-limited settings, reducing preventable complications, and improving patient outcomes. Conclusions: SCI rehabilitation services are essential to global health, with a need for workforce development, research, national registries, and integration into primary and emergency care. Such efforts should improve accessibility and align with global best practices, ensuring comprehensive and accessible rehabilitation for all. Full article

Aim: Electronic prescribing has allowed for the collection of prescription data in real time in Greece for the first time. Hence, the aim of the current study was to present the characteristics of prescriptions for the Greek population during the period from 2015 to 2021. Methods: This retrospective study was based on data extracted from the nationwide Greek electronic prescription database between January 2015 and December 2021. Descriptive statistics methods were used for the needs of the study. As the basic figures examined depend on the size of the population, in order for the results to be comparable, we estimated the corresponding measures per inhabitant, using population data from the Greek Statistical Authority. Appropriate indicators for the comparison of consumption and expenditure over time were estimated. A study of the trend was also carried out using time series and linear regression models. In order to facilitate the design and implementation of specialized policies, it is useful to identify the drug categories with the highest consumption and expenditure, as well as the geographical areas that present similar characteristics. For the first, ABC analysis was used, which helps to identify the most popular categories of drugs, while for the second, cluster analysis was carried out. Agglomerative clustering was used to divide the regions into similar groups. This hierarchical clustering algorithm classifies the population into several clusters, with areas in the same cluster being more similar, and areas in different clusters being dissimilar. The Ward linkage method with Euclidean distance was used. Results: The analysis of prescription drug consumption and expenditure from 2015 to 2021 revealed significant fluctuations and trends across various drug categories, age groups, and geographical areas. Notably, the quantity of prescriptions increased by 20% since 2015, while expenditure surged by over 30%, with significant spikes following the end of the MoU in 2019 and the onset of the pandemic in 2020. In terms of expenditure, antineoplastic and immunomodulation agents (category L) held the largest share, driven by the introduction of new, costly drugs. The expenditure per inhabitant revealed gender and age disparities, with older populations, particularly women, incurring higher costs. Geographically, drug expenditure, and consumption varied significantly, with distinct regional clusters identified. These clusters, while showing some overlap in consumption and expenditure patterns, also highlighted unique regional characteristics. Conclusions: The insights into prescription drug consumption and expenditure trends offer a valuable basis for developing targeted interventions aimed at optimizing healthcare resource allocation. Moreover, the findings underscore the importance of addressing regional and demographic disparities in pharmaceutical use, thereby contributing to more equitable and cost-effective healthcare strategies. More specifically, the age distribution of prescriptions shows the increase in younger ages, which, as a result, anticipates the overall increase in prescriptions. The knowledge of the most convex categories of medicine, as well as the percentages of the use of generic drugs, shows where interventions should be made, with financial incentives and information through new information channels. The geographic disparities recorded should lead to policies that help the residents of hard-to-reach areas to access prescriptions. In addition, the present study provides a strategic framework for policymakers and healthcare managers to guide future studies and inform decision-making processes. Full article

Aim: To determine the clinical association between periodontal disease and diabetes mellitus through an umbrella review. Materials and Methods: A search for publications up to August 2023 was conducted using the following electronic databases: PubMed, Cochrane Database, Scopus, SciELO, Google Scholar, and OpenGrey. We included systematic reviews (SRs) with or without meta-analysis evaluating primary studies that investigated the association between periodontal disease and diabetes mellitus, and there were no time or language restrictions. Literature or narrative reviews, rapid reviews, intervention studies, observational studies, preclinical and basic research, abstracts, comments, case reports, protocols, personal opinions, letters, and posters were excluded. The AMSTAR-2 tool was used to determine the methodological quality of the included studies. Results: The preliminary search yielded a total of 577 articles, of which only 17 remained after discarding those that did not meet the selection criteria. Following their analysis, an association between periodontal disease and diabetes mellitus (type 1 and type 2 diabetes mellitus and gestational diabetes mellitus) was found. Conclusions: The findings and conclusions of this umbrella review indicate with high confidence that periodontal disease is associated with the onset of type 1 and type 2 diabetes mellitus and gestational diabetes. Full article

Background/Objectives: This systematic and bibliographic review examines publications in the field of dementia and video game research from 2004 to 2023. The main objective is to assess developments and trends in video game technology for dementia care and detection. Methods: The PubMed database was the primary source for publications. PRISMA guidelines were applied to structure this review. Ten variables were defined, investigated, and split into three main categories: bibliographic, medical, and technical. Results: The results were synthesized using a quantitative approach to reduce bias through interpretation. Of 209 initial results, 77 publications have been included in the investigation. More studies focus on rehabilitation over assessment and detection of dementia. Clinical trials are typically conducted with limited participants. The most populated trials rarely enrol over 300 subjects. On average, around 38 subjects were enrolled in the trials. These studies are commonly supervised by a trainer or technology specialist, suggesting a technology gap in familiarity in the trial demographic. Conclusions: Most interventions assessed were custom-designed applications with a specific outcome, focusing on physical activity and cognitive exercises. As the first of its kind, this publication focuses on the technical aspects of applied technologies and development methods. Using video games to treat and detect patients with cognitive impairments like dementia can benefit healthcare professionals, caretakers, and patients. Full article

Background: During the COVID-19 pandemic, paracetamol was widely recommended in different clinical settings, and sometimes advised over non-steroidal anti-inflammatory drugs (NSAIDs). These recommendations sparked a strong debate, with reports suggesting either potential benefits or harms for the individuals infected with SARS-CoV-2. As no systematic review is available, we performed a meta-analysis to estimate the impact of paracetamol on COVID-19 clinical outcomes compared to a placebo, no use, or NSAIDs. Methods: We searched PubMed, Scopus, Web of Science, and ClinicalTrials.gov for randomized trials or observational studies evaluating any COVID-19 clinical outcome. Data were combined using a generic inverse-variance approach. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to determine the certainty of evidence for each outcome. Results: One randomized trial and five observational studies, enrolling over 34,000 patients, were included. Overall, as compared to the patients using NSAIDs or receiving no treatment, the individuals who received paracetamol showed no significant differences in the risk of death (summary relative risks 0.93 and 0.91, respectively: both p > 0.05), need to transfer to the intensive care unit, need for respiratory support, or cardiovascular or renal complications. All studies showed a high risk of bias, with a low overall quality of evidence. Conclusions: This meta-analysis found no evidence of harmful or beneficial effects of paracetamol on main COVID-19-related outcomes. Also, the current literature does not provide sufficient data to support a preferential choice between paracetamol and NSAIDs for COVID-19 symptoms management. Further research is needed to confirm the present findings and provide critical insights on the policies to adopt in the case of future pandemics. Full article

Background: Pandemic outbreaks have emerged as a significant global threat, with the potential to cause waves of infections that challenge public health systems and disrupt societal norms. Understanding the underlying behavior of disease transmission can be of great use in the design of informed and timely public health policies. It is very common for many contagious diseases not to have actual incidence but rather incidence in a given subgroup. For example, in Spain, as of 28 March 2022, the incidence of COVID-19 in people under 60 years of age is not registered. Methods: This work provides a Bayesian methodology to model the incidence of any infectious disease in the general population when its cases are only registered in a specific subgroup of that population. The case study used was the coronavirus disease (COVID-19), with data for 52 Spanish provinces during the period of 1 January 2020 to 29 August 2022. Results: Explicitly, two multilevel models were proposed, one for people over or of 60 years of age and the other for people under 60 years of age. Performance of the models was 5.9% and 12.7% MAPE, respectively. Conclusions: Despite the limitations of the data and the complexity and uncertainty in the propagation of COVID-19, the models were able to fit the data well and predict incidence with very low MAPE. Full article

Introduction: The COVID-19 pandemic precipitated substantial disruptions in healthcare utilization globally. In Japan, reduced healthcare utilization during the pandemic’s early phases had been documented previously. However, few studies have investigated the impact of the pandemic’s later stages (2022–2023) on healthcare utilization rates, particularly in the Japanese context. Methods: We employed a quasi-Poisson regression model, adapted from the FluMOMO framework, to analyze temporal trends in Japanese healthcare utilization throughout the pandemic until November 2023. We estimated inpatient and outpatient volumes and hospital length of stay by bed type (general and psychiatric). Results: In general hospital beds, inpatient volumes remained significantly below pre-pandemic levels for every month until November 2023, with a reduction of 7.8 percent in 2023 compared to pre-pandemic levels. Psychiatric inpatient volumes, which had been declining before the pandemic, continued this downward trend, with the average occupancy rate decreasing by approximately 5.3% to 81.3% in 2023 compared to pre-pandemic levels. Significantly reduced outpatient volumes for both general and psychiatric care, in addition to prolonged lengths of hospital stay for psychiatric beds, were observed sporadically for several months in 2022 and 2023, persisting beyond the cessation of state of emergency and quasi-state of emergency declarations. Conclusion: The COVID-19 pandemic fundamentally altered healthcare utilization patterns in Japan. We observed a sustained reduction in general and psychiatric inpatient volumes relative to pre-pandemic baselines nationwide. The prolonged impact on healthcare utilization patterns, persisting beyond emergency measures, warrants continued monitoring of service delivery. Full article

Background/Objectives: Individuals with eating disorders frequently describe encountering a highly critical internal voice that fixates on their eating habits, body shape, and weight. While existing literature acknowledges the significant impact of this eating disorder voice on affected individuals and its influence on treatment trajectories, research in this area remains limited. This study aimed to comprehensively examine and synthesize qualitative data concerning the experience of the eating disorder voice, with the goal of deepening our understanding of its fundamental characteristics and informing more effective approaches to assessment, treatment, and support in clinical settings. Methods: A systematic search was conducted across six databases for studies presenting qualitative findings relevant to the eating disorder voice. Fifteen studies were included, and their findings were reviewed and synthesized. Results: Results revealed that the eating disorder voice is often perceived by individuals as both protective and comforting, yet also controlling and intrusive, often seen as a force more powerful than themselves. Participants described a constant struggle to manage this internal criticism by differentiating themselves from the voice, with the fear of separation from the voice posing a significant challenge. Conclusions: This study underscores the complex nature of the EDV and its profound impact on individuals with eating disorders. Full article

Background/Objectives: The potential and limitations of chatbots in medical education and clinical decision support, particularly in specialized fields like psychiatry, remain unknown. By using the Rasch model, our study aimed to evaluate the performance of various state-of-the-art chatbots on psychiatry licensing exam questions to explore their strengths and weaknesses. Methods: We assessed the performance of 22 leading chatbots, selected based on LMArena benchmark rankings, using 100 multiple-choice questions from the 2024 Taiwan psychiatry licensing examination, a nationally standardized test required for psychiatric licensure in Taiwan. Chatbot responses were scored for correctness, and we used the Rasch model to evaluate chatbot ability. Results: Chatbots released after February 2024 passed the exam, with ChatGPT-o1-preview achieving the highest score of 85. ChatGPT-o1-preview showed a statistically significant superiority in ability (p < 0.001), with a 1.92 logits improvement compared to the passing threshold. It demonstrated strengths in complex psychiatric problems and ethical understanding, yet it presented limitations in up-to-date legal updates and specialized psychiatry knowledge, such as recent amendments to the Mental Health Act, psychopharmacology, and advanced neuroimaging. Conclusions: Chatbot technology could be a valuable tool for medical education and clinical decision support in psychiatry, and as technology continues to advance, these models are likely to play an increasingly integral role in psychiatric practice. Full article

Background: Adolescence is a critical period for developing self-perception, emotional well-being, and health behaviors. Mental health disorders represent a substantial burden for adolescents worldwide. This study examines self-perceived health, mood, and substance use among adolescents, identifying associated risk factors. Method: A cross-sectional study was conducted with 121 adolescents aged from 14 to 18 from a secondary school in Baix Llobregat, Catalonia. Data were collected through questionnaires, and descriptive and comparative analyses were performed. Results: Poor self-perceived health and negative mood were associated with higher alcohol and tobacco use. Girls exhibited better emotional regulation than boys. Conclusions: Poor health perception and negative mood are linked to increased substance use. Early intervention should focus on emotional well-being and prevention, involving both families and schools. Full article

Background: Europe’s aging population presents challenges such as a shrinking labor force, pressure on health services, and increased demand for long-term care. This study assesses the functional profile, depressive symptoms, and quality of life of older adults in the Central Alentejo region of Portugal. Methods: A cross-sectional, descriptive study was conducted with a convenience sample of 868 older adults in Portuguese long-term care facilities across the Évora district. A structured questionnaire collected sociodemographic data, elderly nursing core set patient information, a health questionnaire with nine responses, and WHO Quality of Life Assessment (short version) scores. Results: Nearly half of the participants needed assistance with care. Women (OR = 1.46) and those with cognitive impairment (OR = 10.83) had higher impaired functionality, while education (OR = 0.52) and being overweight (OR = 0.52) were inversely related to functional dependence. Quality of life scores ranged from 56.4 (physical) to 66.6 (environmental). Moderate depressive symptoms were found in 17.1% of participants, with 9% having moderately severe to severe symptoms. Higher dependence doubled the likelihood of depressive symptoms (OR = 2.18). Discussion and Conclusions: High rates of depression and functional dependence correlate with a low perception of quality of life, highlighting the need for research to promote and protect the health of older adults. Full article

Background: Occupational stress and workplace violence are highly prevalent risk factors among healthcare professionals and can affect not only the psychosocial well-being of workers but also that of patients and healthcare organizations. Objective: The objective of this study is to translate and cross-culturally adapt the ENvironmental PRotectors against hOspital work Stress scale to facilitate future psychometric validation of the instrument. Methods: A methodological study was conducted at the School of Medicine of São Paulo State University (UNESP) in São Paulo, Brazil. This study involved three steps: translation and backtranslation by independent native language speakers, analysis by an expert panel, and a pre-test phase. Ten specialists adjusted and approved the final version for semantic, idiomatic, and cultural accuracy across nine items. Results: The content validity index was satisfactory (CVI ≥ 0.80). The final version was administered to 36 nursing and medical staff at a public hospital in São Paulo. No items were excluded from the instrument. Satisfactory content and face validity were achieved, and the criteria recommended by the literature were met. Conclusions: The Portuguese version of ENPROS is appropriate and culturally adapted for use in Brazil. Full article

Background: Self-esteem is a psychological term that, since its emergence in 1890 with William James, has been widely studied. Furthermore, this construct has been examined in different areas of psychology, including the clinical field, where its relationship with mental health and low levels of depression has been demonstrated. In the realm of positive psychology, its connection to resilience and life satisfaction has also been established. Evaluating self-esteem in military personnel is essential, as healthy self-esteem can enhance resilience, improve performance, and promote emotional well-being. Objective: To evaluate validity based on internal structure from the perspective of Classical Test Theory (CTT) and Item Response Theory (IRT), to obtain evidence of validity based on the relationship with other variables, and to estimate the reliability of the Rosenberg Self-Esteem Scale (RSES). Method: To this end, 584 military personnel from the three ranks of the Spanish Army (officers, non-commissioned officers, and professional soldiers and sailors) were evaluated, of which 511 were men (87.70%) and 72 were women (12.30%), with an age range of 18 to 66 years (M = 33.17, SD = 7.38). Results: The results indicate that the unidimensional structure of the RSES shows adequate fit indices (CFI = 0.94, TLI = 0.91, SRMR = 0.05), while the difficulty and discrimination parameters exhibited favorable values. Additionally, an acceptable reliability value was found (ɷ = 0.81; α = 0.80). Conclusions: Therefore, it is concluded that the RSES-JGA presents adequate psychometric properties of validity and reliability, making it a useful and relevant instrument for measuring self-esteem in military personnel of the Spanish Army. This will make it possible to measure the level of self-esteem in military personnel, i.e., the set of perceptions, thoughts, evaluations, feelings, and behavioral tendencies directed towards oneself, one’s own way of being, and towards one’s own body and character traits. Full article

Background/Objectives: Although increased nociceptive excitability and deficient endogenous pain modulation are considered key features of pronociception and central sensitization, their contribution to neuropathic pain (NP) characteristics in SCI is unclear. The aim of this study was to characterize tonic cold perception and endogenous pain modulation in individuals with and without SCI-NP, considering the stage and severity of SCI and, secondarily, NP phenotype. Methods: Temporal summation of pain (TSP) and neuropathic features were assessed using the numerical rating scale (NRS) and Douleur Neuropathique 4 screening questionnaire (DN4) during the tonic cold pressor test (CPT, 12 °C 60 s) applied to the dominant hand and foot. CPT-induced pronociception was assessed as change in algometer pressure pain thresholds (PPTs) measured at the V2, C6, and L4 dermatomes. Results: A total of 72 individuals were recruited (age-sex-matched noninjured, n = 24; SCI-NP, n = 24; SCI-noNP, n = 24 [AIS A: n = 12, AIS B-D: n = 12; subacute SCI: n = 12, chronic SCI: n = 12]). TSP in response to the foot CPT was higher in subacute compared to chronic incomplete SCI-NP, while TSP to the hand CPT was significantly higher in chronic compared to the subacute complete SCI-NP group. Evoked pain intensity during the hand CPT correlated with duration of below-level SCI-NP. The hand CPT induced widespread pronociception (lower PPT), which correlated with 7-day non-evoked (spontaneous) pain intensity in individuals with incomplete SCI-NP. Individuals with below-level NP, but not at-level NP, showed higher TSP during the foot CPT and greater hand CPT-induced L4 dermatome pronociception. Conclusions: Collectively, measurements of above and below-level temporal summation of pain and translesional-induced pronociception in the SCI-NP group highlight the role of these mechanisms in widespread central sensitization, spontaneous pain intensity, and spinothalamic tract hyperexcitability, especially in individuals diagnosed with below-level NP. Full article

Background/Objectives: Mental health disorders pose a substantial challenge for healthcare workers, particularly in the post-COVID-19 era. Public health medical residents (PHRs) played a pivotal role during the pandemic and were significantly affected by the heavy workload. This study aims to uncover potential associations between workload characteristics and symptoms of anxiety and insomnia in Italian PHRs based on data collected in 2022 through the Public Health Residents’ Anonymous Survey in Italy (PHRASI) study. Methods: A total of 379 residents completed the self-administered questionnaire comprising the Generalized Anxiety Disorder-2 (GAD-2), and the Insomnia Severity Index (ISI). Results: While 36% PHRs reported anxiety symptoms (GAD-2 ≥ 3), 12% reported moderate-to-severe insomnia symptoms (ISI ≥ 15). The multivariate logistic regressions showed that a high work–life interference was associated with the presence of anxiety and insomnia symptoms, while attending two or more simultaneous traineeships was associated with insomnia symptoms. A high workload perceived was positively associated with both the mental health outcomes considered, while the perception of work environment manageability was negatively associated with them. Conclusions: These findings underscore the significant role of the workload in influencing the mental health status of PHRs and emphasize the importance of fostering a supportive work environment that prioritizes mental well-being Full article

Introduction: Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection. Viral surveillance for early detection of COVID-19 is a critical strategy to understand this population’s infection dynamics and prevent transmission. The study examines SARS-CoV-2 infection and reinfection among HCWs vaccinated against COVID-19 working at a primary healthcare unit serving a disenfranchised community in Brazil. Methods: The study was conducted in Cidade Estrutural, Federal District, Brazil, between February and October 2021. Participants were interviewed and provided samples. A prospective open cohort study was used to analyze the frequency of SARS-CoV-2 infection and reinfection, and the vaccine-induced seroconversion. Nasopharyngeal swab specimen was collected from workers presenting with flu-like symptoms and subjected to RT-qPCR. Peripheral blood samples were also collected every 30 ± 2 days for eight months, starting from the day participants received their first dose of COVID-19 vaccine, and submitted to serological testing (IgM and IgG chemiluminescence). The frequencies of infection and reinfection (RT-qPCR positive results 90 days after the infection) were calculated along with their respective confidence intervals (95% CI). Results: Of the 128 workers, 61 (47.65%; CI: 39.19–56.25) reported probable SARS-CoV-2 infection before vaccination and 50 (39.06%; CI: 31.04–47.71) had SARS-CoV-2 infection after vaccination, confirmed by molecular test. Reinfection was identified in seven workers (7/50, 14%; CI: 6.95–26.18) based on the 90-day interval between results. The serological data from the 128 workers during the cohort indicated that 68 (53.12%; CI: 44.5–61.5) had IgG antibodies and 46 had IgM antibodies (35.93%; CI: 28.14–44.54) against SARS-CoV-2. SARS-CoV-2 infection was common in 56% of the community health workers (CHWs), 50% of registered nurses, and licensed vocational nurses (33%). Following the COVID-19 vaccination, the percentage of infections among HCWs decreased from 47.83% to 4.35%. Conclusion: These results demonstrate that (i) approximately 40% of the workers were infected with SARS-CoV-2 in 2021 and (ii) reinfections confirmed by RT-qPCR occurred in 14% of the HCWs after vaccination. The results provide valuable insights into the circulation of SARS-CoV-2 among HCWs in a primary care unit serving a minoritized community. Full article

The aim of this study was to assess the effects of an 8-week cognitive-motor training program on postural control and knee proprioception under single and dual task conditions. Design: Randomized clinical trial. Methods: The present study was registered with the ID number NCT04786132. A total of 20 healthy and physically active older adults (73.25 ± 5.98 years) volunteered to participate and were randomly assigned into an experimental and a control group (EG and CG). Postural control was measured with the Romberg test, with open (RBOE) and closed eyes (RBCE) and under unipodal dominant side (RUDL) conditions. Proprioception was assessed by measuring participants’ ability to reposition their dominant knee at 45°. Finally, performance of the cognitive task was measured through a subscale of the Barcelona Test called “categorical evocation in associations”. The EG and the CG completed 8-week training programs with two sessions, 30 min per week, of postural control and proprioception exercises. The EG additionally included music in each session. Results: The analysis using a mixed ANOVA model revealed no significant group × time interaction effects (p < 0.05) for any of the assessments. However, a significant main effect for the time factor was observed, with both the control and experimental groups showing improved outcomes in the post-intervention measurements. Specifically, significant results were found for RBOE (F (4,15) = 11.87, p < 0.001, η²p = 0.76), RBCE (F (4,15) = 11.62, p < 0.001, η²p = 0.75), and proprioception (F (1,18) = 11.53, p < 0.003, η²p = 0.39). Conclusions: The 8-week training program had a positive impact on the post-intervention results for motor control and proprioception, but not on the results of the cognitive task. There were no significant differences between the groups that carried out sessions with or without music. Full article

Background/Objectives: Urinary incontinence (UI) significantly affects women’s health worldwide, but its specific prevalence in Ecuador is not well documented. This research aimed to determine the prevalence of urinary incontinence among sexually active women in the Cuenca canton and the factors associated with its presence. Methods: A descriptive cross-sectional study was conducted from August 2023 to January 2024 involving 460 women aged 30 years or older attending public health centers in Cuenca, Ecuador. The ICIQ-SF questionnaire was used to assess the presence and severity of UI and its impact on quality of life, along with a data collection form. Results: The findings revealed that UI is prevalent in a population that often lacks timely diagnosis, further obscuring the true extent of the issue. The results demonstrated that sociodemographic, gyneco-obstetric, and urological factors significantly influenced the risk of developing this condition. Conclusions: This study demonstrated a high prevalence of UI among women in Cuenca, Ecuador, with a notable impact on quality of life. The aforementioned factors predispose to the development of this condition, highlighting the need for preventive and rehabilitative interventions, as well as appropriate policies to address UI as a public health issue. Full article

Background: The WHO classified the mpox outbreak as a worldwide health emergency. Increasing the contribution of healthcare providers, such as pharmacists, can enhance preventive efforts. Assessing the knowledge and confidence levels of pharmacists in diagnosing and managing mpox cases can shape the response strategies necessary for the management of such outbreaks. Methods: This research employed a cross-sectional survey designed to assess the knowledge and preparedness of pharmacy students and pharmacists in the United Arab Emirates (UAE) regarding the mpox virus outbreak. Independent researchers evaluated the survey items to confirm the face and content validity of the developed survey. The final study’s survey was structured into three distinct sections, each addressing a specific area of interest. Data were analyzed using the IBM SPSS Statistics. Results: The 388 participants had a median age of 22.00 years (IQR = 5.00). The survey revealed that participants primarily relied on the WHO reports for mpox information (79.8%). The total knowledge scores (TK score) varied, ranging from −6 to 23 (median = 6.00), and symptom knowledge scores (SK score) ranged from −3 to 9 (median = 2.00). Older participants (p-value = 0.008) and females (p-value = 0.014) exhibited significantly higher TK scores. Only about 31.0% of participants expressed confidence in diagnosing mpox cases, and 34.6% expressed confidence in managing mpox cases. Nearly a quarter of the participants (24.5%) thought that getting vaccinated against COVID-19 led to contracting mpox more likely, whereas 45.7% believed that a previous infection with COVID-19 increases the risk of having mpox and its associated symptoms. Many respondents (38.7%) expressed their concern that mpox could emerge as the next major epidemic following COVID-19. Conclusion: Although pharmacists and pharmacy students in the UAE are aware of mpox, their knowledge and confidence levels in diagnosing and managing vary significantly. These findings suggest the need for targeted educational programs to enhance the understanding and preparedness of pharmacists to manage and prevent mpox cases. Full article

Background and Objectives: The COVID-19 pandemic posed significant challenges to healthcare systems worldwide, and mortality rates were driven by a complex interaction of patient-specific factors, one of the most important being those related to the scheduling of invasive mechanical ventilation. This study examined the sociodemographic, clinical, and ventilatory factors associated with mortality in COVID-19 patients admitted to the ICU of a hospital in Colombia. Methods: A retrospective cohort study was conducted, involving 116 patients over the age of 18 who were admitted to the ICU with a confirmed diagnosis of COVID-19 between March 2020 and May 2021. Data were collected from the patients’ medical records. Statistical analysis was performed using SPSS version 24^®. Odds ratios (OR) and 95% confidence intervals were calculated to identify factors associated with COVID-19 mortality, followed by adjustment through binary logistic regression. Results: It was found that 65.5% of the patients were male, with a mean age of 64 ± 14 years, and the overall mortality rate was 49%. Factors significantly associated with higher mortality included male sex (OR: 6.9, 95% CI: 1.5–31.7), low oxygen saturation on admission (OR: 7.6, 95% CI: 1.1–55), and PEEP settings at 96 h (OR: 8, 95% CI: 1.4–45). Mortality was not influenced by socioeconomic status or health system affiliation. Conclusions: This study identified male sex, age over 65 years, PEEP greater than 10 cmH₂O at 96 h of mechanical ventilation, and low oxygen saturation as significant factors associated with higher mortality in COVID-19 patients, while no significant associations were found with socioeconomic status or health system affiliation. These findings highlight the importance of focusing on clinical management and ventilatory strategies in reducing mortality, particularly for high-risk groups, rather than relying on socioeconomic factors as predictors of outcomes. Full article

Background: This study aimed to examine the relationship between the work environment, job stress, and health locus of control and presenteeism among clinical nurses in South Korea. Methods: A cross-sectional, descriptive correlational study was conducted on clinical nurses (n = 276) from general hospitals in two small cities. Data were collected via a self-administered structured questionnaire from 1 to 14 December 2022. Descriptive and stepwise multiple regression analyses were conducted for this study. Results: The work environment (ß = −0.28, p < 0.001) and education (ß = −0.13, p = 0.031) were significant predictors of health problems, explaining 10% of the variance. Job stress (ß = 0.34, p < 0.001), external locus of control (ß = 0.25, p < 0.001), physician control locus (ß = −0.15, p = 0.006), work department (ß = −0.13, p = 0.018), and marital status (ß = −0.13, p = 0.022) significantly predicted job impairment, accounting for 25% of the variance. For perceived productivity, job stress (ß = −0.18, p = 0.003), marital status (ß = 0.18, p = 0.002), and external locus of control (ß = −0.16, p = 0.007) were influential, explaining 8% of the variance. Conclusions: To mitigate presenteeism among clinical nurses, interventions should focus on improving the work environment at the organizational level and addressing job stress and health locus of control at the individual level. By implementing targeted strategies, healthcare institutions can reduce job impairment and enhance productivity among nursing staff. Full article

Background/Objectives: Nutrigenetics investigates the role of genetic variants that contribute to the inter-individual variation in response to food intake. Risk factors for cardiovascular disease (CVD) are influenced by the complex interplay of genetic and environmental factors, including the diet. The aim of this scoping review is to analyze the literature on the effect of genotypes on the response to dietary interventions for the treatment of CVD risk factors. Methods: A literature search was conducted in MEDLINE to identify published articles fulfilling the inclusion criteria. Studies published in English between 2014 and 2024 were selected. Data were extracted according to the population, intervention, comparison, and outcome (PICO) format. Results: Forty-eight studies met the inclusion criteria. The studies differed in design, intervention characteristics, tested genotypes, and ancestry. The most frequently analyzed variants were single-nucleotide polymorphisms (SNPs) in genes associated with lipid metabolism, inflammation, and energy balance, among others. The interventions tested the effects of different dietary patterns, diets modified in macronutrient content and types of fat, natural and processed foods, nutraceuticals, and nutrient supplements. Common APOE variants were the most analyzed genotypes showing significant interactions with different dietary interventions affecting blood lipids. Other genotypes found in pathways involving folic acid, lipid metabolism and transport have shown interactions with diverse dietary components across studies. Conclusions: Gene–diet interactions are observed in multiple dietary interventions. Replication of findings of nutrigenetic studies is required across different populations. The response to dietary treatments modifies CVD-related risk factors and shows variation associated with genotypes. Full article

Background/Objectives: Sexuality is part of everyone’s life, especially during adolescence, when young people are discovering themselves and experiencing several changes. Adolescents need to be informed about their sexuality, so they seek and receive information about it from a variety of sources and on different topics. This systematic review aimed to synthesize studies that explored the sources adolescents use and topics they search for. Methods: Quantitative, qualitative, and mixed articles published in Portuguese, Spanish, or English and with respondents aged between 12 and 20 years were included in this study. To fulfill the proposed objectives, three online databases (EBSCOhost, PubMed, and Web of Science) were used, including a total of 48 studies. Results: The most common sources of information are family, friends, school, and the Internet, depending mainly on the reliability of the source and the anonymity when using it. The main topics adolescents search for are sexual intercourse, contraception, relationships, and LGBT issues, since these are less addressed topics. Conclusions: These results are useful in a practical way as a basis for the development of sex education programs that correspond to the needs of adolescents, since they allow us to know which information they are looking for and the sources from which they can receive it. Full article

Background/Objectives: Plant-based diets (PBDs) are dietary patterns characterized by a certain degree of animal-derived food exclusion. PBDs can be divided into different dietary patterns, from vegetarian to vegan, depending on the degree and the extent of animal-derived food avoidance. PBDs are becoming epidemically popular among the general population, including adult subjects as well as children and adolescents, who often follow the dietary pattern chosen by their families. Methods: Our narrative review aims to analyze the most frequently adopted plant-based dietary patterns in children and adolescents and to evaluate their feasibility, advantages, and risks in terms of health promotion and disease prevention in the developmental age. The MEDLINE–PubMed database was searched to collect and select publications from 1980 to 2024. Results: Subjects following these dietary patterns, especially vegan diets, must be under strict nutritional control and receive adequate micronutrients and vitamin supplementation. Conclusions: Nutrition-skilled professionals should be adequately updated and informed about the feasibility and the risks of these different patterns’ adoption at different ages, as they should guide and accompany children and adolescents and their families in their nutritional choices without prejudices, granting adequate macronutrient and micronutrient intake, adequate growth and neurodevelopment. Full article