Search Results (319)

Background/Objectives: Telemedicine has emerged as a pivotal approach to improving access to diabetic retinopathy (DR) screening, diagnosis, management, and monitoring. Over the past two decades, rapid advancements in digital imaging, mobile health technologies, and artificial intelligence have substantially expanded the role of teleophthalmology in DR, resulting in a large volume of pertinent publications. This study aimed to provide a scientific overview of telemedicine applied to DR through bibliometric analysis. Methods: A search of the Web of Science Core Collection was conducted on 15 November 2025 to identify English-language original research and review articles regarding telemedicine for DR. Bibliographic data from relevant publications were extracted and underwent quantitative analysis and visualization using the tools Bibliometrix and VOSviewer. Results: A total of 515 articles published between 1998 and 2025 were included in our analysis. During this period, the research field of telemedicine for DR exhibited an annual growth rate of 13.14%, with publication activity markedly increasing after 2010 and peaking in 2020–2021. Based on the number of publications, United States, China, and Australia were the most productive countries, while Telemedicine and e-Health, Journal of Telemedicine and Telecare, and British Journal of Ophthalmology were the most relevant journals in the field. Keyword co-occurrence analysis revealed three major thematic clusters within the broader topic of telemedicine and DR, namely, public health-oriented work, telehealth service models, and applications of artificial intelligence technologies. Conclusions: The role of telemedicine in DR detection and care represents an expanding multidisciplinary field of research supported by contributions from multiple authors and institutions worldwide. As technological capabilities continue to evolve, ongoing innovation and cross-domain collaboration could further advance the applications of teleophthalmology for DR, promoting more accessible, efficient, and equitable identification and management of this condition. Full article

Violence against women remains prevalent, yet many survivors do not engage with services even where health infrastructure exists. This study investigated the role of institution-facing resources, Institutional Trust (ITR) and Procedural Justice (PJ), and the role of interpersonal resources, Social Support Provided (SSP), in women’s formal care-seeking intentions, as mediated by Psychological Distress (PSS) and General Self-Efficacy (GSE). An online survey was administered to women in Greece (n = 392) and the United Kingdom (n = 328), yielding a sample of 718. To compare the structural paths in the model across the two countries, measurement invariance was first explored, while the model was estimated through multi-group structural equation modeling. Across the pooled sample, PJ and GSE predicted HSB firmly, while ITR had no direct link to the construct. SSP did not directly predict HSB, but was linked to GSE in all models. The results of the interaction and group-difference models showed PJ and SSP had a slight indirect effect through GSE, while distress-based pathways were weaker and context-dependent. Multi-group models revealed significant cross-national differences: the direct effect of ITR and PSS on GSE was stronger in the United Kingdom than in Greece. The direct effect of PJ/GSE and SSP/GSE also had a stronger impact in Greece than in the United Kingdom. Overall, the results indicate that the willingness of women to seek help is less driven by their trust in institutions and more driven by their expectations of fairness in provider interaction and their perceived personal capability, where social support plays a role as the antecedent increasing women’s Perceived Self-Efficacy. The implications include prioritizing procedurally just practices, designing interventions that enhance self-efficacy for system navigation, and mobilizing informal networks as partners in the help-seeking process. Full article

Per- and polyfluoroalkyl substances (PFASs) represent a group of persistent environmental contaminants with known adverse health effects. This study assessed the presence and concentrations of PFASs in surface water across various locations along the Gunpowder River Watershed in Maryland, United States. Gunpowder RIVERKEEPER^® a 501(c)(3) nonprofit collected eleven surface water grab samples from the Gunpowder River Watershed for the study, including both drinking water sources and non-drinking tributaries. Of the 55 PFASs analyzed, multiple compounds, including PFOS, PFOA, PFBS, PFHxA, PFPeA, and PFHpA, were detected above reporting limits at all sampled locations. Total PFAS concentrations varied substantially across the watershed, ranging from 2.1 to 21.3 ng/L in drinking water source tributaries and 6.6–18.4 ng/L in non-drinking tributaries. Several sites exhibited PFOS and PFOA concentrations exceeding the 2022 U.S. EPA interim lifetime health advisory levels, indicating potential risk to downstream communities relying on these water sources. Short-chain PFASs (C ≤ 7) were more abundant than long-chain PFASs, reflecting their greater mobility and persistence in surface waters. These findings demonstrate watershed-wide PFAS contamination and highlight the potential for trophic transfer and bioaccumulation in fish species in these tributaries and subsequent human exposure. Continued monitoring, regulation, and remediation efforts are required to mitigate PFAS contamination and safeguard public health in vulnerable ecosystems and populations. Further research is needed to better understand the extent of PFAS exposure, associated health risks, and effective strategies for prevention and management. Full article

Background: Peer-led Active Rehabilitation Camps (ARC) aim to enhance functional independence and self-management among people with spinal cord injury (SCI). In Poland, where access to specialized spinal units and lifelong follow-up is limited, these programs may help address key health priorities—mobility, bowel and bladder management, sexual well-being, and upper-limb function. This study examined whether participation in ARC helped individuals achieve these priorities and identified factors associated with outcomes. Methods: This prospective cohort study, part of the Inter-PEER project, included 125 adults with SCI who attended one of 16 consecutive ARCs in Poland (2023–2024). Eligible participants used a manual wheelchair, were aged ≥ 16 years, and could complete written questionnaires. Data were collected at camp start (T1), completion (T2), and 3-month follow-up (T3) using surveys and wheelchair skills assessments. Validated instruments (SCIM-SR, MSES, QEWS, WST-Q, LiSat-11) were used and were aligned with the four priority domains. Associations with demographic and injury variables were examined using multivariate regression analyses. Results: Participants showed significant gains across priorities during the 10-day ARC. Mobility improved on all wheelchair-skill measures (e.g., QEWS + 2.6 points, p < 0.001), with most gains sustained at T3. Among participants with tetraplegia, self-care and hygiene scores increased by 24% and remained elevated at follow-up. Confidence in achieving a satisfying sexual relationship increased by camp end and was accompanied by higher sexual-life satisfaction at T3. Regression analyses found only modest associations between outcomes and demographic or injury characteristics. Conclusions: Participation in peer-led ARC programs was associated with rapid, clinically meaningful improvements in several health domains prioritized by people with SCI, especially upper-limb function, sexual well-being, and wheelchair mobility. Our findings highlight the value of integrating structured, peer-based community programs into the continuum of SCI rehabilitation. Full article

Background and Objectives: Mobile Eye Units (MEUs) have emerged as practical innovations to overcome geographic, financial, and systemic obstacles to eye care. Although numerous programs operate across the United States and Canada, a narrative review describing their structure, implementation and services, remain limited. This narrative review examines various MEUs models in the United States and Canada, using real-world examples to highlight each model’s structure, services, populations served, and key benefits and limitations. Methods: We performed a narrative review of peer-reviewed and gray literature published from 1990 to August 2025, identifying mobile eye units in the United States and Canada. Programs were grouped into four operational models based on services, equipment, and implementation characteristics. Ophthalmology residency program websites in the United States were also reviewed to assess academic involvement in mobile outreach. Results: We identified four operational MEU models: Fully Equipped Mobile Units (FEMUs), Semi-Mobile Outreach Units (SMOUs), School-Based Vision Mobile Units (SBVMUs), and Hybrid Teleophthalmology Units (HTOUs). FEMUs provide comprehensive on-site diagnostic capabilities but require substantial financial and logistical resources. SMOUs are lower-cost and flexible but offer more limited diagnostics. SBVMUs facilitate early detection in children and reduce school-based access barriers but depend on school coordination. HTOUs expand specialist interpretation through remote imaging, although their success relies on reliable digital infrastructure. Across all models, follow-up and continuity of care remain major implementation challenges. Approximately 21% of U.S. ophthalmology residency programs publicly report involvement in mobile outreach. Conclusions: MEUs play a critical role in reducing geographic and structural barriers to eye care for underserved populations across United States and Canada. However, limited outcome reporting, particularly regarding follow-up rates and continuity of care, hinders broader assessment of their effectiveness. Strengthening the integration of MEUs with patient navigators, integrated electronic health record, insurance support and support of local health networks is essential for improving long-term sustainability and impact. Full article

Background/Objectives: Intensive care units (ICU) immobility and weakness impair recovery, yet practice for Physical Therapist (PT)-led therapeutic exercise and mobility varies in definitions, dosing, safety, and documentation, which limits comparability and complicates quality assessment. This study aims to integrate adult ICU evidence and present PT-led operational definitions, dose progression principles, safety parameters, outcome measurement, and a documentation minimum dataset. Methods: A scoping review following PRISMA-ScR is used. Eligibility used Population, Concept, and Context: adults in ICU; PT-led therapeutic exercise or mobility; and ICU-initiated or directed care. Primary studies and prespecified quality-improvement reports were included. Data were extracted with a standardized form and summarized descriptively without meta-analysis. Results: Sixty studies were included. Based on the extracted data, this review synthesizes current evidence to propose standardized PT-led operational definitions and a graded progression from in-bed exercise to ambulation. While the individual components are derived from the literature, the conceptual framework for safety parameters and the stop rules were integrated and elaborated to guide clinical decision-making. Adverse events were uncommon and manageable. Outcome measurement centered on validated mobility and function measures at prespecified time points. A concise electronic record minimum dataset specifies provider attribution, timing and duration, activity level with assistance or device, planned and delivered dose with progression, in-session responses, and adverse events, supporting unit-level quality review and comparisons across ICU. Conclusions: A PT-led, graded program that applies shared thresholds, uses validated outcome measures, and employs standardized electronic documentation is feasible and supports safe delivery, clinically meaningful change, and quality improvement across adult ICU. Full article

Adverse exposure to noise pollution is increasingly recognized as a significant public health concern. Strong evidence links noise exposure with negative health outcomes such as cardiovascular disease, mental disorders, stress, and sleep disturbance. The presence of noise in parks, which are environmental settings associated with health promotion, recreation, and restoration, presents a paradox that warrants further exploration. The United States offers a distinct context for exploring this paradox, given its vast public park system and a wide array of anthropogenic and environmental noise sources. Our scoping review synthesized findings from fifteen research studies that investigated noise exposure and noise levels in United States public parks. The review examined how studies measured noise, the integration of subjective perceptions with objective assessments, and the role of park characteristics in shaping park visitor noise experiences. Results highlighted varying methodological approaches, with some studies employing sound level meters or modeling techniques, while others also incorporated surveys to capture visitor perceptions. Despite this variety, evidence on the direct health impacts of park noise exposure remains limited, and longitudinal studies are largely absent. Notably, few studies evaluated how noise interacts with other environmental exposures, such as air pollution or greenness, to influence visitor perception and wellness. By synthesizing the current evidence base, this review suggests knowledge gaps and few methodological inconsistencies that limit the field. Findings call for future research mobilizing standardized, multimodal noise assessment methods, and considerations for health outcome measures. Such advancements are important for informing public health interventions and guiding urban planning strategies to improve the acoustic quality and restorative potential of US parks. Full article

Women in vulnerable living situations with schizophrenia face intersecting challenges, including migration-related trauma, caregiving burdens, and systemic barriers such as cultural dislocation, limited healthcare access, and stigma. These factors heighten vulnerability compared with men and contribute to delayed diagnoses, poor treatment adherence, and adverse outcomes. Advances in artificial intelligence (AI) and digital tools offer potential support, though they should be regarded as complementary rather than stand-alone solutions. This review synthesizes literature on gender-specific care for women with schizophrenia, examining clinical, social, and reproductive needs alongside the impact of migration and psychosocial adversity. Emerging models, including women-focused psychiatric units, perinatal services, and community therapeutic spaces, illustrate holistic approaches that integrate the medical, psychological, and social dimensions of care. Digital interventions, such as smartphone applications, mobile health tools, and digital participation strategies, are considered supportive extensions that offer opportunities to improve access, reduce costs, and enhance continuity of care. Despite this promise, digital tools remain under-validated for women in precarious contexts. Ethical challenges, including algorithmic bias, data privacy risks, and the exclusion of undocumented or marginalized groups, further constrain equitable implementation. This review aims to articulate conceptual linkages among gender, migration, and digital innovation in schizophrenia care, identifying thematic patterns, ethical tensions, and structural limitations in the existing literature. The synthesis provides a foundation for future hypothesis development and interdisciplinary research to advance inclusive and equity-driven mental health interventions. Full article

Background and Clinical Significance: Adults suffering from cerebellar metastases are often at high risk for rapid deterioration of their neurological status because the posterior fossa has limited compliance and the location of these metastases are close to the brain stem and important cerebrospinal fluid (CSF) pathways. In this paper, we present a longitudinal, patient-centered report on the history of an elderly individual who suffered from cognitive comorbidities and experienced a sudden loss of function in her cerebellum. Our goal in reporting this case is to provide a comparison between the patient’s pre-operative and post-operative neurological examinations; the imaging studies she had before and after surgery; the surgical techniques utilized during her operation; and the outcome of her post-operative course in a way that will be helpful to other patients who have experienced a similar situation. Case Presentation: We report the case of an 80-year-old woman who initially presented with progressive ipsilateral limb-trunk ataxia, impaired smooth pursuit eye movement, and rebound nystagmus, but preserved pyramidal and sensory functions. Her quantitative bedside assessments included some of the components of the Scale for the Assessment and Rating of Ataxia (SARA), and a National Institute of Health Stroke Scale (NIHSS) score of 3. These findings indicated dysfunction of the left neocerebellar hemisphere and possible dentate nucleus involvement. The patient’s magnetic resonance imaging (MRI) results demonstrated an expansive mass with surrounding vasogenic edema and marked compression and narrowing of the exits of the fourth ventricle which placed the patient’s CSF pathways at significant risk of occlusion, while the aqueduct and inlets were patent. She then underwent a left lateral suboccipital craniectomy with controlled arachnoidal CSF release, preservation of venous drainage routes, subpial corticotomy oriented along the lines of the folia, stepwise internal debulking, and careful protection of the cerebellar peduncles and dentate nucleus. Dural reconstruction utilized a watertight pericranial graft to restore the cisternal compartments. Her post-operative intensive care unit (ICU) management emphasized optimal venous outflow, normoventilation, and early mobilization. Histopathology confirmed the presence of metastatic carcinoma, and staging suggested that the most likely source of the primary tumor was the lungs. Immediately post-operation, computed tomography (CT) imaging revealed a smooth resection cavity with open foramina of Magendie and Luschka, intact contours of the brain stem, and no evidence of bleeding or hydrocephalus. The patient’s neurological deficits, including dysmetria, scanning dysarthria, and ataxic gait, improved gradually during the first 48 h post-operatively. Upon discharge, the patient demonstrated an improvement in her limb-kinetic subscore on the International Cooperative Ataxia Rating Scale (ICARS) and demonstrated independent ambulation. At two weeks post-operation, CT imaging revealed decreasing edema and stable cavity size, and the patient’s modified Rankin scale had improved from 3 upon admission to 1. There were no episodes of CSF leakage, wound complications, or new cranial nerve deficits. A transient post-operative psychotic episode that was likely secondary to her underlying Alzheimer’s disease was managed successfully with short-course pharmacotherapy. Conclusions: The current case study demonstrates the value of anatomy-based microsurgical planning, preservation of venous and CSF pathways, and targeted peri-operative management to facilitate rapid recovery of function in older adults who suffer from cerebellar metastasis and cognitive comorbidities. The case also demonstrates the importance of early multidisciplinary collaboration to allow for timely initiation of both adjuvant stereotactic radiosurgery and molecularly informed systemic therapy. Full article

Rapid global urbanization has intensified the demand for sensing solutions that can capture the complex interactions between urban environments and their impact on human physical and mental health. Conventional laboratory-based approaches, while offering high experimental control, often lack ecological validity and fail to represent real-world exposures. To address this gap, we present the eMOTIONAL Cities Walker—a portable multimodal sensing platform designed as a wearable backpack unit developed for the synchronous collecting of multimodal data in either indoor or outdoor settings. The system integrates a suite of environmental sensors (covering microclimate, air pollution and acoustic monitoring) with physiological sensing technologies, including electroencephalography (EEG), mobile eye-tracking and wrist-based physiological monitoring. This configuration enables real-time acquisition of environmental and physiological signals in dynamic, naturalistic settings. Here, we describe the system’s technical architecture, sensor specifications, and field deployment across selected Lisbon locations, demonstrating its feasibility and robustness in urban environments. By bridging controlled laboratory paradigms with ecologically valid real-world sensing, this platform provides a novel tool to advance translational research at the intersection of sensor technology, human experience, and urban health. Full article

Background: Gait event detection from inertial sensors offers scalable insights into locomotor health, with applications in clinical monitoring and mobile health. However, supervised methods are limited by scarce annotations, device variability, and sensor placement shifts. This in silico study evaluates self-supervised learning (SSL) as a resource-efficient strategy to improve robustness and generalizability. Methods: Six public smartphone and wearable inertial measurements unit (IMU) datasets (WISDM, PAMAP2, KU-HAR, mHealth, OPPORTUNITY, RWHAR) were harmonized within a unified deep learning pipeline. Models were pretrained on unlabeled windows using contrastive SSL with sensor-aware augmentations, then fine-tuned with varying label fractions. Experiments systematically assessed included (1) pretraining scale, (2) label efficiency, (3) augmentation contributions, (4) device/placement shifts, (5) sampling-rate sensitivity, and (6) backbone comparisons (CNN, TCN, BiLSTM, Transformer). Results: SSL consistently outperformed supervised baselines. Pretraining yielded accuracy gains of ΔF1 +0.08–0.15 and reduced stride-time error by −8 to −12 ms. SSL cut label needs by up to 95%, achieving competitive performance with only 5–10% labeled data. Sensor-aware augmentations, particularly axis-swap and drift, drove the strongest transfer gains. Robustness was maintained across sampling rates (25–100 Hz) and device/placement shifts. CNNs and TCNs offered the best efficiency–accuracy trade-offs, while Transformers delivered the highest accuracy at greater cost. Conclusions: This computational analysis across six datasets shows SSL enhances gait event detection with improved accuracy, efficiency, and robustness under minimal supervision, establishing a scalable framework for human performance and sports medicine in clinical and mobile health applications. Full article

Environmental conditions like temperature, humidity, light, and gas levels directly affect human health, agriculture, and industrial processes. Monitoring these factors in real time is necessary for detecting dangerous situations early and making informed choices. This work presents a compact, mobile, IoT-enabled device that measures environmental data and sends it wirelessly for remote access. The system uses the ESP32 microcontroller, chosen for its low power use, built-in Wi-Fi, and ease of connecting with sensors and cloud services. Key sensors include the DHT22 for temperature and humidity, MQ135 for ammonia and gas detection, and an LDR for checking light intensity. An infrared (IR) sensor identifies obstacles, and a buzzer alerts users to dangerous conditions. The collected data appears on a 16X2 LCD for local monitoring. It is also transmitted to the ThingSpeak cloud platform for long-term storage and visualization. Users can view this data in real time through the Blynk mobile application, which also enables remote control of the device. The system is built for mobility. It operates with DC motors powered by an L298N motor driver. This lets it navigate different environments and collect data from various locations. This feature gives more flexibility and improves the system’s effectiveness compared to traditional stationary monitoring units. The innovative part of this project is the mix of real-time sensing, autonomous movement, and cloud connectivity in a low-cost, portable setup. The system was tested in controlled environments and consistently provided reliable readings. Its practical uses include smart agriculture, urban air quality monitoring, and industrial safety. Full article

Monitoring electrocardiogram (ECG) and respiration continuously and non-invasively is essential for managing cardiopulmonary health. An effective wearable device can be used to regularly monitor key vitals, reducing the need for clinical visits. In this work, we propose a custom device for real-time continuous ECG by inkjet printed (IJP) dry electrodes and respiration monitoring by using a novel single 6-axis inertial measurement unit (IMU). The proposed system can extract the heart rate (HR) and respiration rate (RR) during static and dynamic postures. The respiration process implements a quaternion-based update and multiple filtering stages to estimate the signal. The custom device uses Bluetooth protocol to send the raw and processed data to a mobile application. The RR is investigated in stationary, i.e., sitting and standing, and dynamic, i.e., walking, running, and cycling, postures. The proposed device is evaluated with commercial Go Direct^® respiration belt from Vernier^® for RR and offers an overall accuracy of 99.3% and 98.6% for static and dynamic conditions, respectively. The wearable also offers 98.9% and 97.9% accuracy for HR measurements, respectively, in static and active postures when compared with the Kardia^® device. Furthermore, the device is assessed in an ambulatory monitoring setup in both indoor and outdoor environments. The low-power wearable consumes an average of only 7.4 mA of current during data processing. The device performs effectively and efficiently in both stationary and active states, offering a low complexity, portable solution for real-time monitoring. The proposed system can benefit from the continuous monitoring and early detection of pulmonary and cardio-respiratory health issues. Full article

Wearable devices (WDs) are increasingly integrated into clinical workflows to enable continuous, non-invasive vital signs monitoring. Combined with Artificial Intelligence (AI), these systems can shift clinical monitoring from being reactive to predictive, allowing for earlier detection of deterioration and more personalized interventions. The value of these technologies lies not in absolute measurements, but in detecting physiological parameters trends relative to each patient’s baseline. Such a trend-based approach enables real-time prediction of deterioration, enhancing patient safety and continuity of care. However, despite their shared multiparametric capabilities, WDs are not interchangeable. This narrative review analyzes nine clinically validated devices, Radius VSM^® (Masimo Corporation, Irvine, CA, USA), BioButton^® (BioIntelliSense Inc., Redwood City, CA, USA. Distributed by Medtronic), Portrait Mobile^® (GE HealthCare, Chicago, IL, USA), VitalPatch^® (VitalConnect Inc., San Jose, CA, USA), CardioWatch 287-2^® (Corsano Health B.V., The Hague, The Netherlands. Distributed by Medtronic), Cosinuss C-Med Alpha^® (Cosinuss Gmb, Munich, Germany), SensiumVitals^® (Sensium Healthcare Limited, Abingdon, Oxfordshire, UK), Isansys Lifetouch^® (Isansys Lifecare Ltd., Abingdon, Oxfordshire, UK), and CheckPoint Cardio^® (CheckPoint R&D LTD., Kazanlak, Bulgaria), highlighting how differences in sensor configurations, battery life, connectivity, and validation contexts influence their suitability across various clinical environments. Rather than establishing a hierarchy of technical superiority, this review emphasizes the importance of context-driven selection, considering care setting, patient profile, infrastructure requirements, and interoperability. Each device demonstrates strengths and limitations depending on patient population and operational demands, ranging from perioperative, post-operative, emergency, or post-Intensive Care Unit (ICU) settings. The findings support a tailored approach to WD implementation, where matching device capabilities to clinical needs is key to maximizing utility, safety, and efficiency. Full article

The swift advancement of the digital economy presents new pathways toward achieving common prosperity in China. Based on microdata derived from the China Family Panel Studies (2010–2022), this study employs the “Broadband China” pilot policy as a quasi-natural experiment to explore how digital economy development influences multidimensional relative poverty. We develop a multidimensional relative poverty index encompassing economic, health, education, and living condition aspects utilizing the Alkire–Foster dual cutoff method and employ a staggered Difference-in-Differences design for empirical analysis. Results show that the policy leads to an average decrease of 1.8 percentage points in the probability of multidimensional relative poverty across households. The effect is more pronounced in central and western regions, rural households, and those with a high proportion of non-labor force, particularly in the dimensions of economic, health, and living conditions dimensions. Mechanism analysis via interaction term regression indicates that increased population mobility and improved informal employment are key channels. These findings suggest that enhancing digital infrastructure and tailoring mobility and employment policies to fit regional and urban–rural contexts can effectively alleviate multidimensional relative poverty. This study contributes empirical evidence connecting the advancement of the digital economy to poverty alleviation and aligns with the United Nations Sustainable Development Goal 1 (No Poverty). Full article