Search Results (1,183)

Background: Exposure-based cognitive behavioral therapy (Ex-CBT) is widely seen as the gold-standard treatment for anxiety and obsessive-compulsive disorder (OCD). Yet, minoritized youth are underrepresented in efficacy studies, raising questions about the applicability of Ex-CBT to minoritized youth. Effectiveness data suggest systematic adaptation of Ex-CBT to address youth culture and context is likely needed, and many clinicians make adaptations and augmentations in practice. However, research on the specific strategies clinicians use to address their youth clients’ culture and context within anxiety and OCD treatment is lacking. In the current study, we assess practice-based adaptations, augmentations, and process-based approaches utilized when delivering treatment to youth for OCD and anxiety in public mental health clinics. Methods: We conducted qualitative interviews with 16 clinicians from both specialty anxiety and general mental health clinics serving youth with anxiety or OCD in the public mental health system. Participating clinicians had a mean age of 32.19 (SD = 5.87) and 69% of therapists identified as female; 69% identified as White, 25% identified as Asian, and 6% as Black or African American. In qualitative interviews, clinicians shared how they addressed clients’ culture and context (e.g., social identities, stressors and strengths related to social identities and lived environment). Thematic analysis identified the strategies clinicians employed to address culture and context. Results: Clinicians reported incorporating culture and context through process-based approaches (e.g., building trust gradually, considering clients’ social identity stressors, engaging in self-awareness to facilitate cultural responsiveness) and through culturally adapting and augmenting treatment to promote person-centered care. Core strategies included proactive and ongoing assessment of clients’ cultural and contextual factors, adapting exposures and augmenting Ex-CBT with strategies such as case management and discussion of cultural context, and taking a systems-informed approach to care. Conclusions: Examining practice-based adaptations, augmentations, and process-based approaches to treatment for minoritized youth with OCD or anxiety can inform efforts to understand what comprises person-centered culturally responsive Ex-CBT. Empirical testing of identified strategies is a needed area of future research. Full article

As medical technology develops and digital demands grow, personal health records (PHRs) are becoming more patient-centered than before based on cloud-based health information exchanges. While enhancing data accessibility and sharing, these systems present privacy and security issues, including data breaches and unauthorized access. We developed a post-quantum, group-oriented encryption scheme using the Crystal-Kyber Key encapsulation mechanism (KEM). Leveraging lattice-based post-quantum cryptography, this scheme ensures quantum resilience and chosen ciphertext attack security for layered cloud PHR environments. It supports four encryption modes: individual, group, subgroup-specific, and authorized subgroup decryption, meeting diverse data access needs. With efficient key management requiring only one private key per user, the developed scheme strengthens the privacy and security of PHRs in a future-proof, flexible, and scalable manner. Full article

Family empowerment is a key component of effective family-centered practices in healthcare, mental health, and educational services. The Family Empowerment Scale (FES) is the most commonly used instrument to evaluate empowerment in families raising children with emotional, behavioral, or developmental disorders. Despite its importance, the FES for diverse populations, especially Latinx parents, has rarely been evaluated using innovative psychometric approaches. In this study, we evaluated key dimensions and psychometric evidence of the Family Empowerment Scale (FES) for 96 Latinx parents of children with intellectual and developmental disabilities (IDD) in the United States using an exploratory graph analysis (EGA). The EGA identified a five-dimensional structure, and EGA models outperformed the original CFA 3-factor models for both parents of children with autism and other disabilities. This study identified distinct, meaningful dimensions of empowerment that reflect both shared and unique empowerment experiences across two Latinx parent groups. These insights can inform the design of culturally responsive interventions, instruments, and policies that more precisely capture and boost empowerment in Latinx families. This study contributes to closing a gap in the literature by elevating the voices and experiences of Latinx families by laying the groundwork for more equitable support systems in special education and disability services. 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

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

Background: Social media platforms play a crucial role in contemporary healthcare, facilitating patient participation and enabling communication among healthcare workers, as well as serving as a platform for medical awareness and advocacy. Social media use among healthcare workers has increased to 91%, with 65% using it for health promotion purposes. Nonetheless, current studies have not properly and empirically explored its dimensions. Objectives: This study therefore examines social media dimensions and the productivity of healthcare workers. Methods: Leveraging the professional productivity theory and digital engagement theory, the study employs SPSS to analyze the gathered data through a partial least squares (PLS-SEM) approach to explore social media dimensions and productivity among healthcare workers in a Nigerian Tertiary Hospital. Based on a cross-sectional descriptive survey design and stratified random sampling method, 344 medical workers were analyzed. Findings: The study found that fear of missing out, information sharing, social influence, trust, and social media usage have a significant impact on the productivity of healthcare professionals. Conclusions: This research adds to the growing academic research on the capabilities of social media within the circular economic systems aimed at advancing healthcare delivery in developing economies. The research offers a method for maximizing the use of social media within healthcare settings to foster enhanced healthcare outcomes, particularly productivity. Full article

The European Health Technology Assessment (HTA) regulation (HTAR) came into effect in January 2025 and impacts the HTA process in all European Member States. Member States must give due consideration to the joint clinical assessment (JCA) report. This may require adaptations at the national level. This paper describes the anticipated changes to the Dutch national HTA process and how the Dutch National Health Care Institute (Zorginstituut Nederland, ZIN) prepared for this, because sharing experience between Member States can be of general interest for future expansion of the EU HTAR. ZIN’s implementation activities were facilitated by a project-governance structure and by a continuous gap analysis of the current national assessment and appraisal process of medicinal products, resulting in a concrete action plan. The implementation of the HTAR has two major implications for ZIN’s HTA process, namely that the scoping phase starts much earlier and that the JCA report is the starting point for the national assessment. Gaps, challenges and issues were identified in the categories: information and knowledge, IT and template, communication and stakeholder engagement, capacity and resources, and financial aspects. Based on a thorough and well-defined implementation plan, ZIN is ready to implement the HTAR in national HTA processes and to take on (co-)assessor roles for JCA of medicinal products in 2025. Full article

Geographic disparities threaten equitable access for children to health-promoting safe green spaces, and quality early education in the communities in which they live and grow. To address gaps in the field, we integrated the fields of developmental psychology, public health, and environmental science to examine, at the population level, associations between the environmental burden, socioeconomic vulnerability, and kindergarten readiness in a diverse urban county. Three administrative datasets were integrated through an early childhood data sharing research partnership in Miami-Dade County. The Bruner Child Raising Vulnerability Index, the five domains of the Environmental Burden module from the Environmental Justice Index, and public school kindergarten readiness scores were aggregated at the census tract level. Analysis of variance and multiple regression analyses found associations between socioeconomic vulnerability and race/ethnicity. The socioeconomic vulnerability levels were highest in census tracts with a higher percentage of Black residents, compared to all other races/ethnicities. Areas of greater social vulnerability had lower kindergarten readiness and a higher environmental burden. A higher environmental burden predicted lower kindergarten readiness scores above and beyond race/ethnicity and socioeconomic vulnerability. The findings advance our understanding of global challenges to sustainable healthy child development, such as the persistence of a disproportionate environmental burden and inequitable access to resources such as green spaces and early education programs. The present study results can inform community health improvement plans to reduce risk exposures and promote greater access to positive environmental and educational resources for all children. Full article

Plasmodium vivax malaria continues to pose a significant and enduring public health challenge across the Americas. Transmission-blocking vaccines (TBVs), which target gametocyte surface antigens such as Pvs47 and Pvs48/45, are being investigated as promising tools to interrupt transmission and advance toward disease elimination. To investigate the genetic diversity and phylogeographic structure of the pvs47 and pvs48/45 genes in P. vivax, we conducted molecular analyses on samples collected from seven malaria-endemic regions of Honduras using PCR-based sequencing, population genetics, and phylogenetic approaches. This study presents the first complete characterization of the pvs47 gene and expands the available data on pvs48/45 in P. vivax from Honduras. We observed a low level of genetic diversity with no evidence of geographic structuring within the country. At a global scale, Honduran sequences shared variants with other Latin American strains and exhibited region-specific amino acid signatures. These findings suggest that local selective pressures, possibly driven by mosquito vector compatibility, are shaping the evolution of these TBV candidate genes. Our results underscore the importance of regional surveillance to inform the development and deployment of effective transmission-blocking strategies. Full article

Background/Objectives: Neurofibromatosis type 1 (NF1) and Noonan syndrome spectrum disorders (NSSD) are the most common RASopathies, resulting from germline mutations that affect the RAS-MAPK signaling pathway. Both are associated with increased risk for neurodevelopmental and psychiatric conditions, yet few studies have used structured diagnostic interviews to compare their psychiatric comorbidities. Methods: We conducted clinician-administered DSM-5 diagnostic assessments (KSADS) in 123 children with RASopathies (NF1 = 29, NSSD = 94; ages 5–15). Diagnosis prevalence was compared within each group and to population-based estimates. Results: Psychiatric diagnoses were highly prevalent, at 79.3% in NF1 and 76.6% in NSSD, with ADHD (NF1 = 72.4%, NSSD = 51.1%) and anxiety disorders (NF1 = 37.9% and NSSD = 43.6%) being the most common, rates substantially higher than those reported in general population estimates. Behavioral and sleep disorders were identified in approximately 25% of both groups. Notably, social anxiety disorder was identified in 14.9% of NSSD but not in NF1. Full-scale IQ did not significantly differ by diagnosis status. Specific anxiety disorders, elimination disorders, obsessive–compulsive disorder, and post-traumatic stress disorder were characterized, expanding the known psychiatric phenotype of RASopathies. Conclusions: Children with NF1 and NSSD demonstrate similarly high rates of ADHD, anxiety, and behavioral disorders compared to the general population; in addition, we report sleep disorders in NSSD and characterize psychiatric disorders not previously described in RASopathies. The shared psychiatric profiles may reflect the common effect of RAS-MAPK pathway dysregulation on psychiatric outcomes. These findings highlight the need for early, syndrome-informed mental health screening and intervention in the clinical care of individuals with RASopathies. Full article

This study aimed to develop a Causal Loop Diagram (CLD) to visualise how urban environment factors impact dementia and cognitive decline, and potential causal mechanisms. In Group Model Building workshops with 12 researchers, a CLD was created to identify factors contributing to cognitive decline, and the dynamic interrelationships between these factors. The factors were classified in nine main themes: urban design, social environment, travel behaviours, urban design by-products, lifestyle, mental health conditions, disease/physiology, brain physiology, and cognitive decline outcomes. Five selected feedback loops illustrated some dynamics in the system. The workshops helped develop a shared language and understanding of different perspectives from an interdisciplinary team. The CLD creation was part of a comprehensive modelling approach based on experts’ knowledge which informed other research outputs such as an evidence gap map and an umbrella review, helped the identification of environmental variables for future studies and analyses, and helped to identify future possible systems-based interventions to prevent cognitive decline. The study highlights the utility of CLDs and Group Model Building workshops in interdisciplinary research projects investigating complex systems. Full article

Combining a large collection of patient data and advanced technology, healthcare organizations can excel in medical research and increase the quality of patient care. At the same time, health records present serious privacy and security challenges because they are confidential and can be breached through networks. Even traditional methods with federated learning are used to share data, patient information might still be at risk of interference while updating the model. This paper proposes the Privacy-Preserving Federated Learning with Homomorphic Encryption (PPFLHE) framework, which strongly supports secure cooperation in healthcare and at the same time providing symmetric privacy protection among participating institutions. Everyone in the collaboration used the same EfficientNet-B0 architecture and training conditions and keeping the model symmetrical throughout the network to achieve a balanced learning process and fairness. All the institutions used CKKS encryption symmetrically for their models to keep data concealed and stop any attempts at inference. Our federated learning process uses FedAvg on the server to symmetrically aggregate encrypted model updates and decrease any delays in our server communication. We attained a classification accuracy of 83.19% and 81.27% when using the APTOS 2019 Blindness Detection dataset and MosMedData CT scan dataset, respectively. Such findings confirm that the PPFLHE framework is generalizable among the broad range of medical imaging methods. In this way, patient data are kept secure while encouraging medical research and treatment to move forward, helping healthcare systems cooperate more effectively. Full article

Background/Objectives: Tongue thrust (TT) occurs when abnormal tongue movements cause anterior tongue placement with pressure and contact against or between the teeth, potentially affecting the oral phase of swallowing, impacting eating, breathing and speaking. There is limited literature on the diagnostic and treatment approaches for TT, as well as involvement of health practitioners in its management. This study aims to examine the current knowledge and practices related to TT diagnosis and treatment among health professionals in Australia. Methods: A two-phase explanatory sequential mixed methods approach was adopted, comprising an online survey that collected participants’ demographic information and details on assessment, diagnosis, management, referral practices, and relevant experience and training. Phase one involved 47 health professionals from various disciplines in Australia who completed an online survey in its entirety. Phase two included in-depth interviews with seven speech-language pathologists (SLPs) to gain further insights into their experiences in managing TT. Survey data were analysed descriptively, and interview data was analysed thematically. Results: Most participants diagnosed TT using clinical assessments, such as general observation and oral motor examinations. Treatment approaches commonly included orofacial myofunctional therapy and the use of myofunctional devices. Interviews with SLPs identified four key themes: tongue thrust as a symptom rather than a diagnosis, facilitators to effective treatment, multidisciplinary approaches to management, and training and education gaps in clinical practice. Conclusions: This study provides valuable insights into how TT is identified, assessed, diagnosed, and managed by health professionals in Australia. It highlights the perspectives of SLPs on treatment approaches, as well as their views on the availability and adequacy of training and education in this field. The findings suggest the need for a broader understanding of TT management, emphasising the importance of multidisciplinary collaboration and professional development. These insights are globally relevant, as they stress the shared challenges and the value of international collaboration in improving TT diagnosis and treatment practices. Full article

Patient-generated health data (PGHD) enhance traditional healthcare by enabling continuous monitoring and supporting personalized care, yet concerns over privacy, security, and integration into existing systems hinder broader adoption. This study examined the perceptions, awareness, and concerns of patients and caregivers regarding PGHD and assessed their willingness to share such data for clinical, research, and commercial purposes. A cross-sectional survey was conducted from 6 to 12 November 2023, involving 400 individuals with experience using PGHD. Participants completed structured questionnaires addressing health information management, PGHD usage, and attitudes toward its application. PGHD was most commonly used by patients with chronic conditions and guardians of minors, with tethered personal health record apps frequently utilized. Respondents identified improved self-management and better access to information as key benefits. However, significant concerns about data privacy and security emerged, especially regarding non-clinical use. Younger adults, particularly those in their 20s, showed lower willingness to engage with PGHD due to heightened privacy concerns. These findings suggest that, while support for clinical use of PGHD is strong, barriers related to trust and consent remain. Addressing privacy concerns and simplifying consent processes will be essential to promote equitable and responsible PGHD utilization across diverse patient populations. Full article

Sexual dysfunction is a prevalent and often under-addressed concern among prostate cancer survivors, significantly affecting quality of life for patients and their partners. The True North Sexual Health and Rehabilitation eClinic (SHAReClinic) is a virtual, biopsychosocial intervention developed to improve access to sexual health support for prostate cancer survivors and their partners. This study used a qualitative descriptive design to examine barriers and facilitators influencing the integration of SHAReClinic into oncology care across nine Canadian health care centres. Semi-structured interviews were conducted with 17 knowledge users, including health care providers and institutional leaders. Data were analyzed using a hybrid deductive–inductive thematic approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Participants described SHAReClinic as a much-needed resource, particularly in the absence of standardized sexual health pathways in oncology care. The virtual format was seen as accessible and well suited to addressing sensitive topics. However, limited funding, lack of institutional support, and workflow integration challenges emerged as primary barriers to implementation. Findings offer practical, theory-informed guidance for integrating SHAReClinic into oncology care and highlight key considerations for developing sustainable and scalable survivorship care models. Full article