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Mental health challenges are common among college students, highlighting the need for scalable approaches that aim to reduce distress and support well-being. mHealth tools may complement campus services, though sustained engagement may be difficult. This study sought to discover how a blended intervention combining an mHealth positive psychology intervention (PPI) app with optional wellness coaching might impact student well-being. In this single-arm pilot study, 28 students at a public university were given access to a PPI app (Roadmap 2.0) with mood tracking, a Fitbit® wearable device, and optional wellness coaching. Data sources included PROMIS® surveys at baseline and monthly follow-ups, daily mood ratings, app engagement logs, wearable-derived activity metrics, coaching attendance, and optional exit interviews. Analyses were descriptive and exploratory. From baseline to exit, participants showed descriptive increases in PROMIS® global mental health and positive affect and decreases in depression, anxiety, fatigue, and anger. App engagement declined over time. In exploratory models, app engagement was lower among participants reporting greater psychosocial resources or support. Mood ratings were higher in the days following PPI activity completion, and PPI activity users were observed to have higher mood ratings over time. Interviews supported perceived app-coaching synergy and identified barriers to sustained engagement. A blended PPI mHealth app plus wellness coaching appears feasible in a real-world college setting and was associated with favorable descriptive trends in mental health and well-being outcomes. Controlled studies are needed to evaluate efficacy and assess app versus coaching contributions.

We evaluated whether offering access to a multicomponent mHealth app improves quality of life (QoL) and psychosocial outcomes among breast cancer survivors under pragmatic, nonprescriptive conditions. In this single-center, randomized, controlled trial at Hospital Clínic de Barcelona, women age ≥18 years, disease-free after breast cancer treatment, were recruited (December 2020-December 2021) and randomly assigned 1:1 to usual follow-up plus app access or usual follow-up alone. The app provided CTCAE v4.03-aligned symptom tracking with self-care guidance, educational content, an events calendar, and gamified smartphone-based step counting; no protocolized clinician monitoring or feedback was provided. Outcomes were assessed at baseline and 3, 6, 9, and 12 months using European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (QLQ)-C30/BR23, Hospital Anxiety and Depression Scale (HADS), and Three-Item Loneliness Scale (TILS). The primary end point was the difference in QLQ-C30 Global Health Status/QoL at 3 months. Analyses followed intention-to-treat using mixed models for repeated measures adjusted for baseline values. Of 124 women assessed, 121 were randomized (intervention n = 60; control n = 61). Patient-reported outcome measures were available for 106 of 121 (87.6%) at 3 months and 95 of 121 (78.5%) at 12 months. At 3 months, there was no significant difference in Global Health Status/QoL (adjusted mean difference [Intervention-Control], -2.24 [95% CI, -9.29 to 4.81]; P = .53); estimates at later time points were similarly imprecise. No significant between-group difference were observed for QLQ-BR23 domains, HADS anxiety/depression, or TILS. Exploratory subgroup analyses suggested possible heterogeneity in TILS by hormonal-treatment category; this was descriptive and hypothesis-generating only. App engagement was the highest in months 0-3 (48/60 [80.0%] with any use) and declined thereafter; 12 of 60 (20.0%) never used the app. In a pragmatic, nonprescriptive survivorship trial, offering access to a multicomponent mHealth app without closed-loop clinical integration did not show a statistically significant between-group differences in QoL or psychosocial outcomes; confidence intervals were compatible with meaningful harm and did not exclude small benefit depending on the threshold used to define clinical relevance.

Wearable human activity recognition has become an important component of intelligent fitness tracking, but deploying accurate recognition models on resource-constrained edge devices remains challenging. Existing deep learning methods often rely on recurrent structures, attention mechanisms, or complex hybrid architectures, which increase computational cost and limit real-time deployment. This study proposes DeM-FCN, a lightweight and purely convolutional framework for smart dumbbell-based resistance-training activity recognition. The model integrates a physics-aware input representation, Gaussian noise regularization, stacked one-dimensional convolutional blocks, Global Max Pooling, and a cost-sensitive focal loss to improve subject-independent recognition. The input representation extends raw inertial measurements by introducing trigonometric encoding of Euler angles and acceleration and gyroscope magnitude features, allowing the model to capture both orientation-related motion patterns and orientation-insensitive motion intensity. The proposed model was evaluated using Leave-One-Subject-Out cross-validation on a custom smart dumbbell dataset containing four resistance-training exercises collected from 15 subjects. DeM-FCN achieved an accuracy of 0.966, macro F1-score of 0.916, and macro AUC of 0.982, while maintaining only 73.7 K parameters, 14.84 M FLOPs, and a model size of 0.29 MB. Additional evaluations on PAMAP2 and MHEALTH suggested that the convolutional backbone retained useful class-ranking ability on public IMU-based HAR datasets, while the reduced macro F1-scores indicated that hard-label daily activity recognition remains more challenging than constrained resistance-training recognition due to broader activity diversity, sensor-domain differences, and missing modality information. A refined ablation study confirmed that trigonometric encoding and magnitude features provide complementary benefits, with magnitude features contributing more strongly to cross-subject robustness. The results suggest that DeM-FCN provides a favorable accuracy-efficiency trade-off for wearable resistance-training recognition and offers a practical foundation for edge-oriented fitness monitoring.

Background/Objectives: Maternal mortality remains disproportionately high in low- and middle-income countries, where ineffective referral systems and a lack of infrastructure contribute to delays in emergency obstetric care. In sub-Saharan Africa, referrals are largely conducted via paper, often resulting in lost documents and limited follow-up. Mobile health (mHealth) offers a promising solution by enabling real-time, bidirectional communication. This study aimed to examine how the Mobile Obstetric Referral Emergency System (MORES), a WhatsApp-based referral platform piloted in 20 rural health facilities and two district hospitals in Bong County, Libera, influences healthcare providers' communication, collaboration, and relationships. Methods: A mixed-methods design was used. Ninety one (N = 91) providers completed demographic and Trust and Teamwork surveys. Of the 91 providers, 35 providers from rural health facilities and 56 providers from district hospitals participated in a 10-question survey and individual interviews. Results: Survey results indicated high levels of mutual respect, confidence, and teamwork perceived by both the rural health facility and district hospital providers. Qualitative data further expanded on the quantitative results showing the MORES intervention enhanced the timeliness and accuracy of referrals, supported problem-solving between facilities, and fostered shared goals, mutual respect, and knowledge exchange. Conclusions: Providers perceived the MORES to be associated with increased collaboration and continuity of care, as well as a feasible, low-cost, and sustainable intervention to improve obstetric referral systems in low-resource settings.

Pulse wave velocity (PWV), known as the gold standard for evaluating arterial stiffness, is limited by device dependence. This study aims to explore the feasibility of retinal parameters to assess PWV based on artificial intelligence (AI), providing a new approach for remote and convenient cardiovascular risk assessment. This retrospective study leveraged both cross-sectional and longitudinal data, enrolling patients from Peking University Third Hospital who underwent fundus photography and PWV testing simultaneously over five consecutive years. An optimised AI system automatically quantified retinal vascular parameters, optic morphological features, and lesion counts. Correlation analyses and multivariate linear regression models were employed using the training set to assess associations between retinal features and brachial-ankle PWV (baPWV) or ankle-brachial index (ABI), with validation performed in the test set. In the training set of 3,088 visits, baPWV and ABI showed significant correlations with retinal vascular morphology (including mean vessel density, arteriolar-to-venular ratio, regional curvature, fractal dimension), optic disk/cup parameters (disk area, circularity), and lesion counts (exudative and drusen) (all p&#x2009;<&#x2009;0.001). Elevated baPWV was independently associated with older age, higher blood pressure, lower arteriolar-to-venular ratio, larger disk area, and increased soft exudates and drusen (F&#x2009;=&#x2009;503.864, p&#x2009;<&#x2009;0.001). Higher ABI was linked to older age, higher diastolic pressure, lower arteriolar-to-venular ratio, decreased vessel density, and fewer hard exudates (F&#x2009;=&#x2009;71.368, p&#x2009;<&#x2009;0.001). Validation demonstrated good agreement between predicted and actual baPWV (ICC = 0.762, p&#x2009;<&#x2009;0.001), while agreement for ABI was moderate (ICC = 0.410, p&#x2009;<&#x2009;0.001). Longitudinal analysis further revealed that baPWV changes correlated with fractal dimension, vessel density, arteriolar/venular ratio, and disk circularity, whereas ABI changes were associated with fractal dimension, vessel diameter, vessel density, arteriolar diameter, and drusen count (all p&#x2009;<&#x2009;0.001). This large-scale study demonstrates significant associations between AI-derived retinal features and baPWV/ABI, identifying robust predictive markers. The proposed AI-based retinal analysis offers a non-invasive, scalable, and remote screening paradigm for arterial stiffness and cardiovascular risk assessment. AI-derived retinal parameters, including vascular morphology and optic disk features, show significant correlations with arterial stiffness and vascular health, offering a non-invasive alternative to traditional PWV assessment.Key retinal predictors of elevated baPWV include increased blood pressure, age, lesion counts, reduced arteriolar-to-venular ratio, enabling AI-based cardiovascular risk evaluation.Longitudinal analysis confirms that changes in retinal vascular metrics (e.g. fractal dimension, vessel density) track with baPWV/ABI progression, supporting AI-powered retinal screening as a scalable tool for remote arterial stiffness monitoring.

Persistent mobility limitations after inpatient rehabilitation are common in older adults with cognitive impairment (CI). Home-based exercise interventions can improve locomotor capacity during this vulnerable period; however, evidence that they improve real-world mobility is scarce. To investigate the effects of a home-based exercise programme combined with physical activity (PA) promotion on real-world digital mobility outcomes (DMOs). Single-centre, double-blind, randomised, placebo-controlled trial. Community. 104 community-dwelling older adults with CI (82.3&#x2009;&#xb1;&#x2009;6.0&#xa0;years; 75% women; Mini-Mental State Examination score 23.2&#x2009;&#xb1;&#x2009;2.4) recently discharged from inpatient geriatric rehabilitation. The intervention group received a 12-week home-based exercise programme combined with behavioural change techniques to promote PA; the control group received a 12-week non-specific home-based placebo motor activity programme. DMOs related to walking amount, pattern and pace were measured over 48&#xa0;h at baseline, post-intervention and after a 12-week follow-up using a single body-fixed sensor and validated processing algorithms. Post-intervention, small statistically significant improvements favouring the intervention group were observed in walking pattern and pace outcomes, including longer walking bout (WB) duration, higher walking speed and longer stride length in shorter (10-30&#xa0;s) WBs, and higher 90th percentile walking speed in WBs >10&#xa0;s. These improvements were not sustained at the 12-week follow-up. No between-group differences were found for walking amount. The post-discharge home-based exercise programme combined with PA promotion showed small, short-term improvements in selected real-world walking pattern and pace outcomes in older adults with CI after inpatient rehabilitation; however, these effects were no longer evident at follow-up, and walking amount did not increase.

Background/Objectives: Krebs von den Lungen-6 (KL-6) is a mucin-like glycoprotein that is elevated in a variety of lung diseases and used as a diagnostic and prognostic biomarker in people with cystic fibrosis (pwCF). Single nucleotide polymorphisms (SNPs) in mucin-1 (MUC1) influence KL-6 serum concentration. This study investigated the relationship between serum KL-6 concentrations in pwCF and a MUC1 SNP and its longitudinal dynamics. Methods: The study included pwCF (n = 174) and healthy controls (n = 30). In pwCF, 365 samples were collected for longitudinal analyses; KL-6 levels were measured and the MUC1 SNP rs4072037 was genotyped in pwCF and controls. Cross-sectional and longitudinal associations between KL-6, genotype, and clinical parameters, such as infectious exacerbation, body mass index, inflammatory values and lung function, were analyzed using linear mixed-effects models. Results: Serum KL-6 was significantly elevated in pwCF compared with controls (458 &#xb1; 357 vs. 283 &#xb1; 103 U/mL; p < 0.001). Homozygous G/G carriers exhibited higher baseline KL-6 than A/A carriers (627 &#xb1; 673 vs. 397 &#xb1; 148 U/mL; p < 0.001), while heterozygous individuals showed intermediate levels. Longitudinally, the MUC1 SNP and interindividual differences in vital capacity (ppFVC) primarily determined baseline KL-6 levels, explaining 52.5% of variance. Short-term intraindividual fluctuations were largely driven by infectious exacerbations independent of genotype, accounting for ~10% of within-subject variance. Conclusions: PwCF generally showed elevated serum KL-6 levels and reflected both stable interindividual differences, mainly driven by the MUC1 SNP and ppFVC. Dynamic intraindividualchanges were associated with infectious exacerbations. Given the influence of MUC1 polymorphisms (e.g., rs4072037) on KL-6 concentration, personalized interpretation based on the genotype status may be informative in pwCF.

Existing reviews of technology-enabled care for older adults have primarily focused on technology usability, patient acceptance, and clinical outcomes. However, there remains limited synthesis of the organizational and system-level factors influencing the implementation of technology-enabled care in rural, regional, and remote contexts. This review addresses this gap by mapping barriers and facilitators using the Consolidated Framework for Implementation Research. Using technology to enable or enhance healthcare, rehabilitation, and self-management offers significant potential to improve access, outcomes, and equity for older adults; however, adoption and sustained use in rural, regional, and remote (RRR) settings remain limited. This scoping review aimed to identify factors influencing the implementation of technology-enabled care interventions for community-dwelling older adults in RRR contexts. Searches were conducted in PubMed, MEDLINE, CINAHL, Web of Science, and Scopus for empirical studies published from 2014 onwards. Barriers and enablers were mapped to the Consolidated Framework for Implementation Research (CFIR) and synthesized narratively. The search identified 807 records, of which 433 remained after duplicate removal and 105 proceeded to full-text assessment. Five studies met the inclusion criteria, examining telehealth, telerehabilitation, remote monitoring, and mobile health applications. Across the included studies, 71 implementation factors were identified, comprising 39 barriers and 32 enablers mapped across five CFIR domains and 20 constructs. The most frequently reported barriers related to innovation recipients' capability, innovation design, innovation complexity, and outer setting local conditions. The most frequently reported enablers related to innovation adaptability, innovation complexity, and innovation recipients' motivation. Findings suggest that implementation in RRR settings depends less on technological sophistication than on aligning design and delivery with user capability and local system capacity, reducing cognitive and technical burden, and embedding relational and contextual support.

Chronic pain affects one in five Americans, yet rural patients face significant barriers to evidence-based interventions like biofeedback due to geographic isolation and provider shortages. This pilot study evaluates the feasibility, acceptability, and preliminary effectiveness of Mind Meter, a virtual neuroscience-based biofeedback group intervention, for rural adults with chronic pain. Twenty-nine rural-dwelling adults (mean age 44.9, SD 11.8) with chronic pain (&#x2265;3&#xa0;months) were recruited from a pain management program and twenty-one participants completed a single-session virtual Mind Meter group, integrating pain neuroscience education and biofeedback via affordable equipment (pulse oximeters, skin thermometers). Feasibility was assessed by enrollment (target &#x2265;50%), adherence (&#x2265;80%), and completion rates (&#x2265;75%); acceptability via a 10-item questionnaire (target &#x2265;80% rating &#x2265;4/5); and preliminary effectiveness via pre-post changes in heart rate, temperature, pain, and anxiety, analyzed with paired t-tests (adjusted P < 0.05). Enrollment was 22% (29/132 eligible), below target, while adherence reached 100%, exceeding goals. Acceptability was high, with 90.5% rating the intervention &#x2265;4/5 (mean 4.3, SD 0.9), particularly for clarity of directions (95.2% &#x2265; 4). Statistically significant pre-post improvements occurred in anxiety (mean change -2.2, SD 2.4, P < 0.001, Hedge's g = -0.886) and temperature (mean increase 4.6&#xb0;F, SD 6.1, P = 0.003, g = 0.726); pain decreased (mean -0.8, SD 1.5, P = 0.025) but lost statistical significance after correction for multiple comparisons. Heart rate showed no change (P = 0.615). Virtual Mind Meter is feasible and highly acceptable for rural patients with chronic pain, with promising reductions in anxiety and temperature. Lower than hypothesized enrollment warrants recruitment strategy-adjustments, while preliminary outcomes support further development.

Screening for unhealthy alcohol use is recommended in primary care; however, completion and quality are inconsistent especially during telemedicine visits. Little is known about optimal workflows incorporating electronic screening (e-screening). To evaluate whether use of previsit asynchronous e-screening is associated with improved completion and detection of unhealthy alcohol use via the Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire compared with usual staff-administered screening during telemedicine primary care visits. Pragmatic cluster randomized quality improvement trial conducted at 2 primary care clinics in the Veterans Health Administration (VHA) from June 24 to August 1, 2024. Primary care clinicians (PCCs) were randomized 1:1, stratified by site, to intervention or control. For PCCs in the control arm, patients received usual care including staff-administered AUDIT-C at telemedicine visits. For PCCs in the intervention arm, 24 to 48 hours before visits patients additionally received an invitation to asynchronous self-administered e-screening. Veterans who did not complete e-screening were still eligible for staff completion of screening during their clinic visits. The primary outcome was completion of AUDIT-C; secondary outcome was positive screen result (AUDIT-C &#x2265;5). The exploratory outcome was brief intervention after positive screen result. All statistical models were clustered by PCC and adjusted for patient age, sex, race and ethnicity, comorbidity, prior primary care use, and site. Among 848 veterans in the primary analysis (mean [SD] age, 55.4 [16.1] years; 729 [86.0%] male), use of e-screening was associated with increased telemedicine visit screening completion rates by 30.5 percentage points (74.4% [95% CI, 68.5%-80.3%] for e-screening vs 43.9% [95% CI, 26.6%-61.2%] for usual care; P&#x2009;<&#x2009;.001) and with increased likelihood of a positive screen result (10.6% [95% CI, 8.0%-13.2%] for e-screening vs 2.7% [95% CI, 0.7%-4.7%] for usual care; P&#x2009;<&#x2009;.001). Exploratory analysis identified the proportion of veterans receiving a brief intervention after a positive screen result (2.3% [10 of 442] for usual care vs 5.9% [24 of 406] for e-screening; P&#x2009;=&#x2009;.01). In this study, use of asynchronous e-screening was associated with improved completion and screen-positive results for unhealthy alcohol use in primary care, with the greatest gains for telemedicine encounters. Overall, this approach may close the implementation gap for population-based screening, improve disclosure, and reduce staff burden, particularly in hybrid care models. isrctn.org Identifier: ISRCTN16316660.

Wearable cardioverter-defibrillators (WCDs) are equipped with the TRENDS remote-monitoring system, enabling continuous assessment of arrhythmias, physiological parameters, and patient-reported outcomes. This study evaluated the clinical utility of TRENDS-integrated WCD management and compared it with a historical control. We prospectively analyzed 36 consecutive patients who received a WCD with TRENDS between 2019 and 2024 and compared them with 30 historical controls treated before the implementation of TRENDS. The WCD indications were heart failure as primary prevention (64%) and acute coronary syndrome with ventricular arrhythmias (28%). Among 18 patients who met the criteria for an implantable cardioverter-defibrillator (ICD), including 1 patient with WCD shock, 9 ultimately underwent ICD implantation. The mean daily WCD wear-time was 21.3 h and did not differ significantly from that of the historical control. The response rate to health-related questionnaires was 89%. TRENDS detected symptom exacerbation in 31% of patients, weight gain in 19% of patients, and missed medication in 19% of patients. Daily step-count was significantly lower in patients with ICD indications than in those without (5012 &#xb1; 2980 steps vs. 7977 &#xb1; 3584 steps, p = 0.01). TRENDS data also aided in initiating anticoagulation therapy and optimizing beta-blocker therapy. TRENDS provided clinically actionable physiologic and patient-reported information that supported individualized cardiovascular management.

Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has been shown to increase bystander CPR rates and improve outcomes after out-of-hospital cardiac arrest (OHCA). However, dispatchers cannot directly visualize the scene, which may limit the effectiveness of telephone instructions. Telemedicine-assisted CPR (TA-CPR), incorporating real-time video communication, has been proposed to address this limitation and potentially improve bystander CPR performance. Evidence regarding its effectiveness in real-world EMS systems remains limited. This study aimed to compare bystander CPR rates between TA-CPR and DA-CPR. We conducted a pilot pragmatic cluster-randomized controlled trial involving adult patients with suspected non-traumatic OHCA. Monthly block randomization assigned CPR instruction protocols to either a TA-CPR protocol or a DA-CPR protocol. The primary outcome was bystander CPR rate. Secondary outcomes included ongoing bystander CPR at EMS arrival and protocol compliance. A total of 108 patients were included, with 55 managed using TA-CPR and 53 using DA-CPR. Patients in the TA-CPR group were younger (mean age 63.5 &#xb1; 16.2 vs. 68.9 &#xb1; 14.6 years), and a higher proportion presented with an initial shockable rhythm (20.0% vs. 9.4%). Bystander CPR occurred in 87.3% of TA-CPR cases and 92.5% of DA-CPR cases, with no statistically significant difference (p = 0.53). Ongoing bystander CPR at EMS arrival was also similar between groups (76.4% vs. 84.9%; p = 0.33). Protocol compliance was significantly lower in the TA-CPR group than in the DA-CPR group (69.1% vs. 92.5%; p < 0.01). TA-CPR did not increase bystander CPR rates compared with conventional DA-CPR in this real-world EMS setting.

Background: Over the past two decades, teleophthalmology has become an effective approach for glaucoma screening and follow-up, with its adoption markedly accelerated by the COVID-19 pandemic. Objectives: The aim of the present study was to explore and analyze the attitudes of ophthalmologists in Bulgaria toward the application of teleglaucoma, digital communication, and artificial intelligence in clinical practice. Methods: A cross-sectional survey study was conducted among 113 ophthalmologists between September 2024 and March 2025, representing 10.5% of all licensed ophthalmologists in Bulgaria (n = 1074). Results: Age, professional experience, and specialization influenced the level of involvement in managing glaucoma patients. The level of awareness regarding the term 'teleophthalmology' was higher among respondents with a specialization in ophthalmology and those holding a doctoral degree (p = 0.001). Among the ophthalmologists surveyed, 35.4% (n = 40) provided teleophthalmology services, while an additional 19.5% (n = 22) reported no prior provision of such services but planned to do so in the future. The most preferred method for conducting teleophthalmology consultations was telephone communication (n = 27; 67.5%), followed by communication via Skype, Viber, or Messenger (n = 23; 57.5%). Physicians with longer professional experience more frequently conducted remote consultations with patients they already knew (p = 0.006). A substantial proportion of respondents (85.0%, n = 96) expressed willingness to participate in training related to contemporary trends and the provision of remote medical services. More than half of respondents expressed positive attitudes toward the use of artificial intelligence in ophthalmology, although practical implementation remained limited. Conclusions: The present study outlined the current landscape of attitudes among ophthalmologists in Bulgaria toward teleglaucoma, digital communication, and the use of artificial intelligence in clinical practice. The findings indicated a moderately positive yet cautious stance-remote services were perceived primarily as complementary tools, particularly for the follow-up of previously known patients and for real-time collaboration between specialists.

Despite the potential of mobile health applications for diabetes self-management, patient adoption rates remain low. Understanding patient perspectives is crucial for developing effective and user-friendly solutions that can improve diabetes self-care and education. This study aimed to explore Malaysian patients' perspectives on the use of mobile health applications for diabetes self-management. Qualitative study using semi-structured interviews was conducted with 16 diabetes patients across Malaysia. Interviews were conducted via video conferencing, recorded, transcribed, and analysed using thematic analysis. Participants ranged in age from 24 to 70 years with diabetes duration from 6 to 27 years. Five key themes emerged: (1) limited adoption and awareness, (2) barriers to use, (3) localization and personalization needs, (4) healthcare system integration gaps, and (5) support preferences. Patients expressed interest in mobile health applications but faced significant barriers including economic constraints, technical difficulties, and behavioural challenges. Key desired features included automated glucose monitoring, localized food databases, educational content, and seamless communication with healthcare providers. While patients recognize the potential benefits of mobile health applications for diabetes self-management, successful implementation requires addressing economic barriers, improving digital literacy, developing culturally appropriate content, and ensuring seamless integration with clinical care. Future development should prioritize user-friendly interfaces, affordability, and comprehensive support features that align with patients' daily management needs.

Breast cancer remains the most prevalent cancer among women globally. Adjuvant therapies can cause adverse effects that compromise physical and mental health. Exercise may mitigate these effects; however, many breast cancer survivors remain insufficiently active. This pilot study aimed to test the effectiveness of a 7-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong. We developed a 12-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong; this pilot tested a 7-week abbreviated version. In this 2-group randomized controlled pilot trial, 34 individuals were assessed for eligibility, and 27 were randomized; 24 completed baseline and were included in the modified intention-to-treat analyses (12 per group). The intervention comprised a progressively supervised group-based tele-exercise intervention transitioning to unsupervised sessions, combined with psychological counseling. Outcomes were guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, with emphasis on feasibility, acceptability, and preliminary effects. Recruitment was 79.4% (27/34) and baseline-to-post retention was 100% (24/24), with satisfactory attendance (87.7%) and compliance (85.3%) in the intervention group. Acceptability was high. Preliminary signals of improvement were observed in cardiorespiratory fitness (primary outcome), lower-extremity strength, balance, affected-side shoulder range of motion, and health-related quality of life. This pilot supports the feasibility and acceptability of tele-exercise for breast cancer rehabilitation and provides preliminary evidence to justify a larger trial with longer follow-up to assess sustained effects and broader applicability.

Digital services allow patients to efficiently access healthcare. These services work more effectively than traditional paper-based systems by delivering better patient outcomes, helping address global health challenges, and promoting the universal adoption of health technology. This study examined the impact of digital healthcare adoption and service quality on patient satisfaction in Pakistan's public healthcare sector and the moderating effect of telehealth services on this relationship. This study adopted the technology acceptance model to understand technology sophistication and how electronic medical records, digital patient systems, and technology impact healthcare through efficiency and communication. Simultaneously, the study examined the role of doctor services, nurse services, pharmacy services, and laboratory services in the patient experience. Random sampling techniques were employed, and questionnaires were distributed to 573 respondents across five central districts of Punjab, Pakistan. The hypotheses were tested using IBM SPSS Statistics, Amos, and structural equation modeling. These findings show that digital healthcare adoption and service quality significantly improve patient satisfaction, whereas telehealth services reinforce these relationships by overcoming geographical and logistical hurdles. The conclusions of this study offer pragmatic guidance to policymakers and healthcare administrators for devising digital healthcare strategies to improve patient outcomes.

Tuberculosis has been one of the biggest issues of public health in India with constant diagnostic delays, stigma, and poor treatment-seeking behaviour serve as barriers to Disease elimination process. Although the diagnostic and surveillance technologies have been improved at a rapid pace. The society is still Stemming from lagging in community engagement and thus the awareness cannot be converted to action. This research explores the opportunities of tele-education as a scaled process to enhance the community involvement in the issue of the control of tuberculosis in opposite high-case environments in an urban slum cluster and a tribal village network. An intervention based on the use of four videos, audio modules, quizzes, and ASHA-promoted reinforcement was implemented on 112 households over a period of four weeks via tele-education. The results showed that both sites had great improvements in TB literacy in addition to behaviour change that was observed through the self-initiated referrals, increased uptake of screening, and the facilitation of information with peers. Despite the fact that the urban slum had a higher level of digital participation, the tribal community acquired knowledge the same way by a hybrid offline-based model. The findings highlight the relevance of contextual differentiation, trusted intermediaries and blended learning methods in realizing the maximum impact of tele-education. Tele-education as a potential solution to speed up eliminating TB nationally can be viewed offenders by considering communities as active participants not as passive recipients, through a reformulation of communities as active partners, which facilitates population health initiatives beyond biomedical innovation.