Search Results (12,188)

Background: Hypertension significantly impacts the health-related quality of life (HRQoL) of patients. This study evaluates the influence of sociodemographic, economic, and clinical features on HRQoL among hypertensive patients using the 36-Item Short Form Survey (SF-36). Method: A cross-sectional study was conducted at a public health center in Khamis Mushayt, Saudi Arabia, where 209 adult hypertensive patients were surveyed using simple random sampling. Data were collected through a structured questionnaire covering sociodemographic and clinical details, and multiple linear regression was used to analyze the associations between variables and the SF-36 domains. Results: Of the 209 participants, 122 (58.4%) were female and 87 (41.6%) were male. Complications and multiple antihypertensive medications were linked to poorer physical functioning and general health (p < 0.05). Salt restriction improved physical functioning (B = 12.339, p = 0.008), and exercise reduced body pain (B = −8.487, p = 0.038). Middle-income patients had higher vitality (B = 7.632, p = 0.038) and social functioning (B = 16.465, p = 0.035). Higher-income individuals showed lower social functioning (B = −12.323, p = 0.022). Conclusions: Age, income, marital status, and complications were key determinants of HRQoL in hypertensive patients. Lifestyle interventions like exercise and salt restriction improve physical functioning and reduce pain, while psychological and social support are vital for mental health. Tailored interventions addressing clinical and psychosocial support are crucial for optimizing HRQoL in this population. Full article

Background/Objectives: Older adults are particularly susceptible to undernutrition and conditions that can aggravate it, such as frailty and conditions associated with swallowing difficulties or dysphagia. To address these challenges, it is important to consider the perspectives of older adults and their caregivers, especially those with conditions such as frailty or cognitive impairment, as they can provide valuable insights on supporting nutrition in these vulnerable populations. This participatory approach requires structures formed by scientific research committees working together with other stakeholders, involving various actors at all stages of the research process. The aim of this study is to analyze the methodology for involving patients aged 65 and older with malnutrition or at risk of malnutrition as co-investigators in research. Methods: This protocol has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) checklist. A literature search will be carried out in the following electronic databases: PubMed/MEDLINE, EMBASE and CINAHL. Through the COVIDENCE program, the research team will independently review the different screening phases of the identified studies for possible inclusion or exclusion. Expected Results: This systematic review will provide up-to-date evidence on the use of non-scientific actors at different stages of research. The main limitation stems from the use of non-scientific agents in a topic as specific as adults with or at risk of undernutrition, which may make it difficult to extrapolate the results to other settings. The registration number in PROSPERO is CRD42024444374. Full article

Psychiatric disorders and internal diseases frequently co-occur, posing significant challenges due to overlapping symptoms, shared pathophysiological mechanisms, and increased healthcare burdens. Neuroinflammation has emerged as a central mechanism linking these conditions, driven by systemic inflammation, hypothalamic–pituitary–adrenal (HPA) axis dysregulation, and autonomic nervous system (ANS) imbalance. This review synthesizes current evidence on the role of neuroinflammation in comorbid conditions such as depression, anxiety, cardiovascular disease, and diabetes mellitus, emphasizing bidirectional relationships and shared inflammatory pathways. This analysis identifies gaps in longitudinal studies, biomarker validation, and the integration of multidisciplinary care models. Emerging therapeutic approaches, including IL-6 inhibitors, vagus nerve stimulation, and behavioral interventions, show promise but remain underexplored in combined applications. Furthermore, disparities in research representation limit the generalizability of findings and highlight the need for inclusive clinical trials. Addressing these gaps through precision medicine, advanced biomarker monitoring technologies, and equitable healthcare strategies could transform the management of these complex comorbidities. By advancing our understanding of neuroinflammatory mechanisms and promoting integrated interventions, this review underscores the need for a collaborative, patient-centered approach to improve outcomes and reduce the global burden of psychiatric and internal disease comorbidities. Full article

Background/Objectives: The objective of this study is to assess overall patient satisfaction with hospital services, including cleanliness, ward conditions, and food quality. Another key goal is to determine patient willingness to return for future medical services and identify the factors influencing this decision. Moreover, the study explores the relationship between patient satisfaction and continuity of care, as indicated by previous hospitalizations. Methods: We conducted a retrospective cohort study to evaluate patient satisfaction at the Bihor County Emergency Clinical Hospital in Oradea, Romania. A standardized 40-item questionnaire was developed in accordance with the Framework Agreement on the provision of medical assistance within the Romanian healthcare system. The survey, which was administered over a four-year period (2019–2022), covered seven domains: demographic data, accessibility, hotel conditions, quality of care, patient safety and rights, overall satisfaction, and feedback. A total of 12,802 patients completed the questionnaire, and all statistical analyses were performed using R Studio. Results: This study analyzes patient-reported satisfaction and experiences in a large healthcare facility, based on data from 12,802 participants. Overall, 91% of respondents rated the hospital positively, with 62% giving an excellent score. Spiritual assistance was well received (71%), and 70% of patients expressed willingness to return for future medical needs. Hospital cleanliness and ward conditions were rated highly, with 71% of respondents reporting excellent experiences. Food quality was positively reviewed by 66% of participants. Most patients (95%) confirmed proper hygiene practices by medical staff, and 95% were informed about their diagnosis. However, only 67% were aware of the complaint submission process. The dataset spans 2019–2022, with the highest hospitalizations in 2020 (36%) and obstetrics, cardiology, and general surgery being the most common specialties. Conclusions: This dataset reflects a high level of patient satisfaction across multiple dimensions of hospital services, including cleanliness, quality of care, and patient information. However, areas such as complaint handling and transparency in medication handling require further attention to improve the overall patient experience. The findings underscore the hospital’s strong performance in meeting patient expectations while identifying key areas for continued improvement. Full article

Background/Objectives: General practitioners (GPs) should be able to initiate open conversations about death with their patients. It is hypothesized that a change in attitude regarding discussions of death with patients may be accomplished through doctors’ training, particularly with the use of artificial intelligence (AI). This study aimed to evaluate whether OpenAI’s ChatGPT can simulate a medical communication scenario involving a GP consulting a patient who is dying at home. Methods: ChatGPT-4o was prompted to generate a medical communication scenario in which a GP consults with a patient dying at home. ChatGPT-4o was instructed to follow seven predefined steps from an evidence-based model for discussing dying with patients and their family caregivers. The output was assessed by comparing each step of the conversation to the model’s recommendations. Results: ChatGPT-4o created a seven-step scenario based on the initial prompt and addressed almost all intended recommendations. However, two points were not addressed: ChatGPT-4o did not use terms like “dying”, “passing away”, or “death”, although the concept was present from the beginning of the conversation with the patient. Additionally, cultural and religious backgrounds related to dying and death were not discussed. Conclusions: ChatGPT-4o can be used as a supportive tool for introducing GPs to the language and sequencing of speech acts that form a successful foundation for meaningful, sensitive conversations about dying, without requiring advanced technical resources and without placing any burden on real patients. Full article

Aging has been thought to be factual, inherited, and obligatory. However, aging can be divided into primary (i.e., inevitable physiological changes) and secondary (i.e., age-associated changes driven by life choices, environment, and society) aging. The impact of social norms and life choices is why no two 70-year-olds look the same. The life choice that appears to have the strongest impact on aging is physical activity. Research continues to highlight the power of mitigating age-related losses via physical activity and debunking the notion that age-related changes such as falls, frailty, and functional decline are inevitable. Physiotherapists are the healthcare professionals who reverse or slow down age-related changes and prevent secondary aging from occurring. Physiotherapists are the health profession’s experts in movement science, whose interventions primarily center around physical activity as medicine. Thus, physiotherapists function as pharmacists of physical activity and are well-positioned to prescribe the dosages needed for wellness promotion as well as disease prevention and management. This paper provides guidance from the perspective of the physiotherapist on exercise prescription most optimal and consumable for an older population. Full article

Background/Objectives: Maternal health risks remain one of the critical challenges in the world, contributing much to maternal and infant morbidity and mortality, especially in the most vulnerable populations. In the modern era, with the recent progress in the area of artificial intelligence and machine learning, much promise has emerged with regard to achieving the goal of early risk detection and its management. This research is set out to relate high-risk, low-risk, and mid-risk maternal health using machine learning algorithms based on physiological data. Materials and Methods: The applied dataset contains 1014 instances (i.e., cases) with seven attributes (i.e., variables), namely, Age, SystolicBP, DiastolicBP, BS, BodyTemp, HeartRate, and RiskLevel. The preprocessed dataset used was then trained and tested with six classifiers using 10-fold cross-validation. Finally, the performance metrics of the models erre compared using metrics like Accuracy, Precision, and the True Positive Rate. Results: The best performance was found for the Random Forest, also reaching the highest values for Accuracy (88.03%), TP Rate (88%), and Precision (88.10%), showing its robustness in handling maternal health risk classification. The mid-risk category was the most challenging across all the models, characterized by lowered Recall and Precision scores, hence underlining class imbalance as one of the bottlenecks in performance. Conclusions: Machine learning algorithms hold strong potential for improving maternal health risk prediction. The findings underline the place of machine learning in advancing maternal healthcare by driving more data-driven and personalized approaches. Full article

Background/Objectives: As life expectancy rises and the epidemiological landscape of chronic diseases evolves, the necessity to assess and improve the overall health status of the population becomes increasingly fundamental. Therefore, evaluating health gains is a crucial challenge for modern health systems, particularly in the context of limited resources and increasing demand for services. The aim of this study is to assess health gains and their costs, with data provided by a private Italian clinic. Methods: We conducted a retrospective study on 129 patients admitted between June 2020 and August 2023 in a solvent ward for short-term planned hospitalization. The patients completed the EQ-5D-5L questionnaire at both admission and discharge. Quality-Adjusted Life Years (QALYs) were estimated based on the difference in EQ-5D-5L scores between discharge and admission, assuming that health gains persist up to two years post-discharge. Through QALYs value and hospitalization cost, a cost–utility analysis was performed. Descriptive and statistical analyses were carried out using STATA SE/14.0 software. Results: Of the studied sample, 55% was female, the median age was 81 [11] years old, and the median length of stay (LoS) was 16 [16] days. The patients gained, in median, 0.33 [0.38] in QALY, which was higher for males (0.35 [0.34]) than females (0.29 [0.45]). The QALY gained was greater for the non-geriatric patients (0.41 [0.42]) than geriatric ones (0.32 [0.38]) (p > 0.05). Those with a longer LoS showed a higher gain in QALY (0.35 [0.42]) than those with a shorter one (0.23 [0.29]) (p < 0.05). The cost per QALY gained was, in median, EUR 14,337, which was lower in males (EUR 13,803), in non-geriatric patients (EUR 13,743), and in patients with a shorter LoS (EUR 10,670) (p > 0.05). Conclusions: Although QALY gains differed among the groups, the median cost per QALY remained consistent. These results highlight the need for targeted interventions to optimize resource allocation, both by integrating data into allocation strategies and by employing a multidisciplinary approach to tailor interventions. Full article

Background: Medical errors are common, and in particular, medication errors are one of the leading causes of morbidity and mortality in healthcare. Nurses must disclose errors to build trust and ensure patient safety despite communication barriers and fear of reprisals. Truthful documentation and better collaboration can improve patient outcomes. Aim: The aim of this study was to assess barriers to error disclosure among nurses in the Kingdom of Saudi Arabia. Methods: A descriptive cross-sectional survey was conducted in the months of June and August 2024 using a convenience sample of 255 nurses at King Fahad Hospital (KFH), Hofuf. A self-administered questionnaire that contained socio-demographic questions, as well as the Barriers to Error Disclosure Assessment (BEDA) tool, was deployed. Results: The majority of the sample were female (92.2%) and Bachelor’s degree holders (80.8%) who had 1–5 or 6–10 years of experience, representing 45.5% and 29.0% of the sample, respectively. When medical errors occur, only 18% of the nurses disclosed them to patients and their families, and 34.5% of the respondents disclosed medical errors to another team of healthcare professionals. The types of barriers to error disclosure were identified as relating to confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers. The overall barrier score had an average of 63%. The barriers with the highest scores were those relating to psychological barriers (68.2%), followed by institutional barriers (66.5%) and financial concern barriers (64.5%). Conclusions: Targeted interventions are required for addressing the identified specific needs to support healthcare providers, specifically nurses. New regulations and policy changes are crucial for training programs implementation, enhancing safety culture, and tackling job-related insecurities to minimize barriers to error disclosure and ultimately provide better patient care quality. Further investigations may include a different approach, and it is recommended to provide deeper insights into nurse experiences. Full article

Background: The transition from pediatric to adult care in Duchenne Muscular Dystrophy (DMD) is challenging due to the disease’s complexity and the need for lifelong, comprehensive management. In Romania, ongoing efforts aim to enhance multidisciplinary collaboration, though systemic barriers, such as fragmented healthcare services, persist. Nonsense mutations, including those in exon 30 described here, are often associated with more severe disease progression. Methods: We present the case of a 17-year-old Romanian DMD patient with a nonsense mutation in exon 30 of the dystrophin gene. The patient received multidisciplinary pediatric care addressing his medical needs, including neuromuscular, respiratory, cardiac, and orthopedic management. Transition readiness was assessed using the Transition Readiness Assessment Questionnaire (TRAQ), and the patient’s perspective on the process was documented. Results: Care followed international standards, but the disease progressed predictably, with gradual loss of ambulation, respiratory decline, and cardiac complications. The TRAQ revealed strengths in communication with healthcare providers but moderate confidence in self-management tasks. From the patient’s perspective, fragmented adult services and difficulty accessing specialized neuromuscular support remain major obstacles, underscoring the importance of early, structured transition planning and patient-centered approaches. Conclusions: Transitioning to adult services requires strong communication between pediatric and adult teams and integration of specialized care. Tailored follow-up plans ensure continuity of care and effective disease management. This case reflects broader needs in similar healthcare contexts, highlighting the necessity of robust transition frameworks to respond to patient-specific challenges and ultimately support long-term quality of life. Full article

Background/Objectives: Robotic rehabilitation holds great potential for improving patient outcomes, but the integration of these technologies into clinical practice is hindered by a lack of comprehensive tools for assessing patients’ needs. This systematic review aimed to identify gaps in the current literature, with a focus on methodologies and tools for evaluating such needs, particularly those based on the International Classification of Functioning, Disability, and Health (ICF) framework. Methods: A systematic review of qualitative studies published between 2021 and 2023 was conducted, updating a previous (2020) review. Studies were identified through PubMed, Scopus, and Web of Science using inclusion criteria focused on qualitative methods capturing patients’ experiences with robotic and technological rehabilitation devices. Results: The review analyzed 19 new studies and 20 from the prior review, revealing a reliance on semi-structured interviews targeting small, heterogeneous populations. No studies employed standardized ICF-based tools, and gaps were noted in the exploration of conditions such as Parkinson’s disease, frailty, or conditions that allowed for multi-device experiences. Conclusions: The findings emphasize the necessity for tailored surveys grounded in the ICF framework to completely evaluate the needs of patients suffering from sensory, motor, and/or cognitive disorders caused by different health conditions. This work lays the foundation for more inclusive, effective, and patient-centered robotic rehabilitation strategies. Full article

Background: While the HTA community appears well-equipped to assess preventive and diagnostic technologies, certain limitations persist in evaluating technologies designed for rare diseases, including those based on Artificial Intelligence (AI). In Europe, the EUnetHTA Core Model^® serves as a reference for assessing preventive and diagnostic technologies. This study aims to identify key ethical, legal, and social issues related to AI-based technologies for the prevention and diagnosis of rare diseases, proposing enhancements to the Core Model. Methods: An exploratory sequential mixed methods approach was used, integrating a PICO-guided literature review and a focus group. The review analyzed six peer-reviewed articles and compared the findings with a prior study on childhood melanoma published in this journal (Healthcare), retaining only newly identified issues. A focus group composed of experts in ethical, legal, and social domains provided qualitative insights. Results: Thirteen additional issues and their corresponding questions were identified. Ethical concerns related to rare diseases included insufficient disease history knowledge, lack of robust clinical data, absence of validated efficacy tools, overdiagnosis/underdiagnosis risks, and unknown ICER thresholds. Defensive medicine was identified as a legal issue. For AI-based technologies, concerns included discriminatory outcomes, explicability, and environmental impact (ethical); accountability and reimbursement (legal); and patient involvement and job losses (social). Conclusions: Integrating these findings into the Core Model enables a comprehensive HTA of AI-based rare disease technologies. Beyond the Core Model, these issues may inform broader assessment frameworks, ensuring rigorous and ethically responsible evaluations. Full article

Background: The Copenhagen Psychosocial Questionnaire (COPSOQ) is an international instrument designed for the assessment and improvement of psychosocial conditions in workplaces and for research purposes. After the International COPSOQ Network took over responsibility for the development of COPSOQ, a new version was published in 2019 (COPSOQ III). However, there is no widely recognized instrument for measuring psychosocial work factors, and insufficient research exists regarding the use of COPSOQ III within the Chinese setting. This study seeks to conduct a preliminary validation of the Chinese long version of COPSOQ III. Methods: A cross-sectional questionnaire survey was conducted with a large sample in a medical consortium in China. Item analysis, reliability, and validity were explored. Results: The data management platform showed that 1067 respondents who met the inclusion criteria completed the questionnaire, among which 1054 questionnaires were valid. The content validity results showed that the I-CVI and S-CVI/AVE of each item ranged from 42.86 to 100.00, and the S-CVI/AVE was 92.52, indicating that the Chinese long version of COPSOQ III had good content validity. An exploratory factor analysis (EFA) extracted seven factors, which explained 63.96% of the variation. The results of confirmatory factor analysis (CFA) indicated that the model was well fit (χ²/df = 4.50, CFI = 0.910, TLI = 0.897, IFI = 0.910, RMSEA = 0.058). The Cronbach alpha coefficient of the questionnaire was 0.92. Conclusions: The Chinese long version of COPSOQ III is of good reliability and validity, like the original, and can be used to assess psychosocial work factors in China. Full article

Background: This study aimed to evaluate the impact of mental health comorbidities on unplanned hospital admissions (UHAs) in the Province of Pescara, Southern Italy, during 2015–2022. Mental health comorbidities are underreported in administrative data, yet their association with UHAs has significant public health implications. Methods: A retrospective observational design was used to analyze 59,374 hospital admissions extracted from hospital discharge records (HDRs). Admissions of patients under 18 years of age, deliveries, day admissions, and readmissions were excluded. Socio-economic deprivation was assessed using a standardized deprivation index. Multivariate logistic regression analyzed the association between UHAs and mental health comorbidities, adjusting for socio-demographic and clinical factors. Results: Of the 59,374 admissions, 43,293 (72.9%) were unplanned. Mental health comorbidities had a low prevalence (1552 cases, 2.6%) but were significantly more common in UHAs (3.4%) compared to planned admissions (0.4%, p < 0.001). UHAs were also associated with the female gender (OR = 1.10; 95% CI: 1.06–1.14), younger age categories, living in less deprived areas, two or more physical comorbidities (OR = 1.66; 95% CI: 1.56–1.75), and mental health comorbidities (aOR = 9.85; 95% CI: 7.74–12.55, p < 0.001). Conclusions: Mental health comorbidities significantly increase the risk of UHAs independent of socio-economic deprivation or physical comorbidities. These findings underscore the need for enhanced mental health management to reduce UHAs, improve patient outcomes, and address healthcare inequities. Full article

Neurological disorders represent a significant challenge for healthcare systems, necessitating innovative and multidisciplinary therapeutic approaches. These disorders often lead to difficulties in various aspects of daily life, including physical functioning, mental health, and quality of life (QoL). Telecoaching (TC) and Music Therapy (MT) are two emerging modalities that may provide valuable support for individuals with these conditions. This narrative review aims to analyse recent studies investigating the efficacy of TC and MT in this population. A total of 23 studies were included in this narrative review. These studies indicate that TC positively affects physical functioning and adherence to intervention programs, with participants reporting improvements in gait and balance, as well as a reduction in postural instability and fall rates. Similarly, MT has shown promising outcomes in decreasing anxiety and sleep disorders while enhancing cognitive and emotional well-being. Integrating TC and MT into treatment approaches offers a promising alternative for improving QoL and overall well-being. However, further research is needed to consolidate the evidence and optimize the implementation of these interventions in clinical practice. Future research should focus on longitudinal studies and comparative evaluations to further clarify the role of TC and MT in the treatment of neurological disorders, as well as their long-term effects. Full article