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There is an increasing focus on the importance of interprofessional education as an integral part of health and social care training. However, the fundamental psychological processes underlying successful interprofessional education are not well understood. Here we propose a single framework, Integrating Neuroscience and Social Psychology In Researching Interprofessional Education (INSPIRE), grounded in evidence from social psychology and neuroscience that could be used to generate testable hypotheses to inform the design, development and evaluation of interprofessional education. The application of this framework offers a novel, scientifically grounded approach to improving the learning outcomes of interprofessional education and provides a foundation for future research in this field.
Medical residency is a demanding training stage characterized by high levels of stress and burnout. As digital natives, current medical trainees (ie, residents) are frequent users of social media; however, little is known about how their personal (nonprofessional) use relates to burnout and social media addiction (SMA). This study aims to characterize the prevalence of SMA among Chinese medical trainees and explore its complex relationships with social media use patterns, occupational burnout, and related risk and protective factors. A nationwide cross-sectional survey was deployed through Wenjuanxing and disseminated via WeChat between August 29 and September 10, 2024. Data included demographics, physical and psychiatric health history, work variables (eg, training year and night shifts), personality traits, and social media use. SMA was assessed using the Bergen Social Media Addiction Scale. Logistic regression was performed to identify predictors of addiction, and mediation and moderation analyses were conducted to clarify the role of occupational burnout. Of 3621 medical trainees, 211 (5.8%) met the criteria for SMA (Bergen Social Media Addiction Scale ≥24, indicating addiction). Second-year medical trainees reported the highest addiction prevalence (92/1159, 7.9%). Logistic regression analysis revealed that higher burnout (odds ratio [OR] 1.41, 95% CI 1.23-1.62; P<.001), longer daily use (OR 1.39, 95% CI 1.23-1.56; P<.001), physical health problems (OR 1.56, 95% CI 1.13-2.16; P=.006), and psychiatric history (OR 2.00, 95% CI 1.41-2.84; P<.001) significantly increased the odds of addiction, whereas conscientiousness was protective (OR 0.92, 95% CI 0.86-0.99; P=.02). Social media use showed significant U-shaped associations with burnout, physical health problems, psychiatric history, personality characteristics, and mental health outcomes. For example, medical trainees using social media 1 hour or less (104/404, 25.7% with psychiatric history) and more than 4 hours daily (97/419, 23.2% with psychiatric history) both had higher risk profiles than moderate users. Mediation analysis showed that occupational burnout explained 28.1% of the effect of psychiatric history and 29.6% of the effect of physical health problems on addiction risk. This large-scale survey provides the first systematic characterization of SMA among Chinese medical trainees and elucidates its associated risks and protective factors. Burnout consistently emerged as a key and pervasive predictor of SMA, functioning both as an independent risk factor and as a mediator amplifying the impact of health-related vulnerabilities. Moreover, the findings highlight that both minimal and excessive daily social media use may signal distinct behavioral manifestations of distress, potentially reflecting different clinical phenotypes: digital disengagement under acute stress versus compulsive engagement driven by chronic burnout. Notably, while mental health symptoms exhibited U-shaped associations with usage, SMA risk increased progressively with daily duration. These results underscore the need for interventions that extend beyond simply monitoring usage duration, emphasizing strategies to reduce burnout and enhance the overall well-being of medical trainees.
This study examines how metaverse music platform design influences users' content creation behavior. Drawing on the Stimulus-Organism-Response framework, it develops a dual-path model in which relational-affective cues shape social experience, whereas interaction-oriented cues shape flow experience. Both experiential states are proposed to enhance emotional value perception, which in turn predicts content creation behavior, with technology acceptance examined as a boundary condition. Results from a survey of 435 Chinese users of metaverse music platforms show that emotional resonance and social presence positively predict social experience, whereas aesthetic novelty does not. Avatar customization, narrativity, and multi-sensory positively predict flow experience. Social experience and flow experience both strengthen emotional value perception, which subsequently increases content creation behavior. Technology acceptance strengthens only the social experience route. The study contributes by extending SOR research to metaverse music platforms, clarifying that music-related posting and sharing is shaped through distinct social and flow-based pathways, and showing that technology-related beliefs function as a selective boundary condition rather than a uniform amplifier across the model.
Social care nurses practise at the intersection of health and social care, supporting people with complex, long-term and often fluctuating needs. Despite their central role in care coordination, clinical oversight and safeguarding, social care nursing remains under-recognised in policy, education and workforce planning in England. This article examines the case for recognising social care nursing as a form of specialist community nursing practice. The authors situate social care nursing alongside district nursing and general practice nursing, highlighting shared capabilities in risk management, coordination and autonomous decision making outside hospital environments. International comparisons illustrate how clearer credentials and development pathways can strengthen specialist identity. The article concludes that reframing social care nursing as part of the community nursing workforce is essential to improving professional recognition, education pathways, workforce sustainability and the quality and safety of care.
Cardiac autonomic regulation has been proposed as a critical psychophysiological linkage supporting cognitive and social cognition. While heart rate variability biofeedback (HRVB) has demonstrated robust effects on stress reduction, its potential role in supporting social cognition-particularly theory of mind (ToM)-and the underlying psychophysiological mechanisms remain unclear. This randomized controlled trial examined the effects of a six-session HRVB intervention with preset-paced breathing on social cognition and executive functions in young adults with high perceived stress, and explored whether HRVB-induced changes in cardiac autonomic activity may serve as a psychophysiological mechanism linking the intervention to improvements in social cognition beyond executive function changes. As a manipulation check, participants receiving HRVB (n = 32) showed significant reductions in heart rate, respiratory rate, and perceived stress, accompanied by increased cardiac parasympathetic activity and decreased cardiac sympathetic activity, compared with the control group (n = 32). Significant group × time interaction effects were observed for distinct ToM performances, as well as for executive functions. Importantly, exploratory parallel mediation analyses further revealed that HRVB-induced changes in cardiac autonomic activity mediated improvements in overall ToM performance, whereas changes in cardiac sympathetic activity uniquely mediated improvements in cognitive ToM, even after controlling for executive function changes. Together, these findings provide intervention-based evidence suggesting that HRVB-induced modulation of cardiac autonomic activity is associated with a psychophysiological mechanism preferentially supporting social-cognitive function-particularly ToM-beyond executive control. HRVB may therefore represent a promising psychophysiological intervention for enhancing social-cognitive function in stress-vulnerable and high-arousal populations.
This article explores frailty and its links to loneliness and social isolation among older adults and the key role of district nurses in community-based early identification and management. Frailty, often linked with loneliness and social isolation, increases the risk of hospitalisation and adverse outcomes. Current assessment tools, such as the Rockwood Clinical Frailty Scale, may inadequately address the multidimensional nature of frailty. The author suggests combining the Edmonton Frailty Scale with the University of California, Los Angeles Loneliness Scale for a more holistic approach, alongside enhanced education to improve district nurses' confidence and skills. The article highlights the potential of social prescribing as a valuable non-clinical intervention to reduce loneliness and social isolation, and to support wellbeing. With a UK-wide policy shift towards community care, equipping district nurses with relevant evidence and resources, in conjunction with education, is essential to improve care quality, reduce hospital admissions and promote healthier ageing in the older population.
Problematic smartphone use among adolescents is a growing public health concern closely associated with psychological distress and loneliness. Effective, culturally grounded, school-based interventions are needed. The aim of this study was to assess the effects of a 12-week program combining traditional social sports games and mental exercises on smartphone addiction, nomophobia, psychological distress, and loneliness in adolescents. In this randomized controlled trial, 69 school-recruited Tunisian adolescents (aged 14-16 years) with clinically elevated smartphone addiction scores were assigned to an experimental group (n=36, 52.2%) or a control group (n=33, 47.8%). The experimental group received a 12-week intervention comprising 4 weekly sessions integrating traditional social sports games with mental exercises, whereas the control group continued standard physical education. Outcomes (smartphone addiction, nomophobia, psychological distress, and loneliness) were assessed at baseline and after the intervention using scales validated in Arabic. Linear mixed-effects models adjusted for age, sex, and BMI revealed significant group × time interactions of moderate magnitude across all outcomes (P<.05 in all cases) favoring the experimental group. Adjusted postintervention comparisons confirmed significantly lower scores in the experimental group for smartphone addiction, nomophobia, psychological distress, and loneliness (P<.05 in all cases; partial ηp2=0.08-0.12). Mediation analysis indicated that reductions in loneliness accounted for 34.4% of the intervention's effect on smartphone addiction, consistent with partial mediation. A culturally adapted, school-based intervention combining traditional social sports games and mental exercises significantly reduced problematic smartphone use and improved psychological well-being. The partial mediation through reduced loneliness highlights the critical role of social connectedness in adolescent digital health interventions.
Mental health disorders affect around one in seven adolescents globally. In India, home to one-fifth of the world's adolescent population, attention to adolescent mental health is increasing, but access to care remains limited, particularly for Adivasi (Indigenous) adolescents. Understanding how Adivasi adolescents conceptualise psychosocial distress and the kinds of support they value is essential to design supportive interventions. We conducted a qualitative study in rural West Singhbhum, Jharkhand. Using purposive sampling, we recruited 88 participants: 53 adolescents aged 10-19 years, 13 teachers, 11 parents, three community health workers, and eight mental health programme staff aged 18-25 years. Trained peer interviewers conducted semi-structured interviews and group discussions with adolescents in the Ho Adivasi language. A team including experienced Ho researchers and peer interviewers analysed data using the Framework approach. Adolescents, parents, and teachers used variations of the Ho root word "udu" to describe distress. "Udu" denoted thoughts or worries, depending on context. Sources of "udu" included family responsibilities and societal expectations that grew with age: girls were expected to do household work and received less support for school, while boys described income-earning pressures and a lack of emotional outlets. Other "udu" causes included violence at home, school, and public spaces, as well as family separation through migration, remarriage, or parental loss. Impacts of severe "udu" ranged from social withdrawal and strained relationships to early marriage, migration for work, and suicide attempts. Adolescents experiencing "udu" preferred informal support from friends, siblings, or teachers, while those with experience of help from respectful community health workers or trusted, trained older peers valued these. Group-based support was widely acceptable. Strengthening access to early care, alongside measures supporting family livelihoods and social protection, could improve Ho and broader Adivasi adolescent mental health.
During pregnancy, estrogen levels rise dramatically, but quickly drop to prepartum levels following birth and remain suppressed until ovulation resumes. This "postpartum estrogen withdrawal" state has been linked to changes in the brain and behavior in humans and rodents. Previous research has demonstrated that following a hormone-simulated pseudopregnancy (HSP), an experimental model of postpartum estrogen withdrawal, female mice show increased anxiety-like behaviors and decreased social motivation. Further, these behavioral changes occur concurrently with an increase in ∆FOSB, a transcription factor associated with stable long-term plasticity, in the nucleus accumbens core. To test whether this increase in ∆FOSB is required for these behavioral changes, we used a viral-mediated gene transfer approach to prevent ∆FOSB-mediated transcription in the NAcC during HSP and found that it reduced the high-anxiety behavioral phenotype in estrogen-withdrawn females. However, preventing ∆FOSB-mediated transcription had little effect on social motivation. Together, these results suggest that postpartum estrogen withdrawal increases ∆FOSB in the NAc core to impact anxiety-like behaviors but not social motivation following estrogen withdrawal.
While pediatric liver transplantation has markedly improved long-term survival, adult outcomes remain insufficiently explored beyond graft function, particularly regarding mental health and disease understanding-key dimensions of meaningful survival. To this aim, we evaluated psychosocial, behavioral, and lifestyle outcomes of adults who received a liver transplant during childhood, using validated tools. Fifty adult patients transplanted before 18 years of age at Cliniques Universitaires Saint-Luc completed an anonymous online questionnaire including measures of anxiety (STAI-Trait), depression (BDI-SF), and alcohol use (AUDIT), as well as questions on lifestyle, treatment adherence, and disease knowledge. The results showed that clinically relevant anxiety and depressive symptoms were reported in 49% and 33% of respondents, respectively. Problematic alcohol use was found in 8% of participants, and 24% reported never receiving medical counseling about alcohol risks. Only 31% could correctly explain the pathophysiology of their liver disease, and 36% were unaware of its transmissible genetic nature. Despite these challenges, 76% were professionally or academically active. These findings highlight the persistence of high psychological distress and limited disease understanding into adulthood, supporting the integration of mental health screening and patient education into long-term post-transplant care.
Studies have found that behaviors, beliefs, and emotions can be socially contagious and spread between students. Qualitative research suggests that this may apply to school-related stress as well, but quantitative evidence remains limited and potentially sensitive to methodological choices. This study investigated (1) whether individual students' school-related stress is influenced by their classmates' stress, and (2) to what extent estimates of such influence vary depending on different methodological choices. Panel data from two cohorts of Swedish secondary school students (51.7% girls; Mage wave 1 = 13.0, SD = 0.18; Mage wave 2 = 16.0, SD = 0.19) were used. Data were analyzed using multiverse analysis, systematically varying the type of statistical model (unit fixed effects, lagged dependent variable, prospective cohort, and school fixed effects models), measurement of stress (continuous vs. dichotomized), operationalization of classmates' stress, sample restrictions, and control variables. Of 9,240 model specifications, approximately 80% yielded positive stress contagion effects. However, these were generally small (standardized effects: 0-0.15; odds ratios: 1-1.2) and mostly non-significant, and the size as well as sign of the effects varied substantially across model types. The findings suggest that stress appears to be driven primarily by other factors that may cluster within schools or classes but that contagion per se is probably less important. Reducing school-related stress requires direct intervention focused on concrete and institutional stressors in school rather than targeting direct interpersonal stress transmission. The overall fragility of the estimated contagion effects underscores the importance of methodological transparency and systematic robustness analyses.
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Identification of adolescent e-cigarette use could inform prevention and intervention programming and reduce associated consequences. One way to predict those engaging in use is by examining social media profiles and metrics. Most studies examining substance use content on social media employ self-report or human coding that have methodological limitations. Thus, the current study developed a supervised machine learning algorithm to classify participants into e-cigarette use categories based on Instagram metrics. Participants (n = 67, Mage = 18.27; 64.2% female, 82.1% Hispanic/Latino[a/x], 91% White) in the study provided their Instagram data downloaded through the app. Instagram metrics (i.e., number of followers, number following, number of liked comments, number of liked posts, number of posts, and number of messages) were extracted and included as input features in the model. Adolescents reported their e-cigarette use on a self-report measure. A classification tree method was used to classify participants as engaging in e-cigarette use or not. Data was partitioned into a training and test set using stratified sampling. All analyses were performed in Python. Three input features (number of followers, number of liked posts, and number of messages) were selected through hyperparameter-optimized feature selection. The final model accurately detected e-cigarette use 71% of the time. Findings indicate that supervised learning can predict adolescent e-cigarette use with accuracy consistent with other clinical populations. This study establishes that universal aspects of social media may be harbingers for policy makers and tech companies to provide targeted support and messaging.
Maternal anger, an intense and often stigmatized emotional experience, has been associated with postpartum mood and anxiety disorders. This biomedical lens obscures its relational and sociocultural roots and remains understudied in psychological and sociological literature, especially from a qualitative stance contextualised in an LMIC. Drawing on Benjamin's feminist psychoanalytic theory and Bronfenbrenner's social-ecological model, this study explores maternal anger as a meaningful, biopsychosocial response to relational ruptures and systemic inequities in an Indian context. Vignettes of two urban Indian mothers from diverse backgrounds were chosen to present their lived experiences with maternal anger. Their in-depth, semi-structured interviews were analyzed using the Interpretive Phenomenological Approach. A relational-intersubjective lens guided attention to mutual recognition/ruptures and affective attunement/misattunement, while the social-ecological model mapped influences across the nested systems. The first theme that emerged was Experience of Anger in Relational Qualms, which included the sub-themes of Betrayal and Abandonment in Intimate Relationships and Erasure of their Personhood. The second theme, Socio-cultural Experience of Anger, consisted of Emotional Burden of the Care and Lack of Support, Suppression and Silence, and Intergenerational Scripts. Reconceptualising maternal anger at the intersection of interpersonal and systemic pressures reframes it from pathology to protest. It becomes an embodied critique of relational, gendered and systemic inequities and calls for perinatal mental health interventions that honor mothers' emotional realities. By depathologizing maternal anger, the lived experiences of the two urban Indian mothers contribute novel insights to maternal mental health and underscore the necessity of feminist, context-sensitive approaches in research and care.
Examining the relationship of HIV stigmatisation in different social settings with internalised HIV stigma, loneliness and depression among people with HIV, may help in further understanding HIV stigma and informing approaches and interventions to help to mitigate the impacts. The aim of this paper was to investigate among heterosexual men and women, a devised conceptual model of hypothesized causal connections between socio-demographic, HIV-related and psychosocial factors, measures of HIV stigmatisation, and depressive symptoms, in which feelings of loneliness because of HIV are theorised to mediate the relationship between internalised HIV stigma and depression. This was investigated using structural equation modelling (SEM) and data from Positive Voices, a national cross-sectional study of people living with HIV in the UK (2022-2023). The analysis is based on participants who identified as heterosexual and were cis-gender (N = 1232). The mean age was 52 years; 48.5% were Black African, and 39.0% of white ethnicity. Twenty percent of participants were diagnosed with HIV within the last decade (2014-2022). Overall, 51.6% and 35.2% agreed or strongly agreed with the statements 'I am ashamed of my HIV status' and 'I have poor self-esteem because of my HIV status' respectively; 57.9% (n = 713/1232) agreed/strongly agreed with either item and were classified as positive for internalised HIV stigma. For the measure of having felt isolated/lonely because of HIV, the prevalence of responding with 'yes, in the last year' or 'yes, but not in the last year' was 14.2% and 11.7% respectively. The prevalence of depressive symptoms was 18.6% (PHQ-9 score ≥10). The data were consistent with the devised conceptual model. Of the factors investigated to be directly associated with internalised HIV stigma, the largest Beta coefficient was for the association with HIV stigmatisation in healthcare (Beta = 0.600; p < 0.001). The second largest was for having felt scared to be in public places because of HIV in the last year (Beta = 0.271; p < 0.001), closely followed by HIV stigmatisation from family (Beta = 0.269; p < 0.001). Of the factors investigated to be directly associated with depression, the largest Beta coefficient was for the association with having felt isolated/lonely because of HIV (Beta = 0.492; p < 0.001). The second largest was for the inverse association with resilience (Beta = -0.288; p < 0.001), followed closely by financial hardship (Beta = 0.267; p < 0.001), having 'told most people in my life that I have HIV' (Beta = 0.267; p < 0.001), and the inverse association with supportive network (Beta = -0.202; p < 0.001). The largest Beta coefficient for direct effects was for the association between internalised HIV stigma and having felt isolated/lonely because of HIV (Beta = 0.842; p < 0.001). Internalised HIV stigma was associated with depression indirectly through having felt isolated/lonely because of HIV (indirect Beta = 0.415; p < 0.001). Our findings add to existing literature by implicating a number of key factors that upon intervention may help prevent or attenuate symptoms of depression in people living with HIV, including reducing stigmatisation in healthcare, internalised HIV stigma, and loneliness/social isolation.
Understanding the multifactorial drivers of cardiovascular disease (CVD) risk in LGBTQ+ populations is critical to advancing equitable cardiovascular care. To evaluate and synthesize empirical evidence on factors influencing CVD risk among sexual minority populations. A systematic review was conducted following PRISMA guidelines. Five databases (PubMed, Scopus, MEDLINE, ScienceDirect and ProQuest) were searched for studies published between 2019 and 2024 that examined CVD risk factors among LGBTQ+ adults. Eligible studies were appraised using the Joanna Briggs Institute critical appraisal tool, and findings were synthesized using a convergent integrated approach. Twenty studies met the inclusion criteria, most of which were cross-sectional and conducted in high-income countries. Identified CVD risk factors were classified into six domains: behavioural (e.g., nicotine use, health behaviours, substance use), blood biomarker (e.g., lipid or total cholesterol, HbA1c, C-reactive protein), physical (e.g., BMI, blood pressure, age), comorbidities (e.g., metabolic syndrome, COPD, HIV), psychological (e.g., positive and negative factors) and social (e.g., discrimination, loneliness, marital status). Bisexual, lesbian and gay individuals were most frequently represented. Across studies, minority stress and adverse social determinants were consistently associated with elevated CVD risk. Sexual minority populations face disproportionate cardiovascular risk shaped by behavioural, biological and psychosocial stressors. These findings highlight the need for inclusive, culturally competent nursing practice and identity-informed screening strategies. Nurses should integrate sexual orientation and gender identity into cardiovascular risk assessments, adopt trauma-informed and resilience-promoting approaches, and advocate for policies that reduce structural barriers to equitable care. No patients or members of the public were directly involved in the design, conduct or reporting of this systematic review.
Healthy aging has emerged as a global priority. However, older adults' participation in health promotion programs remains low, and traditional health promotion models have achieved limited success in fostering sustained engagement among this population. Mobile health (mHealth)-based gamification interventions offer a promising way to address these challenges. However, no published reviews support or oppose the use of mHealth-based gamification interventions as health promotion strategies in older adults. The study aimed to identify mHealth interventions using gamification to promote health among older adults. Our scoping review was conducted following the Joanna Briggs Institute recommendations for scoping reviews and Arksey and O'Malley's framework. The process followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklist. A comprehensive literature search was conducted across 8 databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, CINAHL, PsycARTICLES, and IEEE Xplore Digital Library, from their inception to December 10, 2025. Two reviewers independently screened titles, abstracts, and full texts via Rayyan, with disagreements resolved by a third reviewer. This scoping review identified 11 studies. Only 1 article was published before 2022. The interventions were found to improve enjoyment and motivation (n=5), cognitive function (n=3), physical activity (n=2), and digital literacy (n=2). Individual studies also reported improvements in mental health (n=1) and adherence (n=1), a reduction in suicidal ideation (n=1), improvements in physical function (n=1), the promotion of social engagement (n=1), and the identification of mild cognitive impairment (n=1). Game elements used were ranked by frequency as progress, challenges, goals, levels, reward, sensation, storytelling or narration, leaderboard, surprise, and avatar. No research was found to use the game element of "social sharing." mHealth types included augmented and virtual reality-based training systems, wearable devices, mobile phones, tablets, and Windows platforms and devices. Notably, only 4 studies applied theoretical frameworks, and 3 omitted the concrete approach to gamification. As the first scoping review to identify and map mHealth-based gamification interventions for older adults, this study highlights their potential as an innovative approach to health promotion. By systematically synthesizing evidence regarding intervention designs, gamification strategies, and preliminary health outcomes, it establishes a foundation for future inquiry. However, this review is limited by the small number of included studies, precluding broad generalizations. Future research should assess long-term impacts, integrate theoretical frameworks, establish reporting guidelines, design personalized social-interactive interventions, and expand to broader health domains. Ultimately, these insights provide targeted guidance for developing age-appropriate digital health solutions, contributing to the realization of active aging.
Vision impairment is increasingly recognised as a complex condition shaped not only by ocular pathology but also by cognitive, psychological, social and environmental factors that influence participation and quality of life. In line with the United Nations Convention on the Rights of Persons with Disabilities and the International Classification of Functioning, Disability and Health, contemporary vision rehabilitation frameworks adopt a biopsychosocial perspective that extends beyond treatment of the eye condition alone toward holistic support to improve the lives of individuals with vision loss. An overview of the effectiveness and future directions of multidisciplinary vision rehabilitation in clinical practice is presented, and a summary of the findings concerning the international standards of vision rehabilitation, focusing on adults. Furthermore, some examples of achievements in emerging fields are presented, such as neuroplasticity and visual system recovery, technological interventions and psychosocial support, including their future directions. Multidisciplinary models are widely supported but remain difficult to implement because of limited resources, workforce constraints and differences in culture and health policy. Overcoming these barriers is critical to expanding and strengthening multidisciplinary vision rehabilitation. The evidence highlights the need for implementation-focused research, closer collaboration across disciplines and core outcome measures that capture participation, mental health and quality of life, not just impairment. The overview also points to the importance of structured models that integrate neurorehabilitation (artificial intelligence-based) technology and mental healthcare while adapting to regional and cultural contexts. Embedding multidisciplinary vision rehabilitation within health systems is both a clinical necessity and a prerequisite for advancing global commitments to inclusion and equity for people with vision impairment. As population ageing and global demographic change are expected to increase the absolute numbers of adults with vision loss, strengthening collaboration between research, clinical practice and service delivery will be essential to further improve the quality of life of individuals with vision loss.
Mobile health (mHealth) apps improve healthcare providers' accurate disease classification in resource-limited settings. Ethiopia recently introduced the National Health Data Dictionary (NHDD) mobile app for disease classification; however, healthcare providers' awareness of it remains unknown. This study aimed to assess awareness of mobile-based disease classification apps among healthcare providers working in public health facilities in northwest Ethiopia and to determine the factors associated with this awareness. A facility-based cross-sectional study was conducted among 423 healthcare providers working at 19 public health facilities in northwest Ethiopia from October 1 to 25, 2023. Data were collected using a pre-tested self-administered questionnaire. Awareness was defined as being aware of the existence of a mobile app (NHDD) for disease classification. Multilevel logistic regression analysis was used to account for clustering at the health facility level. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was used to identify associated factors. Only 30.73% (95% CI: 26.30%-35.55%) of healthcare providers were aware of a mobile-based app for disease classification. Healthcare providers having social media accounts (AOR = 13.96; 95% CI: 2.33-83.64), ever visited the medical field by a mobile phone (AOR = 2.39; 95% CI: 1.03-5.51), digital literacy (AOR = 6.13; 95% CI: 1.50-25.01), awareness of the ESV-ICD-11 booklet on paper (AOR = 2.34; 95% CI: 1.06-5.18), and access to ESV-ICD-11 training or mentorship (AOR = 2.93; 95% CI: 1.25-6.87) were factors associated with awareness. About one-third of healthcare providers are aware of the mobile-based disease classification app. Social media use, digital literacy, prior mobile use for the medical field, familiarity with the paper-based ESV-ICD-11 booklet, and ESV-ICD-11 training or mentorship were associated factors with awareness. Targeted awareness creation interventions could be considered to support the success of mobile-based app implementation in Ethiopia.
Symptoms in chronic obstructive pulmonary disease (COPD) commonly co-occur as 'symptom clusters', yet little is known about how patients interpret and make sense of these experiences. This study aimed to explore the meanings patients with COPD attribute to symptom clusters, their impact on health-related quality of life, and the strategies used to manage them. A qualitative study using semi-structured interviews was conducted with a purposive sample of 30 patients with COPD recruited from a university teaching hospital in China. Data were analysed using the Framework approach, informed by the Theory of Unpleasant Symptoms and the concept of biographical disruption. Three interrelated themes were identified. First, participants understood symptom clusters as dynamic, interacting experiences, often organised around "trigger symptoms" (e.g., cough precipitating breathlessness and fatigue), rather than as isolated symptoms. Second, these clusters disrupted multiple dimensions of everyday life, including physical functioning, social participation, and sense of self. Third, participants actively negotiated symptom burden through a range of adaptive strategies, prioritising symptoms based on their perceived meaning and impact rather than clinical severity. These findings highlight how symptom experiences are shaped by both physiological interconnections and personal interpretations. This study provides novel insight into how people with COPD experience symptom clusters as interconnected, meaning-laden phenomena. Recognising the role of "trigger symptoms" and patients' subjective prioritisation of symptoms has important implications for person-centred assessment and supports the development of targeted, mechanism-informed approaches to symptom management in COPD. I can't walk long distances. I can't go out and spend time with my friends. This is a big problem in my life. (69-year-old male, GOLD stage III) Other people can run around. They visit relatives or friends during the holidays. I can't. I cough all day long and can only stay at home. (63-year-old female, GOLD stage IV).