搜索结果：In-person

Post-COVID-19, some residency program interviews remained virtual, others returned to in-person, and some allow applicants to choose between a virtual or in-person interview. Concerns exist that this hybrid approach may introduce bias. This study aimed to determine whether this hybrid format influences program rank list position or applicant chance of matching and to explore how programs structure the process. We analyzed de-identified rank list data and interview formats for 1,170 interviews for 91 positions across six programs in a regional network of programs offering a choice of virtual or in-person interviews in the 2023 and 2024 Match. We performed descriptive and bivariant analyses. We also controlled for subinternship participation to assess its impact on rank and match outcomes. Through content analysis of program director survey responses, we explored planning and implementation strategies. Applicants who interview in person are more likely to be ranked higher (average position 45 vs 49 per 100 ranked; P = 0.022) and to match (10.8% vs 5.5%; P<0.001). However, after excluding subinternship participants, interview format was no longer significantly associated with rank position (average position 47 vs 50 per 100 ranked; P = 0.090). In-person interviewees still had higher match rates (9.0% vs 5.2%, P = 0.017). Six program directors (100%) reported use of a standardized scoring rubric and consistent processes for all interview formats to minimize bias. Among programs offering hybrid interviews in a regional network of residency programs, interview format did not appear to influence rank lists after controlling for subinternship at the program; however, those who interview in person are more likely to match.

Stroke is the second leading cause of global disability with the majority of stroke-related disabilities occurring in low- and middle-income countries. In Myanmar, ongoing political instability and healthcare disruption have further limited access to stroke rehabilitation services. This study evaluated a contextually tailored continuing professional development program designed to strengthen evidence-based stroke rehabilitation knowledge, skills, and clinical implementation among physiotherapists in Myanmar. This mixed methods, quasi-experimental study used convenience sampling to recruit rehabilitation professionals participating in a blended learning stroke rehabilitation program in Myanmar. The program combined online coursework, synchronous mentoring, and in-person clinical skills training. Training effectiveness was evaluated using the Kirkpatrick Model across the domains of reaction, learning, behavior, and results. Participants completed pre-training, post-online, post-in-person, and six-month follow-up surveys assessing self-perceived knowledge, skills, and implementation of evidence-based stroke rehabilitation techniques. Quantitative data were analyzed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction. Focus group interviews were conducted six months following training and analyzed using thematic analysis. Quantitative and qualitative findings were integrated during interpretation to better understand implementation within the Myanmar context. Ethical approval was obtained from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Seventeen rehabilitation professionals participated in the online training and 16 physiotherapists completed the in-person clinical skills component. Seven participants participated in focus group interviews six months later. Participants demonstrated significant improvements in self-perceived knowledge and skills related to evidence-based stroke rehabilitation, particularly for interventions requiring minimal equipment. Follow-up surveys indicated integration of evidence-based assessment and treatment approaches into clinical practice. Qualitative findings contextualized these changes and identified four themes: challenges in rehabilitation perception, need for enhanced training in fine motor skills, resourceful adaptation of techniques for low-resource settings, and the importance of a learning community. Integrated findings demonstrated that participants adapted evidence-based rehabilitation concepts using locally available resources and peer support networks. Contextualized training approaches emphasizing adaptability, peer learning, and resource-conscious implementation may support the application of evidence-based stroke rehabilitation practices in LMICs affected by workforce and health system constraints.

Problem-Based Learning (PBL) requires active communication and learner autonomy, which can be challenging in cultural contexts that emphasize group harmony and indirect communication, such as Japan. This challenge is often amplified when PBL is conducted in a non-native language (English), potentially inducing "foreign language anxiety." While the COVID-19 pandemic necessitated a shift to online learning, the specific impact of this format on psychological barriers and student engagement in high-context cultures remains underexplored. We investigated whether the online format could reduce these transactional distances and enhance learning outcomes compared to traditional in-person PBL. We conducted a naturalistic, historical control study comparing fourth-year medical students at Nagoya University during a Child and Adolescent Psychiatry curriculum. The 2019 cohort (n&#x2009;=&#x2009;109) participated in-person, while the 2021 cohort (n&#x2009;=&#x2009;100) participated online. We administered a 15-item questionnaire assessing satisfaction, engagement, and case suitability. Beyond standard descriptive comparisons, we applied a novel multidimensional statistical framework. This included Ordered Logistic Regression adjusted for age and sex to identify predictors of satisfaction, Exploratory Factor Analysis (EFA) to validate the instrument's latent structure, and K-means Clustering to identify distinct student "phenotypes" based on response patterns. The online cohort reported significantly higher satisfaction across most domains (Odds Ratios 0.36-0.51, p&#x2009;<&#x2009;0.05). Factor analysis identified two primary dimensions-"Perceived Learning Efficacy" and "Engagement"-while "Communication Skills" (Question 4) emerged as an independent outlier, failing to load on either dimension. Cluster analysis identified two distinct student phenotypes: a "Traditional/Dissatisfied" profile (Cluster 1: n&#x2009;=&#x2009;77, 69% from the in-person group, predominantly male and older) and a "Digital/Satisfied" profile (Cluster 2: n&#x2009;=&#x2009;127, 57% from the online group, predominantly female and younger). Online delivery of PBL was associated with significantly higher student satisfaction and engagement scores in this Japanese context. Because the study is observational (historical-cohort comparison with no randomisation), this association cannot be attributed causally to the modality, and the role of reduced foreign-language anxiety is an interpretive hypothesis that the present design does not directly test. The identification of distinct student phenotypes suggests that demographic factors (gender, age) and delivery modality interact to shape the learning experience. These findings advocate for a tailored pedagogical approach, where digital formats serve as a "safe harbor" for students with high communication apprehension.

For patients with chronic low back pain (CLBP), telerehabilitation (TR) has been suggested as an alternative to conventional rehabilitation. However, evidence from pragmatic trials comparing TR with routine clinical rehabilitation is still limited. To investigate whether TR is non-inferior to conventional in-person rehabilitation for pain intensity in individuals with CLBP. Secondary objectives included disability, pain catastrophizing, quality of life, and kinesiophobia. A pragmatic non-inferiority randomized controlled trial was conducted with 50 adults with CLBP who were randomly assigned to TR or in-person rehabilitation. The TR program included individualized exercise, education, and self-management delivered remotely, while the control group received usual clinic-based care. The primary outcome was pain intensity assessed using the Numeric Rating Scale (NRS), with disability and other patient-reported outcomes assessed as secondary measures. Between-group comparisons were performed using analysis of covariance, with adjustments made for baseline values, and non-inferiority was evaluated using a pre-specified margin. Both groups showed comparable improvements across outcomes, with no meaningful between-group differences. Non-inferiority was not demonstrated for pain intensity within the pre-specified margin. However, TR demonstrated non-inferiority to conventional rehabilitation for disability measured by the Oswestry Disability Index (adjusted mean difference -0.82 points; 95% CI -5.13 to 3.49). For other outcomes, no clear between-group differences were observed. These findings indicate that telerehabilitation can be considered a clinically acceptable alternative option to in-person rehabilitation for individuals with CLBP, particularly when the primary goal is functional improvement. Careful patient selection may be required when pain reduction is the main treatment objective.

To qualitatively assess applicant perspectives on urology residency application and match cycle processes, which may be of unique value to urology program directors (PDs) as their decisions steer the future direction of the urology match. Applicants to our residency program from the 2024-2025 American Urological Association match cycle were surveyed. Descriptive statistics were tabulated overall and for a qualitative cohort who answered optional free-text response questions. Qualitative data were analyzed with an inductive, grounded theory approach. The primary aim was to assess applicant preferences and experiences by interview format. Secondary aims included assessing use of social media, applicant assessments of fit with residency programs, and suggested changes or improvements to the match cycle. Response rate was 45% (75/166), with 47 (63%) in the qualitative cohort. Detailed results of qualitative analyses are presented in Tables 2-5, organized by emergent theme. Applicants preferred in-person interviews, both overall and when judging fit with programs. However, most were concerned that costs and travel presented a barrier, feeling that programs should offer more financial aid. Some proposed innovative solutions, like regional clustering of interview dates. For gathering information, most applicants preferred program websites over social media, despite noting that these websites often containing outdated and inadequate information. As the urology match cycle continues to evolve, so too do applicant preferences. With in-person interviews once again favored, PDs must utilize both qualitative and quantitative data to overcome the hurdles present as they shape better and more equitable future experiences for all applicants and programs alike.

While tele-mental health has improved access to standard medication management and psychotherapy for rural Veterans, implementation of interventional psychiatry treatments will require in-person care, potentially leading to the exacerbation of rural-urban disparities in access to mental health care. We studied the availability of interventional psychiatry treatments, delivered clinically or in the context of a research trial, to rural and urban Veterans. We used VA electronic medical record data to measure the use of electroconvulsive therapy (ECT), magnetic seizure therapy (MST), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), ketamine (infusion or nasal spray), stellate ganglion block (SGB), and medication-assisted psychotherapy (AP) protocols including 3,4-methylenedioxy-methamphetamine (MDMA)-AP and psilocybin-AP, as appropriate, for VA patients with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) from 2017 through 2024. We compared treatment use in rural and micropolitan locations to use in urban locations. Few patients received any interventional psychiatry treatment across strata. The most common modalities were rTMS, ECT, SGB, DBS, and ketamine. The numbers receiving MST, VNS, MDMA-AP, and psilocybin-AP were too small to report in the micropolitan or rural cells. Micropolitan and rural patients had lower odds of receiving rTMS, ECT, SGB, DBS, and ketamine than urban patients. The largest disparities were for rTMS and ketamine. There appear to be rural-urban disparities in the emerging field of interventional psychiatry, and the disparities are most pronounced for treatments that require repeated in-person visits such as rTMS and ketamine.

Suicide is the second leading cause of death among adolescents, yet access to mental health care remains limited. Youth have unique developmental and contextual considerations as they are avid users of digital technologies, which may influence how they engage with mental health interventions. Crisis Response Planning (CRP), a single-session intervention, has shown promise in adults but has not been systematically evaluated in youth. This study tested the feasibility, acceptability, and preliminary effectiveness of a chat-based version of CRP for adolescents with suicidal ideation (SI). Fifty-one adolescents (ages 14-18 years) endorsing recent SI were randomized to one of three single-session interventions: (1) chat-based CRP, (2) in-person CRP, or (3) virtual self-guided safety planning (control) (NCT06164106). Feasibility, usability, and other implementation outcomes were assessed posttreatment. Suicide risk was evaluated at baseline and 2 weeks posttreatment using the Ask Suicide Screening Questions (ASQ) and the Beck Scale for Suicidal Ideation (BSSI). All three treatments were rated as acceptable and feasible, though chat-based CRP was rated as more appropriate than the control. Approximately 40% of the sample no longer reported past-week SI at follow-up, with no group differences in binary SI outcomes. BSSI scores decreased in the chat-based CRP and control arms, but not in the in-person CRP arm. Results indicate that CRP and other safety planning interventions are feasible and acceptable for adolescents experiencing SI. Virtual formats, especially those that prioritize privacy and eliminate video, may be aligned with adolescent needs though continued development of scalable, youth-centered suicide prevention strategies is needed.

Current nursing workload and staffing shortages have been associated with adverse patient outcomes, including readmissions. Virtual Nursing (VN) is an emerging care delivery model that shifts selected clinical tasks from bedside nurses to remotely located virtual nurses, but its impact on patient outcomes remains unclear. We conducted a retrospective cohort study across nine hospitals in a major Southeastern U.S. health system, including adult patients discharged from inpatient units during the 12 months before and after VN implementation between 2022 and 2024. VN-assisted discharges were compared with traditional in-person discharges using propensity score matching and staggered difference-in-differences analyses. After matching, 4662 VN-assisted and 4662 in-person discharge encounters were included. Patients discharged through VN had lower 30-day emergency department readmission rates than those receiving traditional discharge care (3.7% vs. 13.3%; P&#x2009;<&#x2009;0.001), despite similar baseline readmission risk scores. VN was associated with a lower readmission risk (risk ratio, 0.28; 95% CI, 0.24-0.33) and absolute risk difference (-0.10; 95% CI, -0.11 to -0.08). Similar reductions were observed in both urban and rural hospitals. These findings suggest that centralized VN-supported discharge may improve discharge processes without worsening short-term patient outcomes.

Smoking cessation improves the health and well-being of people who smoke. It also benefits society, given the high economic and personal costs of smoking-related diseases. With the emergence of new digital technologies, there has been a shift in the delivery of smoking cessation interventions, moving from the traditional in-person treatments to remote digital interventions. In particular, despite a tremendous increase in the number of smoking cessation mobile applications, very few have been empirically tested. Additionally, it remains unclear whether therapeutic contact could improve smoking abstinence outcomes. Therefore, the overall goal of this study is to assess the efficacy of a newly developed app adapted from an in-person efficacious cognitive-behavioral treatment (CBT) for smoking cessation compared to the app in combination with different doses of therapeutic contact. We will conduct a randomized controlled trial (RCT) with a sample of 420 individuals seeking smoking cessation treatment at the Smoking and Addictive Disorders Unit of the University of Santiago de Compostela (Spain). Participants will be randomly assigned to: (1) 8 weeks of smoking cessation app (Only app; n&#x2009;=&#x2009;140); (2) 8 weeks of smoking cessation app&#x2009;+&#x2009;8 weekly sessions of group CBT delivered via video calls (High intensity; n&#x2009;=&#x2009;140); or (3) 8 weeks of smoking cessation app&#x2009;+&#x2009;4 biweekly sessions of group CBT delivered via video calls (Low intensity; n&#x2009;=&#x2009;140). We expect that the high intensity therapeutic contact group will result in higher 7-day point-prevalence smoking abstinence (validated via carbon monoxide) at the end of treatment and 3-, 6-, and 12-month post-treatment, compared to the other two conditions. This study will be the first RCT evaluating the dose of therapeutic contact needed when using a smoking cessation app. Findings will contribute to improving the efficacy and reach of smoking cessation treatments. ClinicalTrials.gov number: NCT06900985 registered on March 21, 2025. Protocol version 1.0.

Health guidelines are important resources for informing decisions made by health practitioners, patients, caregivers, policymakers, and other interest-holders. Interest-holder engagement in health guideline development can improve the relevance of recommendations, promote considerations of equity, and support implementation. To facilitate efficient and effective health guideline development, there is a need for a comprehensive, global, evidence-based guidance for interest-holder engagement in guideline development. This paper synthesises the barriers and facilitators to interest-holder engagement in guideline development. Several systematic reviews have examined the topic of interest-holder engagement in guideline development, but few have explicitly focused on barriers and facilitators to engagement and the majority of these were related to patients. With increased recognition of the value of broad interest-holder engagement, understanding the barriers and facilitators to interest-holder engagement is key to developing a relevant and inclusive health guideline. The objective of this review is to identify and synthesise the reported evidence on barriers and facilitators to interest-holder engagement in health guideline development. We address this objective through two research questions: 1. What are the reported barriers to interest-holder engagement in health guideline development across the 18 topics of the GIN-McMaster checklist? 2. What are the reported facilitators to interest-holder engagement in health guideline development across the 18 topics of the GIN-McMaster checklist? We searched five major electronic databases (MEDLINE (OVID), Cumulative Index to Nursing & Allied Health Literature (CINAHL; EBSCO), EMBASE (OVID), PsycInfo (OVID), Scopus, and Sociological Abstracts. We also conducted an extensive grey literature search using the websites of agencies who actively engage interest-holders in research and/or guideline-producing agencies, such as PCORI, WHO and GIN. We searched from database inception up to the 26th September, 2022. Backward and forward citation tracking was performed on included articles to identify other eligible studies. We included primary research studies which qualitatively reported on the barriers or facilitators to interest-holder engagement in health guideline development. This included qualitative or mixed method research studies using methods such as interviews, focus groups, or surveys to collect participant experiences; case studies of existing programmes; and process evaluation studies. We excluded non-empirical publications including commentaries and editorials. We excluded publications with incomplete data, including conference abstracts and protocols. We defined interest-holders as "any individual or group who is responsible for or affected by health- and healthcare-related decisions". We identified 10 types of interest-holders whose input can enhance the relevance and uptake of guidelines. We included studies that reported on the barriers or facilitators to engagement of one or several of these interest-holder groups at any step of the guideline development process. All identified citations from electronic databases were imported into Covidence for screening and selection. Documents identified through our grey literature search were managed and screened using an Excel spreadsheet. A two-part study selection process was used for all identified citations: (1) a title and abstract review and (2) full-text review. At each stage, teams of two review authors independently assessed all potential studies in duplicate using a priori inclusion and exclusion criteria. Data was extracted from each included article in duplicate and independently. We extracted information about study characteristics and methods. Additionally, we extracted qualitatively reported barriers and facilitators and conducted a framework analysis. We selected the Theoretical Domains Framework (TDF) for extracting our barriers and facilitator findings. Developed through a multidisciplinary consensus approach and subsequent validation, TDF consolidates overlapping behavioural theories into 14 domains encompassing 84 theoretical constructs, and provides a theoretical lens through which to view the cognitive, affective, social and environmental influences on behaviour and implementation. Two review authors conducted the analysis. Our qualitative evidence synthesis identified a total of 51 findings, encompassing 23 barriers and 28 facilitators to interest-holder engagement in health guideline development. While the large majority of reported evidence is about patient engagement, many findings are applicable to all interest-holder groups and should be considered by guideline developers who aim to apply a multi-interest-holder engagement approach. Many organisations that produce guidelines lack the resources to support interest-holder engagement. By implementing an organisational interest-holder engagement model, guideline developers can ensure that they have the necessary human and financial resources in place. The interest-holders which are recruited to a guideline project should be knowledgeable and experienced, and guideline developers should consider diverse perspectives, roles, and personal characteristics. Using a network approach for identification and recruitment can help identify appropriate and committed interest-holders. To prevent tokenistic engagement, guideline developers can promote the meaningful engagement of interest-holders by providing practical, technical and emotional support. This includes providing training to empower interest-holders and improve self-efficacy and confidence in guideline development skills. Training should focus on evidence-based methods such as systematic reviews and evidence-to-decision frameworks. Engagement throughout all stages of guideline development supports more meaningful engagement compared to occasional involvement. A skilled moderator/chair can manage group dynamics and support the contributions of all those involved in guideline development. They can also offer explanations and promote plain language as-needed. Finally, many interest-holders have limited time to contribute to guidelines, and developers should establish flexible processes and timelines, and consider interest-holders preferences for in-person and online engagement activities. Identifying and analysing barriers and facilitators to interest-holder engagement is important in order to optimise health guideline development. Knowing facilitators to engagement can support future interest-holder engagement work. More research is needed on the barriers that do not have potential facilitator solutions, to understand how to improve upon known challenges. This review calls for the development of training courses and tools to support and facilitate involvement of all interest-holders, both public and professionals. In addition, it calls for further research to be done with a focus on the dynamics of guideline development, perceived interactions within the group and their impact on decisions. Work should also be done to look at the implementation of guidelines and the influence of interest-holder engagement on uptake. What challenges do patients and other interest-holders face when creating health guidelines, and how can we support them? The review in brief: Health guidelines help many people, such as clinicians and patients, make decisions about healthcare. It is necessary to involve different types of people in the creation of health guidelines. This review summarises the challenges that people face when working together to create health guidelines and what kind of support helps them work together. Most of what we know about the experience of partnership when developing health guidelines is from patients. The main challenges facing patients are unclear roles, need for training and support, difficulty speaking up, and not having enough time to do the work. To support them, guideline developers should offer practical, technical and emotional support and work with flexible timelines and processes. More research is needed to understand the challenges faced by policymakers, practitioners, researchers and patients from different backgrounds and experiences. What challenges do patients and other interest-holders face when creating health guidelines, and how can we support them? Health guidelines are important documents that can help people, such as practitioners and patients, make decisions about healthcare. It is becoming more common to involve different types of people in the creation of health guidelines. We wanted to know what challenges people face when working together to create health guidelines, and what types of supports are useful. What did we do? We looked for literature that described people&#x2019;s experiences when collaborating to create health guidelines. We specifically looked for information that described challenges they faced, how they overcame these challenges, and what type of supports they wished were in place. We were interested in documents that described ten different types of people who can contribute to the guideline development process, including patients, practitioners, and members of the public. We organised our results using a pre-existing checklist (GIN-McMaster Checklist for Guideline Development). What did we find? We found 40 documents that described challenges and ways to support people who are engaged in the guideline development process. Most of the evidence came from high-income countries and most of it was about patients and their experience being part of guideline development. These documents described how finding the right people to include in a guideline project can be challenging, since they need specific skills and knowledge or experience. People described not always understanding their role in the project, and needing more training and support in order to do their work. Organisations that develop guidelines did not always have the resources needed to support them. An important resource is the guideline chair, who leads the group discussions and can support everyone involved in creating the health guideline. The best way to support people is to provide them with choices and flexibility in how they engage in the guideline development process. People may prefer working in-person or online and need enough time to get the work done. What are the limitations of the evidence? Most of the evidence we found is about patients, and more research is needed about different interest-holders such as policy makers, health practitioners, and researchers. More information is also needed about how to involve people from diverse backgrounds, such as those who live in low-income settings. Additionally, we did not find evidence for all of the steps needed to create a guideline, such as priority setting. How up-to-date is this evidence? Evidence was included up to September 26, 2022.

High-tone pelvic floor dysfunction (HTPFD) affects a substantial proportion of women with chronic pelvic pain and is characterized by hypertonic musculature, myofascial tenderness, dyspareunia, and urinary and defecatory symptoms. Although pelvic floor physical therapy (PFPT) is the first-line treatment, access is severely limited: only 2.47% of U.S. zip codes have even one trained pelvic floor physical therapist, and completion rates at some referral centers are as low as 20%. Existing telehealth and home biofeedback tools support muscle-strengthening exercises but cannot guide patients to therapist-defined myofascial trigger points or objectively verify that therapeutic depth, rotational orientation, and force are reproduced during home-based treatment-capabilities essential for HTPFD management. We developed the SmartWand, a Bluetooth-enabled intravaginal device that quantifies insertion depth (cm), rotational orientation (degrees), and applied force (kg/cm&#xb2;) and pairs with a smartphone application to deliver real-time, multimodal guidance. Using a two-phase workflow, a pelvic floor physical therapist first programs patient-specific trigger-point coordinates during an in-clinic session; the patient then independently reproduces those coordinates at home with on-screen directional feedback, auditory confirmation, and haptic cues. In this prospective validation study, 20 adult women-10 with HTPFD and 10 healthy controls-underwent therapist-guided pelvic floor mapping at eight anatomical sites followed by blinded, independent coordinate reproduction. Inter-rater reliability between therapist-programmed and participant-reproduced measurements was assessed using intraclass correlation coefficients (ICC) from two-way mixed-effects models with subject-specific random intercepts to account for repeated within-subject measures. The SmartWand demonstrated excellent agreement for insertion depth (ICC 0.98; 95% CI 0.971-0.986) and rotational orientation (ICC 0.999; 95% CI 0.998-0.999), and good agreement for applied force (ICC 0.877; 95% CI 0.82-0.916). All ICC values surpassed the prespecified success threshold of 0.65. Critically, reliability was consistent across both participant groups, indicating that the hypertonic musculature and myofascial tenderness characteristic of HTPFD did not impair measurement reproducibility. These findings establish proof-of-concept that patients can independently perform technique-specific internal myofascial release-previously considered feasible only under direct therapist supervision-with objective, quantitative verification of accuracy. The SmartWand system represents a meaningful technological advance over existing home biofeedback platforms by enabling therapist-programmed spatial targeting and calibrated force delivery at patient-specific trigger points. By digitizing treatment parameters and generating objective adherence data, this technology has the potential to expand guideline-concordant PFPT to the millions of women with HTPFD who currently cannot access or complete in-person care, and to support standardized dosing and longitudinal monitoring in future hybrid telehealth care models. Randomized controlled trials comparing SmartWand-augmented hybrid PFPT to standard in-person therapy are warranted to establish clinical efficacy.

The "Did You Know? with Video" (DYKV) model introduces an innovative blended learning approach that delivers short educational videos via Facebook to optimize learning experiences in physical education (PE), specifically in gymnastics. In a six-week quasi-experimental design, 54 students (Mage&#x202f;=&#x202f;17&#x202f;&#xb1;&#x202f;0.40&#x202f;years) were assigned to either an experimental group (DYKV, n&#x202f;=&#x202f;27) or a control group (traditional approach, TA, n&#x202f;=&#x202f;27). The two groups participated in a 6-week gymnastics unit, which included a 2-h learning session weekly. The DYKV group received hybrid instruction combining online educational media (two videos per week, totaling 12 videos covering different gymnastic elements) shared via Facebook with in-person teaching while the TA group followed a conventional in-person method. Data on motor performance, knowledge retention, and motivation were collected before and after the intervention. The results showed that the DYKV group achieved significantly greater improvements in motor performance (&#x394;%DYKV&#x202f;=&#x202f;+76.69% vs. &#x394;%TA&#x202f;=&#x202f;+37.58%; p&#x202f;<&#x202f;0.001, &#x3b7;p 2&#x202f;=&#x202f;0.124) and knowledge retention (&#x394;%DYKV&#x202f;=&#x202f;+49.89% vs. &#x394;%TA&#x202f;=&#x202f;+26.53%; p&#x202f;<&#x202f;0.001, &#x3b7;p 2&#x202f;=&#x202f;0.51) alongside a marked increase in autonomous motivation (p&#x202f;<&#x202f;0.001, r&#x202f;=&#x202f;0.73) and decrease in controlled motivation (p&#x202f;<&#x202f;0.001, r&#x202f;=&#x202f;0.87) compared to the TA group. The DYKV model demonstrates potential for enhancing motor, cognitive, and motivational outcomes in PE, further supporting the need for continuous innovation in blended learning within this educational context.

This study examines the associations between intergenerational contact frequency and health outcomes among empty-nest older adults in China, and further investigates whether physical exercise serves as a behavioral pathway underlying these associations. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), we analyzed 3117 community-dwelling individuals aged 65&#xa0;years and older who did not co-reside with their children. Intergenerational contact frequency was measured as a five-level ordinal indicator based on the frequency of in-person visits by children during the past year, using the maximum contact frequency across all children as the primary aggregation rule. Self-rated health and physical exercise frequency were analyzed using ordered logistic regression, while depressive symptoms measured by the CES-D-10 were modeled using negative binomial regression. Mediation effects were decomposed using the Karlson-Holm-Breen (KHB) method with 5000 bootstrap resamples. Higher intergenerational contact frequency was significantly associated with better self-rated health (OR&#x2009;=&#x2009;1.18, 95% CI 1.10-1.27) and fewer depressive symptoms (IRR&#x2009;=&#x2009;0.92, 95% CI 0.88-0.96), after adjusting for age, sex, education, residence, marital status, income, and chronic disease count. More frequent intergenerational contact was also positively associated with physical exercise frequency (&#x3b2;&#x2009;=&#x2009;0.21, p&#x2009;<&#x2009;0.001). Physical exercise partially mediated both associations. The indirect effect through exercise accounted for 18.6% of the association between intergenerational contact and self-rated health (indirect effect&#x2009;=&#x2009;0.088, 95% CI 0.043-0.136), and 13.4% of the association with depressive symptoms (indirect effect&#x2009;=&#x2009;&#x2009;-&#x2009;0.12, 95% CI&#x2009;-&#x2009;0.20 to&#x2009;-&#x2009;0.06). Subgroup analyses suggested that the mediating role of physical exercise was somewhat stronger among rural residents and male older adults. More frequent in-person contact between empty-nest older adults and their children is associated with better physical and mental health outcomes in China, with physical exercise partially explaining these associations. These findings suggest that intergenerational relationships may contribute to healthy aging partly by promoting more active lifestyles among older adults. Due to the cross-sectional design, causal relationships cannot be established. Longitudinal analyses using multiple waves of CHARLS data are needed to clarify temporal ordering and causal mechanisms. Public health strategies that integrate family engagement with community-based exercise promotion may help support healthy aging in China's growing empty-nest older population.

To examine the association between telehealth utilization and mammogram receipt by rurality, and to characterize geographic patterns of concurrent increases in telehealth and mammography use in urban and rural communities. The sample included women, aged 50 years or older, receiving services in primary care or gynecology/women's health practices at MultiCare Health System from 2018 to 2023. For the difference-in-difference (DiD) analyses, women who had only in-person visits during the prepandemic period but had at least one telehealth visit in each year of the postpandemic period were defined as the treatment group. Women who had only in-person visits during both pre- and postpandemic periods were defined as the control group. For the spatial analyses, we analyzed ZIP Codes in which both telehealth and mammography utilization increased from 2018-2019 to 2020-2022. DiD analyses suggested that telehealth use was significantly associated with a greater probability of mammogram receipt among rural women; however, this association was not found in urban women. Spatial analyses indicated that concurrent increases in telehealth and mammogram use occurred in both rural and urban settings but exhibited greater spatial concentration in urban areas and comparatively more dispersed patterns across rural ZIP Code Tabulation Areas. The findings suggest that telehealth may be particularly beneficial for improving mammography screening among rural individuals, who typically experience greater structural barriers to accessing health care. While urban areas may exhibit clustered patterns driven by interconnected care systems, rural areas may experience more diffuse but meaningful gains as telehealth expands access across large geographic distances.

Background/Objectives: Building a donor base that reflects the diversity of Canada is essential to ensuring everyone has timely and reliable access to high-quality blood products. This qualitative research project aimed to both determine barriers to donation for diverse South Asian communities and seek feedback and guidance on proposed interventions to address those barriers. Methods: This study was guided by the principles of community-based participatory research and data was gathered and analyzed using constructivist grounded theory. We conducted eight in-person focus groups and four interviews. Results: Our findings indicate that barriers to donation are systemic. Barriers include inaccessibility, deferrals and negative donation experiences, lack of awareness and newcomer settlement challenges, social exclusion, navigating an unfamiliar donation system, and issues with access to appropriate care in health systems more generally. Participants proposed addressing these barriers through changes in the blood service, such as more convenient access to donation and improved cultural sensitivity and cultural comfort in donation centres, and also through changes in health systems more generally. Recommendations included sustained collaboration with communities to inform policies and practices based on cultural and social contexts. Conclusions: Our study of systemic barriers to blood donation for South Asian communities in Ontario indicates that barriers to donation are systemic. Participants proposed changes to blood services that would address some of these barriers. Where systemic barriers are attached to broader social structures, the strategies to address barriers will require longer-term considerations and resources.

Bangladesh, a lower-middle-income (LMIC) South Asian country, relies on survey data for measuring adult mortality. Mobile phone surveys are an appealing alternative to in-person surveys because they are cheaper and can be deployed when enumerator mobility is hindered. In this contribution, we examined the quality of 'Parental Survival History' data collected over the phone by comparing it with data from a Health and Demographic Surveillance System. We conducted a mobile phone survey from July to December 2021 among residents of the Matlab HDSS. Mobile phone survey data about the respondent's father and mother were individually matched to the HDSS database. Data were compared to the HDSS reference in terms of the vital status of the respondent's parents, their age, the time since death and adult mortality rates. A total of 2231 respondents reported information on their parents. Among these, 90.7% of fathers' names and 95.2% of mothers' names were matched between the mobile phone survey and the HDSS, and the matched dataset was used for subsequent analyses. Concordance in the vital status reports of the parent was very high (both sensitivity and specificity were above 99%). Further, we found that 50% of the parents' ages (current age for those who are alive and age at death for parents who died) were within 5&#x2009;years below and 3&#x2009;years above those recorded in the HDSS. Around 4% of parental deaths were erroneously located within or outside an 8-year reference period. The parents' mortality rate was 52.0 (95% CI: 49.3, 54.8) per 1000 person-years in the mobile phone survey and 52.3 (95% CI: 49.6, 55.0) in the HDSS. In this population, parental survival history data were reported with high accuracy in a mobile phone survey, highlighting their potential for measuring adult mortality in resource-constrained settings.

Collaborative care between optometry and ophthalmology has demonstrated the potential to improve timely access to care. This study examines three settings where real-time optometry-facilitated telehealth was used to expedite specialist eye care in rural and remote Western Australia. Referrals to ophthalmology were triaged to telehealth or face-to-face services. For telehealth, optometrists performed a comprehensive in-person assessment, then facilitated video-consultation with an ophthalmologist during the same attendance for collaborative decision making. In 2023, retrospective chart review was undertaken for ophthalmology services in towns more than 1500&#x2009;km from the capital city. Optometrists performed comprehensive in-person assessments and facilitated telehealth in three settings: hospital, community clinic and visiting outreach. Attendance rates were compared between collaborative telehealth and face-to-face ophthalmology. Follow up outcomes and diagnoses for telehealth consultations were reported. A total of 1876 non-surgical ophthalmology episodes of care were delivered in the 12-month period, of which 1044 (55.7%) were delivered by optometry using telehealth. Of those managed by telehealth, only 83 episodes of care required a subsequent face-to-face ophthalmology consultation. The hospital setting provided the greatest proportion (76.4%) of telehealth. Adjusted logistic regression showed the odds of attendance were 3.6 (95% CI: 2.6-5.0) times higher for telehealth appointments than face-to-face (p&#x2009;<&#x2009;0.001). Surgical rates of outreach ophthalmology were high (30.0 to 74.1% of activity). Common diagnoses in telehealth included cataract, pterygium for direct surgical booking and chronic conditions (glaucoma, diabetic retinopathy) for instituting appropriate management. Collaborative telehealth with optometry improves access to ophthalmology services in rural Australia and should be considered in metropolitan settings and other countries.