Background Healthcare accreditation is widely adopted to improve quality and strengthen institutional credibility. Although research has examined its associations with organisational processes and clinical outcomes, the internal structure of accreditation decisions remains poorly understood. Specifically, the scoring, weighting, and aggregation processes that transform standards compliance into certification results have received limited analytical attention. This scoping review maps the extent to which the published literature addresses accreditation scoring architecture, transparency, and signalling functions in hospital and health service accreditation systems. Methods Scoping review was performed in line with PRISMA-ScR. The searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, and CINAHL using the English-language publications published between January 2000 and March 2026. Sources that were considered eligible were empirical studies, reviews, governance analysis, theoretical papers, and accreditation program documents. The data were obtained through a systematic framework and synthesized in three domains i.e., scoring and weighting mechanisms, transparency and methodological validity as well as market signalling. Results Of 2,968 records identified, 27 sources met the eligibility criteria. The majority (85%) defined accreditation as a standards-based compliance intervention focused on organisational outcomes. Ninety-three percent acknowledged methodological limitations in causal inference. Among the included sources, no published evidence was identified that directly examined weighting schemes, score aggregation, threshold logic, or composite score construction. Only six studies addressed transparency beyond binary certification status, and three considered equity implications. Despite 70% of sources describing accreditation as a reputational or legitimacy signal, empirical analysis of the underlying measurement architecture was absent across the entire corpus. Conclusions Accreditation research has emphasised outcome measurement while neglecting the internal scoring and measurement systems that generate certification decisions. Within the published literature reviewed, the weighting and aggregation mechanisms that shape institutional incentives have received limited analytical attention and remain largely undisclosed in publicly accessible sources. Greater transparency in scoring design and weighting logic is essential, particularly as accreditation becomes more deeply embedded in regulatory, reimbursement, and public reporting frameworks.
Objective Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome with cytokine storm-mediated multiorgan damage. Although serous effusions are frequent complications, the prognostic significance of peritoneal effusion in secondary HLH (sHLH) remains undefined. This study aimed to determine the incidence, clinical and immunological correlates, and prognostic value of peritoneal effusion in sHLH patients. Methods We retrospectively analyzed 107 adult patients diagnosed with sHLH at the Second Affiliated Hospital of Anhui Medical University between March 2013 and March 2023. Peritoneal effusion was diagnosed based on abdominal ultrasound, computed tomography, or positron emission tomography–computed tomography at initial presentation. Clinical characteristics, laboratory parameters, and lymphocyte subset profiles were compared between patients with and without peritoneal effusion. Logistic regression was used to identify risk factors for peritoneal effusion. Overall survival (OS) was estimated using the Kaplan–Meier method, and independent prognostic factors were assessed using multivariate Cox regression analysis. Results Peritoneal effusion was found in 24/107 (22.4%) sHLH patients and was associated with lower white blood cell, lymphocyte, monocyte, and platelet counts. Lower monocyte counts, higher direct bilirubin, and distinct immune dysregulation (reduced CD4+ T cells, higher NK cell percentages) were identified as risk factors for peritoneal effusion. Peritoneal effusion correlated with concurrent serous effusions (p < 0.05) and markedly shorter median survival (19 vs. 103 days, p = 0.002). Multivariate analysis identified peritoneal effusion as an independent mortality predictor (HR=1.88; 95% CI 1.09-3.24, p = 0.023). Conclusions Peritoneal effusion is an independent predictor of mortality in sHLH patients and is associated with a distinct immune profile. Its presence should alert clinicians to a higher risk of death and prompt early, aggressive therapeutic intervention.
Background Chronic kidney disease (CKD) is associated with increased fracture risk not fully explained by reduced bone mineral density. CKD–mineral and bone disorder (CKD-MBD), involving abnormalities in bone turnover, mineralization, and microarchitecture, contributes to skeletal fragility. However, the relationship between routine biochemical markers and semi-quantitative bone histomorphometry remains inadequately defined, particularly in resource-limited settings and the Indian population. The objective of this study was to compare biochemical markers and semi-quantitative bone histomorphometric findings in CKD patients with and without fractures. Methods In this hospital-based comparative cross-sectional study, 48 patients with CKD stage 3–4 were divided into fracture (n = 24) and non-fracture groups (n = 24). Serum calcium, 25-hydroxyvitamin D, parathyroid hormone (PTH), and alkaline phosphatase (ALP) were measured. Bone samples were obtained intraoperatively or via transiliac crest biopsy. Semi-quantitative bone histomorphometry was assessed by a pathologist. Statistical analysis included appropriate group comparisons. Results Fracture patients had significantly lower vitamin D (p = 0.007) and calcium (p = 0.005), and higher PTH (p = 0.002) and ALP (p = 0.001). Semi-quantitative histomorphometric evaluation showed increased osteoid volume, reduced trabecular thickness, and elevated osteoblastic and osteoclastic activity. Conclusion In our study cohort, CKD patients with fractures exhibited a high-turnover bone phenotype with increased osteoid volume and altered bone histology. Biochemical markers may serve as cost-effective adjuncts for fracture risk stratification, particularly where advanced diagnostics are limited. Findings should be interpreted cautiously given the cross-sectional design and small sample size.
Background Balanced crystalloids are preferentially recommended over saline for sepsis resuscitation; however, the optimal timing of administration remains to be defined. Methods This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to analyze adult patients meeting Sepsis-3 criteria. Patients were stratified by Lactated Ringer’s (LR) administration timing relative to documented Sepsis-3 onset: Group A (LR initiation ≤24 h after onset), Group B (LR initiation ≤24 h before onset), Group C (LR initiation 24-48 h after onset), and Group D (reference: no LR exposure during intensive care unit [ICU] admission). The primary outcome was 28-day all-cause mortality. To address confounding, Group B patients were 1:1 Propensity-Score Matched (PSM) with Group D counterparts, followed by multivariable Cox regression and sensitivity analyses. Results PSM generated a balanced cohort of 3,876 patients (1,938 in Group B vs. 1,938 untreated Group D counterparts). Multivariable Cox regression analysis showed that pre-onset LR exposure remained associated with lower 28-day mortality after adjustment for clinical covariates. In additional post-PSM sensitivity analyses, this association persisted after further adjustment for elective surgery and total recorded fluid volume during the 24 hours preceding Sepsis-3 onset. To address timing-related bias, we also compared the ICU admission-to-SOFA time interval and performed a 24-hour ICU-admission landmark analysis; the association remained in the landmark cohort. Kidney outcomes were mixed: any acute kidney injury (AKI) was more frequent in Group B, whereas Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 AKI and renal replacement therapy were less frequent. Conclusion Pre-diagnosis LR exposure within 24 hours before Sepsis-3 onset was associated with lower 28-day mortality in adult patients with sepsis. These observational findings are hypothesis-generating and should not be interpreted as evidence supporting prophylactic LR administration before Sepsis-3 onset.
Purpose Obesity contributes to immune system dysregulation, thereby increasing the risk of developing numerous diseases. Dietary capsaicin (CAP) has been demonstrated to mitigate obesity, while its impact on B cell immunity during obesity remains unexplored. This study aimed to investigate the restorative effect of CAP on B cells deficiency in obese mice, and explore the underlying mechanisms. Methods C57BL/6J mice were fed a standard chow diet or a high-fat diet (HFD), and HFD-fed mice were orally administered CAP. Flow cytometry was employed to evaluate the effect of CAP on B cell function in HFD mice. RNA-seq, RT-qPCR, etc, were utilized to elucidate the underlying mechanisms. Results CAP not only ameliorated HFD-induced metabolic abnormalities, but also reversed the HFD-associated reduction in the population of intestinal germinal center (GC) and IgA + B cells. Consequently, CAP treatment rescued the impaired response to the T cell-dependent antigen in HFD-fed mice. Mechanistically, our results indicate that the effects of CAP are correlated with the upregulation of CXCL12/CXCR4, a pathway critically involved in GC B cell migration. Conclusions CAP alleviates insulin resistance and restores the impaired GC B cell in obese mice. These findings highlight a mechanism underlying the anti-obesity effect of CAP and lay a foundation for its clinical translation.
Background:Cytomegalovirus (CMV) is one of the commoner infections of childhood and the leading non-genetic cause of sensorineural hearing loss. Diagnosis in children is not straightforward. Serology is hard to interpret in early life and viral culture is slow and often insensitive, and neither method suits testing at scale. CMV detection using PCR is easier, but sample type, format, and age affect accuracy. We reviewed how well PCR-based CMV testing performs in neonates and children, and how much the available studies differ from one another. Methods:The Cochrane Library, Web of Science, Scopus and PubMed were searched for English-language reports published between January 2000 and February 2025. Studies were eligible if they reported PCR-based CMV detection in saliva, urine, dried blood spots, whole blood, plasma, serum or amniotic fluid; accuracy was then compared across these specimen types. Quality was assessed with QUADAS-2. Pooled sensitivity, specificity and false-positive rate came from random-effects and bivariate Reitsma models, and further analyses were run by specimen type, age group and test format. Results:We identified 52 studies examining PCR-based CMV detection from neonates to 18 years of age. We analyzed diagnostic accuracy, specimen type performance, prevalence, PCR techniques, geographical distribution, and risk of bias using QUADAS-2. Seven 2×2 tables drawn from five publications, representing four independent research programmes, yielded a pooled sensitivity of 0.898 (95% CI: 0.489-0.988) and a pooled specificity of 0.998 (95% CI: 0.975-1.000), with an area under the summary ROC curve of 0.991. Results for saliva were the most consistent (sensitivity 0.974-1.000). Dried blood spots varied much more, from 0.283 under universal newborn screening to 0.953 where testing was directed at high-risk neonates. Between-study heterogeneity was substantial overall (I2 94.2% for sensitivity and 98.7% for specificity) but was concentrated in dried blood spots and universal screening; saliva-based and targeted testing subgroups were homogeneous (I2 0%). For pooled CMV positivity, heterogeneity reached 99.5%. Patient selection and interpretation of the index test were the weakest QUADAS-2 domains. Conclusion:Real-time PCR on saliva or urine appears accurate enough to be useful in neonatal CMV screening. The pooled estimates should still be read cautiously, given how much the studies differed and the lower sensitivity recorded for dried blood spots.
Background This study aimed to evaluate the association between time-of-day differences in blood lipids and acute kidney injury (AKI) in critically ill patients. Methods This study enrolled 3,227 ICU patients. AKI was defined according to the KDIGO 2012 criteria. Cox regression, restricted cubic splines, Kaplan-Meier analysis, and stratified interaction analysis were used to assess the association between daytime/nighttime levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides and AKI. Results Each 1 mg/dL increase in HDL-C was associated with a 0.5% decrease in AKI risk [HR 0.995, 95% CI 0.993–0.998, P < 0.001]. Each 1 mg/dL increase in triglyceride was associated with a 0.1% increase in AKI risk [HR 1.001, 95% CI 1.000–1.001, P = 0.004]. LDL-C exhibited an L-shaped nonlinear relationship with AKI. At or below 47 mg/dL (daytime), 58 mg/dL (nighttime), and 48 mg/dL (overall), lower LDL-C was associated with higher AKI risk, whereas above these thresholds, LDL-C was no longer associated with AKI risk [daytime: HR 0.977, 95% CI 0.964–0.991, P < 0.001; nighttime: HR 0.992, 95% CI 0.985–0.998, P = 0.009; overall: HR 0.987, 95% CI 0.980–0.994, P < 0.001]. Conclusion Higher HDL-C levels were consistently associated with lower AKI incidence within 28 days after ICU admission. Higher nighttime and overall triglyceride levels were associated with higher AKI incidence. An L-shaped nonlinear relationship was observed between LDL-C and AKI risk, with thresholds at 47 mg/dL (daytime), 58 mg/dL (nighttime), and 48 mg/dL (overall). These findings highlight a complex relationship between lipid metabolism and renal outcomes in critically ill patients and warrant confirmation through prospective studies.
Objective Neuraminidase inhibitors (NAIs) are widely used empirically in critically ill patients with suspected influenza; however, their effect on mortality remains uncertain. This multicenter study evaluates the association between empirical treatment with oseltamivir and the outcome of critically ill patients with Severe Acute Respiratory Infection (SARI) admitted to the Intensive Care Unit (ICU). Methods This was a retrospective cohort study conducted in the ICUs of four hospitals in Saudi Arabia, involving adult patients with SARI from September 2012 to December 2018. Data collected were: demographics, comorbidities, clinical presentation, and outcomes among patients treated with oseltamivir and those who were not. The primary outcome was 90-day mortality. The association of oseltamivir and mortality was evaluated adjusting for propensity score. Results During the study period, 456 patients with SARI were included in the study, 301 were treated with empirical oseltamivir within a median of 1 day from presentation (interquartile range, 0-1 day) and a median of 4 days after symptom onset, while 155 patients were not. No significant differences were observed in baseline characteristics between the two groups. Of the included patients, 334 (73%) were tested for influenza using PCR, and 87 (26%) had a confirmed diagnosis of influenza. Patients on oseltamivir were less likely to require rescue oxygen therapy (22.9% vs. 34.8%, p=0.007), and had shorter hospital stay (20 days vs. 27 days, p=0.01). Patients treated with oseltamivir had significantly reduced 90-day mortality on adjusted analyses (aOR: 0.87, 95% CI: 0.81-0.94, p=0.0002). Subgroup analysis revealed that the association with reduced mortality extends to patients >70 years old (aOR: 0.94, 95% CI: 0.89-0.99, p=0.02) and those with negative influenza tests (aOR: 0.81, 95% CI: 0.79, 0.84, p<0.0001). Conclusion Among critically ill patients with SARI, empirical treatment with oseltamivir was associated with lower mortality. These results add to the body of evidence suggesting clinical benefits of oseltamivir in managing critically ill patients with influenza-like illnesses.
Objectives:To assess whether co-location of a Primary Stroke Center (PSC) and an Emergency Department (ED) was associated with higher intravenous thrombolysis (IVT) rates after alignment of emergency admission pathways in the Central Denmark Region. Methods:This retrospective before-and-after cohort study compared two 6-month periods before (July 1 to December 31, 2021) and after (July 1 to December 31, 2022) co-location following a hospital merger in February 2022. Patients were identified through the Danish Stroke Center Database and linked with prehospital records. The primary outcome was the proportion of patients with acute ischemic stroke (AIS) treated with IVT. Secondary analyses included stroke mimic admissions and transport subgroups. Absolute risk differences were estimated using linear regression with robust variance estimation, and adjusted analyses used inverse probability weighting. Results:The study included 1,950 patients with suspected stroke: 1,059 before and 891 after co-location. Among 914 patients with AIS, the IVT rate increased by 4.6 percentage points (95% confidence interval [CI] 0.1-9.1), from 12.2% (95% CI 9.2-15.2) before co-location. This increase was driven by EMS-transported patients following emergency calls, in whom the IVT rate increased by 10.2 percentage points (95% CI 0.5-19.9). In this subgroup, median door-to-needle time increased from 26.5 to 40.0 minutes (p=0.003). Stroke mimic admissions decreased from 26.3% to 17.9%. Conclusion:Co-location of the PSC and ED was associated with higher IVT rates, particularly among EMS-transported emergency-call patients, suggesting that alignment of emergency admission pathways and stroke center catchment areas may improve access to time-critical reperfusion therapy.
Introduction The prevalence of diabetes mellitus and its micro vascular and macro vascular complications have been increasing among diabetic patients in Ethiopia. Diabetic nephropathy (DN) is one of the most serious complication of diabetes which leads to end-stage renal disease and other complication of diabetes mellitus. A small number of investigations were carried out in Ethiopia, and the incidence of DN was the main source of data for these studies. Therefore, this study was aimed to estimate time to diabetic nephropathy and its predictors among adult diabetes mellitus patients at public general and referral hospital of South Wollo Zone, Amhara National Regional State, Northeast Ethiopia. Methods Retrospective follow up study was conducted among 408 adult diabetes mellitus patients who were on follow up at public general and referral hospital of South Wollo zone from December 10, 2012 to December 9, 2022. Data were entered into Epidata version 4.6, and then exported to Stata version 14 for further statistical analysis. Kaplan Meier survival curve was used to estimate the cumulative survival time and Log rank test was used to compare the survival time between different categories of the predictor variables. Multivariable Cox proportional hazards model was fitted to identify predictors of time to diabetic nephropathy. Result Overall, 71 (17.4%) of the study participants developed diabetic nephropathy with incidence density of 2.35/1000 person-months (95% CI; 1.86, 2.97) and Median survival time of this study was 98 [95% CI: 95 -105] months. Sex [AHR: 0.293, 95%CI: 0.154, 0.555], hypertension [AHR: 1.81, 95% CI: 1.01, 3.24], HbA1C [AHR: 1.93, 95% CI: 1.069, 3.49] and HDL [AHR: 0.399, 95% CI: 0.225, 0.708] were predictors of time to diabetic nephropathy. Conclusion and recommendation The median survival time of this study was 98 [95% CI: 95 -105] months which was relatively long time compared with previous study. Sex, hypertension, HbA1c and HDL were predictors of time to diabetic nephropathy.
Background & Objectives Carbapenem-resistant Enterobacterales (CRE) pose a critical threat in Intensive Care Units (ICUs) within low- and middle-income countries (LMICs), with prevalence exceeding 20% and mortality reaching 50%. Despite high clinical demand, routine screening remains unstandardized in Vietnam due to resource constraints and a lack of validated tools. This study aimed to develop and validate a psychometric instrument to evaluate healthcare workers’ (HCWs) perspectives across three domains: barriers, feasibility and readiness. Methods A cross-sectional validation study was conducted using total population census sampling (n=97, total front-line staff) across three hospitals in Vietnam (Viet Tiep, Kien Thuy, and Thuy Nguyen). Following expert panel review (S-CVI/Avg = 0.89) and a 10.3% pilot test (n=10), construct validity and reliability were evaluated via Exploratory and Confirmatory Factor Analysis (EFA/CFA). Group differences were analyzed using Fisher’s Exact and Chi-square tests. Results The barriers subscale was excluded due to low internal consistency (alpha < 0.60), yielding a refined 16-item, two-factor instrument (6.1:1 observation-to-item ratio). The final tool demonstrated excellent reliability (alpha: 0.84–0.89). CFA confirmed a robust model fit for the Feasibility and Readiness structure [GFI/CFI = 0.95; RMSEA = 0.062]. HCWs reported high Readiness but moderate Feasibility. Significant occupational divergences emerged: 88.9% of nurses viewed sampling as simple (Item R4) compared to only 45.8% of laboratory technicians (p = 0.003). Furthermore, an experience-perception paradox was identified (p < 0.05); mid-career staff (5–10 years) reported the lowest feasibility scores (50.0% high score) compared to junior and senior cohorts. Conclusion The psychometric validation resulted in a methodologically sound 16-item tool tailored for LMICs. The divergence between clinical readiness and laboratory feasibility highlights critical implementation bottlenecks. Sustainable transition to routine CRE surveillance requires resource-optimized targeted workflows to reduce frontline workloads, alongside peer-led governance that leverages senior expertise to mitigate mid-career burnout.
Introduction Bottle-feeding a baby aged 0-23 months is the act of giving any liquid or semi-solid food from a bottle with a nipple. Bottle feeding can increase their risk of excessive weight gain, malnutrition, iron deficiency, and reduced birth spacing. However, no study has been conducted on geographically weighted regression (GWR) analysis and the factors associated with bottle-feeding practice. Objective To assess the geospatial variation and determinants of bottle-feeding practice among children aged 0-23 months in East Africa using GWR. Methods A total sample of 28,562 children aged 0-23 months were included in the study. Excel 2019, STATA version 17, ArcGIS version 10.7.1, and SaTScan version 10.1 were used to analyze children’s bottle-feeding practice. Spatial autocorrelation, hotspot analysis, interpolation, and spatial scan analysis were performed. Ordinary least squares analysis and geographically weighted regression analysis were employed to assess the association between bottle feeding practice and explanatory variables. Results The magnitude of bottle feeding practice among children aged 0-23 months in East Africa was 13%. Rwanda, Central and Eastern Tanzania, Central and some coastal regions of Madagascar, Southern Kenya, and both Southern and Eastern Mozambique were found to have high hotspots of bottle-feeding practice among children aged 0-23 months The primary clusters were 244, and statistically significant clusters were observed in Madagascar and centered at -20.6258N, 46.6889E, 214.8715 km with an LLR of 155.9459, RR: 2.138. Conclusion This study led to the conclusion that the spatial distribution of child bottle-feeding practice was clustered, and hotspot areas were identified in East Africa. Thus, this study aims to reduce the burden of child bottle-feeding practice in hotspot areas in East African countries. The local authorities and policymakers should focus on providing parental counseling, especially in the regions that are identified as high risk for child bottle-feeding practices.
Introduction Cholangiocarcinoma (CCA) is a highly metastatic bile duct cancer with the highest global incidence in Northeastern Thailand. Most patients are diagnosed at advanced stages, necessitating the identification of novel prognostic markers and therapeutic targets. High mobility group A1 (HMGA1) is a non-histone chromosomal protein that orchestrates the transcription of genes involved in tumor progression, and its overexpression has been implicated in multiple malignancies. Aims: This study aimed to investigate the clinical significance and oncogenic roles of HMGA1 in CCA progression. Methods HMGA1 expression was evaluated in a hamster CCA model and human CCA tissues using immunohistochemistry. The functional effects of HMGA1 on cell growth, migration, and invasion, along with the underlying molecular mechanisms were investigated in vitro using human CCA cell lines. Results HMGA1 upregulation was detected as an early event in the cholangiocarcinogenesis of a hamster model. In the human cohort (n = 81), high HMGA1 expression significantly correlated with histological type ( p =0.014), metastatic stage ( p =0.004) and shorter overall survival ( p =0.024). In vitro , siRNA-mediated suppression of HMGA1 remarkably inhibited cell proliferation. While HMGA1 silencing increased cleaved caspase-3, it resulted in only a modest increase in the apoptotic cells. Instead, this caspase activation was primarily associated with a marked reduction in cell migration and invasion through the modulation of epithelial-mesenchymal transition (EMT) markers, and cytoskeletal remodeling in a cell line-specific manner. Conclusions: These retrospective and preclinical findings suggest that HMGA1 is a critical driver of CCA progression and a valuable prognostic indicator. HMGA1 promotes neoplastic transformation and aggressiveness of CCA. Targeting HMGA1 may serve as a potential therapeutic strategy to attenuate CCA progression, warranting further clinical validation.
Background Childhood obesity is a growing public health crisis in Saudi Arabia, which was intensified by the COVID-19 pandemic. This study mapped the prevalence and trends among clinic-attending children to inform prevention strategies. Methods A retrospective cross-sectional analysis of electronic records for 28,275 Saudi children (aged 2–14 years) attending primary care clinics in Saudi Arabia’s Eastern Province (2018–2024). Body mass index (BMI) was classified according to the Centers for Disease Control criteria (overweight: 85th–95th percentile; obesity: ≥95th percentile), excluding secondary causes. Crude and age-standardized prevalence rates were calculated by age, sex, and year using R software. Results Mean age was 5.46 years (51% female). Overall, obesity prevalence was 12.3% (higher in males: 13.1% vs. 11.5% females), rising from 6.2% (ages 2–3 years) to 23.8% (ages 12–14 years). Overweight prevalence was 10.5% (7.3%–17.2% by age). Both reached their highest observed values in 2020 (obesity: 19.1%; overweight: 14.5%), with year-to-year variation thereafter. Conclusion Age-related increases underscore the obesogenic environments among Saudi youth, with COVID-19 amplifying these risks. Findings highlight the need for resilient, Vision 2030-aligned prevention strategies focusing on early intervention and equity.
Background and aim The 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) is widely used to assess health-related quality of life (HRQoL) in HF patients covering key HF-related health status domains. This study validated the Arabic KCCQ version and looked into potential correlation between patients’ HRQoL and their demographics/clinical characteristics, health literacy, medication adherence/knowledge. Methods This was a multicenter validation study from Jordan including HF adult patients. Cronbach’s alpha coefficient was employed to assess the scale internal consistency. Test-retest reliability evaluated stability of participants’ responses overtime. Construct validity was examined through exploratory factor analysis (EFA), supported by Kaiser-Meyer-Olkin measure and Bartlett’s sphericity test. Model fit was evaluated by confirmatory factor analysis (CFA). Associations between KCCQ scores and patient demographic/clinical characteristics, health literacy, medication adherence/knowledge were analyzed using linear regressions. Results A total of 331 participants were recruited from two centers. KCCQ domains’ scores ranged from mean±SD of 42.90±25.43 for symptom stability to 76.80±30.63 for social limitation. The total symptom, clinical summary and overall summary scores were 70.96±29.13, 74.67±25.67 and 70.67±25.70, respectively. The scale demonstrated excellent internal consistency (Cronbach’s alpha=0.937). Test-retest analysis showed strong significant intraclass correlation coefficients and Pearson’s correlation indicating good reliability. EFA and CFA supported data suitability for factor analysis and good model fit. The multivariate regression showed being married, performing exercise, being adherent to medication and taking fewer medications to significantly correlate to better HRQoL. Conclusion The Arabic KCCQ version is a reliable, valid tool for HRQoL assessment among Arabic-speaking communities. Implementing interventions targeting sedentary HF patients not adherent to treatment regimen can improve HRQoL.
Objective During the COVID-19 pandemic, incarcerated populations faced heightened risk of exposure due to healthcare barriers, restrictive environments, and pre-existing health conditions. Consequently, Correctional Officers (COs) faced increased risk of COVID-19 exposure. Given the health benefits of COVID-19 vaccination and the rise in vaccine hesitancy, this study aims to examine the relationship between COs health beliefs and COVID-19 vaccine uptake. Methods A health beliefs survey was administered to Massachusetts-based COs (n=118). Chi-squared Automatic Interaction Detection (CHAID) modeling and logistic regression were utilized to analyze the survey data. Results COs with higher trust in vaccines and a prior positive COVID-19 test were most likely to get vaccinated voluntarily. Those with low trust in vaccines and no previous positive COVID-19 test were least likely to receive the vaccine. Conclusion Despite the severe impact of COVID-19 in correctional settings, and the evidence of vaccine efficacy against hospitalization and death, vaccine uptake among COs remains low.
Objectives The study aimed to assess the spatial distribution of Health Facility Management Teams (HFMTs) functionality and identify geographic hotspots of non-functionality among Ethiopian health facilities. Methods This cross-sectional study utilized data from the Ethiopian Service Provision Assessment (ESPA) 2021-2022, conducted by the Ethiopian Public Health Institute (EPHI) in collaboration with the Ministry of Health (MoH) and ICF. A total of 1,407 health facilities were included, excluding facilities from the Tigray region. HFMT functionality was assessed using four indicators, and facilities meeting all indicators were classified as functional. Descriptive analyses were performed using STATA version 17. Spatial analyses, including Global Moran’s I, Getis-Ord Gi* hotspot analysis, ordinary Kriging interpolation, and SaTScan cluster detection, were conducted using ArcGIS 10.7.1 and SaTScan software. Results Most health facilities had functional HFMTs. However, significant spatial clustering of non-functional HFMTs was observed (Moran’s I = 0.098, p = 0.000024), indicating a non-random geographic distribution. Hotspot analysis identified western, central, and southern Benishangul Gumuz as the primary hotspot areas, with additional hotspots in parts of Afar, Harari, Somali, and Oromia regions. Kriging interpolation predicted a high probability of HFMT non-functionality in central Benishangul Gumuz and surrounding areas. SaTScan analysis confirmed a significant primary cluster centered in Benishangul Gumuz (RR =17.63, LLR = 12.16, p = 0.0042). Conclusion HFMT functionality in Ethiopia exhibits significant geographic variation. Benishangul Gumuz emerged as the principal hotspot of HFMT non-functionality, highlighting the need for targeted management strengthening interventions in high-risk areas.
Background Empty sella (ES) is characterized by the replacement of pituitary tissue with cerebrospinal fluid (CSF) in the sella turcica. Despite its frequency in clinical settings, ES is often underrecognized and incompletely evaluated. The aim of this study was to examine patterns of care and potential disparities across different ES etiologies. Methods This retrospective cross-sectional study aimed to evaluate differences in hormonal assessment and referral patterns among patients with various etiologies of empty sella. All patients aged ≥14 years diagnosed with ES between February 2021 and December 2022 at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, were included. Relevant data were extracted from electronic medical records, and comparisons of hormonal assessment were made based on etiology and reason for endocrine referral. Results Among 287 patients (75.3% female, mean age 49.7 years), 84.6% had primary ES. Only 29.9% were referred to endocrinology (52.4% for ES-specific evaluation). Secondary ES patients received more comprehensive hormonal assessments than primary ES ( P <0.001). Primary ES referrals for ES-specific evaluation correlated with thorough testing ( P <0.001). Conclusions Significant disparities exist in ES management, driven by etiology and referral intent. Standardized referral pathway and universal screening are essential to improve care.
Introduction:Accurate global statistics on reproductive health challenges within schools are difficult to obtain due to variations in data collection and dissemination across countries. Nevertheless, these issues significantly impact the development and well-being of young people worldwide. Objective:This study assessed the utilization of youth-friendly reproductive health services (YFRHS) and associated factors by secondary school students in Yeka Sub-City, Addis Ababa, Ethiopia. Method:An institution-based cross-sectional survey was conducted from May 20-24, 2024, among 415 randomly selected students from 15 secondary schools in Yeka Sub-City, Addis Ababa, to examine YFRHS utilization. Data were collected using a standardized, self-administered questionnaire and analyzed using SPSS version 27. Binary logistic regression identified factors associated with YFRHS use. Variables with p < 0.25 in the bivariate analyses were included in multivariable logistic regression. Statistical significance was determined at p ≤ 0.05, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) used to evaluate the strength of associations. Results:YFRHS utilization was 18.8% (95% CI: 0.154-0.227). Having a sexual partner (AOR = 3.8; 95% CI: 1.7-8.4), parental communication (AOR = 2.2; 95% CI: 1.20-4.02), proximity to YFRHS facilities (AOR = 5.1; 95% CI: 2.5-10.3), and believing that seeking such services improves youth health (AOR = 4.6; 95% CI: 1.50-14.04) were significantly associated with YFRHS utilization. Conclusion:Approximately one in five school-aged youth utilized YFRHS. Utilization was significantly associated with having a sexual partner, positive perceptions regarding the benefits of seeking services, parental communication, and proximity to YFRHS facilities.
Objective Dexmedetomidine has emerged as an important sedative due to its ability to provide cooperative sedation while preserving respiratory drive. However, its clinical use may vary across healthcare systems, particularly in resource-limited settings. This study aimed to assess patterns of dexmedetomidine use, associated protocols, withdrawal experiences, and perceived barriers across different intensive care units in the Palestinian healthcare system. Methods A multicenter cross-sectional survey was conducted between October 2025 and January 2026 in governmental, teaching, and private hospitals. Anesthesiologists, intensive care physicians, and nurses with ≥ 6 months of experience were invited to complete a structured questionnaire addressing sedation practices, dosing, monitoring, withdrawal, perceptions, and institutional protocols. Results A total of 158 healthcare professionals participated (response rate 71.8%). Propofol (86.7%) and midazolam (70.9%) were the most commonly used sedatives, while dexmedetomidine was reported in 56.3% of intensive care units, predominantly as an adjunct (73.4%). Formal protocols were present in only 29.7% of units, and validated monitoring tools were used by 43.7%. Withdrawal symptoms were reported by 38.0% of respondents, most often after 48-72 hours of infusion. Significant sectoral differences were observed, with dexmedetomidine use reported in 55.1% of teaching hospitals and 43.8% of private hospitals, but only 1.1% of governmental hospitals (p < 0.001). Professional role also influenced practice. Fentanyl use was reported by 86.2% of ICU physicians, 66.7% of anesthesiologists, and 47.3% of nurses (p = 0.001). Cost was identified as a barrier by 46.2% of respondents, and inconsistent availability was reported by 43.7%, with both factors limiting routine use. Conclusion Limited protocols, inconsistent monitoring, and cost barriers hindered routine use of dexmedetomidine, while withdrawal was reported after prolonged infusions. These findings provide context-specific evidence to guide national guidelines, hospital protocols, and workforce training, with procurement and monitoring reforms as immediate priorities.
