Although racially minoritized youth with disabilities participate less often in leisure activities than their white peers, their perspectives of participating in activities is under-explored. This study examined how racially minoritized youth with disabilities experience leisure and identified barriers and facilitators that influence their participation. We used a qualitative design informed by a constructionist epistemology and conducted semi-structured interviews with 15 racially minoritized youth with disabilities (aged 15-24 years, mean age 19.9 years) living in Ontario. Data were analyzed using inductive reflexive thematic analysis. Our analysis highlighted three themes: (1) cultural and familial influences (i.e., understandings and definitions of leisure, expectations and support, and discrimination); (2) interpersonal factors in leisure participation (i.e., leisure provider behavior and interactions); and (3) youth recommendations for reducing barriers to leisure participation (i.e., program design, provider training). Youth described these factors as both barriers and facilitators to participation. Multiple cultural, familial, and interpersonal factors influence leisure participation among racially minoritized youth with disabilities. These findings offer guidance for recreation providers designing inclusive programs and services. Leisure participation can play a critical role in enhancing social inclusion and supports the wellbeing of racially minoritized youth with disabilities.Racially minoritized youth with disabilities face intersecting barriers related to race, gender, and disability that can affect their access to and participation in leisure activities.Inclusive, flexible programs, and well-trained leisure providers are essential for creating environments that challenge ableism and racism and promote equitable participation.Rehabilitation clinicians should collaborate with leisure providers and community organizations to promote culturally safe, anti-ableist, and inclusive environments for racially minoritized youth with disabilities.
Knee osteoarthritis (OA) is a prevalent condition and public health concern. Guidelines recommend non-surgical treatments - such as education, exercise and weight management - as core elements of OA management; however, uptake remains low. General practitioners (GPs) play a crucial role in delivery, yet little is known about how GPs navigate OA treatments in the Scandinavian context. To explore Danish GPs' perceptions and experiences of knee OA management, focusing on treatments and referral, and to identify key barriers and facilitators to delivering guideline-recommended treatments. Twelve semi-structured online interviews were conducted with GPs and GP trainees. Participants were recruited through a combination of convenience and self-selection sampling. Data were analyzed inductively using thematic analysis. Four themes were identified: (1) knowledge and practice extend beyond guidelines, (2) non-surgical treatments are limited and inconsistently provided, (3) conceptual and relational tensions are negotiated and (4) fostering patient motivation is challenging. GPs displayed generally up-to-date knowledge of core non-surgical treatments, although familiarity with referral criteria was more variable. They held positive attitudes toward exercise and physiotherapy-led treatment, but experienced limited active dissemination of guidelines. Structural barriers, including fragmented pathways and uneven municipal services limited delivery of non-surgical treatments. Weight loss was viewed as effective in relieving joint pain but an unsustainable treatment focus, highlighting the need for a feasible, weight-inclusive approach to weight management. Strengthening cross-sector coordination, developing and implementing multidisciplinary OA services as well as clarifying where responsibility for fostering patient motivation should be placed, may enhance delivery of non-surgical care.
The ageing of world population is simultaneously a great triumph and a great challenge. It is crucial to adapt health care systems to older population and community pharmacies are not an exception. This study aims to identify barriers and facilitators perceived by pharmacy professionals, that may influence older patients' counselling in community pharmacy. Four focus groups were conducted with 18 pharmacy professionals with at least three years of professional experience in community pharmacy and who were currently working in community pharmacies in Portugal. The meetings were held via Zoom. The audio was recorded, the interviews were transcribed ad verbatim and the data were managed using NVivo (version 15). Three main themes emerged: barriers centered in older adults, centered in physical space and centered in pharmacy professionals. Twelve categories emerged from the data analysis. Literacy, aisles and access and time management were most mentioned categories of each theme, respectively. Also, several facilitators were identified, which were organized according to the same three themes, with an additional one, facilitators centered in society. Ten categories were identified. Human skills, sitting attendance, skills and management of prescriptions were the most cited ones of each theme, respectively. This study demonstrate that it is urgent to involve community pharmacies into age-friendly initiatives, to create safe environments for older population which is one of the most frequent patients in community pharmacies. The project was approved by the Ethics Committee of School of Health of Polytechnic of Porto (reference number CE0084B).
Completion of curative intent radiation for locally advanced cervical cancer (LACC) within 56 days is independently associated with improved outcomes. This study characterizes barriers to care among patients with LACC completing timely definitive treatment with external beam radiotherapy (EBRT) and brachytherapy (BT) boost. Patients treated with curative intent radiation therapy from 2005-2021 at a tertiary care center were retrospectively reviewed, with patient and treatment characteristics being recorded. Multivariate risk analysis of clinical, sociodemographic, and geographic factors yielded a prognostic point-based "LACC-PRO" scoring system. 325 patients with LACC treated with EBRT and BT were analyzed. Prolonged treatment time was associated with non-Hispanic ethnicity (p = 0.002), ECOG ≥ 1 (p < 0.001), current smoking (p = 0.002), lack of insurance coverage (p = 0.025), para-aortic nodal coverage (p = 0.015), lack of pre-BT imaging (p = 0.034), and non-primary site EBRT location (p = 0.005). Total scores on the predictive nomogram ranged from 0-18 (median 7). Among 140 patients with scores >7, 53.6% experienced prolonged treatment compared to 17.8% of the 185 patients with scores ≤7. Clinical and sociodemographic factors detrimentally impact timely completion of definitive radiation for LACC patients. A predictive nomogram may help identify patients at risk for prolonged treatment time. These results require validation in a larger cohort.
To investigate the factors influencing exercise intention among the people after stroke by developing a comprehensive causal model. This study is the first to examine the factors influencing exercise intention among people after stroke using the Health Action Process Approach (HAPA) theory and structural equation modeling. Data were collected from 299 people after stroke. Perceived benefits and barriers to exercise were evaluated with the Exercise Benefits/Barriers Scale (EBBS). Exercise self-efficacy was assessed using the Exercise self-efficacy scale. Exercise intention was assessed using the Exercise Intention Scale. People after stroke's EBBS score was (112.54 ± 13.67); exercise self-efficacy score was (41.68 ± 10.95); and exercise intention score was (14.41 ± 3.48). The total score of EBBS was positively correlated with the total score of exercise self-efficacy and the total score of exercise intention (r = 0.623, 0.681, both P < 0.05), and the total score of exercise self-efficacy was positively correlated with the total score of exercise intention (r = 0.646, P < 0.05). Structural equation modeling showed several causal pathways. Perceived barriers to exercise had an indirect effect on exercise intentions through exercise self-efficacy (β = -0.183, 95% CI -0.286 to -0.101, P < 0.05). Perceived benefits to exercise not only directly affected exercise intentions (β = 0.246, 95% CI 0.073 to 0.424, P < 0.05), but also indirectly affected exercise intentions through exercise self-efficacy (β = 0.152, 95% CI 0.084 to 0.231, P < 0.05). Additionally, perceived benefits and perceived barriers to exercise negatively influenced each other (β = -0.681, P < 0.05). The perceived benefits and barriers to exercise, exercise intention and exercise self-efficacy level of people after stroke need to be improved. Among them, the influence of exercise self-efficacy on exercise intention is the most significant. Consequently, attention and active measures should be directed toward improving exercise self-efficacy in this population, as this would increase their exercise intention and reduce the risk of relapse.
Artificial intelligence (AI) is increasingly integrated into radiology, but pediatric imaging remains underrepresented in implementation studies. To assess the current status, barriers, and enablers of AI adoption in Pediatric Radiology from a global leadership perspective. A cross-sectional international survey of department leaders and division chiefs from pediatric radiology centers worldwide was conducted. The questionnaire included 14 items across domains of AI deployment, enablers, barriers, ethical concerns, stakeholder involvement, and future directions. Descriptive statistics were used for analysis. Eighteen institutions completed the survey (69% response rate). Sixteen centers (88.9%) reported implementing at least one AI tool, with bone age assessment remaining the most widely used application (44.4%). Other applications included image segmentation and quantification (22.2%), imaging protocol optimization (16.7%), and natural language processing (16.7%). The mean clinical impact rating was 3.56/5, with only 16.7% describing AI as "transformational." The most frequently cited barriers were lack of pediatric-specific datasets (83.3%), integration challenges (66.7%), high cost or unclear return on investment (ROI) (50%), and cybersecurity concerns (44.4%). Enablers were primarily human rather than technical, with vendor maturity and integration (72.2%) and internal champions (66.7%) most frequently highlighted. Regional variation was observed, with NLP/reporting clustered in North America and transformational impact ratings concentrated in the Asia-Pacific centers. A slim majority (55.6%) agreed that pediatric AI research currently overemphasizes model development over clinical integration, ethics, and sustainability. Global pediatric radiology leaders report cautious but growing AI adoption. Addressing pediatric data scarcity, enhancing multicenter collaboration, and prioritizing clinical integration and sustainability will be essential for safe and effective deployment. Question How are leading pediatric radiology centers worldwide implementing AI, and what institutional barriers and enablers determine successful clinical integration? Findings Most centers deploy at least one AI tool, but perceived impact remains modest due to pediatric data scarcity and workflow integration challenges. Clinical relevance Addressing pediatric-specific dataset limitations through multicenter collaboration, empowering institutional AI champions, and prioritizing clinical integration over model development alone will be essential for ensuring AI benefits children as effectively as adults.
Building on the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework, the "F-words for Child Development" (Functioning, Family, Fitness, Fun, Friends, and Future) provide a holistic, strengths-based perspective on child development and have been adopted by many organizations. This study explores family caregivers' knowledge, attitudes, uses, and perceived barriers and facilitators to using the F-words to support their children's habilitation. Family caregivers receiving services from four Canadian children's developmental and rehabilitation service organizations completed an online survey with Likert-scaled and open-ended questions. Quantitative and qualitative data were analyzed descriptively and through content analysis, respectively. Findings show families (N = 58) are supportive of the F-words and value their holistic, strengths-based, and family-centred approach. They also face barriers using the F-words including limited F-words knowledge, mixed attitudes (e.g., preference for biomedical approach), and practical challenges within their respective organization. To facilitate use, family caregivers identified direct support is needed from service providers and organizations. Families value the F-words but may face barriers, limiting their use. Implementation should prioritize family-facing strategies (e.g., co-designed tools used with families in services) and consistent integration across health care services, education, and community settings. Families value and support the F-words, but face barriers in using them including limited knowledge of how to use the F-words in their lives and with service providers.System-level supports, including broader organizational support and service provider use of the F-words with families are needed for successful implementation.Collaborating with families is essential to ensure F-words implementation remains meaningful, accessible, and family-centred.
Virtual reality (VR) exercise may help promote physical activity in cancer survivors. Understanding infusion-specific barriers and facilitators is essential for designing effective interventions that can be integrated into chemotherapy care. This study explored adult cancer survivors' perceptions and preferences regarding VR exercise during chemotherapy infusion. This exploratory concurrent mixed-methods study included community-dwelling adults (≥ 18 years) who had completed primary cancer treatment involving chemotherapy. Participants trialled a commercially available immersive VR exercise program paired with a sensor and seated pedal unit, completed a survey on digital technology confidence and preferences, and took part in a focus group or interview to discuss VR exercise during infusion. Qualitative content analysis was used to analyse transcripts. Eight cancer survivors (6 female; mean age 63.6 ± 8.3 years) participated. Most reported being confident (87%) and comfortable (75%) using digital technologies. All participants enjoyed the VR exercise and indicated they would have used it during chemotherapy if available. Positive perceptions included mental wellbeing benefits, distraction, relaxation, and potential enhancement of drug circulation. Participants also identified negative aspects of the experience and potential barriers to implementation, such as cold caps, risk of cannula dislodgement, space constraints, and infusion‑chair suitability. This study provides the first insights into cancer survivors' perceptions of immersive VR exercise during chemotherapy infusion. Findings highlight both the promise and practical considerations of integrating VR exercise into infusion care and represent an initial step toward developing a tailored VR exercise intervention for use during chemotherapy.
Unlike nursing and dentistry, pharmacy lacks a dedicated institute within the National Institutes of Health (NIH) to support its research and training needs, despite having many NIH-funded researchers within Colleges and Schools of Pharmacy (C/SOP). As a result, C/SOPs must compete across all NIH institutes for institutional (T-series) as well as individual (F-series) training grants. In 2024, the Council of Deans of the American Association of Colleges of Pharmacy (AACP) tasked a working group with assessing C/SOP participation in NIH-funded institutional training programs. Reviewing NIH RePORTER data from fiscal year 2024, we identified 26 institutional T32 training grants awarded to 18C/SOP, with most funding focused on pharmacology, toxicology, and chemical biology. Examining data for distribution of funding, we observed that 61% of training grants were awarded to schools of medicine while only 1% went to C/SOPs. We identified barriers that reduce pharmacy participation, which include the absence of dual Doctor of Pharmacy (PharmD)/Doctor of Philosophy (PhD) degree programs, in which research and clinical training are fully integrated and time to both degrees is shortened. Other barriers include a lack of education about how to develop training programs that are competitive for NIH T32 training grants. The task force developed a set of recommendations that include AACP sponsoring a training grant writing program and advocating for funding pharmacist-scientist training programs. This may be particularly important for pharmacy-related fields such as pharmacoepidemiology, pharmacoeconomics, and implementation science.
Students from low-income and underrepresented backgrounds face structural barriers to entering medicine, including limited access to early clinical exposure, physician guidance, and professional networks. To address these disparities, medical students at the Warren Alpert Medical School of Brown University created a year-long Clinical Mentorship Program (CMP) for high school students in Woonsocket, Rhode Island. The intervention combined monthly after-school instruction on basic science content and clinical skills by medical students with structured hospital-based shadowing and guided discussion with resident physicians. Using a mixed-methods pre-post design, the intervention evaluated changes in educational motivation, clinical self-efficacy, medical knowledge, awareness of other academic enrichment programs, and physician access and comfort. High school students demonstrated significant gains in motivation to attend college, understanding of cardiopulmonary anatomy and physiology, understanding of physician roles, comfort interacting with physicians, self-reported physician access, and awareness of local educational opportunities. Qualitative findings highlighted the importance of experiential learning, guided shadowing, a clearer understanding of medical careers, and persistent structural barriers. These findings suggest that community-based programs that leverage local resources, networks, and infrastructure to combine medical education with guided clinical exposure may be feasible entry points into the medical pipeline for students confronting complex socioeconomic disadvantages.
Graduate medical education trainees increasingly use artificial intelligence tools without formal training. This study quantifies the gap between artificial intelligence exposure and readiness and examines attitudes, preferences, and barriers to guide curriculum development. In 2025, a 4-week cross-sectional survey, consisting of 5-point Likert scale questions, of graduate medical education trainees at a single academic medical center assessed artificial intelligence familiarity, confidence, attitudes, curriculum preferences, and barriers to training. Descriptive statistics, χ2 tests, Spearman correlations, Jaccard similarity analysis, and network analysis characterized response patterns. Of 149 eligible trainees, 69 (48.3%) responded. Of all respondents, 85.5% (n = 59) reported active artificial intelligence tool use, and 2.9% (n = 2) had received formal artificial intelligence instruction. Median familiarity (3 [interquartile range, 3-4]/5) exceeded median confidence (3 [interquartile range, 2-3]/5) (P = .02), with 38.5% of high-familiarity trainees reporting low confidence. Trainees uniformly preferred postgraduate year-1 introduction (65.2%) and longitudinal curricula (62.3%), with no differences by training level or specialty. Barrier co-occurrence analysis revealed institutional support and faculty expertise deficits clustered strongly (Jaccard = 0.74). Network analysis identified efficiency beliefs as the central attitudinal hub. Graduate medical education trainees demonstrated high artificial intelligence exposure but low confidence, with formal training being rare. The familiarity-confidence gap suggests that passive exposure does not confer confidence. Uniform curricular preferences support standardized, cross-specialty implementation. Addressing institutional support and faculty expertise together, while separately targeting time constraints, may optimize artificial intelligence curriculum adoption.
A theory- and practice-based implementation strategy bundle (ISB) was developed to support physical therapists and dieticians during implementation of the combined lifestyle intervention ProMuscle for community-dwelling older adults in multiple community-care settings. Alongside a 42-week hybrid type III stepped-wedge randomized cluster implementation effectiveness trial, a process evaluation was conducted to explore possible working mechanisms of the ISB on the adoption, reach, and fidelity of ProMuscle by describing a causal pathway. Additionally, barriers and facilitators for the use of the ISB were identified. During the 6-week transitional period in which clusters transitioned from the control to the intervention group and at the end of the 42-week trial, (group)interviews were held with physical therapists and dieticians. Interview guides were informed by the RE-AIM framework and supplemented with quantitative data from surveys and ISB tracking activity. Interviews were transcribed and thematically analyzed. Insights from the process evaluation informed a causal pathway diagram and the identification of barriers and facilitators for the use of the ISB. Twenty-five physical therapists and dieticians were interviewed during the transitional period, and fifteen participated in the group interviews at the end of the trial. The causal pathway diagram revealed that individual factors (knowledge and beliefs about the intervention, convincing others, and networking), and organizational- and system-level factors (facilitation, collaboration, and support) moderated the influence of the ISB on the implementation outcomes. Particularly organizational and system-level factors could not always be addressed by individual professionals. The fidelity of the ISB was low, according to the healthcare professionals, due to timing of receiving the ISB and lack of education on its use. The results highlight the complexity of real-world implementation in multiple community-care settings and address the need for organizational and policy-level facilitation to enhance the implementation, sustainment, and scale-up of lifestyle interventions for community-dwelling older adults. Additionally, low fidelity of the ISB probably contributed to the non-significant effect of the ISB on the adoption of ProMuscle. Future implementation studies should take the timely delivery of an ISB into account and provide adequate education to healthcare professionals about the use of implementation strategies. ClinicalTrials.gov (NCT05672004) registered at 12/07/2022 https://clinicaltrials.gov/ct2/show/NCT05672004.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity in adults and are now gaining attention in pediatric populations facing a dramatic rise of obesity prevalence and related comorbidities. In addition to weight loss, their role extends to cardiometabolic effects and improvements of kidney function. Liraglutide and semaglutide have demonstrated clinically meaningful efficacy in adolescents, leading to FDA and EMA approvals for patients ≥12 years. Ongoing trials are being conducted to combine GLP-1 analogues with other effective molecules or with bariatric surgery. Current evidence on safety most frequently highlights gastrointestinal adverse events, with no consistent impact on growth or pubertal development reported to date. Psychosocial dimensions, including stigma, mental health risks, and potential disordered eating, together with economic barriers and disparities in access, require careful consideration and efforts to be overcome. Implementing intensive lifestyle interventions is mandatory, including nutritional education, physical activity promotion, and family-based behavioral strategies, to support long-term weight management and address the broader determinants of health. Preliminary studies suggest complementary roles for GLP-1RAs alongside metabolic bariatric surgery in selected high-risk patients. Long-term data on safety and multidisciplinary approaches are required to define the optimal integration of pharmacotherapy into comprehensive, family-centered pediatric obesity care models.
Health disparities facing American Indian and Alaska Native (AI/AN) populations warrant effective behavioral health interventions that are grounded in culture and Indigenous worldviews, but AI/AN people remain underrepresented in clinical trials. Rigorous scientific methods are needed to determine the efficacy of new interventions, particularly in small rural communities with high treatment need and low access to care. However, many AI/AN communities prefer study designs that ensure all participants receive an intervention, and logistical constraints, such as small population sizes and limited staffing, can impede fully powered randomized controlled trials. This manuscript presents the Sequential Cohort Randomized Clinical Trial (SC-RCT), a study design developed through an academic-community partnership to test the efficacy of a behavioral intervention for substance use disorders in a rural AI reservation community. The SC-RCT differs from existing staggered rollout designs (e.g., stepped wedge, dynamic wait-listed) by using sequential cohort enrollment with individual-level randomization, allowing sample size to accrue over time while standardizing waitlist duration and intervention dosage across participants. This approach preserves a randomized comparison between immediate and delayed treatment conditions while accommodating staffing and recruitment constraints. The SC-RCT offers a feasible and culturally responsive option when traditional designs are not practical, and may be especially useful in small or under-resourced populations where equitable access and limited implementation capacity are key considerations. In AI/AN and other communities, this design may help overcome logistical barriers to research and support ethical and effective interventions in community settings. Clinicaltrials.gov ID number: NCT05612061.
Despite significant biomedical advances, human immunodeficiency virus (HIV) remains a persistent global health crisis, with over 40 million people affected as of 2023, two-thirds of whom live in the World Health Organization (WHO) African Region. However, from an HIV prevention perspective, the more urgent concern is the continued occurrence of approximately 1.3 million new infections annually, particularly in sub-Saharan Africa and in settings where incidence is stable or increasing. This commentary explores the evolving landscape of HIV prevention, focusing on the trajectory of oral pre-exposure prophylaxis (PrEP), long-acting injectable cabotegravir (CAB-LA), and the newly emerging lenacapavir. While oral PrEP opened new possibilities, adherence challenges have limited its impact. CAB-LA demonstrated superior efficacy but encountered access, cost, and delivery barriers that restricted uptake. Lenacapavir, offering 6-monthly subcutaneous dosing with ≥ 99.9% efficacy in trials, holds the potential to overcome these hurdles. As of May 2026, lenacapavir had received regulatory approval in 17 countries, including several African nations, while regulatory reviews remained ongoing in multiple additional countries, reflecting the rapid global expansion of access to this long-acting HIV prevention option. However, its success depends on clinical promise, timely licensing, affordability, and integration into health systems. Drawing from real-world lessons of oral PrEP and CAB-LA, this paper argues that a proactive, coordinated rollout of lenacapavir could dramatically expand prevention reach. With global stakeholders aiming for 3 million users by 2028 and strategic licensing in 120 countries, the groundwork is in place. The recent release of WHO guidance recommending lenacapavir as an additional PrEP option further strengthens this momentum. Yet, equitable delivery, user-centred models, and strong policy backing will be critical. Ultimately, long-acting PrEP is not just a clinical breakthrough; it is a test of health systems' ability to deliver innovation at scale.
How, where and what to mechanize in African smallholder agriculture are pertinent development questions. We examine the adoption and impacts of smallholder mechanization hire services using survey data from 642 farmers across Kenya, Zambia, and Zimbabwe. For identification, we employ a control-function instrumental variable approach to address the endogeneity of mechanization hiring decisions. The primary drivers of the decision to adopt mechanization include distance to service providers, labor demand, area cultivated, and social capital. Our instrumental variable estimates show that hiring mechanization services was associated with increased household income and maize yields across the three countries. The heterogeneous effects using a control-function quantile regression show that the benefits are highest in the lower quantiles. Hiring mechanization services significantly increased income at the 25th, 50th, and 75th percentiles, with the largest effects concentrated at the lower end of the income distribution, among poorer households. These findings contrast with concerns that agricultural technologies primarily benefit wealthier farmers. These results demonstrate that smallholder mechanization hire services can serve as an effective pathway out of poverty for smallholder farmers. Our findings suggest that expanding service provider networks and reducing economic and geographical barriers can generate substantial welfare gains. This is especially true for vulnerable farmers who can benefit from better connections between service providers and clients. More broadly, mechanization service provision offers a scalable model for increasing agricultural productivity while promoting inclusive growth in smallholder agriculture.
The toxic drug crisis in Canada is increasingly shaped by a complex and unpredictable unregulated drug supply characterized by polysubstance toxicity, including combinations of opioids and sedating agents that can produce prolonged respiratory depression not fully reversed by naloxone alone. Concurrent reductions in harm reduction infrastructure in Ontario, including the closure of supervised consumption services, may be shifting overdose burden into shelter settings, where overdose response capacity often remains limited and inconsistent. In this context, there is growing interest in whether oxygen and supportive respiratory care may strengthen overdose response within shelter environments. We conducted a multi-site qualitative needs assessment across eight shelter sites in Toronto, Ontario. Semi-structured interviews were conducted with shelter staff (n = 17) and clients (n= 17) to examine overdose response practices, perceptions of oxygen use, and barriers and facilitators to implementation of oxygen-based medical directives. Data were analyzed using reflexive thematic analysis. Three themes were identified: (1) oxygen was perceived as a clinically valuable and client-centred intervention, particularly in the context of polysubstance overdoses where naloxone alone may be insufficient; (2) access to oxygen and pulse oximetry supported more structured, consistent, and confident response practices; and (3) training was identified as a critical enabler of effective implementation of oxygen. Participants described oxygen as improving clinical stabilization while also reducing distress associated with abrupt naloxone reversal and supporting more relationally responsive overdose care. Integrating oxygen into shelter-based overdose response may represent a feasible and pragmatic opportunity to strengthen overdose response capacity in high-risk environments. Expanding access to oxygen alongside standardized training, implementation supports, and clear clinical guidance may improve the consistency, equity, and quality of overdose response in shelter-settings.
BackgroundMenstruation can be complex and challenging to manage, including for those with intellectual disability. People with intellectual disability experience additional barriers that prevent adequate access to information and support. Parents play an important role in supporting young people with intellectual disability with menstruation.ObjectivesThe aim of this study was to explore parental experiences and identify areas of complexity associated with menstruation for their young people with intellectual disability to guide the development of priority supports.DesignA qualitative interview study to deeply explore the rich experiences of parents.MethodsParents of young people with intellectual disability were interviewed about their experiences of supporting their child's menstruation, including their decision-making processes and information and management needs. Data were analysed using inductive reflexive thematic analysis with NVivo software.ResultsThe sample comprised 16 parents (all mothers) who discussed 17 young people with intellectual disability (10-25 years). Five themes were constructed: (1) Setting up for success (establishing positive menstruation attitudes), (2) Competing priorities (wellbeing, convenience, and inclusion prioritised over menstruation), (3) Support from multiple avenues (support from different people, professions, and organisations was important) (4) Protecting dignity and safety (concerns about sexual abuse, pregnancy, distress, socially unacceptable behaviours, and pain), and (5) There is more to be done (information and attitudes need to be improved).ConclusionsIt is important to understand the menstruation experiences and needs of parents of young people with intellectual disability because of management uncertainty and complexity. This study contributes to an under-researched field and can inform changes to better support families including much needed information and education. Managing menstruation (period) can be difficult. It can be even more challenging for people with intellectual disability and their families because of limited information and support. Parents play an important role in supporting young people with intellectual disability with menstruation. In this study, we aimed to understand what parents do and what they need to manage menstruation with their young person with intellectual disability. We interviewed 16 parents of young people with intellectual disability about what they do, how they make decisions, and what information and support they need. We analysed the interviews using a reflexive thematic analysis. The information was organised into five themes: (1) Setting up for success (creating positive menstruation attitudes), (2) Competing priorities (wellbeing, community inclusion, and convenience often prioritised over menstruation), (3) Support from multiple avenues (e.g., support from different people, professionals and groups was important), (4) Protecting dignity and safety (concern for sexual abuse, pregnancy, distress, socially unacceptable behaviours, and pain), and (5) There is more to be done (information and attitudes need to be improved). This is important information that can be used to create resources, programs, and practices to better support people with intellectual disability and their families manage menstruation.
Health Technology Assessment (HTA) is vital for evidence-based decision-making and efficient resource allocation. Although HTA has gained importance in Iran's health policy agenda, its development faces major barriers. Among these, conflicts of interest (COI) remain a critical yet understudied challenge that can undermine the integrity of HTA processes. This study explored how COI manifest within Iran's HTA environment and hinder its development. A qualitative design was used, employing purposive sampling to select key informants involved in HTA and health policymaking. Twenty-eight semi-structured interviews were conducted with policymakers, academics, healthcare professionals, and representatives from regulatory and insurance bodies. Data were analyzed thematically using an inductive approach to identify the types, sources, and impacts of COI. Participants described multiple personal, institutional, and systemic COI influencing HTA. Key themes included the lack of formal disclosure and management mechanisms, strong industry influence, overlapping roles of decision-makers, and weak regulatory oversight. These factors distorted priority-setting, delayed the adoption of cost-effective technologies, and eroded public trust. Cultural norms favoring informal relationships and political patronage further reinforced these problems. COI threaten the credibility and transparency of HTA in Iran. Strengthening governance frameworks, ensuring institutional independence, and promoting ethical accountability are essential to enhance HTA integrity. The findings provide insights for other low- and middle-income countries seeking to institutionalize HTA within complex governance systems. This study highlights that managing COI requires not only technical solutions but also interdisciplinary approaches, particularly drawing on legal frameworks and organizational management theories, to address governance failures in Iran's health system.
Irreversible loss of neuronal cells elicited by neurotraumatic injuries or neurodegenerative disorders is particularly devastating due to the limited regenerative capacity of the central nervous system (CNS). Cell reprogramming-based therapies have emerged as promising therapeutic avenues for neuronal replenishment. However, their therapeutic potential in neural regeneration still faces formidable challenges, including risks of viral vector gene delivery, potential damage from cell transplantation, and significant glial scar (GS) formation following CNS injury. Therefore, developing an optimal approach that simultaneously replaces lost neurons and overcomes these persistent obstacles is crucial for neural regeneration and functional recovery. We engineered a non-viral gene delivery platform using biodegradable poly(β-amino ester) (PBAE) nanoparticles (NPs) to effectively co-deliver plasmids encoding proneural transcription factors ASCL1 and NGN2 directly to astroglia (ATG) within GS region, in combination with neural induction. The biochemical and physiological properties of reprogrammed ATGs were characterized both in vivo and in vitro. The therapeutic potential of PBAE-A/N delivery was assessed in spinal cord injury (SCI) animal models through behavioral evaluations. Finally, the molecular mechanisms underlying ASCL1/NGN2-mediated ATG-to-neuron reprogramming were investigated. PBAE-mediated delivery of ASCL1/NGN2 plasmids effectively reprogrammed resident ATGs within GSs into functional neurons, as evidenced by the acquisition of neuronal morphology and biochemical phenotype (neuronal marker expression), loss of ATG characteristics, scar remodeling, and functionality indistinguishable from those of genuine neurons, including specialized calcium signaling, synaptic activity, and action potential firing. Critically, local administration of PBAE-ASCL1/NGN2 NPs into the GS region of the injured spinal cord significantly ameliorated neurological deficits. Mechanistically, this reprogramming event likely involved the modulation of downstream targeting signaling mediated by Cend1, RanBPM, and Dyrk1, along with crosstalk with the Notch1/Cyclin D1 axis. This study demonstrates that PBAE-mediated ASCL1/NGN2 delivery enables in situ reprogramming of ATG into functional neurons while actively dissolving GSs, thereby addressing both neuronal loss and GS barriers in CNS repair. The identified Cend1/RanBPM/Dyrk1 signaling and its crosstalk with Notch1/Cyclin D1 axis provide mechanistic insights into the events. Collectively, this work presents a novel therapeutic alternative for CNS repair and neurodegeneration by simultaneously replacing lost neurons and eliminating endogenous GSs through in situ cell reprogramming.