Search Results (2,283)

Background/objectives: The growing use of mobile health (mHealth) applications needs reliable tools to assess their usability and user experience in clinical practice to improve the digital health (eHealth) interventions and ensure engagement, as higher engagement is often linked to increased efficacy of healthcare interventions. This study aimed to validate the patient Satisfaction and Usability with APPs questionnaire (pSUAPP), a multidimensional tool designed for the comprehensive assessment of mHealth applications, particularly for the integrated follow-up of patients with chronic diseases. Methods: A validation study was conducted between August and December 2022 with 85 participants from two hospitals in Spain, who completed the pSUAPP questionnaire, comprising 27 Likert-like items across four dimensions: first contact, registration, features and overall experience, and 1 open question. The questionnaire was validated by a panel of 11 experts and further assessed for psychometric properties. Results: The mean pSUAPP score was 79.0 (SD = 12.0), indicating high usability and positive user experience, with the highest scores in the ‘features’ dimension. The pSUAPP demonstrated moderate correlation with the System Usability Scale (SUS) and high reliability (Cronbach’s alpha and omega t > 0.9). A reproducibility analysis showed negligible changes between repeated measures. Conclusions: The pSUAPP questionnaire was found to be a robust tool for evaluating mHealth app usability and user experience, with potential application across various clinical settings. Full article

Human Activity Recognition (HAR) is a vital technology in domains such as healthcare, fitness, and smart environments. This paper presents an innovative HAR system that leverages machine-learning algorithms deployed on the B-L475E-IOT01A Discovery Kit, a highly efficient microcontroller platform designed for low-power, real-time applications. The system utilizes wearable sensors (accelerometers and gyroscopes) integrated with the kit to enable seamless data acquisition and processing. Our model achieves outstanding performance in classifying dynamic activities, including walking, walking upstairs, and walking downstairs, with high precision and recall, demonstrating its reliability and robustness. However, distinguishing between static activities, such as sitting and standing, remains a challenge, with the model showing a lower recall for sitting due to subtle postural differences. To address these limitations, we implement advanced feature extraction, data augmentation, and sensor fusion techniques, which significantly improve classification accuracy. The ease of use of the B-L475E-IOT01A kit allows for real-time activity classification, validated through the Tera Term interface, making the system ideal for practical applications in wearable devices and embedded systems. The novelty of our approach lies in the seamless integration of real-time processing capabilities with advanced machine-learning techniques, providing immediate, actionable insights. With an overall classification accuracy of 90%, this system demonstrates great potential for deployment in health monitoring, fitness tracking, and eldercare applications. Future work will focus on enhancing the system’s performance in distinguishing static activities and broadening its real-world applicability. Full article

In response to growing environmental concerns, the scientific community is increasingly incorporating green chemistry principles into modern analytical techniques. Electrochemical paper-based analytical devices (ePADs) have emerged as a sustainable and efficient alternative to conventional analytical devices, offering robust applications in point-of-care testing, personalized healthcare, environmental monitoring, and food safety. ePADs align with green chemistry by minimizing reagent use, reducing energy consumption, and being disposable, making them ideal for eco-friendly and cost-effective analyses. Their user-friendly interface, alongside sensitive and selective detection capabilities, has driven their popularity in recent years. This review traces the evolution of ePADs from simple designs to complex multilayered structures that optimize analyte flow and improve detection. It also delves into innovative electrode fabrication methods, assessing key advantages, limitations, and modification strategies for enhanced sensitivity. Application-focused sections explore recent advancements in using ePADs for detecting diseases, monitoring environmental hazards like heavy metals and bacterial contamination, and screening contaminants in food. The integration of cutting-edge technologies, such as wearable wireless devices and the Internet of Things (IoT), further positions ePADs at the forefront of point-of-care testing (POCT). Finally, the review identifies key research gaps and proposes future directions for the field. Full article

In the era of big data, breaking down data silos to enable efficient data transactions has become essential, with the fairness and transparency of pricing mechanisms being paramount. This study addresses these challenges by introducing a novel tripartite pricing model for customized data products that integrates the Stackelberg and bargaining game frameworks. By designing distinct utility functions for buyers, sellers, and the platform, the model effectively aligns the varying objectives of each participant. A dynamic adjustment mechanism further enhances this model by adaptively recalibrating the guidance price and pricing range based on real-time updates to buyer budgets and seller offers, thus ensuring fairness and responsiveness throughout the negotiation process. Experimental simulations comprising 100 transaction rounds across diverse buyer–seller profiles validate the model’s effectiveness, achieving a transaction success rate of 92.70% with an average of 6.86 bargaining rounds. These findings underscore the model’s capacity to optimize transaction outcomes, promote pricing equity, and enhance bargaining efficiency. The proposed model has broad applications in sectors such as finance, healthcare, and e-commerce, where precise data pricing mechanisms are essential to maximize transactional value. Full article

(1) Background: Creutzfeldt–Jakob disease (CJD) is a rare and fatal neurodegenerative disorder caused by the accumulation of an altered prion protein, which usually leads to death within one year after clinical onset. CJD patients usually present with rapid cognitive impairment associated with declines in cerebellar, motor, visual, behavioral, and swallowing functions. Moreover, CJD patients lose their ability to eat and take medications orally very early on in treatment; nevertheless, there are no specific nutritional guidelines for this disease shared worldwide. (2) Methods: This review aims to describe the nutritional outcomes of CJD patients in Western countries to compare them with those described in East Asian countries and then aims to explore the most recent trends in the nutritional management of CJD patients, including some dietary compounds that present neuroprotective effects. (3) Results: In Japan’s, Taiwan’s, and China’s healthcare systems, CJD patients receive intensive life-sustaining treatment that prolongs their survival (i.e., artificial feeding); conversely, in Western countries, intensive life-sustaining treatments like tube feeding are not commonly provided to CJD patients. (4) Conclusions: It is difficult to pinpoint the reasons for these discrepancies around CJD palliative care supply, but it is clear that specific nutritional guidelines may directly improve the nutritional management of CJD patients and thus allow their families and caregivers to ensure the best end-of-life care for these patients. Full article

The accurate staging of breast cancer is fundamental for guiding treatment decisions and predicting patient outcomes. However, there can be considerable variation in routine clinical practice based on individual interpretation of guidelines and depending on the healthcare provider initially involved in working up patients newly diagnosed with breast cancer, ranging from primary care providers, triage nurses, surgeons, and/or oncologists. The optimal approach for clinical staging, particularly in asymptomatic patients presenting with intermediate-risk disease, remains a topic of dialogue among clinicians. Given this area of uncertainty, the Research Excellence, Active Leadership (REAL) Canadian Breast Cancer Alliance conducted a modified Delphi process to assess the level of agreement among Canadian expert clinicians on various staging recommendations. In total, 20 items were drafted covering staging based on biological status, the utilization of localization clips, both for the axilla during diagnosis and primary surgical site for margins and radiation therapy planning, and the use of advanced imaging for the investigation of distant metastases. Overall, the consensus threshold among all participants (i.e., ≥75% agreement) was reached in 20/20 items. Differences in clinical practice and recent findings from the literature are provided in the discussion. These consensus recommendations are meant to help standardize breast cancer staging practices in Canada, ensuring accurate diagnosis and optimal treatment planning. Full article

Background/Objectives: Blood pressure (BP) readings are often rounded to the nearest zero end-digit. Guidelines permit rounding to the closest 2 mmHg. This paper investigated the effect of rounding systolic blood pressure (SBP) values on the prediction of cardiovascular disease (CVD) risk among the New Zealand population. A total of 427,299 individuals received opportunistic cardiovascular disease risk assessments at primary care facilities in New Zealand. Method: A total of 292,122 SBP readings possessed a non-zero terminal digit. These were rounded to the nearest zero end-digit. A survival model estimating a 5-year CVD risk was applied to both datasets, i.e., with and without rounding. Hazard ratios and misclassification rates were analysed to emphasise the notable differences. Financial impact was assessed by examining healthcare expenditures. Results: In total, 32% of SBP values exhibited a terminal digit of zero, and 2.85% and 4.24% of men were misclassified as moderate and high risk, respectively, while approximately 3.21% of women were misclassified into the same risk categories. Likewise, 1.19% and 0.47% of men, as well as 0.62% and 0.20% of women, were misclassified into the low and moderate risk categories, respectively. Conclusions: Precisely measuring SBP is crucial in accurately assessing CVD risk and managing healthcare resources effectively. Full article

Background: Headaches are a common symptom in healthcare workers (HCWs), mainly associated with high levels of stress. Different research has studied their incidence during the COVID-19 pandemic, most of them with correlational designs, and at the beginning of the pandemic and focused on the associated occupational variables. Aims: (1) To analyze the incidence of headaches in HCWs at the beginning of the COVID-19 pandemic and their maintenance six months later. (2) To explore the risk factors associated with their onset and maintenance, including sociodemographic, occupational, emotional symptomatology, and personality variables. (3) To propose a model to explain the chronification of stress in burnout, including the moderating role of chronic headaches. Methods: A prospective study (n = 259 HCWs) at three points in time during the COVID-19 pandemic, from the alarm state phase (T1: May–June 2020) to the post-pandemic stage (T3: April–July 2022), including an intermediate measure six months after T1 (T2). Descriptive analyses, Pearson’s chi-square, Student’s t, logistic regressions, and moderated mediation models were conducted using the Process package for SPSS. In addition to headaches, socio-demographic, occupational, emotional symptomatology, and personality variables were included. Results: At T1 the prevalence of headaches was 69.9%. At T2 the prevalence was 73.7%. Of these, 59.5% are T1–T2 sustained headaches. Headaches at T1 were associated with age (p = 0.010) (younger HCWs), professional category (p = 0.049) (nurses), service (p = 0.023) (ICU, COVID hospitalization), non-availability of PPE (p = 0.010), additional COVID-19 symptomatology (p < 0.001), and concern for contagion of family members (p < 0.001) (higher scores). In addition, HCWs with headaches had higher levels of stress (p = 0.001), anxiety (p = 0.001), depression (p = 0.041), and sleep disorders (p < 0.001). A subsequent logistic regression analysis showed that of the above variables, the presence of additional COVID-19 symptoms (p < 0.001) and depression (p = 0.010) were the predictor variables. With regard to the maintenance of headaches (T1–T2), anxiety (p = 0.035), stress (p = 0.001), and cognitive fusion (p = 0.013) were found to be the significant variables. The tested model proposes anxiety (T1) as antecedent, cognitive fusion (T2) as mediator, burnout (T3) as consequent, and chronic headaches (yes/no) as the moderating variable between anxiety and burnout (model 5). The model is significant (F = 19.84, p < 0.001) and contributes to the explanation of 36% of the variance of burnout. The relationships in the model are all statistically significant, and specifically chronic headaches contribute to a 6-fold increase in the likelihood of burnout. Conclusions: The present research differentiates between precipitating and maintenance factors of headaches in HCWs. The former, more studied in previous research, are usually related to sociodemographic and occupational variables and levels of anxiety and stress. Maintenance factors, scarcely explored, are related to the maintenance of emotional symptomatology and the inability to manage intrusive thoughts (i.e., cognitive fusion). Of particular interest is that the presence of chronic headaches itself is capable of producing burnout as a post-COVID syndrome. Full article

Ustekinumab is a fully human IgG1k monoclonal antibody that binds with high affinity and specificity to the p40 subunit of interleukins (IL-) 12 and 23, inhibiting their activity by preventing binding to their receptors. The European extension of the patent (Supplementary Protection Certificate) of ustekinumab expired on 20 July 2024. Biosimilar alternatives to ustekinumab are now an additional option for treating patients. The efficacy data for this drug in moderate-to-severe psoriasis obtained both from clinical trials and indirect comparisons through meta-analyses, are superior to those of etanercept and adalimumab, and its safety profile is more favorable than that of tumor necrosis factor (TNF) inhibitors. Several ustekinumab biosimilars have already been approved by regulatory agencies: between October 2023 and October 2024, Wezlana^® (Amgen ABP 654), Uzpruvo^® (Alvotech AVT04) and Pyzchiva^® (Samsung/Bioepis SB17) have been approved by both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). SteQeyma^® (Celltrion Healthcare CT-P43) was approved by the EMA in August 2024. Otulfi^® (Fresenius Kabi/Formycon) was approved by the FDA in October 2024. Several other potential biosimilar candidates are under development, including BAT2206 (Bio-Thera), DMB-3115 (Dong-A ST), QX001S (Qyuns Therapeutic), BFI-751 (BioFactura), NeuLara (Neuclone), ONS3040 (Oncobiologics), and BOW090 (Epirus Biopharmaceuticals). In most cases, these monoclonal antibodies are expressed in cell lines (e.g., Chinese Hamster Ovary, CHO) different from those used for the originator (Sp2/0 spleen cell murine myeloma); of note, the cell line of origin is not a requirement for biosimilarity in the totality-of-evidence comparison exercise and may facilitate the production and reduce the immunogenicity of biosimilars originated in CHO cultures. This narrative review summarizes the available data on characteristics of the full comparability exercises and comparative clinical trials of these drugs. Full article

Background. National surveys have reported variable prevalence of chronic kidney disease (CKD), due to differences in the characteristics of the population, study design, equations used for the estimated glomerular filtration rate (eGFR), and definitions. The EH-UH 2 survey is the first study evaluating CKD prevalence, characteristics, and awareness in Croatia. Methods. This was a cross-sectional nationwide observational study designed to assess the prevalence of CKD and cardio–kidney–metabolic risk factors in Croatia, which included 1765 randomly selected subjects. We estimated the prevalence of CKD by means of the albumin-to-creatinine ratio (ACR) and eGFR (CKD-EPI equation). Comorbidities and anthropometric and social factors related to the prevalence of CKD were analyzed, and the CV risk profile was evaluated. Results. The weighted prevalence of CKD (any stage), CKD stage ≥G3A A2, and CKD defined only as an eGFR <60 mL/min/1.73 m² were estimated at 17.1%, 9.8%, and 7.9%, respectively. The prevalence was higher in men than in women (11.8% vs. 7.9%; p < 0.001). The weighted prevalence of an ACR >30 mg/g was 15.1%. Older age, male gender, diabetes, ePWV, and uric acid were independently associated with CKD prevalence. The awareness of CKD was 9.5%. Persons unaware of CKD were older with lower income, less education, more frequent diabetes, hypertension (less frequently controlled), and milder renal impairment. Conclusions. In Croatia, the estimated prevalence of CKD is high, being presented more frequently in men than in women. CKD patients have an unfavorable CV risk profile. The awareness of CKD is very low, reflecting poor health literacy in the general population but also in health-care workers. Full article

With the rapid development of information technology from one side and the experience of the COVID-19 pandemic from the other side, people presently prefer to access healthcare services remotely. Telecare Medical Information System (TMIS) provides more flexible, faster, and more convenient e-healthcare services available to all people, particularly those who lack access to physicians due to their geographical restrictions. However, due to the sensitivity of medical information, preventing unauthorized access to patient data and preserving patient privacy is crucial. In this paper, we propose an authenticated key agreement scheme for TMIS to preserve the privacy of the patient’s identity from all internal (even the health server and the physician) and external entities. Moreover, the physician’s identity is kept secret from all external entities. Formal and informal security analysis of the proposed scheme indicates that it is secure against all attacks in the context. Full article

Background/Objectives: The Hogg Eco-Anxiety Scale (HEAS-13) is a thirteen-item measure of eco-anxiety, with four dimensions: (1) affective symptoms, (2) rumination, (3) behavioural symptoms, and (4) anxiety about personal impact. Being a recently developed questionnaire, data on its psychometrics are limited. The aim of this study was to introduce a Polish version of the HEAS-13 and examine its psychometric properties. Methods: Our sample consisted of 634 Polish-speaking adults, with ages ranging from 18 to 67 years. We assessed the HEAS-13’s factor structure, internal consistency, test–retest reliabilities, and its concurrent validity via relationships with climate-related variables, psychopathology symptoms, and well-being. We put emphasis on examining the discriminant validity of the HEAS-13 against general psychological distress. Results: As expected, the Polish HEAS-13 demonstrated strong factorial validity with an intended four-factor structure. The internal consistency and test–retest reliabilities of the scale were good and moderate, respectively. Higher levels of eco-anxiety were associated with higher environmental concerns, the experience of climate change (i.e., one’s perception of being affected by climate change), pro-environmental behavioural engagement, climate change worry, anxiety, and depressive symptoms, as well as lower levels of well-being. We empirically supported the strong discriminant validity of the HEAS-13, demonstrating that eco-anxiety was separable from general psychological distress. We also noted that females, younger people, and those with lower educational levels experienced higher eco-anxiety. To facilitate the use of this measure, we propose a potential screening cut-off value for the HEAS-13, which can indicate meaningfully elevated levels of eco-anxiety. Conclusions: Overall, the Polish version of the HEAS-13 has strong psychometric properties, usefully enabling the examination of climate-related anxiety. Our findings highlight its potential in cross-cultural research and healthcare practice. Full article

Background/Objectives: Over the past few decades, extended-spectrum β-lactamase (ESBL)-producing bacteria have become a great concern in healthcare systems worldwide, imposing large burdens by increasing antimicrobial resistance and patient morbidity. Given the high mortality rates and emergence of multidrug-resistant (MDR) strains, monitoring ESBL prevalence and resistance patterns is crucial. This study aimed to evaluate ESBL-producing Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae over three years, focusing on phenotypic distribution and resistance profiles. Methods: A total of 1599 ESBL-producing bacterial samples were collected and analysed. A panel of 20 antibiotics was tested to determine resistance traits. Data were recorded on phenotypical distribution, isolation types, changes in antibiotic resistance, and the relation of such changes to antibiotic consumption (defined daily dose) from clinical isolates. Results: Phenotypical analysis revealed the minimal presence of the Cefotaximase from Munich (CTX-M) phenotype in E. coli and K. pneumoniae, creating a distinct epidemiological profile compared to global patterns. Shifts in isolation trends, particularly in P. mirabilis, suggest an expected increase in associated-mortality-rate in the coming years. While resistance trends were not statistically significant, MDR and extensively drug-resistant (XDR) strains were identified across all three bacteria. Only meropenem showed consistent 100% efficacy against E. coli, with other antibiotics displaying only partial effectiveness. Conclusions: These findings highlight the need for ongoing surveillance of ESBL-producing bacteria and underscore challenges in managing antibiotic resistance due to limited efficacy of last-resort treatments. The unique phenotypical distribution observed could impact local resistance management strategies in hospital settings in the coming years. Full article

Background/Objectives: Chronic skin wounds (CSWs) are a worldwide healthcare problem with relevant impacts on both patients and healthcare systems. In this context, innovative treatments are needed to improve tissue repair and patient recovery and quality of life. Cord blood platelet lysate (CB-PL) holds great promise in CSW treatment thanks to its high growth factors and signal molecule content. In this work, thermo-sensitive hydrogels based on an amphiphilic poly(ether urethane) (PEU) were developed as CB-PL carriers for CSW treatment. Methods: A Poloxamer 407^®-based PEU was solubilized in aqueous medium (10 and 15% w/v) and added with CB-PL at a final concentration of 20% v/v. Hydrogels were characterized for their gelation potential, rheological properties, and swelling/dissolution behavior in a watery environment. CB-PL release was also tested, and the bioactivity of released CB-PL was evaluated through cell viability, proliferation, and migration assays. Results: PEU aqueous solutions with concentrations in the range 10–15% w/v exhibited quick (within a few minutes) sol-to-gel transition at around 30–37 °C and rheological properties modulated by the PEU concentration. Moreover, CB-PL loading within the gels did not affect the overall gel properties. Stability in aqueous media was dependent on the PEU concentration, and payload release was completed between 7 and 14 days depending on the polymer content. The CB-PL-loaded hydrogels also showed biocompatibility and released CB-PL induced keratinocyte migration and proliferation, with scratch wound recovery similar to the positive control (i.e., CB-PL alone). Conclusions: The developed hydrogels represent promising tools for CSW treatment, with tunable gelation properties and residence time and the ability to encapsulate and deliver active biomolecules with sustained and controlled kinetics. Full article

Therapeutic strategies for early-stage non-small cell lung cancer (NSCLC) are advancing, with immune checkpoint inhibitors (ICIs) and targeted therapies making their way into neoadjuvant and adjuvant settings. With recent advances, there was a need for multidisciplinary lung cancer healthcare providers from across Ontario to convene and review recent data from practical and implementation standpoints. The focus was on the following questions: (1) To what extent do patient (e.g., history of smoking) and disease (e.g., histology, tumor burden, nodal involvement) characteristics influence treatment approaches? (2) What are the surgical considerations in early-stage NSCLC? (3) What is the role of radiation therapy in the context of recent evidence? (4) What is the impact of biomarker testing on treatment planning? Ongoing challenges, treatment gaps, outstanding questions, and controversies with the data were assessed through a pre-meeting survey, interactive cases, and polling questions. By reviewing practice patterns across Ontario cancer centers in the context of evolving clinical data, Health Canada indications, and provincial (Cancer Care Ontario [CCO]) funding approvals, physicians treating lung cancer voiced their opinions on how new approaches should be integrated into provincial treatment algorithms. This report summarizes the forum outcomes, including pre-meeting survey and polling question results, as well as agreements on treatment approaches based on specific patient scenarios. Full article