Search Results (326)

This study suggests the concept of multifunctional social spaces (MSSs) as intergenerational communication platforms, contributing to SDG achievement and environment awareness in local communities. Retirees could perform socially significant practices via local MSS premises supported by municipalities and initiative groups. The basic social vector of an MSS is supposed to produce a synergy effect with the educational and environmental impetus of the Sustainable Environmental Education (SEE) approach. Lifelong education underlies the process of adapting various age groups to different local spaces, namely metropolis, suburb, or rural areas. Test qualitative interviews were conducted with pensioners and young people to discover attitudes towards MSS-prescribed functions within different reference groups. These interviews helped to define the preferred communication instruments for MSS operation. General types of MSSs were classified based on mini case studies. MSS introduction is supposed to influence basic social indices such as population health, life expectancy, and fertility levels in the long term, and support several environmental awareness markers. Future studies could examine such influences in detail and discuss more national and regional specifics. Municipal and regional authorities, as well as local community leaders, could use the results of this study to consider local development, SDG strategies, and roadmaps. Full article

Despite being key partners in the supportive care of the cancer patient, family caregivers are often inadequately prepared for or supported to take on this critical role, subsequently putting their own wellbeing at risk and, by extension, that of the patient. Exercise interventions show promise in mitigating caregiver burden and improving health outcomes for both caregivers and patients; however, the interrelationship between family caregiver and care recipient has gone largely unexplored. Thus, we conducted a single-group pilot study to examine the feasibility and preliminary effectiveness of a 12-week dyadic exercise intervention. Of the 27 caregiver–patient dyads who consented, 21 (77.8%) completed the study, with participants completing an average of 23.1 (96.3%) of the prescribed exercise sessions, suggesting good adherence and study retention. All participants reported higher post-intervention levels of strenuous physical activity (p = 0.017), improved sit-to-stand repetitions (p = 0.004), and social functioning (p = 0.030) compared to baseline. Of note, caregivers reported higher post-intervention scores on the burden in relationship subscale of the Zarit Burden Interview relative to baseline (p = 0.043), suggesting an increase in perceived caregiver burden following the intervention. Overall, dyadic exercise interventions appear feasible and may confer certain physical and psychosocial benefits for both family caregivers and care recipients. However, such programs may also unintentionally exacerbate certain aspects of caregiver burden. Future research should aim to identify factors within dyadic exercise interventions that may contribute to increased caregiver burden, as well as strategies to help mitigate these effects. Full article

Background/Objectives: Urinary tract infections (UTIs) are the primary indication for antibiotic use in nursing homes (NHs); yet inappropriate prescribing, including incorrect initiation, excessive prophylactic prescribing and prolonged treatment duration, is common. This study aimed to identify key determinants of appropriate antibiotic prescribing for UTIs in NHs by exploring the behaviours and perspectives of relevant stakeholders. Methods: Interviews and focus group sessions with regard to a purposive sample of 4 NHs and healthcare professionals were conducted between June 2023 and April 2024 in Flanders (Belgium). The topic guide was developed based on the Theoretical Domains Framework (TDF). A combination of deductive and inductive coding was used to identify behavioural determinants within each TDF domain. Key behavioural determinants were identified based on their importance, relevance, and feasibility. Results: We conducted 31 semi-structured interviews with residents/relatives (n = 13), physicians (n = 9), pharmacists (n = 10), and NH management (n = 5) and held 4 focus group sessions with nurses (n = 16) and nurse aides (n = 10). Appropriate antibiotic prescribing for UTIs in NHs was influenced by a complex interplay of behavioural determinants. Key behavioural determinants included lack of knowledge of guidelines, lack of self-reflection and monitoring, fear of missing complications, feelings of powerlessness, prioritising residents’ comfort, hierarchical relations with treating physicians being dominant, social pressure to prescribe, and the NH as a challenging context. Conclusions: This study identified key behavioural determinants that should be targeted to optimise antibiotic prescribing for UTIs in NHs. These findings underscore the need to conduct a theory-informed, multifaceted intervention to support behaviour change across professional roles and improve antimicrobial stewardship in this setting. Full article

Background: Approximately one quarter of community-dwelling older adults experience at least one fall each year. Falls can result in soft tissue injuries, fractures, or even death. Given this high prevalence, it is essential to identify fall-related risk factors, develop predictive models, and prescribe effective exercise-based interventions to prevent falls. Objective: To analyze risk factors, predictors, and therapeutic interventions for falls in older adults. Methods: A literature search was conducted in SCIELO, PUBMED, and PEDro databases between 15–20 October 2025. Inclusion criteria comprised peer-reviewed, open-access studies in English published from 2020 onward. Findings were categorized into three domains: (1) fall risk factors, (2) predictive models, and (3) exercise-based interventions. Twenty studies met the inclusion criteria. Results: Falls among older adults arise from multifactorial interactions involving physical, clinical, cognitive, and social factors such as impaired mobility, comorbidities, polypharmacy, and cognitive decline. Lower-limb strength and functional performance are key determinants of fall risk. Current predictive models show limited accuracy, with fall history as the strongest predictor. Exercise-based interventions, particularly multicomponent and home-based programs, improve balance, strength, and mobility but show variable effects on fall rates. The absence of standardized parameters for exercise prescription limits the development of evidence-based guidelines. Conclusions: Falls in older adults are multifactorial events influenced by physical and cognitive decline. Predictive models remain imprecise, and although exercise interventions improve functional outcomes, their impact on reducing falls is inconsistent. Standardized exercise protocols are needed to optimize fall prevention strategies. Full article

Background/Objectives: The breast cancer care continuum is associated with a physical and emotional burden resulting in significant needs for rehabilitation. A growing concern has been the underutilization of rehabilitation services, even when they are accessible, highlighting that several women’s needs remain unmet. The aim of this study was to investigate breast cancer patients’ physical and psychological rehabilitation needs and experiences, and to document the barriers encountered throughout the breast cancer care continuum. Methods: A cross-sectional study consisting of a self-reported online survey was conducted. Women aged 18 years and over with a diagnosis of breast cancer, who underwent breast surgery in the last 5 years in Quebec province, Canada, were eligible for this study. A questionnaire was developed by research team members, and content validity was evaluated by an expert group including professionals in rehabilitation, oncological care, and two patient partners. The questionnaire was completed once by each participant on the online platform Qualtrics ©. Closed-ended and open-ended questions were used to collect information on (1) sociodemographic characteristics, (2) clinical profiles, (3) rehabilitation needs, and (4) rehabilitation experiences. Results: The sample included participants from all 17 administrative regions of the Quebec province, 78.0% of whom lived in urban areas. Four hundred and four participants (78.4%) expressed rehabilitation needs, but only two hundred and forty-five participants (47.2%) reported the use of rehabilitation services. A lack of awareness of the service’s availability, the fact that the service was not prescribed or recommended, and financial constraints were cited as major barriers to accessing rehabilitation services. Conclusions: Breast cancer patients expressed significant needs for rehabilitation services but demonstrated low utilization rates, reflecting barriers to rehabilitation. Addressing the fragmented integration of rehabilitation services into the breast cancer care continuum and inequities in access based on social determinants of health should be prioritized. Full article

Background: Falls are a major cause of injury, functional decline, and reduced quality of life among older adults, posing a significant public health challenge. Social prescribing is gaining relevance in gerontology, offering structured strategies to engage individuals in preventive activities, including fall prevention strategies, through engagement in community-based activities. Aim: To examine older adults’ perception of the relevance of personal protection and development activities (e.g., prevention against falling) and compare sociodemographic, behavioural, and engagement profiles between those who agree and those who disagree with its relevance. Methods: A cross-sectional study was conducted with 613 older adults aged 65–93 years. Data collection included sociodemographic, health-related, and behavioural/social engagement variables (including perceptions regarding the benefits of social prescribing and interest in community-based activities). For this analysis, participants were dichotomized based on their agreement with the relevance of personal protection and development activities (e.g., prevention against falling). Of the 569 participants included, 538 (94.5%) agreed with its relevance and 31 (5.5%) disagreed. Descriptive and exploratory analyses were conducted to compare the two groups across variables. Multivariate logistic regression analyses were conducted to explore independent predictors of agreement across sociodemographic, behavioural, social prescribing, and health-related variables. Results: Significant differences were observed between the groups in awareness of active ageing (p = 0.018), volunteering (p < 0.001), participation in social and community activities (p < 0.001), and hobbies like gardening, fishing, or cooking (p = 0.002). Those who agreed with the importance of personal protection and development activities were significantly more likely to value a range of initiatives, including social activities in recreational organizations, physical activity in the community (e.g., hiking), artistic and creative activities (e.g., visual arts, music), technical or technological activities (e.g., do-it-yourself, computers), and cultural enrichment activities (e.g., visiting museums), (p < 0.001). Multivariate analyses showed no effects of sociodemographic or health-related factors, whereas behavioural and engagement-related variables—including volunteering, hobbies, and several social prescribing activities—significantly predicted agreement with the relevance of personal protection and development activities. Discussion: The findings suggest that older adults who perceive fall prevention as relevant are more actively engaged in diverse health-promoting activities, including volunteering, hobbies, and community-based programmes. This pattern may reflect higher health literacy, stronger social networks, and proactive attitudes towards ageing. Conclusions: Perceptions of fall prevention are closely linked to broader patterns of engagement in health-promoting activities among older adults. Recognizing and addressing differences in how these activities are valued can inform more inclusive and targeted gerontological interventions. Full article

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an urban safety-net hospital, with a subgroup analysis of trauma patients who presented with at least three rib fractures. Methods: We performed a retrospective cohort study of two patient populations from our institution: (1) all patients receiving APS consultation from 1 January 2020 to 1 November 2022 (n = 1445) and (2) all patients with traumatic rib fractures during this time, stratified by APS consult status (n = 650). Demographics, insurance, comorbidities, opioid prescribing, and discharge outcomes were analyzed using descriptive statistics, multivariable logistic regression, and log-linear models. As APS consultation criteria were not standardized during the study period, referral patterns reflected routine clinical practice rather than predefined eligibility criteria. Results: Across the full APS cohort, patients were disproportionately represented from vulnerable groups: 30.5% were Black, 81.0% had public insurance, and 32.9% had a substance use disorder (SUD). Methadone use was a strong predictor of non-home discharge, including discharges to a medical facility, hospice, or against medical advice (AMA). In the rib fracture cohort, patients receiving APS consults had significantly higher injury severity scores (Injury Severity Score 17.1 vs. 13.0, p < 0.001). Black patients were less likely to receive APS consult (17.3% vs. 28.8%, p = 0.024). However, this association appeared to be attributable to the younger age and male predominance within this subgroup, as both factors were identified as significant predictors of APS consultation. Conclusions: APS utilization at a high-volume safety-net hospital highlights the intersection of medical vulnerability and structural inequities, with greater involvement among patients who were members of racial and ethnic minorities, publicly insured, or diagnosed with SUD. In trauma populations, younger Black men were over-represented, reinforcing the heightened injury risks Black men may face and the downstream effects on patient care. Taken together, these results highlight how APS involvement acts not only as a marker of increased injury severity but also as an intervention to improve care for vulnerable patient populations. As APS teams regularly serve these populations, they are well-positioned to bridge broader gaps through the integration of addiction and social support services, individualized pain management, and seamless coordination of care across specialties. These findings underscore the need for standardized consultation criteria and integration of social and addiction medicine resources into APS care models. Full article

Objective: Antimicrobial resistance (AMR) is a top ten threat to global public health, and Malta remains among the highest antibiotic-consuming countries in the European Union. This systematic review aimed to identify barriers and facilitators influencing antimicrobial stewardship in Malta, focusing on general practitioners (GPs) and pharmacists. Methods and Measures: Eligible studies included GPs and/or pharmacists practising in Malta and explored influences on prescribing and/or dispensing. Systematic searches were performed in June 2025 and September 2025 using the following databases MEDLINE, PsycINFO, PsycArticles PubMed, and Google Scholar. Data were extracted using a modified Cochrane template, and quality was assessed using Joanna Briggs Institute tools. Findings were synthesised using the socio-ecological model and mapped to the COM-B framework. Results: Seven studies met inclusion criteria, with a total sample size of 495 participants. Barriers included diagnostic uncertainty, knowledge gaps, misconceptions about AMR, patient expectations, commercial pressures, limited diagnostic and IT infrastructure, and defensive prescribing linked to indemnity insurance. Facilitators included stewardship values, stronger guideline adherence among younger GPs, trust-based GP–patient relationships, GP–pharmacist collaboration, and intervention effects from a social marketing programme. Mapping to COM-B showed barriers and facilitators interacting across capability, opportunity, and motivation. Conclusions: Prescribing in Malta is shaped by diagnostic uncertainty, entrenched habits, patient expectations, and structural gaps. Although the evidence base was limited and partly overlapping, consistent findings across mixed method designs highlighted that effective stewardship will require rapid diagnostics, e-prescribing, over-the-counter enforcement, and GP–pharmacist collaboration, supported by policy reforms aligning indemnity and sick-leave systems with AMR goals. Full article

Social anxiety disorder (SAD) is defined as a pathological fear of social interactions in which an individual may be negatively evaluated by others. The crucial component of assessing the state as clinical is the ‘context-insensitivity’ of the fear—i.e., the negative evaluation does not have any tangible repercussions, or the evaluation is not as detrimentally negative, as the patient presumes. However, this model excludes the role of self-conscious emotions, specifically shame, in aggravating social fears. This article models shame as an emotion that is highly aversive, unpredictable, and resistant to metacognitive regulation, which entails a perspective that SAD is the product of high shame-proneness and the inability to voluntarily mitigate it. The evidence of mutual correlates, such as socially prescribed perfectionism and treatment outcomes of cognitive and behavioral therapeutic modalities, is used to justify the argument. The article suggests the possibility of implementing humor as a supplement to a standard SAD-treatment self-regulation strategy that would allow subjects to control the emergence of their shame more efficiently. Finally, a potential randomized control trial study design is proposed to test the perspective outlined. Full article

Background/Objectives: Transportation is a critical social determinant of health with direct impacts on healthcare access and utilization. This study examines transportation challenges faced by low-income individuals with chronic conditions who participated in the Food as Medicine (FAM) program offered by their primary care provider and explores the strategies they employ to overcome those challenges, particularly during the COVID-19 pandemic. Methods: We conducted semi-structured interviews with 36 FAM participants from Grady Health System in Atlanta, Georgia between May 2022 and October 2023. Interviews explored their ability to access routine care, FAM, and healthy food as prescribed by their physicians and nutritionists, as well as how the COVID-19 pandemic affected their transportation challenges and solutions. Results: Participants reported various transportation barriers including long wait times, delays, cost burdens, unreliable services, and coordination failures, which contributed to missing doctor appointments and FAM attendance. To overcome those challenges, participants planned trips in advance, used multiple transportation options, relied on social networks, or reduced and sometimes forwent trips. The COVID-19 pandemic limited their accessibility to healthcare, FAM, and healthy food options by reducing business hours and disrupting transportation services. Alternatives such as telemedicine and online ordering were less utilized due to distrust, dissatisfaction, and limited digital literacy. Conclusions: Transportation barriers can substantially restrict healthcare and food access for low-income individuals managing chronic conditions, especially during public crises that may lead to service disruptions. Transportation assistance that accommodates individuals’ financial circumstances and health conditions, implemented through collaborative efforts of healthcare institutions, transportation agencies, and governments, is essential to facilitating chronic disease management and reducing health disparities. Full article

The mental health of young adults is a widespread and growing concern in many communities, impacting social sustainability. At the same time, there is growing evidence of the value that nature can provide towards improving health and wellbeing. However, there is little research on the scale of the monetized value of relevant wellbeing benefits from nature exposure. Nature prescribing draws on the growing base of evidence about nature and its health and wellbeing connections, with medical practitioners and/or allied health workers providing a prescription to selected patients to participate in a program that offers interventions intended to improve participant health and/or wellbeing, using a nature setting. This paper is the first to undertake a cost–benefit analysis of nature prescribing, involving a program aimed to improve the wellbeing of young adults with mild to moderate mental illness in regional/rural Victoria, Australia. The evaluation demonstrates that a curated, group-based nature exposure program can yield significant improvement in levels of life satisfaction and mental health in this cohort. Paired sample comparisons and multiple regression analyses suggest that the program produced an increase in mean participant life satisfaction scores of ~0.7 units, measured using Personal Wellbeing Index scores. A project benefit–cost ratio of over four resulted from this. Mental health, as measured by Kessler scale scores, also showed solid improvement, and loneliness was reduced. The unique contributions of nature and of the group-based delivery mode to the measured benefits were not identifiable but the combined effect was evident, improving participants’ likelihood of social inclusion, a major social sustainability goal. Furthermore, the solid program benefit–cost ratios indicate an economically sustainable program, which uses an environmental platform (nature) for its delivery. This links all three triple bottom line sustainability outcomes to this program. Topping up group-based nature exposure, after completion of the six-session, two-hours-per-session program, was important for many participants to sustain benefit levels. Participants emphasized the importance of the program being delivered by trained professionals. Achieving involvement of a suitably sized project comparison or control group through the 8-month program evaluation period to follow-up proved challenging, which somewhat weakens the power of the evaluation findings. Full article

Background: Menopause is associated with metabolic, sensory, and psychosocial changes that may reshape eating behaviours and nutrition-related quality of life. This study explored how women experience nutrition and chemosensory changes during menopause and how these intersect with identity, control, and social practices. Methods: We conducted online focus groups (Microsoft Teams) with women living in Ireland (n = 40; mean age 58.3 years (±4.5 years)) between January and March 2025. Discussions followed a semi-structured guide focused on taste/smell, appetite, food choice, and coping. Sessions were recorded, transcribed, anonymised, and analysed following Braun and Clarke’s thematic analysis. Results: Four themes captured patterned meanings in the dataset: (1) Chemosensory Changes—reports of diminished taste, contrasted with heightened smell and selective intensification (sweetness), prompting compensatory behaviours (more salt/spice/strong coffee) and new aversions (e.g., cucumber, spicy dishes) alongside unexpected likes (e.g., dark chocolate); (2) Behavioural and Emotional Consequences—increased snacking, sugar/salt cravings, and perceived loss of satiety co-occurred with weight gain and altered body shape, undermining food pleasure and self-confidence; (3) Interacting Influences—affecting vasomotor symptoms, sleep disturbance, joint pain, and “brain fog” compounded dietary disruptions and social withdrawal (e.g., embarrassment about appetite, reduced desire to dine out); (4) Strategies for Wellbeing—women described medical approaches (HRT, prescribed medications) alongside food modifications and the importance of diagnosis, information, and peer/professional support. Conclusions: Menopause reshapes sensory perception and eating behaviour in complex, individualised ways that extend beyond biology to identity and social life. Nutrition care should integrate symptom management with person-centred strategies and improved access to evidence-based information, diagnosis, and support networks. Full article

Out-of-pocket health expenditure (OOPHE) significantly impacts people with chronic and complex diseases (CCDs) and injuries. Aboriginal communities experience a higher burden of CCDs and injury, along with greater OOPHE inequities. This project aims to develop and implement a social prescribing digital platform (Web App) to reduce OOPHE. It is grounded in citizen science approaches that value the lived experience and knowledge of Aboriginal people in shaping solutions. The project uses a citizen science methodology adapted for these communities, using knowledge interface methodology to weave together Indigenous and Western knowledges. Research methods (Indigenous, quantitative, qualitative) explore the relational nature of OOPHE risks and protective factors through co-design and workshops with Aboriginal participants to develop the Web App. A community-centric developmental evaluation guides the trial and refinement of the platform, allowing for ongoing learning and adaptation. Process measures inform a national scale-up and evaluation framework. Addressing OOPHE is essential to improving health and wellbeing for Aboriginal and Torres Strait Islander individuals and families living with or at risk of CCDs. This initiative aims to reduce the impact of OOPHE through digital social prescribing, there by connecting people with essential community services to access healthcare, offering a scalable approach to addressing health inequities nationwide. Full article

Background/Objectives: Perfectionism is a personality trait characterised by the setting of extremely high and unrealistic personal standards, accompanied by critical self-evaluations. The literature indicates that perfectionism may develop as a learned behaviour, shaped by parent–child interactions, highlighting the influence of parental, individual and environmental factors. This quantitative study examines how parental perfectionism/practices and child temperament contribute to early perfectionism. Methods: The sample comprised 32 first-grade children (9 girls) from Faro district, aged between five and seven, and their parental figures. Parental perfectionism was assessed using self-report questionnaires, while children’s characteristics were evaluated through a combination of parent-report measures, direct observation, and interview-based methods. Results: Children self-rated higher perfectionism than parents attributed, with modest cross-informant agreement for socially prescribed and negligible agreement for Self-Oriented Perfectionism. Direct parent–child associations were small and method-dependent. Coercive/intrusive parenting corresponded to higher child Socially Prescribed Perfectionism, with convergence between observed intrusiveness and self-reported coercive practices. Temperament showed modest, patterned covariation with parenting and child perfectionism. Notably, Effortful Control attenuated the association between parental and child Socially Prescribed Perfectionism, whereas Surgency/Extraversion and Negative Affect did not; no temperament dimension moderated Self-Oriented Perfectionism. Conclusions: Findings indicate a complex interplay between dispositional and environmental factors in early childhood and underscore the value of multi-informant, multi-method assessment. As a pilot study, these findings provide initial insights into the intergenerational transmission of perfectionism in small children and serve as a basis for generating hypotheses and guiding future research, emphasising longitudinal designs and diverse samples to strengthen validity and clarify intergenerational processes. Full article

Antimicrobial resistance (AMR) constitutes a major global health challenge, driven significantly by inappropriate antibiotic use in human medicine. Despite the existence of evidence-based guidelines, variability in antibiotic prescribing persists, influenced by psychosocial factors, diagnostic uncertainty, patient expectations, and local prescribing cultures. Outpatient care, the setting in which most antibiotics are prescribed, is particularly affected by such challenges. Traditional top-down interventions, such as national guidelines, often fail to achieve sustained behavioral change among prescribers. In this comprehensive review, we provide an overview of the psychological and behavioral factors influencing antimicrobial stewardship (AMS) implementation, as well as describe a bottom-up project working to meet these challenges: the “Antibiotic Therapy in Bielefeld” (AnTiB) initiative. AnTiB employs a cross-sectoral strategy aimed at developing rational prescribing culture by means of locally developed consensus guidelines, interdisciplinary collaboration, and regularly held trainings. By addressing both the organizational and psychological aspects of prescribing practices, AnTiB has facilitated a harmonization of antibiotic use across specialties and care interfaces at the local level. The initiative’s success has led to its expansion within Germany, including through the creation of the AMS-Network Westphalia Lippe and the development of AnTiB-based national pediatric recommendations. These projects are all grounded in social structures designed to strengthen the long-term establishment of AMS measures. Our efforts underscore the importance of considering local social norms, professional network, and real-world practice conditions in AMS interventions. Integrating behavioral and social science approaches into outpatient antimicrobial stewardship—exemplified by the practitioner-led AnTiB model—improves acceptability and alignment with stewardship principles; wider adoption will require local adaptation, routine outpatient resistance surveillance, structured evaluation, and sustainable support. Full article