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Evidence is sparse on how community-based health-promoting programs can be culturally adapted for racially minoritized, immigrant older adult populations. Choose to Move (CTM) is an evidence-based health-promoting program that enhances physical activity and mobility and diminished social isolation and loneliness in older adults in British Columbia, Canada. However, racially minoritized older adults were not reached in initial offerings. We purposively sampled CTM delivery staff (n = 8) from three not-for-profit organizations, in Metro Vancouver, British Columbia, that serve Chinese older adults. We used semistructured interviews, ethnographic observations, and meeting minutes to understand delivery staff's perspectives on factors that influence CTM adaptations for Chinese older adults. Deductive framework analysis guided by an adaptation framework, Framework for Reporting Adaptations and Modifications-Enhanced, found three dominant cultural- and immigration-related factors influenced CTM adaptations for Chinese older adults: (a) prioritizations, (b) familiarity, and (c) literacy. Findings may influence future program development and delivery to meet the needs of racially minoritized older adult populations. [ABSTRACT FROM AUTHOR]

Specialize? Diversify? Do patients care? The authors investigate the demand-side effects of a hospital's portfolio strategy, which entails decisions about the depth and breadth of its service offerings. Positing that both depth (focus) and breadth (related focus) signal expertise, the authors use both archival and experimental evidence to examine these effects. The archival study is based on Florida's State Inpatient Databases for 2006–2015 and spans all major departments in health care delivery. The empirical analysis exploits plausible exogenous variation from other health care markets and reveals that patient choice is positively influenced by a hospital's depth (focus) and breadth (related focus) of expertise in a department. Complementing the archival evidence, the authors also conducted online experiments to examine the signaling effects of hospital portfolio strategy on patient choice behavior. The results provide support for the idea that hospital portfolio strategy influences patients' perceptions of hospital expertise in focal and related areas and, subsequently, their choice behavior. The authors also highlight potential synergistic effects between focus and related focus and heterogeneity in the effects across departments, payer types, and hospital profit status. These findings underscore the need for managers to adopt a targeted approach to portfolio decisions in health care. [ABSTRACT FROM AUTHOR]

Background: The incidence and mortality rates of pancreatic cancer are rising globally. This study examines global and regional trends in pancreatic cancer incidence, Disability Adjusted Life Years (DALYs), and mortality from 1990 to 2021, utilizing data from the most recent Global Burden of Disease (GBD) 2021 database. Methods: Data were sourced from the GBD database over the period from 1990 to 2021. Age-standardized rates for incidence, DALYs, and mortality were calculated per 100,000 population. We also calculated the proportion of DALYs and mortality attributable to risk factors. The Bayesian age-period-cohort model was applied to project future trends until 2050. Results: Between 1990 and 2021, the global incidence of pancreatic cancer increased significantly, with the number of cases rising from approximately 207,905 to 508,533 and the age-standardized incidence rate (ASIR) increasing from 5.47 to 5.96 per 100,000 population. The global burden of pancreatic cancer, measured in DALYs, rose from 5.21 million to 11.32 million. Mortality rates showed a similar upward trend, with the number of deaths increasing from around 211,613 to 505,752, and the age-standardized mortality rate (ASMR) rising from 5.655 to 5.948 per 100,000 population. Notable increases in ASIR and ASMR were observed in low-middle and low sociodemographic index regions with males experienced higher rates compared to females. Age-standardized DALYs rate (ASDR) and ASMR worldwide were attributable to tobacco smoking, high BMI, and high fasting plasma glucose. Furthermore, our projection model estimates that the ASIR and ASMR of pancreatic cancer will significantly decline, while the ASDR is anticipated to maintain a steady downward trend by 2050. Conclusion: This study offers a comprehensive analysis of pancreatic cancer trends, providing crucial insights for public health planning and policy-making. Addressing identified risk factors and targeting high-risk populations are essential for effective strategies to reduce the global burden of pancreatic cancer. [ABSTRACT FROM AUTHOR]

In recent years, numerous studies have explored the relationship between atmospheric conditions and respiratory viral infections. However, these investigations have faced certain limitations, such as the use of modestly sized datasets, a restricted geographical focus, and an emphasis on a limited number of respiratory pathogens. This study aimed to develop a nationwide respiratory virus infection risk prediction model through machine learning approach. We utilized the CRFC algorithm, a random forest-based method for multi-label classification, to predict the presence of various respiratory viruses. The model integrated binary classification outcomes for each virus category and incorporated air quality and meteorological data to enhance its accuracy. The data was collected from 31 regions in China between 2016 and 2021, encompassing pathogen detection, air quality indices, and meteorological measurements. The model's performance was evaluated using ROC curves, AUC scores, and precision-recall curves. Our model demonstrated robust performance across various metrics, with an average overall accuracy of 0.76, macro sensitivity of 0.75, macro precision of 0.77, and an average AUC score of 0.9. The SHAP framework was employed to interpret the model's predictions, revealing significant contributions from parameters such as age, NO2 levels, and meteorological conditions. Our model provides a reliable tool for predicting respiratory virus risks, with a comprehensive integration of environmental and clinical data. The model's performance metrics indicate its potential utility in clinical decision-making and public health planning. Future work will focus on refining the model and expanding its applicability to diverse populations and settings. [ABSTRACT FROM AUTHOR]

Background: Assessing all factors influencing older adults' mobility during the hospital-to-home transition is not feasible given the complex and time-sensitive nature of hospital discharge processes. Objective: To describe the mobility factors that Nigerian physiotherapists prioritize to be assessed during hospital-to-home transition of older adults and explore the differences in the prioritization of mobility factors across the physiotherapists' demographics and practice variables. Methods: This cross-sectional study included 121 physiotherapists who completed an online questionnaire, ranking 74 mobility factors using a nine-point Likert scale. A factor was prioritized if ≥ 70% of physiotherapists rated the factor as "Critical" (scores ≥7) and ≤ 15% of physiotherapists rated a factor as "Not Important" (scores ≤3). We assessed the differences in the prioritization of mobility factors across the physiotherapists' demographics/practice variables using Mann Whitney U and Kruskal-Wallis tests. Findings: Forty-three of 74 factors were prioritized: four cognitive, two environmental, one financial, four personal, eighteen physical, seven psychological, and seven social factors. Males and those with self-reported expertise in each mobility determinants more frequently rated factors as critical. Conclusion: Prioritizing many mobility factors underscores the complex nature of mobility, suggesting that an interdisciplinary approach to addressing these factors may enhance post-hospital discharge mobility outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study examines (a) whether disability registration has anticipatory, immediate, and delayed effects on depressive symptoms and (b) how these effects differ by gender. Research Method/Design: Using data from the Korea Welfare Panel Study spanning over 16 waves between 2005 and 2020, this study employed the individual-level fixed effects models to estimate the trajectories of depressive symptoms before and after the registration of physical disability, for a cohort of 20,054 individuals. Furthermore, gender-stratified fixed effects models were used to examine gender differences. Results: Compared to the preregistration reference period (i.e., 4 or more years before disability registration), there was a sustained rise in depressive symptoms leading up to the year of registration, indicating the presence of anticipatory effects. After disability registration, depressive symptoms consistently remained at a statistically higher level than during the initial reference period, with a gradual return to the baseline level of depressive symptoms over time. These anticipatory, immediate, and delayed effects of disability registration were notably more pronounced among men than women. Conclusion/Implications: To develop more effective mental health interventions for people with disability, policymakers should consider gendered trajectories of depressive symptoms before and after disability registration. Impact and Implications: In light of the social, economic, and cultural challenges faced by individuals with disabilities, this study offers new insights into the anticipatory, immediate, and delayed effects of disability registration on depressive symptoms. Before official disability registration, individuals exhibited a gradual increase in depressive symptoms over several years. Subsequent to registration, depressive symptoms remained elevated compared to preregistration levels, eventually returning to the baseline over time. The study's findings underscore the importance of recognizing distinct patterns of depressive symptoms before and after disability registration, emphasizing the necessity for tailored support strategies that address the nuanced experiences of individuals with disabilities at different stages of their journey. [ABSTRACT FROM AUTHOR]

African communities that have been forced to leave their homes experience a considerably greater susceptibility to malaria as a result of densely populated living conditions, restricted availability of healthcare, and environmental influences. Internally displaced individuals frequently live in large settlements with restricted availability to drinking water, essential sanitation, and medical services, intensifying the spread of malaria. As a result, the occurrence of malaria is significantly more common among refugees and internally displaced individuals compared to those who are not displaced. This leads to greater rates of illness and death, especially among young people. Insufficient monitoring worsens the condition, leading to delayed identification and medical intervention, and contributing to a higher incidence of severe malaria and deaths. Furthermore, these communities are faced with economic consequences that contribute to the continuation of poverty and the worsening of socio-economic inequalities. Furthermore, the psychological impact of malaria, which is marked by feelings of anxiety and uncertainty, is particularly severe in vulnerable populations such as displaced children and pregnant women, aggravating the overall burden. Hence, addressing malaria in displaced populations in Africa requires comprehensive and well-coordinated strategies. Advanced diagnostic and surveillance technologies are essential for promptly identifying and treating malaria, providing chances to monitor and control its spread effectively. Collaboration among healthcare, policy, and humanitarian sectors is crucial for implementing comprehensive solutions that incorporate enhanced diagnostics, surveillance, and socio-psychological support. Active involvement of the community, usage of Community Health Workers, and regular collection of surveillance data are crucial in increasing awareness, directing control efforts, and tackling the specific difficulties encountered by displaced groups. Moreover, the implementation of environmental management, the incorporation of health services, and the utilization of adaptable healthcare interventions are essential for reducing the effects of malaria. To mitigate the impact of malaria and improve health outcomes among displaced populations in Africa, it is crucial to focus on these specific areas. [ABSTRACT FROM AUTHOR]

Background: Leptospirosis is a neglected zoonotic disease prevalent worldwide, particularly in tropical regions experiencing frequent rainfall and severe cyclones, which are further aggravated by climate change. This bacterial zoonosis, caused by the Leptospira genus, can be transmitted through contaminated water and soil. The Pacific islands bear a high burden of leptospirosis, making it crucial to identify key factors influencing its distribution. Understanding these factors is vital for developing targeted policy decisions to mitigate the spread of Leptospira. Methodology/Principal findings: This study aims to establish a precise spatio-temporal risk map of leptospirosis at a national scale, using binarized incidence rates as the variable to predict. The spatial analysis was conducted at a finer resolution than the city level, while the temporal analysis was performed on a monthly basis from 2011 to 2022. Our approach utilized a comprehensive strategy combining machine learning models trained on binarized incidences, along with descriptive techniques for identifying key factors. The analysis encompasses a broad spectrum of variables, including meteorological, topographic, and socio-demographic factors. The strategy achieved a concordance metric of 83.29%, indicating a strong ability to predict the presence of contamination risk, with a sensitivity of 83.93%. Key findings included the identification of seasonal patterns, such as the impact of the El Niño Southern Oscillation, and the determination that rainfall and humidity with a one-month lag are significant contributors to Leptospira contamination. Conversely, soil types rich in organic matter may reduce bacterial presence and survival. Conclusions/Significance: The study highlights the significant influence of environmental factors on the seasonal spread of Leptospira, particularly in tropical and subtropical regions. These findings are crucial for public health planning, providing insights for targeted policies to reduce leptospirosis, while advanced machine learning models serve as a robust tool for improving disease surveillance, and risk assessment, which ultimately supports the development of an early warning system. Author summary: Leptospirosis is a neglected worldwide zoonosis caused by the Leptospira bacteria, responsible for nearly 60,000 deaths annually. It is transmitted to humans through contact with infected mammals and contaminated environments, where mammals, particularly rodents, spread the bacteria through their urine. Climate change, which increases heavy rainfall and severe cyclones, further exposes tropical and subtropical regions to bacterial contamination. Additionally, in the South Pacific, the specificities of the local environment and the lifestyle of the inhabitants contribute to increase exposure to the bacteria. In this paper, we conducted a precise spatio-temporal analysis of the risk of Leptospira contamination, incorporating environmental and socio-demographic factors in a subtropical region (New Caledonia) over a 12-year period. This study will facilitate the implementation of timely, targeted prevention and mitigation actions, benefiting public health services. Ultimately, the analysis revealed that accumulated rainfall and humidity with a 1-month lag, as well as the soil types specific to New Caledonia, are the primary factors contributing to the risk of Leptospira contamination. [ABSTRACT FROM AUTHOR]

This article presents a comprehensive dataset compiling reported cases of typhoid fever from culture-confirmed outbreaks across various geographical locations from 2000 through 2022, categorized into daily, weekly, and monthly time series. The dataset was curated by identifying peer-reviewed epidemiological studies available in PubMed, OVID-Medline, and OVID-Embase. Time-series incidence data were extracted from plots using WebPlotDigitizer, followed by verification of a subset of the dataset. The primary aim of this dataset is to serve as a foundational tool for researchers and policymakers, enabling the development of robust, model-based strategies for the control of typhoid fever outbreaks. The article describes the method by which the dataset has been compiled and how the quality of the data has been verified. Furthermore, it discusses the dataset's potential applications in optimizing vaccination campaigns, improving public health planning, and tailoring interventions to specific epidemiologic contexts. This article contributes significantly to the field of infectious disease modeling, offering a valuable resource for enhancing typhoid fever control measures globally. [ABSTRACT FROM AUTHOR]

Background: Community needs assessments can provide valuable insights concerning the health of communities. This study aims to measure health priorities according to community members in Jazan, Saudi Arabia, to assess healthcare service utilization, barriers to accessing these services, and preferences for utilizing government or private healthcare services. Method: Multistage sampling was utilized to reach a sample of adults in community settings. The assessment was performed via personal interviews utilizing a structured questionnaire to measure demographics, health priorities, service utilization, barriers, and preferences for healthcare settings. Chi-squared tests, Student's t-tests, and multivariate regression analysis were used to assess the differences between demographics and service utilization according to the preferred healthcare settings. Results: A total of 3411 participants were recruited for the assessment. The mean age of the participants was 34 years, and 51% were male. The participants viewed diabetes as the most important health condition. Emergency services and primary care were viewed as the most important healthcare services, and time constraints were the main barriers to healthcare accessibility. Thirty-six percent of the participants preferred to utilize healthcare services in the private sector, where age, gender, nationality, education, income, housing type, and family size were statistically associated with the preference for seeking healthcare in either the private or government sectors (p < 0.05). Conclusions: Future assessment is required to recruit healthcare providers and decision-makers to understand the process of strengthening multidisciplinary collaboration to tackle chronic diseases such as diabetes, strengthen the role of emergency and primary healthcare services, and address time constraints pertaining to healthcare accessibility. [ABSTRACT FROM AUTHOR]

Background: Indonesia has implemented a series of healthcare reforms including its national health insurance scheme (Jaminan Kesehatan Nasional, JKN) to achieve universal health coverage. However, there is evidence of inequitable healthcare utilization in Indonesia, raising concerns that the poor might not be benefiting fully from government subsidies. This study aims to identify factors affecting healthcare utilization in Indonesia. Methods: This study analysed cross-sectional survey data collected by the "Equity and Health Care Financing in Indonesia" (ENHANCE) Study. Andersen's behavioural model of health services use was adopted as a framework for understanding healthcare utilization in Indonesia. Sociodemographic variables were categorized into predisposing, enabling and need factors. Outcome measures included the utilization of primary and secondary health services. Multi-level logistic regression models were run to examine factors associated with each type of health service utilization. Results: Of the 31,864 individuals included in the ENHANCE survey, around 14% had used outpatient services in the past month. Fewer than 5% of the study population had visited hospitals for inpatient care and about 23% used maternal and child health services in the past 12 months. Age, gender and self-rated health were key determinants of health services utilization. No significant differences in primary care utilization were found among people with different insurance status, but people who received subsidised premiums under the JKN were more likely to receive primary care from public health facilities and less likely from private health facilities. Compared to people who pay JKN insurance premiums themselves, the uninsured and those whose premiums were subsidised by the government were less likely to visit public and private hospitals when other factors were controlled. Conclusion: This study demonstrates that the distribution of healthcare utilization in Indonesia is largely equitable as predisposing factors (age and gender) and health need were found to greatly influence the utilization of different types of health services. However, enabling factors such as health insurance status were also found to be associated with inequity in utilization of hospital services. Further policy actions regarding resource allocation and health service planning are warranted to achieve a more equitable pattern of health service use in Indonesia. [ABSTRACT FROM AUTHOR]

Background: The maternal and neonatal mortality in South Sudan is among the highest in the world and among other fragile and conflict-affected countries. Within an evolving political economic context, this study aims to capture perspectives of current actors on drivers of the stagnating investments in maternal and newborn health (MNH). Methods: A descriptive case study guided by the health policy analysis triangle to explore contextual factors, policy content, actors' roles and implementation processes for MNH policy and practice. A total of 20 key informants from government, humanitarian and development organizations, civil society, donors and health providers were interviewed. Results: According to respondents, MNH was a priority in South Sudan due to the presence of various legal and policy frameworks. However, financial investment in MNH programs was inadequate due to the government focus on peace and stabilization, and the fragmented parallel systems run by international actors. Funding for MNH was also affected by ongoing conflicts and disease outbreaks, which diverted attention away from the issue. National initiatives to expand service coverage and funding are either inadequate or not well studied. In addition, gendered attitudes and norms continue to impede care seeking, service provision and inclusivity in decision-making for improving MNH prioritization. Stakeholders highlighted the need for accountability to sustain progress and close policy implementation gaps. Conclusion: This study highlighted relevant challenges and opportunities for improving MNH outcomes in South Sudan and similar fragile contexts. Government ownership of the MNH agenda is needed, so is strengthening of national initiatives, gender equity, actor coordination and accountability mechanisms. [ABSTRACT FROM AUTHOR]

PURPOSE: We aimed to analyze regional variations in the assignment of International Classification of Diseases, 10th Revision (ICD-10) codes to acute respiratory infections, seeking to identify notable anomalies that suggest diverse diagnoses of the same condition. METHODS: We analyzed national weekly diagnosis data for acute respiratory infections (ICD10 codes J00-J22) in Poland from 2010 to 2019, covering all 380 county-equivalent administrative regions and encompassing 292 million consultations. Data were aggregated into age brackets. We calculated the Kendall tau correlations between shares of particular diagnoses. RESULTS: We found staggering differences across regions in applied diagnoses that persisted even after disaggregating the data into age groups. The differences did not seem to stem from different levels of health care use, as there was no consistent pattern suggesting variability in milder diagnoses. Instead, there were numerous pairs of strongly negatively correlated codes implying classification ambiguity, with the most problematic diagnosis being J06 (acute upper respiratory infections of multiple and unspecified sites), which was used almost interchangeably with a diverse range of others, especially J00 (common cold) and J20 (bronchitis). CONCLUSIONS: To the best of our knowledge, this is the first study using observable anomalies to analyze regional coding variability for the same respiratory infection. Although some of these discrepancies may raise concerns about misdiagnosis, the majority of cases involving interchangeably used codes did not seem to substantially impact treatment or prognosis. This suggests that ICD codes may have clinical ambiguities and could face challenges not only in fulfilling their intended purpose of generating internationally comparable health data but also in their use for comprehensive government health planning. [ABSTRACT FROM AUTHOR]

Purpose: Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active). Accurate identification of speech errors is necessary to facilitate timely and appropriate intervention. Recent studies have supported the role of magnetic resonance imaging (MRI) in the assessment process for VPD. The purpose of this study was to utilize MRI to support differential diagnosis and treatment planning in a child presenting with inconsistent nasal air escape, mild hypernasality, and compensatory speech errors. Method: A nonsedated, fully awake, velopharyngeal (VP) MRI protocol was implemented to acquire anatomic data at rest and during phonation. Segmentations and visualization of the tongue, palate, adenoids, and nasopharyngeal airway were completed. Anatomic linear measurements were obtained for VP variables to assess VP function, establish a baseline, and monitor change over time. Results: VP anatomy was successfully visualized on MRI in multiple imaging planes. All anatomic measurements fell within normative expectations. Elevation and retraction of the soft palate occurred against the adenoid pad. A pharyngeal fricative was documented, resulting a small VP gap during speech. In contrast, adequate VP closure was obtained for vowels and other oral consonant sounds. Conclusions: Quantitative assessment and visualization of the anatomy demonstrated adequate VP closure capabilities and a pharyngeal fricative substitution that had not been adequately perceived during routine clinical assessments. This study suggests a promising additive role for VP MRI for enhanced differential diagnosis and therapeutic monitoring in children with VPD and concomitant speech disorders. Supplemental Material: https://doi.org/10.23641/asha.27905451 [ABSTRACT FROM AUTHOR]

Purpose: To explore the factors that influence clinicians (occupational therapists, physiotherapists, vascular surgeons, and rehabilitation medicine physicians) when prescribing prosthetic rehabilitation. Additionally, the study aimed to gain insight into clinicians' perspectives regarding the role of patient cognition in prosthetic rehabilitation. Materials and methods: This research constitutes one segment of a broader action research study which was undertaken in 2022. A total of thirty-four key clinicians involved in the amputation and prosthetic rehabilitation pathway within a local health district in Australia were engaged through a combination of group and individual interviews as well as surveys. Results: Five essential considerations when prescribing prosthetic rehabilitation emerged. These included patient's goals, medical history, quality of life, cognitive abilities, and the support available on discharge. This study also revealed variations in opinions among different disciplines concerning appropriateness of prosthetic rehabilitation for the patient cohort. Despite this, there was a desire to build a consensus around a shared approach of identification for patients and clinicians. Conclusion: The identification of these key pillars for clinician consideration has simplified a complex area of care. These pillars could be used to guide pertinent conversations regarding prosthetic rehabilitation and are closely linked with the patient's cognition. IMPLICATIONS FOR REHABILITATION: Five key areas should be considered when prescribing prosthetic rehabilitation; patients' goals, medical history, quality of life, cognitive abilities and supports available on discharge. Qualitative findings show different clinician domains hold very different perspectives on the suitability of patients to receive a prosthesis and undergo prosthetic rehabilitation. Occupational therapists and rehabilitation medicine clinicians most frequently view patients as suitable to undergo prosthetic rehabilitation, followed by physiotherapists and finally vascular surgeons. Vascular surgeons view most patients' complex vascular medical history as a reason why only certain (younger) patients should undergo prosthetic rehabilitation. Communication of expectations between all members of the treating team is paramount for patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to provide insights into conducting an implementation needs assessment using a case example in a less-research-intensive setting. Design and methods: In the case example, an implementation needs assessment was conducted, including (1) an environmental scan of the organization's website and preliminary discussions with key informants to learn about the implementation context, and (2) a formal analysis of the evidence–practice gap (use of sedation interruptions) deploying a chart audit methodology using legal electronic reports. Results: Our needs assessment was conducted over 5 months and demonstrated how environmental scans reveal valuable information that can inform the evidence–practice gap analysis. A well-designed gap analysis, using suitable indicators of best practice, can reveal compliance rates with local protocol recommendations, even with a small sample size. In our case, compliance with the prescribed practices for sedation interruptions ranged from 65% (n=53) to as high as 84% (n=69). Conclusions: Implementation needs assessments provide valuable information that can inform implementation planning. Such assessments should include an environmental scan to understand the local context and identify both current recommended best practices and local best practices for the intervention of interest. When addressing an evidence–practice gap, analyses should quantify the difference between local practice and desired best practice. Impact: The insights gained from the case example presented in this paper are likely transferrable to implementation research or studies conducted in similar, less-research-intensive settings. http://links.lww.com/IJEBH/A257 [ABSTRACT FROM AUTHOR]

Background : Extensive time spent on documentation in electronic health records (EHRs) impedes patient care and contributes to nurse burnout. Artificial intelligence–based clinical decision support tools within the EHR, such as ChatGPT, can provide care plan recommendations to the perinatal nurse. The lack of explicit methodologies for effectively integrating ChatGPT led to our initiative to build and demonstrate our ChatGPT-4 prompt to support nurse care planning. Methods : We employed our process model, previously tested with 22 diverse medical-surgical patient scenarios, to generate a tailored prompt for ChatGPT-4 to produce care plan suggestions for an exemplar patient presenting with preterm labor and gestational diabetes. A comparative analysis was conducted by evaluating the output against a "nurse-generated care plan" developed by our team of nurses on content alignment, accuracy of standardized nursing terminology, and prioritization of care. Results : ChatGPT-4 delivered suggestions for nursing diagnoses, interventions, and outcomes comparable to the "nurse-generated care plan." It accurately identified major care areas, avoided irrelevant or unnecessary recommendations, and identified top priority care. Of the 24 labels generated by ChatGPT-4, 16 correctly utilized standardized nursing terminology. Conclusion : This demonstration of the use of our ChatGPT-4 prompt illustrates the potential of leveraging a large language model to assist perinatal nurses in creating care plans. The next steps are improving the accuracy of ChatGPT-4–generated standardized nursing terminology and integrating our prompt into EHRs. This work supports our broader goal of enhancing patient outcomes while mitigating the burden of documentation that contributes to nurse burnout. [ABSTRACT FROM AUTHOR]

Background and purpose: This project developed and validated an automated pipeline for prostate treatments to accurately determine which patients could benefit from adaptive radiotherapy (ART) using synthetic CTs (sCTs) generated from on-treatment cone-beam CT (CBCT) images. Materials and methods: The automated pipeline converted CBCTs to sCTs utilising deep-learning, for accurate dose recalculation. Deformable image registration mapped contours from the planning CT to the sCT, with the treatment plan recalculated. A pass/fail assessment used relevant clinical goals. A fail threshold indicated ART was required. All acquired CBCTs (230 sCTs) for 31 patients (6 who had ART) were assessed for pipeline accuracy and clinical viability, comparing clinical outcomes to pipeline outcomes. Results: The pipeline distinguished patients requiring ART; 74·4% of sCTs for ART patients were red (failure) results, compared to 6·4% of non-ART sCTs. The receiver operator characteristic area under curve was 0·98, demonstrating high performance. The automated pipeline was statistically significantly (p < 0·05) quicker than the current clinical assessment methods (182·5s and 556·4s, respectively), and deformed contour accuracy was acceptable, with 96·6% of deformed clinical target volumes (CTVs) clinically acceptable. Conclusion: The automated pipeline identified patients who required ART with high accuracy while reducing time and resource requirements. This could reduce departmental workload and increase efficiency and personalisation of patient treatments. Further work aims to apply the pipeline to other treatment sites and investigate its potential for taking into account dose accumulation. [ABSTRACT FROM AUTHOR]

The rising prevalence of Alzheimer's disease and Alzheimer's disease–related dementias has led to renewed public discourse and policy changes in response to the care needs of persons living with dementia and their care partners. Comprehensive dementia care models are central to many recent policy initiatives, most notably the Centers for Medicare & Medicaid Services Guiding an Improved Dementia Experience model. Gerontological nursing research is uniquely positioned to design and lead research investigating the effectiveness of these initiatives, as well as the dissemination and scaling of existing comprehensive dementia care models. The current Annual State of the Science Review provides an overview of the current state of comprehensive dementia care models in the United States and relevant policies. Challenges and opportunities for nursing education, research, and implementation across the translational research continuum are also outlined. [Research in Gerontological Nursing, 18(1), 7–16.] [ABSTRACT FROM AUTHOR]

Background/Objectives: This article presents analytical techniques and a decision support tool to aid in hospital capacity assessment and case mix planning (CMP). To date, no similar techniques have been provided in the literature. Methods: Initially, an optimization model is proposed to analyze the impact of making a specific change to an existing case mix, identifying how patient types should be adjusted proportionately to varying levels of hospital resource availability. Subsequently, multi-objective decision-making techniques are introduced to compare and critique competing case mix solutions. Results: The proposed techniques are embedded seamlessly within an Excel Visual Basic for Applications (VBA) personal decision support tool (PDST), for performing informative quantitative assessments of hospital capacity. The PDST reports informative metrics of difference and reports the impact of case mix modifications on the other types of patients present. Conclusions: The techniques developed in this article provide a bridge between theory and practice that is currently missing and provides further situational awareness around hospital capacity. [ABSTRACT FROM AUTHOR]

Concerning rates of acquired brain injury (ABI) among adults and young people involved in the criminal justice system raise questions about support needs and issues that they face within, and at the juncture between, community-based service systems and criminal justice systems. Data from two studies in Victoria Australia, between 2015 and 2021, highlight key issues that experienced professionals identify as contributors to the repeated cycling through the criminal justice system of people living with an ABI. Systemic issues including poor ABI-literacy; failure to identify, assess or diagnose an ABI (especially among young people); insufficient specialist ABI services; inadequate care coordination and holistic, ongoing community support; and poor integration and information-sharing between custodial and community-based services lead to inappropriate and indifferent responses and attitudes. Our findings, discussion and recommendations provide insights to assist justice and allied health professionals, and to policymakers to thwart patterns of entrenchment in the criminal justice system. [ABSTRACT FROM AUTHOR]

Background: Age-related macular degeneration (AMD) is a leading cause of blindness and low vision worldwide. This study examines the global burden and trends in AMD-related low vision and blindness from 1990 to 2021, with projections through 2050. Methods: Data were obtained from the 2021 Global Burden of Disease (GBD 2021) study, covering 204 countries and regions. Key metrics, including the prevalent case numbers, annual disability-adjusted life years (DALYs), age-standardized prevalence rates (ASPR), and age-standardized DALY rates (ASDALYR), specific to low vision and blindness due to AMD, were calculated per 100,000 population. Trend analysis used the estimated annual percentage change (EAPC) method, and K-means clustering identified regions with similar burdens and trends. Autoregressive Integrated Moving Average(ARIMA) and Exponential Smoothing(ES) models provided future projections. Results: Globally, the total number of prevalent cases and DALYs has substantially increased. The number of prevalent cases of low vision and blindness due to AMD increased from 3,640,180 (95% UI: 3,037,098 − 4,353,902) in 1990 to 8,057,521 (95% UI: 6,705,284-9,823,238) in 2021. DALYs increased from 302,902 (95% UI: 206,475 − 421,952) in 1990 to 578,020 (95% UI: 401,241–797,570) in 2021. From 1990 to 2021, both the ASPR and ASDALYR for AMD-related low vision and blindness showed a downward trend. The ASPR was 94 (95% UI: 78.32-114.42) per 100,000 population, with an EAPC of -0.26 (95% CI: -0.31 to -0.22), and the ASDALYR was 6.78 (95% UI: 4.7–9.32) per 100,000 population, with an EAPC of -0.94 (95% CI: -1.01 to -0.88). The disease burden of AMD-related low vision and blindness increases with age, and the burden for female patients is slightly higher than for males. Regional stratification by the Socio-Demographic Index (SDI) shows that the burden of AMD-related low vision and blindness in areas with low SDI is higher than in areas with high SDI. From 1990 to 2021, notable increases in ASPR and ASDALYR were observed mainly in the southern and central regions of sub-Saharan Africa. Moreover, the increases in prevalence and DALYs vary by region, country, and level of socioeconomic development. The ARIMA model predicts that by 2050, the number of prevalent cases of low vision and blindness due to AMD will reach 13,880,610(95% CI: 9,805,575–17,955,645), and the DALYs will be 764,731(95% CI: 683,535–845,926). The ES model predicts that by 2050, the number of prevalent cases of AMD-related low vision and blindness will reach 9,323,124(95% CI: 5,222,474–13,423,774), and the DALYs will be 641,451 (95% CI: 383,588–899,318). Conclusion: This study indicates that between 1990 and 2021, the global prevalent cases and DALYs caused by AMD-related low vision and blindness have increased over the past three decades, correlating with factors such as age, gender, socioeconomic status, and geographical location. Predictive models indicate that as the population ages, the number of patients with low vision and blindness due to AMD, along with associated DALYs, will continue to rise. By 2050, it is expected that over 9 million people worldwide will be affected by AMD-related vision loss, with women being particularly impacted. These findings can provide data support for public health planning, resource allocation, and the formulation of medical policies, ensuring an effective response to the challenges posed by the future increase in AMD-related low vision and blindness. [ABSTRACT FROM AUTHOR]

AbstractOlder racialized minorities were particularly vulnerable during the last pandemic due to the interlocking influences of structural racism and ageism, which are often disregarded in public health planning. This oversight not only compromises the social justice and health equity goals of public health efforts but it also calls for a more inclusive approach that systematically addresses these deficiencies at every stage of a public health response. To achieve this, we propose Age- and Race-conscious Interventions done Equitably (ARIE), a novel analytical framework grounded in critical race theory and critical gerontology. ARIE is based on a four-step approach, which aligns with different stages of public health interventions. It will help ensure that structural discrimination influencing access to healthcare resources during a biological event is not ignored, and that public health authorities work actively toward identifying and addressing ageist and racist biases in their response plans and interventions. [ABSTRACT FROM AUTHOR]

Background: Malaria is a major public health issue in Nekemte City, western Ethiopia, with various environmental and social factors influencing transmission patterns. Effective control and prevention strategies require precise identification of high-risk areas. This study aims to map malaria risk zones in Nekemte City using geospatial technologies, including remote sensing and Geographic Information Systems (GIS), to support targeted interventions and resource allocation. Methods: The study integrated environmental and social factors to assess malaria risk in the city. Environmental factors, including climatic and geographic characteristics, such as elevation, rainfall patterns, temperature, slope, and proximity to river, were selected based on experts' opinions and literature review. These factors were weighted using the analytic hierarchy process according to their relative influence on malaria hazard susceptibility. Social factors considered within the GIS framework focused on human settlements and access to resources. These included population density, proximity to health facilities, and proximity to roads. The malaria risk analysis incorporated hazard and vulnerability layers, along with Land use/cover (LULC) data. A weighted overlay analysis method combined these layers and generate the final malaria risk map. Results: The malaria risk map identified that 18.2% (10.5 km2) of the study area was at very high risk, 18.8% (10.9 km2) at high risk, 30.4% (17.8 km2) at moderate risk, 19.8% (11.5 km2) at low risk, and 12.6% (7.3 km2) at very low risk. A combined 37% (21.4 km2) of Nekemte City was classified as at high to very high malaria risk, highlighting key areas for intervention. Conclusions: This malaria risk map offers a valuable tool for malaria control and elimination efforts in Nekemte City. By identifying high-risk areas, the map provides actionable insights that can guide local health strategies, optimize resource distribution, and improve the efficiency of interventions. These findings contribute to enhanced public health planning and can support future regional malaria control initiatives. [ABSTRACT FROM AUTHOR]

Background: Schoolgirls in resource-limited settings encounter significant challenges in maintaining proper menstrual hygiene management practices. Studies on associated factors in menstrual hygiene management practices among schoolgirls in Bahir Dar City are limited. Objectives: The study aimed to evaluate the menstrual hygiene practices of schoolgirls and identify factors that influence these practices in the limited settings of Bahir Dar City. Design: This study was a school-based, analytical, cross-sectional study conducted among schoolgirls between the ages of 11 and 25. Methods: A total of 701 schoolgirls, selected at random based on their consent, participated in this school-based, analytical, cross-sectional study. The data collection process was comprehensive, involving a self-administered questionnaire and 5 rounds of observations at 10 schools using the Joint Monitoring Program for Water, Sanitation, and Hygiene monitoring tool. The study used a binary logistics regression model to determine the strength of the association between predictor and outcome variables, ensuring a rigorous analysis with a p -value < 0.05. Results: In this study, 375 (53.50%) participants were found to have good menstrual hygiene practices. Factors such as the mothers' education (diploma and above vs not read and write (AOR = 26.29, 95% CI: 11.69–59.12), fathers' education (diploma and above vs not read and write (AOR = 19.21, 95% CI: 8.51–43.32), having access to basic water service (AOR = 14.62, 95% CI: 5.12–41.73), having access to basic sanitation services (AOR = 21.02, 95% CI: 7.87–56.15), being older among the schoolgirls (AOR = 19.69, 95% CI: 10.18–38.07), having private work (AOR = 15.58, 95% CI: 6.99–34.73), having open discussions with sisters (AOR = 27.01, 95% CI: 11.45–63.73), having friendly discussions about menstrual hygiene with schoolgirl friends (AOR = 18.67, 95% CI: 8.45–41.24), and residing in urban areas (AOR = 6.43, 95% CI: 3.52–11.73)) were significantly associated with good menstrual hygiene practices. Conclusion: The schoolgirls in the study area had good menstrual hygiene practices. However, uneducated parents, inadequate facilities, limited access to absorbent materials, and lack of support were challenges that affected proper menstrual hygiene management practice. To improve menstrual hygiene practices, it is crucial to address these identified modifiable factors and consider education programs, better facilities, community support, and policy changes that prioritize menstrual hygiene management in schools for schoolgirls to manage menstruation. Plain language summary: Menstrual hygiene management practices among schoolgirls Menstruation poses challenges for schoolgirls in resource-limited settings. Cultural norms, lack of proper infrastructure, limited access to affordable products, and insufficient education hinder the practice of proper menstrual hygiene practices. These challenges can lead to health risks, absenteeism, and decreased academic performance. For instance, in the Oromia region, only 35% of the schoolgirls used sanitary pads, while in the Amhara region, 44.9%–33% used sanitary pads. A school-based analytical cross-sectional study was conducted in Bahir Dar City from March 2022 to August 2023 to evaluate the menstrual hygiene practices of schoolgirls and identify the factors that influence these practices in the schools of Bahir Dar City, located in Northwest Ethiopia. The mean age of schoolgirls was 16.82 years (SD = ±1.60), and the age of 8 years was the first menarche experience in 7 (1%) schoolgirls. The overall practices showed that 375 (53.50%) schoolgirls exercised good MHM, and the remaining 326 (46.50%) exercised poor MHM. The study revealed that schoolgirls whose mothers' and fathers' had a college education and above, older schoolgirls, schoolgirls with parents working in private, those attending schools with basic water and sanitation facilities, and those who openly discussed menstruation with their sisters and friends tended to have better MHM practices. Parental education levels, WASH facilities, and schoolgirls' residence areas have been identified as factors affecting schoolgirls' menstrual hygiene practices. The identified modifiable factors are the areas of intervention to increase proper menstrual hygiene practices. Concerned bodies should create a supportive and safe environment to help schoolgirls manage their monthly menstruation safely and comfortably. [ABSTRACT FROM AUTHOR]

Purpose Critical care pharmacists (CCPs) are essential members of the multidisciplinary critical care team. Professional activities of the CCP are outlined in a 2020 position paper on critical care pharmacy services. This study looks to characterize CCP perspectives for priorities in optimizing pharmacy practice models and professional activities. Methods This was a cross-sectional survey conducted from July 24 to September 20, 2023. A 41-question survey instrument was developed to assess 7 domains: demographics, CCP resource utilization, patient care, quality improvement, research and scholarship, training and education, and professional development. This voluntary survey was sent to members of the American College of Clinical Pharmacy's Critical Care Practice and Research Network. The survey was open for a total of 6 weeks. Results There was a response rate of 20.7% (332 of 1,605 invitees), with 66.6% of respondents (n = 221) completing at least 90% of the survey questions. Most respondents were clinical specialists (58.2%) and/or practiced at an academic medical center (58.5%). Direct patient care, quality improvement and medication safety, and teaching and precepting were identified as the CCP activities of highest importance to CCPs. The CCP-to-patient ratios considered ideal were 1:11-15 (selected by 49.8% of respondents) and 1:16-20 (33.9% of respondents). The ideal percentage of time dedicated to direct patient care activities, as identified by survey respondents, was 50% (interquartile range, 40-50). Conclusion These findings highlight the professional activities viewed as having the highest priority by CCPs. Future research is needed to define optimal CCP practice models for the delivery of patient care in real-world settings. [ABSTRACT FROM AUTHOR]

Aero-engines, particularly turbofan engines, are highly complex systems that play a critical role in the aviation industry. As core components of modern aircraft, they provide the thrust necessary for flight and are essential for safe and efficient operations. However, the complexity and interconnected nature of these engines also make them vulnerable to failures and, in the context of intelligent systems, potential cyber-attacks. Ensuring the secure and reliable operation of these engines is crucial as disruptions can have significant consequences, ranging from costly maintenance issues to catastrophic accidents. The innovation of this article lies in a proposed method for obtaining key points. The research method is based on convolution and the basic shape of convolution. Through feature fusion, a self-convolution operation, a half operation, and derivative operation on the original feature data of the engine, two key points of the engine in the entire lifecycle are obtained, and these key points are analyzed in detail. Finally, the key point-based acquisition method and statistical data analysis were applied to the engine's health planning and lifespan prediction, and the results were validated on the test set. The results indicate that the key point-based method proposed in this paper has promising prospects. [ABSTRACT FROM AUTHOR]

Autonomous Medical Evaluation for Guideline Adherence (AMEGA) is a comprehensive benchmark designed to evaluate large language models' adherence to medical guidelines across 20 diagnostic scenarios spanning 13 specialties. It includes an evaluation framework and methodology to assess models' capabilities in medical reasoning, differential diagnosis, treatment planning, and guideline adherence, using open-ended questions that mirror real-world clinical interactions. It includes 135 questions and 1337 weighted scoring elements designed to assess comprehensive medical knowledge. In tests of 17 LLMs, GPT-4 scored highest with 41.9/50, followed closely by Llama-3 70B and WizardLM-2-8x22B. For comparison, a recent medical graduate scored 25.8/50. The benchmark introduces novel content to avoid the issue of LLMs memorizing existing medical data. AMEGA's publicly available code supports further research in AI-assisted clinical decision-making, aiming to enhance patient care by aiding clinicians in diagnosis and treatment under time constraints. [ABSTRACT FROM AUTHOR]

Integrating Ayurveda, Yoga, Unani, Siddha, and Homoeopathy (AYUSH) into preventive medicine enhances holistic health care by addressing lifestyle, mental well-being, and disease prevention. This integration is vital for addressing India's quadruple burden of non-communicable diseases (NCDs), communicable diseases, poor maternal and child health (MCH) outcomes, and an aging population. The National Health Policy 2017 promotes this integration through "Pluralism," aligning with the World Health Organization (WHO)'s Sustainable Development Goal (SDG) 3 and global traditional medicine priorities. Essential actions include adopting integrative care models, standardizing treatment protocols, training healthcare professionals, and advancing research. Despite its promise, challenges persist, such as limited awareness among modern physicians, minimal interaction between practitioners, lack of standardized protocols, and insufficient research on AYUSH's synergistic effects. The Indian Association of Preventive and Social Medicine (IAPSM) can play a pivotal role in overcoming these barriers. By advocating for policy development, adopting integrative care frameworks, and fostering educational and research collaborations with AYUSH institutes, IAPSM can advance the integration of AYUSH into preventive medicine. Promoting research and increasing public awareness of AYUSH's role in disease prevention and health promotion is essential for achieving a comprehensive healthcare system. [ABSTRACT FROM AUTHOR]

Background: Health financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania. Methods: An exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data. Findings: Although there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process. Conclusion: The exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders' engagement and establishing alternative financing of the exemption policy are recommended. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the cost‐effectiveness of the Virtual Rural Generalist Service (VRGS) model of care. Design: A cost–consequence analysis of the VRGS model of care compared with usual care (treatment by local or locum [non‐VRGS] doctors) from the perspective of the health care funder in 2022 prices. Setting: Twenty‐nine rural and remote hospitals in the Western NSW Local Health District where the VRGS has been in operation (VRGS sites). Patients: Patients of any age who presented to an emergency department (ED) or were admitted to hospital at VRGS sites over the pre‐VRGS period (1 February 2019 to 31 January 2020) or the post‐VRGS period (1 July 2021 to 30 June 2022). Intervention: The VRGS model of care, which provides 24‐hour 7‐days‐a‐week rural generalist doctors, both virtually and in person, to small rural and remote hospitals, predominantly for lower acuity ED presentations, daily ward rounds for inpatients admitted by a VRGS medical officer, and ad hoc inpatient medical reviews when local doctors need support or are unavailable. Main outcomes measures: Incremental cost per incremental quality‐of‐care outcome, maintenance of health service activity levels, workforce sustainability (measured by changes in locum shifts), and service acceptability (as determined by thematic analysis of interviews). Results: The cost per standard unit of health care (national weighted activity unit) was lower for the VRGS ($1047) than for usual care ($1753). VRGS doctors dealt with ED presentations of similar complexity to non‐VRGS doctors, and admissions of significantly lower (40%) complexity. Health service activity remained stable from the pre‐VRGS period to the post‐VRGS period, only declining by 4% in the post‐VRGS period, which was during the coronavirus disease 2019 pandemic. Locum shifts decreased from 1456 days in the pre‐VRGS period to 609 days in the post‐VRGS period, improving the sustainability of the workforce. Local doctors and managers found the VRGS to be acceptable, but thought it could be enhanced with additional investment in nursing and technical staff. Conclusions: Our economic evaluation of the VRGS showed that it provided lower cost care and equivalent quality‐of‐care outcomes when compared with usual care for ED presentations of the same complexity, and supported local clinical staff to maintain activity levels despite a pandemic. With additional investment in data capture and in nursing and technical staff to support the service, the VRGS has promise as a flexible service that can help sustain access to quality medical care in rural and remote communities. [ABSTRACT FROM AUTHOR]

This article examines the opportunities and benefits of artificial intelligence (AI)–enabled social media listening (SML) in assisting successful patient-focused drug development (PFDD). PFDD aims to incorporate the patient perspective to improve the quality, relevance, safety, and efficiency of drug development and evaluation. Gathering patient perspectives to support PFDD is aided by the participation of patient groups in communicating their treatment experiences, needs, preferences, and priorities through online platforms. SML is a method of gathering feedback directly from patients; however, distilling the quantity of data into actionable insights is challenging. AI–enabled methods, such as natural language processing (NLP), can facilitate data processing from SML studies. Herein, we describe a novel, trainable, AI-enabled, SML workflow that classifies posts made by patients or caregivers and uses NLP to provide data on their experiences. Our approach is an iterative process that balances human expert–led milestones and AI-enabled processes to support data preprocessing, patient and caregiver classification, and NLP methods to produce qualitative data. We explored the applicability of this workflow in 2 studies: 1 in patients with head and neck cancers and another in patients with esophageal cancer. Continuous refinement of AI-enabled algorithms was essential for collecting accurate and valuable results. This approach and workflow contribute to the establishment of well-defined standards of SML studies and advance the methodologic quality and rigor of researchers contributing to, conducting, and evaluating SML studies in a PFDD context. [ABSTRACT FROM AUTHOR]

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Leisure participation in older age has principally been researched from individual-level theoretical perspectives that view leisure as reflecting adaptations to ageing-related losses and change. Recent orientations to later-life leisure participation, such as innovation theory, emphasise positive developmental aspects and uses of older individuals' leisure pursuits, driven by personal agency. Moreover, the potential of later-life leisure activities to contribute to community is conceptualised in social capital theory perspectives that bridge individual- and community-level functions of leisure participation. This paper presents findings from qualitative thematic analysis of oral histories on leisure conducted with 58 persons aged 60 and over in rural south-west England, to examine the personal uses and functions of their leisure occupations in older age, and the role that these activities play in connecting older individuals to their communities. While participants described lifetime patterns of leisure characterised by a core set of activities and interests, later life was a period of leisure transitions in which they actively used new and continuing pastimes to adapt to changing personal circumstances, abilities and aspirations. The findings also demonstrate how participants' leisure activities – ranging from avidly pursued hobbies to formal volunteering – served individual adaptive and developmental purposes, and were a means of fostering social connectivity and contributing to rural community life. Implications of these findings are discussed in regard to leisure theory, policy and practice. This paper adds to the literature on ageing and leisure by identifying the benefits of examining older persons' leisure participation from a combined conceptual perspective that can elucidate its functions at both the micro- and meso-levels of society. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is a major cause of hospital admission in adults over 65, leading to severe complications and death. However, the disease burden in primary care for older adults in Europe is poorly understood. This pilot study aims to test a study protocol for evaluating the clinical burden of RSV in older adults in primary care settings in Italy. Methods: In the 2022–23 winter season, we designed a study on RSV burden in individuals over 65 with acute respiratory infections (ARIs) in Liguria, Apulia, and Tuscany, Italy. Recruited patients underwent nasopharyngeal swabs for RSV confirmation and provided epidemiological and clinical data. RSV‐positive patients completed follow‐up questionnaires after 14 and 30 days regarding their clinical conditions, healthcare utilization, and socio‐economic impact. Results: We enrolled 152 patients with ARIs; 33 (21.7%) tested positive for RSV. The median disease duration was 14 days, with 3% hospitalized. Among RSV‐positive patients, 87% received drug treatment, 52% of whom received antibiotics. After diagnosis, 74% required further GP consultations within 2 weeks. Additionally, 48% incurred extra costs. On day 30, 21% reported health complications or deterioration. Conclusions: Our pilot study highlights the need for an ARIs surveillance system for older adults in primary care. This is crucial for defining vaccination strategies to reduce the disease burden on these patients and the healthcare system. Moreover, these data are essential for assessing costs and parameters for cost‐effectiveness models, facilitating informed decisions in public health planning and resource allocation. [ABSTRACT FROM AUTHOR]

Purpose: To explore the lived experiences and motivations of individuals engaged in weight management, focusing on psychological, societal, health-related, and personal factors influencing their motivations. Methods: A descriptive exploratory approach, guided by the Self-Determination Theory (SDT), was followed and semi-structured interviews were conducted with ten adults actively involved in weight management. Thematic analysis identified key themes across four domains: (i) psychological motivation (extrinsic and intrinsic), (ii) societal influence (body image, social norms, media influence), (iii) health consciousness (priority of health, health concerns), and (iv) family support and past weight management experiences (learned habits, supportive environment). Results: The findings revealed a nuanced interplay of intrinsic and extrinsic motivations, societal expectations, health priorities, and the impact of family support on weight management. Aligning with SDT, the study emphasizes the role of autonomy, competence, and relatedness in shaping individual motivations for weight management. Conclusions: The study provides valuable insights for tailoring interventions aimed at enhancing well-being by addressing the psychological, societal, health-conscious, and familial factors that influence motivations in weight management. [ABSTRACT FROM AUTHOR]

PURPOSE: Adverse effects of chemotherapy often require hospital admissions or treatment management. Identifying factors contributing to unplanned hospital utilization may improve health care quality and patients' well-being. This study aimed to assess if patient-reported outcome measures (PROMs) improve performance of machine learning (ML) models predicting hospital admissions, triage events (contacting helpline or attending hospital), and changes to chemotherapy. MATERIALS AND METHODS: Clinical trial data were used and contained responses to three PROMs (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire [QLQ-C30], EuroQol Five-Dimensional Visual Analogue Scale [EQ-5D], and Functional Assessment of Cancer Therapy-General [FACT-G]) and clinical information on 508 participants undergoing chemotherapy. Six feature sets (with following variables: [1] all available; [2] clinical; [3] PROMs; [4] clinical and QLQ-C30; [5] clinical and EQ-5D; [6] clinical and FACT-G) were applied in six ML models (logistic regression [LR], decision tree, adaptive boosting, random forest [RF], support vector machines [SVMs], and neural network) to predict admissions, triage events, and chemotherapy changes. RESULTS: The comprehensive analysis of predictive performances of the six ML models for each feature set in three different methods for handling class imbalance indicated that PROMs improved predictions of all outcomes. RF and SVMs had the highest performance for predicting admissions and changes to chemotherapy in balanced data sets, and LR in imbalanced data set. Balancing data led to the best performance compared with imbalanced data set or data set with balanced train set only. CONCLUSION: These results endorsed the view that ML can be applied on PROM data to predict hospital utilization and chemotherapy management. If further explored, this study may contribute to health care planning and treatment personalization. Rigorous comparison of model performance affected by different imbalanced data handling methods shows best practice in ML research. Using patient-reported data to improve ML models predicting hospital utilization during chemotherapy. [ABSTRACT FROM AUTHOR]

Objectives: Previous research documented the values of audiology through a qualitative content analysis of documents representing traditional, best-practice hearing health care. The primary objective of this study was to validate the existing list of audiology values. Through a nationwide survey, this study aimed to elicit the values of practicing audiologists, with a specific focus on the prescription and dispensing of amplification devices, to ensure a comprehensive understanding of their priorities. Additionally, this study sought to identify any values missing from the original list and determine the rank order importance of these values, comparing this to the prioritization of values found in best-practice audiology documents. This comparison aimed to assess the alignment of recommended guidelines and real-world practices in hearing health care. Design: An online survey was distributed to audiologists to elicit the prioritization of values from hearing health care providers. Participants were tasked with sorting and ranking 18 items, each representing a specific value in hearing health care, based on importance. Respondents were encouraged to suggest and rank the importance of additional values not included in the list. Audiologists were recruited from professional association mailing lists and direct contact. Respondent demographics were representative of U.S. audiologists. Qualitative content analysis was used to interpret values suggested by audiologists. Kendall's rank distance test was used to compare values prioritization between audiologists and best-practice audiology documents. Results: After filtering out incomplete or disqualifying responses, data from 289 audiologists across 46 states were analyzed. Additional values suggested by respondents aligned with existing values from best-practice documents; thus, no new values were added as a result of this study. A ranked list of values based on mean order of importance was elicited from U.S.-based audiologists. There was substantial agreement between survey results and the rank order of values found in best-practice audiology documents. A demographic subgroup analysis revealed a broad agreement among audiologists in the rank order of values. Conclusions: This study validated a comprehensive list of values in audiology and identified the rank order of values among a nationally representative sample of audiologists. The findings provide a foundation for future investigations into how these values influence decision-making processes for individuals with hearing difficulty. Addressing values conflicts as potential barriers to hearing health care usage can lead to solutions aligned with values of specific populations, ultimately improving the adoption and effectiveness of hearing health care interventions. [ABSTRACT FROM AUTHOR]

Background: Monitoring and evaluation are crucial in ensuring the effective implementation of health priorities. This descriptive study examined the progress towards implementing Iran's General Health Policies (IGHP) to illustrate how countries can effectively monitor and evaluate their national plans. Additionally, the study sought to identify factors that impede the full implementation of these policies. Methods: Available data sources, formal reports, and studies were examined to gather data on selected indicators. Then, documentary analysis and 21 semi-structured interviews were conducted to identify measures taken to materialize IGHP and factors that hindered the full implementation of IGHP. Data were analyzed using the content analysis method. Results: The results showed that several indicators improved during these years, while there was no data for some indicators. There are some barriers to implementing the IGHP, including lack of full understanding of the policies, absence of necessary mechanisms and infrastructures, lack of coherency and alignment of national health plans and policies, absence of monitoring and evaluation framework, and lack of transparency and accountability in the health system. As countries continue to develop their health plans and policies, lack of clarity regarding the progress of these plans remains a concern. Conclusion: Countries need to strengthen their health planning systems and expedite the implementation of accountability mechanisms within the health system. Enhancing capacity building is essential to establish a comprehensive monitoring and evaluation framework. By fortifying these systems, countries will be better equipped to measure and track progress toward achieving their health objectives. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic laid bare pre‐existing societal fault lines, placing immense strain on intergroup relations and giving rise to xenophobic sentiments. Drawing on Realistic Conflict Theory (RCT) and Social Identity Approach (SIA), our study examined how the public allocation of COVID‐19 variant vaccines could influence the dynamics between local citizens and migrant workers, and under what conditions. One key idea is that valued resource distribution that favour migrant workers may produce increased perceptions of realistic threats among local citizens which could lead to exacerbated negative attitudes and behaviours of high‐status local citizens towards low‐status migrants, whereas higher fairness perceptions of such resource distributions could potentially mitigate these negative attitudes and behaviours. To investigate these predictions, we employed a cross‐cultural approach and conducted an experiment in both an Asian country (Malaysia; N = 197) and a Western country (Australia; N = 210). We manipulated vaccine prioritisation, assessed local citizens' perceptions of the realistic threat and fairness of vaccine prioritisation, and measured their attitudinal responses towards migrant workers. Our results showed that the perceived unfairness in migrant‐favouring vaccine prioritisation, rather than realistic threat, negatively affected local citizens' perceptions of the migrant workers. We discuss the implications of these findings in the context of intergroup relations. [ABSTRACT FROM AUTHOR]

Although family caregivers are increasingly recognized for their essential role in helping vulnerable adults live in the community for as long as possible, their priorities and perspectives have not been well‐integrated into quality assessments of home‐ and community‐based services (HCBS). Our overall goal was to identify measurement gaps to guide monitoring and improve HCBS. Caregiver‐specific measurement priorities were identified during a multi‐level stakeholder engagement process that included 34 Veterans, 24 caregivers, and 39 facility leaders, clinicians, and staff across four VA healthcare systems. We mapped items from national quality measure sets for HCBS identified during an environmental scan onto the stakeholder‐identified measurement priorities. Only 5 of 11 non‐VA measure sets and three of four VA measure sets explicitly included caregiver‐specific items that were aligned with or relevant to stakeholders' measurement priorities. Six of 14 stakeholder‐identified priorities were not reflected in any measure sets, such as those that explicitly assess caregiver‐reported experience with services that directly or indirectly support their role as caregivers within HCBS. Although family caregivers fulfill a critical role in helping adults with complex medical needs live independently for as long as possible, their priorities and perspectives have not been well‐integrated into quality assessments of HCBS. Measures that acknowledge caregivers' roles and incorporate their priorities can help healthcare systems to better monitor and improve HCBS quality, thereby enabling Veterans to remain in the community as long as possible. [ABSTRACT FROM AUTHOR]

Background: Outcome monitoring can support the delivery of quality service that meets the needs of clients, clinicians and services. However, few studies have examined client or staff perspectives on the design and implementation of outcomes monitoring within a service. Implementation of outcomes monitoring requires understanding the preferences and expectations of relevant stakeholders. Objective: Informed by the Consolidated Framework for Implementation Research, this study aimed to investigate the preferences and priorities of relevant staff, clients and family members to inform the design and implementation of an effective outcomes monitoring system in the context of a mental health service for military veterans and their families. Method: Twenty‐nine staff participated across five online focus groups, including clinical staff, peer workers, policy staff and supervisors. Ten clients participated in online or telephone semi‐structured interviews. Thematic analysis was used to develop themes from the data. Results: Clients and staff agreed that outcomes monitoring should cover more than symptoms, particularly by incorporating functional outcomes. Assessing mental health over time was considered a valuable tool for supporting treatment processes and providing actionable information. Challenges identified by clients and staff included the need for efficient processes, ensuring measures are relevant and acceptable, and maintaining client privacy. The ability to personalise data collection and have a streamlined, responsive system were key attributes of a quality outcomes monitoring framework. Conclusions: Findings suggest that an effective outcome monitoring framework should be client‐led, tailored to the individual's needs, and provide feedback on progress. Outcomes monitoring should also be efficient, accessible and allow for safe information sharing. [ABSTRACT FROM AUTHOR]

The article focuses on enhancing patient participation in treatment planning within inpatient behavioral health settings. It explores how patient-centered care and shared decision-making (SDM) improve treatment outcomes and comply with regulatory standards, emphasizing the importance of collaborative, individualized care.

Background: Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents. Aim: The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. Research design, participants, and research context: We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. Ethical considerations: Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). Findings: We identified an overarching theme—nursing home nurses struggling on multiple fronts, "just do it"—and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. Conclusions: Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize. [ABSTRACT FROM AUTHOR]

Introduction: Exploring health consumer preferences in care is an essential foundational, and ongoing activity, when designing and delivering models of care. We undertook a study to explore: (i) what allied health (AH) services are most important to health consumers and (ii) how health consumers expect to access these services in residential aged care (RAC) to determine consumer priorities in future AH models of care in RAC. Methods: A mixed method study was conducted with aged care residents and community members (friends or family of residents/people who believe they may use RAC services). The study comprised two focus‐group activities where participants were asked to (1) rank the AH services most important to them and then (2) categorise how they would prefer to access each AH service. Focus group members used card sort methods (Q‐methodology) to aid prioritisation, categorisation and discussion. Card sorting data were analysed using inverted factor analysis and descriptive statistics. Qualitative focus group data were deductively coded using a coding structure created by the research team informed by quantitative results. Results: Data were collected from 16 participants who formed five focus groups in a community forum. The analysis revealed three factors, that represented shared meaning amongst groups of participants (viewpoints) regarding prioritisation of AH services: 'Prioritising urgent needs', 'Prioritising long‐term healthy habits and lifestyle', and 'Prioritising social well‐being'. Data from the card sort activity, which related to 'how health consumers expect to access AH services', were also categorised into three categories: 'It is always provided', 'A professional will assess my need' and 'I or my family will ask for this service if I need it'. Participants wanted most AH services to be provided regularly, with some such as 'Exercise and rehabilitation' and 'Meaningful activity' to be provided up to one hour every day. Conclusion: Consumers value a range of AH services and have an expectation that these will be provided in RAC on a regular basis. To ensure consumers make informed preferences regarding the future of services in RAC, health systems need to trial innovative AH models of care and embed consumer evaluation. [ABSTRACT FROM AUTHOR]

This article describes (a) key elements of a high-quality technical assistance (TA) system; (b) the operationalization of a high-quality TA system (Getting To Outcomes-Technical Assistance; GTO-TA) being implemented in a training and TA center (TTAC) interested in transforming its support services to include an evidence-informed approach to TA; and (c) key lessons learned in successfully transitioning from "TA-as-usual" to an evidence-informed TA system. GTO-TA is one operationalization of a systematic, proactive, evidence-informed approach to TA. GTO-TA includes best practices and core elements for a comprehensive TA system; it aims to increase the readiness (reduce barriers and increase facilitators) of an organization to deliver an innovation (program, policy, practice, and process new to an organization) with quality. We describe the collaboration between the Wandersman Center and the Geographic Health Equity Alliance team to co-design and implement the GTO-TA system. Data from surveys, interviews, and consensus conversations led to important lessons learned, which are applicable to other TTACs seeking to develop a more proactive and systematic approach to TA. Lessons include: changing internal operations to facilitate TA providers making necessary changes in providing TA and understanding the relative advantage perceptions about a new TA system that influence adoption and must be considered. [ABSTRACT FROM AUTHOR]