Scoping review of qualitative data of patient experience and unmet needs following facial trauma.

Facial trauma is a common presentation to the emergency department, encompassing a spectrum from soft tissue injuries to fractures of the facial skeleton. Beyond the evident physical consequences, patients frequently face significant psychosocial issues, which are often overlooked in the recovery phase of treatment. The purpose of this review was to establish the experiences of patients following facial trauma using qualitative patient-reported data. A scoping review, searching four electronic databases (MEDLINE, Web of Science, PsychINFO, and Cochrane Library) using PRISMA methodology was conducted. Only one paper fulfilled the inclusion criteria. The paper used semi-structured open-ended interviews to obtain 20 patients' experiences of sustaining maxillofacial trauma and then synthesised the qualitative interviews into different themes. The findings from this scoping review highlight the profound need for prospective qualitative research in craniomaxillofacial traumatology, to better understand and address the experiences and perspectives of patients following facial trauma.

Experiences of people with unexplained hearing concerns seeking hearing healthcare in the United States.

OBJECTIVE: Up to 10% of adults seeking hearing healthcare for significant hearing concerns have diagnostic test results that indicate normal hearing. Knowledge of the interactions between patients with unexplained hearing concerns and hearing healthcare providers is minimal. In this study, we explored what themes emerged when individuals with unexplained hearing concerns discuss their experiences seeking hearing healthcare. DESIGN: We employed a prospective, cross-sectional qualitative design with semi-structured interviews. STUDY SAMPLE: Fifteen adults who had sought professional hearing evaluations in the United States due to hearing concerns but had audiological testing that indicated hearing within normal limits, and no other medical explanation for their hearing concerns participated in the study. Saturation of themes was reached by Interview #2, suggesting sufficient sampling. RESULTS: Thematic analysis revealed 3 themes from the interviews: (1) dismissive healthcare providers, (2) misalignment of patient concerns and assessment protocols, and (3) doctor shopping. CONCLUSION: These findings highlight the need for improved care for patients with unexplained hearing concerns. Clinicians could help improve care provision for patients with unexplained hearing concerns, despite a lack of professional guidance on diagnostic tests or treatment recommendations, by soliciting, listening to, and trusting patient experiences as they seek support for their hearing concerns.

Ethical concerns in caring for persons with anorexia nervosa: content analysis of a series of documentations from ethics consultations.

BACKGROUND: Caring for patients with anorexia nervosa (AN) is associated with high levels of moral distress among healthcare professionals. The main moral conflict has been posited to be between applying coercion to prevent serious complications such as premature death and accepting treatment refusals. However, empirical evidence on this topic is scarce. METHODS: We identified all 19 documentations of ethics consultations (ECs) in the context of AN from one clinical ethics support service in Switzerland. These documentations were coded with a sequential deductive-inductive approach and the code system was interpreted in a case-based manner. Here, we present findings on patient characteristics and ethical concerns. FINDINGS: The ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case. CONCLUSIONS: Ethical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. However, currently, uncertainty around general justifiability, eligibility criteria, and concrete protocols hinders their adoption.

COVID-19 vaccine hesitancy among unvaccinated individuals in a primary care setting, Pretoria.

BACKGROUND:  South Africa faced challenges while implementing coronavirus disease 2019 (COVID-19) measures such as mass vaccination. Some people rejected or were hesitant to receive government-recommended vaccines. This study explored COVID-19 vaccination hesitancy among unvaccinated individuals in a primary care setting in Pretoria, South Africa. METHODS:  This was an exploratory phenomenological study that included one-on-one interviews with 12 individuals at Temba Community Health Centre in Pretoria, South Africa. RESULTS:  The research revealed five themes: perceptions of COVID-19 disease, perceptions of COVID-19 vaccine, factors related to non-vaccination, information sources about the COVID-19 vaccine, and long-term vaccination decisions. There were seven linked sub-themes. CONCLUSION:  Overall, participants had a good understanding of COVID-19 disease, but limited knowledge about the vaccine, causing hesitancy to get vaccinated. Reasons for not getting vaccinated included health-related concerns, safety concerns, personal experiences, and social and political factors. Safety and health-related concerns were prevalent, with adverse vaccine outcomes being the most common concern. Most participants had experienced a historic encounter with a vaccine-related death or illness.Contribution: Vaccine hesitancy should be viewed as a powerful concern from the community, and a key source of worry for the health authorities over any vaccine-related doubt.

The characterization of developmental toxicity in fetal offspring induced by acetaminophen exposure during pregnancy.

OBJECTIVE: Acetaminophen (APAP), an antipyretic and analgesic commonly used during pregnancy, has been recognized as a novel environmental contaminant. Preliminary evidence suggests that prenatal acetaminophen exposure (PAcE) could adversely affect offspring's gonadal and neurologic development, but there is no systematic investigation on the characteristics of APAP's fetal developmental toxicity. METHODS: Pregnant mice were treated with 100 or 400 mg/kg∙d APAP in the second-trimester, or 400 mg/kg∙d APAP in the second- or third-trimester, or different courses (single or multiple) of APAP, based on clinical regimen. The effects of PAcE on pregnancy outcomes, maternal/fetal blood phenotypes, and multi-organ morphological and functional development of fetal mice were analyzed. RESULTS: PAcE increased the incidence of adverse pregnancy outcomes and altered blood phenotypes including aminotransferases, lipids, and sex hormones in dams and fetuses. The expression of key functional genes in fetal organs indicated that PAcE inhibited hippocampal synaptic development, sex hormone synthesis, and osteogenic and chondrogenic development, but enhanced hepatic lipid synthesis and uptake, renal inflammatory hyperplasia, and adrenal steroid hormone synthesis. PAcE also induced marked pathological alterations in the fetal hippocampus, bone, kidney, and cartilage. The sensitivity rankings of fetal organs to PAcE might be hippocampus/bone > kidney > cartilage > liver > gonad > adrenal gland. Notably, PAcE-induced multi-organ developmental toxicity was more considerable under high-dose, second-trimester, and multi-course exposure and in male fetuses. CONCLUSION: This study confirmed PAcE-induced alterations in multi-organ development and function in fetal mice and elucidated its characteristics, which deepens the comprehensive understanding of APAP's developmental toxicity.

The stronger the ability, the greater the destructiveness? CEO ability and stock price crash risk.

The impact of CEO ability on corporate behavior is dual-faceted. Based on the "rent-seeking hypothesis", this paper focuses on the "dark side" of CEO ability and suggests that CEO ability may hurt corporate behavior. Using the DEA method to measure CEO ability and selecting Chinese A-share listed companies from 2007 to 2017 as a sample, we examine the relationship, mechanisms, and boundary conditions between CEO ability and stock price crash risk. Our study finds that CEO ability exacerbates stock price crash risk positively. Mechanism tests based on CEO tenure, agency conflict, and litigation risk reveal that CEO ability intensifies stock price crash risk for alleviating career concerns, seeking private gains, and risk avoidance, supporting the "rent-seeking hypothesis". Boundary condition tests based on internal and external governance environments show that internal control quality and external audit supervision can play a governance role in mitigating the exacerbating effect of CEO ability on stock price crash risk. The conclusions are of significant importance for companies, relevant departments, and global market participants to strengthen governance and supervision to prevent the negative impact of CEO ability on stock prices, thereby promoting the stable development of global financial markets.

Understanding the importance of weight management: a qualitative exploration of lived individual experiences.

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.

Effects of website-based risk communication of radio-frequency electromagnetic fields on general public.

Background: Radio-frequency electromagnetic fields (RF-EMFs) are utilized in communications and appliances and are indispensable in daily life. However, some people have concerns about the adverse health effects of RF-EMFs; therefore, effective risk communication (RC) is needed in this field. Objective: In this study, we investigate public attitudes towards RF-EMFs and examine the impact of RC via a website on these attitudes and objective knowledge. Methods: Three web surveys were conducted over 10 weeks with the same participants. The questionnaires were conducted at three different time points with 5-week intervals: baseline survey (T1), RC evaluation survey (T2), and follow-up survey (T3). Participants of T2 were randomly recruited from among those of T1, and participants of T3 were randomly selected from among the T2 respondents. Approximately half of the respondents in each of T2 and T3 were assigned to the control group. Twelve items regarding attitudes toward RF-EMFs and objective knowledge were evaluated in all surveys (T1-T3). After removing low-engagement data, the number of valid answers was 782 in T3. Differences between T1 and T2 (Sub T1-T2) and T1 and T3 (Sub T1-T3) were analyzed. Participant selection was randomized and the authors were blind to this selection until analysis. Results: Four clusters were identified: Cluster 1 (Non-anxious, 25.0%), Cluster 2 (Anxious, 16.0%), Cluster 3 (Low-interest, 40.5%), and Cluster 4 (High-interest, 18.5%). A decrease in subjective RF-EMF exposure levels was noted in Cluster 2 immediately after website viewing. Temporary increases and decreases in health concerns about RF-EMF usage activities were observed in Clusters 1 and 2, respectively, immediately after viewing. Clusters 1 and 3 showed a temporal decrease in needs for RF-EMF usage activities at T2 but it returned to the baseline level 5 weeks later. Cluster 4 was less responsive to the risk communication. Subanalysis stratified by gender and age showed fluctuations in responses, especially in Clusters 1 and 2. Conclusion: We demonstrate the effectiveness of RF-EMF risk communication via websites, particularly for Cluster 2. The results of this study showed that offering objective and comprehensible information through a website can significantly reduce concerns and perceived risks related to RF-EMFs.

Dietary Adherence to Recommendations among a Cohort of Adults and Teens with Celiac Disease Maintaining a Gluten-Free Diet Compared to a Nationally Representative Sample: A Cross-Sectional Study.

Celiac disease (CeD) is a common autoimmune condition, with a prevalence of ~1%. Currently, a gluten-free diet (GFD) is the only treatment option. Due to fortification rules excluding gluten-free products in the United States of America (U.S.A.), understanding the nutritional adequacy of a GFD is important for promoting optimal health among those with CeD. Cross-sectional examination of multiple 24 h dietary recalls from a study sample of 50 adults and 30 teens with CeD was used to determine nutritional adequacy and excesses according to U.S.A. recommendations. The results were compared with those of 15,777 adults and 2296 teens from a nationally representative sample not reporting CeD, the National Health and Nutrition Examination Survey (NHANES) 2009-2014. Compared with NHANES, our study population was more at risk of low folate and carbohydrate (adults) consumption, and of excessive niacin and vitamin A (teens), as well as saturated and total fat consumption (adults). Overall, though, compared with NHANES, our study participants had similar nutrient concerns but fewer nutritional imbalances, with some notable exceptions. In addition to maintaining a GFD, individuals with CeD should be counseled to maintain a balanced diet and to pay attention to nutrient-dense foods. Special attention should be given to teens in providing dietary counseling to potentially mitigate the risk of future morbidity.