ObjectivesThe aim is to uncover the perspectives of Twitter users on Multiple Sclerosis (MS) in English tweets by: (i) determining the sentiment of the text (ii) identifying the discussed topics.MethodsThe tweets were scanned in April 2023 using the keywords "multiple sclerosis, multiplesclerosis". Artificial intelligence-based sentiment analysis was conducted on a total of 1168 tweets and content analysis was performed on 17.4% of these tweets.ResultsTweets of 44% are positive and 22.3% are negative sentiment. As a result of content analysis, three themes and their sub-themes were identified: (i) announcement sharing: invitation to support, promotion of academic publications, (ii) information sharing: information providers, information seekers, news providers, (iii) experience sharing: challenging MS, facilitated MS, emotionally impactful MS, comparative MS, misunderstood MS. Subjective content such as experiences is shared less frequently compared to objective content such as announcements and information.DiscussionThe findings of this study can serve as a guiding factor in supporting positive views, managing negative views, and promoting the expression of subjective experiences.

ObjectiveDetermining the factors affecting the continuity of care (CoC) levels of people with chronic conditions, is critical to enhancing the quality of health care and patient outcomes. The objective of this study is to identify CoC levels in patients with rheumatoid arthritis (RA) and the factors that influence CoC levels.MethodsThe study's sample consists of 440 RA patients. The survey was used to collect data for this study, which is a cross-sectional study. The CoC level of the patients was determined using the "CoC Scale."ResultsThe mean total CoC score was 60.19, slightly above the midpoint of the 0-100 scale. Multivariate analysis showed that disease-related parameters including drug regimen complexity, comorbidity status, receipt of RA training, and disease duration were significantly associated with CoC (p < .05). Additionally, socio-demographic characteristics such as educational level, smoking status, place of residence, and age also showed statistically significant associations with CoC (p < .05).Discussion: The findings of the study are expected to provide significant data and information to physicians in order to raise the CoC level, which is anticipated to play a key role in enhancing treatment outcomes, lowering disease costs, and improving health-care quality.

ObjectivesThe 2025 recognition of type 5 diabetes by the International Diabetes Federation has significant implications for healthcare professionals, particularly diabetes educators. This study explores educators' perceptions and responses to this emerging classification, focusing on undernourished populations in low-resource settings.MethodsA qualitative descriptive design was used, with semi-structured interviews conducted with 16 certified diabetes educators in Indonesia, including nurses, nutritionists, pharmacists, and doctors. Interviews were held in April and May 2025, and data were analyzed thematically using Braun and Clarke's framework.ResultsFour themes emerged: (1) Early-stage Awareness, educators were unfamiliar with the classification but recognized similar clinical patterns; (2) We're Not Prepared, highlighting gaps in training and resources; (3)ContextMatters, linking type 5 diabetes to malnutrition and socioeconomic inequities; and (4) Ready to Respond, If Equipped, with educators expressing willingness to adapt if provided with appropriate training. Participants also emphasized the need for national education programs, culturally relevant materials, and cross-sector collaboration.DiscussionWhile educators' preparedness is limited, their willingness to respond is strong. Targeted training, culturally relevant resources, and collaborative support are essential for effective education. Future research should evaluate the effectiveness of these strategies across different settings.

ObjectivesThis study aims to evaluate the nursing dependence of patients with lower urinary tract symptoms (LUTS) in communities and nursing homes under the medical consortium model. It also investigates the relationship between sociodemographic factors, LUTS, and nursing dependence.MethodsA cross-sectional survey was conducted from January 2023 to October 2024, involving 213 patients with LUTS from communities and nursing homes in xxx City, xxx Province. Participants completed questionnaires assessing demographic information, LUTS severity, and nursing dependence. Statistical analyses were performed using SPSS 29.0, employing t-tests, Kruskal-Wallis tests, and Pearson correlation tests.ResultsAmong male patients, 48.57% exhibited moderate prostate symptoms, while 65.72% had moderate nursing dependence. Female patients mainly experienced moderate urinary storage (49.07%) and voiding (43.52%) symptoms, with 60.19% showing nursing dependence. Pearson correlation analysis revealed significant positive correlations between the severity of LUTS and nursing dependence (P < 0.01).DiscussionIn communities and nursing homes under the medical consortium model, the severity of LUTS is moderate and strongly correlates with nursing dependence. This highlights the need for targeted interventions to address care needs and improve quality of life for these patients.

ObjectivesMany factors affect caregiver burden. Limited studies exist on the effect of social support and fatigue on family caregivers. This study aims to explore the impact of fatigue and social support on the burden experienced by family caregivers of palliative care patients.MethodsThe study was conducted with 80 family caregivers. Data were collected using the Piper Fatigue Scale, the Burden Interview, and the Multidimensional Scale of Perceived Social Support. Regression analysis was used to evaluate the data.ResultsThe regression analysis revealed that higher scores on the MSPSS were significantly associated with lower Burden Interview scores (p < 0.05). Conversely, higher PFS scores were significantly correlated with increased Burden Interview scores (p < 0.05).DiscussionBoth fatigue and social support play a critical role in shaping the caregiving burden experienced by family caregivers. Interventions aimed at reducing caregiver fatigue and enhancing social support may help alleviate this burden.

Background and PurposeThere is inconsistency and lack of conceptual clarity regarding the concept of "recurrence" in diabetes-related foot ulcers. Therefore, the purpose of this concept analysis is to analyze the concept of recurrence-related to diabetes-related foot ulcer after the healing of a previous foot ulcer.MethodThe Rodger's evolutionary concept analysis method was employed to analyze the concept of recurrence in diabetes-related foot ulcers. Eight databases, including PubMed, EMBASE, CINAHL Plus with Full Text, MEDLINE with Full Text (EBSCO), Web of Science, Cochrane Library, PsychoINFO, and Scopus, were searched. Additionally, Google Scholar, bibliographies, and hand searching were conducted. The search spanned from inception through August 13, 2023, yielding 3290 studies. Among these, 3242 did not meet the inclusion criteria, leaving 46 articles that fulfilled the criteria.FindingsIn a majority of the studies (n = 20, 43%), diabetes-related foot ulcer recurrence occurred at the same site after the healing of previous foot ulcers. In contrast, in fourteen (20%) studies, the diabetes-related foot ulcer recurrence was described as not at the same site as the previous foot ulcer. In the other twelve (26%) studies, the attribute of recurrence was not identified.ConclusionsThe concept of recurrence-related to diabetes-related foot ulcer should be reserved for diabetes-related foot ulcers at the same site after the healing of previous foot ulcers.

ObjectivesThis study aimed to identify patients at higher risk for regional disengagement from health services using the Patient-centered Relevance Index (P-RI).MethodsThis nationwide retrospective cohort study analyzed the relationship between the P-RI and individual patient characteristics, including medical conditions and healthcare utilization patterns. The National Health Insurance Service claims database was used to characterize healthcare utilization by 3,046,914 patients with DM from 2017 to 2020.ResultsAs compared to the mild condition group, all other groups had a lower P-RI. Significant differences were observed among the groups with P-RI lower by 16.5%, 14%, 13%, 0.4%, and 0.6% in the repeated inpatient treatment (β = -0.165, P < 0.001), complication (β = -0.141, P < 0.001), extended long-term care stay (β = -0.130, P < 0.001), comorbidity (β = -0.041, P < 0.001), and other (β = -0.058, P < 0.001) groups, respectively. Additionally, the P-RI was high among low-income and older patients with high acuity.DiscussionSouth Korea's healthcare delivery system is not regionally self-sufficient. A relatively low P-RI in the high income and younger groups indicates healthcare access inequity. Therefore, a continuous management system that ensures uniform healthcare access needs to be established.

The current study was conducted to determine the impact of health literacy and factors related to adherence to drug treatment, using the model proposed by the World Health Organization, in older adults with hypertension residing in informal settlements in Hamadan. This cross-sectional study was conducted on 405 patients in Hamadan city, located in the western part of Iran. Data were collected using an interviewer-administered questionnaire that included the 5-dimensional model proposed by the World Health Organization, Health Literacy for Iranian Adults, and Morisky Medication Adherence Scale-8. A two-stage sampling procedure was used to select patients from 14 comprehensive health service centers and health bases. The data were analyzed using SPSS v.24. The study found that medication adherence was suboptimal in 63% of the participants. Additionally, 87.5% of patients had inadequate or insufficient health literacy. Factors related to medication adherence included age (odds ratio (OR) = 1.07), annual income (OR = 0.17), duration of hypertension (OR = 7.33), health literacy (OR = 1.03), self-reported health status (P < 0.05), and regular medication use (P < 0.008). The results of this study indicate that more than half of the older adults in the study had suboptimal medication adherence and insufficient health literacy. The study also found that various factors, such as socioeconomic status, disease and treatment-related factors, and patient-related factors, influence medication adherence among older adults.

ObjectiveThe aim of the current study was to better understand if perceived parental distress moderates the effects of having a chronic illness and poor physical quality of life on psychological problems reported by emerging adults.MethodsParticipants consisted of 538 college-attending emerging adults (53.5% women; 46.5% men). Participants completed an online study that was composed of questions regarding chronic illness, the World Health Organization Quality of Life - Brief, the Adult Self-Report scale, and the Adult Behavior Checklist.ResultsIn both emerging adult women and men, endorsing a chronic illness is significantly associated with psychological problems. Psychological problems in both emerging adult women and men were significantly predicted by the three-way interaction between endorsing a chronic illness, physical quality of life, and perceived maternal distress. Specifically, increased perceived maternal distress was associated with higher psychological problems in both emerging adult women and men with chronic illnesses and low physical quality of life.DiscussionFor emerging adult women and men with a chronic illness, higher perceived maternal distress was associated with poorer psychological adjustment, while lower perceived maternal distress was associated with better psychological adjustment.

This study investigated the relationship between parent-reported degree of openness and extent of problems in parent-adolescent communication and parent involvement in adolescent Type 1 diabetes management, parent and family wellbeing and adolescent glycaemic control. A cross-sectional quantitative survey was conducted. Parents completed measures of parent-adolescent communication, parent monitoring of diabetes care, diabetes family responsibility, parent knowledge of diabetes care, parent activation, parent diabetes distress, and diabetes family conflict. In total, 146 parents/guardians (121 mothers, mean age 46.56 years, SD 5.18) of adolescents aged 11-17 years (mean age 13.9 years, SD 1.81) with Type 1 diabetes completed the survey. Open parent-adolescent communication was significantly correlated to adolescents' voluntarily disclosing diabetes-specific information to their parents more frequently, increased parental knowledge of their adolescent's diabetes care completion, parents feeling more capable and willing to take action in relation to their adolescent's diabetes health, lower levels of diabetes-related parental distress, less diabetes-specific family conflict, and optimal glycaemic control. Parent-adolescent communication has an important role to play in Type 1 diabetes healthcare management and psychosocial wellbeing during adolescence. Optimising open parent-adolescent communication represents a potentially useful target for interventional research and should be considered by healthcare professionals during healthcare encounters.