BACKGROUND: Individuals with a history of cancer increasingly seek health information from online resources, including NCI-designated Cancer Center websites. Centers receive NCI designation because they provide excellent care and engage in cutting-edge research. However, the information presented on these webpages and their accessibility is unknown. An evaluation of the survivorship-focused webpages from NCI-designated Cancer Centers is needed to assess survivorship information and accessibility of these webpages.
METHODS: We conducted an evaluation of the survivorship-focused webpages from 64 NCI-designated Cancer Centers. We evaluated where survivorship-focused webpages were housed, if there was a survivorship clinic or program, target audience of the webpage, how cancer survivor was defined, contact methods, and available resources. Accessibility outcomes included readability, font type, font size, color scheme, and alternative text (alt text) descriptors. An artificial intelligence (AI) audit was conducted to assess if the webpage was compliant with national accessibility guidelines.
RESULTS: Most cancer centers had a survivorship-focused webpage, with 72% located on the cancer center\'s website and 28% on a health system website. Survivorship information available varied considerably and was often lacking in detail. Although three-quarters of webpages targeted patients only, variable definitions of cancer survivor were observed. Accessibility issues identified included inconsistent use of alt text descriptors, font size smaller than 15 points, and color schemes without adequate contrast. The average reading-level of information presented was above 12th grade. Only 9% of webpages were compliant with online accessibility guidelines; 72% semicompliant and 21% were noncompliant.
CONCLUSIONS: Information presented on NCI-designated Cancer Center survivorship-focused webpages was inconsistent, often lacking, and inaccessible. NCI-designated Cancer Centers are role models for cancer research in the United States and have an obligation to provide survivorship information. Changes to content and website design are needed to provide better information for individuals seeking resources and health information relative to their cancer and care.

BACKGROUND: Nurses are increasingly demanded to achieve gold-standards of care with fewer resources. Dealing effectively with stress experienced in their daily-work-life is thus crucial. This study is based on the Demands-Resources-and-Individual-Effects (DRIVE) Nurses Model and applied the person-centred approach with a twofold objective: 1. to identify patterns of coping strategies (Problem-Focused; Seek-Advice; Self-Blame; Wishful-Thinking; Escape/Avoidance) adopted by nurses to deal with perceived stress; 2. to explore potential differences in perceived Demands (Effort), Resources (Rewards, Job-Control, Social-Support), and Psychopathological Symptoms (Anxiety, Phobic-Anxiety, Obsessive-Compulsive, Somatization, Depression, Interpersonal-Sensitivity, Hostility, Psychoticism, Paranoid-Ideation) according to the emerged patterns.
METHODS: This cross-sectional study was reported by using the STROBE Checklist. Overall, 265 nursing professionals completed self-report measures. Non-hierarchical k-means-cluster-analysis was employed to derive patterns of coping. MANOVAs were used to test differences in Demands, Resources, and Psychopathological Symptoms according to the emerged patterns.
RESULTS: Three stable and meaningful patterns of coping were identified and labelled as Active/Solution-Oriented, Dysregulated/Emotion-focused, and Passive/Disengaged. Nurses belonging to Dysregulated/Emotion-focused group emerged to be at higher risk (higher effort/psychopathological suffering; lower resources) - followed by Passive/Disengaged group - in comparison with nurses belonging to Active/Solution-Oriented group.
CONCLUSIONS: Fostering nurses\' awareness of their latent coping patterns and supporting active approaches/emotional regulation strategies for stress management should represent a key goal when defining interventions promoting nurses\' health within/beyond the healthcare settings.

OBJECTIVE: Enhancing workplace communication and support processes to enable individuals living with disabilities to sustain employment and return to work is a priority for workers, employers, and community stakeholders. The objective of this study was to evaluate a new resource that addresses support challenges, the Job Demands and Accommodation Planning Tool (JDAPT), and assess its use, relevance, and outcomes over a nine-month follow-up period.
METHODS: Workers with physical and mental health/cognitive conditions causing limitations at work were recruited using purposive sampling. Online surveys were administered at baseline (prior to using the JDAPT), and at three and nine months post-baseline. Information was collected on demographics (e.g., age, gender) and work characteristics (e.g., job sector, organization size). Outcomes included assessing JDAPT use and relevance, and changes in self-efficacy, work productivity difficulties, employment concerns, difficulties with job demands, and absenteeism.
RESULTS: Baseline participants were 269 workers (66% women; mean age 41 years) of whom 188 (69.9%) completed all three waves of data collection. Many workers reported using JDAPT strategies at and outside of work, and held positive perceptions of the tool\'s usability, relevance, and helpfulness. There were significant improvements (Time 1-2; Time 1-3) in self-efficacy, perceived work productivity, and absenteeism with moderate to large effect sizes in self-efficacy and productivity (0.46 to 0.78). Findings were consistent across gender, age, health condition, and work context variables.
CONCLUSIONS: The JDAPT can enhance support provision and provide greater transparency and consistency to workplace disability practices, which is critical to creating more inclusive and accessible employment opportunities.

UNASSIGNED: This study identified rural community experiences and preferences related to available resources and their effects on stress following tornadoes and floods.
UNASSIGNED: The Rural Natural Disaster Stress and Recovery survey was distributed from December 2021 to February 2022 in rural disaster-affected communities. Within the analysis sample (N = 159) of self-selected participants representing both agricultural and non-agricultural occupations, 125 responded to the Resource Use and Effect survey component that evaluated the effects of 22 resources on post-disaster stress. Additional qualitative questions provided further data.
UNASSIGNED: The most frequently used resources post-disaster were found to be talking about the event (98.3%), friends and neighbors (97.6%) and family (97.6%). Using a derived Impact per Use score, groups from the neighboring community and personal faith activities most often reduced stress. Resources that increased stress were identified as FEMA or other government organizations; repairing, replacing, or rebuilding property; and following news or social media. Participants reported help from their community (35.8%) or things they did for themselves (31.2%) most effectively decreased disaster stress. Family, friends, faith, neighbors, and community were top choices to decrease stress in a future disaster.
UNASSIGNED: Rural residents identified available resources for reducing disaster stress, but some common post-disaster activities were found to increase stress. Rural emergency management should adapt response and recovery plans and activities to leverage readily accessible people, groups, and activities to mitigate negative mental and emotional health effects.

UNASSIGNED: The motivation process from personal resources to commitment of administrative employees is still little studied. This article uses the Job Demands-Resources model to investigate how the multiplicative effect of personal resources and a goal-oriented climate among public employees influences their satisfaction and engagement at work. Specifically, it proposes a model where the influence of psychological capital on engagement is mediated by job satisfaction and moderated by the goal orientation climate.
UNASSIGNED: A total of 326 employees of the administrative staff of a Spanish Public Administration answered a self-reported survey. Partial Least Square-Structural Equation Modeling (PLS-SEM) approach was used to evaluate the validity and reliability of the data, as well as, to test the hypotheses formulated.
UNASSIGNED: The SEM results show the positive impact of psychological capital on employee engagement, and the mediating role of job satisfaction in this relationship. Furthermore, the existence of a goal-oriented climate negatively moderated the relationship between Psychological Capital and Job Satisfaction, reducing the mediation effect.
UNASSIGNED: These findings open new doors for future research in the necessary adaptation of human resource policies to improve the motivation process in the public administration context.

OBJECTIVE: The purpose of the study was to assess the challenges faced by state animal health officials (SAHOs) when managing equine disease outbreaks.
METHODS: A survey was conducted to assess SAHOs\' collaboration with horse owners and practicing veterinarians to provide biosecurity and infection disease control. It was sent to 180 email addresses listed in the Equine Disease Communication Center website database. The responses in each category for each question were tabulated and reported as a percentage.
RESULTS: There were 72 survey responses from 45 states. The number of states responding suggested that the results represent SAHOs\' current opinions. Fifty percent of responders identified the lack of resources and training for equine health management and equine reportable disease prevention and control. There is a lack of owner compliance in managing disease outbreaks, and boarding stables, horse shows, and racing facilities require the most resources for outbreak management. The survey indicated on-site communication as the most effective for managing an outbreak, and the Equine Disease Communication Center is to be a valued resource for alerts and disease information.
CONCLUSIONS: At the state level, there is a lack of needed personnel and resources to effectively manage an equine infectious disease outbreak. Furthermore, failure of veterinary and owner compliance in reporting and managing equine infectious diseases allows disease spread.
CONCLUSIONS: Lack of sufficient resources for management of reportable diseases will potentially result in disease spread with a negative impact on horse health and the equine industry.

Hepatocellular carcinoma is one of the common malignant tumors of digestive tract, which seriously threatens the life of patients due to its high incidence rate, strong invasion, metastasis, and prognosis. At present, the main methods for preventing and treating HCC include medication, surgery, and intervention, but patients frequently encounter with specific adverse reactions or side effects. Many Traditional Chinese medicine can improve liver function, reduce liver cancer recurrence and have unique advantages in the treatment of HCC because of their acting mode of multi-target, multi-pathway, multi-component, and multi-level. Sesquiterpenoids, a class of natural products which are widely present in nature and exhibit good anti-tumor activity, and many of them possess good potential for the treatment of HCC. This article reviewed the anti-tumor activities, natural resources, pharmacological mechanism of natural sesquiterpenoids against HCC, providing the theoretical basis for the prevention and treatment of HCC and a comprehensive understanding of their potential for development of new clinical drugs.

UNASSIGNED: Prior pandemic research has focused on physicians and nurses who provide direct patient care. Literature on the experiences of nonnurse/physician clinicians and nonclinical health care professionals is sparse.
UNASSIGNED: An observational, cross-sectional study was conducted over threetime points to examine the impact of COVID-19 on clinical and nonclinical healthcare professionals (n = 464).
UNASSIGNED: There were no significant differences in distress across survey waves, except for anger (p = .046). No significant differences in distress scores were found between job types. Multiple linear regression results varied. Both the threat and interrupted plans scores were significant predictors of distress. Resources available to healthcare providers (HCPs) were underutilized in all three waves.
UNASSIGNED: Healthcare professionals\' distress increases with exposure. Integrating self-care resources for staff may mitigate the impact and maintain a healthy work environment.
UNASSIGNED: Occupational health providers should incorporate these findings when developing opportunities to address the needs of health care professionals in the workplace.

BACKGROUND: The diagnosis of inflammatory rheumatic diseases (IRDs) is often delayed due to unspecific symptoms and a shortage of rheumatologists. Digital diagnostic decision support systems (DDSSs) have the potential to expedite diagnosis and help patients navigate the health care system more efficiently.
OBJECTIVE: The aim of this study was to assess the diagnostic accuracy of a mobile artificial intelligence (AI)-based symptom checker (Ada) and a web-based self-referral tool (Rheport) regarding IRDs.
METHODS: A prospective, multicenter, open-label, crossover randomized controlled trial was conducted with patients newly presenting to 3 rheumatology centers. Participants were randomly assigned to complete a symptom assessment using either Ada or Rheport. The primary outcome was the correct identification of IRDs by the DDSSs, defined as the presence of any IRD in the list of suggested diagnoses by Ada or achieving a prespecified threshold score with Rheport. The gold standard was the diagnosis made by rheumatologists.
RESULTS: A total of 600 patients were included, among whom 214 (35.7%) were diagnosed with an IRD. Most frequent IRD was rheumatoid arthritis with 69 (11.5%) patients. Rheport\'s disease suggestion and Ada\'s top 1 (D1) and top 5 (D5) disease suggestions demonstrated overall diagnostic accuracies of 52%, 63%, and 58%, respectively, for IRDs. Rheport showed a sensitivity of 62% and a specificity of 47% for IRDs. Ada\'s D1 and D5 disease suggestions showed a sensitivity of 52% and 66%, respectively, and a specificity of 68% and 54%, respectively, concerning IRDs. Ada\'s diagnostic accuracy regarding individual diagnoses was heterogenous, and Ada performed considerably better in identifying rheumatoid arthritis in comparison to other diagnoses (D1: 42%; D5: 64%). The Cohen κ statistic of Rheport for agreement on any rheumatic disease diagnosis with Ada D1 was 0.15 (95% CI 0.08-0.18) and with Ada D5 was 0.08 (95% CI 0.00-0.16), indicating poor agreement for the presence of any rheumatic disease between the 2 DDSSs.
CONCLUSIONS: To our knowledge, this is the largest comparative DDSS trial with actual use of DDSSs by patients. The diagnostic accuracies of both DDSSs for IRDs were not promising in this high-prevalence patient population. DDSSs may lead to a misuse of scarce health care resources. Our results underscore the need for stringent regulation and drastic improvements to ensure the safety and efficacy of DDSSs.
BACKGROUND: German Register of Clinical Trials DRKS00017642; https://drks.de/search/en/trial/DRKS00017642.

BACKGROUND: In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns.
OBJECTIVE: This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective.
METHODS: Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable).
RESULTS: We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts.
CONCLUSIONS: This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions.