Search Results (8,466)

Background/Objectives: Current menopause assessment instruments primarily evaluate vasomotor, somatic, and urogenital symptoms, with limited attention to oral, sensory, and integrated psychological domains. Evidence that oral tissues are estrogen-responsive suggests that oral symptoms may represent an important but underrecognized component of menopausal burden. This study aimed to develop and provide initial psychometric validation of the Multidimensional Menopausal Burden Questionnaire (MMBQ-44), a 44-item instrument integrating systemic, oral, and psychological symptoms. Methods: A cross-sectional validation study was conducted in 308 women aged 45–65 years (perimenopausal n = 66, menopausal n = 40, postmenopausal n = 202). The MMBQ-44 combined items from the Menopause Rating Scale (MRS), Xerostomia Inventory (XI), Oral Health Impact Profile-14 (OHIP-14), and psychological measures derived from the PHQ-9, GAD-7, and HADS. Instrument development included expert review, cognitive interviewing, and field testing. Psychometric evaluation assessed item performance, internal consistency, factor structure, discriminant validity, and known-groups validity. Exploratory factor analysis used principal axis factoring with promax rotation, with factor retention determined by parallel analysis. Results: Internal consistency was good to excellent across domains (Cronbach’s α: 0.813–0.941; McDonald’s ω: 0.864–0.953). All corrected item–total correlations exceeded 0.30. The questionnaire showed strong factorability (KMO = 0.931; Bartlett’s χ² = 9006.2, p < 0.001). Parallel analysis identified four factors explaining 48.6% of total variance. Psychological and OHIP domains emerged clearly, whereas several MRS and XI items cross-loaded onto related factors. Most HTMT ratios were below 0.85, supporting discriminant validity. Floor effects were observed for OHIP (37.0%) and XI (23.4%). Known-groups validity was modest, with OHIP scores differing significantly across menopausal stages. Conclusions: The MMBQ-44 demonstrates strong reliability and acceptable construct validity as an integrative screening instrument for menopausal burden. Further confirmatory studies and refinement of oral symptom items are warranted. Full article

An ethnographic study employing 72 qualitative interviews with agricultural producers and associated water decision-makers concerning farm climate change adaptation in Saskatchewan, Canada concludes that farm size matters. Inductively we established a distinction of 2025 hectares as the differentiation between small and large agricultural farms; very small farms (less than 810 hectares) and one very large farm (51,030 hectares) were most vulnerable. Our research deviates from prior research that has concluded either large or small farms are more adaptive. In Saskatchewan, large farms mitigate climate impact risk of drought or flood over a bigger area, and have institutional and financial capacity to undertake adaptations. However, small farmers embrace more adaptation through environmental farm practices. Unlike other areas of the world where farms are becoming smaller and fragmenting, the trend is toward larger farms. Farmers thought of their farms as businesses; however, their multi-generational connection to the land was strong, and the concept of sustainability was rejected as farmers wanted to leave the land in a better state for future generations. The most important adaptive strategy identified, regardless of size, was ensuring the financial health of a farm through cashflow and the ability to pay expenses and debt. Full article

Plant-based traditional medicine underpins primary health care across rural areas, yet its long-term continuity depends on both the transmission of local knowledge and the management of the plant resources that sustain this practice. This study aimed to identify medicinal plant species in Colcamar district (Amazonas, Peru) that combine high cultural importance with deficient reported environmental management, using a sustainability-oriented cultural–environmental prioritisation index. An observational, analytical cross-sectional study was conducted in five annexes of Colcamar district. Household heads and traditional medicine practitioners (n = 87) were interviewed during a single ethnobotanical field campaign in 2025, generating 1038 plant-informant records for 102 species with taxonomic identification and at least one valid plant-informant record. Cultural importance was estimated using the relative frequency of citation (RFC). Environmental management was assessed using a custom instrument of 11 indicators evaluated through exploratory factor analysis, Cronbach’s alpha, and intraclass correlation by informant. The factor analysis yielded a two-factor solution (KMO = 0.786; 50.6% of variance explained): socio-economic valuation and environmental management. Internal consistency was acceptable for the total scale (alpha = 0.826) and for each retained factor (alpha ≥ 0.85). Three indicators with intraclass correlation below 0.10 (source of acquisition, cultivation technique, and agroecosystem practices) varied across species and were used to build the environmental management index (EMI). Hierba santa (Cestrum auriculatum Lindl.) showed the highest cultural importance (RFC = 0.540), whereas pava (Petiveria alliacea L.) showed the lowest environmental management (EMI = 0.250), defining priority groups for management intervention. Exploratory regression suggested an unconfirmed trend towards higher socio-economic valuation among expert informants, although this finding should be interpreted cautiously because the global model was not statistically significant and only seven informants were classified as experts. The index should be interpreted as a sustainability-oriented prioritisation tool rather than as a direct ecological estimate of population status, regeneration, or harvesting pressure. Full article

Introduction: Long COVID-19 is a complex and multifaceted condition characterized by persistent and fluctuating symptoms extending beyond the acute phase of infection. Aim: To explore the health and support experiences of the Spanish population living with long COVID-19. Methodology: A qualitative study with an interpretative phenomenological approach was used. Semi-structured interviews were conducted over 10 months (2023–2024) across 17 Spanish provinces. The sample included 36 participants. Results: Participants reported persistent and fluctuating symptoms that severely limited daily functioning and generated anxiety, depression, and post-traumatic distress. Chronic fatigue and cognitive impairment affected social participation and work performance, frequently leading to absenteeism and job loss. Delayed diagnosis limited professional knowledge, and perceived lack of credibility contributed to dissatisfaction with healthcare services. Family members and patient associations were key sources of emotional and practical support. Conclusions: Long COVID-19 has a multidimensional impact that requires a comprehensive and multidisciplinary approach. Participants’ narratives reveal how underestimation of symptoms, delayed diagnosis, social stigma, limited healthcare and social support, additional family burdens, and disrupted work and social routines create complexity in care and challenge existing health and economic systems. Full article

Introduction: Improving adult pneumococcal vaccination is a public-health priority in Romania, and evidence regarding patient-level outcomes following different approaches to physician training remains limited. Materials and methods: This non-randomised, multicentre, quasi-experimental implementation study examined patient-level changes across three geographically distinct Romanian settings between August and November 2025. Physicians in Iași and Dolj counties received in-person training combining medical content with communication techniques based on motivational interviewing, whereas physicians in the webinar group received online medical training without a dedicated communication module. Eligible adult patients completed questionnaires before and after counselling and reported whether they had been vaccinated or had scheduled a vaccination appointment. Results: The analysis included 295 questionnaire pairs from patients nested within 29 physicians. Baseline attitudes differed markedly across settings (composite score of 5.64 in the webinar group, 5.29 in Dolj County, and 4.09 in Iași County; p < 0.001), as did strong baseline vaccination intention (75.6%, 48.1%, and 27.2%, respectively). Using a composite score comprising all seven attitude items, with item 7 reverse-coded and vaccination intention analysed separately, the cluster-robust group-by-time model indicated different mean changes between settings (global p = 0.001): +0.28 in the webinar group, +1.02 in Iași, and +0.60 in Dolj. Strong vaccination intention increased within each setting, but the magnitude of change did not differ between settings (group-by-time p = 0.929). The combined self-reported vaccination-or-scheduling outcome was observed in 81.5% of patients in the webinar group, 49.4% in Iași, and 73.3% in Dolj; after adjustment for baseline intention, there was no longer evidence of an overall group difference (p = 0.651). Discussion and conclusions: Because training approach, delivery modality, geographical setting, physician cohort, and patient population were not independently allocated, and because baseline levels differed markedly between settings, the findings should be interpreted as exploratory implementation patterns rather than causal comparative effects. Full article

School behavioral health (SBH) systems coaching is a developing approach to implementation support for the delivery of high-quality behavioral health support in schools through a multi-tiered prevention and intervention framework. Articulating coaching components and understanding how, when, and why external coaching supports systems change and implementation are essential, but research on the nature, scope, mechanisms, and effectiveness of external coaching for school behavioral health is limited. In the current study, we describe the development and implementation of the School Behavioral Health Academy (SBHA) Coaching program in South Carolina and present findings from a qualitative formative evaluation study. Thematic analysis of key informant interviews with district and school program implementation leaders (N = 8) provides evidence of perceived improvements in systems practices and positive staff and student outcomes related to participation in SBHA Coaching. Articulated barriers and facilitators point to potential mechanisms of change and implementation determinants. Participants described perceived changes and needs related to SBH understanding, infrastructure, norms, and mindsets, as well as the coaching skills and methods they found influential. Results are interpreted in relation to behavior change theory, systems change theory, and the Implementation Drivers Framework. Future directions for program development, research, and practice are discussed. Full article

Introduction: Tuberculosis [TB] and diabetes mellitus (DM) remain major public health concerns worldwide. TB negatively affects an individual’s glucose tolerance, increasing the risk of developing DM. Similarly, DM reduces the host’s ability to fight TB infection and increases the likelihood of developing TB and poor response to TB medication. This study analysed stigma and health-seeking behaviour in a sub-district of Accra Metropolis. Methods: We used a mixed-methods research approach involving a cross-sectional survey and in-depth interviews to explore community knowledge, stigma, and health-seeking behaviour related to TB and DM. A total of 437 individuals were selected for a survey using a simple random sampling technique, while 22 participants, including three TB patients, four nurses, one medical doctor, four students from a nursing and midwifery school, five students from a school of hygiene, and five community members, were involved in the study. Healthcare providers and patients were purposively selected, while students and community members were recruited through convenience sampling. Descriptive and logistic regression analyses were performed on the quantitative data using STATA, while the qualitative data were thematically analysed using the MAXQDA software. Results: Participants’ age, sex, and educational levels were significantly associated with their knowledge of TB and DM. Males were 0.600 times as likely as females to be knowledgeable about DM (95% CI: 0.386–0.934, p = 0.024). Social determinants of health, such as poverty, local beliefs, stigma, and negative attitudes from healthcare workers, may influence TB patients’ preference for traditional remedies over biomedical treatment. Conclusion: Therefore, we observed that addressing cultural barriers, stigma, and financial costs related to TB and diabetes care will help increase patients’ willingness for biomedical treatment. Full article

Objective: Latines in the United States (US) experience disproportionate HIV-related inequities, exacerbated by immigration-related legal precarity and exclusionary policies. This study explores how racialized legal status (RLS), a mechanism by which race-neutral legal classifications disproportionately burden minorities, impacts the lived experiences of Latines with HIV (LWH) across the HIV care continuum. Methods: We conducted a secondary qualitative analysis of in-depth interviews with 21 LWH, 15 healthcare providers, and 10 key informants in Prince George’s County, Maryland. Drawing on RLS framework, data was analyzed thematically, focusing on emergent themes related to immigration, politics, and legal status and their impact on LWH. Results: Policies linking access to health and social services to legal status intensified economic instability and social exclusion, thus leading to suboptimal disease management. Fear of deportation, institutional mistrust, discrimination, and intersectional stigma contribute to healthcare avoidance, disrupting continuity and engagement across the HIV care continuum. Institutions providing services to LWH struggle to circumvent barriers caused by RLS, straining local and community-based resources. Conclusions: RLS erodes whole-person care by creating barriers for healthcare and social services access. Addressing inequities among Latines requires multilevel responses that reduce exclusionary policies and support the well-being of individuals at the intersection of immigration status and chronic disease management. Full article

As population aging accelerates, providing psychosocial support for adults in the retirement transition has become increasingly important. For this population, a central challenge is adapting to changes in social roles, daily routines, and social relationships, yet existing social robot research has paid insufficient attention to these companionship-related needs. From an embodied cognition perspective, this study developed a needs-driven design pathway for a social companion robot for this population in urban China. Sixteen key needs were identified through user interviews and prioritized through a Kano survey with 184 valid responses from urban community-dwelling adults in the retirement transition. Based on the classification and prioritization results, these needs were synthesized into four design strategies: emotional responsiveness and trust building, social connectedness and sustained engagement, low-burden interaction and daily life support, and safety, health, and privacy protection. Privacy and safety were treated as foundational conditions for product design and practical deployment. The strategies were subsequently mapped to technical features and hardware elements through quality function deployment (QFD), using an expert-panel evaluation procedure and sensitivity analysis to determine module-level configuration priorities. A single-session, laboratory-based concept evaluation was conducted with 50 participants using concept renderings and interaction-flow videos. Concept 3, whose overall configuration emphasized coordinated voice, screen-based visual, and expression/action feedback, received a significantly higher mean participant-level Behavioral Intention (BI) score than Concept 2, which placed greater emphasis on spatial mobility assistance through a mobile wheel module (8.94 ± 0.97 vs. 8.51 ± 1.21; adjusted p = 0.003). These evaluation findings informed the final concept configuration and provided preliminary support for its companionship-oriented multimodal interaction approach. Full article

Background: Human papillomavirus (HPV) is associated with multiple head and neck cancers, many of which are preventable with the 9-valent HPV vaccine. We developed an interactive HPV vaccination education program (IHVEP) to equip patients with HPV-associated cancers to serve as health educators. Objective: To pilot test the adapted IHVEP, evaluate its content using the Information-Motivation-Behavioral Skills (IMB) model and the Suitability Assessment of Materials (SAM) instrument, and identify factors relevant to optimizing digital health interventions. Methods: A previously developed cervical cancer–focused IHVEP was adapted for patients with oropharyngeal cancer. Participants completed the program and participated in semi-structured interviews. Feedback was analyzed and organized into themes aligned with the IMB and SAM frameworks. Results: Participants generally perceived the adapted IHVEP as informative, motivating, and empowering. Key motivators included physician recommendation and a desire to protect others. The program appeared to enhance participants’ perceived ability and self-efficacy to promote HPV vaccination. Modules were described as clear, well-organized, linguistically accessible, and culturally appropriate. Feedback identified areas for improvement related to technology, content, and functionality. Conclusions: Findings suggest that effective digital health interventions may benefit from incorporating training in evaluating health information, ensuring intuitive design and navigation, and including content featuring real individuals. These results will inform further refinement of IHVEP and the development of future digital health interventions. Full article

Background/Objectives: Dental trauma is recognized as a global public health problem due to its prevalence and psychosocial consequences. This study aimed to verify the prevalence of traumatic dental injuries in practitioners of combat sports and whether they were associated with sociodemographic and sports variables in a capital city in southeastern Brazil. Methods: This cross-sectional observational study included 284 athletes over 18 years of age from 17 academies that offered combat sports. Data collection was performed by a single examiner through individual interviews and a questionnaire addressing sociodemographic profile, access to oral health services, sport modality, experience with dental trauma during combat sports, mouthguard use, and guidance on dental injuries. Descriptive analyses, frequency tables, the Chi-square test (p < 0.05), and Odds Ratio were used. Results: Most participants were male (n = 203; 71.48%), aged up to 25 years (n = 75; 26.41%). The most practiced sports were Jiu-Jitsu (n = 79; 27.82%) and Kickboxing (n = 77; 27.11%). Among participants who suffered dental trauma (n = 19; 6.69%), single episodes predominated (n = 9; 47.37%), enamel fractures were most frequent (n = 7; 36.84%), and anterior teeth were the most affected (n = 9; 47.36%). Most were not using a mouthguard at the time of trauma (n = 15; 78.95%), although they considered mouthguard use important (n = 229; 80.63%), and most had not received guidance on dental trauma (n = 237; 83.45%). Age group was significantly associated with dental trauma (p = 0.016; OR = 3.33; 95% CI: 1.167–9.524). Conclusions: The prevalence of dental trauma among fighters was low. Mouthguard adherence was inconsistent, post-trauma management was inadequate, and most respondents had never received guidance on dental trauma. Public health policies should strengthen awareness and prevention of dental injuries in sports. Full article

People living with HIV (PLHIV) are at an increased risk of progressing from Mycobacterium tuberculosis (TB) infection to TB disease. Tuberculosis preventive treatment (TPT) is recommended for PLHIV; however, its uptake remains suboptimal. In Zimbabwe, three months of weekly rifapentine and isoniazid (3HP) and six months of daily isoniazid (6H) are the most commonly prescribed TPT regimens. We explored barriers to TPT uptake among PLHIV from the perspective of healthcare workers (HCWs) in Zimbabwe. Facility nurses who had been implementing TPT for at least six months were invited to participate in in-depth interviews and/or focus group discussions conducted in March 2023. Audio recordings were transcribed into English, coded using NVivo 12 (QSR International), and analyzed thematically. Eleven HCWs participated in in-depth interviews and 15 in focus group discussions. Barriers were categorized as person- and health system-related. Person-related barriers included misconceptions about TPT, fear of adverse events, and pill burden. Health system barriers included stock-outs of TPT medications, limited HCW knowledge and skills to promote TPT, limited expertise in initiating TPT among children under five years of age, and limited access to chest radiography. Barriers to TPT uptake and completion remain in Zimbabwe and contribute to missed opportunities for TB prevention among PLHIV. TPT implementation could be strengthened through an uninterrupted supply of TPT medications, continuous training and mentorship of HCWs, and community engagement to improve awareness of the benefits and risks of TPT. Full article

Background/Objectives: Older adults have high rates of suicide, but there is little research on age-specific correlates of suicide. The purpose of this study was to examine risk and protective factors for suicidal ideation and attempts across adult and older adult age groups in a racially diverse sample. Methods: Using a cross-sectional analysis of California Health Interview Survey (CHIS) data from 2021 to 2024 (N = 92,397) linked with 2020 CDC/ATSDR Social Vulnerability Index data, the analytic sample was 64,263 California adults selected by address-based sampling and stratified by age: 45–64 years (31.5% of the overall pooled sample), 65–74 years (12.6%), and ≥785 years (9.1%). Outcomes were lifetime suicidal ideation and attempts. Weighted logistic regression models examined risk and protective factors. Results: Approximately 19% of the sample reported lifetime suicidal ideation, and 6% reported lifetime attempts. Psychological distress, childhood exposure to household mental illness or suicidality, and poor self-rated health were risk factors across all age groups, with associations strengthening with age. Among those with lifetime ideation, these risk factors showed even larger associations in older adults. Protective factors included indicators of sociodemographic vulnerability. Conclusions: Suicide risk and protective factors differ substantially across older adulthood. Findings highlight the need for tailored interventions and integration of suicide screening into primary care for older adults. Full article

Sexual and reproductive health research has often centered women’s contraceptive and pregnancy-related experiences, while young men’s perspectives on sexual behavior, STI prevention, and reproductive responsibility remain less visible. This qualitative study explored how young Black heterosexual college men understood sexual health knowledge, masculinity, STI risk, condom use, pregnancy prevention, and readiness for fatherhood. Thirteen self-identified Black college men aged 19–22 years participated in individual semi-structured interviews at a Historically Black College/University (HBCU) in the southern United States. Interviews were conducted online, transcribed, de-identified, and analyzed using reflexive thematic analysis. Four themes were identified: fragmented sexual health knowledge and informal learning; learning masculinity through sexual socialization and developing sexual autonomy; experiential learning, STI stigma, and the negotiation of sexual risk; and reproductive responsibility and pregnancy prevention. Participants described limited formal sexual health education, peer and media influences on masculinity, risk judgments shaped by trust and familiarity, and stronger concern for pregnancy prevention than for STI prevention. Findings suggest that sexual health education and campus-based prevention should engage young Black men as reproductive actors with distinct needs, responsibilities, and relational contexts. Programs should integrate STI prevention, condom counseling, partner communication, alcohol-related risk reduction, and reproductive-intention counseling into male-centered, stigma-sensitive approaches. Full article

Background/Objectives: End-of-life (EOL) preparedness remains critically understudied among Hispanic patients with advanced breast cancer and their patient–caregiver dyads, despite evidence that preparedness significantly influences quality of life, care decisions, and caregiver well-being. This study aimed to explore how Hispanic patient–caregiver dyads conceptualize and experience EOL preparedness. Methods: A qualitative descriptive design was employed, guided by the Dyadic Cancer Outcomes Framework, which highlights patient and caregiver characteristics, relationship processes, individual and relational outcomes, the cancer care trajectory, and the broader social context as interrelated influences on dyadic experience. Semi-structured individual interviews were conducted in Spanish with 11 metastatic patient–caregiver dyads (n = 22 participants) recruited through Ponce Health Sciences University and the Ponce Research Institute in Puerto Rico. Data were analyzed using codebook thematic analysis in NVivo 15, with themes interpreted through the framework’s components. Results: Six interdependent themes of EOL preparedness were identified: psychological and emotional, spiritual, informational, practical, physical, and caregiver role preparedness. Spiritual preparedness, grounded in faith, prayer, and surrender to divine will, functioned as the foundational axis organizing all other themes. Preparedness was dynamic and turning-point-driven, challenged anew at each stage of disease progression. Financial vulnerability, caregiver invisibility within formal care systems, and insufficient anticipatory information were identified as primary barriers. Family support and faith communities were the most consistently cited facilitators. Conclusions: The findings yield the first grounded, dyadic conceptualization of EOL preparedness with Hispanic advanced breast cancer patient–caregiver dyads. We propose a formal definition positioning preparedness as a dynamic, multidimensional, relationally embedded, and spiritually anchored process that is fundamentally interdependent between patient and caregiver. These results directly inform the development of a culturally tailored, dyadic EOL preparedness intervention for this underserved population. Full article