Mitochondrial Ca²⁺ dysregulation is a central pathogenic event in skeletal muscle disorders, yet the dichotomy between overload and deficiency is often overlooked. This review summarizes mechanisms governing mitochondrial Ca²⁺ transport and sarcoplasmic reticulum-mitochondria communication. We examine prerequisites of Ca²⁺ overload, including RyR1/SERCA dysfunction and mitochondrial calcium uniporter (MCU) complex remodeling, leading to suppressed ATP synthesis, reactive oxygen species overproduction, and necrosis. Conversely, we address mitochondrial Ca²⁺ deficiency in aging, sarcopenia, and diabetes, resulting from altered MCU stoichiometry and reduced organelle tethering, causing metabolic inflexibility and impaired antioxidant defense. Additionally, therapeutic strategies limiting Ca²⁺ overload and prospects of pharmacological MCU activation to enhance bioenergetics in sarcopenia are discussed.
Plasma cells exhibit diverse morphological features ranging from typical mature forms to atypical and anaplastic forms. This morphological heterogeneity can pose diagnostic challenges, particularly in distinguishing reactive from neoplastic processes. This manuscript highlights the spectrum of plasma cell morphology, emphasizing the importance of integrating morphological findings with clinical and laboratory data for precise diagnosis.
Human attention is often guided by contextual cues that signal where or how to focus in complex environments. Research on object contextual cueing has largely emphasized spatial regularities, but it remains unclear whether socially meaningful information can also provide such guidance. Across three experiments using face stimuli, we examined whether social cues can serve as contextual cues independently of spatial arrangements. In all experiments, participants searched for a target face among distractor faces, with spatial configurations fully randomized on every trial, and contextual information was defined by different types of social mappings. In Experiment 1, the cue was defined by consistent associations between a target identity and a specific set of distractor identities. In Experiment 2, the cue was the overall mood, quantified as the ratio of angry to happy faces. In Experiment 3, the cue was relational information, specifically facing-direction patterns within pairs of profile-view faces. Performance under Consistent Mapping conditions was compared with Variable Mapping conditions, in which these social regularities changed across trials. Bayesian analyses revealed reliable contextual cueing effects across all three experiments, with faster responses under Consistent than Variable Mapping conditions. The effect was strongest in Experiment 2, suggesting that global social cues may be encoded more efficiently than local relational cues. Post-experiment awareness tests indicated minimal explicit knowledge and no reliable association between awareness measures and contextual cueing. Together, these findings suggest that socially meaningful relational structure can provide stable predictive information that supports object-based contextual learning even when spatial regularities are absent.
Autoimmune diseases encompass over 100 distinct diseases where the immune cells betray our body by attacking the tissues they are meant to protect. Even though rare, 15 million Americans are collectively affected by autoimmune diseases, a number that continues to rise every year. Current treatment modalities primarily focus on alleviating symptoms rather than providing prevention or a cure. Tolerogenic dendritic cells (tolDCs) have gained popularity for autoimmune disease treatment as an alternative to traditional systemic immunosuppressive therapies due to their ability to restore immune homeostasis. However, clinical translation of tolDC therapies faces significant hurdles once injected into the body due to suboptimal delivery routes, systemic distribution throughout the body, faster clearance rate, phenotypic instability, and inefficient homing. So, the big question here is: How can we retrain dendritic cells to restore the immune balance while overcoming these challenges? Engineered biomaterials such as nanoparticles, microparticles, hydrogels, and polymer scaffolds offer innovative solutions by enabling targeted delivery of ex vivo-generated tolDCs or in situ reprogramming of endogenous dendritic cells (DCs) by delivering drugs and other bioactive agents at strategic locations. These platforms provide tunable release kinetics, enhanced targeting specificity, improved safety profiles, and high potency, highlighting their importance as a promising alternative to conventional administration methods. Biomaterials can modulate immune responses from inflammatory immune activation to immune tolerance, which is essential for long-term disease management. This review highlights recent advances in biomaterial-based delivery systems for DC delivery and their potential to redefine therapeutic strategies for autoimmune diseases.
Cervical cancer remains a leading cause of mortality among women worldwide, particularly in low- and middle-income countries, yet human papillomavirus (HPV) vaccination-the most effective method of prevention-faces variable uptake and acceptance. This study addresses the problem of suboptimal HPV vaccination by examining the factors associated with parental consent for HPV vaccination of adolescent girls in two distinct Peruvian cities, the capital city of Lima and a large city in the Peruvian Amazon, Iquitos. Cross-sectional survey data were collected in 2017 from 986 women attending public health centers, and the Capability, Opportunity, Motivation, Behavior model was applied to categorize behavioral factors associated with women's willingness to vaccine their daughters for HPV. Overall, 90.1% of women reported willingness to vaccinate their daughters, with higher support in Iquitos (94.2%) than in Lima (84.7%). Women who were willing to vaccinate tended to be younger and were more likely to believe the vaccine was safe (Capability), know that it was free and be willing to pay for it (Opportunity), and know someone who had been vaccinated (Motivation). This study contributes to the literature on parental willingness to vaccinate daughters against HPV in a Latin American context applying a validated behavioral framework. Findings provide insight into psychosocial and contextual factors associated with self-reported parental willingness to vaccinate daughters against HPV. The results have implications for public health research and practice by identifying modifiable barriers and facilitators that can inform targeted vaccine promotion strategies in Peru and similar settings, particularly in informing future vaccine promotion strategies in contexts where vaccine confidence may have shifted following the COVID-19 pandemic.
Skin continually faces stresses that compromise its structure and barrier quality, impacting skin appearance and comfort. By sustaining the main biological process of epithelisation, we could improve skin repair, thus correcting skin appearance or discomfort. A stronger barrier will ultimately lead to improvement of the skin surface smoothness, fine lines and radiance. To bolster barrier function, the cohesion of the stratum corneum involving keratinocyte transglutaminase (TGK) and filaggrin (FLG) and the stratum granulosum via tight junction proteins, is critical. Carboxymethyl beta-glucan (CM-BG), a water-soluble derivative of β-glucan, has shown promise in skin repair and anti-ageing applications. This study investigates its wound repair potential using in vitro assays and a 3D human full-thickness wounded skin model. The effects of CM-BG on various skin biological processes, including inflammation, differentiation and extracellular matrix remodelling, were investigated using a range of in vitro assays. Its potential to promote wound healing, epidermal recovery and barrier function was further assessed in a 3D reconstructed skin model. These comprehensive investigations revealed CM-BG's multifaceted actions in skin biology. Findings showed CM-BG selectively activates Dectin-1 receptors in a concentration-dependent manner. Furthermore, CM-BG exhibited anti-inflammatory properties by inhibiting key pro-inflammatory mediators (PGE2, IL-12/IL-23p40, IL-1β) while promoting the release of anti-inflammatory cytokines IL-10. Additionally, CM-BG significantly enhanced the expression of TGK, tight junction proteins (Claudin-1, Zonula occludens-1 and Occludin) and collagen type I. A 3D skin wound healing model confirmed these findings. CM-BG accelerated wound repair, reduced Transepidermal Water Loss and increased epidermal/dermal thickness in the wounded area. Additionally, post-injury, CM-BG also showed increased expression of key markers on the 3D reconstructed skin model. These results suggest CM-BG is a valuable topical ingredient for promoting wound healing, skin repair and mitigating skin ageing by interacting with Dectin-1 receptors, modulating inflammation, improving skin barrier function and boosting collagen production. Further clinical studies are warranted to confirm these promising findings. La peau est constamment soumise à des agressions qui compromettent sa structure et la qualité de sa fonction barrière, ce qui affecte son aspect et son bien‐être. En soutenant le processus biologique fondamental d'épithélialisation, nous pourrions améliorer la régénération cutanée et, par conséquent, corriger l'aspect de la peau ou atténuer les sensations de désagrément. Une barrière plus solide conduira à terme à une amélioration de la douceur de la surface cutanée, des ridules et de l'éclat de la peau. Pour renforcer la fonction barrière, la cohésion de la couche cornée, impliquant la transglutaminase des kératinocytes (TGK) et la filaggrine (FLG), ainsi que celle de la couche granuleuse via les protéines des jonctions serrées, est. essentielle. Le carboxyméthyl bêta‐glucane (CM‐BG), un dérivé hydrosoluble du bêta‐glucane, s'est. révélé prometteur dans les applications liées à la régénération cutanée et à la lutte contre le vieillissement. Cette étude examine son potentiel en matière de cicatrisation à l'aide de tests in vitro et d'un modèle 3D de peau humaine lésée sur toute l'épaisseur. Les effets du CM‐BG sur divers processus biologiques cutanés, notamment l'inflammation, la différenciation et le remodelage de la matrice extracellulaire, ont été étudiés à l'aide d'une série de tests in vitro. Son potentiel pour favoriser la cicatrisation des plaies, la régénération épidermique et la fonction barrière a ensuite été évalué dans un modèle de peau reconstruite en 3D. Ces études approfondies ont mis en évidence les multiples effets du CM‐BG sur la biologie cutanée. Les résultats ont montré que le CM‐BG active de manière sélective les récepteurs de la dectine‐1 en fonction de la concentration. De plus, le CM‐BG a démontré des propriétés anti‐inflammatoires en inhibant des médiateurs pro‐inflammatoires importants (PGE2, IL‐12/IL‐23p40, IL‐1β) tout en favorisant la libération de la cytokine anti‐inflammatoire IL‐10. De plus, le CM‐BG a considérablement renforcé l'expression de la TGK, des protéines des jonctions serrées (Claudin‐1, Zonula occludens‐1 et Occludin) et du collagène de type I. Un modèle 3D de cicatrisation cutanée a confirmé ces résultats. Le CM‐BG a accéléré la réparation des plaies, réduit la perte d'eau transépidermique et augmenté l'épaisseur de l'épiderme et du derme dans la zone lésée. De plus, le CM‐BG administré après la lésion a également montré une expression accrue de marqueurs importants sur le modèle de peau reconstruit en 3D. Ces résultats suggèrent que le CM‐BG est. un ingrédient topique précieux permettant de favoriser la cicatrisation des plaies, la régénération cutanée et le ralentissement du vieillissement cutané grâce à son interaction avec les récepteurs de la dectine‐1, à sa capacité à moduler l'inflammation, à améliorer la fonction de barrière cutanée et à stimuler la production de collagène. Des études cliniques supplémentaires sont nécessaires pour confirmer ces résultats prometteurs.
Nurses show low enthusiasm for senior title promotion despite its career benefits. Understanding their experiences and difficulties can inform more effective policy implementation. The nurse promotion system directly affects remuneration and work enthusiasm. Mobilizing nurses' initiative within this framework remains a key challenge for policymakers and hospital administrators. To explore the views and experiences of clinical nurses with intermediate titles on the promotion system of senior titles. A descriptive phenomenological study was conducted. A total of 13 clinical nurses with intermediate professional titles from 11 different departments (the average years of obtaining the intermediate title were 7.54 years) participated in face-to-face semistructured interviews. The data were analyzed using Colaizzi's seven-step data analysis method (1978). The COREQ guidelines were followed for reporting. Rigor was ensured through member checking and peer debriefing. Five categories emerged: Escape (perceived inadequacy, clinical/family burden, and lack of guidance/role models); Transform (clinical influence, environmental impact, and enhanced self-awareness); Challenge (research learning, degree hurdles, and trial/failure); Reflection (early career planning, perseverance, and continuous self-growth); and Expect (career/psychological support, research environment, and diversified criteria). These categories formed a cyclical process from Escape to Transform, interrupted by Challenge, leading to Reflection, and culminating in Expect for systemic change. Nursing managers and educators should attach great importance to the promotion experience of nurses, promptly address their promotion needs, and provide career planning training and guidance as early as possible. By planning career development in advance, actively learning and enhancing professional and research capabilities, the comprehensive ability and professional pride of nurses can be strengthened, and the promotion rate of senior professional titles for nurses can be increased. Nurse managers, policy makers, and nursing schools should jointly design a career development framework including mentorship, protected research time, methodological support, career planning workshops, diversified criteria, and innovation-friendly environments. Context-tailored implementation may enhance nurses' promotion enthusiasm and success rates.
Young people across the world use opioids and experience drug-related harms yet remain excluded from many opioid-related harm reduction policies and services. In this commentary, we trace our collective advocacy as young people who use opioids and youth harm reduction workers from Canada, Indonesia, Kenya, Mexico, Uganda, and the United States. Specifically, we describe the creation of our Youth RISE cohort in 2023 and our community engagement to strengthen access to harm reduction for young people globally. Over a two-month period, we held weekly online meetings where we exchanged perspectives and experiences with three set thematic discussion topics-needs, challenges, and recommendations-related to youth opioid use and harm reduction within our respective countries. Our work reflects the challenges we have faced confronting entrenched prohibitionist policies and navigating services that stigmatize and control young people who use opioids. Despite these challenges, we share a commitment to advance person-centered harm reduction and push for structural reforms to improve the health and rights of young people who use opioids and other drugs. Recommendations from our work together converge on the need to move beyond punitive approaches toward comprehensive, youth-tailored harm reduction grounded in evidence, equity, and human rights. Specifically, we call for investment in youth-tailored harm reduction programs (e.g., drug-checking, supervised consumption spaces, naloxone), prescribed alternatives, comprehensive drug education, and systemic action to address the stigma and surveillance that come with abstinence-focused approaches to youth opioid use. Beyond this, we argue that meaningful youth engagement is essential to genuinely resourcing youth harm reduction and ensuring that it effectively responds to young people's diverse and evolving realities of opioid use amid the harms of criminalization and prohibitionist-based drug policies.
Adolescent pregnancy remains a persistent and inequitable in Latin America. Chile has achieved one of the fastest declines in adolescent fertility in the region, offering insights into how policy and health system responses may accelerate progress.MethodsWe conducted a national descriptive-analytical case study using a mixed-methods approach to examine policies, programs, and health system transformations implemented in Chile between 2010 and 2023. Data sources included administrative data, repeated cross-sectional surveys, policy documents, and scientific literature. The analysis was guided by frameworks on political prioritization and health system building blocks.ResultsAdolescent fertility among girls aged 15-19 declined from 51.6 births per 1,000 in 2010 to 10.6 in 2023 (- 79%). This reduction coincided with sustained political commitment, rights-based health system reforms, and expansion of adolescent-responsive primary care services. Access to contraception-including long-acting methods-increased substantially, alongside improvements in service delivery and health system capacity. Declines occurred alongside persisting and, in some cases, widening socioeconomic inequalities. As a result, marked socioeconomic and territorial inequities in contraceptive uptake persist.ConclusionsChile's experience suggests that rapid declines in adolescent fertility can occur alongside coordinated, rights-based policies and strengthened health systems, particularly with expanded access to contraception. However, causal attribution cannot be established. Adolescent pregnancy is still a major challenge in Latin America and is closely linked to inequality, gender norms, and limited access to education and health services. This study looks at how Chile achieved one of the fastest declines in adolescent pregnancy in the region between 2010 and 2023.We analyzed national data, policies, and health programs to understand what contributed to this change. During this period, adolescent birth rates dropped by about 79%, from 51.6 to 10.6 births per 1,000 girls aged 15–19. This decline happened alongside strong government commitment, expansion of adolescent-friendly health services, and improved access to contraception, including long-acting methods.However, not all adolescents benefited equally. Pregnancy rates remain much higher among those living in poverty and in certain regions. Access to services, including abortion, is still unequal, and some adolescents face barriers such as stigma, lack of confidentiality, and limited education about sexual and reproductive health.The findings show that reducing adolescent pregnancy requires more than health services alone. It also depends on education, social conditions, and policies that support young people’s rights and choices. Chile’s experience suggests that progress is possible, but continued efforts are needed to reduce inequalities and ensure that all adolescents can access the information and services they need.
This study aims to examine the differences in microbial community abundance and species distribution in the bronchoalveolar lavage fluid (BALF) obtained from non-cystic fibrosis bronchiectasis (NCFB) patients between those with and without Pseudomonas aeruginosa (P. aeruginosa) colonization, and to assess the impact of P. aeruginosa colonization on airway microecological imbalance in NCFB. Sixty-four patients were enrolled, grouped into P. aeruginosa-colonized (PA, 29) and non-colonized (NPA, 35) groups. Among patients with NCFB, those with P. aeruginosa colonization had greater disease severity than those without colonization, with significantly higher bronchiectasis severity index (BSI) scores (P < 0.05). The proportions of patients with higher Bhalla and E-FACED scores were also greater in the PA group than in the NPA group (62.1% vs 42.8% and 34.1% vs 20%, respectively). Annual hospitalization frequency was numerically higher in PA (2.14 ± 2.43 vs 1.47 ± 0.86; P = 0.543). The PA group exhibited poorer pulmonary function, with significantly lower FEV1 and FEV1% predicted (both P < 0.01). In addition, NCFB patients in the PA group showed higher proportions of elevated white blood cell counts (31% vs 17.1%) and neutrophil percentages (41.4% vs 31.4%). Microbiota analysis of BALF demonstrated reduced alpha diversity in NCFB patients with P. aeruginosa colonization, with a predominance of Pseudomonas, whereas non-colonized NCFB patients had relatively higher abundances of Streptococcus, Acinetobacter, Rothia, Veillonella, and Prevotella. Overall, P. aeruginosa colonization in NCFB is associated with increased disease severity, heightened inflammation, and impaired lung function, accompanied by decreased microbial diversity, Pseudomonas dominance, and suppression of commensal taxa. Pseudomonas aeruginosa is a common colonizer in the airways of patients with non-cystic fibrosis bronchiectasis (NCFB), linked to disease severity, but research on its impact on clinical outcomes and airway microbiome diversity remains limited. This study compared P. aeruginosa-colonized (PA group) and non-colonized (NPA group) NCFB patients and found that the PA group had more severe disease (higher exacerbation, severity scores) and reduced bronchoalveolar lavage fluid (BALF) microbial α/β diversity (marked by Pseudomonas dominance and suppressed symbionts like Streptococcus). These findings indicate that P. aeruginosa reshapes the microecology and is associated with airway microbial imbalance. This study confirms that P. aeruginosa colonization is a key factor in NCFB disease progression and airway microecological imbalance, highlighting reduced colonization and restored homeostasis as precision intervention strategies that inform targeted therapies.
To describe limitations in functioning (activities and participation) and environmental and personal factors that are associated with functioning using the ICF framework among persons living with spinal cord injury in the community of Bangladesh. Cross-sectional study, Bangladesh arm of the International Spinal Cord Injury (InSCI) Community Survey (2023-2024). 789 individuals with spinal cord injury. Face-to-face interview through culturally adapted InSCI questionnaires. Generalized linear models were used to determine the associated factors. Participants were predominantly male (73%), aged 18-40 years (51%), and from rural areas (63%). More than one-third had tetraplegia (34%). Tetraplegic participants reported greater limitations across all ICF domains compared with paraplegics (all p <  0.01). Determinants of poorer outcomes included male sex, younger age, low education, rural residence, and severe injury of all ICF domains. Individuals with spinal cord injury in Bangladesh face severe restrictions in functioning and participation, shaped by sociodemographic and clinical factors. These findings echo global evidence from other InSCI countries and LMIC studies, highlighting systemic barriers common to resource-constrained settings. Addressing these disparities through accessible rehabilitation, policy reforms, and cross-national knowledge exchange is critical to advancing equitable spinal cord injury care worldwide.
Considerable effort has been invested during the last decade to develop ethical frameworks to guide the use of artificial intelligence (AI) technologies. Most of these frameworks take the form of an axiomatic list, that is, a list of principles or values taken as self-evident truths. This paper argues these lists face three challenges: divergence within the core principles, structural incoherence, and ethics washing. Three proposals are then put forward to address these challenges and ensure the effective implementation of AI ethics. First, an ethics framework must be parsimonious and, second, a framework building on multiple principles or values must also provide a balancing structure to deal with the different implications of these principles. The third proposal is to envision AI ethics as a process more than a static list of axiomatic principles or values.
Community-based screening initiatives can facilitate early detection and link individuals to care. This study aimed to assess the prevalence of diagnosed and undiagnosed hypertension among adults in the Aseer region during Ramadan and contextualize these findings within national hypertension trends using World Health Organization (WHO) data from 1990 to 2019, with projections to 2027. A cross-sectional study was conducted from March 11-18, 2025, including 657 adults. Participants were classified as non-hypertensive, previously diagnosed, or having undiagnosed hypertension. Multinomial logistic regression was used to identify factors associated with hypertension status. Secondary analysis of WHO data was performed to examine national trends in hypertension prevalence and projection using autoregressive integrated moving average (ARIMA) and Poisson regression models. Primary data revealed that 56.3% had undiagnosed hypertension (stage 1: 43.8% and stage 2: 56.2%) and 16.6% had a prior diagnosis (stage 1: 27.5% and stage 2: 62.4%). Older age (adjusted odds ratio (aOR): 17.17, 95% CI 4.80-61.42 for ages 55-64), male sex (aOR: 2.24, 95% CI 1.16-4.33), higher body mass index (aOR: 1.10, 95% CI 1.05-1.15), diabetes (aOR: 2.23, 95% CI 1.14-4.37), and self-reported dyslipidemia (aOR: 3.52, 95% CI 1.72-7.24) were independent predictors of diagnosed hypertension. Male sex and higher BMI were also significant predictors of undiagnosed hypertension. Between 1990-2019, secondary data revealed that females showed a significant decline in the prevalence of hypertension from 34.1% (95% CI: 21.5-49.2) to 30.2% (95% CI: 21.4-40.1) (APC: -0.58%), while prevalence among males increased from 34.4% (95% CI: 21.5-49.1) to 36.3% (95% CI: 26.6-46.7) (APC: 0.18%). Overall prevalence decreased slightly from 34.4% (95% CI: 24.9-45.1) to 34.0% (95% CI: 27.1-41.5) (APC: -0.4%). Forecasts for 2027 predicted a continued decline among females to 27.47% (95% prediction interval (PI): 26.42-28.51) (APC: -2.73%) and a modest increase among males to 36.82% (95%PI: 36.55-37.09) (APC: 1.4%), with the total prevalence projected to decrease slightly to 33.39% (95%PI: 32.64-34.14) (APC: -1.01%). Ramadan-based screening revealed a high burden of undiagnosed and uncontrolled hypertension. Along with forecasts of rising male but falling female prevalence, this underscores the urgent need for targeted community-based screening, education, and management to improve hypertension awareness and control. During a community health screening held in the holy month of Ramadan in Saudi Arabia’s Aseer region, nearly three out of every four (72.9%) of screened participants were found to have high blood pressure. Alarmingly, more than half of them had never been diagnosed (56.3%). Even among those who already knew they had high blood pressure, the majority still had levels that were not under control. The study also looked at national health data from 1990 to 2019 and made projections to 2027. While high blood pressure has been declining among women over the past three decades, it continues to rise among men and is expected to keep increasing through 2027. Men face higher risks than women, and having obesity, diabetes, or older age all increase the chances of having the condition. These findings show that relying on routine medical visits alone is missing most cases of high blood pressure. Urgent action is needed to make blood pressure screening a regular practice, especially targeting high-risk groups like men and people with excess weight, and to improve follow-up care so that those who are diagnosed get their blood pressure under control.
Facial acne scarring is a widely prevalent dermatological disease manifested as a permanent aftereffect of acne vulgaris. While fractional CO₂ laser and needling procedures are essential to treating atrophic acne scars, comparative and safety data remains limited. This systematic review and meta-analysis directly compares their efficacy and safety. According to PRISMA guidelines, PubMed, Cochrane, Google Scholar, and ClinicalTrials.gov were systematically searched. Only studies comparing fractional CO₂ laser with needling-based monotherapy treating facial atrophic acne scars in adults were included. A random-effects model was employed for meta-analysis using Review Manager (RevMan) to compare efficacy and safety outcomes. A total of 17 studies were included in the meta-analysis. For primary efficacy outcomes, the results were non-significant for mean scar score reduction (SMD: -1.08, 95% CI: [-2.48, 0.32], I² = 97%) or mean quantitative scar reduction (SMD: 0.12, 95% CI: [-0.80, 1.04], I² = 92%), with significant heterogeneity. However, categorical treatment success was significantly high for CO₂ laser (RR: 1.10, 95% CI: [1.01, 1.20], I² = 0%). For safety outcomes, fractional CO₂ laser showed significantly high risk of post-inflammatory hyperpigmentation (PIH) as compared to standard microneedling (RR: 3.04, 95% CI: [1.49, 6.21], I² = 3%), but showed significantly low pain scores as compared to RF microneedling (SMD: -0.74, 95% CI: [-1.27, -0.21], I² = 0%). No significant differences were found for erythema, crusting/scabbing, or edema. Both fractional CO₂ laser and microneedling procedures show comparable efficacy in treating atrophic acne scars, however, patient variables such as skin type, scar type, and possible complications should be taken into consideration. Moreover, further tailored therapies are crucial to treating acne scars with low risk for complications.
ObjectiveWe examined the association between 18 covariates measuring women's self-reported positive experiences with their main HIV care provider/clinics, drawing on the Substance Abuse and Mental Health Services Administration "trauma-informed care" framework, and multiple HIV treatment/care outcomes.MethodsData (2014-2021) were drawn from a longitudinal community-based cohort with women living with HIV in Metro Vancouver (the Sexual Health and HIV/AIDS: Longitudinal Women's Needs Assessment) and analyzed using multivariable logistic regression with generalized estimating equations.ResultsMultivariable analysis suggested that principles of "safety and respect" (eg, feeling safe discussing sexual and/or reproductive health, confidentiality) and "strength-based collaboration" (eg, agency in scheduling, actively participating in one's own care) were significantly associated with higher odds of optimal HIV treatment/care outcomes.ConclusionsOur study provides evidence for the benefit of incorporating and scaling up education, training and health systems policies that support women's positive experiences with their main HIV care provider/clinics in a trauma- and violence-informed framework. Plain Language Summary TitleSafety, respect and collaboration in HIV care linked to achieving better treatment outcomes among women living with HIVPlain Language SummaryMany women living with HIV have experienced trauma or violence, which can make it harder to stay engaged in HIV care and treatment. Health services that recognize and respond to these experiences, known as trauma- and violence-informed care, take into account the broader context of a person's life and the challenges they may face when accessing health services. This approach is gaining attention as a way to improve HIV treatment and care outcomes. We explored how women's experiences with HIV care providers and clinics were linked to their treatment and care outcomes, using principles from the Substance Abuse and Mental Health Services Administration trauma-informed care framework. We focused on 18 factors related to women's experiences of HIV care, such as safety, respect, collaboration, and choice. The study drew on data from 2014 to 2021 from the Sexual Health and HIV/AIDS Women's Needs Assessment community-based cohort of women living with HIV in Metro Vancouver. We used statistical methods to look at whether these 18 factors were connected with outcomes across the HIV care continuum. Outcomes included: being on antiretroviral therapy (ART); feeling confident in taking HIV medicine (self-efficacy); and consistently taking HIV medicine over different time periods (the last 2 weeks, month, and 3-6 months). Findings showed that women who reported positive HIV care experiences aligned with trauma- and violence-informed principles—particularly feeling safe, respected, and having a say in their care—were more likely to report positive HIV treatment and care outcomes. These outcomes included being on ART, having higher confidence in their ability to take medicines, and consistency in taking HIV medication over time. Our study provides strong evidence that integrating trauma- and violence-informed principles into HIV care experiences can improve treatment outcomes for women living with HIV. Supporting and scaling up services that prioritize safety, respect, and collaboration can play a key role in improving health and well-being.
Older adults residing in long-term care (LTC) homes (also referred to as LTC facilities) often have limited opportunities to access nature environments, which are known to support psychological well-being. Virtual reality (VR) offers a novel approach to delivering immersive nature experiences for this population. This qualitative study explored the perceptions of using VR to view nature landscapes among older adults in LTC homes. Using purposive sampling, we recruited 16 older adults (aged 60-84) from 10 LTC facilities in Taiwan. Participants viewed six 360-degree nature videos (each about 2 min long) in a single VR session via a VR headset. Within 1 week of the VR session, participants completed individual, face-to-face, semi-structured interviews. Data were analyzed using content analysis. Five themes and corresponding categories were generated: (1) as a window to the past, revisiting childhood/youth and reconnecting with places once visited; (2) embracing serenity, feeling relaxed/lightness, savoring the joy, sensing ease/comfort, and feeling inner calm/tranquility; (3) escaping the confines of reality, unlocking a sense of freedom and revisiting natural landscapes; (4) rekindling the healing power of dreams/hope, reigniting hope and motivation and fulfilling unfinished dreams; and (5) unreal and unsettling realities, expressing negative experiences including loneliness, dizziness, and a virtual-reality gap. Immersive VR nature experiences can evoke nostalgic memories, promote relaxation, provide a temporary sense of freedom, and inspire hope. However, some participants also reported challenges such as dizziness, feelings of artificiality, or loneliness, highlighting the importance of careful design and individualized implementation.
Problematic sexual behavior (PSB) among youth presents a persistent challenge within child welfare and multidisciplinary response systems. Because multidisciplinary responses shape investigation, referral, and service decisions, it is important to understand how professionals-including clinicians, law enforcement, child advocacy center staff, child welfare professionals, and prosecutors-perceive children who act out sexually on other children. This study examines how case and respondent characteristics jointly shape professional perceptions of PSB using vignette-based survey data from 363 multidisciplinary team members across Texas. Respondents assigned to vignettes involving a 14-year-old child displaying PSB were more likely than those assigned to a 10-year-old to agree the child was old enough to accept responsibility, knew the behavior was wrong, and should face criminal consequences. Political ideology, professional role, and geographic area of practice were each independently associated with these judgments. Mental health professionals and liberal-identifying respondents were less likely to endorse criminal consequences, while court/legal professionals and conservative-identifying respondents showed opposing patterns. Suburban practitioners were more likely than rural practitioners to endorse responsibility and knowledge of wrongdoing, while urban practitioners were less likely to endorse criminal consequences. Findings highlight the need for developmentally informed, coordinated approaches to training and intervention across multidisciplinary systems.
Emergency situations pose a serious threat to population health, especially of vulnerable populations. Hence, governments must be prepared to provide coordinated emergency relief, based on official guidance, which includes the protection of breastfeeding-a pillar of food security for infants and young children. The Republic of Croatia did not have a policy on infant feeding in emergencies, despite facing several disasters in the past. In the 2015 World Breastfeeding Trends Initiative Report, Croatia received only 1 of 10 points for "Infant feeding during emergencies." Consequently, a multidisciplinary working group within the Ministry of Health was formed in 2019, with the task of preparing a national policy. The "Operational Guidance on Infant Feeding in Emergencies" (OG) was used as a template. This seminal document was translated and carefully adapted to the Croatian setting, which proved to be a lengthy, complex and consultative process. A draft was sent to relevant government departments and organizations for feedback, validation, and approval. The revised guidance was posted on the government's official website for public consultation. On September 12, 2023, the Minister of Health of the Republic of Croatia adopted the document "Infant and young child feeding in emergency situations-Guidance for aid workers and program leaders in emergency situations." Developing Croatia's national guidance through a volunteer-based, multisectoral working group was cost-effective, relied on existing expertise, and fostered strong collaboration between government, civil society, and international organizations. Using the OG as the foundation ensured alignment with global standards and accelerated the drafting process.
Stroke is the third leading cause of death and the fourth leading cause of disability globally, particularly in low- and middle-income countries, where the disease burden is increasing significantly. Risk prediction of first-stroke is crucial for stroke prevention. Although artificial intelligence (AI)-based prediction models have rapidly developed in recent years, their clinical utility in primary community healthcare settings remains unclear. This study aimed to systematically review and analyze the application of algorithms, especially machine learning (ML)-based ones, in first-stroke risk prediction models within community settings. We searched PubMed, EMBASE, and the Cochrane Library from inception to 30 June 2024 for studies developing or validating multivariable stroke risk models for primary care. We analyzed AUC/C-statistic values with 95% confidence intervals (CI) and conducted a meta-analysis. A total of 43 studies encompassing 93 models were included. The Cox regression model was the most common traditional method (n = 32, 74.42% of traditional models). Among ML models, 25 algorithms were identified, with logistic regression being the most frequent (n = 8, 18.60%). The meta-analysis showed a pooled AUC of 0.79 (95% CI: 0.77-0.81) for the Cox regression model, while logistic regression, random forest, and eXtreme Gradient Boosting models yielded 0.76 (95% CI: 0.64-0.89), 0.77 (95% CI: 0.61-0.93), and 0.77 (95% CI: 0.59-0.94), respectively. Notably, 76.7% of the included studies had a high risk of bias, and 20.9% raised high concerns regarding their applicability to community primary healthcare settings. ML models did not outperform traditional regression models, with significant performance variability observed. Despite the increasing use of ML models for first-stroke risk prediction, their clinical utility in community primary healthcare remains unverified. Current ML models show no significant advantage over traditional regression methods and face challenges in algorithm innovation, data standardization, and external validation. Furthermore, the prevalence of methodological flaws and applicability concerns among existing studies underscores the need for caution. Future research should focus on standardized validation and real-world clinical analysis to develop effective stroke prevention tools.
Outcome measures are essential in healthcare. This study aimed to use Think Aloud methodology to explore the face validity of three patient-reported outcome measures (PROMs)-the Subjective Norms, Self-Regulation, and Expected Illness Perception questionnaires-among individuals undergoing surgery for lumbar spinal stenosis (LSS). Twelve participants aged 59-88 verbalised their thoughts while completing the questionnaires. Content analysis revealed 96 issues across the 3 PROMs. The Expected Illness Perception and Subjective Norms questionnaires yielded the highest number of problems, particularly around phrasing and inconsistent response scales. While the Self-Regulation questionnaire was generally well understood, some items still prompted confusion. Findings highlight the importance of clear item phrasing, scale consistency, and contextual framing to reduce cognitive burden and enhance usability. Recommendations for item revision are provided to improve face validity and interpretability. Further qualitative and quantitative evaluation in a more diverse participant population is warranted before clinical or research use.