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In Denmark, informal caregivers can receive a Municipal Care Allowance to provide end-of-life care at home. While this policy acknowledges the value of caregiving, little is known about how it shapes caregivers' lived experiences and support needs during caregiving leave. This study explores the lived experiences of informal caregivers during caregiving leave, with a focus on existential, emotional, and relational dimensions. Inspired by Reflective Lifeworld Research (RLR), seven narrative interviews were conducted with caregivers who had provided end-of-life care at home. Data were analysed collaboratively using a bridled phenomenological approach to uncover the essence and themes of the phenomenon. Creative non-fiction narratives were used to illustrate findings. The essence of caregiving leave is characterised by a profound relational connection with the dying person and a purposeful structuring of everyday life around caregiving. Three themes emerged: Giving Love and History, Giving Life and Letting Go, and Giving Peace and Meaning. Caregivers experienced caregiving as both meaningful and burdensome, navigating emotional, existential, and practical terrains. The study followed the Ethical Guidelines for Nursing Research in the Nordic Countries. Informed consent was obtained orally or in writing, and anonymity was ensured. The study is approved by the University College Absalon Internal Review Board. Although the RLR approach provided deep insight into caregivers' lifeworlds, the small and context-specific sample may limit its transferability. Researcher bias cannot be entirely excluded despite efforts to bridle pre-understandings. Caregiving leave is not solely a period of strain but also a space for relational and existential growth. healthcare professionals should adopt relationally attuned and existentially sensitive approaches to support caregivers as co-travellers in the end-of-life journey.
The Cardiovascular-Kidney-Metabolic (CKM) syndrome framework acknowledges metabolic dysfunction-associated steatotic liver disease (MASLD) as a major manifestation, yet hepatic involvement remains insufficiently incorporated into risk stratification. This review proposes the metabolic disorder-MASLD-cardiovascular disease-kidney disease (MMCK) syndrome as an operational extension that integrates hepatic fibrosis assessment into cardiometabolic-renal care. We conducted a comprehensive narrative review across PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus through March 2026. We synthesized evidence on pathophysiological crosstalk, proposed the Multi-Organ Risk Score (MORS)-enabled MMCK staging criteria (Stages 0-4), and developed stage-specific management algorithms. The MMCK framework introduces four key operational advances: (i) quantitative multi-organ risk stratification through the MORS (L + C + B + K, range 0-12) with mandatory FIB-4/VCTE-based hepatic fibrosis assessment as the L-Score; (ii) stage-specific therapeutic thresholds linked to objective clinical cutoffs; (iii) a structured multidisciplinary team governance model with MORS-based electronic health record triggers; and (iv) a three-tiered endpoint framework for quality improvement and prospective validation. Observational evidence indicates that incorporating MASLD fibrosis into cardiometabolic staging improves coronary artery disease risk prediction. The MMCK framework positions MASLD as a cardiovascular risk-modifying axis within established cardiometabolic-renal care. The MMCK syndrome operationalizes hepatic integration within established cardiometabolic-renal care by providing a quantitative, stage-specific framework for multi-organ risk assessment and management. Future research should prospectively validate MORS-based staging in diverse cohorts and evaluate whether MMCK-guided management improves clinical outcomes compared with CKM-guided care alone.
Pembrolizumab has become a cornerstone in the treatment of multiple tumor types. In Portugal, it is currently reimbursed across 25 indications. However, a comprehensive holistic assessment of its cumulative clinical and humanistic impact is lacking. The aim was to estimate the population-level clinical and humanistic outcomes associated with pembrolizumab use in Portugal from 2017 to 2024, and to project its potential future impact until 2030. We developed a Microsoft Excel-based tool to aggregate outputs from validated, Portugal-adapted, cost-effectiveness models across all reimbursed indications for pembrolizumab. Using a real-world number of treated patients, clinical outcomes such as incremental life years (LYs), incremental quality-adjusted life years (QALYs), and avoided deaths were estimated. Forecasts through 2030 were developed using market and epidemiological projections. Alternative scenarios evaluated the additional benefits of accelerated reimbursement decisions and expanded patient access. Between 2017 and 2024, among 13,530 treated patients, pembrolizumab was associated with estimated lifetime outcomes of 14,042 incremental QALYs, 17,914 incremental LYs, and 2021 deaths avoided. Scenario analyses showed that with accelerated reimbursement, within 180 days of market approval, and full uptake, cumulative gains could have increased by up to 14,705 QALYs (total 28,746 QALYs) and an additional 1250 deaths could have been avoided (total 3271 avoided deaths). Forecasts project continued substantial benefits for patients treated between 2025 and 2030, with lifetime outcomes estimated at approximately 31,306 QALYs, 38,274 LYs, and 4841 deaths avoided for the currently reimbursed indications. Pembrolizumab has delivered significant clinical benefits in Portugal. Our results suggest that more timely reimbursement decisions and broader access could have yielded measurable additional health gains. These findings highlight the potential impact of access timelines on health outcomes, while acknowledging that broader assessments of value require consideration of cost-effectiveness, budget impact, and opportunity costs. Pembrolizumab's benefits to the Portuguese health system is expected to grow through 2030.
Men bear a disproportionate burden of undertreated mental health problems globally yet consistently underutilize formal psychological services, primarily due to traditional masculine norms that frame help-seeking as incompatible with masculine identity. Music therapy and music-based interventions offer a promising pathway that may circumvent these barriers by providing masculinity-congruent, non-clinical contexts for emotional expression and social connection. This narrative review synthesizes evidence on the mechanisms, outcomes, and clinical implications of music therapy and music-based interventions for male mental health, advancing the gateway mechanism hypothesis as a novel theoretical framework. A systematic search was conducted across PubMed and the University of Alberta Library Primo discovery platform in June 2026, searching across PsycINFO, CINAHL, MEDLINE, Academic Search Complete, Web of Science, Scopus, and additional databases. Search strings targeted music therapy in combination with male mental health, depression, anxiety, veterans, PTSD, and related terms, yielding a combined multi-database pool of approximately 1,243 results. After screening for relevance and applying inclusion criteria, 38 peer-reviewed sources were included in this narrative review conducted in accordance with SANRA guidelines. Evidence from randomized controlled trials, systematic reviews, and qualitative studies supports music therapy's effectiveness for depression, anxiety, PTSD, and trauma across predominantly male populations, with the strongest evidence in military veterans. The gateway mechanism hypothesis proposes that music functions as a masculinity-congruent, low-threat entry point through which men gradually develop psychological safety, engage in licensed emotional expression, and move toward help-seeking. The most direct experimental support comes from the Boys Do Cry RCT, which found that a music video significantly improved men's help-seeking intentions compared to non-musical control conditions. Evidence gaps persist around racialized, Indigenous, and 2SLGBTQ+ men, and around non-Western and low-income contexts. Effect sizes where reported are small to moderate; most studies are limited by small samples, heterogeneous designs, and absence of sex-disaggregated reporting. Music therapy represents a clinically meaningful, non-stigmatizing, and evidence-supported pathway to male mental health engagement. Practical implications include framing music-based programs around musical participation rather than mental health, prioritizing group formats, and selecting genres that align with participants' masculine cultural identity. Future research should employ longitudinal designs testing the gateway mechanism directly, incorporate validated masculinity norms instruments, ensure sex-disaggregated reporting, and develop culturally adapted approaches for diverse male populations globally.
To explore patients' fundamental care needs, to which extent they are met and to assess how the care activities of Registered Nurses and assistant nurses are accomplished. A further aim is to investigate their associations with contextual factors in an emergency department setting. Quantitative exploratory observational study with data collected through structured observations. Seventy-five patients, 30 registered nurses, and 20 assistant nurses were recruited from one emergency department. Structured observation protocols, spot checks, and follow-up dialogues were used. Descriptive and analytical statistics were calculated. A total of 812 fundamental care needs were observed: physical (45%), psychosocial (38%), and relational (14%). The prevalence of missed nursing care was 20% and was more prevalent among older patients, those receiving care in shared spaces, and during crowding. In total, 3797 care activities were observed. Medical/technical activities were implemented at a higher rate than integration of care activities; unlike the latter, higher rates were significantly associated with crowding, the surgical section, and registered nurses compared to assistant nurses. Missed nursing care was more prevalent among older patients and those in shared spaces or during crowding. The increased rate of medical/technical care activities was associated with crowding, whereas the integration of care activities remained unchanged. Fast-track solutions robust to crowding could reduce missed nursing care among older patients. Staff and management should critically assess physical layout in relation to crowding and missed nursing care. Crowding is a system-level phenomenon representing a significant driver of missed nursing care in the emergency department, and responsibility for addressing this decline in care quality must be acknowledged at system and policy levels. This study provides evidence of how organizational conditions shape nursing care delivery in emergency departments and will inform interventions to improve care quality and safety. None.
To explore neonatal intensive care unit (NICU) nurses' perspectives on strategies and barriers to parental involvement in newborns' pain management (PM). Newborns undergo several painful procedures in the NICU that affect their neurodevelopment. When properly prepared and guided, parents can play an active role in their newborn's PM. Nurses play a crucial role in facilitating parental involvement. An exploratory, qualitative, and descriptive design was used. Online focus group interviews were conducted with 24 nurses from three Portuguese NICUs. Inductive content analysis was performed, and reporting followed the Consolidated Criteria for Reporting Qualitative Research. Nurses described strategies to involve parents in PM, including parental education and training, progressive parental involvement, nonpharmacological methods, and communication. Facilitators for parental involvement in newborn PM included nurses' clinical expertise, the quality of the nurse-parent relationship, multidisciplinary teamwork, and an environment that provides physical comfort. Excessive workload, inadequate nurse-to-baby ratios, and limited physical space were identified as barriers. Parental reactions, such as emotional shock, stress, and avoidant attitudes, also posed challenges. Although parental involvement and nonpharmacological approaches support family-centered PM, ongoing organizational barriers and parental emotional distress limit their consistent application. Supporting parental involvement in neonatal PM requires systemic and relational strategies. Recommendations include acknowledging parents' willingness to engage, reviewing nurses' workload, and developing organizational policies that encourage collaboration and create an environment conducive to parental presence.
In Africa, the transmission of Monkeypox (mpox), especially in countries that were initially unaffected, including Burundi, is still inefficiently reported. This study has analyzed various demographics and cases, alongside the transmission pathways and risk factors to apprise effective, setting-specific control strategies for mitigation of mpox outbreaks while also guiding prospective responses to similar outbreaks in resource-restricted contexts. To effectively characterize the transmission patterns of clade Ib monkeypox virus, the study evaluated the laboratory-confirmed mpox cases in Bujumbura, Burundi, alongside their contacts, as from 25th July 2024-26 th October 2024. Collection of data was mainly done via patient interviews, national surveillance data, and electronic health records. A total of 850 laboratory-confirmed mpox cases alongside 7773 acknowledged contacts were included in the study. The average age of the patients was 20.3 (interquartile range: 22.0; range: 3 months-71 years), while a larger proportion of the patients (71.9%) comprised children aged < 5 years and younger adults aged between 16 years and 29 years. Sexual contact (58.6%) and household exposure (38.6%) were found to be the primary transmission routes. The basic reproduction number was 1.21 (95% CI (confidence interval): 1.11-1.31), with 14.0% secondary attack rates (95% CI: 12.1-15.9) among sexual contacts, as well as 13.0% (95% CI: 11.2-14.8) among household contacts. The average incubation period was found to be 9.5 days (95% CI: 7.5-11.4), while the serial interval was 15.5 days (95% CI: 12.4-18.7). To effectively control and manage mpox outbreak in resource-restricted contexts, the study findings have stressed on the requirement for targeted interventions to tackle sexual contact networks alongside household transmissions.
Perinatal morbidity and mortality are substantially higher for Aboriginal and Torres Strait Islander (hereafter called First Nations) mothers and babies compared with non-First Nations peoples. Women birth in systems designed and informed by Western values, and many report negative interactions with health professionals and a lack of cultural safety in the mainstream maternity system. To redress unacceptable health outcomes and system challenges, we implemented a culturally tailored caseload midwifery care programme called Baggarrook Yurrongi, at three tertiary maternity services in Melbourne, Australia. The model included continuity throughout pregnancy, labour, birth and the early postnatal period, recognition of culture as central to identity, and respecting and acknowledging the cultural background, beliefs and values of First Nations peoples. This paper describes maternal and infant health outcomes. This prospective non-randomised translational study used routinely collected clinical outcome data to explore whether, for women expecting a First Nations baby, receiving the new model was associated with improved clinical outcomes compared with usual care prior to and since implementation (adjusted for age, Body Mass Index, marital status, parity, diabetes and hypertensive disorders). Specifically, would the model decrease the proportion of First Nations babies born low birthweight (<2500 g) and increase the proportion born 'healthy' (alive, at term, of normal weight and size, and not admitted to neonatal special or intensive care (NICU)). All births were included except multiple pregnancies, where babies had major congenital anomalies, and births occurring within the first six months of model implementation. Baseline data were from 2012 to model commencement (2017) (99,952 non-First Nations and 1159 First Nations births). 'After' data were collected to 2022 (62,499 non-First Nations and 1038 First Nations births), and 669/1038 eligible women (64.5%) received the Baggarrook Yurrongi model. Fewer First Nations babies whose mothers received the model compared with those who received usual care 'Before' were low birthweight (AOR 0.67, 95% CI 0.47, 0.93) and more were born 'healthy' (AOR 1.45, 95% CI 1.14, 1.84). Culturally tailored caseload midwifery care significantly improved perinatal outcomes for women and their First Nations babies. Given poor perinatal outcomes are major risk factors affecting short- and long-term health, we recommend widespread model implementation, adapted to the needs of local First Nations communities, and supported by policymakers. Future research should include monitoring implementation and outcomes of the programme, along with robust cost-effectiveness analysis data to inform scale-up. Australian National Health and Medical Research Council.
Type 1 diabetes and disordered eating (T1DE) affects 8-37.1% of adults and is associated with high rates of morbidity and mortality. The absence of a standardised case definition of T1DE and its severity hinders effective screening, diagnosis and treatment. This systematic review aimed to (1) synthesise existing case definitions and diagnostic criteria for T1DE in adults and (2) identify key characteristics to inform consensus for future diagnostic criteria. A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Eligible studies involved adults (≥18 years) with type 1 diabetes assessing disordered eating; paediatric studies, mixed samples without disaggregated data, non-empirical designs and non-English publications were excluded. PubMed, MEDLINE, EMBASE, CINAHL and PsycINFO were searched up to November 2025 for peer-reviewed studies involving adults with T1DE. Qualitative and quantitative data on definitions, diagnostic criteria and assessment tools were extracted. Study quality was appraised using a modified Graphical Appraisal Tool for Epidemiological studies (GATE) checklist. Due to heterogeneity of data, a narrative synthesis of findings was performed to describe current definitions of T1DE. Sixty-one studies met the inclusion criteria, with a pooled sample of 111,208 participants (76% women) from over 22 countries. T1DE was defined using a heterogeneous array of terms, diagnostic frameworks and assessment tools (29 distinct methods). The Diabetes Eating Problem Survey-Revised (DEPS-R) was the most used questionnaire, but many studies relied on criteria adapted from general eating disorder classifications or generic questionnaires. Approximately three-quarters of the studies assessed insulin omission behaviours, but the operationalisation of the cognitions for insulin omission varied widely. Beyond physiological markers such as HbA1c and BMI, studies explored various diabetes-related and psychological constructs, although often considering diabetes and disordered eating separately rather than as an integrated condition. This systematic review highlights the lack of a unified, evidence-based definition of T1DE, resulting in inconsistent screening, diagnostic and reporting practices. Establishing clear, consistent, evidence-based diagnostic criteria and screening questionnaires for T1DE is critical to improving early detection and developing targeted interventions. These findings provide a foundation for refining T1DE definitions as a stepping stone to an international consensus definition. PROSPERO registration no. CRD420250223622 FUNDING: King's College London and King's College Hospital through the KMRT KCH Joint Research Committee studentship. This work was also conducted as part of the National Institute for Health Research (NIHR; CS-2017-17-023)-funded STEADY project (Safe management of people with Type 1 diabetes and EAting Disorders studY). NZ's salary was part-funded by the NIHR via the NIHR Clinician Scientist award to MS; JT and KI are part-funded by the NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. MS was funded through her NIHR Clinician Scientist Fellowship (CS-2017-17-023).
Women experiencing homelessness have complex needs. Although participation and shared decision-making are legal rights, meaningful involvement remains challenging. The study was conducted with a Women Advisory Board (WAB). To investigate professionals' perceptions of prerequisites and opportunities for participation and shared decision-making for women with comorbidities experiencing homelessness, regarding collaboration to provide care and support - and to ascertain the Women's Advisory Board's reasoning about the professionals' perceptions. Twelve interviews with professionals in social services, healthcare and non-governmental organisations in Sweden were conducted and analysed with content analysis. Professionals reported that collaboration for women with comorbidities experiencing homelessness often fails. Organisations work in isolation, lack a holistic perspective, and avoid responsibility. Women are seldom heard, while bureaucratic language and professional control dominate. Meetings overlook lived experiences of illness, substance use disorder, and homelessness, hindering participation. These women are vulnerable, ashamed, and exposed to violence. Effective collaboration requires a woman-centred approach, adaptation, preparation, and follow-up. The WAB's reasoning confirmed these perceptions. Professionals and the WAB agree that collaboration requires committed and flexible professionals, who work together acknowledging the individual woman's circumstances-not their own organisational framework. It is questionable whether user participation is possible under the prevailing conditions.
Nutritional care is essential for improving clinical outcomes in people with cancer, and communicating with healthcare professionals about clinical nutrition is fundamental for effective nutritional management. The aim of this study was to evaluate the perceptions of healthcare professionals and patients regarding nutritional care in oncology, including the role of nutritionists, professional practices, and patient experiences. This cross-sectional study included healthcare professionals and patients from public and private oncology institutions. Data were collected using semistructured questionnaires. Professionals were questioned regarding criteria related to identifying nutritional risk, conducting assessments, and recommending nutritional therapy. Patients reported their perceptions of nutritional care, prior nutritional counseling, adherence to recommendations, and willingness to pay for consultations. Quantitative variables were expressed as frequencies, percentages, means ± standard deviations, medians, and ranges. A P-value ≤ 0.05 was considered statistically significant. The study included healthcare professionals (n = 130) and patients (n = 360). Most professionals acknowledged the need and relevance of nutritional care during cancer treatment, but reported assessing the nutritional status of patients based primarily on body weight. Although 81.4% of physicians could identify patients at nutritional risk, 31.4% relied primarily on weight loss and body mass index as the main criteria, suggesting potential limitations in the methods used. Patients in both systems recognized the importance of nutritional care, although 7.3% did not follow recommendations of dietitians, citing a lack of dietary novelty. Professionals and patients recognize the importance of nutritional care and the role of dietitians in oncology; however, gaps remain in translating this recognition into practice.
The article discusses the importance of authentic engagement in palliative care and how acknowledging the patients' and carers' experiences and feelings can help to deliver meaningful care.
Coronary artery disease often develops silently before myocardial infarction, and current risk-based prevention pathways miss some individuals with clinically important disease, particularly those without standard modifiable cardiovascular risk factors. High-sensitivity cardiac troponin I is a blood biomarker of low-level myocardial injury, but its relationship to silent coronary atherosclerosis remains incompletely understood. Here we show, in 1,613 adults undergoing coronary computed tomography (CT) imaging, that low-level high-sensitivity cardiac troponin I is associated with clinically actionable coronary disease, defined by coronary calcium score ≥100, and with quantitative CT markers of plaque burden. A threshold of 2.3 ng l-1 enriched for actionable disease, especially in individuals without standard risk factors. Normalizing troponin for myocardial mass, age and renal function improved prediction and provided mechanistic insight into baseline troponin elevation in chronic coronary syndromes. A two-stage strategy using troponin before CT imaging increased diagnostic yield and reduced the number of scans required. Prospective validation is warranted before clinical implementation.
There is growing focus on community-engaged research (CEnR) in the clinical and translational sciences, supportive policies, environments, and processes within academic medical centers. The purpose of this evaluation was to gather academic and community member perspectives on key actionable strategies for supporting CEnR in an academic medical center. We used a sequential mixed method design by first conducting qualitative in-depth interviews with academic leaders, investigators, and staff (total, n = 54) and focus group discussions with community members (n = 33). Themes from these qualitative data informed the adaptation of an institutional survey that gathered perspectives from a broader group of academic and community members affiliated with the institution (n = 85). Both qualitative and quantitative data were integrated to inform actionable strategies. Survey findings revealed that the institution was perceived as committed to health equity and CEnR, but institutional respondents expressed more concerns than community members about instrumental support of the work. Interviews and focus groups highlighted the opportunity to better align research efforts with community needs through more robust CEnR infrastructure and through interface with the clinical practice to promote patient access. Academic and community members emphasized the need for authentic, sustained engagement beyond federal mandates, including financial investment, capacity-building, and fostering trust. Leaders acknowledged structural challenges, siloed efforts, and the necessity for stronger coordination to increase integration of community engagement into the institutional mission. Findings suggest that aligning academic leaders, researchers, staff perspectives, and community members is essential to support and promote CEnR at an institutional level.
Neoadjuvant chemo-immunotherapy has transformed the treatment landscape for resectable non-small-cell lung cancer (NSCLC). However, real-world surgical data from nationwide European cohorts remain limited. This study evaluated surgical outcomes and practice patterns during the first year of nationwide implementation of neoadjuvant chemo-immunotherapy with nivolumab in the Czech Republic. This prospective, multicenter, observational cohort study included all consecutive patients with resectable programmed cell death ligand-1(PD-L1) ≥ 1% NSCLC treated according to the CheckMate 816 protocol (platinum-based chemotherapy plus nivolumab) at all eight accredited thoracic oncology centers in the Czech Republic between August 2023 and August 2024. Surgical and pathological outcomes were assessed. Sixty-four patients initiated neoadjuvant therapy and 56 (87.5%) underwent resection. Minimally invasive surgery was attempted in 46.4% of cases, with an 11.5% conversion rate. Clavien-Dindo grade ≥ III complications occurred in 14.3%, with grade IIIb representing the highest severity. 30-day mortality was 0%. Although 90-day mortality was 5.4%, none of the deaths were directly attributable to surgery. R0 resection was achieved in 98.2%. In the intention-to-treat population, pathological complete response and major pathological response rates were 40.6% and 48.4%, respectively. Pathological complete response was significantly higher in squamous than in non-squamous NSCLC (66.7% vs. 27.6%; p = 0.003). In this first nationwide cohort from a European country, early adoption of neoadjuvant chemo-immunotherapy with nivolumab in patients with resectable PD-L1 ≥ 1% NSCLC was associated with acceptable perioperative outcomes, high R0 resection rates, and substantial pathological response. These results demonstrate the successful adoption of a novel NSCLC treatment modality across a nationwide healthcare system.
Chronic opioid use, a key predictor of opioid overdose, is common among adolescents and young adults (AYA) with inflammatory bowel diseases (IBD), underscoring a need for tailored interventions to monitor risk for opioid-related harm. Prior research highlights the need to engage both AYA patients with IBD and IBD-focused clinicians in the development of pain management and opioid safety interventions. Human-centered design offers a promising approach to address this gap by directly engaging patients and clinicians in cocreating solutions. We aimed to explore and identify AYA patient and clinician perspectives to inform the design and development of a digital opioid safety tool. Using convenience sampling, we conducted semistructured interviews with AYA patients with IBD and IBD-focused clinicians (gastroenterologists, surgeons, and nurses) in July-August 2023 in person or by video-based conferencing. Interviews explored patient experiences with pain management, opioid use, and transitions to adult care, as well as clinician experiences in monitoring pain and prescribing opioids. A co-design workshop, following the interviews, brought patient and clinician participants together to reflect as a group on the unique challenges of managing pain in IBD care, and consider potential creative solutions to enhance pain management safety. The workshop was facilitated in person in September 2023 and included 7 patients and 8 clinicians who previously participated in individual interviews. Data were audio recorded, transcribed, and thematically analyzed using an inductive approach to identify themes. Twenty participants (7 AYA patients and 13 clinicians) contributed to the study. Thematic analysis generated three domains of needs that a digital opioid safety tool should address: (1) Intersecting Needs (ie, relevant at the patient and clinician and/or health system levels), (2) Patient-Level Needs (ie, relevant at the patient level only), and (3) Clinician- and/or Health System-Level Needs (ie, relevant at the clinician and/or health system levels only). Intersecting needs included integrating opioid safety interventions into multidisciplinary chronic care, supporting AYA transitions to independence, and acknowledging individual patient differences. Patient-level needs included assessing lived experiences of pain routinely, setting clear expectations about pain management, and connecting patients with safe nonopioid alternatives. Clinician- and/or health system-level needs included accounting for pain management received outside the IBD clinic; addressing gaps in information, education, and resources regarding opioid risk or pain management; and coordinating safety efforts across clinical teams. Incorporating these insights into the development of a digital opioid safety tool may enhance alignment between patient and clinician expectations on pain management and opioid use. This study underscores the value of human-centered design in developing digital opioid safety tools that are practical, patient-focused, and effectively integrated into clinical workflows. Findings may guide future intervention design, prototyping, and testing with continued engagement of AYA patients with IBD and clinicians.
This article discusses the role of epidemiology and collective health in addressing racism and racial health inequalities in Brazil. The reflections presented were inspired by the conference "Unveiling Inequities: the role of epidemiology in confronting racism", held during the 12th Brazilian Congress of Epidemiology in 2024. Through a critical and historical analysis, the study seeks to understand how the Brazilian field of epidemiology - consolidated in Latin America and recognized for its contributions to collective health - still reproduces mechanisms that render Black and Indigenous researchers invisible. It argues that combating racism should not be the isolated responsibility of a specific group, but rather a collective and ethical commitment involving the entire scientific community. Morbidity and mortality data speak for themselves and for the majority of the Brazilian population, revealing the urgent need for a more explicit debate on racism within epidemiology and for reflection on how institutions and research groups are organized and operate based on power relations. Furthermore, it proposes that contemporary topics such as digital health, climate change, and mental health be analyzed through intersectional perspectives that consider race, gender, class, and other dimensions of inequality. The text emphasizes that recognizing racism as a social determinant of health is an essential condition for building an epidemiology committed to equity and the right to life. Acknowledging these gaps is necessary to move forward, as highlighted in Brazil's Fifth Brazilian Plan for the Development of Epidemiology.
Medicinal plants represent a vast and evolutionarily refined reservoir of structurally diverse bioactive compounds that have historically contributed to major therapeutic breakthroughs. However, despite their pharmacological richness, systematic translation of plant-derived metabolites into clinically approved drugs remains constrained by persistent bottlenecks, including extract complexity, dereplication redundancy, structural elucidation challenges, taxonomic ambiguity, and multi-component pharmacology. This review presents a bottleneck-driven and systems-oriented framework for integrating artificial intelligence (AI) into medicinal plant-based drug discovery (MPDD) to address some of these bottlenecks. Rather than reiterating broadly documented AI tools used in synthetic drug development, the manuscript critically examines phytomedicine-specific challenges and maps AI applications across key stages of the pipeline: medicinal plant identification, extraction optimization, plant metabolite identification and dereplication, absorption, distribution, metabolism, excretion, and toxicity (ADMET) prediction, virtual screening, network pharmacology, repurposing, and generative de novo design of pseudo-natural products. Emphasis is placed on the foundational requirement of making phytochemical datasets truly AI-ready through metadata harmonization, dataset balancing, novelty-aware modeling, and structured data engineering. Emerging approaches such as transformer-based foundational models, graph neural networks (GNNs), generative AI (GAI) architectures, and multi-omics-integrated network pharmacology are discussed within a pragmatic translational context. Importantly, this review maintains a balanced perspective, acknowledging that fully AI-driven clinically approved botanical drugs/synthetic drugs have yet to emerge and identifies challenges limiting the progress. By integrating computational methods with infrastructural reform, this work outlines a progressive roadmap to transition AI in medicinal plant research from exploratory studies toward standardized, reproducible, and biologically grounded next-generation drug discovery.
Hypertension is a leading cause of cardiovascular disease with significant burden experienced in low-and middle-income countries. The Hypertension Treatment in Nigeria (HTN) Program implemented a large-scale hypertension treatment program in the Federal Capital Territory (FCT) of Nigeria. Identification of benefits is important to acknowledge and demonstrate the value of research beyond evaluation of pre-identified scientific outcomes. This manuscript aims to identify the benefits and impact of the HTN Program using the Translational Science Benefits Model (TSBM). The HTN Program was a type II interrupted time series trial conducted from January 2020 to December 2023 to evaluate effectiveness and implementation of a multilevel hypertension control program in 60 primary healthcare centers in Nigeria. TSBM benefits were identified and verified by cataloging events, results, and procedures and aligning using the Translating for Impact Toolkit. The domains include policy, community, clinical, economic, and a new fifth domain, capacity building. The HTN Program enrolled 21,922 patients. Hypertension treatment increased from 86.8% (95%CI: 86.5%, 87.2%) at baseline to 96.2% (95%CI: 96.0%, 96.4%) at the end of the study period. Hypertension control also increased from 22.3% (95%CI: 21.7%, 22.9%) at baseline to 56.4% (95%CI: 55.9%, 56.8%). Thirty-three TSBM benefits were identified across five domains. Most benefits were identified in the policy (9), capacity building (9), and community (7) domains. The HTN Program not only improved hypertension treatment and control in primary care in the FCT of Nigeria but also demonstrated broader impacts beyond its initial effectiveness and implementation objectives supporting program sustainment and scale-up.Trial Registration: NCT04158154.