We evaluated whether offering access to a multicomponent mHealth app improves quality of life (QoL) and psychosocial outcomes among breast cancer survivors under pragmatic, nonprescriptive conditions. In this single-center, randomized, controlled trial at Hospital Clínic de Barcelona, women age ≥18 years, disease-free after breast cancer treatment, were recruited (December 2020-December 2021) and randomly assigned 1:1 to usual follow-up plus app access or usual follow-up alone. The app provided CTCAE v4.03-aligned symptom tracking with self-care guidance, educational content, an events calendar, and gamified smartphone-based step counting; no protocolized clinician monitoring or feedback was provided. Outcomes were assessed at baseline and 3, 6, 9, and 12 months using European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (QLQ)-C30/BR23, Hospital Anxiety and Depression Scale (HADS), and Three-Item Loneliness Scale (TILS). The primary end point was the difference in QLQ-C30 Global Health Status/QoL at 3 months. Analyses followed intention-to-treat using mixed models for repeated measures adjusted for baseline values. Of 124 women assessed, 121 were randomized (intervention n = 60; control n = 61). Patient-reported outcome measures were available for 106 of 121 (87.6%) at 3 months and 95 of 121 (78.5%) at 12 months. At 3 months, there was no significant difference in Global Health Status/QoL (adjusted mean difference [Intervention-Control], -2.24 [95% CI, -9.29 to 4.81]; P = .53); estimates at later time points were similarly imprecise. No significant between-group difference were observed for QLQ-BR23 domains, HADS anxiety/depression, or TILS. Exploratory subgroup analyses suggested possible heterogeneity in TILS by hormonal-treatment category; this was descriptive and hypothesis-generating only. App engagement was the highest in months 0-3 (48/60 [80.0%] with any use) and declined thereafter; 12 of 60 (20.0%) never used the app. In a pragmatic, nonprescriptive survivorship trial, offering access to a multicomponent mHealth app without closed-loop clinical integration did not show a statistically significant between-group differences in QoL or psychosocial outcomes; confidence intervals were compatible with meaningful harm and did not exclude small benefit depending on the threshold used to define clinical relevance.
Wearable human activity recognition has become an important component of intelligent fitness tracking, but deploying accurate recognition models on resource-constrained edge devices remains challenging. Existing deep learning methods often rely on recurrent structures, attention mechanisms, or complex hybrid architectures, which increase computational cost and limit real-time deployment. This study proposes DeM-FCN, a lightweight and purely convolutional framework for smart dumbbell-based resistance-training activity recognition. The model integrates a physics-aware input representation, Gaussian noise regularization, stacked one-dimensional convolutional blocks, Global Max Pooling, and a cost-sensitive focal loss to improve subject-independent recognition. The input representation extends raw inertial measurements by introducing trigonometric encoding of Euler angles and acceleration and gyroscope magnitude features, allowing the model to capture both orientation-related motion patterns and orientation-insensitive motion intensity. The proposed model was evaluated using Leave-One-Subject-Out cross-validation on a custom smart dumbbell dataset containing four resistance-training exercises collected from 15 subjects. DeM-FCN achieved an accuracy of 0.966, macro F1-score of 0.916, and macro AUC of 0.982, while maintaining only 73.7 K parameters, 14.84 M FLOPs, and a model size of 0.29 MB. Additional evaluations on PAMAP2 and MHEALTH suggested that the convolutional backbone retained useful class-ranking ability on public IMU-based HAR datasets, while the reduced macro F1-scores indicated that hard-label daily activity recognition remains more challenging than constrained resistance-training recognition due to broader activity diversity, sensor-domain differences, and missing modality information. A refined ablation study confirmed that trigonometric encoding and magnitude features provide complementary benefits, with magnitude features contributing more strongly to cross-subject robustness. The results suggest that DeM-FCN provides a favorable accuracy-efficiency trade-off for wearable resistance-training recognition and offers a practical foundation for edge-oriented fitness monitoring.
Background/Objectives: Maternal mortality remains disproportionately high in low- and middle-income countries, where ineffective referral systems and a lack of infrastructure contribute to delays in emergency obstetric care. In sub-Saharan Africa, referrals are largely conducted via paper, often resulting in lost documents and limited follow-up. Mobile health (mHealth) offers a promising solution by enabling real-time, bidirectional communication. This study aimed to examine how the Mobile Obstetric Referral Emergency System (MORES), a WhatsApp-based referral platform piloted in 20 rural health facilities and two district hospitals in Bong County, Libera, influences healthcare providers' communication, collaboration, and relationships. Methods: A mixed-methods design was used. Ninety one (N = 91) providers completed demographic and Trust and Teamwork surveys. Of the 91 providers, 35 providers from rural health facilities and 56 providers from district hospitals participated in a 10-question survey and individual interviews. Results: Survey results indicated high levels of mutual respect, confidence, and teamwork perceived by both the rural health facility and district hospital providers. Qualitative data further expanded on the quantitative results showing the MORES intervention enhanced the timeliness and accuracy of referrals, supported problem-solving between facilities, and fostered shared goals, mutual respect, and knowledge exchange. Conclusions: Providers perceived the MORES to be associated with increased collaboration and continuity of care, as well as a feasible, low-cost, and sustainable intervention to improve obstetric referral systems in low-resource settings.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong evidence base for improving perinatal outcomes, but less than half of eligible women enroll. To assess whether WIC enrollment is improved with direct digital referrals from prenatal care to WIC and/or a registered dietitian nutritionist (RDN) compared with usual care. In this 4-arm randomized clinical trial, pregnant participants were enrolled in 2024 and followed up for 6 months in a large integrated health system in Pennsylvania. Pregnant participants who met WIC income eligibility were recruited, and 1539 potential participants were identified through the electronic health record (EHR) and sent recruitment materials. Data were analyzed from April 29, 2024, to June 11, 2025. Four models were compared, and individuals in all models received usual prenatal care. Model 1 provided patients with WIC written information. Model 2 provided patients with a direct digital referral to WIC. Model 3 provided WIC written information plus a digital referral to an RDN for telehealth counseling (1 session monthly for 6 months). Model 4 provided a combination digital referral to WIC and RDN. WIC and RDNs contacted participants after receiving referrals to arrange care. The primary outcome was measure of the difference in WIC enrollment via participant survey at 6-month follow-up. Of 514 pregnant participants who completed screening, 140 were ineligible and 134 were not interested. Of 240 eligible, consenting participants (mean [SD] age, 29.2 [6.1] years; mean [SD] gestational age, 17.8 [11.1] weeks), 202 had outcome data. Randomization to digital WIC referral models increased enrollment (models 2 and 4: 78% [80 of 103]) vs no digital referral (models 1 and 3: 65% [64 of 99]) (P = .04). Randomization to RDN (models 3 and 4: 78% [76 of 97]) also increased enrollment vs no RDN (models 1 and 2: 65% [68 of 105]) (P = .03). Compared with model 1 where WIC enrollment was 54% (27 of 50), enrollment was significantly higher in other models (model 2: 75% [41 of 55]; model 3: 76% [37 of 49]; model 4: 81% [39 of 48]; all P = .03). In this randomized clinical trial of pregnant individuals, both digital WIC referral and RDN referral improved WIC enrollment, offering scalable strategies to improve perinatal health. ClinicalTrials.gov Identifier: NCT06311799.
Maternal health in Lebanon is severely impacted by the country's ongoing socioeconomic crisis, disproportionately affectivng disadvantaged Lebanese and refugee women due to limited healthcare access. Digital prompting interventions have improved antenatal and postnatal care utilization, particularly when the husband of the pregnant woman is also engaged. This study aims to assess the influence of digital prompting and husband engagement on the satisfaction of disadvantaged pregnant women in Lebanon with their reproductive health journeys, using the artificial intelligence (AI)-based gamified mHealth intervention titled "Gamification and Artificial Intelligence and mHealth Network for Maternal Health Improvement" (GAIN MHI). This study was conducted across seven primary healthcare centers in Lebanon, targeting pregnant women up to 16 weeks of gestation with mobile phone access. The intervention included digital messages for both pregnant women and their husbands, alongside the GAIN MHI App for healthcare providers. Over 11 months, data was collected to assess maternal satisfaction, antenatal care (ANC) attendance, and the role of husband engagement in supporting maternal wellbeing. A total of 1028 pregnant women participated. Husband involvement significantly improved support for ANC visit, reminder's frequency, and psychological support. Women receiving mobile health support were more likely to report better physical health (odds ratio (OR) = 2.16; p = 0.03) and mental health (OR = 2.12; p = 0.03). Increased ANC visits were associated with higher likelihood of satisfaction with baby health (OR = 1.35; p = 0.05) and with service quality (OR = 2.68; p = 0.01). Husband support for ANC visits improved satisfaction both predelivery (OR = 2.15; p < 0.01) and postdelivery (OR = 2.05; p < 0.01). The combined effect of all support factors significantly boosted satisfaction with self-care predelivery (OR = 2.07; p < 0.01) and postdelivery (OR = 3.82; p < 0.01). The findings emphasize the importance of hybrid digital health models integrating mobile-based education, spousal support, and healthcare provider engagement to enhance maternal satisfaction and health outcomes. Future programs should adopt this approach to ensure comprehensive maternal care.
Allergic diseases affect more than one billion people globally, yet care access is profoundly unequal. The "forgotten billion" refers to underserved populations-especially in LMICs and marginalized groups within high-income countries-who face disproportionate morbidity and preventable deaths due to gaps in diagnosis, essential medicines, immunotherapy and biologics, trained workforce, and policy prioritization. To synthesize recent (2014-2026) evidence on global burden and inequities in allergic disease care, analyze system-level gaps, review scalable innovations, present diverse case studies, and propose prioritized recommendations, monitoring frameworks, and a research and financing agenda. We conducted a structured narrative review of peer-reviewed literature and global guidance documents, focusing on burden metrics (prevalence, DALYs, mortality), access indicators, interventions (task-sharing, telemedicine, point-of-care tools, immunotherapy access, digital health, procurement/policy levers), and implementation science frameworks. Sources prioritized include WHO materials and guideline bodies (GINA, ARIA, EAACI), plus global reports and primary studies. Asthma illustrates the equity chasm: in 2019 it caused approximately 21.6 million DALYs and approximately 461,000 deaths globally, with approximately 90% of burden borne in LMICs and most deaths occurring in LMICs. Systematic reviews show essential inhaled asthma medicines-especially inhaled corticosteroids (ICS) and ICS-containing combinations-are often unavailable or unaffordable in LMICs. Scalable strategies with documented impact include task-shifted care packages (Malawi), standardized primary care training (South Africa), community health worker home visiting (Boston), and public-sector access programs (Brazil), alongside national allergy strategies (Finland). Closing the allergy care chasm requires shifting from specialist-centric innovation to systems-first equity: universal access to essential medicines and equitable pathways to targeted therapies for severe disease, standardized primary care delivery with task-sharing, market-shaping and pricing policy reform, digitally enabled self-management designed to reduce (not widen) inequities, and integrated environmental action. Implementation must be measured with equity-sensitive frameworks and supported by durable financing aligned with UHC and NCD agendas.
Background: Many patients with heart failure with reduced ejection fraction (HFrEF) remain undertreated in routine practice. Delayed treatment intensification, poor adherence, and fragmented follow-up are common barriers. Low-cost digital support may help reduce this implementation gap. Objective: This study evaluated whether a simple digital support pathway was associated with better 6-month treatment adherence and guideline-directed medical therapy (GDMT) optimization in ambulatory patients with stable HFrEF. Methods: This single-center matched cohort study compared a prospective digital-support cohort with a historical usual-care cohort. The intervention combined smartphone-based telemanagement, home blood pressure and heart-rate reporting, daily weight surveillance, and scheduled video consultations. The co-primary endpoints were treatment adherence at 6 months and GDMT optimization, assessed by change in foundational HFrEF drug classes and by a prespecified exploratory GDMT optimization score. Results: After 1:1 propensity-score matching, 200 patients were included, with 100 patients in each cohort. Treatment adherence at 6 months was higher in the digital-support cohort than in usual care (82.0% vs. 64.0%, p = 0.004). The intervention cohort also had more frequent class addition, more dose escalation, a greater increase in foundational drug classes, and a larger improvement in GDMT optimization score (all p < 0.001). Heart failure hospitalization and the composite of heart failure hospitalization or all-cause death were less frequent in the digital-support cohort, but these clinical outcomes were exploratory. Conclusions: A pragmatic low-cost digital support pathway was associated with better adherence and more complete GDMT optimization in ambulatory patients with HFrEF. The findings support further prospective multicenter evaluation.
Posttraumatic stress, along with comorbid mental health challenges and hazardous alcohol use, disproportionately affects people living with HIV. The drivers of these stressors are both intraindividual, rooted in early life adversity and firsthand violence exposures, and contextual, often place-based. Imparting effective coping skills and distinguishing between changeable and unchangeable stressors can improve stress management in the short term, with cascading effects on key HIV continuum of care end points, such as antiretroviral therapy adherence. However, problem- and emotion-based coping skills, delivered via traditional linear in-person group modalities, may falter in the moment. To address this, we adapted the evidence-based Living in the Face of Trauma intervention into an iOS- and Android-native app, featuring daily diary-triggered coping skills recommendations, self-guided Living in the Face of Trauma psychoeducational sessions, and a customizable geofencing function. This mixed methods study aimed to examine the acceptability, feasibility, and user experiences of NOLA (New Orleans, Louisiana) Gem, focusing on user interaction costs relative to geographic ecological momentary assessment (GEMA) alone and refining future optimization options. People living with HIV (N=32) were recruited across New Orleans and initially randomized 1:1 to treatment (NOLA Gem + GEMA) versus control (GEMA) for 21 days. Feasibility was assessed via enrollment and attrition rates. At the immediate postassessment, participants completed acceptability and usability measures and a brief structured usability interview. Analyses included descriptive statistics, bivariate logit modeling, and synergistic human-large language model deductive coding. In total, 30 participants (n=22 in the GEMA + NOLA Gem treatment arm) completed the pilot, representing 94% (n=29) of baseline enrollees. Acceptability was very high across the board: 100% (n=30) of users considered NOLA Gem "very" or "somewhat" successful in addressing their daily lives, with 91% (n=28) endorsing increased calm and emotional well-being. In addition, 50% (n=11) of NOLA Gem users were "extremely likely" (Net Promoter Score=10/10) to recommend the app to friends. Eight (27%) GEMA and GEMA + NOLA Gem users reported privacy concerns. Eleven (50%) NOLA Gem users received geofencing alerts; perceptions of this feature's helpfulness were mixed. No statistically significant sociodemographic or clinical predictors of disparate acceptability or increased privacy concerns were found. No additional frictions were evidenced by GEMA + NOLA Gem versus GEMA users. Qualitatively, NOLA Gem users praised the just-in-time mindfulness, breathing, problem-solving skills delivery, and broader stress control and self-insight benefits. A subset of users pointed out the burdensome length and sometimes inconvenient timing of the daily diaries. Recommendations for next-generation personalization included user-specific dynamic daily diary and geofencing prompt tailoring. Our small pilot study demonstrated high NOLA Gem acceptability and feasibility, as well as a rich and beneficial user experience among people living with HIV, with clear and actionable opportunities for improvement.
Nearly half of all 4.8 million annual paediatric deaths worldwide are caused by acute illnesses, which are preventable with timely triage, emergency care and prehospital transport. We assessed the feasibility of using telemedicine to connect emergency medical technicians (EMTs) in ambulances with paediatric telemedicine physicians (TMPs) to improve patient care in a low-resource setting. We conducted a pilot cluster-randomised trial in Karachi, Pakistan, with city's primary emergency medical transport provider and a paediatric telemedicine facility. Ten ambulances were randomised equally to intervention (real-time audiovisual telemedicine support) and control arms. The intervention was piloted using 25 simulated cases, followed by low-acuity and high-acuity patients as classified by the Medical Priority Dispatch System. Primary outcomes included rates of refusal, call completion, safety (rated by EMTs and TMPs) and completion of the Paediatric Early Warning Score (PEWS) in ambulances and hospitals. Of 166 parents approached, 151 (91%) consented; 73 patients were assigned to the intervention and 78 to the control. The mean patient age was 2.5 years (SD 43 months; range 1 day-12 years). Ambulance dispatchers categorised 35.7% as low acuity and 64.3% as high acuity. Most cases (68%) were interhospital transfers. Calls were completed in 96% of cases; 87% of calls received favourable audio/video quality scores. All interactions were rated as very safe, safe or neutral; none was deemed unsafe. 91% of EMTs and TMPs rated the system as usable (System Usability Scale). PEWS was completed for 100% of patients in ambulances and 86% in the emergency department. Providing real-time telemedicine support to EMTs in ambulances is feasible and safe in low-resource settings. These findings support further research into the clinical impact and scalability of prehospital telemedicine for paediatric emergencies. This project is a pilot trial for the Cluster Randomised Trial NCT07027813 titled 'Feasibility and Efficacy of Ambulance-Based m-Health for Paediatric Emergencies (FEAMER) Trial (FEAMER)' registered on 19 June 2025. The link to the clinicaltrials.gov is attached here: https://clinicaltrials.gov/study/NCT07027813.
The present review aims to 1) provide a comprehensive overview of remote patient monitoring (RPM) across the existing research literature involving people with MS (pwMS) and 2) provide updated information on the availability of these technologies. A systematic literature search was conducted in PubMed, Embase, Web of Science and Scopus. Studies were included if they evaluated adult pwMS, applied RPM over at least 1 week, and reported objective outcomes. Included studies were categorised as evaluating apps, wearables or combinations of the two. A total of 77 studies involving 9463 pwMS were included. Participants had a mean age of 46 years, 69.7% were female, and most presented with mild to moderate disability (EDSS 2-3.5). Wearables were used in 37 studies, 33 employed apps and 4 combined both. Wearables were most commonly wrist-worn, primarily assessing step count and gait, while mobile apps focused on motor function, cognition and quality of life. Most wearables and apps remain restricted to research use, with only few being commercially available. Application of RPM in MS is promising, offering broad possibilities for monitoring health status, but is limited by device heterogeneity and restricted availability. Future efforts should prioritise standardised, multi-domain RPM solutions that ensure data security and broad clinical applicability. Remote patient monitoring offers significant opportunities for remote assessment and long-term tracking in pwMS.Across identified studies, participants were were predominantly younger or middle-aged (mean age 45 years), suggesting that potential challenges for older patients remain underexplored.Most studies included participants with EDSS scores between 2.5 and 4.0, limiting conclusions about the suitability of wearable monitoring for individuals with more severe gait impairments.Only a small number of the wearables and apps identified in the reviewed studies are currently commercially available, as many remain limited to research use and/or have been discontinued.
Despite the potential of mobile health applications for diabetes self-management, patient adoption rates remain low. Understanding patient perspectives is crucial for developing effective and user-friendly solutions that can improve diabetes self-care and education. This study aimed to explore Malaysian patients' perspectives on the use of mobile health applications for diabetes self-management. Qualitative study using semi-structured interviews was conducted with 16 diabetes patients across Malaysia. Interviews were conducted via video conferencing, recorded, transcribed, and analysed using thematic analysis. Participants ranged in age from 24 to 70 years with diabetes duration from 6 to 27 years. Five key themes emerged: (1) limited adoption and awareness, (2) barriers to use, (3) localization and personalization needs, (4) healthcare system integration gaps, and (5) support preferences. Patients expressed interest in mobile health applications but faced significant barriers including economic constraints, technical difficulties, and behavioural challenges. Key desired features included automated glucose monitoring, localized food databases, educational content, and seamless communication with healthcare providers. While patients recognize the potential benefits of mobile health applications for diabetes self-management, successful implementation requires addressing economic barriers, improving digital literacy, developing culturally appropriate content, and ensuring seamless integration with clinical care. Future development should prioritize user-friendly interfaces, affordability, and comprehensive support features that align with patients' daily management needs.
This study examined the association between attitudes toward digital technology and intentions to use digital mental health solutions, with perceptions of mental health apps and online therapy as potential mediators. A cross-sectional survey was conducted with 360 undergraduate students at Sultan Qaboos University (SQU) (July 2025). The mean age was 21.24 (SD = 3.12), with 50.3% of female respondents and 49.7% male. Using a validated questionnaire, we included assessments of attitudes and beliefs about digital technology, perceptions of mental health apps and online therapy, and intention to use digital mental health solutions. Mediation analysis was performed using structural equation modeling. Attitudes toward digital technology were significantly associated with intention (β = 0.358, p < 0.001). Perceptions of mental health apps significantly mediated this relationship (indirect effect = 0.065, p = 0.006), while perceptions of online therapy did not (indirect effect = 0.030, p = 0.109). The total indirect effect through both mediators was significant (0.095, p = 0.002), with a strong total effect on intention (0.454, p < 0.001). These findings suggest that improving students' perceptions of mental health apps may help them use digital mental health services. Implementation strategies in similar university settings should target service-specific perceptions to drive adoption of these tools.
Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4-22%, CBD 2-22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1-5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin's rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T2 provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan-Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS -5.36 (95% CI -5.65, -5.07), ODI -17.68 (95% CI -19.73, -15.63), BPI-S -6.73 (95% CI -6.99, -6.47), and BPI-I -3.41 (95% CI -3.65, -3.16); all four contrasts had |z| ≥ 16.9 and p < 10-20. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T2 was F(4, 232) = 872.8, p < 10-20. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10-69), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient's own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = -0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05-1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022-2024, with patients returning to in-person follow-up by Year 4-5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54-0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile-ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden-supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials.
Falls are a significant concern for older adults, particularly those with neurological, vestibular, cognitive and post-viral conditions, due to dizziness and imbalance. Conventional balance rehabilitation programmes, though effective, face challenges in adherence and accessibility. The TeleRehabilitation Decision Support System (TeleRehaB DSS) uses artificial intelligence (AI) and motion tracking to provide individualised multisensory balance rehabilitation (MBR) remotely. This trial aims to evaluate the acceptability, feasibility, safety and preliminary efficacy of a home-based TeleRehaB DSS among community-dwelling older adults at risk of falls due to stroke, mild cognitive impairment (MCI), long COVID and vestibular dysfunction. This multicentre, assessor-blinded randomised controlled trial will recruit 460 community-dwelling adults aged 40-80 years with stroke, MCI, vestibular dysfunction or long covid across five sites in the UK, Europe and Southeast Asia. Participants will be randomised to a 9-week remotely supervised home exercise programme using either TeleRehaB DSS (high-tech or low-tech MBR with exergames and cognitive training) or standard care (OTAGO home exercise programme or Meniere's Dizziness booklet). Primary outcomes include feasibility, acceptability and safety, alongside clinical measures of balance and health-related quality of life (Functional Gait Assessment, EuroQol five-dimensional descriptive system instrument). Secondary outcomes assess balance, cognition, physical activity, dizziness, psychological well-being, fatigue and confidence. Usability, user experience and digital health literacy will also be evaluated. Anonymised data will undergo quality checks and be analysed using descriptive and exploratory statistics, mixed-effects models, cost-effectiveness analysis (incremental cost-effectiveness ratio) and thematic analysis of qualitative interviews, adjusting for site and relevant confounders. This study has received institutional ethical approvals in the UK, Germany, Greece and Thailand and from Madeira, Portugal. Findings from this study will be submitted for peer-reviewed publications. NCT06534164.
To evaluate the impact of a Rhode Island (RI) Latent Tuberculosis Infection (TB Infection) Extension of Community Healthcare Outcomes (ECHO) telementoring program on primary care clinicians' self- reported learning and performance. Utilizing an exploratory, sequential, mixed- methods design, we first conducted 24 qualitative interviews with RI primary care clinicians and nurses to identify TB infection management gaps. These findings informed the curriculum for a six-session RI TB Infection ECHO course launched in 2021. Participant learning and performance were evaluated using pre- and post-course-structured questionnaires and follow-up qualitative interviews. Qualitative analysis revealed that participating clinicians felt comfortable with TB infection screening but lacked confidence in treatment initiation and selection. Following the ECHO course, participants demonstrated significant increases in self-reported confidence across the majority of TB infection practice areas (P<0.05). Notably, 75% of post-survey respondents reported making specific practice changes, such as adopting shorter treatment regimens and improving newer test interpretation. The mentored research award was instrumental in the establishment of the first Project ECHO hub at The Warren Alpert Medical School of Brown University. By achieving Level 5 (Performance) on Moore's Educational Framework through documented practice change, the program demonstrated that tele- mentoring can effectively democratize specialized TB infection knowledge. This framework has since scaled to a regional TB infection ECHO program.
Tuberculosis has been one of the biggest issues of public health in India with constant diagnostic delays, stigma, and poor treatment-seeking behaviour serve as barriers to Disease elimination process. Although the diagnostic and surveillance technologies have been improved at a rapid pace. The society is still Stemming from lagging in community engagement and thus the awareness cannot be converted to action. This research explores the opportunities of tele-education as a scaled process to enhance the community involvement in the issue of the control of tuberculosis in opposite high-case environments in an urban slum cluster and a tribal village network. An intervention based on the use of four videos, audio modules, quizzes, and ASHA-promoted reinforcement was implemented on 112 households over a period of four weeks via tele-education. The results showed that both sites had great improvements in TB literacy in addition to behaviour change that was observed through the self-initiated referrals, increased uptake of screening, and the facilitation of information with peers. Despite the fact that the urban slum had a higher level of digital participation, the tribal community acquired knowledge the same way by a hybrid offline-based model. The findings highlight the relevance of contextual differentiation, trusted intermediaries and blended learning methods in realizing the maximum impact of tele-education. Tele-education as a potential solution to speed up eliminating TB nationally can be viewed offenders by considering communities as active participants not as passive recipients, through a reformulation of communities as active partners, which facilitates population health initiatives beyond biomedical innovation.
Tuberculosis (TB) has been a major health issue of concern globally, where timely diagnosis has been a major factor in spreading the disease and causing death, especially in underprivileged environments. The aim of the presented study was to construct and analyze an Information and Communication Technology (ICT)-enabled model of engaging communities in the effort of increasing the rates of early TB detection by means of increased community engagement and simplified diagnostic routes. It was a prospective, quasi-experimental study that was carried out in twelve community health centers in three districts over a period of eighteen months where ICT-enabled intervention sites (n = 6) were compared with the conventional screening sites (n = 6). ICT framework also incorporated a mobile health application to the community health worker, automated short message service (SMS) to monitor the symptoms, cloud-based case management, and geographic information system (GIS) to monitor the hotspots. One thousand eight hundred four hundred and seventy seven presumptive TB cases were registered where 923 were ICT-enabled and 924 were control sites. Findings indicated that ICT-enabled sites recorded much higher rates of case detection (78.4% vs. 52.1, p < 0.001), median time to diagnosis was lower (12.3 ± 4.2 days vs. 28.7 ± 8.9 days, p < 0.001), and higher rates of treatment initiation within 48 h were recorded (89.2% vs. 61.4, p < 0.001). The efficiency of community health workers increased by 43.6 and there was 2.8 fold greater number of household contacts screened by the worker per monthly. ICT-enabled model had better performance with regard to the facilitance of early TB detection using enhanced community engagement, which is a cost-effective and scalable solution to TB control programs fortification.
Climate change poses an increasing threat to global health, demanding urgent action from healthcare systems. Nephrology contributes substantially to healthcare-related environmental impact and must adopt sustainable practices. Peritoneal dialysis (PD) patients are key stakeholders in these efforts, yet their perspectives remain underexplored. This study assessed PD patients' practices and attitudes regarding recycling, transport logistics, and digital healthcare. An observational study was conducted in two centers using a 17-item questionnaire developed through literature review and expert input. The survey addressed recycling behaviors, delivery logistics, and use of telemedicine. Associations between patient characteristics and sustainability-related behaviors were analyzed. Ninety PD patients were included (mean age 54.4 ± 14.3 years; 64.4% male). Most patients (84.4%) reported recycling at least one PD-related material, mainly paper (83.3%) and plastic packaging (66.7%). PD solution and drainage bags were recycled in 21.3% of the cases, despite their classification as hospital waste. Recycling habits were not associated with age, residence, or PD modality (P > .05). Most patients received monthly deliveries (85.6%) and were satisfied with delivery frequency (88.9%), while alternative delivery options were largely rejected. Telemedicine was approached cautiously, with 84.4% preferring in-person visits; however, most patients accepted digital information, particularly younger individuals (P = .005; P = .001). PD patients demonstrate high engagement in recycling, mainly reflecting pre-existing household recycling habits. Transport-related sustainability challenges require system-level solutions, beyond approaches that focus solely on patient mobility. Despite preferring face-to-face care, patients show openness to digital tools, underscoring the importance of incorporating patient perspectives into greener nephrology practices.
Universal telehealth aims to support access to timely coordinated chronic disease care. Large-scale evidence on the extent to which this occurs to guide telehealth policy is limited. To examine temporal changes in uptake and timeliness of general practitioner chronic disease management (GP-CDM) services in Australia following universal telehealth introduction (March 2020) and removal of subsidized telephone (but not video) GP-CDM services (July 2021). Whole-of-population cohort study of linked national claims and death data, 2018-2022. Interrupted time-series analyses quantified temporal changes in GP-CDM service uptake and timeliness following telehealth policy changes. From 2018 to 2022, each month an average of 568 858 GP-CDM services were delivered, with 25-43 users and 44-76 services per 1000 population aged 45-<85 per month. After universal telehealth introduction, GP-CDM uptake remained stable, with similar trends pre- and early-pandemic. Monthly uptake decreased substantially following the removal of telephone GP-CDM services [decrease of 4.0 users (95%CI -6.3, -1.7) and 6.9 services (-10.5, -3.3) per 1000 population]. In the first month of telehealth, 38.7% of people using GP-CDM services used telehealth (37% telephone, 1.7% video), declining to 2.2-5.4%/month after removal of telephone GP-CDM services. Small improvements in GP-CDM timeliness stalled once telephone services were no longer available. Patterns were similar across population subgroups. Telehealth policies in Australia sustained access to chronic disease care during the pandemic. Limiting access to these services to video alone was associated with a greater than expected decline in use had the pandemic and introduction of telehealth not occurred.
Mental health applications increasingly serve as stand-alone interventions or adjuncts to clinical care, yet their capacity to support users experiencing acute psychological distress remains poorly characterized. This study introduces the Mental Health App Crisis Support Assessment Framework (MHACSAF), a structured instrument for evaluating crisis support implementation in mental health apps, and reports findings from its application to six commercial AI-powered products. MHACSAF is grounded in suicide prevention guidance from the World Health Organization, evidence-based safety planning interventions, and established principles of digital health evaluation and accessibility. The framework comprises an eligibility screening step followed by seven scored dimensions totaling 65 possible points: ease of access, coverage and prioritization, hotlines and emergency services, content clarity, technical accessibility, localization, and awareness. Three licensed clinical psychologists independently evaluated Wysa, Youper, Flourish, Earkick, Replika, and Ash using iOS platforms between December 2025 and January 2026. Inter-rater reliability was strong (Fleiss' kappa = 0.87, 95% CI [0.71, 1.00]; ICC(2,1) = 0.94, 95% CI [0.83, 0.99]). Mean total scores ranged from 13.0 to 40.3 (M = 24.9, SD = 9.3); no application achieved 'Good' or 'Excellent' classification. Wysa performed best but still demonstrated gaps in accessibility, localization, and offline functionality. Technical accessibility for users with disabilities was nearly absent across products. Crisis resources were frequently buried behind conversational interfaces, and several apps delegated safety-critical information to external websites with broken or inaccessible links. These findings indicate that current AI mental health applications inadequately address user safety during psychological emergencies and suggest MHACSAF provides a reproducible methodology for benchmarking and improving crisis support implementations.