Search Results (16,152)

Children and adolescents in hot and humid climates face increasing health risks due to climate change. Although the concept of Health-Promoting Schools (HPSs) is widely recognized, a systematic framework that integrates climate adaptability, child-specific needs, and multidimensional environmental design is still lacking. To address this gap, this study conducted a systematic literature review of 89 publications with three objectives: (1) synthesize research from the past decade on the impact of school physical environments on the health and academic performance of children and adolescents; (2) develop an evidence-based synergistic design framework with a categorized indicator system; and (3) integrate qualitative and quantitative evidence on how these indicators influence different health dimensions. The resulting framework emphasizes multidimensional, synergistic optimization and provides climate-responsive design strategies tailored to educational settings in hot and humid regions. By offering a theory-to-practice pathway, the framework complements existing healthy building guidelines for K–12 schools and supports designers and policymakers in creating environments that enhance thermal resilience, cognitive performance, and holistic child development. Full article

Background and Objectives: Abortion on request, contraceptive access barriers, and mental health may jointly shape women’s quality of life (QoL). We examined how abortion history, structural barriers, and psychosocial factors relate to modern contraceptive use, depressive and anxiety symptoms, and QoL among women attending a Romanian tertiary center. Methods: We conducted a single-center observational study combining retrospective chart review with an online survey of 200 women aged 18–45 years. Validated instruments (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], World Health Organization Five-Item Well-Being Index [WHO-5], and World Health Organization Quality of Life–BREF [WHOQOL-BREF]) and indices of access barriers, perceived stigma, and social support were used. Analyses included multivariable regression, structural equation modelling, latent class analysis, and moderation analysis. Results: Overall, 55.0% of women reported ≥1 abortion on request. Compared with those without abortion history, they were older (31.2 ± 4.9 vs. 26.8 ± 4.8 years, p < 0.001), more often had lower levels of education (51.8% vs. 33.3%, p = 0.013), and were less likely to use modern contraception at last intercourse (52.7% vs. 71.1%, p = 0.012). PHQ-9 (8.8 ± 4.0 vs. 7.3 ± 4.3) and GAD-7 (7.0 ± 3.2 vs. 5.7 ± 3.4) scores were higher (both p = 0.010), while QoL was lower (55.4 ± 8.1 vs. 59.5 ± 7.8, p < 0.001). In adjusted models, access barriers (OR per point = 1.3, 95% CI 1.1–1.6), but not abortion history, predicted non-use of modern contraception. QoL correlated strongly with PHQ-9 (r = −0.6) and WHO-5 (r = 0.5; both p < 0.001). Latent class analysis identified a “high-barrier, distressed, abortion-experienced” profile with the poorest mental health and QoL. Conclusions: Structural access barriers and current depressive and anxiety symptoms, rather than abortion history alone, were key correlates of contraceptive gaps and reduced QoL, underscoring the need for integrated reproductive and mental health care. 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

Background: Intimate partner violence (IPV) represents a major public health problem in Europe, with significant physical, psychological, and social consequences. Nurses are often the first professionals capable of detecting early signs of IPV, yet they lack validated instruments to assess their clinical competency in detection, evaluation, documentation, and intervention. This study aimed to develop and validate the Intimate Partner Violence Nursing Competency Scale (IPVNCS), aligned with the Nursing Intervention Classification (NIC 6403). Methods: A cross-sectional psychometric study was conducted among registered nurses in the Community of Madrid. A 30-item Likert-type self-administered instrument (1–5 scale) was developed based on NANDA, NIC 6403, and NOC frameworks. A total of 202 nurses participated. Reliability was assessed through Cronbach’s alpha. Construct validity was examined using exploratory factor analysis (EFA) with Promax rotation and confirmatory factor analysis (CFA) using AMOS 26. Ethical approval was obtained (CEU San Pablo, code 843/24/104). Results: After item refinement, 26 items remained across four dimensions: (1) Intervention and Referral, (2) Detection and Assessment, (3) Documentation and Recording-keeping, (4) Psychosocial Support. The instrument showed excellent reliability ($\alpha$ = 0.97). KMO was 0.947 and Bartlett’s test was significant (p < 0.001). CFA demonstrated satisfactory fit: ${\chi }^2$/df = 2.066, RMSEA = 0.073, CFI = 0.92, TLI = 0.91, NFI = 0.86. The final model adequately represented the latent structure. After debugging, its psychometric properties were significantly improved. Four redundant items were eliminated, achieving internal consistency ($\alpha$ = 0.97), a KMO value of 0.947 and a significant Bartlett’s test of sphericity. It showed a better fit, according to ${\chi }^2$/df = (2.066); Parsimony = (720.736); RMR (0.0529; RMSEA (0.073); NFI (0.860); TLI (0.910) and CFI (0.920). The final model provides an adequate representation of the latent structure of the data. This study provides initial evidence of construct validity and internal consistency reliability of the IPVNCS. Conclusions: The IPVNCS is a valid and reliable tool to assess nursing competencies for clinical management of IPV. It supports structured evaluation across four core nursing domains, enabling improved educational planning, clinical decision-making, and quality of care for victims. The scale fills a gap in clinical nursing assessment tools and can support protocol development in emergency, primary care, and hospital settings. Full article

Background/Objectives: Oral frailty and hypofunction in older adults are strongly associated with declines in nutritional status, physical function, swallowing ability, and overall health. Isolated interventions usually fail to achieve sufficient improvement since these conditions result from interrelated biological, psychological, and social factors. Multidisciplinary approaches combining oral management, nutritional support, and physical rehabilitation have shown promise. This narrative review synthesized evidence from 15 studies examining multifaceted interprofessional interventions across hospitals, communities, long-term care facilities, and home-care settings. Methods: A structured search of PubMed and Web of Science (2000–2025) identified original studies assessing oral, nutritional, or physical outcomes in older adults post-interprofessional interventions. Fifteen eligible studies were extracted; the findings were integrated using narrative synthesis owing to design and outcome heterogeneity. Results: Educational multidisciplinary interventions improved oral hygiene, caregiver awareness, and oral motor function. Multidisciplinary rehabilitation and multidomain programs consistently improved tongue pressure, swallowing function, mastication ability, appetite, body composition, activities of daily living, and oral intake resumption. Nutrition support team-delivered interventions reduced aspiration risks and improved oral environment and swallowing function. Community-based programs using munchy meals and combined exercises enhanced oral and physical functions. Social participation provided psychological benefits. Home-care dysphagia rehabilitation enabled 69% of tube-fed patients to resume oral intake. Conclusions: This narrative review supports a triadic, interprofessional approach in geriatric care, highlighting consistent improvements in oral function through integrated oral, nutritional, and rehabilitative interventions. Full article

Pharmacy-based point-of-care (POC) services have evolved from pilot initiatives to an essential component of decentralized healthcare delivery. These services—ranging from rapid infectious-disease screening to chronic-disease monitoring—improve access, reduce diagnostic delays and empower pharmacists as front-line healthcare providers. The present paper is an updated, in-depth review of the evolution of pharmacy POC services worldwide, combined with the analysis of the regulatory and educational frameworks supporting implementation, technological drivers such as biosensors, mobile health and artificial intelligence and in-depth socioeconomic considerations. Benefits for patients, pharmacies and healthcare systems are contrasted with challenges including variable reimbursement, uneven regulatory oversight and workforce preparedness. Full article

Background/Objectives: Self-care is a cornerstone of healthy aging and chronic disease management; however, evidence on the most effective intervention models for improving quality of life in older adults with chronic non-communicable diseases (NCDs) remains fragmented. This review aimed to evaluate the effectiveness of self-care interventions in promoting quality of life and health outcomes in older adults with NCDs. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251040613). Randomized and non-randomized clinical trials published between 2019 and 2024 were retrieved from Scopus, Web of Science, and EBSCOhost. Eligible studies included adults aged ≥60 years with NCDs receiving self-care interventions. Data extraction and risk of bias assessment were independently performed using Joanna Briggs Institute tools. Results: Twenty-nine studies involving 7241 older adults were included. Self-care interventions comprised nurse-led educational programs, digital health strategies, community- and peer-based approaches, and person-centered care models. Multicomponent and continuous interventions demonstrated consistent improvements in physical and psychological domains of quality of life, self-efficacy, autonomy, symptom management, and treatment adherence. Digital interventions enhanced monitoring and engagement, although their effectiveness varied according to sensory and health literacy limitations. Conclusions: Structured, person-centered, and nurse-led self-care interventions are effective in improving quality of life and autonomy among older adults with NCDs. These findings support their integration into primary and community-based care, reinforcing their relevance for clinical practice, care planning, and the development of assistive and educational strategies in aging care. Full article

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used analgesics. However, their inappropriate or excessive use may lead to serious adverse effects. The aim of the study was to analyze behavioral patterns and attitudes toward the use of over-the-counter (OTC) NSAIDs, as well as the perception of risks associated with their use. Methods: A cross-sectional survey was conducted among 567 respondents. An anonymous questionnaire consisting of 26 items was used, addressing sociodemographic characteristics, frequency of reading drug information leaflets, frequency of NSAID use, and awareness of potential adverse effects associated with these medications. Results: The demographic factors significantly influenced NSAID-related behaviors. Women were significantly more likely than men to read drug information leaflets and reported more frequent use of OTC NSAIDs. Older respondents exhibited greater adherence to the principles of responsible NSAID use. Higher educational attainment was associated with more frequent and attentive reading of drug information leaflets. Urban residents reported higher median frequencies of NSAID use, whereas students demonstrated greater awareness of potential NSAID adverse effects compared with non-students. Conclusions: The results reveal complex patterns of NSAID consumption and underscore the need for implementing targeted public health interventions. Full article

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and thematically analyzed by two coders, with discrepancies resolved by consensus and reviewed by a third researcher. Results: Participants identified five key dyadic themes and four HCP themes. Adolescents described the gameplay as intuitive and enjoyable, highlighting interactive challenges and realistic avatars. Parents valued the clarity of HPV information and noted that the game helped initiate health-related conversations. Both adolescents and parents suggested enhancements including voice narration and greater customization and agreed that the game was well suited for 10–15-min clinic wait times, with text messaging preferred for follow-up. HCPs emphasized challenges such as parental hesitancy and competing clinical demands and viewed the game as a feasible adjunct to support vaccine-related discussions. Conclusions: Findings suggest the acceptability, usability, and perceived clinical applicability of a brief, clinic-based digital game for HPV-related education and engagement among adolescents and their parents. Full article

Background: Large language models (LLMs) are becoming progressively integrated into clinical practice; however, their role in cardiovascular (CV) prevention remains unclear. This review synthesizes current evidence on LLM applications in preventive cardiology and proposes a governance framework for their safe translation into practice. Methods: We conducted a comprehensive narrative review of literature published between January 2015 and November 2025. Evidence was synthesized across three functional domains: (1) patient applications for health literacy and behavior change; (2) clinician applications for decision support and workflow efficiency; and (3) system applications for automated data extraction, registry construction, and quality surveillance. Results: Evidence suggests that while LLMs generate empathetic, guideline-concordant patient education, they lack the nuance required for unsupervised, personalized advice. For clinicians, LLMs effectively summarize clinical notes and draft documentation but remain unreliable for deterministic risk calculations and autonomous decision-making. System-facing applications demonstrate potential for automated phenotyping and multimodal risk prediction. However, safe deployment is constrained by hallucinations, temporal obsolescence, automation bias, and data privacy concerns. Conclusions: LLMs could help mitigate structural barriers in CV prevention but should presently be deployed only as supervised “reasoning engines” that augment, rather than replace, clinician judgment. To guide the transition from in silico performance to bedside practice, we propose the C.A.R.D.I.O. framework (Clinical validation, Auditability, Risk stratification, Data privacy, Integration, and Ongoing vigilance) as a roadmap for responsible integration. Full article

Language delay is a fairly frequent phenomenon in young children, with associated negative outcomes across the academic, social, and emotional areas of their lives. This qualitative study was designed to deeply examine mothers’ experiences and the ways in which they promote the development of their children with language delay. Twenty mothers of children with language delay (aged four to nine), who were recruited through advertisements posted by language preschool/school teachers, participated in semi-structured interviews. Thematic analysis revealed themes relating to the challenges of raising a child with language delay, along with how mothers create a safe emotional environment for their child’s development, find opportunities and encourage social interactions, utilize their day-to-day routines to promote language and learning, and actively engage with their children’s educational framework. These results highlight how mothers serve as the “architects” of their children’s development. Despite the difficulties they encounter, such as high stress levels, mental health challenges, isolation, and guilt, and the far-reaching implications of their children’s language delay on their day-to-day living, mothers shape the home environment to promote their children’s academic, social, and emotional development. The study thus indicates that mothers intuitively promote their children’s development and that practitioners and others can support mothers’ own initiatives along with providing guidance. Full article

Objectives: This study aimed to evaluate adherence to therapy in hypoparathyroidism and related endocrine–metabolic disorders and to assess its association with biochemical outcomes, hypocalcemia episodes, and health-related quality of life (HRQoL). Methods: In accordance with PRISMA 2020 guidelines, PubMed, Scopus, Google Scholar, and the Cochrane Library were searched until September 2025. The eligible studies were randomized controlled trials, cohort, case–control studies, cross-sectional, and observational studies that reported adherence to calcium/vitamin D or recombinant parathyroid hormone therapy. Results: twenty-three studies were included in the qualitative synthesis, and 11 studies were included in the quantitative meta-analysis. Pooled medication adherence compliance was 70–82% and improved with simplified regimens and the use of recombinant PTH. Additionally, this was also associated with an improvement in HRQoL (p < 0.0001) and a lower risk of hypocalcemia (p < 0.0001). Conversely, multifactorial regulation was observed as the level of adherence had no significant effect on serum calcium levels (p = 0.7116). Sensitivity analyses demonstrate the strength of findings and indicate no significant publication bias. Conclusions: Medication adherence is a key factor in determining patient-centered outcomes in hypoparathyroidism. Better adherence is linked to a higher quality of life and fewer episodes of hypocalcemia, while its effect on biochemical parameters seems minimal. Educational programs, simple treatment regimens, and wider access to rhPTH therapy can be used to improve patient management of the disease over time. Full article

Background/Objectives: Obesity has a high prevalence and is associated with many health risks. Minimal effects from behavioral obesity treatments might be linked to their atheoretical dependence on simply educating participants on healthy eating and increased physical activity/exercise, rather than evolving behavior-change methods through theory-based research. The use of pharmacologic interventions has recently overtaken bariatric surgery in medically based efforts to obtain greater weight losses than through behavioral means. Methods: The present longitudinal observational study aimed to extend earlier treatment-associated findings concerned with the order of emphasizing 3-, 6-, and 9-month changes in the theory-driven psychosocial constructs of self-regulation, self-efficacy, and mood associated with 12-month improvements in weight-loss behaviors. The “parent study” of women with obesity (N = 106) found significant paths through changes in self-regulation → mood → self-efficacy and mood → self-regulation → self-efficacy. In the present extension of that investigation, only those participants who did not already complete recommended physical activity amounts and consume recommended portions of fruits/vegetables at baseline were included (N = 73). Results: Only paths from changes in mood → self-regulation → self-efficacy were significantly associated with 12-month improvements in both physical activity and dietary behaviors. A mean weight change of −5.2 kg, or −5.5% from baseline weight, was found. Baseline scores in emotional eating and anxiety significantly moderated the mood–self-regulation change relationships within the significant paths. Conclusions: Findings suggested that future treatment contents focus on early physical activity-associated improvement in mood because of its association with increased usage of treatment-developed self-regulatory skills. Those skills should then be leveraged because of their association with feelings of ability (i.e., self-efficacy) to overcome lifestyle barriers to weight-loss behavior changes. Further improvements in behavioral obesity treatments should be reconsidered as either stand-alone modalities or, after appropriate testing, as an adjunct to medical means. Full article

Green space equity is increasingly recognized as a critical environmental condition for healthy aging, yet existing research often overlooks how different green space attributes—accessibility and diversity—are associated with distinct dimensions of older adults’ health. Limited attention has been paid to their nonlinear threshold effects or to the social pathways through which green spaces influence health outcomes. Using the United States county-level panel data from 2020 to 2023, this study integrates fixed-effects models, Extreme Gradient Boosting (XGBoost), and mediation analysis to examine the associations between green accessibility measured by the Two-Step Floating Catchment Area (2SFCA) method, and green diversity measured by the Shannon Index, on the general, physical, and mental health of older adults. Findings indicate that (1) higher green accessibility is associated with better general health, whereas green diversity shows a stronger association with physical health, reflecting its link to more heterogeneous ecosystem service environments. (2) Green accessibility demonstrates the threshold effect, in which the strength of association with health becomes steeper once accessibility approaches higher levels. (3) Green space equity is linked to health partly through social structures. Education clustering and marital stability mediate the associations with general health, while mental health appears to depend more on the social interaction opportunities embedded within green environments than on their physical attributes alone. The study proposes an integrated “physical environment–social structure–health outcome” framework and a threshold-oriented spatial intervention strategy, highlighting the need to prioritize improvements in green accessibility in underserved areas and prioritizing green diversity and age-friendly social functions where accessibility is already high. These findings offer evidence for designing inclusive, health-oriented urban environments for aging populations. Full article

Since the COVID-19 pandemic, wastewater monitoring has become an additional tool in the surveillance of infectious diseases. Many EU countries put wastewater surveillance systems (WSS) in place to track SARS-CoV-2 and its variants and other pathogens, such as the influenza virus or Respiratory syncytial virus (RSV). In Germany, several research and pilot projects funded by the EU, the Federal Ministry of Education and Research, the Federal Ministry of Health, and projects at Federal State level have been launched in the last four years. In Germany, wastewater monitoring was not implemented as a public health tool before the COVID-19 pandemic, but in September 2022, it has been legally determined in the German infection protection act (Infektionsschutzgesetz, IfSG). As Germany is a federal state, competencies in epidemic management partly belong to the 16 federal states (“Länder”). In the federal states, the local health authorities at the county (“Kreise”) level also have specific risk management and communication competencies. Furthermore, WSS has been incorporated into the revised Urban Wastewater Treatment Directive (EU) 2024/3019. For this reason, the federal states and local health authorities play a pivotal role in successfully implementing wastewater monitoring as a supplementary component of disease surveillance in Germany. Between November 2021 and August 2022, the federal state of Thuringia, Germany, supported a pilot study to implement a surveillance system for SARS-CoV-2-RNA in wastewater of 23 wastewater treatment plants in 17 counties in Thuringia. Here, we describe the study design and the system behind the logistics and the planning, and we provide an overview of the options for involving the public health service. Furthermore, the possibilities for IT concepts and approaches to innovative AI solutions are shown. We also aim to explore the feasibility and potential barriers to further implementing wastewater surveillance as a supplementary public health tool in Thuringia. Full article