Background/Objectives: Psychiatric inpatient care is characterised by power asymmetries between care providers and care receivers. Despite international guidelines and policies promoting autonomy, involvement, and empowerment, these ideals remain challenging to implement in clinical practice. Psychiatric self-admission has been developed to strengthen autonomy; however, its implementation may challenge established power structures, professional roles, and responsibilities within mental healthcare settings. This study aimed to explore stakeholder perspectives on power transfer during the implementation of psychiatric self-admission in Scandinavia. Methods: A qualitative multi-source study was conducted using semi-structured interviews, focus group interviews, and document collection. Interviews were conducted with 36 participants involved in the development and implementation of self-admission in Denmark, Norway, and Sweden. Additionally, approximately 250 documents were gathered. The documentary material was analysed alongside the interviews and focus groups to provide an understanding of the implementation of self-admission models and how power transfer was represented within these processes. The analyses were inspired by methods in qualitative content analysis and document analysis. Results: Findings on stakeholder perspectives on power transfer during implementation revealed a tension reflected in two subthemes: ‘Responsive and Responsible’, where self-admission was viewed as a necessary response to needs that the healthcare system was unable to address, and ‘Unsafe and Unsound’, where self-admission was associated with uncertainties and risks related to losing control. Conclusions: Implementing psychiatric self-admission, which involved challenging traditional power relations in healthcare, was permeated by trust, distrust, and fear. The findings highlight the need to address stakeholders’ concerns related to safety and professional responsibility.
Background: This study aimed to investigate the prevalence and levels of depressive, anxiety, and stress symptoms among dentists at an academic institution, and to identify demographic and work-related factors correlated with these psychological conditions. Methods: A cross-sectional study was conducted among full-time dentists teaching at King Saud University (Riyadh, Saudi Arabia). Data were collected using a self-administered questionnaire that captured demographic and work-related variables, alongside the validated 21-item Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using descriptive statistics, Chi-square tests, and multiple linear regression to determine significant associations. Results: A total of 114 participants completed the questionnaire, of which 86.8% were faculty and the rest non-faculty. The prevalence of depressive, anxiety, and stress symptoms was 21.9%, 32.5%, and 34.2%, respectively, predominantly at moderate levels. The prevalence of at least one subscale was 44.7%, and a significant correlation was found for the co-occurrence of the three subscales (p < 0.001). Regression analysis indicated three correlates of stress: dissatisfaction, female sex, and choosing a career in academia were significantly associated with the stress scores (p < 0.05). No significant factors were correlated with the anxiety or depression subscales. While females and dissatisfied participants reported higher scores for stress, intending to work in academia as a primary career choice was significantly correlated with lower levels of stress, highlighting the potential importance of intrinsic motivation for academia. Conclusions: A considerable proportion of participants experience depression, anxiety, and stress symptoms, suggesting the need for targeted institutional strategies to support mental well-being, particularly among vulnerable groups.
Objectives: Epilepsy is a chronic neurological disorder associated with substantial morbidity, reduced quality of life, and a considerable global healthcare burden. We aimed to assess anti-seizure medication (ASMS) utilization patterns, adherence levels, and factors influencing seizure control and adverse effects among pediatric patients with epilepsy in Oman. Methods: A retrospective cross-sectional study was conducted at Sultan Qaboos University Hospital (SQUH) between January 2023 and November 2024. A total of 305 pediatric patients aged 2–12 years receiving at least one ASMS with a minimum of two years of follow-up were included. Data were extracted from electronic medical records. Adherence was assessed using the Medication Possession Ratio (MPR). Statistical analysis was performed using SPSS. Results: Levetiracetam (68.52%) was the most prescribed ASMS, followed by sodium valproate (22.62%) and topiramate (8.52%). Adherence was observed in 54.68% of patients. Mean seizure duration decreased progressively across follow-up visits. Seizure control was achieved in 43% of patients. Patients without adverse effects had significantly better seizure control (56.2% vs. 10.2%, p < 0.001). Dose increases were associated with higher rates of adverse effects. Conclusions: Levetiracetam was the most commonly prescribed ASMS. Seizure type influenced drug selection. Adverse effects had a strong negative impact on seizure control, while adherence showed a limited association, indicating that managing side effects is crucial for effective treatment. Optimizing ASMS dosing and minimizing adverse effects are essential to improving outcomes in pediatric epilepsy. Dose adjustments, particularly dose increases, were associated with a higher frequency of adverse effects. Careful dose optimization may therefore be important to balance tolerability and seizure management. In this study, just over half of the patients evaluated (54.68%) were classified as adherent based on Medication Possession Ratio.
The quality of dental care is determined not only by the dentist’s technical competence but also by their ability to communicate effectively, listen actively, and establish a relationship of trust with the patient. Patients’ perceptions of dentists’ soft skills represent an essential component of patient-centered care; however, evidence from Romania remains limited. Aim: To evaluate patients’ perceptions of the importance of dentists’ non-technical (soft) skills in private dental practices and to analyze the influence of socio-demographic characteristics on these perceptions. Materials and Methods: The study included 297 patients attending private dental practices in Iași, Romania, who anonymously completed a questionnaire consisting of 20 items rated on a five-point Likert scale. Statistical analysis was performed using SPSS Statistics version 31.0. The Chi-square test and Fisher’s exact test were applied where appropriate. Results: Communication and interpersonal skills were considered the most important competencies by patients (91.3%), followed by cognitive skills (84.2%) and personal characteristics (80.2%), whereas artistic skills received the lowest level of appreciation (49.9%). Communication and interpersonal skills were the most highly valued domain (91.3%), followed by cognitive skills (84.2%) and personal characteristics (80.2%), whereas artistic skills received the lowest ratings (49.9%). Younger patients, urban residents, individuals with higher educational attainment, and those attending regular dental check-ups tended to assign greater importance to several of the non-technical competency domains assessed. The most pronounced age-related difference concerned digital technologies, with acceptance of telemedicine and digital communication decreasing markedly with increasing age. Conclusions: Communication and interpersonal skills were the non-technical competencies most highly valued by patients. The observed differences according to socio-demographic characteristics support the need for an individualized communication approach in dental practice.
Background: Insomnia requires long-term self-management, prompting many patients to turn to Traditional Chinese Medicine-based lifestyle (TCM-L) practices for health preservation. However, a consensus-based TCM-L content framework is lacking. This study aims to develop a consensus-based TCM-L content framework using a modified Delphi method. Methods: A modified Delphi study was conducted in two phases. In phase 1, a preliminary content framework was developed based on a systematic review, TCM textbooks, and clinical guidelines, consisting of 10 initial domains and 82 subordinate items. In phase 2, 18 local Chinese medicine practitioners were purposively recruited to evaluate the framework over four iterative rounds. Items were rated on a 5-point Likert scale, with consensus defined as a mean ≥ 4.0, a coefficient of variation < 0.25, and a consensus level of agreement ≥ 80%. Iterative modifications, deletions, and additions were informed by both these numerical thresholds and qualitative expert feedback. Kendall’s W was calculated to assess the coordination of consensus. Results: All 18 experts completed four rounds (100% response rate) with high authority (Cr = 0.864–0.883). The initial 10 domains and 82 subordinate items were refined to six domains and 49 subordinate items. Expert consensus was statistically significant across rounds (p < 0.01), with Kendall’s W demonstrating a high concordance of 0.717 for domain importance in the final round. The prioritized sequence of the six domains in the final TCM-L framework was: (1) Domain 1: introduction to TCM-L, (2) Domain 4: sleep–wake routines, (3) Domain 3: dietary regulation, (4) Domain 2: emotional regulation, and tied at (5) Domain 5: mind–body exercise and Domain 6: acupoint massage. Conclusions: This study established a consensus-based TCM-L content framework for insomnia, providing a culturally relevant foundational structure for future lifestyle interventions, clinical education, and self-management support.
Objectives: Exchange characteristics describe and evaluate the state of collaboration and the collaborative counterpart from the perspectives of both parties. They reflect the interaction tendencies between collaborators and are important factors influencing the effectiveness of interprofessional teamwork. This study aimed to assess the current exchange characteristics between clinical pharmacists and physicians and identify between-group differences. It also explored approaches to enhancing professional respect, trust, and clarity of Role Recognition among physicians and clinical pharmacists. Method: Separate questionnaire versions were developed for clinical pharmacists and physicians, and a nationwide cross-sectional survey was conducted among both groups. First, descriptive statistics were used to characterize the current status of exchange characteristics in interprofessional collaboration. Second, paired-samples t-tests were conducted to compare clinical pharmacists and physicians across 774 matched pairs. Finally, subgroup analyses were performed using data from 448 clinical pharmacist questionnaires and 446 physician questionnaires. Kruskal–Wallis tests, Mann–Whitney U tests, and chi-square tests were used to examine differences in exchange characteristics across healthcare professionals with different characteristics. Results: A total of 448 clinical pharmacist and 446 physician questionnaires were analyzed. Compared with clinical pharmacists, physicians reported greater professional respect (p < 0.001), clearer role recognition (p < 0.001), better team communication ability (p < 0.001), and a stronger sense of fairness (p < 0.001) in interprofessional collaboration. In subgroup analyses, clinical pharmacists who graduated from universities and those with higher educational attainment reported greater professional respect. Younger clinical pharmacists reported lower levels of fairness and trust, while physicians in central regions and those in non-permanent employment experienced more severe job burnout. Conclusions: Exchange characteristics differed significantly across healthcare professionals by training pathway, region, hospital grade, employment status, gender, age, and education. To strengthen interprofessional collaboration, efforts should focus on optimizing training models, enhancing early-career professional education, improving remuneration systems, and clarifying role boundaries.
Background/Objective: The H-HT represents a critical vulnerability for patient–family caregiver dyads. This study developed and content-validated a middle-range nursing theory, the Adaptarte Model, designed to guide dyadic adaptation during the H-HT within the Latin American healthcare context. Methods: A sequential exploratory multimethod design was executed in two phases. Phase 1 integrated three evidence streams: clinical practice insights, a JBI-guided scoping review, and two focus groups with transitional care professionals. Qualitative content analysis and iterative consensus refined the model’s core concepts, assumptions, and propositions. Phase 2 evaluated the model’s content, structure, functionality, and projection using an international panel of eleven Latin American experts meeting strict eligibility criteria. Data were analyzed using Lawshe’s Content Validity Ratio (CVR) modified by Tristán (cutoff = 0.58) and the overall Content Validity Index (CVI). Reporting followed PRISMA-ScR and GRAMMS guidelines. Results: Expert consensus confirmed the essential model components. Item-level CVR values ranged from 0.90 to 0.99, yielding an overall CVI of 0.96, while external functionality and conceptual projection achieved an average rating of 0.88. Conclusions: The Adaptarte Model demonstrates high content validity and structural clarity, establishing a rigorous theoretical foundation for subsequent empirical research. Rather than being ready for immediate clinical implementation, it provides a structured blueprint for prospective protocol development. Systematic empirical testing and longitudinal studies are now imperative to evaluate its clinical utility and drive future healthcare transformations. The scoping review protocol was prospectively registered on the Open Science Framework (OSF) URL (accessed on 23 September 2024).
Background/Objectives: Medical secretaries, who serve as patients’ first point of contact and are frequently exposed to stress arising from illness, waiting, and the hospital environment, remain under-examined in health-workforce research. Previous studies have positioned emotional intelligence in different roles within job-attitude and performance models, including as an antecedent of job satisfaction. Because cross-sectional self-report data cannot establish temporal ordering or causal mediation, the present study examined whether emotional intelligence statistically accounts for part of the cross-sectional association between medical secretaries’ job satisfaction and self-reported job performance. Methods: A cross-sectional study was conducted with medical secretaries from two public hospitals in Bitlis Province, Türkiye (April–May 2025). Of 176 eligible employees invited, 134 complete questionnaires were analyzed (response rate: 76.1%). Emotional intelligence was assessed with the Wong and Law Emotional Intelligence Scale, job satisfaction with the five-item short form of the Brayfield–Rothe scale, and self-reported job performance with a four-item scale. Group comparisons, Pearson correlations, linear regression, a 10,000-resample bootstrap indirect-association analysis, a reverse-model sensitivity analysis, and a Harman single-factor diagnostic were performed. Results: Job satisfaction was positively associated with self-reported job performance (r = 0.275; p = 0.001) and emotional intelligence (r = 0.341; p < 0.001), while emotional intelligence showed a stronger association with performance (r = 0.539; p < 0.001). The conditional direct association of job satisfaction with performance was not statistically significant after emotional intelligence entered the model (β = 0.103; p = 0.187); the cross-sectional indirect association through emotional intelligence was 0.114 (95% bootstrap CI: 0.042–0.204). Explained variance increased from 7.6% to 30.0%, leaving 70.0% unexplained. In the reverse specification (emotional intelligence → job satisfaction → performance), the indirect association was not statistically supported (ab = 0.009; 95% bootstrap CI: −0.005 to 0.025). Harman’s first unrotated component accounted for 38.7% of item variance. Conclusions: Emotional intelligence accounted statistically for a meaningful but incomplete portion of the job satisfaction–performance association in this sample. The results are compatible with the proposed indirect pathway but do not establish temporal order or causality. Replication using longitudinal designs, multiple data sources, objective performance indicators, and additional occupational factors such as emotional labor, burnout, workload, and organizational support is warranted.
Background: Hypertension requires lifelong antihypertensive medication to reduce cardiovascular risk. While most studies have focused on individual determinants of adherence, the role of perceived environmental and social characteristics remains unclear. This study examined the associations of depressive symptoms, satisfaction with the community environment, social participation, and social contact with antihypertensive medication non-adherence among older adults with hypertension in South Korea. Methods: A cross-sectional secondary analysis was conducted using the 2023 Korea Community Health Survey, including 44,822 adults aged 65 years and older with physician-diagnosed hypertension who were currently taking antihypertensive medication. Medication non-adherence was defined as taking medication on fewer than 24 of the previous 30 days, and associated factors were identified using complex sample multivariable logistic regression. Results: The prevalence of medication non-adherence was 0.4%. Higher satisfaction with the community environment was associated with lower odds of medication non-adherence (OR = 0.83, 95% CI = 0.72–0.95), whereas greater social participation was associated with higher odds (OR = 1.39, 95% CI = 1.09–1.78). Social contact, depressive symptoms, and the remaining characteristics were not significantly associated with medication non-adherence. Conclusions: Antihypertensive medication non-adherence among older adults is associated with perceived environmental characteristics as well as individual factors. Whether community-based approaches addressing these conditions can improve medication adherence requires evaluation in longitudinal or interventional studies.
Objectives: Multimorbidity is a growing global health challenge, yet the role of mind–body therapies in addressing its complex health burdens remains insufficiently characterised. This study aimed to map the research landscape and clinical evidence structure of mind–body therapies for multimorbidity. Methods: Bibliometric analysis integrated with evidence mapping was conducted using English-language publications indexed in the Web of Science Core Collection, PubMed, and Embase from January 2004 to July 2026. CiteSpace and R were used to construct knowledge networks, visualise temporal, geographical, collaborative, and thematic patterns, and generate evidence maps. Clinical studies were coded according to intervention type, comparator, comorbidity pattern, outcome domain, and reported outcome direction. Results: Of 6441 records identified, 119 publications were retained for bibliometric analysis and 77 clinical studies for evidence mapping. Publication activity increased after 2017 but remained geographically concentrated, with limited international collaboration. Keyword, clustering, timeline, and co-citation analyses showed sustained research attention to chronic pain, post-traumatic stress disorder, substance use disorders, anxiety disorders, mindfulness-based approaches, and biofeedback or neurofeedback. The evidence map covered 53 condition combinations, most of which were represented by only one clinical study. Mindfulness-based interventions were the most frequently studied approach (31.2%), followed by multicomponent mind–body interventions. Randomised controlled designs represented only a minority of the clinical evidence, and many studies had no comparator. Psychological outcomes and clinical symptoms were commonly assessed, although outcome categories were not mutually exclusive and findings varied across studies. Conclusions: Research on mind–body therapies for multimorbidity is expanding, but the evidence remains heterogeneous across condition combinations, interventions, comparators, and outcomes. Publication frequency and bibliometric prominence do not establish comparative effectiveness. Future studies should include broader condition combinations, use robust comparative designs, and report standardised outcomes and safety data.
Background/Objectives: The increasing integration of artificial intelligence (AI) into assistive technologies challenges evaluation models traditionally centred on usability, satisfaction and device-related outcomes. Because AI-enabled systems are probabilistic, data-dependent and adaptive, their evaluation must also address algorithmic behaviour, user agency and consequences in everyday life. This critical review aimed to identify and compare standardised instruments, frameworks and structured procedures for evaluating AI-enabled assistive technologies and to determine the extent to which they connect AI-specific properties with the goals of persons with disabilities, activities, participation and environmental conditions. Methods: MEDLINE/PubMed, Scopus and IEEE Xplore were searched without publication-date restrictions, with final searches completed on 30 June 2026 and complemented by backward and forward citation searching. Data were extracted on approach type, purpose, stage of application, target populations and technologies, methodological evidence, evaluated dimensions and outcomes. Evidence was classified as documented, partially documented, not documented or not applicable, while dimensional coverage was coded as explicit, partial or absent. Results: Of the 2299 records screened by title and abstract, 478 publications underwent full-text assessment and 45 were retained in the documentary corpus. These publications supported 16 evaluation approaches: four frameworks, three structured procedures and nine measurement instruments published between 2001 and 2026. The person-related dimension was explicitly operationalised in 15 approaches and activity in nine, whereas participation was explicit in only one and environmental factors in six. AI-specific properties were explicitly evaluated in three approaches, and everyday-life outcomes over time in two. Among the approaches included in this review, none combined comprehensive coverage of person, activity, participation and environment with AI-specific evaluation and longitudinal monitoring. Conclusions: Evaluation remains fragmented across assistive technology, human–computer interaction, human–robot interaction and AI assessment traditions. The review proposes assistive validity as a higher-order criterion linking technical performance, agency and meaningful outcomes for persons with disabilities. It also identifies a modular and longitudinal evaluation architecture as a priority for future empirical development and validation.
Background/Objectives: Mindfulness-based interventions (MBIs) have gained increasing attention in sport psychology due to their potential to enhance psychological well-being and performance-related outcomes among athletes. Despite various systematic reviews and meta-analyses examining mindfulness in athletic contexts, broader scoping evidence mapping randomised controlled trials (RCTs) of MBIs targeting psychological well-being among athletes remains limited. This scoping review aims to map and synthesise empirical evidence from RCTs examining MBIs and psychological outcomes among athletes, identify methodological and conceptual gaps, and guide future systematic reviews and meta-analytic investigations. Methods: The review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews and was reported according to the PRISMA-ScR guidelines. Searches were conducted across Scopus, Web of Science, and PubMed, initially in March 2026 and updated in April 2026. Data were extracted on study characteristics, participant demographics, intervention features, comparator conditions, outcome measures, and key findings. Results: A total of 17 studies met the inclusion criteria and were included in the review. The included studies generally reported beneficial effects of MBIs across psychological well-being, emotion regulation, cognitive functioning, and sport-related psychological outcomes among athletes. Beneficial effects were reported for several outcomes, including mindfulness, mental toughness, emotional intelligence, mental well-being, flow state, self-compassion, psychological flexibility, emotional regulation, attention, life satisfaction, and grit. Reductions in psychological distress, particularly anxiety and stress, were also reported in several studies, although findings for anxiety were not consistent across trials. Findings were mixed for some other outcomes, including self-esteem, acceptance, and depression. Improvements were additionally reported in social relationships, pleasure regulation, and overall psychological functioning. Conclusions: The findings suggest that MBIs may offer beneficial effects across multiple dimensions of psychological functioning among athletes, although effects were not uniform across outcomes or interventions. These findings indicate the potential utility of structured MBI programmes within athlete support settings, particularly when delivered by or in collaboration with sport psychologists and mental performance consultants, while highlighting the need for further well-designed RCTs to clarify intervention-specific effects and longer-term outcomes.
Background/Objectives: Digital inequalities are increasingly recognized as a health-equity issue, yet self-reported practical digital competence and psychosocial well-being among adults with severe disabilities remain understudied. This study examined their cross-sectional association and indirect associations through perceived self-determination in daily life and subjective social isolation in a parallel model. Methods: Cross-sectional data from 1519 adults in a 2023 Seoul survey were analyzed. Self-reported practical digital competence was assessed with six task-ability items, perceived self-determination in daily life with one item, and subjective social isolation with two items. Adjusted product-of-coefficients models used 2000 bootstrap replications to calculate bias-corrected confidence intervals. Results: Self-reported practical digital competence was positively associated with psychosocial well-being (b = 0.085, p < 0.001). The indirect association through perceived self-determination in daily life was significant in the main analysis (estimate = 0.076, BC 95% CI [0.050, 0.106]) and remained significant across all sensitivity analyses. Self-reported practical digital competence was not significantly associated with subjective social isolation (b = −0.026, p = 0.203), and the corresponding indirect association was nonsignificant (estimate = 0.006, BC 95% CI [−0.003, 0.016]) and inconsistent across specifications. The direct association was near zero and nonsignificant after both psychosocial variables were included. Conclusions: The indirect association through perceived self-determination in daily life was consistent across analyses, but this single-item measure should be interpreted as a narrow indicator of perceived autonomy or control rather than the broader multidimensional construct of self-determination. Evidence for subjective social isolation was limited and specification-sensitive, and simultaneous measurement precludes temporal or causal interpretation. Digital inclusion efforts may benefit from combining practical digital skills with opportunities to support meaningful goals and everyday choices. Broader relational and environmental supports may also be needed for subjective social disconnection, and longitudinal and intervention research is warranted.
Background: Growth standards and growth references serve different purposes. The WHO Child Growth Standards for ages 0–5 years describe growth under specified optimal conditions, whereas the WHO 5–19-year curves are a reference reconstructed from historical NCHS data. This study aimed to develop sex-specific growth reference curves for Jordanian children and adolescents and compare selected centiles descriptively with WHO growth standards and references. Methods: Retrospective anthropometric records collected between 2019 and 2025 through the Ministry of Health’s Hakeem National E-Health Program were used. Following medical eligibility screening, 63,187 measurement records were selected before analytical cleaning using proportionate stratified random sampling by sex and governorate, with age balancing across four broad age groups. Analytical cleaning excluded 506 boys’ and 1084 girls’ records, producing a final height-for-age and BMI-for-age sample of 61,597 measurement occasions from 33,170 Jordanian children and adolescents (27,933 occasions from 14,594 boys and 33,664 occasions from 18,576 girls). Weight-for-age used 16,071 occasions from 9537 boys and 16,185 occasions from 10,214 girls aged 2–10 years. LMS/BCPE-based centile modeling was conducted within GAMLSS, and the 3rd, 15th, 50th, 85th, and 97th centiles were compared with WHO values. Results: Separate sex-specific models were developed, and the Jordanian curves differed descriptively from WHO curves at several ages and centiles. Conclusions: The population-proportionately stratified Jordanian curves provide direct local context for describing attained anthropometric distributions. Future studies should compare both the Jordanian and WHO curves against Jordan-specific outcomes and classification decisions to determine their respective clinical roles.
Cardiovascular diseases remain the leading cause of global mortality, yet conventional diagnostics are episodic and clinic-centered, missing the dynamic physiological events that unfold between encounters. Wearable devices offer continuous, real-world monitoring and, together with artificial intelligence, digital biomarkers, and telecardiology, increasingly support a shift toward predictive, preventive, personalized, and participatory (P4) cardiovascular care. This narrative review synthesizes the contemporary evidence base for wearable cardiovascular technology and organizes it around the four pillars of P4 medicine, with the explicit aim of distinguishing what is clinically proven from what remains aspirational. The wearable ecosystem now spans consumer smartwatches, medical-grade ECG patches, smart textiles, and emerging soft bioelectronics, generating an expanding repertoire of digital biomarkers. Evidence is strongest where validation is most mature: atrial fibrillation screening, supported by large-scale studies, and structured heart-failure telemonitoring, associated with reductions in heart-failure hospitalization of 18–32% in structured programs. For acute coronary syndrome triage, cuffless blood pressure, cardiac rehabilitation, and AI-derived prognostic markers, the supporting evidence is growing but rests largely on analytical and early clinical validation rather than on demonstrated improvements in hard cardiovascular outcomes. Across all four pillars, translation is constrained by accuracy variability across demographic subgroups, regulatory fragmentation, data privacy concerns, interoperability deficits, and inequitable access for elderly, low-income, and low- and middle-income populations. Realizing the P4 promise will require harmonized validation standards, demographic-stratified accuracy reporting, equitable access strategies, and a clinical infrastructure capable of converting continuous wearable data into actionable decisions.
Background: Pressure injuries are a major patient safety concern, particularly among hospitalized patients at high risk. Identifying factors associated with pressure injuries is essential for effective prevention. Therefore, this study aimed to identify factors associated with pressure injuries among high-risk hospitalized patients. Methods: A case–control study was conducted among 80 inpatients, including 40 with hospital-acquired pressure injuries (HAPIs) and 40 without HAPIs, admitted to the Department of Medicine, Mahasarakham Hospital, between April 2023 and December 2025. Data were obtained from medical records and structured data collection forms. Descriptive statistics and bivariable analyses using chi-square or Fisher’s exact tests were performed. Variables with p < 0.25 were considered for multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: Patients with HAPIs had higher proportions of edema, incontinence, hypoalbuminemia, and nil per os (NPO) status. Bivariable analysis identified associations with Braden score ≤17, impaired level of consciousness, mechanical ventilation, inotropic/vasopressor use, physical restraint, edema, incontinence, low serum albumin, and NPO status (p < 0.05). In the final multivariable model, endocrine and metabolic diseases (AOR = 25.92; 95% CI: 1.06–633.10; p = 0.046), mechanical ventilator use (AOR = 104.79; 95% CI: 11.78–932.05; p < 0.001), inotropic/vasopressor use (AOR = 17.26; 95% CI: 1.15–258.41; p = 0.039), and diarrhea (AOR = 24.34; 95% CI: 1.88–315.36; p = 0.015) were statistically associated with HAPIs. Cardiovascular diseases showed a borderline association (AOR = 18.78; 95% CI: 1.00–354.36; p = 0.050), while physical restraint was not statistically significant (AOR = 5.40; 95% CI: 0.80–36.66; p = 0.084). Conclusions: Several clinical factors were associated with HAPIs. However, large AORs and wide CIs indicate substantial uncertainty in the magnitude of these associations. Findings should be interpreted cautiously and confirmed in larger prospective studies. Prevention should emphasize early risk identification, management of critically ill patients, and appropriate moisture and pressure injury prevention.
Background/Objectives: Healthcare service quality is a critical dimension of patient safety and operational performance. Traditional assessment approaches are often limited in their ability to support prediction, which has increased interest in machine learning (ML) models. This systematic review assessed the effectiveness of ML algorithms in predicting healthcare service quality metrics, with emphasis on their applications, comparative performance and implementation challenges. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Scopus, CINAHL, and ScienceDirect for studies published between 1 January 2020 and 30 July 2025. Following title/abstract screening and full-text review, 49 studies were included. Studies were grouped into conventional/ensemble ML and deep learning categories based on the primary model class analyzed in each article. Results: The reviewed studies focused mainly on acute clinical and operational outcomes, especially length of stay (27.0%), mortality (23.0%), and readmission rates (18.0%), while subjective, patient-centered metrics received less attention. Conventional and ensemble ML models, particularly RF and XGBoost, were frequently reported, while deep learning models were used in more complex prediction tasks. Conclusions: The evidence suggests that well-validated and interpretable ML models can support healthcare quality prediction. However, important challenges remain regarding implementation, validation, generalizability, and data heterogeneity.
Background/Objectives: Sleep-related problems are common among university students and are linked to adverse academic and health outcomes. This study evaluated the association between lifestyle medicine adherence and sleep-related problems among first-year Ecuadorian university students. Methods: A cross-sectional study was conducted in Quito, Ecuador, during the 2024–2025 academic year. First-year undergraduate students aged 16–35 years were recruited through a census-based, non-probability strategy (N = 2007). Lifestyle medicine adherence was assessed using the Short Multidimensional Inventory Lifestyle Evaluation for University Students (U-SMILE), and sleep-related problems were defined using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 1 Cross-Cutting Symptom Measure sleep domain (score ≥ 2), a symptom screen that is conceptually related to, but not identical with, the U-SMILE sleep quality domain. Multivariable binary logistic regression models were used and adjusted for sociodemographic and health-related covariates. A post-hoc sensitivity analysis recomputed the global U-SMILE score after excluding the sleep quality domain. Results: The median age was 18.0 years, and 51.0% were female. Among participants with Level 1 sleep data (n = 1906), 47.8% were classified as having sleep-related problems. In the fully adjusted model (n = 1893), higher overall U-SMILE scores were associated with lower odds of sleep-related problems (odds ratio (OR) per 1 point = 0.93, 95% Confidence Interval (CI): 0.91–0.94; OR per 1 SD = 0.56, 95% CI: 0.50–0.62). In a post-hoc sensitivity analysis, this association persisted after excluding the sleep quality domain from the global score (OR per 1 point = 0.94, 95% CI: 0.93–0.95; OR per 1 SD = 0.66, 95% CI: 0.60–0.73). Among non-sleep domains, the strongest associations were avoidance of substance use (OR = 0.87), social relationships (OR = 0.90), and nutrition (OR = 0.90); physical activity, nature engagement, and stress management were also significant. Conclusions: Higher lifestyle medicine adherence was associated with lower odds of sleep-related problems, including in post-hoc analyses when the sleep domain was omitted from the U-SMILE total. These findings support multidimensional lifestyle medicine approaches for sleep health promotion in university settings.
Background/Objectives: Digital pathology is transforming diagnostic workflows through whole-slide imaging (WSI), digital archiving, artificial intelligence (AI)-assisted analysis, and remote consultation. The existing literature only partly addresses patient access to pathology records and cross-institutional sharing within a holistic governance framework. This study proposes a Self-Sovereign Identity (SSI)-based conceptual governance model that treats digital pathology archives as components of long-term clinical memory. Here, clinical memory refers to a pathology-specific information layer that preserves record context, provenance, integrity, and longitudinal links across time and institutions while supporting governed reuse and legally bounded patient-managed access. Methods: Eighty publicly available complaints from the Şikayetvar platform were examined using codebook-based thematic content analysis. Aggregated National Health Service (NHS) Written Complaints data were used to provide an illustrative external governance context. These data were not used for cross-country prevalence comparison or corroboration. Results: The main complaint themes were absent or inaccessible pathology results (66.3%) and records that remained unavailable despite notifications that the results were ready (55.0%). Complaint themes, the literature, regulatory sources, technical standards, and internal clinical review were synthesized while preserving different analytical functions, and 11 governance requirements were identified. Conclusions: Developed through Design Science Research, the model integrates verifiable credentials (VCs), a patient digital wallet, purpose- and time-limited authorization, dynamic consent and access revocation, secure off-chain storage, and blockchain-based integrity and auditing. The model was examined through an internal requirement-coverage assessment and a supplementary post hoc benchmark-oriented assessment. These analyses indicate conceptual consistency rather than independent validation. Real-world technical, clinical, usability, security, and equity validation remains necessary.
Background: Dual-method menstrual hygiene use, defined as the use of both modern menstrual hygiene products (e.g., sanitary pads) and traditional materials (e.g., cloth), remains under-researched among young women in India. While socioeconomic factors are associated with menstrual practices, religious affiliation may also be associated with differences in reported material use. This study examined the association between religious affiliation and dual-method use among women aged 15–24 years using nationally representative survey data supplemented by contextual evidence from the qualitative and contextual literature. Methods: Quantitative analysis used nationally representative National Family Health Survey-V (NFHS-V, 2019–21) data for 240,230 women aged 15–24 years. Survey-weighted bivariate and multivariable logistic regression analyses estimated the prevalence and adjusted odds of reported dual-method use across sociodemographic and religious groups. Seven purposively selected qualitative and contextual sources were used to provide contextual insights into the quantitative findings. Results: Muslim women had the highest prevalence of reported dual-method use (31.7%), compared with 27.5% among Hindu women and 21.6% among other religious groups. The association between religious affiliation and dual-method use was also observed across several demographic subgroups. Among women with improved toilet facilities, dual-method use was higher among Muslim women than Hindu women (32.3% vs. 27.0%). Similarly, among women with higher education, prevalence was 30.1% among Muslim women compared with 23.3% among Hindu women. After adjustment for measured sociodemographic, socioeconomic, structural, and regional characteristics, Muslim women had 36% higher odds of reported dual-method use than Hindu women (AOR 1.36, 95% CI: 1.29–1.43; p < 0.001). The qualitative and contextual literature provided contextual insights into the potential roles of privacy, household expectations, and disposal concerns in menstrual material use. However, NFHS-V cannot establish whether materials were used concurrently or sequentially or identify the specific contexts of use. Conclusions: Religious affiliation was associated with dual-method menstrual hygiene use after adjustment for socioeconomic and demographic characteristics. The findings indicate that menstrual health interventions should address socioeconomic barriers alongside the social and cultural contexts in which menstrual practices occur. Community-informed approaches incorporating privacy, disposal, household norms, and infrastructure may complement product provision and contribute to more equitable menstrual health outcomes.
