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Introduction
Regular physical activity (PA) and good motor performance are essential for children’s physical and mental health. However, historical trends suggest that levels of PA and motor performance in children and adolescents are at a low point. The relationships between PA, motor performance, health and their respective determinants, as well as their individual development throughout childhood and adolescence, are not yet fully understood. Therefore, continuous monitoring of PA, motor performance and health is needed to identify vulnerable subpopulations and provide data for policy-makers and health promotion professionals. The Motorik Monitoring 2.0-Study aims to analyse the developmental, historical and periodic trends in motor performance and PA, as well as the underlying determinants, in children and adolescents in Germany.

Methods and analysis
A representative sample of children and adolescents aged 4–17 years is drawn across 195 sample points in Germany. The assessment, carried out by test instructors, includes (1) a PA questionnaire covering different settings, including determinants, (2) anthropometric measures, (3) fine and gross motor performance tests focusing on coordination, flexibility, strength and endurance, (4) 24 hours device-based measured physical behaviour by accelerometry for 1 week and (5) a health interview focusing on health behaviour, physical and mental health as well as socioeconomic status. In addition, external data may be linked to the study using geographical information systems (eg, area deprivation, access to sports facilities). Analyses will be conducted using mixed-effects models to account for the nationwide structure of the study.

Ethics and dissemination
Ethical approval was obtained from the Ethics Committee of the Karlsruhe Institute of Technology. Results will be published in open-access scientific journals and disseminated at congresses for scientists, policy-makers and stakeholders.

Trial registration number
The study was registered in the NFDI4health database (https://csh.nfdi4health.de/resource/1034). The NFDI4health database is a central platform of the National Research Data Infrastructure for Personal Health Data. It is used to collect, manage and provide health data for scientific research and facilitates access to high-quality data for epidemiological and clinical studies.

Introduction
Chronic health conditions are the leading causes of morbidity and mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. The burden arising from these conditions presents immense challenges to countries with dysfunctional public healthcare systems, such as South Africa. This necessitates patients to have a good understanding of the conditions and optimal self-management approaches. We explored patients’ understanding of chronic health conditions and self-management practices, including self-monitoring, in the rural South African community of Agincourt in the subdistrict of Bushbuckridge, Mpumalanga Province.

Methods
We randomly selected patients receiving routine care for chronic health conditions in primary healthcare facilities who were linked to the Agincourt Health and Demographic Surveillance System to participate in focus group discussions. Six focus groups (three with men and three with women) were conducted, with 17 male and 19 female participants (n=35) living with different chronic health conditions. Data were collected using body mapping exercises and semistructured focus group discussions facilitated by two experienced qualitative research assistants. An inclusive thematic approach was used for analysis.

Results
Participants identified most chronic health conditions and their progression. Participants expressed that some consequences of chronic health conditions were unavoidable and some were attributed to medications. Three themes emerged on the management of chronic health conditions: (1) individual-level management, where participants actively changed or managed lifestyle factors associated with the conditions; (2) clinic-level management and support, where participants believed that following instructions from healthcare providers facilitates better management of their condition(s); and (3) prevention and screening, to prevent disease progression and development of complications. Participants also highlighted the role of religion in the control of chronic disease risk factors and traditional treatments for uncommon conditions such as epilepsy. Costs associated with lifestyle changes and equipment to manage and monitor health were highlighted as barriers to self-management of chronic health conditions.

Conclusions
Our findings contribute to emerging research on chronic health conditions and self-management approaches. Participants in our study demonstrated a good understanding of various chronic health conditions but lacked knowledge of self-management practices and faced barriers to self-management. There is a need for further studies on self-management of chronic health conditions, including self-monitoring among patients in rural sub-Saharan settings.

Objective
We aimed to investigate the relationship between serum neurofilament light chain (NfL) and grip strength using data from the 2013–2014 US National Health and Nutrition Examination Survey (NHANES).

Design
Secondary analysis of cross-sectional, population-based data.

Setting
NHANES sample, 2013–2014.

Participants
We studied 1925 participants aged 20–75 years.

Outcome measures and analysis
We applied a multivariable generalised linear regression model, adjusted for several potential confounders, and restrictive cubic spline models to evaluate the association between serum NfL and grip strength. Subgroup analyses were conducted using stratified multivariable linear regression analysis.

Results
We included 1925 participants (average age: 44.8±0.44 years) from the NHANES database. Participants with higher serum NfL levels had a significantly higher prevalence of medical conditions (hypertension, diabetes, cardiovascular disorder, chronic kidney disease (CKD) and cancer) compared with those with lower NfL levels (all p

Introduction
Where a person lives, the characteristics of their housing and neighbourhood environment influence their exposure to climate-related hazards and vulnerability to associated mental health impacts. This suggests that the built environment may be a promising focus for integrated policy responses to climate change and public mental health challenges. However, few empirical studies have focused on the role of the built environment as an important mediator of climate-attributable mental health burden. The proposed scoping review seeks to identify and synthesise existing conceptual models and frameworks linking climate change to mental health via built environment pathways. We aim to provide a preliminary overview of the housing and neighbourhood pathways through which climate change may impact mental health, which will inform future empirical work in this emerging area of research.

Methods and analysis
A systematic scoping review of the global peer-reviewed and grey literature will be conducted in accordance with Arksey and O’Malley’s methodological framework and Joanna Briggs Institute recommendations. Included articles must present a conceptual model or framework incorporating relevant built environment pathways through which climate change may impact mental health and well-being. Relevant models and frameworks will be identified through systematic searches (for English-language reports) of Medline, PsycINFO, Embase, Scopus, Web of Science and grey literature databases. Two reviewers will independently screen the article titles, abstracts and full texts, with conflicts resolved by a third reviewer. Data extraction will occur using a predefined template. The presentation of findings will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, including a narrative synthesis of the role of housing and neighbourhood factors in the relationship between climate change and mental health, as identified from the existing literature. The review will lay essential foundations for future empirical research and place-based policy responses to the mental health consequences of a changing climate.

Ethics and dissemination
The scoping review will be a secondary analysis of published data, for which ethics approval is not required. The results will be disseminated through a peer-reviewed publication and targeted distribution to stakeholders involved in climate change, built environment and health research and policymaking.

Study registration
Open Science Framework: doi.org/10.17605/OSF.IO/XR74C.

Objectives
To explore the association between smoking status (current vs former), changes in smoking habits (among current smokers only) and negative changes in dietary and physical activity habits during the initial COVID-19 lockdown in Israel.

Design
A secondary analysis of an online cross-sectional study (6 April 2020 to 28 April 2020). Dependent variables included deteriorations in dietary habits score and odds of reporting worsening of physical activity habits during the first COVID-19 lockdown. The study analysed the association between these variables and ‘smoking status’ (current vs former) and, within smokers, changes in smoking habits, using multivariate logistic and linear regression models. For changes in physical activity habits, there was a significant interaction with baseline physical activity levels (p=0.04), therefore, analysis was stratified accordingly.

Setting
Online data collection.

Participants
660 participants, current or former smokers in Israel, Hebrew speakers and ≥18 years old.

Primary outcomes
Self-reported negative changes in dietary habits and physical activity during the first COVID-19 lockdown.

Results
The sample (n=660) included 66.2% (n=437) current smokers and 33.8% (n=223) former smokers. Among current smokers, 43.5% (n=190) indicated an increase in their smoking habits. Of all respondents, 25% (n=170) reported a negative dietary change and 48% (n=192) spent less time engaging in physical activity, with 66% (n=437) reporting increased levels of stress. No significant association was found between smoking status and the dietary habits score in the multivariate linear regression (B=–0.046, CI –0.493 to 0.401, reference group: former smokers). This indicates that being a current smoker was associated with a non-significant 0.046 point decrease in the dietary habits score compared with former smokers. Similarly, no significant association was found between smoking status and odds of reporting worsening of physical activity, even after stratifying by baseline physical activity levels. Among participants who currently smoke, no significant association was found between changes in smoking habits and the dietary habits score (B=0.391, 95% CI –0.061 to 0.843, p=0.090, reference group: those who smoke the same or less) or with odds of reporting worsening of physical activity (OR=1.16, 95% CI 0.688 to 1.956, p=0.577, reference group: those who smoke the same or less).

Conclusion
Among current and former smokers, high rates of negative health habit changes were found, emphasising the need for interventions during future crises. Smoking status and/or changes in smoking habits among current smokers were not associated with negative changes in dietary and physical activity habits.

Objectives
Adolescent Sexual and Reproductive Health encompasses their physical and emotional well-being, including their ability to avoid unwanted pregnancies, unsafe abortions, sexually transmitted infections (STIs) and any type of sexual violence and coercion. However, these risks may be mitigated through improved knowledge, encouraging positive attitudes, and adopting better practices. This study aimed to identify the factors associated with knowledge, attitudes and practices (KAP) related to HIV, STI, family planning and pregnancy among adolescents residing in rural Thatta.

Design
A cross-sectional study.

Setting
62 villages from Thatta, Gharo and Jungshahi registered under the Global Network Maternal and Newborn Health Registry in Thatta, Pakistan.

Participants
632 adolescents aged 14–19 years.

Outcome measures
The association between sociodemographic factors and KAP was assessed using a modified version of the ‘Asking Young People about Sexual and Reproductive Behaviors’ tool. Statistical analysis was performed on Stata V.15.0 using multiple linear regression.

Results
Among 632 adolescents, 82.7% were females. No significant differences were found in mean scores of knowledge and attitudes between males and females. However, a difference of 0.13 (95% CI 0.005, 0.24) in practice scores was observed. In design-based multivariable analysis, adolescents’ marital status (β 5.13; 95% CI 1.34, 8.91) and father’s occupation (β 3.41; 95% CI 0.90, 5.93) were associated with knowledge. Marital status (β 1.34; 95% CI 0.82, 1.86), household income (β –2.36; 95% CI –4.64, –0.07), father’s occupation (β –1.42; 95% CI –2.52, –0.33) and mother’s education (β –1.41; 95% CI –2.71, –0.11) were associated with attitudes. Moreover, marital status (β 0.24; 95% CI 0.06, 0.41) and mother’s occupation (β 0.64; 95% CI 0.38, 0.90) were associated with practices.

Conclusion
No differences in knowledge and attitudes between male and female adolescents were found. These findings suggest that community awareness programmes should be implemented to improve sexual and reproductive health KAP for both male and female adolescents in Thatta.

Background
Over 6 million people have fled their homes in response to the full-scale invasion of Russian armed forces into Ukraine and are forcibly displaced since the start on 4 February 2022. Refugees, both adults and children, have a high risk of developing mental health disorders, in particular post-traumatic stress disorder, depression and anxiety disorders. Research into the mental health of Ukrainian families and their needs is urgently needed. The primary aim of this study is to increase our understanding of the consequences of potentially traumatic events for the mental health of parents and children. This may inform the development of mental health and psychosocial support interventions which can be readily implemented in the family context.

Methods and analysis
We will conduct a four-wave longitudinal online survey study among Ukrainian families displaced to the Netherlands. This study is a part of the Nadiya data collection, intended to assess the mental health responses of Ukrainian refugee families to the stress of war, forced migration, family separation and adaptation to new circumstances in their hosting country. Participants are assessed at four time points, approximately 6 months apart. Data collection for T1 started in May 2023. We aim to recruit a total of n=1500 participants at T1, of which n=1000 adults (18 years and older) and n=500 children (8–11 years) and teenagers (12–17 years). To investigate symptom profiles and associated risk and protective factors among parents and children, we will use latent class growth modelling.

Ethics and dissemination
The data collection procedure has been approved by the Ethical Committee of the Faculty of Social Sciences of Utrecht University. Data will be deposited, stored and shared using Utrecht University’s institutional research data repository Yoda. This research project is part of the Global Collaboration on Traumatic Stress; all authors are affiliated with this network. The findings will be published in peer-reviewed, open access journals and further disseminated through conference presentations, news updates at the project website and on the websites of the Dutch Society for Traumatic Stress Studies (www.ntvp.nl), and the European Society of Traumatic Stress Studies, as well as through media contributions.

Trial registration number
The current study was registered on 26 March 2024 on The Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/9FP7U.

Stroke, Ahead of Print. BACKGROUND:Lp(a) (lipoprotein[a]) is a risk factor for cardiovascular disease; however, its association with cerebrovascular disease is not as well established.METHODS:Data from a population-based cohort of Hispanics/Latinos included 16 333 individuals with baseline Lp(a) levels (nmol/L) and self-reported prevalent stroke or transient ischemic attack (TIA). A subset of 2642 individuals with brain magnetic resonance imaging was also included. Linear and multivariate logistic regression assessed the association of Lp(a) with (1) self-reported stroke or TIA, (2) cerebral injury defined as self-reported stroke or TIA or evidence of a stroke on brain magnetic resonance imaging, (3) white matter hyperintensity volume, and (4) silent brain infarcts. Sampling weights were utilized given the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) complex sample design.RESULTS:Mean age±SE was 41.1±0.3 years, 52.0% female, and median interquartile range (Q1, Q3) Lp(a) level of 19.7 (7.3–60.6) nmol/L; brain magnetic resonance imaging subset mean age±SE was 49.9±0.4 years, 56.4% female, and median (interquartile range) Lp(a) level of 21.7 (8.1–62.9) nmol/L. Each unit increase in log-transformed Lp(a) was associated with higher odds of self-reported stroke or TIA (odds ratio, 1.13 [95% CI, 1.01–1.27];P=0.03). Lp(a) levels in the highest quintile ( >77 nmol/L) were significantly associated with higher odds of prevalent stroke or TIA compared with Lp(a) 77 nmol/L with Lp(a) of 6 to

Annals of Internal Medicine, Ahead of Print.

This Medical News article is an interview with Pilar Ortega, MD, MGM, about the need for interventions to improve health care quality and access for patients with non-English language preference, and why equitable design is essential for new AI-driven health technologies and digital advancements.

This review of meta-analyses examines data from meta-analyses reporting associations between social determinants of health and suicide-related outcomes to determine which factors are most strongly associated with suicide risk.

In the first month of the new administration responsible for leading the US, the executive branch has issued a flurry of orders, including ones associated with the dismissal or resignation of tens of thousands of federal employees. Many of these have substantial consequences for science, medicine, and public health. Amidst the dizzying array of actions, it is difficult to know where to focus and how best to respond. However, the silencing of science and health-related communications through suppression or erasure of information, and the corresponding silence by many in the fields of biomedicine and public health, deserve special consideration.

Introduction
Over the past decades, there has been increasing recognition that assessing patients with cancer’s health-related quality of life (HRQoL) is pivotal to delivering optimal patient-centred healthcare. However, with the increasing number of patient-reported outcome measures (PROMs) available, it becomes more and more challenging to identify the most appropriate PROM to capture HRQoL. Therefore, the aim of this systematic review is to (1) identify all available PROMs assessing HRQoL across the European cancer continuum and (2) critically appraise, compare and summarise the psychometric properties of the identified PROMs.

Methods and analysis
Bibliographic databases MEDLINE and PubMed Central (through PubMed) and EMBASE (through Scopus) will be comprehensively searched from database inception until March 2024. Studies reporting on the measurement properties of PROMs assessing HRQoL throughout the European cancer continuum will be included. The evaluation of the psychometric properties, data extraction and data synthesis will be conducted according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. Two reviewers will independently assess the methodological quality using the COSMIN risk of bias checklist and the COSMIN criteria for good measurement properties. Subsequently, findings will be qualitatively summarised. The Grading of Recommendations Assessment, Development and Evaluations (GRADE) guidelines will be used to grade and summarise the quality of the evidence.

Ethics and dissemination
Ethical clearance for this research is not required, as the systematic review will only use information from previously published research. The results of this review will be submitted for publication in a peer-reviewed journal and will be used to provide a set of evidence-based recommendations for a European project (EUonQOL), which aims at developing a new PROM (EUonQOL toolkit) to assess HRQoL across the European cancer continuum. Moreover, findings will be disseminated to a clinical audience and policymakers through conferences, supporting researchers and clinicians in choosing the best measure to evaluate HRQoL in patients with cancer and survivors in Europe.

PROSPERO registration number
CRD42023418616.

Objective
This study aimed to examine the trends and inequalities in women’s use of quality antenatal care (ANC), quality intrapartum care and immediate postnatal care (PNC) services, and the determinants that contributed to changes in receiving these services from 2001 to 2019 in Ethiopia using the Ethiopia Demographic and Health Surveys (EDHSs) data.

Design, outcomes, setting and analysis
Secondary data analyses of four waves of nationally representative EDHSs from 2005 to 2019 were conducted. We defined quality ANC as having blood pressure measurement, blood and urine tests, iron supplementation and being informed of pregnancy-related complications during ANC visits; quality intrapartum care as having health facility birth, birth assisted by skilled personnel and newborn put to the breast within 1 hour of birth and immediate PNC as having maternal and newborn PNC within 24 hours of birth. We used control charts, multivariate logistic regression decomposition analyses and equiplots to measure and analyse trends and inequalities over two decades using data from EDHSs 2005–2019.

Results
Over the period 2001–2019, there were increases in the percentage of quality ANC (3.7%–39.6%), intrapartum care (3.9%–43.3%) and immediate PNC (2.6%22.1%) services received. However, there were widening inequalities between these services received by women, favouring those from advantageous socioeconomic backgrounds. From 2001–2019, the largest significant increases in the percentage of women receiving quality ANC and immediate PNC services were due to changes in the distribution of sociodemographic and maternal care characteristics, while the largest significant increase in the percentage of women receiving quality intrapartum care was due to changes in the effects of these characteristics.

Conclusions
The healthcare system in Ethiopia should expand access to all the recommended maternal healthcare interventions to disadvantaged population subgroups. Universal coverage of quality maternal and newborn healthcare across the continuum is needed. There is also a need to promote ≥4 ANC, early initiation of ANC, girls’ and women’s education and enabling women’s economic empowerment.