Recovery housing provides critical support for individuals with opioid use disorder (OUD), yet residents who use medications for OUD (MOUD) often face barriers to entry and long-term support. No existing validated instruments currently assess these barriers, which can differ by MOUD type and reflect both attitudinal stigma and logistical capacity within recovery housing settings. We developed and tested two parallel versions (Operator and Resident) of a novel tool, the Recovery Housing Barriers to Medications for Addiction Treatment (RHB-MAT) measure. Item generation was informed by literature review and structured input from current housing operators and residents, resulting in scales addressing attitudinal barriers (for both operators and residents) and capacity barriers (for operators) and MOUD type (buprenorphine, methadone, naltrexone). Surveys were administered to 145 recovery housing operators and 250 residents across the United States. Exploratory and confirmatory factor analyses were conducted to establish dimensionality. Internal consistency, and convergent, divergent, and concurrent criterion validity were examined using established measures of stigma and related constructs. Factor analyses supported a multidimensional structure, distinguishing attitudinal barriers across both groups and capacity barriers among operators. Internal consistency across scales was acceptable to strong (α = 0.74-0.92) across all but one subscale. Convergent validity was supported while divergent validity was less consistent. Concurrent criterion validity was generally demonstrated with associations between Operator RHB-MAT scores and their house's unique medication acceptance policies by MOUD type. Overall, residents evidenced higher attitudinal barrier scores than operators. The RHB-MAT represents the first validated measure of MOUD-related barriers in recovery housing, with tailored versions for both operators and residents. This tool can be used in research, policy, and practical quality improvement efforts to identify and address attitudinal and capacity-related barriers that impede access to evidence-based OUD treatment in recovery residences.
Falls are the leading cause of accidental injury among older adults, 30% of community-dwelling adults aged 65 and over fall each year, with nearly half occurring outdoors. These falls are complex, understudied, and insufficiently addressed in current age-friendly cities or walkability frameworks. This study aimed to build interdisciplinary consensus on risks, preventive actions, and barriers to fall prevention in outdoor public spaces through a Delphi process. A three-phase Delphi study was conducted with 64 participants in round 1, 60 in round 2, and 49 in round 3, including four expert groups: older adults who had fallen outdoors, health and research professionals, urban planners, and decision-makers (local and regional policy-makers, elected officials, and public-space managers involved in urban planning). Phase one collected open responses on risks, preventive actions (modification of physical layout, public-space management, and behavior-related factors), and barriers to these actions. Responses were synthesized using AI-assisted analysis with systematic human validation. In phases two and three, the relevance of 124 propositions were rated on a 10-point Likert scale. Consensus was defined as ≥ 70% of ratings ≥ 7/10 and interquartile range ≤ 2.5. Consensus was reached for key intrinsic factors such as gait and balance impairments, visual and vestibular deficits, cognitive decline, and polypharmacy, as well as for environmental factors including irregular or inappropriate surfaces, obstacles, or signage, and crowding. Highly relevant preventive actions included integrating fall prevention into street and sidewalk design, training urban planning professionals, awareness campaigns, systematic maintenance, safer crossings, participatory co-design public-space adaptations and urban design features involving older adults and local stakeholders, and improved data monitoring through surveillance, mapping, and sharing of fall-related and environmental risk information. Main barriers were insufficient budgets, high costs, limited integration of fall prevention into planning priorities, and lack of evaluation of the impact of implemented actions. Outdoor fall prevention is a transversal challenge requiring integration of public health and urban planning. This Delphi highlights actionable priorities to embed fall prevention in local and national strategies, in particular in rapidly aging regions.
Over the past several decades, immunotherapy has emerged as a transformative paradigm in oncology. Within this domain, vaccines targeting tumor-specific neoantigens represent one of the most advanced approaches, engineered to activate the host immune system and elicit potent, antigen-specific T-cell responses. By stimulating both CD8+ cytotoxic and CD4+ helper T cells, these vaccines enable highly selective tumor cell elimination while establishing durable immunological memory. Despite their promise, the rational development and clinical translation of neoantigen-based vaccines remain constrained by substantial challenges that limit their broad therapeutic impact. This review provides a comprehensive synthesis of the field, tracing the entire pipeline from the molecular origin and computational prediction of neoantigens to the design principles guiding vaccine formulation. It examines mechanisms of action across diverse platforms-including mRNA, peptide, and dendritic cell vaccines-and explores synergistic strategies that combine adjuvants or immune checkpoint blockade to enhance efficacy. In addition, we critically evaluate key barriers to success, such as immunosuppressive tumor microenvironments, T-cell dysfunction, and antigenic escape. Finally, we highlight recent clinical advances aimed at overcoming these barriers, thereby outlining a framework for optimizing neoantigen vaccine design to maximize their therapeutic potential in cancer treatment. Notably, encouraging progress has been reported in malignancies such as non-small cell lung cancer and melanoma, underscoring the translational promise of this strategy.
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The aim of this study is to understand the factors contributing to patients' non-adherence to lifestyle modification plans among visitors of the Lifestyle Clinics in King Abdul-Aziz Medical City, Jeddah. Adherence to these plans is crucial for improving health outcomes and preventing chronic diseases. A cross-sectional study was conducted at the Lifestyle Clinics within the Primary Healthcare department of King Abdulaziz Medical City, Jeddah. Participants were adults referred for weight reduction. Data were collected using a questionnaire covering sociodemographic characteristics, adherence to lifestyle modifications, and barriers to adherence. The adherence level was assessed using a validated 13-item questionnaire, and the data were analyzed using IBM SPSS Statistics. A total of 380 participants were included, with a median age of 42 years (IQR: 32-50 years). Approximately 45.5% were adherent to the lifestyle modification plan, while 54.5% were non-adherent. Significant positive correlations were found between age and adherence (Correlation Coefficient=.205, p<.001), with healthcare workers showing higher adherence levels (p=0.027). Common barriers to adherence included lack of willpower (74.5%), energy (70.8%), and time (68.9%). Statistically significant associations were identified between lack of energy (p=0.019) or time (p=0.023) and non-adherence. This study identified key factors associated with non-adherence to lifestyle modification plans, particularly younger age, non-healthcare occupations, and perceived barriers such as lack of energy and lack of time. Despite high levels of knowledge regarding healthy lifestyle practices, adherence remained suboptimal, highlighting the gap between awareness and behavioral implementation. Addressing practical barriers through targeted, behavior-focused interventions may improve adherence and long-term health outcomes.
Men show a higher mortality than women, especially at a young age (between 15 and 39 years). They are more likely to engage in unhealthy behaviours and tend not to implement preventative efforts or to seek help. While (mental) health promotion programmes aim to foster healthy behaviours, men often do not feel addressed by them and are therefore reluctant to participate. This synthesis aims at drawing together barriers to and facilitators of male participation in (mental) health promotion programmes and identifying how to best address men in health communication and programme promotion. This rapid qualitative evidence synthesis includes a sample of 21 studies. 18 are qualitative studies and 3 are mixed-methods studies with separately reported qualitative findings that captured the perspectives of males aged 12 to 79 years and of professionals working in men's health on the barriers to and facilitators of participation in (mental) health promotion programmes and on preferred health communication. Studies were purposefully selected to maximise variation across interview content, context, and participant characteristics (e.g., age, occupation). The selection was restricted to studies published between 2015 and 2025. Gender norms were one of the main barriers to participation in men's (mental) health promotion programmes. Preferably such programmes should be integrated into settings attractive or familiar to men, such as sport clubs or handicraft workshops, or the workplace. Peers and peer support played a crucial role within men's health promotion and were found to facilitate positive behavioural changes. When reaching out to men, clinical and stigmatising terminology should be avoided in favour of action-oriented language that emphasises control and practical solutions while keeping the messaging simple and focused on tangible benefits. Health promotion programmes for men require embedding interventions within male-relevant contexts, such as sports, workplaces, and peer networks, that ease participation and reduce stigma. To reach and benefit men, communication strategies should use relatable, non-stigmatising language from credible messengers and should frame self-care as compatible with masculine identities.
In order to understand barriers related to GDMT treatment of hyperkalemia, the RPA convened a nephrology expert panel to review and discuss hyperkalemia across a continuum of care providers and settings. The panel focused on the real-world solutions and identifying opportunities for more education. The panel discussion started with a review of goals, a presentation on the epidemiology of hyperkalemia, and a review of the latest KDIGO Guidelines for Diabetes Management in Chronic Kidney Disease. Following presentations by leading experts in the field, the panelists engaged in a facilitated discussion of incidence and patient management pathways, K+ binders, current KDIGO Guidelines and the ISN Optimization of RAASi Therapy Toolkit, barriers to optimal care, and possible solutions to overcome barriers. Consensus emerged that prescriptive protocols, potassium-restrictive diets and RAASi discontinuation are not appropriate treatments.
The growing proportion of women in veteran communities internationally highlights a rising need for veteran support services tailored to their unique experiences. Despite this, support services remain predominantly designed for men, leading to underutilization and dissatisfaction among women veterans. This scoping review aimed to provide a comprehensive international review of the current state of knowledge regarding the experiences of women veterans in accessing and engaging with veteran-specific support services. This study followed the Joanna Briggs Institute scoping review methodology. Five databases were searched for papers published from 2000 onwards. Studies reporting on barriers and/or facilitators to access and experiences of engaging with veteran-specific support services reported by women veterans were included. There were no limitations on study methodology or country of origin, and all publications reporting primary research were included. A total of 117 studies were included in the review. This research originated predominantly from the US (n = 109), with seven UK papers, and one Canadian. Eleven themes were identified across the literature, highlighting gendered barriers and facilitators of accessing veteran-specific support for women. Women veterans report feelings of discomfort, exclusion, and discrimination within veteran services, which are perceived as being set up and designed for men. Women report experiencing stigma in help-seeking compounded by a perception of feminine weakness experienced during military service. Some women didn't want to access services they saw as military-adjacent, due to gendered adverse experiences during military service, including discrimination, harassment, and sexual violence. A lack of identification with the term 'veteran' further hinders women's engagement with veteran-specific services. Enablers of access include care that is sensitive to women's needs, trauma-informed service user-provider relationships, and peer support. The reviewed evidence suggests women experience unique challenges and needs in accessing veteran-specific services. Support services should focus on developing care that is, culturally competent, trauma-informed and sensitive to the needs of women, to address gendered barriers to engagement. More research is needed to confirm these research findings outside of the US context, and incorporating an intersectional lens in future research will be essential for improving the support systems for women veterans internationally.
Smoking, including e-cigarette use, remains a significant global public health issue, with a concerningly high prevalence among female university students in Thailand. Given the unique physiological and psychosocial barriers that female face in cessation, this study aimed to identify determinants of the intention to quit smoking among female university students in Thailand. A cross-sectional study was conducted in the Bangkok vicinity. Using snowball sampling, 423 female university students aged 18-25 years who were current users of tobacco products were recruited. Data were collected via an online questionnaire and analyzed using logistic regression. A majority of participants used e-cigarettes (67.8%), and 52.5% reported a high intention to quit. Factors significantly associated with intention to quit included decisional balance (Adjusted Odds Ratio (AOR) = 3.556; 95% Confidence Interval (CI): 1.852-6.828) and self-efficacy (AOR = 3.371; 95% CI: 1.639-6.932). Other positive correlates were type of smoking (AOR = 3.102; 95% CI: 1.350-7.129), vigorous physical activity (AOR = 2.692; 95% CI: 1.250-5.794), norms and support from peers (AOR = 2.606; 95% CI: 1.124-6.040), and previous quit attempts (AOR = 2.550; 95% CI: 1.194-5.449). Conversely, nicotine dependence (AOR = 0.058; 95% CI: 0.027-0.122), frequency of smoking (AOR = 0.394; 95% CI: 0.202-0.767), and BMI (AOR = 0.500; 95% CI: 0.252-0.992) were inversely associated with intention to quit. Interventions must focus on enhancing decisional balance, self-efficacy and providing targeted support to overcome their unique barriers.
Recurrent aphthous ulcers (RAU) is a common idiopathic oral mucosal disorder marked by painful, round ulcers on non-keratinized tissues such as the buccal, labial, and lingual mucosa. These recurrent lesions impair oral function and quality of life. However, systemic treatments, such as oral or injectable medications, often exhibit limited efficacy and are associated with notable adverse effects. The effectiveness of topical treatments is often limited by the barrier properties of the oral epithelium and the dynamic oral environment. Continuous salivary flow and mechanical forces from speaking and mastication dilute, remove, or prevent adequate absorption of locally applied drugs, contributing to inconsistent therapeutic outcomes. Biomedical microneedles offer a promising alternative for delivering drugs to the oral mucosa, overcoming many shortcomings of conventional topical, oral, and injectable methods. Their capacity to painlessly breach superficial barriers enhances drug bioavailability while minimizing discomfort, bleeding, and infection risk. These features collectively improve patient adherence and provide a more acceptable treatment modality for recurrent conditions such as RAU. With rapid advancements in microneedle materials, fabrication techniques, and drug-loading strategies, emerging microneedle-based delivery systems are increasingly adaptable to the unique environment of the oral cavity. These include superior mucosal adhesion to prevent detachment, sustained drug release for prolonged retention, penetration into the pseudomembrane to bypass physical barriers, and the potential for designing multifunctional and smart-responsive systems. Such characteristics render microneedle-based systems a more acceptable and effective approach for managing recurrent conditions like RAU. This review provides an updated framework for understanding the potential of innovative microneedle technologies in the management of recurrent aphthous ulcers and highlights future opportunities for clinical translation.
Understanding how women navigate induced abortion care pathways is critical to ensuring person-centred, quality reproductive health services. Evidence indicates that persistent abortion stigma, the lack of choices of abortion methods and respectful care during abortion remain a global challenge to reproductive healthcare. Yet there is minimal evidence regarding abortion care pathways. This study explored induced abortion care pathways in Addis Ababa healthcare facilities. We used a descriptive qualitative approach, adopting purposive sampling techniques to recruit women who sought induced abortion care from seven facilities. The data were collected from May to July 2024. In-depth semi-structured interviews with sixteen women were digitally recorded and transcribed into the local language before being translated into English. Data were coded, organised, and analysed using inductive thematic analysis. Five main themes and their corresponding subthemes were developed through data analysis. Themes were: (i) social and emotional support, (ii) moral and social meanings shaping abortion care, (iii) accessibility and service delivery, (iv) perceived competency of abortion providers, and (v) physical and emotional effects of abortion. Many women attended the clinic alone, without their families, and received no support. Women often sought care at clinics away from their community due to concerns related to fear of stigma and social pressure. This study found long waiting times to receive abortion care, a lack of medicine and ultrasound at some facilities and limited availability of second-trimester abortions. Women reported that many providers were welcoming and competent, while others reported poor communication, the use of medical jargon, and stigmatising behaviours. Participant reported pressure to accept methods they did not want during contraceptive counselling and fear of breaches in privacy and confidentiality. Participants also described physical symptoms such as bleeding and pain, and felt ashamed and upset after the abortion, which could be associated with negative experiences. Inadequate social support, abortion stigma, and barriers to accessing abortion services, such as long waiting times and insufficient resources, were identified as significant gaps. These findings emphasised the need to strengthen person-centred abortion care and address systemic and socio-cultural barriers that undermine the quality of care. Abortion care should be easy to access, fair for everyone, and respectful of women’s needs. Kind communication and emotional support during abortion enhance the quality of care. This study explored abortion care experiences in healthcare facilities in Addis Ababa.We spoke with women who came for abortion care. We conducted face-to-face interviews employing open-ended questions. We analysed the data by thoroughly reading and checking the information to identify common patterns in women’s experiences.Women had varied experiences of support. Some received strong support from family or friends, which made them feel less worried and more confident. Some went through the abortion procedure alone as they feared pressure or shame. Many women felt abortion was a “sin” or morally wrong, while others felt confident that they had made the best decision for their lives. Women reported waiting times and service availability as challenges to accessing quality care. In addition, negative experiences such as feeling judged and ignored, as well as poor communication from providers, are reported. Women explained physical symptoms such as bleeding, fatigue and emotional outcomes including anxiety, guilt and self-blame after abortion. At the same time, some felt relieved after the abortion and satisfied with the care received.This study found that women faced challenges such as stigma and judgment, long waiting times, and limited availability of abortion services in some places. Improving the quality of abortion care can help women feel supported, reduce emotional distress, and protect their health and dignity.
Parents of undiagnosed children (POUC) experience significant psychosocial challenges, including anxiety, uncertainty, and isolation, that stem from parenting medically complex children while facing obstacles throughout the diagnostic journey. Despite these well-described challenges, a mental health intervention designed to meet the unique needs of POUC, which is necessary to promote the psychological and overall wellbeing of this population, does not exist. Acceptance and Commitment Therapy (ACT) has proven effective in a wide range of populations and shows promise for POUC. With the goal of designing and implementing an ACT-based intervention tailored to POUC, this pre-implementation study aimed to understand their psychosocial needs and prior mental health support experiences, explore their reactions towards ACT, and determine their anticipated barriers, facilitators, and preferences for participating in an ACT skills group, guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured, individual interviews were conducted with 18 POUC, including an experiential portion that exposed participants to key ACT concepts and exercises. Inductive coding based on participant responses and deductive coding based on the CFIR were employed to code interview transcripts. Reflexive thematic analysis was performed to identify key findings. Isolation was a psychosocial challenge for which all participants desired support. Many participants reported inadequacies in their prior mental health support, primarily due to lack of understanding from therapy providers regarding their unique circumstances. Although most participants indicated that ACT could help them manage difficult thoughts and emotions and act in alignment with their values, they also described achievability, collaboration, and accountability as key elements that could support their uptake. The main barriers, facilitators, and preferences that participants highlighted were related to group design (accessibility, flexibility) as well as their own characteristics as recipients (capability, need, and motivation). This pre-implementation study affirmed the potential value of ACT for POUC and identified key opportunities for tailoring an ACT skills group to meet their needs. Future research, including pilot implementation studies, are needed to evaluate the effectiveness of a tailored ACT skills group and further refine both the intervention and its implementation strategy.
Home care nurses play a central role in providing palliative care to patients with life-limiting illnesses. Although holistic needs assessment is recommended, systematic assessment is not standard in primary care, and nurses often struggle to address complex psychosocial and existential concerns. PRO-Pall is a structured instrument developed to support holistic palliative care across healthcare sectors. This study explores home care nurses' experiences with PRO-Pall, focusing on its perceived benefits and implementation challenges. Qualitative interviews were conducted with home care nurses from municipalities actively testing PRO-Pall. Data were analysed using thematic analysis. Drawing on Bourdieu's theory of practice, the analysis interprets nurses' engagement with the instrument through the concepts of habitus, field, and capital. Two overarching themes emerged: (1) Enhancing holistic care with patients and within families, and (2) Systemic barriers to holistic care within homecare institutions and across interdisciplinary and cross-sectoral collaboration. Nurses found PRO-Pall useful for initiating sensitive conversations and adapted the tool flexibly to support individual needs. Its focus on holistic care aligned with nurses' professional habitus. However, systemic barriers, including limited time, inadequate digital infrastructure, and fragmented coordination, restricted consistent use. Home care nurses regard PRO-Pall as a meaningful support for holistic palliative care. Effective integration depends on alignment between individual dispositions, organisational conditions, and access to social, cultural, symbolic, and economic capital. Strengthening training, resources, and collaborative structures is essential for the sustainable use of systematic needs assessments in municipal palliative care.
Treatments for older adults with acute myeloid leukemia (AML) are often underutilized, with older adults often receiving no active treatment. Little is also currently known about patient, physician and hospital factors that may play a role in the treatment older adults receive. The objective of this study was to identify the association of patient, hospital, and physician factors with treatment pathway among adults aged 65-75 years diagnosed with AML. Treatment pathways included: 1) chemotherapy with alloHCT (alloHCT); 2) chemotherapy with an NMDPSM search (chemo with search); 3) chemotherapy without an NMDP search (chemo without search); and 4) no chemotherapy or alloHCT (no therapy). This retrospective cohort study linked Centers for Medicare and Medicaid (CMS) Medicare claims, NMDP donor search, and publicly available CMS and National Provider Identifier (NPI) physician and hospital datasets. Patients aged 65-75 diagnosed with AML between 2010 and 2017 who were enrolled in fee-for-service (Part A and B) Medicare for at least one year after diagnosis or until death were included. AlloHCT and chemotherapy were identified using diagnosis and procedure codes; no therapy was identified by the absence of alloHCT or chemotherapy codes. Multivariable hierarchical logistic regression was used to identify patient, hospital, and physician factors associated with treatment receipt, with hospital as a random effect. A total of 4,394 patients met eligibility criteria: 599 (13.6%) received alloHCT; 655 (14.9%) received chemo with search; 2,762 (62.9%) received chemo without search, and 378 (8.6%) received no therapy. Receipt of alloHCT was associated with year of diagnosis, sex, race, education, and age when compared with chemo with search. Compared to those who received chemo without search, receipt of alloHCT was associated with year of diagnosis, race, education, region, Elixhauser comorbidity index (ECI), and age. Receipt of alloHCT when compared to receipt of no therapy was associated with year of diagnosis, education, ECI, age, medical school affiliation, and years since medical school graduation and specialty. Among those receiving chemotherapy alone, factors associated with search included year of diagnosis, sex, education, ECI, and age. This population-based analysis assessed the association of patient, hospital, and physician characteristics at the time of AML diagnosis with receipt of alloHCT and donor search in the first year after diagnosis for adults aged 65-75 with Medicare coverage. Results highlight that older age, higher comorbidities, and lower education are key barriers to receiving alloHCT and donor search. Physician- and hospital-level factors, such as lack of medical school affiliation and non-hematologist specialty, can further limit access, as seen by the association with receipt of alloHCT when compared to those who received no therapy, but not to chemotherapy with or without a donor search. Additional research and interventions are needed to improve access to treatment, focusing on age-related, geographic, and referral barriers, and could include educational outreach for older adults, and standardized referral guidelines to support timely transplant evaluation.
Computer perception (CP) technologies are poised to deliver near real-time behavioral insights with high precision. As technical barriers recede, our field's ethical focus must shift from "Can we trust the data?" to "Should we use it here, and how?" We propose a contextual ethics framework that: (1) defines the appropriate scope of CP integration; (2) advocates codesigned roadmaps to manage expectations and epistemic conflict; (3) expands evaluation beyond performance metrics to humanistic outcomes; and (4) anticipates future high performance systems to safeguard dignity, empathy, and shared decision-making in clinical care.
Breast and cervical cancer represent a significant disease burden. Health care quality measures captured through electronic clinical data systems could be used to assess follow-up of abnormal breast and cervical cancer screening results. The National Committee for Quality Assurance (NCQA) wanted to explore the feasibility of using health plan electronic clinical data systems to develop quality measures for follow-up of abnormal breast and cervical cancer screening test results. NCQA interviewed quality improvement leaders from ten health plans, recruited through a purposive sample representing varying sizes, geographic regions, and commercial, Medicare, and Medicaid product lines. Health plan leaders identified several barriers, including a lack of standardized data integration as well as opportunities such as supporting provider and health system data aggregation and other support. Findings indicate that improved data governance, particularly around data standardization and information technology infrastructure integration, would increase the feasibility of monitoring follow-up after abnormal breast and cervical cancer screening results.
This study aimed to characterize practices and decision-making for extracorporeal membrane oxygenation (ECMO) for congenital anomalies of the kidney and urinary tract (CAKUT). General practices (GP) section inquired about institutional practices and barriers, ECMO criteria, and dialysis. The hypothetical cases (HC) illustrated four clinical scenarios with varying degrees of renal severity for ECMO candidacy. Then, 99 (42 centers) and 91 (38 centers) physicians completed the GP and HC components, respectively. The majority considered ECMO on a case-by-case basis (66%). Bilateral renal agenesis was the most common diagnosis for exclusion (52%). Prenatal markers used for ECMO exclusion included anhydramnios (43%) and lung volumes (43%). The majority of centers had nephrology involved in ECMO decision-making. Challenges for implementing ECMO included disease heterogeneity (79%) and poor evidence on outcomes (66%). HC responses demonstrated variability in considering ECMO for CAKUT. Variability among providers and institutes underscores the need for consensus-based guidelines to optimize decision-making and outcomes.
Depression leads to a significant societal burden worldwide, yet most individuals affected lack adequate care. Digital mental health treatments (DMHTs) offer evidence-based, accessible interventions via websites, text messaging, virtual reality, and mobile apps, among other technologies. Studies demonstrate DMHT effectiveness, often comparable to traditional therapies, with high treatment acceptability and satisfaction. Key challenges include poor engagement, high attrition, and limited integration into routine care. Despite these barriers, innovations such as human support, improved reimbursement practices, patient-treatment matching strategies, and emerging AI-driven tools promise to broaden DMHTs' impact and position these programs as a frontline treatment option for depression globally.
In this research, a surface ligand engineering strategy is employed to fabricate UiO-66 confined Au nanoclusters (UiO-66@Au) with controllable multienzyme performances. Especially, ligand PSS and PVP can trigger optimized peroxidase (POD) and glucose oxidase (GOx) mimic activity respectively. Mechanistic studies revealed that electron transferring between Au and ligands can be an effective tactic to regulate the multienzyme activity. Theoretical calculations revealed that electron-withdrawing polystyrene sulfonate (PSS) can decrease the key energy barriers of ·OH desorption in POD process and electron-donating polyvinylpyrrolidone (PVP) decreased the key energy barriers of O2 to OOH∗ in GOx catalysis, which confirmed the enhanced POD and GOx activity correspondingly. For practical application, PSS-UiO-66@Au coupled lateral flow assay (LFA) can visually detect HER2-positive breast cancer exosomes as low as 428 exosomes/μL, about 16355-fold higher sensitivity than that of common LFA. PVP-UiO-66@Au with superior GOx-mimic activity can detect salivary glucose as low as 19 μM, meanwhile, due to the effective gluconic acid adsorption repulsion by PVP, PVP-UiO-66@Au displays superior stability even after 10 reuse cycles This work provides a simple route to regulate the multi-enzyme properties of UiO-66@Au and broadens the application in multiple target biosensing.