Rural adolescents face disproportionately higher rates of disordered eating, though it is unknown what about living in a rural community impacts disordered eating risk. The objective of the present study was to understand how rural adolescents describe their rural culture as impacting eating disorder risk using a qualitative study design. Semi-structured interviews using the American Psychiatric Association Cultural Formulation Interview were conducted among individuals (Mage = 20.0, Range 16-25) who developed disordered eating as an adolescent (10-19 years of age) while living in a rural community. Interviews were recorded and transcribed verbatim, and transcripts were analyzed using inductive thematic analysis. Four themes were identified: "Everyone knows everyone," Diet Culture & Weight Stigma, Body Ideals, and Initiating Events. Participants reported that everyone in their community knew everyone else and about their lives. Participants described this innate sense of community as being helpful at times, and harmful at other times. The sense of community was seen as a strength when participants felt they could get support from their community members. But felt that the close sense of community was harmful as there was a very narrow definition of acceptable social standards and a strong pressure to meet those expectations. Participants reported a strong cultural overvaluation of thinness, including the normalization of dieting and disordered eating, as well as frequent experiences of implicit and explicit weight stigma. Relatedly, body ideals differed by gender, but thinness was valued by girls and younger adults and muscularity by boys. Participants described many situations they believed contributed to their disordered eating, including chronic stressors like food insecurity, traumatic events like deaths, and a fear of rejection for not fitting social expectations in their rural communities. Findings suggest that specific aspects of living in rural communities may uniquely increase eating disorder risk, particularly the pressure to fit the narrowly defined social expectations in rural communities. However, the study also identified aspects of living in rural communities that participants viewed as protective and potentially useful in future preventative efforts, such as having a strong sense of community and support from that community. Rural communities face higher rates of disordered eating, but it is unknown what impacts disordered eating risk in rural communities. The current study interviewed ten people who developed disordered eating in adolescence when living in a rural community. The goal of the interviews was to understand what about living in a rural community impacted their eating disorder risk, both good and bad. From these interviews, we learned that participants thought there were things about living in a rural community that were both protective and harmful for their disordered eating, and sometimes both. They thought that the strong sense of community put pressure on them to fit a certain mold, but also that sense of community could be used as a strength to help people get treatment. They also felt that in their community there was an emphasis on being thin that was harmful. Overall, findings suggest that there are things about living in a rural community that impact eating disorder risk, some of which are similar to other populations and some may be unique, and more work is needed in rural populations.
Psychological safety is important for excellence in team performance. Team performance is compromised when team members fear the consequences of speaking up to raise concerns about wrongdoing or an individual. Consistent delivery of safe and the best quality of care is the prime responsibility of healthcare teams. Those involved in neonatal intensive care are not an exception. The importance of psychological safety in healthcare cannot be overemphasised considering the unique nature and complexity of this industry. It is also important for teaching hospitals with added responsibility for high-quality training, education and research. The issue of psychological safety is more relevant for healthcare organizations considering their strict hierarchy where careers depend on performance appraisals. Facilitating a culture of psychological safety is the responsibility of everyone holding a leadership role in an organization. We briefly review the history of psychological safety, the reasons why it matters in healthcare, impact on all stakeholders when it is missing, tools for assessing its presence and balance in a team, and the role of leaders at all levels in facilitating a culture of psychological safety in an organization. The barriers and facilitators of psychological safety and key issues about the phenomenon of whistleblowing are discussed.
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This commentary explores the fragmented landscape of pharmacy education assessment frameworks and their impact on curricular design. Pharmacy education operates much like a restaurant kitchen where multiple stakeholders influence what appears on the menu. Tools such as the ACPE Standards 2025 (including COEPA and Appendix 1), ACCP Pharmacotherapy Toolkit, and NABP NAPLEX competencies all aim to clarify expectations, yet their misalignment creates ambiguity and inconsistency in defining the entry-level pharmacist, creating a confusing and inconsistent recipe. Our attempt to crosswalk these frameworks was unsuccessful, underscoring a critical insight: the solution is not to create an additional toolkit, but to harmonize the existing ones. Such scaffolding would provide clarity in delivering PharmD programs to prepare entry-level graduates across the Academy and decrease the administrative burden of interpreting these frameworks. To advance the quality and coherence of PharmD education, the Academy and other stakeholders must commit to a coordinated, collaborative effort to align these frameworks and build the missing scaffold.
An understanding of the nature of long Covid (LC) is evolving, with recent evidence highlighting the role of increased sympathetic activation and decreased parasympathetic response. Building upon this emerging science, the 'Transforming Long COVID' (TLC) programme was developed to support participants in their recovery by (i) introducing education on the neuroscience underpinning persistent symptoms (with a particular focus on the autonomic nervous system) and (ii) the development of self-management strategies to support recovery. The aim of this study was to examine the feasibility of the TLC programme with a cohort of people significantly affected by LC. Seventeen participants took part in the 8-week TLC programme which comprised of seven content sessions and one discussion (Q&A) session. Participants completed survey scales (investigating anxiety, pain-related interference, pain catastrophising, sleep disturbance and fatigue) at baseline, immediately post-programme (at 8 weeks), and retention (at 13 weeks). Participants also took part in focus group interviews to investigate their experiences of the programme. Fourteen participants (82%) attended at least six of the seven TLC content sessions. Decreases in mean values over time were observed across all measures, indicating a positive (non-significant) change. Participants reported an increase in understanding of LC, new hope for recovery, belief that they now had a realistic pathway for recovery, validation of their experiences and symptoms, meaningful improvements in function, and enhanced ability to respond to and attenuate physical symptoms. No adverse events were reported. Participants highlighted a number of programme strengths, along with some potential areas for improvement. The TLC programme was shown to be feasible based on engagement, adherence, acceptable completion of surveys, and no adverse events. Study findings point to the potential for this programme to be refined, trialled and evaluated with a larger sample. Four people (living with LC, ME/CFS, chronic migraine and chronic Lyme, fibromyalgia, and centralised pain syndrome), who have experience of applying a recovery approach aligned with the TLC programme, acted in a PPI (Public and Patient Involvement in research) capacity on this study. In addition, the lead author has personal experience with the illness, and developing the recovery approach, which helped inform programme structure and development [1]. These individuals provided advice and guidance on the potential structure for the group programme, course duration, tool selection, and language and wording of the programme and materials. Further detail is provided in the Supplementary Materials.
Adolescents with type 1 diabetes (T1D) report increased stress and anxiety in comparison to their peers, which may result in out-of-range glycemic outcomes. Complementary therapies such as mindfulness may improve stress and anxiety. However, mindfulness training is mostly delivered in-person for adolescents. As adolescents with T1D are high consumers of technology, with busy schedules that impede their ability to complete in-person training, we designed an mHealth application, Appricate©, to deliver mindfulness-training. The goal of this pilot study was to qualitatively describe the experience of participating in an 8-week mHealth mindfulness-training intervention based on the principles of MBSR, Appricate©, among adolescents with T1D. We conducted semi-structured interviews with 12 adolescents aged 12 to 19 years old who had T1D for >6 months and had completed our 8-week mHealth mindfulness-training intervention. We identified five themes based on participant interviews: (1) initial appeal and attractiveness, (2) usability, (3) engagement, (4) user outcomes, and (5) recommendations. Appricate© was reported as "well made" that was "very easy to use" with engaging lessons. Participants had improved sleep, stress and anxiety management and better ability to manage school and after-school activities after using Appricate©. Participants also recommended additional content and options for personalization.
It is important that children and adolescents have safe spaces in their lives. That space can be a physical location, with a person they know, or even a place they can go in their mind. When dealing with the many stressors around them, knowing there is a place that can provide some relief is essential. Research has shown that having access to a physical safe space can decrease the risk of posttraumatic stress disorder, anxiety, and substance use.1 Having safe spaces, safe people, or even the ability to use skills to take a break from these stressors can be a privilege that is not shared by all, based on income, race, intellectual status, and much more. Feeling like one is constantly being targeted and less likely to have a safe space can cause kids to be more avoidant or to feel more like they need to defend themselves.2 As child and adolescent psychiatrists, one of our roles is to help our patients to be able to find these safe spaces wherever they can. Identifying a trusted adult in various settings is a great example of this, especially for youth who have had adults treat them poorly. Knowing safe spaces in your community that youth can go to, both to have a place in which they can relax and a place in which they can open up to others if needed, is essential. It is also important to recognize that not everyone can access the same spaces when identifying these resources. Not everyone can get to a location or can afford a membership, so being aware of this will be essential to ensure access for all your patients. This month's Media Forum highlights an example in which having a safe space was essential for the safety of the main character, and another in which the lack of safe spaces had significant impacts on the family.
There are around 20,000 mental health apps available in app stores. The Organisation for the Review of Care and Health Apps (ORCHA), a United Kingdom digital health compliance company, has assessed a number of digital mental health apps with regard to their quality, professional and clinical assurance, data privacy, and user experience. This study analyzes the data that were collected by ORCHA when they assessed mental health apps. This study aimed to examine the characteristics of mental health apps regarding their quality, target users, features, underpinning evidence, and data privacy. A dataset comprising ORCHA Baseline Review assessments of over 2000 digital health apps, including 436 mental health apps, was used. This study uses exploratory data analysis to gain insight into the quality and characteristics of mental health apps. Methods such as descriptive and inferential statistics, k-modes clustering, and association rule mining were used to explore the quality of mental health apps as well as reveal insights into the different cost types, target users, app features, data types, and evidence of app content. Information provision, data capture, and data sharing were the most common features within the 436 mental health apps. The examined apps primarily targeted the following groups: adults (n=229, 52.5%), everyone (n=184, 42.2%), and teens (n=135, 31%). The cost of apps has not been linked to the quality of mental health apps, although paid apps or apps with in-app purchases may include additional services. Indicated user acceptance or benefit is the most common type of evidence provided by these mental health apps. A total of 241 (55.3%) apps included a qualified professional in app development, and 251 (57.6%) apps provided evidence within the app that the developer validated any guidance with relevant reliable information sources or references. Usage data and email were the most commonly collected data types. Association rule mining showed that email, IP address, name, and usage data are often co-collected by the same apps. K-modes cluster analysis showed that mental health apps can be categorized into 2 clusters, where one cluster of apps (n=182, 41.7%) collected more data than apps in the other cluster. Mental health apps are commonly targeted for everyone to use, but many apps are targeted toward teens or adults. Our study suggests that many publicly available mental health apps did not take the precautions (such as the involvement of appropriate health professionals, literature references, or conducting tests) to ensure that their content is valid and research based. Greater effort on behalf of mental health app developers is needed to ensure that the public is provided with high-quality apps. Moreover, our study indicates that the mental health apps that collect more data tend to score better on the ORCHA Baseline Review assessment.
Age-related decline in sex hormones is the most frequent cause of primary osteoporosis; however, secondary causes contribute to osteoporosis in a substantial proportion of cases. These causes are diverse and often overlooked, ranging from endocrine diseases to chronic inflammatory conditions and medication use. The identification and exclusion of secondary causes of osteoporosis is crucial, because treatment typically begins by addressing the underlying condition. Investigation to exclude common secondary causes is recommended for everyone presenting with fractures indicative of osteoporosis. Advanced investigations are reserved for premenopausal individuals and those aged <50 years, and for older people in whom common risk factors, comorbidities or drugs predisposing to osteoporosis are absent. The risk of fracture can be underestimated by bone mineral density in some chronic diseases and overestimated in others. Specific adjustments can be made to the criteria in the online fracture risk FRAX calculator to provide a more accurate estimation of fracture risk in people with some forms of secondary osteoporosis. The response to conventional anti-osteoporosis treatments can be suboptimal if the underlying condition remains unrecognized and untreated. In most conditions, the evidence for antiresorptive or anabolic therapy is based on changes in bone mineral density rather than fracture. This Review covers the aetiology, pathogenesis, diagnosis and management of secondary osteoporosis, together with key areas for future research.
Many autistic people experience poor mental health but often face barriers to accessing appropriate care. This study examined whether autistic adults encounter more or different barriers to mental healthcare compared to non-autistic adults. Participants (non-autistic n = 173; diagnosed autistic n = 173; self-identified autistic n = 158) completed an online survey assessing 29 barriers adapted from the Barriers to Healthcare Checklist, rated by presence and severity. Barriers were categorised as person, provider or system related. Analyses of variance compared groups on the mean number and severity of barriers, and chi-square tests compared group incidence of each barrier. Overall, systemic barriers (e.g. cost) and difficulties with system navigation (e.g. finding services) were the most commonly reported barriers and rated as the most severe. Autistic participants experienced a significantly higher number and severity of barriers than non-autistic participants. Provider-related barriers (practitioners' knowledge, attitudes and skills) were particularly severe for autistic groups. In contrast, person-level barriers (e.g. sensory sensitivities), though often reported in general healthcare, were less impactful in mental healthcare. Findings suggest that efforts to improve mental healthcare access for autistic people should prioritise addressing the most frequent and severe barriers: system and navigation challenges, and practitioner knowledge and skills in autism.Lay abstractAutistic people often experience poor mental health but face many challenges when trying to access mental healthcare. These challenges can include things like high costs, difficulty finding the right support or healthcare professionals not understanding autism. We looked at whether autistic adults face more or different barriers to mental healthcare compared to non-autistic adults. We surveyed over 500 adults, including those with a formal autism diagnosis, those who self-identified as autistic, and non-autistic adults. The survey asked about 29 possible barriers to getting mental healthcare. These included things related to the person (such as anxiety, sensory sensitivities or difficulty finding services), the healthcare provider (like psychologists' and psychiatrists' lack of autism knowledge, or poor communication) and the healthcare system (such as long waiting lists or high cost). We asked whether participants had experienced each barrier and how much each one affected their ability to get help. We found that nearly everyone experienced some barriers, especially challenges with the healthcare system and knowing how to find help, but autistic participants faced more barriers and were more strongly affected by many of them than non-autistic participants. Compared to non-autistic people, autistic people had a lot of problems with providers which prevented them getting the care they needed. We concluded that, to improve access to mental health support for autistic adults, we need to focus on the most common and harmful barriers: making the system easier to use, reducing costs and improving practitioners' understanding of autism and working with autistic people. By addressing these areas, we can help ensure that autistic people receive the mental healthcare they need.
Disparities in cardiac arrest survival persist across gender, race, age, disability, socioeconomic status, and geographical location in part due to unequal access to life-saving interventions such as bystander cardiopulmonary resuscitation (CPR) and early defibrillation. Inequities in access to training, equipment, and local implementation may reinforce these disparities across the chain of survival. Current diversity, equity and inclusion (DEI) approaches to disparities in resuscitation research often examine inequities in isolation, limiting their ability to explain how structural, social, and institutional factors interact to influence outcomes. To address these limitations, this concept paper proposes examining the chain of survival through an intersectional lens, which considers Justice at the forefront of Equity, Diversity, and Inclusion (JEDI). Adding justice as an ethical principle aims to target these broader factors, and when combined with DEI efforts, may lead to a more comprehensive approach on examining inequities in resuscitation. Within the European Resuscitation Council (ERC), this intersectional JEDI lens provides a support for identifying inequities and barriers across both the chain of survival and the formula of survival, including medical science, educational efficiency, and local implementation, so that giving and receiving high-quality resuscitation becomes realistically attainable for everyone.
A Joint Strategic Needs Assessment (JSNA) is the process through which health and wellbeing boards in England assess the needs of their local populations to identify inequalities in health and its wider determinants and inform both commissioning priorities and a Joint Local Health and Wellbeing Strategy. We sought to determine how and to what extent JSNAs address the needs of LGBTQ+ people in England. The local authorities in receipt of a Public Health Grant in 2024 were identified and their websites searched for current (i.e. published in 2020 or later) JSNAs. Those which referenced LGBTQ+ health and wellbeing were assessed against pre-specified methodological and content criteria indicative of LGBTQ+-inclusive practice (e.g. LGBTQ+ community involvement in JSNA development). Counts and percentages described the frequency with which each criterion was met across the eligible JSNAs, and choropleth maps illustrated patterns of inclusion across England. Of 142 local authorities with an eligible JSNA, 108 referenced LGBTQ+ health and wellbeing at least once. However, few local authorities considered the diversity within LGBTQ+ communities or the impact of intersecting marginalised characteristics. Most disaggregated data for LGBTQ+ people concerned mental illness, sexually transmitted infections, HIV, and substance use. Currently, English JSNAs do not adequately characterise the needs of local LGBTQ+ communities and disproportionately focus on highly stigmatised behaviours and conditions. Are LGBTQ+ health needs included in local public health plans?In England, local councils are responsible for identifying and responding to the health needs of people in their communities. One way they do this is through a document called a Joint Strategic Needs Assessment (JSNA). These reports are meant to highlight health inequalities and help councils make better decisions about local health services. This study looked at how well JSNAs in England include the health and wellbeing of LGBTQ+ people. The researchers searched for the most recent JSNA reports (from 2020 onwards) from all 142 local councils that receive public health funding. They then checked whether LGBTQ+ people were mentioned in the reports and, if so, how well their needs were considered. This included looking at whether local LGBTQ+ communities had been involved in developing the reports and whether the reports took into account different identities and experiences within LGBTQ+ groups. They found that while 108 of the 142 JSNAs mentioned LGBTQ+ health, the coverage was often limited. Most reports focused narrowly on topics that are already heavily stigmatised, including mental health, HIV, sexually transmitted infections, and alcohol or other drug use. Few reports looked at the full range of issues LGBTQ+ people face, or how other factors like race, ethnicity, disability, or poverty may also affect their health. Overall, the study shows that many local councils are not doing enough to understand or plan for the health needs of LGBTQ+ communities. The authors suggest that more inclusive and community-informed approaches are needed to ensure that public health services work for everyone.
Physical inactivity and suboptimal diet in pregnancy are important modifiable risk factors for gestational diabetes, a major contributor to pregnancy complications. We aimed to assess the effects of physical activity and/or diet-based lifestyle interventions during pregnancy on gestational diabetes and if these vary by maternal (body mass index, age, parity, ethnicity, education) and intervention characteristics using individual participant data meta-analysis of randomised trials, and a cost-effectiveness analysis. International Weight Management in Pregnancy Collaborative Network database was updated by searching major databases from February 2017 to March 2022. The main outcomes were gestational diabetes by any criteria and by the National Institute for Health and Care Excellence. Other outcomes were gestational diabetes as per International Association of Diabetes in Pregnancy Study Group and maternal and perinatal outcomes. We performed a two-stage random-effects individual participant data meta-analysis to obtain summary estimates (odds ratio) with 95% confidence intervals. Study quality of included trials was assessed, and heterogeneity summarised using τ2. Where possible, we added the aggregate data from non-individual participant data trials to the meta-analysis. We ranked interventions by effectiveness using network meta-analysis and undertook model-based economic evaluation to assess cost-effectiveness. The cost-effectiveness analysis took an NHS cost perspective compared an overall lifestyle intervention versus usual care with a time horizon covering the beginning of pregnancy until the discharge of the mother and infant from the hospital following delivery. Ninety-two trials (32,284 women) were included; 54 (23,698 women) provided individual participant data. Lifestyle interventions reduced the odds of gestational diabetes (any criteria) by 10% in individual participant data trials (odds ratio 0.90, 95% confidence interval 0.80 to 1.02, 54 studies, 23,361 women), and the findings reached statistical significance when non-individual participant data were included (odds ratio 0.81, 95% confidence interval 0.73 to 0.89, 92 studies, 31,947 women). Physical activity significantly reduced the odds of gestational diabetes by 36% (odds ratio 0.64; 95% confidence interval 0.48 to 0.84), and diet by 19% (odds ratio 0.81; 0.69 to 0.96), but not mixed interventions. Women with middle (odds ratio 0.68, 95% confidence interval 0.51 to 0.90) and high educational level (odds ratio 0.71, 95% confidence interval 0.54 to 0.93) benefited more than those with low educational status, and no differences by maternal body mass index, age, parity or ethnicity. There was no significant reduction in gestational diabetes defined by National Institute for Health and Care Excellence criteria (odds ratio 0.98, 95% confidence interval 0.84 to 1.13) in individual participant data trials. For gestational diabetes defined using International Association of Diabetes in Pregnancy Study Group criteria, interventions reduced gestational diabetes by 14% (odds ratio 0.86, 95% confidence interval 0.75 to 0.97, τ2 = 0.00, 16 studies, 6174 women) in individual participant data trials and by 17% (odds ratio 0.83, 95% confidence interval 0.72 to 0.95, τ2 = 0.01, 25 studies, 7883 women) when non-individual participant data trials were added. Overall, physical activity reduced caesarean section (odds ratio 0.83; 0.72 to 0.96), small-for-gestational age (odds ratio 0.72; 0.56 to 0.92) and large-for-gestational age babies (odds ratio 0.81; 0.71 to 0.94); diet-based interventions reduced any preterm birth (odds ratio 0.37; 0.20 to 0.68) compared to controls. No differences were observed for other outcomes. Lifestyle interventions were on average more expensive and more effective at averted gestational diabetes and major outcome averted compared to usual care. We could not identify the specific intervention components and delivery methods associated with improved outcomes, due to variations in reporting. Lifestyle interventions in pregnancy prevent gestational diabetes, and the effects vary according to the definition of gestational diabetes. Physical activity-based interventions may be the most effective. Lifestyle interventions should be implemented and evaluated in routine clinical practice to prevent gestational diabetes, with additional support for women with low socioeconomic status. This study is registered as PROSPERO CRD42020212884. www.crd.york.ac.uk/PROSPERO/view/CRD42020212884. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129715) and is published in full in Health Technology Assessment; Vol. 30, No. 39. See the NIHR Funding and Awards website for further award information. During pregnancy, not eating well, not moving enough, and being overweight can lead to a condition called ‘gestational diabetes’. It is when mothers have high sugar levels for the first time. This can cause problems for both the mother and the baby during pregnancy and later in life. Being more active and eating healthily could lower the chances of mothers developing ‘gestational diabetes’. However, these changes might help some mothers more than others. It could depend on things like how much they weigh, their age, how many babies they have had before, their ethnicity, and education level. We wanted to see if improving physical activity and diet – ‘lifestyle interventions’ – could prevent gestational diabetes, and whether all mothers benefit. We looked at individual information from almost 24,000 women in different studies from all over the world, that recruited a total of about 32,000 women. Some studies looked at changes in physical activity, some at diet changes and some at both. When we put all this information together, we found that lifestyle interventions could reduce the odds of gestational diabetes by about 10% when considering only studies that shared their data, although some women could see a slight 2% increase in risk. Including information from studies that did not share data, showed greater benefit, reducing the odds by about a fifth. Lifestyle interventions seemed to work better in mothers who were more educated, so support is needed to make them work for everyone. Physical activity seemed to be the most effective intervention, and reduced caesarean births, having babies who were either too small or too big for their age, and the need for special care after birth. Eating better also lowered the risk of having a baby too early. Although lifestyle intervention was more expensive to the NHS, it lowered the chances of gestational diabetes.
Although COVID-19 is no longer a public health emergency, it remains the most prevalent circulating infectious-like-illness in Europe. Whether immunocompromising conditions (ICCs) still carry increased mortality risk during the Omicron era is unclear. We conducted a cohort study across EuCARE sites in 8 countries among adults admitted to hospital with COVID-19 between 2020-2023. ICCs and COVID-19 pneumonia at hospitalization were defined using clinical information and ICD-10 codes. Logistic regression and counterfactual mediation analysis was used to compare 28-day in-hospital mortality risk associated with ICCs using COVID-19 pneumonia and vaccination at hospital entry as intermediates. Proportion of the total effect of ICCs mediated and the controlled direct effects (CDEs) were calculated. We also formally tested for interaction between SARS CoV-2 variants and ICCs for mortality risk. 42,488 individuals were included, of which 1,675 (3.9%) had an ICC. 55% were male, median (IQR) age was 67 (52, 79) years. Overall, 4,344 (10.2%) individuals died in hospital. ICCs were associated with increased mortality, OR = 1.49 (1.25, 1.79) with no evidence for an attenuation during the Omicron phase (p-interaction=0.60). Mediation analyses showed that the total effect of ICCs was mediated by vaccination but only weakly by pneumonia. With Omicron, the excess mortality associated with ICC was higher under the scenario that everyone in the cohort was to develop COVID-19 pneumonia [CDE =1.22 (0.09, 1.65)]. ICC remains a significant risk factor for in-hospital death, even during the Omicron era, particularly if the infection led to the development of pneumonia.
The National Institutes of Health (NIH) Sex as a Biological Variable (SABV) policy aims to improve the rigor and reproducibility of biomedical research by encouraging sex-inclusive study designs and sex-based analyses. To evaluate policy implementation, we examine 574 funded publications (2017-2024) linked to grants from 21 NIH Institutes and Centers. We assess sex inclusion and sex-based reporting and analyses, while examining associations with author gender. Sixty-one percent of studies include both sexes, with human-subject research more likely to do so than non-human studies (p = 1.31×10-23). Of the single-sex studies, 34% focus on sex-specific topics. Among studies to include both sexes, 83% report sample sizes by sex, yet only 44% conduct sex-based analyses. Sex-based analyses are more common in human-subject studies (p = 0.00002) and in articles with women first authors (50% vs. 39%, p = 0.036). Articles with women as first and last author dyads are significantly more likely to analyze data by sex (OR = 2.24, 95% CI: 1.33-3.79). These findings suggest that while the SABV policy has encouraged sex inclusion, gaps remain in sex-based analyses. Author gender may influence these research practices, underscoring the need for continued efforts to fully integrate SABV into NIH-funded research studies. The U.S. National Institutes of Health (NIH) requires researchers to consider sex as a biological variable (SABV) to improve research quality and ensure findings benefit everyone. To assess how well this policy is being implemented, 574 NIH-funded publications from 2017–2024 were reviewed. Most studies (61%) included both sexes, particularly those involving humans. However, fewer than half (44%) analyzed results by sex, even when both sexes were included. Sex-based analyses were more common in human studies and in articles with women as first or senior authors. These findings show progress in sex inclusion, but many studies still fail to compare results by sex. Without these analyses, important differences may be missed. Stronger guidance and incentives are needed to ensure biomedical research fully considers sex and produces results that benefit all people.
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.
Early detection of Parkinson's disease (PD) through speech analysis offers significant clinical advantages, yet no validated tools exist for Arabic-speaking populations, representing a critical gap in global healthcare. Previous studies have relied on limited machine learning (ML) classifiers and voice attributes, which may introduce bias and hinder effective technique discovery. To address this, we developed an optimal PD prediction pipeline by testing multiple ML classifiers and feature extraction methods. We created the first Arabic PD speech dataset, comprising 40 subjects (17 with PD and 23 controls), and validated our methodology on an independent Spanish cohort of 100 subjects. Feature extraction included traditional, audio-to-text, and deep voice features from a pre-trained Whisper model. We employed feature selection and dimensionality reduction techniques to refine the dataset dimensions. Final features were assessed using twelve classifiers with leave-one-out and k-fold cross-validation for robust performance evaluation. Shapley additive explanations (SHAP) were utilized to determine feature importance as vocal biomarkers. Linear Discriminant Analysis achieved optimal performance with 90% accuracy, precision, recall, and F1-score using leave-one-out cross-validation. Linear Support Vector Classification also performed well, achieving 87.7% precision and 87.5% recall. When tested on the independent Spanish dataset, our methodology attained 83% accuracy, confirming cross-linguistic generalizability. SHAP analysis indicated that audio-to-text features provide contextual insights on fluency and coherence, while traditional features effectively capture acoustic variations. This study establishes the first validated Arabic PD speech classification system and demonstrates its universal applicability, laying the groundwork for global speech-based PD screening. Parkinson’s disease (PD) affects how a person speaks, often causing changes in voice quality and fluency that are hard for the human ear to measure in early stages. While technology can analyze these changes to help doctors diagnose the disease early, most of this research has been done in English or European languages. This has created a gap in care for over 400 million Arabic speakers worldwide. In this study, we developed the first validated system specifically designed to detect Parkinson’s disease from Arabic speech. We recorded speech samples from individuals with Parkinson’s and healthy volunteers. We then used advanced computer programs (machine learning) to identify patterns in their voices. To make sure our tool works for everyone and not just one group, we also tested it on a different group of people speaking Spanish. Our system was able to identify Parkinson’s with 90% accuracy in the Arabic group and 83% accuracy in the Spanish group. This research is important because it shows that speech-based tools can work across different languages and cultures. Because this tool can run on simple technology like a smartphone, it could make Parkinson’s screening much more accessible and affordable, especially in areas where specialized doctors are hard to find. This is a major step toward using technology to provide fairer healthcare for people with neurological conditions globally.
The past five years of success with calcitonin gene-related peptide (CGRP) based drugs has transformed migraine into a relatively treatable neurological disorder. There are now eight monoclonal antibodies and small-molecule receptor antagonists available for the acute and preventive treatment of migraine. However, while the drugs have been remarkably effective and safe so far, they do not work for everyone, and some adverse effects have become apparent. We describe key developments with the CGRP therapeutics regarding real-world effectiveness and safety. Emerging evidence supporting combinatorial treatment strategies within the CGRP drugs and with onabotulinumtoxinA will be discussed. The future of peptides is bright for migraine therapeutics. A monoclonal antibody against pituitary adenylate cyclase - activating polypeptide (PACAP) has shown promise in a clinical trial and evidence suggests that CGRP and PACAP therapeutics may be complementary. A second CGRP receptor, AMY1, which is also activated by another peptide, amylin, is a new therapeutic target validated by clinical and preclinical data. Building on the CGRP story, centrally acting CGRP antagonists are an untapped area that should be explored. We close with a brief speculation on possible future applications of CGRP drugs for other disorders.