Search Results (531)

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

In an era where digitalization shapes economic and social landscapes, the intersection of digital skills, ethics, and integrity plays a crucial role in understanding the vulnerability of youth classified as NEET (Not in Education, Employment, or Training). This study explores how risky internet use and digital skill gaps contribute to socio-economic exclusion, integrating a multivariate and spatial approach to assess regional disparities in Europe. This study adopts a systems thinking perspective to explore digital exclusion as an emergent outcome of multiple interrelated subsystems. The research employs logistic regression, Principal Component Analysis (PCA) with Promax rotation, and Geographic Information Systems (GIS) to examine the impact of digital behaviors on NEET status. Using Eurostat data aggregated at the country level for the period (2000–2023) across 28 European countries, this study evaluates 24 digital indicators covering social media usage, instant messaging, daily internet access, data protection awareness, and digital literacy levels. The findings reveal that low digital skills significantly increase the likelihood of being NEET, while excessive social media and internet use show mixed effects depending on socio-economic context. A strong negative correlation between digital security practices and NEET status suggests that youths with a higher awareness of online risks are less prone to socio-economic exclusion. The GIS analysis highlights regional disparities, where countries with limited digital access and lower literacy levels exhibit higher NEET rates. Digital exclusion is not merely a technological issue but a multidimensional socio-economic challenge. To reduce the NEET rate, policies must focus on enhancing digital skills, fostering online security awareness, and addressing regional disparities. Integrating GIS methods allows for the identification of territorial clusters with heightened digital vulnerabilities, guiding targeted interventions for improving youth employability in the digital economy. Full article

Muslims are religiously obligated to care for the Earth, yet little empirical research exists on how Muslim communities in the U.S. engage with climate change. This study used a mixed-methods approach to explore climate change knowledge, attitudes, and practices (KAP) among 82 Muslims in Knoxville, Tennessee, building on prior theoretical or internationally focused work. Results found that participants largely accepted anthropogenic climate change and were strongly willing to act, citing Islamic principles such as stewardship and divine accountability as key motivators. However, many felt underinformed and lacked clarity on how to take action. Religious texts, more than religious leaders, shaped environmental views, offering interpretations that both aligned with and diverged from scientific narratives. Education and personal experience were the most frequently cited sources of climate understanding. Religion emerged as an important source of climate knowledge and a filter through which scientific information was interpreted. The knowledge and environmental attitudes inspired by their religion guided many participants to mitigate climate impacts, although some expressed a more fatalistic view of climate change. These findings suggest that effective climate communication in Muslim communities should integrate faith-based teachings with scientific messaging and engage religious leaders as amplifiers. Expanding this research to include more diverse Muslim populations across the U.S. can provide deeper insight into how Islamic worldviews shape climate engagement and behavior. Full article

The extensive use of digital media among adolescents has raised concerns about its impact on emotional development and mental health. Understanding the psychological factors behind problematic digital media use is essential for effective prevention. This study examined whether the relationships between emotion regulation (negative and positive), compulsive use, cognitive preoccupation, and negative outcomes linked to digital media are consistent across sex and academic year. We used a cross-sectional design with 2357 adolescents (12–16 years old) from Compulsory Secondary Education. Participants completed validated self-report questionnaires assessing problematic digital media use, and associated consequences in four domains: internet, video games, social networking, and messaging. Four structural equation models (SEMs), each focused on a media type, tested whether these relationships remained stable across sex and academic year. All models showed good fit, and differences between groups were minimal, supporting valid comparisons. Results confirm that emotion regulation difficulties and problematic digital media use are consistently associated with negative outcomes in all adolescents, regardless of sex or academic level. Preventive strategies targeting emotional regulation and digital media behaviors may be broadly applied to reduce emotional and functional problems related to excessive media use. Full article

Health professionals and institutions, as users and influencers, use social networks to disseminate information and knowledge about health issues, in the case of organ donation and transplantation (ODT) to spread the social benefits of the process and increase the positive attitude towards ODT. The aim of this work was to analyse the perception and use of social networks by university students of health sciences to determine whether, in their opinion, social platforms are suitable for the promotion of ODT after participating in an educational programme specialising in ODT and communication. The students indicated that social networks are a good medium for disseminating messages about ODT, with WhatsApp standing out as the most appropriate after the programme. Eighty-six per cent say that social media can positively influence the attitude towards ODT and 65% have started to follow ODT institutional accounts on social media. Addressing communication in specialisation programmes in the field of health and ODT raises awareness of the responsible use of social media among university health students and strengthens their capacity as prescribers of the social benefits of ODT. Full article

This paper examines how Marley Dias’ activism on Instagram promotes racial justice, Black feminist thought, and youth mobilization through digital storytelling, representation, and audience engagement. Using a mixed-methods analysis of 744 posts published between 2016 and 2025, the study combined critical thematic coding, temporal mapping, and engagement metrics to analyze the discursive and emotional strategies behind Dias’ activism. Five key themes were identified as central to her activist work: diversity in literature, lack girl empowerment, racial justice, Black representation, and educational advocacy. The findings reveal that Dias strategically tailors her messages to suit Instagram’s unique features, using carousels and videos to enhance visibility, foster intimacy, and provide depth in education. Posts that focused on identity, aesthetics, and empowerment garnered the highest levels of engagement, while posts that concentrated on structural issues received lower, yet still significant, interaction. The paper argues that Dias’ Instagram account serves as a dynamic platform for youth-led Black feminist resistance, where cultural production, civic education, and emotional impact converge. This case underscores the political potential of digital literacies and encourages a reconsideration of how youth-driven digital activism is reshaping contemporary public discourse, agency, and knowledge production in the social media age. Full article

The Undetectable = Untransmittable (U=U) message is a cornerstone of HIV-related public health communication, yet global levels of awareness and acceptance remain unclear across key populations. This study aimed to assess the global prevalence of awareness and acceptance of the U=U message among men who have sex with men (MSM), people living with HIV (PLWH), healthcare professionals, and the general population. A systematic review and meta-analysis was conducted using data from PubMed, Embase, and Google Scholar without language restrictions through 31 October 2023. Eligible studies included prospective cohort studies, randomized clinical trials, and cross-sectional studies reporting numerical data on U=U awareness and acceptance. From 1171 screened records, 43 studies were included. Data were analyzed using a random effects model. The findings showed that U=U awareness was high among PLWH, moderate among MSM and healthcare professionals, and low in the general population. Complete acceptance of U=U was low in MSM and the general population, and moderate in PLWH and healthcare professionals. Any acceptance was moderate among MSM and the general population, and high among PLWH and healthcare professionals. These results highlight the need for targeted education strategies to enhance understanding and reduce HIV-related stigma, particularly in populations with lower awareness and acceptance. Full article

Generative artificial intelligence (AI) is rapidly transforming healthcare systems since the advent of OpenAI in 2022. It encompasses a class of machine learning techniques designed to create new content and is classified into large language models (LLMs) for text generation and image-generating models for creating or enhancing visual data. These generative AI models have shown widespread applications in clinical practice and research. Such applications range from medical documentation and diagnostics to patient communication and drug discovery. These models are capable of generating text messages, answering clinical questions, interpreting CT scan and MRI images, assisting in rare diagnoses, discovering new molecules, and providing medical education and training. Early studies have indicated that generative AI models can improve efficiency, reduce administrative burdens, and enhance patient engagement, although most findings are preliminary and require rigorous validation. However, the technology also raises serious concerns around accuracy, bias, privacy, ethical use, and clinical safety. Regulatory bodies, including the FDA and EMA, are beginning to define governance frameworks, while academic institutions and healthcare organizations emphasize the need for transparency, supervision, and evidence-based implementation. Generative AI is not a replacement for medical professionals but a potential partner—augmenting decision-making, streamlining communication, and supporting personalized care. Its responsible integration into healthcare could mark a paradigm shift toward more proactive, precise, and patient-centered systems. Full article

Multi-agent large language models promise flexible, modular architectures for delivering personalized educational content. Drawing on a pilot randomized controlled trial with middle school students (n = 23), we introduce a two-agent GPT-4 framework in which a Profiler agent infers learner-specific preferences and a Rewrite agent dynamically adapts science passages via an explicit message-passing protocol. We implement structured system and user prompts as inter-agent communication schemas to enable real-time content adaptation. The results of an ordinal logistic regression analysis hinted that students may be more likely to prefer texts aligned with their profile, demonstrating the feasibility of multi-agent system-driven personalization and highlighting the need for additional work to build upon this pilot study. Beyond empirical validation, we present a modular multi-agent architecture detailing agent roles, communication interfaces, and scalability considerations. We discuss design best practices, ethical safeguards, and pathways for extending this framework to collaborative agent networks—such as feedback-analysis agents—in K-12 settings. These results advance both our theoretical and applied understanding of multi-agent LLM systems for personalized learning. Full article

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population. Full article

Pedestrian behaviour and safety are essential components of urban sustainability. They are influenced by a complex interplay between various factors from different perspectives, particularly in culturally and linguistically diverse (CALD) communities. This study presents a comprehensive overview of the factors influencing pedestrian behaviour and safety with a focus on CALD communities. By synthesizing the existing literature, the study identifies six key groups of influencing factors: social–psychological, cultural, risk perceptions, environmental, technological distractions, and demographic differences. It discovers that well-designed interventions, such as tailored education campaigns and programs, may effectively influence pedestrian behaviour. These interventions emphasize the importance of targeted messaging to address specific risks (e.g., using mobile phones while crossing the road) and engage vulnerable groups, including children, seniors, and CALD communities. The study reveals that CALD communities face higher risks of pedestrian injuries and fatalities due to language barriers, unfamiliarity with local road rules, and different practices and approaches to road safety due to cultural differences. This study underlines the importance of developing and promoting tailored road safety education programs to address the unique challenges faced by CALD communities to help promote safer pedestrian environments for all. Full article

Introduction: Lung cancer (LC) is the leading cause of cancer mortality and is responsible for 1.8 million deaths annually. The early identification of risk factors, particularly smoking, is essential in improving outcomes. Public health campaigns play a crucial role in raising awareness, but misinformation and resource limitations hinder their effectiveness. This study evaluates the impact of a public awareness campaign on Saudi citizens’ understanding of lung cancer (LC) risks and screening. Methods: An interventional study was conducted in Riyadh, Saudi Arabia, using pre- and post-campaign self-administered surveys. A total of 1,426 participants aged 18 or older were surveyed either before or after the campaign. A matching approach was used to control for confounding variables. Each participant may receive a maximum total score of 14 for their knowledge of lung cancer and a maximum total score of 10 for their awareness of lung cancer screening. Results: A total of 713 participants were surveyed pre-campaign, and 859 post-campaign). After matching, 308 participants remained for the analysis, with no significant demographic differences between those who were surveyed before and after the campaign. Post-campaign, awareness was significantly improved, which is reflected in an increase in accurate responses to key statements. The median knowledge scores increased from 11.0 to 23.0, indicating a substantial increase in understanding. Conclusions: The campaign effectively enhanced the awareness of LC risk factors and screening. However, new misconceptions regarding universal screening emerged, emphasizing the need for clear messaging. Future initiatives should address socioeconomic and gender disparities, promote collaborative decision-making, and implement long-term educational strategies. These findings align with previous research and highlight areas for improvement in public health outreach. Full article

Introduction: In the United States, vaccine hesitancy is higher among rural and racially and ethnically diverse communities, and messaging from trusted individuals may increase vaccine acceptance. The purpose of this study is to understand vaccine hesitancy, messaging from trusted individuals, and vaccine acceptance strategies among racially and ethnically diverse, medically underserved rural populations. Methods: The researchers conducted 12 in-person focus groups, each consisting of 5 to 12 participants, with community members and trusted leaders from three rural counties in Eastern North Carolina (n = 119). Thematic analysis was used to synthesize insights from the discussions, allowing for the identification of recurring patterns and community-specific considerations regarding vaccine perceptions and messaging. Results: The researchers identified seven key themes within the primary focus areas of the study: factors influencing vaccine hesitancy, messaging from trusted individuals, and strategies to improve vaccine acceptance. Participants reported differences in trust based on how long a vaccine has been available, concerns about becoming sick after a vaccine, seeing the symptoms of vaccine-preventable diseases, and misinformation on social media. Overall, participants reported trust in messages from medical providers. Trusted leaders advised people to conduct their own research on vaccines when determining whether to receive vaccinations. Lastly, social determinants such as cost, education, and transportation were identified as key barriers to vaccination. Conclusions: Our findings indicate that medical providers are trusted messengers for vaccine information and the promotion of vaccine uptake. However, distrust linked to fear, misinformation, and structural barriers persist. Public health efforts to increase vaccination confidence among rural, racially and ethnically diverse populations in the United States Southeast should address these factors in future vaccine interventions and educational efforts. Full article

Background: Colonoscopy is an important and essential diagnostic and screening tool for colorectal cancer and other pathologies in the colon. High-quality bowel preparation (BP) is a key quality measure of colonoscopy and is critical for maximizing its effectiveness, including enhancing adenoma detection rates. However, inadequate bowel preparation (IBP) remains a frequent challenge and is influenced by multiple factors. This review aims to summarize and evaluate educational and technological interventions implemented before colonoscopy to improve BP quality. Methods: The methodology comprised a structured narrative review of studies published in English, including randomized controlled trials, prospective studies, observational cohorts, and meta-analyses. Interventions were categorized by their delivery mode and impact on BP adequacy. Interventions included written materials, internet-based education modules, short message service (SMS) reminders, visual aids, instructional videos, verbal communication, telephone support, smartphone applications, and virtual reality (VR) platforms. Results: Most studies reported significant improvements in BP quality with enhanced patient education, particularly with the use of instructional videos and smartphone applications. Verbal communication and telephone support also demonstrated positive outcomes but were limited by resource availability. VR represents a promising emerging technology, though its implementation remains costly and complex. Conclusions: Enhanced educational interventions are proven methods to optimize BP quality. The selection of an appropriate modality should consider patient characteristics, technological accessibility, and institutional resources. Personalized strategies targeting high-risk populations can further reduce IBP rates and improve overall colonoscopy outcomes. Full article

Chronic pain is a prevalent public health concern in the United States, frequently managed with over-the-counter (OTC) painkillers without professional medical supervision. This study investigates household-level patterns of over-the-counter painkiller use utilizing a nationally representative dataset from NielsenIQ, focusing on how reported health conditions, whether self-identified or professionally diagnosed, affect purchasing behaviors. By linking consumer purchase data with self-reported ailment information, this study analyzed painkiller expenditures across different ailment types and demographic groups. Results show that over-the-counter painkiller purchases were highly symptom-driven, particularly for headache-related products, which were the most frequently purchased category across all household types. Nearly one-third of single-member households purchased over-the-counter painkillers for headaches, regardless of diagnosis type, indicating a strong role of perceived need in driving behavior. Females and older individuals more frequently reported ailments, with consistently higher proportions across both pain-related and other conditions. Nonetheless, a notable share of households reported over-the-counter painkiller use without any reported ailments. The findings suggest that diagnostic status plays a limited role in determining over-the-counter painkiller usage, emphasizing the need for improved public health messaging around safe self-medication. These insights can inform targeted education, labeling regulations, and policy interventions to support safer and more equitable pain management practices at the population level. Full article