Several artificial intelligence (AI) governance frameworks have emerged to help health systems (HS) address AI-related risks. However, most fail to capture the multidimensional and evolving nature of real-world governance. This systematic review aimed to synthesize existing AI governance frameworks for HS and to propose an integrative AI governance model identifying key components to guide AI-related policy, practice, and research in HS. A comprehensive search was conducted in 8 academic databases (PubMed, MEDLINE, Embase, ACM Digital Library, Web of Science, Scopus, Social Sciences Abstracts, and PsycINFO), gray literature databases, and international organization web portals in October 2024 (updates: July 2025 and March 2026) and limited to studies published from November 2014 to March 2026 in English, French, Spanish, or Portuguese. Eligible documents included peer-reviewed articles and reports proposing AI governance frameworks for HS. Two reviewers independently selected the frameworks, assessed their quality using the Appraisal of Guidelines for Research and Evaluation for Health Systems, and extracted data. Results were synthesized using thematic analysis. The research retrieved 10,175 records, among which 19 AI governance frameworks were identified. Most were published between 2022 and 2024 (n=13, 68%), half (n=10, 53%) were developed by authors based in North America, and only one-third (n=6, 32%) were derived from primary studies. The frameworks focused on 4 levels of AI governance: international (n=3, 16%), national (n=5, 26%), local (n=3, 16%), and organizational (n=8, 42%). All of them underline the crucial role of multidisciplinary bodies in the structure of AI governance in HS. Six key AI governance processes in HS emerged as critical: (1) need and/or problem identification (n=14, 74%), (2) data governance (n=17, 89%), (3) risk assessment and management (n=17, 89%), (4) validation and/or evaluation (n=18, 95%), (5) maintenance and monitoring (n=16, 84%), and (6) integration (n=9, 47%). Additionally, 4 pivotal relational mechanisms were identified: (1) ethical principles and/or values (n=17, 89%), (2) education and training (n=14, 74%), (3) communication (n=12, 63%), and (4) standards and regulations (n=13, 68%). Our study provides a comprehensive synthesis of existing AI governance frameworks for HS across 4 levels (local, regional, national, and international), underpinned by a quality assessment of the 19 identified frameworks. It differs from existing studies that concentrate on specific dimensions or settings by contributing an integrative AI governance model for HS comprising 2 dimensions and 4 relational mechanisms across the 4 levels, explicitly modeling their interactions. Future research should test and operationalize the proposed model to enhance its practical applicability. Strengthening the methodological rigor of AI governance frameworks will be essential for the responsible integration of AI in HS. As the framework is primarily grounded in Global North and English-language literature, validation in other contexts is warranted.
Mental health challenges among Zambian youths are an increasing public health concern. Recent studies estimate that ~20% of the Zambian population is affected by mental health disorders, with adolescents showing a sharp rise in reported cases, from 0.7% in 2021 to 1.54% in 2023 (2 914 to 6 825 cases). Despite this growing burden, only 0.1% of government health expenditure is allocated to mental health services, and there is currently no youth-specific policy framework in place. With young people aged 15 - 35 years comprising 36.7% of Zambia's total population, the lack of investment and targeted interventions underscores the urgency of addressing barriers and strengthening facilitators to improve youth access to mental healthcare. To explore the barriers and facilitators that influence youths' access to mental health services in Zambia, with a focus on understanding the underlying factors that impact service utilisation. A systematic literature review was conducted, drawing on studies published between 2005 and 2025 from databases including Google Scholar, PubMed and ResearchGate. A total of 20 articles were identified and reviewed, with inclusion based on relevance to youth mental health service accessibility in Zambia. The review did not involve any primary participants; instead, the sample consisted of peer- reviewed studies, national reports and institutional documents. Data were analysed manually using a qualitative thematic approach, where key patterns, recurring themes and emerging categories of barriers and facilitators were identified and synthesised. This approach allowed for an in-depth understanding of the cultural, social and systemic factors that influence youths' access to mental health services. The findings highlight several barriers to accessing mental health services, including stigma, cultural beliefs, inadequate infrastructure and resources, low mental health awareness and gendered norms. The majority of the reviewed literature focused on urban and peri-urban settings, with fewer studies addressing rural contexts. In urban and peri-urban settings, common themes included stigma, limited infrastructure concentrated in tertiary hospitals and gendered expectations that discouraged male youths from seeking care. In rural contexts, the analysis revealed geographical inaccessibility, severe shortages of trained personnel and reliance on traditional or informal sources of support. Across both settings, low awareness of mental health conditions consistently emerged as a barrier. Conversely, facilitators such as school-based mental health programmes, community outreach initiatives, peer support groups and mobile-based interventions were identified as effective strategies to enhance accessibility for youths. Access to mental health services for Zambian youths is a multifaceted web of social, cultural and systemic factors. Addressing these challenges requires a comprehensive approach. The article concludes with recommendations aimed at improving youth-friendly mental health service delivery and access.
Medical schools worldwide have struggled for decades to determine the most effective strategy for selecting students to meet the needs of their healthcare systems. Despite recent changes in the direction of medical education, most medical schools have been slow to respond and adapt their selection. Applying a standard admission strategy across dissimilar contexts, such as the Asia-Pacific region, is challenging due to differing school missions, contexts and health priorities. In addition to academic achievements, several selection approaches have been implemented across the globe, with the hope of selecting those who are 'best' suited to be doctors. An equitable and fit-for-purpose selection approach is crucial for meeting priority community needs and ensuring institutional accountability. This scoping review aims to explore the selection strategies used by medical schools in low-and middle-income countries (LMICs) within the Asia-Pacific region to contribute to a fit-for-purpose workforce. This scoping review was conducted between July 2024 and December 2024 using the methodology outlined by Arksey and O'Malley. Inclusion and exclusion criteria were developed to meet the objectives of this review. SCOPUS, EMCARE, OVID Medline, ERIC and CINAHL databases were searched. Only documents in the English language were considered eligible for inclusion. There was no date restriction applied for the reviewed documents. Grey literature was searched, and unpublished theses, policy documents, abstracts of conference materials, technical reports and guidelines were extracted using the inclusion criteria. The study population consisted of medical students and graduates from LMICs within the Asia-Pacific region. Key concepts searched included selection, recruitment, admission and matriculation. The outcomes of interest were health workforce, medical workforce, fit-for-purpose, medical graduates, doctors and physicians. Five other team members worked independently and collaboratively to assess the elligibility of relevant studies. Three were very senior medical education experts, one senior dental educator and a senior research fellow whose expertise is in health systems and medical education. The Quality Assessment Tool for Studies with Diverse Designs was used to assess the quality of selected studies. The information extracted from each study was deductively coded using a framework that captured selection approaches, factors informing the selection strategy, and fit-for-purpose workforce considerations. This was followed by inductive coding to extract major themes. A total of 5045 studies were retrieved from the five databases. Ten (62%) studies from the five databases and 6 (38%) from other sources were included. Five major themes emerged from the inductive analysis of the included studies: engagement of key stakeholders in the selection approach (political validity), prioritizing the health needs of the communities that medical schools serve (social accountability), responding to the needs of communities in which schools are located (responding to context), ensuring a sustainable selection approach, and a purposive and mission-driven strategy. This review highlights the different selection approaches that medical schools use within LMICs in the Asia-Pacific region. The engagement of stakeholders in the selection process, premised on a clear mission and purpose, is imperative within each context. A proposed selection framework aimed at contributing to a fit-for-purpose workforce could guide selection approaches in LMICs in the Asia-Pacific region and similar contexts.
Objective: To assess the prevalence of myopia and its main influencing factors among Chinese primary and secondary school students using meta-analysis. Methods: A meta-analysis was conducted. Databases including CNKI, Wanfang Data, China Biology Medicine Database, PubMed and Web of Science Core Collection were electronically searched to collect cross-sectional studies on influencing factors of myopia in Chinese primary and secondary school students published from January 2013 to October 2024. Two researchers independently screened the literature, extracted data and assessed the methodological quality based on the Agency for Healthcare Research and Quality (AHRQ) criteria. Meta-analysis was performed using Stata 18.0 software to calculate the pooled prevalence and the odds ratios (OR) with 95% confidence intervals (CI) for each influencing factor. Heterogeneity test, publication bias assessment and sensitivity analysis were also conducted. Results: A total of 76 studies were included, covering 31 provinces, autonomous regions and municipalities directly under the Central Government of China, with a cumulative sample size of 1, 823, 018 participants. Eight main influencing factors of myopia were analyzed. The meta-analysis results showed that the risk of myopia in female primary and secondary school students was 1.45 times that in male students (OR=1.45, 95%CI:1.29-1.63), and the risk in secondary school students was 4.11 times that in primary school students (OR=4.11, 95%CI:3.76-4.50). Parental history of myopia (at least one parent affected), excessive daily use of electronic devices, and incorrect eye use posture were identified as risk factors (P<0.05). In contrast, performing eye exercises ≥10 times per week, engaging in outdoor activities ≥ 5 hours per week, and sleeping > 8 hours per day were protective factors (P<0.05). Sensitivity analysis indicated that the results were robust. Conclusions: The prevalence of myopia among Chinese primary and secondary school students remains high, and the spectrum of influencing factors exhibits distinct "Chinese context" characteristics: the harm of high-intensity near-work driven by academic pressure far outweighs that of isolated electronic screen exposure, while poor reading and writing postures, specifically deviations from the "One Fist, One Chi, One Cun" standardized posture guidelines, significantly elevate myopia risk. Given that the development of myopia is jointly influenced by genetic, behavioral, and environmental factors, it is recommended that while drawing upon international experiences, we fully leverage the strengths of indigenous institutional advantages, such as Chinese eye exercises, and embed standardized posture education into daily classroom routines. Ultimately, the goal is to construct a "society-school-family" trinity prevention and control system with Chinese characteristics, actively guide primary and secondary school students in cultivating healthy eye-use habits, and further strengthen the implementation intensity of comprehensive myopia intervention measures. 目的： 探讨中国中小学生近视眼患病率和主要影响因素。 方法： 荟萃分析。检索中国知网、万方数据知识服务平台、中国生物医学数据库、PubMed及Web of Science核心合集，收集2013年1月至2024年10月发表的中国中小学生近视眼影响因素相关横断面研究。由2名研究者独立筛选文献、提取数据并基于美国医疗保健研究与质量局标准进行方法学质量评价，采用Stata 18.0软件进行荟萃分析，计算合并患病率及各影响因素的优势比（OR）与95%置信区间（CI），并行异质性检验、发表偏倚评估及敏感性分析。 结果： 共纳入76篇文献，文献来源涵盖我国31个省、自治区、直辖市，累计调查人数1 823 018人，分析了8种近视眼的主要影响因素。分析结果显示，我国中小学生女生近视风险是男生的1.45倍（OR=1.45，95%CI：1.29~1.63），中学生近视风险是小学生的4.11倍（OR=4.11，95%CI：3.76~4.50）。父母至少一方有近视史、每天过度使用电子产品、不正确的用眼姿势是危险因素（P<0.05）；坚持我国特有的眼保健操制度（每周≥10次）、每周户外活动≥5 h、每天睡眠>8 h是保护因素（P<0.05）。敏感性分析显示结果稳健。 结论： 我国中小学生近视率处于较高水平，升学压力驱动下的高负荷用眼模式危害远大于单一电子屏幕暴露，不良读写姿势对“一拳一尺一寸”规范的背离显著推高风险。近视眼的发生受遗传、行为与环境因素共同影响，建议在借鉴国际经验的同时，充分发挥眼保健操等本土制度优势，将标准化姿势教育下沉至日常课堂，构建具有中国特色的“社会-学校-家庭”联动防控体系，积极引导中小学生养成良好的用眼习惯，并进一步加大近视眼综合干预措施的实施力度。.
Adolescent substance use and substance use disorders are significant public health issues. Our goal was to evaluate the association between adolescent substance use, detected via blood alcohol levels and urine drug screens, and trauma-related outcomes at a Level I pediatric trauma center. Most of the literature is focused on adult trauma patients with limited data in the pediatrics. In this retrospective cohort study, we analyzed data from adolescent trauma patients 13-17 years of age presenting to a Level I pediatric trauma emergency department (ED). Demographic data, Injury Severity Score (ISS), intensive care unit (ICU) admission, hospital length of stay (LOS), and ED disposition were extracted from the Pennsylvania Trauma Systems Foundation Database Collection System, which includes comprehensive information on demographics, clinical characteristics, and outcomes of trauma patients. These data were compared between patients whose alcohol levels and urine drug screening were positive and negative. Our primary outcome measures were ISS and LOS in the hospital and ICU. Our secondary outcome measures were need for surgery, mortality, and disposition from the ED. Specific substances, including tetrahydrocannabinol (THC), benzodiazepines, and opioids, were further analyzed as drugs associated with these outcomes. We performed multivariate regression models to identify independent associations of blood alcohol levels or urine drug screen positivity with trauma severity and ICU admissions. Among 405 adolescents who had toxicology testing done, 11/286 (3.8%) tested positive for alcohol, while 95/377 (25.2%) had positive urine drug screens predominantly for THC (19.9% of the 95 who had a positive screen). Blood alcohol level-positive patients demonstrated significantly lower ISS (P < .001), shorter ICU stays (P. < .01), and shorter overall hospital stays (P< .01) compared to blood alcohol level-negative patients. Conversely, benzodiazepine positivity was strongly associated with higher ISS, increased ICU admissions, and prolonged hospitalization stays. Multivariate analysis showed that older age was associated with increased ISS (β = 0.30 per year, P < .06) and ICU admission (OR 1.16, 95% CI, 1.04-1.28, P < .01). Blood alcohol level and most urine drug screen results were not independently associated with primary outcomes of ISS and LOS in the hospital and ICU, although benzodiazepine positivity was strongly associated with increased ISS (P < .001) and ICU admission (OR ≈ 30, P < .001). Adolescent trauma patients who were positive for benzodiazepines were associated with significantly worse outcomes, emphasizing the need for targeted screening and intervention strategies. Alcohol positivity was paradoxically associated with less severe trauma presentations. These findings highlight the complexity of substance use on adolescent trauma and underscore the importance of nuanced clinical assessments and targeted interventions addressing both substance use and underlying sociodemographic vulnerabilities.
Integrating biobanking and genomic research into health systems in low- and middle-income countries (LMICs) provides considerable opportunity to advance precision medicine and promote global health equity. However, persistent structural disconnect exists between the physical infrastructure for biospecimen collection and digital frameworks required to generate, manage, and share associated data. This biospecimen-data divide excludes LMIC populations from the benefits of genomic research and increases community vulnerability to extractive data policies and dependency on high-income-country (HIC) partners. This conceptual analysis aims to: (1) deconstruct the biospecimen-data divide by describing its core elements and interrelations; (2) introduce the DIGS (Digital Infrastructure, Interoperability, Governance, and Skills) Model as a framework for reconceptualizing biobanking as integrated digital enterprise; (3) examine how decisions regarding digital infrastructure may reproduce or reduce health inequities in LMIC settings. A critical scoping review was conducted using the Arksey and O'Malley framework and reported in line with PRISMA-ScR. Five databases-PubMed, Scopus, Web of Science, Embase, and Global Index Medicus-were systematically searched, yielding 2,390 records. After deduplication (n = 880), title and abstract screening (n = 1510), and full-text review (n = 296), 154 studies were included in the final synthesis. These included peer-reviewed articles, policy documents, and grey literature on biobanking, digital health infrastructure, and data governance in LMIC contexts. Four interdependent structural gaps underpin the biospecimen-data divide: (1) infrastructure gap, reflecting constraints on data generation and flow; (2) interoperability gap, arising from incompatible systems that create data silos; (3) human-capital gap, marked by limited availability of personnel with combined laboratory and data stewardship expertise; (4) governance gap, defined by weak ethical and regulatory structures. Together, these gaps reveal deeper asymmetries between HICs and LMICs. The DIGS Model reframes biobanking as a cyclical, equitable process requiring coordinated investment across all four dimensions. The DIGS Model challenges the prevailing infrastructure-first paradigm, which prioritizes physical assets over digital capabilities. It advances partnership models that center LMIC leadership in data governance, redefining sustainability as the cultivation of local capacity to generate, interpret, and control data. The framework offers researchers, funders, and policymakers a shared diagnostic tool for bridging the biospecimen-data divide without reinforcing existing dependencies.
Wound microbial burden and infection can delay wound healing, increase complications and rapidly progress to spreading or systemic infection, particularly in high-risk patients. Early diagnosis and appropriate treatment are essential for improved outcomes and reduced antimicrobial resistance (AMR). AMR is a growing concern in wound care due to reported inappropriate use of topical antiseptics, as well as systemic antibiotics. A recent survey found 41.8% of healthcare professionals used antimicrobial prophylactically, against recommendations, while 37.2% did not follow antimicrobial stewardship (AMS) guidance, indicating a potential gap in best-practice treatment. The primary aim of this document was to provide evidence-based guidance on the role of microbial-binding dressings (MBDs) in managing microbial burden, preventing infection and reducing the need for antimicrobial intervention in both surgical incisions and hard-to-heal wounds. The secondary aim was to summarise key findings in four clinical pathways. This guideline was developed according to AGREE II with a pragmatic literature review with GRADE assessments and a modified Delphi process for developing evidence-based statements. The literature search asked: 'In adults with a wound or surgical incision, do MBDs, compared with standard care, reduce surgical site infections, microbial burden, signs of infection, antibiotic use, antiseptic dressing use, time to healing or complication rates?'. For the statements, a 10-member expert panel scored agreement from 1 to 5, over three rounds (two remote and one in person), with acceptance at a mean score of ≥4.00 (SD ≤1.00). The literature review returned 12 studies on surgical incisions and 17 on hard-to-heal wounds, varying in evidence level and certainty. From 13 original statements, strong agreement was reached for 14; nine in round one, two in round two and three in round three (in-person meeting), with one statement split into two prior to agreement. The statements fit three themes: challenges of wound infection and AMR; benefits of MBDs for infection prevention and control (IPC); and early IPC in future AMS strategies. The guideline presents each statement with supporting evidence and detailed guidance for implementation in practice. This is followed by four easy-to-use AMS clinical pathways to support practical implementation, decision-making and consistency in care, currently under evaluation, with further validation studies expected. This guideline identifies and aims to meet a clear need for evidence-based best practice to enhance AMS in wound care. A paradigm shift towards infection prevention, early intervention and first-line treatment using MBDs should be considered an opportunity in everyday practice to minimise progression of infection, limit antimicrobial requirements and thus tackle the global threat of AMR.
Digital health interventions (DHIs) offer major potential for improving cardiovascular disease (CVD) primary and secondary prevention, but their adoption by healthcare providers (HCPs) remains inconsistent. To identify barriers and facilitators to DHI uptake in CVD primary and secondary prevention from HCPs' perspectives. We conducted a systematic review of studies published between 2020 and 2024 that investigated HCPs' perceptions of DHI implementation for CVD primary and secondary prevention. We appraised individual study quality using a validated tool. We performed a qualitative synthesis of reported barriers and facilitators, categorized according to country income level and according to the World Heart Federation Roadmap domains: HCPs, patients, technology, and health systems. We included 125 primary studies (101 qualitative, 15 quantitative, 9 mixed methods). The most frequently cited barrier was excessive workload, both from existing responsibilities and additional tasks introduced by DHIs. The leading facilitator was the perceived positive clinical impact of DHIs-such as improved adherence, reduced hospital readmissions, and better outcomes. HCP motivation, adequate training, and system integration also facilitated adoption. Many factors-like effects on HCP-patient relationships and workflow-functioned as either barriers or facilitators, depending on the setting. Patient-related barriers included limited digital access and literacy; facilitators included perceived gains in patient-centered care. Health system factors such as organizational structure, financing, and policy support were commonly mentioned, with mixed views. Technology-related facilitators included usability, adaptability, and integration with electronic records; instability was a key barrier. This is the first systematic review to synthesize post-COVID-19 literature on HCPs' perceptions of DHIs in CVD primary and secondary prevention. While offering a rich, global overview, limitations include a predominance of qualitative studies and lack of data from low-income countries. Effective implementation must address workload, align with workflows, and build trust through training and leadership. This research analyzed 125 studies from 33 countries to understand the factors that influence healthcare professionals' uptake of digital health tools, such as apps and wearable devices, for preventing cardiovascular disease.The leading facilitator for adoption is the perceived positive clinical impact; doctors and nurses are highly motivated to use digital tools when they help patients follow treatments better, reduce hospital readmission rates, and improve overall heart health.The most significant barrier is the perceived excessive workload. While some digital health tools can be time-saving, many providers feel that they add burdensome technical tasks to their already busy schedules, which undermines their acceptance.Uptake is also influenced by patient-related factors, such as digital literacy and internet access, as well as technological factors like how easily a tool integrates into existing hospital computer systems.To improve the future of cardiovascular care, digital tools should be co-designed with clinicians to ensure they fit seamlessly into daily work routines and are supported by proper training and strong institutional leadership.
Background/Objectives: Precision nutrition is moving beyond population-based guidance and isolated gene-diet interactions toward integrative models of dietary response. However, current approaches remain fragmented across nutrigenomics, microbiome research, multi-omics profiling, digital health, and machine learning. This review proposes the Nutri-Exposome Intelligence Framework as a conceptual, data science-driven model for integrating cumulative dietary, environmental, microbial, molecular, clinical, and digital exposures for precision chronic disease prevention. Methods: This conceptual review synthesizes the literature on precision nutrition, nutrigenetics, nutrigenomics, exposomics, gut microbiome research, multi-omics integration, wearable and biomarker-based monitoring, and machine learning in nutrition studies. Evidence was organized into a framework linking exposure assessment, host susceptibility, microbiome-mediated biotransformation, molecular response profiling, computational modelling, personalized intervention, and longitudinal feedback. Results: The proposed framework consists of seven interconnected layers: diet, environment, and lifestyle exposures; host genome and microbiome; multi-omics molecular responses; machine learning-based integration; risk prediction and responder stratification; personalized dietary intervention; and wearable and biomarker-based feedback. It positions the nutri-exposome as a cumulative exposure-response system and highlights how machine learning can support data harmonization, feature engineering, predictive modelling, responder classification, explainable interpretation, and adaptive refinement of dietary recommendations. Key applications include obesity, type 2 diabetes, cardiovascular disease, metabolic dysfunction-associated steatotic liver disease, cardiovascular-kidney-metabolic syndrome, and broader cardiometabolic prevention. Conclusions: Nutri-exposome intelligence offers a structured pathway for transforming complex nutrition data into predictive, explainable, and adaptive precision nutrition strategies. Implementation will require longitudinal and multi-ethnic cohorts, standardized metadata, causal validation, interpretable machine learning, ethical governance, and equitable access to support responsible clinical and public health translation globally.
Access to healthcare-defined as the ability to obtain timely and necessary medical services - is critical during public health emergencies. The Coronavirus Disease 2019 (COVID-19) pandemic (2020-2021) substantially disrupted routine healthcare delivery in the United States, particularly affecting racial and ethnic minority groups who already face barriers to care. While previous studies have examined disparities in COVID-related outcomes, fewer have assessed racial differences in access to care for non-COVID-19 conditions over an extended pandemic period. This study investigated whether race and ethnicity were associated with limited or delayed access to non-COVID-19 healthcare services during the COVID-19 pandemic in the U.S. We used cross-sectional, nationally representative data from the National Health Interview Survey (NHIS) from July 2020 to December 2021. The analytic sample included 40,955 U.S. adults aged 25 years and older. Survey-weighted logistic regression models accounting for the NHIS complex sampling design (strata and primary sampling units) were used to estimate associations between race/ethnicity and 2 binary outcomes: inability to obtain needed non-COVID-19 medical care and delays in receiving such care, adjusting for demographic, socioeconomic, and health-related covariates. Complete-case analysis was used due to minimal missingness. Sensitivity analyses using alternative weight rescaling produced substantively similar results. All results are based on the weighted sample; however, unweighted results are provided in the appendix. Among respondents, 13.8% reported being unable to access needed care, and 21.5% reported delaying care during the pandemic. After adjustment, American Indian/Alaskan Native and multiracial individuals were significantly more likely to experience barriers to care, with lower odds of receiving needed care (odds ratio [OR] = 0.64; 95% confidence interval [CI]: 0.534-0.782) and higher odds of delay (OR = 1.5; 95% CI: 1.247-1.813). Non-Hispanic Asian respondents were least likely to delay care (OR = 0.67; 95% CI: 0.585-0.774). Racial and ethnic disparities in access to non-COVID-19 healthcare were observed throughout the pandemic period. The observed disparities are consistent with prior literature on inequities in healthcare access during public health emergencies and may help inform future research and policy discussions regarding healthcare access during future emergencies.
Low-dose aspirin is proven to reduce the incidence of pre-eclampsia, yet adherence remains low. This systematic review synthesises qualitative evidence on barriers and facilitators to low-dose aspirin adherence in pregnancy and uses a co-production approach to develop an explanatory model of this complex behaviour. The overall aim is to contribute to the development of a theory of adherence, targeting this health issue. Data sources: A search of electronic databases (Medline, Web of Science, CINAHL, PsycINFO, Embase, Scopus, Open Grey, Google Scholar, Prospero), charity and professional organisations' archives was conducted using predefined terms. Citation searching was also performed. Searches were not time-limited or language-specific and completed in November 2024. Studies, which included qualitative data on low-dose aspirin determinants of adherence in pregnancy were included. Quality was assessed using the Critical Appraisal Skills Programme checklist. A meta-ethnography approach with reciprocal translation and line-of-argument synthesis was used. The co-production approach was utilised to streamline future intervention development by engaging key stakeholders in evidence synthesis, enabling them to translate evidence into action, support implementation and overcome the subjectivity inherent in meta-ethnography. Co-production activities followed the nominal group technique and structured discussions. Out of 3757 items identified through systematic searches of published studies and grey literature, six studies were included in the review. No studies were excluded based on quality. Four 3rd-order constructs with a total of 10 sub-themes were identified: informational gap, verbal and non-verbal health system communication, personal assets and autonomous control. In an explanatory model, we demonstrate that women are advised to take low-dose aspirin in a context of lack of information and misconceptions (informational gap) with patchy and inconsistent messages from the health care system. Women ultimately control their decision about the use of low-dose aspirin, however, the arrival at a decision depends on the utilisation of individual assets (unique personal or social characteristics inherited or acquired). Improving the quality and delivery of information for women and their support networks can reduce the strain on personal resources and make this essential preventive treatment more accessible and equitable. A group consisting of representatives from two national charities and a service user worked alongside an academic team, contributing to all aspects of this work, including formulating the research question, participating in the selection of the search terms, conducting screening of the abstracts, data extraction, quality assessment, synthesis, drafting a graphic representation and this manuscript.
The Mental health care: Adverse Sequelae of COVID-19 study aimed to (1) compare the consequences of the COVID-19 pandemic for mental health services and people with pre-existing mental health conditions (MHCs) in six low- and middle-income countries and (2) identify good practice to mitigate these impacts. An observational study, using a mixed-methods convergent design triangulating data from (1) semistructured interviews or focus groups and/or a self-completed survey, (2) routine service utilisation data, (3) local grey literature and (4) expert consultation. The study was conducted in Chile, Ethiopia, Georgia, Nigeria, South Africa and Sri Lanka. 121 key informants. We found clear evidence in all sites that the pandemic exacerbated pre-existing disadvantages experienced by people with MHCs and led to a deterioration in the availability and quality of care, especially psychosocial care. Alongside increased vulnerability to COVID-19, people with MHCs faced additional barriers to accessing prevention and treatment interventions compared with the general population. To varying extents, sites showed accelerated implementation of digital technologies, but with evidence of worsening inequities in access. In sites where primary care-based mental healthcare was more developed or prioritised, systems seemed more resilient and adaptive. Our findings have the following implications. First, these mental health service reductions are clear examples of 'structural stigma', namely policy level decisions in healthcare which place a low priority upon services for people with MHCs. Second, integration of mental healthcare into all general healthcare settings is key to ensuring accessibility and parity of physical and mental healthcare. Third, digital innovations should be designed to strengthen and not fragment health systems. We discuss these findings in terms of anticipating such challenges for future pandemics and preparing layers of resilience.
Childhood cancer survival and stage at diagnosis vary internationally. Here, we explore differences in child health surveillance and healthcare practices across countries participating in the International Benchmarking of Childhood Cancer Survival by Stage (BENCHISTA) collaboration-with a focus on timely cancer diagnosis. We conducted a scoping review of five databases (MEDLINE, Embase, SCOPUS, Web of Science, and ProQuest Central) for articles published in English or Spanish between 1 Jan 2012 and 15 Oct 2025, describing child health surveillance and acute care pathways, limited to the 29 countries involved in the BENCHISTA collaboration. Two reviewers independently screened abstracts; a third resolved conflicts. In parallel, a semi-structured questionnaire was distributed (to one general practitioner, one paediatrician) in 27 countries who contributed to the BENCHISTA database. We collected standardised information on national child health practices and validated against published national guidance. Of 2,963 articles screened, 33 were included. Three key themes emerged: (1) healthcare-seeking behaviour of families and their interaction with frontline professionals, (2) awareness of alarm symptoms by caregivers and clinicians, and (3) system-level and training-related factors affecting timely diagnosis. Studies highlighted challenges such as low symptom recognition, variation in paediatric training, and limited referral guidance. Questionnaire responses showed variation in the number of routine child health checks with physical examination for children < 5 years (median 10; range 2-21), paediatric training, and access to diagnostic tools.  There is substantial international variation in routine child health surveillance and acute illness assessment. These findings will inform interpretation of BENCHISTA data and may guide future strategies to support early cancer diagnosis. • Childhood cancer survival and stage at diagnosis vary internationally. • Early recognition of alarm symptoms is critical but often delayed due to system-level gaps. • This study combines a scoping literature review and clinician survey across 27 countries, identifying shared barriers to timely diagnosis. • It reveals variation in paediatric training of front-line healthcare practitioners, referral pathways, and child health surveillance practices, even among high-income countries.
Asian Americans are severely underrepresented in Alzheimer disease and related dementias research, and the cognitive aging of Asian Indians in the United States is poorly understood. There is a pressing need to bridge the gap in the literature concerning dementia and cognitive impairment among Asian Indians to reduce the current disparities. This study examines how knowledge, beliefs, and attitudes shape dementia disparities among older Asian Indian immigrants in the United States. In-depth interviews were conducted with Asian Indian adults, ages 50 years and older, who immigrated from India to the United States. Participants were recruited through cultural and faith-based organizations by using flyers and social media advertisements. Interviews explored perceptions of dementia and aging, barriers to receiving care, and beliefs related to aging. Interviews were audio-recorded and transcribed, and inductive thematic analysis was conducted by 2 investigators. Participants (n=29) were mostly women (73%) and 65-74 years old (38%) and had been in the United States for an average of 35 years. Cognitive impairment and dementia were viewed as natural functions of aging, and participants were unaware of screening methods to detect cognitive impairment early. Participants perceived dementia as more prevalent among Asian Indians living outside of India due to loss of social support. Overall, this study shows challenges and opportunities to advancing culturally appropriate cognitive aging care among Asian Indian immigrants in the United States. Findings from this study provide valuable insights into this underresearched area and can inform culturally sensitive interventions and policies to support the cognitive health of Asian Indian immigrants as they age.
This paper describes the development and validation of highly sensitive search hedges for Ovid MEDLINE and Ovid APA PsycInfo that effectively identify literature on transgender and gender diverse (TGD) populations. Two librarians developed the search hedges using relevant keywords and controlled vocabulary terms, building on previous work on identifying transgender populations in evidence synthesis. The hedges were tested and refined to capture diverse and expansive gender identities across cultures and disciplines. The hedges were validated for sensitivity using a gold standard set of 144 articles from the Knowsy portal of evidence syntheses tagged as Two-Spirit, transgender, or gender non-binary. To assess precision an international research team of subject experts independently screened a randomized sample of search results in a two-stage screening process with an additional screener resolving disputes. The final search hedges demonstrated 100% sensitivity in both MEDLINE and APA PsycInfo, identifying all 144 relevant articles from the Knowsy gold standard set. The MEDLINE search hedge achieved a 71% precision, and the APA PsycInfo hedge achieved a 67% precision. These results balance comprehensive retrieval while minimizing non-relevant articles for an efficient screening process. These search hedges in MEDLINE and APA PsycInfo are valuable tools for researchers and librarians to more effectively identify literature on TGD populations. These tools will be crucial for ongoing work in addressing gaps in research and health disparities faced by TGD populations and will be particularly valuable for researchers conducting evidence synthesis projects related to this population.
The 21st Century Cures Act mandates patient access to electronic health record (EHR) information, including test results, and prohibits practices that interfere with that access. Many health systems operationalized this through patient portals, enhancing transparency and patient engagement. This narrative review synthesizes emerging literature on patients' and clinicians' experiences with portal-based access to oncology test results. We conducted a narrative review in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA), performing a non-systematic literature search of PubMed/MEDLINE and Google Scholar for studies published between January 2021 and December 2025. We included qualitative, quantitative, and mixed-methods studies, as well as policy analyses, using non-empirical sources for contextualization rather than as primary evidence, with emphasis on high-stakes results and context relevant to metastatic or advanced cancer populations. Twenty articles were included. Patients consistently valued timely access to their health information and reported increased transparency and engagement, though preferences varied by test type. Evidence regarding potential harms was mixed: some patients reported distress or confusion when accessing complex results, while others reported no changes or felt better prepared for clinical encounters. Clinicians concerns regarding patient distress, portal messaging, and workflow disruption were reported in surveys and qualitative studies, although empirical findings were not uniform across studies. Direct evidence focused specifically on patients with metastatic cancer was limited, with only one study explicitly examining this group. The available literature describes both potential benefits and challenges associated with expanded electronic access to oncology test results. Evidence specific to patients with advanced cancer remains sparse, highlighting an important gap and the need for further research to inform patient-centered disclosure practices in oncology.
Unlike ventricular electrical disease, the impact of similar atrial disease on cardiac function has received insufficient importance. We aimed to examine data on atrial anatomy, electrical disease, and pacing to ameliorate abnormalities, offering pointers towards future practice. We used PubMed to explore atrial anatomy, activation, and pacing aiming to improve function. From inception of pacing, causes of deterioration in ventricular systolic function went unrecognized. Their eventual recognition led to fresh pacing strategies, termed conduction system pacing, which have yielded improved and preserved long-term ventricular function: now standard practice. Study of atrial anatomy/conduction implies that similar approaches may improve atrial function and also reduce incidence of atrial fibrillation. Impact of atrial electrical disease on diastolic and subsequent ventricular systolic function has been ignored, despite data showing how pacing alternative atrial sites can abbreviate atrial activation and improve ventricular filling: methods that have not been widely adopted. Comprehension of atrial anatomy/conduction underpins abandonment of right atrial appendage pacing paralleling the move away from right ventricular apical pacing on similar principles. When treating heart failure, atrial resynchronization should be considered along with ventricular resynchronization. Crucially, convenient pacing sites have been outmoded by active-fixation leads that can be placed at stimulation sites approximating normal conduction, including the atria; achievement hinges on understanding atrial anatomy and activation. Atrial resynchronization may significantly improve cardiac function where dyssynchrony relates to atrial disease/conduction delay, but more evidence of benefits must be collected. As resynchronization therapy moves forward, there should be parallel focus on evaluating coordination of atrial activation and timing with respect to the ventricles.
Rapid, validated dietary screening tools are lacking for individuals with spinal cord injury (SCI), where routine clinical check-ups do not allow sufficient time for extensive dietary assessments typically required to evaluate adherence to dietary recommendations. We developed a 15-item dietary screener (SCI NutriTool) and evaluated its accuracy in classifying non-adherence to a healthy food pyramid compared with a validated food frequency questionnaire (FFQ). The SCI NutriTool was developed through literature review and expert consensus. In a validation study, 51 adults with SCI (mean age 57.0 years; 76.5% men; 68.8% traumatic injury) completed the SCI NutriTool twice and a validated 97-item FFQ, which served as the reference method. The SCI NutriTool demonstrated substantial variability in performance across food groups, reflecting its domain-specific screening properties. Sensitivity was high for fruits and vegetables (91.7%), protein-rich foods (90.5%), and sweetened/alcoholic beverages and snacks (82.4%), with relatively high positive predictive values (PPV: 73.7-90.5%), supporting the tool's ability to identify individuals who are likely non-adherent and may benefit from further nutritional assessment or counselling. In contrast, for starchy foods and nuts, oils, and fatty spreads/sauces, sensitivity was low (20.0% and 50.0%), while specificity was modest. This indicates that the tool performs better in correctly identifying adherent individuals in these domains, which is reflected in higher negative predictive values (NPV: up to 94.1%). However, the low sensitivity suggests that individuals with non-adherence may be missed, limiting the tool's usefulness as an early screening trigger for these food groups. The SCI NutriTool's performance varies across food groups, demonstrating a stronger ability to identify non-adherence in protein-rich foods, fruit and vegetables, sweetened and alcoholic beverages, and snacks, but limited discriminatory capacity for others. In particular, it is not suitable for screening non-adherence to starchy foods and fats. Accordingly, it is best used as a triage tool to guide further dietary assessment and targeted nutritional interventions rather than as a standalone diagnostic instrument.
The rapid global expansion of telemedicine has created regulatory heterogeneity affecting documentation requirements, with particular implications for neurological services where documentation demands differ from general consultations. To systematically examine documentation requirements for telemedicine across global jurisdictions, analyze convergence and divergence in regulatory approaches, evaluate specialty-specific requirements for neurology and telestroke, and explore liability frameworks for teleconsultations. Scoping review following PRISMA-ScR framework. Comprehensive searches of academic databases and grey literature through August 2025, examining sources published, enacted, or updated after January 1, 2020. A composite regulatory intensity score was developed to enable systematic comparison across jurisdictions. Analysis of 147 regulatory sources across 52 jurisdictions revealed universal requirements for documentation elements while demonstrating substantial variation in consent documentation, data retention, electronic prescribing, and platform regulation. Regulatory intensity scores categorized jurisdictions across the full spectrum, with higher scores associated with more comprehensive documentation requirements. Telemedicine has transitioned from emergency contingency to regulated permanent care globally, with convergence on core principles but meaningful divergence in implementation specifics. Interoperability and mutual recognition rather than uniformity should guide regulatory harmonization efforts.
The Scholarship of Teaching and Learning (SoTL) is the practice of critically examining student learning to improve teaching and then disseminating insights from this work for others to build on. SoTL often justifies faculty members' careers in health professions education (HPE); however, SoTL is not universally understood or acknowledged in promotion and tenure (P&T) decisions across HPE institutions. We conducted a scoping review of the published literature to map how SoTL has been conceptualized, realized, and described as institutionally recognized by P&T committees. In July 2024 (updated in July 2025 and April 2026), the authors searched 7 databases for peer-reviewed publications referring to any scholarship relating to education, teaching, and/or learning in HPE in the United States. We followed Arksey & O'Malley's scoping review methodology and incorporated stakeholder feedback. Articles were grouped by discipline: medicine and other health professions. Of the 4,588 articles identified, 130 were included for full review, with 52 reporting on SoTL activities in medical education (40%) and 78 in other HPE domains (60%). While articles shared core SoTL concepts, SoTL was operationalized in a variety of ways, many blurring the distinction between scholarly teaching and SoTL. The articles demonstrated that SoTL has been inconsistently recognized by P&T committees. Using Institutional Logics to support analysis, we found that the recognition of SoTL in HPE organizations varies with the degree of alignment between the logics of research and teaching. We propose strategies for increasing this alignment and provide literature-based distinctions between scholarly teaching, SoTL and educational research to support this goal.