Search Results (994)

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and requires sustained patient engagement to achieve optimal maternal and neonatal outcomes. This narrative review synthesized current evidence on patient engagement strategies and developed clinical principles for implementing patient-centered care across the GDM care continuum. Methods: A domain-based narrative review was conducted using the Consensus literature search platform. A total of 5359 records were identified. After multi-phase screening for relevance and eligibility, 37 studies, including systematic reviews, randomized controlled trials, observational studies, and qualitative research, were included. Evidence was synthesized across four domains: universal screening and linkage to care, whole-person assessment, digital patient engagement, and postpartum transition. Results: Universal screening consistently detected more women with GDM than risk-based approaches, although greater detection alone did not consistently improve maternal or neonatal outcomes. Evidence supported structured patient education, culturally responsive communication, self-management support, and active clinician feedback as key components of effective engagement. Digital health interventions, including telehealth, mobile applications, and remote monitoring, improved adherence, self-management, patient satisfaction, and, in many studies, glycemic control when integrated with clinician oversight. Postpartum follow-up remained a persistent gap despite evidence supporting reminder systems and coordinated care transitions. These findings informed a stepped clinical care pathway tailored to low-resource community health settings. Conclusions: Current evidence supports several components of patient-centered GDM care that informed a proposed stepped clinical care pathway integrating early identification, whole-person assessment, structured education, self-management support, digital engagement, and coordinated postpartum care. Many recommended strategies can be implemented using existing personnel and low-cost digital technologies, although additional implementation research is needed to evaluate culturally tailored interventions and long-term effectiveness in underserved populations. Full article

Introduction: Dating violence is an early form of intimate partner violence characterized by controlling behaviors, psychological and sexual abuse, and digital coercion. Despite its high prevalence among adolescents and young adults, it remains underrecognized and insufficiently addressed in healthcare settings. Nurses are strategically positioned to identify and respond to dating violence due to their close contact with patients and holistic approach to care. However, important gaps remain between existing protocols and their implementation in clinical practice. Methods: An exploratory qualitative study was conducted within a constructivist paradigm as part of a multicenter research project on dating violence among health sciences university students. Twelve experts, including nurses, healthcare professionals, and representatives of survivor-led organizations, participated in focus groups and reflective journals between September and December 2025 at the University of Barcelona. Data were analyzed using an interpretative phenomenological approach, with inductive thematic analysis guiding coding and theme development. Methodological rigor was ensured following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethical approval was obtained. Results: Four themes emerged: (1) barriers to identification, including the normalization of controlling behaviors, myths of romantic love, and limited recognition of psychological and digital violence; (2) challenges in nursing responses, such as insufficient training, clinical uncertainty, organizational barriers, and lack of screening tools; (3) identification strategies, including systematic screening, relationship-centered interviewing, emotional education, and recognition of subtle warning signs; and (4) actions following identification, focused on validation, confidentiality, risk assessment, interdisciplinary referral, and ongoing support. Conclusions: Findings highlight the need to update protocols to explicitly address digital violence and strengthen nursing-led interventions. Participants emphasized the need for enhanced professional training, context-appropriate screening tools, and intersectoral collaboration as potential strategies to improve the identification and response to dating violence. Full article

In this scoping review, we explored research on the use of intervention and standardised quality assurance programmes in Nordic early childhood education and care (ECEC) from 2010 to 2025. By examining peer-reviewed articles, we aimed to map the characteristics of research on the use of such programmes, focusing on their purposes, findings, implications, knowledge gaps, limitations, and directions for future research. We systematically searched eight educational databases, and after a comprehensive screening process that included hand searches, we identified 69 studies that met the inclusion criteria. The results revealed a significant increase in studies on intervention programmes in ECEC, particularly between 2021 and 2023. Most of the studies employed quantitative methods, including quasi-experimental and randomised controlled trials. The studies consistently advocated implementing intervention programmes in ECEC as part of a preventive early strategy. Rooted in Anglo-American traditions of evidence-based intervention and effectiveness research, these developments contrast with key features of the traditional Nordic model and may indicate an ongoing ideological shift in Nordic ECEC. However, such developments should also be understood considering broader international trends towards intervention- and outcome-oriented research. This study highlights the need for further qualitative research exploring how such programmes shape pedagogical practices, professional autonomy, and children’s participation in Nordic ECEC. Full article

Previous studies suggest that educator–infant interactions during mealtime have significant potential to promote early language learning. As most of this research has focused on Western contexts, little is known about whether and how educators’ interactions with infants during mealtime in early childhood education and care (ECEC) settings vary across cultures. To address this knowledge gap, using a multi-case study approach, we compared the natural mealtime interactions of 12 educators with infants in ECEC settings in Australia and China, with six educators participating in each country. Drawing on systemic functional linguistic (SFL) theory and multimodal discourse analysis (MDA), this study examined (1) the situational context of the mealtime practices (each meal’s duration, educators’ movement and whether they modelled eating behaviours, and infants’ eating behaviours); (2) educators’ infant-addressed language and gesture use; and (3) infants’ use of vocalisation and gesture. The analysis revealed several differences: (1) the Australian educators sat with the infants, while the Chinese educators moved around the tables and served the infants; (2) the Australian educators’ talk included a higher percentage of mental processes, statements, and gestures, while the Chinese educators used more material processes and commands in their speech and fewer gestures; and (3) the Australian infants vocalised more and used more gestures. Adopting a systemic functional and multimodal discourse analysis (SF MDA) approach enabled us to relate such differences to both the situational and broader cultural context of educator–infant interactions. This study thus contributes to a richer, more nuanced understanding of the factors that shape educator–infant interactions and the potential of mealtime in ECEC settings to provide infants with opportunities for language learning across cultures. Full article

Indigenous populations internationally experience eating disorders (EDs) at similar or higher rates than colonizing majority populations. In Canada, emerging evidence suggests that this is also true among First Nations, Métis, and Inuit (FNMI) populations. However, most existing recommendations and best practices for ED prevention, early intervention, and treatment do not consider unique contextual and cultural factors that are relevant to FNMI Peoples, such as the effects of historical and ongoing colonialism. This scoping review aimed to map policy-related documents on the prevention, early intervention, and treatment of EDs among FNMI Peoples. We searched academic databases and targeted websites for ED policies, reports, toolkits, guidelines, and fact sheets. Targeted searches included the websites of Indigenous health authorities (e.g., National Collaborating Centre for Indigenous Health) and community websites, ED-specific organizations (e.g., National Eating Disorder Information Centre), and health professional associations (e.g., Canadian Psychological Association). We found only two relevant documents: one commentary serving as a call to action and one education resource for people experiencing EDs or disordered eating and their family members. Both documents were led by Indigenous authors with lived experience of EDs and were published by the National Eating Disorder Information Centre. In the absence of wider guidance on prevention, early intervention, and treatment among FNMI populations, health professionals may face challenges when providing effective and culturally responsive care. This review illustrates the infancy of the policy landscape related to the prevention, early intervention, and treatment of EDs for FNMI populations in Canada. Full article

Background/Objectives: Preterm birth remains a significant global public health challenge, associated with increased morbidity, rehospitalisation, and long-term vulnerability. The transition from the neonatal intensive care unit (NICU) to the home environment represents a critical phase. This practice-focused narrative review synthesises current evidence on community-based post-discharge follow-up for preterm infants, with particular emphasis on the complementary contribution of community health nursing and midwifery within multidisciplinary follow-up models, endocrine-metabolic surveillance and coordinated care for medically complex infants. Methods: A narrative synthesis of review articles, clinical guidelines, and empirical studies published between 2016 and 2026 was undertaken. Searches were performed in PubMed, Scopus, and CINAHL using terms related to preterm birth, NICU discharge, community follow-up, family-centred care, community health nursing, midwifery, and metabolic disorders. Results: Community-based, family-centred follow-up programmes are associated with improved continuity of care, increased parental confidence, enhanced breastfeeding outcomes, and reduced healthcare utilisation. Community health nurses, midwives and health visitors contribute complementary expertise within multidisciplinary follow-up by coordinating continuity of care, providing clinical surveillance of growth and feeding, supporting caregiver education, facilitating early identification of complications, and ensuring timely referral. However, endocrine and metabolic vulnerabilities remain underrepresented in many follow-up models, while infants with complex healthcare needs require individualised, risk-stratified surveillance. Conclusions: Community-based, interdisciplinary, and family-centred follow-up after NICU discharge is essential to enhance the quality and safety of care for preterm infants. Integrated, risk-stratified models of follow-up that combine preventive surveillance, family education, multidisciplinary coordination, and continuity of care may facilitate earlier recognition of complications and improve long-term outcomes. Full article

Background: Hypertension commonly complicates Type 2 diabetes mellitus (T2DM), contributing significantly to increased morbidity and mortality. This study determined the prevalence and factors associated with hypertension among people with T2DM at a tertiary health facility in Northern Uganda. Methods: A hospital-based cross-sectional study was conducted from 18 July to 24 October 2024. Participants with confirmed T2DM were selected through systematic random sampling at Lira Regional Referral Hospital (LRRH) in Lira City, Uganda. Data were collected using a structured questionnaire adapted from the WHO STEPS (2022) tool. Patient charts and registers were used to verify information. Data were analyzed using STATA version 16. Multivariable logistic regression was performed, and p-values < 0.05 were considered statistically significant. Results: A total of 340 participants were enrolled in the study; the median age was 55 years; 244 (71.8%) were female; and nearly half of the participants (163, 47.9%) had attained primary education. Overall, 67.1% (228/340) of the participants with T2DM had hypertension. Factors independently associated with higher odds of hypertension were as follows: age 61+ years (aOR = 5.55, 95% CI: 1.34–23.1, p = 0.018), being overweight (aOR = 3.77, 95%CI: 1.05–13.57, p = 0.042), T2DM duration of more than five years (aOR = 2.51, 95% CI: 1.41–4.67, p = 0.002), and being widowed (aOR = 8.04, 95% CI: 1.87–34.61, p = 0.005). Earning UGX 50,001–100,000 per month (aOR = 0.35, 95% CI: 0.13–0.93, p = 0.037) was associated with 65% lower odds of having hypertension. Conclusions: Two-thirds of patients with T2DM had hypertension, and factors such as older age, being overweight, a longer T2DM duration, and marital status significantly increased hypertension risk; meanwhile, moderate-income status offered a protective effect. The high burden of hypertension among patients with T2DM demonstrates the necessity for targeted public health interventions such as comprehensive lifestyle modification programs, routine screening for hypertension, early detection, and its management among patients with T2DM through enhanced healthcare access. These interventions should focus on integrated care approaches that monitor and manage T2DM alongside hypertension. Full article

Background: Death-associated protein kinase 1 (DAPK1) is a key regulator of apoptosis and immune responses; however, its prognostic significance in oral cancer remains insufficiently characterized. This study investigated the prognostic relevance of DAPK1 in oral squamous cell carcinoma (OSCC) and examined its associations with immune infiltration and apoptosis-related signaling pathways. Methods: A retrospective translational study design was employed, integrating TCGA-based expression and methylation analyses of 528 head and neck squamous cell carcinoma (HNSCC) tumors, UALCAN epigenetic profiling, GeneMANIA protein–protein interaction mapping, TIMER 2.0 immune correlation analyses in 422 HPV-negative HNSCC patients, and multiplex immunofluorescence validation using a tissue microarray cohort of 82 patients with histologically confirmed OSCC, of whom 75 were eligible for the final analysis at Kaohsiung Veterans General Hospital, Taiwan. Results: In vitro validation using Western blot analysis in FaDu cells showed that epidermal growth factor receptor (EGFR) inhibition with gefitinib induced upregulation of DAPK1 protein expression at 10 μM and increased total caspase-3 expression. Higher DAPK1 signal in whole-field quantification was associated with increased CD4+ and CD8+ T-cell infiltration and enrichment of apoptosis-related pathways. Patients with high DAPK1 expression demonstrated a consistent protective trend for overall survival in a pre-specified fully adjusted primary model (adjusted HR = 0.51, 95% CI: 0.21–1.21, p = 0.126), and exhibited significantly improved survival in a secondary parsimonious model (adjusted HR = 0.41, 95% CI: 0.18–0.91, p = 0.029). Multiplex immunofluorescence further confirmed stronger DAPK1 and caspase-3 staining, along with denser lymphocytic infiltration within the tumor microenvironment. Conclusions: Collectively, these findings suggest that DAPK1 is associated with apoptosis-related signaling, increased immune-cell infiltration, and favorable clinical outcomes in OSCC, although its independent prognostic value requires validation in larger cohorts. Full article

General practitioners (GPs) are at the forefront of stunting interventions, but only a few studies have examined their understanding of growth monitoring. Therefore, this study aims to assess the effectiveness of massive open online course (MOOC)-based Continuing Medical Education (CME) programs to increase GPs’ knowledge of nutrition and early detection of growth abnormalities. The study procedures were carried out using a pre- and post-cohort approach involving 121 GPs, mostly working in primary care in Indonesia. The pre- and post-test scores were observed before and after the 12-week MOOC intervention, and the participants were asked for feedback. There were 190 verified participants; the attrition rate was 27.4% (n = 52), and there were six participants with incomplete data, leaving 121 participants as the final sample. The results showed that post-test scores significantly increased after intervention in all domains. These domains included early-life nutrition (7.00 to 9.00), breastfeeding and lactation management (5.56 to 7.78), and feeding problems (7.33 to 8.00) (p < 0.001). Participants reported high satisfaction and preferred a combination of synchronous and asynchronous learning. The feedback suggested improving parental education techniques, specifically in low-socioeconomic settings, and strengthening collaboration between GPs and nutritionists in managing feeding problems. Full article

Background and Clinical Significance: Carbimazole is a widely used medication to treat Graves’ disease, although it can rarely cause acquired aplastic anemia, a complication that happens in less than 0.01% of people. Case Presentation: We report a 36-year-old woman treated with supratherapeutic dose carbimazole who, after approximately six months of treatment, developed high grade fever, severe menorrhagia, spontaneous epistaxis, and pancytopenia. Her bone marrow biopsy showed severe bone marrow failure with only 5% cellularity and trilineage hypoplasia. Other potential causes were ruled out. Immediate discontinuation of carbimazole was done, and supportive care, including blood transfusions, broad-spectrum antibiotics, G-CSF, and eltrombopag, was started. The patient deteriorated during her hospital stay, developed neutropenic sepsis and acute respiratory failure from diffuse alveolar hemorrhage, which required intubation and pulse steroid therapy. She was stabilized and discharged, with a referral to a tertiary medical center for starting antithymocyte globulin (ATG) immunosuppressive therapy, which she subsequently completed; two months after discharge she was transfusion independent with near-normalization of her blood counts. Conclusions: This case serves as a stark reminder of how lethal thionamide-induced bone marrow failure can be, highlighting the vital need for immediate drug cessation, swift intensive care, and thorough patient education on early warning signs. Full article

Flanders, the Dutch-speaking part of Belgium, was the first region in Europe to implement universal neonatal hearing screening (UNHS) in 1998. Early detection of hearing loss, in combination with advances in hearing technology, has provided new opportunities and different challenges especially for children with a severe to profound hearing loss. Both the population of students with hearing loss and their educational contexts and needs have undergone significant changes. The government of education and the government of health care in Flanders created several services to support students with a hearing loss and their families, which we describe in this chapter. Although the demand for specialized staff training to meet all these challenges increased, the availability of such training has declined. Historically, specialized training for professionals in deaf education was always organized by or with the special schools for the deaf. However, the expertise is diminishing as now most children are mainstreamed and the special schools have become much smaller. The specialized training supported by the government of education focuses on education of all types of children with special needs, with limited information about children with a hearing loss. Private organizations, such as ONICI (Independent Information and Research Centre on Cochlear Implants) have taken the initiative to start up training courses on different topics related to hearing loss, with great success. It is hoped that governmental support will expand to sustain these opportunities. Full article

Early childhood education and care (ECEC) systems in equitable welfare states are designed to provide comparatively standardised institutional inputs, yet substantial developmental gaps among children persist. This study examined this configuration—descriptively labelled the “Flemish Paradox”—using data from the OECD’s International Early Learning and Child Well-being Study (IELS 2025) for the Flemish Community of Belgium (2363 five year olds in 200 ECEC centres; parent-questionnaire data were available for a subset of the sample, and missing parent-report data were addressed through multiple imputation). Children’s cognitive and executive skills were measured with standardised direct tablet-based assessments, while home environments were reported by parents, separating measurement sources. Two-level hierarchical linear models with design-based weighting (child weight and 92 BRR replicate weights), pooled across five plausible values and 20 multiply imputed datasets, showed comparatively limited between-centre outcome variation (ICC ≈ 23% for foundational learning, ≈11% for executive function). Within centres, family socioeconomic status (B = 25.11, p < 0.001) and a print-focused home literacy index (PHLI; B = 16.60, p < 0.001) were positively associated with foundational learning, and centre-mean PHLI showed an independent contextual association (B = 24.11, p < 0.001). A positive within-centre indirect association through children’s executive function skills was estimated (3.60, 95% Monte Carlo CI [1.83, 5.40]); a secondary exploratory analysis indicated a parallel between-centre pattern (8.40, 95% CI [1.16, 15.65]). Centre socioeconomic composition was strongly associated with outcomes (B = 36.38, p < 0.001); the analysis did not provide evidence that it modified the within-centre PHLI–learning association (p = 0.219). The findings are consistent with cultural-capital perspectives and indicate that family resources, print-focused home literacy, and EFs are jointly associated with early learning within a multilevel ECEC context. However, the cross-sectional design does not establish temporal or causal mediation, and the results should not be interpreted as evidence regarding the effectiveness of particular family- or centre-based interventions. Full article

Background/Objectives: Liver cirrhosis (LC) is a major cause of morbidity and mortality requiring continuous monitoring and early recognition of clinical deterioration. Home telemonitoring is increasingly considered a supportive strategy for outpatient hepatology care; however, patient acceptance remains insufficiently characterized in Eastern Europe, and no validated instrument currently exists for this population. This study aimed to develop and provide the initial psychometric validation of a Technology Acceptance Model (TAM)-based questionnaire assessing acceptance of home telemonitoring among patients with LC. Methods: In this prospective cross-sectional study, 130 adult patients with LC (Child–Pugh A/B/C) were enrolled. A 25-item questionnaire, including 13 Likert-scale items mapped to Perceived Usefulness (PU), Perceived Ease of Use (PEU), and Intention to Use (ITU), was administered under supervision. Psychometric evaluation included internal consistency, exploratory and confirmatory factor analyses, structural equation modelling (SEM), convergent and discriminant validity, and known-groups validity. Results: Internal consistency was excellent (Cronbach’s α = 0.934; McDonald’s ω = 0.950). EFA identified a 2-factor structure explaining 77.9% of the variance, whereas CFA supported the theoretically driven 3-factor TAM, which showed improved incremental fit (CFI = 0.927; TLI = 0.908) and was retained on theoretical grounds. SEM confirmed the TAM pathway, with PU strongly predicting ITU (β = 0.823, p < 0.001), whereas PEU significantly influenced PU (β = 0.343, p < 0.001) but not ITU directly. The model explained 69.5% of the variance in ITU. Known-groups validity was supported across digital access, IT comfort, education level, and disease severity. Patients with advanced cirrhosis and lower digital confidence showed lower acceptance scores. Conclusions: The proposed 13-item Likert scale demonstrated good initial psychometric performance and may represent a useful tool for assessing telemonitoring acceptance and readiness for digital monitoring among patients with LC. Pending further multicentre validation and assessment of predictive validity, the instrument may support identification of patients requiring additional support for successful telemonitoring adoption. Full article

Scoliosis is a complex three-dimensional spinal deformity that requires early detection, accurate radiological assessment, individualized treatment planning, and long-term monitoring. In recent years, artificial intelligence (AI) has emerged as a promising tool across multiple stages of scoliosis management, including screening, automated imaging analysis, deformity classification, prediction of progression, surgical planning, postoperative outcome assessment, and patient education. This narrative review summarizes current and emerging applications of AI in scoliosis, with particular emphasis on studies published after 2023. Deep learning algorithms, including convolutional neural networks, U-Net-based architectures, transformer models, and generative approaches, have demonstrated high accuracy in automated Cobb angle measurement, vertebral segmentation, coronal and sagittal parameter assessment, and radiation-free screening using surface topography or smartphone-based photographs. Machine learning models have also shown potential in predicting curve progression, treatment response, risk of postoperative complications, and patient-reported outcomes by integrating radiological, clinical, biomechanical, and, increasingly, multimodal data. In parallel, large language models and generative AI tools are being investigated for patient education, communication support, readability improvement, and research hypothesis generation. Despite these advances, important limitations remain, including limited external validation, dataset heterogeneity, potential algorithmic bias, insufficient interpretability, and incomplete integration into clinical workflows. Moreover, while AI systems show strong performance in automated measurement and screening tasks, their role in complex therapeutic decision-making, such as Lenke classification, fusion-level selection, and autonomous surgical planning, remains experimental. Overall, AI has the potential to improve the precision, efficiency, and personalization of scoliosis care; however, prospective multicentre studies, transparent reporting, explainable model design, and regulatory validation are essential before widespread clinical implementation. Full article

Higher education institutions are increasingly expected to contribute to achieving the United Nations Sustainable Development Goals (SDGs) by equipping students with the competencies needed to address complex sustainability challenges. Among these competencies, critical thinking, perspective-taking, evidence-based reasoning, and informed decision-making are considered essential for education for sustainable development. However, limited research has examined how SDG-oriented instructional approaches can foster sustainability-oriented reasoning through argumentative engagement within teacher education. This study investigated the implementation of an SDG-oriented argumentative writing course designed for pre-service teachers. Using a scholarship of teaching and learning approach, this study examined participants’ learning readiness, argumentative performance, and perceived learning outcomes. Data were collected from 16 pre-service teachers through learning readiness questionnaires, argumentative writing tasks, Toulmin-based text analysis, self-assessment questionnaires, and reflective feedback. Descriptive statistics indicated a moderate-to-high level of learning readiness before instruction (M = 4.38) and highly positive perceived learning outcomes after the course (M = 4.61). Qualitative findings further indicated that SDG-related issues provided meaningful contexts for engaging pre-service teachers in critical reflection, perspective integration, and sustainability-oriented reasoning. Participants’ written work showed evidence of structured argumentation, particularly in claim construction and reason development, whereas evidence integration and rebuttal construction remained challenging higher-order dimensions of sustainability-oriented reasoning. Self-assessment data further revealed increased awareness of issue analysis, argumentation strategies, and the social relevance of sustainability-related topics. This study contributes to the growing literature on sustainability in higher education by illustrating how SDG-oriented argumentative writing may support sustainability-oriented reasoning within a teacher education course. The findings provide context-specific insights into how argumentative engagement can encourage evidence-based reasoning, perspective integration, and reflective judgment when addressing sustainability-related issues. Implications are discussed for curriculum innovation, education for sustainable development, and the design of instructional scaffolds that support sustainability-oriented reasoning in teacher education. Full article