Search Results (186)

Background/Objectives: Effective diabetes self-management is critical for glycemic management and well-being, yet Latino youth face unique cultural and socioeconomic barriers that are insufficiently explored in the literature. This review mapped existing evidence on diabetes self-management for Latino youth. Methods: Searches were conducted in PubMed, CINAHL, SCOPUS, Web of Science, LILACS, ERIC, and The Cochrane Library, using the gray literature and reference lists, in September 2024, following JBI guidelines. The included studies were qualitative, quantitative, and mixed-methods studies and reviews on diabetes self-management for Latinos aged 0–30 with type 1 or 2 diabetes. Studies including participants over 30 or with gestational diabetes were excluded. Two reviewers independently extracted data using a standardized table and analyzed findings using the Association of Diabetes Care & Education Specialists framework (ADCES7) for self-care behaviors: healthy eating, being active, monitoring, taking medication, problem-solving, reducing risks, and healthy coping. Results: Forty-five studies (forty from the United States) were included from 860 citations. The findings highlighted challenges in adopting diabetes-friendly diets, including cultural preferences, food insecurity, and limited resources. Physical activity improved glycemic control but was hindered by family and school obligations. Continuous glucose monitoring (CGM) enhanced outcomes, though economic barriers limited access. Family-centered education improved medication adherence, while family support strengthened problem-solving. CGMs and insulin pumps reduced complications, and culturally adapted psychological support enhanced emotional well-being and glycemic management. Conclusions: This review underscores persistent disparities in diabetes self-management among Latino youth. While the study designs and settings were heterogeneous, the findings highlight the need for culturally tailored, family-centered interventions that address structural barriers and psychosocial needs to improve care. Full article

Background/Objectives: HIV-related stigma and fear among healthcare professionals represent significant barriers to effective patient care, contributing to delayed diagnosis and suboptimal treatment for people living with HIV (PLHIV). Although these issues have been studied in various settings, there is a lack of evidence on how they manifest among general practitionersin Colombia—a key group in the healthcare system. This study investigated the prevalence of stigma and fear among Colombian general practitioners and identified associated factors. Methods: A cross-sectional, observational study was conducted between February and May 2024, using a self-administered online survey targeting general practitioners. A validated 28-question instrument adapted from the Health Policy Project assessed fear, stigma, and related factors. Results: Among 579 participants, 68.6% exhibited low fear levels; however, specific clinical tasks, such as taking blood samples, elicited greater concern. Stigmatizing beliefs—such as associating HIV with irresponsible behavior—were reported by 25% of participants. Prior training in HIV care was inversely associated with stigma (OR = 0.681; 95% CI: 0.489–0.949), while older age and heterosexual orientation correlated with higher stigma levels. Conclusions: Despite generally low levels of fear and stigma, gaps in HIV-related training among physicians highlight the need for targeted educational initiatives. Promoting comprehensive HIV education in medical curricula and continuing professional development can reduce stigma, enhance confidence in care, and foster a more inclusive healthcare environment. Full article

Background/Objectives: Approximately 1% of people worldwide suffer from epilepsy. The development of safer and more effective antiepileptic medications (AEDs) is still urgently needed because all AEDs have some unwanted side effects and roughly 30% of epileptic patients cannot stop having seizures when taking current AEDs. It should be noted that the derivatives of pyrazolo[3,4-b]pyridine are important core structures in many drug substances. The aim of this study is to synthesize new derivatives of piperazino-substituted pyrazolo[3,4-c]-2,7-naphthyridines and 9,11-dimethylpyrimido[1′,2′:1,5]pyrazolo[3,4-c]-2,7-naphthyridines for the evaluation of their neurotropic activity. Methods: The synthesis of the target compounds was performed starting from 1-amino-3-chloro-2,7-naphthyridines and using well-known methods. The structures of all the synthesized compounds were confirmed by spectroscopic data. Compounds were studied for their potential neurotropic activities (anticonvulsant, sedative, anti-anxiety, and antidepressive), as well as side effects, in 450 white mice of both sexes and 50 male Wistar rats. The anticonvulsant effect of the newly synthesized compounds was investigated by using the following tests: pentylenetetrazole, thiosemicarbazide-induced convulsions, and maximal electroshock. The psychotropic properties of the selected compounds were evaluated by using the following tests: the Open Field test, the Elevated Plus Maze (EPM), the Forced Swimming test, and Rotating Rod Test to study muscle relaxation. For the docking studies, AutoDock 4 (version 4.2.6) was used, as well as the structures of the GABA_A receptor (PDB ID: 4COF), the SERT transporter (PDB ID: 3F3A), and the 5-HT_1A receptor (PDB ID: 3NYA) obtained from the Protein Data Bank. Results: A series of piperazino-substituted pyrazolo[3,4-c]-2,7-naphthyridines (3a–j) and 9,11-dimethylpyrimido[1′,2′:1,5]pyrazolo[3,4-c]-2,7-naphthyridines (4a–j), as well as new heterocyclic systems, i.e., isoxazolo[5,4-c]-2,7-naphthyridines 6a–d, were synthesized and evaluated for their neurotropic activity. The investigation showed that some of these compounds (3a,b,d,f–i and 4a,d,f,i) display high anticonvulsant activity, especially in the test of antagonism with pentylenetetrazol, surpassing the well-known antiepileptic drug ethosuximide. Thus, the most active compounds in the pentylenpotetrazole test are 3h, 3i, and 4i; the ED50 of compound 4i is 23.8, and the therapeutic index is more than 33.6, which is the highest among these three active compounds. On the other hand, they simultaneously exhibit psychotropic (anxiolytic, antidepressant, or sedative) or behavioral depressant) effects. The effective compounds do not cause myorelaxation at the tested doses and have high therapeutic indices. Docking on the most active compounds, i.e., 3h, 3i, and 4i, is in agreement with the experimental results. Conclusions: The studies reveled that some of these compounds (3i, 4a, and 4i) display high anticonvulsant and psychotropic activities. The most active compounds contained methyl and diphenylmethyl groups in the piperazine ring. The docking studies identified compounds 3i, 4i, and 4a as the most potent anticonvulsants, showing strong affinity for GABA_A, 5-HT_1A receptors, and the SERT transporter. Notably, compound 4i formed two hydrogen bonds with Thr176 and Arg180 on GABA_A and exhibited a binding energy (−8.81 kcal/mol) comparable to that of diazepam (−8.90 kcal/mol). It also showed the strongest binding to SERT (−7.28 kcal/mol), stabilized by interactions with Gly439, Ile441, and Arg11. Furthermore, 4i displayed the best docking score with 5-HT_1A (−9.10 kcal/mol) due to multiple hydrogen bonds and hydrophobic interactions, supporting its potential as a dual-acting agent targeting both SERT and 5-HT_1A. Full article

In the United States (US), a longstanding solution to the unmet need for mental health treatment is integrated behavioral health care (IBH). Within a primary care model, problems are identified and treatment combines care for physical, mental and substance use disorders. Treatments are delivered through the collaboration of primary and behavioral health providers. According to US federal billing guidelines, in one integrated model, the Collaborative Care Model (CoCM), the psychiatric consultant must be a medical professional trained in psychiatry and capable of prescribing medications, i.e., either a psychiatrist, Psychiatric Mental Health Nurse Practitioner (PMHNP) or Physician Assistant. The development of integrated care has been slow for particular vulnerable populations, in part due to the lack of psychiatric consultants. PMHNPs are increasingly taking on the role of psychiatric consultants on CoCM teams and creating nurse-led IBH models for underserved populations. In this paper, eight such models are discussed along with implementation challenges and the strategies used to address them. Nurse leaders have the capacity to enhance and expand integrated care, particularly for underserved populations, through the optimal utilization of care teams, expanding measured outcomes, and developing measures for team-based effectiveness. Future directions are proposed that will accelerate this PMHNP-led expansion of IBH. Full article

Medication adherence is a crucial factor for managing chronic conditions, especially in aging adults. Previous studies have identified predictors of medication adherence. However, current methods fail to capture the time-varying nature of how risk factors can influence adherence behavior. This objective of this study was to implement multitrajectory group-based models to compare a time-varying to a time-fixed approach to identifying non-adherence risk factors. The study population comprised 11,068 Medicare beneficiaries aged 65 and older taking select medications for hypertension, high blood cholesterol, and oral diabetes medications, between 2008 and 2016. Time-fixed predictors (e.g., sex, education) were examined using generalized multinomial logistic regression, while time-varying predictors were explored through multitrajectory group-based modeling. Several predisposing, enabling, and need characteristics were identified as risk factors for following at least one non-adherence trajectory. Time-varying predictors displayed an alternative representation of those risk factors, especially depression symptoms. This study highlights the dynamic nature of medication adherence predictors and the utility of multitrajectory modeling. Findings suggest that targeted interventions can be developed by addressing the key time-varying factors affecting adherence. Full article

Patient-tailored hip implants are a major area of development in orthopedic surgery. Thanks to the recent developments in titanium printing, the medical industry now places special demands on implants. The lattice design enhances osseointegration and brings the stiffness of the implant closer to that of the bone, so this is an important direction in the development of hip implant design processes. In our previous research, several lattice structures were compared from a strength perspective, considering surgical specifications regarding cell size. The so-called 3D lattice infill type built into ANSYS with a predefined size has proven to be suitable for medical practice and can be easily manufactured with additive manufacturing techniques. A major step in the implant design process is numerical strength analysis, which elucidates implant material response. Due to the complex geometry of the lattice structure, finite element calculations are extremely time-consuming and require high computation capacity; therefore, the focus of our current research was to develop a surrogate numerical model that provides sufficiently fast and accurate information about the behavior of the designed structure. The developed surrogate model reduces the simulation time by more than one hundred times, and the accuracy of the calculation is more than satisfactory for engineering practice. The deviation from the original model is, on average, below 5%, taking deformation into account. This makes the design phase much more manageable and competitive. Full article

Suicidal behavior among older military veterans is an important medical and social problem. The goal of this literature review is to discuss this underappreciated issue and identify suicide preventive interventions that can be utilized with the older military veteran population. Older veterans experience psychiatric, medical, and social problems associated with their age and/or military experience that can contribute to suicide risk. These problems include relationship losses through death or estrangement, depression, cognitive decline, loneliness, isolation, frailty, mobility issues, and chronic pain. Therefore, older veterans face a unique set of challenges. Suicide prevention in older veterans should take a multipronged approach which includes screening for suicidality, management of psychiatric and medical disorders, social assistance, safety planning, lethal means restriction, and involving family members in the veteran’s healthcare. Family members should be included in the safety planning process when possible. Gatekeeper training programs can be utilized to train individuals who are working with older veterans to reduce suicides amongst this age group. Full article

Preeclampsia is a form of gestational hypertension that usually appears after the 20th week of pregnancy. Evidence suggests that low-dose aspirin (LDA) effectively reduces the risk of developing preeclampsia, but the uptake rate remains low. This scoping review aims to synthesize and integrate existing knowledge domains relevant to the factors that influence women’s medication decisions during pregnancy, and to develop a causal explanation for at-risk women’s LDA uptake decisions. We introduced systems thinking to map the variables and develop causal loops to show variable interactions and causal explanations guided by the Theory of Planned Behavior. We extracted 65 variables, and grouped them into provider- (n = 19), patient- (n = 39), and system-level (n = 7) factors. By identifying variable interactions, we built a theory to explain various causal pathways leading to LDA treatment uptake. Mapping the variables and supporting the relationships of these variables with theories and concepts increases our study’s generalizability to medication decisions for other pregnancy complications. Full article

Autonomy is being increasingly used in domains like maritime, aviation, medical, and civil domains. Nevertheless, at the current autonomy level, human takeover in the human–autonomy interaction process (HAIP) is still critical for safety. Whether humans take over relies on situation awareness (SA) about the correctness of autonomy decisions, which is distorted by human anchoring and omission bias. Specifically, (i) anchoring bias (tendency to confirm prior opinion) causes the imperception of key information and miscomprehending correctness of autonomy decisions; (ii) omission bias (inaction tendency) causes the overestimation of predicted loss caused by takeover. This paper proposes a novel HAIP safety assessment method considering effects of the above biases. First, an SA-based takeover decision model (SAB-TDM) is proposed. In SAB-TDM, SA perception and comprehension affected by anchoring bias are quantified with the Adaptive Control of Thought-Rational (ACT-R) theory and Anchoring Adjustment Model (AAM); behavioral utility prediction affected by omission bias is quantified with Prospect Theory. Second, guided by SAB-TDM, a dynamic Bayesian network is used to assess HAIP safety. A case study on autonomous ship collision avoidance verifies effectiveness of the method. Results show that the above biases mutually contribute to seriously threaten HAIP safety. Full article

Background/Objectives: The health-seeking behavior of men is a public health concern and is associated with poor health outcomes and lower life expectancy among men. Masculinity norms are among the factors contributing to men’s poor health-seeking behavior. This study explored the views and experiences of purposively selected nurses on men’s health-seeking behavior. Methods: Through qualitative descriptive design, individual semi-structured interviews were conducted with 14 professional nurses, and collected data were audio recorded and transcribed verbatim. Tech’s eight steps were used to analyze data and guide the development of the main themes and sub-themes. Trustworthiness was ensured through credibility, confirmability, dependability, and transferability. Ethical approval was granted by the University of Venda Research ethics committee with reference number FHS/21/PH/26/1215. Results: Self-medication, a lack of trust in Western medicine, and the use of traditional healers were identified as reasons men underutilize health care services. Men were viewed as people who consult heath care services when illness is severe, feel uncomfortable with female nurses, and value respect from clinicians. Conclusions: Cultural norms still remain a barrier among men in this study setting, as men did not feel comfortable with their private parts being physically examined by female clinicians. There is a need to take note of cultural norms impacting health care service usage by men. Full article

(1) Background: Creutzfeldt–Jakob disease (CJD) is a rare and fatal neurodegenerative disorder caused by the accumulation of an altered prion protein, which usually leads to death within one year after clinical onset. CJD patients usually present with rapid cognitive impairment associated with declines in cerebellar, motor, visual, behavioral, and swallowing functions. Moreover, CJD patients lose their ability to eat and take medications orally very early on in treatment; nevertheless, there are no specific nutritional guidelines for this disease shared worldwide. (2) Methods: This review aims to describe the nutritional outcomes of CJD patients in Western countries to compare them with those described in East Asian countries and then aims to explore the most recent trends in the nutritional management of CJD patients, including some dietary compounds that present neuroprotective effects. (3) Results: In Japan’s, Taiwan’s, and China’s healthcare systems, CJD patients receive intensive life-sustaining treatment that prolongs their survival (i.e., artificial feeding); conversely, in Western countries, intensive life-sustaining treatments like tube feeding are not commonly provided to CJD patients. (4) Conclusions: It is difficult to pinpoint the reasons for these discrepancies around CJD palliative care supply, but it is clear that specific nutritional guidelines may directly improve the nutritional management of CJD patients and thus allow their families and caregivers to ensure the best end-of-life care for these patients. Full article

Autism is a challenging brain disorder affecting children at global and national scales. Applied behavior analysis is commonly conducted as an efficient medical therapy for children. This paper focused on one paradigm of applied behavior analysis, imitation, where children mimic certain lessons to enhance children’s social behavior and play skills. This paper introduces IMITASD, a practical monitoring assessment model designed to evaluate autistic children’s behaviors efficiently. The proposed model provides an efficient solution for clinics and homes equipped with mid-specification computers attached to webcams. IMITASD automates the scoring of autistic children’s videos while they imitate a series of lessons. The model integrates two core modules: attention estimation and imitation assessment. The attention module monitors the child’s position by tracking the child’s face and determining the head pose. The imitation module extracts a set of crucial key points from both the child’s head and arms to measure the similarity with a reference imitation lesson using dynamic time warping. The model was validated using a refined dataset of 268 videos collected from 11 Egyptian autistic children during conducting six imitation lessons. The analysis demonstrated that IMITASD provides fast scoring, takes less than three seconds, and shows a robust measure as it has a high correlation with scores given by medical therapists, about 0.9, highlighting its effectiveness for children’s training applications. Full article

Background/Objectives: Socioeconomic status and parental lifestyle influence dietary behaviors, including the administration of oral dietary supplements in children. The aim of this study was to evaluate the effects of selected health, dietary, and sociodemographic factors on the use of dietary supplements by children. Methods: In this cross-sectional observational study, a diagnostic survey based on the computer-assisted web interview method was conducted in November 2022 among 2826 parents whose children attend public educational institutions in Krakow, Poland. The study group included data on 497 nursery children (17.6%), 599 kindergarten children (21.2%), 1594 primary school children (56.4%), and 136 secondary school children (4.8%). Results: Among all respondents, 72.2% were taking oral nutritional supplements, with vitamin D supplementation being particularly popular in all groups. Logistic regression analysis identified predictors of supplement use, including special diet (p < 0.001), use of medication for chronic disease (p = 0.012), regularity of main meals (p = 0.022), and attending a sports school (p = 0.021). A decrease in supplement use was observed with the increasing level of education of children (p < 0.001). Conclusions: These results highlight the importance of various health, dietary, and sociodemographic factors in influencing decisions regarding dietary supplementation in children. Further assessment of dietary supplement usage should be conducted alongside evaluations of nutrient intake from the children’s diet. Full article

Introduction: Family medicine physicians take care of a diverse population of patients with a variety of acute and chronic diseases. These patients include family, friends, and acquaintances who may ask for direct medical care or help in accessing healthcare products and services within or outside of officially approved procedures. This is ethically challenging due to an ambiguous medical code of ethics, but it is commonly accepted as normal behavior by society. The aim of this study was to explore family medicine physicians’ perspectives regarding the benefits, difficulties, and ethics of responding to medical care requests and/or favors from family, relatives, friends, and acquaintances and to make recommendations. Methods: The study sample consisted of junior and senior family medicine physicians working in primary healthcare centers affiliated with the Ministry of Health in Saudi Arabia. In-depth semi-structured interviews were conducted to collect data. Using social exchange theory, this qualitative study explores how family medicine physicians perceive and handle requests for medical favors from family members and others. Results: Semi-structured interviews were conducted with 19 family medicine physicians (six focus groups) with clinical experience ranging from 3 to 20 years. The data analysis identified three themes: perceived benefits and costs of cultural and social connectedness, shortcomings in patient management and healthcare systems, and recommendations to address challenges between physicians and patients who are relatives. Discussion and Conclusions: This study shows that treating others outside of normal access to healthcare services presents several ethical, moral, and professional challenges. Therefore, policy adaptation requires understanding this intricate dilemma and improving laws, system regulations, and guidelines for physicians and community members to improve access to care, reduce system abuse, empower providers, and enhance community awareness and compliance. Full article

Objective: Although medically unexplained body complaints occur relatively frequently in adolescents, the causes are little-researched. This study examines the influence of cultural and family-related factors on somatic complaints. Methods and Measures: In a cross-cultural and cross-sectional study of 2415 adolescents from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey), the associations of family variables with body complaints were tested and the cultural impact analyzed. Body complaints were assessed via self-reporting with a translated version of the body complaints scale of the Youth Self Report (YSR). In addition, Perceived Maternal/Paternal Behavior was assessed, as well as cultural dimensions of the eight counties. Results: Overall, females reported higher rates of body complaints than boys did. An additional negative impact of parental psychological control and anxious rearing was found that generalized across cultures, with a particularly strong impact on girls. Girls in stepparent families and boys in single-parent families reported more body complaints. Finally, body complaints were associated with Hofstede’s cultural factors in both genders, like individualism vs. collectivism, power distance, uncertainty avoidance, and masculinity vs. femininity. Conclusion: These findings are particularly important for primary care providers, as they stress the relevance of taking into account family and cultural factors in body complaints which affect boys and girls differently, to provide adequate care. Full article