340880 research outputs found
Sort by
Motivation Matters:Elucidating Factors Driving Exercise In People With Parkinson's Disease
No full textTen questions concerning the economics of indoor environmental quality in buildings
No full textIndoor environmental quality in buildings encompasses air quality, thermal environment, acoustics, and lighting. While engineering and health sciences have studied the impact of these attributes on occupants, a limited number of economic studies have investigated their financial implications. However, the profitability of optimizing the indoor environment for real estate developers, investors, and tenants remains unclear. This tenquestion paper summarizes existing literature on the economic value of improvements in indoor environmental quality. The first four questions summarize existing evidence, showing that these factors influence human performance, health, and well-being through different pathways, not all of which are sufficiently understood. The second part explores the economic value of optimized indoor environments and how economic research on energy-efficient buildings can serve as a suitable blueprint. This literature confirms that energy-efficient buildings provide a higher property value and offer a profitable investment case. However, to our knowledge, no research so far could effectively quantify the financial benefits of improved occupant productivity, health, and well-being due to an optimized indoor environmental quality, and how it could be used in a cost-benefit analysis to compare it with the rent and price premium tenants and owners need to pay for health-certified buildings. Existing studies on this topic often rely on indirect measures and lack direct evidence linking these improvements to objectively measured productivity or health outcomes. Therefore, this paper concludes with suggestions for future research to facilitate studies on the economic value of indoor environmental quality improvements and related healthy building attributes
Identifying patients' signs and symptoms to guide eHealth-directed diuretic therapy intensification in heart failure-Insights from the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF)
No full textHeart failure significantly burdens healthcare systems. eHealth products could alleviate this burden by providing patients with recommendations for intensifying diuretic therapy. As evidence on guiding diuretic therapy is scarce, our goal was to identify clinical parameters that eHealth products can use to support heart failure patients in intensifying their diuretic therapy. A post-hoc analysis of the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF), comparing an NT-proBNP-guided management strategy with a symptom-guided strategy in elderly heart failure patients, was conducted. Clinical data were collected during patient evaluations at 1, 3, 6, and 12 months of follow-up. At each visit, any increase or new prescription of diuretic therapy was recorded as the outcome event. Mixed-effects logistic regression analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI), investigating the relationship between the patient data and the odds of diuretic therapy intensification. In this retrospective analysis, 568 heart failure patients were included. Over a 12-month period, 2013 follow-up visits were conducted, during which diuretics were initiated or increased in 370 visits (18.4%). Higher New York Heart Association (NYHA) classification (OR 2.60, 95%CI 1.94-3.50), presence of edema (OR 2.84, 95%CI 2.15-3.77), paroxysmal nocturnal dyspnea (OR 1.52, 95%CI 1.04-2.21), and orthopnea (OR 1.39, 95%CI 1.04-1.85) were significantly associated with the initiation or increase of diuretics. Dyspnea, edema, paroxysmal nocturnal dyspnea, and orthopnea are associated with the intensification of diuretic treatment in HF patients. These symptoms, which patients can easily report, should be integrated into eHealth devices that offer guidance on managing diuretic therapy
<i>LongHealth</i>:A Question Answering Benchmark with Long Clinical Documents
No full textRecent advancements in large language models (LLMs) offer potential benefits in healthcare, particularly in processing extensive patient records. However, existing benchmarks do not fully assess LLMs' capability in handling real-world, lengthy clinical data. We present the LongHealth benchmark, comprising 20 detailed fictional patient cases across various diseases, with each case containing 5090 to 6754 words. The benchmark challenges LLMs with 400 multiple-choice questions in three categories: information extraction, negation, and sorting, challenging LLMs to extract and interpret information from large clinical documents. We evaluated eleven open-source LLMs with a minimum of 16,000 tokens and also included OpenAI's proprietary and cost-efficient Generative Pre-trained Transformers-3.5 Turbo for comparison. The highest accuracy was observed for Mistral-Small-24B-Instruct-2501 and Llama-4-Scout-17B-16E-Instruct, particularly in tasks focused on information retrieval from single and multiple patient documents. However, all models struggled significantly in tasks requiring the identification of missing information, highlighting a critical area for improvement in clinical data. In conclusion, while LLMs show considerable potential for processing long clinical documents, their current accuracy levels are insufficient for reliable clinical use, especially in scenarios requiring the identification of missing information. The LongHealth benchmark provides a more realistic assessment of LLMs in a healthcare setting and highlights the need for further model refinement for safe and effective clinical application. We make the benchmark and evaluation code publicly available
Understanding stigma:The experiences of people with drug-sensitive pulmonary tuberculosis in Rawalpindi, Pakistan
No full textIntroduction Tuberculosis (TB) is a major global health problem and Pakistan is ranked fifth among the 30 high-burden countries in the world. TB-related stigma affects health seeking behaviour and treatment adherence, increasing disease transmission and worsening health outcomes. This study aimed to explore experiences of stigma among people with TB (PWTB) in Rawalpindi to help inform targeted stigma reduction interventions that could improve health seeking behaviour, treatment adherence and the mental well-being of PWTB in Pakistan.Methodology In-depth interviews were conducted with 15 people with pulmonary drug sensitive TB from Rawalpindi, Pakistan. For assessing emerging themes, an inductive themed analysis approach was used. Next, a deductive approach was applied by analysing and interpreting the data against the Health Stigma and Discrimination Framework.Results TB- related stigma among participants was driven by fear of infection, which in some cases was due to misconceptions surrounding TB transmission as well as social judgement and gender norms. Stigma manifested through: anticipated and perceived stigma in the form of non-disclosure and fear of social exclusion; enacted stigma among friends and family, in the workplace and healthcare settings; and internalised stigma, The negative outcomes of stigma that resulted for some participants included non- adherence and social exclusion, in the form of loss of marriage prospects and employment.Conclusion This study confirms that TB-related stigma persists in Pakistan, impacting he well-being, medication adherence and treatment outcomes of PWTB. The distinct drivers, manifestations and outcomes of stigma in Rawalpindi Pakistan uncovered from this study, supported by previous research, can help inform targeted stigma reduction interventions such as public education programmes
Enzymatic remediation of polyester microfibers in sewage sludge and green compost samples
No full textMicroplastics are accumulating in all ecosystems worldwide, posing risks to biodiversity, environmental and personal health. In agricultural soils, an important source of microplastics is the application of contaminated biofertilizers such as sewage sludge and compost. Preventing micro and macro plastics from entering wastewater treatment plants (WWTPs) and compost heaps in the first place, and developing treatments for the removal of microplastics in these biofertilizers, would be a major step against microplastic pollution. In this article, a novel method for studying the potential of hydrolase enzymes as a bioremediation technique is described. Specifically, we investigated the LCCICCG cutinase against poly(ethylene terephthalate) (PET) microfibers in buffered water, sewage sludge, and green compost, at their usual operating temperatures (55-70ºC). The assessment of biodegradation was carried out through monomer detection. Different enzyme loadings (0 – 300 µg); substrate concentrations (0 –200 mg/cm3) and mixing methods (shaking – rotating) were tested. Up to 16.6 mg of PET per cm3 of matrix were degraded in 24 h both in buffered water and sewage sludge, with slightly worse results in compost of maximum 13.9 mg/cm3. This difference might be attributed to the total water content of the samples, which is lower for compost. Additionally, in compost, rotational mixing slowed down degradation by 35% in comparison with shaking. The results are discussed in the context of existing limitations, cumulating in a series of recommendations for possible intervention points along the microplastic pollution chain
Catastrophic and impoverishing out-of-pocket payments for health care in Poland in 2013–2021
No full textProtecting households from financial hardship when accessing health care is a universal policy objective across European countries. Previous analyses have shown that households in Poland relatively often experience financial strain due to out-of-pocket payments for health. This study aims to provide new evidence on financial protection in Poland, using indicators of catastrophic and impoverishing health spending. We used data from annual household budget surveys between 2013 and 2021. Catastrophic spending is defined as payments for health greater than 40% of the household's capacity to pay, while impoverishing spending occurs when out-of-pocket payments are higher than the capacity to pay. We employed logistic regression to identify factors associated with catastrophic payments. The incidence of catastrophic spending was 9% in 2021 and remained relatively constant over the years analyzed, nearing 10% only in 2020. Further, 3.3% of households in 2021 were impoverished or further impoverished, down from 4.1% in 2013. Payments for medicines contribute the most to catastrophic spending, but the role of other services has been increasing. We found a significant association between catastrophic payments and gender, age, education, disability, residence place, number of children, main source of income, and consumption level. It is necessary to address existing coverage gaps and to evaluate implemented policies in order to develop more effective measures to reduce the burden of out-of-pocket payments in Poland
Establishing a research consortium in psychosocial oncology and formulating a collective research agenda:a Dutch example
No full textThe field of psychosocial oncology faces many challenges, including the increasing number of cancer survivors in need of psychosocial support, alarming health disparities, and growing health care shortages. In 2024, Dutch psychosocial oncology researchers established the Psychosocial Oncology research COnsortium Netherlands (POCON) to better address these challenges together. In this letter, we describe the strategies we used to successfully launch POCON. After writing a mission statement, we developed a collective psychosocial oncology research agenda by (1) distributing a survey among Dutch senior researchers to determine priority themes for collaboration, (2) visualizing the current Dutch landscape of psychosocial oncology research by modeling a network of keywords based on recent publications in the field, and (3) comparing the identified priority themes and keyword network with more general cancer agendas in the Netherlands. Three overarching themes that were featured throughout these general agendas aligned with the identified priority themes but are currently underrepresented in psychosocial oncology research, as shown by the keyword network: "equity in cancer,""implementation of innovations,"and "personalized care."Based on these themes, we established three POCON committees. In addition, we established a fourth committee "Data Inventory"to further facilitate collaboration. Each committee is tasked with developing action plans to strengthen collaborative research efforts. Strategies that proved helpful throughout this process included prioritizing collaboration over competition, keeping up the momentum, and adopting a hands-on approach. By joining efforts and strengthening both national and international research collaborations, we strive to optimize psychosocial care for patients with cancer and their families
Adherence to eHealth Interventions Among Patients With Heart Failure:Scoping Review
No full textBACKGROUND: Heart failure (HF) is a significant global health challenge, requiring innovative management strategies like eHealth. However, the success of eHealth in managing HF heavily relies on patient adherence, an area currently not sufficiently investigated despite its critical role in ensuring the effectiveness of this approach. OBJECTIVE: This review was initiated to gather evidence on adherence to eHealth devices among patients with HF. The goal was to survey the current state of adherence, pinpoint factors that promote successful engagement, and identify gaps needing further research. METHODS: A scoping review was conducted to gather quantitative data on eHealth engagement from relevant clinical HF studies indexed in PubMed, CINAHL, and PsycINFO up to February 2025. Descriptive characteristics of the publications were extracted, and generalized mixed model analyses were used to identify eHealth characteristics affecting patient adherence. RESULTS: Our analysis included 70 studies, primarily using noninvasive eHealth interventions with wearables (n=51), followed by wearables only (n=8), noninvasive eHealth interventions without wearables (n=6), invasive devices (n=3), and telephone support (n=2). The median number of patients per study was 49 (IQR 20-139), and the median follow-up duration was 180 (IQR 84-360) days. Variability in reporting and definitions of eHealth adherence was noted. In total, 20 studies assessed adherence trends, with 13 noting a decline, 6 observing no change, and 1 reporting an increase over time. Factors influencing adherence were explored in 29 studies; 7 indicated higher adherence with increasing patient age, 2 showed a negative correlation, and 9 detected no age-related differences. No gender differences were found in the 10 publications that reported on gender, and 9 studies found no association between adherence and the New York Heart Association classification, while 1 noted higher adherence in patients with more severe symptoms. In 35 (50%) studies, adherence was quantified as the percentage of mean days the intervention was used, yielding a median adherence rate of 78% (IQR 61%-86%; range 31%-98%). No significant correlations were found between adherence rates and the number of eHealth device users, type of intervention, follow-up duration, number of parameters monitored, or data collection frequency. CONCLUSIONS: Reporting and definitions of patient adherence in HF studies are incomplete and inconsistent. Trends indicate a decrease in eHealth use over time. Customizing devices to meet patient needs may help mitigate this issue. Future research should offer a more detailed description of adherence to pinpoint factors that enhance patient adherence with eHealth technologies
Exploring applications of electrically evoked compound action potentials using the vestibulo-cochlear implant
No full textOBJECTIVES: Vestibulo-cochlear implants are a potential treatment approach for patients with loss of vestibular function. A critical aspect is the development of reliable and objective outcome measures, to assess their efficacy and optimize their performance. As in cochlear implant care and other neural prostheses, electrically evoked compound action potentials (eCAP) can be used to measure the neural response to implant stimulation. eCAPs might provide information about the presence and misalignment of the electrically evoked vestibulo-ocular reflex, and potential vestibulo-cochlear interactions. This could be valuable in intra-operative functionality assessment, as input for fitting, and to measure spread of excitation. This study aimed to explore the potential role of eCAPs in vestibulo-cochlear implant research. DESIGN: eCAPs were measured in ten subjects with a vestibulo-cochlear implant. Different configurations were used, i.e., trans-canal, vestibulo-cochlear and cochleo-vestibular. The predictive value of eCAPs was evaluated for four outcomes: presence of an electrically evoked vestibulo-ocular reflex (eVOR), degree of misalignment of the eVOR, auditory perception due to vestibular stimulation, and the prevalence of vestibular activation due to cochlear stimulation. RESULTS: The results demonstrated a high positive predictive value of the eCAP for the presence of an eVOR (i.e., 1.0), while the negative predictive value was low (i.e., 0.54). The presence of trans-canal eCAP did not correspond with the degree of misalignment in the eVOR. Furthermore, the predictive values for auditory perception were low (i.e., =0.5). eCAP recordings in the cochlea to vestibular configuration imply a high likelihood of cochlear to vestibular interaction (i.e., 67% of electrodes). CONCLUSIONS: The presence of a vestibular eCAP was demonstrated to be a predictor of the presence of the eVOR. However, the low negative predictive value prevents the eCAP from providing a reliable indicator for intra-operative electrode position evaluation. eCAP measurements in vestibulo-cochlear configurations indicated that spread of excitation between the cochlea and canals is already possible at stimulation levels within the clinical fitting range of both the vestibular and cochlear electrodes. Measured eCAPs did not correspond with misalignment of the eVOR or the presence of an auditory percept as result of vestibular stimulation. Future research is needed to elucidate the full potential of vestibulo-cochlear implant eCAP measurements