Search Results (1,250)

Introduction: With the emergence of the expert patient and the expansion of health literacy, the importance of planning and building health technologies aimed at teaching and training health professionals, especially nurses, due to their activities with patients in Primary Health Care, with the aim of meeting the real and constant demands of the expert patient, is evident. Methods: Methodological study with a quantitative approach. The course was constructed based on a scope review, scientific reference, and observational visits during the months of September 2021 and August 2022. For validation, an organized electronic form was used with general information about the research and items of the course constructed for later evaluation by the judges with the three-point Likert scale and with the application of the Delphi Technique between the months of September and October 2022; for the agreement of the judges, the Content Validation Coefficient > 0.8 was considered. Results: Based on the content selected in the scope review, the reference contribution, and the observational visits, the course was constructed. Nine judges participated in the validation stage in Delphi I with a total Content Validation Coefficient above 0.90 and with some suggestions for modifications and improvements pointed out by them. In Delphi II, six judges evaluated the course, resulting in a total Content Validation Coefficient of 0.99. Conclusions: The course developed was considered valid to support the training of Primary Health Care nurses in the formation of the expert patient, with a view to promoting patient autonomy in self-care management, optimizing Primary Health Care, and reducing unnecessary hospital admissions. Full article

Background: Cerebral palsy (CP) is a lifelong neurodevelopmental disorder characterised by motor impairment and commonly associated with comorbidities such as cognitive, communicative, and behavioural difficulties. While the physical and functional aspects of CP have been extensively studied, the mental health needs of this population remain largely underexplored, particularly concerning suicidal ideation and self-injurious behaviours. The purpose of this review is to synthesise the existing literature on suicidality in individuals with CP, explore theoretical and clinical risk factors, and identify key gaps in the current evidence base. Methods: A narrative literature review was conducted focusing on studies addressing suicidal ideation, self-harm, or related psychiatric outcomes in individuals with CP. Additional literature on risks and protective factors was included to support theoretical inferences and clinical interpretations. Results: Only a limited number of studies addressed suicidality directly in CP populations. However, several reports document elevated rates of depression, anxiety, and emotional distress, particularly among adults and individuals with higher levels of functioning. Communication barriers, chronic pain, social exclusion, and lack of accessible mental health services emerged as critical risk factors. Protective elements included strong family support, inclusive environments, and access to augmentative communication. Conclusions: Suicidality in individuals with CP is a neglected yet potentially serious concern. Evidence suggests underdiagnosis due to factors such as communication barriers and diagnostic overshadowing. Future research should prioritise disability-informed methodologies and validated tools for suicidal ideation, while clinicians should incorporate routine, adapted mental health screening in CP care to ensure early detection and person-centred management. Full article

Boron-containing compounds (BCCs) have emerged as potential drugs. Their drug-like effects are mainly explained by their mechanisms of action in enzymes. Nowadays, some experimental data support the effects of specific BCCs on GPCRs, provided there are crystal structures that show them bound to G protein-coupled receptors (GPCRs). Some BCCs are recognized as potential ligands of GPCRs—the drug targets of many diseases. Objective: The aim of this study was to collecte up-to-date data on the interactions of BCCs with GPCRs. Methods: Data were collected from the National Center of Biotechnology Information, PubMed, Global Health, Embase, the Web of Science, and Google Scholar databases and reviewed. Results: Some experimental reports support the interactions of BCCs with several GPCRs, acting as their labels, agonists, or antagonists. These interactions can be inferred based on in silico and in vitro results if there are no available crystal structures for validating them. Conclusions: The actions of BCCs on GPCRs are no longer hypothetical, as the existing evidence supports BCCs’ interactions with and actions on GPCRs. Full article

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

Dementia prevention is a global public health priority, and lifestyle interventions, including nutrition, have gained interest for their potential to maintain cognitive health. Among nutritional interventions, omega-3 polyunsaturated fatty acids (n-3 FA), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been widely studied for their potential to support cognitive health. This systematic review evaluated whether n-3 FA supplementation improves global cognition in cognitively unimpaired older adults. Nineteen randomized controlled trials (RCTs) met inclusion criteria, of which five reported significant improvements in global cognition. A random-effects meta-analysis of 11 placebo-controlled RCTs showed no significant effect (SMD = −0.02, 95% CI: −0.07 to 0.04). Heterogeneity in supplement type, dosage, duration, and outcome measures may have contributed to inconsistent findings and limited comparability. Furthermore, methodological quality of the trials was generally low. While current evidence does not demonstrate a significant effect of n-3 FA supplementation on global cognition, future research should prioritize well-powered, longer-duration RCTs that incorporate biomarker monitoring and more appropriate doses. Clarifying the role of n-3 FA in cognitive aging remains essential for informing nutrition-based dementia prevention strategies. Full article

Promoting sustainable development requires a clear understanding of how short-term fluctuations in anthropogenic emissions affect urban environmental quality. This is especially relevant for cities experiencing rapid industrial changes or emergency policy interventions. Among key environmental concerns, variations in ambient pollutants like ozone (O₃) are closely tied to both public health and long-term sustainability goals. However, traditional chemical transport models often face challenges in accurately estimating emission changes and providing timely assessments. In contrast, statistical approaches such as the difference-in-differences (DID) model utilize observational data to improve evaluation accuracy and efficiency. This study leverages the synthetic difference-in-differences (SDID) approach, which integrates the strengths of both DID and the synthetic control method (SCM), to provide a more reliable and accurate analysis of the impacts of interventions on city-level air quality. Using Shanghai’s 2022 lockdown as a case study, we compare the deweathered ozone (O₃) concentration in Shanghai to a counterfactual constructed from a weighted average of cities in the Yangtze River Delta (YRD) that did not undergo lockdown. The quasi-natural experiment reveals an average increase of 4.4 μg/m³ (95% CI: 0.24–8.56) in Shanghai’s maximum daily 8 h O₃ concentration attributable to the lockdown. The SDID method reduces reliance on the parallel trends assumption and improves the estimate stability through unit- and time-specific weights. Multiple robustness checks confirm the reliability of these findings, underscoring the efficacy of the SDID approach in quantitatively evaluating the causal impact of emission perturbations on air quality. This study provides credible causal evidence of the environmental impact of short-term policy interventions, highlighting the utility of SDID in informing adaptive air quality management. The findings support the development of timely, evidence-based strategies for sustainable urban governance and environmental policy design. Full article

Background/Objectives: Hepatic cancers, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), are major global health concerns due to rising incidence and limited therapeutic success. While traditional risk factors include chronic liver disease and environmental exposures, recent evidence underscores the significance of genetic alterations and gut microbiota in liver cancer development and progression. This review aims to integrate emerging knowledge on the interplay between host genomic changes and gut microbial dynamics in the pathogenesis and treatment of hepatic cancers. Methods: We conducted a comprehensive review of current literature on genetic and epigenetic drivers of HCC and CCA, focusing on commonly mutated genes such as TP53, CTNNB1, TERT, IDH1/2, and FGFR2. In parallel, we evaluated studies addressing the gut–liver axis, including the roles of dysbiosis, microbial metabolites, and immune modulation. Key clinical and preclinical findings were synthesized to explore how host–microbe interactions influence tumorigenesis and therapeutic response. Results: HCC and CCA exhibit distinct but overlapping genomic landscapes marked by recurrent mutations and epigenetic reprogramming. Alterations in the gut microbiota contribute to hepatic inflammation, genomic instability, and immune evasion, potentially enhancing oncogenic signaling pathways. Furthermore, microbiota composition appears to affect responses to immune checkpoint inhibitors. Emerging therapeutic strategies such as probiotics, fecal microbiota transplantation, and precision oncology based on mutational profiling demonstrate potential for personalized interventions. Conclusions: The integration of host genomics with microbial ecology provides a promising paradigm for advancing diagnostics and therapies in liver cancer. Targeting the gut–liver axis may complement genome-informed strategies to improve outcomes for patients with HCC and CCA. Full article

Background: International migration is a growing global phenomenon involving diverse groups, such as labor migrants, international marriage migrants, refugees, and international students. International migrants face unique mental health challenges influenced by adversities such as social isolation and limited access to mental health services. This study employs bibliometric methods to systematically analyze the global body of literature on international migrants’ mental health. Methods: The literature on the mental health of international migrants published until October 2024 was searched using the Web of Science database. The search terms included (‘International migrants’ OR ‘migrant workers’ OR ‘international students’ OR ‘refugees’ OR ‘asylum seekers’ OR ‘smuggled migrants’) AND ‘mental health’. VOSviewer was used to conduct bibliometric analysis, focusing on co-authorship patterns, keyword co-occurrence, and citation networks. Results: Over the past four decades, research on the mental health of international migrants has grown substantially, with major migration destinations such as the United States, Europe, and Australia playing prominent roles in this field. ‘Post-traumatic stress disorder (PTSD)’ was the most frequent keyword in publications, with strong links to ‘trauma’ and ‘depression’. In recent years, with the impact of global socioenvironmental changes and emergencies such as the COVID-19 pandemic, the research focus has gradually shifted towards social support, service accessibility, and cultural adaptation. Conclusions: International migration is a far-reaching global phenomenon, and addressing the mental health of migrant populations is essential for advancing public health, social cohesion, and sustainable development. This study provides the first bibliometric overview of research in this domain, mapping its thematic evolution and collaborative structure. The findings offer valuable insights into the field’s development and may support future interdisciplinary collaboration and the formulation of culturally informed, evidence-based approaches in migrant mental health. Full article

Background/Objectives: Patients with an ileoanal pouch change their diet to manage their symptoms and will often resort to the internet for nutrition advice. Currently, no evidence-based dietary guidelines exist to inform online resources. Hence, this study aims to assess the quality of online nutrition information directed towards patients with an ileoanal pouch. Methods: A systematic Google search was conducted to identify consumer websites including information on nutrition for those with ileoanal pouches. Quality was assessed using the DISCERN instrument, and the readability of written content was assessed using the Flesch–Kincaid score. A summative content analysis was used to identify the frequency of particular topics. Websites were also assessed against standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision-making support tools. Results: A total of 12 websites met the inclusion criteria. Mean total DISCERN scores across all websites are 33 out of 75, indicating that overall, the websites were of poor quality. The mean Flesch–Kincaid score was 57 out of 100, or “fairly difficult” in terms of readability. The main themes according to the content analysis were “general dietary advice for pouch”, “dietary strategies for symptom management”, “addressing risks associated with having a pouch”, and “optimisation of nutritional intake”. Overall, websites did not meet the standards for shared decision-making. Conclusions: Online nutrition information for patients with an ileoanal pouch is of poor quality and difficult to understand. There is a need for higher quality online resources for these patients, ideally co-produced with a multidisciplinary team and patient, to provide patients with good quality, understandable, and accessible nutrition information. Full article

Demand for mental health support has exerted unprecedented pressure on statutory services. Innovative solutions such as Green or Nature-Based Social Prescribing (NBSP) programmes may help address unmet need, improve access to personalised treatment, and support the sustainable delivery of primary services within a prevention model of population health. We piloted an innovative health economics-informed Social Return on Investment (SROI) analysis and forecast of a ‘Making Well’ therapeutic craft and horticulture programme for mental health between October 2021 and March 2022. Quantitative and qualitative outcome data were collected from participants with mild-to-moderate mental health conditions at baseline and nine-weeks follow-up using a range of validated measures, including the Short Warwick–Edinburgh Mental Well-being Scale, ICEpop CAPability measure for Adults (ICECAP-A), General Self-Efficacy Scale (GSES), and a bespoke Client Service Receipt Inventory (CSRI). The acceptability and feasibility of these measures were explored. Results indicate that the Making Well programme generated well-being-related social value in the range of British Pound Sterling (GBP) GBP 3.30 to GBP 4.70 for every GBP 1 invested. Our initial pilot forecast suggests that the programme has the potential to generate GBP 5.40 to GBP 7.70 for every GBP 1 invested as the programme is developed and delivered over a 12-month period. Despite the small sample size and lack of a control group, our results contribute to the evidence-base for the effectiveness and social return on investment of NBSP as a therapeutic intervention for improving health and well-being and provides an example of the use of health economic well-being outcome measures such as ICECAP-A and CSRIs in social value analysis. Combining SROI evaluation and forecast methodologies with validated quantitative outcome measures used in the field of health economics can provide valuable social cost–benefit evidence to decision-makers. Full article

Background: Chronic Kidney Disease (CKD) is a major global health issue, with diabetes being its primary cause and cardiovascular disease contributing significantly to patient mortality. Recently, two classes of medications—sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—have shown promise in protecting both kidney and heart health beyond their effects on blood sugar control. Methods: We conducted a narrative review summarizing the findings of different clinical trials and mechanistic studies evaluating the effect of SGLT2i and GLP-1 RAs on kidney function, cardiovascular outcomes, and overall disease progression in patients with CKD and DKD. Results: SGLT2i significantly mitigate kidney injury by restoring tubuloglomerular feedback, reducing intraglomerular hypertension, and attenuating inflammation, fibrosis, and oxidative stress. GLP-1 RAs complement these effects by enhancing endothelial function, promoting weight and blood pressure control, and exerting direct anti-inflammatory and anti-fibrotic actions on renal tissues. Landmark trials—CREDENCE, DAPA-CKD, and EMPA-KIDNEY—demonstrate that SGLT2i reduce the risk of kidney failure and renal or cardiovascular death by 25–40% in both diabetic and non-diabetic CKD populations. Likewise, trials such as LEADER, SUSTAIN, and AWARD-7 confirm that GLP-1 RAs slow renal function decline and improve cardiovascular outcomes. Early evidence suggests that using both drugs together may offer even greater benefits through multiple mechanisms. Conclusions: SGLT2i and GLP-1 RAs have redefined the therapeutic landscape of CKD by offering organ-protective benefits that extend beyond glycemic control. Whether used individually or in combination, these agents represent a paradigm shift toward integrated cardiorenal-metabolic care. A deeper understanding of their mechanisms and clinical utility in both diabetic and non-diabetic populations can inform evidence-based strategies to slow disease progression, reduce cardiovascular risk, and improve long-term patient outcomes in CKD. Full article

Background: Autism spectrum disorder (ASD) is characterised by atypical behavioural and cognitive diversity, yet the neural underpinnings linking brain activity and individual presentations remain poorly understood. In this study, we investigated the relationship between resting-state functional magnetic resonance imaging (fMRI) signal complexity and intelligence (full-scale intelligence quotient (FIQ); verbal intelligence quotient (VIQ); and performance intelligence quotient (PIQ)) in male adults with ASD (n = 14) and matched neurotypical controls (n = 15). Methods: We used three complexity-based metrics: Hurst exponent (H), fuzzy approximate entropy (fApEn), and fuzzy sample entropy (fSampEn) to characterise resting-state fMRI signal dynamics, and correlated these measures with standardised intelligence scores. Results: Using a whole-brain measure, ASD participants showed significant negative correlations between PIQ and both fApEn and fSampEn, suggesting that increased neural irregularity may relate to reduced cognitive–perceptual performance in autistic individuals. No significant associations between entropy (fApEn and fSampEn) and PIQ were found in the control group. Group differences in brain–behaviour associations were confirmed through formal interaction testing using Fisher’s r-to-z transformation, which showed significantly stronger correlations in the ASD group. Complementary regression analyses with interaction terms further demonstrated that the entropy (fApEn and fSampEn) and PIQ relationship was significantly moderated by group, reinforcing evidence for autism-specific neural mechanisms underlying cognitive function. Conclusions: These findings provide insight into how cognitive functions in autism may not only reflect deficits but also an alternative neural strategy, suggesting that distinct temporal patterns may be associated with intelligence in ASD. These preliminary findings could inform clinical practice and influence health and social care policies, particularly in autism diagnosis and personalised support planning. Full article

Although intracranial hypertension (ICH) has traditionally been framed as simply a numerical escalation of intracranial pressure (ICP) and usually dealt with in its clinical form and not in terms of its complex underlying pathophysiology, an emerging body of evidence indicates that ICH is not simply an elevated ICP process but a complex process of molecular dysregulation, glymphatic dysfunction, and neurovascular insufficiency. Our aim in this paper is to provide a complete synthesis of all the new thinking that is occurring in this space, primarily on the intersection of glymphatic dysfunction and cerebral vein physiology. The aspiration is to review how glymphatic dysfunction, largely secondary to aquaporin-4 (AQP4) dysfunction, can lead to delayed cerebrospinal fluid (CSF) clearance and thus the accumulation of extravascular fluid resulting in elevated ICP. A range of other factors such as oxidative stress, endothelin-1, and neuroinflammation seem to significantly impair cerebral autoregulation, making ICH challenging to manage. Combining recent studies, we intend to provide a revised conceptualization of ICH that recognizes the nuance and complexity of ICH that is understated by previous models. We wish to also address novel diagnostics aimed at better capturing the dynamic nature of ICH. Recent advances in non-invasive imaging (i.e., 4D flow MRI and dynamic contrast-enhanced MRI; DCE-MRI) allow for better visualization of dynamic changes to the glymphatic and cerebral blood flow (CBF) system. Finally, wearable ICP monitors and AI-assisted diagnostics will create opportunities for these continuous and real-time assessments, especially in limited resource settings. Our goal is to provide examples of opportunities that exist that might augment early recognition and improve personalized care while ensuring we realize practical challenges and limitations. We also consider what may be therapeutically possible now and in the future. Therapeutic opportunities discussed include CRISPR-based gene editing aimed at restoring AQP4 function, nano-robotics aimed at drug targeting, and bioelectronic devices purposed for ICP modulation. Certainly, these proposals are innovative in nature but will require ethically responsible confirmation of long-term safety and availability, particularly to low- and middle-income countries (LMICs), where the burdens of secondary ICH remain preeminent. Throughout the review, we will be restrained to a balanced pursuit of innovative ideas and ethical considerations to attain global health equity. It is not our intent to provide unequivocal answers, but instead to encourage informed discussions at the intersections of research, clinical practice, and the public health field. We hope this review may stimulate further discussion about ICH and highlight research opportunities to conduct translational research in modern neuroscience with real, approachable, and patient-centered care. Full article

Background: Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication globally. Maternal vitamin D deficiency has been linked to the risk of GDM. The aim of this study was to explore and synthesise current evidence on the association between vitamin D deficiency and the development of gestational diabetes in Western countries. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodological framework. Relevant studies were identified through a comprehensive search across seven databases: ProQuest Public Health, Google Scholar, PubMed, ScienceDirect, The Lancet, BMC Public Health, the International Journal of Women’s Health, and Scopus. Studies were included based on predefined inclusion and exclusion criteria relevant to the research question. The review followed the JBI protocol, and the PRISMA flowchart was used to guide and visualise the study selection process. Results: Nineteen studies were included in the final analysis, comprising research predominantly from Australia (5), the United States (5), and Canada (4). The findings indicate a notable association between vitamin D deficiency and GDM risk, moderated by factors such as maternal age, ethnicity, seasonal variation, and body mass index (BMI). Older maternal age and higher BMI were linked with lower vitamin D levels and a higher incidence of GDM. Ethnic groups with darker skin tones showed higher rates of vitamin D deficiency, increasing vulnerability to GDM. Seasonal patterns revealed lower vitamin D levels during winter months, correlating with greater GDM risk. These patterns underscore the need for targeted preventive strategies, including the potential role of vitamin D supplementation. Conclusions: This review supports an observed association between maternal vitamin D deficiency and increased GDM risk, influenced by demographic and environmental factors. While the evidence points to a potential preventative role for vitamin D, further high-quality research, including systematic reviews and meta-analyses, is essential to establish causality and inform clinical guidelines. The review identifies knowledge gaps and suggests directions for future research and clinical practice. Full article

Introduction: This prospective descriptive study explored the disparities in perceptions and experiences regarding healthcare services between providers and users during the COVID-19 pandemic, with a specific focus on the impact of the digital divide on access to and quality of care. The study revealed significant inconsistencies in the experiences of healthcare providers and patients, particularly regarding the effectiveness of digital health interventions. Methods: This study was a prospective descriptive analysis conducted to evaluate and compare the use of electronic healthcare services between healthcare employees (HΕs) (N = 290) and consumers (Cs) (N = 263) from December 2024 to May 2025, utilizing an electronic survey after the COVID-19 pandemic. To ensure the statistical validity of the sample size, a power analysis was performed using G*Power 3.1.9.2 software. A questionnaire was developed to evaluate the readiness of healthcare employees and consumers for electronic healthcare services. It was validated to ensure reliability within this population and comprised 49 questions. Results: The response rate of the participants was 89.19%, and the Cronbach’s alpha for the questionnaire was 0.738. The study revealed notable differences in perceptions regarding health-related information and digital health technologies across genders and age groups. Specifically, 28.8% of females and 27.3% of males considered it important to be well-informed about health issues (χ² = 8.83, df = 3, p = 0.032). Conclusions: This research contributes to filling a gap in comparative analyses of provider and user perspectives, offering a comprehensive view of how digital health was adopted and experienced during a global crisis. Practically, it provides an evidence base to guide future interventions aimed at fostering more equitable, resilient, and user-friendly digital healthcare systems. Full article