Search Results (2,165)

Background: Digital health (mHealth) interventions are increasingly integrated into maternity care to improve health literacy and reassure expectant mothers. However, the “double-edged sword” of continuous monitoring may be associated with heightened anxiety. This study aimed to describe mHealth usage patterns and investigate the association between technology engagement and mental health outcomes among pregnant women in Romania, where perinatal distress is a significant public health challenge. Methods: This observational, cross-sectional study included 100 pregnant and immediate postpartum women at a tertiary maternity unit in Romania. Participants were stratified into mHealth Users (n = 52) and Non-Users (n = 48). Validated instruments, including the PHQ-9, GAD-7, and EPDS, assessed depressive and anxiety symptoms. Predictors of adoption were identified using multivariable binary logistic regression. Results: mHealth users were predominantly from urban environments (80.8% vs. 54.2%, p = 0.004) and reported higher rates of daily physical activity (p < 0.001). Users experienced significantly higher median scores for depression (PHQ-9: 6 vs. 4, p = 0.047), generalized anxiety (GAD-7: 7 vs. 6, p = 0.015), and pregnancy-specific anxiety (35 vs. 29.5, p = 0.028) compared to non-users. In the multivariable model, high psychological distress (OR 0.08 for low-stress vs. high-stress, p = 0.009) and urban residency (p = 0.043) were independent predictors of mHealth adoption. Notably, 96.2% of users shared their digital data with healthcare providers. Conclusions: mHealth adoption in this population is characterized by a “paradox of monitoring,” where usage is strongly associated with pre-existing psychological vulnerability and associated with higher distress. While these tools serve as markers for mental health risk, the high rate of data sharing offers a clinical opportunity for a hybrid model of care. Obstetricians should view high digital engagement as a prompt for targeted mental health screening and proactively mediate patient-generated data to mitigate anxiety. Full article

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

Behavioral parent training (BPT) is a front-line psychosocial treatment for childhood ADHD, yet its real-world effectiveness is often constrained by parents’ ability to consistently implement learned strategies. Parental ADHD is a prevalent and mechanistically important factor shaping both parenting behavior and child treatment response. Among parents with ADHD, deficits in executive functioning and emotion regulation, abilities essential for consistent and effective BPT implementation, often interfere with parents’ ability to apply learned strategies. Consequently, parental ADHD predicts reduced in-home skill use and attenuated child treatment gains, positioning it as a potentially critical, treatment-relevant risk factor. This narrative review synthesizes evidence on the intergenerational transmission of ADHD-related impairments, the impact of parental ADHD on parenting practices, and the role of parental ADHD as a moderator of BPT outcomes. We also examine existing approaches to addressing parental ADHD within the context of child BPT, including both pharmacological and psychosocial strategies, and evaluate their implications for parenting and child response. Building on this, we propose an intergenerational reconceptualization of psychosocial care for childhood ADHD in which parental functioning is routinely assessed and supported within BPT. Promising directions include integrating CBT-informed strategies to scaffold parents’ cognitive and regulatory processes, incorporating digital health tools that provide just-in-time guidance at the point of parenting performance, and tailoring BPT emphasis for families affected by multigenerational ADHD. Ultimately, embedding parent-focused supports within BPT may be essential for strengthening treatment impact, durability, and real-world effectiveness for many children and families. Full article

Erectile dysfunction (ED) is a common multifactorial condition with significant physical, psychological and relational consequences. While historically associated with aging, its rising prevalence among younger men underscores the need for updated diagnostic and therapeutic frameworks. This narrative review synthesizes contemporary evidence on the pathophysiology, diagnostic workup and management of ED, with emphasis on guideline-directed care and emerging treatment modalities. A comprehensive literature search was conducted, with evidence synthesized from key clinical guidelines, landmark trials and recent peer-reviewed studies. Lifestyle optimization remains the foundational step, followed by first-line pharmacotherapy with phosphodiesterase type 5 inhibitors (PDE5is), which demonstrate high efficacy and safety across diverse patient populations. For patients with inadequate PDE5is response, second-line options include alprostadil (intracavernosal, with approximately 70% success rates or intraurethral), vacuum erection devices and penile prosthesis surgery, with patient and partner satisfaction exceeding 95% for the latter when performed in experienced centers. Psychosexual therapy is an integral adjunct, particularly in psychogenic or mixed etiologies. Regenerative approaches such as low-intensity extracorporeal shockwave therapy (Li-SWT) and platelet-rich plasma (PRP) injections are under investigation; current evidence supports their use only in experimental settings due to limited long-term data. A multidisciplinary, individualized strategy—incorporating pharmacologic, surgical and psychosocial interventions—remains the cornerstone of modern ED management. This review critically distinguishes well-established evidence from ongoing clinical debates and translates findings into practical guidance for daily practice. Ongoing technological advances may further refine diagnostic accuracy and treatment personalization, but high-quality studies are needed to establish the role of regenerative and digital tools. Full article

Background: Hand trauma accounts for up to one-third of trauma-related emergency department (ED) visits and ranges from minor lacerations to complex multi-structural injuries. As healthcare systems, workflows, and patient behavior evolve, contemporary epidemiological data are crucial to guide triage, optimize resource allocation, and adapt patient care pathways. Methods: We performed a retrospective observational study of all hand-related ED consultations at a Swiss university hospital in 2013, 2016, 2019, and 2022. In total, 8644 cases were analyzed for demographics, diagnosis, anatomical localization, injury complexity (≥2 functional structures), seasonal distribution, and animal-related injuries. Temporal trends and demographic or clinical shifts were assessed using descriptive and inferential statistics. Results: Among 8644 cases, most patients were male (63.8%) with a median age of 38 years (IQR 26–55). Lacerations (32.2%) and blunt trauma (29.1%) were the most frequent diagnoses, primarily involving digits II–V. The proportion of complex injuries declined significantly from 40.0% in 2013 to 32.5% in 2022 (p < 0.001), while cat-bite injuries almost doubled from 1.3% in 2013 to 2.3% in 2022. Case volumes peaked in spring and early summer. Conclusions: Over the analyzed decade, hand trauma cases in the ED have shifted toward a rising proportion of minor, low-acuity conditions, possibly reflecting reduced primary care access and evolving referral patterns. These trends highlight the need for adaptive triage models, strengthened outpatient care, and structural responses to primary care shortages to ensure efficient resource use and maintain high-quality hand trauma management. Full article

Digital elevation models (DEMs) are key fundamental inputs in hydrological modelling, yet the influence of spatial resolution on basin delineation and process representation remains insufficiently understood, particularly in small catchments. This study investigates the influence of DEM resolution on topographic characterization and hydrological response in a small agroforestry basin in central Portugal. Three DEMs with resolutions of 5 m, 10 m, and 30 m were generated from contour data and satellite sources and processed using the TOPAZ-based TopAGNPS delineation framework. The sensitivity of basin structure to delineation parameters—critical source area (CSA) and minimum source channel length (MSCL)—was assessed, and the resulting configurations were used as inputs to the AnnAGNPS model. Results show that DEM resolution strongly influences the representation of hydrological cells and stream reaches. Increasing resolution from 30 m to 5 m leads to a nearly doubling of average cell slope and increases reach slope by more than four times, with corresponding changes in drainage network density and connectivity. Log-linear relationships were identified between slope and contributing area, as well as between slope and reach length, consistent with established geomorphic scaling laws. Hydrological simulations further indicate that resolution-dependent delineation significantly influences runoff, erosion, and peak discharge estimates, with finer resolutions increasing sensitivity to parametrization. Among land-cover scenarios, desertified conditions generate substantially higher runoff and peak flows compared to naturalized and forested conditions. Overall, the findings demonstrate that DEM resolution, together with preprocessing and delineation choices, exerts a critical control on hydrological model outputs. These effects are particularly pronounced in low-relief, human-influenced catchments, where coarse-resolution DEMs may lead to systematic underestimation of hydrological responses. The study highlights the need for resolution-aware modelling strategies and careful parametrization to improve the reliability and transferability of hydrological simulations. Full article

Background: Augmented reality (AR)-based systems offer novel opportunities for digital support in physiotherapy and rehabilitation. This is especially relevant in the context of an aging population and the growing shortage of healthcare professionals. Methods: This study employed a user-centered design with iterative prototype refinement and investigated the perceived usability and user acceptance of a prototype AR-based sports therapy system (“STAR”), developed within an ongoing interdisciplinary research project, from the perspectives of patients and healthcare professionals across one iteration cycle. After an initial needs analysis (T0), participants interacted in an observer role with the system at two time points (T1, T2) using an AR headset (Microsoft HoloLens 2). They did not perform exercises but only interacted with the application by navigating through the system and viewing the exercise demonstrations. Between T1 and T2, a tutorial was integrated, exercise animations and voiceovers were revised, and voiceover controls and navigation were optimized. Usability was measured using the System Usability Scale (SUS), and user acceptance via the Technology Usage Inventory (TUI). Results: A total of 15 participants (10 patients and 5 therapists) completed both testing sessions. The average SUS score across both patients and therapists improved from 54.5 (SD = 18.8) to 71.2 (SD = 13.1), reflecting a statistically significant increase in perceived usability (p < 0.001). The usability rating improved from “ok” to “good” according to the SUS interpretation scale. The TUI subscales skepticism, immersion, accessibility and usability improved significantly, while interest, usefulness and intention-to-use only showed trend-level changes. Conclusions: The findings suggest that a user-centered development process can enhance the perceived usability and user acceptance of AR- based virtual care tools during the prototype stage by providing early-stage empirical evidence linking specific user-centered design interventions to changes in Technology Acceptance Model-related acceptance constructs. Full article

Background: Hospice refers to specialised end-of-life care that supports patients and families, making it an important area for studying how language shapes experiences and expectations of care. This study compares hospice discourse on websites in Hong Kong and the United Kingdom, analysing how NLP-based sentiment and interpersonal features, such as personal pronouns and conjunctions, shape logical relations, structure information, and express emotion in patient narratives. Methods: Using a mixed approach that integrates sentiment analysis with Systemic Functional Linguistics (SFL), and taxonomy of conjunctions in particular, this study draws on a 52,086-word corpus from 40 hospice websites (20 from each region). The corpus analytical tool AntConc was used to identify co-occurrence, interpret log-likelihood, and perform concordance analysis. Results: The findings reveal significant differences in the digital delivery of hospice care across regions. According to our data, UK websites tend to express a wider range of personal emotions and frequently use concessive conjunctions when discussing sensitive palliative care topics. In contrast, Hong Kong websites tend to use more additive and causal conjunctions, projecting a stronger focus on institutional care. For example, Hong Kong texts tend to use formal, service-oriented connections such as “we + offer”, reflecting a more informational communicative style. However, both regions frequently use personal pronouns such as “you” and “we” to convey positive sentiment and demonstrate empathy towards patients and their caregivers. Conclusion: These patterns appear to be used strategically by hospice providers to build trust, signal alignment, and strengthen relationships tailored to each region. Lastly, this study makes an original contribution by combining computational and functional linguistic approaches to develop a systematic method for examining culturally shaped digital communication in end-of-life contexts, thereby enriching the field of healthcare discourse analysis. Full article

Globalization refers to the increasing density of economic, social, and technological interconnections on a global scale. In the healthcare industry, it simultaneously accelerates innovation and increases systemic vulnerabilities. This study aims to review and conceptually synthesise the main channels of impact: (1) pharmaceuticals, clinical development, and regulation; (2) supply chains and resilience; (3) service mobility (health tourism); (4) human resources and competencies; (5) digitalization, artificial intelligence (AI), and data governance; (6) ethics, law, and public policy; and (7) sustainability and climate change. The COVID-19 pandemic highlighted the risks associated with global interdependencies, particularly in supply chains, while also demonstrating the innovation-accelerating effects of knowledge sharing and international cooperation. Particular attention is given to artificial intelligence and digital health, which open up new potential for efficiency and quality improvement from research and development through diagnostics to healthcare organization, while simultaneously intensifying concerns related to data protection, cyber security, and liability. Telemedicine, platform-based systems, and real-world data may contribute to addressing the care needs of ageing societies, but only when supported by appropriate competencies and sound data governance. As global data flows intensify, the importance of data protection, bias mitigation, transparency, and accountability correspondingly increases. Through the cultural channels of globalization, health-conscious lifestyles and complementary approaches are also spreading, which we address in a brief, separate subsection. The guidelines of international organizations foster standardization; however, due to differences in local capacities and institutional environments, the effects are not homogeneous. In conclusion, the study emphasises the dual nature of globalization; it expands access and accelerates innovation, while at the same time creating new vulnerabilities—in supply chains, labour mobility, and data security—and, together with climate-related risks, generating complex adaptive pressures for the healthcare industry. Full article

Complex psychosis is a clinically relevant rehabilitation construct rather than a formal diagnostic category and refers to psychotic illness associated with treatment-resistant symptoms, functional impairment, and additional cognitive, psychiatric, neurodevelopmental, or physical health complexity. In this clinician-oriented narrative review, we synthesised current evidence on rehabilitation interventions for adults with complex psychosis, integrating direct evidence from specialist rehabilitation settings with indirect evidence from schizophrenia-spectrum studies when clinically informative. We searched major clinical databases, prioritised guidelines, systematic reviews, meta-analyses, and controlled studies, and organised the synthesis by functional domain and pathway relevance. Evidence was strongest for cognitive remediation, particularly when combined with broader psychiatric rehabilitation or vocational support, for family interventions in relapse prevention, and for individual placement and support in competitive employment. Social–cognitive and metacognitive interventions appear clinically valuable, although transfer to real-world functioning is more variable. Community-based rehabilitation, supported accommodation, illness self-management, and ecological adaptation strategies remain central to functional recovery when embedded within multidisciplinary pathways. Digital and virtual interventions are promising adjuncts, but their efficacy remains heterogeneous and implementation challenges include engagement, privacy, and service integration. Overall, rehabilitation in complex psychosis is most convincing when it is personalised, measurement-based, and delivered through integrated service models linking assessment, intervention selection, supported living, and recovery-oriented care. Full article

The impact of oncological diseases extends far beyond the clinical patient, profoundly affecting the mental health of caregivers, family members, and volunteers who navigate complex emotional landscapes of grief, anxiety, and trauma. While the domain of digital health has seen a proliferation of serious games aimed at pediatric patient education and treatment adherence, the specific perspective of the “second-order patient”, the caregiver or survivor, remains significantly under-explored. The primary objective of this study is to systematically review the current state of interactive narratives in oncology, palliative care, and grief support, identifying research gaps to inform the broader design space of empathy-driven serious games. Following the PRISMA guidelines, 31 articles were selected from an initial query of 116 records. Interventions were categorized into Serious Games, Games, and Gamification. The analysis reveals a critical thematic transition: early interventions relied heavily on biological “battle” metaphors to empower patients, whereas the current literature advocates for “thanatosensitive” designs that foster empathy. However, a distinct research gap persists regarding narratives that explore post-loss meaning reconstruction and the hospital volunteer experience. Synthesizing these findings, this paper establishes an evidence-based theoretical framework demonstrating a significant opportunity for games that prioritize dialogue and emotional processing over traditional winning conditions. As a practical application of these findings, we also briefly outline the conceptualization of a prototype simulating a widower’s experience volunteering in a palliative ward, shifting the ludic focus from defeating a disease to navigating loss. Full article

Background/Objectives: Pediatric HIV case-finding and monitoring remain constrained by delayed early infant diagnosis (EID), loss to follow-up, and limited viral load (VL) testing—challenges particularly consequential in the operationally diverse Asia–Pacific region. We systematically reviewed innovations in point-of-care (POC) and near-patient HIV diagnostics and digital monitoring relevant to children and adolescents. Methods: Following a registered protocol (INPLASY2025110058) and PRISMA 2020 guidance, we searched PubMed, EMBASE, Cochrane Library, and WHO Global Index Medicus for studies on POC/near-patient EID and VL testing, dried blood spot (DBS) workflows, and digital monitoring tools. Risk of bias was assessed using RoB 2, QUADAS-2, and MMAT. Results: Fifty-three primary studies were included (39 sub-Saharan Africa, 12 Asia–Pacific, 1 multi-country/global, 1 Americas/Caribbean). Patient selection and flow/timing were common limitations in diagnostic accuracy studies; sample representativeness and nonresponse bias were frequent concerns in implementation studies. The most consistent benefits of POC EID and near-patient VL testing were shorter turnaround times and improved cascade completion when paired with quality assurance and connectivity. Conclusions: POC diagnostics and digital monitoring can help close pediatric HIV cascade gaps, though evidence derives predominantly from sub-Saharan Africa. Impact depends on implementation design. Asia–Pacific programs should prioritize generating context-specific evidence alongside the adaptation of established lessons. Full article

Objectives: Despite the widespread availability of digital clinical information, timely access to relevant biomedical evidence during routine consultations remains limited in practice. Primary care clinicians, in particular, face significant time constraints that make it difficult to integrate comprehensive literature searches into everyday workflows. This study evaluates whether an ontology-based recommender system can support routine clinical workflows by reducing information retrieval time while preserving the clinically acceptable usefulness of retrieved evidence. We assessed the performance of the HOPE (Health Operation for Personalised Evidence) system compared with realistic manual PubMed searches conducted by physicians. Materials and Methods: We conducted an observational evaluation involving 50 primary care physicians, who independently assessed 30 anonymised, rewritten clinical cases representative of common primary care scenarios. HOPE automatically extracted biomedical concepts from case descriptions using natural language processing and mapped them to Unified Medical Language System (UMLS) ontologies to generate ranked PubMed recommendations. A subset of 10 physicians also conducted manual PubMed searches in line with their usual clinical practice. Article relevance was assessed using a predefined binary criterion, and a reference relevance set was established by consensus among three senior physicians using a pooled document set. Retrieval performance was evaluated using Precision@k, relative Recall@k, and Normalised Discounted Cumulative Gain (NDCG@k). Manual search time was measured using a standardised stopwatch protocol, whereas HOPE response time was logged automatically by the system. Results: Inter-physician agreement in relevance assessment was substantial (Fleiss’ κ = 0.66; 95% CI: 0.61–0.70). HOPE achieved moderate-to-high precision within the top-ranked results (Precision@3 = 0.72), with relative recall increasing as additional documents were considered. Ranking metrics indicated that relevant articles were generally positioned early in the result lists. The mean total retrieval time for manual PubMed searches was 13.3 ± 1.7 min per case, compared with 17.4 ± 2.1 s for HOPE-assisted retrieval (p < 0.001). Conclusions: In a controlled, workflow-oriented evaluation using synthetic clinical cases, HOPE substantially reduced information retrieval time while maintaining clinically acceptable relevance in the retrieved literature. These findings support the use of ontology-based, AI-assisted systems as workflow-support tools to facilitate timely access to biomedical evidence, without replacing clinical judgment. Full article

Access to autism intervention services is shaped by persistent structural constraints, including limited availability, cost, and service continuity, which often require caregivers to assume expanded roles in supporting their children’s development. This study examines how such constraints contribute to the emergence and persistence of caregivers as proxy interventionists and how technology-mediated systems support or partially support these roles from a human factors perspective. A sequential mixed-methods design was employed across two phases. The first phase integrated quantitative caregiver and service provider surveys with qualitative interviews to examine service access, early technology adoption, and satisfaction patterns during periods of disrupted service delivery. The second phase examined post-adoption contexts through caregiver and service provider qualitative interviews to understand sustained caregiver-mediated practices, technology use, and associated cognitive, emotional, and coordination demands. An empirically grounded conceptual framework was derived to organize relationships among structural access constraints, role redistribution, technology-mediated interaction mechanisms, and human factors demands. The findings highlight the need for human-centered digital systems that provide structured guidance, coordination support, and accessible intervention resources. This work contributes to the design of scalable, technology-mediated support systems for autism care and offers practical implications for user-centered digital health interventions. Full article

The digital transformation of healthcare requires stronger digital competencies among pharmacists, yet evidence on the effectiveness of structured training remains scarce. This study examines the impact of a blended digital health training programme delivered to practicing pharmacists in Bihor County, Romania, as part of the Romanian pilot of the EU-funded European Health Professionals’ and the DigitAl team SkillS (H-PASS) project. A single-group pre–post educational design was applied to pharmacists from Bihor County, Romania, participating in a modular digital health training programme delivered between May and July 2025. A total of 84 pharmacists completed both pre-training and post-training self-reported competency assessments comprising 18 items across three modules: digital innovation and change management, communication and collaboration, and data management and digital literacy. Paired samples t-tests, Cohen’s d effect sizes, Cronbach’s alpha, moderator analyses, and ceiling effect analyses were conducted using Python-based statistical workflows. Statistically significant improvements were observed across all three modules (all p < 0.0001), with large effect sizes (d = 1.04–1.30). Post-training internal consistency increased substantially, with overall Cronbach’s alpha reaching 0.74. The greatest item-level gains were recorded in adaptive communication, cultural adaptation of care, and data protection ethics. No significant moderation effects were found for age, gender, or years of experience. Course satisfaction showed a moderate positive correlation with competency gains (r = 0.528), while perceived improvement was not significantly associated with observed score change. A ceiling effect indicated greater gains among participants with lower baseline competencies. The Romanian implementation of the H-PASS training programme was associated with improved self-reported digital health competencies among practicing pharmacists, high-lighting its potential as a scalable model for digital upskilling in healthcare. Full article