Search Results (416)

A global poly-crisis of climate change, biodiversity loss, dwindling natural resources, geopolitical instability, among other complex challenges, is on the rise. Societal transformations are therefore imminent, whether intended or unintended. The key question is how to steward and facilitate such changes where fragmentation and siloed ways of working persist. The concept of synergies and the notion of synergic action could help overcome fragmented efforts to steer transformative changes. However, there exists a critical research gap in understanding the conditions needed to enable synergic action. This paper thus explores how synergic action is currently undertaken and the key essentials needed to deliver synergic action. The study uses a case study of the Yorkshire food system transformation to learn from its exemplar practitioners. The study used semi-structured interviews and a thematic analysis process to reach our two key findings. First, we highlight the three types of synergic action: (1) Non-systemic synergic action, (2) Non-systemic synergic action with multiple outcomes, and (3) Systemic synergic action. Differentiating types of synergic action can help identify where synergic action is already underway and guide more explicit efforts towards transformative change. The second key finding is the five essentials for synergic action, which are (1) leadership for synergic action; (2) networking, partnerships, and collaborations; (3) care and understanding; (4) a systems approach; and (5) intentionality for synergic action. This study brings to the fore the importance of intentionality, without which the first four essentials are less likely to coalesce. This is important to inform the reflection and learning of practitioners of systemic change about how they are currently and could be working more synergistically in the future, driven by clear intentionality. Full article

The impacts of the climate crisis compel congregations to reimagine their mission and identity in various ways. Working with data taken from U.S. clergy participating in an online program for education and support on climate and environmental issues, as well as selected congregational leaders from their congregations, this article examines the ways that ministers and their congregations in primarily North American mainline Protestant contexts frame the climate crisis and how those understandings both create tension and open space for new conversations about their Christian and congregational vocation. It also describes how these ministers and congregations engage with environmental issues through means beyond technological solutions and consumption choices, such as collaborating with other community organizations, hosting rituals for grieving or meaning-making, and inviting transformative encounters with the more-than-human world. Finally, it will suggest possible strategies for leaders and their congregations to frame and creatively engage with the environment through various methods. Full article

Background: Stigma associated with tuberculosis (TB) continues to undermine patient well-being, treatment adherence, and public health goals and objectives. This study aims to systematically review the literature to identify and synthesize TB stigma reduction interventions published between 2015 and 2025. Methods: Following the PRISMA guidelines, we conducted a comprehensive literature search across PubMed, Scopus, Science Direct, ProQuest, and Google Scholar. Eligible studies included those with qualitative, quantitative, and mixed-methods designs that focused on interventions related to TB-related stigma. We categorized the studies into three groups: (1) intervention development studies, (2) TB treatment programs with stigma reduction outcomes, (3) stigma-specific interventions. Data extraction and quality appraisal were conducted independently by two reviewers using the Mixed Methods Appraisal Tool (MMAT). Results: A total of 15 studies met the inclusion criteria. Five studies focused on co-developing stigma interventions, which incorporated multi-level and multicomponent strategies targeting internalized, enacted, anticipated, and intersectional stigma. Two studies assessed TB treatment-related interventions (e.g., home-based care, digital adherence tools) with incidental stigma reduction effects. The remaining seven studies implemented stigma-targeted interventions, including educational programs, video-based therapy, peer-led support, and anti-self-stigma toolkits. Interventions addressed stigma across individual, interpersonal, institutional, community, and policy levels. Conclusions: This review highlights the evolution and diversification of TB stigma interventions over the past decade. While earlier interventions emphasized education and support, recent strategies increasingly integrate peer leadership, digital platforms, and socio-ecological frameworks. The findings underscore the need for comprehensive, contextually grounded interventions that reflect the lived experiences of people affected by TB. Full article

Background: Digital platforms and inclusive leadership are pivotal in modern healthcare, influencing organizational performance and patient outcomes. Despite the growing adoption of these factors, their combined impact on leadership effectiveness and patient care remains insufficiently understood. Prior research has primarily examined digital technology or leadership inclusivity separately, lacking integrative studies that address their joint effect on healthcare outcomes. There is a need to explore how these variables interact to improve leadership and patient-related metrics. Methods: This cross-sectional study surveyed 250 participants, including healthcare leaders, professionals, and patients, using structured questionnaires. The data analysis involved multiple regression, structural equation modeling (SEM), and hierarchical linear modeling (HLM) to examine the direct and hierarchical relationships among digital platform usage, leadership inclusivity, leadership effectiveness, and patient outcomes. Results: Leadership inclusivity showed a significant positive effect on leadership effectiveness (β = 0.16, p < 0.01) and patient satisfaction (β = 0.09, p < 0.05). Digital platform usage demonstrated a smaller but positive association with leadership effectiveness (β = 0.04) and patient satisfaction (β = 0.03). Leadership effectiveness was found to correlate moderately with patient safety (β = 0.23) and treatment efficacy (β = 0.25), with minimal organizational-level effects. Conclusions: This study uniquely integrates the adoption of digital technology with inclusive leadership, highlighting their synergistic influence on healthcare delivery. It advances the existing literature by providing quantitative evidence on how these elements interact to shape leadership and patient care outcomes. Full article

Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways. Full article

Background/Objectives: International guidelines recommend the combined use of the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI) to support early and accurate diagnosis of cerebral palsy (CP). However, their implementation remains inconsistent. This study aimed to map their reported global use and identify associated enablers and barriers. Methods: A scoping review was conducted following JBI and PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Cochrane, PEDro, ProQuest, Web of Science, and Scopus. Eligible studies were charted and thematically analyzed, focusing on tools use and implementation factors at individual, organizational, and system levels. Results: Fourteen articles (seven surveys, seven implementation studies) from seven countries met the inclusion criteria. While awareness of GMA, HINE, and MRI was generally high, routine clinical use was limited—particularly outside structured implementation initiatives. Major barriers emerged at the system level (e.g., limited training access, time constraints, lack of standardized referral pathways) and social level (e.g., unclear leadership and coordination). Conclusions: The limited integration of GMA, HINE, and MRI into routine practice reflects a persistent “know–do” gap in early CP detection. Since implementation is shaped by the dynamic interplay of capability, opportunity, and motivation, bridging this gap demands sustained and equitable action—by addressing system-wide barriers, supporting professional development, and embedding early detection within national care pathways. Full article

This study explores how Black student leaders (BSLs) at public historically white institutions (HWIs) in Florida and Georgia navigate racial battle fatigue (RBF) in the context of anti-DEI legislation. Amid rising political hostility toward diversity, equity, and inclusion (DEI) efforts, this research examines the lived experiences of 11 BSLs as they respond to racialized campus climates that are increasingly ambiguous and unsupportive. Using a critical qualitative approach, data were collected through two in-depth interviews per participant and analyzed using inductive and deductive coding. Four major findings emerged: (1) BSLs experience heightened psychological, physiological, and emotional forms if stress linked to their identity and leadership roles; (2) anti-DEI policies contribute to institutional erasure and confusion; (3) students express emotional withdrawal, hypervigilance, and disillusionment with performative leadership; (4) students employ culturally grounded coping strategies centered on self-care, spirituality, and community. This study underscores that BSLs are both empowered and burdened by their leadership, especially under politically restrictive conditions. The findings call for student affairs educators to prioritize engagement and belonging and offer identity-affirming support. Further, scholars with academic freedom are urged to continue documenting racialized student experiences. These insights are critical to protecting Black student leadership and equity-centered educational transformation. Full article

This article describes the design and implementation of a Specialized Mental Health Clinical Pastoral Education (CPE) program for clergy and theological students of all spiritual, religious, and cultural backgrounds. Addressing the need for mental health competencies in religious leaders and chaplains, this training equips participants with specialized skills in individual and group mental health spiritual assessment and spiritual care. Program participants become effective members of a multiprofessional team, gain knowledge of mental health philosophies of concordant and discordant spiritual orienting systems, and gain greater relational capacity. The Mental Health CPE Program includes traditional and novel CPE elements: (1) clinical practice, (2) group and individual supervision, (3) didactic presentations and journal clubs, (4) verbatim (Protocols of patient encounters) and case presentations, (5) group leadership training and practica, and (6) experience of faith reflections. This article provides insights into the origins of CPE, a description of the implementation in a free-standing psychiatric hospital, and observed developmental changes of program participants. We include graduates’ anecdotal feedback about their learning experience and its impact on their leadership in chaplaincy and in religious communities. Additionally, we report on areas for future development and further study of the effectiveness of Mental Health CPE. Full article

This paper is based on our engagement in a cross-sector network in Leeds, UK, taking local climate action. It draws on in-depth engagements with participants in this network, to explore how they negotiate being in, while at the same time wanting to push beyond, a climate emergency. We found three emergent trends: a reworked interpretation of the climate emergency through longer-term, holistic, historically grounded, and politicised definitions; novel forms of disruptive, collaborative place leadership that could help respond to this longer emergency; and a value-based focus on a reparative ethics of self-care, people-care, and Earth-care that foregrounds climate justice and accountability to frontline communities. We end by recommending that place-based actors can enhance the effectiveness of their collective action by broadening emergency definitions, developing politics and strategy, and supporting values-based climate justice and equity. Full article

Introduction: Work life quality (WLQ) in nursing is a critical factor that influences both staff well-being and the quality of care provided to patients. Spiritual intelligence (SI) and servant leadership (SL) have been identified as potential positive predictors of WLQ, as they facilitate resilience, job satisfaction, and stress management in highly demanding hospital environments. However, the specific relationship between these constructs in the Peruvian nursing context has not yet been thoroughly explored. Objective: We aimed to examine the impact of spiritual intelligence and servant leadership on the work life quality of Peruvian nurses, assessing their predictive role through a structural equation modeling approach. Methods: A cross-sectional and explanatory study was conducted with a sample of 134 Peruvian nurses (M = 36.29 years, SD = 7.3). Validated Spanish-language instruments were used to measure SI, SL, and WLQ. Structural equation modeling (SEM) with a robust maximum likelihood estimator (MLR) was employed to evaluate the relationships between the variables. Results: Spiritual intelligence showed a positive correlation with WLQ (r = 0.40, p < 0.01) and with servant leadership (r = 0.44, p < 0.01). Likewise, servant leadership had a significant relationship with WLQ (r = 0.53, p < 0.01). The structural model demonstrated a good fit (χ² = 1314.240, df = 970, CFI = 0.96, TLI = 0.96, RMSEA = 0.05, SRMR = 0.08). The hypothesis that SI positively predicts WLQ was confirmed (β = 0.41, p < 0.001), as was the significant effect of SL on WLQ (β = 0.26, p < 0.001). Conclusions: The results indicate that both spiritual intelligence and servant leadership are key predictors of work life quality in Peruvian nurses. SI contributes to developing a transcendent perspective on work and greater resilience, while SL fosters a positive and motivating organizational environment. It is recommended to implement training programs and leadership strategies focused on these constructs to enhance work life quality in the healthcare sector. Full article

Gender inequality remains a persistent issue in healthcare, especially in ophthalmology, where women face systemic barriers such as pay gaps, limited surgical opportunities, harassment, and unequal family expectations. Despite increasing entry into the field, women remain underrepresented in leadership, affecting career advancement and patient care. This study examines how virtual platforms, and co-led initiatives can address gender disparities in eye health. In 2021, Women in Ophthalmology, Seva Foundation, and Orbis International launched the Women’s Leaders in Eye Health (WLEH) initiative—a global community promoting mentorship, networking, and leadership development. Starting with virtual webinars and informal networking, the initiative expanded to in-person events in 2023 due to strong global engagement and demand. Early virtual programming, including webinars and “Coffee Hour” sessions, proved effective and laid the groundwork for broader offerings such as mentorship and professional development grants. WLEH’s success underscores the power of collaboration in promoting gender equity. By fostering connections and leadership pathways, WLEH offers a scalable model to break down gender challenges and uplift the next generation of women leaders to deliver more accessible eyecare globally. Full article

This article describes a case study of the partnership between Healthy Birth Initiatives, a community-based organization (CBO) and Black-led public health nurse home visiting program, and the maternal health division of the Providence Health System located in the Pacific Northwest. This study’s purpose was to explore the formation, significance, and impact of this partnership from the perspectives of staff and leadership members from both organizations. We conducted a case study through qualitative interviews with staff, participant observation, and debrief of leadership meetings. We completed a hybrid deductive–inductive thematic analysis of the data, followed by member checking with study participants and other key interest holders. Key facilitators of the CBO–health system partnership included the vital role of leaders in prioritizing the partnership; health system willingness to incorporate new information from the CBO to improve care; and health system utilization of resources to institutionalize changes that emerged from this partnership. Challenges to the CBO–health system partnership included CBO resource limitations; fragmented referral processes and information sharing; and the persistence required to nurture the relationship without formalized roles. This study contributes to the literature by offering staff perspectives on how a CBO–health system partnership formed, successes, early lessons learned, and practical suggestions for how to develop stronger alignment to provide culturally responsive patient-centered care to Black families. Full article

Background: As population aging continues to accelerate, it is increasingly important to promote a positive perception of older adulthood from an early age. Service-Learning (SL), when integrated into Physical Education (PE), offers an opportunity to foster critical and prosocial awareness in primary school students, encouraging attitudes of respect and empathy toward older adults. Method: A qualitative study was conducted with 40 sixth-grade students who participated in an SL project at an adult day care center. Through weekly adapted PE sessions, the students engaged in direct interaction with older adults. Data were collected through reflective journals and analyzed using content analysis techniques. Results: The findings reveal a positive impact on students’ perceptions of older adults. Significant development of prosocial competencies, such as empathy, collaborative leadership, and communication skills, was observed. Furthermore, students expressed an enhanced sense of usefulness and social commitment. Conclusions: Intergenerational SL in PE is an effective strategy for improving academic learning, transforming attitudes, promoting civic values, and contributing to more inclusive education. Full article

Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently accompanied by comorbid conditions that contribute to disability and worsen long-term outcomes. Among these, malnutrition and osteosarcopenia remain under-recognised. This cross-sectional study aimed to assess the prevalence of malnutrition and osteosarcopenia among elderly women with RA and explore the clinical impact of these conditions. Methods: Sixty-five women over 65 years with RA were evaluated using Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and EWGSOP2-based assessments for sarcopenia; bone status was measured by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and three-dimensional DXA (3D-DXA). Results: Malnutrition was identified in 49.2% and osteosarcopenia in 52.3% of participants. A significant bidirectional association was observed: malnourished patients had higher rates of osteosarcopenia (65.6% vs. 34.4%; p < 0.05), and osteosarcopenic patients were more frequently malnourished (61.8% vs. 39.1%; p < 0.05). Both conditions were associated with older age, lower body mass index (BMI), impaired muscle parameters, and reduced bone mineral density. Malnourished and osteosarcopenic patients reported worse fatigue and lower physical quality of life, despite similar inflammatory activity. Significant correlations were found between muscle mass indices and bone quality metrics assessed by 3D-DXA. These findings highlight a substantial burden of malnutrition and osteosarcopenia in elderly women with RA, even with well-controlled disease despite similar inflammatory activity (mean Disease Activity Score 28: 2.8 ± 1.0; 43.1% in remission. Conclusions: There is a substantial burden of malnutrition and osteosarcopenia in elderly women with RA that support the integration of systematic nutritional and musculoskeletal screening into routine care. Future studies should evaluate age- and disease-specific mechanisms and assess the benefit of multidisciplinary strategies to prevent frailty and improve long-term outcomes. Full article

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care. Full article