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Search Results (389)

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16 pages, 336 KB  
Article
Oral Health Monitoring of Homebound Older Adults Using Teledentistry in Primary Health Care: A Pilot Pragmatic Randomized Feasibility Trial
by Maria Eduarda Pes Basco, Gabriela Bampi, Eva María Rosel Gallardo, Jose Antonio Gil Montoya, Gabriel Schmitt da Cruz and Ana Lúcia Schaefer Ferreira de Mello
Int. J. Environ. Res. Public Health 2026, 23(10), 1265; https://doi.org/10.3390/ijerph23101265 - 29 Sep 2026
Viewed by 146
Abstract
Population aging increases demand for home-based dental care, but access remains limited for homebound older adults. Although teledentistry can help overcome mobility barriers, its feasibility within routine Primary Health Care (PHC) requires further investigation. This pragmatic pilot trial evaluated a teledentistry protocol for [...] Read more.
Population aging increases demand for home-based dental care, but access remains limited for homebound older adults. Although teledentistry can help overcome mobility barriers, its feasibility within routine Primary Health Care (PHC) requires further investigation. This pragmatic pilot trial evaluated a teledentistry protocol for monitoring homebound older adults. Six homebound older adults in the Brazilian PHC system were assigned to receive either one remote monitoring visit via a telehealth platform or one conventional home visit over three weeks. Feasibility was assessed using the Acceptability, Adequacy, and Feasibility measures of the intervention (scale 1 to 5), along with diagnostic instruments (OFI-8, OHIP-14, Kihon Checklist). In this small pilot sample, descriptive trends of adequacy (3.5), feasibility (3.3), and acceptability (3.0) were presented, with the acceptability score sitting exactly at the predefined 3.0 progression threshold. Digital literacy barriers may have influenced participation and frequently required caregiver mediation. Remote data collection appeared stable in this pilot setting. The intervention group showed a descriptive worsening of OHIP-14 scores, which future studies can examine. In conclusion, while preliminary observations suggest that remote monitoring could be delivered in this small pilot sample, digital literacy challenges indicate that a hybrid model—combining teledentistry with targeted in-person visits—should be examined in larger, future trials as a potentially more equitable approach. Full article
11 pages, 1751 KB  
Article
Implementation of an Advanced Practice Provider-Led Postoperative Telephone Follow-Up Program After Cardiac Surgery: A Single-Center Quality Improvement Study
by Kate Winkler, Regina Doonan, Kelsy Rice, Jessica Baldwin, Morgan Whisenhunt, Alicia Clarke, George Trip Zorn and Todd C. Crawford
Hearts 2026, 7(4), 28; https://doi.org/10.3390/hearts7040028 - 28 Sep 2026
Viewed by 145
Abstract
Purpose: Unplanned readmissions after cardiac surgery confer an increased risk for adverse outcomes. Early contact with health care providers has been shown to reduce readmissions. Herein, we present the design and early results of an advanced practice provider (APP)-led targeted calling service for [...] Read more.
Purpose: Unplanned readmissions after cardiac surgery confer an increased risk for adverse outcomes. Early contact with health care providers has been shown to reduce readmissions. Herein, we present the design and early results of an advanced practice provider (APP)-led targeted calling service for postoperative patients. Methods: We performed an institutional quality improvement project with a scripted postoperative telephone call curated to identify and triage postoperative patients at risk for unplanned readmission. Beginning in 2025, patients were categorized as either low risk or high risk for readmission by our clinical discharge nurse coordinator and discharging APP. We attempted to contact all patients within the first 72 h of discharge to review vital signs trends, weight stability, fluid balance, rhythm disturbances, or wound healing complications with a scripted questionnaire. Patients with concerns are triaged at the discretion of the outpatient APPs, with priority given towards in-person assessment. Unplanned readmissions were then evaluated retrospectively, readmit reasons were captured, and readmission rates were compared from January 2021 through November 2025. Results: At our institution, readmission rates after open cardiac surgery have declined from 10.9% in 2021 to 9.50% through November 2025. Our Readmissions Working Group has also observed a consistent decrease in isolated coronary artery bypass grafting (CABG) readmission rates from >10% in 2021 and 2022 to 8.5% through November 2025. Pleural and pericardial effusions, arrhythmias, and wounds remain the prevailing reasons for readmission in our postoperative patients. Conclusions: An APP-led postoperative phone call quality improvement initiative with an early triage to nurse-practitioner clinic enabled our group to identify early deviations from the expected course of convalescence and enact timely interventions for our postoperative patients. Full article
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29 pages, 560 KB  
Article
The Effect of a Fortified Date Bar on Perceived Stress and Morning Salivary Cortisol in Female Students: A Pilot Randomized Controlled Trial
by Evgeniya Klein, Daria Velina, Sherzodkhon Mutallibzoda, Svetlana Tefikova, Olga Orlovtseva, Natalia Lebedeva and Igor Nikitin
Nutrients 2026, 18(19), 3134; https://doi.org/10.3390/nu18193134 - 23 Sep 2026
Viewed by 211
Abstract
Background/Objectives: Chronic stress poses a serious threat to public health and is associated with the rising global burden of mental disorders, including anxiety and depression. University students, particularly young women, represent a highly vulnerable group due to the combination of academic pressure, [...] Read more.
Background/Objectives: Chronic stress poses a serious threat to public health and is associated with the rising global burden of mental disorders, including anxiety and depression. University students, particularly young women, represent a highly vulnerable group due to the combination of academic pressure, social adaptation challenges, and gender-specific stress reactivity. This pilot randomized controlled parallel-group trial aimed to evaluate the effect of a 4-week daily consumption of a date bar fortified with magnesium (240 mg), vitamin C (300 mg), inulin (1000 mg), and grape seed extract (100 mg) on perceived stress and morning salivary cortisol in healthy female university students under natural academic load. Methods: Thirty healthy female students (aged 18–28 years) were randomized in a 1:1 ratio to either the intervention group (fortified date bar) or the control group (placebo bar) for 4 weeks. The primary outcome was the change in morning salivary cortisol levels (measured 30–60 min after awakening), and the secondary outcome was the change in perceived stress assessed by the Perceived Stress Scale (PSS-14). Measurements were performed at baseline and within 24–48 h after the intervention. Adherence was monitored via daily digital reports and weekly in-person meetings. Statistical analysis was performed using non-parametric tests (Mann–Whitney U test, Wilcoxon test) with effect sizes (rank-biserial correlation, r). Per-protocol analysis was applied for the primary outcome (n = 28) and available-case analysis for the secondary outcome (n = 29). Participants and outcome assessors were blinded to group allocation throughout the study. Results: No adverse events were reported. Median adherence was 100% in both groups, with all participants demonstrating ≥ 90% compliance. No statistically significant changes in morning salivary cortisol were observed within or between groups (within-group: p = 0.173 in the intervention group, p = 0.326 in the control group; between-group: p = 0.104), although a consistent trend toward a reduction was observed in the intervention group (median Δ = −0.64 ng/mL) with a moderate effect size (r = 0.43 within-group; r = −0.37 between-group). For perceived stress, a statistically significant reduction in PSS-14 scores was observed within the intervention group (median Δ = −4.0 points; p = 0.009) with a large effect size (r = 0.80), while no significant change occurred in the control group (p = 0.624). Between-group comparison for PSS-14 changes did not reach statistical significance (p = 0.073), although the effect size was moderate (r = −0.40). No significant correlation was found between changes in cortisol and changes in PSS-14 scores (ρ = −0.134; p = 0.496). Conclusions: In this pilot randomized controlled trial, four-week consumption of a fortified date bar was associated with a reduction in perceived stress among healthy female university students, as reflected by a large within-group effect size on PSS-14 scores. However, given the exploratory nature of the study, the small sample size, and the absence of an a priori power calculation, this finding should be regarded as preliminary and hypothesis-generating rather than as evidence of established efficacy. A consistent, albeit non-significant, trend toward reduced morning cortisol was also observed, suggesting a possible modulatory effect on the HPA axis that requires confirmation in larger, longer-term studies with optimized dosages. The dissociation between subjective and objective stress measures underscores the multidimensional nature of the stress response and supports the use of complementary assessment approaches in future research. The fortified date bar may warrant further investigation as a potentially feasible, acceptable, and economically accessible component of primary stress prevention strategies in young populations, although this possibility remains to be tested in adequately powered confirmatory trials. Full article
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8 pages, 213 KB  
Article
Cooperative Extension Delivery of the National Diabetes Prevention Program: Outcomes by Age Group and Delivery Modality
by Azin Pourkhalili, Lynn Margheim and Carlin Rafie
Trends Public Health 2026, 1(2), 16; https://doi.org/10.3390/tph1020016 - 21 Sep 2026
Viewed by 148
Abstract
Objective: To examine differences in attendance, weight loss, and physical activity across age groups and delivery modalities in the National Diabetes Prevention Program lifestyle change program (LCP) delivered by Cooperative Extension. Methods: We conducted a retrospective analysis of de-identified program data collected from [...] Read more.
Objective: To examine differences in attendance, weight loss, and physical activity across age groups and delivery modalities in the National Diabetes Prevention Program lifestyle change program (LCP) delivered by Cooperative Extension. Methods: We conducted a retrospective analysis of de-identified program data collected from January 2018 through August 2022. Of 189 enrolled participants, 139 attended at least eight sessions and were included in the outcome analyses. Outcomes at 6 and 12 months were compared by age group (<60 vs. ≥60 years) and delivery modality (in-person vs. synchronous distance learning). Results: Fifty-three percent of participants were aged ≥60 years, and 51% participated through distance learning. At 6 months, participants aged ≥60 years attended more sessions than younger participants (p < 0.001). Among participants aged ≥60 years, those in distance learning attended more sessions than those attending in person at 6 months (17.11 vs. 14.82; p < 0.001) and 12 months (21.28 vs. 17.69; p < 0.001) and achieved greater weight loss at 6 months (4.61% vs. 2.07%; p = 0.02). Overall, 35% achieved at least 5% weight loss, and 62% averaged at least 150 min of physical activity per week by program completion. Conclusions and Implications: Selected outcomes differed by age group and delivery modality. Among adults aged ≥60 years, synchronous distance learning was associated with higher attendance and greater short-term weight loss and may help expand access to evidence-based diabetes prevention. These findings should be interpreted cautiously because delivery modality was not randomly assigned and outcome measurement differed by modality. Full article
14 pages, 2485 KB  
Article
Modernizing Brain Injury Services in British Columbia: Developing Research Priorities for Children and Youth with Acquired Brain Injury
by Scott Ramsay, Jessica A. Harasym, Whitney MacRae, Dana Seidel, Remei Van Raamsdonk, Julia Schmidt, Molly Cairncross, William Paneka, Noah Silverberg, Paul van Donkelaar, Shelina Babul, Roberta Price and Olivia Hale
Healthcare 2026, 14(18), 3016; https://doi.org/10.3390/healthcare14183016 - 15 Sep 2026
Viewed by 332
Abstract
Background/Objectives: Acquired brain injury (ABI) affects tens of thousands of British Columbians, yet research priorities specific to pediatric populations have received limited attention. This transdisciplinary engagement study aimed to identify and rank key research priorities for health and care services for children [...] Read more.
Background/Objectives: Acquired brain injury (ABI) affects tens of thousands of British Columbians, yet research priorities specific to pediatric populations have received limited attention. This transdisciplinary engagement study aimed to identify and rank key research priorities for health and care services for children and youth with ABI in British Columbia, Canada, by bringing together researchers, clinicians, community organization representatives, and people with lived experience (PWLE). Methods: A hybrid Nominal Group Technique (hNGT) combining virtual and in-person participation was employed from January to May 2025. Thirty advisory panel members—10 researchers, 13 clinicians, five community organization representatives, and two community members, representing a range of disciplines and geographic locations—participated across three phases: silent idea generation using an online platform, a hybrid round-robin clarification meeting, and priority ranking via an online survey. The hybrid approach was designed to maximize engagement and accessibility while preserving equitable opportunities to contribute. Results: The advisory panel contributed 49 initial ideas through the online brainstorming platform. Following round-robin clarification, 28 ideas remained in scope and were consolidated into 19 potential research priorities. Twenty advisory members completed the anonymous final ranking, which identified the 11 highest-ranked research priorities. The highest-ranked priority called for greater diversity among research participants to better represent the varied needs of children and youth with ABI. Seven of the 11 priorities addressed intersecting identities and the inclusion of underrepresented populations. Conclusions: This hNGT study identified 11 research priorities that can guide future ABI research. The findings emphasize the need for research that reflects the heterogeneous nature of pediatric ABI across diverse communities and contexts. Full article
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13 pages, 1027 KB  
Article
Changes in Patient Attitudes and Vaccination Intention After Pneumococcal Vaccination Counselling by Trained Family Physicians: A Multicentre Implementation Study in Romania
by Roxana Surugiu, Virginia-Maria Rădulescu, Anca Deleanu, Anca Lăcătuș, Mirela Mustață, Dana Fărcășanu, Iulia Vișinescu, Alexandra Aurora Dumitra and Gheorghe Gindrovel Dumitra
Germs 2026, 16(3), 20; https://doi.org/10.3390/germs16030020 - 13 Aug 2026
Viewed by 397
Abstract
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 [...] Read more.
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
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17 pages, 6086 KB  
Article
Training Community–Academic Teams to Use Low-Cost Air Monitors: A Mixed Method Evaluation of the RISE Communities Program
by Mackenzie Martin, Daniel Hargraves, Patrick Ryan and Jacqueline Knapke
Int. J. Environ. Res. Public Health 2026, 23(8), 1051; https://doi.org/10.3390/ijerph23081051 - 13 Aug 2026
Viewed by 662
Abstract
Concerns regarding poor air quality in communities experiencing disproportionately high levels of air pollution frequently motivate formation of community–academic partnerships. Low-cost air monitors can assess air pollution but require specific training. The RISE Communities program was created to support partnerships in air quality [...] Read more.
Concerns regarding poor air quality in communities experiencing disproportionately high levels of air pollution frequently motivate formation of community–academic partnerships. Low-cost air monitors can assess air pollution but require specific training. The RISE Communities program was created to support partnerships in air quality training and community-engaged research. The RISE Communities program in-person training took place in Cincinnati, OH, in summers 2023 and 2024. The training included hands-on workshops, lectures, and monthly webinars with continued expert guidance for one year following the in-person training. A mixed method evaluation included pre-, post-, and one-year follow-up surveys, webinar evaluation surveys, and focus groups at the conclusion of each cohort. Participants reported significantly increased confidence in describing the health impacts of air pollution and using low-cost air sensors. Subjective feedback commented on the need for more tailored and interactive webinars and data training. Participants agreed that the goals of the RISE Communities training program were met and skills were sustained. This mixed method evaluation study demonstrates that an immersive training program for academic and community partners resulted in significantly higher confidence levels related to community partnership, data analytics, data visualization, and achieving project planning outcomes. Full article
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19 pages, 1920 KB  
Article
Satisfaction Resilience in Virtual Home Health Care for Chronic Disease Management: Lifestyle-Integration Motivation and Functional Equivalence Beliefs in a Cross-Sectional Study
by Ahmed Alqheedan, Saleh Alzughaibi, Eman Alanazi, Mohammed Alsahli, Amani Othman, Rasha Alhazzaa and Mansour Almanaa
Healthcare 2026, 14(16), 2484; https://doi.org/10.3390/healthcare14162484 - 11 Aug 2026
Viewed by 319
Abstract
Background/Objectives: Virtual home health care (VHHC) is increasingly used to support chronic disease management, yet patient satisfaction is often examined through a linear barrier-focused lens, in which more barriers are assumed to produce lower satisfaction. This study introduced a satisfaction resilience framework [...] Read more.
Background/Objectives: Virtual home health care (VHHC) is increasingly used to support chronic disease management, yet patient satisfaction is often examined through a linear barrier-focused lens, in which more barriers are assumed to produce lower satisfaction. This study introduced a satisfaction resilience framework to identify factors associated with preserved satisfaction among barrier-exposed VHHC users. Methods: This cross-sectional analysis included 517 adults with chronic diseases who had used VHHC services and were recruited across five regions of Saudi Arabia. Patients were classified by barrier load and overall satisfaction into four groups: Resilient, Vulnerable, Comfortable, and Disengaged. Group differences were examined using one-way ANOVA, chi-square tests with Cramér’s V, point-biserial correlations, and a linear probability model restricted to high-barrier patients. Results: Overall, 167 patients (32.3%) reported high barrier exposure. Among them, 109 (65.3%) were classified as Resilient and 58 (34.7%) as Vulnerable, despite statistically equivalent barrier counts. Resilient patients reported higher motivation count, provider trust, perceived effectiveness, and functional equivalence with in-person care. Lifestyle-integration motivations, particularly avoiding work absence and waiting rooms, differentiated Resilient from Vulnerable patients, whereas access-related motivations did not. Perceived functional equivalence showed the largest between-group effect. In the high-barrier subsample, motivation count and provider trust were independently associated with Resilient status, while demographic variables were not significantly associated with it. Conclusions: Satisfaction with VHHC among chronic disease patients is not determined by barrier exposure alone. Service-design and communication strategies that strengthen lifestyle integration, functional equivalence beliefs, and provider trust may help healthcare teams support satisfaction resilience among patients who experience barriers to virtual care. Full article
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25 pages, 680 KB  
Article
A Randomized Controlled Trial: eHealth Interventions for Self-Management and Psychological Coping in Cancer Patients
by Manal Saleh Moustafa Saleh, Safaa Gaber Aly Salem, Khaled Abdallah Khader, Riham Hashem Fathi, Hanan E. Elsabahy, Hamad G. Dailah, Hind Mobark Fahd Alshamry, Shaimaa Mohamed Nageeb Mohamed, Eman Ahmed Gouda Ahmed and Laila A. Hamed
Healthcare 2026, 14(15), 2391; https://doi.org/10.3390/healthcare14152391 - 4 Aug 2026
Viewed by 507
Abstract
Background: Enhancing self-management and coping strategies in cancer patients is critical to improving their quality of life and treatment outcomes. eHealth interventions, such as mobile apps, telehealth platforms, and online support tools, offer accessible, personalized, and cost-effective solutions that empower patients to actively [...] Read more.
Background: Enhancing self-management and coping strategies in cancer patients is critical to improving their quality of life and treatment outcomes. eHealth interventions, such as mobile apps, telehealth platforms, and online support tools, offer accessible, personalized, and cost-effective solutions that empower patients to actively manage their symptoms, adhere to treatment plans, and reduce psychological distress. These digital tools play a pivotal role in bridging care gaps, especially for individuals facing barriers to in-person support, underscoring their growing importance in modern oncology care. Aim: The aim of this study was to evaluate the efficacy of an eHealth intervention in enhancing self-management and coping strategies in cancer patients. Methods: This study was designed as a randomized controlled trial (RCT) and is reported in accordance with the CONSORT guidelines to ensure transparent and comprehensive reporting. A study and control group pre-test/post-test design was employed to investigate the impact of the intervention in the cities of Shaqra and Sajir, Riyadh, Saudi Arabia. A total of 212 participants were recruited using the Symptom-Management Self-Efficacy Scale (SMSE) and the Jaloweic Coping Scale. Result: Before the intervention, the correlation between coping behaviors and self-management practices was weak and statistically insignificant for both groups (study: r = 0.091, p = 0.351; control: r = 0.048, p = 0.622). After the intervention, a significant positive correlation emerged in the study group (r = 0.267, p = 0.006), suggesting that improvements in coping behaviors were associated with enhanced self-management practices. However, no significant change was observed in the control group (r = 0.081, p = 0.412). Conclusions: The intervention significantly improved self-management practices and coping behaviors in the study group, while the control group showed minimal or no improvement. The findings indicate that self-management and coping strategies are interrelated, and demographic factors such as age, education, and income influence the extent of improvement. Trial Registration: ClinicalTrials.gov identifier NCT07457112, registered on 5 March 2026, retrospectively registered. Full article
(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)
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12 pages, 464 KB  
Review
Emerging Digital Technologies for Monitoring and Rehabilitation Support in Chronic Dust-Induced Lung Diseases: A Scoping Review
by Nazym Sagandykova, Madina Baurzhan, Alexandr Gulyayev, Sayagul Kairgeldina, Shyngys Sergazy, Gulnur Daniyarova, Karlygash Absattarova, Liudmila Kovalenko and Akmaral Izbassarova
J. Pers. Med. 2026, 16(8), 407; https://doi.org/10.3390/jpm16080407 - 29 Jul 2026
Viewed by 351
Abstract
Background/Objectives: Chronic dust-induced lung diseases, including pneumoconiosis and asbestosis, require long-term monitoring and individualized management. Conventional rehabilitation and follow-up often depend on in-person visits and may not provide continuous assessment outside clinical settings. This scoping review mapped evidence on digital technologies used to [...] Read more.
Background/Objectives: Chronic dust-induced lung diseases, including pneumoconiosis and asbestosis, require long-term monitoring and individualized management. Conventional rehabilitation and follow-up often depend on in-person visits and may not provide continuous assessment outside clinical settings. This scoping review mapped evidence on digital technologies used to monitor patients, assess respiratory symptoms and functional status, and support rehabilitation follow-up in chronic dust-induced lung diseases. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute methodology. PubMed, Scopus, and Web of Science were searched from inception to 29 June 2026 without language restrictions. Five eligible publications were included. Results: The evidence was grouped into three categories: wearable monitoring of activity and respiratory symptoms, analysis of data from a digital rehabilitation platform, and electronic medical record (EMR) analysis. Wearable sensors showed high performance in recognizing basic activity states and cough events under controlled conditions. Platform- and EMR-based approaches showed potential for using clinical and functional data to support patient stratification and monitoring. However, most studies were limited to early technical or algorithmic validation and did not assess long-term home use, patient adherence, integration into clinical workflows, or clinical and rehabilitation outcomes. Conclusions: Digital technologies may support objective monitoring and rehabilitation follow-up in chronic dust-induced lung diseases, but the evidence base remains small and clinically immature. Prospective studies in real-world settings should evaluate usability, external validity, workflow integration, and clinically meaningful outcomes. Full article
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15 pages, 431 KB  
Article
Comparing Digital and In-Person CBT-Based Group Psychoeducation for Anxiety, Depression, and Stress in University Students: A Quasi-Experimental Study
by Francielle Assumpção, Gabriela Oltramari, Gabriel Henrique Bomfim de França, Natália Martins Dias and Fernanda Machado Lopes
Psychiatry Int. 2026, 7(4), 162; https://doi.org/10.3390/psychiatryint7040162 - 21 Jul 2026
Viewed by 726
Abstract
The increasing prevalence of anxiety, depression, and stress has intensified the demand for scalable, evidence-based psychological interventions that can be delivered across traditional and digital modalities. University students represent a high-risk group due to academic demands and developmental transitions, making them a relevant [...] Read more.
The increasing prevalence of anxiety, depression, and stress has intensified the demand for scalable, evidence-based psychological interventions that can be delivered across traditional and digital modalities. University students represent a high-risk group due to academic demands and developmental transitions, making them a relevant population for evaluating flexible, technology-mediated interventions. Cognitive-behavioral therapy (CBT)-based psychoeducation offers a structured approach that may accommodate variability in accessibility, preferences, and delivery contexts. This quasi-experimental pre–post study evaluated a CBT-based psychoeducation protocol delivered in group settings in both online and in-person formats. A total of 104 undergraduate and graduate students participated and completed the intervention. Symptom severity was assessed using the Depression, Anxiety and Stress Scale (DASS-21), the Hamilton Anxiety Rating Scale (HAM-A), and the Beck Depression Inventory–II (BDI-II). Significant reductions in anxiety, depression, and stress symptoms were observed over the intervention period, with moderate to large effect sizes. DASS-21 scores decreased from moderate to mild severity levels, and reductions were also observed in BDI-II and HAM-A scores. No significant differences were found between delivery modalities. These findings support the potential of CBT-based group psychoeducation as a scalable intervention. Similar patterns of symptom change were observed across delivery formats, contributing to the expansion of accessible and digitally informed mental health care. Full article
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16 pages, 280 KB  
Study Protocol
Wear-Smile: A Multidisciplinary Telemedicine-Based Smoking Cessation Program Assisted by Wearable Monitoring Devices for Persons Who Smoke—Protocol for a Randomized Controlled Trial
by Maria Pia Di Palo, Massimo Amato, Carmine Vecchione, Michele Ciccarelli, Marina Garofano, Federica Di Spirito, Michele Davide Mignogna, Francesco Corallo, Maria Pagano, Irene Cappadona, Colomba Pessolano, Alessia Nunziante and Alessia Bramanti
Healthcare 2026, 14(14), 2055; https://doi.org/10.3390/healthcare14142055 - 9 Jul 2026
Viewed by 508
Abstract
Background: Tobacco smoking remains one of the leading preventable causes of morbidity and mortality worldwide and is associated with cardiovascular, respiratory, oral, and psychological disorders. Although conventional smoking cessation interventions are effective, barriers related to accessibility, adherence, healthcare costs, and continuity of care [...] Read more.
Background: Tobacco smoking remains one of the leading preventable causes of morbidity and mortality worldwide and is associated with cardiovascular, respiratory, oral, and psychological disorders. Although conventional smoking cessation interventions are effective, barriers related to accessibility, adherence, healthcare costs, and continuity of care frequently limit long-term success. Recent advances in technology may offer innovative opportunities to improve multidisciplinary smoking cessation pathways. Methodology: The Wear-Smile project is a non-profit, monocentric, randomized controlled trial registered in the Clinical Trial Protocol Registry and Results System (code No.: NCT07593742), designed to evaluate the effectiveness of a multidisciplinary telemedicine-based smoking cessation program assisted by wearable remote-monitoring devices. Adults who smoke combustible or heated tobacco or electronic nicotine delivery systems will be randomly allocated in a 1:1 ratio to either an experimental group receiving telemedicine-assisted rehabilitation integrated with wearable monitoring devices or a control group receiving standard in-person smoking cessation care. The intervention will include a multidisciplinary behavioral smoking cessation intervention involving cardiology, respiratory, dental, and psychology specialists. Primary outcomes will include Continuous Abstinence Rates and Point Prevalence Abstinence assessed at 6 and 12 months. Secondary outcomes will include cardiopulmonary and oral health parameters, smoking-related variables, health- and oral health-related quality of life (QoL), as well as adherence, usability, acceptability, and satisfaction with the rehabilitation program. Conclusions: The project may provide preliminary evidence regarding the potential feasibility, acceptability, and effectiveness of a multidisciplinary smoking cessation program integrating telemedicine and wearable monitoring technologies in improving abstinence outcomes, patient engagement, continuity of care, and QoL. Full article
23 pages, 272 KB  
Article
Entrepreneurial Learning in Rural Contexts: A Qualitative Analysis of Student Reflections from the RISE29 Internship Program
by Emily Pauline Yeager, Dennis Barber, Tristyn Daughtry and Michael Harris
Sustainability 2026, 18(14), 6959; https://doi.org/10.3390/su18146959 - 8 Jul 2026
Viewed by 315
Abstract
Rural communities face persistent economic challenges, and universities increasingly serve as catalysts for regional entrepreneurial development. This study evaluates the RISE29 program, a consulting-based internship initiative placing interdisciplinary undergraduate teams as paid interns with small businesses in economically distressed counties of Eastern North [...] Read more.
Rural communities face persistent economic challenges, and universities increasingly serve as catalysts for regional entrepreneurial development. This study evaluates the RISE29 program, a consulting-based internship initiative placing interdisciplinary undergraduate teams as paid interns with small businesses in economically distressed counties of Eastern North Carolina, examining what students across disciplines learned. Drawing on Cope’s entrepreneurial learning framework as a sensitizing theoretical lens, the study asks: (1) What themes characterize the entrepreneurial learning experiences described by RISE29 interns across cohorts and disciplines? (2) How do reflective depth, student agency, and program satisfaction vary across cohort periods, disciplinary affiliations, and program structures? A multi-layered qualitative analysis of 158 written reflection papers submitted across ten cohorts (Spring 2019–Summer 2022) was integrated with deductive qualitative analysis guided by Cope’s entrepreneurial learning framework, constructivist grounded theory coding, reflexive thematic analysis, reflective depth coding, sentiment and tone analysis, and cross-group comparison. Seven themes emerged: communication as the central axis of learning; collaborative identity development; leadership identity formation; encounter with Eastern North Carolina’s rural communities; professional identity and career clarity; real-world learning and classroom transfer; and program satisfaction with constructive critique. All four dimensions of Cope’s framework were present across disciplines, and non-Business students, in several cases, demonstrated a high degree of analytical depth warranting further investigation. Reflective depth increased in cohorts using an expanded prompt, though overlapping structural changes across the study period preclude single-factor attribution. Place-based, consulting-driven experiential programs generate substantive entrepreneurial learning across disciplinary lines, though findings reflect students’ perceived learning rather than verified competency acquisition. These results support investment in client vetting, structured reflection, cross-disciplinary teaming, and in-person community engagement. Full article
13 pages, 236 KB  
Article
Implementation of a Multidisciplinary Transitional Home Care Program for Very-Low-Birth-Weight Infants: A Structured Program Evaluation
by Chia-Wen Hung and Li-Min Wu
Healthcare 2026, 14(13), 1919; https://doi.org/10.3390/healthcare14131919 - 1 Jul 2026
Viewed by 376
Abstract
Background: Very-low-birth-weight (VLBW) infants require ongoing medical follow-up and coordinated family support after discharge due to their immature physiological development and a high risk of complications. Fragmented transitional care and caregiver burden may compromise follow-up adherence and infant health outcomes. This study aimed [...] Read more.
Background: Very-low-birth-weight (VLBW) infants require ongoing medical follow-up and coordinated family support after discharge due to their immature physiological development and a high risk of complications. Fragmented transitional care and caregiver burden may compromise follow-up adherence and infant health outcomes. This study aimed to describe the implementation, feasibility, and service-level outcomes of a multidisciplinary transitional home care program designed to support continuity of care and family-centered transitional support for high-risk infants through a retrospective descriptive program evaluation. Methods: Since 2022, our hospital has implemented a government-supported transitional home care program for low and VLBW infants. A multidisciplinary team provided individualized discharge planning, risk stratification, home-based follow-up, telehealth consultations, developmental monitoring, caregiver education, and psychosocial support. Program outcomes were evaluated using enrollment coverage, follow-up completion, developmental assessment attendance, caregiver stress scores, and service utilization. Results: From 2022 to September 2025, enrollment coverage reached 97.7–100% for infants ≤ 1500 g and 100% for preterm infants > 1500 g. A total of 949 video consultations and 2168 telephone or in-person follow-ups were conducted, totaling 3117 service encounters. Developmental assessment attendance rates reached 95%, 93%, and 88% at scheduled corrected-age intervals. Mean caregiver stress scores showed favorable observational trends, decreasing from 14.64 to 10.81. Fifty-two referrals to social resources enhanced service accessibility and family support. Conclusions: This multidisciplinary transitional home care program demonstrated high enrollment coverage and sustained follow-up engagement within a tertiary medical center setting. The findings support the feasibility and potential applicability of integrated and family-centered transitional care models in supporting continuity of care and caregiver support for high-risk infants after discharge. Due to the descriptive retrospective design and absence of a control group, causal relationships cannot be established. Full article
(This article belongs to the Section Healthcare Organizations, Systems, and Providers)
12 pages, 216 KB  
Protocol
Experiences, Needs, and Beliefs Regarding Footwear Among People with Diabetes Mellitus in Spain: A Qualitative Focus Group Study Protocol
by Paloma López-Ros, Aitor Gonzalez-Ibanez, David Montoro-Cremades, Laura Tabernero Grau, Javier Marco-Lledo, Vicenta Martínez-Córcoles and Jonatan García-Campos
Diabetology 2026, 7(7), 125; https://doi.org/10.3390/diabetology7070125 - 1 Jul 2026
Viewed by 609
Abstract
Background/Objectives: Diabetes mellitus (DM) is a group of chronic metabolic disorders characterised by persistent hyperglycaemia and an increasing global prevalence, imposing a significant socioeconomic and healthcare burden. Among its associated complications, the diabetic foot is a critical condition that doubles the risk of [...] Read more.
Background/Objectives: Diabetes mellitus (DM) is a group of chronic metabolic disorders characterised by persistent hyperglycaemia and an increasing global prevalence, imposing a significant socioeconomic and healthcare burden. Among its associated complications, the diabetic foot is a critical condition that doubles the risk of mortality. Although therapeutic footwear is an essential preventive strategy, research on treatment adherence has predominantly focused on quantitative parameters. This protocol aims to explore the experiences, needs, and perceived barriers of people with DM regarding therapeutic footwear use from a qualitative perspective. Methods: A qualitative focus group study will be conducted in the province of Alicante, Spain. Participants will be adults with a confirmed diagnosis of DM recruited across IWGDF foot risk categories 1–3 through purposive sampling. A total of 8–10 focus groups of 10–12 participants will be conducted in separate in-person and online modalities. Data will be analysed using reflexive thematic analysis within a constructivist epistemological framework, following the six-phase approach proposed by Braun and Clarke. The study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethical approval will be obtained from the relevant Ethics Committee prior to data collection. Results/Expected Outcomes: The findings are anticipated to generate patient-centred, evidence-based insights into the psychosocial and experiential dimensions of therapeutic footwear adherence, informing the development of novel educational strategies and improvements in footwear design to optimise treatment adherence and clinical outcomes. Conclusions: This protocol provides a rigorous and transparent methodological framework for qualitative investigation of therapeutic footwear adherence in people with DM, contributing to a more comprehensive and person-centred approach to diabetic foot prevention. Full article
(This article belongs to the Section Complications and Comorbidities of Diabetes)
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