To identify and synthesise evidence pertaining to 'health check' programmes for the assessment of cardiovascular risk factors and disease delivered to adult populations in countries with universal healthcare. A systematic umbrella review was undertaken. The protocol for this systematic umbrella review was registered on the PROSPERO registry and was undertaken based on Cochrane guidance and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, Scopus, Google Scholar and Health Management Information Consortium (HMIC) were searched. These searches identified records published between January 2009 and February 2025. The inclusion criteria for the review were as follows: population-adults aged ≥18 years; intervention-health checks including the assessment of cardiovascular risk factors and disease; comparators-non-recipients, variations of health checks and within-person pre/post assessments; outcomes-uptake and diagnosis rates, cardiovascular disease (CVD) and related clinical and behavioural risk factors, referral changes, and barriers and facilitators to uptake. Studies published prior to 2009 (when NHS Health Checks were introduced) and those from countries without universal healthcare provision were excluded. Screening was performed independently by two reviewers and conflicts were resolved via discussion or adjudication by a third reviewer. Data extraction and quality appraisal were performed independently by a single reviewer and checked by a second reviewer. The quality of included reviews was assessed using the Risk of Bias in Systematic Reviews (ROBIS) (for quantitative evidence) and the Swedish Agency for Medical and Social Evaluation tool (for qualitative evidence). The results of this systematic umbrella review were synthesised narratively. Results from meta-analyses reported by the included systematic reviews showed that the effects of health checks on cardiovascular and total mortality, stroke and coronary heart disease were mixed and generally non-significant. Conversely, health checks generally showed significant, positive effects (reductions) in CVD risk factors including blood pressure, body mass index and cholesterol levels. Non-significant reductions in smoking were found in two meta-analyses. Health checks were generally cost-effective; however, it was found that the cost-effectiveness of health checks could be improved through targeting towards 'high risk' populations defined based on socioeconomic factors, obesity and family history of CVD. Health check attendance versus non-attendance was related to demographic, attitudinal, socioeconomic and practical factors. The effectiveness of health checks was influenced by factors including social support to make changes to health behaviours and the availability and accessibility of referral options. Overall, health checks had a positive impact on the detection of and improvement in the levels of cardiovascular risk factors. There was limited evidence of impact on the occurrence of longer term CVD events, which could reflect the limitations of onward treatment for CVD. Cardiovascular health checks could be more effective and cost-effective if targeted towards high-risk groups. The ability to access appointments at convenient times and venues and increased opportunities for social support may increase health check uptake, and increased availability and accessibility of referral options may improve their effectiveness. CRD42024487529.
This article analyzes the management of Federal expenditure on mental health between 2001 and 2022, reflecting on how this management denies and reaffirms the principles of Brazilian Psychiatric Reform. It involves research, based on publicly accessible data available on Ministry of Health databases, i.e. the I.T. Department of the SUS, the Integrated Public Health Budget System, and the Electronic System of the Citizen Information Service between 2001 (when Law No. 10,216 was enacted) and 2022 (the last year of the Bolsonaro government). Federal spending on mental health, in relation to total spending on health services, fell in the five years, from an average of 2% to 1.7%. Out-of-hospital expenditure on mental health reached 80%, and funding for Brazil's community-based psychosocial care centers (CAPS) increased but saw a reduction in spending on other areas. The management of federal spending reveals the progress, limitations, and setbacks in Brazilian Psychiatric Reform, especially in redirecting resources to institutionalizing healthcare actions, and making mental health expenditure "invisible" within the health budget, which makes the social control of policy application difficult. Este artigo analisa a direção dos gastos da União com saúde mental entre 2001 e 2022, refletindo como essa direção dialeticamente nega e reafirma os princípios da Reforma Psiquiátrica brasileira. Trata-se de pesquisa documental, a partir de dados de acesso público disponíveis nos bancos de dados do Ministério da Saúde (Departamento de Informática do Sistema Único de Saúde do Brasil; Sistema Integrado de Orçamento Público da Saúde, bem como informações obtidas por meio do Sistema Eletrônico do Serviço de Informações ao Cidadão) entre 2001 (ano da Lei nº 10.216) e 2022 (último ano do governo Bolsonaro). Os gastos federais com a saúde mental, em relação aos gastos totais com ações e serviços de saúde, apresentaram decréscimo nos últimos cinco anos, passando da média de 2% para 1,7%. Os gastos extra-hospitalares em saúde mental alcançaram o percentual de 80%, e houve crescimento dos gastos com custeio de CAPS, mas tal crescimento foi acompanhado de redução em gastos com outras ações. O direcionamento dos gastos federais apontou para avanços, limites e retrocessos no processo de consolidação da Reforma Psiquiátrica, em especial ao redirecionar recursos para dispositivos assistenciais de cunho institucionalizante, e invisibilizar gastos com saúde mental no orçamento da saúde, dificultando o controle social na condução da política. Este artículo analiza la dirección del gasto federal en salud mental entre 2001 y 2022, reflexionando sobre cómo esta dirección niega y reafirma dialécticamente los principios de la Reforma Psiquiátrica Brasileña. Se trata de una investigación documental, basada en datos públicos de las bases de datos del Ministerio de Salud (Departamento de Informática del Sistema Único de Salud de Brasil; Sistema Integrado de Presupuesto Público de Salud, así como información obtenida por medio del Sistema Electrónico del Servicio de Información al Ciudadano) entre 2001 (año de la Ley n.º 10.216) y 2022 (último año del gobierno de Bolsonaro). El gasto federal en salud mental, en relación con el gasto total en acciones y servicios de salud, disminuyó en los últimos cinco años, de un promedio del 2% al 1,7%. El gasto extrahospitalario en salud mental alcanzó el 80%, y se observó un crecimiento en el gasto en CAPS, pero este crecimiento estuvo acompañado de una reducción en el gasto en otras acciones. La asignación del gasto federal indicó avances, limitaciones y retrocesos en el proceso de consolidación de la Reforma Psiquiátrica, especialmente al redirigir recursos a la institucionalización de dispositivos de atención e invisibilizar el gasto en salud mental en el presupuesto de salud, lo que dificulta el control social en la ejecución de la política.
The rise of social media has significantly impacted public health programs, with platforms such as YouTube, Facebook, X (formerly known as Twitter), Instagram, and, more recently, TikTok being used to promote health information, raise awareness about disease outbreaks, and support disease prevention programs. However, the diverse and often unverified nature of the content on social media can make it challenging to discern accurate information, contributing to user uncertainty, which may in turn contribute to low vaccination rates in some regions. This is especially true in Louisiana as its COVID-19 vaccination rates were among the lowest in the country in 2022. Therefore, understanding public sentiment on social media and developing targeted campaigns to counter unverified information is essential for advancing public health campaigns. The goal was to gain insights into the underlying factors that contribute to Louisiana's low vaccination rates for routine immunizations by (1) performing social media listening to develop an infodemic management plan and (2) promoting accurate information via a social media campaign. Social media listening was conducted using Meltwater, a media monitoring and social media listening platform, supplemented by Google Alerts and Google News to identify if vaccine-related stories or sentiments were attracting unusual attention. Additionally, a social media campaign aimed at educating Louisiana residents about disease manifestation, symptoms, vaccines available for disease prevention, and potential side effects was developed. Posts were published 2 to 3 times a week and boosted for 7 days. From November 13, 2023, to June 11, 2024, social media listening identified at least 15 unique, noteworthy stories that signified sentiment spikes. These conversations were predominantly related to vaccine hesitancy, with users expressing opposition to vaccines or reluctance to engaging with vaccine-related information. Sentiment spikes included themes related to mistrust of vaccines and concerns about their safety and efficacy. The social media campaign received 69,600 impressions, reached 43,429 users, and received 652 reactions and likes, 62 shares, and 105 comments. Most of the audience was female, with higher engagement from older users on Facebook and younger users on Instagram. Finally, posts related to hepatitis B, rotavirus, and measles, mumps, and rubella vaccines received the most attention. Social media has become a key tool for digital health, helping to implement disease prevention programs and promoting advances in medicine. However, unverified information remains a major reason for the aversion to vaccination despite the dissemination of information from reputable public health organizations, health professionals, hospitals, and medical centers. To address this, information that is accessible, understandable, and culturally competent must be circulated to mitigate disinformation and improve attitudes toward vaccination. More research is needed to evaluate the effectiveness of social media campaigns in reducing vaccine hesitancy and improving willingness to adopt public health recommendations to increase vaccination rates.
Healthcare institutions worldwide generate growing volumes of heterogeneous clinical data, yet legal, ethical, and infrastructural constraints often prevent these data from being centralized for analysis. Federated learning approaches offer a promising solution by enabling multi-site computation without transferring sensitive patient information, but require well-designed cross-site data harmonization. Modern Data Lakehouse architectures address this requirement by providing a scalable, governed foundation for multimodal clinical dataset integration through unified storage, metadata-rich governance, and FAIR-aligned data access. Despite increasing interest in such technologies across the Middle East and North Africa (MENA) region, operational deployments remain limited due to fragmented infrastructures, insufficient data governance, and gaps in practical expertise. This perspective article reports on a German-Tunisian knowledge and technology transfer initiative conducted within the DAAD Ta'ziz Partnership programme. As mentioned in the, 'the Arabic word 'Ta'ziz' means 'strengthening/consolidation' and has been chosen to clearly express the intended outcome of the programme' [https://www.daad.de/en/information-services-for-higher-education-institutions/further-information-on-daad-programmes/taziz-partnership/ (visited on November 28th, 2025)]. The collaboration between the University Hospital of Cologne and the University of Sfax introduced and implemented federated learning concepts via the Personal Health Train paradigm, and explored the design of a Data Lakehouse tailored to emerging healthcare ecosystems in Tunisia. Through an internship programme, hands-on MLOps training, and a large-scale workshop, the project built technical capacity in containerized analytics workflows, data governance, FAIR data management, and lakehouse engineering. We synthesize lessons learned regarding infrastructural limitations, data governance maturity, interoperability challenges, and institutional readiness, and outline considerations for sustainable adoption of distributed analytics in the MENA region. The findings highlight the critical importance of capacity building, bidirectional knowledge exchange, proof-of-concept validation, and administrative engagement for deploying trustworthy AI and modern data infrastructures in sensitive healthcare environments. We by emphasizing the need for further developments regarding federated learning and Data Lakehouse adoption in Tunisia, and how cross-regional partnerships can accelerate responsible, privacy-preserving digital health innovation.
The emergence of disease-modifying therapies targeting amyloid pathology represents a major paradigm shift in the management of Alzheimer disease (AD). However, their implementation poses substantial organizational, infrastructural, and clinical challenges for health systems. To identify the key challenges and establish priority recommendations for the effective incorporation of amyloid-targeting therapies into the Spanish National Health System. This multiphase consensus study was conducted within the Spanish National Health System between September 2024 and July 2025. The study comprised a narrative literature review, qualitative research, regional workshops, and a modified RAND/UCLA Delphi process. A total of 56 experts participated, including a scientific committee of 6 Alzheimer disease specialists and an expert panel of 50 multidisciplinary professionals involved in AD care. Identification of key challenges across the AD care pathway; development, evaluation, and prioritization of consensus-based recommendations; and estimation of patient demand, including projected increases in day hospital activity and magnetic resonance imaging utilization. Ten key challenge areas were identified, encompassing early detection and referral, diagnostic confirmation, assessment of patient eligibility, treatment administration in day hospitals, monitoring of amyloid-related imaging abnormalities, evaluation of treatment effectiveness, infrastructure and capacity, professional training, patient information and support, and health care planning. Of the 43 recommendations assessed, 38 were rated as appropriate and necessary, with 14 prioritized for immediate implementation. Demand estimation models indicated that 11 to 26 patients per 100,000 inhabitants could be treated under current care patterns, increasing to 17 to 115 per 100,000 inhabitants under alternative eligibility scenarios. This consensus defines the clinical, organizational, and infrastructural requirements necessary to integrate amyloid-targeting therapies into routine care within the Spanish National Health System. The prioritized recommendations define immediate actions to address the challenges identified and may serve as a reference for other health systems facing similar implementation processes.
YouTube, a video-sharing platform, aids health information sharing, and while social media's role in heart failure care remains unclear, it can enhance interaction, education, and engagement, fostering patient-centered care and encouraging treatment adherence and active health management. The aim of the study was to evaluate the quality and usability of heart failure-related YouTube videos as a source of information for patients. A total of 100 English-language YouTube videos on heart failure were analyzed. Videos were categorized based on uploader identity (healthcare vs. non-healthcare professionals) and assessed using quality criteria for consumer health information, Global Quality Scale, Journal of the American Medical Association criteria, and Video Power Index. Quantile regression analysis was performed to identify independent predictors of video quality. Of the videos analyzed, 69% were uploaded by healthcare professionals. The mean quality criteria for consumer health information score was 21, Global Quality Scale was 3, and Journal of the American Medical Association was 3. Videos from professionals and longer videos had significantly higher quality scores. Quantile regression showed that video duration predicted high Global Quality Scale values at the 75th and 90th percentiles, while professional source was a consistent predictor across most quantiles. The overall quality of YouTube videos on heart failure was found to be low to moderate, with substantial room for improvement. Videos uploaded by healthcare professionals, however, consistently demonstrated higher quality across evaluation metrics. Longer videos tend to have higher quality, but popularity does not correlate with content reliability. Efforts should be made to improve video content for better patient education.
Availability of trustworthy information has a critical role during public health emergency events. Science communication and trust in information sources, health experts and governments significantly influence public adherence to preventive measures and vaccine uptake. To investigate these effects on vaccine confidence in Southeast Asia, a region with diverse governance structures, trust levels and health literacy, this study examines trust in science and authority across six countries. Between January and June 2023, we conducted online surveys in Singapore, Philippines, Indonesia, Thailand, Malaysia and Vietnam with a total of 6611 respondents to measure their attitudes and trust towards science, vaccines, the government's management of COVID-19 and international health institutions. Our analyses explored the relationship between population trust in science, authorities and vaccine confidence. We found generally high trust in science and authority, along with strong confidence in vaccines. Trust in science increased by 0.98 (95% CI 0.93 to 1.03) for every unit increase in trust in government. Trust in information from medical staff and scientists was highest, while information from politicians and social media was least trusted. We found a positive association between the three indices across some, but not all countries. The perception of scientific support for the vaccine rollout was positively associated with vaccine confidence in nearly all contexts, with effect sizes ranging from 0.55 (in Thailand and Indonesia) to 1.07 (in Singapore). Our findings indicate that to enhance resilience against future public health emergencies and improve adherence to directives for non-urgent health concerns, health authorities should focus on communicating scientific support behind health guidelines and build trust in science and authority in the long term.
To understand how primary healthcare providers perceive a hypothetical electricity supply interruptions (ESI) situation (electricity shortages and blackouts), and their needs for a better preparation and response. In Canton of Vaud, Switzerland, interviews with 16 experts of 13 institutions/organisations involved in ESI management were conducted to develop a locally adapted ESI scenario. Perceived risk, knowledge, capacity to adapt, and needs of 8 private practice physicians and nurses were then explored through semi-structured, scenario-based interviews. Although they considered ESI unlikely and were aware of their heavy dependence on electricity-powered administrative and medical tools, healthcare professionals were willing to continue treating their patients in their own practices or in suitable primary care centres. However, better communication with public health stakeholders, participation in training sessions and to the development of checklists closer to their needs, and a plan indicating them their best possible location would be necessary. Redefining the role of primary healthcare providers in crises through better training, information, and integration as cooperative partners could represent a key opportunity to enhance the resilience of the whole healthcare system.
The World Health Organization package of essential non-communicable disease interventions (PEN) comprises evidence-based interventions for primary healthcare systems in low- and middle-income countries (LMICs). Implementation fidelity, defined as the degree to which an intervention is delivered as intended, is crucial for intervention effectiveness. Yet, across LMICs, evidence on fidelity to PEN is scarce and mostly limited to pilot studies. We evaluated fidelity to PEN during national scale-up in Nepal using a convergent parallel mixed methods study design based on the Conceptual Framework for Implementation Fidelity. Data were collected in 2021 from 105 randomly selected primary healthcare facilities across all seven provinces of Nepal. Using direct observation of 172 non-communicable disease (NCD) patient visits, we quantified health service providers' adherence to PEN protocol 1 (hypertension and diabetes management) and protocol 2 (lifestyle counselling). We calculated overall fidelity scores and examined their potential determinants in multivariable regression models using generalized estimating equations. Moreover, we conducted semi-structured interviews with 47 providers and 33 NCD patients to elicit their views on factors affecting fidelity. We analyzed verbatim interview transcripts using thematic analysis. PEN-trained health service providers managing hypertension and diabetes patients (protocol 1) mainly focused on asking about medication (76% of patient visits), measuring blood pressure (82%), and adjusting medication (85%). Blood glucose was measured in 28% of eligible patient contacts. Other care steps, including cardiovascular risk estimation, were mostly skipped. Lifestyle counselling for NCD patients (protocol 2) most frequently entailed salt restriction advice (41%) and instructions on medications (62%) and follow-up appointments (69%). Overall fidelity scores for protocols 1 and 2 were 20.8 and 22.1 out of 100, respectively. In multivariable regressions, prior PEN training was associated with 25% (95%-CI: 1-54%; p = 0.04) and 32% (95%-CI: -4-80%; p = 0.08) higher fidelity scores for protocols 1 and 2, respectively. Qualitative data suggested that providers and patients were generally engaged by the intervention, though various factors impede fidelity, including negative user experiences and limited availability of medical supplies. Strategies to improve fidelity to PEN that participants suggested were intervention manuals, supervision and monitoring visits, brief refresher trainings, and community outreach programs. Implementation fidelity to PEN during scale-up in Nepal was often limited to a few diagnostic and therapeutic actions. Next to enhancing user experience, ensuring a reliable supply of diagnostic equipment and medicines will likely be crucial to sustainably improve NCD care. Fidelity assessments in resource-limited settings should examine the availability of key implementation resources.
Comprehensive brain health is increasingly being recognized as critically important worldwide and incorporates elements of neurological and psychiatric health. This evolution in the view of cerebral wellbeing considers the many factors that can affect brain health and the interconnectedness of conditions affecting this organ. Such interplay between neurological and depressive diseases is highlighted by observations that these conditions share underlying pathophysiology and frequently co-occur in the same patient. A review of the literature on depression in post-stroke, Parkinson's disease, multiple sclerosis, and migraine, confirmed the high prevalence of depression in patients with neurological diseases, with approximately one third of patients with neurological diseases having depression. The search results also highlighted the importance of early detection of depression, and that appropriate treatment may substantially improve outcomes of both the depression and the neurological disease. However, there was a disparity in the amount of literature on depression in the different neurological diseases, with only three of the 80 retrieved articles discussing migraine and depression. Information on multidisciplinary care was also limited. Unmet needs with respect to management of depression in patients with neurological diseases include effective screening processes that can differentiate between overlapping symptoms. There is also a lack of clear, evidence-based treatment guidelines. Based on our clinical experience, we provide recommendations for best practice management of depression in patients with neurological diseases, including structured patient interviews to aid with diagnosis of depression, involvement of patient families and friends where relevant, multidisciplinary care that incorporates personalized treatment based on the specific symptoms, co-medications and needs of the patient, and continued follow up and monitoring. Antidepressant options are available with different mechanisms of action and adverse event profiles. Overall, evidence indicates that depression in neurological disorders is underdiagnosed and undertreated. We suggest that structured screening and tailored, multidisciplinary care can improve outcomes.
Chronic liver disease is a major global health burden, and preventive strategies are crucial, given its insidious progression. Although individual nutrients and foods' associations with chronic liver disease are studied, dietary patterns' holistic effects matter more. This study systematically evaluated the links between 2 healthy dietary indices-the Alternative Healthy Eating Index (AHEI) and the Healthy Eating Index (HEI)-and chronic liver disease, namely, metabolic dysfunction-associated steatotic liver disease, liver fibrosis, cirrhosis, fatty liver, and liver cancer. A systematic literature search was conducted in the PubMed, Web of Science, Cochrane Library, and Embase databases for relevant observational studies published up to February 2025. Data extraction and quality assessment were performed independently by the authors. A total of 28 articles comprising 50 studies (n = 18 prospective cohort, 25 cross-sectional, and 7 case-control studies) involving 624 914 participants were included. A random-effects model was used for the meta-analysis. Results showed the AHEI (OR = 0.71; 95% CI, 0.62-0.80) and HEI (OR = 0.68; 95% CI, 0.61-0.77) were significantly negatively associated with chronic liver disease. Subgroup analysis found the AHEI protected against MASLD, liver cancer, and overall chronic liver disease, notably in Asia and North America. The HEI protected against MASLD, fibrosis, liver cancer, and chronic liver disease, with marked effects in North America. This study's strengths lie in its large sample size, integration of multiple study designs, and rigorous methodological framework, which collectively enhance the generalizability of its results. The findings suggest the AHEI and HEI are associated with a lower risk of chronic liver disease, providing valuable guidance for clinical practice, such as advocating for these dietary patterns among high-risk populations. However, limitations exist, including potential heterogeneity in dietary assessment methods and unaccounted confounders. Future research should address these issues to further optimize chronic liver disease management strategies. PROSPERO registration no. CRD42025065410.
Extremely preterm infants are at very high risk of neonatal death and disabilities. Their survival rate is much variable in developed countries and in France is much lower than other countries. Our objective is to evaluate the impact of an intervention to standardize the perinatal management of extremely preterm infants. Women hospitalized between 22 and 26 weeks for risk of preterm delivery with a alive fetus or a stillbirth at admission and with a delivery between 22 and 26 completed weeks. Our complex intervention aimed at standardizing the organization of care based on the following principles: A collective obstetric-pediatric prognostic assessment, in a non-emergency setting, with a consensus decision about the obstetric and neonatal management proposed-either active or palliative care; An interview with the parents to inform them, answer their questions, propose either active or palliative care and then ask their opinion. A Stepped-wedge cluster-randomized trial. Perinatal networks will be randomly allocated to the intervention in 5 waves every 3 months, with a total recruitment period of 21 months (including 3-month transition periods). All perinatal networks will have a period with and without the intervention. After the allocation of clusters to the intervention period, the teams will be trained in the intervention protocol and then will undergo a 3-month transition period to learn the protocol thoroughly. We hypothesis hypothesized is that survival without severe morbidity will could rise from 20 to 35% after the intervention, but envisaged different scenarios with varying survival without severe morbidity in the control and intervention periods. The intraclass correlation coefficients was set to 0.07. With an average number of 60 to 70 extremely preterm infants recruited per year, a number of 20 clusters (perinatal networks) were was sufficient to provide at least 80% power in most scenarios, and 25 clusters would provide at least 80% power in all scenarios envisaged. Twenty-five perinatal networks including 34 neonatal level-3 hospital, and 285 maternity units overall. Child's survival without severe morbidity at hospital discharge. Improvement of the health of extremely preterm infants and, if the intervention shows that it is effective, equitable access to care according to place of birth in France. The protocol was approved by the Committee for Protection of Persons Involved in Biomedical Research (CPP Ile de France V PARIS), and the French Data Protection Authority (30/12/2021, N°21.03700000050-MS02). The trial was registered before the beginning of the study at ClinicalTrials.gov (December 20, 2021-NCT05248477).
During public health events, nodes on social networks that are aware of the truth may still actively disseminate rumors, thereby influencing the rumor propagation process. However, existing research has not yet taken into account the impact of transmitter nodes on rumor dissemination. Therefore, our study proposes an SNITR rumor propagation model that incorporates a rumor-transmitter mechanism. When rumor information emerges on social networks, susceptible users may neglect to propagate the received rumor information upon exposure (neglected nodes), some users may believe the rumors and spread them (infected nodes), while others may publicly state the truth to reduce the spread of rumors (transmitter nodes). Eventually, users will enter a recovered state and no longer participate in the rumor propagation process. By introducing the rumor-transmitter mechanism, a competitive coupling mechanism among different user groups is established. Additionally, the dynamics of the rumor propagation model are analyzed, the system's equilibrium points and basic reproduction number are calculated, and it is demonstrated that the equilibrium points are both locally and globally asymptotically stable. Finally, simulation experiments validate the effectiveness of the theoretical model and demonstrate that it aligns well with the intrinsic mechanisms of actual rumor propagation.
Older patients with type 2 diabetes mellitus (T2DM) frequently encounter challenges, including a diminished capacity for self-management, a high prevalence of negative emotions, and cognitive decline and physiological changes attributable to long-term disease burden, leading to compromised glycemic control and impaired quality of life. Traditional diabetes nursing interventions often lack systematic strategies to address the psychological and cognitive needs specific to this patient population. The Information-Motivation-Behavioral Skills (IMB) model is a theoretical framework designed to promote health behavioral changes; however, research investigating its specific application in regulating psychological state and managing cognitive function in older patients with T2DM remains limited. To investigate the effectiveness of a nursing intervention based on the IMB model in older patients with T2DM. Data from 86 older patients with T2DM were divided into 2 groups: intervention (structured IMB model-based nursing + routine care [n = 43]); and control (conventional T2DM care [n = 43]). Psychological state (Self-Rating Anxiety and Depression Scales [SAS, SDS]), cognitive function (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), glycemic control (fasting blood glucose [FBG], 2 h postprandial blood glucose [2hPBG], and glycated hemoglobin A1c [HbA1c]), and satisfaction with nursing were compared between the 2 groups before and after a three-month intervention. SAS and SDS scores significantly decreased in both groups after intervention, with a more pronounced reduction in the intervention group (P < 0.05). MMSE and MoCA scores improved in both groups, with significantly higher scores in the intervention group (P < 0.05). Glycemic control (FBG, 2hPBG, and HbA1c) improved substantially in the intervention group (P < 0.05). Satisfaction with nursing among the intervention group (95.35%) was significantly greater than that in the control group (79.07%) (P < 0.05). The IMB model-based nursing intervention alleviates anxiety and depression, improves cognitive function, enhances glycemic control, and increases satisfaction with nursing in older patients with T2DM, thus meriting broader clinical implementation.
Medication adherence in older adults with chronic diseases is a public health challenge, given the growing and irreversible aging of the population, with direct repercussions on clinical outcomes and collective wellbeing. This scope review seeks to identify the main barriers and facilitators of pharmacological adherence and effective evidence-based interventions to optimize it. A scope review was conducted for the period 2015-2025. Forty-one observational and interventional scientific studies (clinical trials) were selected from PubMed, Scopus, Web of Science, and ScienceDirect. Initially, a search was performed in six databases covering public health, medicine, life sciences, and biomedicine (PubMed and ScienceDirect), evidence-based healthcare (Cochrane Library), social sciences, arts, and humanities (Scopus and Web of Science), and research output, with an emphasis on Latin America, Spain, and Portugal. The four databases with the largest number of publications on the older adult population were selected, including topics such as medication adherence (compliance with pharmacological treatment and prescribing recommendations), medication persistence (uninterrupted continuity in medication recovery and administration), and patient prioritization interventions using automated mechanisms. The final selection of articles was carried out by three experts, who performed a critical appraisal of the evidence. The discrepancies were resolved by two other researchers, following the identification, screening, selection and inclusion phases of the PRISMA-2020 guidelines. The analysis of the information was carried out through synthesis and narrative integration. Individual barriers were identified, including demographic (age, sex, educational level, and income), psychological (anxiety, depression, and self-efficacy), cultural (beliefs, fatalism, and stigmas), physical and mental health status (multimorbidity and cognitive impairment), and pharmacological (number of medications and adverse effects) factors. Facilitators identified are related to the health system (continuity of care, fragmentation of care, assertive communication, access, and provision of medicines). The interventions include personalized health education. Medication adherence in older adults should be addressed with comprehensive and sustainable interventions. These interventions combine pharmacist education, technological support, continuous monitoring, and patient participation in therapeutic decision-making. Strategies should be designed with a collaborative approach involving patients, families, and healthcare professionals, ensuring measurable clinical outcomes and improving their quality of life.
Social media has fundamentally altered the landscape of health communication, creating new opportunities for patient education, peer support, and clinical engagement in medical practice. Platforms such as Facebook, YouTube, X (formerly Twitter), and Instagram now serve as primary conduits for health information, enabling patients with acute and chronic conditions to seek guidance, compare clinical experiences, and build supportive communities. Literature shows that well-implemented social media strategies can improve self-management behavior, medication adherence, and disease awareness across diverse patient populations. However, these gains are counterbalanced by substantive risks, including the proliferation of misinformation amplified by automated bots, ethical dilemmas surrounding professional boundaries and patient confidentiality, and the uneven quality of user-generated health content. Artificial intelligence (AI) is increasingly being integrated with social media channels to provide personalized, scalable health information and chatbot-assisted patient education. This narrative review examines current literature to delineate the scope and prospects of social media for patient education and engagement and to propose best practices for clinicians navigating this rapidly evolving digital environment.
Advancements in precision medicine, particularly the use of neuroimaging and neurophysiologic techniques, may improve diagnosis, prognosis, and treatment of mental health disorders. Recent efforts to develop large neuroimaging datasets have yielded promising results for identifying mental health biomarkers. This scoping review identifies and characterizes studies of neuroimaging and neurophysiologic techniques used to address a variety of mental health disorders. We searched MEDLINE and Embase (January 2010-September 2023). Eligible studies examined neuroimaging and neurophysiologic techniques (e.g., magnetic resonance imaging [MRI] or electroencephalogram [EEG]) for diagnosis, prognosis, and/or treatment response for eligible mental health disorders. From eligible studies, we abstracted information on populations, clinical settings, imaging techniques, study designs, outcomes, and analytic approaches. From 58,824 unique search results, we identified 441 eligible primary studies and 27 systematic reviews addressing mental health disorders. Most studies focused on depressive disorders (k = 320 primary studies [17 systematic reviews]); fewer examined bipolar disorders (k = 61 [3]), posttraumatic stress disorder (PTSD; k = 39 [2]), obsessive compulsive disorder (OCD; k = 26 [1]), anxiety disorders (k = 22 [3]), or substance use disorders (SUD; k = 25 [0]). Three-quarters of primary studies used MRI-based techniques and 20% employed EEG. Two-thirds of studies focused on diagnosis (nearly all cross-sectional); the remaining studies mostly addressed symptom response to various treatments, including antidepressants and psychotherapy. Most primary studies were small (N < 100; k = 263), and generally included y oung and middle-aged adults; only 5 focused on older adults (sample mean age ≥ 65). Studies were most commonly conducted in China (k = 181), the United States (k = 83), or Canada (k = 22). Although many eligible studies evaluated MRI or EEG for diagnosis and/or treatment response for depressive disorders, most were small and cross-sectional. There was less existing evidence examining other neuroimaging techniques or focusing on other mental health disorders (PTSD, OCD, anxiety disorders, or SUD). Given these evidence gaps, it is likely premature to implement neuroimaging and neurophysiologic tests in clinical settings. To determine clinical utility, future research should use large samples in longitudinal designs and investigate a broader set of disorders. https://doi.org/10.17605/OSF.IO/5PHG2 . not applicable.
22q11 deletion syndrome (22q11DS) is the most common microdeletion in humans, leading to a wide range of variable clinical manifestations that can affect any part of the body. Most individuals with 22q11DS are diagnosed during childhood and the responsibility of care falls on their primary caregivers, usually their parents, who need to balance the needs of all family members including themselves. This affects parental wellbeing. This study investigates the perspective of healthcare professionals (HCPs), in Europe and Canada, on the parents' struggle with time invested in caring for their children, factors contributing, the impact of this responsibility and some strategies on how to support the families. This interview study was part of a larger research initiative aimed at improving the psychosocial well-being of individuals with 22q11DS and their families. The qualitative component concentrated on gathering insights from HCPs involved in patient care. We conducted qualitative content analysis after transcribing the semi-structured interviews. The research question focused on time poverty within families caring for a child with 22q11DS from the perspective of HCPs. The 20 HCPs interviewed came from diverse professional backgrounds, but all had clinical experience with children with 22q11DS. Our analysis of the data identified three primary themes, centered on time poverty of families caring for a child with 22q11DS. Centralization of care and insufficient coordination were the main modifiable reasons for the time struggle, affecting the families, especially mothers and families living in rural areas. Strategies proposed to mitigate this issue included improved coordination and decentralization of care, and digitalization. Time poverty for families with a child with 22q11DS may result from fragmented and uncoordinated medical care, and centralized care disconnected from local care. Better communication between different HCPs, local and central, and a robust support system could enhance these families' well-being and assure an equal distribution of care services without gender bias or exclusion of rural underserved populations.
The global polio program has relied on supplementary immunization activities (SIA) in countries where routine immunization (RI) coverage is suboptimal. During these SIAs, oral poliovirus vaccine (OPV) is administered to all children under the age of 5 years. However, implementing SIAs in areas with insecurity and conflict, such as the South Khyber Pakhtunkhwa (South KP) region of Pakistan is very challenging because of attacks against vaccination teams and community boycotts among other reasons. These challenges sometimes lead to cancelation, delays, and poor quality of immunization campaigns. We conducted a retrospective secondary data analysis using Pakistan polio program data sourced through National Polio Emergency Operations Center's dashboard, the Expanded Program on Immunization's Management Information System, and the World Health Organization's Immunization Data and Information Management System (IDIMS) to document the different vaccination strategies implemented in the South KP region of Pakistan from January 2022 to December 2024. During this period several SIAs were canceled in the region. In addition, SIAs in South KP were not synchronized with the rest of the province and country, and the duration of these campaigns were sometimes shortened. To address these challenges, several context specific novel interventions were initiated including mobile vaccination teams, ring-fencing vaccination around insecure areas, establishment of permanent transit vaccination points, and closer integration with routine immunization services through targeted use of fractional dose inactivated poliovirus vaccine, identification of zero-dose children during polio SIAs, extended outreaches, and provision of integrated health services through community health camps. Findings from South KP show that strategic alignment between polio and RI programs, flexible operational modalities, and locally responsive engagement can sustain vaccination services despite ongoing insecurity.
 Neck and back pain represent a major source of disability worldwide and are associated with significant health and economic impacts. Patient education and self-management are recognized as essential components of chronic pain management within multidisciplinary care approaches. However, despite the widespread use of various educational strategies in clinical practice, there is a notable scarcity of literature from India on structured educational materials or programs specifically designed to address chronic neck pain, indicating a critical gap in culturally relevant, evidence-based educational interventions in this context.  This study aims to develop and validate a neck care module for patients with chronic mechanical neck pain. The first objective is to develop a structured neck care module specifically designed for individuals experiencing chronic mechanical neck pain. The second objective is to evaluate the developed module for face and content validity to ensure its clarity, relevance, comprehensiveness, and suitability for patient education and clinical use.  Phase 1 of the study involved the systematic development of a neck care module through four sequential stages. First, a comprehensive literature search was conducted to identify relevant evidence and existing recommendations related to the management of chronic mechanical neck pain. Second, illustrative images were created to visually support the educational content and enhance patient understanding. Third, the module was prepared by integrating evidence-based information with the developed visual materials to ensure clarity and practical applicability. Finally, the preliminary module was reviewed through consultation with multidisciplinary stakeholders involved in pain management to obtain expert input and refine the content. Draft versions of the module were evaluated using the patient education materials assessment tool (PEMAT) to assess understandability and actionability. The final module was validated for content and face validity by experts and the target audience, respectively.  Results: The developed neck care module demonstrated acceptable content validity (CVI = 0.85) and excellent face validity (97.89% agreement), indicating that experts and target users perceive the module's content as relevant, comprehensive, and appropriate for patients with chronic mechanical pain. These validation findings support the module's potential as a reliable educational tool to enhance patient understanding and self-management, warranting further evaluation of its clinical effectiveness in practice.