Stress-related illness is a common and increasing cause for sick leave in Sweden. Spending time in nature reduces stress and promotes health and well-being. Accordingly, nature-based interventions (NBI) for people with stress-related illness have been developed and implemented in southern Scandinavia; however, such interventions are uncommon in the Circumpolar North. Previous studies have examined the effects and experiences of participating in NBI, but research about different stakeholders\' perspectives on NBI is lacking. The aim of this study was to explore different key stakeholders\' perceptions of the value of NBI in promoting health in people with stress-related illness. Data were collected through semi-structured interviews with 11 persons with stress-related illness experience, 14 healthcare professionals, and 11 entrepreneurs offering NBI. Qualitative content analysis resulted in four categories: Providing opportunity for recovery, Offering new perspectives and opportunity for reflection, Empowering balance and control in life, and Enabling one to overcome barriers. Although the study was conducted in a region where NBI is not widely implemented, the different stakeholders expressed similar perceptions of the value of NBI, indicating that NBI may be a valuable complement to health care which reaches people with stress-related illness needs and promotes their health.

暂无摘要。

Vaccine hesitancy is considered as one of the greatest challenges to control the ongoing coronavirus disease 2019 (COVID-19) pandemic. A related challenge is the unwillingness of the general public to pay for vaccination. The objective of this study was to determine willingness-to-pay (WTP) for COVID-19 vaccine among individuals from ten low- middle-income countries (LMICs) in Asia, Africa, and South America. Data were collected using an online questionnaire distributed during February - May 2021 in ten LMICs (Bangladesh, Brazil, Chile, Egypt, India, Iran, Nigeria, Pakistan, Sudan, and Tunisia). The major response variable of in this study was WTP for a COVID-19 vaccine. The assessment of COVID-19 vaccine hesitancy was based on items adopted from the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) vaccine hesitancy scale constructs. In this study, 1337 respondents included in the final analysis where the highest number of respondents was from India, while the lowest number was from Egypt. A total of 88.9% (1188/1337) respondents were willing to pay for the COVID-19 vaccination, and 11.1% (149/1337) were not. The average WTP for COVID-19 vaccination was 87.9 US dollars ($), (range: $5-$200). The multivariate model analysis showed that the country, monthly household income, having a history of respiratory disease, the agreement that routine vaccines recommended by health workers are beneficial and having received the flu vaccination within the previous 12 months were strongly associated with the WTP. Based on the country of origin, the highest mean WTP for COVID-19 vaccine was reported in Chile, while the lowest mean WTP for the vaccine was seen among the respondents from Sudan. The availability of free COVID-19 vaccination services appears as a top priority in the LMICs for successful control of the ongoing pandemic. This is particularly important for individuals of a lower socio- economic status. The effects of complacency regarding COVID-19 extends beyond vaccine hesitancy to involve less willingness to pay for COVID-19 vaccine and a lower value of WTP for the vaccine.

OBJECTIVE: To assess and identify patients\' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes.
METHODS: The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall\'s tau was used to identify correlations between responses and outcomes.
RESULTS: A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03).
CONCLUSIONS: Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.

The pivotal role of Human Resource Management (HRM) in hospital administration has been acknowledged in research, yet the examination of HRM practices in the world\'s premier hospitals has been scant.
This study explored how the world\'s leading hospitals attain operational efficiency by optimizing human resource allocation and melding development strategies into their HRM frameworks. A comparative analysis of the HRM frameworks in the top five global hospitals was undertaken to offer a reference model for other hospitals.
This research offers a comparative exploration of the HRM frameworks utilized by the top five hospitals globally, underscoring both shared and distinct elements. Using a multi-case study methodology, the research scrutinized each hospital\'s HRM framework across six modules, drawing literature from publicly accessible sources, including websites, annual reports, and pertinent English-language scholarly literature from platforms such as Google Scholar, PubMed, Medline, and Web of Science.
The analyzed hospitals exhibited inconsistent HRM frameworks, yet all manifested potent organizational cultural attributes and maintained robust employee training and welfare policies. The design of the HR systems was strategically aligned with the hospitals\' objectives, and the study established that maintaining a sustainable talent system is pivotal to achieving hospital excellence.
The HRM frameworks of the five analyzed hospitals align with their developmental strategies and exhibit unique organizational cultural attributes. All five hospitals heavily prioritize aligning employee development with overall hospital growth and place a spotlight on fostering a healthy working environment and nurturing employees\' sense of achievement. While compensation is a notable performance influencer, it is not rigorously tied to workload in these hospitals, with employees receiving mid-to-upper industry-range compensation. Performance assessment criteria focus on job quality and aligning employee actions with organizational values. Comprehensive welfare and protection are afforded to employees across all five hospitals.

UNASSIGNED: Recent research has emphasized that achievement motivation is context-sensitive and varies within individual students. Ubiquitous temporal landmarks such as exams or deadlines are evident contextual factors that could systematically explain variation in motivation. Indeed, research has consistently found that university students increase their study efforts as exams come closer in time, indicating increasing study motivation. However, changes in study motivation for a specific exam as it comes closer have rarely been investigated. Instead, research on developmental changes in expectancy and value beliefs has consistently founds that achievement motivation declines over a semester. Surprisingly, declining motivation thus apparently coincides with increasing study efforts for end-of-semester exams.
UNASSIGNED: The present research investigates this apparent contradiction by assessing how exam-specific motivation and study behavior change under equal methodological conditions as an exam draws closer. Using parallel growth curve models, we examine changes in expectancy-value beliefs, performance approach and avoidance motivation and study behavior as well as motivational want- and should-conflicts among 96 students over eight weekly measurement points.
UNASSIGNED: Results show that students study more for their exam as it comes closer and increase their use of surface learning strategies more rapidly than their use of deep learning strategies. However, even exam-specific expectancy and attainment value beliefs decline while performance-avoidance motivation increases over time, indicating that students increasingly study out of fear to fail as exams come closer. Consistent with these findings, students\' experience of should conflicts decreases while their want conflicts increase over time. We discuss several possible mechanisms underlying our findings in addition to potential theoretical consequences and suggest future research opportunities to better understand students\' changes in situative motivation and study behavior in the context of temporal landmarks.

The concept of value in healthcare is mainly based on economic and financial aspects. However, the literature has emphasised the need to investigate value from other perspectives. The present study aimed to explore the views of physicians and patients on the value of healthcare, and to examine in depth the psychosocial and organisational elements that have emerged but that need to be investigated more. Therefore, two qualitative studies were performed, in which 69 physicians and 111 patients participated. The data were analysed using content analysis and text mining using t-lab software. The results revealed common elements between the two healthcare actors that constitute value in healthcare, including competence, professionalism, and soft skills like communication and empathy. Furthermore, the importance of functioning health services and effective organisational culture in local healthcare and investment emerged. These findings can guide healthcare organisations to consider the potential psychosocial factors related to value in healthcare, which affect organisation in terms of costs and healthcare relationships. In addition, these findings are a first step in filling the gap found in the literature regarding the consideration of value from a non-economic perspective and the difficulty of defining and measuring it.

This retrospective study aimed to evaluate the consistency of transrectal contrast-enhanced ultrasonography (TR-CEUS) with post-operative pathology and the value of contrast-enhanced ultrasonography (CEUS) in staging surgically treated cervical cancer when combined with conventional ultrasonography (US).
From October 2020 to March 2023, hospitalized patients with stage IB and II cervical cancer confirmed by total hysterectomy were consecutively enrolled. The standard images of US and CEUS by transabdominal (TA-US/CEUS) and transrectal (TR-US/CEUS) approaches and magnetic resonance imaging (MRI) were acquired, on which the size and stage of the tumors were evaluated, and the consistency of results with the pathological specimen was analyzed.
Thirty-nine patients with cervical cancer were finally enrolled in this study. The results showed that CEUS significantly improved the reliability of TA-US in evaluating tumor diameter; the intraclass correlation coefficient (ICC) was from 0.672 to 0.735. TR-US indicated good reliability with or without the addition of CEUS (ICC = 0.796 and 0.780). In terms of tumor staging, CEUS improved the consistency of transabdominal (weighted κ values from 0.689 to 0.731) and transrectal staging of tumors (κ from 0.758 to 0.785), and the staging of TR-US combined with TR-CEUS had the highest consistency with post-operative results, similar to MRI (κ, respectively 0.785 and 0.789). CEUS can reflect the heterogeneity of the tumor. Heterogeneous enhancement and perfusion defects were more common in >2 cm cervical cancer (50%, 20/40 and 52.5%, 21/40), respectively, and perfusion defects were more common in moderately to poorly differentiated tumors (66.67%, 20/30).
For stage IB and IIA cervical cancer, CEUS can aid in assessing the International Federation for Gynecology and Obstetrics staging of tumors alongside TA-US and TR-US. The combination of TR-US and TR-CEUS has shown good consistency with pathology in the staging of cervical cancer, comparable to that of MRI.

OBJECTIVE: To compare and contrast nurses\' work values and communication styles across Generation X, Y, and Z.
BACKGROUND: Intergenerational differences in the work values of nurses are well known, but the commonalities remain largely uninvestigated. It is also unclear if there are intergenerational differences and commonalities in the rhetorical communication style of nurses.
METHODS: This study used a cross-sectional research design. Participants were 243 nurses of Generation X (n = 78), Y (n = 86), and Z (n = 79) working at a general hospital in Korea. Structured questionnaires were used to collect the data from September to October 2019. The differences in work values and communication types were measured and analyzed using the χ2 test.
RESULTS: The work values of Generation X differed from those of Generation Y and Z, who preferred extrinsic work values. There was no significant intergenerational difference in communication types, although Generation X and Y were similar to each other in communication types and different from Generation Z.
CONCLUSIONS: Although the work values of the three generations are different, their communication styles are similar so that they may reduce the generational gap through communication. In particular, Generation Y nurses prefer extrinsic work values and share some work values with Generation Z; however, the dominant communication type of Generation Y is similar to Generation X, not Z. Therefore, Generation Y could play a key role in connecting Generation X with Z during communication.
CONCLUSIONS: Nursing organizations should delegate the authority to Generation Y so that Y may have a voice in the nursing group as the mediator between X and Z.

Non-melanoma skin cancer (NMSC) is the most common cancer type and incidence increases with age. As a consequence, an increasing number of frail patients are being referred for consideration of skin cancer surgery. However, some of these patients may not live long enough to experience benefit from surgery, while being at risk of postoperative complications.
To investigate the treatment burden of surgical excision of skin cancers in frail individuals.
We conducted a single-center retrospective cohort study analyzing outcomes of skin cancer excision in frail versus non-frail patients.
Eighty-eight patients were included. The complication rate was higher in frail versus non-frail patients: 12 (27.9%) versus 9 (18.8%), with 5 unplanned postoperative hospital attendances leading to 3 hospital admissions in the frail cohort. Nine patients in the frail group (21%) died within 6 months of their procedure versus no deaths in the non-frail group (p < 0.001 Fisher\'s Exact test), with no deaths attributed to skin cancer.
Treatment-related complications and mortality are common in frail patients after surgical excision of skin lesions clinically suspicious for skin cancer. Careful consideration should be given, and patients should be adequately counseled about treatment risks and alternative management options, including active surveillance, in particular, if the lesions are expected to remain asymptomatic.