Search Results (1,905)

Background/Objectives: Dementia represents a growing public health challenge. The WHO Global Action Plan on the Public Health Response to Dementia emphasizes early detection, risk reduction, and innovation as key priorities. Mild Behavioral Impairment (MBI), defined as the emergence of persistent neuropsychiatric symptoms in older individuals, represents a potential marker of early neurodegeneration and possible window for early intervention. This review explores the role of MBI in dementia prevention, mapping current evidence within the WHO Global Action Plan framework. Methods: A comprehensive search was performed in PubMed, Scopus, and the official WHO website, during 1 September 2025–10 November 2025, without time restrictions. Eligible sources included original clinical studies, reviews, and policy documents addressing MBI, dementia prevention, and public health. Data were thematically synthesized according to the seven objectives of WHO: (1) dementia as a public health priority, (2) dementia awareness and friendliness, (3) dementia risk reduction, (4) dementia diagnosis, treatment, care and support, (5) support for dementia carers, (6) information systems for dementia, and (7) dementia research and innovation. Results: Accumulating evidence indicates that MBI assessment can capture early behavioral manifestations of neurodegenerative and other forms of dementia, correlating with fluid, neuroimaging and genetic biomarkers. Integrating MBI screening through the easy-to-administer MBI Checklist (MBI-C) into clinical and community-based care, including telemedicine pathways and research, may enhance early identification and personalized interventions, enrich the pool for clinical trials, and facilitate research in biomarker and therapy. MBI-related research further supports its integration in remote digital monitoring and population-based prevention. Conclusions: Embedding MBI-informed screening and interventions into national dementia strategies aligns with WHO objectives for early, equitable and scalable prevention and brain health. Full article

Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct from coverage-only parity) and to summarize reported effects on telehealth utilization, modality mix, quality/adherence, equity/access, and expenditures. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science for U.S. studies that explicitly modeled state payment parity or stratified results by payment parity vs. coverage-only vs. no parity. We included original quantitative or qualitative studies with a time or geographic comparator and free full-text availability. The primary outcome was telehealth utilization (share or odds of telehealth use); secondary outcomes were modality mix, quality and adherence, equity and access, and spending. Because designs were heterogeneous (interrupted time series [ITS], difference-in-differences [DiD], regression, qualitative), we used structured narrative synthesis. Results: Nine studies met inclusion criteria. In community health centers (CHCs), payment parity was associated with higher telehealth use (42% of visits in parity states vs. 29% without; Δ = +13.0 percentage points; adjusted odds ratio 1.74, 95% CI 1.49–2.03). Among patients with newly diagnosed cancer, adjusted telehealth rates were 23.3% in coverage + payment parity states vs. 19.1% in states without parity, while cross-state practice limits reduced telehealth use (14.9% vs. 17.8%). At the health-system level, parity mandates were linked to a +2.5-percentage-point telemedicine share in 2023, with mental-health (29%) and substance use disorder (SUD) care (21%) showing the highest telemedicine shares. A Medicaid coverage policy bundle increased live-video use by 6.0 points and the proportion “always able to access needed care” by 11.1 points. For hypertension, payment parity improved medication adherence, whereas early emergency department and hospital adoption studies found null associations. Direct spending evidence from open-access sources remained sparse. Conclusions: Across ambulatory settings—especially behavioral health and chronic disease management—state payment parity laws are consistently associated with modest but meaningful increases in telehealth use and some improvements in adherence and perceived access. Effects vary by specialty and are attenuated where cross-state practice limits persist, and the impact of payment parity on overall spending remains understudied. Full article

Objective: To assess whether chronic rhinosinusitis (CRS) severity is associated with obstructive sleep apnea (OSA) in adult people with cystic fibrosis (pwCF). Methods: We conducted a retrospective single-center study of 44 adults with CF who underwent overnight polysomnography (PSG), Epworth Sleepiness Scale (ESS) assessment, and sinus computed tomography (CT). CRS severity was quantified using the Lund–Mackay score (LMS) and the main nasal cavity score (MNCS). OSA was defined by Apnea–Hypopnea Index (AHI) thresholds per American Academy of Sleep Medicine criteria. Results: Participants had a mean age of 31.1 ± 8.4 years and a mean percent predicted FEV1 of 51.8 ± 15.7. Sinus CT showed radiological evidence of CRS in all participants. Mean AHI was 5.3 ± 4.4/h; 48% had AHI ≥ 5/h. There were no significant differences between pwCF with and without OSA in age, sex, BMI, lung function, total sleep time, sleep efficiency, or ESS score (all p > 0.05). Mean LMS and MNCS did not differ between OSA and non-OSA groups (both p > 0.05), and neither score correlated with PSG parameters or ESS (all p > 0.05). Receiver operating characteristic (ROC) analysis demonstrated low discriminative ability of LMS and MNCS for predicting OSA (AUCs < 0.70, p < 0.05). Conclusions: In this cohort of adults with CF, CT-based CRS severity was not associated with OSA. Given the substantial prevalence of OSA observed, PSG screening should be considered irrespective of CRS severity. Full article

The limitations of conventional diabetes management are increasingly evident. As a result, both type 1 and 2 diabetes in pediatric populations have become major global health concerns. As new technologies emerge, particularly artificial intelligence (AI), they offer new opportunities to improve diagnostic accuracy, treatment outcomes, and patient self-management. A PRISMA-based systematic review was conducted using PubMed, Web of Science, and BIREME. The research covered studies published up to February 2025, where twenty-two studies met the inclusion criteria. These studies examined machine learning algorithms, continuous glucose monitoring (CGM), closed-loop insulin delivery systems, telemedicine platforms, and digital educational interventions. AI-driven interventions were consistently associated with reductions in HbA1c and extended time in range. Furthermore, they reported earlier detection of complications, personalized insulin dosing, and greater patient autonomy. Predictive models, including digital twins and self-learning neural networks, significantly improved diagnostic accuracy and early risk stratification. Digital health platforms enhanced treatment adherence. Nonetheless, the barriers included unequal access to technology and limited long-term clinical validation. Artificial intelligence is progressively reshaping pediatric diabetes care toward a predictive, preventive, personalized, and participatory paradigm. Broader implementation will require rigorous multiethnic validation and robust ethical frameworks to ensure equitable deployment. Full article

Background/Objectives: The purpose of this study was to evaluate the reliability and diagnostic accuracy of smartphone-based photogrammetry for the assessment of pes planus and to determine its agreement with standard radiographic measurements. Methods: This prospective diagnostic study included 100 skeletally mature patients (50 males, 50 females; mean age 43.4 years) who underwent standardized lateral weight-bearing foot radiographs and smartphone-based foot photography. The calcaneal pitch angle (CPA) was measured on radiographs, and a corresponding photographic arch pitch angle (P-APA) was measured from standardized smartphone photographs using digital software (Angle Meter iOS v1.9.8). Three independent observers performed each measurement twice. Inter- and intra-observer reliability was assessed using intraclass correlation coefficients (ICC). Agreement between methods was evaluated with Pearson correlation, Lin’s concordance correlation coefficient (CCC), Bland–Altman analysis, and Deming regression. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy of calibrated P-APA, with the radiographic threshold of 18° serving as the reference standard for pes planus classification. Results: All measurements demonstrated excellent intra- and inter-observer reliability (ICC ≥ 0.900). P-APA values were systematically higher than radiographic values (31.8° ± 4.3 vs. 21.8° ± 5.5; p < 0.001). A strong correlation was observed between the two methods (r = 0.799, p < 0.001), but concordance was poor (CCC = 0.222). Bland–Altman analysis revealed a mean bias of +10.1° with wide limits of agreement (3.8° to 16.4°). Deming regression yielded the calibration equation Radiographic CPA = (P-APA × 1.371) − 21.883. ROC analysis of calibrated values yielded an AUC of 0.885 (95% CI, 0.820–0.951), with an optimal cutoff of 22.8° (sensitivity, 100%; specificity, 61.1%), corresponding to 32.6° on the uncalibrated photographic scale. Conclusions: Conventional weight-bearing radiography remains the reference standard for diagnosis and clinical decision-making in pes planus. The smartphone-derived photographic arch pitch angle is a non-equivalent surrogate measure that shows substantial systematic bias and limited agreement with radiographic calcaneal pitch, and therefore cannot replace weight-bearing radiographs. Smartphone photogrammetry may be used only as a complementary tool for preliminary screening or telemedicine support; any positive or equivocal findings require radiographic confirmation. Full article

Outpatient neurosurgical oncology has expanded with advances in anesthesia, imaging, and minimally invasive techniques, enabling safe same-day discharge for selected patients undergoing procedures such as stereotactic biopsy and craniotomy. In this review, we find that across multiple international series, same-day discharge rates in several studies ranging from 85 to 95%, with low complication (3–6%) and readmission rates when structured pathways, including standardized selection criteria, enhanced recovery protocols, and routine 4-h postoperative CT imaging, are used. Studies on economic analyses demonstrate substantial cost savings driven by reduced inpatient bed utilization, with no increase in adverse events. Key challenges identified include medicolegal concerns amongst physicians, patient education, and limitations in organization adoption. Telemedicine and remote monitoring are increasingly incorporated to streamline preoperative evaluation and postoperative follow-up, improving access and continuity of care. Emerging technologies such as laser interstitial thermal therapy and focused ultrasound may further expand the outpatient neuro-oncology repertoire. Overall, current evidence supports outpatient neurosurgical oncology as a safe, efficient, and patient-centered model when applied with structured clinical pathways and patient selection. Full article

Background and Objectives: Telemedicine has become an essential component of chronic Inflammatory Bowel Disease (IBD) care, yet the factors that shape patient satisfaction with remote consultations remain only partially understood. This study aimed to assess satisfaction with institutional telemedicine services among Italian patients with ulcerative colitis (UC) and Crohn’s disease (CD), and to identify sociodemographic, clinical and organisational predictors to inform more person-centred telehealth models. Materials and Methods: We conducted a prospective, multi-centre, cross-sectional study in three IBD units in northern, central and southern Italy between June and October 2024. Consecutive adult patients who had completed a scheduled, non-emergency telemedicine visit were invited within 24–48 h to complete an online questionnaire including the Italian Telemedicine Satisfaction Questionnaire (I-TSQ), sociodemographic items, IBD-related variables, and telemedicine process indicators (accessibility, technology usability, technical support, time saved). Data were analysed descriptively and with multivariable linear regression to determine independent predictors of satisfaction, adjusting for recruiting centre. Results: A total of 705 patients participated (54.9% UC; 55.3% disease duration > 10 years). Overall, telemedicine satisfaction was high (mean I-TSQ total 57.5 ± 4.9; range 35–70), and all respondents reported reduced indirect costs compared with in-person visits. Greater ease of technology use, more frequent contact with the care team, male sex, older age, and employment were independently associated with higher satisfaction scores. Conversely, first-ever teleconsultations, CD, subcutaneous therapies, more difficult platform access, and the need for technical support were linked to lower satisfaction. Model fit was modest (R² up to 0.20), suggesting the presence of additional unmeasured relational and contextual factors. Conclusions: Telemedicine for IBD is widely accepted in Italy, but satisfaction is strongly conditioned by digital usability, previous experience, and clinical complexity. Tailored telehealth pathways that incorporate user-friendly platforms, proactive technical support, and attention to vulnerable subgroups are needed to translate high satisfaction into sustained, equitable remote care. Full article

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

Background: The UGT1A1 gene is associated with the toxicity caused by SN38, the cytotoxic component of Sacituzumab govitecan (SG) used in the treatment of metastatic triple-negative breast cancer (mTNBC), among other approved indications. In this study, we aimed to analyze the effect of UGT1A1*28 allele on the safety and, secondarily, the effectiveness of SG in mTNBC. Methods: This was a multicenter, ambispective study that included patients treated with SG for mTNBC. Genotyping for UGT1A1*28 was performed using real-time polymerase chain reaction (PCR). Adverse events (AEs) of grade ≥ 2 during the first three cycles were compared between patients who were homozygous mutant (UGT1A1*28/*28) and those with wild-type (WT) or heterozygous genotypes. Effectiveness between the two groups was also compared using progression-free survival (PFS) and overall survival (OS) assessed with the Kaplan–Meier method. Results: A total of 81 patients were included: 37.0% were WT, 55.6% heterozygous, and 7.4% homozygous mutant. All UGT1A1 *28/*28 patients experienced grade ≥ 2 AEs (100% vs. 69.3%; p = 0.109), with a statistically significant association in the case of febrile neutropenia (33.3% vs. 6.7%; p = 0.025), and a trend towards higher rates of anemia and diarrhea (50.0% vs. 17.3%; p = 0.053). Genotype did not influence PFS or OS; however, dose reductions were associated with better survival outcomes. Conclusions: This real-world study shows a correlation between toxicity and the presence of the UGT1A1*28 mutation in patients treated with SG for mTNBC. Improving treatment tolerability through dose reductions may enhance SG effectiveness. These findings support the implementation of UGT1A1 genotyping in routine clinical practice. Full article

Introduction: Rare diseases disperse expertise across institutions and borders, making structured second-opinion systems a pragmatic way to concentrate subspecialty knowledge and reduce diagnostic delays. This scoping review mapped the design, governance, adoption, and impacts of such services across implementation scales. Objectives: To describe how second-opinion services for rare diseases are organized and governed, to characterize technological and workflow models, to summarize benefits and barriers, and to identify priority evidence gaps for implementation. Methods: Using a population–concept–context approach, we included peer-reviewed studies describing implemented second-opinion systems for rare diseases and excluded isolated case reports, purely conceptual proposals, and work outside this focus. Searches in August 2025 covered PubMed/MEDLINE, Scopus, Web of Science Core Collection, Cochrane Library, IEEE Xplore, ACM Digital Library, and LILACS without date limits and were restricted to English, Portuguese, or Spanish. Two reviewers screened independently, and the data were charted with a standardized, piloted form. No formal critical appraisal was undertaken, and the synthesis was descriptive. Results: Initiatives were clustered by scale (European networks, national programs, regional systems, international collaborations) and favored hybrid models over asynchronous and synchronous ones. Across settings, services shared reproducible workflows and provided faster access to expertise, quicker decision-making, and more frequent clarification of care plans. These improvements were enabled by transparent governance and dedicated support but were constrained by platform complexity, the effort required to assemble panels, uneven incentives, interoperability gaps, and medico-legal uncertainty. Conclusions: Systematized second-opinion services for rare diseases are feasible and clinically relevant. Progress hinges on usability, aligned incentives, and pragmatic interoperability, advancing from registries toward bidirectional electronic health record connections, alongside prospective evaluations of outcomes, equity, experience, effectiveness, and costs. Full article

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

Background/Objectives: Mobile health (mHealth) interventions can enhance chronic disease management, but their integration into public healthcare systems remains complex. DiabeText is the first SMS-based intervention in Spain delivering personalized diabetes self-management support using electronic health record data. This study explored perceived barriers and facilitators to the implementation of DiabeText in the Spanish public health context from the perspective of key stakeholders. Methods: A qualitative study was conducted using semi-structured interviews with 14 purposively selected stakeholders involved in digital health, diabetes care, data protection, and healthcare management across several Spanish regions. Interviews were thematically analyzed using Braun and Clarke’s approach and guided by the Implementation Research Logic Model. Results: Participants reported several barriers, including concerns regarding data protection, uncertainty about long-term sustainability, insufficient training and engagement of healthcare professionals and low digital literacy among certain patient groups. Facilitators included favorable institutional momentum for digital innovation, funding availability, perceived clinical utility and scalability of DiabeText, and growing patient familiarity with digital tools. Recommended strategies included integration into existing healthcare systems and workflows, professional training and use of familiar communication platforms. Conclusions: Effective implementation of DiabeText requires addressing regulatory, organizational, and equity-related barriers while leveraging institutional support and readiness for innovation. Early involvement of healthcare professionals, robust data governance, and investment in digital literacy are essential to ensure sustainable and equitable adoption. These findings provide actionable insights to support the integration of mHealth tools into chronic disease care in Spain and similar settings. Full article

Background: Early diagnosis of Alzheimer’s disease (AD) is essential for slowing disease progression and mitigating cognitive decline. However, conventional diagnostic methods are often invasive, time-consuming, and costly, limiting their utility in large-scale screening. There is an urgent need for scalable, non-invasive, and accessible screening tools. Methods: We propose a novel screening framework combining a pre-trained multimodal large language model with structured MMSE speech tasks. An artificial intelligence-assisted multilingual Mini-Mental State Examination system (AAM-MMSE) was utilized to collect voice data from 1098 participants in Sichuan and Chongqing. CosyVoice2 was used to extract speaker embeddings, speech labels, and acoustic features, which were converted into statistical representations. Fourteen machine learning models were developed for subject classification into three diagnostic categories: Healthy Control (HC), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD). SHAP analysis was employed to assess the importance of the extracted speech features. Results: Among the evaluated models, LightGBM and Gradient Boosting classifiers exhibited the highest performance, achieving an average AUC of 0.9501 across classification tasks. SHAP-based analysis revealed that spectral complexity, energy dynamics, and temporal features were the most influential in distinguishing cognitive states, aligning with known speech impairments in early-stage AD. Conclusions: This framework offers a non-invasive, interpretable, and scalable solution for cognitive screening. It is suitable for both clinical and telemedicine applications, demonstrating the potential of speech-based AI models in early AD detection. Full article

Background: Artificial intelligence (AI) is rapidly transforming clinical medicine by enabling earlier disease detection, personalized risk stratification, precision diagnostics, and optimized therapeutic decision-making across multiple specialties. Methods: This narrative review synthesizes the most recent evidence from prospective randomized controlled trials, large cohort studies, and real-world implementations of AI in cardiology, pulmonology, neurology, hepatology, pancreatic diseases, and other key areas of internal medicine. Studies were selected based on clinical impact, external validation, and regulatory approval status where applicable. Results: AI systems now outperform traditional clinical tools in numerous high-stakes applications: >88% freedom from atrial fibrillation at 1 year with AI-guided ablation, noninferior stent optimization versus OCT guidance, >95% sensitivity for atrial fibrillation and low ejection fraction detection on single-lead ECG, substantial increases in adenoma detection rate and melanoma triage accuracy, automated pancreatic cancer detection on routine CT with 89–90% sensitivity, and significant improvements in palliative care consultation rates and post-PCI outcomes using AI-supported telemedicine. Over 850 FDA-cleared AI devices exist as of November 2025, with cardiology and radiology dominating clinical adoption. Conclusions: AI has transitioned from experimental to clinically indispensable in multiple specialties, delivering measurable reductions in mortality, morbidity, hospitalizations, and healthcare resource utilization. Remaining challenges include external validation gaps, bias mitigation, and the need for large-scale prospective trials before universal implementation. Full article

Objectives: Telemedicine has rapidly expanded in oral and maxillofacial surgery (OMFS), especially during the COVID-19 pandemic, but its specific roles and limitations across the care pathway remain unclear. This narrative review aimed to map telemedicine modalities and indications in OMFS, summarize reported outcomes, and identify priorities for future research. Methods: A narrative synthesis was undertaken after a systematic search of medical and engineering databases to 10 October 2025. Studies applying telemedicine, telehealth, telepresence or teleradiology to OMFS practice were eligible, including trials, observational cohorts, technical reports and surveys. Data were extracted in duplicate and organized thematically; heterogeneity precluded meta-analysis. Results: Fifty studies met the inclusion criteria. Telemedicine was mainly used for preoperative consultation and triage, postoperative follow-up, trauma teleradiology and tele-expertise, oncologic and oral medicine follow-up, temporomandibular disorders, and education or humanitarian work. In low-risk outpatient and postoperative settings, remote consultations showed high concordance with in-person plans, similar complication or reattendance rates, reduced travel, and high satisfaction. In trauma networks, telemedicine supported timely triage and reduced unnecessary inter-hospital transfers. Evidence in oral oncology and complex mucosal disease was more cautious, favouring hybrid models and escalation to face-to-face assessment. Data on cost-effectiveness and impacts on equity were limited. Conclusions: Telemedicine in OMFS has moved from niche innovation to a pragmatic adjunct across the clinical pathway. Current evidence supports its use for selected pre- and postoperative care and trauma triage within risk-stratified hybrid models, while underscoring the need for stronger comparative and implementation studies, clear governance on equity and data protection, and alignment with wider digital and AI-enabled health systems. Full article