Search Results (7,976)

Objective: To analyse written submissions from individuals and families with lived experience of attention-deficit hyperactivity disorder (ADHD) to the 2023 Australian Senate Inquiry, using artificial intelligence (AI)-assisted thematic analysis. The aim was to identify priority concerns, service needs, and community-proposed solutions. Methods: A mixed-methods study of 505 publicly available submissions from individuals with ADHD and their families. Submissions were analysed using large language model (LLM)-assisted data extraction and thematic clustering, with human validation and review. Main Outcome Measures: Frequency and thematic distribution of (1) problems experienced; (2) services wanted; and (3) solutions suggested. Results: Thematic analysis of 480 eligible submissions revealed high costs and long wait times for assessment and treatment (each cited by 46%), lack of specialised care (39%), diagnostic delays (36%), and gender bias (27%). The most common service request was for affordable and accessible ADHD-specific care (71%), followed by services tailored to diverse populations and life stages. Proposed solutions focused on Medicare-funded access to psychological and psychiatric services (68%), expanded roles for general practitioners, improved provider training (39%), and recognition of ADHD under the National Disability Insurance Scheme. Submissions also highlighted misalignment between current clinical guidelines and public expectations. Conclusions: The findings highlight substantial unmet needs and systemic barriers in ADHD diagnosis and care in Australia. The AI-assisted analysis of consumer submissions offers a scalable method for integrating lived experience into policy development, providing numerical weighting to the individuals’ responses. Coordinated reforms in access, funding, and workforce training are needed to align services with both clinical evidence and community expectations. Full article

Background/Objectives: Sarcopenia (Sp) and obesity (Ob) have significant negative effects on steatotic liver disease (SLD). Here, we examined the effects of sarcopenic Ob (SO) on liver fibrosis in patients with SLD. Methods: We included 811 patients who visited our outpatient clinic and underwent FibroScan (Echosens, France). Liver stiffness (LS) was assessed using body mass index (BMI) and grip strength (GS). We conducted a similar analysis by converting the difference in estimated glomerular filtration rate (dGFR) based on creatinine and cystatin C levels into GS. Results: The cutoff values for distinguishing metabolic dysfunction-associated steatotic liver disease (MASLD; 298 patients) with LS > 10 kPa (advanced fibrosis) were set separately for men and women using receiver operating characteristic analysis. BMI was set at >26 kg/m² in women and >27 kg/m² in men (modified Ob (mOb)), and GS was set at <16 kg in women and <31 kg in men (modified Sp (mSp)). The ratio of advanced fibrosis was higher in the group with both mSp and mOb (mSpOb) than in the group with mSp alone or mOb alone in MASLD or alcoholic liver disease (ALD, 97 patients). However, this association has not yet been observed in other diseases. The dGFR was used to set the cutoff value corresponding to advanced fibrosis. Sp-dGFR (SpdG) was >1.14 in women and >−0.76 in men in the MASLD group. mSpOb, SpdG and Ob are associated with advanced fibrosis in MASLD logistic regression analysis. Conclusions: SO, assessed using BMI and GS or dGFR, was associated with elevated LS in patients with SLD. Full article

Practical training and recruitment strategies are critical for the sustainable implementation of psychosocial interventions. However, few studies have examined how to prepare community partners and doctoral students to support culturally adapted psycho-oncology interventions. This pre-pilot study aims first to evaluate two distinct training programs and recruitment procedures, and second to explore preliminary pre-post outcomes of the Caregiver-Patients Support to Cope with Advanced Cancer (CASA) intervention, using the Consolidated Framework for Implementation Research (CFIR). Three clinical psychology graduate students received CASA training, and two community partners completed Recruitment training. We present descriptive pre- and post-assessments, along with qualitative feedback, for both training and institutional (Puerto Rico Biobank) and community-based recruitment outcomes. A related-samples nonparametric analysis examined pre- and post-CASA intervention signals. Results indicated knowledge gains among doctoral students (pre-test M = 3.3; post-test M = 9.3) and community partners (pre-test M = 4.5; post-test M = 9.5). Preliminary outcomes revealed significant improvements in spiritual well-being (Z = −2.618, p = 0.009) and quality of life (Z = −2.957, p = 0.003) and a reduction in depressive (Z = −2.764, p = 0.006), anxiety (Z = −2.667, p = 0.008), and distress (Z = −2.195, p = 0.028) symptoms following CASA. Of 26 recruited dyads, institutional referrals enrolled 16 dyads (61.5%), while community partners referred 10 dyads with a 90.9% success rate. Findings support the feasibility of both training and CASA exploratory outcomes suggest meaningful psychosocial benefits for Latino dyads coping with advanced cancer. Combining institutional infrastructure with community engagement may enhance sustainability and equitable access to psycho-oncology care. Full article

As population aging accelerates, the mounting burden on informal family caregivers in areas lacking formal care systems threatens the sustainability of elder care. This study aims at evaluating how the rural living environment and external connectivity jointly alleviate caregiver burden and exploring whether regional accessibility serves as a substitute for local infrastructure deficits. Guided by Ecological Systems Theory, we analyzed a cross-sectional dataset of 327 matched caregiver-recipient dyads from rural China using multivariate regression and mediation models. Results indicate that a favorable local environment reduces burden both directly and indirectly through improved recipient health. Crucially, county-level accessibility moderates this relationship via a substitution effect, where the marginal relief from local environmental improvements is most potent in isolated areas but diminishes where external access is convenient. Dimension-specific analyses show that developmental and physical strains are particularly sensitive to these factors. We conclude that sustaining informal care requires a dual-pathway strategy: prioritizing local “soft” assets like community safety and cultural activities while enhancing regional connectivity to service hubs. Ultimately, this research provides empirical evidence and a theoretical framework for enhancing rural informal care sustainability through environmental optimization, thereby advancing Sustainable Development Goals regarding health, reduced inequalities, and sustainable communities. Full article

Background: The rapid ageing of the cardiovascular population has profoundly transformed clinical practice, with an increasing proportion of patients presenting advanced age, frailty, multimorbidity, and functional vulnerability. Conventional cardiology models, largely derived from younger and selected populations, often fail to adequately address the complexity of cardiovascular care in older adults. Despite the growing development of cardiogeriatrics, the core competencies required for contemporary geriatric cardiology practice remain insufficiently defined. Methods: This narrative review synthesises evidence from cardiology, geriatrics, heart failure, and the palliative care literature, complemented by clinical expertise in integrated cardiogeriatric care pathways, to identify key competencies relevant to the care of older adults with cardiovascular disease. Results: Four major domains of geriatric cardiology competencies were identified: (1) advanced cardiovascular expertise adapted to ageing physiology, frailty, and multimorbidity; (2) integration of comprehensive geriatric assessment into cardiovascular decision-making; (3) a dedicated cardiogeriatric communication mindset supporting shared decision-making under prognostic uncertainty; and (4) system-based competencies focused on multidisciplinary coordination, care transitions, and therapeutic proportionality. Conclusions: Defining the core competencies of the geriatric cardiologist is essential to addressing the clinical and organisational challenges of an ageing cardiovascular population. This framework provides a pragmatic foundation for clinical practice, education, and future research, supporting integrated cardiogeriatric care models aligned with patient-centred outcomes. Full article

Ants act as keystone species in terrestrial ecosystems, providing important ecosystem services. The large-scale production and application of GO constitute a predominant contributor to its inevitable environmental dispersion. Most GO toxicity studies have focused on plants, animals, and microorganisms, with limited research on ground-dwelling ants. In the study, we used Camponotus japonicus as a model to investigate the toxic effects of GO on ants by integrating physiological characteristics, gut microbiota and transcriptome profiling. Results showed that GO exposure induced mitochondrial dysfunction, as evidenced by mitochondrial ROS accumulation and elevated mitochondrial membrane permeability. Physiological assessments revealed that GO exposure induced oxidative stress. Specifically, GO treatment significantly suppressed superoxide dismutase (SOD) and catalase (CAT) activities, while enhancing peroxidase (POD) and carboxylesterase (CarE) activities and increasing the levels of malondialdehyde (MDA) and trehalose. Gut microbiota analyses showed that GO remarkably reduced the relative abundance of beneficial bacterial symbionts (e.g., Candidatus Blochmannia) and destabilized the whole community structure. Furthermore, transcriptome profiling revealed 680 differentially expressed genes (DEGs) in the ants after GO exposure, most of which were significantly enriched in pathways associated with oxidative phosphorylation. This study suggests that GO may compromise ant-mediated ecosystem function and provides a reference for understanding the environmental risks of GO. Our findings also offer new insights for protecting the ecosystem services of ants. Full article

Background/Objectives: Dementia represents a growing public health challenge. The WHO Global Action Plan on the Public Health Response to Dementia emphasizes early detection, risk reduction, and innovation as key priorities. Mild Behavioral Impairment (MBI), defined as the emergence of persistent neuropsychiatric symptoms in older individuals, represents a potential marker of early neurodegeneration and possible window for early intervention. This review explores the role of MBI in dementia prevention, mapping current evidence within the WHO Global Action Plan framework. Methods: A comprehensive search was performed in PubMed, Scopus, and the official WHO website, during 1 September 2025–10 November 2025, without time restrictions. Eligible sources included original clinical studies, reviews, and policy documents addressing MBI, dementia prevention, and public health. Data were thematically synthesized according to the seven objectives of WHO: (1) dementia as a public health priority, (2) dementia awareness and friendliness, (3) dementia risk reduction, (4) dementia diagnosis, treatment, care and support, (5) support for dementia carers, (6) information systems for dementia, and (7) dementia research and innovation. Results: Accumulating evidence indicates that MBI assessment can capture early behavioral manifestations of neurodegenerative and other forms of dementia, correlating with fluid, neuroimaging and genetic biomarkers. Integrating MBI screening through the easy-to-administer MBI Checklist (MBI-C) into clinical and community-based care, including telemedicine pathways and research, may enhance early identification and personalized interventions, enrich the pool for clinical trials, and facilitate research in biomarker and therapy. MBI-related research further supports its integration in remote digital monitoring and population-based prevention. Conclusions: Embedding MBI-informed screening and interventions into national dementia strategies aligns with WHO objectives for early, equitable and scalable prevention and brain health. Full article

Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct from coverage-only parity) and to summarize reported effects on telehealth utilization, modality mix, quality/adherence, equity/access, and expenditures. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science for U.S. studies that explicitly modeled state payment parity or stratified results by payment parity vs. coverage-only vs. no parity. We included original quantitative or qualitative studies with a time or geographic comparator and free full-text availability. The primary outcome was telehealth utilization (share or odds of telehealth use); secondary outcomes were modality mix, quality and adherence, equity and access, and spending. Because designs were heterogeneous (interrupted time series [ITS], difference-in-differences [DiD], regression, qualitative), we used structured narrative synthesis. Results: Nine studies met inclusion criteria. In community health centers (CHCs), payment parity was associated with higher telehealth use (42% of visits in parity states vs. 29% without; Δ = +13.0 percentage points; adjusted odds ratio 1.74, 95% CI 1.49–2.03). Among patients with newly diagnosed cancer, adjusted telehealth rates were 23.3% in coverage + payment parity states vs. 19.1% in states without parity, while cross-state practice limits reduced telehealth use (14.9% vs. 17.8%). At the health-system level, parity mandates were linked to a +2.5-percentage-point telemedicine share in 2023, with mental-health (29%) and substance use disorder (SUD) care (21%) showing the highest telemedicine shares. A Medicaid coverage policy bundle increased live-video use by 6.0 points and the proportion “always able to access needed care” by 11.1 points. For hypertension, payment parity improved medication adherence, whereas early emergency department and hospital adoption studies found null associations. Direct spending evidence from open-access sources remained sparse. Conclusions: Across ambulatory settings—especially behavioral health and chronic disease management—state payment parity laws are consistently associated with modest but meaningful increases in telehealth use and some improvements in adherence and perceived access. Effects vary by specialty and are attenuated where cross-state practice limits persist, and the impact of payment parity on overall spending remains understudied. Full article

Abdominal pain is the cardinal symptom of irritable bowel syndrome (IBS) and the primary determinant of disease burden and healthcare utilization. Despite its diagnostic centrality and high prevalence across all IBS subtypes, effective management remains a clinical challenge. This narrative review explores the pathophysiological mechanisms underlying IBS-related pain, emphasizing the role of visceral hypersensitivity, altered brain–gut communication, and luminal factors such as gas and distension. We examine current guideline recommendations, real-world treatment patterns, and evidence supporting both pharmacological and non-pharmacological interventions. Particular focus is placed on the fixed-dose combination of alverine citrate/simeticone, which targets both motor and sensory pathways. Mechanistic studies demonstrate its smooth muscle relaxant, antinociceptive, and anti-inflammatory actions. Clinical trials support its efficacy in reducing pain, improving quality of life, and lowering healthcare resource use. Despite these advances, several unmet needs remain, including subtype-specific treatment strategies, mechanistic biomarkers, and broader access to integrated care. The review concludes with a call for more personalized, mechanism-based approaches to pain management in IBS, with alverine citrate/simeticone offering a pragmatic option within this evolving therapeutic framework. Full article

Communication in mammals constitutes a complex, multimodal system that integrates visual, acoustic, tactile, and chemical signals whose functions extend beyond simple information transfer to include the regulation of social relationships, coordination of behaviour, and expression of emotional states. This article examines the fundamental mechanisms of communication from biological, neuroethological, and behavioural perspectives, with particular emphasis on domesticated and farmed species. Analysis of sensory signals demonstrates that their perception and interpretation are closely linked to the physiology of sensory organs as well as to social experience and environmental context. In companion animals such as dogs and cats, domestication has significantly modified communicative repertoires ranging from the development of specialised facial musculature in dogs to adaptive diversification of vocalisations in cats. The neurobiological foundations of communication, including the activity of the amygdala, limbic structures, and mirror-neuron systems, provide evidence for homologous mechanisms of emotion recognition across species. The article also highlights the role of communication in shaping social structures and the influence of husbandry conditions on the behaviour of farm animals. In intensive production environments, acoustic, visual, and chemical signals are often shaped or distorted by crowding, noise, and chronic stress, with direct consequences for welfare. Furthermore, the growing importance of multimodal technologies such as Precision Livestock Farming (PLF) and Animal–Computer Interaction (ACI) is discussed, particularly their role in enabling objective monitoring of emotional states and behaviour and supporting individualised care. Overall, the analysis underscores that communication forms the foundation of social functioning in mammals, and that understanding this complexity is essential for ethology, animal welfare, training practices, and the design of modern technologies facilitating human–animal interaction. Full article

Expanding longevity, together with a decrease in mortality, leads to an increase in the older population worldwide. In this review, ageing and older adults, as well as psychosocial and advanced technological interventions, will be discussed. Older adults are associated with an increased incidence of multimorbidity and disability; thus, they have a higher demand for health services than younger individuals. Challenges in welfare services and inadequate family and community-based care support negatively impact the psychosocial and economic wellbeing of older people. Active ageing and successful ageing are crucial aspects for a better quality of life in this age group, as there is a complex interplay of different domains and disease types that influence quality of life in older adults. Additionally, promoting the social participation of older adults is vital for improving their quality of life. Furthermore, the use of technology in older adults has a positive impact on their quality of life; however, aside from the promotion and implementation of technological interventions, challenges persist at all levels of acceptance and use. A better understanding of these challenges and implementing measures to overcome them will have a significant impact on the technological acceptance of older adults and their use in daily life activities, resulting in more favourable quality of life outcomes. Full article

Background: Language barriers remain a major obstacle to equitable healthcare access for immigrants and refugees across Europe. Greece, as both a transit and host country, faces persistent challenges in providing linguistically and culturally appropriate care. Methods: This study presents a narrative literature review synthesizing international, European, and Greek evidence on the effects of limited language proficiency, professional interpretation, and intercultural mediation on healthcare access, patient safety, satisfaction, and clinical outcomes. Peer-reviewed studies and selected grey literature were identified through searches of PubMed, Scopus, Web of Science, and CINAHL. Results: The evidence consistently demonstrates that the absence of professional interpretation is associated with substantially higher rates of clinically significant communication errors, longer hospital stays, increased readmissions, and higher healthcare costs. In contrast, the use of trained medical interpreters and intercultural mediators improves comprehension, shared decision-making, patient satisfaction, and clinical outcomes. Comparative European data from Italy, Spain, Germany, and Sweden show that institutionalized interpretation systems outperform Greece’s fragmented, NGO-dependent approach. Greek studies further reveal that limited proficiency in Greek is associated with reduced service utilization, longer waiting times, and lower patient satisfaction. Conclusions: This narrative review highlights the urgent need for Greece to adopt a coordinated, professionally staffed interpretation and intercultural mediation framework. Strengthening linguistic support within the healthcare system is essential for improving patient safety, equity, efficiency, and the integration of migrant and refugee populations. Full article

Amid escalating ecological degradation, social fragmentation, and rising mental health challenges—especially in rural and agricultural communities—there is an urgent need to reimagine systems that support both planetary and human flourishing. This viewpoint examines an emerging paradigm in agriculture that emphasizes the role of farmers’ inner development in fostering practices that enhance ecological health, community well-being, and a resilient food system. A key goal is to draw more academic attention to growing community calls for more holistic, relational, and spiritually grounded approaches to food systems as an important focus for ongoing research. Drawing on diverse case studies from Japan, India, and Europe, we examine how small-scale and natural farming initiatives are integrating inner development, universal human values, and ecological consciousness. These case studies were developed and/or refined through a program led by the Conscious Food Systems Alliance (CoFSA), an initiative of the United Nations Development Programme (UNDP) that seeks to integrate inner transformation with sustainable food systems change. The initiatives are intended as illustrative examples of how agriculture can transcend its conventional, anthropocentric role as a food production system to become a site for cultivating deeper self-awareness, spiritual connection, and regenerative relationships with nature. Participants in these cases reported significant shifts in mindset—from materialistic and extractive worldviews to more relational and value-driven orientations rooted in care, cooperation, and sustainability. Core practices such as mindfulness, experiential learning, and spiritual ecology helped reframe farming as a holistic process that nurtures both land and life. These exploratory case studies suggest that when farmers are supported in aligning with inner values and natural systems, they become empowered as agents of systemic change. By linking personal growth with planetary stewardship, these models offer pathways toward more integrated, life-affirming approaches to agriculture and future academic research. Full article

Vaccination remains a cornerstone of infection prevention in adult solid organ transplant (SOT) recipients, a population at heightened risk for vaccine-preventable diseases due to chronic immunosuppression and comorbidities. Updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice (AST IDCOP) and other international bodies emphasize the need for timely and comprehensive vaccination strategies before and after transplantation. This review synthesizes current literature and practice guidelines on vaccination in adult solid organ transplant (SOT) candidates and recipients. Published peer-reviewed studies, clinical trials, and consensus guidelines were evaluated, with emphasis on vaccination timing, safety, immunogenicity, dosing strategies, and serologic response monitoring in the SOT population. Comprehensive vaccination planning before transplantation, combined with appropriate post-transplant booster strategies, remains vital to improving long-term outcomes in SOT recipients. This review provides clinicians with an updated, evidence-based framework for integrating evolving vaccination guidelines into the care of adult transplant patients. Full article

This theoretical opinion article critiques person-centered dementia care (PCDC) for overlooking the structural dimensions of Othering and stigma. In response to these limitations, we propose three key conceptual shifts essential to overcoming Othering and stigma experienced by people with dementia. First, although PCDC emphasizes individual agency, it is constrained by institutional priorities and professional perspectives, which can unintentionally reinforce structural inequalities. Centering the lived experiences of people with dementia as essential knowledge can rebalance power and validate their expertise. Second, reducing stigma means moving beyond PCDC’s individualized focus to recognize the social conditions that perpetuate Othering. This requires inclusive interactions and professional reflection that challenge biomedical assumptions. Third, PCDC is often limited to formal care settings, neglecting how people with dementia maintain social roles and a sense of community belonging. Addressing stigma, therefore, requires extending support into everyday life through contextual, strengths-based approaches that sustain social roles. Full article