Eye-related symptoms ranging from mild irritation to acute vision loss can lead to emergency calls. While many cases are benign, others involve chemical exposures or trauma requiring urgent care to prevent permanent damage. Prehospital characteristics, dispatch categorization, and early management of eye-related emergencies remain unexplored. The aim of this study was to provide a systematic description of eye-related emergency calls, including patient characteristics, dispatch categorization, and prehospital management, within the framework of the Danish Index for Emergency Care. We conducted a retrospective cohort study of all emergency calls [1-1-2] in Region Zealand, Denmark, from November 2017 to June 2025, describing eye symptoms. We linked data from the Computer-Aided Dispatch (CAD) system, the Prehospital Patient Records (PPJ), and the Danish National Patient Registry (NPR). Patient demographics, paramedic assessment of primary problem, on-scene symptoms, prehospital treatments and hospital outcomes were analysed using descriptive statistics. A total of 376 patients were identified calling 1-1-2 and registered with eye related symptoms as the main complaint. Of these, 36 (9.6%) were excluded due to missing patient identifiers or prehospital patient records, leaving 340 in the cohort. Median age was 49.5 years (IQR 29-68), and 62.1% were male. Most calls were categorized as priority B (urgent situation not assessed as acute life-threatening) (70.9%). The leading primary problems were chemical exposures (31.5%), vision loss (25.9%), and ocular trauma (18.2%). Vision disturbance (54.4%) was the most frequently prehospital reported symptom. Prehospital interventions were rarely documented, with irrigation being the most reported procedure (27.1%). Notably, 39 of 340 patients (11.5%) were suspected of stroke prehospitally, and among 283 admitted to hospital, 21 (7.4%) received a confirmed TIA or stroke diagnosis. The median length of stay was 3.7 h (IQR 2.0-7.7). Most frequent discharge diagnoses were injury of the eye and orbit (17.7%), burn and corrosion confined to eye and adnexa (9.9%), and foreign body on external eye (7.8%). Eye-related emergency calls were primarily caused by chemical exposures, vision loss, and trauma, with relatively short hospital stays. Several patients classified as eye-related problems were later diagnosed with stroke, highlighting the need for better dispatcher recognition of visual stroke symptoms. Not applicable.
Management of contacts to medical communication centers relies heavily on clinical judgment, contextual understanding, and communication skills. Decision support systems, intended to complement medical expertise, may, due to their rigidity, impede effective caller interaction and may, together with the obligatory documentation of calls, contribute to a workflow that draws attention away from the communication. Recommender systems have demonstrated potential in supporting decision-making across various domains by nudging individuals toward better choices without undermining autonomy. We built a prototype that combined artificial intelligence-based question recommendations with structured documentation (hereafter: the prototype) and conducted a feasibility study to test its influence on operators' performance. This study aimed to examine whether the prototype influenced the operators' performance during telephone triage. We hypothesized that the prototype would affect medical quality without affecting communication quality. A quasi-experimental pre- and posttest feasibility study was conducted in a simulated setting. Twenty-five operators were voluntarily recruited from 5 Norwegian medical communication centers, in which 22 operators contributed to both the pretest (before the prototype) and the posttest (with the prototype). The operators handled the same 15 medical cases presented by simulated callers, with a 5-month interval between the 2 sessions. The question recommender was trained on other data and then fine-tuned on the 15 scenarios used. Audio recordings of the calls were rated using the tool Assessment of Quality in Telephone Triage. Pre- and posttest values were compared, with overall medical and communication quality as the primary outcomes. Secondary outcomes included specific items related to medical content and communication, accuracy of triage, patient safety, call duration, and efficiency. A total of 320 paired calls were analyzed. Overall medical quality improved significantly with use of the prototype, from a mean of 6.83 points pretest to 7.16 points posttest rated on a 10-point scale (difference 0.34, 95% CI 0.11-0.57; P=.004). The effect size was small (Cohen dz=0.16). No significant change was observed in overall communication quality, with a mean of 7.06 points pretest and 6.97 points posttest (difference -0.09 points, 95% CI -0.28 to 0.10; P=.35). A significant decrease from pre‑ to posttest was observed in the specific items "Collects information about the patient's location" (P<.001) and "Ensures that the triage decision is understandable and feasible" (P=.002). None of the remaining secondary outcomes showed significant changes. The prototype yielded a modest improvement in medical quality within the scenario‑based test environment. Although overall communication quality remained unchanged, aspects of the interaction were negatively affected. Artificial intelligence-based question recommendations combined with structured documentation may serve as useful functionalities within a decision support system, but each functionality requires further testing and development before such technology can be implemented in the triage of unselected, real‑world calls.
Jay Bhattacharya clashes with epidemiologists over widely used design.
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In this AM Last Page, the authors share visualization strategies that can be used to communicate curricular change as part of the Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR) change management model. Compared to other change management models, ADKAR's focus on individual change is particularly effective at addressing personal responsibility and sustaining adoption.
Early activation of emergency medical services is the first link in the chain of survival, yet training in emergency call competence has received limited attention compared to cardiopulmonary resuscitation (CPR). Teaching children to place an emergency call may provide a crucial and age-appropriate entry point for first aid education. In this prospective randomized, controlled experimental study, 71 pupils (7-9 years old) from second and third grades of a German elementary school were randomized to frontal instruction or simulation-based training; a control group completed a test call prior to training. Test calls were conducted using mobile phones, assessed by trained dispatchers, and scored with a validated evaluation sheet (maximum 17 points; ≥11 defined as sufficient). Overall, 84.5% of children achieved a sufficient emergency call. After training, 100% recalled the correct emergency number, compared with 78% in the control group (p = 0.042). No significant differences were found between frontal and simulation groups. Grade level was a strong predictor: 91% of third graders delivered sufficient calls, compared to 64% of second graders. Notably, 9.9% of all children were unable to speak after the dispatcher's greeting, and 12.5% could not provide a location, the majority being second graders. Dispatcher behavior strongly influenced outcomes, with significant differences in 11 of 13 assessed items. Primary school children are capable of placing sufficient emergency calls after a brief training. Instruction format (frontal vs. simulation) had little impact, suggesting that emergency call teaching can be delivered efficiently in classroom settings, preserving simulation time for psychomotor CPR skills. Future trainings should emphasize reducing fear of speaking, ensuring knowledge of addresses, and incorporating dispatcher training to optimize communication with child callers.
Traditional studies of rat communication have focused on a few individuals in simplified laboratory settings, leaving colony-level vocal-behavioral dynamics largely unexplored. Here, we examined the nocturnal lives of a rat colony housed in an enhanced naturalistic habitat (ENH). Using infrared cameras and ultrasound microphones, we recorded 18,412 ultrasonic vocalizations (USVs) alongside social behaviors. Analyses revealed structurally distinct USVs not previously characterized statistically or behaviorally. Notably, 22 kHz calls-typically associated with aversion-occurred across multiple social behaviors lacking obvious aversive context. Brief exposure to cat hair elicited uniquely modified 22 kHz calls as rats fled to their burrows, remaining hidden for two days. The introduction of an unfamiliar caged rat, and the disruption of the colony's social structure then showed how social stressors alter vocal-behavioral dynamics. These findings reveal the structured and context-sensitive nature of rat vocal communication, establishing the ENH as a powerful model for studying social-vocal behavior.
Rheumatoid arthritis (RA) causes persistent symptoms that limit individuals' ability to engage in meaningful daily occupations. Occupational therapy plays a key role in integrating lifestyle and behavioral strategies into comprehensive RA management. To examine the efficacy of a client-centered, modular lifestyle intervention (LI) on occupational performance and health outcomes of individuals with RA. A randomized controlled trial. Rheumatology outpatient clinic of a university hospital. Forty-five individuals diagnosed with RA were randomly assigned to an LI group (n = 23) or a control group (n = 22). The LI group received an eight-session, occupation-based LI; the control group received twice-weekly well-being check phone calls over 4 wk. The primary outcome was the Canadian Occupational Performance Measure (COPM) Performance score. Secondary outcomes included COPM Satisfaction, Disease Activity Score-28, visual analog scale for pain, Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire, and Rheumatoid Arthritis Quality of Life Scale scores. Assessments were conducted at baseline, postintervention, and 6-mo follow-up. Compared with the control group, the LI group demonstrated significantly greater improvements in the primary outcome (COPM Performance) as well as in secondary outcomes including COPM Satisfaction, pain, fatigue, and quality of life. A delayed reduction in disease activity was observed at the 6-mo follow-up. The LI produced durable improvements in occupational performance and patient-reported outcomes, supporting its integration as a sustainable adjunct to pharmacological care for individuals with RA. Plain-Language Summary: People with rheumatoid arthritis often have difficulty completing daily activities because of pain, fatigue, and limitations in movement. This study explored whether a structured lifestyle program based on occupational therapy principles could help improve these challenges. All participants continued their usual medical treatment throughout the study. In addition, one group received an eight-session lifestyle intervention focused on meaningful daily activities, healthy habits, energy conservation, and participation in social and leisure activities. The control group received their usual medical treatment along with brief well-being check phone calls. Participants who received the lifestyle program showed greater improvements in performing and enjoying daily activities and reported lower fatigue levels than those in the control group. These findings suggest that adding an occupation-based lifestyle program to standard medical care may provide meaningful benefits for people living with rheumatoid arthritis.
A recent systematic review has demonstrated objective neurocognitive difficulties in people with body dysmorphic disorder (BDD). Limited research has also shown that individuals with BDD frequently self-report cognitive difficulties, but little is known about how they understand these difficulties in relation to their disorder or daily and life functioning. This study aimed to comprehensively examine adults' perceptions of cognitive difficulties in BDD. A mixed-methods design was employed using an international online survey, which analysed quantitative and qualitative data (Interpretative Phenomenological Analysis) of lived experiences of cognitive difficulties from participants who self-reported a BDD diagnosis or severe BDD symptomatology via the Dysmorphic Concern Questionnaire (N = 433). Most participants (82%) endorsed significant cognitive difficulties they believed were linked to their disorder, with 75% reporting substantial effects on daily life and overall quality of life. Few had discussed these concerns with clinicians due to shame, misattribution, or uncertainty about their relevance. Participants expressed strong support for research into cognitive aspects of BDD. Perceived cognitive difficulties are widespread, distressing, and functionally impactful for individuals with BDD. These findings highlight the need for clinicians to actively assess cognitive difficulties, consider the possibility of co-occurring conditions such as ADHD, and incorporate this understanding into treatment planning to enhance engagement and therapeutic outcomes. Research Question(s) or Topic(s): How do adults with body dysmorphic disorder perceive their cognitive difficulties and what impacts do they report? Adults who reported a diagnosis of body dysmorphic disorder or severe dysmorphic concerns described frequent cognitive difficulties they believed were connected to their condition. Most reported effects on daily functioning and quality of life, yet many had not discussed these concerns with clinicians due to shame, uncertainty about their cause, or not recognising their significance. Study Contributions: This study offers the most detailed account to date of how people with body dysmorphic disorder understand and experience their cognitive difficulties. It identifies barriers to disclosure, emphasises the need for clinicians to enquire proactively about cognitive concerns, and calls for further research to clarify their role in the disorder.
The rapid advancement of artificial intelligence (AI), particularly large language models (LLMs), raises critical questions about the value system these systems appear to reflect in comparison with human values. This study aimed to examine Spranger's six value types (religious, social, theoretical, economic, political, and aesthetic) as manifested in three LLMs (OpenAI-o1, Gemini-2.0, and DeepSeek-V3), and to compare them with the value system of a sample of students at King Khalid University. A descriptive-comparative design was employed, administering the Study of Values to both groups: 214 students (male and female across academic levels) and the three LLMs, with repeated administrations to the latter to ensure test-retest reliability. Results indicated statistically significant differences in both the prominence and ranking of values across groups. Theoretical values consistently dominated in the LLMs, followed by social, aesthetic, and political values, with religious values ranking lowest. In contrast, students prioritized religious values, followed by theoretical values, while aesthetic values occupied the lowest ranks. Further, significant effects of gender and academic level were observed among students: religious values were more salient among females, theoretical values among males, and aesthetic values among undergraduates. These findings suggest that LLMs project value system shaped by their training data, rather than by human cultural or moral frameworks. The study highlights the importance of integrating culturally diverse value dimensions into AI development and calls for raising students' awareness of using AI tools in ways aligned with human values. Effect-size estimates further indicated very large human-AI discrepancies, particularly in the religious (d = 2.21) and theoretical domains (d = 1.22).
Anthropogenic noise is considered a marine pollutant by the European Union and can impact marine animals in various ways. Noise that overlaps in time and frequency with animal communication signals can interfere with communication and thus impact ecological functions mediated by acoustic signals, depending on how animals compensate for increasing noise. Our study investigated Lombard responses in long-finned pilot whales using sound and movement recording tags in an area with high anthropogenic pressure, the Strait of Gibraltar. We tested if pilot whales increase their vocal amplitude in response to noise, and whether vocal compensation is signal or context specific. We analyzed 1336 calls from 18 individuals in small social groups of simultaneously tagged animals, allowing us to parse which individual emitted which call and how call output level depended on masking noise level. We found that pilot whales increase their call output level with 0.50±0.04 dB per 1 dB increase in noise level to partially compensate for the effects of masking noise. Call type significantly influenced the Lombard response magnitude, with vocal compensation ranging from 0.11 to 0.87 dB per 1 dB increase in noise level, whereas animals exhibited similar Lombard responses for different dive contexts (non-foraging, deep dive descent and ascent). Our results indicate that pilot whales only compensate partially for increased noise levels, and that Lombard response magnitude depends on signal type. This emphasizes the need for understanding the ecological consequences of communication disruptions to ensure sustainable management of human activities.
Active pharmaceutical ingredients (APIs) are essential for global health, yet their use and release into the environment contribute to the transgression of the Earth System Boundary for Novel Entities. This study proposes a novel framework for an Environmentally Safe and Just Pharmacy, establishing 4 overarching criteria and 12 subcriteria designed to ensure that the pharmaceutical lifecycle is environmentally safe and just from a novel entities perspective. Using the extensive expertise of our global author group, we conclude that current practices for API design and development, approval and monitoring, use and disposal are only partially or poorly aligned with our criteria. Key vulnerabilities include a lack of environmental considerations in early-stage drug design, widespread exceedances of environmental concentrations deemed safe to ecosystems, persistent selection for antimicrobial resistance in the environment, and severe data gaps in low- and middle-income countries. We further highlight environmental injustices, particularly for Indigenous and marginalized communities whose cultural identities and livelihoods are compromised by chemical contamination. To address these challenges, we present a 10-point roadmap for a transition to a sustainable future by 2050. This plan includes calls for green chemistry investments, the integration of social and cultural equity into risk assessments, and the global upgrade of treatment and management infrastructure. We emphasize that solutions to pharmaceutical impacts must be culturally sensitive and safeguard the dignity of vulnerable populations to ensure a truly just transition that operates within Earth System Boundaries.
Hope research has been constrained by Western-centric models that prioritize individual agency and pathways, often neglecting relational and transcendent dimensions prominent in collectivist and religious societies. Using a genetic algorithm, we developed and validated the HOPE-4 scale across two independent samples of Algerian adults (Study 1: N = 338; Study 2: N = 290; total N = 628), comprising four facets: Willpower (agency), Waypower (pathways), Faith-Based Hope (transcendent trust), and Communal Hope (relational solidarity). Confirmatory factor analysis supported a hierarchical structure with excellent fit, high internal consistency (α = 0.93-0.95; ω = 0.96-0.97), strong convergent validity with established measures of hope and psychological capital, and moderate inter-facet correlations indicating discriminant validity. Based on approximate fit criteria, the scale showed configural, metric, and scalar invariance across gender and age groups. Scores also showed high consistency across demographic groups. These findings underscore the salience of faith-based and communal hope in Arab-Islamic contexts, extending traditional frameworks and addressing calls for emic instruments. The HOPE-4 provides a robust, culturally attuned tool for hope assessment, with implications for research and interventions in Arabic-speaking populations.
Obesity care is central to addressing the global prevalence of obesity, yet patients still report lack of access to effective obesity-related services. Leadership among healthcare professionals (HCPs) is enacted through clinical decision-making, service design, advocacy, and communication practices that shape patient experience and access to care. In obesity prevention and management, it is therefore critical to translate evidence into effective, equitable practice. This study conducted a scoping review, with the question: "What leadership strategies in obesity care can support healthcare practitioners with effective decisions, communication, and solutions for people living with obesity?". Data from primary studies were synthesized in accordance with scoping review best practice and PRISMA guidelines. In total, 28 primary studies published between 2014 and 2025 were included. Obesity care and support strategies were mapped inductively according to frequency of strategy approach across studies, resulting in three categories: 1. Structural strategies; 2. General strategies; 3. Population-specific strategies. Findings were then synthesized deductively from the research question under the headings of 1. Communication; 2. Decision-making; and 3. Solutions. Mapping identified that the evidence base reporting adequate strategies remains limited, with gaps across policy, research, and practice compared with other chronic conditions. Key findings highlight calls for leadership at a structural level, particularly towards improving policy to address weight stigma across domains, and ensure that services are adequately resourced and financed. At service levels, the provision of high-quality and evidence-based obesity care requires the need for leadership in the development and evaluation of multi-level, interdisciplinary, and holistic approaches. HCPs also require training with skills for constructive conversations about weight, and in collaborative healthcare planning. To improve outcomes for people living with obesity, healthcare requires coordinated leadership across systems to address the drivers of obesity and ensure equitable access to services that are evidence-based, de-stigmatized, well-resourced, and supported by policy. Obesity care is an important part of helping people to improve their health and quality of life, yet many people around the world living with obesity still struggle to access the right support and services. This review brought together findings from 28 studies published from 2014 to 2025 that describe what helps healthcare professionals provide better care and support for people living with obesity. These studies reported strategies that demonstrate leadership approaches that can support healthcare professionals in making improved decisions, communicating effectively, and providing high-quality care interventions. These were grouped into three main areas: Structural strategies – such as improving policies, research, and funding for obesity care at government or system level.General strategies – such as teamwork and collaboration between different healthcare professionals in services that provide obesity care and support.Population-specific strategies – such as care for women during and after pregnancy, or the different needs that children can have. The review found that healthcare professionals are calling for improved leadership and support beyond primary care and at political and organizational levels. This includes developing better policies, reducing weight stigma in society and in healthcare, and ensuring that obesity services are properly funded and based on the best available evidence. Overall, the findings highlighted that effective obesity support and care need leadership for a joined-up approach across systems and the involvement of different professionals. People living with obesity should have access to services that are evidence-based, respectful, well-resourced, and free from stigma.
Simulation is a cornerstone of medical education, but do training materials reflect the diversity of the patients they are meant to simulate? This viewpoint examines the underrepresentation of skin tones in dermatology simulation materials, explores the desire among learners to train with inclusive equipment, and calls for more representative resources.
Digital health tools, particularly patient portals, can support caregiving, but there is limited understanding of how sociodemographic and geographic factors influence digital health engagement among U.S. caregivers, especially dementia caregivers. Dementia caregiving involves complex coordination, medication management, and frequent healthcare interactions. Therefore, access to online medical records is particularly valuable. Moreover, most previous research focuses on general digital health adoption or patient portal use among patients, not caregivers, particularly among dementia caregivers, and rarely considers geographic differences or the interaction effects between age and caregivers' self-rated health. Comparing dementia caregivers to those without is essential because dementia caregiving entails more extensive care, longer duration, behavioral challenges, and emotional strain. These factors may increase reliance on digital health tools like online medical records. However, national studies often do not distinguish between dementia and non-dementia caregiving in digital health analyses. This study explored how sociodemographic and geographic factors are associated with caregivers' frequency of accessing care recipients' online medical records, especially for caregivers of individuals living with dementia compared to those caregivers of individuals without dementia. We also evaluated the interaction effect between age and health condition, motivated by the hypothesis that digital engagement is influenced not only by age but also by functional health status. This study examined caregivers' portal access frequency using data from the 2022 National Health Interview Survey, collected between March 7th and November 8th, 2022. Descriptive statistics captured differences in access frequency and sociodemographic characteristics between dementia caregivers and non-dementia caregivers. Three ordered logistic regression models examined predictors of accessing online medical records for dementia caregivers, non-dementia caregivers, and all caregivers, followed by an all-caregiver model with interaction terms to assess moderation effects between caregiver age and self-reported health. ArcGIS Pro was adopted to visually capture the geographic regional divide in portal access frequency across the U.S. Of the 6,252 total responses, 916 caregivers provided data on portal access frequency. More than half of dementia caregivers (60.25%) and non-dementia caregivers (51.11%) did not access online medical records in the past 12 months. Frequent access (≥ 10 times/year) was low across both groups (dementia caregivers (7.03%) vs. non-dementia caregivers (12.66%)). Survey-weighted ordered logistic regression models identified significant sociodemographic and geographic disparities in portal access frequency. Being female (OR = 1.931, SE: 0.074), having a bachelor's degree (OR = 1.769, SE: 0.168), and being married (OR = 1.749, SE: 0.068) were associated with higher portal access frequency in the all-caregivers model, and similar results were found in dementia caregivers and non-dementia caregivers. Regarding geographic disparities, dementia caregivers residing in micropolitan areas had substantially lower odds of frequent portal access than those in metropolitan areas (OR = 0.633, SE: 0.071); a similar trend was observed among dementia and non-dementia caregivers. Rural residence was also associated with lower portal access among dementia caregivers (OR = 0.529, SE: 0.152) and non-dementia caregivers (OR = 0.654, SE: 0.097). In the all-caregiver sample, caregivers in small-town areas (OR = 0.522, SE: 0.071) had lower odds of portal access compared to metropolitan caregivers. Health status showed differential patterns across caregiving groups. Among dementia caregivers, reporting very good health (vs. excellent) was associated with lower odds of portal access (OR = 0.268, SE: 0.023), whereas among non-dementia caregivers, very good health was associated with higher portal access (OR = 1.246, SE: 0.062). Good or fair health was associated with lower portal access across all caregiver groups. Interaction analysis revealed that as caregiver age increased, those in poor health had a significantly lower portal access frequency. Accessing online medical records among family caregivers remains limited and varies notably by gender, educational attainment, geographic location, and the interaction between age and health status. These findings highlight the importance of developing tailored digital support strategies that address the intersecting socioeconomic and health-related barriers faced by caregivers, particularly as artificial intelligence-enabled tools become more prevalent in dementia care. Older caregivers in poor health are especially unlikely to adopt digital resources, underscoring the urgent need for targeted outreach and educational initiatives. Additionally, the persistent geographic digital divide among dementia caregivers, especially those in small towns, calls for increased support to promote equitable access to caregiving technologies. This study conducted a secondary data analysis, so trial registration is NOT required because it does not run a prospective randomized trial. And Institutional Review Board approval is also not needed because the dataset is de-identified and public.
One in four persons with a uterus is unable to afford menstrual products, with even higher prevalence among low-income populations, an unmet need that contributes to preventable infections, missed school and work, and persistent health inequities. Despite the essential role of menstrual products in basic health and hygiene, many public health coverage programs across the United States, including Medicaid and other assistance programs, continue to exclude items such as pads and tampons. This gap disproportionately harms individuals who already face significant economic and health disparities. Although Flexible Spending Accounts and Health Savings Accounts now permit the use of funds for menstrual products, these mechanisms primarily benefit individuals with stable employment and disposable income, leaving the most vulnerable populations unprotected. Continued exclusion by insurance and assistance programs imposes an unnecessary financial and health burden and undermines dignity and well-being. Federal and state policymakers, including Congress, the Centers for Medicare & Medicaid Services, and state Medicaid agencies, have clear authority to address this inequity by expanding definitions of "durable medical equipment" and "hygiene supplies" to explicitly include menstrual products and by removing administrative barriers to coverage. The American Medical Women's Association calls for federal action to classify menstrual products as essential health services under Medicaid and other public assistance programs.
The growing intersection between climate change and human mobility argues that migration, displacement, and immobility are increasingly shaped by both sudden-onset and slow-onset climate hazards, alongside underlying social and governance vulnerabilities. Most climate-related mobility occurs within national borders and carries considerable implications for health, livelihoods, and urban systems. Global frameworks such as the Global Compact for Migration and the UN Framework Convention on Climate Change have begun to acknowledge these dynamics; however, a major adaptation gap is identified at the national level. Climate-related mobility is often referenced in national adaptation plans, but coherent implementation strategies, coordination mechanisms, and monitoring systems remain underdeveloped. To address this adaptation gap, this Personal View proposes a structured diagnostic assessment tool to evaluate how effectively mobility is integrated into national adaptation plans across domains, including risk assessment, governance, legal preparedness, financing, and monitoring and evaluation. Rather than ranking countries, the tool supports context-sensitive analysis, strengthens institutional readiness, and facilitates cross-country learning. This paper calls for a shift towards anticipatory, rights-based adaptation planning that recognises mobility as both a potential risk and an adaptive strategy in response to climate change.
A novel quitline intervention (counseling plus provision of alternative forms of nicotine) was developed for people using a smoke-free, alcohol and other drug (AOD) withdrawal service. The objectives were: to code the intervention manual for behavior change techniques (BCTs) and to evaluate bespoke training, delivery of counseling provided (quality, number of BCTs) and acceptability. The manual was coded for 29 BCTs. Training outcomes were measured by counselor self-reported confidence. Delivery of counseling was analyzed by independent rating of the quality (maximum 100, all components delivered) and number of BCTs used in all recorded calls (n = 71) for randomly selected clients (n = 30). Acceptability was measured by uptake, clients' acceptability item ratings (n = 37) and recall of counseling content (n = 38) at six weeks post-baseline. Coding of the manual identified 25/29 BCTs. Counselor (n = 10) self-reported confidence increased post-training (p = 0.03). High quality calls were delivered with a mean rating of 82.0 (SD13.16) and a mean of 8.50 (SD3.10) BCTs delivered per call. The BCTs assessment, pharmacological support and advising distraction were used frequently. Acceptability of counseling was good, with high uptake (77%; 68/88 clients contacted), counselors were rated as supportive (92%; 34/37), the majority of clients felt encouraged (87%; 32/37) and recalled counseling content for pharmacotherapy (79%; 30/38) and how to manage cravings (76%, 29/38). A novel quitline intervention for residents of smoke-free, AOD withdrawal unit was delivered with high quality, had high acceptability, offered continuity of care pre- to post-discharge and facilitated tobacco cessation. Content of skills training to manage cravings, commenced in residence, was recalled by recipients post-discharge to sustain tobacco abstinence.
Modern personal technologies, such as smartphone apps with artificial intelligence (AI) capabilities, have a significant potential for helping people make necessary changes in their behavior (e.g., adopt healthier lifestyles). Current research highlights that realizing this potential through the design and use of personal technologies calls for a critical reappraisal of the role of healthcare interventions as the driving force of behavior change and requires a more explicit focus on human agency and experience. This paper contributes to this line of investigation by developing and presenting a conceptual framework, informed by activity theory, which views behavior change as an outcome of the combined agencies of healthcare professionals, technology designers, and, most importantly, the persons themselves. According to the framework, the process of behavior change can be represented as a transformation, achieved through an interplay between the activity systems of intervention, development, and empowerment. In addition to presenting the conceptual framework, we offer insights into how these ideas can be implemented through examples of digital companions. Implications of the analysis for the design of personal technologies for supporting healthier lifestyles, with a special focus on intelligent digital companions, are discussed.