Search Results (236)

Digital mental health resources have expanded rapidly in the wake of the COVID-19 pandemic, offering new opportunities to improve access to mental healthcare through technologies such as AI chatbots, mobile apps, and online platforms. Despite this growth, significant challenges persist, including low user retention, limited digital literacy, unclear privacy regulations, and insufficient evidence of clinical effectiveness and safety. AI chatbots, which act as virtual therapists or companions, provide counseling and personalized support, but raise concerns about user dependence, emotional outcomes, privacy, ethical risks, and bias. User experiences are mixed: while some report enhanced social health and reduced loneliness, others question the safety, crisis response, and overall reliability of these tools, particularly in unregulated settings. Vulnerable and underserved populations may face heightened risks, highlighting the need for engagement with individuals with lived experience to define safe and supportive interactions. This review critically examines the empirical and grey literature on AI chatbot use in mental healthcare, evaluating their benefits and limitations in terms of access, user engagement, risk management, and clinical integration. Key findings indicate that AI chatbots can complement traditional care and bridge service gaps. However, current evidence is constrained by short-term studies and a lack of diverse, long-term outcome data. The review underscores the importance of transparent operations, ethical governance, and hybrid care models combining technological and human oversight. Recommendations include stakeholder-driven deployment approaches, rigorous evaluation standards, and ongoing real-world validation to ensure equitable, safe, and effective use of AI chatbots in mental healthcare. Full article

The integration of sustainable development into biology education has been a growing area of interest. Biology education for sustainability is considered through competencies and skills, taking different dimensions of knowledge into account. Solving problems requires not only knowledge but also communicative and strategic activity. Thus, biology education must emphasize the main visions of scientific literacy proposed in the literature, supporting students to understand society and everyday socioscientific challenges at the local as well as at the global level, and to deal with differing scientific results and uncertain information. However, there are very few studies from a holistic didactic viewpoint on the implementation of sustainable education (SE) in biology education in the context of teacher education and school education for promoting a sustainable future. This study addresses this gap via a bibliometric and content analysis of the literature (n = 165 and 131, respectively) based on the categories of the sustainable development goals (SDGs), subject aims, learning objectives, content knowledge, teaching methods, competencies and skills, and assessment methods. The literature analyzed emphasizes the environmental and social SDGs, the development of students’ factual and conceptual knowledge and learning, interactive teaching and learning methods, critical thinking and reflection, and summative and formative assessment methods. There is much less attention on economic and institutional SDGs, scientific skills, environmental attitudes, knowledge creation, strategic thinking and empathy, and diagnostic assessment methods. Compared to earlier studies performed in the 2010s, teaching and learning methods have become more diverse in contrast to the earlier focus on teacher-centered methods. Overall, the conclusion is that biology education must evolve beyond content mastery to integrate ethical, technological, and transdisciplinary dimensions—empowering learners not only to understand life but to sustain it—aligned with quality education (SDG 4), good health and well-being (SDG 3), and life on land (SDG 15). The findings also suggest that powerful knowledge needs to be emphasized for providing essential insights into ecosystems, biodiversity, and the processes that sustain life on Earth. They also highlight the importance of regular evaluations of teaching and learning for detecting how pedagogical and didactic approaches and strategies have supported students’ learning focused on sustainable development. Full article

Background/Objectives: Even with solid proof of its benefits for cardiovascular health and metabolism, adherence to the Mediterranean Diet (MD) in Spain has noticeably declined in recent years. The socioeconomic changes occurring in recent decades have prompted shifts in cooking habits and in how food is socially experienced, particularly among children and adolescents. The MD is more than just food: it is a cultural tradition and a lifestyle, rich in food and cooking skills, and food wisdom passed down over generations. When these practices fade, it affects both health and the environment, making them vital components in strengthening support for food knowledge, cooking abilities, and a healthier lifestyle. Considering these shifting dietary patterns and the growing need for targeted educational strategies, the present study aimed to investigate the association between cooking skills, MD-related health literacy, and adherence to the Mediterranean Diet across different developmental stages: childhood, adolescence, and adulthood in a sample of the Spanish population. Additionally, a secondary objective was to identify potential critical windows for intervention based on the strength of these associations. Methods: This cross-sectional study included 832 Spanish participants grouped by age: children and early adolescents (n = 408), older adolescents (n = 136), and adults (n = 288). Cooking skills were assessed using CooC11 for children and FCSk for older groups. Adults also completed Lit_MEDiet to assess MD-related health literacy. Adherence was measured with KIDMED (children/adolescents) and MEDAS (adults). Spearman correlations and standardized linear regressions were used. All statistical tests were two-sided, and statistical significance was set at p < 0.05. Results: In children, no significant association was found between cooking skills (CooC11) and KIDMED scores (β = 0.008; p = 0.875). Among adolescents, a strong positive association emerged between FCSk and KIDMED (β = 0.313; p < 0.001; ρ = 0.371), indicating a large, standardized effect and suggesting that this stage is particularly sensitive to food skills. In adults (18+), both food and cooking skills (FCSk) (β = 0.189; p = 0.001) and MD-related health literacy (Lit_MEDiet) (β = 0.187; p = 0.004) were moderately associated with MEDAS scores. Conclusions: These findings suggest that mid-adolescence could represent a favourable developmental window where food skills may hold potential to influence positive dietary behaviours. Regarding adults, the results indicate that combining practical and educational components appears to beneficial for dietary quality. Overall, this study supports the relevance of age-tailored public health strategies to potentially enhance long-term adherence to the Mediterranean Diet. Full article

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid a rapid socioeconomic transition, offers a critical setting to examine how advancements in women’s empowerment over the past decade have influenced child immunization completion within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved significantly, marked by higher literacy rates, nearly half of women completing primary education, and expanded digital access, with 82.4% owning mobile phones and approximately 50% using the internet daily. While non-working women slightly increased, agricultural employment declined by 20%, and cash earnings rose from 48.7% to 82.5%. Most women participated in major household decision-making, either independently or jointly. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Women in agricultural work were less likely to complete measles vaccination for their children than non-working women. Joint decision-making regarding the use of respondents’ income was associated with a higher likelihood of measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making about respondents’ health care was associated with a higher likelihood of measles completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women’s empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern observed for measles suggests that vaccines scheduled for older ages encounter greater structural and behavioral barriers. To overcome these challenges, strategies should focus on enhancing defaulter tracking, implementing reminder systems, expanding outreach and catch-up programs, and improving the convenience of vaccination services. Full article

The integration of artificial intelligence (AI) tools, such as the chat generative pre-trained transformer (ChatGPT), into health professions education is rapidly accelerating, creating new opportunities for personalized learning and clinical preparation. These tools have demonstrated the potential to enhance learning efficiency and critical thinking. However, concerns regarding reliability, academic integrity, and potential overreliance highlight the need to better understand how healthcare students adopt and perceive these technologies in order to guide their effective and responsible integration into educational frameworks. This nationwide, cross-sectional, survey-based study was conducted between February and April 2024 among undergraduate students enrolled in medical, pharmacy, nursing, dental, and allied health programs in Saudi Arabia. An online questionnaire collected data on ChatGPT usage patterns, satisfaction, perceived benefits and risks, and attitudes toward integrating them into the curricula. Among 1044 participants, the prevalence of ChatGPT use was 69.25% (n = 723). Students primarily utilized the tool for content summarization, assignment preparation, and exam-related study. Key motivators included time efficiency and convenience, with improved learning efficiency and reduced study stress identified as major benefits. Conversely, major challenges included subscription costs and difficulties in formulating effective prompts. Furthermore, concerns regarding overreliance and academic misconduct were frequently reported. In conclusion, the adoption of generative AI tools such as ChatGPT among healthcare students in Saudi Arabia was high, driven by its perceived ability to enhance learning efficiency and personalization. To maximize its benefits and minimize risks, institutions should establish clear policies, provide faculty oversight, and integrate AI literacy into the education of health professionals. Full article

Second language acquisition (SLA) is critical for refugee integration and a determinant of health and health care access. Although numerous studies have examined language barriers and health communication, the reciprocal relationship between health and second language acquisition remains underexplored in public health research. This qualitative study draws on interviews with twenty Syrian refugees (nine men and eleven women, aged 22–65) resettled in Norway. Data were collected through semi-structured interviews and analysed using reflexive thematic analysis. Two overarching themes were identified: (1) Learning under strain: health problems and post-migratory stressors constrained SLA; and (2) Relational support: reciprocal interactions with neighbours, colleagues, and volunteers enabled both language learning and functional health. These social arenas acted as low-threshold, health-promoting settings that mitigated isolation and strengthened belonging. The study highlights that language operates as a social determinant of health: inclusive, relational spaces facilitate both SLA and health by enhancing communicative participation and access to care. Refugee integration policy should therefore support accessible community spaces outside formal education to strengthen social inclusion, health literacy and refugees’ ability to navigate health and welfare services. Full article

This study empirically analyzed changes in the representation of older adults in Korean digital media from 2020 to 2024. As Korea enters a super-aged society, social perceptions of aging and older adults are rapidly evolving through digital platforms. This study aimed to identify how public discourse about older adults has shifted in emotional tone and thematic structure within online media environments. Approximately 200,000 text data points were collected from news and YouTube comments containing keywords related to older adults. Text mining techniques—including Latent Dirichlet Allocation (LDA) topic modeling, sentiment analysis, and time-series analysis—were applied to examine annual trends and emotional transitions. The findings revealed a clear shift in thematic emphasis from “health,” “care,” and “vulnerability” toward “participation,” “self-management,” and “digital activity.” Negative sentiments decreased (from 58.3% in 2020 to 37.8% in 2024), while positive sentiments increased (from 22.5% to 42.7%). These results indicate that the image of older adults in digital discourse has transformed from that of passive care recipients to active and independent participants in society. The study supports the ongoing policy debate in Korea on redefining the age threshold for “older adults” from 65 to 70 years, emphasizing capability over chronological age. Digital media play a critical role in shaping these changing perceptions, highlighting the need for intergenerational media literacy education and policy interventions that promote inclusive and age-positive communication. Full article

Background/Objectives: Within public health and preventive nutrition, food labeling plays a critical role in supporting healthier dietary behaviors. This study aimed to evaluate the behaviors, perceptions, and nutritional literacy of young adults from Iași, Romania, regarding simple carbohydrates (SCHO) consumption and food label-reading habits. Materials and Methods: A cross-sectional survey was conducted between May–June 2023 using 20-item Likert-scale questionnaire completed by 150 participants aged 18–30 years. Statistical analysis included descriptive metrics, Chi-square tests, and Pearson’s correlation, with significance set at p ≤ 0.05. Results: The cohort consisted of 72% females (N = 108) and 28% males (N = 42), with 42.7% (N = 64) holding university degrees. Although 22% (N = 33) considered SCHO consumption highly important, only 13.3% (N = 20) frequently read nutrition labels (p ≤ 0.05). Dietary patterns showed that 27.3% primarily consumed sweets, while others combined sweets with carbonated beverages, dairy products, or whole grains; overall, 44% (N = 66) reported frequent sweet consumption. Label reading was highest for sweets (40.7%), lower for dairy products (19.3%) and soft drinks (9.3%). Additionally, 30.7% (N = 46) checked only expiration dates, whereas just 11.3% (N = 17) reviewed nutritional content. Trust in label accuracy was low: 48% (N = 72) expressed neutrality and 14% (N = 21) disagreed. Although 77.3% (N = 116) recognized the link between sugar intake and dental caries, only 23.3% (N = 35) felt well informed about oral health risks. Taste dominated food selection (68.7%), while nutritional value was cited by 16.7% (N = 25). Conclusions: Young adults from Iași demonstrated notable gaps in nutritional literacy and suboptimal dietary behaviors, emphasizing the need for structured educational strategies to improve preventive practices relevant to systemic and oral health. Full article

Rural and unincorporated communities (UCs) experience persistent health disparities driven by limited healthcare infrastructure, geographic isolation, and socioeconomic inequities. Health literacy (HL), the ability to obtain, understand, and use health information, is a critical yet underexplored determinant of health outcomes in these settings. This study examined HL and barriers to healthcare and health information access among low-income adults living with chronic conditions in nine rural UCs in Southern California. A descriptive cross-sectional survey was administered in English or Spanish to 222 respondents during community food distribution events. The questionnaire included demographics, self-reported health status, chronic disease history, perceived access to care and health information, trust in information sources and HL assessment using the Newest Vital Sign (NVS). Over four-fifths (82.7%) of respondents demonstrated limited or possibly limited HL. Although Spanish-speaking respondents scored significantly lower than English speakers on the NVS, language was not a significant predictor of HL after adjusting for age, gender, education and Hispanic origin. Lower education and older age were associated with reduced HL. One in four respondents reported barriers to healthcare access, primarily due to distance and appointment availability. Over half of the respondents reported difficulty accessing or understanding health information, regardless of HL or demographic characteristics. Doctors were the most trusted source of health information, while trust in government and religious organizations was lowest. Findings reveal pervasive low HL and broad challenges accessing care and health information across rural UCs, highlighting the structural and educational inequities underlying these disparities. Addressing these gaps requires community-driven, bilingual, and culturally resonant strategies that build trust, enhance communication, and strengthen health system accessibility for residents of unincorporated rural regions. Full article

Atrial fibrillation (AF) is the most common sustained arrhythmia and a growing global health burden, yet conventional monitoring with Holter devices, event recorders and implantable loop recorders often fails to adequately capture recurrence. Rapid advances in digital health, wearable biosensors and artificial intelligence (AI) have transformed consumer smartwatches and wearables into potential clinical tools capable of continuous, real-world rhythm surveillance. This narrative review synthesizes contemporary evidence on smartwatch-based AF monitoring, spanning core technologies—photoplethysmography, single-lead electrocardiography and AI fusion algorithms—and validation studies across post-ablation follow-up. Compared with traditional modalities, smartwatch-based AF monitoring demonstrates improved detection of AF recurrence, enhanced characterization of AF burden, symptom–rhythm correlation, and greater patient engagement. At the same time, key limitations are critically examined, including motion artifacts, false-positive alerts, short recording windows, adherence dependence, digital literacy and access gaps, as well as unresolved issues around regulation, interoperability and data privacy. By integrating engineering advances with guideline-directed care pathways, smartwatch-based AF monitoring holds promise to complement, rather than immediately replace, established diagnostic tools and to enable more proactive, individualized AF management. Future work must focus on robust clinical validation, equitable implementation and clear regulatory frameworks to safely scale these technologies. Full article

Background: Transition from paediatric to adult care in congenital heart disease (CHD) represents a pivotal and vulnerable phase that critically influences long-term survival, morbidity, and quality of life. Advances in paediatric cardiology and surgery have generated a rapidly growing population of adults with congenital heart disease who exhibit complex, lifelong, and multidisciplinary needs. However, survival does not equate to cure, and discontinuity of care during adolescence remains a major predictor of adverse outcomes. Despite widespread recognition of their importance, transition programmes are heterogeneous worldwide, and standardised, evidence-based protocols are missing. Objective: This review calls for action acknowledging the urgent need for structured and standardised transition programmes in CHD care, integrating the key elements that should be addressed in any programme to optimise outcomes. Content: Transition should be understood as a multidisciplinary, longitudinal process integrating medical management, patient and family education, psychological preparation, and societal inclusion. Core domains include tailored physical activity, nutritional counselling, cardiovascular risk factor management, infective endocarditis prevention, reproductive health, psychosocial support, and engagement of primary care providers, educators, and employers. Evidence demonstrates that structured transition programmes enhance health literacy, adherence, and self-management, while reducing loss to follow-up. The active involvement of primary care providers, psychologists, educators, and employers is essential to sustain holistic and equitable care. Conclusions: Transition should be reframed as an essential, lifelong component of CHD care. The development and implementation of standardised, multidisciplinary, evidence-based transition protocols are urgently required to ensure continuity, empower patients, and optimise long-term clinical and psychosocial outcomes for adults with CHD. Full article

Background: The 2022 Pakistan floods devastated healthcare access for pregnant women in already impoverished areas in Sindh province. This study examines how Cash for Health assistance (CH) of USD 112 alleviated financial burdens and improved maternal health outcomes and resilience, bridging a critical literature gap on cash effectiveness in humanitarian crises. Methodology: This study used a mixed-methods approach to assess the CH assistance intervention for families of pregnant/lactating women in flood-affected rural Sindh, Pakistan. A pre-post quantitative analysis of baseline (May–June 2024) and endline (August–November 2024) survey data in ~100 villages (Jamshoro/Sehwan) examined changes in healthcare access, expenditure, and preferences using t-tests, proportion tests, and multivariable regression. Concurrently, five qualitative case studies from key informant interviews provided thematic content analysis, triangulating findings on economic, health, and social impacts. Results: Respondents predominantly had low literacy rates and were from households of daily wage laborers in vulnerable, flood-affected areas. While income and education remained low, instances of forgone care due to financial barriers increased (68% to 97%, p < 0.001). CH significantly improved healthcare access (58% to 98%, p < 0.001). Access to regular physicians (20% to 69%) and private facilities (10% to 41%) notably expanded. Healthcare expenditure significantly increased from USD 9.3 to USD 25, with a shift in spending preference towards medication, consultations, and diagnostics. CH also significantly improved food security (21% to 97%), meal frequency, and overall household stability, including reducing domestic violence. Qualitative data emphasized pre-existing vulnerabilities and CH’s role in addressing health, nutrition, and psychosocial needs. Conclusions: CH significantly improved healthcare access and reduced financial burdens for vulnerable pregnant women post-disaster. However, a sustainable impact requires integrated “cash plus” models, combining financial aid with stronger health systems, psychosocial support, and literacy for long-term resilience. Full article

Across the globe, adolescents often grow up surrounded by cultural silence, taboo, or discomfort regarding conversations about sexuality, relationships, and power. The absence of timely, comprehensive, and honest conversations about sexuality, power dynamics, and sexual pleasure during adolescence can significantly impact young people’s mental health and well-being. This commentary paper examines the detrimental effects of the “unspoken curriculum” surrounding sexuality, characterized by silence, misinformation, and avoidance, on the psychological development of young individuals. It examines how the lack of open dialogue contributes to anxiety, shame, distorted perceptions of sexuality, and vulnerability to exploitation. Furthermore, this article underscores the critical need for parents, educators, and society at large to engage in transparent conversations that encompass not only the biological aspects of sexuality but also the essential elements of power, consent, sexual pleasure, healthy relationships, and emotional literacy. By drawing on global research, this paper reveals both common challenges and unique regional barriers, advocating for culturally responsive yet universally rights-based solutions. By fostering open communication and providing accurate, age-appropriate information, we can empower young people to navigate their sexual development with confidence, respect, and a positive sense of self, thereby safeguarding their mental health and fostering healthier societal attitudes towards sexuality. Full article

Background/Objectives: In rural communities, caregivers of people living with dementia face limited access to support services. Digital interventions offer potential solutions for support. This paper reports on the evaluation of Verily Connect, a web-based multicomponent intervention developed to support caregivers. The aim of this qualitative study was to critically evaluate the implementation of Verily Connect to better understand its barriers and enablers. Methods: Using the Consolidated Framework for Implementation Research (CFIR), qualitative data were collected through semi-structured interviews with 24 health service professionals across 12 rural Australian communities. Thematic analysis was conducted to identify barriers and facilitators to implementation. Results: Key barriers included limited digital literacy, resistance to technology and privacy concerns, as well as competing organisational priorities, and inadequate technological infrastructure. Facilitators included organisational alignment and supportive management. Conclusions: The perceived relevance and usability of Verily Connect were enhanced by its co-design with caregivers and integration into health service models. Addressing digital literacy for caregivers, infrastructure limitations, and organisational readiness is essential for future technology-based health interventions in rural dementia care. Full article

This article explores the potential of an integrated pedagogical approach that combines project-based learning (PBL) with Internet of Things (IoT) technologies to achieve the United Nations’ Sustainable Development Goals (SDGs). Within the context of Education for Sustainable Development (ESD), this model transforms students from passive consumers of information into active agents of change. The study demonstrates that leveraging IoT sensors enables students to tackle pressing and complex sustainability challenges by engaging them in a comprehensive problem-solving cycle—from collecting real-world data to developing innovative solutions. By analysing the existing scientific literature, the approach is shown to significantly improve critical thinking skills, systems thinking, creativity, and teamwork. The study also proposes a new conceptual framework (hypothesis), the EcoHabits model, whose effectiveness remains to be empirically validated. This model demonstrates IoT’s potential to enhance sustainability competencies, improve health literacy, and promote individual and collective behaviour change. Despite its significant pedagogical benefits, the article identifies key implementation challenges, including the need for adequate teacher training and community collaboration. In conclusion, this innovative framework offers a promising solution for preparing future generations to address global issues and become active, responsible citizens of the 21st century. Full article