Countries in the WHO's South-East Asia Region (SEAR) have made significant progress in training healthcare workers. However, concerns remain about the quality and competencies of these workers, particularly in areas such as people-centred care and empathy. There is evidence that integrating the humanities into medical education and training could address these concerns and further enhance the quality of primary care. We aimed to study the role of medical humanities in medical education across the SEARO through a scoping review, focusing specifically on the role of the arts (e.g., visual and performance arts) in medical education. A published scoping methodology was used, without quality-based exclusion, to ensure comprehensive coverage. We included empirical qualitative or mixed-method studies from PubMed (January 2010-June 2024) focusing on undergraduate medical students in the WHO South-East Asia Region countries. Additional articles and grey literature were identified via reference screening. Data were extracted using a standardised form, with dual-reviewer screening and senior investigator arbitration. We found that several medical schools have integrated diverse art forms (e.g., narrative writing, literature, visual art, drama, cinema, music, photography) into their curricula through modules, electives, or mandatory structured teaching programs, typically in the first academic year. Informal volunteer groups, formal medical humanities units, or dedicated departments organised these. While short-term positive impacts were reported, evidence of long-term impacts was limited. It is timely for health professional education institutions and organisations such as the WHO Regional Office for South-East Asia to support a more coordinated effort to integrate the humanities into health professional education- drawing on locally relevant arts and cultural traditions while reducing the lingering influence of less relevant colonial and foreign models. Regulatory authorities should guide the introduction of humanities into curricula to foster more people-centered healthcare professionals who are empathic and compassionate.
Background/Objectives: Cross-border meteorological disaster medical rescue policies in the Guangdong-Hong Kong-Macao Greater Bay Area face challenges in coordination, completeness, and effectiveness. Existing policy systems lack systematic quantitative evaluation. This study aims to assess the current policy landscape and provide evidence-based recommendations for optimizing cross-border medical rescue policy supply and enhancing regional emergency coordination. Methods: We reviewed policy documents on cross-border meteorological disaster medical rescue issued from 2005 to 2025 and used a combination of text mining and the PMC index model to quantitatively analyze and evaluate selected policy texts. The PMC scoring criteria (0-10 scale) define scores ≥ 7 as "excellent" and 5-6.99 as "good". Results: Policy word frequency analysis showed that "emergency," "disaster," "meteorology," and "management," were core high-frequency words; semantic network clustering revealed five major thematic modules: monitoring and early warning, emergency rescue, medical treatment, material support, cross-border coordination. The PMC indices of the 26 policies ranged from 5.65 to 9.42, with an average score of 6.95, which corresponds to the "good" level. Policy 14 scored 9.42, reaching the "perfect" level; eight policies received an "excellent" rating, indicating generally high policy quality. From a dimensional perspective, X9 (policy evaluation), X1 (Nature of policy), and X8 (policy guarantee) scored relatively high, while X4 (policy type) and X2 (policy timeliness) scored relatively low. Conclusions: The overall performance of the cross-border meteorological disaster medical rescue policy system is good, with relatively sound policy transparency and institutional guarantees. However, the policy system has the following shortcomings: insufficient cross-border coordination mechanisms, shallow integration of medical rescue professional content into comprehensive policies, and an emphasis on short-term emergency response with inadequate medium- and long-term strategic planning. It is recommended to strengthen medium- and long-term top-level strategic planning, enhance the functional allocation of health departments in meteorological disaster emergency plans, and establish a cross-regional joint policy evaluation and dynamic revision mechanism.
Medical sciences students are exposed to intense academic and clinical pressures that can compromise psychological well-being. Promoting resilience in this population is crucial for mitigating the psychological impact of these demands. Self-compassion has been linked to greater resilience, yet the mechanisms underlying this relationship, particularly the role of savoring, remain underexplored. This study examined whether savoring mediates the association between self-compassion and resilience. In this cross-sectional correlational study, 310 students from Kashan University of Medical Sciences were selected through stratified random sampling. Participants completed the Connor-Davidson Resilience Scale, the Self-Compassion Scale, and Bryant's Savoring Beliefs Inventory. Data were analyzed using structural equation modeling in AMOS-26. Self-compassion showed a significant positive association with both savoring and resilience. Savoring was also positively related to resilience. Mediation analyses indicated that savoring partially accounted for the relationship between self-compassion and resilience, supporting its role as an underlying psychological mechanism. The findings highlight the potential importance of positive emotional processes in understanding resilience among medical sciences students. Interventions that simultaneously strengthen self-compassion and savoring may enhance adaptive functioning in this population.
Pediatric nursing requires exceptional humanistic care. However, humanistic education is often delivered separately from professional nursing courses, creating a gap between caring principles and clinical practice. This mixed-methods study evaluated the effectiveness of the "Humanities in Course" model in enhancing nursing students' humanistic caring abilities and improving the caring climate in pediatric nursing education. A concurrent mixed-methods approach was adopted. Using a non-probability whole-population sampling method, all third-year undergraduate nursing students enrolled in the Pediatric Nursing course during the 2023 academic year were invited to participate. Seventy-five students who completed the course and provided both pre- and post-course data were included in the final analysis. Quantitative data were collected before and after the course using the Caring Ability Inventory, Peer Group Caring Interaction Scale, and Organizational Climate for Caring Questionnaire, and were analyzed using descriptive statistics and paired-sample t-tests. Students' perceptions of the course were evaluated after the intervention using a self-developed Teaching Effectiveness Evaluation Questionnaire. Qualitative data were collected from students' narrative diaries written after the RealCare Baby® 3 experiential learning activity and analyzed using Colaizzi's seven-step method with NVivo 12. Students' total caring ability scores increased significantly from 188.11 ± 18.69 before the course to 203.57 ± 16.26 after the course (p < 0.001). Significant improvements were also observed in the total scores of the Peer Group Caring Interaction Scale and the Organizational Climate for Caring Questionnaire after the intervention. The teaching effectiveness evaluation showed that most students perceived the course positively, with 94.7% reporting curricular attractiveness, 96.0% reporting improved analytical problem-solving ability, and 98.7% reporting enhanced patience when interacting with patients. Qualitative analysis of narrative diaries identified five themes: gratitude to parents, professional quality development, bioethics, operational learning, and course experience. The "Humanities in Course" model may be a feasible approach for embedding humanistic education into pediatric nursing education. It was associated with improvements in students' overall humanistic caring ability, peer caring interaction, and perceived caring climate, while qualitative findings indicated perceived development in professional quality, bioethical awareness, operational learning, and reflective understanding of pediatric caring. Future controlled, multi-center, and longitudinal studies with objective and multi-source outcome measures are needed to confirm the effectiveness, sustainability, and transferability of this model.
To explore health management trajectories in rural older adults with chronic diseases, examining behavioral evolution and identifying transition triggers across disease stages. Face-to-face, semi-structured interviews with 39 Chinese rural older adults were analyzed thematically. Findings reveal three behavioral stages: (1) Early self-management, where patients rationalize symptoms and attempt independent control; (2) Medical assistance-seeking, involving multi-facility consultations for diagnosis/treatment optimization; (3) Active treatment cessation, prioritizing symptom alleviation and functional preservation. Transitions between stages are driven by symptom control efficacy. Results demonstrate that health behaviors that differ from biomedical recommendations may reflect patients' own contextual logic and lived priorities. The study highlights the need to differentiate older adults' pragmatic health reasoning from biomedical perspectives in chronic care interventions.
To evaluate the impact of urban-rural health insurance integration on the health outcomes and financial burden of rural older adults. Utilizing panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 to 2018, we employed a staggered difference-in-differences model coupled with propensity score matching (PSM-DID) for rigorous causal identification. The policy significantly reduced out-of-pocket medical expenditures for rural households by approximately 5.6% (p = 0.034). Concurrently, significant improvements were observed in both physical health (a 0.092-point reduction in ADL impairment scores) and mental health (a 0.725-point reduction in CES-D depression scores). Mechanism analyses revealed that the integration did not significantly increase the probability of outpatient or inpatient visits-thereby ruling out supplier-induced demand and moral hazard-while effectively reducing the incidence of catastrophic health expenditure by 1.9% (p = 0.004). Heterogeneity analyses indicated that while the financial relief was universally distributed across varying educational levels, the policy dividends were predominantly captured by the younger-old demographic. Notably, the reduction in financial burden was not statistically significant for the oldest-old cohort (aged 75 and older). The urban-rural health insurance integration has achieved a dual dividend of financial protection and health enhancement without triggering the overutilization of medical services. Nevertheless, the unmet care expenses for older adults with severe disabilities underscore the urgent necessity for a secondary safety net, such as long-term care insurance.
As a pioneering development in modern gynecology, telerobotic laparoscopic surgery overcomes geographical barriers and optimizes resource allocation. However, its inherent "de-presence" has also raised significant ethical challenges and philosophical questions. Based on the practical application of remote technologies in gynecological surgery, this study first examines how network latency affects the safety of delicate pelvic anatomical dissections, considering the "ethicization" of technical parameters. Next, it analyzes the reconstruction of the responsibility chain - including the lead surgeon, on-site assistants, equipment manufacturers, and telecommunication providers - while clarifying the boundaries of legal liability among these stakeholders. Additionally, from the perspectives of both clinicians and patients, this paper discusses the heightened professional responsibility and cognitive anxiety under the "technological halo," as well as patients' expectations and concerns about their bodies being mediated by technology. To address these challenges, the study proposes establishing a "Techno-Humanistic Dual-Gate" ethical review system and emphasizes the importance of upholding the spirit of medical humanities. These measures aim to ensure that telerobotic surgery develops in a healthy manner by integrating technological precision with humanistic care. 远程机器人辅助腹腔镜手术作为现代妇科学的前沿演进方向，在突破地理限制、优化资源配置的同时，其“去在场化”特征亦引发了深层的伦理挑战与哲学省思。本文立足于远程技术在妇科手术领域中的应用实际，首先从技术参数的伦理角度出发，探讨了网络延迟对妇科盆腔精细解剖安全的影响。其次，分析了远程场景下由主刀医生、现场助手、设备厂商及通信服务商构成的责任链条重构，厘清多元主体的法律责任边界。在此基础上，从医生和患者双重角度出发，审视技术光环下的责任感知与焦虑情绪，以及患者在技术中介化过程中的期待与担忧。为应对上述挑战，本文提出建立“技术-人文双闸”伦理审批制度，并强调坚守医学人文精神的重要性，以推动远程手术在技术与人文的融合中健康发展。
This article examines Brazil's free psychoanalytic clinics as radical experiments in what I call sanitary emancipation-a mode of mental health care production that links wellbeing to liberation from colonial oppression. Based on ethnographic research with clinical collectives in São Paulo, Rio de Janeiro, and beyond, I argue that these grassroots initiatives mobilise a "corruptive" form of emancipation: an imperfect, materially entangled refusal of purity that emerges from a discipline (psychoanalysis) marked by elitist and patriarchal histories. Through practices of territorial listening-offering sessions in breadlines, public squares and sites of racist police violence-these clinics reimagine care in ways that directly challenge the coloniality of power, knowledge and being embedded in Global Mental Health paradigms. Situated within Brazil's post-Psychiatric Reform landscape, clinics like Coletivo Pontes da Psicanálise (with its Afro-Brazilian escuta de gira approach) and Margens Clínicas (working in territories scarred by state violence) and several others confront DSM-driven diagnostic logic as a neo-colonising discourse under financial capitalism. Their work critically fulfils the promise of the medical humanities by, first, politicising care as a commons rather than a commodified service; second, fostering situated knowledges grounded in relational and territorial forms of alienation; and third, resisting the de-politicised metrics of global health epidemiology. These unfinished, situated experiments in street psychoanalysis and anti-racist care ethics reveal both radical potential and inevitable capitalist contamination. Ultimately, they offer a compelling model for rethinking mental health through insurgent, place-based and decolonial frameworks.
Artificial intelligence-enabled patient decision aids (AI-PDAs) hold promise for supporting older adults with chronic diseases in accessing personalized health information, clarifying preferences, and engaging in shared decision-making. Achieving equity in their design requires attention to the complex health care and digital contexts in which these tools are used. While the Digital Health Equity Framework (DHEF) provides a conceptual foundation, practical strategies for its application remain limited. This study aimed to identify equity-related determinants and generate actionable design strategies for applying the DHEF to AI-PDAs for older adults. A mixed methods study was conducted. Semistructured interviews were conducted with older adults living with hypertension and/or diabetes, health care providers, and medical students to explore equity determinants relevant to AI-PDAs. In parallel, a review of reviews synthesized existing evidence on approaches to addressing these determinants. Interview findings and review findings were integrated through an iterative mapping process conducted by the research team and refined through multidisciplinary expert consultation involving medicine, public health, social services, and computer science. A total of 33 stakeholders were interviewed, including 15 older adults, 8 health care providers, and 10 medical students. Thirteen reviews were included in the umbrella review. The integrated synthesis identified equity determinants spanning individual, interpersonal, community, and societal levels across both the health care and digital environments, together with cross-level concerns related to algorithmic fairness. These findings informed 5 recommendations for equitable AI-PDA development: (1) co-design with end users to address their needs, (2) embrace relationship-centered design, (3) leverage community resources to improve support, (4) promote accessible and equitable artificial intelligence (AI) governance in society, and (5) enhance equitable AI through algorithmic fairness. Together, these recommendations provide practical guidance for design, pilot testing, implementation, and evaluation. By integrating stakeholder perspectives with synthesized review evidence, this study extends the DHEF from a primarily conceptual framework toward a more practice-oriented approach for AI-PDAs for older adults with chronic disease. Health care settings serve as a mediating sociotechnical context where AI tools may either support or constrain equitable care participation. The findings underscore the need for interdisciplinary collaboration to align technological innovation with equity-oriented design. Future work should focus on co-designed prototypes, real-world testing, and measurable equity outcomes.
Institution-level interventions can lead to positive health outcomes for individuals and communities. Focusing attention on how the organization of specific institutions leads to negative health outcomes can provide the basis for systemic reform that addresses structural, social, and environmental determinants of health in immediate and practical ways. Enacting policy and practical reforms in institutions requires identifying and overcoming mythical thinking through robust, interdisciplinary qualitative health research that addresses the narratives that stakeholders employ to keep institutions as they are. This article focuses on two contemporary health crises among American adolescents to describe how institutions promote negative health outcomes through commonsense policies and practices that are rooted in American mythic thinking. These institutional practices stand in opposition to scientific, medical, and qualitative evidence that demonstrate the immediate and long-term effects of specific institutional practices, including early school start times and exposure to injury through contact sports. Overcoming the institutional resilience to change depends on identifying norms and their basis in mythic thinking, and, secondarily, supplanting those norms with narratives based in the reality of institutional effects on individual lives and communities. Qualitative health research that draws strengths from across the social sciences, humanities, and arts is poised to aid in these institutional reforms but must shift its focus to institutions as a primary driver in promoting well-being.
Postural tachycardia syndrome (POTS) is a common, often disabling disorder of autonomic nervous system regulation without a unifying etiological account. Converging evidence suggests infectious, physical, and emotional threats frequently precede onset. We propose a hypothesis-generating model in which POTS may, in some individuals, involve threat-induced, centrally maintained disruption of brain-body communication that may be responsive to neuroplasticity-based behavioral medicine. In this paper, we synthesized multidisciplinary literature and our team's data spanning (a) autonomic and central nervous system responses to threat and trauma, (b) neurological alterations associated with early life stress, (c) links between adverse childhood experiences and posttraumatic stress disorder with autonomic symptom burden, and (d) clinical developments targeting the threat system and autonomic regulation. These data suggest that chronic or overwhelming threat exposure is associated with sympathetic activation, reduced vagal tone, and neuroplastic alterations within cortico-limbic and brainstem networks that parallel POTS features (exaggerated tachycardia, autonomic rigidity, multisystem dysregulation). Preliminary data indicate individuals with higher trauma exposure and PTSD symptoms report greater autonomic symptom severity and poorer global health. Emerging imaging suggests a potentially important role for the periaqueductal gray (PAG), a midbrain hub for autonomic, cardiovascular, motor, and pain responses to threat, which may fail to reset after trauma, leaving the ANS in a sustained escape-mode (fight/flight/freeze) that increases POTS risk. Overall, these findings provide preliminary conceptual support for a unified hypothesis linking trauma, PAG-mediated threat responses, and sustained autonomic dysregulation in POTS, underscoring the importance of trauma-informed care. Behavioral interventions that target threat reduction and autonomic regulation such as rate variability biofeedback and neuroplasticity-oriented psychotherapies, may complement standard medical care. Prospective, longitudinal studies are needed to clarify causal pathways and identify responsive subgroups, and randomized clinical trials are required to establish the efficacy of nervous system-focused behavioral interventions.
Rapid population ageing presents one of the defining global health challenges of the twenty-first century. While digital technologies are increasingly used to support older adults, their deployment often remains fragmented, inequitable, and insufficiently guided by ethical and legal frameworks. This paper proposes an integrated policy agenda for healthy longevity, based on the interdisciplinary work of the Einstein Circle Longevity - Healthy Ageing Assisted by Digital Technologies. Drawing on literature, expert deliberation, and practical exemplars, we developed a conceptual framework encompassing seven interrelated domains-medical, technical, practical, interactive, psycho-social, ethical, and legal. The framework highlights the need to reframe health and ageing policy around functional ability and healthspan, not merely disease outcomes, and to embed equity and participation throughout the design and governance of digital health systems. Digital technologies can extend preventive and personalised care, foster independence, and enhance participation across the life course. Yet their benefits remain unevenly distributed because of disparities in digital access, usability, and representation in data and design. Policies must ensure that technologies respect human rights, protect autonomy, and strengthen - rather than replace - social relationships and professional care. Realising the potential of digital health for healthy longevity requires investment in interoperable infrastructure, participatory design, and ethical and legal safeguards. Cross-sector collaboration and transparent governance are essential to ensure that technology adds not only years to life, but life to years.
ObjectiveTo assess diabetes mellitus-related knowledge, attitudes, risk perception, and preventive understanding among non-diabetic adults in Iraq.MethodsThis cross-sectional study used convenience, voluntary sampling to recruit adults aged 18 years or older without a prior diagnosis of diabetes mellitus from different regions of Iraq between June and October 2025. Participants completed a culturally adapted questionnaire assessing sociodemographic characteristics, diabetes mellitus knowledge, attitudes, information sources, and beliefs regarding prevention. Descriptive statistics, Mann-Whitney U tests, quantile regression, and binary logistic regression were used.ResultsThe study included 874 participants. Nearly half (48.4%) reported a family history of diabetes mellitus. Common symptoms, such as frequent urination (89.9%) and excessive thirst (84.2%), were widely known, whereas less obvious symptoms, such as unexpected weight loss, were less well recognized. Awareness of some complications, such as loss of consciousness (94.2%) and amputation (93.8%), was high, while awareness of others, such as kidney damage (69.5%) and eye disorders (78.3%), was moderate. Quantile regression analysis showed significantly lower knowledge scores among participants without a medical background (β = -4.214, p < 0.001). In addition, higher knowledge scores were significantly associated with more positive attitudes toward diabetes mellitus (odds ratio = 1.179, 95% confidence interval: 1.108-1.255, p < 0.001), whereas older age was associated with less favorable attitudes (odds ratio = 0.545, p < 0.001).ConclusionsAdults without diabetes in Iraq demonstrated a good basic understanding of diabetes mellitus; however, important gaps remain in knowledge of symptoms, complications, and key risk factors. These findings highlight the need for practical, evidence-based public health education to support prevention efforts and reduce the future burden of diabetes mellitus.
The Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) has generated intense debate in Thailand, concerning its implications for public health, particularly intellectual property, and access to medicines. During 2018-2022, Thailand undertook an extended in-country process to provide evidence on its economic opportunity and public health challenges for the Cabinet decision. However, there is no evidence indicating whether Thailand has decided to join the CPTPP. This study examines Thailand's CPTPP negotiation process using a political economy framework, focusing on the institutional and actor landscape that shaped the negotiations. This study employed a qualitative research design grounded in political economy theory, integrating state-centred and power-centred analytical frameworks. Data collection comprised a document review and in-depth interviews with 31 stakeholders from the health and trade sectors, covering state officials, academics, the private sector, and civil society representatives. The findings demonstrate critical public health concerns centred on pharmaceutical access, plant variety protection, and medical device regulatory standards. The findings also reveal a complex landscape of stakeholder dynamics and power asymmetries in Thailand's CPTPP negotiation process. Although both state and non-state actors played influential roles in shaping public discourse and decision-making, the decision-making was dominated by state trade actors, as the lead negotiating authority, marginalising health sector perspectives despite their active engagement. While civil society leveraged collaborative power to exert political pressure, structural imbalances and a lack of transparency persisted. In addition, intra-sectoral differences also existed and were influenced by institutional positioning. The study highlights the need for stronger institutional mechanisms to promote inclusive stakeholder participation and greater policy coherence between trade and public health objectives in future trade negotiations. Not applicable.
Over the past few decades, scholars in the humanities and social sciences have increasingly interrogated the histories and legacies of violence against Romani people through critical, decolonial, feminist, and anti-racist lenses. Building on this body of research, this article examines continuities of anti-Roma racism in a specific place, Romania, and how they can help reproduce and shape health outcomes and inequities today. Using a critical analysis of Romanian laws, policies, literature, and public discourse, we propose the right to a remedy for past collective injustices faced by historically oppressed and racialized populations as a pathway to the full realization of the right to health in places marked by continuous collective injustices. We argue that the realization of the right to health must be understood and addressed beyond equal access and protections against violations of the right to health; it also requires addressing the legacies and persistence of anti-Roma racism and its long-term impacts on health, well-being, and quality of life, as well as addressing other enduring oppressions.
Infertility is on the rise among couples of reproductive age globally. In Uganda, while the prevalence of infertility has varied in recent studies due to differences in definitions and measures used, there is growing evidence for risks faced by those directly affected. The experiences and impact of involuntary infertility among the affected individuals and/or couples in Uganda have however not been extensively examined. This study examined the experiences of infertility before a decision to do In Vitro Fertilization (IVF) among individuals or couples who successfully had children through IVF treatment in Uganda. In this qualitative phenomenological study, we conducted individual in-person or virtual audio-recorded in-depth interviews with eight participants (one couple and six spouses). Audio recordings were transcribed verbatim and transcripts thematically analyzed. Four themes emerged: (1) Personal and social expectations (2) Frustrations with seeking help, inconclusive medical tests and delays in diagnosis (3) Stigma from family, workplace and community and (4) Psychological and emotional effects of infertility. These themes show growing distress due to failure to have normal conception as per personal and societal expectations. Finding care and the delays in diagnosis were frustrating for participants. Participants' emotional and mental health problems resulted from a combination of factors such as unmet expectations of early conception; stigma and challenges with care and diagnosis. The stress that comes with delays in conception is exacerbated by a prolonged search for possible causes of ongoing infertility and diagnosis. A socio-cultural environment that espouses traditional beliefs and expectations about normality of conception increases risks of stigma and serious emotional and mental health problems among individuals facing infertility in Uganda. Public health campaigns on negative beliefs about infertility can reduce the psychological impact on affected individuals and couples.
Introduction The use of generative artificial intelligence (GenAI) has been widely adopted across multiple fields and is beginning to be integrated into research, specifically in qualitative and mixed-methods designs. Currently, GenAI can be used for data familiarization and analysis. However, approaches that integrate GenAI with human analysis are still relatively new, and no studies in medical education have explored this approach. The overarching purpose of this study is to compare GenAI-led and human-led thematic analyses of qualitative data and to explore strategies that can enhance GenAI-led thematic analysis, thereby providing insights into how GenAI and human-led analyses can complement each other. Methods  A GenAI platform (Microsoft 365 Copilot; Microsoft Corporation, Redmond, Washington, USA) was used to conduct reflexive thematic analysis and generate themes through a qualitative research dataset that includes 23 interview transcripts, whereby data were collected in 2024. The GenAI analysis was conducted through an iterative process of exploring the functions of Copilot, optimizing data input, and investigating prompting strategies. The quality of the GenAI analysis was explored by comparing its output to the human-led analysis. Results Overall, we found that, through effective prompting strategies, Copilot was able to create a thematic table, providing a comprehensive view and summary of the data. However, at times, Copilot could not use the entirety of a large prompt. Additionally, through examining the Copilot-generated and human-generated codebooks, it was found that Copilot took a more interpretive analytical approach compared to the human-led analysis, which utilized a qualitative descriptive approach. Conclusion In conclusion, since the use of GenAI to support qualitative analysis is new, we caution readers to explore the functions of the GenAI platform they use and understand the prompting strategies that yield the optimal analytical approach and output for their objectives. Specifically, it is important to reflect on the types of qualitative analysis that GenAI can support and to consider reflexivity and potential biases throughout the research process.
The majority of somatic symptoms have unexplained medical causes, and it is claimed that psychological factors are important in the initiation and exacerbation of somatic complaints. This study, cross-sectional and correlational in nature, investigated the mediating role of eudaimonic well-being on the relationship between self-determination and somatic symptoms. Mediations were examined at both the whole-construct and component levels to better understand these relationships. A total of 486 participants took part in this study, comprising 403 females (82.9%) and 83 males (17.1%), with an age range of 18 to 36 years (M = 22, SD = 2.27). Self-determination, eudaimonic well-being, and somatic symptoms were measured using questionnaires. Mediations were tested at the construct and component levels using the PROCESS macro. The results show that eudaimonic well-being mediates the relationship between self-determination and somatic symptoms (b = -0.21, SE = 0.03, 95% CI = [-0.32, -0.10]). Component-level analyses reveal that the relationship between controlling motives and somatic symptoms is mediated by negative affect (b = 0.39, SE = 0.08, 95% CI [0.23, 0.56]). These findings identify the variables that may explain the origin of somatic symptoms, emphasising self-determination as a starting point and eudaimonic well-being as a mechanism by which motivational factors affect health outcomes.
Antimicrobial resistance (AMR) is a major public health problem driven partly by inappropriate antibiotic use. Students of health studies represent future healthcare professionals with an important role in patient education, infection prevention, and antimicrobial stewardship. This study assessed knowledge, attitudes, and behaviours regarding antibiotic use and AMR among students of the Faculty of Health Studies, University of Mostar. An anonymous cross-sectional online survey was conducted in March 2025 using a self-selected convenience sample. The questionnaire was adapted from a previously published survey among Cypriot university students and distributed through student WhatsApp groups and by e-mail. Of 1113 invited students, 220 completed the survey, yielding a response rate of 19.8%. During the previous 12 months, 39.5% of respondents reported antibiotic use. Most respondents reported adherence to medical instructions regarding dosage and duration of therapy, while 20.5% reported self-medication with antibiotics and 29.5% reported keeping unused antibiotics at home. Approximately 42% perceived antibiotics as easy or very easy to obtain without a prescription. Only 36.4% of respondents correctly distinguished antibiotics from other medications. Although most respondents recognised that bacteria can develop resistance, misconceptions persisted regarding humans and viruses. Differences between study programmes were observed for some attitudes and perceptions, whereas gender and year of study were not significantly associated with most responses. Health studies students demonstrated partial knowledge of antibiotics and AMR, together with behaviours that may contribute to inappropriate antibiotic use. Strengthened curricular content on rational antibiotic use, infection management, infection prevention, and antimicrobial stewardship appears justified. The findings are also consistent with the need to consider broader stewardship measures, including better enforcement of existing prescription-only dispensing requirements in Bosnia and Herzegovina.
Children with overweight or obesity are at elevated risk for later-life mental health challenges, but the role of accelerometer-derived waking movement behaviors remains uncertain. Thus, we examined longitudinal associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) at age 7 with later-life internalizing and externalizing problems. We used data from the UK Millennium Cohort Study, focusing on children with overweight or obesity at age 7 who had valid accelerometer data and a complete set of predefined analytic variables (N = 858). Exposures were average daily minutes of SB, LPA, and MVPA. Outcomes were parent-reported Strengths and Difficulties Questionnaire-based internalizing and externalizing problems scores at ages 11 and 14. A generalized random forests approach was used to estimate average treatment effects (ATEs) and conditional average treatment effects (CATEs), adjusted for relevant demographic, socioeconomic, body mass index, parental distress, baseline mental health, and co-occurring movement intensities; day-of-week activity-pattern variables were used as exploratory candidate moderators. Estimated ATEs were small. After applying the Benjamini-Hochberg false-discovery-rate (FDR) correction across the 12 primary exposure-outcome tests, only the association between higher SB and lower internalizing problems at age 11 remained statistically significant (ATE = -0.013 SDQ points per additional min/day; 95% CI, -0.019 to -0.007; q < 0.001). No other pathway survived FDR correction, and other nominal or directionally suggestive estimates were interpreted as exploratory. CATE summaries and calibration tests provided limited evidence of reproducible heterogeneity. Accelerometer-derived waking movement behaviors at age 7 were associated with later SDQ problems scores in small and outcome-specific ways among children with overweight or obesity. Since the study is based on observational data and relies on measured-confounder assumptions, the findings should be interpreted cautiously, and as model-based estimates rather than definitive causal evidence.