Search Results (451)

Background/Objectives: Behaviours that challenge (BtC) are common in people with dementia. International guidelines recommend using non-pharmacological interventions (NPIs) as first-line treatments. A promising training package that provides a framework for delivering NPIs is “Communication and Interaction Training” (CAIT); this programme has received national recognition within the UK. Our study aimed to explore staff’s perceptions of the effect of CAIT on their understanding and responses to the behaviours and emotions of people with dementia. The study also sought to further understand how CAIT worked and the conditions which help implement it. Methods: Reflexive thematic analysis was used to analyse interviews with 11 staff who had been trained in the use of CAIT and then attempted to implement the contents of the training in clinical settings. Results: Six main themes emerged regarding the impact of the training: enhancing understanding, transforming interactions, skills development, accessible and flexible, socio-cultural change enablers, and obstacles in training. CAIT was viewed positively by the participants and was perceived to improve their knowledge, attitudes and skills. Conclusions: The positive findings are consistent with previous studies on CAIT and its current use in guiding training programmes in the UK. Implications for the delivery of CAIT are discussed, as well as suggestions for further trials of the programme. Full article

A cancer diagnosis has long-term physical and psychological consequences, and patients vary considerably in their mental health outcomes during the disease process. Psychological resilience has been identified as a protective factor, yet the mechanisms through which it influences mental health remain unclear. This study aims to examine the mediating role of psychological flexibility in the relationship between psychological resilience and mental health among individuals diagnosed with cancer. A total of 234 cancer patients participated in this cross-sectional study. Data were collected using the Depression, Anxiety and Stress Scale (DASS-21), the Connor–Davidson Resilience Scale–Short Form, and the Psychological Flexibility Scale. Path analysis was conducted to test the proposed mediation model. The results indicated that psychological resilience was positively associated with psychological flexibility, and psychological flexibility was negatively associated with depression, anxiety, and stress. Psychological flexibility fully mediated the relationship between psychological resilience and mental health. These findings suggest that psychological flexibility plays a key role in explaining how psychological resilience contributes to better mental health outcomes in cancer patients. Interventions aiming to enhance psychological flexibility may therefore be beneficial in psychosocial support programs for individuals coping with cancer. Full article

Training the public health workforce is a critical component of health system strengthening. In Mexico, postgraduate education operates under a national accreditation framework intended to ensure academic quality and social relevance, yet comprehensive information about the scope and distribution of training programs is limited. This study characterizes public health and related academic programs available in 2024, examining the institutional sector, delivery modality, geographic distribution, and accreditation status. A systematic institutional mapping was conducted through structured searches of the official websites of public and private higher education institutions. Eligible programs included bachelor’s degrees, specializations, master’s degrees, and PhDs that were active between March and November 2024. Searches used predefined keyword combinations, repeated at multiple timepoints, and were restricted to official institutional domains. Data were extracted on academic level, institutional sector, delivery format, duration, geographic region, and inclusion in the National Postgraduate System. Descriptive statistics and logistic regression were used to analyze accreditation patterns; geospatial analysis assessed regional distribution. A total of 175 programs were identified across 30 of Mexico’s 32 states. Professional master’s degrees represented the largest category, followed by research-oriented master’s and PhD programs. Public institutions offered nearly two-thirds of all programs. Among postgraduate programs, fewer than half were accredited, with accreditation concentrated in master’s degrees in science (84.6%) and PhDs (55.6%). Only 23.0% of professional master’s degree were accredited. Most programs were delivered fully in person; online offerings were limited and more common in private institutions. Research-oriented programs were geographically concentrated in a small number of states, whereas professional programs exhibited broader but uneven national distribution. Public health education in Mexico shows growth in professionally oriented training but also reveals persistent gaps in accreditation, geographic equity, and flexible delivery modalities. The disproportionate expansion of professional programs without corresponding integration into accreditation frameworks raises concerns for workforce planning and educational equity. Strengthening national information systems, improving institutional reporting standards, and aligning accreditation criteria with workforce needs are essential to ensure that public health training supports progress towards universal health coverage and the Sustainable Development Goals. Full article

Gender incongruence significantly impacts the family system, yet the subjective experiences of caregivers remain relatively underexplored. This narrative review synthesizes contemporary evidence regarding psychological distress, emotional burden, and quality of life among caregivers of transgender and gender-diverse individuals. A targeted literature search of PubMed, Scopus, PsycInfo, and Google Scholar (2015–2025) was conducted, identifying 16 studies for thematic synthesis. Results indicate that caregivers consistently report elevated emotional distress, characterized by chronic anxiety, hypervigilance, and ambiguous loss. This burden is primarily driven by prolonged exposure to uncertainty, the weight of complex medical decision-making—particularly regarding fertility and hormone therapy—and vicarious minority stress stemming from social stigma and systemic barriers. Notably, distress is often intensified by sociopolitical climates rather than the transition process itself. Conversely, access to peer support networks, healthcare relationships, and engagement in advocacy emerged as vital protective factors facilitating resilience and adaptive meaning-making. We can conclude that caregiver well-being is a multifaceted process deeply embedded in social and institutional contexts. These findings underscore the necessity of integrated, family-centered medical-psychological models that explicitly support caregivers to ensure more equitable and effective gender-affirming care pathways. Full article

Background: Medication adherence and persistence in treating chronic diseases present as a continuous challenge for healthcare providers in long-term management. The most frequent reasons that several diseases are poorly controlled in the population include suboptimal drug adherence and discontinuation of therapies. One main issue why physicians cannot detect patients with poor adherence is that they have relatively limited time and tools to do so. Aim: To review the critical role of medication adherence in the management of chronic diseases by addressing the following: what medication adherence is; its critical role; factors and strategies influencing it; challenges and consequences of poor adherence; patients at risk; present and future strategies in place to detect and improve adherence; implications for public health and health value creation for patients; key analytical frameworks for understanding it; determinants; how adherence improves health; the role of healthcare professionals and technological innovations; implications of medication adherence; adherence as a key area for exploring the psychological mechanisms underlying patient behavior; and patient adherence as a major social and public health challenge. Finally, this review considers strengths, limitations, recommendations, and future value. Methodology: The following databases were used to carry out the review: PubMed, Scopus, Google Scholar, and ScienceDirect. The following themes were combined in the search: what adherence is, why it is critical, why adherence occurs, and how to improve adherence. The following search terms were used: what adherence is and critical, why and adherence and occurs, and how and to improve adherence. Results: Under the theme of why adherence is critical, five sub-themes were reviewed; four sub-themes were reviewed under the theme of why adherence occurs; and five sub-themes were reviewed under the theme of how to improve adherence. Conclusions: Strategies to enhance medication adherence involve a comprehensive approach that includes patient education, streamlined treatment plans, digital tools, and effective communication from healthcare professionals. Full article

Objectives: The present study examined the prevalence of depression, anxiety, and other mental disorders among patients visiting primary healthcare centers (PHCs) in Makkah, Saudi Arabia, and explored demographic, lifestyle, and socioeconomic determinants associated with these conditions. Methods: The study analyzed regional-level data from PHC patients diagnosed with mental health illnesses. The prevalence rates of depression, anxiety, and other mental health disorders were calculated and associated risk factors were assessed using binary variables. Results: The study found that 40% of the population was diagnosed with depression, 25% with anxiety, and 35% with other mental disorders. Depression was most prevalent among patients aged 50–64 years, while anxiety was highest among those aged 19–34 years. The lowest rates were observed in patients aged 65 years or older. Females exhibited higher rates of depression and anxiety than males. Saudi nationals accounted for most cases, with unemployment having the highest prevalence. Single individuals reported the highest prevalence of depression and anxiety. Conclusions: The research indicates a significant prevalence of depression, anxiety, and other mental disorders among primary healthcare patients in Makkah, with females, the unemployed, and younger individuals at elevated risk. Low follow-up rates suggest barriers to ongoing mental health care and highlight the need for targeted interventions. Full article

Contemporary clinical medicine relies on the integration of clinical observation with physiological and pathological mechanisms to improve diagnosis, therapeutic decision-making, and patient outcomes. However, most current biomedical research interprets these mechanisms predominantly through the lens of upward emergence, according to which higher-order biological functions arise from the interaction of simpler lower-level components. Although indispensable for understanding visceral diseases, this perspective provides only partial access to biological complexity. Accumulating evidence from neuroscience, developmental biology, endocrinology, psychiatry, and regenerative medicine shows that higher-level systemic functions can also reorganize, modulate, or generate lower-level structures, a phenomenon known as downward emergence. Together, upward and downward emergence form a bidirectional framework that more accurately reflects the complex organizational pattern of biological systems. This editorial argues that clinical practice and biomedical research must explicitly acknowledge this bidirectional dynamic, as many diseases (including malignancy) cannot be fully understood through upward emergence alone. Downward emergent processes explain phenomena such as morphogenesis, regeneration, matrix remodeling, immunological reprogramming, endocrine-neurovegetative integration, and forms of pathological transformation that are difficult to interpret through classical reductionism. Viewing cancer as the pathological expression of a disturbed supracellular program provides a coherent explanation of its complex biology and highlights the possibility that malignant progression could be responsive to higher-order regulatory instructions. In this context, the Journal of Mind and Medical Sciences is undertaking a conceptual and editorial realignment, positioning itself as a journal of bidirectional emergence in health and disease. Rather than diminishing its clinical mission, this shift strengthens it by providing a more comprehensive framework for understanding physiological and pathological organization, one that integrates structure–function and function–structure relationships. As medicine moves toward increasingly integrative and mechanistic models of disease, adopting a bidirectional perspective becomes not only scientifically justified but also necessary for advancing diagnostic accuracy, therapeutic innovation, and the development of novel supracellular strategies for human health. Full article

Background: Medication errors pose significant health risks and economic burdens globally. In Saudi Arabia, the reported error rates range from 1.6% to 84.8%; yet, the contributing factors remain inadequately understood. This systematic review aims to identify the associated factors and predictors of medication errors across Saudi healthcare settings. Methods: Electronic databases (EMBASE, CINAHL, and PubMed) were searched for peer-reviewed articles published from January 2010 to January 2025. Studies reporting statistically significant factors associated with medication errors or error reporting in Saudi Arabia were included. A quality assessment was conducted using the Appraisal tool for Cross-Sectional Studies (AXIS). Results: Thirteen studies met the inclusion criteria. Healthcare-worker-related factors included age (workers < 35 years are more prone to errors), experience level (4–5 years optimal for reporting), negative attitudes toward errors (AOR = 14.08), and a lack of training (AOR = 7.29). Patient-related factors included advanced age (1.0–2.7-times increased risk), males, polypharmacy (1.1–5.3-times increased risk), and high-risk medications (hypoglycemic drugs, warfarin, and antibiotics). System-related factors included day shift timing (AOR = 1.1), oral medication route (AOR = 0.4), ICU setting (3.3-times increased risk), medical unit setting (1.7-times increased risk), confusing packaging, and look-alike/sound-alike medications. Conclusions: Our findings emphasize that medical errors arise from a complex interplay between healthcare-worker-related factors (age, experience, and attitudes) and hospital-administration-related factors (reporting mechanisms, documentation practices, shift timing, and workload). Full article

Unexpected in-hospital cardiac arrest (IHCA) in the emergency department is defined as an unexpected cardiac arrest during the stay in the emergency department with measured vital signs when entering the emergency department, requiring immediate emergency treatment to save a life. Since IHCA is an urgent medical event, especially in the emergency department, this study explored the risk prediction of IHCA events in the emergency department. IHCA not only has a high mortality rate, but is also likely to cause permanent neurological damage. In the emergency environment, due to the complexity and rapid changes in the patient’s condition, traditional assessment tools often fail to identify high-risk cases in a timely manner. In view of this, this study uses both the Power BI visual analysis platform and the binary decision tree model to construct a data-driven risk prediction tool. Power BI analysis successfully presented the dynamic ranking of influencing factors, and the decision tree prediction model showed excellent performance, with an accuracy of 91%, a recall rate of 89%, an F1-score of 89%, and an overall accuracy of 100%; this prediction system is expected to improve the efficiency of emergency medical care, identify high-risk patients in a timely manner, and assist medical staff in intervening in advance and implementing preventive measures. This study provided two different approaches: Power BI and decision tree. Power BI requires no coding and can be used by medical professionals without a programming background, while decision tree is designed for professionals with a programming background. While the structures of Power BI and decision tree differ slightly, they are generally similar and can both serve as intelligent clinical tools. Full article

Cognitive decline among older people is a growing concern worldwide since it impacts quality of life and independence. Recently, we reported that an epicatechin-enriched product improves cardiometabolic status, physical performance/mobility, and quality of life (QoL) in over-60-year-old subjects. Here, we explored the effects of an (−)-epicatechin-enriched cacao supplement on the cognitive conditions of older and sedentary individuals residing in a community center. Twelve persons with the inclusion criteria were included in this proof-of-concept study. We evaluated reasoning, memory, attention, coordination, and perception using CogniFit software, version 4.6.18. Patients received a mixture of cacao flour and 15 mg of free (−)-epicatechin twice daily for 3 months. The main results from the trial suggested a positive and significant improvement in perception, coordination, reasoning, attention, and memory. Full article

Vulvar carcinoma is the fourth most common gynecological cancer, with squamous cell carcinoma being the most frequent type. Vulvar intraepithelial neoplasia (VIN) is a precursor lesion and is strongly associated with human papillomavirus (HPV) infection. This paper presents two patients in their sixth decade of life, the first diagnosed with VIN 3 (carcinoma in situ) and the second with stage IA keratinizing squamous cell carcinoma. Both patients had HPV infection; immunohistochemistry confirmed HPV-dependent VIN3 in the first case, while the second patient had a pre-existing HPV high-risk 53 infection. Both patients underwent partial vulvectomy, with the second also having bilateral inguinal–femoral lymph node dissection, which showed no lymph node invasion. The first patient had a histopathological result of VIN 3 with clear margins. The second patient underwent adjuvant radiotherapy following restaging pathology. Both are showing favorable postoperative progress. Conclusions. The early diagnosis of vulvar neoplasms enables less radical but effective surgeries, balancing oncologic control with quality of life. A multidisciplinary approach is essential for adjusting treatments, improving both clinical outcomes and patient well-being. Full article

Background: Chronic pain poses a major global health burden, often inadequately managed by conventional analgesics due to limited efficacy and side effects. In this context, plant-based therapies offer a promising alternative. This study aimed to evaluate the antioxidant and analgesic potential of four medicinal plants traditionally used for pain relief: Morus alba, Angelica archangelica, Valeriana officinalis, and Passiflora incarnata. Methods: Phytochemical analyses quantified total phenolic acid, flavonoid, and polyphenolic acid contents in the extracts. Antioxidant activity was assessed using the ABTS radical scavenging assay. Analgesic effects were evaluated in vivo using the hot-plate and tail-flick tests in mice treated for 14 days with plant extracts or paracetamol. Results: Morus alba showed the highest polyphenolic content and strongest antioxidant activity (IC₅₀ = 0.0695 mg/mL). In analgesic tests, Angelica archangelica demonstrated the most significant effect in the hot-plate test (72.2% increase in latency), while Valeriana officinalis had the highest efficacy in the tail-flick test (41.81%), exceeding paracetamol’s performance in that model. Conclusions: While antioxidant activity correlated with polyphenol content, analgesic effects appeared to involve additional mechanisms. These findings support the potential of Angelica archangelica and Valeriana officinalis as effective natural alternatives for pain relief. Full article

Background: Oncocytoma and angiomyolipoma (AML) are benign renal tumors that may mimic malignant lesions on imaging. With the increasing use of partial nephrectomy (PN) for renal masses, accurate preoperative characterization of these lesions is essential. This study highlights the role of partial nephrectomy as a valuable diagnostic tool in situations where imaging is inconclusive or raises concern for malignancy without definitive confirmation. In the absence of a reliable preoperative diagnosis, partial nephrectomy provides direct histologic verification with minimal perioperative morbidity. Moreover, it offers curative potential when malignancy is present. By achieving both diagnostic certainty and renal preservation, this approach is well-suited for clinical scenarios in which imaging ambiguity might otherwise result in overtreatment through radical surgery or undertreatment Material and methods: in this retrospective study, we reviewed our 5-year experience (2019–2024), 188 partial nephrectomies—including bilateral procedures and operations on solitary kidneys—using robotic and open approaches. All of these 30 tumors were solid renal masses with indeterminate imaging features or suspicious characteristics suggestive of malignancy, further underscoring the limitations of current preoperative diagnostic modalities. Results: Histopathological evaluation confirmed benign renal tumors in 30 cases, with oncocytoma diagnosed in 18 cases (16 robotic, 2 open) and AML in 12 cases (9 robotic, 3 open). Conclusions: Even when imaging raises suspicion of malignancy or remains inconclusive, many small renal masses are ultimately confirmed as benign upon histopathological examination. This study underscores the diagnostic uncertainty associated with small renal tumors and highlights the value of partial nephrectomy as a decisive diagnostic intervention. In situations where non-invasive modalities fail to provide definitive answers, partial nephrectomy offers tissue confirmation with minimal morbidity. Furthermore, when malignancy is present, this approach ensures appropriate oncologic management while preserving renal function. Our findings support the integration of this strategy into routine clinical practice, particularly when diagnostic clarity is essential for guiding safe and effective treatment. Full article

Background/Objectives: Deep caries lesions represent an actual concern in preserving tooth vitality and preventing irreversible pulpitis. As presently the non-selective approach is considered an overtreatment, the concept of selective caries removal is highly recommended. The goal of this narrative review is to focus on current trends in carious dentine excavation and adjunctive therapies. Methods: A keyword-based selection of scientific publications issued in the last six years, i.e., 2019–2024, was conducted with the search engine of PubMed (MEDLINE) and ScienceDirect databases, using the following keywords: deep carious lesion; caries removal; indirect pulp capping; adjunctive antimicrobial therapy; adjunctive anti-enzymatic therapy; biomimetic restorative dentistry. Discussions: In deep caries management, the current trends of carious dentine excavation recommend preferentially partial caries removal technique as less risky to pulp exposure and more conservative compared to the stepwise technique (SW). Presently, advanced additional procedures such as antimicrobial photodynamic therapy and an anti-enzymatic approach are also considered for caries arrest. Conclusions: Selective caries removal and adjunctive photodynamic antimicrobial therapy are procedures of choice in preserving pulp vitality. Anti-enzymatic therapies impede decoupling with time of adhesive restorations from the smear layer. Biomimetic restorative dentistry and smart materials introduce the principles of artificial intelligence in the therapeutic approach of deep caries. Full article

Background: Multinodular goiter (MNG) is a common thyroid condition characterized by multiple nodules within the thyroid gland. This study aims to evaluate the incidence and clinical features of occult thyroid carcinoma in patients with multinodular goiter, based on the experience from a medium-volume cancer center. Methods: A retrospective analysis was conducted on patients diagnosed with multinodular goiter who underwent thyroidectomy. Clinical, radiological, and histopathological data were reviewed to identify cases of occult thyroid carcinoma. Factors such as age, sex, and histopathological characteristics were analyzed to determine potential risk factors for malignancy in this cohort. Results: A total of 332 patients with MNG were included in the study, with 61 (17.5%) diagnosed with occult thyroid carcinoma. The incidence of occult carcinoma was more frequent in females, with a notable predilection for papillary carcinoma. Regarding age, occult tumors were more frequently encountered in the 20–40 age group, irrespective of gender. Conclusions: In conclusion, we observed that in our center over a 6-year period, the incidence of thyroid cancer after total thyroidectomy for multinodular goiter sits at 17.5%. Thyroid diseases are more frequent in women, which in turn leads to an increased rate of occult carcinomas. Up to 70% of the cancers were papillary. The clinical risk factors associated with a higher probability of cancer were lower age and female gender. Full article