Search Results (6,823)

Timely access to children’s mental health services depends on accurate identification of service urgency; however, triage practices in Ontario, Canada vary widely, contributing to prolonged wait times and inconsistent pathways to care. This study aimed to develop and validate an empirically based decision-support algorithm to support standardized triaging and prioritization in Ontario based children’s mental health agencies. Data were drawn from 17,564 children and youth aged 4–18 years assessed with the interRAI Child and Youth Mental Health Screener (ChYMH-S) as part of routine clinical practice. Interactive decision tree modelling was used to identify combinations of clinical indicators associated with high service urgency, with age-stratified models for children 7 years and younger, 8–11 years, and 12 years and older. The resulting interRAI Children’s Algorithm for Mental Health and Psychiatric Services (ChAMhPS) classified individuals into seven urgency levels. The algorithm demonstrated good discrimination for services required within seven days (c-statistic = 0.70) and for the urgency of a comprehensive assessment (c-statistic = 0.73), with stable performance across derivation and testing samples. Higher algorithm levels were associated with an increased likelihood of urgent assessment or service need. The ChAMhPS algorithm offers a standardized, empirically derived tool to support clinical decision-making and improve consistency in triage and prioritization of children and youth with urgent mental health needs. Full article

An updated understanding of the U.S. oral health care system is essential for addressing the burden of oral disease, high dental expenditures, and persistent inequities in access. This narrative review synthesizes current evidence on the prevalence of major oral diseases, dental care delivery, financing, dental workforce, and public health initiatives, and highlights the challenges and future opportunities in the U.S. A comprehensive search of PubMed, Google Scholar, and reports from U.S. federal agencies and professional organizations was conducted between September 2025 and March 2026. Following the latest National Health and Nutrition Examination Survey, untreated caries remains widespread, affecting 11% of children (ages 2–5), 10% of adolescents (ages 12–19), 21% of adults (ages 35–49), and 12% of older adults (ages 65–74). Periodontal diseases are common, with 42% of adults aged 30 years or older having periodontitis. Oral cancer incidence stands at 11.5 per 100,000 and increases sharply with advancing age. Edentulism among older adults (ages 65–74) was approximately 11%. The U.S. dental workforce includes over 200,000 dentists, yet shortages affect rural and low-income areas, with 62 million Americans living in Dental Health Professional Shortage Areas. Dental care is primarily delivered through private practices, supplemented by community health centers. Financing relies mostly on private insurance and out-of-pocket payments, while the coverage of public programs like Medicaid varies across states, and Medicare generally excludes routine dental care for older adults. Water fluoridation remains widespread, yet ongoing debates highlight persistent challenges. School-based dental sealants and topical fluoride programs are widely recognized as cost-effective and scalable, offering substantial benefits at the population level. Nevertheless, community-based preventive measures are often hindered by resource constraints, inequitable access, and in some cases political conflicts. In summary, oral diseases remain prevalent in the U.S. Limited public coverage, workforce shortages in rural or underserved areas, and uneven access to dental care highlight the need for systemic reforms to improve oral health equity. These findings point to the importance of strengthening dental public health research and coordinated policy action to reduce structural barriers and expand access to dental care. Full article

Background/Objectives: To examine the association of social determinants of health (SDOHs) with primary and cost-related medication nonadherence among adults with diabetes. Methods: A retrospective cross-sectional analysis was conducted using 2021 data from the Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the United States civilian noninstitutionalized population. Adults aged ≥ 18 years with a diagnosis of diabetes in 2021 were included. The outcomes include primary medication nonadherence (no antidiabetic prescriptions filled) and cost-related medication nonadherence (delaying prescriptions due to cost). The exposure variables include SDOHs such as financial stress, food insecurity, transportation barriers, social support, access to medical care in the neighborhood, and healthcare discrimination. Weighted multivariable logistic regression analyses were conducted to assess the association between SDOHs and medication nonadherence. Results: Among 21.9 million patients with diabetes, 6.5% reported cost-related nonadherence and 17.4% exhibited primary nonadherence. Difficulty paying rent or mortgage (OR 2.32, 95% CI: 1.27–4.23), food insecurity (OR 2.13, 95% CI: 1.27–3.58), and transportation barriers (OR = 2.15; 95% CI: 1.20–3.63) were significantly associated with cost-related nonadherence. In the Medicare subgroup, both difficulty paying rent or mortgage (OR = 2.41, 95% CI: 1.03–5.64) and food insecurity (OR = 2.16, 95% CI: 1.18–3.96) significantly increased cost-related nonadherence. Conclusions: Financial strain, food insecurity, and transportation barriers are associated with cost-related nonadherence. These findings suggest considering social and economic factors in strategies supporting diabetes medication adherence across populations, including Medicare beneficiaries. Full article

The Street Clinic (Consultório na Rua—CnR) is a strategic component of Primary Health Care in Brazil, aimed at populations experiencing homelessness, a group characterized by high levels of social and health vulnerability. This study critically analyzes the experiences of healthcare professionals working within a CnR team, identifying the meanings attributed to their work, the challenges encountered, and the strategies developed within the territory. This is an exploratory study with a qualitative approach, grounded in health narratives and the philosophical hermeneutics of Hans-Georg Gadamer. Four professionals participated, representing the totality of eligible members of a team in a medium-sized municipality in Southern Brazil, with between one and eleven years of experience in the service. Hermeneutic analysis revealed that the CnR functions as an entry point to Primary Health Care and Psychosocial Care, with the bond between team and users serving as the primary mechanism for overcoming barriers to access. Professionals report ethical suffering arising from the tension between their commitment to comprehensive care and the structural limitations of the service, including shortages of supplies, institutional instability, and precarious employment arrangements. It is concluded that strengthening the CnR requires not only investment in infrastructure and expansion of the teams, but also policies that recognize and support the complexity of street-based work, including care for the caregivers themselves. Full article

In the United States, access to healthcare is shaped not only by patient need but also by payer policies that determine which providers are reimbursable, how care is sequenced, and what constitutes a legitimate entry point into the system. These gatekeeping functions, while valuable for supporting clinical prioritization, risk stratification, and continuity of care, can also unintentionally reinforce structural inequities and credential hierarchies that delay or limit timely and equitable care, particularly for historically marginalized populations. While reform efforts often focus on expanding benefits or provider networks, fewer address the underlying design of access itself or the rules that govern how patients enter care. It is argued in this paper that a more equitable and efficient healthcare system requires multi-entry care models, in which nurses, behavioral health clinicians, pharmacists, and community health workers may serve as condition-appropriate, reimbursable first points of contact within coordinated care teams. Drawing on evidence from Medicare, Medicaid, the Veterans Health Administration, and commercial payers, these models may support cost containment, improve care coordination, facilitate appropriate utilization, and promote earlier patient engagement. While findings from these models are not uniform across all settings, evidence suggests that outcomes are highly dependent on implementation context, system design, and supporting infrastructure. When implemented with appropriate safeguards (such as interoperable health records, team-based care requirements, and coordinated referral tracking), multi-entry systems can preserve continuity while expanding access. Payers are uniquely positioned to lead this transformation by aligning reimbursement policy with patient needs, supporting team-based care infrastructure, and embedding accountability into access pathways, thereby creating a system that can be more responsive, inclusive, and sustainable. Full article

Background/Objectives: A psychiatric consultation is a professional evaluation aimed at establishing a diagnosis, a prognosis, and developing a treatment plan. The objective was to assess psychiatric consultations (PCs) at the Community Mental Health Center (CMHC), Emergency Room (ER) and General Hospital (GH) to highlight differences across settings. Methods: With a retrospective design, we examined all PCs performed between 1 January 2024 and 31 December 2024 at the CMHC, ER and GH of Baggiovara in Modena. Descriptive statistical analysis and a multivariate logistic regression were performed. Results: We collected a total of 3174 PCs for 1801 patients, performed in the three settings: 52% in ER, 30% in CMHC and 18% in GH. In ER, PCs were most frequently requested for suicide risk (26%), psychomotor agitation (14%) and substance intoxication (14%). In CMHC, the most common diagnoses were depressive disorders (22%), acute anxiety (20%) and acute psychotic episodes (13%). In GH, consultations mainly addressed psychiatric symptoms associated with medical and eating disorders. The overall rate of psychiatric hospitalization after PCs was 16.2%, reaching 23.4% for consultations in ER. Discontinuation of pharmacological therapy was significantly associated with an increased risk of hospitalization (p < 0.001), which rose to 17% when therapy had been interrupted for more than one year. Conclusions: PCs at ER were the access point for most hospitalizations. Therapeutic discontinuation, acute psychosis and substance use represented the main predictors of hospitalization. Strengthening shared care pathways among CMHC, ER and GH represents an effective model of integration between hospital and community services, ensuring continuity of care. Full article

Cardiometabolic disease is increasingly shaped by the overlap among obesity, type 2 diabetes, chronic kidney disease, heart failure, and atherosclerotic cardiovascular disease, underscoring the need for prevention strategies that extend beyond glucose-centered care. This narrative review critically examines the mechanistic rationale, clinical evidence, guideline evolution, and practical implementation of sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) within the cardiorenal–metabolic continuum. A structured literature search was conducted in PubMed, Scopus, and Web of Science, focusing primarily on publications from January 2019 to March 2026, with selected landmark studies from earlier years included for context. Priority was given to randomized controlled trials, major cardiovascular and kidney outcome trials, meta-analyses, clinical practice guidelines, scientific statements, and expert consensus documents. The reviewed evidence indicates that SGLT-2 inhibitors show the most consistent benefits in reducing heart failure events, slowing chronic kidney disease progression, and lowering cardiorenal risk, whereas GLP-1 receptor agonists are more strongly associated with reductions in major adverse cardiovascular events, residual atherosclerotic risk, and body weight. Emerging data also support extension of this therapeutic paradigm beyond diabetes, particularly in obesity-associated cardiovascular risk. Contemporary care is increasingly moving toward phenotype-informed treatment selection, earlier organ-protective intervention, and multidisciplinary management, although cost, access, tolerability, and implementation barriers remain important limitations. SGLT-2 inhibitors and GLP-1 receptor agonists are therefore central to modern cardiovascular prevention across the cardiovascular–kidney–metabolic spectrum. In this context, the proposed Cardiometabolic 2.0 framework may serve as a clinically oriented model for integrating these therapies within contemporary organ-protective care. Full article

Background: Tuberculosis (TB) remains a major cause of morbidity and mortality among children worldwide, with approximately one million new pediatric cases annually. The conventional treatment for drug-susceptible TB has long relied on a 6-month multidrug regimen, which is highly effective but associated with challenges in adherence, toxicity, and healthcare burden. Objectives: To evaluate whether short-course therapy is an appropriate regimen for children and young adolescents with drug-susceptible TB, with particular focus on its efficacy, safety, and applicability in different clinical contexts. Methods: A structured narrative review of the literature was conducted, including randomized controlled trials, observational studies, and international guidelines addressing treatment duration in children and young adolescents with drug-susceptible TB. Evidence was synthesized focusing on children and young adolescents <16 years with drug-susceptible TB treated with short-course regimens compared to standard therapy. Results: A shorter treatment regimen, particularly 4-month courses, has been investigated as an alternative to standard therapy in the pediatric population with drug-susceptible TB. Children often present with paucibacillary and non-severe forms of TB, providing a biological rationale for treatment shortening. Evidence from a randomized controlled trial has demonstrated that a 4-month regimen is non-inferior to the standard 6-month therapy in children and young adolescents with non-severe, drug-susceptible TB. These findings have informed recent international guideline updates, which now recommend short therapy in carefully selected patients. However, a short regimen is not appropriate for infants younger than 3 months, children with severe or complicated TB, extrapulmonary disease such as central nervous system involvement, or those with drug-resistant TB. The overall quality of evidence remains moderate, and long-term relapse data are still emerging. Conclusions: Short-course therapy represents a promising but selective strategy in pediatric drug-susceptible TB management. It offers potential advantages, including improved adherence, reduced drug toxicity, and lower healthcare costs. However, its safe implementation requires accurate patient selection, access to appropriate diagnostic tools, and structured follow-up. Careful application within clearly defined clinical criteria is essential to ensure optimal outcomes. Full article

American Indian and Alaska Native (AI/AN) populations experience disproportionately high kidney cancer incidence and mortality compared to other groups in the United States. Literature was reviewed to explore the factors contributing to the unequally higher kidney cancer burden in AI/AN communities and to develop recommendations to reduce these disparities. The incidence of kidney cancer has been rising over the past few decades, and this increase has been especially steep among AI/AN populations. Death rates in AI/AN populations are roughly twice those of the non-Hispanic White population. The elevated kidney cancer burden in AI/AN populations may be driven by both clinical and behavioral risk factors (obesity, diabetes, hypertension, chronic kidney disease, smoking, and environmental factors) and structural drivers of health, which can critically shape these disparities. Systemic inequalities limit AI/AN patients and community members’ access to chronic disease management, smoking cessation programs, primary and specialty care for early detection, and ultimately, treatment. AI/AN patients may have mistrust or other cultural barriers to engaging with the healthcare system and providers, while implicit bias in healthcare providers may lead to undertreatment. Therefore, key interventions and tailored programs aimed at reducing kidney cancer incidence and mortality are needed. Here we highlight some current interventions, including access to disease management and smoking cessation programs, facilitating healthcare access and quality, adopting patient navigation and culturally competent education, and developing strategies for early detection. In partnership with AI/AN communities, a combination of prevention, early detection, and healthcare system improvements is needed to close the kidney cancer gap. Full article

Against the backdrop of rapid population aging, rural public spaces face growing challenges in meeting the everyday needs of older adults. Drawing on a place-based care perspective, this study develops age-friendly design strategies attuned to the spatial and cultural characteristics of rural environments. Using a mixed-methods approach that includes field observations, structured interviews, and questionnaire surveys, we identify the needs of older adults in rural public spaces. These needs are first clustered using the K-means algorithm and then analyzed using the FKANO model to extract core priorities. Their relative importance is quantified by an integrated procedure that combines ordinal relation diagrams and entropy weighting. Building on these results, we propose an age-friendly design framework and validate it with spatial simulation to assess scale, accessibility, and connectivity. The findings highlight five critical features prioritized by older adults in rural areas: non-slip surfaces, barrier-free access, safety railings, lighting systems, and public restrooms. The study provides a targeted and actionable pathway for the age-adaptive transformation of rural public spaces, offering both a theoretical foundation and a practical design paradigm for aging-friendly rural environments worldwide. Full article

Retinopathy of Prematurity (ROP) affects preterm infants worldwide, involving abnormal development of retinal blood vessels associated with supplemental oxygen use in neonatal care. Although there have been strides in identifying at-risk infants, implementing early screening, updating disease criteria through the International Classification of Retinopathy of Prematurity (ICROP), and developing new therapies, ROP remains a leading cause of preventable blindness. As preterm birth survival rates rise, the incidence of ROP continues to increase and is projected to rise even in countries with abundant resources and well-established care programs. Improving ROP care requires global standardization of screening, diagnosis, and management to prevent missed diagnoses and minimize outcome variability. Intravitreal anti-vascular endothelial growth factor (VEGF) injections are changing the landscape of ROP management, but longitudinal research is needed to determine their long-term safety in preterm infants. Effective ROP management relies on teamwork across disciplines and open communication with parents. Given that parents are lifelong caregivers of a child who may be affected by ROP-related vision impairment, including them in the care team and encouraging psychosocial support is vital. Socioeconomic disparities and limited access to ROP-trained ophthalmologists exacerbate disease burden, underscoring the need for innovative solutions to improve access to care. This perspective emphasizes the importance of globally standardizing ROP prevention and care, noting that efforts are still incomplete, equitable access has not been realized, and the long-term role of anti-VEGF agents in ROP treatment remains unclear. Full article

Australia’s ban on social media for under-16s, introduced in December 2025, made it the first country worldwide to implement a nationwide prohibition on major platforms for adolescents. This narrative literature review compares Australia’s age-based restriction with international approaches to protecting young people from online risks. The review synthesized 26 academic studies and 15 grey literature sources (policy documents, legislation, and official reports published between 2015 and 2025). It employed Bronfenbrenner’s bioecological systems theory to examine effects across family, platform, institutional, and broader socio-legal contexts. Three key themes emerged: (A) Empirical findings on age-threshold policies remain inconclusive and context-dependent. While unregulated use relates to psychological vulnerabilities, structured and intentional engagement can promote social connection, identity exploration, and support access, especially for marginalized youth. (B) Global responses vary, favoring alternatives like parental consent, platform duty-of-care obligations, and screen-time control measures. (C) Balanced, sustainable harm reduction depends on combining parental involvement, platform accountability, and digital literacy education. Overall, while Australia’s precautionary approach addresses legitimate developmental and public health concerns, its effectiveness seems limited by enforcement challenges, risks of digital exclusion, and potential human rights issues. Bronfenbrenner’s framework underscores the need for coordinated governance across interconnected systems to lessen online harm. Full article

Silver diamine fluoride (SDF) is a key preservation-based intervention in pediatric dentistry. It can arrest many cavitated lesions, reduce treatment burden, and expand access for children who cannot receive conventional restorative care. This viewpoint article offers a reasoned, heuristic framework for calibrating SDF guidance to the strength of the underlying evidence. It does not present a systematic review or formal policy standards. Foundational trials support the clinical usefulness of 38% SDF. The 2017 AAPD guidelines provided conditional recommendations based on low-quality evidence. The current challenge is no longer whether to endorse SDF but how to calibrate guidance on its implementation. Later studies addressing intervals and implementation often have open-label designs, small samples, single centers, or overlapping data sources. Mechanistic and microbiome studies support biological plausibility, but policy should not treat them as definitive evidence. We propose a hypothesis-generating framework that separates claims about the existence of an effect (for which there is stronger directional support) from claims about its optimal conditions (which remain more uncertain), highlights dataset overlap, and matches recommendation strength to study quality. The framework supplements GRADE and provides illustrative upgrade pathways. The goal is to preserve SDF access while making guidelines more transparent, credible, and precise. Full article

Background/Objectives: Mental health service utilization gaps remain a persistent global public health challenge. Among the 61.5 million adults with any mental illness in the United States, nearly half went without treatment in the past year, and dropout rates from outpatient services among those who do enter care range from 19.7% to 30.8%. Only 30 to 60% of individuals with lifetime mental illness are in active recovery at any given time. Existing theoretical frameworks, including Andersen’s Behavioral Model, the Health Belief Model, and the COM-B framework, each address isolated phases of the care continuum but offer no unified structure for understanding the complete, sequential journey from first contact through sustained recovery. This article introduces the Access, Initiation, Engagement, Retention, and Recovery (AIERR) model to address this theoretical gap. Methods: A conceptual review was conducted following Hulland’s framework for theory development through narrative synthesis. Literature was identified through targeted searches in PubMed, PsycINFO, and Google Scholar, prioritizing peer-reviewed empirical studies, systematic reviews, and foundational theoretical frameworks. Sources were assigned to AIERR stages using predefined decision rules corresponding to each phase’s defining characteristics. Results: AIERR maps five sequential, interconnected stages: Access (structural, cultural, and systemic conditions enabling service reach), Initiation (the transition from provider identification to first appointment attendance), Engagement (active and meaningful treatment participation), Retention (sustained continuity of care), and Recovery (long-term reclamation of life quality and community belonging). For each stage, the framework identifies individual-level and structural-level barriers, facilitating conditions, and targeted intervention points. Conclusions: AIERR advances mental health services theory by unifying previously siloed frameworks, establishing stage-specificity as a core theoretical principle, and reorienting research and intervention strategy toward the upstream structural conditions that produce downstream utilization failures. These theoretical contributions require empirical testing to confirm. Implications for health equity research, clinical practice, and health systems design are discussed. Full article

Background: Delivering comprehensive cancer prevention, diagnosis, and treatment across Hawaiʻi and the U.S.-Affiliated Pacific Islands (USAPI) is constrained by geographic isolation, oncology workforce shortages, and persistent cancer inequities. Objectives: The University of Hawaiʻi Cancer Center, the state’s only National Cancer Institute-designated cancer center, partners with community healthcare systems to address cancer health disparities. Here, we describe an implementation-focused strategy initiated in December 2024 that is designed to improve equitable access to evidence-based oncology services across the catchment area. Approach: This program description integrates publicly available demographic and health system data and presents a structured implementation framework centered on (1) workforce development and oncology training pathways; (2) a statewide clinical oncology network supported by telehealth; (3) community-engaged screening and early detection outreach; and (4) strengthening clinical research and trial infrastructure with deliberate inclusion of underserved populations. Evaluation: We outline an evaluation framework incorporating process and outcome metrics spanning workforce capacity, screening participation, timeliness of care, clinical trial enrollment, and equity indicators stratified by county, island, and population group. Conclusions: This approach offers a scalable, implementation-oriented model for developing an academic oncology ecosystem that emphasizes measurement, accountability, and equity, with potential applicability to other geographically dispersed and ethnically diverse regions. Full article