Search Results (16,388)

As population aging accelerates, the mounting burden on informal family caregivers in areas lacking formal care systems threatens the sustainability of elder care. This study aims at evaluating how the rural living environment and external connectivity jointly alleviate caregiver burden and exploring whether regional accessibility serves as a substitute for local infrastructure deficits. Guided by Ecological Systems Theory, we analyzed a cross-sectional dataset of 327 matched caregiver-recipient dyads from rural China using multivariate regression and mediation models. Results indicate that a favorable local environment reduces burden both directly and indirectly through improved recipient health. Crucially, county-level accessibility moderates this relationship via a substitution effect, where the marginal relief from local environmental improvements is most potent in isolated areas but diminishes where external access is convenient. Dimension-specific analyses show that developmental and physical strains are particularly sensitive to these factors. We conclude that sustaining informal care requires a dual-pathway strategy: prioritizing local “soft” assets like community safety and cultural activities while enhancing regional connectivity to service hubs. Ultimately, this research provides empirical evidence and a theoretical framework for enhancing rural informal care sustainability through environmental optimization, thereby advancing Sustainable Development Goals regarding health, reduced inequalities, and sustainable communities. Full article

Effective asset management is crucial for improving the reliability, resilience, and cost efficiency of distribution networks throughout the asset life cycle. Distribution transformers are among the most critical components, as their failures can cause extensive service interruptions and substantial economic impacts. Therefore, robust and transparent maintenance prioritization strategies are essential, particularly for utilities managing several transformers. Traditional time-based maintenance, while simple to implement, often results in inefficient resource allocation. Condition-based maintenance provides a more effective alternative; however, its performance depends strongly on the reliability of indicator selection and weighting. This study proposes a systematic weighting framework for distribution transformer maintenance prioritization using a multi-criteria decision-making (MCDM) approach. Each transformer is evaluated across two dimensions, including health condition and operational impact, based on indicators identified from the literature and expert judgment. To address uncertainty and judgmental inconsistency, particularly when the consistency ratio (CR) exceeds the conventional threshold of 0.10, the Fuzzy Analytic Hierarchy Process (FAHP) is employed. Seven condition parameters characterize transformer health, while impact is quantified using five indicators reflecting failure consequences. The proposed framework offers a transparent, repeatable, and defensible decision-support tool, enabling utilities to prioritize maintenance actions, optimize resource allocation, and mitigate operational risks in distribution networks. Full article

Existing research highlights that Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) teachers are often exposed to additional stressors in schools which adversely affect their mental health. Some mitigate the effects of these stressors by separating their personal and professional identities while others choose to integrate their identities so that they can be authentic, advance social justice in school contexts or be visible and vocal role models. Less is known about the experiences of pre-service teachers who are undertaking teacher preparation programmes. This systematic literature review presents the results of 20 published papers which represent the global experiences of both pre-service teachers and serving teachers. The findings highlight identity management, experiences of discrimination, agency and lack of confidence of teacher educators. Two new frameworks are presented that lay the foundations for embedding LGBTQ+ inclusion and proposed mandatory elements of curricula for initial teacher training. This systematic literature review has been informed by the following research questions RQ1. What are the experiences of LGBTQ+ pre-service teachers? RQ2. How do LGBTQ+ pre-service teachers negotiate their identities? RQ3. How do LGBTQ+ pre-service teachers disrupt hetero/cis-normative cultures in schools? RQ4: How well does the teacher education programme prepare pre-service teachers for teaching LGBTQ+ inclusive education? Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background: Considering the significant impact on quality of life and the chronic nature of temporomandibular dysfunction (TMD), seeking healthcare is also part of the reality of individuals with this disorder. However, cultural differences and similarities in the experiences of individuals with TMD have not yet been investigated. This study aimed to describe and compare the experiences, beliefs, and sociocultural factors of Brazilian and Spanish individuals with TMD, focusing on their perceptions of the disorder, diagnostic pathways, information-seeking behaviors, and treatment expectations. Methods: A descriptive qualitative study was conducted. A purposive sample of 50 participants (25 Brazilian, 25 Spanish), aged 18–50 and diagnosed with TMD according to DC/TMD criteria, was recruited. Data were obtained through semi-structured interviews and analyzed using thematic analysis. Results: Six themes emerged, revealing both similarities and differences between the groups. Brazilian participants reported uncertainty about which professional to consult and difficulty accessing specialized care. In contrast, Spanish participants frequently sought physical therapists as their first option and identified them as primary sources of information. Beliefs about TMD etiology varied across samples. Treatment expectations also differed. Brazilians emphasized the difficulty of obtaining effective care, while Spanish participants perceived physiotherapy as being limited to muscular disorders. Perceptions of occlusal splint effectiveness showed variation between the groups. Conclusions: These findings underscore the necessity of culturally sensitive approaches to patient care that address not only clinical aspects, but also the sociocultural context that influences health behaviors. Full article

Purpose: This study examined the relationships among fear of cancer recurrence (FCR), unmet healthcare needs, and quality of life (QOL) among breast cancer survivors post-treatment, particularly within the Thai cultural and healthcare context, where limited research has been conducted. Methods: A cross-sectional descriptive correlational design with purposive sampling was used. A total of 122 breast cancer survivors, 1–5 years prior, were recruited from the Breast Clinic and Chemotherapy Unit at the National Cancer Institute. Instruments included a demographic questionnaire, the FCR Inventory Short Form, the Cancer Survivors’ Unmet Needs measure, and the EORTC QOL-C30 with the breast cancer module (QLQ-BR23). Cronbach’s α ranged from 0.82 to 0.92. Data were analyzed using descriptive statistics, Spearman’s rank correlation, and Pearson’s correlation coefficient. Results: Participants reported moderate levels of FCR (M = 13.39, SD = 4.50), low unmet healthcare needs (M = 25.63, SD = 14.82), and moderate overall QOL (M = 54.82, SD = 0.22). FCR was negatively correlated with overall QOL (r = −0.248, p <0.01) and functional QOL (r = −0.242, p < 0.01). Unmet healthcare needs were also negatively correlated with overall QOL (r = −0.261, p < 0.01). Multiple linear regression analysis revealed that both FCR and unmet healthcare needs had a significantly negative relationship with overall QOL (p < 0.05). Conclusions: FCR and unmet healthcare needs independently impair QOL among breast cancer survivors. Early, culturally appropriate survivorship care in Asian contexts is essential to address these needs and improve QOL. Full article

The use of interpreter services is an important component of medical care. It is critical for medical students to practice this during training. It is known that simulation and role play provide important opportunities for students to practice skills. This scoping review maps the experience that medical students around the world have practicing with interpreter services in a simulated environment. We searched within three major databases (PubMed, ERIC, and SCOPUS) using a wide range of search terms for publications from the past 15 years. This scoping review was conducted according to PRISMA-ScR guidelines. Of the 1341 studies initially obtained from search terms, 22 were ultimately found to meet inclusion criteria. There is variability in curricula offered including when in medical school, what other specialties are involved, and how the education is conveyed. Most publications lacked longitudinal follow-up and assessment of learner competence was limited. Review articles, a prevalence study, and proof of concept studies also serve to demonstrate the breadth of publications on this subject. This is an area of important consideration within medical education today. Many studies highlight the relative scarcity of formal programs as well as a lack of consistency. Where programs do exist, the importance of including simulation is highlighted. Full article

Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct from coverage-only parity) and to summarize reported effects on telehealth utilization, modality mix, quality/adherence, equity/access, and expenditures. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science for U.S. studies that explicitly modeled state payment parity or stratified results by payment parity vs. coverage-only vs. no parity. We included original quantitative or qualitative studies with a time or geographic comparator and free full-text availability. The primary outcome was telehealth utilization (share or odds of telehealth use); secondary outcomes were modality mix, quality and adherence, equity and access, and spending. Because designs were heterogeneous (interrupted time series [ITS], difference-in-differences [DiD], regression, qualitative), we used structured narrative synthesis. Results: Nine studies met inclusion criteria. In community health centers (CHCs), payment parity was associated with higher telehealth use (42% of visits in parity states vs. 29% without; Δ = +13.0 percentage points; adjusted odds ratio 1.74, 95% CI 1.49–2.03). Among patients with newly diagnosed cancer, adjusted telehealth rates were 23.3% in coverage + payment parity states vs. 19.1% in states without parity, while cross-state practice limits reduced telehealth use (14.9% vs. 17.8%). At the health-system level, parity mandates were linked to a +2.5-percentage-point telemedicine share in 2023, with mental-health (29%) and substance use disorder (SUD) care (21%) showing the highest telemedicine shares. A Medicaid coverage policy bundle increased live-video use by 6.0 points and the proportion “always able to access needed care” by 11.1 points. For hypertension, payment parity improved medication adherence, whereas early emergency department and hospital adoption studies found null associations. Direct spending evidence from open-access sources remained sparse. Conclusions: Across ambulatory settings—especially behavioral health and chronic disease management—state payment parity laws are consistently associated with modest but meaningful increases in telehealth use and some improvements in adherence and perceived access. Effects vary by specialty and are attenuated where cross-state practice limits persist, and the impact of payment parity on overall spending remains understudied. Full article

Recognizing cervical cancer as a major public health concern, Romania was among the first EU countries to introduce human papilloma virus (HPV) vaccination in 2008. Despite multiple strategies implemented over the past 17 years, HPV vaccine coverage remains one of the lowest in the EU, while cervical cancer mortality rates are among the highest. To explore the underlying factors, we conducted a cross-sectional study involving 209 family physicians at the national level. The study assessed their attitudes, practice, knowledge, and training needs related to HPV vaccination. The majority of physicians (90%) reported that they provide HPV vaccination services, and 88.5% considered themselves to have good and very good knowledge about HPV, which they routinely share during consultations with patients. However, respondents noted that both physician and public attitudes toward HPV vaccination are only moderately positive, which limits vaccine uptake and the success of prevention efforts. Parental hesitation was the main barrier, mentioned by 81.8% of respondents. The majority (71.3%) of doctors indicated that they were able to adequately respond to patients’ questions, but 81.4% of respondents expressed the view that additional training is needed for healthcare professionals on HPV infection and vaccination. These findings highlight the need for coordinated efforts to increase demand and trust in HPV vaccination. Recommended strategies include targeted professional training, public information campaigns, and the development of strong cross-sector partnerships to support vaccination efforts. Full article

Background: Prostate cancer remains a significant public health burden globally, particularly in sub-Saharan Africa, where rising incidence rates are compounded by limited screening, late-stage diagnosis and disparities in healthcare access. In South Africa, the Eastern Cape Province reports high prostate cancer prevalence, with many patients presenting at advanced stages. Understanding the epidemiological profile of affected individuals is critical for developing targeted health strategies. Objectives: This sub-study aims to describe the epidemiological characteristics of patients diagnosed with prostate cancer, using secondary data from Nelson Mandela Academic Hospital (NMAH), focusing on patients seen between March 2020 and November 2021. Methods: A quantitative cross-sectional study design is employed. De-identified secondary data extracted from clinical records of male patients diagnosed with prostate cancer and managed at NMAH during the study period. Variables include demographic information, clinical characteristics, health service utilization indicators. Analysis: Data will be captured and coded in Microsoft excel 2013 (Microsoft corporation, Seattle, WA, USA). The data will then be exported to STATA 18 for analyses. Descriptive statistics will be used to summarize the data. Inferential analyses such as logistic regression and chi-square tests will be used to explore associations between variables and treatment outcomes. The study provides insights into the demographic and clinical profiles of prostate cancer patients in a high-burden setting. It is anticipated that findings will highlight the age distribution, stage at diagnosis, and treatment patterns among patients diagnosed with prostate cancer. This will inform future prevention and intervention strategies in the Eastern Cape Province. Conclusions: By mapping out the epidemiological patterns of prostate cancer in the Eastern Cape through this sub-study, the research contributes to evidence-based planning and resource allocation, ultimately supporting efforts to reduce prostate cancer morbidity and mortality in rural South Africa. Full article

Climate change and land-use intensification are speeding up the loss of ecosystem services that support human health, food security, and environmental stability. Vegetative interventions—such as urban forests in cities and cover crops in farming systems—are increasingly seen as nature-based solutions for climate adaptation. However, their benefits are often viewed separately. This review combines 20 years of research to explore how these strategies, together, improve provisioning, regulating, supporting, and cultural ecosystem services across various landscapes. Urban forests help reduce urban heat islands, improve air quality, manage stormwater, and offer cultural and health benefits. Cover crops increase soil fertility, regulate water, support nutrient cycling, and enhance crop yields, with potential for carbon sequestration and biofuel production. We identify opportunities and challenges, highlight barriers to adopting these strategies, and suggest integrated frameworks—including spatial decision-support tools, incentive programs, and education—to encourage broader use. By connecting urban and rural systems, this review underscores vegetation as a versatile tool for resilience, essential for reaching global sustainability goals. Full article

Background/Objectives: Long COVID (LC) is associated with more than 200 symptoms. This study aimed to evaluate the correlation between symptoms clusters and pharmacological treatment in patients with LC and to explore differences by sex. Methods: We conducted a cross-sectional descriptive study including 304 participants diagnosed with LC according to the World Health Organization criteria. Symptoms during the acute phase, at the time of diagnosis of LC, and those persisting across both phases were collected by anamnesis. Symptoms were grouped into six clusters: systemic, neurocognitive, respiratory/cardiovascular, musculoskeletal, neurological/neuromuscular, and psychological/psychiatric. Drug use was assessed through a questionnaire verified by the medical records, including the consumption of cardiovascular drugs, antidepressants/anxiolytics, and anti-inflammatory/analgesics. Results: Patients reported a mean of 5.23 ± 1.10 symptoms in the acute phase, 4.20 ± 1.70 at LC diagnosis, and 3.83 ± 1.80 persisting across both phases. The most consumed pharmacological group was cardiovascular drugs (43.3%), followed by antidepressants/anxiolytics (34.8%). Psychotropic drugs and anti-inflammatory/analgesic drugs showed a positive association with all symptomatic groups (p < 0.05). Cardiovascular drugs showed a positive association with cardiorespiratory (β = 0.19, p < 0.05), neuromuscular (β = 0.11, p < 0.05), and psychological (β = 0.14, p < 0.05) symptoms. Conclusions: Psychotropic and anti-inflammatory/analgesic drugs were positively associated with all symptom clusters, while cardiovascular drugs were associated only with cardiorespiratory, neuromuscular, and psychological symptoms, highlighting the relevance of better characterization of treatment patterns in this population. Full article

As new technologies, such as electronic medical records (EMRs), are introduced into healthcare services, we need to consider how they may be incorporated into simulated environments, so as to maintain and enhance authenticity and learning opportunities. While EMRs have revolutionised clinical practice, many education settings continue to rely on paper-based documentation in simulation, creating a widening gap between educational environments and real-world clinical workflows. This disconnect limits learners’ ability to engage authentically with the tools and resources that underpin contemporary healthcare, impeding the transfer of knowledge to the clinical environment. This practice-based commentary draws on institutional experience from a large, multi-disciplinary simulation-based education facility that explored approaches to integrating EMRs into simulation-based education. It describes the decision points and efforts made to integrate an EMR into simulation-based education and concludes that while genuine EMR systems increase fidelity, their technical rigidity and data governance constraints reduce authenticity. To overcome this, Adelaide Health Simulation adopted an academic EMR (AEMR), a purpose-built digital platform designed for education. The AEMR maintains the functional realism of clinical systems while offering the pedagogical flexibility required to control data, timelines, and learner interactions. Drawing on this experience, this commentary highlights how authenticity in simulation-based education is best achieved not through technological replication alone, but through deliberate use of technologies that align with clinical realities while supporting flexible, learner-centred design. Purpose-built AEMRs exemplify how digital tools can enhance both fidelity and authenticity, fostering higher-order thinking, clinical reasoning, and digital fluency essential for safe and effective contemporary healthcare practice. Here, we argue that advancing simulation-based education in parallel with health service innovations is required if we want to adequately prepare learners for contemporary clinical practice. Full article

Expanding longevity, together with a decrease in mortality, leads to an increase in the older population worldwide. In this review, ageing and older adults, as well as psychosocial and advanced technological interventions, will be discussed. Older adults are associated with an increased incidence of multimorbidity and disability; thus, they have a higher demand for health services than younger individuals. Challenges in welfare services and inadequate family and community-based care support negatively impact the psychosocial and economic wellbeing of older people. Active ageing and successful ageing are crucial aspects for a better quality of life in this age group, as there is a complex interplay of different domains and disease types that influence quality of life in older adults. Additionally, promoting the social participation of older adults is vital for improving their quality of life. Furthermore, the use of technology in older adults has a positive impact on their quality of life; however, aside from the promotion and implementation of technological interventions, challenges persist at all levels of acceptance and use. A better understanding of these challenges and implementing measures to overcome them will have a significant impact on the technological acceptance of older adults and their use in daily life activities, resulting in more favourable quality of life outcomes. Full article

Criminal justice system (CJS) involvement is common among individuals with opioid use disorder (OUD), yet limited research examines retention in medications for OUD (MOUD) within community settings. This study assessed whether CJS involvement predicted retention on buprenorphine/naloxone and explored related demographic and clinical factors. A retrospective cohort included adults (n = 367) enrolled in a low-barrier outpatient MOUD program in Texas (January 2022–April 2024). CJS involvement was identified from program records. Retention was measured as the number of continuous days with buprenorphine/naloxone prescriptions. Analyses used univariate tests, logistic regression, and nonparametric kernel regression. Nearly one-quarter (24.8%) were CJS-involved. Retention at 180 days was similar between CJS and non-CJS groups (38%). CJS participants initiated substance use earlier and reported higher heroin and injection drug use. Behavioral health sessions were associated with both CJS involvement (OR = 1.10, p ≤ 0.001) and longer retention (β = 10.81 days/session, p = 0.001). With comprehensive, low-barrier services, individuals involved with CJS achieved MOUD retention comparable to their peers. Early behavioral health engagement was a strong predictor of retention, suggesting a key intervention point to enhance outcomes and advance equity for justice-involved populations. Full article