Search Results (17,086)

Background and Objectives: Visual evoked potentials (VEPs) are established tools for detecting optic pathway involvement in multiple sclerosis (MS); however, the distinct clinical significance of longitudinal changes in latency and amplitude remains unclear. This exploratory study aimed to evaluate the clinical utility of serial VEP assessments in patients with relapsing–remitting MS (RRMS) by examining the associations between temporal changes in latency and amplitude and concurrent markers of disease activity and disability. Materials and Methods: We retrospectively analyzed 83 patients with RRMS from three centers who underwent at least two pattern-reversal VEP assessments ≥ 1 year apart. Patients with recent optic neuritis were excluded. Longitudinal changes in VEP latency and amplitude were evaluated in relation to relapse activity during the same inter-assessment interval, baseline MRI and CSF findings, and disability assessed by the Expanded Disability Status Scale (EDSS). Sensitivity analyses were stratified and adjusted for disease-modifying therapy (DMT) efficacy tier, and progression independent of relapse activity (PIRA) was examined using a formal definition. Results: Over a median follow-up of 2 years, 43.4% of patients developed P100 latency prolongation, which was independently associated with a higher annualized relapse rate during the same interval (odds ratio [OR] 2.91, p = 0.005; area under the curve (AUC) 0.72 for concurrent on-study relapse activity), an association that persisted after adjustment for DMT efficacy tier, but not with disability worsening. In contrast, 56.6% of patients exhibited amplitude reduction, which was associated with greater disability accumulation at the group level, with higher EDSS scores at follow-up despite similar baseline values (p < 0.05); the corresponding inverse correlation between amplitude decline and EDSS change was only nominally significant (ρ = −0.231, p = 0.036), did not survive correction for multiple comparisons, and was attenuated after adjustment for baseline EDSS. Formally defined PIRA events were rare (n = 3), precluding inference. Baseline magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) findings differed in the latency group, with fewer MRI lesions and a lower immunoglobulin G (IgG) index, whereas no corresponding differences were observed in the amplitude group. Conclusions: In this exploratory cohort, longitudinal prolongation of VEP latency was associated with concurrent relapse activity, whereas amplitude decline showed a weaker, group-level association with disability. These findings are consistent with, but do not demonstrate, distinct inflammatory and neurodegenerative substrates, and warrant prospective validation before serial VEP monitoring can inform individualized management in MS. Full article

Telework has expanded rapidly, and understanding the behaviors employees enact under it has become correspondingly important. This study develops an integrative conceptual framework specifying the multidimensional nature of telework behavior. A systematic literature review following PRISMA identified 114 review articles, which were analyzed using constructivist grounded theory. Six behavioral dimensions were identified, covering performance, communication, environmental, task, policy, and well-being conduct. Antecedents were grouped into individual factors, job characteristics, organizational norms, technological factors, and work environment factors. Outcomes were grouped into job satisfaction, productivity, turnover, health and well-being, work–life balance, and social isolation. Three contextual moderators were identified, namely telework modality, telework preference, and cultural and national context. Fourteen propositions link these categories and are advanced as testable claims rather than established findings, since they are derived from published review evidence and have not been empirically tested. The framework proposes telework behavior as the construct through which the conditions of remote work are translated into employee and organizational outcomes, and it specifies a content domain from which measures of the construct can be developed. It also indicates where organizations can direct policy, training, and intervention. Full article

Background: Slowing the progression of dementia and maintaining mental and social health and well-being are important aspects of health and healthcare for people living with dementia (PLwD). Relationships with family caregivers and unique caregiver insights are also important aspects of the health and well-being of PLwD. Methods: A group-based gaming system was developed to promote health and well-being for PLwD through movement, cognitive exercises, and social interaction. Included were family caregivers of clients living with mild- or moderate-stage impairment in an adult day center selected for the gaming intervention. Prior to implementing the intervention, three separate focus groups were conducted with 21 caregivers of PLwD, divided into each of the three focus groups based on their availability, to explore what it is like to care for someone living with dementia, their loved ones’ mood, and their questions or concerns regarding the gaming intervention. Responses were thematically analyzed. Results: In total, 21 caregivers participated in the focus groups. Six themes were identified: mutuality and strategies for coping with varying emotions; new challenges and successes with connecting and relating; multidimensional challenges with adjusting to decline, help-seeking, and providing care; community, social support, and resilience; technology and community resources as tools to ease caregiving burdens, and interest in digital gaming for PLwD. Conclusions: Our results suggest that group-based digital gaming interventions may be useful to both caregivers and PLwD, by offering meaningful opportunities for social engagement. Full article

Background: Stress represents a significant public health concern and is associated with diminished psychological resilience among students and young adults. Mental toughness, the capacity to function effectively under pressure, may be influenced by attitudes toward emerging technologies. Methods: This cross-sectional study investigated whether trust in artificial intelligence (AI) moderates the relationship between perceived stress and mental toughness. Students attending a Historically Black College or University (HBCU) participated (n = 109); 84.4% were aged 18–25 years. Perceived stress was assessed using an adapted six-item DASS stress index, while mental toughness and AI trust were measured using adapted multi-item scales. Hierarchical regression analyses examined the moderating role of AI trust. Results: Higher perceived stress was associated with lower mental toughness. Although AI trust did not directly predict mental toughness after accounting for the interaction, a significant interaction emerged: students with greater AI trust showed a weaker negative association between stress and mental toughness. Conclusions: Higher AI trust was associated with attenuation of the negative relationship between perceived stress and mental toughness among students. These findings may inform future research on trustworthy AI, student well-being, and evidence-based public health strategies for students in high-stress environments. Full article

Objective: Informed consent documents often prioritize institutional liability over patient comprehension, and conventional readability metrics are inadequate to assess their ethical and cognitive complexities. This study aims to develop and demonstrate the preliminary feasibility of the Universal Health Communication Index (UHCI), an AI-driven Health Technology Assessment (HTA) framework utilizing large language models (LLMs) to objectively evaluate the multidimensional quality and operational impact of medical consent forms. Methods: The UHCI employs a hybrid natural language processing architecture to evaluate clinical texts across five dimensions: Accessibility, Transparency, Autonomy, System Burden, and Medical Adequacy. The pipeline deploys an ‘AI Persona’ to simulate patient cognitive load and an ‘AI Gold Standard’ utilizing clinical guidelines (UpToDate) to identify omitted risks. The framework was benchmarked in an exploratory proof-of-concept against a fifty-eight-member multidisciplinary human baseline and subsequently tested in a cross-lingual proof-of-concept by comparing standardized lumbar puncture consent forms across three distinct healthcare jurisdictions (Turkey, the UK, and the USA). Results: The algorithm effectively quantified abstract bioethical concepts into an objective HTA metric, demonstrating preliminary numerical agreement with the human baseline across five pilot forms (mean difference: 2.73, SD: 5.94). The framework effectively penalized the ‘illusion of transparency’ and defensive medical terminology. In the cross-lingual case study, although the global scores were comparable, the algorithm successfully discerned between forms prioritizing patient-centered autonomy and those reflecting directive institutional discourse. Conclusions: Transcending conventional readability formulas, the UHCI provides healthcare administrators and policymakers with a scalable, practical methodology to optimize clinical documentation. By identifying institutional bias and communicational barriers, this AI-assisted screening tool promotes equitable patient engagement and supports evidence-based health policies, demonstrating the responsible integration of AI into clinical workflows without replacing human clinical judgment. Full article

Background: Invasive pneumococcal disease (IPD) is predominantly caused by Streptococcus pneumoniae and is associated with high mortality. This vaccine-preventable disease has been a significant public health concern, particularly among children < 5 years and adults > 50 years in India. Pneumococcal vaccines help prevent pneumococcal infections caused by certain strains of S. pneumoniae, but diagnostic challenges in India hinder disease management. Methods: The objective of this expert panel discussion is to deliberate upon the pathogenesis and epidemiology of S. pneumoniae in India, techniques for overcoming the diagnostic challenges in the isolation and detection of S. pneumoniae, and to explore opportunities for partnerships between clinicians and microbiologists to bridge gaps. A non-systematic, targeted literature search was conducted to identify studies supporting key themes of expert panel discussion. Eight microbiologists, one infectious disease, one pediatrics and neonatology, and one respiratory medicine specialist from different parts of India participated in the discussion. Results: The panelists reiterated that while culture is the gold standard, multiplex real-time polymerase chain reaction and BioFire^® FilmArray^® technology have been the most common diagnostic methods for the detection of S. pneumoniae in India, especially in tier 1 cities. Conclusions: This article elucidates the challenges faced by microbiologists and clinicians in isolating and detecting the pathogen, and proposes solutions to determine the true burden of pneumococcal disease in India. This information could further inform public health policy and vaccination strategies. Full article

Introduction: Mobile phone text messaging (Short Message Service; SMS) interventions are digital health strategies that may support mental health care. This scoping review examined related study designs, outcomes, and gaps across the literature. Methods: Systematic searches identified 38 eligible studies from 1542 abstracts. Data were extracted and thematically analyzed to identify trends and outcomes. Texting interventions were categorized as cognitive, motivational, instrumental/practical, or combined approaches. Results: Study design included randomized controlled trials (RCTs), quasi-experimental pilots and systematic reviews, with RCTs providing the strongest evidence for improvements in adherence and relapse prevention. Outcomes included behavioral measures (e.g., medication adherence, therapy homework completion, and reduced non-attendance) alongside clinical measures (e.g., symptom reduction and relapse prevention). Cognitive reminders that were most common reduced non-attendance and improved adherence, particularly for medication and appointments, although they were less effective in severe depression. Motivational and combined interventions demonstrated higher acceptability and engagement, particularly in adolescents and high-risk individuals. Success was influenced by diagnosis, age, gender, and social status, including adherence at baseline. Conclusions: Overall, text-based interventions were generally acceptable, accessible, and cost-effective for improving mental health engagement. Limitations included lack of long-term evaluations, technological barriers, and lack of personalization. Future research should address these gaps and include underrepresented populations. Full article

Widespread antibiotic use in aquaculture has increased selective pressure on resident bacterial communities, accelerating the emergence of resistance in key pathogens and raising concerns for animal health, environmental microbiomes, and food-chain safety. Reducing dependence on therapeutic antimicrobials requires alternative strategies that remain effective under the processing and biosafety constraints of intensive production systems, where recurrent bacterial diseases continue to cause substantial economic losses. Live probiotics, currently the most extensively studied microbiome-based intervention, have practical limitations, including reduced viability during feed pelleting and extrusion, transient gut colonization, strain-specific host responses, biosafety concerns related to horizontal transfer of antimicrobial-resistance genes, and variable regulatory requirements across regions. Postbiotics, defined as preparations of non-viable microbial biomass, with or without metabolites, that confer a demonstrated health benefit in the target host, and paraprobiotics, which emphasize inactivated whole-cell preparations that preserve surface-associated microbial molecular patterns, may help address several of these constraints. These approaches offer improved compositional definition, greater feed-processing stability, and a potentially more favorable biosafety profile. Because they are non-viable, their anti-pathogen effects do not depend on growth or competitive colonization but may instead involve preformed antimicrobial compounds retained in some preparations, interference with pathogen attachment, modulation of the intestinal environment, reinforcement of barrier function, and stimulation of host immune responses. This review synthesizes current evidence on postbiotics and paraprobiotics in aquaculture, with emphasis on structural classification, pattern-recognition receptor signaling, intestinal barrier function, innate immune priming, encapsulation technologies, and translational readiness. Taken together, available evidence supports postbiotics and paraprobiotics as promising, but not yet fully characterized, alternatives to live probiotics within antibiotic-reduction strategies for aquaculture. Progress toward commercial application will depend on resolving key questions related to dose–response relationships, processing stability in formulated feeds, and species-specific efficacy. Full article

Immersive Virtual Reality (VR) environments are increasingly adopted in clinical psychology and stress-management contexts; however, their therapeutic effectiveness depends on the system’s ability to understand and dynamically respond to users’ affective states. Emotional regulation plays a key role in psychological resilience, directly influencing stress coping mechanisms, cognitive performance, and overall mental well-being. Despite recent advances, automatic recognition of scenario-associated affective conditions in VR remains challenging because head-mounted displays occlude facial features. This study proposes a VR-based serious game for affective training and regulation, in which users interact with goal-oriented scenarios targeting fear, anger, and joy. We introduce a multimodal affective computing model to objectively assess users’ emotional responses by integrating electrocardiogram (ECG) signals and posture-based features extracted through computer vision. An early-fusion architecture combined with a Long Short-Term Memory (LSTM) network captures temporal dependencies in synchronized multimodal data. We established a controlled experimental framework using immersive VR scenarios, enabling the collection of synchronized physiological and behavioral data from a cohort of 20 healthy adult participants. The proposed model was evaluated under a strict Leave-One-Subject-Out (LOSO) cross-validation scheme across independent subjects, achieving a robust inter-subject accuracy of $78.94\%\pm 10.77\%$ and a global macro F1-score of 0.635, demonstrating strong generalization to entirely unseen users without data leakage. Furthermore, the system maintained an outstanding balance in detecting active emotional states (recall > 80.0% for fear, anger, and joy). Additionally, subjective evaluations using the PANAS and SGU questionnaires confirmed the coherence between detected and perceived emotional states, as well as the system’s high usability. The results suggest the potential viability of combining immersive environments and multimodal affective computing to explore the technical feasibility of adaptive frameworks that could eventually translate into healthcare contexts. This work may contribute to the development of intelligent digital health technologies by providing a foundation for responsive VR systems that can monitor emotional regulation and are fully aligned with sustainable well-being ecosystems (SDG 3: Good Health and Well-being and SDG 10: Reduced Inequalities). Full article

Background/Objectives: Irritable bowel syndrome (IBS) is one of the most common disorders of gut–brain interaction and one of the most frequent functional bowel disorders encountered in clinical practice. The lack of reliable biomarkers, coupled with inconsistent clinical presentations and variable therapeutic outcomes, creates a landscape of ongoing uncertainty for clinicians. Against this background, non-pharmacological and technological developments—such as digital health interfaces, sensor technologies, and medical devices—emerge as potential support tools for clinical management. This qualitative study explored how healthcare professionals manage diagnostic and therapeutic uncertainty in IBS across care settings while evaluating the potential role and value of integrating these technological and non-pharmacological innovations into routine practice. Methods: Fifteen semi-structured interviews were conducted with healthcare professionals involved in IBS care across primary and specialized settings and one expert patient with lived experience in the Barcelona metropolitan area. Data were analyzed using principles of grounded theory. Results: The notion of “catch-all category” articulates four interrelated themes that characterize IBS in clinical practice: persistent clinical uncertainty, pragmatic diagnostic strategies, patient engagement in biopsychosocial and longitudinal management, and the implementation and interpretability of digital and non-pharmacological support. Participants described IBS management as shifting from exclusionary, symptom-based diagnostics toward holistic biopsychosocial and gut–brain-axis models. This transition underscores the necessity for resources that empower patients through education, support clinicians through longitudinal monitoring, and facilitate shared management strategies. Conclusions: The findings suggest that IBS management is not a single diagnostic act but a longitudinal process of uncertainty management. Future digital or non-pharmacological support tools for IBS should prioritize longitudinal monitoring, clinically interpretable information, and low burden for professionals and patient–professional communication. Full article

Background/Objectives: Despite major advances in precision medicine, equitable and timely access to innovative oncology therapies remains challenging because of differences in reimbursement systems, health technology assessment (HTA), and healthcare organization. Physicians are well positioned to identify barriers affecting the implementation of these therapies in routine practice. This study evaluated Bulgarian physicians’ perceptions of innovative oncology therapies, assessed patient access, identified barriers to timely availability, and examined factors perceived as associated with these perceptions. Methods: A cross-sectional web-based survey was conducted between March and May 2025 among physicians involved in oncology care in Bulgaria. The questionnaire comprised six domains addressing professional characteristics, self-perceived knowledge, clinical implementation, perceptions of patient access, barriers to implementation, and policy priorities. Descriptive statistics, Pearson’s chi-square tests, Cramér’s V, and multivariable ordinal logistic regression were used to analyze the data. Results: A total of 114 physicians participated. Respondents generally reported moderate-to-high levels of self-perceived knowledge regarding innovative oncology therapies. Self-perceived knowledge was higher among medical oncologists (adjusted p < 0.001) and physicians treating at least 100 patients with cancer per month (adjusted p = 0.003). Overall, 57.9% of respondents (95% CI: 48.7–66.6%) rated the perceived timeliness of access as good or very good, while 68.4% (95% CI: 59.4–76.2%) reported encountering patients who sought treatment abroad because innovative therapies were perceived as unavailable or insufficiently accessible in Bulgaria. Professional experience (aOR = 0.68, 95% CI: 0.50–0.93; p = 0.014) and higher monthly patient volume (aOR = 0.45, 95% CI: 0.21–0.96; p = 0.039) were independently associated with more favorable perceptions of access. Financial constraints, regulatory and HTA-related delays, and perceived delays in pharmaceutical-company submissions were the principal perceived barriers. Conclusions: Bulgarian oncology specialists demonstrate high self-reported professional readiness for innovative oncology therapies; however, the perceived timely patient access remains constrained primarily by financial, organizational, and reimbursement-related factors. Although, these findings reflect physicians’ perceptions and do not establish causal determinants of access, strengthening reimbursement pathways, HTA implementation, molecular diagnostic capacity, and clinical research infrastructure may improve equitable access to innovative oncology therapies within the evolving European HTA framework. Full article

Community Mobile Health Vehicles (CMHVs) represent an innovative healthcare delivery model that integrates medical services into residents’ daily community life. By extending healthcare coverage to underserved populations, CMHVs can improve access to health management services while enhancing the efficiency of healthcare resource utilization. However, existing studies have primarily focused on health outcomes or the adoption of digital health technologies, with limited attention paid to users’ willingness to utilize CMHVs and their relationship with sustainability dimensions, including social equity, economic efficiency, and environmental responsibility. Drawing on survey data collected from community residents in China, this study employs Exploratory Factor Analysis (EFA) to identify the key determinants influencing users’ willingness to use CMHVs. Furthermore, the Entropy Weight Method (EWM) is applied to prioritize both the identified factors and their corresponding design strategies according to their relative importance. The results reveal five principal determinants: Cognitive Ease, System Adaptability, Institutional Trustworthiness, Technical Reliability, and Environmental Compliance. These factors and their associated design strategies exhibit varying levels of importance in promoting user engagement, optimizing resource allocation, and facilitating community integration. Based on the findings, this study proposes a set of sustainability-oriented design prioritization strategies for CMHV service systems. The proposed framework provides both theoretical and empirical insights for urban healthcare service planning and supports the coordinated achievement of economic, social, and environmental sustainability goals. The study further offers evidence-based guidance for the implementation, continuous improvement, and long-term sustainability of CMHVs within urban healthcare and mobile health service systems. Full article

Rabbit odontogenic abscesses are among the most challenging chronic infections encountered in exotic animal medicine because of their polymicrobial etiology, biofilm-associated persistence, and poor response to conventional antimicrobial therapy. Biofilm formation plays a central role in disease pathogenesis by promoting bacterial adhesion, extracellular polymeric substance (EPS) production, quorum sensing (bacterial cell-to-cell communication), metabolic heterogeneity, and the persister-cell formation (transiently antibiotic-tolerant bacterial subpopulations), collectively reducing antimicrobial susceptibility and contributing to treatment failure and recurrence. In addition to biofilm-mediated tolerance, antimicrobial resistance (AMR) further complicates disease management through mechanisms including horizontal gene transfer, efflux pump activation, enzymatic antibiotic degradation, reduced membrane permeability, and target modification. This review summarizes current knowledge on the microbiology, biofilm dynamics, and resistance mechanisms associated with rabbit odontogenic infections while examining recent advances in molecular diagnostics, including culture-independent sequencing technologies, metagenomics, and advanced imaging approaches. Current and emerging anti-biofilm strategies, such as local antimicrobial delivery systems, enzymatic biofilm disruption, quorum-sensing inhibitors, bacteriophage therapy, antimicrobial peptides, photodynamic therapy, and nanotechnology-based approaches, are critically discussed in the context of their potential application in rabbits. Comparative evidence from human endodontic infections and other veterinary biofilm-associated diseases highlights the translational relevance of rabbit odontogenic abscesses as a naturally occurring model for chronic polymicrobial infections. Finally, key research gaps are identified, emphasizing the need for standardized experimental models, integrated multi-omics analyses, combining genomic, transcriptomic, proteomic, and metabolomic data, longitudinal clinical investigations, and evidence-based antimicrobial stewardship. By integrating microbiology, biofilm biology, antimicrobial resistance, and One Health concepts, this review provides a comprehensive framework to support future research and improve the diagnosis, treatment, and prevention of rabbit odontogenic infections. Full article

Climate-induced floods increasingly disrupt agricultural production systems, posing escalating threats to food security and economic stability in climate-exposed and trade-integrated regions. This study examines the relationship between flood shocks and agricultural total factor productivity (TFP) change across China and ten ASEAN economies and investigates whether public service capacity and structural conditions attenuate this negative association. A country–year panel dataset covering 1993–2024 is constructed by aggregating event-level flood records from EM-DAT and matching them with World Bank indicators of agricultural production, population, public services, and industrial structure. Agricultural TFP change is measured using the DEA-Malmquist index, with arable land, agricultural land, agricultural employment, fertilizer use, agricultural freshwater use, and rural electricity access as inputs and crop production and agricultural value added as outputs. A two-way fixed-effects model is then applied to examine the conditional association between flood mortality severity and agricultural TFP change. The empirical results show that greater flood mortality severity is significantly associated with lower agricultural TFP change. This negative contemporaneous association remains evident across the reported alternative specifications and sensitivity analyses. Current health expenditure per capita, energy use per capita, access to basic drinking-water services, and medium- and high-tech manufacturing value added are positively associated with an attenuation of the negative association between flood mortality severity and agricultural TFP change. These findings suggest that agricultural productivity performance under climate-related disturbances is shaped not only by exposure to flood shocks but also by policy-relevant capacities embedded in public service provision and structural conditions. A notable finding is that the marginal association becomes positive and statistically significant at high observed levels of health expenditure per capita and energy use per capita, whereas the corresponding estimates for drinking-water services and medium- and high-technology manufacturing remain statistically indistinguishable from zero. Full article

Artificial intelligence is being adopted across African public administration; health; education and finance; and the systems concerned act on a recorded or inferred gender value before they deliver anything at all. The problem this article addresses is that the categories operating in digital identity registers; automated facial analysis; biometric enrolment for social grants and language technologies are binary; anatomically grounded and administratively fixed; and that this specification reached the continent as a colonial import rather than as a description of how gendered standing is actually held. The article traces the descent of that binary; recovers from one southern African site a documented account of how gendered personhood is conferred and revised; and converts that account into design requirements. The design is conceptual and genealogical, reading three corpora against one another: the ethnographic record of the Balobedu of Bolobedu in Limpopo, South Africa; principally the Krige corpus and later commentary upon it; the technical and audit literature on gender classification; and South African identification law. Yoruba and Igbo scholarship is retained for comparison. Standing at the site is shown to be conferred through office; seniority; cattle and marriage rather than read from the body; so that a woman may hold the position of husband and a queenship may pass through a line of women. Systems in current use represent none of the properties by which such standing is held; and the article specifies thirteen changes to datasets; taxonomies; interfaces and procurement through which they could do so. Full article