Out-of-pocket (OOP) costs pose a significant barrier to participating in cancer clinical trials (CCTs). Financial reimbursement programs (FRPs) that reduce the burden of OOP costs can support participation in CCTs if the information is readily available to participants at the time of enrollment. Prior studies have shown the importance and impact of FRPs, but despite improvements, significant barriers still remain. This study was designed to explore the feasibility and acceptability of automated texts designed to offer, screen, and enroll CCT participants in an FRP for OOP travel and lodging-related clinical trial costs. This study used a mixed methods approach. Eligible participants were those who consented to participate in a breast, leukemia, or chimeric antigen receptor T cell (CAR-T) trial at the Abramson Cancer Center of the University of Pennsylvania, a National Cancer Institute comprehensive cancer center. Quantitative data were collected through engagement metrics, including text response rates and enrollment rates, as well as patient-reported satisfaction scores. Qualitative data were derived from semistructured interviews. Program enrollment rates were used to determine feasibility, whereas the engagement metrics were used to measure the acceptability of the program. Semistructured interviews were conducted with a subsample of patients who responded to at least one of the FRP texts and agreed to be interviewed to determine the barriers to and facilitators of enrolling in the Improving Patient Access to Cancer Clinical Trials (IMPACT) program via text, perceived advantages and disadvantages of the text messaging program compared to a phone call, and overall feedback on the acceptability of the automated text messaging program. Quantitative data, including engagement with texts, FRP eligibility screening, and enrollment rates, were collected from all participants who successfully received a text (n=51), and qualitative data were collected from a subsample of participants who agreed to participate in a semistructured interview (n=28) about the text-based program. Participants' mean age was 58 (SD 12) years, approximately 65% (n=33) of participants were female, 21% (n=11) of participants were Black, and 4% (n=2) of participants were Hispanic or Latino. There was high engagement with texts (n=49, 96.1%) and a high screening rate for FRP eligibility (n=33, 64.7%). Of those who successfully screened, 26 (51%) screened via text. We also saw high overall FRP enrollment rates of those who completed the texts (n=16 of 24 eligible, 66.7%) and high satisfaction (Net Promoter Score=51). The text-based platform streamlined the enrollment process, allowing one-third of patients to complete enrollment independently, without assistance from the FRP coordinator. Reported facilitators for completion of the text conversation included support from the coordinator and introduction of the FRP by CCT teams. Barriers were a lack of communication from CCT teams, patient skepticism about the legitimacy of the texts, and limited program information via text. Despite the small sample size and single study site, these findings suggest that automated text messaging can be an effective, low-cost, and scalable strategy to increase awareness and streamline enrollment in FRPs.
Knowledge of past cultures relies heavily on surviving written material. Over the centuries, texts were copied, altered, and often lost, leaving scholars to reconstruct partial genealogies-stemmata-from shared innovations between surviving copies. Yet, a general understanding of the processes shaping textual transmission remains elusive. Within the broader topic of cultural evolution, text transmission provides a favorable context for integrating formal modeling with empirical evidence: explicitly identified items (texts), transmitted through deliberate manual replication, have left tangible artifacts (manuscripts)-traces of a dynamical, cultural, and historical process. Rethinking textual transmission through a complexity science approach, this study combines stochastic models and simulations, informed by historical scholarship, with empirical data from a corpus of circa 2,000 medieval manuscripts spanning four centuries. Our framework quantifies how variation in copying and destruction rates influences survival or extinction, and reproduces key stylized facts observed empirically in reconstructed stemmata, such as imbalance, a feature debated for over a century. Further, this approach provides broad trends estimates suggesting that up to 60%; of texts and more than 95%; of manuscripts may have been lost. Our findings highlight the role of drift in cultural transmission, while providing a formal basis to integrate drivers such as cultural selection and historical contingencies (eg the Black Death). It bridges philology and cultural evolution approaches, while providing a theoretical and empirical framework applicable to numerous other traditions-eg Classical literature, legal and scientific texts, religious canons-where replication and loss also shape what endures.
Large language models (LLMs) have developed rapidly since the release of ChatGPT by OpenAI on November 30, 2022. This vogue comes to mind us "Can we distinguish LLMs-generated texts each other?" "What stylometric features are effective for differentiating LLMs such as fingerprints?" The purpose of this study was to distinguish the 300 Japanese texts (e.g., public comments) generated by six LLMs [ChatGPT (GPT5), Claude 3.5, Gemini, Microsoft Copilot, Llama 3.1, and Perplexity]. To this end, we explored the effective stylometric features [e.g., function-word unigrams, part of speech (POS) bigrams, and phrase patterns] using the following analyses: (1) UMAP (Uniform Manifold Approximation and Projection) to visually explore distributional differences among LLMs, (2) Random Forest (RF) and XGBoost with leave-one-out cross-validation to differentiate LLMs, and (3) SHAP (SHapley Additive exPlanations) based on Random Forest to identify effective stylometric features. First, UMAP demonstrated the separation of texts among the five LLMs except for Llama 3.1, which displayed substantial overlap with the other five LLMs. Second, RF achieved the highest performance across all stylometric features, with macro F1 scores exceeding 0.95 and reaching 1.00 for several LLMs. The detection performance of XGBoost was lower than that of RF, with the macro F1 scores ranging from 0.88 to 0.94. Finally, SHAP revealed LLM-specific patterns in function-word unigrams, POS bigrams, and phrase patterns. These findings indicate that Japanese public comments generated by the six LLMs can be accurately distinguished by focusing on the combination or patterns of stylometric features, suggesting LLM-specific linguistic fingerprints regardless of similarities in the underlying transformer architectures.
Ophthalmological reports are often written at a complexity level that exceeds the reading ability of many patients. Large language models (LLMs) may help simplify these texts, but their performance depends on prompt design and must preserve clinical fidelity. This study evaluated whether different prompting strategies improve the readability and safety of simplified ophthalmological reports. We analyzed 443 de-identified reports from a tele-ophthalmology platform, including 280 retinal fundus and 163 ocular ultrasound reports. Each report was simplified by four LLMs (GPT-3.5, GPT-4.0, Gemini, and Copilot) using three prompts: a basic command, a patient-oriented prompt, and a targeted 7th-grade reading level prompt. Readability was measured with the average Readability Grade Level (aRGL). A representative eligible subset of the generated texts was independently evaluated by two third-year ophthalmology residents, and each selected response underwent independent review by both evaluators, with disagreements resolved by a board-certified retina ophthalmologist. Outcomes included factual accuracy, information completeness, and potential for harm. The original reports were highly complex, with a median aRGL of 13.8 overall, 11.6 for fundus reports, and 15.4 for ocular ultrasound reports. All LLMs improved readability scores to varying degrees. Prompt engineering was a major determinant of performance, and the targeted 7th-grade prompt produced the best results across models. Copilot, Gemini, and GPT-4.0 achieved median aRGL values closest to the recommended patient-facing reading level, while GPT-3.5 showed weaker performance in some comparisons. Clinical validation showed substantial agreement between raters (kappa range, 0.70-0.97). After adjudication, 91% of simplified texts were factually accurate, 86% retained all critical information, and 95% showed no potential for harm. LLMs can simplify ophthalmological reports while preserving clinical fidelity, but performance depends strongly on prompt specificity. These tools show promise for patient-facing communication, although human oversight remains essential.
This paper discusses the works of Western Orientalists on southwestern Arabia in the first half of the twentieth century. It looks into the ways British travellers portrayed the region in the wider colonial and Orientalist contexts. The paper uses postcolonial theories of Edward Said, Homi Bhabha, and Mary Louise Pratt in the analysis of the travel works of Kinahan Cornwallis, Harry St. John Philby, and Wilfred Thesiger. To find the political and cultural representations within these texts, a descriptive-analytical and discourse-based approach was taken. The findings indicate that the western interest in southwestern Arabia came up in a colonial intelligence set up that was characterized by British imperial ambitions. Cornwallis was rather an intelligence collector, Philby was a geographical traveler and a political diplomat, and Thesiger was a humanistic and nostalgic depiction of Bedouin life. Their works were colonial ambivalent, with the appreciation of local culture existing alongside political and cultural bias. It is also revealed in the analysis that such stories were determined by the significant historical changes, such as the fall of the Ottoman Empire, and the rise of the Saudi state. The paper has concluded that the writings of Orientalist travels on southwestern Arabia are inseparable with the political and colonial contexts. It suggests the necessity to increase the number of critical studies of Orientalist discourse, translating Western accounts of travels into Arabic, and encouraging more focus on indigenous stories and voices.
Social media platforms produce a constant stream of user-generated text, which holds promise as a source of useful information regarding population-level and individual mental health states. However, existing methods for sentiment analysis on social media texts process these texts as individual, static instances, failing to consider the underlying dynamics of emotional states, which are naturally evolving in nature. In this paper, we introduce a novel framework for Temporal Sentiment Progression Analysis, which uses domain-specific transformer architectures to reconstruct the entire emotional evolution of a user over a given period of time. This framework captures important aspects of emotional evolution, including variability, volatility, and key emotional inflection points in a user's emotional progression. Our approach performs per-comment sentiment and thematic classification using transformer models, followed by post hoc statistical analysis to examine temporal patterns in user discussions. The framework was evaluated on a dataset of approximately 4,000 Reddit comments collected from eight mental health-related subreddits, with additional synthetic samples used only during training to address class imbalance. Performance evaluation was conducted exclusively on authentic Reddit comments and further validated using external Reddit-based mental health datasets and comparative baseline experiments. Our experimental results on a large-scale social media dataset reveal different sentiment progression archetypes, which are strongly correlated with self-reported mental health concerns. Our proposed framework achieves a high classification accuracy of 92%. Our approach shifts from static sentiment analysis to dynamic sentiment progression analysis, which can help in understanding the evolution of emotional distress in a more nuanced manner and can be useful in the development of context-aware interventions for mitigating mental health concerns.
Guinea worm disease, a neglected tropical disease caused by the parasite Dracunculus medinensis, is referred to as "'Irq al-Madanī" in medieval Arabic medical literature. This study examines Guinea worm disease, or "'Irq al-Madanī," through an analysis of medieval medical texts written in the Islamic world between the 9th and 12th centuries. Understanding its historical context provides valuable insights into the development of parasitology and public health in premodern medical traditions. Relevant sections from the works of prominent medieval Islamic physicians, including Thābit b. Qurra, Abū Bakr Muḥammad b. Zakariyyā' al-Rāzī, 'Alī b. al-'Abbās al-Majūsī, Abū l-Qāsim Khalaf b. 'Abbās al-Zahrāwī, Abū 'Alī Ibn Sīnā, and Abū Marwān 'Abd al-Malik b. Zuhr, were examined to analyze how "'Irq al-Madanī" was described, diagnosed, and treated. The findings were compared with one another and with contemporary medical knowledge and literature on Guinea worm disease. The analysis highlights overlapping, complementary, and divergent perspectives on the disease's etiology, pathogenesis, diagnosis, and treatment, all situated within the framework of humoral pathology. In addition to the use of medicinal substances, surgical intervention was also documented as part of therapeutic practice. Insights from the examined medieval Islamic texts largely align with earlier knowledge about the disease. Although some observations and findings correspond with contemporary approaches, key differences emerge, particularly in the conceptualization and interpretation of the disease.
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have transformed the management of severe aortic stenosis across a wide range of patient risk profiles. As populations age and indications extend to lower-risk and younger patients, determining the appropriate role of age in selecting TAVR versus SAVR has become increasingly complex. Current guidelines emphasize individualized decision-making, yet age-based referral patterns remain common in clinical practice. This review examines how age thresholds are applied in contemporary guidance from the United States (US), Europe, and the Asia-Pacific region. Additionally, this review evaluates whether chronological age alone is a defensible basis for referral or treatment selection. This evidence-based narrative review queried PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1, 2013, through December 31, 2025, using the search terms: ("aortic stenosis" AND ("TAVR" OR "transcatheter aortic valve implantation (TAVI)" OR "SAVR")) AND ("age" OR "appropriateness"). English-language abstracts and full texts were screened in duplicate. Eligible studies included randomized controlled trials, national or continental registries, health economic simulations, and clinical practice guidelines that reported age-stratified outcomes or recommendations. Single-case reports, editorials, and animal studies were excluded. Of the 1628 titles screened, 87 full texts were reviewed, and 45 studies were retained. Across regions, guidelines converge on a core principle: age is informative but insufficient in isolation. U.S. guidance generally favors SAVR in patients younger than 65 years or those with a life expectancy greater than 20 years, and favors transfemoral TAVR in patients older than 80 years or with a life expectancy shorter than 10 years. European guidance typically favors SAVR in patients younger than 75 years and TAVR in those older than 75 years. Meanwhile, Asia-Pacific recommendations adopt a similarly individualized approach but place greater emphasis on bicuspid anatomy, rheumatic disease, local health system infrastructure, and cost. Recent data support a cautious approach in younger patients. In observational U.S. analyses of patients younger than 65 years, TAVR use increased substantially despite guideline preference for surgery, and TAVR was associated with higher long-term mortality or higher pacemaker and readmission burdens in selected cohorts. Contemporary randomized data suggest broadly similar outcomes between TAVR and SAVR in older or intermediate-age populations; however, uncertainty persists in younger low-risk patients, particularly those with bicuspid anatomy and long projected survival. Age-based cutoffs should be interpreted as decision anchors rather than rigid rules. The most defensible framework integrates age with life expectancy, valve durability, anatomy, frailty, comorbidity burden, coronary artery disease, feasibility of future valve-in-valve therapy, and patient preferences within a multidisciplinary heart team. Expansion of TAVR into younger populations should remain measured until more robust long-term durability and lifetime management data become available.
This paper presents a supervised multi-label framework for detecting multidimensional perceived risk in HIV-related Reddit discourse. A longitudinal corpus of 329,707 texts collected from r/hivaids and r/HIV between 2015 and 2025 was analyzed to identify three risk dimensions: transmission risk, health deterioration risk, and social stigma risk. A stratified sample of 2,000 texts was annotated by domain experts, achieving substantial inter-annotator agreement (Cohen's κ = 0.74-0.81). A RoBERTa-base model was fine-tuned using class-weighted binary cross-entropy loss and per-class threshold optimization. The proposed model achieved a macro-F1 score of 0.87 and a macro-AUC-ROC of 0.97, outperforming 12 baseline models, including traditional machine learning, neural network, and alternative transformer-based approaches. Ablation experiments confirmed the importance of transformer fine-tuning and class weighting, while also showing that handcrafted features provided only marginal gains. Applied to the full corpus, the model revealed significant upward trends in transmission risk and health deterioration risk, strong co-occurrence between transmission and stigma-related discourse, and distinct information-seeking patterns across risk categories. The findings demonstrate that transformer-based multi-label learning can support scalable, reproducible analysis of HIV-related health perceptions in online communities, with potential applications in public health surveillance, communication strategy design, and digital intervention planning.
This scoping review analyzed research trends and the effectiveness of sexual media literacy educational interventions for adolescents and provided foundational evidence for developing effective programs. Guided by Arksey and O'Malley's scoping review framework, ten databases were systematically searched for studies published between 2015 and 2025. Studies involving adolescents and individuals who educate or mediate adolescents' media use were included. Two independent reviewers screened titles, abstracts, and full texts, yielding a final sample of 11 studies. The included studies predominantly targeted middle school students, and the theory of planned behavior was the most commonly applied theoretical framework. Most programs (81.8%) emphasized strengthening adolescents' ability to interpret sexual content in media. Program duration ranged from 1 to 10 sessions, with total instructional time ranging from 90 minutes to 18 hours. Reported outcomes included improvements in sexual media literacy (72.7%), knowledge (36.4%), attitude (54.5%), behavior (45.5%), belief (18.2%), and interpersonal process (36.4%). The main teaching methods were lecture-based delivery (63.6%), offline interactive activities (63.6%), and web-based programs (36.4%). Overall, the programs improved adolescents' sexual media literacy, sexual health outcomes, and sexual health-related communication skills. This review provides evidence that sexual media literacy programs can improve adolescents' media interpretation skills and sexual health-related outcomes. Integrating learner-centered approaches with media-based instruction may be particularly useful and has meaningful implications for developing tailored sexual media literacy programs for adolescents. This scoping review analyzed research trends and the effectiveness of sexual media literacy educational interventions for adolescents and provided foundational evidence for developing effective programs. Guided by Arksey and O’Malley’s scoping review framework, ten databases were systematically searched for studies published between 2015 and 2025. Studies involving adolescents and individuals who educate or mediate adolescents’ media use were included. Two independent reviewers screened titles, abstracts, and full texts, yielding a final sample of 11 studies. The included studies predominantly targeted middle school students, and the theory of planned behavior was the most commonly applied theoretical framework. Most programs (81.8%) emphasized strengthening adolescents’ ability to interpret sexual content in media. Program duration ranged from 1 to 10 sessions, with total instructional time ranging from 90 minutes to 18 hours. Reported outcomes included improvements in sexual media literacy (72.7%), knowledge (36.4%), attitude (54.5%), behavior (45.5%), belief (18.2%), and interpersonal process (36.4%). The main teaching methods were lecture-based delivery (63.6%), offline interactive activities (63.6%), and web-based programs (36.4%). Overall, the programs improved adolescents’ sexual media literacy, sexual health outcomes, and sexual health-related communication skills. This review provides evidence that sexual media literacy programs can improve adolescents’ media interpretation skills and sexual health-related outcomes. Integrating learner-centered approaches with media-based instruction may be particularly useful and has meaningful implications for developing tailored sexual media literacy programs for adolescents.
The variation of language concerning tobacco products and tobacco use is known to impact the understanding of related risks and influence behaviors including use uptake and product cessation. Transnational tobacco companies can use such complexities to change the acceptability of tobacco use and influence public understanding of related risks. These changes, in turn, impact tobacco use behaviors. Looking at variations in the language used by different groups can therefore offer helpful insights into tobacco use cultures and make imbalances of information between groups plain. This paper examines the language of tobacco use, specifically smoking, across a sample of health organizations (the National Health Service, the World Health Organization, the National Institute for Health and Care Excellence, and the Centers for Disease Control and Prevention), the tobacco industry (British American Tobacco and Philip Morris International), and in "general English." Through corpus-assisted analysis, the study aims to illustrate differences in tobacco use and tobacco user characterizations by 2 transnational tobacco companies, health organizations, and users of general English. The study assesses the possible implications of these differences for public health. We queried 4 bodies of text (corpora) from 3 different groups; 2 of these corpora were preexisting corpora of general spoken and written English in the United Kingdom and the United States. The remaining 2 sampled tobacco-related documents from 2 transnational tobacco companies and from the United Kingdom and international organizations with a focus on health between 2003 and 2023. The 2 sampled corpora contained 1355 documents and 10,023,538 words. We used the corpus analysis software LancsBox (Lancaster University) to identify variations in characterizations of tobacco users and tobacco use behaviors between these groups, using the stems "smoker*" and "smok*." Frequency and collocation analysis showed clear differences in how the 3 groups described smokers and smoking, with only limited overlap in the terms they used. Only 7 of 23 unique categorizations of "smoker*" were shared. There was a significant association (P<.001) between individual corpora and singular or plural noun forms. Health organization texts more often used clinical and population-focused classifications, whereas tobacco industry texts more often framed smokers as consumers or people involved in legal disputes. General English corpora showed the widest range of labels for tobacco users. While there was some overlap in terminology used between corpora, the most common categorizations in each corpus were highly varied, showing very little shared language between groups in their descriptions of either tobacco users or use behaviors. This variance indicates that these groups may not share the same sense-making resources related to tobacco use, which may render information flows around tobacco vulnerable to distortion.
This article investigates the political practices related to abortion in Ecuador from their politicisation in 2006 until 2023, two years after the decriminalisation of abortion in all rape cases. We identify: 1) the discursive and embodied practices that construct and politicise the aborting body within feminist advocacy for legal, safe, and free abortion in Ecuador; 2) the effects of these practices; and 3) feminist challenges to conservative discourses that, in some cases, appropriate their rhetorical strategies. Based on participant observations of feminist demonstrations and the analysis of texts produced by Ecuadorian feminist organisations, we trace three 'tactical strategies' (using Lugones' conceptualization) that introduce different configurations of the body and propose different effects: 1) abortion as reparation, along with the notion of the victim body; 2) abortion as a right, along with the citizen body; and 3) abortion as dissidence, along with the configuration of the sovereign body. These tactical strategies need to be understood within the broader political context and evolving anti-choice forces. The coexistence of different strategies can lead to both complementary effects and friction. In this study, we explored how feminist collectives advocated for legal, safe, and free abortion in Ecuador from 2006 until 2023. These two years followed the decriminalisation of abortion in all rape cases. We used participatory observation and document analysis. We identified overall ‘tactical strategies’ that activists are using. The concept of ‘tactical strategies’ was developed by Latin American feminist researcher Maria Lugones to bring together both high-level strategies and the everyday practices (tactics) that social groups use to achieve their aims. The concept criticizes the divide between ‘grand’ strategies and ‘minor’ tactics. Everyday acts of resistance are seen as just as important and relevant as better known actions, such as political advocacy. Through the analysis, we identified three tactical strategies: reparation, rights and dissidence. Reparation foregrounds a girl who is pregnant as a consequence of rape or incest. She is portrayed as a victim in need of an abortion as a form of repairing the violence. Rights are associated with the woman citizen who can exercise her right to health with the support of the legal and medical system. Dissidence does not trust official or institutional structures to ensure access to safe, legal, and free abortion. It centres around autonomous networks of feminist accompaniment for self-managed abortion. Each of these tactical strategies poses possibilities and challenges. How they are used depends on the social and political contexts. Sometimes they complement each other, but at other times, they may be contradictory.
Food-based dietary guidelines (FBDGs) are key public health instruments aimed at promoting healthy dietary patterns. However, dairy-products recommendations vary substantially across countries, reflecting not only scientific evidence but also socioeconomic conditions, institutional capacity, and food system characteristics. The extent to which these differences are structured linguistically across income levels has not been systematically quantified. The present study aims to explore the use of advanced NLP techniques to characterize semantic differences and similarities in dairy-products dietary messages within FBDGs from countries with different levels of socioeconomic development. We conducted a comparative analysis of dairy-products recommendations extracted from national FBDGs officially recognised by the Food and Agriculture Organization, covering 98 countries. Using advanced natural language processing techniques, including lexical frequency analysis, co-occurrence networks, and latent topic modelling, we examined semantic patterns in recommendation statements and justificatory texts. Countries were stratified according to World Bank income group classifications. Across all income groups, "milk" emerged as the central lexical anchor of dairy recommendations. However, high-income countries demonstrated greater lexical diversity and semantic complexity, incorporating differentiated references to product types, fat content, and fermentation (e.g., yogurt, cheese, low-fat). In contrast, low- and lower-middle-income countries presented more general and nutritionally basic messaging, primarily focused on consumption adequacy and child nutrition. Justification texts consistently contained higher nutrient-related terminology density than recommendation statements. Dairy-products dietary messaging in national FBDGs shows consistent descriptive differences across income groups. These semantic disparities likely reflect contextual differences in institutional capacity, epidemiological priorities, and food system infrastructure. The findings may be particularly relevant for the Americas, where high-, upper-middle-, and lower-middle-income countries coexist within a region undergoing rapid nutrition transitions and facing the persistent triple burden of malnutrition. In this context, PAHO/WHO may play an important role in supporting greater harmonisation of dietary guidance across diverse socioeconomic settings. NLP-based approaches offer scalable tools for monitoring global nutrition policy discourse and supporting evidence-informed policy development. Research supported by the Vice-Presidency of Research and Doctoral Studies of Universidad San Sebastián, Grant USS-FIN-26-APCS-01; Institutional collaboration provided by the Scientific Committee of Dairy Products of the Chilean Dairy Consortium (Consorcio Lechero) through the "Gracias a la Leche" program.
BackgroundBreast cancer is the leading cause of cancer-related deaths worldwide and the second most common cancer among women globally. Breast self-examination is a highly cost-effective method for the early detection of breast cancer in asymptomatic women. Despite this, the practice of breast self-examination remains low in Ethiopia.ObjectivesThis study aimed to evaluate the practice of Breast Self-Examination and Its Associated Factors among Women of reproductive age in Seven Public Health Facilities in Addis Ababa, Ethiopia.DesignThis study employed a quantitative, multicenter, institution-based, cross-sectional, analytical design.MethodsThe study was conducted among women of reproductive age receiving medical care at designated public health facilities in Addis Ababa, Ethiopia. The study participants were selected using a simple random sampling technique from the study population. The data were reviewed, coded, and entered into Epi Info version 7.0, then transferred to SPSS version 27 for analysis. A P-value of less than 0.05 was considered statistically significant. Results were reported by using texts and frequency distribution tables.ResultA total of 553 respondents participated in the study; of these, only 96 (17.3%) participants ever practiced breast self-examination. Education and Occupational status were found to have a significant association with the practice of breast self-examination. There is a strong association between knowledge and the practice of breast self-examination (BSE). Women of reproductive age who were knowledgeable about BSE were 4.75 times more likely to perform it compared to those with poor knowledge [AOR = 4.75, 95% CI (3.85, 7.45)].ConclusionThe practice of breast self-examination among the study participants was low. Therefore, we recommend that the Ministry of Health and other relevant organizations promote community awareness about breast cancer and the importance of breast self-examination. This study explores how women of reproductive age in Addis Ababa, Ethiopia, practice breast self-examination (BSE) and the factors that influence their behavior. Breast self-examination is a simple method women can use to check their own breasts for any changes or abnormalities, which can help in early detection of breast cancer. The research was conducted across seven public health facilities and involved surveying a diverse group of women. The study aimed to identify how many women perform BSE regularly, what knowledge they have about it, and what factors encourage or discourage them from doing so. Key findings revealed that many women were unaware of the importance of BSE or did not know how to perform it correctly. Factors such as education level, access to health information, and support from healthcare providers were significant influences on whether women practiced BSE. Women who received education about breast health and BSE were more likely to engage in regular self-examinations. The study highlights the need for improved education and awareness campaigns about breast health among women in Addis Ababa. By providing better access to information and resources, healthcare facilities can empower women to take charge of their breast health, potentially leading to earlier detection of breast cancer and better health outcomes. Overall, increasing awareness and knowledge about BSE is crucial for improving women's health in the region.
High-risk and innovative medical devices (MDs) and in vitro diagnostic devices (IVDs) in the European Union are subject to increasingly stringent and evolving regulatory requirements. This scoping review maps methodological approaches to evidence generation across their life cycle. A comprehensive and systematic search of major bibliographic databases and grey literature sources was conducted (January 2025, updated November 2025). Studies were selected through dual independent screening using predefined inclusion criteria. Data were extracted using a structured approach and supported by AI-assisted thematic analysis. Findings were synthesized narratively to map methodological approaches to evidence generation and evaluation. A total of 15,679 records were identified, with 14,259 remaining after duplicate removal and 859 full texts assessed for eligibility. Of these, 90 studies met the inclusion criteria. In addition, records identified through other methods were screened, with 75 progressing to full-text assessment; of these, 8 were included. Evidence generation for high-risk and innovative MDs and IVDs requires an integrated, life-cycle approach combining multiple study designs. While randomized controlled trials remain important, observational studies, real-world evidence, registries, and post-market surveillance are essential for assessing long-term safety and effectiveness. However, current practices show substantial variability, methodological limitations, and regulatory inconsistencies. An integrated lifecycle approach is needed for robust evaluation of high-risk and innovative MDs and IVDs. Strengthening methodological standards, improving the quality of real-world data, and enhancing regulatory harmonization are essential. Open Science Framework (OSF), doi: 10.17605/OSF.IO/XNBSP.
The first years of life are a critical period for the development of the gut microbiota. The intake of ultra-processed foods (UPF) is increasing worldwide, even among infants. This systematic review summarizes the available evidence on the relationship between UPF consumption and gut microbiota during the first 2 years of life (PROSPERO CRD42025106520). Exclusion criteria were the absence of gut microbiota data as an outcome or UPF as an exposure; children with comorbidities or older than 2 years; in vitro or animal studies; and review papers. Literature searches were conducted on May 12, 2025, in PubMed, LILACS, Scopus, and Web of Science. The risk of bias was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies, the Joanna Briggs Institute Critical Appraisal Tool for cross-sectional and randomized trials, and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-randomized studies. Of the 2,212 records identified (1,520 after duplicate removal), 72 full texts were reviewed, and seven studies were included: six were observational (five cohort and one cross-sectional), and one was a randomized trial. Three studies evaluated the relationship between UPF intake and gut microbiota alpha diversity, but only one showed significant effects. Six studies assessed taxonomic associations: three reported decreased Bifidobacterium abundance, and three found increased Blautia. The evidence was limited by a moderate risk of bias, small sample sizes, and inconsistent diversity findings. Nevertheless, early-life UPF intake was linked to taxonomic changes, suggesting the potential for adverse effects on the gut microbiota.
The International Psychogeriatric Association (IPA) developed a consensus syndromic definition of agitation in neurocognitive disorders. To facilitate adoption of the IPA criteria, we systematically reviewed validated measures of agitation and evaluated alignment with IPA criteria. This review was pre-registered on PROSPERO (CRD42023429494). We searched MEDLINE, EMBASE, and PsycINFO from inception to June 30, 2023 (updated September 9, 2025) using search clusters for 1) neurocognitive disorders; 2) agitation; and 3) psychometric outcomes. Title/abstract screening identified validation studies of agitation scales in neurocognitive disorder samples (e.g., mild cognitive impairment, dementia). Full texts were then reviewed to extract agitation scales. Scale instructions, items, and response fields for each scale were evaluated for alignment with IPA agitation criteria by at least three independent reviewers. We retrieved 2,477 unique search records, of which 2,231 were excluded at title/abstract screening. From the 240 full-text articles, 41 unique agitation scales were identified and evaluated. Across all scales, physical aggression was the most common agitation domain assessed, followed by verbal aggression, and excessive motor activity. The Neuropsychiatric Inventory - Nursing Home demonstrated the greatest combination of IPA agitation domain coverage and alignment. The Cohen-Mansfield Agitation Inventory had a lower-than-expected efficiency score for alignment. The most common reason for low alignment was failing to capture persistence and distress. Numerous agitation scales have been validated in populations with neurocognitive disorders. Few align strongly with the IPA agitation criteria. We provide a comprehensive list of information about validated agitation scales, scale characteristics, and alignment with IPA agitation criteria.
Type 1 diabetes (T1D) is associated with chronic kidney disease (CKD) and major adverse cardiovascular events (MACE). Contemporary data on the natural history of kidney function decline and the effect of therapies on slowing disease progression in T1D-related CKD are limited. We conducted a scoping review to describe the natural trajectory of kidney function and its effects in individuals with T1D in the USA. In our scoping review of observational studies and grey literature, we searched EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature [CINAHL; Elton B. Stephens Company (EBSCO)], MEDLINE (Ovid), Scopus (Elsevier), Global Health (Ovid), and the Food and Drug Administration from inception to 25 April 2025. The study population included adults (age ≥ 18 years) with T1D in the USA. Our outcomes were change in estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), MACE (myocardial infarction, ischemic stroke, cardiovascular death, unstable angina, or heart failure hospitalization), and healthcare resource use (HCRU). We screened 6437 abstracts and selected 22 texts that matched our criteria. In one cohort, more than 50.0% of individuals with T1D developed moderately increased albuminuria (UACR > 30-299 mg/g) after 20 years and two cohort studies in T1D observed a progressive annual eGFR decline of 3 mL/min/1.73 m2. Five cohort studies found higher proportions of individuals with T1D experienced MACE or kidney failure versus those without T1D. Cross-sectional studies estimated total annual cost of HCRU in the USA at $17-27.8 billion for those with T1D, with annual per-patient costs ranging from $73,534-$112,833 for kidney failure and $40,889-$86,417 for components of MACE. T1D is associated with a high burden of CKD, MACE, and healthcare costs. A clearer understanding of the trajectory of kidney function decline in T1D would help providers and policymakers understand the impact potential therapies to treat T1D-related CKD may have on reducing the risk of kidney failure, MACE, and HCRU.
ObjectiveTo identify and map the intervention models, outcome domains and evidence gaps of telerehabilitation studies initiated during the hospital-to-home transition after a stroke.DesignA scoping review following the Arksey and O'Malley framework, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.Data sourcesPubMed, Web of Science and Physiotherapy Evidence Database were searched from 2000 onward (original search: April 2025). An updated supplementary search using broader terms was conducted in the same three databases in May 2026, applying the same start date and the same eligibility criteria.Review methodsTwo independent reviewers screened the titles, abstracts and full texts. Data on the study design, participants, intervention characteristics, comparators and outcomes were extracted and descriptively synthesised. The studies were grouped by intervention model.ResultsEighteen studies were included and classified into four models: caregiver-mediated exercise, technology-driven motor telerehabilitation, multidisciplinary transitional care and low-technology or mobile health-supported. Technology-driven models showed motor outcomes comparable to conventional rehabilitation but inconsistent between-group superiority. Caregiver-mediated models did not improve primary mobility outcomes but suggested benefits for caregivers and psychosocial outcomes. Multidisciplinary models frequently improved quality of life, self-management and broader outcomes. Participation-level outcomes remained under-represented in the literature.ConclusionTelerehabilitation during the hospital-to-home transition is feasible and has been delivered through diverse models. Future research should evaluate participation, community reintegration, caregiver outcomes and implementation fidelity.
The COVID-19 pandemic has placed a significant burden on health professionals (HPs). They face higher infection risks due to the nature of their work environment and patient care responsibilities. Their ability to access and apply reliable COVID-19 information affects their own preventive behavior and that of those around them. In this context, health literacy (HL) has become increasingly important. Despite extensive research, information to foster COVID-19-related HL in HPs remains limited. This systematic review aimed to identify, appraise, and synthesize intervention studies on the effectiveness of COVID-19-related HL interventions in HPs. Five electronic databases (eg, PubMed (MEDLINE), Embase), six clinical trials registries (eg, ISRCTN registry), one preprint server (MEDRXIV), published conference proceedings, and five gray literature databases (eg, opengrey.eu, ProQuest) were searched in May 2022 and updated in August 2025. Reference lists of included studies were screened manually. Two reviewers independently screened titles, abstracts, and full-texts according to eligibility criteria and extracted data; disagreements were resolved by discussion or consultation with a third reviewer. We included randomized controlled trials (RCTs), nonrandomized studies of interventions, and uncontrolled before-and-after studies evaluating the effectiveness of any COVID-19-related HL intervention. Primary outcomes include COVID-19-related HL, its four facets (access, understand, appraise, and apply COVID-19 information), and indicators (eg, COVID-19-related knowledge), assessed at postintervention and follow-up. When studies were sufficiently similar, random-effects meta-analyses were performed; otherwise, a narrative synthesis was provided. Risk of bias was assessed using validated tools based on study design, and the overall certainty of the evidence was evaluated by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. We included 15 RCTs (2034 participants), 4 nonrandomized studies of interventions (291 participants), 74 uncontrolled before-and-after studies (327,298 participants), 5 ongoing studies, and 1 study with awaiting classification. Interventions targeted a broad range of health occupational groups. Intervention type, delivery mode, methods, settings, and comparator varied widely. No outcome measure explicitly referred to an HL model. Most studies aimed to enhance COVID-19-related knowledge and skills, and had a high risk of bias. COVID-19-related interventions may increase knowledge of vaccines (standardized mean difference 1.00; 95% CI 0.33 to 1.67, I2=24%), and the infection prevention control skills, such as donning and doffing of personal protective equipment (standardized mean difference 1.95; 95% CI 1.82 to 3.09, I2=46%), but the evidence remains very uncertain. COVID-19-related HL interventions may promote HP's short-term competencies in infection control. However, the evidence remains uncertain, primarily due to the low quality of studies, characterized by a high risk of bias. Interventions specifically designed to enhance the full COVID-19 HL operationalized by its four facets are lacking. High-quality RCTs with sufficient statistical power, grounded in HL theoretical principles, are needed to achieve precise understanding.