Risultati per: Importanza dell’ecografa nel setting della medicina generale. Introduzione con survey

Objective
To explore the Welsh public’s views of violence and aggression (V&A) directed at EMS (emergency medical services) staff, awareness of policy changes and the reach of media campaigns.

Design/setting/participants
Survey involving non-probabilistic purposive sampling of 1010 Wales adults (aged 18+) from a matched panel, representative of the population, derived from a UK YouGov panel of >360 000 adults registered.

Results
Most (62.5%) participants had heard of V&A directed towards EMS staff; 81.1% had heard about it through the media. 21.0% of participants had witnessed V&A towards EMS staff; younger participants were more likely to have witnessed an incident 18.7% via a social setting and 81.1% through the media. 90.4% disagreed with the statement that V&A towards EMS staff can be acceptable in some cases, and 53.3% were not aware of related media campaigns. Participants thought intoxication with alcohol (92.4%), drugs (90.5%) and altered mental status following illness and/or injury (84.3%) would likely contribute to V&A towards EMS staff. 22.0% of participants were aware of the Assaults on Emergency Workers Act. Although I thought the act was unlikely to deter perpetrators who were intoxicated with drugs (75.2%), alcohol (75.2%), with altered mental status following illness and/or injury (75.6%) or other member of the public (42.4%). Younger participants were more likely to think the act would deter those intoxicated with drugs, alcohol, with altered mental status following illness and/or injury and other members of the public. Those with social grades of C2/D/E thought the act was likely to deter those intoxicated with drugs.

Conclusion
There is good public awareness of V&A directed towards EMS staff in Wales who find it unacceptable. Our survey found limited awareness and perceived effectiveness of related legislation and media campaigns in the last 2 years. Participants thought legislation would not deter those intoxicated with drugs, alcohol or altered mental status. Therefore, we recommend further research to understand and develop evidence-based interventions for these groups of people. We also recommend amplifying messages targeted towards young people and through social settings where V&A may be encountered.

Al via il nuovo progetto promosso da 1 Caffè Onlus con i medici internisti per l’umanizzazione delle cure

Progetto internisti-Caffè onlus per l’umanizzazione delle cure

LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, plus) identifying individuals face numerous health care disparities, in terms of access and outcomes.1,2 Over 7% of the United States (U.S.) population identifies as LGBTQ+, yet health care providers (HCPs) receive scant training in LGBTQ+ health, rendering them ill-equipped to meet these health care needs.3,4 Basic understanding of sexual orientation and gender identity (SOGI) terminology is essential to provide culturally competent care to LGBTQ+ individuals.

Objective
Though vaccination coverage in Ethiopia has shown steady progress over the years, there are districts with below targeted vaccination coverage. This study assessed the magnitude and determinants of recently introduced vaccines uptake among children aged 12–23 months in Ethiopia.

Design
National cross-sectional study.

Setting
Ethiopia.

Participants
Mothers with children aged between 12 and 23 months.

Outcome measures
The outcome variable was the uptake of recently introduced vaccines (rotavirus vaccine (RV) and pneumococcal conjugate vaccine (PCV)) among children aged 12–23.

Results
Our analysis revealed that 45.7%, 53.4% and 43.5% of the children completed vaccination with PCV, RV and both PCV and RV, respectively. Being in the age group of 20–34 (adjusted OR (AOR)=2.03, 95% CI: 1.37 to 3.02) and 35–49 (AOR=2.44, 95% CI: 1.52 to 3.91), having at least four antenatal care contacts (AOR=2.73, 95% CI: 2.06 to 3.62), having postnatal care (AOR=1.84, 95% CI: 1.42 to 2.37), delivery in the health facility (AOR=1.45, 95% CI: 1.17 to 1.79) and having exposure to media (AOR=1.24, 95% CI: 1.09 to 1.56) and any of the wealth quintile categories higher than poorest category were positively associated with the uptake of newly introduced vaccines. Rural residency was found to be negatively associated with the uptake of newly introduced vaccines.

Conclusion
The overall full uptakes of newly introduced vaccines among children aged 12–23 months were significantly lower. Hence, this study emphasises the need to strengthen maternal and child healthcare services, particularly to the younger age mother and those with lower socioeconomic status.

Objective
The burden of non-communicable diseases is rising in low-and-middle-income countries, with diet being a key risk factor. This study aimed to assess the patterns, socioeconomic inequalities and determinants of eating healthy in Kenya. The study is the first in Kenya to use a healthy diet index to assess dietary patterns.

Design and methods
We analysed cross-sectional data from the 2015/16 Kenya Integrated Household Budget Survey. The study’s outcome variable was a continuous healthy diet index (HDI) constructed using principal component analysis from nine WHO/Food and Agriculture Organization (FAO) healthy diet recommendations. The HDI score and WHO/FAO healthy diet recommendations met were summarised for Kenyan households. Using the concentration index, we examined the socioeconomic disparities in healthy eating. In addition, multivariable linear regression was used to determine factors that influence healthy eating in Kenya.

Results
A total of 21 512 households in Kenya were included, of which 60% were rural and about two-thirds headed by males. The HDI score ranged between –1.13 and 1.70, with a higher value indicating healthier eating. Overall, the average HDI score was 0.24 (95% CI: 0.24 to 0.25), interpreted as moderate. We identified key determinants including socioeconomic status and urban–rural residency differences. Healthy eating was concentrated among higher socioeconomic households, regardless of gender or location. Higher socioeconomic status (β=0.28, 95% CI 0.26 to 0.30), rural residence (β=0.18, 95% CI 0.15 to 0.20), household head being in union (β=0.04, 95% CI 0.02 to 0.06) or employed (β=0.05, 95% CI 0.02 to 0.08) were significantly associated with increased HDI scores, whereas male-headed households and lack of education were associated with significant decreases in HDI scores on average.

Conclusions
Most Kenyan households do not meet all the healthy dietary recommendations, and socioeconomic inequalities exist in eating healthy. Targeted interventions that promote healthy eating based on key determinants in Kenya are required.

Objective
To report on the findings from a national survey of UK intensive care units (ICUs) exploring nurse staffing models currently in use and changes since COVID-19.

Design
A survey was designed and distributed using a web-based platform to senior unit leads via Intensive care national audit & research centre contacts.

Participants
Senior nurses representing the 331 National Health Service adult ICUs across the UK (across 231 hospitals/155 trusts), including the Channel Islands and Isle of Man.

Outcome measures
A 15-item survey.

Results
A total of 196 survey responses representing 300 units, majority general and single units, resulting in a 90.6% unit-level response rate. ICU unit characteristics included the average number of total, level 3 and level 2 critical care beds of 26.36 (SD=21.48), 15.67 (SD=15.33) and 10.96 (SD=8.86), respectively. Most units reported nurse to patient ratios compliant with national guidelines and service specifications. Post-COVID-19 changes to ICU nurse staffing establishments were reported by 44% respondents, including increases in non-registered staff. However, limited data were provided regarding decision-making around and changes to bedside allocation of nurses since COVID-19.

Conclusions
Increased numbers and use of non-registered staff within the ICU is indicative of an alternative staffing model to address nursing shortages. However, more research is needed to understand how this staffing group is being used compared with, and alongside, registered nurses.

Trial registration number
Clinicaltrials.gov: NCT05917574.

Objectives
For transgender and gender-diverse (TGD) people, it is known that there is a lack of healthcare professionals with experience in trans healthcare. This may result in either inadequate provision of healthcare or in an increased seeking of adequate trans healthcare. Little is known about healthcare services utilisation and resulting costs in treatment-seeking TGD people with gender incongruence or gender dysphoria (GIC/GD). Therefore, the aim of this study was to determine the excess costs associated with GIC/GD in Germany.

Design
In a secondary analysis, baseline data of a randomised controlled trial with a sample of TGD people with GIC/GD were combined with data of a telephone survey conducted in a representative sample of the general German population. The data sets were matched using entropy balancing. Self-reported healthcare services utilisation was valued by standardised unit costs for the German healthcare system, and absenteeism from work and unemployment were valued with the gross hourly wage of persons in manufacturing and services sectors.

Settings
TGD people with GIC/GD living at least 50 km outside Hamburg in the federal state Bremen, Mecklenburg-Western Pomerania, Lower Saxony or Schleswig Holstein and the German general adult population.

Participants
Treatment-seeking TGD people with GIC/GD (n=167) and people of the general German population (n=2811).

Primary and secondary outcome measures
6-month excess healthcare costs and indirect costs from a societal perspective were calculated for the year 2020 using two-part models with logit specification for the first part and a generalised linear model with gamma family and log link function for the second part.

Results
The total 6-month excess costs associated with GIC/GD from a societal perspective were estimated to be 672 (95% CI: –3315 to 4657; p=0.741) per person. The direct excess healthcare costs were estimated to be 2 (–1115 to 1119; p=0.977) and the indirect excess costs due to absenteeism from work and unemployment were 669 (–3031 to 4370; p=0.723) per person. The total excess costs associated with GIC/GD in trans men, trans women and non-binary people were estimated to be –5572 (–12 232 to 1088), 4238 (–1694 to 10 170) and 3041 (–4268 to 10 351) per person (all with p >0.05), respectively.

Conclusions
The total 6-month costs in TGD people with GIC/GD did not differ statistically significantly from the costs in the general German population. Indirect excess costs due to absenteeism from work accounted for the largest part of the excess costs associated with GIC/GD, yet with wide 95% CIs. Potential causes of absenteeism from work, such as experienced or expected discrimination, need to be identified and addressed so that TGD people can experience a healthy work environment.

Trial registration number
NCT04290286.

The acceptability of IPV has declined substantially in the last 20 years, especially among women. Heterogeneity in changes in IPV-related attitudes across countries suggests that pooled estimates should be interpreted cautiously and that national or subnational trends may be more informative. Future research should investigate specific country- and local-level factors that may be driving changes in IPV-supportive attitudes.

Objective
Individuals with diabetes are at high risk for tuberculosis (TB) infection. This study aimed to identify the barriers to access to TB education among internal migrants with diabetes in China.

Design
Cross-sectional study.

Setting
The 2017 China Migrants Dynamic Survey.

Participants
1978 migrants with diabetes were included. Consumer-side and provider-side factors both at the individual and the provincial level were considered.

Outcome measures
Two-level and multivariate logistic regression models were established to identify the factors associated with exposure to TB education among migrants with diabetes over the past year at their migration destination.

Results
Slightly more than one-third (33.52%) of the study participants received TB education. Individuals residing in provinces with higher TB death rates (adjusted OR (AOR)=1.48, 95% CI 1.02 to 2.15) and higher government spending as a proportion of total health expenditure (AOR=2.06, 95% CI 1.41 to 3.02) were more likely to be exposed to TB education. Higher individual awareness of essential public health services (AOR=3.52, 95% CI 2.69 to 4.59), establishment of personal health records at the migration destination (AOR=1.46, 95% CI 1.12 to 1.90), participation in community monitoring of hypertension/diabetes (AOR=1.95, 95% CI 1.52 to 2.51) and other factors were significant predictors of exposure to TB education (p

Objective
Healthcare professionals must possess statistical literacy to provide evidence-based care and engage patients in decision-making. However, there have been concerns about healthcare professionals’ inadequate understanding of health statistics. As an initial step in addressing the issue, we assessed the statistical literacy of medical students and doctors in South Korea by evaluating their comprehension of four statistical concepts: (a) single-event probability, (b) relative risk reduction, (c) positive predictive value and (d) 5-year survival rate.

Design
Cross-sectional survey study.

Setting
The survey was conducted from October 2018 to January 2019 in one medical school and its affiliated teaching hospital in Seoul, South Korea.

Participants
303 medical students from all six grades and 291 doctors from various specialties.

Primary and secondary outcome measures
The primary outcome measure was the correct answer rate for each question. The secondary outcome measure was the mean number of correct answers across the four statistical literacy questions, calculated for each individual.

Results
The correct answer rates for basic numeracy questions were close to 100%. Regarding statistical literacy, 95.5% and 83.2% of the participants accurately understood single-event probability and relative risk reduction, respectively. However, only 49.3% and 49.2% of the participants accurately understood the positive predictive value and 5-year survival rate, respectively. The correct answer rates for the question about the 5-year survival rate differed significantly between students (40.9%) and doctors (57.7%) (p

Lung ultrasound (LUS) has proven high diagnostic accuracy for community-acquired pneumonia (CAP) in developed countries. However, its diagnostic performance in resource-limited settings with high pulmonary tuberculosis (TB) incidence is less established. Additionally, the role of LUS in monitoring CAP progression remains underexplored.
Objectives
To validate the diagnostic performance, monitoring and prognostic utility of LUS for CAP in a high pulmonary TB incidence setting.

Design
Prospective single-centre cohort study.

Setting
Pulmonary department of a tertiary hospital in Vietnam.

Participants
A total of 158 patients suspected of having CAP were enrolled, with 136 (mean age 62 years, 72.8% male) included in the final analysis.

Interventions
Patients underwent LUS and chest X-ray (CXR) within 24 hours of admission, with a follow-up LUS on days 5–8.

Primary and secondary outcome measures
The primary outcome was the diagnostic accuracy of LUS and CXR compared with discharge diagnosis. Secondary outcomes included the accuracy compared with CT scan results, changes in LUS parameters—consolidation size, number and Lung Ultrasound Score (LUSS)—and their association with in-hospital mortality.

Results
LUS demonstrated higher sensitivity than CXR (96.0% (95% CI 90.0% to 99.0%) vs 82.8% (95% CI 73.9% to 89.7%)). LUS specificity was 64.9% (95% CI 47.5% to 80.0%), compared with 54.1% (95% CI 36.9% to 70.5%) for CXR. The moderate specificity for LUS was due to sonographic-similar conditions, notably TB in 5.1% of patients. Consolidation size and numbers showed marginal resolution, while LUSS showed more pronounced decreases over time. The baseline LUSS showed limited discriminative ability for predicting mortality (area under the curve, AUC 0.65, 95% CI 0.55 to 0.75), while follow-up LUSS and changes in LUSS (LUSS) demonstrated higher levels of discrimination (AUC 0.81 (95% CI 0.71 to 0.89) and 0.89 (95% CI 0.80 to 0.95), respectively). For each one-point increase in LUSS, the odds of in-hospital mortality went up by 70% (p=0.002). An improved LUSS effectively ruled out mortality (negative predictive value 97.4%).

Conclusion
Although LUS is highly sensitive for diagnosing CAP, its specificity in TB-endemic regions warrants further caution. Serial LUS assessments, particularly monitoring LUSS changes, are valuable for tracking disease progression and prognostication, with increasing LUSS indicating potential clinical deterioration.

Opere, video e installazioni negli ospedali sono benefici per i pazienti. Cultura e medicina alleate contro i tumori, ma non solo

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

Objectives
This study aims to provide an in-depth analysis of the symptoms, coexisting conditions and service utilisation among people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID. The major research questions include the clustering of symptoms, the relationship between key factors and diagnosis time, and the perceived impact of National Institute for Health and Care Excellence (NICE) guidelines on patient care.

Design
Cross-sectional survey using secondary data analysis.

Setting
Community-based primary care level across the UK, incorporating online survey participation.

Participants
A total of 10 458 individuals responded to the survey, of which 8804 confirmed that they or a close friend/family member had ME/CFS or long COVID. The majority of respondents were female (83.4%), with participants from diverse regions of the UK.

Primary and secondary outcome measures
Primary outcomes included prevalence and clustering of symptoms, time to diagnosis, and participant satisfaction with National Health Service (NHS) care, while secondary outcomes focused on symptom management strategies and the perceived effect of NICE guidelines.

Results
Fatigue (88.2%), postexertional malaise (78.2%), cognitive dysfunction (88.4%), pain (87.6%) and sleep disturbances (88.2%) were the most commonly reported symptoms among participants with ME/CFS, with similar patterns observed in long COVID. Time to diagnosis for ME/CFS ranged widely, with 22.1% diagnosed within 1–2 years of symptom onset and 12.9% taking more than 10 years. Despite updated NICE guidelines, only 10.1% of participants reported a positive impact on care, and satisfaction with NHS services remained low (6.9% for ME/CFS and 14.4% for long COVID).

Conclusions
ME/CFS and long COVID share overlapping but distinct symptom clusters, indicating common challenges in management. The findings highlight significant delays in diagnosis and low satisfaction with specialist services, suggesting a need for improved self-management resources and better-coordinated care across the NHS.

This essay describes a rational and stepwise framework for considering whether to accept requests to take on extra work for physicians, especially women and minoritized physicians.