Search Results (1,684)

Background/Objectives: British trans and gender-expansive individuals face stigma and consistently experience lengthy waits for gender-enhancing interventions. Researchers are using a range of qualitative methodologies to give this marginalised community a voice. In this study the focus is on the lived experiences of British transgender men seeking medical intervention around their gender identity. The aim was to explore how psychological well-being for this group of transmen was both threatened and supported. Methods: Online semi-structured interviews using auto-photography were conducted with eleven transmen aged between 18 and 68 years. Both verbal and visual data were analysed together using interpretive phenomenological analysis. Analysis: Three themes focus on challenges and supportive strategies utilised by participants both before their decision to transition and after. All participants expressed significant mental health difficulties before commencing their transition, typically originating from childhood and continuing until they gained access to gender-affirming medical care. Their transition journeys damaged their well-being through resistance and rejection from families and communities, and difficulties navigating healthcare systems. A series of resources which significantly enhanced well-being were also reported. Unconditional acceptance and belonging found within and beyond the trans community, connecting with nature and ultimately progressing with gender-affirming healthcare were key elements in protecting and promoting well-being. Conclusions: The toll on the well-being of trans and other gender-expansive individuals is considerable and recent changes in UK law have exacerbated the hostile environment faced by TGE individuals. Community-based allyship and access to affirmative professional psychological support at all stages is vital. Full article

Background/Objectives: Health Promotion Centres (HPCs) in Slovenia represent a European best practice for integrated prevention and health promotion. This study explores the feasibility of adapting the Slovenian HPC model to Bergamo Province, Lombardy, considering local population needs and health system characteristics. Methods: We conducted a qualitative feasibility and policy analysis based primarily on documentary review, complemented by a webinar, a study visit to Slovenia, and expert consultations (conducted in two group discussions) with professionals from ATS (Agenzia Tutela della Salute) Bergamo and local ASST (Azienda Socio-Sanitaria Territoriale) providers. Data were analysed using the PIET-T framework (Population–Intervention–Environment–Transfer). Results: Eight key elements define the Slovenian model: (1) governance and stewardship; (2) structural financing; (3) standardized service portfolio; (4) systematic preventive referrals; (5) integration with primary care and screening; (6) multidisciplinary teams with codified training; (7) community outreach and equity orientation; and (8) information systems and reporting. While Bergamo shares similar demographic and epidemiological profiles, differences in behavioral risk factors, project-based financing, fragmented initiatives, and limited digital integration necessitate adaptation. The comparative assessment highlighted key areas requiring contextual adaptation, including financing mechanisms, organisational coordination, workforce capacity, digital interoperability, and approaches to equity. Conclusions: The Slovenian HPC experience demonstrates the potential of integrated, community-based health promotion. Its adaptation to Lombardy appears feasible if core components are preserved and tailored to local governance, population, and health system conditions. These organisational features may be particularly relevant for time-dependent conditions, such as acute cardiovascular and cerebrovascular events, by potentially supporting more timely risk-factor management and coordination across diagnostic and emergency pathways. Rather than a blueprint for reform, this experience offers useful insights to reinforce prevention and health promotion within the ongoing territorial care reform in Lombardy. Full article

Background: Sepsis constitutes a major healthcare burden worldwide, with an estimated 48.9 million incident cases and 11.0 million deaths in 2017, accounting for nearly one-fifth of all global deaths. Even with advances in definitions and guidelines, significant inequalities persist in awareness, early treatment, and health system readiness. Methods: We performed a structured narrative review of epidemiology studies, clinical case definitions, diagnostic approaches, stewardship interventions, and health system reports. Both electronic sources (PubMed, Web of Science, Embase, Scopus) and grey literature (World Health Organization [WHO], National Institute for Health and Care Excellence [NICE], Society Critical Care [SSC]) were explored. Evidence incorporated themes were organized across recognition, diagnostics, antimicrobial therapy, organ support, guidelines, and health system determinants. Results: Measurement tools, including quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA), exhibited suboptimal sensitivity and utility in varied clinical environments. Biomarkers (procalcitonin, presepsin, CD64) and rapid molecular diagnostics, including metagenomic next-generation sequencing (mNGS) and AI-based devices, enhance detection but are limited by cost and infrastructure constraints. Each hour of delay in antibiotic therapy is associated with a 6–10% increased risk of mortality, underscoring the importance of stewardship, including the incorporation of empiric regimens with rapid de-escalation. Health system bottlenecks—human resources, funding, infrastructure—continue to be a significant determinant of outcomes, especially in low- and middle-income countries. Conclusions: Attaining the 2030 WHO targets for sepsis involves precision diagnostics, adaptable guidelines, stewardship frameworks, and resilient health systems. Fair application and resource allocation are crucial to lower the incidence and mortality worldwide. Full article

Simulation-based learning experiences (SBLE) are widely used in health professions education to enhance clinical skills, confidence, and decision-making in a safe environment. In Doctor of Physical Therapy (DPT) programs, peer simulation offers a cost-effective alternative to high-fidelity simulation and standardized patients, though its effectiveness across different instructional formats remains underexplored. This study examined the differences in student confidence in outpatient physical therapy between cohorts of students from three educational delivery methods, which included face-to-face (F2F), virtual instruction (VI), and F2F combined with integrated clinical experiences (F2F + ICE), prior to their first clinical experience. Using a three-group comparative design, 107 students across three academic years (2019, 2020, and 2022) completed pre- and post-course surveys assessing confidence in four domains and interest in outpatient care. A two-way ANCOVA, controlling baseline interest, revealed significant differences in confidence across all cohorts between pre- and post-course assessment time periods (p < 0.001), with no significant differences between cohorts under the various delivery formats at post-course assessment. While the F2F + ICE group demonstrated higher baseline confidence, this difference was not found post-course. Findings suggest that peer simulation effectively improves perceived confidence in outpatient physical therapy regardless of delivery mode. These results support the integration of SBLE in DPT curricula to prepare students for clinical practice and highlight the need for further research across multiple programs. Full article

Emerging contaminants (ECs) are trace-level chemical and biological compounds detected in the environment, particularly in water, including personal care products, microplastics, nanoplastics, antibiotic resistance genes, etc., which have the potential to endanger ecosystems and human health. Forensic techniques, which are used to detect and trace the sources of ECs with specificity and accuracy, like gas and liquid chromatography coupled with mass spectrometry, Fourier transform infrared spectroscopy, inductively coupled plasma mass spectrometry, isotope ratio mass spectrometry, remote sensing, geographical information systems, and statistical and machine learning approaches are discussed in this study. The present analysis also outlines the types of emerging contaminants, along with their possible sources, including domestic and municipal wastewater, wastewater from healthcare institutions, urban runoff and stormwater, industrial and commercial discharges, effluents from agricultural and animal husbandry, and pollution from recreational activities in water. The review concludes by emphasizing the future need for real-time detection systems, integrated data analysis, and stronger regulatory frameworks to manage ECs more effectively. Full article

As artificial intelligence (AI) continues to expand across clinical environments, healthcare is transitioning from static decision-support tools to dynamic, autonomous agents capable of reasoning, coordination, and continuous interaction. In the context of geriatric medicine, a field characterized by multimorbidity, cognitive decline, and the need for long-term personalized care, this evolution opens new frontiers for delivering adaptive, assistive, and trustworthy digital support. However, the autonomy and interconnectivity of these systems introduce heightened cybersecurity and ethical challenges. This paper presents a Secure Agentic AI Architecture (SAAA) tailored to the unique demands of geriatric healthcare. The architecture is designed around seven layers, grouped into five functional domains (cognitive, coordination, security, oversight, governance) to ensure modularity, interoperability, explainability, and robust protection of sensitive health data. A review of current AI agent implementations highlights limitations in security, transparency, and regulatory alignment, especially in multi-agent clinical settings. The proposed framework is illustrated through a practical use case involving home-based care for elderly patients with chronic conditions, where AI agents manage medication adherence, monitor vital signs, and support clinician communication. The architecture’s flexibility is further demonstrated through its application in perioperative care coordination, underscoring its potential across diverse clinical domains. By embedding trust, accountability, and security into the design of agentic systems, this approach aims to advance the safe and ethical integration of AI into aging-focused healthcare environments. Full article

A hybrid AI and LLM-enabled architecture is presented for real-time decision support in industrial batch processes, where supervision still relies heavily on human operators and ad hoc SCADA logic. Unlike algorithmic contributions proposing novel AI methods, this work addresses the practical integration and deployment challenges arising when applying existing AI techniques to safety-critical industrial environments with legacy PLC/SCADA infrastructure and real-time constraints. The framework combines deterministic rule-based agents, fuzzy and statistical enrichment, and large language models (LLMs) to support monitoring, diagnostic interpretation, preventive maintenance planning, and operator interaction with minimal manual intervention. High-frequency sensor streams are collected into rolling buffers per active process instance; deterministic agents compute enriched variables, discrete supervisory states, and rule-based alarms, while an LLM-driven analytics agent answers free-form operator queries over the same enriched datasets through a conversational interface. The architecture is instantiated and deployed in the Clean-in-Place (CIP) system of an industrial beverage plant and evaluated following a case study design aimed at demonstrating architectural feasibility and diagnostic behavior under realistic operating regimes rather than statistical generalization. Three representative multi-stage CIP executions—purposively selected from 24 runs monitored during a six-month deployment—span nominal baseline, preventive-warning, and diagnostic-alert conditions. The study quantifies stage-specification compliance, state-to-specification consistency, and temporal stability of supervisory states, and performs spot-check audits of numerical consistency between language-based summaries and enriched logs. Results in the evaluated CIP deployment show high time within specification in sanitizing stages (100% compliance across the evaluated runs), coherent and mostly stable supervisory states in variable alkaline conditions (state-specification consistency ${\Gamma }_s\ge 0.98$), and data-grounded conversational diagnostics in real time (median numerical error below 3% in audited samples), without altering the existing CIP control logic. These findings suggest that the architecture can be transferred to other industrial cleaning and batch operations by reconfiguring process-specific rules and ontologies, though empirical validation in other process types remains future work. The contribution lies in demonstrating how to bridge the gap between AI theory and industrial practice through careful system architecture, data transformation pipelines, and integration patterns that enable reliable AI-enhanced decision support in production environments, offering a practical path toward AI-assisted process supervision with explainable conversational interfaces that support preventive maintenance decision-making and equipment health monitoring. Full article

Childhood malnutrition remains a pressing public health challenge in Europe, where stunting, wasting, and underweight coexist with rising rates of childhood overweight and obesity. This policy review provides a strategic roadmap for promoting healthy nutrition in early childhood by synthesizing WHO and EU guidance and proposing coordinated action across three time horizons. Short-term goals (1–3 years) include harmonizing food-based dietary guidelines, implementing universal nutrition screening in pediatric care, and strengthening breastfeeding-supportive environments. Mid-term priorities (3–7 years) focus on fiscal levers, such as sugar taxes and healthy food subsidies; reformulating children’s products; and embedding nutrition education within school curricula. Long-term strategies (7+ years) emphasize harmonized EU-wide monitoring systems, alignment of early-life nutrition with social protection policies, and sustained investment in research on the DOHaD. Through a unified, multisectoral strategy emphasizing early-life nutrition, equitable access to healthy foods, education, and robust regulation, Europe can effectively address the double burden of malnutrition and sustainably reduce childhood obesity. Full article

Background/Objectives: Missed nursing care is a recognized indicator of nursing quality and safety, while caring is a foundational concept in nursing practice. Few studies have empirically examined their relationship. This scoping review aimed to map and synthesize existing evidence on the conceptualisation, measurement approaches, and empirical relationships between caring and missed nursing care. Methods: The review was conducted using JBI methodology, reported according to PRISMA-ScR guidelines, and was registered in the Open Science Framework. Literature was searched in PubMed, CINAHL Ultimate (EBSCOhost), MEDLINE (EBSCOhost), and Web of Science, with additional grey literature searches in ProQuest Dissertations & Theses and Google Scholar. The review included studies examining caring in relation to missed nursing care across any healthcare setting. All study designs were considered. Data were extracted using an extraction tool, developed based on JBI guidelines, and piloted. Data were analyzed descriptively, tabulated, and summarized narratively. Results: Five quantitative cross-sectional studies met the inclusion criteria, conducted between 2012 and 2024 in the Philippines and Slovenia. Caring was assessed using the Caring Behaviors Inventory, Caring Ability Inventory, or CARE-Q, while missed nursing care was measured using the MISSCARE Survey or the Missed Nursing Care Scale. Most studies used Watson’s Theory of Human Caring, Duffy’s Quality Caring Model, or the Missed Nursing Care Model as theoretical frameworks. Across studies, caring behaviours and caring ability were negatively associated with missed nursing care. Conclusions: Caring can function as a moral and relational ideal and as a measurable and actionable factor related to patient outcomes. However, the evidence base remains limited, with inconsistent theoretical foundations and a lack of experimental studies. Future research should adopt theory-based, experimental approaches with diverse samples to explore causal mechanisms and evaluate strategies that strengthen caring competence and caring organizational cultures. Full article

Racism within healthcare systems remains a critical barrier to equitable care for Indigenous Peoples. Despite calls from the Truth and Reconciliation Commission of Canada to integrate anti-racist frameworks into health education, implementation remains limited. Understanding how educators integrate Indigenous-specific anti-racist pedagogy is essential for developing effective and sustainable teaching approaches. This study aimed to identify the pedagogical principles that educators implement when teaching Indigenous-specific anti-racism in health professionals’ education programs. Using biographical narrative methodology, we conducted 17 in-depth interviews between September 2023 and March 2024 with educators who met three criteria: (1) teaching in Canadian health professional programs, (2) explicit commitment to anti-racist approaches, and (3) focus on Indigenous health content. Analysis was validated through race-based focus groups (n = 8), individual follow-up interviews (n = 4), and written feedback (n = 5). Thematic analysis identified six interconnected pedagogical principles specifically designed for Indigenous-specific anti-racist education, grounded in educators’ lived experiences: (1) centering and privileging Indigenous knowledge, worldviews, and strategies; (2) adopting a relational approach to teaching and learning; (3) contextualizing content in relation to colonialism; (4) supporting transformational learning leading to action; (5) embracing discomfort and addressing resistance; and (6) incorporating accountability mechanisms. These principles collectively create safe and transformative learning environments that challenge systemic racism in healthcare education. Implementing Indigenous-specific anti-racist pedagogy requires a holistic, systemic approach that centers Indigenous knowledge, fosters relational learning, and embeds accountability. These principles provide a framework for educators and institutions committed to decolonizing health education and advancing health equity for Indigenous Peoples. Full article

Background/Objectives: Nurses working in closed psychiatric wards experience substantial psychosocial and spiritual burdens, emotional strain, and ethical tension due to continuous exposure to patients in crisis. As formal caregivers, nurses’ health and multidimensional well-being are essential for sustaining compassionate, dignity-preserving practice. However, the lived meaning of self-care within highly restrictive psychiatric environments remains insufficiently understood. This study explores how psychiatric nurses in South Korea experience and interpret self-care. Methods: A qualitative phenomenological design was used. Eight psychiatric nurses with more than three years of experience in closed psychiatric wards participated in in-depth, face-to-face interviews conducted between August 2018 and January 2019. Data were analysed using Colaizzi’s method to identify and synthesise essential themes. Results: Five categories captured the essence of nurses’ self-care experiences: (1) struggling to establish therapeutic roles as a psychiatric nurse; (2) conflating professional identity with ideals of good nursing; (3) recognising a gradual loss of motivation and hope to continue psychiatric nursing; (4) acknowledging the need to care for oneself and refocus on inner vitality; and (5) engaging in self-care through interactions with patients. Self-care was understood as a reflective, relational, and transformative process rather than as a set of stress-relief activities. Conclusions: Psychiatric nurses perceived self-care as an existential journey involving vulnerability, self-reflection, and renewal, which fostered both personal and professional growth. By framing self-care as an ethically grounded, relational practice that sustains therapeutic presence and safeguards moral and professional integrity, this study extends existing self-care literature beyond behavioural strategies. Full article

Background/Objectives: The Thriving at Work model proposes that organisations have a responsibility to provide supportive work environments that identify individual health outcomes, which organisations can use to determine where workforce support is needed. The aims of this study are to (1) identify and compare the predictors of early-career nurses’ thriving at work in New Zealand and Australia and (2) provide innovative and theory-informed recommendations to improve organisational support of early-career nurses to increase retention in the profession. Design: A multinational cross-sectional study design was followed. Methods: The methods include a sub-study of an international action research programme to support the thriving of early-career nurses, which evaluates and compares results from surveys of nurses at approximately three months post-registration in 2024 and 2025. A theory-informed survey assesses predictors and outcomes of thriving at work. Results: Early-career nurses (N = 320) from New Zealand (n = 277) and Australia (n = 43) completed the survey. New Zealand early-career nurses experience greater quality of care and authenticity at work; however, they also report greater burnout. For Australian early-career nurses, authenticity at work is the greatest predictor of thriving. In New Zealand, thriving is linked to burnout and colleague support. Conclusions: New Zealand must focus on reducing burnout and fostering workplaces that value social connection if it wants to mitigate early-career nurse attrition to Australia for better working conditions. In Australia, the value of authenticity at work highlights the importance of organisational cultures that enable nurses to express their true selves and professional identity. The findings highlight the need for tailored approaches in each country to strengthen workforce sustainability and improve nurse wellbeing. Implications for the Profession: In New Zealand, additional funding to bolster the recruitment and retention of the nursing workforce is crucial to improve patient ratios and reduce workloads. The remuneration of nurses must also remain competitive with Australia. Additionally, workplaces should incorporate Māori values and practices into workplace policies to strengthen social connections. Australian organisations should include authentic management training, psychological safety initiatives, and policies that value diversity and encourage open communication. Full article

Elder abuse is an increasingly common problem in modern society, in the context of rapid population aging. Despite increasing awareness, this phenomenon remains heavily underreported, and effective interventions are yet to be made, thus leading to significant medical, social, and legal implications. The purpose of this review is to present an updated situation of the depths of elder abuse, presenting its prevalence both at the global and European level, the two main environments in which it is the most common (community and institutional settings), different forms of abuse, risk factors, and consequences for each one of them, as well as medico-legal aspects on the matter. A narrative review was conducted based on PubMed/MEDLINE, Scopus, and Web of Science databases, in association with data presented in reports from international organizations. The review included only articles published in English, in peer-reviewed journals, addressing elder abuse in adults aged 60 years and older, and those that didn’t respect the criteria were excluded. Elder abuse comes in different forms, most of the time overlapping, with psychological abuse being the most prevalent. Each one of them has its own risk factors and specific consequences, but all of them will eventually lead to increased morbidity, accelerated cognitive impairment, and functional decline. In community settings, the elders usually experience abuse related to dependency on the family and social isolation, while in institutional settings, abuse is frequently associated with understaffing and inadequate care. From a forensic perspective, functional and cognitive decline complicate the proper documentation of the abuse. Thus, the role of the physician in providing legal support to the victim is essential. Elder abuse continues to be heavily overlooked, losing sight of the fact that its consequences extend beyond immediate physical harm, affecting the general physical and mental health of the victims. A possible solution to this problem is envisioned, with the purpose of raising awareness of this situation and contributing to a change in the perspective from which society looks at the elderly. Full article

Vascular diseases remain a major global health burden despite remarkable technological advances in vascular surgery and endovascular therapies. Conditions such as peripheral arterial disease, abdominal aortic aneurysm, carotid stenosis, chronic venous disease, diabetic vasculopathies, and vascular chronic ulcers are not only biological entities but are deeply shaped by social structures, cultural norms, and economic inequalities. This article introduces Vascular Sociology as an interdisciplinary field that integrates vascular surgery with medical sociology to provide a more comprehensive understanding of vascular health and disease. Drawing on classical and contemporary sociological theory, including concepts such as social determinants of health, embodiment, illness narratives, and the disease–illness–sickness triad, the article argues that vascular pathology reflects cumulative social exposures across the life course. Socially patterned behaviors, work conditions, food environments, healthcare access, gender norms, and geographic inequalities profoundly influence disease onset, progression, treatment decisions, and outcomes. The paper highlights how surgical success is contingent not only on technical excellence but also on patients’ social contexts, including health literacy, trust in institutions, caregiving resources, and the capacity to adhere to long-term follow-up and rehabilitation. By outlining conceptual foundations, epidemiological evidence, and mixed-methods research strategies, the article positions Vascular Sociology as a framework capable of bridging biomedical knowledge with lived experience. This approach expands the definition of vascular outcomes to include social reintegration, identity transformation, and equity of care, ultimately aiming to improve patient-centered practice, reduce disparities, and inform more socially responsive vascular health policies. Full article

Background/Objectives: Across geographical and cultural contexts, how individuals identify, communicate and help-seek for distress is often shaped by how mental health itself is understood. Insight into how adolescents and adults in their routine environment, such as teachers, understand mental health is crucial for developing context-specific mental health promotion strategies to young people. Sri Lanka, a country that navigates the dual legacies of pre-and-post-colonial mental health frameworks, has this need. The aim was to explore Sri Lankan school-going adolescents’ and their teachers’ perspectives of mental health and its determinants. Methods: Semi-structured interviews were conducted with 28 school-going adolescents in grades 10–12/13 and 14 of their school teachers, from seven secondary schools in Gampaha District, Sri Lanka. Interviews were transcribed, translated, coded inductively and analysed thematically. Results: All participants drew on culturally meaningful language that is rooted in Buddhist perspectives to conceptualise mental health. Causes and risk factors of poor mental health were attributed to individual, immediate environmental and structural factors. School environment played a central role in exacerbating other risk factors. Adolescents exhibited more knowledge of informal care avenues for mental health-related concerns. Conclusions: Findings highlight several implications including opportunities to leverage culturally contextualised language/frameworks when promoting mental health to Sri Lankan adolescents, diversifying mental health research and initiating school-based mental health programmes that integrate mental health promotion into routine educational practice to transform learning institutions across Sri Lanka to become mental health-promoting schools. Full article