Health care workers (HCWs) are vital in disaster response. This study explores HCWs’ experiences delivering care in the earthquake-affected zone in Türkiye.

A qualitative study with a phenomenological design was conducted. Eighteen HCWs, including physicians, nurses, and National Medical Rescue Team (UMKE) members, were selected through maximum variation sampling. Data were collected through semi-structured interviews and analyzed thematically using Braun and Clarke’s 6-phase approach, following COREQ guidelines.

Three periods (pre-arrival, in the earthquake zone, and post-departure) and 8 themes were identified. In the pre-arrival phase, emotional symptoms and general organization were the main themes. In the earthquake zone, physical symptoms, basic needs, health care organization, health care delivery, and other services were prominent. The post-departure phase focused on emotional symptoms and return to routine work. Overall, emotional difficulties persisted throughout all phases, while organizational problems were concentrated in the pre-arrival and in the earthquake zone periods.

HCWs experienced emotional challenges across all periods and organizational problems in the pre-arrival and in the earthquake zone period. Clear information before arrival, structured orientation upon arrival, balanced staff distribution, and continuous psychological support throughout all phases are essential to protect HCWs’ well-being and sustain health care delivery during disasters.

Diagnosing clinically uncertain parkinsonian syndromes (CUPS) is challenging. Dopamine transporter (DaT) SPECT imaging (DaTscan) aids in differentiation, but its real-world impact on management in Canada, where it is not publicly funded, is unclear. The objective was to determine the impact of DaTscan results on clinical management for patients with CUPS in a Canadian tertiary care movement disorder service.

We conducted a retrospective chart review of 42 patients with CUPS referred for a DaTscan from a tertiary clinic in London, Ontario. DaTscan result was categorized as “Abnormal” (positive scan) or “Normal” (negative scan). The primary outcome was a change in management (Present/Absent). The association was assessed using Fisher’s Exact test.

Forty-two patients were included (median age 63 years; 50% female). Twenty-seven scans (64%) were abnormal, and 15 (36%) were normal. Overall, clinical management was changed in 13 patients (31%; 95% CI: 18% to 47%). A change in management was significantly more likely after a normal scan (60%, 9/15 patients) compared to an abnormal scan (15%, 4/27 patients) (p = 0.009). Changes after a normal scan primarily involved discontinuing dopaminergic therapy (7/9, 78%).

In this specialized clinic, DaTscan results informed management in 31% of CUPS patients. A normal scan provides the objective evidence needed to withdraw unnecessary dopaminergic medications confidently.

Malignant otitis externa is a life-threatening infection in which facial nerve palsy is a morbid complication. This TriNetX study identified predictors of facial nerve palsy in malignant otitis externa.

Retrospective analysis compared malignant otitis externa-only (n = 12 032) versus malignant otitis externa plus facial nerve palsy (n = 719) cohorts for demographics, biochemical markers and co-morbidities using t-tests and odds ratios (p < 0.05).

Male gender (p = 4.65 × 10−15) and Hispanic and/or Latino ethnicity (17.66 vs 13.02 per cent, p = 0.0014) predicted facial nerve palsy. The significant biochemical markers were albumin, blood urea nitrogen (p < 10−18), glucose, erythrocyte sedimentation rate (ESR), creatinine, iron and activated partial thromboplastin time. The key co-morbidities were hypertension (odds ratio = 3.72, p = 6.95 × 10−55), chronic kidney disease (odds ratio = 3.12, p = 1.44 × 10−49), malnutrition (odds ratio = 3.44) and electrolyte imbalances (odds ratio = 2.59). Migraines and/or headaches were non-significant.

Male sex, Hispanic and/or Latino ethnicity, hypoalbuminemia, elevated blood urea nitrogen and/or glucose and/or ESR, and co-morbidities (hypertension, chronic kidney disease, malnutrition) strongly predict facial nerve palsy in malignant otitis externa. Early risk factor management may prevent facial nerve palsy.

A high rate of food insecurity among college students has been documented in various studies. Knowledge gaps exist regarding food insecurity and cultural food access among international college students. We explored the demographic correlations of food insecurity and cultural food access and affordability for international college students.

Cross-sectional online survey from 2 to 16 November 2022.

A public university in the southwestern USA.

Three hundred and thirty-five international undergraduate and graduate students.

About 22 % of the sample reported high food security, 18 % marginal food security, 30 % low food security and 31 % very low food security. Twenty-seven percent reported that they were able to find cultural foods at the university, and 29 % reported that they were able to afford the cultural foods available on campus. Enrolment status, primary caregiver status, housing location and vehicle ownership predicted food security status. Region of origin, gender, being a primary caregiver for an adult with special needs and vehicle ownership were associated with access to cultural foods. Region of origin, being a primary caregiver for children, housing location and vehicle ownership were associated with being able to afford cultural foods on campus. The predictors differ between undergraduate and graduate international students.

Researchers and student services professionals who develop programmes and resources to support international students should consider differences within the group of international students, especially differences by region of origin and degree status (undergraduate v. graduate), and work to ensure students have access to reliable transportation.

A semi-automated surveillance system for surgical site infections (SSIs), SPICMI (Surveillance and Prevention Program for Infectious Risk in Surgery and Interventional Medicine), has been implemented in French hospitals, leveraging data from electronic health records (EHRs).

To evaluate the performance of the SPICMI algorithm in detecting SSIs in orthopedic and digestive surgery.

Surveillance data were collected annually from the EHRs. The algorithm identified suspected SSIs based on two criteria: (1) surgical revision during the index stay or readmission, (2) positive microbiological samples from the wound. Suspected SSIs identified were subsequently validated by surgeons.

A stochastic modeling approach was used to estimate probability intervals for performance indicators. Various detection scenarios were constructed based on SPICMI criteria. Logistic regression analysis was performed using surveillance data. Data unavailable in the database were estimated through a literature review and expert opinions.

The probability of surgical revision following an SSI varied significantly between surgical specialties, ranging from 92% in orthopedic surgery to 45.2% in gynecology. In orthopedic and digestive surgery, the SPICMI algorithm demonstrated good reliability for detecting SSIs in minimizing false-negative and false-positive cases (Youden index: 0.96 and 0.79, respectively). Sensitivity (Se) was lower in digestive surgery (0.7–0.9) compared to orthopedic surgery (0.9–1), while specificity (Sp) remained high (0.9–1) in both specialties.

The SPICMI algorithm shows potential to support efficient use of time and resources in SSIs surveillance management. Further evaluation is needed with a broader panel of surgery procedures.

Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), presents increasing global health burdens. Despite advancements in therapy, disparities in mortality trends across demographic and geographic lines persist in the United States.

To analyze IBD-associated mortality trends in the U.S. from 2018 to 2023 using CDC WONDER data, highlighting demographic, regional, and sex-based disparities.

A retrospective analysis of death certificate data from the CDC WONDER database was performed. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, and region. Trends were evaluated via join-point regression, with the annual percentage change (APC) and average annual percentage change (AAPC) calculated to assess statistical significance.

A total of 25,153 IBD-related deaths were recorded. The AAMR increased from 8.269 (2018) to 10.761 (2023), with a notable increase until 2022 (APC: +8.91), followed by a decline in 2023 (APC: −7.55). Men presented higher AAMRs than women did (10.882 vs. 9.838). Non-Hispanic White individuals had the highest AAMR (11.401), whereas Non-Hispanic Black and Asian populations presented the steepest increases (APC: 10.49 and 13.45, respectively). Regionally, the Midwest had the highest AAMR (11.531), with Oregon demonstrating the highest state-level mortality.

This study reveals increasing IBD mortality in the U.S., with significant sex, racial, and geographic disparities. These findings highlight systemic inequities in healthcare access, particularly in access to biologic therapy and specialty care. Targeted public health strategies are crucial for reducing disparities and enhancing outcomes in high-risk populations.

Identifying diagnoses from noncoded healthcare visit records presents logistical challenges when large number of records are screened. This study aimed to develop a screening process to identify otitis media (OM) diagnoses in free-text primary care visit records.

The free-text primary care records of 200 children aged 0 to 4 years were reviewed independently by three clinicians to determine whether OM was a diagnosis considered during each visit. Terms (abbreviations, words, and phrases) identifying visits where OM was considered or excluded were documented. These terms were used to design a software algorithm subsequently used to detect OM diagnosis within these primary care records. The diagnostic performance of the software algorithm was determined against the gold standard clinicians’ review and described using sensitivity, specificity, predictive values (PVs), and likelihood ratios (LRs) with 95% confidence intervals (CIs).

The 200 children had 10,034 primary care visits. Clinician review identified 917 (9%) visits where OM was considered, and 9117 (91%) visits where OM was excluded. The software algorithm identified 801/917 visits where OM was considered and 8705/9117 visits where OM was excluded. The algorithm sensitivity was 87% (95% CI 85–89), specificity 96% (95% CI 95–96), positive PV 66% (95% CI 63–69), negative PV 99% (95% CI 98–99), positive LR 19.33 (95% CI 17.54–21.31), and negative LR 0.13 (95% CI 0.11–0.16).

Software algorithms can assist in screening healthcare visit records. When combined with clinician review, they enable accurate identification of OM visits from non-coded records.

Cumulative stress exposure is extensively involved in carcinogenesis. However, cancer risk associated with allostatic load (AL), a valid measure of chronic stress, has not been comprehensively evaluated in large cohorts, and the combined effect of AL and personality trait on cancer risk remains unknown.

This prospective cohort study was conducted based on 245,683 participants from the UK Biobank, with a median follow-up of 13.5 years. The AL score was calculated based on 11 biomarkers. Personality traits were constructed and categorized into two clusters. Multivariable Cox regression model was used to assess the risk of incident cancer according to AL and personality clusters, and multiplicative and additive interactions were evaluated.

High AL was associated with an increased cancer risk compared to low AL (hazard ratio [HR] = 1.06, 95% confidence interval [CI]: 1.04–1.09), particularly for cancers of stomach, liver, kidney, esophageal, lung, colorectal, breast, and leukemia (HR ranged from 1.08 to 1.43). Personality clusters was associated with risk of lung cancer (HR = 1.14, 95% CI: 1.05–1.23), but not overall cancer. Significant synergistic interaction was observed between high AL and ‘nervous-dominant’ personality for overall cancer risk, with the strongest association observed for liver cancer (HR = 1.58, 95% CI: 1.24–2.02).

High AL was related to higher risks of overall cancer and site-specific cancers, particularly when combined with nervous-dominant personality, highlighting the interplay between chronic physiological stress and psychological factors in cancer development.

This study aims to compare the dosimetric accuracy between the enhanced leaf model (ELM) in Eclipse V18.0 and the traditional multileaf collimators (MLCs) modelling in Eclipse V16.1 for volumetric modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT) treatments. The objective is to evaluate whether the ELM improves dose calculation accuracy and agreement with measurements in clinical practice.

A retrospective analysis of 30 patients was conducted, categorized into Head-and-Neck (H&N), pelvic and lung SBRT groups. Treatment plans were created using the Acuros XB algorithm in both Eclipse versions. Gamma index pass rates for 1%/1 mm, 2%/2 mm and 3%/3 mm criteria were calculated using portal dosimetry for patient-specific quality assurance. Validation of MLC modelling was performed using closed leaf fields, sweeping gap fields, and the Picket Fence (PF) test across 6MV, 10MV, 6FFF and 10FFF photon energies.

Eclipse V18.0 demonstrated statistically significant improvements (p < 0·05) in dosimetric accuracy and gamma index pass rates across all photon energies and test conditions. In fully blocked fields, dose discrepancies reduced from 1.1% in V16.1 to 0.49% in V18 for 6MV. For the 6 mm sweeping gap test, discrepancies reduced from 1.19% to 0.31% for 6MV. The 1%/1mm gamma pass rates improved from 70% to 91.8% for H&N cases and from 82.4% to 87.3% for SBRT cases.

The ELM in Eclipse V18.0 significantly improves dose calculation accuracy and treatment deliverability, supporting its adoption in clinical practice for VMAT and SBRT to achieve better treatment accuracy and outcome.

Exposure to workplace bullying is associated with an increased risk of mental health conditions, yet it is debated whether the association is causal. This study aims to address this by examining whether onset of workplace bullying is associated with initiating treatment with psychotropic medication, here used as a proxy measure for onset of common mental disorders.

We used two longitudinal datasets from Sweden and Denmark (mean age: 47.4, women: 52.8%), combined with national registry data on psychotropic medication purchases. Using a target trial approach, the study population (N = 25 309) consisted of employees free of workplace bullying and psychotropic medication use at baseline. We used Cox proportional hazards regression (adjusted for sociodemographic variables, depressive symptoms and psychosocial work characteristics) to assess the association between onset of exposure to workplace bullying and incident treatment with psychotropic medication during 2 years.

In total, 1490 individuals (5.9%) experienced onset of workplace bullying. Bullying onset was associated with incident treatment with any psychotropic medication (HR: 1.42, 95% CI 1.15–1.77, model adjusted for sociodemographic variables). This association was attenuated in the fully adjusted model (HR: 1.24, 95% CI 0.99–1.53). In analyses focusing on antidepressant treatment, the estimates were stronger (HR: 1.55, 95% CI: 1.15–2.09, fully adjusted model). The results further demonstrated an exposure–response relationship, such that higher frequency of bullying exposure was associated with an increased risk of initiating any psychotropic treatment and antidepressants.

Individuals experiencing onset of workplace bullying were at higher risk of starting antidepressant treatment within 2 years. This is the first study showing that onset of workplace bullying can contribute to the development of mental health conditions requiring medical treatment. These results underline the importance of preventive interventions that reduce workplace bullying.

The specialties of ENT and anaesthesia have always had a unique relationship because of their longstanding history of co-operation over the shared airway.

This historical review narrates how the modern practice of ENT surgery has developed following advances in anaesthetic techniques, as well as inspiring them.

From the earliest use of anaesthetic gases by Long, Wells and Morton, to their rapid adoption for use in tonsil and cleft palate surgical procedures, ENT surgeons were early beneficiaries of this new technology. The demands of surgery for facial injuries in World War II was a driver for anaesthetic advances, and Ivan Magill reinvented the specialty in response.

Further developments in managing the shared airway, including jet ventilation, total intravenous anaesthesia and awake fibre-optic intubation, have shaped the modern ENT operating theatre, and highlight the vital collaboration between ENT and anaesthesia over the past 150 years.