Search Results (1,946)

Non-communicable diseases (NCDs) remain a major contributor to global morbidity and mortality, with India bearing a substantial share of this burden. The COVID-19 pandemic disrupted routine clinical care and accelerated the transition to telemedicine for chronic disease management. This study explores healthcare providers’ perspectives on the use of telemedicine for NCD care during and after the pandemic, including its perceived benefits, limitations, and future relevance within the broader digital health landscape. Semi-structured interviews were conducted with 33 purposively selected healthcare providers with experience in telemedicine for NCD care between February and June 2025, audio-recorded, transcribed verbatim, and thematically analyzed using NVivo 15. Providers reported that telemedicine supported continuity of care, reduced the need for in-person visits, facilitated medication adherence, and offered reassurance for patients during periods of restricted mobility. However, limitations were identified, including the inability to conduct physical examinations, connectivity challenges, and low digital literacy, particularly among older adults. While overall satisfaction with telemedicine was positive, participants emphasized the need for strengthened digital infrastructure, greater patient awareness, and simplified platforms to improve usability. The findings underscore telemedicine’s continued relevance for NCD management beyond the pandemic, contingent on improved accessibility and system integration. Full article

Background/Objectives: Mitochondrial dysfunction, often reflected by a decline in mitochondrial DNA copy number (mtDNA-CN) in peripheral blood cells (PMBCs), is a key hallmark of biological aging and is linked to numerous adverse health outcomes, including frailty and cardiovascular disease. Furthermore, emerging evidence suggests that vitamin D may influence mitochondrial dysfunction. This cross-sectional study aims to investigate the associations of mtDNA-CN with muscular strength, self-rated health, and serum 25-hydroxyvitamin D₃ (25(OH)D₃) levels in a community-dwelling elderly population. Methods: A total of 149 elderly outpatients (≥65 years) from Soria, Spain, were included in this cross-sectional study. Muscular strength was assessed using the hand grip strength (HGS) test, and self-rated health-related quality of life (QoL) was measured using the EuroQoL five-dimension questionnaire (EQ-5D). Genomic DNA was extracted from peripheral blood, and mtDNA-CN was quantified using quantitative real-time PCR (qPCR). Serum 25(OH)D₃, intact parathyroid hormone (iPTH), phosphorus, calcium, albumin and other mineral metabolism markers were measured. Statistical analyses, including Spearman correlations and multivariate logistic regression, were performed to assess associations, with stratification by sex. Results: In the total population, a marginally significant positive correlation was observed between mtDNA copy number (mtDNA-CN) and serum 25(OH)D₃ levels (r = 0.210; p = 0.010), which did not remain significant after Bonferroni correction. Among women, lower mtDNA-CN was significantly linked to muscle weakness (p = 0.005), mobility problems (p = 0.009), and a trend toward self-care difficulties (p = 0.016). Multivariate analysis confirmed an independent association with increased mobility impairment risk (adjusted OR = 0.983; 95% CI: 0.97–1.00; p = 0.009). No significant associations were observed between mtDNA-CN and dynapenia or QoL components in the male group. Conclusions: This study identified a marginally significant positive correlation between serum 25(OH)D₃ levels and mtDNA-CN in the total population (r = 0.210; p = 0.010), which did not persist after Bonferroni correction, suggesting an exploratory link between vitamin D status and mitochondrial homeostasis in older adults. In addition, these results highlight sex-specific differences in mtDNA-CN as a potential biomarker of functional decline, particularly of mobility, in women. These findings support the idea that mtDNA-CN could serve as an integrated biomarker and that sex-specific nutrition could be used to promote healthy aging. Full article

Frailty is a multidomain reduction in physiologic reserve that impacts recovery and can contribute to poor outcomes following trauma beyond what chronological age, comorbidities, or injury severity predicts. In geriatric trauma patients, a large proportion are frail or prefrail on initial encounter in the emergency department, and because there are opportunities for actionable management plans, major trauma guidelines endorse systematic screening integrated into coordinated geriatric trauma care. We reviewed the literature and identified practical instruments used in the acute trauma setting for risk stratification. Additionally, we highlight the feasibility of using these instruments, as some can be completed via patient report, proxy input, or chart review when cognition, language, or caregiver availability limits history-taking. Implementation efforts succeed when shared mental models are leveraged and screening is embedded in the electronic health record system, linked to order sets and trigger-based pathways that offer downstream goal-directed care management, such as early mobility, delirium prevention, nutrition, medication review, and comprehensive geriatric assessment. Additionally, we highlight the importance of initiating early goals-of-care discussions and coordinating care with palliative care services. Resource-limited systems can preserve the same architecture by using nurse-led or allied staff-led screening, tele-geriatric consultation, and virtual interdisciplinary huddles. Lastly, we expand upon opportunities for longitudinal post-discharge follow-up. We describe how targeted initiatives translate research into practice, improve outcomes, and support longitudinal reassessment through in-person and telehealth follow-up visits. Full article

This study presents Care-MOVE, a smartphone-based application designed for continuous, passive, and unobtrusive monitoring of mobility, environmental exposure, and cognitive status in older adults within a telemedicine framework. The system integrates movement-related data collected through smartphone sensors (GPS, activity recognition, and caloric expenditure estimation) with contextual air quality information and standardized neuropsychological assessments, resulting in a comprehensive multimodal dataset (Care-MOVE Dataset). An exploratory proof-of-concept study was conducted on a subsample of 53 participants aged over 65, each monitored continuously for five days, contributing on average more than 30,000 longitudinal records. To investigate whether daily motor behavior can serve as a digital biomarker of cognitive functioning, several Machine Learning and Deep Learning models were evaluated using a Leave-One-User-Out (LOUO) cross-validation strategy. The comparative analysis included traditional classifiers (Logistic Regression, Random Forest, Gradient Boosting, K-Nearest Neighbors, and Support Vector Machines) as well as temporal deep learning architectures (1D CNN, LSTM, GRU, and Transformer). Among all of the evaluated approaches, the Support Vector Machine with RBF kernel achieved the best performance, reaching an accuracy of 98.1%, a balanced accuracy of 0.988, and an F1-score of 0.981, demonstrating robust generalization across unseen subjects. For this reason, the study was designed and presented as an exploratory proof-of-concept rather than a definitive clinical validation. This integrated approach not only enables the collection of detailed and contextualized data but also opens new perspectives for proactive digital healthcare, focused on risk prevention, improving quality of life, and promoting autonomy in elderly patients. Full article

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and long-term adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centre-based model and to support more flexible, patient-centred care. Methods: This narrative “review on a systematic backbone” synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and tele-rehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multi-component digital CR solutions. Only original studies with clinical, functional, or patient-reported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealth-enabled home-based or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centre-based CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved risk-factor profiles and quality of life to a degree comparable with face-to-face CR. Conclusions: Digital technologies can credibly support core objectives of CR in high-risk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patient-centred rehabilitation. Full article

The incorporation of artificial intelligence (AI) and digital technology in healthcare has revolutionized service delivery, improving diagnostic precision, patient outcomes, and operational efficacy. Nonetheless, despite considerable progress, numerous problems persist that impede the realization of full potential. Current reviews predominantly emphasize the advantages of AI in disease detection and health guidance, neglecting significant concerns such as social opposition, regulatory frameworks, and geographical discrepancies. This SLR, executed in accordance with PRISMA principles, examined 21 publications from 2020 to 2025 to assess the present condition of AI and digital technologies inside Saudi Arabia’s healthcare industry. Initially, 863 publications were obtained, from which 21 were chosen for comprehensive examination. Significant discoveries encompass the extensive utilization of telemedicine, data analytics, mobile health applications, Internet of Things, electronic health records, blockchain technology, online platforms, cloud computing, and encryption methods. These technologies augment diagnostic precision, boost patient outcomes, optimize administrative procedures, and foster preventative medicine, contributing to cost-effectiveness, environmental sustainability, and enduring service provision. Nonetheless, issues include data privacy concerns, elevated implementation expenses, opposition to change, interoperability challenge, and regulatory issues persist as substantial barriers. Subsequent investigations must concentrate on the development of culturally relevant AI algorithms, the enhancement of Arabic natural language processing, and the establishment of AI-driven mental health systems. By confronting these challenges and utilizing emerging technologies, Saudi Arabia has the potential to establish its status as a leading nation in medical services innovation, guaranteeing patient-centered, efficient, and accessible healthcare delivery. Recommendations must include augmenting data privacy and security, minimizing implementation expenses, surmounting resistance to change, enhancing interoperability, fortifying regulatory frameworks, addressing regional inequities, and investing in nascent technologies. Full article

Background: Fungal infections are considered a global health concern, resulting in high morbidity and mortality rates, especially in immunocompromised individuals. Traditional diagnostic techniques, such as microscopy, culture, and polymerase chain reaction (PCR), suffer from low sensitivity, long processing time, and accessibility challenges, especially in resource-limited settings. Artificial intelligence (AI) and machine learning (ML) tools have demonstrated potential to enhance diagnostic accuracy and efficiency. This systematic study assesses the progress, precision, and efficacy of AI-driven diagnostic tools for fungal infections within various clinical contexts in comparison to traditional procedures. Methods: A systematic review was conducted according to PRISMA principles. Literature searches were conducted in PubMed, ScienceDirect, Web of Science, and Ovid, focusing on research employing AI models to diagnose fungal infections. The inclusion criteria were research that compared AI-based tools with conventional diagnostic methods in terms of sensitivity, specificity, and accuracy. Data extraction and quality evaluation were performed utilizing validated instruments, such as the Methodological Index for Non-Randomized Studies (MINORS). Results: Eleven research studies met the inclusion criteria: six retrospective and five prospective investigations. AI models, such as convolutional neural networks (CNNs), Faster R-CNN, VGG19, and MobileNet, have improved diagnostic accuracy, sensitivity, and specificity compared to traditional methods. However, differences in dataset quality, model validation, and real-world applicability remain as limitations. Conclusions: AI-driven diagnostic technologies provide significant benefits in identifying fungal infections, improving the speed and accuracy of diagnoses. However, additional extensive investigations and clinical validation are required to improve model generalizability and facilitate smooth incorporation into healthcare systems. Full article

Digital mental health resources have expanded rapidly in the wake of the COVID-19 pandemic, offering new opportunities to improve access to mental healthcare through technologies such as AI chatbots, mobile apps, and online platforms. Despite this growth, significant challenges persist, including low user retention, limited digital literacy, unclear privacy regulations, and insufficient evidence of clinical effectiveness and safety. AI chatbots, which act as virtual therapists or companions, provide counseling and personalized support, but raise concerns about user dependence, emotional outcomes, privacy, ethical risks, and bias. User experiences are mixed: while some report enhanced social health and reduced loneliness, others question the safety, crisis response, and overall reliability of these tools, particularly in unregulated settings. Vulnerable and underserved populations may face heightened risks, highlighting the need for engagement with individuals with lived experience to define safe and supportive interactions. This review critically examines the empirical and grey literature on AI chatbot use in mental healthcare, evaluating their benefits and limitations in terms of access, user engagement, risk management, and clinical integration. Key findings indicate that AI chatbots can complement traditional care and bridge service gaps. However, current evidence is constrained by short-term studies and a lack of diverse, long-term outcome data. The review underscores the importance of transparent operations, ethical governance, and hybrid care models combining technological and human oversight. Recommendations include stakeholder-driven deployment approaches, rigorous evaluation standards, and ongoing real-world validation to ensure equitable, safe, and effective use of AI chatbots in mental healthcare. Full article

Background: The diaphragm is the primary respiratory muscle, and its proper function is essential for efficient breathing. Respiratory muscle weakness is a common complication that can hinder the withdrawal of mechanical ventilation. This weakness not only negatively affects patients’ quality of life but also represents an economic challenge for healthcare systems, as it significantly increases medical costs due to prolonged hospitalization and the need for additional procedures to manage associated complications. Ultrasonography has emerged as a precise technique for assessing diaphragmatic function through measurements such as diaphragmatic excursion and thickening fraction, with the right hemidiaphragm being the most suitable for evaluation. However, several studies have shown that diaphragmatic ultrasound measurements vary considerably in both healthy individuals and patients, mainly due to the lack of standardization of body position during assessment. Therefore, it is necessary to investigate how patient posture influences diaphragmatic ultrasound measurements in order to standardize protocols, improve diagnostic accuracy, and support reliable clinical decision-making. We employed ultrasonography to determine the influence of changes in body position on diaphragmatic excursion in a healthy population from the city of Cali. Methods: A descriptive cross-sectional study was conducted in 36 healthy adults aged 18 to 65 years, distributed into sex and age groups. Diaphragmatic excursion was assessed using a 3.5–5 MHz ultrasound transducer. Participants were evaluated in five body positions: supine at 0°, and head-of-bed inclinations of 30°, 45°, 70°, and 90°. Results: A progressive increase in diaphragmatic excursion was observed from the supine position (0°) up to 70° inclination. The 70° inclination showed the greatest diaphragmatic mobility as measured by ultrasonography. This finding suggests the existence of an optimal intermediate position in which biomechanical conditions and intra-abdominal pressure allow more efficient diaphragmatic contraction. Conclusions: The results of this study demonstrate that changes in body position significantly influence diaphragmatic excursion in healthy individuals, with a trunk inclination of 70° yielding the greatest diaphragmatic mobility. These findings support the importance of considering body posture as a key determinant in the functional assessment of the diaphragm using ultrasonography. Full article

Background: Cancer patients admitted to the bone marrow transplant (BMT) unit face life-threatening medical conditions. Consequently, their family members experience uncertainty, resulting in high levels of anxiety and depression (AD). Limited updates and communication from medical staff exacerbate these emotional burdens. To address these challenges, we developed a mobile health (mHealth) intervention, FamCarePlus, and evaluated its feasibility, usability, and efficacy. We hypothesized that the FamCarePlus application would demonstrate a high degree of feasibility and usability and would reduce AD compared to a control group relying solely on traditional communication through the nurses’ station. Methods: We employed a quasi-experimental pretest/posttest non-randomized, non-blinded self-report design over 3 weeks, with an experimental group (n = 10) using FamCarePlus and a control group (n = 9). We selected participants via convenience sampling using the electronic medical record to identify eligible patients and families, guided by inclusion and exclusion criteria. We used descriptive statistics and the Hospital Anxiety and Depression Scale (HADS) guidelines to analyze the data. Feasibility was defined by a retention rate > 80%, with usability testing using the System Usability Scale (SUS) and NASA Task Load Index (NASA-TLX) surveys. The HADS measured AD, comparing baseline to Week 3. Results: We met our feasibility criteria of >80%. All SUS and NASA scores were in the higher index, suggesting a significant degree of usability and low workload demand on participants. For efficacy, we compared baseline mean scores, with the experimental group reporting lower AD levels at Week 1 (41.9% and 27.8%, respectively) than the control group (55.2% and 34.2%, respectively). From Week 1 to Week 3, the percentage change showed an 8.6% decrease in anxiety in the experimental group, compared to a 12.8% decrease in anxiety in the control group. These results were consistent when analyzed according to HADS guidelines. Conclusions: The findings of this study provide preliminary evidence that the FamCarePlus intervention is feasible and usable, while also demonstrating that its use may be associated with a sustained reduction in AD levels among family members of patients admitted to the BMT unit. These outcomes underscore the potential of digital interventions to address disparities in patient health information access and psychosocial support. Full article

The Danish healthcare system has transitioned from a decentralised municipal hospital model to a centralised structure dominated by large, specialised hospitals. While this shift has improved efficiency and healthcare quality in some respects, it has also created challenges in terms of accessibility, patient mobility, and sustainability. Community health centres represent a strategic response to these issues by decentralising essential healthcare services and reintroducing geographical proximity as a core principle of healthcare. In this article, we propose drawing on the 15-min city concept to discuss how accessibility and spatial equity should be integrated into the planning of community health centres as platforms for active living and strong communities. We argue that proximity and accessibility in healthcare can benefit from a broader view of mobility and a focus on developing active, independent mobility systems. Data from semi-structured interviews with patients and professionals at 11 community health centres and three regions empirically demonstrate this. The 15-min city concept can lead to a reduction in travel time and improve accessibility and proximity for older adults. Full article

Background: Truck drivers constitute a high-risk occupational group due to irregular schedules, prolonged sedentary work, fatigue, and limited access to healthcare, contributing to adverse physical and mental health outcomes. Although mobile health (mHealth) tools offer potential to support driver health, sustained engagement remains a persistent challenge. Objectives: This systematic review aimed to identify behavioural, technological, and contextual determinants influencing truck drivers’ compliance, retention, and long-term engagement with digital health interventions. Methods: Following the PRISMA 2020 guidelines, six eligible studies were identified and thematically synthesised across technology acceptance, behaviour change, and persuasive system design perspectives. Results: Across studies, sustained engagement was facilitated by self-monitoring, real-time feedback, goal-setting, coaching support, and simple, flexible system design. In contrast, technological complexity, high interaction demands, limited digital literacy, privacy concerns, misalignment with irregular schedules, and fatigue consistently undermined engagement and retention. Autonomy, trust, and voluntary participation emerged as cross-cutting determinants supporting continued use. Based on the synthesis, an integrative framework was developed to explain how behavioural, technological, and contextual factors interact to shape truck drivers’ compliance, engagement, and retention with mHealth. Despite generally moderate to high study quality, the evidence base remains fragmented and dominated by short-term evaluations. Conclusions: The findings highlight the importance of context-sensitive, user-centred design to support effective digital health interventions in the trucking sector. Full article

Falls are a leading cause of morbidity and loss of independence among community-dwelling older adults. Mobile health (mHealth) application (app)-based interventions have emerged as a scalable approach to fall prevention. However, evidence from individual trials remains fragmented, underscoring the need for a comprehensive quantitative synthesis. This systematic review and meta-analysis examined whether mHealth app-based interventions reduce fall incidence and improve fall-related risk factors. A systematic search of PubMed, EMBASE, CENTRAL, and Web of Science identified randomized controlled trials meeting predefined eligibility criteria. Nine trials comprising 3437 participants were included, with dual-independent data extraction, quality appraisal, and assessment of evidence certainty. Compared with usual care or control conditions, mHealth app-based interventions reduced fall risk by 11% over 12 months (risk ratio 0.89, 95% CI 0.81–0.98), corresponding to an absolute risk reduction of 6.6%. The pooled reduction in fall rate, however, did not reach statistical significance. Secondary analyses showed moderate improvements in balance, strength, and mobility, a significant decrease in fear of falling, and no serious adverse events. Overall, mHealth app-based interventions provide modest but meaningful benefits and may complement comprehensive fall-prevention strategies for older adults. Full article

Parental stress is a critical yet understudied dimension of childhood total blindness, a condition that imposes substantial developmental, emotional, and functional challenges on families. This cross-sectional study assessed parenting stress, maternal health symptoms, and children’s functional vision-related quality of life in 81 mothers of children aged 0 to 12 years with total congenital blindness. Parenting stress was assessed in the full sample using the Parenting Stress Index–Fourth Edition (PSI-4). Children’s functional vision-related quality of life was evaluated in age-specific subsamples using the Quality of Family Vision Impact (QFVI-3 for children aged 0–3 years and QFVI-7 for children aged 3–7 years). All participants also completed a sociodemographic and maternal health survey. Total Parent Stress showed moderately elevated percentile scores (mean ≈ 67), with the highest PSI-4 subdomains in Adaptability, Depression, and Health. Approximately 21% of mothers scored within the clinical range for high stress. Maternal symptoms including sadness, insomnia, headaches, forgetfulness, and musculoskeletal pain were significant (all p < 0.01). QFVI global scores indicated moderate impairments in functional vision-related quality of life across age groups. Life Stress demonstrated a small-to-moderate negative correlation with QFVI-7, suggesting that cumulative environmental stressors may adversely affect children’s functional outcomes. Several factors were associated with more favorable outcomes. Among children under three years of age, maternal engagement in physical activity was associated with higher QFVI scores, whereas among children aged 3–7 years, school attendance was associated with higher functional vision-related quality of life scores. In contrast, sociodemographic disadvantage, limited access to educational adaptations, and reduced maternal participation in work or leisure activities were associated with higher levels of parental stress. These findings highlight the importance of multidisciplinary, family-centered care incorporating psychosocial assessment, early stimulation, orientation and mobility support, and maternal mental health interventions in pediatric ophthalmology. Full article

Background: Pharmacists in Saudi Arabia are assuming increasingly diverse and specialized roles amid rapid healthcare transformation. However, evolving expectations and expanding responsibilities may influence their job satisfaction, well-being, and career stability. This study aimed to assess job satisfaction, burnout, well-being, and career intentions among pharmacists across multiple practice sectors in Saudi Arabia. Method: A nationwide cross-sectional survey was conducted between December 2024 and January 2025 using an electronic questionnaire distributed to licensed pharmacists. The instrument assessed mental well-being, job satisfaction, burnout, workplace environment, and career mobility. Descriptive and inferential analyses were performed using SPSS version 20.0. Results: A total of 531 pharmacists completed the survey; 65% were male, and 89.3% were Saudi nationals. Sector distribution differed significantly by gender (p < 0.001): females were more represented in clinical and hospital pharmacy, while males predominated in the pharmaceutical industry–related roles. Male pharmacists reported higher work environment scores (p = 0.028) and greater sector mobility (34.2% vs. 23.7%, p = 0.012). Approximately 30.5% of participants had changed their employment sector at least once. Community pharmacists reported the highest burnout levels, whereas those in regulatory and administrative roles demonstrated the greatest job satisfaction (both p < 0.001). Participation in professional development showed strong positive associations with job satisfaction and intention to remain in the current role. Conclusions: Marked variations exist in pharmacists’ well-being, satisfaction, and career mobility across sectors in Saudi Arabia, with notable gender differences. Enhancing professional development, ensuring equitable work environments, and promoting sector-specific support strategies may help inform discussions on pharmacist engagement and retention within the evolving national healthcare system. Full article