Search Results (792)

Residential radon is an invisible radioactive gas produced during the uranium-238 decay series and is an established cause of lung cancer. In Canada, recent national surveillance suggests that about one in five residential buildings may exceed the national radon guidelines, yet household testing remains uncommon. This narrative clinical review translates international and Canadian evidence into practical primary-care and hospital-to-community actions. Evidence was prioritized from carcinogen classifications, World Health Organization guidance, pooled residential case–control analyses, Canadian surveillance and guidance, and the peer-reviewed literature on mechanisms, histology, and risk communication. Radon-222 can enter buildings from soil gas; its short-lived progeny deposits in the respiratory tract and emits high-linear-energy-transfer alpha particles that can damage bronchial epithelial DNA. Because elevated levels cannot be reliably predicted from symptoms, smoking status, house age, or community maps, clinicians should use a simple workflow: ask about prior testing and lower-level occupancy; test with a long-term, approved device in the lowest occupied level; act by interpreting the result, advising mitigation, and directing patients to certified radon professionals when needed; document the exposure assessment, result, advice, referral, and retesting plan; and follow up after mitigation or major building changes. This review clarifies Canadian residential and workplace guidance, contrasts global reference-level approaches, and distinguishes radon prevention from lung cancer screening. No individual patient information or human-subject data are reported. Full article

In August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a Public Health Emergency of Continental Security (PHECS), and the World Health Organization (WHO) followed with a second Public Health Emergency of International Concern (PHEIC), in response to the rapid expansion of clade Ib monkeypox virus (MPXV) across eastern Democratic Republic of the Congo (DRC) and neighboring countries. Both declarations have since been lifted (September 2025 and January 2026), yet clade Ib transmission and severe outcomes in pregnant women and children persist. We argue that closing these emergency mechanisms marks not the end of the epidemic but the start of a harder phase: sustaining surveillance, care, and research amid shrinking donor support, including the dissolution of the United States Agency for International Development (USAID). We contend that integrating mpox into existing HIV, sexually transmitted infection (STI), and reproductive health platforms is the most realistic route to durable routine care, while pregnancy, paediatric disease, severe cases, and zoonotic spillover still need dedicated pathways. Sustainable management ultimately depends on domesticated financing, stronger institutions, genuine community engagement, and action on the ecological drivers of spillover. Full article

Background: Individuals with intellectual and/or developmental disabilities (IDDs) experience persistent health inequities, exacerbated by the systemic lack of education of health care professionals about their care. In response to a 2020 call from the Administration for Community Living in the United States, five institutions formed the IDD Health Equity Consortium to develop a suite of educational materials and practice experiences to improve the education of health care professionals in the health and health care of individuals with IDDs. Methods: The Collective Impact Model, designed to align organizations and stakeholders around a shared agenda for system change, was used to organize IDD Health Equity Consortium programs. Backbone infrastructure included a cross-sector steering committee, an Advocate Advisory Committee, and three Consortium Action Networks focused on communication, measurement, and education, practice, and policy. A scoping review of the literature was conducted, and a Participatory Planning and Decision-Making process engaged individuals with IDDs, family members, students, faculty, and professionals in identifying important themes for developed materials. Results: Learning modules, case studies, service-learning experiences, and simulation experiences were developed across Consortium institutions and were disseminated across multiple other institutions, with beginning alignment with interprofessional and disability competencies. Mixed-methods evaluation strategies assessed learner outcomes, including knowledge checks and pre and post evaluations using established measures of skills, comfort levels, and approach; and interprofessional socialization, valuing, and collaborative practice behaviors. Conclusions: By involving individuals with IDDs in curriculum development and building multi-institution and cross-sector infrastructure, the Consortium developed scalable materials that address longstanding gaps in health care professional education. The developed suite of educational materials and practice experiences and early evaluation findings provided a foundation for further program refinement and future empirical studies examining long-term effects on practice and clinical outcomes. Full article

This community-engaged qualitative study co-defined digital health and artificial intelligence (AI) priorities with First Nations communities in Manitoba, Canada, including those with disabilities. Grounded in Indigenous research methodologies and community-based participatory research, the project responded to persistent inequities in rehabilitation and health service access shaped by geography, colonial legacies, and jurisdictional fragmentation. These inequities are especially important in the context of aging, as older adults and Elders may experience compounded barriers related to disability, chronic conditions, mobility limitations, and digital exclusion. Over approximately 12 months, an interdisciplinary team consisting of First Nations scholars and partners, disability organizations, clinicians, and researchers conducted relationship-building visits and meetings with First Nations leadership, Elders/Knowledge Keepers, health providers, and community members to inform the design of a Gathering focused on disability, digital health, and AI. A one-day community-engaged Gathering was held on Treaty 1 and 2 Territory in Winnipeg and convened approximately 70 participants from multiple First Nations communities and disability/health organizations. Five facilitated roundtables explored: (1) health and research priorities for First Nations persons with disabilities; (2) primary care and disabilities; (3) digital access and cultural safety; (4) culturally safe and ethical AI use; and (5) health system challenges, disability, and digital health. Data consisted of facilitator-produced, de-identified table summaries, facilitator reflection forms, and participant-validated plenary notes; no recordings or individual sociodemographic data were collected. Using qualitative description and team-based content analysis, three interrelated domains emerged: (1) relationships, identity, trust, and cultural safety; (2) system, infrastructure, and equity conditions required for accessible care and digital inclusion (e.g., connectivity “dead zones,” device access, transport, and culturally safe services); and (3) opportunities, risks, and governance principles for AI and data use (e.g., AI literacy, privacy, bias, Indigenous data sovereignty, and Nation-specific governance). Findings emphasize that equitable digital health and AI must be relational, disability-informed, culturally safe, and led under First Nations authority, with AI positioned to support, rather than replace, human care relationships. The findings also highlight the importance of designing digital health and AI initiatives that remain accessible and trustworthy for older adults and Elders, particularly where aging, disability, and rural or remote living intersect. Full article

Background/Objectives: The purpose of this nursing-led quality-improvement initiative was to strengthen organizational culture, support staff well-being, and improve patient safety by implementing an evidence-based collaboration model that redefined registered nurse (RN) and unlicensed assistive personnel (UAP) teamwork in acute care settings. Methods: Guided by transformational leadership principles, Nursing Professional Development (NPD) practitioners, nurse directors and managers, and frontline staff collaboratively redesigned communication and workflows. After piloting the process change, expansion occurred across acute care and step-down units through leader-supported team training alongside ongoing rounding, observations, and feedback cycles. The four phases of the EPIS framework of implementation science were used to implement the initiative, and data were collected via direct observation, anonymous staff surveys, and organizational retention and quality reports. Results: Across the seven units in Cluster 1 of the expansion, 335 RNs and 180 UAPs participated. Standardized communication using a structured handover tool increased from 18% to 95% with corresponding improvements in discussions of quality-related measures such as fall risk, turn schedules, and toileting. Patient safety measures exceeded threshold goals for fiscal year (FY) 2026 across falls with harm, pressure injuries, and catheter-associated urinary tract infections (CAUTI). RN and UAP retention demonstrated overall improvement, with RNs exceeding their retention goal and UAPs exceeding their goal by removing a single outlier unit. Perceptions of overall team communication throughout the shift increased for both RNs and UAPs. Conclusions: This initiative exemplifies how uniting transformational leadership with frontline staff empowerment supports inclusion, improved quality measures, and strengthened workforce resilience. This scalable framework for nurse-led transformation fosters belonging, safety, and shared outcomes across organizations. Full article

Tuberculosis (TB) remains a leading cause of infectious disease-related mortality worldwide despite major advances in diagnostics, treatment, and programmatic control. Achieving the goals of the World Health Organization End TB Strategy requires a greater emphasis on prevention alongside improvements in diagnosis and treatment. This viewpoint examines evolving priorities in TB prevention and highlights key insights from studies included in the Special Issue ‘New Perspectives in Tuberculosis Prevention and Control’. The articles published in the Special Issue highlight the importance of identifying populations at increased risk of infection, disease transmission, and disease progression; strengthening the implementation of tuberculosis preventive treatment among household contacts and people living with HIV; and addressing the behavioral, social, and structural determinants that influence access to TB prevention and care. They also demonstrate persistent challenges related to medicine availability, healthcare worker capacity, patient initiation and follow-up, program monitoring, and the implementation of preventive interventions in resource-constrained settings. Emerging developments in diagnostics, biomarkers, vaccines, and digital health may contribute to the longer-term TB prevention agenda but require further evaluation of their feasibility, affordability, and programmatic relevance. Collectively, the evidence indicates that effective TB prevention extends beyond individual biomedical interventions and requires coordinated approaches involving healthcare systems, communities, surveillance systems, and social support mechanisms. Continued investment in implementation research, health-system strengthening, program management, economic evaluation, and multisectoral action will be critical to translate existing evidence into sustainable, equitable, and context-specific strategies for reducing the global burden of TB. Full article

Background and Objectives: Despite substantial advances in surgical techniques, anesthesia, and perioperative care, postoperative complications remain a major source of morbidity, mortality, prolonged hospitalization, and healthcare utilization following adult cardiac surgery (CS). Increasing evidence suggests that many of these complications are influenced by modifiable perioperative factors that can be addressed through multidisciplinary care. Materials and Methods: A narrative review was conducted to synthesize current evidence regarding perioperative practices associated with the prevention of postoperative complications in adult CS. A comprehensive literature search of PubMed/MEDLINE, Scopus, and Web of Science identified studies published between January 2015 and April 2026, supplemented by landmark studies and relevant clinical guidelines. Results: The identified evidence was organized into four major domains: infection prevention practices, physiological optimization strategies, protocol adherence and patient safety measures, and organizational and human factors. The strongest evidence supports timely antimicrobial prophylaxis, standardized infection prevention bundles, perioperative glycemic control, maintenance of normothermia, and patient blood management as key interventions associated with improved postoperative outcomes. Surgical safety checklists, standardized perioperative pathways, and adherence to evidence-based protocols further contributed to improved patient safety and consistency of care. Emerging evidence also highlighted the importance of communication, teamwork, safety culture, workload management, and healthcare professionals’ knowledge in facilitating successful implementation of perioperative interventions. Conclusions: Prevention of postoperative complications following CS requires a multidisciplinary, systems-based approach integrating evidence-based clinical interventions with standardized perioperative protocols and effective organizational practices that facilitate consistent implementation of evidence-based perioperative care. Future research should focus on prospective evaluation of integrated perioperative strategies, development of practical risk-stratification models, and further investigation of organizational determinants influencing implementation and postoperative outcomes. Full article

Background/Objective: The Behavioral and Mental Wellness in Indigenous Communities (BMWIC) education program was created to address mental health (MH) resource gaps in the Fort Belknap Community (FBC). Designed to enhance MH literacy, task-shifting capacity, and MH care coordination skills, the FBC partnered with Johns Hopkins School of Nursing (JHSON) to co-develop a culturally aligned MH training program. This protocol outlines the development of the BMWIC curriculum. Methods: Steps 1–5 of the 6-step Collaborative Participatory Adaptation Model (CPAM) guided the development of the BMWIC, including collaboration, review of evidence-based models, cultural adaptation of materials, and the creation of a robust evaluation plan to be conducted. Four courses were ultimately developed on: historical trauma, culturally informed MH screening and care, risk and protective factors and health-related Tribal, state and federal legal jurisdiction in American Indian and Alaska Native (AI/AN) communities. Discussion: The BMWIC development process serves as a prime example of translating community priorities into an educational intervention through a combination of best practices in health science education with Indigenous ways of knowing (IWK). Targeted training and task shifting, such as through the BMWIC, may have the potential to expand MH-related knowledge and strengthen the capacity of community health systems to identify psychological and behavioral concerns early, coordinate care more effectively, and improve access to MH care and resources at the community level. Conclusions: This protocol may be useful for academic-community partnerships creating culturally informed educational programs across disciplines and specialties in service to Indigenous communities. The next steps will involve piloting and evaluating the curriculum and collaborating with healthcare organizations to determine sustainable pathways for scaling the BMWIC where it is most needed. Full article

Hospitals are complex institutions where clinical, social, and cultural practices intersect. In Ghanaian hospitals, interactions are shaped by multilingual communication, professional hierarchies, cultural norms, and community expectations. Drawing on five months of ethnographic fieldwork, this study examines coordination of care in a Ghanaian hospital to understand how boundaries (i.e., professional hierarchies, communication barriers, community accountabilities), ruling relations, and power dynamics influence care. Institutional ethnography (IE) was implemented. Participants were purposively sampled, and data were collected through participant observation, documentary materials, and interviews with nurses (n = 11), patients (n = 21), and caregivers (n = 11). Thematic and IE analyses trace how boundaries and professional hierarchies, informal economies, and multilayered surveillance (“medical,” “social,” and “community” gazes) organize care work through institutional texts and how nurses, patients, and caregivers access or deliver care. The findings showed that boundaries at the Yendi Hospital were simultaneously rigid and negotiable, with informal economic activities compensating for institutional resource constraints. Communication work was central to navigating linguistic and cultural diversity, while surveillance from within and beyond the hospital-shaped behaviour and accountability. These everyday practices revealed how institutional texts and societal forces co-produce the conditions of care, with implications for teamwork, patient–provider relationships, and hospital governance. Full article

On behalf of the Canadian Association of Psychosocial Oncology, we are pleased to present the abstracts from the 2026 Annual Conference, titled “A New Horizon: Expanding the Access and Impact of Psychosocial Oncology”. The 41st Annual CAPO Conference was held in St. John’s, Newfoundland from 8 June 2026 to 9 June 2026. As we stand at a new horizon in psychosocial oncology, we recognize the unprecedented opportunities to expand both the access to and the impact of comprehensive cancer care. This conference will explore innovative strategies for breaking down traditional barriers that have historically limited access to psychosocial support, including geographic isolation, resource constraints, cultural disparities, and systemic inequities in healthcare delivery. This expansion of reach and influence represents not merely growth in service numbers, but a fundamental transformation in how we conceptualize, design, and implement patient-centered psychosocial care across diverse communities and care settings. We will explore scalable solutions that amplify impact while maintaining the deeply personal, human-centered approach that defines excellence in psychosocial oncology. From telehealth innovations and peer support networks to community-based interventions and integrated care models, this conference will showcase evidence-based strategies that expand our collective ability to support individuals and families navigating the cancer journey, wherever they may be. This conference brought together key stakeholders including multidisciplinary professionals from nursing, psychology, psychiatry, social work, spiritual care, nutrition, medicine, rehabilitation medicine, occupational health and radiation therapy for both adult and pediatric populations. Participants included clinicians, researchers, educators in cancer care, community-based organizations and patient representatives. Patients, caregivers and family members presented abstracts that speak to their role in managing cancer experiences and care. Over one-hundred and fifty (150) abstracts were submitted for presentation as symposia, 20 min oral presentations, 10 min oral presentations, 90 min workshops and poster presentations. We congratulate all the presenters on their research work and contributions. Full article

Intimate partner violence is a public health and human rights issue that must be addressed and measured to inform care and prevention efforts. The Violence Scale (EV) is used to assess different types of violence; however, there is no evidence of its validity and reliability in Colombia, nor are there specific studies on men. Objective: To evaluate the metric properties of the Partner Violence Scale (EV, by its Spanish acronym) in men within the Colombian community context. Methodology: Content validation was carried out with expert judges and victims of partner violence. Subsequently, the EV was tested on a sample of 1293 Colombian men who had not reported/denounced partner violence. Confirmatory factor analyses were performed using rival models to evaluate the best-fitting factor structure, along with mean variance extracted analysis as an indicator of convergent validity and reliability analysis. Results: Every tested structure for organizing intimate partner violence showed adequate fit indicators (CFI > 0.95; TLI > 0.95). However, the lowest level of error was evident in the five-factor structure (psychological, physical, severe physical, economic, and sexual violence; RMSEA = 0.009; SRMR = 0.080). All items were loaded by the factor to which they belong, and all loadings were significant (p < 0.005). The extracted mean variances exceeded 40%, and there were high reliability indicators for the total test (>0.94) and for each factor (>0.70). Conclusion: The Violence Scale(EV) provides adequate evidence of validity and reliability to be used as a tool for assessing violent behaviors experienced by Colombian men. Its use is recommended as an instrument for highlighting violence that has been normalized due to the socio-cultural barriers that men face. Full article

Background/Objectives: Community psychiatric care aims to support recovery, autonomy, and lower reliance on inpatient services, but co-occurring substance use may reduce these gains. This study examined associations between psychiatric care pathway, non-tobacco substance-use severity, recovery-related patient-reported outcomes, clinical instability, and direct mental health cost in adults with severe mental illness in Romania. Methods: This cross-sectional observational study included 128 adults receiving psychiatric hospital care, long-term residential care, or protected community housing within one regional psychiatric care network. Participants had at least 12 months of uninterrupted care in their current setting. Substance use was assessed with the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), excluding tobacco from the analytic severity score. Outcomes included SF-36 physical and mental scores, brief service-experience ratings of autonomy and perceived coercion, emergency department visits, relapse, readmission, inpatient days, outpatient visits, and annual direct mental health cost. Results: Any non-tobacco substance use was most common in hospital care, intermediate in residential care, and least common in community housing. Mental quality of life was lowest among hospital participants with substance use and highest among community participants without substance use. In multivariable models, ASSIST-derived severity was independently associated with a lower SF-36 mental score and a higher direct cost, while autonomy was independently associated with better mental quality of life and lower direct cost. The cost outcome was modeled primarily with a gamma generalized linear model with a log link because costs were positive and right-skewed. Because pathway allocation was clinically determined rather than randomized, and because autonomy, perceived coercion, and mental quality of life were all self-reported at a single assessment, every multivariable and path estimate is exploratory. Conclusions: Community psychiatric pathways were associated with more favorable recovery indicators, but non-tobacco substance use remained an important marker of poorer outcomes and greater service burden. The findings support addiction-sensitive community psychiatric care and routine monitoring of autonomy and perceived coercion as service-quality indicators. Because the design was cross-sectional and the care pathways were non-equivalent at baseline, these results are hypothesis-generating and do not establish that care pathway, substance use, or autonomy exerts a causal effect on any outcome measured. Full article

The COVID-19 pandemic accelerated the use of telemedicine and revealed persistent barriers in rural primary healthcare, especially among older adults and caregivers. This study proposes an LLM-mediated smart tele-primary-care framework to support respiratory infection monitoring in underserved communities of Córdoba, Colombia. The framework is based on caregiver-centered teleconsultation, remote monitoring, preventive education, structured symptom reporting, risk-based teletriage, and clinician-supervised digital support. The LLM functions as a controlled conversational interface to collect symptoms, organize patient information, reinforce health education, generate follow-up reminders, and identify predefined warning signs, without replacing clinical judgment or making autonomous diagnostic or treatment decisions. A preliminary scenario-based assessment examined whether the proposed workflow supports coherent triage and appropriate escalation of high-risk cases. Importantly, the described architecture—a telematic system for intelligent-engine access in assisted medicine support (ATIMAMS)—has been implemented and is currently operational at the Systems Engineering Program, Universidad del Sinú (Montería, Colombia), providing intelligent decision support for telemedicine consultations and remote assistance appointments in the study region. Overall, the study presents a context-sensitive, low-barrier, and safety-aware model for strengthening rural primary care, improving continuity of care, and supporting caregiver-mediated respiratory infection monitoring. Full article

Background/Objectives: Routine depression screening is recommended in primary care, yet depression may remain underdetected among Filipino American patients. Provider-level factors, including culturally responsive preparation, communication challenges, workflow constraints, and attitudes toward mental health screening, may influence opportunities for early identification and referral. This exploratory cross-sectional study examined provider perspectives on barriers to depression screening and mental health discussions with Filipino American patients using the Capability, Opportunity, Motivation, and Behavior (COM-B) framework as an implementation-informed organizing lens. Methods: A cross-sectional survey was conducted among healthcare providers (N = 81) with experience caring for Filipino American patients in the United States. Survey items assessed provider confidence, perceived adequacy of mental health training, cultural and communication barriers, perceived stigma-related concerns, comfort discussing mental health, and interest in additional culturally responsive resources. Items from the adapted Attitudes Toward Assisting Filipino American Patients with Mental Health Symptoms (ATFA) scale and one item from the Mental Illness Clinicians’ Attitudes scale were conceptually mapped to the COM-B domains. Descriptive statistics, internal consistency estimates, and nonparametric tests were used to summarize findings and explore differences by provider characteristics. Results: Most providers recognized that Filipino cultural beliefs and customs may influence mental health help-seeking and symptom expression. Although many providers reported confidence identifying mental health symptoms, fewer reported adequate training to assess mental health concerns among Filipino American patients. Communication barriers, stigma-related concerns, and interest in additional culturally tailored resources were commonly reported. COM-B domain scores were not significantly associated with provider role or years of clinical experience. Providers who identified as Filipino reported greater perceived capability and opportunity related to initiating mental health discussions compared with non-Filipino providers. Conclusions: Findings suggest that provider motivation to address mental health concerns may be present, while capability- and opportunity-related barriers, including culturally responsive training, communication support, workflow integration, and referral resources, may remain important targets for future implementation efforts. Because this exploratory study used a modest convenience sample and an adapted measure that requires further psychometric validation, the findings should be interpreted with caution. Larger studies using validated instruments are needed to examine further provider-level determinants of culturally responsive depression screening among Filipino American patients. Full article

The United States has one of the world’s largest criminal justice systems, with nearly 5.5 million people under correctional supervision and almost 2 million incarcerated. This scale of confinement, coupled with the rise of privatization across correctional and related services, reflects a broader neoliberal trend in public governance. This paper explores the consequences of privatization and marketization of the U.S. criminal justice system—particularly the proliferation of private prisons and immigrant detention centers—and draws parallels to the consequences of privatization of health and social care, especially long-term care (LTC). Both systems reveal shared logics of marketization that prioritize profit maximization, efficiency, and cost-cutting at the expense of care, justice, and equity. Relying on interdisciplinary perspectives from public health and criminology, this paper situates private corrections within the health policy framework of the Commercial Determinants of Health (CDoH), arguing that privatized carceral institutions not only harm incarcerated individuals but also endanger workers, families, and surrounding communities through systemic under-resourcing, precarious labor conditions, and structural violence. By comparing the private, for-profit prison industry with private for-profit LTC systems, we illustrate how these structures have commodified both care and correctional systems. These findings suggest that privatization within carceral and care sectors perpetuates health inequities and reinforces cycles of racial, gendered, and economic disadvantage. Accordingly, this paper calls for strengthening publicly held models and a reassertion of public accountability and interdisciplinary collaboration to restore social justice, health, and human dignity as central organizing principles of both systems for residents, workers, their families, and communities. Full article