Search Results (64,092)

Background: This study aimed to investigate and analyze the remote teaching methods implemented in nursing education and clinical practice during the COVID-19 pandemic, with the aim of developing post-pandemic educational strategies. Methods: A structured questionnaire was administered to 92 full-time nursing professors nationwide, who were responsible for clinical courses in adult nursing. The data were analyzed using descriptive statistics via SPSS. Results: The majority (96.7%) of the participants implemented remote clinical practice during COVID-19. The primary teaching methods included virtual simulation programs (76.1%) and online nursing skills programs (75%). The clinical scenarios were primarily instructor-developed (63%) or drawn from virtual simulation cases (54.3%). Most professors (69.6%) modified their evaluation methods, and 85.9% reported changes in their assignment structures compared to their pre-pandemic practice. Conclusions: This study provides valuable insights into the effective remote clinical practice in nursing education, identifying specific programs and implementation considerations suitable for post-pandemic educational environments. Full article

Previous studies have examined the association between family dysfunction and pubertal timing in adolescent girls. However, the evidence is lacking on the role of family dysfunction during sensitive developmental periods in both boys and girls from racial and ethnic minority groups. This study aimed to determine the effect of family dysfunction on the timing of pubertal maturation among US Hispanic/Latino children and adolescents. Participants were 1466 youths (50% female; ages 8–16 years) from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth). Pubertal maturation was measured using self-administered Pubertal Development Scale (PDS) items for boys and girls. Family dysfunction included measures of single-parent family structure, unhealthy family functioning, low parental closeness, and neglectful parenting style. We used multivariable ordinal logistic and linear regression analyses to examine the associations between family dysfunction and pubertal maturation (individual and cumulative measures), with adjustment for childhood BMI and socioeconomic factors, design effects (strata and clustering), and sample weights. Multivariable models of individual PDS items showed that family dysfunction was negatively associated with growth in height (OR = 0.66, 95% CI: 0.44, 0.99) in girls; no associations were found in boys. In the assessment of cumulative PDS scores, family dysfunction was associated with a lower average pubertal maturation score (b = −0.63, 95% CI: −1.21, −0.05) in boys, while no associations were found in girls. Pubertal timing lies at the intersection of associations between childhood adversity and adult health and warrants further investigation to understand the factors affecting timing and differences across sex and sociocultural background. Full article

Deaths of despair (DoD), encompassing suicide, drug overdose, and alcohol-related mortality, are often linked to social and psychological distress. This study examined the long-term risk of DoD among individuals previously hospitalized for suicide attempts, with a focus on substance use problems and psychiatric disorders as potential risk factors. A prospective cohort of 1044 individuals admitted to inpatient care following a suicide attempt between 1987 and 1998 was followed for up to 32 years using national registers. Cox proportional hazards regression models were used to assess associations between psychiatric diagnoses and mortality outcomes. The results showed that substance use problems, compared to no such problems, were associated with an increased risk of all-cause mortality but not DoD. In secondary analyses, dysthymia was linked to an increased risk of suicide but not non-suicidal DoD, suggesting distinct underlying mechanisms. Notably, aside from gender, no control variables were significantly associated with non-suicidal DoD, indicating that other factors may play a more prominent role in this high-risk population. These findings challenge the traditional DoD framework and highlight the need for tailored prevention efforts that consider the distinct risk profiles of suicide and non-suicidal DoD. Future research should incorporate socioeconomic and demographic factors to enhance understanding and prevention strategies. Full article

Background: Although effective and recommended by guidelines worldwide, Cardiac Rehabilitation (CR) remains scarce and underutilized. CR implementation has taken place in middle-income countries, but the progress is influenced by both positive and negative factors that remain underexplored. This study identified the barriers and facilitators of CR in a middle-income country, specifically China. Methods: An exploratory qualitative study was conducted using semi-structured interviews. Results: Fifteen CR stakeholders were interviewed. According to the interviewees, the delivery of CR is impeded due to a lack of resources, a lack of CR professionals, and a lack of coordination between health institutions. The participation of CR is hindered by a lack of awareness, a lack of reimbursement, and a lack of access to CR. However, the interviewees also mentioned facilitating factors, namely, a positive attitude of stakeholders, high motivation of some patients, and policy support. Conclusions: More awareness regarding the effectiveness of CR is needed. Implementing CR in secondary and primary health institutions could overcome the barriers regarding travel distance and transportation to faraway hospitals. The CR reimbursement methods are needed to ease the financial burden on patients. Our findings reveal factors that need to be considered by policymakers to deliver CR on a wider scale in China. Full article

We sought to characterize momentary changes in fatigue, sleepiness, and difficulty with concentration during short and long duration shifts worked by emergency medical services (EMS) and fire personnel across the United States. In addition, we tested for differences in pre-shift and on-shift sleep stratified by shift duration. We examined real-time mobile-phone text message queries during scheduled shifts from the EMS Sleep Health Study, a nationwide, cluster-randomized trial (ClinicalTrials.gov Identifier: NCT04218279). Linear mixed effects models were used and Bonferroni p-values reported for multiple comparisons. In total, 388 EMS clinicians from 35 EMS/fire agencies documented 4573 shifts and responded to 64.6% of 161,888 text message queries. Most shifts (85.5%) were 12 or 24 h in duration. Mean sleep hours pre-shift was 6.2 (SD1.9) and mean sleep hours on shift was 3.4 (SD2.9) and varied by shift duration (p < 0.0001). The highest level of fatigue, sleepiness, and difficulty with concentration during any shift occurred during 24 h shifts and corresponded to the early morning hours at 03:00 or 04:00 a.m. The real-time assessments of sleep hours and fatigue in this study revealed deficits in sleep health for EMS and fire personnel and critical time points for intervention during shifts when the risk to safety is high. Full article

This review of the literature examines diseases and pathogen characteristics on military vessels, in order to improve the success of missions on a boat. Our aim is to understand the spread of disease, aiming to maximize biological resilience and hopefully eliminate outbreaks. Keyword research was conducted from various sources of information, including scientific publications, theses, public health organization websites, and clinical trials. A synthesis of bacterial, viral, fungal, and parasitosis characteristics was established, and a risk prioritization index was defined, based on contagiousness (basic reproduction number (R0)) and clinical severity. For instance, COVID-19 was assessed as moderately contagious, with critical severity, and Influenza A H1N1 as having a minor level of contagiousness with critical severity, resulting in a level two out of three risk prioritization index. This approach demonstrates that while diseases have numerous characteristics, a method for classifying them by isolating specific criteria and prioritizing them could be proposed. In conclusion, further work is needed to analyze onboard operator activities and develop simulation models related to pathogen characteristics. Full article

Adolescents’ knowledge about climate change is key to protecting the well-being of all generations and to promoting individuals’ rights and resilience. This study assesses the climate change literacy of Indonesian adolescents and its determinants. This nationwide study was conducted in 2023 in Sumatra, Java, Kalimantan, Sulawesi, and Eastern Indonesia. A total of 1126 adolescents aged 13–19 years were selected through multi-stage sampling. The data were analyzed using the chi-square test and multinomial logistic regression. This study found that 49.7% of adolescents had poor climate change literacy. In the multivariate analysis, the significantly related factors had an odds ratio of 1.66–4.75. Climate change literacy was higher in adolescents from the West and Central Regions, from public or religious schools, and those with educated parents, than in adolescents from the Eastern Region, from private or vocational schools, and those whose parents had low education, respectively. This study suggests the need to promote equality in climate change literacy among Indonesian adolescents through formal and informal education. High-quality formal education would necessitate well-trained teachers with expertise in climate change, as well as a structured, age-appropriate curriculum. Meanwhile, informal education through another information dissemination and social media-based movements can help broaden outreach among adolescents. Full article

The acquisition of reliable health information plays a pivotal role in shaping informed decision-making and health-related behaviours. This investigation examined the factors influencing health information use and trust in health sources among the adult population in South Tyrol, Italy, employing a population-based cross-sectional survey (n = 2090). Descriptive analyses revealed sociodemographic disparities, with younger individuals and those with higher educational attainment demonstrating increased engagement with digital sources, while older adults and those with lower educational levels exhibited a greater reliance on traditional media and healthcare professionals. Correlation analyses showed that elevated health literacy (HLS-EU-Q16) was linked to enhanced engagement with structured and professional health sources, whereas higher patient activation (PAM-10) exhibited a negative correlation with a dependence on healthcare professionals, indicating that more activated individuals are less reliant on medical consultations for health information. Individuals reporting a better health status were less inclined to use health information sources, such as media, healthcare professionals, or the internet, as opposed to relying on personal knowledge or experience. Ordinal regression models further identified age, education, and linguistic background as crucial predictors of health information use and trust in sources. These findings highlight the influence of health literacy and patient activation on information engagement and trust and emphasise the need for tailored public health initiatives to ensure equitable access to reliable health information across diverse demographic groups. Full article

This study aimed to address the unexplored relaxing effects of stargazing with different night sky darknesses in a planetarium by conducting an experiment to investigate the physiological effects of the relaxation/stress state on brain and autonomic nervous system activity, as well as the psychological healing effects. Five healthy young women participated in our experiment. We conducted physiological measurements of oxygenated hemoglobin (OxyHb) concentration in the left and right prefrontal cortices by near-infrared spectroscopy, heart rate variability as a measure of the relaxation/stress state, and a psychological assessment of healing on an 11-point Likert scale. We used 9 types of stimuli: 6-star image stimuli that imitated dark star fields (low light pollution) to bright night sky (high light pollution), and movie stimuli that were viewed daily. The results showed that (1) visual stimulation with images of dark night sky significantly reduced the concentration of OxyHb in the right prefrontal cortex and (2) the psychological rating of healing was significantly higher compared to bright night sky. The results of this study will help solve the problems of the mental and physical effects of light pollution on astronomical observations and the reproduction of star images in planetariums. Full article

This paper discusses the responsible use of artificial intelligence (AI) in public health and in medicine, and questions the development of AI ethics in international guidelines from a public health perspective. How can a global ethics approach help conceive responsible AI development and use for improving public health? By analysing key international guidelines in AI ethics (UNESCO, WHO, European High-Level Expert Group on AI) and the available literature, this paper advocates conceiving proper ethical and legal frameworks and implementation tools for AI in public health, based on a pragmatic risk-based approach. It highlights how ethical AI principles meet public health objectives and focuses on their value by addressing the meaning of human-centred innovations, transparency, accountability, diversity, equity, privacy protection, technical robustness, environmental protection, and post-marketing surveillance. It concludes that AI technology can reconcile individual and collective ethical approaches to public health, but requires specific legal frameworks and interdisciplinary efforts. Prospects include the development of supporting data infrastructures, of stakeholders’ involvement to ensure long-term commitment and trust, of the public’s and users’ education, and of international organisations’ capacity to coordinate and monitor AI developments. It formulates a proposal to reflect on an integrated transparent public health functionality in digital applications processing data. Full article

Built environment and physical activity (PA) studies have predominantly used fixed or home-centric approaches to identify environmental exposures. In this study, GPS-derived daily activity spaces were used to examine the relationships between the built environment and sedentary behavior (SB), light PA (LPA), and moderate-to-vigorous PA (MVPA). Thirty-one adults were assessed with activity monitors and GPS units. Three types of activity spaces were created: 50 m buffered GPS tracks, minimum convex hulls (MCHs), and standard deviational ellipses (SDEs). The environmental variables included land use mix, greenness, and intersection, multi-use trail, bike infrastructure, and bike station densities. Repeated measures regression was used to test the associations for 141 person-days, controlling for age, gender, income, body mass index, crime, precipitation, and temperature. Greenness within MCH activity spaces was positively associated with LPA (p = 0.02). The bike infrastructure density within SDE spaces had a significant positive association with MVPA (p = 0.04). Multi-use trail, bike infrastructure, and bike station densities had significant negative associations with LPA (p ≤ 0.05). There were no significant adjusted associations with SB. The few significant associations in this study varied by outcome and type of activity space. Further studies are needed to determine optimal, yet flexible methods for activity spaces in built environment and PA research. Full article

The COVID-19 pandemic and the subsequent hard lockdown in South Africa, implemented in March 2020, significantly disrupted disability and rehabilitation services. Persons with disabilities experienced limited access to essential Orthotic and Prosthetic services, particularly in rural provinces such as the Eastern Cape. This study aimed to explore how Medical Orthotists and Prosthetists reconfigured their services during and after the pandemic to inform disability-inclusive emergency responses. A descriptive qualitative study was conducted with 12 Medical Orthotists and Prosthetists practicing in the public sector in the Eastern Cape. Semi-structured interviews were conducted via MS Teams, and the data were analysed by using thematic analysis to identify key themes related to service disruptions and adaptations. Four main themes emerged: (1) disrupted access to Orthotic and Prosthetic services, (2) backlogs and limited services, (3) safety measures and adaptation control, and (4) lingering challenges and gaps. Service delivery was hindered by halted outreach clinics, limited access to materials, budget reallocations, and the deprioritisation of rehabilitation services. This study highlights the challenges faced by Medical Orthotists and Prosthetists in maintaining the functionality of Orthotic and Prosthetic services during the pandemic. These findings emphasise the need for disability-inclusive policies and strategies to ensure the continuity of rehabilitation services during emergencies. Full article

Introduction: African healthcare professionals face significant mental health challenges; therefore, telemedicine can overcome geographical barriers and improve access to mental healthcare. Objective: The objective of this study was to identify the key factors influencing the adoption of telemedicine as a tool to support healthcare workers’ mental health in an Angolan healthcare network and develop a telemedicine model tailored to this context. Methodology: This mixed-method study collected quantitative data from a questionnaire applied to healthcare workers (n = 275), which were analyzed using descriptive statistics and logistic regressions. Qualitative data were obtained through structured interviews (n = 5) with psychologists and psychiatrists, and analyzed using thematic analysis in MAXQDA (Version 2022, VERBI Software, Germany), to identify recurring patterns and themes. The data were triangulated to ensure the rigor and consistency of the findings. Participation was anonymous and voluntary, and informed consent was obtained from all participants. Results: Previous experiences with mental health consultations, perceptions of teleconsultations, and doctor–patient relationship were significant in influencing telemedicine adoption by workers. The thematic analysis revealed four themes: perception and ease of telemedicine use, intention to use, and the perception of mental health in Angola. The key adoption factors for providers included project feasibility, management support, training, payment policies, and adherence to legal, ethical, and deontological standards. Conclusions: The adoption of telemedicine for occupational mental health requires culturally adapted interventions and compliance with technological and data protection standards. Hospital management must address infrastructure challenges and mental health perceptions, and implement sustainable strategies that promote occupational well-being within the organization. Full article

The consequences associated with pregnancy termination have garnered attention from healthcare professionals, particularly in Indonesia. However, national-level evidence on the factors driving pregnancy termination in Indonesia remains limited. This research aimed to identify patterns and characteristics associated with pregnancy termination among reproductive-age women in Indonesia. A cross-sectional study analyzed secondary data from the 2012 and 2017 Indonesian Demographic and Health Survey, involving women aged 15–49. The weighted sample included 42,269 individuals in 2012 and 47,001 in 2017. Binary logistic regression identified the correlates of pregnancy termination. Among 89,270 women of reproductive age, the prevalence of pregnancy termination was 12.68% in 2012 and 12.95% in 2017. Pregnancy termination was more frequently reported among women aged 44–49 years (adjusted odds ratio (AOR): 4.34, 95% confidence interval (CI): 3.54–5.33), those with secondary education (AOR: 1.29, 95% CI: 1.14–1.46), married women (AOR: 195.40, 95% CI: 114.70–332.90), employed women (AOR: 1.05, 95% CI: 1.00–1.09), individuals with health insurance (AOR: 1.07, 95% CI: 1.02–1.11), those who had experienced domestic violence (AOR: 1.07, 95% CI: 1.02–1.11), and regular television viewers (AOR: 1.10, 95% CI: 1.05–1.15). Conversely, pregnancy termination was less commonly reported among women with 1–2 living children (AOR: 0.80, 95% CI: 0.74–0.87), those who expressed no preference for having more children (AOR: 0.89, 95% CI: 0.84–0.94), and women using modern contraception (AOR: 0.76, 95% CI: 0.72–0.80). The findings revealed that the prevalence did not observe any changes in the incidence of pregnancy terminations between 2012 and 2017. Further evaluation by healthcare professionals is crucial to understanding the reasons behind pregnancy termination, especially among women of reproductive age. Insights into factors related to pregnancy termination, especially sociodemographic factors, can help mitigate the pregnancy termination in this population. Full article

The relationship between socioeconomic and demographic characteristics and health effects of green spaces has been studied, suggesting that certain groups may reap more health benefits from exposure to nature. However, the link between the perceived benefits of nature and socioeconomic and demographic characteristics remains a gap in the literature. We used a subsample (n = 711, 2018–2019) from an environmental cardiovascular risk cohort to investigate the perceived benefits of nature. Participants completed an 11-item survey about their perceptions of the benefits of nature at in-person visits. Socioeconomic and demographic characteristics including income, education, race, biological sex at birth, and age, were self-reported. Generalized linear models were used to evaluate associations between the perceived benefits of nature and demographic and socioeconomic factors; odds ratios and 95% confidence intervals (CIs) are reported. Both unadjusted and fully adjusted models for race, age, sex, and education are reported. Our results suggest that participants who identified as male, a member of a minoritized population, and/or completing less education perceived nature as less beneficial. Although additional research is needed to better understand contributors to these perceptions, access to convenient, safe, and multi-use green spaces may be important in encouraging time in nature and shifting perceptions of the benefits of greenness. Full article