Search Results (63)

Electronic nicotine delivery systems (ENDS) are perceived as safer than conventional smoking, but there is limited knowledge about their risks. This quasi-experimental study aimed to evaluate the perceived usefulness and acceptability of an innovative information strategy concerning the potential harms of e-cigarettes among university students in oral health programs in Mexico and Colombia. The methodology involved implementing a three-phase strategy, utilizing an interactive, self-managed educational game (bowling game) developed on the Genially digital platform and anchored in scientific evidence. Of the 230 invited students, 213 consented to participate in the initial phase. High engagement was demonstrated in the second phase, with 94.8% (n = 203) of students using the game for an average of 5 min and 16 s, and 25.62% answering all embedded knowledge questions correctly on the first attempt. Results from the acceptability phase (n = 36) were highly positive, with 72.2% of IUVA students and 19.4% of BUAP students agreeing the strategy was both entertaining and useful for knowledge improvement. The findings suggest that gamified and interactive digital learning strategies are highly accepted and strengthen academic commitment and knowledge acquisition regarding the public health risks of e-cigarettes. Further longitudinal studies are necessary to evaluate the sustained impact of these digital educational tools. Full article

Background: Telepharmacy consultations (TPCs) became a routine element of pharmacy operations. However, there is limited data available on local pharmacy customer feedback related to TPC. Methods: A customer survey was developed seeking feedback on TPC. The pharmacy customers were invited to complete the survey in two local pharmacies in Germany. The survey and corresponding informed consent form were approved by the Ethics Committee. Results: In total, 178 pharmacy customers were enrolled (median age 41–50 years). From those, 37% agreed when asked whether they were generally interested in TPC. A total of 37% had the nearest pharmacy 5–15 min from their home. A total of 42% visited their pharmacy quarterly. A total of 36% used technical devices in median 1–2 h per days. A total of 33% classified their own digital skills at least as sufficient. A total of 59% would use their smartphone as a potential device for TPC. A total of 83% rated it as (slightly) important that the pharmacist providing TPC can be heard clearly. A total of 76% each (strongly) agreed that an argument for TPC would include limited mobility or pandemic/quarantine. A total of 33% (strongly) agreed that a key argument against TPC were technical requirements. A total of 75% considered situations of immobility to be the most important future perspective for TPC. Conclusions: Many pharmacy customers see TPC as an opportunity, e.g., in cases of limited mobility or during pandemic or quarantine. However, the use of appropriate technology can be a limiting factor. Full article

The global increase in dementia cases, which is predicted to exceed 152 million by 2050, poses substantial challenges to healthcare systems and caregiving structures. Concurrently, the expansion of mobile health (mHealth) technologies offers scalable, cost-effective opportunities for dementia care. This study systematically reviews 100 publicly available dementia-related mobile applications on the Apple App Store (iOS) and the Google Play Store (Android), categorised using the Mobile App Rating Scale (MARS), as well as the targeted end-users, Internet of Things (IoT) integration, data protection, and cost burden. Applications were evaluated for their utility in cognitive training, memory support, carer education, clinical decision-making, and emotional well-being. Findings indicate a predominance of carer resources and support tools, while clinically integrated platforms, cognitive assessments, and adaptive memory aids remain underrepresented. Most apps lack empirical validation, inclusive design, and integration with electronic health records, raising ethical concerns around data privacy, transparency, and informed consent. In parallel, the study identifies promising pathways for energy-optimised IoT systems, Artificial Intelligence (AI), and Ambient Assisted Living (AAL) technologies in fostering dementia-friendly, sustainable environments. Key gaps include limited use of low-power wearables, energy-efficient sensors, and smart infrastructure tailored to therapeutic needs. Application domains such as cognitive training (19 apps) and carer resources (28 apps) show early potential, while emerging innovations in neuroadaptive architecture and emotional computing remain underexplored. The findings emphasize the need for co-designed, evidence-based digital solutions that align with the evolving needs of people with dementia, carers, and clinicians. Future innovations must integrate sustainability principles, promote interoperability, and support global aging populations through ecologically responsible, person-centred dementia care ecosystems. Full article

Background: Chronic non-communicable diseases—chiefly chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVDs)—remain the leading causes of morbidity and mortality worldwide. Despite the proliferation of telehealth programs, few longitudinal studies have rigorously evaluated theory-based, nurse-led digital education across multiple chronic conditions within a unified self-care framework. PROSELF (Promotion of Self-Care through Educational Interventions in Chronic Patients) addresses this gap. Methods: Promotion of Self-Care (PROSELF) is a prospective, longitudinal, multicenter, non-interventional study in community and primary-care settings in Southern Italy. A 12-month nurse-led digital educational intervention—grounded in the Middle-Range Theory of Self-Care of Chronic Illness—targets the three core self-care dimensions (maintenance, monitoring, and management) through individualized tele-education, asynchronous reinforcement, and structured follow-up at baseline, 3, 6, and 12 months. Validated self-care, quality-of-life, and social-support measures will be used. Data will be analyzed using repeated-measures and multivariate models to evaluate longitudinal changes in self-care, adherence, and related outcomes. Participation requires digitally informed consent. Results: The PROSELF study is expected to demonstrate the effectiveness of a 12-month, nurse-led digital educational program in improving adherence and self-care behaviors among patients with chronic diseases (COPD, diabetes, and cardiovascular disease). The intervention will leverage validated self-care assessment tools and tele-educational follow-up sessions. Conclusions: Findings from this study will inform the design of scalable, evidence-based, behaviorally informed models for digital chronic care delivery and nursing education. Full article

Human papillomavirus (HPV) vaccination is a cornerstone of cancer prevention across genders. In the United Kingdom (UK), the programme now includes boys, yet uptake remains below target, with persistent disparities by gender and region. This commentary examines the drivers of these gaps, including the historical framing of the HPV vaccine as a vaccine for girls, limited public awareness of boys’ eligibility, and challenges in school-based delivery. Gendered misconceptions, cultural norms, and inadequate communication continue to limit uptake in boys, while healthcare professionals, including general practitioners, dentists, and pharmacists, remain underused in supporting vaccine access and tackling parental hesitancy. Schools are central to equitable delivery, but teachers often lack training and possess low-to-moderate knowledge of HPV-related topics, including HPV vaccination availability for boys and HPV-related cancers affecting men. Drawing on health behaviour theory, we propose evidence-informed, multi-level recommendations to improve uptake, from gender-inclusive messaging and more efficient consent processes to digital engagement tools that support parents. We also highlight our ongoing research into parental attitudes toward HPV vaccination for boys aged 9–12 in England, which will inform future targeted interventions and policy development. Full article

Background/Objectives: Vaccination is a critical public health measure for older adults in residential aged care facilities (RACFs). In Australia, COVID-19, influenza, pneumococcal, and shingles vaccines are recommended and funded for this group. However, vaccination coverage remains suboptimal, with limited understanding of the underlying causes. Methods: A mixed-methods design explored the enablers and barriers to vaccination from the perspectives of frontline providers, RACF staff, residents and family members. Descriptive statistics were used to quantify the prevalence of perceived enablers and barriers within stakeholder groups. Qualitative data—collected through open-ended questions—were analysed using manual, deductive-iterative coding to identify key themes. Key quotes illustrate the findings. Results: Input was gathered from seven in-reach geriatric staff, 40 general practitioners (GPs), 90 RACF staff, 17 RACF residents, and 84 family members of residents. Results were grouped under four key themes: operational, communication, coordination, and financial. RACF staff identified limited access to vaccination histories as the most significant barrier and relied on external providers to upload data to the Australian Immunisation Register (AIR). On-site clinics were essential, but organisational policies prevented nurse-led vaccination of residents. Most RACFs stored only influenza vaccines and depended on external providers for others. Simplified, translated information was called for. Healthcare provider and RACF endorsement was valued, but RACF staff felt ill-equipped to handle conversations around vaccine hesitancy. Consent processes were burdensome, and responsibility for tracking vaccination schedules was unclear with calls for streamlined processes. Low provider remuneration was also noted, with calls for increased government support. Conclusions: This work identifies key enablers and barriers to resident vaccination in RACFs. Improving delivery requires organisational policy change, staff support, digital access, and continued advocacy. Analysis of targeted interventions and coverage will be reported separately. The approach is replicable for other vulnerable groups. Full article

The evolution of decentralized clinical trials, driven by advanced digital technologies, is transforming traditional clinical research. It introduces innovative methods for informed consent, remote patient monitoring, and data analysis, enhancing study efficiency, validity, and participation while reducing patient burden. Some clinical procedures can be conducted remotely, increasing trial accessibility and reducing population selection biases, particularly for cardiovascular patients. However, this also presents complex regulatory and ethical challenges. The article explores how digital platforms and emerging technologies like block chain, AI, and advanced cryptography can promote traceability, security, and transparency throughout the trial process, ensuring participant identification and documentation of each procedural step. Clear, legally compliant informed consent, often managed through electronic systems, both for research participation and data management in line with GDPR, is essential. Ethical considerations include ensuring participants understand trial information, with adaptations such as simplified language, visual aids, and multilingual support. The transnational nature of decentralized trials highlights the need for coordinated regulatory standards to overcome jurisdictional barriers and reinforce accountability. This framework promotes trust, shared responsibility, and the protection of participants rights while upholding high ethical standards in scientific research. Full article

Introduction: Tuberculosis (TB) remains a public health concern, and people at risk for TB are hesitant to seek care. The first South African National TB prevalence survey, conducted in 2017–2019, found that most participants with TB symptoms did not seek care for TB. In 2022, an estimated 23% of people with TB in South Africa were undiagnosed, contributing to the country’s burden of “missing” TB cases. This study explores health-seeking behaviour among people with TB (PwTB) in South Africa, focussing on barriers and facilitators to care-seeking and the quantification of TB-related stigma from a patient and community perspective. Methods: We conducted a mixed-method study in the City of Johannesburg (COJ) Metropolitan Municipality from February to March 2022. PwTB aged 18 and older initiating TB treatment for microbiologically confirmed pulmonary TB were recruited from three primary healthcare facilities in the COJ. After providing written informed consent, they participated in a one-time, in-depth, face-to-face interview. The interviews were digitally recorded and conducted by trained facilitators. We used thematic analysis with deductive approaches to develop themes. We used the Van Rie TB stigma assessment scale to quantify perceived stigma. Results: We interviewed 23 PwTB with an overall median age of 39 years and 14 (61%) males. Patient-level barriers to accessing TB care included visiting traditional healers and pharmacists before their TB diagnosis; wrong or missed diagnosis by private doctors; work commitments; scarcity of resources to attend the clinic or walk long distances; perceived and experienced stigma; and a lack of TB knowledge. Facility-level barriers included long clinic queues and uncertainty about where to receive TB care in the clinic. Facilitators for TB care-seeking included being in contact with someone who had TB, receiving encouragement from family, or having knowledge about TB transmission and early diagnosis. The overall median total stigma score among 21 PwTB was 53 (IQR: 46–63), with median community and patient stigma scores of 25 (IQR: 22–30) and 31 (IQR: 21–36), respectively. Conclusions: We found important considerations for the TB programme to improve the uptake of services. Since PwTB consult elsewhere before visiting a facility for TB care, TB programmes could establish private–public partnerships. TB programmes could also increase TB awareness in the community, especially among males, and mobile clinics could be considered to assist with TB case detection and treatment provision. Applying behavioural design techniques and co-designing interventions with patients and providers could improve TB health-seeking behaviours. Full article

Background/Objectives: The maintenance of peri-implant soft tissue health is critical for the long-term success of implant therapy, particularly in edentulous patients rehabilitated with mandibular overdentures. Leukocyte- and platelet-rich fibrin (L-PRF) has been proposed as an autologous biomaterial to enhance peri-implant tissue quality. This randomized controlled clinical trial evaluated the effect of L-PRF on peri-implant mucosal thickness in edentulous patients treated with mandibular implant-retained overdentures. Methods: Edentulous patients received two interforaminal implants to retain a mandibular overdenture and were randomly assigned to a test group (L-PRF applied during surgery) or a control group (standard protocol without L-PRF). Clinical measurements of keratinized mucosal thickness and width were recorded at baseline, 12 weeks, and 24 weeks. Volumetric analyses of soft and hard tissue changes were performed using digital superimposition of STL models. The trial was conducted in accordance with the Declaration of Helsinki and approved by the Scientific Ethics Committee of the Aconcagua Health Service. All participants provided written informed consent. Results: A significant increase in keratinized mucosal thickness was observed in the L-PRF group at 12 and 24 weeks compared with baseline (p < 0.01). No significant differences were detected between the groups in soft tissue volume (p = 0.12) or bone volume (p = 0.45). Mucosal width remained stable in both groups throughout follow-up. Conclusions: The application of L-PRF at implant placement resulted in a significant gain in peri-implant mucosal thickness, suggesting a soft tissue modulating effect. Enhancing keratinized mucosal thickness during implant surgery may improve peri-implant tissue quality and support long-term stability of mandibular overdentures. Full article

Driven by technological advances and regulatory developments, the clinical trials industry is undergoing a period of transformation. Decentralized clinical trials (DCTs) promise to streamline processes, increase participant engagement and improve data quality. The pediatric clinical trial landscape is challenging, as participation in a clinical trial affects the whole family. DCTs allow for increased patient engagement, thereby improving trial quality and consequently drug safety. The Italian Medicines Agency (AIFA), in its quest for regulatory simplification and alignment with the European framework, has established comprehensive guidelines to facilitate these decentralized trials. The present work aims to delve into the regulations to understand the feasibility of conducting decentralized pediatric trials in Italy. Full article

The integration of blockchain technology into healthcare offers a robust solution to challenges in secure data sharing, privacy protection, and operational efficiency. Effective exchange of sensitive patient information among hospitals, clinics, insurers, and researchers is essential for better outcomes and medical advancements. Traditional centralized systems often suffer from data breaches, inefficiency, and poor interoperability. This paper presents a blockchain-based secure data-sharing framework tailored for healthcare, addressing these limitations. The framework employs a hybrid blockchain model, combining private and public blockchains: the private chain ensures fast transactions and controlled access, while the public chain fosters transparency and trust. Advanced cryptographic methods—such as asymmetric encryption, hashing, and digital signatures—safeguard patient data and maintain integrity throughout the datalifecycle. Smart contracts automate processes like consent management, access control, and auditing, ensuring dynamic permission enforcement without intermediaries. Role-based access control (RBAC) further limits access to authorized entities, enhancing privacy. To tackle interoperability, standardized data formats and protocols enable smooth communication across diverse healthcare systems. Large files, such as medical images, are stored off-chain, with only essential metadata and logs on the blockchain. This approach optimizes performance, scalability, and suitability for large-scale healthcare deployments. Full article

(1) Background: Data literacy is becoming increasingly important for healthcare professionals in both outpatient care and research. Since healthcare data and the possibilities for its use and misuse are increasing in these areas, healthcare professionals need diverse knowledge regarding the collection, use and evaluation of data. A core component of this is an understanding of the ethical, legal, and social implications (ELSI) of working with health data. (2) Methods: Within the DIM.RUHR project (Data Competence Center for Interprofessional use of Health Data in the Ruhr Metropolis), the challenge of training in data literacy for different healthcare professionals is addressed. Based on a learning objectives matrix for interprofessional data literacy education, an ELSI concept was developed through collaboration with interprofessional project partners. The study was conducted between December 2024 and April 2025. (3) Results: The foundational structure of the ELSI concept was based on the learning objectives matrix and an unstructured literacy search for ELSI concepts in similar contexts. Using an iterative design-based research approach, a group of experts from different fields (didactics, applied ethics, health sciences, law, sociology, informatics, and psychology) developed an ELSI concept for healthcare professionals. The following categories were identified as crucial: 1. philosophy of science: a basic understanding of science and the hurdles and opportunities; 2. ethics: an overview of the biomedical principles and a technological assessment; 3. law: an overview of the reservation of permission and self-determination; 4. social aspects: an overview of health inequalities and different forms of power relations and imbalances. (4) Conclusions: The ELSI concept can be used in the orientation of healthcare professionals in outpatient care and research—regardless of their profession—to develop data competencies, with the aim of providing a holistic view of the challenges and potential in the collection, use, and evaluation of healthcare data. The DIM.RUHR project’s approach is to develop open educational resources that build on the ELSI concept to teach specific skills at different competence levels. Full article

Background: Prostate cancer (PCa) is one of the most common malignancies among men in Saudi Arabia and contributes significantly to cancer-related morbidity and mortality. The objective of this survey was to evaluate community awareness and screening practices related to PCa among men in the Asir region of Saudi Arabia. Method: A cross-sectional study was conducted from 5 October to 25 December 2024 among men aged 40 and above in the Asir region, excluding those with a prior PCa diagnosis. Using convenience sampling, 399 participants were recruited via social media and community outreach. Data were collected through a self-administered online questionnaire covering demographics, medical history, PCa knowledge, information sources, prevention, screening awareness, and barriers. Informed consent was obtained from all participants. Results: The study comprised 399 male participants, with 37.09% aged 40–50, 36.34% aged 51–60, and 26.56% over 60. Most participants (363; 90.97%) were married, 245 (61.4%) had a university education, 282 (70.67%) lived in urban areas, and 180 (45.11%) were employed. Over half of the participants, 222 (55.63%), had a personal history of prostate problems. Additionally, 272 (68.17%) had health insurance, and 153 (38.34%) reported a monthly income between 10,000 and 14,999 SAR. The study found that 329 (82.5%) participants had good knowledge of PCa but only 197 (49.4%) had good awareness of screening methods. Key predictors of good awareness of PCa screening included a personal history of prostate problems (odds ratio—OR = 4.791, p = 0.000, confidence interval—CI 2.727–8.418) and health insurance (OR = 0.359, p = 0.000, CI 0.203–0.636). Common barriers to screening were affordability, n = 116 (29.07%), and perceived good health, n = 201 (50.37%). Additionally, 154 participants (38.59%) found screening uncomfortable, while 156 (39.59%) believed the Digital Rectal Exam (DRE) was harmful or embarrassing. Significant differences in perceived barriers were found based on age (F = 11.449, p < 0.001), education (F = 2.608, p = 0.051), occupation (F = 3.668, p = 0.026), family history (F = 17.407, p < 0.001), and income (F = 5.148, p = 0.006). Conclusions: The study highlights a significant gap between general knowledge and specific awareness of prostate cancer (PCa) screening among men in the Asir region. Although 82.5% demonstrated good overall knowledge, only 49.4% were aware of screening methods, and just 44.36% had undergone PSA testing. Common barriers included perceived good health, fear of diagnosis, embarrassment, and financial concerns. However, due to the use of convenience sampling, online distribution, and geographic restriction to the Asir region, the findings may not be generalizable to the broader male population in Saudi Arabia, particularly older men and those in rural areas. Addressing these gaps requires targeted education, empowerment of healthcare providers, and coordinated public health strategies to enhance early detection and reduce the PCa burden. Full article

Artificial Intelligence (AI) is reshaping mental healthcare by enabling new forms of diagnosis, therapy, and patient monitoring. Yet this digital transformation raises complex policy and ethical questions that remain insufficiently addressed. In this paper, we critically examine how AI-driven innovations are being integrated into mental health systems across different global contexts, with particular attention to governance, regulation, and social justice. The study follows the PRISMA-ScR methodology to ensure transparency and methodological rigor, while also acknowledging its inherent limitations, such as the emphasis on breadth over depth and the exclusion of non-English sources. Drawing on international guidelines, academic literature, and emerging national strategies, it identifies both opportunities, such as improved access and personalized care, and threats, including algorithmic bias, data privacy risks, and diminished human oversight. Special attention is given to underrepresented populations and the risks of digital exclusion. The paper argues for a value-driven approach that centers equity, transparency, and informed consent in the deployment of AI tools. It concludes with actionable policy recommendations to support the ethical implementation of AI in mental health, emphasizing the need for cross-sectoral collaboration and global accountability mechanisms. Full article

In today’s digital era, social media platforms like Instagram have become deeply embedded in daily life, generating billions of content items each day. This vast stream of publicly accessible data presents a unique opportunity for researchers to gain insights into human behaviour and personality. However, leveraging such unstructured and highly variable data for psychological analysis introduces significant challenges, including data sparsity, noise, and ethical considerations around privacy. This study addresses these challenges by exploring the potential of machine learning to infer personality traits from Instagram content. Motivated by the growing demand for scalable, non-intrusive methods of psychological assessment, we developed a personality prediction system combining convolutional neural networks (CNNs) and random forest (RF) algorithms. Our model is grounded in the Big Five Personality framework, which includes Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. Using data collected with informed consent from 941 participants, we extracted visual features from their Instagram images using two pretrained CNNs, which were then used to train five RF models, each targeting a specific trait. The proposed system achieved an average mean absolute error of 0.1867 across all traits. Compared to the PAN-2015 benchmark, our method demonstrated competitive performance. These results highlight that using social media data for personality prediction offers potential applications in personalized content delivery, mental health monitoring, and human–computer interactions. Full article