The phenomenon of Unfinished Nursing Care raises important questions from theoretical and empirical perspectives, as well as legal and forensic implications that have not been considered in the available literature to date. The analysis of rulings issued in a given country may expand available knowledge by introducing a legal-forensic lens into this field of research, enabling the identification of unlawful behaviors attributed to nurses, the types of omissions recognized by judges, and the judicial reasoning underlying the attribution of individual criminal responsibility. To analyze and synthesize criminal rulings issued by the Italian Supreme Court of Cassation in which registered nurses were convicted for omissions or delays in the provision of nursing care. A qualitative document analysis was conducted. Supreme Court of Cassation rulings involving nurses held responsible for adverse outcomes in patients due to episodes of poor care attributable to Unfinished Nursing Care were considered. The DeJure database was searched. Extracted data were synthesized in narrative form, focusing on the main characteristics of the rulings, their consequences for patients, nurses, and the health care system, the omitted or delayed interventions sanctioned, and the concurrent reasons underlying such omissions. Between December 2004 and October 2022, the Italian Supreme Court of Cassation issued 10 rulings. In eight cases, the patients died; in the remaining cases, the patients suffered permanent consequences. The most reported omissions included failure to monitor vital signs and postoperative care, inadequate patient monitoring, failure to document notes and allergies, neglect of basic care, failure to check surgical sites, and delays in response time. The rulings identified reasons ranging from a single cause to multiple concurrent factors at the individual nurse, unit, and system-wide levels. This is the first document analysis of Italian case law on Unfinished Nursing Care, offering a forensic perspective based on legally documented omissions rather than self-reported data. Omissions leading to criminal convictions most often concerned patient monitoring, postoperative surveillance, documentation, and basic nursing care. Omissions or delays in nursing care may lead to severe patient harm while also exposing individual nurses to criminal liability, despite the inherently multidisciplinary and system-based nature of care delivery.
Arnold-Chiari malformation (ACM) is a rare congenital disorder affecting the cranio-cervical junction. It is characterized by symptoms related to the cerebellum, bulbar region, and medulla, often accompanied by hydrocephalus. These symptoms can profoundly affect the daily lives of individuals with ACM, significantly reducing their quality of life (QoL). To explore the experiences of individuals with ACM across various aspects of daily life and their impact on perceived QoL. A descriptive qualitative study was conducted in Spain using a convenience sampling approach. In 2025, data were collected through in-depth, semi-structured interviews with open-ended questions involving 14 participants (n = 14). Interviews were conducted either in person or online, audio-recorded with participants' consent, and transcribed verbatim. Data were analyzed using thematic analysis, following an inductive process of coding, categorization, and theme development to ensure methodological rigor and credibility. Fourteen participants with type I ACM (79% women; mean age: 50.5 years) were interviewed. Most had undergone surgery, and half had lived with the diagnosis for more than 10 years. The mean self-reported QoL score was 6.71/10. Five main themes emerged: diagnostic journey, symptoms, impact on QoL, treatment experiences, and coping strategies/support networks. This study underscores the urgent need for more accessible, compassionate, and specialized healthcare for individuals with ACM. Key obstacles include delays in diagnosis, limited clinical knowledge, and insufficient follow-up care. Enhancing the training of healthcare professionals and implementing specific care protocols are essential. In addition, greater institutional support and recognition within public policy are crucial for improving the QoL of individuals living with this condition.
Depression is one of the leading causes of disability in Chile and significantly affects adults' well-being and social participation. Despite its high prevalence, depression stigma has been scarcely studied in the country. Because its manifestations vary across sociocultural contexts, understanding how it is configured in Chile is essential for developing contextually relevant interventions. Within this framework, depression stigma is examined through its core components -stereotypes, prejudice, and discrimination- by analyzing the beliefs, emotions, and behaviors directed toward people living with depression The aim of this study is to explore, from the perspective of Chilean adults, the socially shared beliefs about people living with depression, as well as the emotions and behaviors directed toward them, and to examine the extent to which these contents are understood as expressions of depression stigma. A qualitative study was conducted using purposive sampling and minimum group representativeness criteria based on gender, socioeconomic status, and history of depression. Sixty-six adults from three regions of Chile took part in individual semi-structured interviews. Interviews were transcribed, reviewed, returned to participants for checking, and coded by two independent coders. Data were then analyzed using a deductive-inductive content analysis approach supported by Atlas.ti, and findings were triangulated. Findings were organized into three analytical macro-categories - beliefs, emotions, and behaviors directed toward people with depression - consistent with the cognitive, affective, and behavioral components of stigma described in the literature. Within beliefs, contents related to affective characteristics, behavioral characteristics, and dispositional attributions associated with people with depression emerged. Within emotions, compassionate emotions, defensive and discomfort-related responses, and affective disconnection were identified. Within behaviors, overprotection, social distancing, invalidation and judgment emerged, along with interaction scripts based on avoidance or support. Depression stigma in Chile is configured through contents that, to varying degrees, are understood as stereotypes, prejudice, and discrimination. Beliefs combine elements linked both to mental health literacy and to stereotypes; emotions are primarily interpreted as expressions of prejudice; and behaviors reflect both subtle and overt forms of discrimination. Additionally, some themes showed divergent interpretations among participants, particularly between those with and without a history of depression. Taken together, these findings contribute to a better understanding of how this phenomenon is structured in the Chilean context and provide input for the development of culturally relevant assessment instruments and intervention strategies.
Artificial intelligence (AI) has the potential to improve health among older adults, yet how different stakeholders decide to develop, finance, and adopt AI innovations is not well understood. This study aimed to understand the decision-making of different stakeholders regarding AI and technologies for the health care of older adults. We conducted semistructured interviews with 15 older adults and care partners, 15 clinicians, 8 health system or insurance leaders, 5 investors, and 6 technology developers. Data were analyzed using thematic content analysis. All stakeholders considered cost, value, and usability important in adopting AI health technologies but emphasized different aspects of each concept. Older adults and care partners prioritized out-of-pocket costs and ease of use, whereas payers emphasized disease prevalence and implementation feasibility. Developers and investors focused on profitability and scalability, resulting in tension with end users' priorities. Participant suggestions included problem-driven design, greater stakeholder engagement, public-private partnerships, and educating older adults about AI. As with prior health-related technology innovations, aligning decisional priorities across stakeholders is critical to motivate impactful AI health technologies for older adults.
As digital technologies become increasingly embedded in daily life, their roles in mental health care have expanded and diversified. Digital tools are being explored as interventions for obsessive-compulsive disorder (OCD) across the care continuum, including symptom recognition, access to care, treatment, and self-management. However, there is limited empirical understanding of how individuals living with OCD use digital technologies in situ to navigate their health care journeys or how they envision technology shaping future models of care. This study aimed to explore how individuals living with OCD use digital technologies to navigate their health care experiences and to understand the perceived roles of technology across the OCD care continuum. We conducted semistructured interviews (N=24) with adults who self-reported a diagnosis of OCD and were recruited through online OCD communities and advocacy networks. Interviews were conducted via Health Insurance Portability and Accountability Act (HIPAA)-compliant Zoom between May and December 2024 (median duration 51, IQR 6.25 minutes). Transcripts were coded in Dedoose (version 9.2.22) using a constructivist grounded theory approach. Coding proceeded iteratively through open and focused coding, with theoretical saturation reached after 15 interviews. Constant comparison and analytic memos guided the development of a conceptual framework describing the relationships between technology and OCD health care. Participants (median age 26, IQR 12.8 years; range 20-64 years; 16/24, 67% female; 7/24, 29% male; 1/24, 4% nonbinary) described technology as integral to 3 aspects of the OCD health care journey. The first aspect was discovery and understanding, in which social media and online content helped participants identify their symptoms, relate them to the diagnosis, and seek care. The second aspect was facilitating OCD health care, in which digital tools such as telehealth platforms, apps, and wearables helped participants bridge gaps in care. The third aspect was imagining the future, in which participants viewed emerging technologies as potential ways to improve symptom recognition and management. Digital technologies are reshaping how individuals with OCD identify symptoms, engage with treatment, and envision future care delivery. Participants described using online communities, telehealth, and mobile health tools to address barriers across the OCD health care continuum, while emphasizing interest in technologies that provide adaptive and real-time symptom support. These findings underscore the importance of incorporating lived experience into digital mental health innovation and suggest that technology may support a shift toward more continuous, personalized, and accessible OCD care models.
The Australian dietary guidelines for pregnancy advise on optimal maternal intake. However, previous literature demonstrates suboptimal adherence to guidelines, with no evidence of the experience of sourcing nor uptake of the dietary guidelines among pregnant women. We aimed to explore pregnant women's knowledge of nutrition information, including the current Australian dietary guidelines for pregnancy. Nineteen pergnant women were recruited using convenient sampling. Semi-structured interviews were analysed thematically, underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework. Three themes were identified. Women showed limited awareness and/or utilization of the dietary guidelines for pregnancy, partially due to the inconsistent opportunity to receive guidelines from maternity healthcare providers. When seeking advice independently, women's capability to acquire pregnancy-related food knowledge was primarily dedicated to food safety and to identifying reliable advice from other non-evidence-based information. Women's motivation to utilize the dietary guidelines for pregnancy is low, with the perception that the broad recommendations may not meet their diverse, individual nutritional needs. To optimize pregnancy nutritional intake, multi-disciplinary efforts should be made to increase the awareness of the dietary guidelines for pregnancy and to support the delivery and uptake of dietary advice among pregnant women.
Access to physical rehabilitation services, including orthotics and wheelchairs, is recognized as a fundamental human right but remains limited in many low- and middle-income countries due to resource constraints, fragmented care, and a shortage of trained rehabilitation professionals. In Cambodia, where the health system still faces challenges from past conflict, these services are delivered through a mix of government, international, and nongovernmental organizations. This study investigated the pathways to obtaining orthoses and wheelchairs in Cambodia and their impact on individuals with physical impairments. Semistructured interviews were conducted to explore experiences and the impact of accessing physical rehabilitation and assistive products for orthosis and wheelchair users. Interviews were conducted face-to-face with translation support, audio recorded, transcribed, and analyzed using thematic analysis. Interviews were conducted with participants in Phnom Penh and the Kandal province in Cambodia. In total, 17 participants aged 18 to 65 years who were current or previous patients of the Exceed Worldwide physical rehabilitation center located in Phnom Penh took part in the study. Three themes emerged (early experiences of illness and health care seeking, pathways to assistive products, and the impact of these assistive products). Access to orthoses and wheelchairs often involved lengthy delays and inconsistent experiences with medical care and physiotherapy. Despite these challenges, assistive products played a vital role in improving mobility, independence, and social participation, contributing to greater confidence and emotional well-being. However, issues such as poor environmental accessibility and delays in repair or replacement limited their effectiveness. The findings demonstrate that, while assistive products offer significant benefits, they do not fully address the systemic barriers faced by people with physical disabilities in Cambodia. Persistent challenges such as stigma, environmental constraints, and emotional strain demonstrate the need for integrated policy reforms and a robust continuum of care that ensures coordinated, ongoing support across all stages of rehabilitation.
With evidence linking credible and quality COVID-19 vaccine information to positive vaccination attitudes and intentions, it's vital to understand how communities facing health disparities access health information about COVID-19. This interview study of 49 Hispanic individuals in a large southern suburban county is a part of a larger three-year multi-method study. Through the lens of self-determination theory, this project investigates perceptions of four television-aired Spanish-language video messages on CseOVID-19 vaccination developed from findings of prior local focus groups and panel surveys supported by community partners. The present study's findings show human-centered, gain-frame messaging was positively received and highlight the need for targeted Spanish-language public health messaging in Spanish news media to improve quality information about COVID-19. Gentler suggestions for health protective behaviors may foster greater perceived resonance, credibility, and informational value of public health messages, with potential implications for psychological reactance and subsequent responses.
Parents who receive a fetal congenital heart disease (CHD) diagnosis commonly report elevated psychological distress, including symptoms of anxiety and depression. Emerging research also highlights associations between maternal psychological distress and impaired fetal neurodevelopment. This study aimed to explore parents' emotional and psychological experiences, and psychological support needs, following a fetal CHD diagnosis, to generate evidence to inform the future development of a psychologically informed antenatal intervention. Fourteen parents who had received a fetal diagnosis of CHD participated in semi-structured interviews, conducted either in person or online. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Four interconnected themes were identified: (1) Suspended in Uncertainty; (2) Layers of Grief; (3) Finding a Way Through; and (4) Psychologically Safe Support. Together, these themes describe the emotional impact of a fetal CHD diagnosis, parents' efforts to cope and adapt, and the need for flexible, accessible psychological support during the antenatal period. Parents experience significant psychological challenges following a fetal CHD diagnosis, alongside unmet needs for tailored psychological support during the antenatal period. Clinical psychology support should therefore be integrated into fetal cardiology services to improve parental wellbeing and support optimal outcomes for both parents and infants.
Despite advances in wearable mobile health (mHealth) technologies and their associated apps designed to promote physical activity, and the importance of adapting them to users, little is known about older adults' perceptions of these technologies. This review aimed to synthesize and analyze qualitative evidence exploring the perceptions of adults aged 50 years and older regarding areas to improve, barriers to, and facilitators of wearable mHealth technologies (activity trackers and companion apps) to promote physical activity. A qualitative systematic review and meta-ethnography was conducted. Comprehensive searches were performed across 8 databases (MEDLINE, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycINFO, ProQuest, and ÍnDICEs-CSIC) for articles published in English or Spanish between January 2013 and January 2024. The synthesis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Ten articles met the inclusion criteria and were synthesized using meta-ethnography. Three main themes emerged: (1) barriers to promoting physical activity caused by wearable mHealth technologies: personal barriers (physical aspects, perceptions about technology, and personal preferences), technological barriers (functionality, content, design, alarms, availability, and accessibility), and environmental barriers (season of the year); (2) personal facilitators (consideration that these apps improve health, perceptions about technology, and personal preferences), technological facilitators (functionality, content, and design), relational facilitators (technological and social support), environmental facilitators (seasonal variations), and health care professionals (support and monitoring by health care services); and (3) personal areas (perceptions about technology and personal preferences), technological areas (functionality, content, and design), and relational areas (technological support). Although older adults acknowledge the potential of wearable mHealth technologies to promote physical activity, their effective engagement is hindered by distinct personal, technological, and environmental barriers. Bridging the digital divide requires designers to prioritize user-centered, age-friendly interfaces that are integrated with continuous support from health care professionals. To promote genuine health equity, future research must rigorously report intersectional demographics to ensure that mHealth interventions mitigate, rather than inadvertently exacerbate, existing disparities.
Dietary attitudes are relevant to self-management in hemodialysis, but clinical associations alone cannot explain patients' experiences. This explanatory sequential mixed-methods study included 66 patients quantitatively and 18 purposively selected patients with lower dietary attitude scores qualitatively. Correlations were evaluated with false discovery rate correction, followed by exploratory adjusted multivariable linear regression. Qualitative data were analyzed thematically and integrated through a joint display. The exploratory adjusted model accounted for 54.3% of the variance. Longer hemodialysis duration, comorbidity, higher blood urea nitrogen, and a higher triglyceride-to-high-density lipoprotein ratio were associated with lower dietary attitude scores, whereas higher ferritin was associated with higher scores. Among participants with lower ASDTHP scores, themes involved emotional, social, environmental, functional, and motivational experiences. Dietary attitudes were associated with clinical and psychosocial factors. The qualitative findings reflected participants with lower ASDTHP scores. Individualized multidisciplinary support may help address dietary self-management barriers.
Individuals with multiple sclerosis (MS) often use multiple medications, but evidence comparing their effectiveness is scarce. This study aims to (a) describe pain medication use and perceived effectiveness, (b) identify factors associated with the total number of pain medications, (c) explore the reasons for stopping and (d) use qualitative data to explore the lived experience of PwMS in relation to pain medication effectiveness and reasons for stopping. Participants from the Australian MS Longitudinal Study completed a pain survey in 2021 (n = 1691); 26 participants self-nominated to participate in focus groups. Participants with regular pain were asked which pain medications they used, to what extent the medications reduced pain, which medications they stopped using and the reasons for stopping. Quantitative data were analysed using descriptive statistics; negative binomial regression was used to determine factors associated with the total number of medications. Qualitative data were analysed using thematic analysis. Among 899 participants with regular pain, 87.3% were using pain medication. In terms of perceived effectiveness, 62.3% of all reported medications resulted in 'much improvement', 'very much improvement' or 'complete pain relief'. The medications commonly reported to be effective were opioid-containing medications, cannabinoids, antimigraine medications, a combination of paracetamol and nonsteroidal anti-inflammatory drug (NSAID) products and sedatives. Having more pain types, greater pain severity, being female and greater disability (all p < 0.05) were associated with taking a higher number of medications. Common reasons for stopping a medication were side effects and ineffectiveness. Qualitative data supported the quantitative findings. Most people with pain used medications, and the effectiveness was acceptable for the majority of people. Despite that, stopping medications until the right ones were found was common, often due to side effects and ineffectiveness. This suggests that, with adjustments to treatment plans, effective pain control is achievable for most PwMS with pain.
The purpose of this study was to identify participation determinants among high-risk individuals in risk-stratified upper GI (UGI) cancer screening. This sequential mixed-methods study was conducted in a population-based UGI cancer screening program in Ningxia Province, China. It integrates quantitative and qualitative methods to comprehensively examine participation determinants. Between April and December 2023, quantitative data were collected from 2,571 high-risk individuals identified by validated diagnostic models. Subsequently, 42 high-risk individuals (median age: 63.0 years; 81.0% male) were interviewed by stratified purposive sampling from March to April 2024. Logistic regression explored factors associated with screening adherence. Thematic analysis of qualitative interviews integrated quantitative findings using the Capability, Opportunity, and Motivation-Behavior framework. Of the high-risk individuals, 52.8% declined endoscopy. Nonparticipation was significantly associated with older age (adjusted odds ratio [aOR], 1.28 [1.06-1.54]), male sex (1.31 [1.01-1.70]), Hui ethnicity (1.35 [1.12-1.62]), nonsmoking (1.23 [1.01-1.50]), nondrinking (1.36 [1.09-1.71]), no family history of UGI cancer (1.48 [1.20-1.84]), fewer UGI symptoms (2.64 [2.19-3.18]), and no prior UGI examination (1.67 [1.37-2.05]). In the qualitative phase, seven key barriers were identified, including insufficient knowledge about UGI cancer and risk assessment, physical limitations, low perceived risk, gastroscopy-related fears, cost concerns, time constraints, and inadequate information. Addressing limited knowledge and program accessibility may improve participation and real-world implementation of risk-stratified UGI cancer screening.
To explore how nurse practitioner (NP) students understand, experience, and develop diagnostic reasoning (DR) during their NP education, and to examine how prior nursing experience and clinical learning environments shape this development. DR is a core competency for NP practice and represents a significant shift in responsibility during the transition from registered nurse (RN) to NP. While existing literature has focused primarily on teaching strategies, limited research has examined DR from the learner perspective. This qualitative study employed Interpretive Description. Twenty-four NP students in their final semester from two Canadian universities participated in semi-structured interviews. Data were analyzed using a five-phase qualitative analytic process. Themes were developed through iterative coding and constant comparison. Four themes emerged: (1) structured sense-making and professional identity transformation (2) prior RN experience as a double-edged influence (3) developing DR under conditions of complexity and constraint, and (4) scaffolded and iterative pathways to diagnostic development. Participants described DR as the "biggest leap" in the RN-to-NP transition, representing not only systematic hypothesis refinement but also diagnostic accountability as the most responsible provider. DR was experienced as inherently relational and co-constructed within the clinical encounter. Prior RN experience provided experiential foundations that supported pattern recognition, while at times narrowing diagnostic breadth due to specialization and habituated practice patterns. Developing DR in primary care was experienced as intellectually taxing, shaped by cognitive load, uncertainty, and contextual fragmentation. Students actively strengthened their DR through self-regulated strategies, while simulation, engaged preceptors, and iterative reassessment functioned as scaffolded supports for DR development. NP students experience DR as a cognitive, relational, and identity-forming process that extends beyond technical skill acquisition to encompass diagnostic accountability. Educational approaches that explicitly address role transition, relational competencies, and structured reasoning may better prepare learners to assume diagnostic responsibility and navigate clinical uncertainty in NP practice.
To evaluate in situ simulations as a training strategy for the initial care of trauma victims in a hospital fire scenario. A qualitative, descriptive, and exploratory study was conducted using in situ simulations, following the Consolidated Criteria for Reporting Qualitative Research (COREQ). It was developed in a large hospital in the capital of Paraná with the participation of 16 professionals. Data analysis was conducted using Bardin's Content Analysis and categories were evaluated based on Kolb's theoretical framework for experiential learning. The responses were categorized into six categories, which allowed us to highlight simulation as a qualification strategy for professionals working in hospitals during disasters. In situ simulations demonstrated the potential for training in critical situations, promoting multi-professional integration, strengthening safety culture, and identifying weaknesses in institutional protocols. Periodic inclusion of this type of training in hospital safety plans is recommended.
This systematic review and meta-analysis examined vaccine hesitancy and related vaccination behaviours in autism spectrum disorder (ASD)-related populations. We aimed to quantify the burden of hesitancy and synthesize evidence on refusal, delay, and under-vaccination among caregivers of children with ASD and, where available, autistic adults. Following PRISMA 2020 and a prospectively registered PROSPERO protocol (CRD420251154536), we searched MEDLINE/PubMed, Web of Science, EBSCO, and TR Dizin from inception to 28 September 2025. Quantitative, qualitative, and mixed-methods studies addressing vaccine hesitancy or vaccination behaviours in ASD-related populations were eligible. Narrative synthesis was undertaken across all included studies, and meta-analysis was performed where outcomes were sufficiently comparable. Twenty studies were included (16 quantitative, 3 qualitative, 1 mixed-methods). Among studies using a common instrument and threshold (PACV ≥ 50), the pooled prevalence of vaccine hesitancy among caregivers of children with ASD was 23.65% (95% CI 15.87-33.71). Compared with caregivers of neurotypical children, caregivers of children with ASD had higher odds of vaccine hesitancy or refusal (pooled OR = 2.31, 95% CI 1.66-3.22). They also had higher odds than families of children with other neurodevelopmental conditions (pooled OR = 2.23, 95% CI 1.48-3.35). Sibling-focused analyses suggested greater under-vaccination among younger siblings in ASD-affected families (pooled RR = 3.20, 95% CI 2.59-3.96). Narrative findings consistently implicated the disproven MMR-autism claim, safety concerns, and distrust. Vaccine hesitancy and related under-vaccination appear to be disproportionately concentrated in ASD-affected families. Autism-informed counselling, explicit myth-correction by trusted clinicians, and service adaptations may improve timely vaccine uptake.
This study examines the reliability and scoring bias of generative AI (Gen-AI)-based pronunciation assessment compared with human raters, addressing whether AI-generated scores can be trusted in real educational settings. Sixty students participated in a 12-week program. A total of 180 pronunciation samples were evaluated across eight subcomponents (individual phonemes, stress, rhythm, intonation, linking, reduction, fluency, and clarity) by three standardized human raters and Gen-AI using the same 7-point rubric. Quantitative analyses (intraclass correlation coefficients, paired-samples t-tests, and Pearson correlations) assessed reliability and bias, while semi-structured interviews with raters provided explanatory qualitative insights. Gen-AI demonstrated moderate reliability with human raters across most components, showing the highest agreement in fluency and the weakest in individual phonemes. However, Gen-AI consistently assigned significantly higher scores than human raters across all subcomponents. Qualitative findings revealed that discrepancies originated from Gen-AI's limited discriminative power, systematic flaws in handling missing data, decontextualized scoring approach, lack of sensitivity to L1 interference, and inability to interpret pragmatic context. While Gen-AI cannot fully replace human expertise, it can function as a complementary tool for formative assessment and autonomous practice. A hybrid assessment model integrating Gen-AI's efficiency with human raters' contextual and interpretive insights is recommended for effective foreign language pronunciation education.
This study sought to understand the professional practices in caring for people living with HIV/AIDS considering the global commitments to end the AIDS epidemic by 2030 in a priority municipality of Santa Catarina, Brazil. Qualitative research based on the constructivist branch of grounded theory was carried out in primary health and specialized care with in-depth interviews with 45 participants, including healthcare providers, managers, and people living with HIV/AIDS, from 2020 to 2021. Data analysis obtained the core category "Unveiling local professional practices aimed at global commitments to confront the HIV/AIDS epidemic", supported by seven subcategories that evince the expansion of timely rapid testing with reception and counseling, guarantee of access, early diagnosis and immediate start of antiretroviral therapy, engagement with the therapeutic regimen and its contradictions, social stigmatization, fear and overcoming HIV/AIDS, and the limitations of information systems. Practices related to preventive and clinical aspects stood out, with nurses playing a leading role in them. Coping with the social stigmatization by people living with HIV/AIDS experience still features an incipient approach in several dimensions: themselves, their families, healthcare providers, and social life. Overcoming the HIV/AIDS epidemic requires articulated and equitable strategies that consider the social determinants of health, expand access, and promote the well-being of people living with HIV/AIDS. Este estudo objetivou compreender as práticas profissionais no cuidado às pessoas que vivem com HIV/aids frente aos compromissos globais estabelecidos para o fim da epidemia de aids até 2030, em um município prioritário de Santa Catarina, Brasil. Trata-se de uma pesquisa qualitativa ancorada na vertente construtivista da Teoria Fundamentada nos Dados, realizada nos cenários da atenção primária à saúde e da atenção especializada, valendo-se de entrevistas em profundidade com 45 participantes, dentre profissionais da assistência, gestores e pessoas que vivem com HIV/aids, realizadas entre 2020 e 2021. A análise dos dados originou a categoria central “Desvelando práticas profissionais locais voltadas aos compromissos globais para o enfrentamento da epidemia de HIV/aids”, sustentada por sete subcategorias que revelam a ampliação da testagem rápida oportuna com acolhimento e aconselhamento, garantia de acesso, diagnóstico precoce e início imediato da terapia antirretroviral, o engajamento ao regime terapêutico e suas contradições, a estigmatização social, o medo e a superação frente ao HIV/aids, e as limitações dos sistemas de informação. Sobressaíram as práticas relacionadas a aspectos preventivos e clínicos com protagonismo do enfermeiro. Observou-se uma abordagem incipiente quanto ao enfrentamento da estigmatização social vivenciada pelas pessoas com HIV/aids em diferentes dimensões: por elas próprias, por seus familiares, por profissionais de saúde e no convívio social. Superar a epidemia de HIV/aids demanda estratégias articuladas e equitativas que considerem os determinantes sociais da saúde, ampliem o acesso e promovam o bem-estar das pessoas que vivem com HIV/aids. Este estudio tuvo como objetivo comprender las prácticas profesionales en el cuidado de las personas que viven con VIH/sida a la luz de los compromisos mundiales establecidos para poner fin a la epidemia del sida para el 2030, en un municipio prioritario de Santa Catarina, Brasil. Se trata de una investigación cualitativa basada en el enfoque constructivista de la Teoría Fundamentada en Datos, realizada en entornos de atención primaria de salud y especializada, con base en entrevistas en profundidad con 45 participantes, entre los que se incluyen profesionales de la asistencia, gestores y personas que viven con VIH/sida, llevadas a cabo entre el 2020 y el 2021. El análisis de datos dio como resultado la categoría central “Revelación de prácticas profesionales locales orientadas a los compromisos mundiales para afrontar la epidemia del VIH/sida”, respaldada por siete subcategorías que revelan la ampliación de las pruebas rápidas oportunas con apoyo y asesoramiento, el acceso garantizado, el diagnóstico precoz y el inicio inmediato de la terapia antirretroviral, la participación en el régimen terapéutico y sus contradicciones, la estigmatización social, el miedo y la superación de los desafíos frente al VIH/sida, y las limitaciones de los sistemas de información. Sobresalieron las prácticas relacionadas con los aspectos preventivos y clínicos, en las que los enfermeros desempeñaron un papel protagonista. Se observó un enfoque incipiente con respecto al afrontamiento de la estigmatización social que experimentan las personas con VIH/sida en diferentes dimensiones: por parte de ellas mismas, de sus familias, de los profesionales de la salud y en la vida social. Para superar la epidemia del VIH/sida se necesitan estrategias coordinadas y equitativas que tengan en cuenta los determinantes sociales de la salud, amplíen el acceso y promuevan el bienestar de las personas que viven con VIH/sida.
Medical Visual Question Answering (Med-VQA) aims to answer clinically relevant questions based on medical images. However, existing methods often struggle to provide visual evidence that is consistent with the query and verifiable. Under scarce evidence-level supervision and biases induced by imbalanced data distributions, models tend to rely on shortcut signals from language priors and visual priors, replacing critical visual evidence with prior-driven cues and thereby distorting both answers and evidence. To address this issue, we propose DE-CaGI, a causal gradient intervention framework that achieves debiased learning and evidence grounding at the optimization level. First, DE-CaGI constructs auxiliary branches to characterize shortcut learning, explicitly estimates bias gradients driven by language and visual priors, and suppresses shortcut-related gradient components when updating the backbone representation module, thus weakening the pull of shortcut directions on model updates. Then, building on the debiased updates, DE-CaGI introduces visual evidence gradients induced by multitask evidence supervision and imposes evidence-consistency constraints on the backbone update direction, so that the model can move toward representations consistent with annotated evidence while suppressing shortcut effects. Experiments on VQA-RAD and SLAKE demonstrate stable improvements on both open-ended and closed-ended questions and yield competitive overall accuracy. Further analyses show that DE-CaGI more effectively reduces reliance on language and visual priors, while qualitative results indicate better evidence alignment. The source code is publicly available at https://github.com/cloneiq/DE-CaGI.