Search Results (4,968)

Low uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black women has been partly attributed to barriers related to patient-provider communication. The goal of this paper was to investigate the association between exposure to the #ShesWell campaign and Black women’s communication about PrEP with a healthcare provider (HCP). We conducted a cross-sectional survey of 403 sexually active, Black women after the initial phase of #ShesWell and used multivariable regression models to analyze whether exposure to #ShesWell was associated with talking to an HCP about PrEP or intention to discuss PrEP with an HCP in the future. Approximately 33% of women surveyed reported exposure to #ShesWell. Campaign exposure was significantly associated with talking to an HCP in the past year about PrEP (OR = 4.96, p = 0.001) and intention to discuss PrEP with an HCP in the next six months (B = 0.29, p = 0.038). Stronger beliefs that doctors should initiate sexual health conversations were positively associated with past PrEP conversations (OR = 2.32, p < 0.001) and future intention (B = 0.11, p = 0.029). Greater comfort discussing prevention (B = 0.35, p < 0.001), self-efficacy discussing PrEP (B = 0.29, p = 0.001), and concern about getting HIV (B = 0.51, p < 0.001) were also associated with intention to discuss PrEP with an HCP. Findings highlight the potential for communication campaigns to motivate patient-provider communication about PrEP, addressing a reported barrier to PrEP uptake among Black women. Full article

This article explores strategies for integrating anti-racist approaches into university-level study of religion teaching on multiple levels, including curriculum design, selection of teaching materials, self-reflection practices, responses to concrete classroom situations and fostering environments that protect students of colour while encouraging “white” students to critically examine their own privileges. To contextualize this endeavour, the article first outlines the current situation and describes some challenges related to racism and anti-racism efforts within a Swiss university context, drawing on recent empirical studies. This is followed by an examination of the historical development of racial thought, culminating in contemporary discussions of neo-racism and its connection with the classification category religion. A working definition of racism suitable for academic teaching is then proposed. The article further investigates the relationship between racism and the study of religion, arguing that the discipline has a crucial role to play in addressing and combating racist ideologies. This argument is supported by some empirical data from the author’s doctoral research, as well as examples drawn from the author’s teaching experience at the University of Zurich. By combining historical analysis with practical teaching strategies, thearticle aims to provide a coherent framework for embedding anti-racist principles in higher education. Full article

Despite growing global momentum to reduce the number of children who never received a dose of any vaccine, i.e., zero-dose (ZD) children, persistent geographic and social inequities continue to undermine progress toward universal immunization coverage. In Madagascar, where routine vaccination coverage remains below 50% in most regions, the non-governmental organization Doctors for Madagascar and public sector partners are implementing the SOAMEVA program: a targeted community-based initiative to identify and reach ZD children in sixteen underserved districts in the country’s south. This paper outlines the equity-sensitive evaluation design developed to assess the implementation and impact of SOAMEVA. It presents a forward-looking evaluation framework that integrates both quantitative program monitoring and qualitative community insights. By focusing at the fokontany level—the smallest administrative unit in Madagascar—the evaluation captures small-scale variation in ZD prevalence and program reach, allowing for a detailed analysis of disparities often masked in aggregated data. Importantly, the evaluation includes structured feedback loops with community health workers and caregivers, surfacing local knowledge on barriers to immunization access and program adoption. It also tracks real-time adaptations to implementation strategy across diverse contexts, offering insight into how routine immunization programs can be made more responsive, sustainable, and equitable. We propose eight design principles for conducting equity-sensitive evaluation of immunization programs in similar fragile settings. Full article

Background/Objectives: The advent of tyrosine kinase inhibitors (TKIs) revolutionized the management of chronic myeloid leukemia (CML), achieving survival rates near those of the general population. Despite this success, prolonged therapy presents challenges, including physical, emotional, and financial burdens. Treatment-free remission (TFR), defined as sustained deep molecular response (DMR) after discontinuing TKIs, has emerged as a viable clinical goal. This study evaluates real-world data from the Canary Islands Registry of CML (RCLMC) to explore outcomes, predictors, and the feasibility of TFR. Methods: This retrospective observational study included 393 patients diagnosed with CML-CP between 2007 and 2023. Molecular response was monitored according to international guidelines. Survival probabilities were estimated using the Kaplan–Meier method. Logistic regression analysis was performed to identify predictors of molecular relapses after TKI discontinuation. Results: Of the 383 patients who received TKI treatment, 58.3% achieved molecular response grade 2 (MR2) (BCR-ABL1 ≤ 1%), 95.05% achieved MR2, and 50.5% reached MR4 within the first year. Of the 107 patients attempting TFR, 73.2% maintained remission at 36 months. Relapses occurred in 24 patients, all regaining molecular response upon reintroduction of TKIs. No cases of disease progression were observed. Conclusions: Our findings support the feasibility and safety of TFR in a real-world clinical setting for well-selected patients, with outcomes consistent with international studies. The study underscores the importance of molecular monitoring and patient-specific strategies to optimize outcomes. Full article

Background/Objectives: Chronic cervical myofascial pain syndrome (CMPS) is often diagnosed in the current population by doctors of various specialties. One method of treating spinal pathology is mesotherapy. The purpose of this study is to evaluate the efficacy and safety of collagen mesotherapy, as well as to assess the frequency of pain medication after mesotherapy in chronic CMPS. Methods: Patients were diagnosed and treated by an orthopedist in three different offices between 1 January 2018 and 31 December 2024. The patients were diagnosed with chronic CMPS. Patients were qualified for cervical spine mesotherapy, which was performed weekly, in five repetitions. Retrospectively, based on medical records and in accordance with inclusion and exclusion criteria, two groups were created: group I (n = 65) with injectable type I collagen and group II (n = 65) with 1% lignocaine. Patients were evaluated using the VAS and Laitinen scale before the start of therapy, 1 week after the end of therapy, and at 3-month follow-up. In addition, the frequency of taking analgesic medications after mesotherapy was assessed. Results: After mesotherapy of the cervical spine with both injectable collagen type I and lignocaine 1%, statistically significant improvements were observed in terms of a decrease in pain on the scales used (p < 0.001), as well as a decrease in analgesic medication intake (p < 0.001). Collagen treatment yielded better results after 3 months of follow-up. No mesotherapy-related side effects were observed during the treatment or follow-up periods. Conclusions: Cervical spine mesotherapy using injectable type I collagen and lignocaine 1% is an effective and safe method for chronic CMPS. At a 3-month follow-up, injectable type I collagen appears to be more effective. After mesotherapy and at the 3-month follow-up, both groups reported less pain medication intake compared to before the intervention. Full article

Sarcopenia is characterized by a reduction in muscle function and skeletal muscle mass relative to that of healthy individuals. In older adults and those who are less resistant to sarcopenia, glucocorticoid secretion or accumulation during treatment exacerbates muscle protein degradation, potentially causing sarcopenia. This study assessed the preventive effects and mechanisms of heat-killed Lactobacillus plantarum postbiotic beLP-K (beLP-K) against dexamethasone (DEX)-induced sarcopenia in C2C12 myotubes and Sprague-Dawley rats. The administration of beLP-K did not induce cytotoxicity and mitigated cell damage caused by DEX. Furthermore, beLP-K significantly reduced the expression of forkhead box O3 α (FoxO3α), muscle atrophy f-box (MAFbx)/atrogin-1, and muscle RING-finger protein-1 (MuRF1), which are associated with muscle protein degradation. DEX induced weight loss in rats; however, in the beLP-K group, weight gain was observed. Micro-computed tomography analysis revealed that beLP-K increased muscle mass, correlating with weight and grip strength. beLP-K alleviated the DEX-induced reduction in grip strength and increased the mass of hind leg muscles. The correlation between beLP-K administration and increased muscle mass was associated with decreased expression levels of muscle degradation-related proteins such as MAFbx/atrogin-1 and MuRF1. Therefore, beLP-K may serve as a treatment for sarcopenia or as functional food material. Full article

Background: Self-report physical activity (PA) scales, accelerometry, and heart rate (HR) monitoring are reliable tools for PA measurement for children with cerebral palsy (CP); however, there are limitations for those who are primary wheelchair users. The purpose of our study was to evaluate face and construct validity of the PROMIS^® Pediatric PA parent proxy short form 8a in measuring PA amount and intensity in children with CP who are non-ambulatory. Methods: Face validity: Semi-structured interviews with parents and pediatric physical therapists (PTs) were conducted about the appropriateness of each item on the PROMIS^® Pediatric PA short form. Construct validity: Children with CP who were non-ambulatory participated in a one-week observational study. PA amount and intensity were examined using PA monitors (Actigraph GT9X) and HR monitors (Fitbit Charge 4). Activity counts and time in sedentary and non-sedentary intensity zones were derived and compared to the PROMIS^® T-scaled score. Results: Twenty-two physical therapists (PTs) and fifteen parents participated in the interviews, and ten children completed 1-week PA observation. Eight and seven participants completed sufficient time of uninterrupted PA and HR monitor wear, respectively. Parents and PTs agreed that several questions were not appropriate for children with CP who were non-ambulatory. PA intensity via activity counts derived from wrist worn monitors showed a strong positive correlation with the PROMIS^® PA measure. Conclusions: Construct validity in our small sample was established between PROMIS^® scores and accelerometry activity counts when documenting PA amount and intensity; however, there were some differences on PROMIS^® face validity per parent and PT respondents. Despite some concerns regarding face validity, the PROMIS^® Pediatric PA parent proxy short form 8a shows promise as a valid measure of physical activity amount and intensity in non-ambulatory children with CP, warranting further investigation and refinement. Full article

According to the National Institutes of Health, approximately 465 million individuals are affected by type II diabetes mellitus (T2DM) and could benefit from managing their condition with a high-quality diet based on proper, nutrient-rich food choices. A plant-based diet not only has health benefits but also helps mitigate climate change by reducing greenhouse gas emissions, but the Mediterranean diet has the most beneficial effect on overall health. In contrast, ultra-processed foods have a negative impact on T2DM outcomes. Reviewing the nutritional profile of different meals, snacks and desserts would be helpful in enhancing their quality, strengthening the role of dietitians and doctors and protecting against T2DM complications. This approach would also increase simplification and education for consumers. The PubMed-Medline, Web of Science, Scopus and Cochrane Library databases were searched for relevant articles published up to May, from 2000 (based on publication date). The results support the need to reinforce health claims and highlight public demand for food choices while also improving patient quality of life. Full article

The incorporation of digital health into the medical curricula is becoming more important to better prepare doctors in the future. Digital health comprises a wide range of tools such as electronic health records, health information technology, telemedicine, telehealth, mobile health applications, wearable devices, artificial intelligence, and virtual reality. The present study aimed to explore the medical and biomedical students’ perspectives on the integration of digital health in medical curricula. A cross-sectional study was conducted on the medical and biomedical undergraduate students at the College of Medicine and Health Sciences at Sultan Qaboos University. Data was collected using a self-administered questionnaire. The response rate was 37%. The majority of respondents were in the MD (Doctor of Medicine) program (84.4%), while 29 students (15.6%) were from the BMS (Biomedical Sciences) program. A total of 55.38% agreed that they were familiar with the term ‘e-Health’. Additionally, 143 individuals (76.88%) reported being aware of the definition of e-Health. Specifically, 69 individuals (37.10%) utilize e-Health technologies every other week, 20 individuals (10.75%) reported using them daily, while 44 individuals (23.66%) indicated that they never used such technologies. Despite having several benefits, challenges exist in integrating digital health into the medical curriculum. There is a need to overcome the lack of infrastructure, existing educational materials, and digital health topics. In conclusion, embedding digital health into medical curricula is certainly beneficial for creating a digitally competent healthcare workforce that could help in better data storage, help in diagnosis, aid in patient consultation from a distance, and advise on medications, thereby leading to improved patient care which is a key public health priority. Full article

The escalating climate crisis and global disruptions have prompted a critical re-evaluation of operations management within manufacturing and supply systems. This conceptual article addresses the theoretical and strategic gap in aligning resilience and sustainability by proposing an Integrated Sustainable Operational Strategy (ISOS) framework. Drawing on systems theory, circular economy principles, and sustainability science, the framework synthesizes multiple operational domains—circularity, localization, digital adaptation, and workforce flexibility—across macro (policy), meso (organizational), and micro (process) levels. This study constructs a conceptual model that explains the interdependencies and trade-offs among strategic operational responses in the Anthropocene era. Supported by multi-level logic and a synthesis of domain constructs, the model provides a foundation for empirical investigation and strategic planning. Key propositions for future research are developed, focusing on causal relationships and boundary conditions. The novelty of ISOS lies in its simultaneous integration of three strategic pillars—circularity, localization, and digital resilience—within a unified, multi-scalar architecture that bridges fragmented operational theories. The article advances theory by redefining operational excellence through regenerative logic and adaptive capacity, responding directly to SDG 9 (industry innovation), SDG 12 (responsible consumption and production), and SDG 13 (climate action). This integrative framework offers both theoretical insight and practical guidance for transforming operations into catalysts of sustainable transition. Full article

Background/Objectives: It is essential to explore and disseminate positive deviance strategies that promote resilience, mindfulness, and well-being beyond stress and burnout reduction strategies for residents and physicians who experience high levels of occupational stress. This scoping review maps studies that investigate positive deviance strategies to enhance the well-being of residents and physicians. Methods: A scoping review was conducted by PRISMA guidelines to identify English-language studies on strategies for physician well-being. PubMed, MEDLINE, Embase, and ERIC were searched using terms related to well-being, coping, and medical education. Results: Among the 38 studies included, 17 (44.7%) targeted physicians in graduate medical education (GME), while 19 (50%) focused on continuing medical education (CME). Positive deviance strategies were identified in 26 studies and were most frequently implemented at the microsystem level, such as small group interventions (e.g., coaching, mentoring, and workshops). These strategies addressed individual and organisational factors that contribute to physician well-being and were associated with improvements in life satisfaction, resilience, professional identity, and psychological safety. The review found that positive deviance strategies were often proactive, values-driven, and disseminated organically over time, emphasising the importance of longitudinal engagement and sustained institutional support. Conclusions: This scoping review highlights the growing use of positive deviance strategies, especially at the microsystem level, to promote physician well-being. These approaches emphasise sustainable, values-driven practices and may offer effective, context-sensitive solutions within healthcare systems. Full article

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article

Background: Emotional safety is increasingly recognized as crucial for high-quality patient care, encompassing a patient’s sense of security, courteous treatment, being heard, and a peaceful environment. Purpose: The purpose of this study was to explore the perceptions of patients and providers (doctors and nurses) regarding emotional harm and safety in relation to hospitalized patients. Methods: We conducted a qualitative study in public-sector teaching hospitals in Peshawar, Pakistan. Data were collected after we obtained informed consent using individual interviews with 15 providers, namely, doctors (n = 7) and nurses (n = 8), and five focus group discussions (FGDs) with 25 hospitalized patients. Data from both the interviews and FGDs were analyzed using Braun and Clarke’s six-phase approach to thematic analysis. Results: The key themes revealed by the providers’ perspectives were factors contributing to emotional harm, staff-related factors, coping mechanisms and solutions, and the impact of prior experiences and involvement. The main themes that emerged from the patients’ perspectives were anxiety upon admission, the impact of communication, emotional stress due to treatment delays, systemic/bureaucratic challenges, financial burden, a lack of emotional support, and post-hospitalization concerns. The consistent perspectives shared by both patients and providers included the impact of systemic factors, communication issues, the role of staff attitude/behavior, financial concerns, and the influence of prior experiences. Conclusions: This study highlights the complex interplay of systemic, staff-related, and patient-specific factors. It suggests a need to improve communication, staff support, administrative processes, financial counseling, emotional support integration, and discharge planning to minimize harm and create a patient-centered environment. Full article

Trust in Traditional Thai Medicine (TTM) among Thai people has been reduced due to a lack of objective standards and the susceptibility of the general population to false information. The emergence of generative artificial intelligence (Gen AI) has significantly impacted various industries, including traditional medicine. However, previous Gen AI models have primarily focused on prescription generation based on Traditional Chinese Medicine (TCM), leaving TTM unexplored. To address this gap, we propose a novel fast-learning fine-tuned language model fortified with TTM knowledge. We utilized textual data from two TTM textbooks, Wat Ratcha-orasaram Ratchaworawihan (WRO), and Tamra Osot Phra Narai (NR), to fine-tune Unsloth’s Gemma-2 with 9 billion parameters. We developed two specialized TTM tasks: treatment prediction (TrP) and herbal recipe generation (HRG). The TrP and HRG models achieved precision, recall, and F1 scores of 26.54%, 28.14%, and 24.00%, and 32.51%, 24.42%, and 24.84%, respectively. Performance evaluation against TCM-based generative models showed comparable precision, recall, and F1 results with a smaller knowledge corpus. We further addressed the challenges of utilizing Thai, a low-resource and linguistically complex language. Unlike English or Chinese, Thai lacks explicit sentence boundary markers and employs an abugida writing system without spaces between words, complicating text segmentation and generation. These characteristics pose significant difficulties for machine understanding and limit model accuracy. Despite these obstacles, our work establishes a foundation for further development of AI-assisted TTM applications and highlights both the opportunities and challenges in applying language models to traditional medicine knowledge systems in Thai language contexts. Full article

Background: Kidney transplantation from a living donor is considered the most beneficial form of treatment for end-stage renal failure, which, in addition to providing patients with better treatment results, significantly improves their quality of life. Understanding factors that influence the willingness to donate kidneys to strangers is critical in promoting and expanding the living donor pool. When considering the decision to become an altruistic kidney donor, individuals must evaluate multiple factors, including the identity of the recipient and their own perceived level of safety. This study aimed to assess the willingness of dialysis center employees to act as living kidney donors for a stranger. Methods: We conducted a cross-sectional study from February 2023 to June 2024 among dialysis specialists across Poland. The study involved 1093 people (doctors and nurses). The study used our survey questionnaire and standardized tools. Results: Nurses (vs. physicians) and those who advocated the regulation of unspecified living kidney donation in Poland, did not believe in the risk of organ trafficking, and would donate a kidney to a husband/wife or friend and accept kidney transplantation from a husband/wife were more likely to donate a kidney to a stranger. Furthermore, respondents who accepted a loved one’s decision to donate a kidney to a stranger were significantly more willing to donate a kidney to such a person themselves. Perceived self-efficacy was positively associated with the willingness to donate a kidney to a stranger. Conclusions: Less than half of healthcare professionals supported unspecific living organ donation in Poland, and nurses were more willing to donate than physicians. The factors supporting the decision generally included knowledge about organ donation and transplantation, a lack of fear of organ trafficking, and attitudes towards donation. Full article