ObjectiveHealthcare data breaches have increased in both frequency and severity, yet limited empirical evidence exists on the factors associated with large-scale breach events. To address this gap, this study analyzed breaches reported to the US Department of Health and Human Services Office of Civil Rights between 2010 and 2025 to determine predictors of large breaches.MethodsA total of 7327 breach reports from the Office for Civil Rights were analyzed. Logistic regression assessed predictors of high‑severity incidents (≥ 100,000 individuals affected). Differences in breach size between incident types were assessed using Wilcoxon rank‑sum tests. Negative binomial regression modelled factors associated with breach magnitude and temporal trends in Hacking/IT classifications over time, adjusting for covariates.ResultsBreach sizes were highly right-skewed; the median breach affected 3892 individuals (IQR: 1255–19,471), and roughly 10% of the incidents accounted for the majority of individuals affected. Hacking/IT events were associated with severe breaches (OR = 2.6) and increased from 4% in 2010 to 80% in 2025. Network server incidents resulted in significantly larger breaches than device theft events. Business associate involvement was independently associated with a larger breach magnitude (IRR = 2.0).ConclusionHacking/IT mechanisms, network server involvement, and business associate participation were the strongest factors associated with breach severity and magnitude. These findings highlight persistent vulnerabilities in healthcare organizations and reinforce the need for targeted cybersecurity strategies.

Purpose/IntroductionProton pump inhibitors (PPIs) are commonly prescribed for stress ulcer prophylaxis (SUP) in non-critically ill hospitalized patients despite limited evidence supporting routine use. This leads to unnecessary medication exposure and possible adverse effects. This study evaluated medical residents’ knowledge of PPI-related adverse effects and the appropriateness of SUP indications, and examined differences across specialties and the relationship between safety knowledge and prescribing decisions.MethodsWe carried out a cross-sectional electronic survey of medical residents enrolled in Saudi Commission for Health Specialties (SCFHS) accredited programs. The questionnaire was sent by the SCFHS, which had nine Likert-scale items assessing PPI risk knowledge and SUP appropriateness. A response rate could not be calculated because the total number of survey recipients was not available. Composite scores were calculated for knowledge, appropriateness, and overall competency. Group comparisons and correlations were analyzed using standard parametric methods.ResultsA total of 119 residents completed the survey. The mean PPI risk knowledge score was 3.31 ± 0.65, with 47.1% achieving competency. The mean SUP appropriateness score was 2.85 ± 0.39, and only 5.9% met the competency threshold. Correct identification of inappropriate SUP use was particularly low for high-dose corticosteroids alone (5.0%), dual antiplatelet therapy alone (10.9%), and mechanical ventilation for less than 24 hours (19.3%). Internal medicine residents demonstrated higher knowledge and overall competency scores than other specialties, while appropriateness scores did not differ by specialty. No significant correlation was observed between knowledge and appropriateness (r = 0.10, p = 0.262).ConclusionResidents demonstrated moderate awareness of PPI-related risks but limited recognition of appropriate SUP indications in non-critically ill patients. These findings suggest that medication safety knowledge alone may not correspond to guideline-concordant prescribing decisions and highlight opportunities to strengthen targeted educational efforts.

Pharmacists increasingly play clinical roles, yet patients often continue to view them primarily as dispensers. Misalignment in role expectations may undermine communication and the effective use of pharmacy services. This study aimed to examine the extent to which pharmacists and patients in Jordan share similarperceptionsof their respective roles in the pharmacist-patient relationship. A cross-sectional survey was conducted from October 2024 to May 2025 with 403 pharmacists and 806 patients recruited from community pharmacies across Jordan. Participants completed parallel roleperceptionquestionnaires assessing multiple domains of pharmacist and patient roles, including information sharing and responsible behavior. Mann-Whitney U-tests were used to compare mean ranks between groups. Pharmacists generally assigned higher mean ranks to both pharmacist and patient roles than patients did. For example, pharmacists reported greater agreement than patients on discussing medication side effects (mean rank 669.50 vs. 572.75, p < 0.001), helping patients manage medications (672.84 vs. 571.08, p < 0.001), and greeting patients at the prescription counter and collecting prescription information (640.53 vs. 587.23, p = 0.007). Pharmacists also rated patients' willingness to collaborate in medication management more highly than patients rated themselves (704.63 vs. 555.19, p < 0.001), indicating a consistent perception gap across the assessed roles. The findings highlight clear perceptual gaps between pharmacists and patients in Jordan regarding their respective roles, particularly in response behavior and information sharing. These gaps may influence pharmacist-patient interaction and collaboration, highlighting areas for further research and targeted interventions.

Sexual abuse remains a pervasive global public health concern, disproportionately affecting adolescents with intellectual disabilities (ID). While numerous educational interventions have been developed, most remain fragmented, context-specific, and rarely account for cultural and systemic disparities across settings. A comprehensive and inclusive synthesis is needed to reimagine prevention strategies for this vulnerable population. This scoping review aimed to reimagine sexual abuse prevention by systematically mapping existing educational models, identifying gaps, and outlining inclusive future directions for adolescents with ID. Following the PRISMA-ScR guideline, a comprehensive search was conducted across PubMed, Scopus, CINAHL, and ScienceDirect, supplemented by grey literature and reference list screening. Eligibility was guided by the PCC (Population-Concept-Context) framework. Studies published between 2015 and 2025 involving adolescents with diagnosed ID (aged 12-18) were included. Data were thematically synthesized, and methodological quality descriptively assessed using the MMAT and JBI checklists. Sixteen studies met inclusion criteria, spanning diverse contexts from high-income to low- and middle-income countries. Interventions included school-based curricula, community workshops, digital platforms, and family-centered programs. While knowledge and awareness improved across most studies, evidence of sustained behavioral change was limited. Key gaps included inadequate cultural adaptation, limited caregiver involvement, and systemic barriers such as stigma and insufficient provider training. Although some programs demonstrated strong content validity, scalability and long-term effectiveness remain underexplored. This review reimagines sexual abuse prevention as an inclusive, multi-level endeavor that extends beyond knowledge provision to engage caregivers, educators, and health systems. Future research must prioritize longitudinal designs, cultural tailoring, and systemic integration to build sustainable, equitable, and context-sensitive interventions.

Thyroid cancer is the most prevalent endocrine malignancy, with surgical intervention being the primary treatment modality. Postoperative nausea and vomiting (PONV) are common complications following thyroid surgery, significantly impacts patient recovery. Consequently, this study analyzed the risk factors for PONV in patients with thyroid cancer post-surgery and developed a predictive model. This retrospective study involved 393 patients who underwent thyroid cancer surgery at a tertiary-level Class A hospital between July 2024 and February 2025. The patients were randomly divided into a training set (n=275) and a validation set (n=118). A predictive model was constructed using multivariate logistic regression analysis, and a nomogram was developed. The model's discrimination was evaluated using receiver operating characteristic (ROC) curves, while calibration was assessed through calibration curves, and clinical applicability was determined via decision curve analysis (DCA). The overall incidence of postoperative nausea and vomiting (PONV) was found to be 29.01%. The final predictive model developed from the training set incorporated four variables: age (≥50 years), a history of PONV or motion sickness, non-use of ondansetron, and a delay in the time to first oral intake (> 6hours). The area under the curve (AUC) values for the training and validation sets were 0.76 and 0.68, respectively. Additionally, the calibration curves for both sets exhibited strong consistency. Furthermore, the decision curve analysis (DCA) results indicated good clinical applicability for both the training and validation sets. Patients with thyroid cancer exhibit a heightened risk of postoperative nausea and vomiting, which correlates with age, a history of PONV or motion sickness, the administration of ondansetron, and the time to first oral intake. The PONV prediction model constructed using these variables demonstrates favourable discriminatory ability, calibration, and clinical utility.

Black adults experience diabetes complications and mortality in disproportionate rates in the United States, with barriers to care driven by factors such as limited access to quality healthcare, socioeconomic disparities, racial discrimination contributing to mistrust and health misperceptions, and social determinants of health such as food insecurity. Poor diabetes outcomes occur, in part due to insufficient access to novel diabetes medications and technologies, and low participation in diabetes management education programs. Within care teams across various healthcare settings, limited health literacy, and poor patient-provider communication, often influenced by implicit bias, further hinders effective diabetes management. Peer support, especially when integrated effectively into a multidisciplinary care team, is a promising approach to address these challenges. Peer supporters, individuals with shared lived experience and cultural backgrounds can foster trust, translate medical guidance in lay terms, and provide ongoing and sustained emotional, social, and tangible support. Peer-led interventions reduce diabetes distress and improve self-efficacy, medication adherence, and clinical outcomes, especially when tailored for Black adults. To effectively integrate peer supporters into care teams, defined roles, structured workflows, and strategically engaging them in patient care planning and team meetings is needed. Comprehensive and robust training, certifications, and continuing education ensure their competence, while maintaining role authenticity. Visibility within clinic and healthcare spaces, role clarity, administrative support, funding and continuous evaluation enhance the sustainability of peer supporters. Facilitators of their role include policy advocacy and funding avenues including Medicaid and Medicare reimbursements. Future efforts should focus on policy reforms to address structural inequities, support the expansion of peer supporters within care teams, including focused roles to thrive professionally, and establish sustainable models through participatory designs and robust evaluations. To address diabetes inequities in Black adults, culturally tailored peer support within multidisciplinary teams is critical, requiring collaborative engagement of healthcare systems, communities, and policy makers.

BackgroundSustained self-care is essential for effective hypertension management, particularly dietary salt reduction. In many community-based settings, including primary care areas in Indonesia, hypertension control remains suboptimal due to inadequate self-care practices and persistent high salt consumption, contributing to unfavorable biomarkers such as elevated blood pressure, BMI, and metabolic indicators.ObjectiveThis study aimed to evaluate the effectiveness of the Behavior-Tailored Intervention (BHATIN) model on knowledge, Theory of Planned Behavior (TPB) constructs, self-efficacy, hypertension self-care behaviors, salt preference, and clinical outcomes (blood pressure, BMI, and metabolic biomarkers) among adults with hypertension.MethodsA quasi-experimental pretest–posttest design with a non-equivalent control group was conducted among 90 adults with hypertension (intervention = 45; control = 45). The intervention group received the BHATIN program integrating TPB-based behavioral strategies, mindfulness-informed coaching, skill-based training, and social support, while the control group received standard care. Data were collected using knowledge, TPB-based questionnaires and clinical measurements (salt preference, blood pressure, BMI, and metabolic biomarkers) and analyzed using paired and independent t-tests (p < 0.05).ResultsThe intervention group showed significant improvements in attitude, subjective norm, perceived behavioral control, intention, self-efficacy, and self-care behaviors (all p < 0.001). Significant reductions were also observed in systolic and diastolic blood pressure, total cholesterol, random blood glucose, and salt preference (p < 0.05), where the control group showed minimal change.ConclusionThe BHATIN model improves psychosocial determinants, self-care behaviors, salt preference, and selected clinical biomarkers among adults with hypertension, providing a feasible nurse-led strategy for community-based hypertension management.

PurposeThe psychological well-being of caregivers profoundly influences the treatment efficacy, long-term visual rehabilitation, and overall family well-being of children with strabismus. However, the heterogeneity within this caregiver population has not been explored.Patients and MethodsA cross-sectional survey was conducted among 409 caregivers. Latent profile analysis was performed based on levels of depression symptoms, resilience, and social support to classify caregivers. Multiple logistic regression analysis was used to identify the factors of profile membership.ResultsThree distinct profiles were identified: vulnerable and distressed group (36.19%), paradoxically distressed group (7.34%), and resilient and adapted group (56.47%). Regression analyses revealed that low education was a risk factor for vulnerable and distressed group. Younger age (<30 years) was a strong risk factor for paradoxically distressed group, whereas having two children was a protective factor. The clinical features of the children showed no significant association with caregivers’ psychological adaptation profiles.ConclusionCaregivers of children with strabismus exhibited significant heterogeneity in psychological adaptation, which was primarily driven by their own demographic factors rather than the child’s clinical features. These findings provide a critical basis for developing targeted psychological interventions.

ObjectiveTo explore the effect of meticulous nursing intervention on self-care ability of patients with acute stroke.MethodsThis randomized controlled trial included 100 stroke patients admitted to our hospital from June 2024 to December 2024. The participants were divided into a control group and a study group (50 cases in each group) using the random number table method. The control group received routine perioperative nursing, while the study group received systematic and meticulous nursing interventions on the basis of routine nursing. The primary outcome measures were the National Institutes of Health Stroke Scale (NIHSS) scores (to evaluate neurological deficits) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores (to evaluate quality of life) before and after the intervention. The key secondary outcome measures included the Fugl-Meyer Assessment (FMA) scores for the lower limbs, the Functional Ambulation Category (FAC) scores, and the Exercise of Self-Care Agency (ESCA) scale scores.ResultsSignificant between-group differences were observed in primary caregivers (P=0.045), hospitalization time and hospitalization expenses (all P<0.001). After-intervention, the study group demonstrated superior outcomes compared to the control group in NIHSS scores, WHOQOL-BREF scores, FMA scores, and FAC scores (all P<0.001). Furthermore, the study group showed significantly higher scores in health knowledge level, self-concept, and self-care skills (all P<0.001).ConclusionMeticulous nursing can enhance treatment and rehabilitation compliance, promote neurological functional recovery, improve self-care capacity through multi-level nursing interventions, alleviate stroke-induced motor dysfunction in lower extremities, and consequently elevate the overall quality of life during rehabilitation.

PurposeThis review aimed to map the association between parental (both maternal and paternal) risk factors, from preconception through the postnatal period, and fetal-infant growth faltering.Patients and MethodsThis scoping review followed the PRISMA-ScR frameworks to systematically gather and analyze evidence from major databases (PubMed, Scopus and Web of Science). The inclusion criteria encompassed studies involving pregnant women, fetuses, or infants aged 0–24 months, including those diagnosed with fetal or infant growth faltering that examined maternal and/or paternal risk factors, conducted in Low- and Middle-Income Countries (LMICs), using study designs such as observational, cross-sectional, cohort, case-control, or randomized controlled trials, and published in English between 2020 and 2025. Data were analysed through thematic synthesis.ResultsFrom 4235 initial records, we identified 17 eligible studies for this review. The findings showed that the determinants of fetal and infant growth disorders are multifaceted, falling into four key areas. These included individual factors including maternal age, education, nutritional status, health condition, reproductive history, mental health and psychological, marital and socioeconomic,occupation, substance use, and infant factors; environmental concerns including household sanitation and hygiene, water, fuel source, house conditions. Community factors including poverty, deprivation, ethnicity, social inequality, and geographical characteristics. Policy factors, including coverage and quality Antenatal care (ANC), and access to maternal and child health services. These factors represent secondary conditions shaped by broader social and structural determinants of health, rather than direct causal factors. The key determinants shown to influence fetal and infant growth are individual, environmental, community, and policy factors.ConclusionFetal and infant growth are influenced by a combination of behavioural, socioeconomic, and environmental factors. These factors contribute considerably to the increased risk of growth disorders in fetal and infant.