Healthy aging has emerged as a global priority. However, older adults' participation in health promotion programs remains low, and traditional health promotion models have achieved limited success in fostering sustained engagement among this population. Mobile health (mHealth)-based gamification interventions offer a promising way to address these challenges. However, no published reviews support or oppose the use of mHealth-based gamification interventions as health promotion strategies in older adults. The study aimed to identify mHealth interventions using gamification to promote health among older adults. Our scoping review was conducted following the Joanna Briggs Institute recommendations for scoping reviews and Arksey and O'Malley's framework. The process followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklist. A comprehensive literature search was conducted across 8 databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, CINAHL, PsycARTICLES, and IEEE Xplore Digital Library, from their inception to December 10, 2025. Two reviewers independently screened titles, abstracts, and full texts via Rayyan, with disagreements resolved by a third reviewer. This scoping review identified 11 studies. Only 1 article was published before 2022. The interventions were found to improve enjoyment and motivation (n=5), cognitive function (n=3), physical activity (n=2), and digital literacy (n=2). Individual studies also reported improvements in mental health (n=1) and adherence (n=1), a reduction in suicidal ideation (n=1), improvements in physical function (n=1), the promotion of social engagement (n=1), and the identification of mild cognitive impairment (n=1). Game elements used were ranked by frequency as progress, challenges, goals, levels, reward, sensation, storytelling or narration, leaderboard, surprise, and avatar. No research was found to use the game element of "social sharing." mHealth types included augmented and virtual reality-based training systems, wearable devices, mobile phones, tablets, and Windows platforms and devices. Notably, only 4 studies applied theoretical frameworks, and 3 omitted the concrete approach to gamification. As the first scoping review to identify and map mHealth-based gamification interventions for older adults, this study highlights their potential as an innovative approach to health promotion. By systematically synthesizing evidence regarding intervention designs, gamification strategies, and preliminary health outcomes, it establishes a foundation for future inquiry. However, this review is limited by the small number of included studies, precluding broad generalizations. Future research should assess long-term impacts, integrate theoretical frameworks, establish reporting guidelines, design personalized social-interactive interventions, and expand to broader health domains. Ultimately, these insights provide targeted guidance for developing age-appropriate digital health solutions, contributing to the realization of active aging.
Parkinson's disease is one of the fastest growing neurological disorders with regards to disability and death. Though this burden is felt globally, inequities in research, advocacy, prioritization and funding mean that the needs of people with Parkinson's disease in low- and middle-income countries, and from marginalized communities in high-income countries, remain poorly recognized. Parkinson's disease is increasingly being acknowledged as a global public health issue requiring a public health response. Global advocacy efforts, awareness-raising initiatives, research collaborations, partnerships and investment in Parkinson's disease have therefore accelerated in recent years, with the positioning of people affected by PD as authoritative voices paramount to this drive. Yet despite this progress, inequalities in access to treatments, care and support persist. Responding to the global burden posed by Parkinson's disease requires sustained, multi-sectoral, concerted action, building on an integrated and systems-oriented approach. The generation of momentum for a public health approach to Parkinson's disease must be met with implementation at the country level, alongside sufficient allocation of resources, monitoring and evaluation. The approach offered in this paper builds on the five cross-cutting strategic objectives outlined in the World Health Organization's Intersectoral global action plan on epilepsy and other neurological disorders 2022-2031 (IGAP) implementation toolkit, offering a platform to build a unified global response to Parkinson's disease. Action should therefore center on the integrated themes of (1) prioritization and governance; (2) diagnosis, treatment and care; (3) promotion and prevention; (4) research and information systems; and (5) a tailored Parkinson's disease-specific public health approach. A global response to Parkinson's diseaseParkinson's disease is one of the world's fastest growing brain disorders. While Parkinson's disease affects people across the globe, individuals living in low- and middle-income countries, and those from marginalized communities in higher income countries, do not receive the attention, care and support they need to live well. Parkinson's disease has been recognized as an important global public health issue, including by the World Health Organization. As a result, international advocacy efforts, awareness campaigns, research efforts and investments have grown. People with lived experience are also increasingly involved in shaping these efforts, which is an important step forward. Despite this progress, there are still inequalities in who can access a diagnosis, treatment and care. Addressing the challenge of Parkinson's disease requires long-term and coordinated action across many sectors. Efforts need to be integrated into broader health systems and supported by strong political commitment. The recognition of Parkinson's disease as a public health priority must be met by plans to implement strategies, accompanied by monitoring to understand if the strategies are working. This paper offers recommendations that build on the World Health Organization's approach to tackling neurological disorders through an ‘intersectoral global action plan’. These objectives provide a foundation for building a unified global response to Parkinson's disease. The key areas for action include: (1) stronger prioritization and leadership; (2) improved access to diagnosis, effective treatment and care; (3) the promotion of brain health and disease prevention; (4) improved research and health information systems; and (5) tailored public health strategies specific to Parkinson's disease. Together, these actions will help to reduce inequalities and ensure that all people impacted by Parkinson's disease can receive the care and support they need, no matter where they live.
To explore and assess the effect of payment schemes on oral health promotion and prevention programmes. A scoping review was conducted using the Arksey & O'Malley framework. MEDLINE (via PubMed), Embase (via Scopus), and The Cochrane Library were searched. Unpublished literature was also collected. Searching and screening were conducted until 31 July 2025. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All studies comparing payment methods for oral health prevention and promotion were included. A conceptual framework linking payment mechanism to provider incentive, service delivery behaviour, and preventive care outcomes was used to guide synthesis, with findings classified across three outcome levels: utilisation (Level 1), quality of preventive care processes (Level 2), and clinical oral health outcomes (Level 3). The studies were grouped according to the payment system, their impact on the service provider and receiver, and their advantages and disadvantages. After summarising the results, the data were analysed by consulting experts and compared with existing policies. Quality assessment was carried out using Joanna Brigg's Institute's Quality appraisal tools. Out of the 30 studies included, the review found that payment systems have various forms, with four main payment systems being Pay for performance (n = 3), Fee for service (n = 15), Capitation (n = 10), and Global Budget (n = 2). Other payment systems such as salary, treatment vouchers, or direct payment by the employer were also identified, and have been shown to increase preventive dental services and oral health promotion activities. Fee-for-service payment is consistently associated with higher treatment volumes but lower rates of preventive care delivery, while capitation incentivises prevention but carries risks of patient selection and service reduction without adequate risk adjustment. Pay-for-performance and value-based payment approaches show promise for improving preventive care quality, though evidence remains limited. No single payment model reliably promotes oral health prevention across all contexts. A mixed payment model combining the activity incentives of fee-for-service, the cost-sharing principles of capitation, and the quality orientation of value-based payment offers the most promising framework for advancing oral health promotion. Policymakers should consider hybrid financing structures supported by quality monitoring, and further research is needed to evaluate their long-term effects on clinical oral health outcomes.
Policy Points Wellness has grown into a multi-trillion-dollar industry encompassing a multitude of products and practices that affect health and well-being. Applying a lens of commercial determinants of health to wellness is useful to examine its intersection with systems of capital production, corporate interests, and neoliberal norms of personal responsibility. The global digital revolution has fueled both the growth of the wellness industry and the spread of health misinformation, posing regulatory, social, and political challenges. As wellness movements gain prominence in American and global policymaking, attention to these intersections is crucial to understanding consequences for health policy. The global wellness industry has multifaceted impacts on health and well-being, including through the sale and consumption of wellness products, the provision of health information to consumers, and the promotion of specific norms and values. Despite its growing prominence, the wellness industry and its impacts on health and policymaking remain understudied. This article examines how the wellness industry operates as a commercial, social, and political determinant of health. We draw on commercial determinants of health and corporate political activity frameworks to analyze the strategies, structures, and discourses of the wellness industry. We examine existing academic literature, regulatory documents, industry data, and media and policy sources to map the wellness industry's characteristics, regulatory environment, and political dimensions, including its role in shaping US public health policy through the Make America Healthy Again (MAHA) movement. The wellness industry deploys political strategies closely resembling those of other harmful commodities industries, including undermining scientists and policymakers, promoting personal empowerment, and lobbying against regulation. While wellness products and practices are often framed as responding to the erosion of institutional trust and health care systems' failure to address persistent health inequities, their promotion may deepen, rather than alleviate, these crises. The MAHA movement illustrates how wellness logics have become embedded in policymaking, platforming individualized wellness while falling short of addressing the systemic drivers of ill health and inequity. Applying a commercial determinants of health lens to wellness highlights the need for stronger regulatory oversight of health claims, demonetization of harmful online health misinformation, and structural investment in equitable health care systems. This is particularly urgent given the MAHA movement's alignment of wellness with populist politics. Further research is merited to systematically document wellness industry practices across diverse national contexts and investigate links between wellness discourse, health inequalities, and political polarization.
Perinatal mental health issues are a global problem that constitutes a significant part of the burden on maternal and infant health. This situation could pose a risk, especially for immigrant women, who are a vulnerable group. This study aimed to investigate the effect of midwife-led education based on Pender's Health Promotion Model on the perinatal mental health of immigrant women. This randomised controlled experimental study was conducted with 52 participants in the intervention group and 54 participants in the control group (n = 48 in the post-test). The study consisted of five interviews. While the pre-test was administered during the first interview in the pregnancy period, the post-test was administered in the first month postpartum. Data were collected through the Personal Information Form, the Edinburgh Postnatal Depression Scale, and the Perinatal Anxiety Screening Scale. While the intervention group women's depression scores did not show a significant difference over time, the control group women's scores showed a significant difference. The intervention group had significantly lower depression scores in the third and fourth interviews. However, no significant difference was observed between the groups in terms of their anxiety scores. The midwife- led education based on Pender's Health Promotion Model was found to protect and improve immigrant women's perinatal health. In light of these results, it is recommended that education programs may contribute to the development of perinatal mental health within the framework of midwifery care models should be planned and implemented in clinical practice.
Noncommunicable diseases (NCDs) are the leading global cause of death, with physical inactivity being a major modifiable risk factor. In Japan, high NCD mortality and low physical activity rates prompted municipalities to launch incentive programs promoting healthier behaviors. However, long-term experiences and motivations beyond immediate rewards remain unclear. A qualitative descriptive study was conducted in Nakasatsunai Village, Hokkaido, Japan. In 2022, 17 individual and one focus group interviews were held with 21 participants continuously engaged in the Health Point Project. Participants earned points through step tracking, health checkups, and events, which could be exchanged for vouchers. Data were analyzed using inductive content analysis with co-author review and member checking. Participants' mean age was 60.3 years. Eight categories described continued participation: looking forward to the benefits without active effort; being encouraged to engage in physical activity within well-designed environments; hoping to maintain good health; recognizing the benefits and impacts of exercise; engaging in activities in their own way or style; adopting exercise and health care as habits; being inspired by peers; and feeling a sense of community. Incentives motivated initial participation, while habit formation, health improvements, social interaction, and community involvement sustained long-term engagement. Participants' sustained involvement was driven not only by financial incentives but also by experiences of personal connection and community belonging. Thus, municipal incentive programs may enhance both individual health behaviors and social well-being, underscoring the importance of integrating opportunities for social interaction alongside financial incentives in sustainable health promotion initiatives.
Nonexclusive breastfeeding is a major risk factor for childhood lower respiratory infections, yet its global burden remains unquantified. Although exclusive breastfeeding is widely recommended, the attributable burden of early infancy lower respiratory infections linked to nonexclusive breastfeeding and cross-country performance gaps have not been systematically assessed. This analysis fills that gap by combining burden estimates with frontier benchmarking. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 database, we estimated deaths, disability-adjusted life years, age-standardized mortality rates, age-standardized disability-adjusted life-year rates, and population attributable fractions of lower respiratory infections attributable to nonexclusive breastfeeding across 204 countries and territories from 1990 to 2021. Temporal trends were assessed with joinpoint regression, and frontier analysis was applied to identify efficiency gaps. In 2021, nonexclusive breastfeeding accounted for 37,890 lower respiratory infection deaths and 3.41 million disability-adjusted life years globally, with boys carrying a higher burden. India, Nigeria, and Pakistan had the largest absolute numbers, whereas Chad, Somalia, and South Sudan had the highest standardized rates. Neonates (<28 days old) showed the highest mortality and disability-adjusted life-year rates, indicating greater vulnerability than with infants aged 1-5 months. Globally, age-standardized mortality rates and age-standardized disability-adjusted life-year rates declined significantly from 1990 to 2021 (average annual percentage change -4.87%), although sub-Saharan Africa and South Asia still bore the heaviest burden. Frontier analysis revealed substantial potential for further reduction in low- and low-middle sociodemographic index countries through improved breastfeeding and health system strengthening. Despite global progress, nonexclusive breastfeeding remains a major contributor to childhood lower respiratory infections, particularly among neonates and in low-sociodemographic index settings. Strengthening breastfeeding promotion and maternal-child health services is critical to reducing mortality, morbidity, and regional inequities. To achieve this, scaling evidence-based policies, such as Baby-Friendly practices, community lactation support, maternity protection, and strong enforcement of the International Code of Marketing of Breast Milk Substitutes is essential.
Gestational diabetes mellitus (GDM) is associated with fetal overgrowth, increased risks of perinatal morbidity and mortality, and long-term complications for mother and child, including cardiovascular disease and type 2 diabetes. Innovative, peer-based digital health interventions are emerging globally as a potential approach to assist and empower women in effective self-care and well-being during pregnancy. However, there remains substantial potential to develop and evaluate culturally sensitive digital health interventions for pregnant women with GDM, especially in low- and middle-income countries. This study aimed to bridge the gap between the World Health Organization (WHO) self-care framework and local practice by designing and piloting the "Healthy Pregnancy" intervention, a multiplatform digital ecosystem for women with GDM in northern Vietnam, through a staged cocreation and pilot refinement process. Between December 2022 and February 2024, drawing on the WHO's conceptual framework for self-care and cocreation approach, we iteratively developed "Healthy Pregnancy," a digital health intervention, in 4 stages: (1) formative studies and self-care construct prioritization, (2) cocreation processes with key stakeholders, (3) development and design translation, and (4) pilot testing and final refinement. In stage 1, we identified gaps in current digital health interventions in low- and middle-income countries, explored the sociocultural realities of women with GDM in Vietnam, and prioritized 7 self-care constructs. In stage 2, we conducted a cocreation workshop to enable key stakeholders to co-design the foundational infrastructure for the potential intervention. In stage 3, we established a multicomponent digital intervention ecosystem with explicitly defined operating workflows. Finally, in stage 4, we gathered suggestions for a digital health intervention from a pilot test group of pregnant women with GDM, to refine and optimize the system schematic and information flow before moving to the real intervention. By applying a cocreation approach across all stages of development of the "Healthy Pregnancy" digital health intervention, from problem identification to solution development and evaluation, we developed a locally tailored GDM self-care model. This process not only addressed gaps in standard care but also empowered pregnant women through a supportive, multiple-stakeholder environment. This study demonstrates a rigorous cocreation pathway for systematically translating WHO self-care constructs into a feasible, culturally adapted digital ecosystem for GDM in Vietnam and offers a transferable, people-centered design process alongside a practical blueprint for integration into routine maternal care.
Human activities increasingly disrupt global ecosystems, contributing to climate change, biodiversity loss, and emerging health threats. In response, the One Health framework has gained attention as an integrative approach encompassing human, animal, and environmental health. In a symposium at APPW2025, experts in Exposome science and Digital Transformation discussed how interdisciplinary integration can advance predictive and preventive medicine. This review summarizes five key topics: Exposome as a determinant of disease risk, epigenetic mechanisms encoding environmental memory, environmental programming of brown adipose tissue, adaptive prioritization of environmental signals, and simulation-based drug repurposing. Collectively, these studies highlight a paradigm shift from conventional linear exposure-disease models toward a systems-level understanding integrating cumulative exposures, biological memory, and predictive modeling. The convergence of Exposome science and Digital Transformation provides a foundation for advancing One Health into a predictive and actionable scientific framework.
The literature on the Commercial Determinants of Health has primarily focused on the political power and interventions of corporations versus countermeasures by civil society. However, there is a gap in the discourse concerning industry use of legal threats and actions to silence public health organizations and their public health communication campaigns (PHCCs). This legal review aims to understand legal challenges brought against PHCCs and provide best practices for effective campaigns while minimizing legal risk. We used jurisprudence in Mexico and the United States as proxies for civil and common law countries, supplemented by international law and principles to identify the best defenses and mitigation strategies against defamation and trademark infringement actions. Legal frameworks in these countries demonstrate the ability of aggressive evidence-based public health campaigns to withstand these legal challenges. Based on these legal protections, we recommend that advocates implement PHCCs that (1) contain facts that are true and substantiated with evidence, (2) frame messaging as opinion or satire, (3) highlight the non-commercial purpose of informing people about the impact of their consumption choices on health and well-being and (4) explain how the messaging advances the rights to health and access to information. A PHCC's success in court can also set important precedents regarding the right of advocates to disseminate and the right of populations to receive important health messages. Following these recommendations and best practices, health advocates can minimize legal risk and continue to provide effective evidence-based PHCCs that promote and protect public health.
Society faces multiple challenges, including lifestyle diseases and global climate change. Framing health education within sustainable development may enhance motivation for behavior change because proenvironmental behaviors, as well as healthy behaviors, often rely on the same behavior change principles. Combining these perspectives may therefore reinforce health behaviors and climate-friendly choices. This pilot study aims to explore changes in dietary intake, diet-related carbon footprint, and physical activity among office workers receiving sustainable plus healthy lifestyle (sustainable lifestyle arm) or healthy lifestyle education (healthy lifestyle arm) alone. It also aims to assess the feasibility of the intervention functions, including workshop attendance rate, participants' dietary goals, social support, and facilitators and barriers to behavior change. A 2-armed participant-blinded cluster randomized study, including an experimental intervention arm (sustainable lifestyle; n=19) and a control intervention arm (healthy lifestyle; n=14), was conducted in Sweden. The study lasted 8 weeks and included 6 workplace-based workshops and was framed by the behavioral change wheel and the socioecological model. Diet, carbon footprint, and physical activity were assessed using the web-based questionnaires Meal-Q and Active-Q. Attendance rate, individual goals, social support, and facilitators and barriers were assessed using printed questionnaires. The reduction of total diet-related carbon dioxide equivalents (CO2e) was 0.8 kg and 0.4 kg per day for the sustainable and healthy lifestyle arm, respectively. Also, there was a statistically significant interaction between time and lifestyle when the carbon footprint was expressed as a qualitative aspect of diet, that is, CO2e kg per 1000 kcal per day (P=.05). Moreover, the intake of vitamin C, a marker for fruits and vegetables, increased to 8.0 and 12.5 mg per 1000 kcal per day for the sustainable and healthy lifestyle arms, respectively. In addition, total sedentary time decreased by 0.4 hours per day in the sustainable lifestyle arm, but not in the healthy lifestyle arm. This indicates that the educational workshops in respective arms had different impacts on health behavior over time. Minor differences were found in dietary goals, with the sustainable lifestyle arm setting more goals related to ecological and vegetarian foods. No differences were seen between arms regarding barriers or facilitators. This study suggests that embedding healthy lifestyle recommendations within a sustainable development context may be an efficient way to reduce carbon footprint and increase healthy behavior among office workers. Given the ongoing global epidemic of metabolic diseases, climate change, and environmental degradation, promoting a sustainable lifestyle in a workplace context has the potential to counteract these trends.
Mental health issues such as depression, loneliness, and cognitive decline are prevalent among older adults. They are particularly pronounced in rural areas due to socioeconomic disadvantages, limited health literacy, and social isolation. These challenges have been exacerbated by the COVID-19 pandemic, highlighting the urgent need for accessible, community-based mental health strategies. Social prescribing-linking individuals to nonmedical community resources-offers a promising model, especially when coupled with culturally relevant and digitally facilitated interventions. This study aimed to evaluate the effectiveness of a pilot social prescribing project for individuals aged 65 years and older residing in rural South Korea. Specifically, it examined the changes in social support, loneliness, depression, cognitive function, and life satisfaction among the older adults before and after the intervention and the relationships among these factors. A quasi-experimental, nonequivalent control group pretest-posttest design was conducted with 294 participants from Wonju City, Gangwon-do (n=148 in the experimental group, n=146 in the control group). The 8-week intervention featured a community-based music storytelling program incorporating local cultural elements and digital education. Statistical analyses, including t tests, difference-in-differences analysis, and structural equation modeling, were conducted to evaluate changes in scores and the effectiveness of the program intervention. The study confirmed that the social prescribing pilot project effectively reduced depression and increased social support and life satisfaction compared with the control group (P<.05, 95% CI). While cognitive function showed slight improvement, the change was not statistically significant. Social support emerged as a key mediating factor, positively influencing cognitive function and life satisfaction, and was negatively associated with depression. There was no statistically significant direct effect found between loneliness and cognitive function or social support. This pilot study supports the feasibility and mental health benefits of integrating community and digital support through culturally embedded social prescribing for rural older adults. The findings highlight the importance of leveraging local resources and social networks to address mental health disparities in underserved aging populations, offering valuable insights for policymakers and practitioners developing inclusive aging and health promotion strategies.
Research using the multidimensional sleep health (MDSH) framework has increased globally, often relying on self-report measures. The Ru-SATED scale and Sleep Health Index (SHI) are common self-report measures of MDSH, but comparative data on their measurement properties and contextual characteristics remain limited. Seven electronic databases were searched for measurement properties and uses of the two scales over the past twelve years. This review identified 19 psychometric validation studies concerning two original and 17 cross-cultural, and summarized contextual comparison of MDSH measures and frameworks. Measurement properties of both measures were assessed with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, and contextual comparisons were conducted narratively. Both measures exhibited acceptable psychometric properties across diverse cultural settings, with the SHI findings showing greater consistency than those of the Ru-SATED scale. Aggregating the Ru-SATED and SHI frameworks fully covered the sleep characteristics assessed by five instruments grounded in the World Sleep Society initiative, encompassing regularity, satisfaction, alertness, timing, efficiency, duration, and disorder. Notably, the SHI framework incorporates targeted sleep disorder assessment while the Ru-SATED framework specifically excludes such assessment, highlighting the distinct focus and scope of each tool. Instrument selection depends primarily on research purpose, study sample, and intended use. We recommend characterizing both sleep health and sleep disorders to fully capture the complex relationships between sleep and health outcomes.
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Malnutrition during pregnancy is a public health concern. Interventions implemented through the health sector can prevent maternal malnutrition. Our aim is to identify implementation strategies for delivering nutritional interventions through primary health care to prevent malnutrition in all its forms during pregnancy. We followed the Cochrane Handbook for Systematic Reviews and PRISMA guidelines. A search strategy was developed for five databases. The information was systematized using the Template for Intervention Description and Replication. Meta-analyses were performed using a random-effects model. We used the Risk of Bias and the Non-randomized Studies of Interventions tools, and the certainty of the evidence followed the GRADE guidelines. We included 51 studies conducted across high-, middle-, and low-income countries. Multiple micronutrient supplementation (MMS) was more effective than iron-folic acid (IFA) supplementation alone in improving hemoglobin levels and other anemia-related indicators, when initiated during the first or second trimester of pregnancy and delivered with in-person, individualized counseling and follow-up. Our meta-analysis confirmed that MMS improved maternal anemia compared to IFA with a moderate certainty of the evidence. Healthy eating counseling, physical activity, and weight gain monitoring, when combined, were effective in achieving weight gain when the interventions were guided by prenatal care protocols and included materials and resources to support. Our meta-analysis showed a non-significant reduction in excessive weight gain with very low certainty, no meaningful effect on low weight gain with low certainty, and a potentially meaningful increase in the likelihood of gaining weight within the recommended range with very low certainty. A coordinated package of health system-delivered interventions, including MMS, behavioral counseling, and monitoring of maternal weight gain, should be implemented within primary health care, beginning in the first or second trimester, to prevent all forms of malnutrition during pregnancy. Effective implementation strategies to provide these interventions can be adapted to local contexts. The protocol for this review was registered in PROSPERO with the ID CRD4202460299.
Contemporary food systems contribute to climate change and influence food security, diet quality, equity and regional resilience. Addressing these interconnected challenges requires coordinated, place-based actions across the entire food system, with dietitians and nutrition professionals increasingly recognised as key system actors. To describe a dietitian-led, systems-thinking approach used to inform the development of a regional food strategy in New South Wales, Australia and to identify opportunities for dietitians and nutrition professionals in food system change across health, equity and environmental sustainability domains. Using a socioecological model of health promotion and a collective impact methodology, a 2-year evidence-building and co-design programme of work was undertaken. Mixed methods were used across Ottawa Charter action areas: Building Healthy Public Policy; Creating a Supportive Environment; Developing Personal Skills; and Strengthening Community Action. Activities included diet affordability analysis, food environment and production mapping, community surveys, social network analysis, pilot skills-building initiatives and cross-sector stakeholder engagement. The programme generated a coordinated regional evidence base on food security, food environments and local food systems, which informed the establishment and governance structure of a cross-sector Food Futures Taskforce and the co-design of a regional Food Charter and Action Plan with defined priorities and responsibilities. Findings highlight the central role of dietitians as knowledge translators, equity advocates and facilitators of systems change. This case study demonstrates how dietitians can operationalise systems thinking to catalyse regional food system governance and transformation. The approach offers a transferable model for integrating research, policy and practice to advance healthy, equitable and sustainable food systems.
Empathy is central to humanised nursing but vulnerable to erosion in demanding academic and clinical settings. Positive mental health (PMH) encompassing emotional, psychological, and social well-being, may regulate how self-compassion is statistically linked to empathic engagement. However, evidence in nursing students remains limited. To examine the statistical association of positive mental health in the relationship between self-compassion and empathy among undergraduate nursing students within a structural equation modelling (SEM) framework. Observational, analytical, cross-sectional study. A total of 402 nursing students from a public university completed validated measures of self-compassion, empathy, and PMH. SEM with latent variables was conducted using diagonally weighted least squares (DWLS) to account for ordinal and non-normal data. Model fit was assessed using multiple indices, acknowledging the complexity of the latent structure. Self-compassion was positively associated with PMH (β = 0.772, p < 0.001), which related positively to empathy (β = 0.689, p < 0.001). The indirect effect via PMH was positive (β = 0.532, p < 0.001), while the direct effect of self-compassion on empathy was negative when controlling for PMH (β = -0.553, p < 0.001), indicating an inconsistent mediation pattern. The model explained 59.6% of the variance in positive mental health and 19.3% in empathy. PMH appears to be a key correlate in the association between self-compassion and empathy. Findings suggest that emotional well-being may be an important foundation for relational competence, although the study's cross-sectional nature precludes causal inferences and the marginal model fit warrants a cautious interpretation. Fostering empathy may require more than interpersonal skills training. Nursing curricula could benefit from integrating positive mental health promotion, including training in self-compassion and emotional regulation, to support empathic and humanised nursing practice across educational and clinical contexts.
Longitudinal trends in breastfeeding (BF) are often overlooked in favor of binary or time-to-cessation measures. Characterizing these trends can inform promotion of sustained BF practices. We identified distinct BF profiles among participants of a maternal and child health program. The Healthy Future program consisted of community health workers delivering a BF curriculum to mothers through monthly home visits. The program was evaluated in rural Sichuan, China with a cluster-randomized controlled trial (assigned to program versus not). We clustered 6-month postpartum trends (n = 949) of maternal-reported infant feeding using dynamic time warping. For each month, participants were categorized as either exclusive breastfeeding (EBF), mixed feeding (MF, feeding breastmilk plus other foods or liquids), or not breastfeeding (NBF). After identifying clusters, we regressed BF profiles on intervention assignment using adjusted multinomial logistic regression. Cluster analysis revealed seven profiles: always EBF, always MF, never breastfed, EBF until the 5th month, MF until the 5th month, mostly EBF, and NBF from the 3rd month. The intervention was associated with improved odds of always EBF (ROR = 2.61, 95% CI 1.25, 5.42), MF until the 5th month (ROR = 2.52, 95% CI 1.18, 5.39), and NBF from the 3rd month (ROR = 2.82, 95% CI 1.16, 6.87) compared to being never breastfed. Mothers in the never breastfed cluster had the lowest age, education, BF knowledge and attitudes, and decision-making power. Cluster analyses found the intervention significantly improved EBF, particularly in mothers characterized by higher baseline educational attainment and BF knowledge. Targeted efforts are needed to help mothers initiate EBF from birth and continue EBF through month 6.
This review aimed to estimate the global prevalence of autism spectrum disorder (ASD) and identify methodological and contextual covariates influencing prevalence estimates. Despite increasing research, the true global burden of ASD remains unclear due to substantial variability in reported prevalence across studies. The specific methodological and contextual factors driving this heterogeneity have not been fully quantified. Electronic databases, including PubMed, Scopus, Web of Science, Embase, and Google Scholar, were systematically searched from 2004 to 2025. All human population-based studies were included, irrespective of region or diagnostic framework. Nineteen studies, comprising approximately 20.6 million participants, met the inclusion criteria and reported ASD prevalence. To estimate pooled prevalence, a random-effects model (REML) was used, and Bayesian hierarchical modeling was conducted to provide posterior estimates. Publication bias and sensitivity analyses were conducted, followed by meta-regression to account for covariates such as diagnostic framework, study setting, and region. The frequentist pooled prevalence of ASD was 0.8% (95% CI: 0.4%-1.7%), with substantial heterogeneity (I² ≈ 100%) and a wide prediction interval (0.03%-17.3%). Bayesian hierarchical modeling produced a posterior mean prevalence of 1.55% (95% CrI: 0.75%-4.1%), and a Bayesian sensitivity analysis excluding an extreme outlier study yielded a posterior mean prevalence of 0.9% (95% CrI: 0.6%-1.8%) with substantial heterogeneity (τ = 1.14, I² = 99.98%) and a prediction interval of 0.09%-9.5%, indicating strong consistency between frequentist and Bayesian estimates. Regional prevalence varied: North America (1.9%), Africa (6.3%) (wide confidence intervals reflecting limited data), Europe (0.4%), Latin America (0.2%), and the Middle East (0.6%). Meta-regression analysis demonstrated that ASD prevalence was influenced by diagnostic framework, study setting, and region (R² ≈ 0.78), and the combined impact of all covariates explained a substantial proportion of the variance in effect sizes. Our updated meta-analysis indicated that global ASD prevalence varies widely across regions, largely due to methodological and contextual differences rather than demographics alone. Standardized diagnostic practices, enhanced surveillance, and targeted investment in underrepresented regions are critical for improving the accuracy and comparability of prevalence estimates. This updated synthesis provides a more robust and context-sensitive estimate of global ASD prevalence and supports the interpretation of variability observed in prior studies.
This study aims to review the development trends of clinical trials for lung cancer cellular therapy systematically, analyze the spatiotemporal distribution, research entities, cell types, target selection quantitatively, thus, trial design characteristics and reveal the evolutionary patterns, driving factors, and scientific challenges in this field. The findings are intended to provide a reference for subsequent research, policy formulation, and clinical translation. Clinical trials of cellular therapies for non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) worldwide up to July 2025 were retrieved. A cross-referencing strategy was applied to include interventional clinical studies in the process of excluding non-cellular therapies and records with missing key information. Two researchers independently screened and extracted data, 452 trials were included ultimately. Descriptive statistical methods were used to make analysis of core indicators, such as annual trends, geographical distribution, funding entities, target mechanisms, research phases, and trial status. Results Global clinical trials for lung cancer cellular therapy entered a rapid development phase, which started in 2016, peaked in 2024 (51 trials). Trials were highly concentrated on early stages, with Phase I and Phase I/II studies accounting for 79.9% (361/452). Only 7 Phase III studies were conducted, this gave a highlight of significant translational bottlenecks. Geographically, a bipolar driving pattern emerged between China and the United States. China experienced explosive growth post-2016 and leaded globally in trial numbers by 2024 (31 trials). Funding entities shifted from early public sector dominance to industry-led by small and medium-sized biotech companies. In terms of targets, PD-1 (25 trials) and IL-2Rα (22 trials) were the most popular, while emerging targets, for instance, cancer-testis antigen 1B and mesothelin gradually gained prominence. Mechanistically, immuno-oncology therapies and T-cell stimulators predominated. Among therapies such as CAR-T, NK, TCR-T, TIL, and DC vaccines, CAR-T and TIL, all showed the highest recent activity, while DC vaccines were relatively mature. This study systematically analyzed the current status and trends of global clinical trials for lung cancer cellular therapy, which demonstrated the rapid development driven by technological breakthroughs, policy support, and capital investment. Nevertheless, lung cancer cellular therapy still faces scientific challenges, such as target selection, efficacy enhancement, and safety optimization. Future research should explore deeply to give a promotion of clinical translation and application.