Search Results (5,712)

Background: Spinal cord stimulation (SCS) is an established intervention for refractory chronic neuropathic pain, but response to trial stimulation and long-term benefit remain heterogeneous. Clinicians need practical tools to document patient-selection domains discussed in the neuromodulation literature without overstating the precision of currently available evidence. Methods: We conducted a narrative synthesis of randomized trials, cohort studies, registry analyses, systematic reviews, and consensus recommendations addressing SCS outcomes and candidate selection. The objective was not to derive or validate a multivariable prediction model, but to construct a transparent, bedside-oriented framework organizing clinically accessible domains relevant to SCS trial candidacy. Results: Six domains were incorporated into the proposed SCS Trial Success Score (STSS): primary indication, psychological status, smoking status, opioid burden, body mass index, and pain duration. The resulting 0 to 12 point score is presented as an evidence-informed clinical profile rather than a validated prognostic instrument. Three descriptive categories are proposed: more favorable profile, optimization-sensitive profile, and less favorable profile. These categories are intended to guide documentation, shared decision-making, and optimization of modifiable factors, not to determine eligibility automatically. Conclusions: Pending prospective validation, checklist-mode use is the preferred interim application of the STSS. The framework may support structured pre-trial assessment, identification of modifiable factors, and shared decision-making. It should not be used as a standalone numerical decision rule, to deny access to neuromodulation, or to replace multidisciplinary judgment. Prospective derivation, calibration, external validation, and decision-curve analysis are required before the STSS can be considered a clinical prediction rule. Full article

Background: Cervical cancer remains a significant health issue in Indonesia, where structural barriers, fragmented information, and sociocultural norms continue to hinder timely diagnosis and treatment. Families play a central role throughout the illness journey, yet their perspectives are often overlooked in the development of digital patient navigation systems. This study explored family experiences, caregiving challenges, and expectations for a family-centered digital navigation model, DIVA.ID, by integrating Digital Health frameworks and Family Systems Theory. Methods: A qualitative descriptive approach was employed through semi-structured, in-depth interviews with 18 purposively selected family caregivers of women with cervical cancer at a major referral hospital in West Java. Participants were selected because they were directly involved in daily care, treatment decisions, logistical support, or emotional assistance. Interviews were conducted between August and October 2025 and continued until thematic saturation was reached, as indicated by repetition of categories and the absence of new major codes in the final interviews. Data were analyzed using inductive–deductive content analysis guided by Elo and Kyngäs, with five researchers conducting independent coding, iterative code comparison, consensus meetings, and theoretical mapping. Results: Four main themes emerged: (1) family involvement in decision-making, including collective discussion, shifting authority roles, and patient autonomy; (2) caregiver burden, involving physical exhaustion, psychological distress, social restriction, stigma, financial pressure, and employment disruption; (3) psycho-spiritual coping mechanisms, including emotional sharing, prayer, crying, patience, and surrender to God; and (4) digital healthcare needs, covering BPJS guidance, treatment information, scheduling, communication pathways, shelter support, and mental–spiritual support. Mapping these themes to Digital Health frameworks and Family Systems Theory clarified how DIVA.ID could translate family experiences into practical navigation functions. Conclusions: This study provides empirical foundations for a culturally sensitive, family-centered digital navigation model in Indonesia. Rather than demonstrating effectiveness, the findings identify design requirements for DIVA.ID that should be tested in subsequent feasibility, usability, and intervention studies. Full article

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects. Full article

Background/Objectives: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been associated with potential clinical and economic benefits; however, its adoption among patients remains limited in some healthcare settings. This study examined patients’ intention to use RM services by applying an extended Technology Acceptance Model (TAM) that incorporates perceived effectiveness (PE), perceived barriers (PB), perceived threat (PT), and economic considerations, as well as the influence of socioeconomic factors. Methods: A cross-sectional survey was conducted among 104 patients with CIEDs in Taiwan using validated questionnaires. Structural equation modeling (SEM) was employed to examine the relationships among the proposed constructs. The association between intention to use and actual service utilization was explored. The correlations between sociodemographic factors and the constructs were analyzed using analysis of variance (ANOVA). Results: SEM showed that perceived effectiveness (PE), perceived usefulness (PU) and perceived ease of use (PEOU) were significantly associated with intention to use RM services, with economic considerations also having a significant contribution. Intention to use RM services further predicted actual adoption. However, PB and PT did not moderate these relationships. Sociodemographic factors influenced RM acceptance, with younger, more educated, employed, higher-income, and professionally employed patients reporting stronger perceptions and greater intention to use RM. Conclusions: This study reinforces the TAM framework in the context of health-related technology adoption. Overall, the adoption of RM services is complex and shaped by psychological, economic, and demographic factors, highlighting the need for user-friendly design, targeted education on clinical benefits, and flexible pricing and reimbursement strategies to improve equitable and sustained use. Full article

Background/Objectives: Diet and sleep are both important modifiable factors in healthy aging, yet little is known about whether attention to healthy eating behaviors is associated with objectively measured sleep. This study examined the association between self-reported attention to fruit and vegetable intake and actigraphy-measured sleep efficiency among women aged 45 years and older. Methods: This cross-sectional study included 143 women aged 45 years and older recruited from community centers. Participants wore a wrist-worn actigraphy device continuously for 7 days and completed daily sleep logs. Attention to fruit and vegetable intake was assessed using a single-item, four-category self-report measure. Hierarchical multiple linear regression was used to examine its independent association with sleep efficiency after adjustment for sociodemographic, health-related, and psychological covariates. Results: The mean age of the participants was 56.34 ± 7.67 years, and the mean sleep efficiency was 82.69 ± 8.60%. In the fully adjusted model, participants who reported “often” paying attention to fruit and vegetable intake had significantly higher sleep efficiency than those who reported doing so “almost every day” (β = 0.24, p = 0.013). Older age was independently associated with lower sleep efficiency (β = −0.31, p = 0.001). Conclusions: In this exploratory cross-sectional study, a single-item measure of self-reported attentiveness to fruit and vegetable intake showed a category-specific association with actigraphy-measured sleep efficiency. Longitudinal studies using more detailed dietary and behavioral measures are needed to clarify the direction and meaning of this association. Full article

Rapid population ageing in China urgently demands improved attention to elderly friendly community green space design. Despite national efforts toward community renovation and urban regeneration, existing projects often overlook the systematic optimisation of green spaces explicitly tailored to elderly residents, leading to environments that inadequately support their physical, psychological, and social needs. Given that home-based care remains the predominant preference for elderly populations in China, creating optimised community green spaces is essential to facilitate healthy ageing-in-place effectively. This study systematically investigates the discrepancies between elders’ observed usage patterns and their stated landscape design preferences in two residential communities in Suzhou, China. By integrating year-round observational data with subjective interviews, the research identifies critical mismatches between elderly individuals’ actual behaviours and expressed preferences, highlighting significant deficiencies in current landscape designs. Comparative analyses reveal that prioritising microclimate comfort, accessible pathways, and targeted seating arrangements significantly enhances elderly usage frequency and satisfaction. Ultimately, this study provides practical, policy-aligned recommendations for designing climate-adaptive, elderly centric community green spaces, effectively contributing to sustainable urban renewal and the Healthy China 2030 initiative. Full article

Gestational Diabetes Mellitus (GDM) represents a significant public health concern due to its association with adverse maternal and neonatal outcomes, as well as elevated long-term metabolic risks. Its prevalence varies substantially depending on the diagnostic criteria used and the population studied. Women with GDM frequently experience heightened stress, anxiety, and uncertainty, underscoring the need for accessible information, counseling, and ongoing support to navigate glucose monitoring, dietary adjustments, and treatment regimens. Although clinical management has been extensively studied, research has largely focused on metabolic monitoring and therapeutic interventions, often underemphasizing prevention strategies, women’s informational needs, and maternal psychological well-being. Emerging evidence and international guidelines increasingly advocate for integrating these components into structured, woman-centered GDM care plans that actively involve families. Such approaches empower women to engage in self-management, enhance health literacy, support adherence to lifestyle and pharmacological interventions, and promote sustainable behavioral changes. This narrative review presents a comprehensive, holistic model of care across the perinatal continuum, emphasizing early risk identification, preventive strategies, and multidisciplinary coordination. Core elements include individualized antenatal education, empathetic communication, and family engagement, fostering self-efficacy, continuity of care, and integration of medical, educational, and psychosocial interventions. Equipping healthcare professionals with the competencies to deliver this holistic, woman-centered framework is essential to optimize maternal and neonatal outcomes and mitigate the long-term health consequences of GDM. Full article

In this study, we examine whether personality profiles moderate a recently proposed environmental behaviour–well-being model. The model is grounded in Self-Determination Theory, which suggests that pro-environmental behaviour may contribute to subjective well-being through the satisfaction of basic psychological needs. A total of 403 adolescents from four Lithuanian schools participated in this study. Participants were selected using a convenience sampling method, and the average participant age was 14.89 years (56.6% female). Structural equation modelling demonstrated acceptable model fit (CFI = 0.988, TLI = 0.986, NFI = 0.929, RMSEA = 0.043 [0.022–0.058], SRMR = 0.113, χ² (353) = 416.92, p = 0.011) and indicated that personality profiles moderate several pathways within the environmental behaviour–well-being model. Additionally, the results showed that pro-environmental behaviour and connectedness to nature did not significantly predict subjective well-being across all personality profiles. The findings highlight the importance of considering personality differences when designing sustainability-related educational interventions aimed at promoting environmental citizenship and improving subjective well-being. Full article

Background/Objectives: The Al Haouz earthquake that struck Morocco on 8 September 2023, resulted in substantial material, human, and psychological impacts. Children are at increased risk of psychological disorders, notably post-traumatic stress disorder (PTSD). This study aims to assess probable PTSD and its associated factors among children exposed to the Al Haouz earthquake. Methods: This cross-sectional study, conducted between December 2024 and January 2025, included 536 children from the affected areas. Probable PTSD was assessed using the 20 item Child and Adolescent Trauma Screen (CATS). Sociodemographic and exposure-related data, including post-earthquake conditions, were collected using a structured questionnaire. Data analysis was performed using SPSS software, version 25. Results: Analysis revealed that 47.6% of the children presented with probable PTSD. Multivariable analysis identified several factors independently associated with probable PTSD among children exposed to the earthquake, including age between 11 and 15 years (AOR = 2.02; p < 0.001), female gender (AOR = 1.82; p = 0.001), advanced level of education (AOR = 1.87; p = 0.006), housing damage (AOR = 2.08; p = 0.015), physical injury (AOR = 1.86; p = 0.012), proximity to the epicenter (AOR = 2.22; p = 0.006), temporary shelter in tents (AOR = 1.75; p = 0.02), difficulty of evacuation (OR = 1.97; p = 0.01), and loss of a family member (AOR = 1.98; p = 0.013). Conclusions: This study revealed a high frequency of probable PTSD in children exposed to the Al Haouz earthquake and identifies several associated factors, highlighting the need to targeted, multidimensional interventions. Full article

Background: Patient activation is associated with both health outcomes and the utilization of healthcare resources. Since various factors influence activation levels among older ill adults, further exploration of this topic is needed. Specifically, we aim to examine the extent to which changes over time in self-rated symptoms of depression are associated with changes in patient activation and to what extent self-rated health status and satisfaction of basic psychological needs (autonomy, relatedness, and competence) have a mediation effect. Methods: A longitudinal and correlational design was employed in which two hundred and seven participants with heart failure or chronic obstructive pulmonary disease were recruited from two hospitals in the middle of Sweden. The sample used in this study is the same as that used in a randomized controlled trial. A questionnaire was administered at baseline, and at 30-, 90-, and 180 days post-discharge, involving ratings of depression, patient activation, self-rated health, and satisfaction of basic psychological needs (autonomy, relatedness, and competence). As the results from the original study showed no difference between the two randomized groups in patient activation, the analysis in this study was conducted using a combined sample in which the intervention and control groups were merged. For estimation of the direct effects and the components of indirect effects, we employed multilevel modeling using a linear mixed model, and to test mediation, the stand-alone program RMediation was used. Results: Over time, increases in depressive symptoms were associated with reduced patient activation, with this relationship mediated by declines in relatedness and competence. No evidence was found showing that autonomy or self-rated health had a mediation effect. Conclusions: The results indicate that older chronically ill individuals may benefit from interventions targeting psychological mediators to improve and sustain activation. Full article

Drug use, mental health, and gender identity are complex phenomena influenced by multiple social, psychological, and cultural factors. Previous research indicates that the university stage represents a period of vulnerability for mental health, especially among students whose gender identity differs from the traditional categories of man or woman. This study aimed to examine the association between gender identity, drug use, and symptoms of anxiety and depression among students at a public university in Mexico. A cross-sectional correlational study was conducted through a public invitation survey among undergraduate students enrolled in a public university in Mexico. Data were collected using the Drug Use Questionnaire for University Students administered through the LimeSurvey platform. Variables included sociodemographic characteristics, gender identity (man, woman, and other identity), drug use, and symptoms of anxiety and depression. The results indicate that students who identified with another gender identity showed a higher likelihood of using the substances analyzed compared with those who identified as women, particularly prescription drugs and marijuana. Additionally, they presented higher odds of reporting anxiety and depressive symptoms compared with those who identified as men. These findings highlight the need for targeted prevention and support strategies to improve mental health among students with diverse gender identities. Full article

Eating behavior and eating habits are shaped from the earliest stages of life through interactions among biological, familial, social, and environmental factors. The aim of this narrative review is to integrate evidence on the early-life determinants of eating behavior and their influence on dietary intake from infancy to adolescence. A narrative review was conducted with a structured search approach prioritized on longitudinal studies, intervention trials, and policy evaluations when available, and using cross-sectional evidence mainly to describe patterns and sociodemographic factors. Synthesizing the current evidence, our framework proposes that breastfeeding, responsive complementary feeding, and self-regulatory parenting are associated with higher responsiveness to internal hunger, satiety cues, and preference for nutrient-dense foods. Conversely, coercive practices, early exposure to highly palatable foods, and the influence of food marketing are linked to dominant hedonic responses and impulsive consumption patterns. Furthermore, family environments characterized by stress or food insecurity, together with high access to low-nutrient foods, may increase vulnerability to poor eating habits and emotional eating during adolescence. Overall, the evidence highlights the need for preventive interventions that integrate parenting support, school food education, digital marketing regulation policies, and the promotion of healthy food environments across multiple sectors. Understanding the biological, psychological, and social factors linking early determinants to dietary intake and eating behaviors across development is essential for promoting a balanced relationship with food and preventing chronic diseases from an early age. Full article

Background/Objective: Medication overuse headache (MOH) is a disabling secondary headache disorder that arises from an underlying primary headache, most commonly migraine. Although treatment reduces headache frequency and medication overuse, the interictal burden—the impact experienced between headache attacks—remains poorly characterized over the long term. This study evaluated interictal burden and clinical outcomes two years after MOH diagnosis. Methods: This study was derived from a prospective multicenter cohort of patients with MOH, using data from a single center. Of 149 patients enrolled between April 2020 and November 2022, 117 (78.5%) completed the two-year follow-up. Clinical characteristics, medication overuse, monthly headache days, and standardized questionnaires were assessed at baseline and follow-up. Interictal burden was evaluated at two years using the Migraine Interictal Burden Scale (MIBS-4), with scores ≥5 indicating severe burden. Results: At baseline, patients (81.2% female; median age, 45.0 years) reported a median of 16.0 monthly medication days (interquartile range, 13.0–23.0). Medication overuse decreased from 100% at baseline to 24.2% at one year and 17.1% at two years. Among 117 patients with available two-year MIBS-4 data, 25 (21.4%) had severe interictal burden. Compared with those without severe burden, these patients had greater headache-related impact and disability (HIT-6: 68.0 vs. 64.0, p = 0.019; MIDAS: 110.0 vs. 36.0, p = 0.002), higher psychological burden (PHQ-9: 11.0 vs. 8.0, p = 0.032; GAD-7: 7.0 vs. 4.0, p = 0.010), and were more likely to be current smokers (20.0% vs. 4.3%, p = 0.036). Notably, 14.4% of patients with resolved medication overuse still reported severe interictal burden. Conclusions: Two years after MOH diagnosis, severe interictal burden was observed in a substantial proportion of patients and was associated with greater baseline disability and psychological distress. These findings highlight the need for long-term monitoring and management beyond initial medication withdrawal. Full article

Background: Despite being considered a country with a larger health workforce in Africa, the South African health workforce continues to experience shortages and a maldistribution of health workers across regions and sectors. Current projections suggest that the workforce is expected to decline further, especially among doctors, nurses and midwives, in large part, due to attrition—which could compromise the delivery of primary health and maternity services. These health workforce shortages and uneven distribution threaten the sustainability and effectiveness of health services in South Africa and drives the need to investigate the factors that may be influencing career choice and change decisions among health professionals in South Africa. Methods: A qualitative exploratory study, making use of purposive sampling and semi-structured interviews, was conducted to investigate the factors influencing career choice and change decisions among health professionals in South Africa. The participants were qualified health professionals in the fields of medicine, nutrition, pharmacy, nursing, and psychology working in the private, public, and academic sectors. Data was collected until saturation was achieved and then thematically analyzed using MAXQDA 24. Results: A total of 10 participants made up of three males and seven females were interviewed. These participants worked in different employment sectors with some having dual roles in private practice, public sector, and academia. The analysis revealed three major themes that capture the nature of and factors influencing career choice and career changes occurring in South Africa. The first theme related to factors influencing career choice (including altruism, family influence, personal experiences, financial/job security, academic achievement, career guidance, and opportunity for change). The second theme focused on career change dynamics (nature of career changes and career transitions occurring in the form of specialization, switching health professions, exiting health professions, adding non-health interests, and shifting focus areas). The third theme revealed factors influencing career change. These were categorized into personal and individual factors, workplace or job-specific factors, and administrative factors. This study has contributed to understanding the career choices and career changes taking place within the health professions in South Africa. It has also revealed a need for reforms in policy and practice for the current health professionals who have no intention of changing their careers while highlighting implications for future training of health professionals. Also, addressing the challenges of poor working conditions, lack of support, unemployment and placement delays, and other administrative barriers will help mitigate some of the issues leading to health workforce shortages and inequities in the South African context. Conclusions: The strongest motivator for choosing a career in health professions is the desire to care for others, while retention of the health workforce is challenged by personal, workplace, and administrative factors. Enhancing workplace conditions and support systems, implementing policy reforms, and minimizing administrative barriers is essential for achieving universal health coverage and sustaining a resilient health workforce in South Africa. Full article

The present integrative umbrella review aims to provide a comprehensive overview of the evidence and practices related to mental health and career transitions in elite sport toward the implementation of service provision through digital interventions. Following PRIO guidelines, an extensive search across five databases (2015–2025) identified 52 eligible manuscripts (e.g., conceptual, review, and position studies). Data extraction focused on mental health, dual-career pathways, career transition challenges and needs, and identity-related issues among high-performance athletes. The findings revealed a strong consensus that athlete well-being is shaped by the dynamic interaction of mental health symptoms, sport-specific stressors, identity processes, and structural conditions across the athletic lifespan. Mental health vulnerabilities (e.g., anxiety, depression, disordered eating, and distress) were consistently reported, particularly during injury, deselection, and retirement. Dual-career engagement, diversified identities, and proactive career planning emerged as key protective factors, while stigma, limited literacy, and uneven access to psychological services remained persistent barriers. Five main thematic areas (Matrix 1) operationalized in ten higher-order intervention domains (e.g., Matrix 2, screening, monitoring, literacy, and others) and 14 potential online implementation strategies (Matrix 3) were identified. However, the evidence highlights fragmented implementation and a lack of scalable, cross-national tools to support athletes during and beyond their competitive careers. Therefore, a harmonized, evidence-based, multidimensional framework for the development and implementation of digital support resources has been proposed. This integrative review underscores the need for integrated, culturally sensitive, and digitally enabled support systems to promote sustainable transitions and long-term athlete well-being. Full article