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Patient-accessible electronic health records (PAEHRs) offer benefits, such as supporting self-management and care engagement. However, some patients, particularly those with mental health conditions, might experience negative emotions such as worry when reading unexpected or sensitive information in their PAEHRs. A web-based survey of 4459 respondents distributed via the Finnish national patient portal included multiple-choice and open-ended questions. Respondents consisted of two patient groups who had received care either for 1) mental health or 2) other conditions. Inductive content analysis was performed to explore the kind of information that was perceived as sensitive in the PAEHR. Associations between sociodemographic factors including the type of care and reporting health information as sensitive were calculated via the multivariable binary logistic regression analysis. Mental health (61.3%), and intimate health (8.3%) were the most frequently mentioned as especially sensitive types of information among respondents, who also stressed that the sensitive nature of the health information depended on the context. Within the mental health information type, therapy or treatment was most often mentioned (3.5%) as sensitive. Respondents who had received mental health care were significantly more likely to perceive certain information as sensitive (53.2%) than other patients (28.8%; Adjusted OR=2.783, 95% CI=[2.333, 3.319], p<0.001). This study delves into the sensitive character of mental health information within PAEHR. The sensitivity of information also depends on the consequences for the patients when data will be used in another context. Documenting sensitive information carefully and safeguarding it is recommended to maintain trust in electronic health records and healthcare.

Crohn's disease (CD) is primarily characterised by chronic gastrointestinal inflammation; however, its systemic nature frequently leads to musculoskeletal complications. Among these, clinically significant foot pathologies can impair mobility and negatively impact patients' overall quality of life. Despite their relevance, the specific influence of podiatric manifestations on health-related quality of life in individuals with CD remains insufficiently explored, underscoring a critical gap in current disease management. The aim of this study was to assess the extent to which foot-related health issues affect the quality of life in people living with CD compared with a healthy population. This multicenter observational case-control study was conducted across five provinces in southern Spain-M&#xe1;laga, Granada, Ja&#xe9;n, Sevilla, and C&#xe1;diz-between January 2024 and February 2025. The study included 110 participants, evenly divided between individuals diagnosed with CD (n&#x2009;=&#x2009;55) and healthy controls (n&#x2009;=&#x2009;55), matched for age, sex, and body mass index. All participants completed the validated Spanish version of the Foot Health Status Questionnaire (SFHSQ), which assesses four foot-specific domains and four general health domains. Due to the non-normal distribution of the data, non-parametric statistical methods were applied, with the Mann-Whitney U test used to evaluate differences between groups. Participants with CD exhibited significantly lower scores across all domains of the SFHSQ, with the exception of the Footwear domain, which showed no statistically significant difference (p&#x2009;=&#x2009;0.406). Compared with healthy controls, individuals in the CD group reported greater impairments in foot pain, foot function, general foot health, and in broader health-related domains including general health, physical activity, and social capacity (p&#x2009;<&#x2009;0.01 for all). CD significantly compromises foot-related QoL. These results highlight the need to include podiatric evaluations as part of comprehensive, multidisciplinary care approaches aimed at enhancing mobility, functional capacity, and general well-being in affected individuals.

Mobile apps and wearable devices may help to facilitate early detection of mental health conditions by providing objective, real-time data to supplement other forms of feedback and diagnoses. Few studies have investigated the acceptability and feasibility of using a mobile app to track survey- and wearable-based data in mental health research in Sub-Saharan Africa. This pilot study evaluated the feasibility and acceptability of using a mobile app and wearables to capture mental health-based survey data and passively sensed data among Kenyan health care workers. A mixed methods study was conducted among health care workers employed at 4 hospitals in Nairobi, Kenya, over 30 days. A mobile app was used to collect and integrate active (baseline questionnaire and daily mood) and passive (wearable) data. The baseline questionnaire gathered information on sociodemographics, work environment, and mental health assessments on depression, anxiety, personality, early family environment, posttraumatic stress disorder, and substance use. A wearable device was used to gather data on steps, heart rate, and sleep. Qualitative interviews were conducted post trial to gain in-depth insights into participants' experiences during the study. Fifty-one participants enrolled in the pilot study. They were primarily nurses (47%) and female (70%), with a median (IQR) age of 32 (29-36) years. Attrition over 30 days was low, with only one participant dropping out due to device malfunction, which was a broken screen. Completeness of the baseline survey was high, with participants completing 96.1% of the questions. Further, 58% of the daily mood ratings were completed over the 30 days. For the wearable measures, participants submitted steps, heart rate, and sleep data on 93%, 73%, and 51% of study days, respectively. The proportion of days the wearable was worn for over 10 hours was 63%. Interviews revealed 2 primary themes. The first was intrinsic and extrinsic motivation; participants indicated that they liked having their health metrics tracked and receiving congratulatory messages from the app, encouraging increased step counts. The second theme was technical and usability challenges; 48% (10/21) of the participants reported discomfort wearing the watch while sleeping and challenges with synchronization of data due to the nonautomated nature of the process. Participants suggested additional prompts to remind them to complete the daily mood question. This pilot study demonstrates the feasibility of deploying mental health surveys, collecting data through wearable devices, and integrating such data within a single mobile platform under real-world infrastructure constraints. Health care workers in Kenya were willing to provide sensitive information through mental health assessments using a mobile app. To improve adherence, future studies should consider addressing some contextual factors such as daily prompts, enhanced data synchronization methods, and comfort concerns to improve adherence, especially during sleep.

Multimorbidity, the presence of several chronic conditions, is linked to higher mortality and healthcare use and thus poses a major challenge for aging populations. While most studies rely on simple counts of conditions, clustering approaches have been proposed to describe patterns of co-occurring diseases. We aimed to evaluate the extent to which these methodological choices influence prevalence and association with health profiles and mortality. Using UK Biobank baseline data (n&#x2009;=&#x2009;474,397), collected between 2006 and 2010, we compared six count-based definitions of multimorbidity based on different condition lists (extended, most prevalent, or body systems) and thresholds (&#x2265;2 versus&#x2009;&#x2265;3 conditions). We also applied a clustering analysis to characterize subtypes of multimorbidity among participants with at least two chronic conditions. We compared prevalence and associations with concurrent health outcomes (polypharmacy, self-rated health, frailty, falls, surgery, chronic pain), blood-based measures (C-reactive protein, Cystatin-C, HDL, LDL Cholesterol, IGF-1), and 3- and 10-year mortality risks. Analyses were undertaken separately in men and women using multivariable regression models adjusted for sociodemographic characteristics and body mass index. Multimorbidity prevalence ranged from 1.0% (cluster-based) to 35.3% (count-based). Count-based definitions using lists with more conditions yielded higher prevalence. Higher thresholds identified more severe health profiles on all measured health outcomes, blood-based measures, but not higher mortality risks. Associations with blood-based measures were more pronounced using clustering, with the highest differences from the standard definition distributed across clusters. Odds ratios for 3-year mortality ranged from 1.44 [1.26; 1.64] to 4.60 [3.73; 5.62] for men and 1.35 [1.07; 1.69] to 3.83 [2.78; 5.14] for women. For 10-year mortality, they ranged from 1.42 [1.34; 1.50] to 3.86 [3.46; 4.30] in men and 1.29 [1.21; 1.39] to 3.33 [2.93; 3.77] for women, with clustering identifying groups with low prevalence and high mortality risks. Findings should be interpreted in light of the selected nature of the UK Biobank cohort and the cross-sectional assessment of several health indicators. Operational definitions of multimorbidity substantially influence prevalence estimates, while associations with mortality appear more robust across count-based approaches. Clustering analyses provide complementary insights into heterogeneity within multimorbid populations. Future translational studies are warranted to determine how multimorbidity definitions can be optimized to ultimately improve clinical management and health outcomes in practice.

IntroductionWith growing attention to the role of social factors in shaping health, efforts have emerged to integrate social risk information into population health surveillance and healthcare delivery. However, current approaches to address social risk tend to focus on responding to each risk factor in isolation, overlooking the interconnected nature of multiple social risks that often cluster together.MethodsThis study used latent class analysis to identify profiles of co-occurring social risk using a national sample of 110,028 adults across 17 U.S. states.ResultsThree profiles emerged: Low Social Risk, Moderate Financial Strain with Food Insecurity, and High Financial Strain with Food and Housing Insecurity. These profiles were characterized by their health conditions and examined in relation to self-reported health (SRH). The High Financial Strain with Food and Housing Insecurity profile was characterized by elevated rates of depression, obesity, hypertension, and the highest odds of reporting poor/fair SRH (OR = 3.1, 95% CI: 2.78-3.67). The Moderate Financial Strain with Food Insecurity profile also showed increased odds of poor SRH (OR = 2.03, 95% CI: 1.85-2.23).ConclusionThe findings underscore the importance of understanding clustering of social risks to provide more targeted, effective population health strategies.

Australian rural and remote communities face challenges accessing allied health services due to a range of workforce, funding and service challenges. The Allied Health Rural Generalist Education and Training Scheme (TAHRGETS) was introduced to provide training, supervision and workplace project opportunities for early career allied health professionals across rural and remote private and non-government services in Australia. The purpose of this study was to explore the enablers and barriers to implementing rural generalist training positions in private and non-government settings and make recommendations for sustainable implementation. A qualitative study utilising semi-structured interviews was undertaken utilising thematic analysis which was then mapped against the Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Twenty-five allied health professionals, 21 managers and supervisors and five project team members were interviewed. Twenty-six characteristics were identified including 19 enablers and 11 barriers to implementation. Enablers included the structured nature of the training positions, study time at work, funding provided to organisations, facilitation of the programme and support provided by managers and supervisors. Barriers included recruiting participants while transitioning into the workforce, time constraints, workload pressures and limited incentive for completion. Rural generalist training positions for private and non-government organisations across rural and remote Australia were enabled through tailored support mechanisms and robust facilitation; however, policy level recognition is required for ongoing sustainability.

Mental health stigma remains prevalent in clinical practice, affecting even family physicians. Despite serving as frontline mental health providers, family physicians also face stigma and barriers to seeking care. Drawing on 2024 Council of Academic Family Medicine Educational Research Alliance study data, this study investigates family physician educators' perceptions of stigma, their help-seeking intentions, and the obstacles they encounter when pursuing mental health support. This cross-sectional study drew responses from a 2024 survey of family medicine educators and practicing physicians between October 15 and November 22, 2024. Out of the initial pool of 4,844 participants completing the survey, our sample included 1,195 respondents. One-way analysis of variance and simple linear regression were performed in Stata 14.0 to test our hypotheses rigorously. Bivariate analyses identified statistically significant associations across five key relationships: years since degree completion and stigma score, age and stigma score, race and barriers to care, underrepresented in medicine status and barriers to care, and gender and barriers to care. Furthermore, linear regression models demonstrated that all three stigma categories (personal, perceived, and stigma of others) were significantly linked to higher barrier scores. These findings underscore the pervasive nature of mental health stigma among family physicians, highlighting its detrimental impact on help-seeking and well-being. Targeted interventions are crucial for reducing stigma, addressing barriers to care, and protecting physicians' mental health, ultimately improving patient outcomes.

This study aims to systematically examine global research on digital human resource management (HRM) in healthcare using bibliometric analysis of 61 documents published between 1988 and 2024. This number reflects the emerging and highly specialized nature of digital HRM in healthcare research. VOSviewer software was utilized to map co-authorship networks and keyword co-occurrences and to generate overlay and density visualizations. A threshold-based approach was applied to identify key themes and research patterns across the literature. There has been significant publication growth, especially after 2018, with the United States, United Kingdom, and India emerging as the leading contributors. Results reveal four thematic clusters representing technological, organizational, demographic, and governance perspectives. These insights illuminate underexplored areas, such as leadership integration and equity, which are essential for guiding digital transformation in healthcare workforce management. Healthcare managers and policymakers should prioritize the strategic integration of digital HRM tools into system-level planning. Emphasis should be placed on aligning digital solutions with organizational leadership, workforce development, and public health goals, particularly in resource-constrained settings.

This study investigates the impact of different types of personal protective equipment (PPE), specifically Powered Air-Purifying Respirators (PAPRs) and traditional N95 masks with face shields, on the physiological stress responses of healthcare workers (HWs) during the COVID-19 pandemic. Utilizing an interventional randomized crossover trial design, the research encompasses a simulation phase with ten participants followed by field testing involving thirty frontline healthcare professionals in a tertiary-care hospital setting. Heart rate (HR) and movement data were collected through smartwatches, while trained observers recorded the duration and nature of various activities undertaken during simulations. Data analysis employed statistical techniques, including Principal Component Analysis (PCA) and t-Distributed Stochastic Neighbor Embedding (t-SNE), to explore potential correlations between PPE type, HR, and movement. Clustering validation measures such as the Calinski-Harabasz, Davies-Bouldin, and Silhouette scores were applied to evaluate the difference between each type of PPE. The results indicated no significant differentiation in HR responses between the two PPE types. However, because HR may lack the sensitivity to fully capture variations in cognitive load or stress, these findings should be interpreted as an exploratory baseline. Additionally, no clear distinctions were observed regarding individual user responses or the activities performed, even when considering movement data. Although the findings imply non-inferiority of the examined PPE, future research including heart rate variability as a more comprehensive indicator of stress would be informative. This research contributes valuable insights into PPE selection and its implications for healthcare worker performance and well-being in high-stress environments, ultimately aiming to inform guidelines and training programs to enhance healthcare delivery during infectious disease outbreaks.

Community-based psychiatric rehabilitation services are increasingly used to reduce recurrent hospitalization and improve continuity of care among individuals with schizophrenia spectrum disorders. However, long-term real-world longitudinal data evaluating hospitalization outcomes following community mental health center follow-up remain limited. This study aimed to evaluate the impact of community mental health center (Toplum Ruh Sa&#x11f;l&#x131;&#x11f;&#x131; Merkezi [CMHC]) follow-up on psychiatric hospitalization burden among individuals with schizophrenia spectrum disorders using a retrospective mirror-image design. This retrospective longitudinal mirror-image study included 652 individuals with schizophrenia spectrum disorders followed at a community mental health center in T&#xfc;rkiye between 2015 and 2025. Annualized psychiatric hospitalization rates before and after CMHC enrollment were calculated for each participant. Hospitalization reduction scores were defined as the difference between pre-CMHC and post-CMHC annual hospitalization rates. Sociodemographic and clinical variables associated with hospitalization reduction were evaluated using nonparametric analyses, correlation analyses, and multivariable linear regression models. Psychiatric hospitalization burden significantly decreased following CMHC enrollment. Mean annual hospitalization rates declined from 0.179&#x2009;&#xb1;&#x2009;0.204 admissions/year before CMHC follow-up to 0.061&#x2009;&#xb1;&#x2009;0.159 admissions/year after enrollment (p&#x2009;<&#x2009;0.001). The mean hospitalization reduction score was 0.118&#x2009;&#xb1;&#x2009;0.218, corresponding to a large effect size. In multivariable regression analyses, higher pre-CMHC annual hospitalization rates independently predicted higher post-CMHC hospitalization rates (&#x3b2;&#x2009;=&#x2009;0.315, p&#x2009;<&#x2009;0.001), whereas longer CMHC follow-up duration was independently associated with lower post-CMHC hospitalization rates (&#x3b2; = -0.119, p&#x2009;=&#x2009;0.004). Hospitalization reduction scores were positively correlated with both CMHC follow-up duration (r&#x2009;=&#x2009;0.308, p&#x2009;<&#x2009;0.001) and total number of psychiatric hospitalizations (r&#x2009;=&#x2009;0.386, p&#x2009;<&#x2009;0.001). Most sociodemographic and clinical variables were not significantly associated with differential hospitalization reduction outcomes. Long-term follow-up within a community mental health center was associated with significant reductions in psychiatric hospitalization burden among individuals with schizophrenia spectrum disorders. Sustained rehabilitation follow-up and continuity of care may contribute to improved long-term clinical stabilization and reduced inpatient psychiatric service utilization. These findings suggest that sustained CMHC follow-up may be associated with reduced psychiatric hospitalization burden in routine clinical practice. Non applicable.

Pregnancy involves significant physiological, psychological, and social changes that impact a woman's quality of life and well-being. Understanding the interplay of these factors is crucial for improving prenatal care and maternal health outcomes. This study uses network analysis to explore the symptom network underlying quality of life and subjective well-being in pregnant women. From November 2024 to February 2025, a total of 796 pregnant women were recruited from three tertiary hospitals in Nantong City. The 36-Item Short Form Health Survey questionnaire (SF-36) and The Chinese Resident Subjective Well-Being Scale Abbreviated Version (SWBS-CC20) were used to assess the quality of life and perceived subjective well-being of the pregnant women, respectively. Network analysis was applied to construct a symptom network, and centrality measures (including expected influence and bridge expected influence) were calculated to identify key symptoms. The network analysis revealed that the symptoms with the highest expected influence on quality of life and subjective well-being were: SWBS3 (Motivation from goals), VT (Vitality), and SWBS11 (Friendship difficulties). The symptoms with the highest bridge expected influence were: GH (General health), SWBS6 (Physical discomfort), and MH (Mental Health). Additionally, the symptoms with the highest predictive power were VT (Vitality), SWBS3 (Motivation from goals), and MH (Mental Health). The study's findings underscore the multifaceted nature of quality of life and subjective well-being during pregnancy, revealing that both psychological factors and social aspects play crucial roles. The prominence of vitality and mental health as key predictors highlights the need for comprehensive prenatal care that goes beyond physical health to address emotional and social well-being. This insight suggests that integrating targeted interventions to support mental health, enhance social connections, and boost vitality could substantially improve the overall experience and outcomes for pregnant women.

Emerging evidence increasingly suggests a strong correlation linking the human gut microbiome and bone health, particularly in its ability to modulate bone metabolism and the genesis of bone disorders. It is essential to properly understand the mechanisms of the human microbiome to prevent and treat such bone complications. While several therapeutic and analytical techniques have been explored in the past, tissue engineering has recently gained prominence as a strategy that can take advantage of the microbiome's potential. Within this context, microbial exopolysaccharides represent a promising yet largely overlooked source of functional and structural polysaccharides. These natural polymers have significant potential offering meaningful advancements in creating effective materials for bone repair and regeneration. Their potential roles span from enhancing scaffold architecture and mechanical integrity to modulating immune response and promoting osteogenic activity. This review investigates the dynamic interplay between microbiome and bone health through exopolysaccharide-driven tissue engineering. The use of both gut-derived and non-gut microbial EPS in bone tissue engineering has been emphasized. Further EPS driven strategies and their potential for treating bone dysbiosis and contributing to the development of cell-free scaffolds for bone disorders like osteoporosis and osteoarthritis have been discussed.

Triple-negative breast cancer (TNBC) lacks effective targeted therapies, and pivotal trials of pembrolizumab with neoadjuvant chemotherapy (KEYNOTE-522) underrepresent patients with cardiometabolic comorbidities. We evaluated how metabolic dysfunction affects treatment tolerability, pathologic complete response (pCR), and overall survival (OS) in routine care. We conducted a retrospective cohort study of women with early-stage triple-negative breast cancer (TNBC) treated with the KEYNOTE-522 regimen at the Cleveland Clinic between January 1, 2020, and March 31, 2025. Metabolic syndrome was defined using a constellation of cardiometabolic risk factors consistent with criteria proposed by the American Heart Association and the National Heart, Lung, and Blood Institute, adapted to available real-world clinical data (BMI, HbA1c in place of fasting glucose, hypertension, chronic kidney disease, HDL&#x2009;<&#x2009;50&#xa0;mg/dL, triglycerides&#x2009;>&#x2009;150&#xa0;mg/dL; &#x2265;3 criteria). Data included demographics, tumor characteristics, treatment details, cardiometabolic comorbidities, CTCAE-graded adverse events, pathologic complete response (pCR), and overall survival (OS). Kaplan-Meier methods estimated survival; logistic regression evaluated predictors of pCR; Cox proportional hazards models assessed OS. Median follow-up was 28.8 months. Among 222 patients with early-stage TNBC treated with the KEYNOTE-522 regimen, 55 (24.8%) met criteria for metabolic syndrome. Patients with metabolic syndrome were older (median 65 vs. 55 years, p&#x2009;=&#x2009;0.0004) and more frequently Black (43.6% vs. 18.0%). Cardiometabolic comorbidities were more prevalent, including obesity (85.5% vs. 35.9%), diabetes (72.7% vs. 7.8%), hypertension (69.1% vs. 24.6%), CKD (21.8% vs. 4.8%), low HDL (83.6% vs. 12.0%), and elevated triglycerides (58.2% vs. 6.0%) (all p&#x2009;<&#x2009;0.001). Dose reductions were more frequent among patients with metabolic syndrome (32.7% vs. 20.4%), with similar treatment discontinuation rates. pCR rates did not differ significantly (72.7% vs. 68.9%, p&#x2009;=&#x2009;0.62), and no cardiometabolic factors independently predicted pCR. With median follow-up of 28.8 months, metabolic syndrome was associated with worse overall survival. Hypertension (HR 3.83, 95% CI 1.47-9.96, p&#x2009;=&#x2009;0.006) and diabetes (HR 3.07, 95% CI 1.33-7.08, p&#x2009;=&#x2009;0.009) were independent predictors of mortality. Cardiometabolic comorbidities, particularly hypertension, were associated with poorer survival and greater treatment intolerance despite preserved pCR. Systematic cardiometabolic assessment and proactive management should be integrated into TNBC care.

Porcine reproductive and respiratory syndrome (PRRS) remains one of the most significant health and welfare challenges in global pig production. The disease is associated with substantial economic losses, impaired herd health, increased antimicrobial use, and ongoing animal welfare concerns. Despite widespread implementation of vaccination, biosecurity, and herd stabilization strategies, PRRS continues to persist endemically in many production systems, highlighting the need for additional disease-control approaches. Recent advances in genome editing have enabled the development of host-directed resistance strategies in pigs. In particular, targeted editing of the scavenger receptor CD163, a key host factor required for PRRS virus entry into macrophages, using CRISPR-Cas9 has demonstrated resistance to several PRRSV strains in experimental models. Deletion of the SRCR5 domain of CD163 prevents viral infection while largely preserving normal receptor function, representing a more targeted approach compared with complete gene knockout. Current evidence suggests resistance to both major PRRSV genotypes, although most data derive from controlled experimental studies rather than commercial field conditions. Important considerations remain regarding long-term health and welfare outcomes, immune competence under production environments, ethical considerations surrounding germline genome editing, and differences in regulatory frameworks that may influence adoption. From a pig health management perspective, genome-edited PRRS resistance should be viewed as a complementary strategy rather than a replacement for established control measures such as vaccination, biosecurity, and herd health management. Careful evaluation, veterinary oversight, and coordinated regulatory guidance will be necessary to determine how this technology may be integrated responsibly into future PRRS control programs.

Adolescence is a critical developmental period for emotional health, and anxiety disorders are a major public health concern. Adherence to the Mediterranean diet has been associated with improved mental health outcomes in adults; however, evidence in adolescents remains limited. We analyzed data from 86 adolescents participating in the KLOTHO birth cohort. Dietary quality was assessed using the KIDMED index, whereas maternal adherence to the Mediterranean diet during pregnancy was evaluated using a Mediterranean diet score. Psychological outcomes included behavioral difficulties (Strengths and Difficulties Questionnaire), anxiety symptoms (Spence Children's Anxiety Scale), and mood-related outcomes (Mood and Feelings Questionnaire). Associations were examined using Spearman's correlation analyses and multivariate linear regression models adjusted for sex, body mass index (BMI), sleep duration, and physical activity. Higher adherence to the Mediterranean diet in adolescents was inversely associated with anxiety levels in correlation analyses (&#x3c1; = -0.294, p = 0.029). However, after adjustment for sex, body mass index, sleep duration, and physical activity, the association with total anxiety score was attenuated and no longer statistically significant associated with lower anxiety levels in correlation analyses (&#x3c1; = -0.294, p = 0.029). In adjusted models, the KIDMED score was not associated with total anxiety score but was independently associated with lower scores in specific anxiety domains, including social phobia and separation anxiety. Maternal adherence to the Mediterranean diet was associated with lower overall anxiety in offspring but not with specific anxiety subdomains. Adherence to the Mediterranean diet during adolescence is modestly associated with lower levels of specific anxiety symptoms, suggesting a modest domain-specific association between dietary patterns and emotional health.

Hypertension remains a major public health challenge in China, especially in high-altitude ethnic minority areas where prevalence is high but awareness, treatment, and control rates remain low. Self-management is crucial for delaying complications and improving quality of life, yet previous studies have mainly focused on low-altitude areas and Han Chinese populations and have largely relied on total-score comparisons. Because self-management is multidimensional, such approaches may obscure population heterogeneity. Latent profile analysis (LPA) can identify subgroups with distinct behavior patterns, but evidence in hypertensive patients from high-altitude ethnic minority areas is scarce. This study aimed to identify latent profiles of self-management behaviors in this population and to examine factors associated with profile membership. A cross-sectional study was conducted between December 2024 and May 2025 among hypertensive patients attending Gannan Tibetan Autonomous Prefecture People's Hospital. Latent profile analysis was performed to identify distinct self-management behavior profiles. Multinomial logistic regression was subsequently used to examine factors associated with profile membership, including self-efficacy, social support, chronic disease health literacy, age, ethnicity, smoking, and drinking. Three distinct profiles of self-management behaviors were identified: 1) a comprehensive management type, characterized by consistently good performance across all behavioral dimensions; 2) a low treatment management type, marked by poor medication adherence and inadequate blood pressure monitoring; and 3) a low risk factor management type, characterized by weak control of smoking, alcohol use, and work-related stress. Multiple logistic regression analyses demonstrated that self-efficacy played a role in each patient group, while social support, chronic disease-related health literacy, ethnicity, and dietary habits only exerted corresponding effects in specific patient subgroups. Self-management behaviors among patients with hypertension in high-altitude ethnic minority regions exhibited substantial heterogeneity, yielding three distinct latent profiles with clearly differentiated characteristics. The study found that self-efficacy played a role across all three behavioral categories, facilitating early identification of individuals who require intervention. Concurrently, clinical practice and public health interventions can implement stratified, precision-based management strategies tailored to the primary factors that influence different patient populations.

Although motorcycle-based food delivery workers face a significant risk of accidents, previous research has primarily focused on traffic accidents, neglecting the multidimensional nature of safety, which includes perceived accident risk, near-miss experiences, and accident-related anxiety. This study addresses this gap by investigating how occupational fatigue and health behaviors are associated with the Traffic Accident Risk Index (TARI) and its subdomains (near-miss experiences, self-rated accident anxiety, and other-rated accident anxiety). A cross-sectional study was conducted. Data were collected from South Korean delivery workers via an online survey and analyzed using multiple linear regression. In total, 336 workers were included in the analysis. Occupational fatigue was positively associated with the overall risk index (B=0.017, 95% CI 0.012 to 0.021; P<.001) and all subdomains, including near-miss experiences (B=0.016, 95% CI 0.011 to 0.021; P<.001), other-rated accident anxiety (B=0.019, 95% CI 0.013 to 0.024; P<.001), and self-rated accident anxiety (B=0.016, 95% CI 0.011 to 0.021; P<.001). Inconsistent helmet use was associated with a higher TARI (B=0.413, 95% CI 0.030 to 0.796; P=.04), other-rated accident anxiety (B=0.495, 95% CI 0.025 to 0.966; P=.04), and self-rated accident anxiety (B=0.493, 95% CI 0.036 to 0.949; P=.04). Insufficient physical activity was associated with a higher TARI (B=0.368, 95% CI 0.016 to 0.719; P=.04) and self-rated accident anxiety (B=0.586, 95% CI 0.168 to 1.005; P=.006). Current smoking was associated with near-miss experiences (B=0.298, 95% CI 0.041 to 0.555; P=.02). Conversely, shorter break times were associated with lower accident risk (30 min to 1 h: B=-0.329, 95% CI -0.650 to -0.007; P=.045) and near-miss experiences (<30 min: B=-0.474, 95% CI -0.936 to -0.011; P=.045; 30 min to 1 h: B=-0.470, 95% CI -0.846 to -0.095; P=.01) than breaks exceeding 2 hours. Occupational fatigue was associated with a higher overall perceived accident risk, more near-miss experiences, and greater accident-related anxiety. Modifiable health behaviors showed additional domain-specific associations. Prevention efforts may benefit from combining fatigue management with strategies to improve helmet use, increase physical activity, and support smoking cessation. Future research should refine the measurement of break time and establish evidence-based rest guidance for motorcycle-based delivery workers.

Colorectal cancer (CRC) screening programmes in North America have effectively reduced CRC incidence. Among the nearly six million colonoscopies performed annually in the United States, 4%-11% detect large benign colorectal neoplasms, many of which can be removed endoscopically, minimizing the need for surgery. Endoscopic removal is less invasive, preserves bowel function and lowers healthcare costs. Despite these benefits, segmental colectomy for benign neoplasia remains common, with surgeries increasing between 2000 and 2014. To address this, efforts have focused on improving access to advanced endoscopic care through training and collaboration initiatives, although their impact on surgery rates is unclear. This study aims to evaluate temporal trends in the surgical management of benign colorectal neoplasia using data from the American College of Surgeons (ACS) National Quality Improvement Program (NSQIP) 2016-2022 database. Adult patients undergoing elective colectomy and/or proctectomy for colorectal neoplasia between 2016 and 2022 were identified in the ACS-NSQIP database utilizing Current Procedure Terminology (CPT) codes and International Classification of Diseases, Tenth Revision (ICD 10) codes. Patients were then classified based on the nature of the pathology as either benign or malignant. The primary outcome was to determine the frequency of resections per year for benign neoplasia. The secondary outcomes included postoperative 30-day overall morbidity, system-specific complications and healthcare resource utilization for patients undergoing resections for benign neoplasia. Multivariable regression models were fit to identify variables associated with each secondary outcome. Overall, 207,250 patients underwent colectomy and/or proctectomy for colorectal neoplasia between 2016 and 2022. Among them, 35,108 (17.5%) had resection for benign neoplasia. The proportion of patients undergoing resection for benign neoplasia decreased yearly from 3458 (22.5%) in 2016 to 2396 (12.7%) in 2022. Most benign lesions were in the right colon (63.5%), removed during a colectomy with primary anastomosis (91.5%), using a minimally invasive approach (82.8%). The 30-day overall morbidity and mortality was 6.8% and 0.4%, respectively. There were 1114 (3.2%) patients who required a reoperation and 2798 (8.0%) who required a readmission following surgery for benign neoplasia. Patients who were American Society of Anaesthesiologists (ASA) class 4 (odds ratio (OR) 2.13, 95% confidence interval (CI) 1.46-3.10), active smokers (OR 1.47, 95% CI 1.31-1.63) and those undergoing a proctectomy (OR 1.45, 95% CI 1.09-1.93) all had increased odds of postoperative morbidity. Our study of the ACS-NSQIP 2016-2022 database demonstrated a temporal decrease in the proportion of elective colorectal resections for benign neoplasms every year, with associated low morbidity and mortality. Identification of patient and treatment factors associated with postoperative morbidity, such as ASA class, smoking and type of operative intervention, can help practitioners better counsel patients regarding different management strategies and effectively select patients for the approach most suitable for their presentation.

Digital meditation-based interventions (MBIs) reach vast global audiences with millions of active users, yet concerns persist about the frequency and nature of adverse experiences (ie, AExs) occurring during meditation training. Some researchers have argued that AExs are substantially underdetected and reflect iatrogenic harm caused by meditation (ie, adverse effects [AEfs]). Others contend that these experiences largely reflect common stressors that would be experienced without meditation. These competing perspectives underscore the need for further research, particularly in the context of digital MBIs, the most widely used form of meditation training. This study examined the prevalence, predictors, and subjective evaluations of AExs during a digital MBI and tested whether reported experiences may be caused by meditation practice via comparisons between meditation-exposed and nonexposed participants. Data were drawn from 2 trials of the Healthy Minds Program. Exploratory study 1 (n=315) consisted of a sample of distressed US undergraduate students to estimate the prevalence of AExs and identify baseline predictors. Preregistered confirmatory study 2 (n=594) sampled distressed US adults from all 50 states to replicate findings from study 1 and to examine participants' subjective evaluations of AExs. Study 2 additionally compared AEx rates between participants who did and did not complete guided meditations to assess whether AExs could be caused by meditation exposure. Study 3 (n=87) used qualitative methods to analyze study 1 participants' responses to an open-ended question regarding their strategies for coping with AExs. In studies 1 and 2, 27.9% (88/315) and 10.1% (40/396) of participants, respectively, reported at least one AEx during the study period, with 6.7% (21/315) and 3% (12/396) reporting functional impairment, largely aligning with previous research. Critically, in study 2, rates of AExs did not significantly differ between participants who did and did not complete guided meditations, suggesting that these experiences were not caused by meditation practice. Higher baseline depression, anxiety, loneliness, experiential avoidance, and perceived barriers to meditation predicted more frequent AExs. In studies 1 and 2, 89.8% (79/88) and 90% (36/40) of participants who reported AExs, respectively, indicated that they were glad to have learned to meditate. Qualitative analyses showed that participants used diverse coping strategies, often using skills learned through the Healthy Minds Program. AExs were relatively common but occurred at comparable rates among participants who did and did not meditate, challenging claims that such experiences were caused by meditation practice in distressed individuals. Although a small subset of participants reported some degree of functional impairment, most evaluated their AExs as tolerable and described their overall MBI experience as positive. Together, these findings highlight the importance of distinguishing AExs that likely reflect epiphenomena of preexisting distress or symptoms from iatrogenic harm attributable to MBIs.