This study evaluated the effectiveness of an Educational App for Complementary Therapy in Diabetes Management in improving health literacy, quality of life, and diabetes empowerment through complementary therapy. An assessor- and investigator-blinded randomized controlled trial was conducted. The report of this study adheres to the CONSORT 2025 guideline. Eighty-eight participants with type 2 diabetes who reported complementary therapy use were randomly assigned to either an app-based intervention or a standard-education control group. The eight-session intervention incorporated self-control, cognitive, psychological, and behavioural strategies. Outcomes, including diabetes empowerment, complementary therapy health literacy, and quality of life, were assessed at three time points. Data were analysed using generalized estimating equations. Participants in the intervention group demonstrated statistically significant improvements in CT-related critical health literacy and quality of life compared with the control group, but no statistically significant improvement in diabetes empowerment. Results suggest that the educational app enhances individuals' knowledge and capacity to evaluate the use of complementary therapies. The Educational App for Complementary Therapy in Diabetes Management is a promising digital tool for improving complementary therapy health literacy and quality of life in diabetes care. Although empowerment did not improve, the app's design and alignment with empowerment processes highlight its potential for extended educational and clinical use. Future research should explore longer-term engagement, methods of reinforcement, and broader implementation across diverse populations. Healthcare professionals can utilize the app to enhance patient education on the use of complementary therapies, thereby improving communication, shared decision-making, and the overall quality of diabetes management. What problem did the study address? The use of complementary therapy alongside conventional diabetes care is common, yet individuals often lack adequate knowledge to evaluate its potential benefits, risks, and safety. Disclosure of complementary therapy use to healthcare professionals is frequently low, posing risks of adverse interactions and undermining coordinated care. Knowledge, health literacy, and a supportive environment are critical components of chronic disease management, but they are underexplored in the context of digital interventions focused on the use of complementary therapies. What were the main findings? This study evaluates the Educational App for Complementary Therapy in Diabetes Management for smartphones-a digital educational intervention designed to enhance complementary therapy health literacy and safe decision-making among individuals diagnosed with diabetes. The intervention demonstrated statistically significant improvements in complementary therapy health literacy and quality of life, underscoring its potential clinical utility. While diabetes empowerment did not improve within the study period, the intervention's grounding in the WHO empowerment process framework and interactive features suggest that longer or more reinforced exposure may yield stronger health outcomes. Where and on whom will the research have an impact? The app empowers individuals to make safer and more informed decisions regarding complementary therapy use, improving self-management and quality of life. The findings provide a practical digital tool to support safer CT-related decision-making by helping participants appraise CT information, evaluate benefit-risk, and communicate with healthcare professionals. The research supports the integration of digital health literacy interventions into diabetes management programs, promoting evidence-based and patient-centred practice. This study was reported in accordance with the CONSORT 2025 statement. Professional experts contributed to the co-design of the intervention. The intervention was pilot-tested with patients, whose feedback informed protocol refinements to enhance feasibility and acceptability. ClinicalTrials.gov identifier: NCT06317584.
Survivors of adolescent and young adult (AYA) cancer (ages 15-39 y at diagnosis) face persistent psychosocial challenges, including isolation from peers, identity disruption, and unmet supportive care needs. Approximately 90,000 AYAs are diagnosed with cancer annually in the United States, and 86% survive at least 5 years. However, few age-appropriate, scalable, and developmentally tailored online psychosocial interventions exist for this population. Expressive writing (EW) shows promise for improving psychological well-being in survivors of AYA cancer, but traditional individual approaches do not address the preference of AYAs for peer support. A virtual, group-based EW intervention combining private emotional processing with facilitated peer discussion may address multiple unmet needs. The primary objective is to evaluate the feasibility and acceptability of a virtual, group-based EW intervention tailored for survivors of AYA cancer. Secondary objectives are to explore preliminary changes in quality of life and psychosocial outcomes, including perceived stress, coping self-efficacy, cancer-related intrusive thoughts, self-compassion, and posttraumatic growth. This single-arm feasibility study enrolls 30 survivors of AYA cancer who were diagnosed at ages 15 to 39 years; are 18 to 39 years old at study entry; are 1 to 5 years postdiagnosis; can speak, read, and write in English; and have regular internet access. Participants are assigned to 1 of 3 groups of 10 on the basis of developmental-stage preferences: emerging adults (18-25 y), young adults (26-39 y), or a mixed-age group (18-39 y). The 8-week intervention consists of 4 private writing sessions of 20 minutes each (odd-numbered weeks), alternating with 4 facilitated group discussions on a closed Facebook platform (even-numbered weeks). All procedures are conducted online, with questionnaires and private writings delivered via REDCap (Research Electronic Data Capture). Primary outcomes include feasibility (success criteria: ≥75% of participants complete assessments; ≥75% complete ≥1 private writing sessions; ≥70% complete all private writing sessions; ≥75% complete ≥1 group discussions; ≥70% complete all group discussions) and acceptability (success criterion: mean score ≥3 on a 0-4 scale). Secondary and exploratory outcomes are assessed at baseline and at 1-month and 3-month follow-ups. Qualitative data are collected through semistructured interviews, open-ended responses, private essays, and group posts or comments and analyzed using the constant comparative method. This study was funded in September 2024. Recruitment was completed between June 25 and July 7, 2025. Participants are currently completing 3-month follow-up assessments. Data management is expected to be completed by May 2026, and the results will be submitted for publication by the end of 2026. This study provides critical feasibility and acceptability data for the first developmentally adapted, virtual, group-based EW intervention for survivors of AYA cancer. The findings will inform the optimization and design of a randomized controlled trial to evaluate the intervention's efficacy in improving outcomes for this population.
Major depressive disorder (MDD) is a prevalent mental illness characterised by persistent sadness, loss of interest in activities and cognitive impairment. While pharmacological and psychotherapeutic treatments remain the standard for MDD management, non-pharmacological interventions, such as aerobic exercise, have gained attention for their potential benefits in reducing depressive symptoms and improving quality of life. Although several studies have explored the effectiveness of aerobic exercise in managing MDD, there is still no comprehensive synthesis of the existing evidence. This study aims to synthesise existing evidence on the effects of aerobic exercise interventions in the management of individuals diagnosed with MDD. The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. A comprehensive search will be conducted across Cochrane, Medline, PEDro, CINAHL, Scopus, Web of Science and BioMed Central databases. Search terms will be developed using the Population, Intervention, Comparison, Outcome and Study design (PICOS) framework, incorporating keywords and Medical Subject Headings related to 'Major Depressive Disorder', 'Aerobic Exercise', 'Depression', and 'Quality of Life'. Only intervention studies, including randomised controlled trials, quasi-experimental and pre-post intervention studies, will be included involving adults aged 18 years or older diagnosed with MDD according to standardised criteria (eg, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Statistical Classification of Diseases and Related Health Problems -10 (ICD-10)). For included intervention studies, the comparator will be standard care, placebo or no-exercise control groups. The primary outcome is change in depressive symptoms, and secondary outcomes include quality of life, anxiety and stress-related biomarkers. Three independent reviewers will screen studies, extract data using Covidence software (Veritas Health Innovation in partnership with Cochrane) and assess study quality using the updated Cochrane Risk of Bias 2.0 (Rob-2) tool alongside the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. If feasible, a meta-analysis will be conducted using RevMan V.5.4 (Cochrane's Review Manager), with effect sizes determined by mean differences, standardised mean differences or ORs, depending on the outcome type. This study is currently at the proposal stage, with article searches expected to begin in November 2025 and data extraction anticipated to be completed by January 2026. No ethical approval is required as this review uses existing published data. Findings will be disseminated through a peer-reviewed journal and presented at academic conferences. CRD420251151897.
This study aimed to evaluate and compare quality of  life  and  surgical  outcomes  following  laparoscopic  donor nephrectomy (LDN) versus the standard open donor nephrectomy (ODN) technique. This open-label randomized clinical trial was conductedat  Imam  Khomeini  Hospital,  Urmia,  Iran,  from  2022  to  2023). Ninety-one  kidney  donors  were  randomly  assigned  to  the  ODN (n = 46)  or  LDN  (n = 45)  group.  Outcomes  included  hemoglobin changes,  renal  function,  hospitalization  length,  operation  time, time  to  return  to  normal  activities,  complications,  and  one-year quality of life (SF-36). Data were analyzed using t-tests and Chi-square tests (P < .05). The  mean  duration  of  surgery  was  significantly  longer in  the  LDN  group  compared  to  the  ODN  group  (3.13 ± 0.37  vs. 2.30 ± 0.37 hours; P < .001). However, the ODN group experienced a  significantly  greater  reduction  in  hemoglobin  (-1.59 ± 0.78  vs. -1.04 ± 0.94; P = .004)  and  longer  hospitalization  (4.06 ± 0.38  vs. 3.31 ± 0.55  days; P < .001).  Furthermore,  a  significantly  higher proportion  of  LDN  patients  returned  to  normal  activities  within one  month  of  surgery  (84.1%  vs.  54.5%; P = .004).  There  were  no significant  differences  regarding  urinary  output,  complications,or long-term quality of life (P > .05). Although laparoscopic donor nephrectomy requires a longer operative time, it offers superior clinical benefits, including reduced  blood  loss,  shorter  hospital  stays,  and  faster  functional recovery. These findings support the adoption of the laparoscopic approach as the preferred standard of care for living kidney donors to optimize postoperative recovery.
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is a challenging chronic disease to manage. Patients' daily self-care decisions are associated with improved AF outcomes, quality of life, and decreased hospital use and cost. However, many patients find these real-world or naturalistic decisions difficult, often because of their inherent complexity and ambiguity, coupled with the uncertainty of AF. Intervention research using technology to support AF self-care has largely emphasized making decisions with clinicians. Patients with AF are increasingly using consumer technology; yet, little is known about the use of technology by patients with AF in independent self-care decision-making. Addressing this gap will facilitate developing interventions that better leverage technology to enhance patients' naturalistic decision-making. This study aimed to explore the experiences of older adult patients in using technology to support self-care decision-making. Following an interpretive descriptive qualitative approach, older adult patients with AF were recruited from 3 specialty heart function clinics in a Western Canadian province to participate in 1 of 6 facilitated virtual focus groups for 1.5 hours. Patients were asked about their self-care decision-making since AF diagnosis, their AF-specific technology use and its use in making self-care decisions, their technology motivations, benefits, constraints, and other possibilities for use. Inductive thematic analysis was used to code the transcribed data, moving from open coding to clustering of common codes into categories, looking for patterns of meaning between and across categories to iteratively arrive at main themes and subthemes. Thirty patients (n=15, 50% women) with AF (mean age, 73, SD 5.7 years; range 63-85 years) participated in the focus groups. Participants' experiences of using technology to make daily self-care decisions were highly variable but centered on its personalized use to meet their individualized needs, preferences, and life context. The personalizing process of technology use in decision-making was characterized by three themes: (1) beginning technology use in their own times and ways, during their AF trajectory-pre-, at the time, at some point AF post diagnosis, and could be either self-initiated and/or provider recommended or influenced; (2) developing patterns of AF self-care decision-making using technology, including establishing their personal baseline, keeping out of the danger zone, watchful waiting, and seeking decision-making support; and (3) finding the place for technology in normalizing daily life, either settling on or limiting its use to normalize life. Findings expand understandings of naturalistic decision-making by elucidating the personalized process of technology use in AF self-care.
Although human papillomavirus (HPV) infection constitutes a significant public health challenge, the HPV vaccination coverage remains suboptimal in China. Recent roll-out of new policies calls for an updated evaluation on the knowledge, attitude, and practice on HPV and HPV vaccination among adolescents and their parents. This nationwide cross-sectional survey targeted adolescents aged 9-17 y paired with one of their parents. Sociodemographic factors and the awareness, knowledge, attitude, practice and willingness toward HPV and HPV vaccination were collected for adolescents and their parents. Univariable and multivariable regression analyses were conducted to evaluate the factors associated with the knowledge, attitude, and practice of adolescents and their parents. A total of 1,000 pairs of adolescents and their parents were included. Awareness of HPV and HPV vaccine was 34.2% and 43.9% among adolescents, and 61.0% and 68.0% among parents. Although 77.0% of the adolescents and 78.2% of the parents believed in the benefits of HPV vaccine on adolescents, the vaccination rate remained low among adolescents (7.4%). The willingness toward HPV vaccination was significantly higher among the unvaccinated adolescents whose parents acknowledged the risk of HPV infection on themselves or communicated with their children about reproductive health. The findings underscored critical gaps in knowledge, attitude, and practice toward HPV and HPV vaccination among Chinese adolescents and their parents. To address these challenges, family-oriented, school-based and physician-led educational initiatives, enhancement of the accessibility and convenience of HPV vaccination, expansion of HPV vaccine indications, and evidence to support its inclusion in the National Immunization Program are needed. Human papillomavirus (HPV) is a very common virus that can cause several cancers and other diseases in both women and men. Vaccination during adolescence, especially before sexual activity begins, is one of the most effective ways to prevent HPV-related diseases. However, HPV vaccination coverage among adolescents in China remains low. This study surveyed 1,000 pairs of adolescents aged 9–17 y and one of their parents from across China to understand their knowledge, attitudes, and behaviors related to HPV and HPV vaccination. We found that awareness of HPV and the HPV vaccine was limited, particularly among adolescents. While most adolescents and parents believed that the HPV vaccine is beneficial, only a small proportion of adolescents had actually received the vaccine. Importantly, parents played a key role in adolescents’ willingness to be vaccinated. Adolescents were more likely to want the HPV vaccine if their parents understood the health risks of HPV, discussed reproductive health topics with them, or recognized the benefits of vaccination. Concerns about vaccine safety and limited access were common reasons for not getting vaccinated. These findings highlight the need for family-based education programs that target both adolescents and parents, improve understanding of HPV and vaccine safety, encourage open family communication and physician engagement in education initiatives, and provide evidence supporting the inclusion of HPV vaccination in the national immunization program, which may increase uptake and reduce HPV-related diseases in the future.
The study aims to estimate the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) in the Greater Kasai region of the Democratic Republic of the Congo (DRC) and to examine how demographic and socio-economic factors, such as displacement status and livelihood conditions, are associated with these mental health outcomes. A cross-sectional two-stage multi-cluster sampling survey. In 2016-2019, a violent conflict in the Greater Kasai region of the DRC led to widespread atrocities and massive displacement. The population not only has to cope with the aftermath of interpersonal violence, loss of loved ones and displacement but also faces severe food shortages and livelihood crises. Data were collected in 2022 from 4069 randomly selected heads of households (displaced and non-displaced) within 126 randomly selected localities in 27 health zones in the Greater Kasai. The study collected data from households with different displacement experiences: internally displaced people (IDPs), returned IDPs, repatriated refugees and members of the host community (those without a displacement history). The primary outcomes are mental health disorders. Anxiety, depression and PTSD were measured with the Generalised Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. The prevalence of anxiety, depression and PTSD was 8.3%, 18.3% and 37.8%, respectively. Anxiety affected 10% of non-displaced respondents, with a similar prevalence among IDPs (9%) and returned IDPs (8%), compared with a substantially lower prevalence among repatriated refugees (4%). About 17% of non-displaced respondents have symptoms of depression; this number is considerably higher for IDPs (22%) and returned IDPs (22%) but lower for repatriated refugees (11%). Around 40% of the non-displaced individuals, IDPs and repatriated refugees are characterised by PTSD, while this share is lower for returned IDPs (31%). Overall, a one unit increase in food insecurity (on a 0-7 scale) is associated with higher levels of anxiety (0.33 on a 0-21 scale, p<0.001), depression (0.60 on a 0-27 scale, p<0.001) and PTSD (0.07 on a 0-5 scale, p<0.05); these associations exist for those with and without a displacement history. Food insecurity is associated with poor mental health in Greater Kasai. Further research needs to explore how to develop synergistic interventions to improve both mental health and livelihoods in conflict-affected populations.
Multiple sclerosis (MS) frequently leads to mobility impairment, fatigue and a significant decline in health-related quality of life (QoL). Home-based assistive technology, such as robotic exoskeletons, offers a promising solution to enhance independent mobility and increase the intensity of motor training. Long-term functional and quality of life benefits of light lower-limb exoskeleton home use have yet to be determined. The primary objective of this study is to determine the efficacy of an 8-week period, home-based use of a robotic exoskeleton in improving QoL in individuals with MS, compared with a no-device control period. This is a multicentre, randomised, controlled and single-blinded cross-over trial. A total of 28 patients with confirmed MS (Expanded Disability Status Scale (EDSS) score 5.0-7.0) will be recruited across three rehabilitation centres. Participants will be randomly assigned to two 8-week phases: intervention (daily home-based exoskeleton use) or control (physical activity advice), separated by an 8-week wash-out period. The primary outcome is the change in the MS Quality of Life assessed by the Functional Assessment of Multiple Sclerosis (FAMS) physical composite score from baseline to the end of each phase. Secondary outcomes include changes in walking performance (2-minute Walk, 10 M Walk, Timed Up-and-Go, Four Square Step Test and Sit-to-Stand Test), fatigue severity (Fatigue Severity Scale and Fatigue Impact Measurement Scale (EMIF)-MS), and strength capacity (Manual Muscle Testing, Tardieu scale), self-confidence (Rosenberg), anxiety and depression (Hospital Anxiety and Depression Scale), satisfaction to use (Technical Aid Satisfaction Scale) and intention to use (Unified Theory of Acceptance and Use of Technology). This study was registered on ClinicalTrials.gov on 1 February 2024 (Trial registration number: NCT05835622 https://clinicaltrials.gov/ct2/show/NCT05835622). Patient recruitment is currently underway and is anticipated to be completed by January 2026. Primary endpoint data collection is expected to be completed in June 2026.This study protocol describes a rigorous trial designed to provide high-level evidence on the impact of a home-based robotic exoskeleton on QoL in individuals with MS. By determining intervention effectiveness, the results will provide clinical guidelines, potentially facilitating the widespread adoption of home-based assistive robotics to substantially improve the independence and overall QoL for patients with MS. NCT05835622.
Poststroke depression (PSD) affects approximately 33% of stroke survivors and is associated with worse outcomes, poor quality of life (QOL) and mortality. Despite its prevalence and consequences, there is no consensus on the most effective strategy for PSD prevention. Behavioural activation (BA) is an effective intervention for depression across diverse populations and is considered safer, better tolerated and a longer-lasting alternative to antidepressant medications. This study aims to test the effectiveness of a remotely delivered BA intervention to prevent PSD (Tele-BA-S). We will conduct a randomised effectiveness trial of 350 low-income adults (≥ 55 years) within 3 months of ischaemic or haemorrhagic stroke and with subthreshold depression (Patient Health Questionnaire-9 score <9 and 24-item Hamilton Depression Rating Scale (HDRS) score <15). Eligible and consented adults will be randomly assigned to Tele-BA-S or treatment-as-usual. Tele-BA-S will be comprised of an orientation session, 5 weekly BA sessions and 2 follow-up monthly booster calls delivered by trained community health workers. We will conduct assessments at 1 month, 2 months, 4 months, 6 months and 9 months after baseline. The primary outcome (PSD) will be measured by the 24-item HDRS. Secondary outcomes will include anxiety (Generalised Anxiety Disorder-7 Scale), psychological well-being (Ryff Scale of Psychological Well-being), QOL (Stroke Specific QOL Scale), medication adherence (Medication Adherence Report Scale-5), rehabilitation adherence (Rehabilitation Adherence Inventory), number of emergency department visits and hospitalisations, functional outcome (Barthel Index) and degree of disability (Modified Rankin Scale). Mediating variables will include self-efficacy (Stroke Self-Efficacy Questionnaire), motivation (Motivation in Stroke Patients for Rehabilitation Scale) and activity engagement (Neuro-QOL Participation in Roles and Activities). Exploratory implementation measures will also be collected. Primary analysis will follow the intention-to-treat principle and evaluate intervention effects over time using mixed-effects models. Ethical approval was obtained by the University of Texas Health Science Center at Houston's (UTHealth Houston) Committee for the Protection of Human Subjects Institutional Review Board. The trial protocol, statistical analysis plan and code, and deidentified participant data will be made available via the National Institute of Mental Health Data Archive. The results will be presented at academic conferences and submitted for publication. The authors declare that they have no conflicts of interest relevant to the content of this manuscript. NCT06864715.
Medical improv is an innovative educational method that uses techniques and exercises from improvisation theatre to facilitate learning among healthcare students in a broad range of domains including communication, teamwork and professional skills. To date, there are few reports on the use of this pedagogical method outside of North America. We report here on the development, implementation and evaluation of a medical improv seminar series for undergraduate medical students in Sweden. We developed an extracurricular five-part seminar series in medical improv in collaboration with a local theatre group and according to best practice guidelines. The seminar series was held twice during spring 2024 and was open to all undergraduate medical students at Uppsala University. We developed a questionnaire to assess participating students' perceptions of the acceptability and relevance of the seminar series, as well as experienced levels of psychological safety. Students voluntarily completed the questionnaire at the end of the fifth seminar. Participating students (N = 17) were highly positive concerning the acceptability and relevance of the teaching method, and uniformly recommended the seminar series to fellow students. Our results provide strong evidence of high levels of experienced psychological safety in each participating student group at the end of each seminar series. Our study provides strong support for future efforts to implement medical improv as a teaching method in undergraduate settings and outside of North America. We contend that there are promising signs that medical improv may be a widely applicable teaching method that both stimulates learning in essential competency areas and fosters greater psychological safety; more broadly, it may provide a space for playfulness, stress-relief and the cultivation of resilience among medical students.
Coercive control is a complex behavioural phenomenon where severity, frequency and patterns need to be examined collectively. However, approaches to measuring coercive control to date have demonstrated limited understanding of these patterns of behaviour by a partner or ex-partner that reflect an individual woman's experience. The aim of this study was to develop a holistic contemporary valid self-report measure of coercive control by partners. Standard instrument development, with academic and lived experience feedback and psychometric testing, using secondary data analysis, to develop the Coercive-Composite Abuse Scale (C-CAS). Australian survey of women: feedback from experts. Data for scale development from 854 adult women in Australia, where items assessed 5-year and 12-month abuse frequency. Feedback from five survivors and eight expert researchers. Scale reliability and validity; robustness of subscales; association with fear of a partner. Developed from existing scales and informed by academic and lived-experience expertise, the C-CAS factor analysis revealed a four-factor structure accounting for 57% of variance - Psychological Control (13 items, α=0.928), Sexual and Reproductive Coercion (6 items, α=0.887), Severe Coercive Control (8 items, α=0.820) and Technology-Facilitated Threats (3 items, α=0.754), showing excellent internal consistency. Evidence of the scale's face, content and construct validity was demonstrated, with further testing needed to confirm these findings. The factors combined into four key patterns- three of combined abuse and psychological control, which were experienced alone by some women. Our hypotheses asserting distinct patterns of abuse types for individuals, with severe combined patterns eliciting greater fear of a partner/ex-partner, were confirmed. The C-CAS, a self-report measure of coercive control experiences among women, has demonstrated initial reliability and validity and is suitable for use in population or clinical studies. Additional validation with diverse samples is required.
Introduction: As global cancer incidence and survival rates continue to rise, understanding the experiences and needs of individuals in the survivorship phase is critical to inform policies that promote equitable care and adequate support for cancer survivors. Objective: The objective of this study was to examine the lived social and workplace experiences of cancer survivors in Newfoundland and Labrador (Canada) using a qualitative research design. Methods: The study was open to cancer survivors of majority age who resided in Newfoundland and Labrador after their diagnosis. Between June 2023 and August 2024, twenty-five individuals participated in the study. Data were collected virtually through focus groups, individual interviews, or written responses. Demographic and socioeconomic characteristics of participants were collected via a survey. Thematic analysis was performed on all qualitative data. Two patient partner investigators informed the research throughout the entire project. Results: Data were rich and diverse, revealing a range of positive and negative experiences in social and workplace settings. Major themes included stigma in social and workplace environments, financial toxicity, workplace accommodations, social support and information needs. Young participants had unique challenges. Participants offered recommendations aimed at enhancing available supports and improving the quality of life of cancer survivors. Overall, findings highlight shared experiences across different regions and cultures while also painting the local context. Discussion: The results of this study reveal diverse experiences among cancer survivors within social and workplace settings. The findings and resulting recommendations can inform meaningful improvement to policies and programs, thus promoting equity and enhancing the lived experiences of cancer survivors.
Sexually transmitted infections (STIs) have emerged as significant public health concerns, imposing a substantial burden on both individuals and the healthcare system of the country. Additionally, STIs may also result in major extensive psychological consequences that profoundly affect individuals with STIs. Despite the government's implementation of different initiatives aimed at addressing STI-related challenges, these conditions are associated with shame and stigma which act as barriers to the effective utilisation of healthcare services. The purpose of the present study is to generate evidence on barriers and facilitators to service utilisation and management of STIs in India. Indian Council of Medical Research, New Delhi, is conducting a multi-centre study employing a mixed-method approach. The study involves different levels of healthcare systems, including both government and private healthcare facilities across seven sites in several states of India, including Maharashtra, Rajasthan, Punjab, Bihar, Uttar Pradesh and New Delhi. For the quantitative data, individuals seeking healthcare services related to STIs will be enrolled and assessed using a semi-structured pilot-tested questionnaire. In-depth interviews and focus group discussions will also be conducted with different stakeholders as per the standard guidelines of the qualitative method by the designated trained project staff. Descriptive and inferential statistics will be applied to the quantitative data, while the qualitative data will be analysed using a deductive approach with thematic content analysis. The study protocol has been approved by the ethics review committees of all the participating sites individually. The findings from this study will be published in peer-reviewed journals and disseminated through scientific conferences and meetings among policy-makers and government agencies. AIIMS/IEC/2024/609; AIIMS/Pat/IEC/2024/1205; F. 7/BIOETHICS/AIIMS-RBL/APPROEM/2021/1; KIMSDU/IEC/11/2022; LHMC/IEC/2024/11; IEC/02/EX/2024; PGI/IEC/2024EIC000373.
Childhood traumas increase the risk of psychosis and voice-hearing. While trauma profiles have been identified in voice-hearers, pathways linking these to voice-related distress remain unclear. This study examined between-group differences in mediation by psychological and behavioral variables in profile-distress associations, with potential moderation by gender. This cross-sectional study derived childhood trauma profiles via latent class analysis of Childhood Trauma Questionnaire (CTQ) scores from 266 voice-hearing Challenge trial participants with schizophrenia-spectrum diagnoses. Mediation analyses (structural equation modeling with bootstrapped 95% confidence intervals for indirect effects) tested between-group differences in indirect effects of negative voice content, persecutory beliefs about voices, voice power, voice relating style, negative self/other beliefs, emotion regulation, depression, and sleep disturbances in the association between childhood trauma profiles (exposure) and voice-related distress (outcome), with gender as a moderator. Hypotheses were preregistered on the Open Science Framework. Reporting followed AGReMA-guidelines. Three childhood trauma profiles were established: (1) 'variable severity' (n = 160), (2) 'severe neglect and emotional abuse' (n = 84), and (3) 'severe poly-trauma' (n = 22). Significant between-group differences in indirect effects were observed for persecutory beliefs about voices (1 < 3), voice power (1 < 3), and sleep disturbances (1 < 2). Age-adjustment revealed a between-group difference in indirect effect of negative self-beliefs (1 < 3). No moderation by gender was found. This is the first investigation of mediators and moderators of childhood trauma profiles and voice-related distress in clinical voice-hearers. Findings suggest that trauma profiles may provide indicators of mediators potentially relevant to inform individualized formulation and therapy planning.
Early integration of palliative care for patients with advanced cancer is recommended by major organizations and guidelines, yet palliative care is often still perceived as end-of-life care or as incompatible with active oncological treatment. Such misconceptions may delay timely integration. We conducted a cross-sectional mixed-methods survey among healthcare professionals in oncology services in Ostrobothnia, Finland. The survey included 15 Likert-scale statements (1-5) addressing perceived knowledge, values and role beliefs, and perceived capacity and support, plus one free-text question: "What is palliative care?". Likert responses were summarized descriptively and compared across demographic groups using non-parametric tests. Free-text responses were coded using a predefined framework of 25 themes derived from the WHO definition of palliative care and Finnish national quality recommendations, generating a binary concept-coverage score (0-25). Responses were also classified for an end-of-life/non-concurrent conceptualization ("non-concurrent framing"). Group differences in concept-coverage scores were tested using Mann-Whitney U. Ninety-six professionals completed the survey (response rate 88.1%); 95 responded to the free-text item. While participants strongly endorsed statements about palliative care benefits and values, endorsement was lower for perceived competence and lowest for resources and support. Nearly one-third of participants expressed a non-concurrent/end-of-life framing of palliative care in their free-text definition. Concept-coverage scores were significantly lower among participants with non-concurrent framing compared with those without, particularly framework categories related to practical factors and system-level drivers. The open-ended responses indicated variability in the conceptualization of palliative care, including descriptions consistent with an end-of-life or non-concurrent view. This pattern identifies a potential target for education and implementation aligned with national guidance and quality recommendations.
This dataset results from a multi-lab replication of Diener et al. (2010) organized by the Collaborative Replication and Education Project (CREP). This project aimed to understand the relationships between different types of needs (basic needs, psychological needs, standard of living, etc.), people's positive and negative feelings, and life evaluations. This dataset includes data collected across each site contributing to the study. It includes predictor variables associated with participants' mood and current financial comfort. It also includes demographic data like education, gender, marital status, residential area and income. The data are stored in a. csv file to be used for additional analysis, as an educational tool, and further interdisciplinary collaboration.
Males, who disproportionately account for 83% of oropharyngeal cancer cases, are underrepresented in health promotion research, including human papillomavirus (HPV) vaccination studies. The initial exclusion of males in HPV vaccine research, policies, and interventions has negatively affected male vaccine uptake. Furthermore, stigma, a well-documented barrier to healthcare engagement, has been overlooked in HPV vaccination behaviors. This study aimed to provide a more contextualized understanding of HPV vaccine disparities among adult males by applying the Health Stigma and Discrimination Framework (HSDF) to examine how stigma is produced, enacted, and sustained across social systems, which may impact male vaccine uptake. This qualitative study analyzed previously collected data from virtual group interviews conducted in 2021 with a convenience sample of 13 vaccine-eligible males aged 18-35 residing in El Paso, Texas, United States. Participants completed a demographic survey and participated in semi-structured discussions about their knowledge, attitudes, and experiences with HPV and vaccination. Data were analyzed by employing the Critical Discourse Analysis (CDA) method and the Health Stigma and Discrimination Framework (HSDF) to guide the methodological and analytical processes, helping to map stigma processes and mechanisms across individual, interpersonal, and structural levels to identify multi-level influences on male HPV vaccine behavior. Analysis identified four overarching themes reflecting the discursive construction of stigma processes and mechanisms, spanning proximal to distal levels of influence. At the individual level, (1) male sexual health and manhood reflects how internalized sex-specific beliefs and masculine norms fostered shame and discomfort around male sexual health, often framing males as unaffected by HPV rather than vulnerable or in need of vaccination. At the interpersonal level, (2) cultural and familial forces captures how discourses of intergenerational silence, religious morality, and sexual health taboos perpetuated stigma processes and mechanisms, constraining open discussion about HPV and vaccination. At the systemic level, (3) structural barriers to vaccination reflects how policy environments, institutional practices, and health system norms perpetuate systemic-level obstacles restricting vaccine access. Finally, at the multi-level, (4) stigma resistance reflects counter-narratives that highlight affirming, peer-informed, perspectives and reframed male vaccination as legitimate and necessary. Findings provide an in-depth examination of how stigma processes and mechanisms-rooted in masculine norms, sexual health taboos, intergenerational silence, misinformation, and institutional exclusion-shape HPV vaccination access, beliefs, and behaviors among vaccine-eligible adult males. In contrast, participants expressed resistance to these stigmatizing narratives by reframing male vaccination as a necessary and achievable health behavior when supported by peer-informed, culturally resonant messaging. These findings highlight the need for multi-level interventions that replace stigmatizing discourses and practices with affirming male narratives in HPV and broader sexual and reproductive health prevention efforts.
Maintaining activities of daily living is of great importance for patients who have cancer, and dependency is associated with psychological distress. However, evidence for rehabilitation remains scarce in this setting. The objective of this study was to evaluate the efficacy of a structured rehabilitation program for maintaining activities of daily living among patients with terminal cancer. This multicenter randomized controlled trial across 19 Japanese inpatient hospices/palliative care units enrolled patients who had terminal cancer with an Eastern Cooperative Oncology Group performance status of 2-3, a life expectancy ≥3 weeks, and no severe symptoms. Participants were randomly assigned (1:1, stratified by performance status and site) to either a 3-week structured rehabilitation program that incorporated key elements of rehabilitation for patients with terminal cancer or usual unstructured rehabilitation. The primary outcome was a change in the total modified Barthel Index from baseline to day 22. Secondary outcomes included the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15-Palliative Care score and safety. Between July 8, 2019, and February 20, 2024, 130 patients were randomized (59 to the intervention group, 71 to the control group; 56 patients [43.0%] were women). The primary analysis included 77 participants who had complete data available. The mean change in total modified Barthel Index was -1.31 (95% confidence interval [CI], -10.89, 8.08) in the intervention group and -15.51 (95% CI, -24.02, -7.01) in the control group. The between-group difference was 14.21 (95% CI, 1.77-26.64; p = .026), exceeding the minimally clinically important difference (9.25). Patient-reported physical functioning on the European for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 15-Palliative Care instrument was also significantly higher in the intervention group than in the control group. No serious harms occurred. Structured rehabilitation maintained activities of daily living better than unstructured rehabilitation in patients with terminal cancer, supporting its integration into routine care even in the last stage of cancer.
Total knee arthroplasty (TKA) is a common and effective procedure for end-stage knee osteoarthritis, yet patients frequently encounter a complex and dynamic symptom experience during the initial period that can significantly impact their rehabilitation and quality of life. This study aimed to explore the symptom experience of patients within 6 weeks after TKA. A longitudinal qualitative study using semi-structured interviews. This study was conducted in an orthopaedics department of a tertiary general hospital in China. Interviews were conducted with 16 patients at 3-5 days postoperatively, 14 patients at 2 weeks postoperatively and 10 patients at 6 weeks postoperatively. Data were collected between July 2024 and November 2024. A purposive sampling method was used to recruit patients. Data were analysed using directed content analysis, with data collection and analysis performed concurrently. Three themes and nine subthemes were identified: (1) symptom perception, including perceived complexity of symptoms, self-identity conflict due to functional limitations, activation of negative emotions and psychological adaptation and interaction and amplification effects among symptoms; (2) symptom evaluation, characterised by the dynamic cognitive reframing of symptom meaning, self-blame tendency and internalisation of responsibility and interference from social and medical information; (3) symptom coping, involving dynamic evolution of active coping strategies and self-efficacy reinforcement, temporal characteristics of passive coping patterns and rehabilitation barriers. The symptom experience of patients who had TKA is complex and dynamic. Healthcare providers should implement tailored interventions based on patients' symptom experiences at different stages to facilitate symptom management, alleviate distress and negative emotions and improve quality of life.
To evaluate nursing students' attitudes towards end-of-life care and assess the impact of an elective educational course on shaping these attitudes. A cross-sectional observational study with a post-test-only design was conducted at the University of Padua in northern Italy. The study involved 475 third-year nursing students, with 228 participants (48%) completing an online survey. The validated Frommelt Attitude Toward Care of the Dying Scale, Form B, Italian Version (FATCOD Form B-I) was used, and data were analysed through descriptive statistics, t-tests and correlation analyses. Participants demonstrated overall positive attitudes towards end-of-life care, with a mean FATCOD Form B-I score of 118.65 (SD = 9.63). Female students scored significantly higher in communication (p < 0.001) and family care (p = 0.002) than males. However, no significant differences were found between students who completed the elective palliative care course and those who did not. Fear and discomfort with death negatively influenced relationship building with patients, while communication and active care were strongly correlated (r = 0.45, p < 0.001). Although nursing students exhibited generally positive attitudes, the elective course alone was insufficient to significantly enhance preparedness for end-of-life care. A comprehensive, integrated palliative care education programme is necessary to address emotional barriers and improve relational competencies, ensuring students are equipped for compassionate and competent end-of-life care. Although nursing students exhibited generally positive attitudes towards end-of-life care, theoretical instruction alone proved insufficient to significantly enhance their preparedness for palliative care practice. These findings have direct implications for nursing education and clinical care quality: integrating comprehensive, experiential palliative care education throughout nursing curricula, rather than relying on optional standalone courses, may better equip future nurses to deliver compassionate and competent end-of-life care. Despite international recommendations, many nursing students feel unprepared for end-of-life care. This study examined whether an elective palliative care course produces meaningful attitudinal change among final-year nursing students. Students showed generally positive attitudes, with the highest scores in Family care and Communication. No significant difference emerged between students who attended the elective course and those who did not. The findings impact nursing educators and curriculum designers, ultimately benefiting future nurses and the terminally ill patients and families they will care for. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies. No patient or public contribution.