Search Results (2,669)

Background: Respiratory infections pose a significant public health challenge, particularly among healthcare workers (HCWs). The COVID-19 pandemic exacerbated absenteeism due to respiratory illnesses, affecting healthcare workforce stability. Identifying factors influencing absenteeism is crucial for workforce resilience and effective care. Methods: This retrospective longitudinal study analyzed HCW absenteeism due to respiratory diseases from 2017 to 2023 at the “Sf. Maria” Children’s Emergency Hospital in Iași, Romania. Data from 3827 HCWs were examined, including demographic and occupational variables (age, gender, job role) and disease types. Statistical analyses (chi-square tests, ANOVA, and regression models) were conducted using SPSS to assess absenteeism trends and associated risk factors. Results: Sick leave peaked in 2020 (8322 days) and remained high in 2021 (8134 days), gradually decreasing in 2022–2023 but not returning to pre-pandemic levels (~5000 days/year). Nurses accounted for most leave days, while male staff and HCWs aged 41–50 were most affected. Seasonal variations showed higher absenteeism in transitional months and lower rates in summer. COVID-19 was the leading cause of absenteeism during the pandemic, with quarantine measures further increasing sick leave duration. Conclusions: Pediatric hospitals must strengthen infection control measures to protect HCWs and sustain care continuity. Preventive actions such as immunization, staff training, and health monitoring are critical in reducing absenteeism, maintaining a resilient workforce, and ensuring quality care during health crises. Full article

In recent years, biosensors have emerged as a promising solution for therapeutic drug monitoring (TDM), offering automated systems for rapid chemical analyses with minimal pre-treatment requirements. The use of saliva as a biological sample matrix offers distinct advantages, including non-invasiveness, cost-effectiveness, and reduced susceptibility to fluid intake fluctuations compared to alternative methods. The aim of this study was to explore and compare two types of low-cost biosensors, namely, the colourimetric and electrochemical methodologies, for quantifying paracetamol (acetaminophen) concentrations within artificial saliva using the MediMeter app, which has been specifically developed for this application. The research encompassed extensive optimisations and methodological refinements to ensure the results were robust and reliable. Material selection and parameter adjustments minimised external interferences, enhancing measurement accuracy. Both the colourimetric and electrochemical methods successfully determined paracetamol concentrations within the therapeutic range of 0.01–0.05 mg/mL (R² = 0.939 for colourimetric and R² = 0.988 for electrochemical). While both techniques offered different advantages, the electrochemical approach showed better precision (i.e., standard deviation of response = 0.1041 mg/mL) and speed (i.e., ~1 min). These findings highlight the potential use of biosensors in drug concentration determination, with the choice of technology dependent on specific application requirements. The development of an affordable, non-invasive and rapid biosensing system holds promise for remote drug concentration monitoring, reducing the need for invasive approaches and hospital visits. Future research could extend these methodologies to practical clinical applications, encouraging the use of TDM for enhanced precision, accessibility, and real-time patient-centric care. Full article

Background: Current research on Alzheimer’s Disease has progressively focused on Mild Cognitive Impairment (MCI) as a pre-dementia state, as well as on Subjective Memory Complaint (SMC), as a potential early indicator of cognitive change. Consequently, timely interventions to prevent cognitive decline are essential and are most effective when combined with motor training. Nevertheless, motor-cognitive dual-task training often employs non-ecological tasks and is confined to clinical contexts lacking generalizability to daily life. The integration of 360° media could overcome these limitations. Therefore, the aim of the current work is twofold: (a) to present a dual-task training using 360° technology for its interactivity, versatility, and ecological validity, and (b) to propose a protocol to test its efficacy through a randomized clinical trial. Methods: This study will recruit 90 older adults (MCI and SMC). Participants will follow two phases of training: in-hospital rehabilitation and at-home rehabilitation. The experimental design will follow a 2 × 3 × 2 structure with 3 factors: type of treatment (360° training vs. traditional rehabilitation), time (baseline, post in-hospital training, and post at-home training), and group (SMC vs. MCI). Results: The expected outcome is an improvement in cognitive and motor functioning after the experimental training. Conclusion: This study will advance the literature on non-pharmacological interventions and innovative technological tools for cognitive trainings in the early stages of cognitive decline. Full article

Background/Objectives: To map and analyze patient expectations regarding communication in IC and identify communication that both heightens anxiety in the IC process and reduces anxiety in the IC process before surgery. Methods: Ethics approval was granted. A power analysis indicated a required sample of 90 patients. A conjoint-based experimental design was performed, post-discharge, overcoming typical biases of surveys. Results: The sample comprised 104 patients who underwent surgery in the last year. Three verbal communication messages were perceived as significantly decreasing pre-operative anxiety for the total sample. Mathematical clustering yielded three distinct mindsets. Post hoc ANOVA indices indicated that the mindsets were significantly different. Patients belonging to each mindset differed from patients belonging to other mindsets in their expectations from the dialogue with surgeons to mitigate their anxiety. Mindset 1 (70% of the sample) comprised patients who expected information that was tailored to their specific situation. To feel safer, they needed to know that nothing unexpected would happen. Mindset 2 (13%) comprised patients who expected providers to talk with them about benefits and risks at the clinic, not at the hospital, and have a dialogue with them. Mindset 3 (17%) comprised patients who perceived a lack of information regarding the purpose of signing the informed consent and lack of sufficient time to thoroughly read the form or signing the form minutes before the procedure as elements that would heighten their anxiety. Conclusions: Three verbal communication messages in the IC dialogue were thought to decrease pre-operative anxiety for all patients, as follows. “I want to make sure you read and understand the consent form entirely” “Everything is provided in clear and simple terms”. The surgeon says, “Let’s go over the entire form”. Full article

The global economy was profoundly impacted by the emergence of the COVID-19 pandemic, with the hotel industry being among the sectors most severely affected. This study explores the relationship between environmental, social, and governance (ESG) performance and financial performance during the pandemic, focusing on 35 of the world’s largest hotel companies. A structured methodology was employed to assess short-term financial resilience using the shock depth (SD) and recovery rate (RR) indicators and long-term performance through the value-added weekly index (VAWI) and K-ratio. The findings of this study indicated that faster recovery was associated with greater capitalization. Furthermore, analysis of ESG scores indicated a median increase from 2019 to 2022, particularly in the figures of the environmental component. Despite these increases, pre-pandemic ESG scores demonstrated limited influence on short-term financial performance, though a correlation was observed between governance scores (as ESG score subscores) and long-term K-ratios. This finding suggests potential trade-offs between improving financial performance and maintaining governance standards in the sense of ESG scores. This study points to the intricate interplay between ESG and financial metrics during systemic crises, providing valuable insights for risk management and strategic planning in the hospitality business. The implications of these findings extend to the enhancement of resilience and the alignment of ESG strategies with financial sustainability. Full article

Thyroid dysfunction and type 2 diabetes melittus (T2DM) are two of the most common endocrine disorders, and the emerging condition of prediabetes necessitates additional research to better understand the complex interactions between thyroid hormones, metabolic regulation, and the progression from prediabetes to T2DM. This study sought to investigate changes in selected markers of thyroid function in patients with pre-diabetes. Upon obtaining ethics permission, blood samples were collected from patients in King Edward Hospital in Durban, South Africa. The samples were classified as non-diabetic, pre-diabetic, and type 2 diabetic using the ADA guidelines. The thyroid stimulating hormone (TSH), thyroxine (T4) triiodothyronine (T3), Thyroglobulin (TG), and thyroid peroxidase antibody (TPOAb) concentrations were determined in these samples. The results showed elevated TSH, decreased T3 and T4, decreased thyroglobulin (Tg), and elevated TPOAb in the prediabetic group which became considerably pronounced with the shift to T2DM. The alterations in these markers during prediabetes may indicate an early stage of thyroid dysfunction necessitating further investigation as these alterations become more pronounced during type 2 diabetes mellitus. Full article

Background and Objectives: Patients taking anticoagulants, particularly warfarin and non-vitamin K oral anticoagulants (NOACs), face an elevated risk of postoperative bleeding during minor oral surgeries, highlighting the urgent need to identify reliable predictors for bleeding complications. In this study, we evaluated the effectiveness of predictors of bleeding complications in patients receiving anticoagulants who underwent minor oral surgeries. Materials and Methods: The electronic medical and dental records of 206 patients who underwent oral surgery at the University of Ulsan Hospital between 2015 and 2023 were retrospectively reviewed. Patients were categorized into those taking warfarin and those taking NOACs, and postoperative bleeding was determined. Risk factors were statistically analyzed using the chi-square or Fisher’s exact test and Student’s t-test. Results: Among the 206 patients (86 on warfarin, 120 on NOACs), 84 (36 on warfarin, 48 on NOACs) experienced bleeding complications following their procedures. Time in the therapeutic range (TTR) and international normalized ratio (INR) values were significantly associated with bleeding complications in the warfarin group, while the type of NOAC was associated with bleeding in the NOAC group. Perioperative bleeding was significantly correlated with postoperative bleeding in both groups. Conclusions: Taken together, these findings highlight the correlations between postoperative bleeding and specific factors associated with anticoagulant drugs in patients that underwent oral surgery. Identifying these predictors can improve patient management by enhancing pre- and perioperative assessments, reducing the risk of bleeding, and optimizing surgical outcomes. Full article

Acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM) share common risk factors. To evaluate the long-term incidence and predictors of new-onset T2DM (NODM) among post-AMI adults, we conducted a retrospective analysis of AMI survivors hospitalized between 2002 and 2017. Eligible patients were followed for up to 16 years to identify NODM, stratified by demographic and clinical characteristics. Among 5147 individuals (74.2% males, mean age 64.6 ± 14.9 years) without pre-existing T2DM, 23.4% developed NODM (cumulative incidence: 0.541). Key risk factors included an age of 50–60 years, a minority ethnicity (Arabs), smoking, metabolic syndrome (MetS), hemoglobin A1C (HbA1C) ≥ 5.7%, and cardiovascular comorbidities. A total score (TS), integrating these factors, revealed a linear association with the NODM risk: each 1-point increase corresponded to a 1.2-fold rise (95% CI 1.191–1.276, p < 0.001). HbA1C ≥ 6% on the “Pre-DM sub-scale” conferred a 2.8-fold risk (p < 0.001), while other risk factors also independently predicted NODM. In conclusion, post-AMI patients with multiple cardiovascular risk factors, particularly middle-aged individuals, Arab individuals, and those with HbA1C ≥ 6% or MetS, are at a heightened risk of NODM. Early identification and targeted interventions may mitigate this risk. Full article

Background/Objectives: Food insecurity during pregnancy is associated with higher risks of negative physical outcomes for both mother and child. This study aims to understand experiences of food insecurity among low-income Singaporean pregnant women and its impact on nutritional status. Methods: In this cross-sectional, mixed-methods study, 49 food-insecure pregnant women were recruited from KK Women’s and Children’s Hospital between November 2021 and November 2023, among which 11 in-depth interviews were conducted. Questionnaires, anthropometric measurements, 24-Hour dietary recalls, metabolic and nutritional blood tests were conducted for all subjects. Descriptive quantitative analysis was performed and integrated with qualitative thematic analysis to explain findings. Results: On average, women were overweight pre-pregnancy (body mass index 26.1 ± 6.9 kg/m²) and had low haemoglobin and 25-hydroxyvitamin D levels. Calorie intake and intake from major food groups did not meet recommendations during pregnancy, except for “Grains”. From interviews, effects of financial constraints, how participants managed their food supply and pregnancy-related symptoms, supported findings from 24-Hour dietary recalls. Conclusions: Food insecurity led to suboptimal nutritional status and diets in Singaporean pregnant women despite appearing well-nourished. Further exploration of perspectives of food-insecure mothers, healthcare providers and welfare organisations is needed to devise long-term solutions to improve food security and alleviate malnutrition. Full article

Background and Objectives: The coronavirus disease 2019 pandemic presented unprecedented challenges in balancing infection control measures with the timely management of ST-segment elevation myocardial infarction (STEMI), a time-sensitive condition. This study investigates the pandemic’s effects on STEMI management times and outcomes at a high-volume medical center in Taiwan. Materials and Methods: A retrospective analysis of 1309 STEMI patients was conducted at Chang Gung Memorial Hospital between 2017 and 2022. Patients were divided into pre-pandemic and pandemic groups. Measurement outcomes include in-hospital mortality rate, management times (e.g., door-to-balloon time), the rates of intra-aortic balloon pump (IABP) and/or veno-arterial extracorporeal membrane oxygenation (VA-ECMO) usage, mechanical ventilation, inotropic support, and the length of intensive care unit (ICU) and hospital stay. Kaplan–Meier survival analysis and statistical comparisons were performed to assess temporal trends and prognostic outcomes. Results: No significant difference in in-hospital mortality was observed between pre-pandemic (5.85%) and pandemic (7.03%) groups (p = 0.45). The pandemic group experienced longer management times, including door-to-cath arrival (p = 0.0335) and door-to-balloon time (p = 0.014), although all times remained below the 90 min threshold. Quality improvements during the first outbreak allowed the institution to handle higher case volumes during subsequent waves without further delays. Ninety-day survival analysis showed no significant disparity between groups (p = 0.3655). Conclusions: Pandemic-related delays in STEMI management were effectively mitigated through workflow optimization, preventing significant increases in mortality rates. This study highlights the adaptability of healthcare systems in responding to crises while maintaining quality care for time-sensitive emergencies. Future multicenter studies could provide broader insights into global STEMI management strategies under pandemic conditions. Full article

Antimicrobial resistance (AMR) poses a global public health threat. Wastewater analysis provides valuable insights into antimicrobial resistance genes (ARGs), identifying sources and trends and evaluating AMR control measures. Between February 2022 and March 2023, pre-treatment urban wastewater samples were collected weekly from treatment plants in Pantano D’Arci, Siracusa, and Giarre (Sicily, Italy). Monthly composite DNA extracts were prepared by combining weekly subsamples from each site, yielding 42 composite samples—14 from each treatment plant. Real-time PCR analysis targeted specific ARGs, including blaSHV, erm(A), erm(B), blaOXA, blaNDM, blaVIM, blaTEM, and blaCTX-M. The preliminary findings revealed that blaERM-B, blaOXA, blaTEM, and blaCTX-M were present in all samples, with erm(B) (median value: 8.51; range: 1.67–30.93), blaSHV (0.78; 0.00–6.36), and blaTEM (0.72; 0.34–4.30) showing the highest relative abundance. These results underscore the importance of integrating ARG data with broader research to understand the persistence and proliferation mechanisms of ARGs in wastewater environments. Future studies should employ metagenomic analyses to profile resistomes in urban, hospital, agricultural, and farm wastewater. Comparing these profiles will help identify contamination pathways and inform the development of targeted ARG surveillance programs. Monitoring shifts in ARG abundance could signal cross-sectoral contamination, enabling more effective AMR control strategies. Full article

Background and Objectives: Malnutrition’s prevalence and its relationship with functional ability in patients with end-stage spine pathologies, i.e., any disease of the vertebral bodies, intervertebral discs, and associated joints requiring surgical intervention, are yet to be explored. This retrospective study aimed to investigate the association between malnutrition, disability, and physical health in patients undergoing elective spine surgery in our Italian hospital. Materials and Methods: Data between 2016 and 2019, recorded at pre-admission visits, were extracted from our institutional spine registry (ClinicalTrials.gov number: NCT03644407), excluding minor patients or those undergoing emergency or oncological surgery. The measures were the Oswestry disability index (ODI) and the physical health (PH) summary of the 36-item Short-Form Health Survey. Clinical data were linked to nine laboratory parameters from pre-operative routine blood tests, and equations to ascertain the risk of malnutrition and its diagnosis were attributed. Results: The study sample included 2258 spine patients (58.15% females) who underwent surgery in our Italian hospital. The ODI and PH significantly varied across body weight difference (BWd) strata in younger adults (adjusted-p = 0.046, η² = 0.04; adjusted-p = 0.036, η² = 0.06) and adults (adjusted-p = 0.001, η² = 0.02; adjusted-p = 0.004, η² = 0.02). Protein malnutrition with acute/chronic inflammation (PMAC) in both adults (adjusted-p < 0.001, η² = 0.04; adjusted-p < 0.001, η² = 0.04) and older adults (adjusted-p = 0.010, η² = 0.04; adjusted-p = 0.009, η² = 0.05) had also a discernible impact in determining the ODI and PH. In older adults, the ODI was associated with iron deficit malnutrition (IDM) (adjusted-p = 0.005, η² = 0.06) and both the ODI and PH were associated with vitamin B deficit (VBD) (adjusted-p = 0.037, η² = 0.01; adjusted-p = 0.049, η² = 0.01). Trend monotonicity was diagnosis- and sex-specific, with meaningful ordered patterns being observed mostly in young males and older females. Conclusions: Functional ability showed an association with malnutrition in younger adults and adults when using BWd, in adults and older adults when using PMAC, and in older adults when using IDM and VBD. The authors advocate for the inclusion of nutritional management in the pre-operative evaluation to potentially enhance recovery after spine surgery. Full article

Background/Objectives: Falls are the most common adverse in-hospital event, resulting in a considerable social and economic burden on individuals, their families, and the healthcare system. This study aims to develop and implement an automatic coding system using large language models (LLMs) to extract and categorize free-text information (including the location of the fall and any resulting injury) from in-hospital fall records. Methods: The study used the narrative description of the falls reported through the Incident Reporting system to the Risk Management Service of an Italian Local Health Authority in Italy (name not disclosed as per research agreement). The OpenAI application programming interface (API) was used to access the generative pre-trained transformers (GPT) models, extract data from the narrative description of the falls, and perform the classification task. The GPT-4-turbo models were used for the classification task. Two independent reviewers manually coded the information, representing the gold standard for the classification task. Sensitivity, specificity, and accuracy were calculated to evaluate the performance of the task. Results: The analysis included 187 fall records with free-text event descriptions detailing the location of the fall and 93 records providing information about the presence or absence of an injury. GPT-4-turbo showed excellent performance, with specificity, sensitivity, and accuracy values of at least 0.913 for detecting the location and 0.953 for detecting the injury. Conclusions: The GPT models effectively extracted and categorized the information, even though the text was not optimized for GPT-based analysis. This shows their potential for the use of LLMs in clinical risk management research. Full article

Traumatic Brain Injuries (TBIs) pose a significant global health burden, with high mortality and long-term disability rates. This retrospective cohort study investigates the implementation and impact of the Brain Trauma Foundation (BTF) guidelines on TBI management in a Saudi Arabian tertiary care center. Data from the pre-implementation (2012) and post-implementation (2022) of BTF guidelines periods were compared. The patient demographics, injury severity, guideline adherence, and outcomes were analyzed. The results revealed a 33% increase in severe TBI cases from 2012 to 2022, possibly due to the development of a well-established trauma system designed to manage such cases. More importantly, implementing the BTF guidelines led to a marked improvement in patient outcomes. Compliance with guidelines, including the avoidance of hypoxia and hypotension, hyperosmolar therapy, and DVT prophylaxis significantly increased post-implementation. Mortality rates decreased from 45.4% to 14.2%, accompanied by a reduction in the intensive care unit (ICU) length of stay and an increase in the hospital length of stay. A comparison with international trauma centers highlights the importance of protocol-based management in improving the TBI outcomes and reducing the mortality—factors such as specialist-led care, institutional policies, and increased resources influenced guideline adherence and patient care. This study underscores the critical role of evidence-based guidelines in optimizing TBI management and emphasizes the need for their widespread implementation in clinical practice. In conclusion, this study demonstrates the substantial impact of BTF guidelines on enhancing TBI patient outcomes in a Saudi Arabian tertiary care center. The implementation of these guidelines resulted in a significant reduction in mortality and in an improved adherence to the best practices in TBI management, highlighting the importance of evidence-based protocols in optimizing patient care and outcomes. Full article

Background and Objective: Crohn’s Disease (CD) is a chronic inflammatory condition with significant physical and psychological impacts, often requiring comprehensive self-management. This study examines the effects of COBMINDEX (Cognitive–Behavioral and Mindfulness Intervention with Daily Exercise) on coping strategies and life satisfaction in CD patients, focusing on gender-specific responses. Study objectives were to assess the impact of COBMINDEX on adaptive and maladaptive coping strategies and life satisfaction in CD patients, and to examine gender differences in these outcomes. Materials and Methods: A pre-planned secondary analysis of a randomized controlled trial, conducted from 2018 to 2021, at two public tertiary hospitals in Israel. A total of 120 CD patients (45 men and 75 women) were randomly assigned to either theCOBMINDEX group or a wait-list control group. Participants were assessed at baseline and post-intervention for coping strategies, mindfulness, psychological symptoms, and life satisfaction using validated scales. Quantile regression explored the gender-specific predictors of life satisfaction. This study was registered at ClinicalTrials.gov (NCT05085925) and Israel Ministry of Health (MOH_2020- 02- 24_008721. asp). Results: Both genders showed significant improvements in mindfulness, emotion-focused coping, and active coping (p < 0.05). Women exhibited reduced dysfunctional coping and greater emotional support use. For men, emotion-focused coping and mindfulness positively predicted life satisfaction, while for women, reductions in psychological symptoms and dysfunctional coping were significant predictors (p < 0.01). Conclusions: COBMINDEX enhances coping strategies and life satisfaction in CD patients, with notable gender differences. These findings highlight the importance of gender-tailored psychological interventions to improve overall patient well-being. Full article