Search Results (3,827)

Early engagement with psychotherapy is a public mental health issue because potential patients’ first appraisals of psychological care may shape treatment expectations, willingness to continue, and openness to receiving effective support. In first-contact therapeutic encounters, people respond not only to the content of a therapist’s intervention but also to the interpersonal meaning conveyed by the therapist’s response style. Guided by a recognition–resistance framework and models of narcissistic self-regulation, we examined how therapist response style and trait narcissistic admiration and rivalry shape early appraisals of psychological care in a vignette-based psychotherapeutic encounter. In a between-subjects vignette experiment, Hebrew-speaking adults in Israel (N = 972) were randomly assigned to read a validation-based, recognition-supportive, autonomy-supportive therapist response or a more directive and challenging response to the same clinical scenario. Participants then reported perceived recognition, autonomy-related resistance, anticipated alliance, therapist credibility, expected benefit, and willingness to continue. The validation-based response elicited higher perceived recognition, lower autonomy-related resistance, and greater willingness to continue. Perceived recognition and autonomy-related resistance mediated the effects of response style on all therapy-related outcomes. Narcissistic admiration predicted more favorable appraisals, and narcissistic rivalry predicted lower recognition and greater resistance, but neither moderated style effects nor indirect pathways. Recognition and autonomy-related resistance emerged as proximal appraisal pathways linking therapist response style to anticipated engagement with psychological care in this analogue vignette context. However, the predicted moderation and moderated-mediation effects involving narcissistic admiration and rivalry were not supported. This pattern suggests that, in the present design, admiration and rivalry functioned more as general appraisal orientations than as differential-susceptibility moderators of therapist response style. The moderated-mediation component of the recognition–resistance framework should therefore be regarded as unsupported pending independent replication and more ecologically valid tests. These findings position first-contact therapist communication as a candidate modifiable feature of public mental health engagement, with implications for future research on treatment uptake, early retention, trust in services, and access to effective psychological care. Full article

Cancer remains a growing public health concern in South Africa, particularly in underserved communities where disparities in awareness and access to care contribute to delayed diagnosis. This study evaluated the impact of a culturally tailored educational intervention based on an adapted Cancer-Community Awareness Access Research and Education (c-CARE) module in Johannesburg and iLembe districts. A pilot study using a quasi-experimental pre–post design was conducted to assess changes in knowledge and attitudes among 210 traditional health practitioners, community health workers, and faith-based leaders. Structured surveys measured awareness of multiple myeloma, prostate, lung, breast, and cervical cancers. Data were captured in REDCap and analyzed using SPSS version 30. Significant improvements in knowledge were observed across all cancers. Awareness of lung cancer increased from 74.3% to 96.7%, multiple myeloma from 26.7% to 96.7%, prostate cancer from 52.5% to 98.3%, breast cancer from 93.4% to 98.7%, and cervical cancer from 84.8% to 96.0%. Participants demonstrated improved understanding of screening modalities and risk factors, including tobacco-related harms. Despite these gains, screening-related fears remained evident. These findings demonstrate that contextually adapted, community-based training can strengthen cancer literacy and support early detection strategies in underserved settings. Full article

Ornamental aquarium keeping collectively involves millions of freshwater, marine, and reef systems in which fish, corals, invertebrates, biofilters, microbial communities, and human husbandry practices are closely interconnected. In these domestic aquatic animal systems, preventive and curative treatments may include antimicrobials, antiparasitics, antiseptics, oxidizing agents, copper-based products, dips, and commercial formulations targeting microbial proliferations or visible system deterioration. Many interventions occur without veterinary diagnosis, microbiological confirmation, standardized dosing, active-ingredient transparency, or post-treatment monitoring. This raises concerns for aquatic animal health and welfare, as whole-system treatments may affect not only the intended pathogen or pest but also non-target organisms, biofilter communities, animal-associated microbiota, and water quality stability. Digital communities and online platforms can rapidly circulate empirical treatment protocols, although they may also provide opportunities for stewardship education and improved husbandry guidance. Current evidence does not support interpreting ornamental aquaria as major independent drivers of antimicrobial resistance. The more defensible concern is stewardship: biologically active compounds may be used repeatedly and empirically in animal systems without diagnosis, professional guidance, or systematic monitoring. This Perspective argues that ornamental aquaria should be recognized as an overlooked interface between aquatic animal health, welfare, antimicrobial stewardship, and One Health. It proposes a research and communication agenda focused on treatment transparency, diagnosis, prevention, biofilter protection, and responsible care practices. Full article

Globally, the growth of ageing populations is significant, with more people requiring supported living environments, including residential aged care (RAC). Given the influence of the environment on health outcomes, it is important to consider approaches to evaluate aged care design, including both the built environment and products and technology. With the overarching aim to identify the scope of RAC-built environment and assistive technology design interventions and the way this data is captured methodologically, this review (i) identified methods and measures used to evaluate RAC-built environment and assistive technology design, and examined populations these methods and measures were used with, and (ii) mapped identified approaches to the International Classification of Functioning, Disability and Health (ICF). An a priori review protocol was developed, and a scoping review was then conducted. Eight databases were searched for publications between January 2000 and February 2023, resulting in 81 included studies, which were then mapped to ICF activity, participation and environment domains. Twenty methods and 16 methodologies were identified. Sixty-one articles collected data directly from resident populations, primarily including older adults (n = 52). Forty-nine publications reported on the evaluation of built design, 23 reported on products and technology, and nine reported on both, but with limited inclusion of valued participation as a goal or outcome. While some participatory methods were identified, 25% of the studies did not include consumer perspectives. Analyzing aged care design can identify ways to facilitate, or remove barriers to, healthier spaces and lives in RAC. Use of internationally recognized terminology and an integrative lens on the relationship between technology and environmental design is recommended. Full article

Background. Orthotic and prosthetic devices for general-use and activity-specific function can provide critical preventive health benefits for individuals with limb loss, limb difference, and mobility impairments, and yet coverage remains inconsistent across U.S. states. Objective. To evaluate the fiscal impact of clarifying insurance coverage for orthotic and prosthetic devices across 23 states lacking comprehensive coverage. Methods. A cost consequence analysis was conducted using data from the U.S. Census Bureau, Kaiser Family Foundation, Government Accountability Office, and a recent actuarial analysis informing baseline cost, coverage, and prevalence assumptions. Per-member-per-month (PMPM) cost increases were compared against device enabled preventive health savings to estimate net fiscal impact. Sensitivity analyses modeled three scenarios based upon a combination of uptake (% eligible individuals accessing device) and physical activity equivalent annual cost saving, respectively: conservative (25% uptake, $1000), moderate (50% uptake, $2500), and high-impact (75% uptake, $5000). Return on investment (ROI) was calculated for the moderate scenario as the ratio of annual savings to implementation cost. Results. Under the assumptions of the moderate scenario, projected ROI remained positive across all states, ranging from approximately 1.5× in Florida to over 114× in Vermont, with 78% of states (18 of 23 states) demonstrating returns greater than 4×. Moderate scenario annual net savings ranged from approximately $10.8 million in Vermont to $437.0 million in California, with substantial projected savings also observed in Florida ($235.5 million), New York ($225.2 million), and Virginia ($143.8 million). PMPM cost increases for 70% of states range between $0.03 and $0.43, with all modeled states remaining below $1.46. Discussion. In our healthcare system dominated by high-cost and reactive care, the ROI obtained by this cost-consequence analysis (CCA) using evidence-based assumptions supports orthotic and prosthetic coverage clarification as preventive interventions to restore function. Full article

Background: Fasting plasma glucose, glycated hemoglobin (HbA1c), and oral glucose tolerance testing remain central to the diagnosis and monitoring of dysglycemia, but they mainly reflect the average glycemic exposure or discrete time-point measurements and may not capture intraday and interday glucose fluctuations. Glycemic variability (GV) has been associated with oxidative stress, endothelial dysfunction, inflammation, and diabetes-related complications, although much of the evidence derives from experimental, clinical, and diabetes-care settings rather than occupational cohorts. Aim: This narrative review examines the physiological basis, measurement, and potential occupational relevance of GV and continuous glucose monitoring (CGM) in working populations. Methods: Literature was narratively selected from biomedical databases, major guidelines, consensus statements, and occupational-health sources, prioritizing reviews, clinical guidelines, cohort studies, mechanistic studies, and CGM studies. No systematic search, risk-of-bias assessment, or quantitative synthesis was performed. Main findings: CGM is an established technology in selected diabetes-care contexts and provides metrics such as coefficient of variation, time in range, time above range, and time below range. Its use in occupational medicine, however, remains investigational outside selected clinical circumstances. Work-related factors such as shift work, circadian disruption, sleep loss, psychosocial stress, irregular meal timing, sedentary behavior, and variable physical workload may influence glucose regulation, but direct evidence linking these exposures to CGM-measured GV in workers remains limited. Implications: Potential applications include research on occupational determinants of metabolic health, monitoring of workplace lifestyle interventions, and individualized management of workers with diabetes in safety-sensitive roles, provided that consent, confidentiality, clinical follow-up, equity, and data-governance safeguards are ensured. Conclusions: GV assessment may complement traditional metabolic markers in selected occupational-health contexts, but routine CGM-based surveillance of general worker populations is not currently supported by sufficient evidence. Further longitudinal and interventional studies are required. Full article

Background/Objectives: Primary-care access in Alberta, Canada, is shaped by geography, attachment, timeliness, continuity, and local service capacity. Rural communities may face travel burden, workforce fragility, and intermittent services, whereas suburban communities may have nearby facilities but still experience delayed access, low attachment, and fragmented episodic care. Rural Wyoming has some similar geographic and workforce constraints, although the jurisdictions differ in financing, regulation, and pharmacist scope. This systematic review and narrative synthesis examined evidence on coordinated community pharmacist–family physician care in rural and suburban Alberta and considered, separately, the contextual relevance of the findings to rural Wyoming and comparable frontier settings. Methods: We searched PubMed/MEDLINE, Embase, Scopus, CINAHL, and the Cochrane Library using controlled vocabulary and free-text terms to identify English-language peer-reviewed studies and practice-relevant evidence published from 1 January 2010 to 19 April 2026. Two authors screened titles/abstracts and full texts and resolved decisions by consensus. Methodological appraisal used design-appropriate Critical Appraisal Skills Programme criteria, and outcome-level certainty was considered using GRADE domains. Results: Thirty-four eligible peer-reviewed or practice-evaluation records were included in the narrative synthesis, and seven official contextual or methodological sources supported jurisdictional interpretation. Evidence was strongest for hypertension, cardiovascular risk reduction, medication management, and chronic disease monitoring. No included study directly compared the same intervention in Alberta and Wyoming; evidence for emergency-department effects and equivalent effectiveness across settings was limited. Conclusions: Coordinated pharmacist–family physician care may extend access to selected medication-related and chronic disease services when supported by documentation, referral, follow-up, and red-flag protocols. Application to Wyoming should be treated as a context-dependent proposition requiring local adaptation and prospective evaluation, not as demonstrated transferability or a substitute for physician-led longitudinal primary care. Full article

Dental caries remains one of the most prevalent yet preventable non-communicable diseases worldwide, disproportionately affecting populations with limited access to dental care and persistent socioeconomic inequalities. Early-stage lesions frequently remain undetected because of their asymptomatic nature, inadequate screening infrastructure, and the absence of continuous monitoring technologies, resulting in preventable complications and increased healthcare costs. To address these challenges, this study proposes an Internet of Things (IoT)-enabled intraoral wearable sensing device (I-OWSD) for continuous, quantitative, real-time monitoring of biomarkers associated with caries progression. The proposed framework integrates intraoral wearable sensing, cloud-based telemedicine services, and artificial intelligence (AI)-assisted analytics to support preventive oral healthcare and remote clinical decision-making. Two primary contributions are presented. First, a fractional-order delay-type model (FODM) based on the Caputo–Fabrizio derivative is proposed to capture the memory-dependent and nonlocal dynamics of caries progression. Mathematical analysis establishes the model’s non-negativity, boundedness, existence, uniqueness, and stability properties. Second, a biocompatible intraoral sensor interface is designed to enable continuous data acquisition and secure wireless communication with digital health platforms. Simulation results based on the proposed FODM suggest that, under an estimated adoption rate of 67.49%, the I-OWSD framework could reduce caries prevalence by approximately 15% while improving opportunities for early intervention and preventive care. The findings demonstrate the potential of combining fractional-order modelling, wearable sensing, and AI-driven teledentistry to advance continuous oral health monitoring and preventive dental care. Full article

Background: Stigma toward people with mental illness remains a major barrier to quality care, persisting even among mental health professionals. This study evaluated the effectiveness and feasibility of a structured anti-stigma intervention for psychiatry trainees. Methods: Outcomes were assessed at baseline, post-intervention, and 3-month follow-up using a knowledge quiz, the Attitudes to Addressing Stigma and Discrimination Scale (ASTAD), and an Objective Structured Clinical Examination (OSCE). Feasibility outcomes were also evaluated. Results: Significant improvements were observed across all measures immediately after training, with medium to large effect sizes. Knowledge scores increased post-intervention (+6.68; 95% CI 5.86–7.50) and remained significantly higher at follow-up (+6; 95% CI 4.99–7.01). Total ASTAD scores improved post-intervention (+5; 95% CI 3.26–6.74) but did not maintain at follow-up. OSCE scores increased by 0.95 points (95% CI 0.62–1.28) post-training. The intervention reached 40% of eligible trainees, with high satisfaction and perceived relevance to clinical practice. Participants reported increased awareness of stigma, improved communication skills, and greater confidence in addressing stigma in patient interactions. Experiential learning methods, including role-play and case discussions, were identified as the most impactful components. Barriers to participation included workload, scheduling constraints, and limited institutional support. Participants recommended integrating the intervention into formal training curricula. Conclusions: The intervention was feasible, acceptable, and effective in improving stigma-related knowledge, attitudes, and clinical skills among psychiatry trainees. While knowledge gains were sustained, attitudinal and behavioral changes were only partially maintained, highlighting the need for longitudinal integration and ongoing reinforcement. Full article

Sarcoidosis is a multisystem disease characterised by a heterogeneous clinical presentation and variable disease course. Despite low mortality, the burden of sarcoidosis extends beyond organ involvement, with many patients reporting significant impairment in quality of life (QoL). Fatigue, chronic cough, and small fibre neuropathy (SFN) are among the most prevalent and debilitating symptoms reported by patients, often demonstrating poor correlation with conventional markers of disease activity and frequently persisting despite apparent disease control. This review examines the impact of sarcoidosis on QoL and highlights the limitations of traditional assessment tools, including imaging and pulmonary function testing, in capturing the full extent of disease burden. The role of patient-reported outcome measures (PROMs) is discussed, including generic instruments and sarcoidosis-specific tools such as the King’s Sarcoidosis Questionnaire (KSQ), Sarcoidosis Health Questionnaire (SHQ), and Sarcoidosis Assessment Tool (SAT), alongside symptom-specific measures targeting fatigue, neuropathic symptoms, and cough. Current and emerging management strategies aimed at improving QoL are reviewed, including immunosuppressive therapies, biologic agents, and non-pharmacological interventions. Despite increasing recognition of QoL as a key outcome, its integration into clinical trials remains inconsistent. Incorporating PROMs into routine clinical practice and research is essential to enable comprehensive assessment and support patient-centred care. Greater emphasis on QoL outcomes may improve therapeutic decision-making and overall disease management in sarcoidosis. Full article

Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when timely appointments are unavailable. This article describes and evaluates the Cranston Ridge Medical Clinic Registered Nurse Prescriber-led Triage–Treatment–Continuity model in Calgary, Alberta, Canada. Methods: The manuscript is reported as a single-clinic practice innovation and service evaluation using aggregate, non-identifying operational data from 1 April 2025 to 31 March 2026. The model combines medical office assistant emergency recognition, RN prescriber-led stability assessment, traffic-light urgency classification, a booking-contingency algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, safety-netting, and communication with the patient’s primary care provider through the electronic medical record. Results: During the evaluation period, 5032 pathway contacts were managed. Of 5030 stable contacts assigned traffic-light categories, 4950 (98.4%) were Code Red same-day contacts, 55 (1.1%) were Code Yellow 24–48-h contacts, and 25 (0.5%) were Code Green non-urgent contacts. Two contacts triggered EMS/911 activation before traffic-light classification. Following RN prescriber assessment, 9 emergency department referrals, 2 urgent care referrals, 85 primary care provider follow-up appointments, and 5 patient refusals were recorded; no safety incidents or complaints were recorded in the aggregate monitoring dataset. A CIHI-informed 15% reference scenario corresponds to approximately 755 potentially avoided ED/UCC visits, but no confirmed diversion or monetary savings are claimed. Conclusions: The model reframes triage as an integrated primary care intervention that combines assessment, treatment, escalation, and continuity. Further ethics-approved research is required to evaluate patient-level outcomes, safety, confirmed health-system utilization effects, stakeholder experience, and cost-effectiveness. Full article

Background/Objectives. The intestinal microbiota is a key contributor to postoperative complications, yet direct interventions targeting dysbiosis—antibiotics, probiotics, and synbiotics—have produced inconsistent results. This paradox indicates a fundamental gap in understanding host–microbiota interactions under surgical stress. We aimed to re-examine the causal role of dysbiosis in postoperative pathogenesis and propose a revised therapeutic paradigm centered on host barrier protection. Methods. A narrative literature review was conducted, searching PubMed/MEDLINE, Scopus, and Web of Science for articles published between 2009 and 2025. Reference lists of included publications were additionally screened. Studies in English and Russian were eligible; 107 references were included. Results. We hypothesize that dysbiosis in surgical patients may, at least in part, represent a predictable ecological response to systemic hypoperfusion, pharmacological burden, and ischemia–reperfusion injury, rather than acting solely as an independent pathogenic agent. Microbial shifts, characterized by the depletion of short-chain fatty acid-producing commensals and the expansion of pathobionts, frequently accompany epithelial injury; however, available human data are predominantly observational and do not permit definitive determination of the temporal sequence. This hypothesis provides the conceptual foundation for the proposed therapeutic reorientation. Conclusions. The present findings support the rationale for transitioning from microbiome manipulation to a “host-first” strategy, which prioritizes the restoration of intestinal barrier integrity through the administration of cytoprotective agents and targeted metabolic substrates (glutamine and butyrate). We propose the Gut Resilience Index (GRI) as a theoretical construct to identify patients approaching a critical threshold necessitating rescue therapy. It must be emphasized that both the “host-first” strategy and the GRI remain hypothetical frameworks requiring prospective validation. The most critical next steps include the development and validation of the GRI in prospective cohort studies, as well as randomized controlled trials directly comparing barrier-oriented strategies with standard care. Full article

Background: Maternal identity is the perception and recognition of a woman as a mother. Within this emerging identity, the maternal role takes on special importance as a manifestation of the set of responsibilities that a woman assumes in the care and upbringing of her baby. Respectful professional accompaniment during the period of maternal role acquisition is key to perinatal mental health and secure bonding with the baby. The main objective of this systematic review with narrative synthesis was to analyze the effects of psychological support programs aimed at maternal role acquisition during the transition to motherhood. Methods: Studies with experimental and quasi-experimental designs addressing maternal role acquisition in pregnant or postpartum women were included. A systematic search was conducted in PsycINFO, MEDLINE, PubMed and SCOPUS from inception to March 2025 following PRISMA recommendations. Due to the heterogeneity in study designs, interventions and outcome measures, a narrative synthesis was performed instead of a meta-analysis. Results: A total of 11 studies were extracted with a total sample of 1244 women, including five randomized controlled trials and six quasi-experimental studies. Psychological support programs focusing on maternal role acquisition generally showed improvements in maternal identity construction, self-efficacy and maternal competence, although not all findings reached statistical significance. In addition, several studies reported reductions in postnatal depressive symptoms, as well as improvements in subjective well-being and maternal role perception. Conclusions: results suggest that psychological support programs targeting maternal role acquisition may represent a promising approach for supporting perinatal mental health. However, the evidence should be interpreted with caution due to methodological limitations and heterogeneity across studies. In fact, most included studies were conducted in Eastern cultural contexts (Iran, China), limiting generalizability to Western populations without further adaptation and validation. Additionally, incomplete reporting of standardized effect sizes and precision measures across studies limits the quantitative interpretation of the findings. This review was not prospectively registered, and title/abstract screening was conducted by a single reviewer, increasing the risk of selection bias. Further research using rigorous and standardized designs is needed to clarify the effectiveness and generalizability of these interventions. Full article

Background/Objectives: Norway’s ageing population includes many older adults living alone who receive home care and are at increased risk of loneliness. Loneliness is the subjective sense of unmet or imbalanced social needs, shaped by culture and living conditions, and can be social (lack of contact) or emotional (absence of close, trusting relationships). In older people, it often follows partner or role loss or reduced mobility or participation and is associated with emotional pain, lowered self-worth and poorer health and quality of life. This study aimed to explore patients’ experiences of loneliness while living alone and receiving home care. Methods: Twelve older patients (aged 74–98 years) participated in in-depth interviews, which were analysed using phenomenological-hermeneutical analysis in line with Lindseth and Norberg’s recommendations. Results: The results are presented under the following themes: (I) An overwhelming and painful feeling, (II) A presence without connection, and (III) Experiencing a sense of alienation. Conclusions: This study describes complex feelings of loneliness for the majority of participants, often worsened by poor mobility and shrinking social networks. From the patient perspective, good home care goes beyond practical and medical tasks: patients need to be treated as whole persons, with respect and understanding, to alleviate loneliness. Staffing stability, predictable visiting times, time for conversation, and small acts of kindness are central to well-being and the prevention of loneliness. Municipal healthcare should prioritize relationship-building, communication skills, and organizational solutions that enable continuity and flexibility. Focusing on the patient perspective in planning and evaluation will create better targeted interventions and support dignified ageing. Full article

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and hospitalization in infants worldwide. In 2024, the Piedmont region introduced universal immunoprophylaxis with Nirsevimab for all infants experiencing their first RSV season. We carried out a multicenter retrospective observational study across the three pediatric units of ASL TO4 (Ivrea, Ciriè, Chivasso), comparing bronchiolitis-related hospitalizations during the 2023–2024 season (pre-Nirsevimab) with those from the 2024–2025 season (post-Nirsevimab). The primary outcome was the proportion of RSV-positive hospitalizations. Secondary outcomes included age at admission, need for respiratory support, PICU/NICU transfer, and length of stay. Immunization coverage was assessed using the regional electronic registry. Immunization coverage exceeded 88% across all centers (overall 90.4%). A total of 179 bronchiolitis hospitalizations were recorded (134 pre- vs. 45 post-Nirsevimab). RSV-positive admissions showed a reduction from 70.9% to 55.6% after implementation (OR 0.52; 95% CI 0.24–1.09). Center-specific analyses suggested reductions in Ciriè (OR 2.48; 95% CI 1.41–4.39) and Chivasso (OR 2.28; 95% CI 1.09–4.77), with a similar trend observed in Ivrea. In a supplementary denominator-based analysis restricted to infants younger than 12 months, RSV-related hospitalization incidence decreased from 42.0 to 10.3 per 1000 infants between seasons (OR 4.23; 95% CI 2.64–6.78; p < 0.0001). Disease severity remained unchanged between seasons in terms of respiratory support, length of stay, and PICU/NICU transfers. Age at admission increased significantly during the post-intervention season (mean 118.3 vs. 160.9 days; Welch’s two-sample t-test, p = 0.026). Among 15 immunized infants hospitalized in 2024–2025, 6 were RSV-positive, none required intensive care, and only two needed high-flow nasal cannula (HFNC). Universal Nirsevimab prophylaxis was associated with a trend toward reduction in RSV-related hospitalizations at the aggregate level, although the overall comparison did not reach statistical significance. Center-specific analyses suggested reductions in RSV-positive admissions in some participating units. A supplementary denominator-based analysis among infants younger than 12 months showed a lower incidence of RSV-related hospitalizations during the post-implementation season. No evidence of increased severity among breakthrough cases was observed. High coverage demonstrated the feasibility of implementation and its potential public health value. Continued longitudinal surveillance over additional RSV seasons is essential to better define the durability of protection and long-term epidemiological impact. Full article