Search Results (6,289)

Intimate partner violence (IPV) is a significant global public health issue that requires accessible, scalable, and contextually appropriate interventions. Mobile health (mHealth) technologies provide a promising platform to deliver support, information, and safety planning tools for individuals at risk of IPV. This study aimed to develop and pilot-test iCanPlan, a mobile application designed to support IPV prevention in Thailand. The application evaluates IPV risk, identifies indicators of danger, and provides a countrywide list of assistance sources. iCanPlan consists of four main components: (1) an IPV risk assessment tool, (2) a list of support resources, (3) educational materials presented in the form of infographics, and (4) encouraging quotes from well-known public figures. The app features a clean, user-friendly interface with intuitive navigation and color-coded components to enhance usability. In addition, a preliminary study was conducted with 30 experts from multidisciplinary fields, including gender-based violence research, social work, psychology, public health, and non-governmental organizations. Participants used the application for one month and subsequently evaluated it using a structured questionnaire based on heuristic evaluation principles. The questionnaire assessed usability, safety features, content quality, cultural appropriateness, language clarity, ethical considerations, and overall evaluation using a five-point Likert scale. Data was analyzed using descriptive statistics (mean and standard deviation) in SPSS. The findings demonstrated excellent performance across all domains, with high mean scores for usability (M = 4.93), safety features (M = 4.73), and content quality (M = 4.82), while cultural appropriateness, language clarity, ethical considerations, and overall evaluation achieved perfect scores (M = 5.00). These results indicate strong agreement among experts regarding the application’s usability, safety, and relevance. The study highlights the potential of iCanPlan as a culturally appropriate and user-friendly digital intervention for IPV prevention. Further research involving the target population is needed to evaluate its effectiveness and long-term impact on help-seeking behavior and IPV-related outcomes. Full article

Cervical cancer remains a major global health challenge, particularly in low- and middle-income countries, where access to screening, vaccination, and timely treatment may be limited. Cervical cytology has played an important historical role in prevention, but it is labor-intensive, time-consuming, and subject to observer variability and limited sensitivity. In many contemporary screening programs, HPV testing is now used as the primary screening test, while cytology is used mainly for the triage of HPV-positive women. In recent years, artificial intelligence (AI), particularly deep learning (DL), has shown considerable potential in medical image analysis and computer-aided diagnosis. This review summarizes current applications of AI in cervical cytology and related diagnostic workflows, including automated and assisted slide screening, liquid-based cytology, the triage of equivocal or HPV-positive cases, and colposcopy support. Across these settings, AI-assisted systems may improve efficiency, standardization, and diagnostic consistency, and may reduce workload in resource-constrained environments. However, the evidence is heterogeneous, and important challenges remain, including the need for large and diverse datasets, prospective validation, regulatory approval, digital infrastructure, workflow integration, and the resolution of ethical and legal issues. AI should therefore be regarded as a promising adjunct to human expertise rather than a replacement in cervical cytology and related clinical diagnostic pathways. Full article

Background: This study fills a gap in the literature by examining how perceptions of health news are associated with interpersonal trust in physicians and institutional distrust in the healthcare systems, particularly in the Türkiye context. While previous studies have examined trust in physicians and distrust in healthcare systems separately using different independent variables, evidence remains limited on the simultaneous association between health news perception and both trust in physicians and distrust in the healthcare system, particularly in the Türkiye context and using validated measurement tools. Therefore, the main objective of this study is to examine the association between health news perception, trust in physicians, and distrust in the healthcare system. Methods: The population of this cross-sectional study consisted of individuals aged 18–60 residing in the central district of Kutahya. The study data were collected face-to-face using a two-part questionnaire. A total of 719 completed questionnaires were analyzed. Results: 58% of the participants in the study were aged 41 and above. Commercial concerns and advertising, consumption promotion, behavioral change, health behavior exploitation, and trust in health news were positively associated with distrust in the healthcare system (β = 0.119, β = 0.196, β = 0.054, β = 0.061, β = 0.046; p < 0.01, p < 0.05). The model explained 22.4% of the variance (R² = 0.224). Commercial concerns and advertising, consumption promotion, behavioral change, health behavior exploitation, and trust in health news were negatively associated with trust in physicians (β = −0.221, β = −0.014, β = −0.014, β = −0.127, β = −0.211; p < 0.05, p < 0.01). The model explained 25.3% of the variance (R² = 0.253). Conclusions: The study found that health news perception was associated with trust in physicians and distrust in the healthcare system. Therefore, understanding the associations between health news perception, trust in physicians, and distrust in the healthcare system is important for improving individual and public health. For this reason, it is of great importance to raise the level of health and digital health literacy in society through policies developed under the leadership of public health experts. Full article

Introduction: Wounds increase the risk of hospitalization in home health (HH) settings by up to 52%. They also consume a notable portion of HH budgets due to frequent nursing visits for wound assessment and care. To address these challenges, a U.S.-based HH enterprise adopted a Digital Wound Care Solution (DWCS) to enhance wound management and operational efficiency. This study examines the impact of integrating the DWCS into practice, focusing on clinical and operational indicators and potential cost savings. Methods: This study employed a quasi-experimental pre–post design to evaluate the impact of the DWCS on clinical and operational outcomes. Data were extracted from the DWCS and EMR databases, encompassing pre-adoption (2022) and post-adoption (2023) periods. The analysis included wound data from 16,276 patients in 2023 and 19,252 patients in 2022, covering an 8-month period (March–October) across 11 branches. The key performance indicators included skilled nursing (SN) visits per episode (VPE), time to complete SN visits, hospitalization rates, and staff optimization. Results: The adoption of the DWCS was associated with clinical and operational improvements. SN VPE decreased by 7.5%, resulting in an estimated annual savings of $1.3 million. A directional change in wound-related hospitalization rates was observed at 30 days (20.7% to 20.3%) and 60 days (32.4% to 31.5%); however, these changes did not reach statistical significance and should be interpreted as trends. The projected prevention of 200 hospitalizations with estimated annual cost savings of $3.4 million to the health system represents modeled projections based on observed directional trends rather than realized savings. A 1.9% shift in staff roles increased the utilization of licensed practical nurses with no adverse indicators identified within the scope of this analysis, saving $112,748 annually. Conclusions: The adoption of the DWCS was associated with fewer and shorter SN visits and a shift toward more LPN utilization, with anticipated reductions in costs Wound-related admissions showed downward trends but did not reach statistically significant levels. This pre–post design precludes causal attribution, and findings should be interpreted as associations rather than definitive effects of the intervention. These findings support further investigation of wound care models integrating AI within a value-based home health setting. Full article

Background: Insomnia symptoms associated with late chronotypes are prevalent among young adults, and frequently lead to sleep deprivation, morning-awakening difficulties, and excessive daytime sleepiness. These conditions are associated with psychological distress, impaired academic functioning, and reduced self-esteem. Although chronobiological behavioral interventions are effective, their accessibility remains limited. To bridge this gap, we developed a smartphone application delivering digital brief behavioral treatment for insomnia (BBT-I). We also designed a four-week program integrating the app with light therapy (LT) via wearable glasses named “Digital BBT-I + LT”. This randomized controlled trial will evaluate the efficacy of digital BBT-I with LT and digital BBT-I alone compared with a waitlist control group. Methods: This three-arm parallel-group randomized controlled trial will target young adults with insomnia symptoms and late chronotypes. Participants will be randomized to receive digital BBT-I with adjunctive LT, digital BBT-I alone, or a waitlist control condition. The primary outcome will be insomnia symptom severity, assessed using the Insomnia Severity Index. Evaluations will be conducted at baseline, weekly during the four-week intervention period (days 8, 15, 22, and 29), and at the 3-month follow-up. Discussion: Late chronotypes and insomnia significantly impair sleep and mental health in young adults. Despite the recognized importance of chronobiology-based treatments, they are rarely adopted as standard care. This highlights the need for scalable digital interventions, such as digital BBT-I. By rigorously assessing these strategies, this trial aims to provide clinical evidence regarding accessible interventions to improve sleep and mental health outcomes in this population. Full article

Digital games have been increasingly recognized as promising tools for supporting meaningful learning in school contexts. This study examined the effects of Alien Health, an embodied video game designed to promote nutrition and healthy eating learning among fifth-grade students in Chile. A quasi-experimental repeated-measures design was conducted with 327 students from 10 public, subsidized-private, and private schools in the Province of Concepción. Using pre-existing fifth-grade classes, participants were organized into a control group, who received traditional teacher-led instruction and an experimental group, who engaged with the video game without teacher mediation. Learning outcomes were assessed using the Nutrition and Healthy Eating (NHE) test, a 10-item curriculum-aligned instrument developed for this study and reviewed by expert teachers. The test was administered at pretest, posttest, and delayed retest. Data were analyzed through repeated-measures ANOVA, considering total scores, curricular sub-objectives, and Bloom-based cognitive categories. Results showed a differentiated pattern over time. Control students tended to achieve higher scores at the immediate posttest, particularly in tasks associated with factual recall, whereas experimental students showed more stable performance at delayed retest and stronger outcomes in some higher-order tasks, especially food classification and integrative diet design. Differences in school type and gender were also observed, suggesting that the effects of the intervention varied across educational contexts. Overall, the findings indicate that embodied video games may serve as a valuable complement to traditional instruction by supporting longer-term knowledge retention and conceptual integration in primary education. The study contributes empirical evidence from a Latin American context to the literature on embodied learning, game-based education, and nutrition teaching. Full article

Background: Arterial hypertension is one of the most prevalent chronic non-communicable diseases and a leading cause of cardiovascular morbidity and mortality worldwide. Its burden remains particularly high in rural and resource-limited settings, where access to healthcare is often constrained by shortages of healthcare professionals, geographical barriers, and underdeveloped infrastructure. These factors may contribute to delayed diagnosis, suboptimal disease control, and increased risk of complications. In this context, telemedicine has emerged as a useful approach to supporting hypertension management and improving access to care in rural populations. Methods: This study presents a narrative review of the literature focusing on the application of telemedicine in the management of arterial hypertension in rural populations. A structured literature search of PubMed, Scopus, and Web of Science databases was conducted for studies published between 2015 and 2025. The review included randomized controlled trials, systematic reviews, meta-analyses, and observational studies evaluating telemedicine interventions, including remote blood pressure monitoring, mobile health applications, and teleconsultations. Study selection was guided by relevance to the research objective, with particular attention to rural and resource-limited contexts. Results: Telemedicine interventions have been associated with improvements in blood pressure control, treatment adherence, and access to healthcare services. Evidence from randomized controlled trials and meta-analyses suggests modest reductions in systolic and diastolic blood pressure compared with standard care. However, a substantial proportion of the available evidence originates from studies conducted in general or mixed populations rather than exclusively rural settings. Therefore, the applicability of these findings to rural contexts remains limited and should be interpreted with caution. The effectiveness of telemedicine may vary depending on differences in healthcare infrastructure, resource availability, digital accessibility, and organizational models across healthcare systems. Integrated care approaches involving primary healthcare providers and specialist support may contribute to improved continuity of care, although their impact appears to be context-dependent. Key barriers include limited telecommunication infrastructure, digital literacy challenges, and difficulties in integrating telemedicine into routine clinical practice. Conclusions: Telemedicine may represent a useful approach to supporting hypertension management in rural populations. However, its implementation requires careful consideration of local healthcare systems, patient characteristics, and organizational context. Telemedicine should be viewed as a context-dependent strategy rather than a uniform solution. Further context-specific research is needed to evaluate the long-term clinical, organizational, and economic impact of telemedicine interventions in rural hypertension management. Full article

Background/Objectives: Human papillomavirus (HPV) vaccination coverage among adolescents remains below public health targets despite strong evidence of vaccine effectiveness in preventing HPV-related cancers. Digital interventions (e.g., serious games) may improve HPV vaccine uptake, but evidence for effects on vaccination behavior remains limited. Methods: This secondary analysis of a randomized controlled trial evaluated a co-designed, game-based digital intervention to increase HPV vaccine initiation among unvaccinated youth aged 11–14 years and their parents. The sample included 64 parent–adolescent dyads (33 intervention and 31 usual care dyads). The primary outcome was HPV vaccine initiation at 2-month follow-up. Results: A significantly greater proportion of adolescents in the intervention group initiated HPV vaccination compared with controls (88.5% vs. 46.2%; χ²(1) = 10.58, p = 0.001; risk difference = 0.423, 95% CI = [0.196, 0.650]). No significant between-group baseline differences were observed in parent HPV vaccination intention, knowledge, or psychosocial perceptions, although adolescent vaccination intention was higher in the intervention group. In adjusted logistic regression controlling for adolescent baseline HPV vaccination intention, intervention participants remained significantly more likely to initiate vaccination than controls (OR = 9.31, 95% CI = 2.13–40.70, p = 0.003). Intervention acceptability was high, with most parents and adolescents reporting that the game was easy to use, engaging, and relevant to vaccination decision-making. Conclusions: These findings provide preliminary evidence that a brief, family-centered, game-based digital intervention may help increase HPV vaccination initiation among adolescents. Larger trials with longer follow-up are needed to assess vaccine series completion and effectiveness across diverse settings. Full article

This paper presents a fully automated platform for real-time monitoring of fatigue-induced microstructural changes in metallic materials, using Rayleigh surface waves and Laser Doppler Vibrometry (LDV). The system integrates ultrasonic excitation, non-contact optical sensing, and high-speed signal processing in a unified LabVIEW environment. Rayleigh waves are generated via a contact transducer, while LDV captures surface vibrations with sub-nanometric velocity resolution, ensuring repeatability and eliminating coupling variability. The software automates synchronization, deterministic data acquisition, filtering, FFT analysis, and extraction of nonlinear coefficients (β₂, β₃) at high execution rates without the need for post-processing. Experimental validation under cyclic loading revealed a clear sensitivity hierarchy: the Rayleigh wave velocity remained invariant, the acoustic attenuation responded gradually, while the nonlinear parameters exhibited the earliest and steepest response to fatigue damage, confirming their superiority as early-stage indicators. The system offers low-latency timing, long-term stability, and modular design, establishing a robust data-streaming foundation that can support future integration with digital twin frameworks and machine learning models. Furthermore, the acoustic findings were successfully cross-validated using Infrared Thermography, which confirmed the critical damage transition phase. This work bridges nonlinear acoustics and software automation, providing a scalable diagnostic solution for predictive maintenance within structural health monitoring systems. Full article

Background/Objectives: Telemedicine and remote patient monitoring have emerged as promising strategies to improve outcomes in heart failure (HF), but prior meta-analyses reported conflicting results, partly due to insufficient differentiation between intervention modalities. This systematic review and meta-analysis evaluated the impact of distinct telemedicine strategies on clinically relevant outcomes in HF. Methods: Conducted according to PRISMA 2020 and a prospectively registered PROSPERO protocol (CRD420261355507), this analysis included randomized controlled trials (RCTs) comparing telemedicine-based strategies—non-invasive telemonitoring, structured remote patient management (RPM), or haemodynamic-guided monitoring—against standard care, identified through searches of PubMed/MEDLINE, Embase, and CENTRAL (inception to 15 March 2026). Random-effects meta-analyses (DerSimonian–Laird) were performed, with predefined subgroup, sensitivity, and publication bias analyses. Results: Sixteen RCTs (n = 8618) were included. Telemedicine significantly reduced all-cause mortality (RR 0.82, 95% CI 0.73–0.92; I² = 34%; GRADE: moderate), all-cause hospitalization (RR 0.79, 95% CI 0.71–0.88; GRADE: moderate), HF-related hospitalization (RR 0.68, 95% CI 0.59–0.78; GRADE: high), and composite outcomes (RR 0.75, 95% CI 0.67–0.84; GRADE: moderate). A prespecified subgroup analysis revealed a significant mechanistic gradient (p for interaction = 0.008): haemodynamic-guided monitoring conferred the largest mortality reduction (RR 0.71), followed by structured RPM (RR 0.79), whereas non-invasive telemonitoring alone did not reach statistical significance (RR 0.93; p = 0.14). Conclusions: Telemedicine-based strategies yield clinically meaningful reductions in mortality and hospitalization in HF, but benefit is contingent upon intervention intensity and physiological specificity. Haemodynamic-guided monitoring and structured RPM provide robust outcome reductions, whereas passive telemonitoring alone is insufficient. These findings support consideration of structured remote patient management and haemodynamic-guided monitoring in appropriately selected patients and settings, while implementation and comparative effectiveness research remains necessary. Full article

The growing use of quantified self-technologies (QST) in chronic disease management is linked to better self-monitoring and patient engagement. However, little is known about how patients in resource-constrained settings fund and sustain the use of QST in diabetes self-management. This study asked: “How do patients with diabetes perceive and experience the economic burden of using QST in Zimbabwe?” Using a qualitative design, 20 patients with diabetes participated in semi-structured interviews. The reflexive thematic analysis of Braun and Clarke generated three interrelated themes: technology investment costs, conventional healthcare costs, and socio-economic constraints. The findings show that the economic experience of QST adoption is context-dependent and is shaped by the financial realities of patients with diabetes and their access to technology. By focusing on patient-level cost experiences, the study adds qualitative evidence to public health debates on digital health affordability and highlights the need to assess perceived financial implications within a third-world socio-economic context. It is concluded that, although QST is available in third-world countries, sustained use depends on the financial capacity of patients with diabetes. Full article

Background and Aims: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality worldwide, with lipid abnormalities playing a central role in disease development. While the causal role of low-density lipoprotein cholesterol (LDL-C) in ASCVD is well-established, the long-term population impact of combined lipid profiles, particularly the HDL-C/LDL-C ratio, remains less clearly quantified. This study aimed to estimate the lifetime burden of cardiovascular outcomes associated with different lipid risk profiles using a patient-level simulation framework. Methods: The authors analyzed projected lifetime ASCVD events across four HDL-C/LDL-C risk strata, ranging from low (≥0.45) to very high (<0.25), using the National Health Model Database of Projected and Estimated Outcomes (NHM-DPEO)—a digital twin of national healthcare systems built from multiple data sources, including national health and demographic statistics and estimates from the relevant literature. The framework is structured as a patient-level simulation model that projects individual health trajectories over a lifetime horizon. Model outputs were assessed for plausibility by comparison with published epidemiological estimates. Results: The NHM simulation revealed a strong, graded relationship between lipid profiles and cardiovascular survival. Life expectancy declined from 80.2 years in the lowest risk group (HDL-C/LDL-C ≥ 0.45) to 63.0 years in the very-high-risk group (HDL-C/LDL-C < 0.25), a reduction of 17.2 years, with 13.7 fewer QALYs. Similarly, participants with LDL-C > 5.0 mmol/L had a life expectancy 13.4 years shorter than those with LDL-C < 3.1 mmol/L. The burden of ASCVD increased exponentially with worsening lipid ratios: MI events rose from 5000 to 73,090 per 100,000 births, with onset in the highest risk group occurring as early as age 20. Ischaemic heart disease followed a similar pattern, showing up to 92% of events attributable to elevated lipid risk. While ischaemic stroke risk displayed a more complex pattern due to earlier MI mortality in high-risk groups, overall cardiovascular mortality and lifetime event burden were dominated by LDL-driven disease. These findings demonstrate that sustained LDL-C reduction and balanced HDL-C/LDL-C ratios confer substantial survival benefits across both sexes and all age groups. Conclusions: This study shows that lipid balance has a decisive influence on cardiovascular survival. Sustained LDL-C reduction and favourable HDL-C/LDL-C ratios markedly extend life expectancy and delay the onset of MI and IHD. The magnitude of this survival benefit highlights the need for early and continuous lipid control as a cornerstone of ASCVD prevention. The NHM quantifies these lifetime effects, offering valuable insights for targeted strategies that improve both longevity and quality of life. Full article

Digital technologies are increasingly integrated into elderly care systems and have important implications for sustainable social development. This study investigates whether China’s Smart Health and Elderly Care (SHEC) Pilot Program enhances elderly care service provision and improves the spatial equity of resource distribution. Using prefecture-level data on elderly care institutions from 2010 to 2021, this paper employs a staggered difference-in-differences (DID) approach to identify the impact of SHEC on elderly care service provision. SHEC is treated as a digitally oriented policy initiative rather than a direct measure of digital technology adoption intensity. The results show the following: First, the pilot program significantly expands the service capacity of the elderly care system, as reflected in increases in both the number of elderly care institutions and bed capacity. Second, the policy has stronger effects on service capacity expansion in less-developed and high-aging regions, whereas the estimated effects are limited in more-developed and low-aging regions. Third, the analysis also provides exploratory evidence on potential supply-side and demand-side mechanisms. Finally, the equity analysis based on the Theil index suggests that participation in SHEC improves allocative equity, thereby supporting sustainable social development. This paper contributes to the literature by highlighting how digital empowerment-oriented policy interventions in the elderly care sector promote the sustainable expansion and equitable allocation of public service resources. Full article

Background/Objectives: Recovery of upper limb function after stroke is highly heterogeneous, and accurate prediction of clinically meaningful functional transition remains a major challenge in rehabilitation medicine. We developed and temporally validated machine learning (ML)-based prognostic models for predicting transition from non-functional movement to functionally usable upper limb capacity in patients undergoing intensive inpatient rehabilitation during the early subacute phase of stroke. Methods: This retrospective cohort study included 960 patients with ischemic or hemorrhagic stroke admitted to a tertiary rehabilitation center between 2010 and 2025. Three functional recovery outcomes were defined: motor impairment recovery, defined as Fugl-Meyer Assessment for Upper Extremity score ≥ 32; gross manual dexterity recovery, defined as Box and Block Test score ≥ 2 blocks/min; and functional pinch strength recovery, defined as pinch strength ≥ 1.1 kgf. Multidimensional predictors spanning demographic, clinical, neurophysiological, neuroimaging, and rehabilitation-related domains were integrated. Four ML algorithms were evaluated using stratified 5-fold cross-validation and temporal validation in a chronologically independent cohort (2024–2025). Models were developed under two tracks: Track A, incorporating only baseline variables available at admission (primary prognostic model), and Track B, additionally incorporating cumulative rehabilitation-related variables (exploratory). Results: Random Forest demonstrated the best overall performance. During temporal validation, models achieved AUROC of 0.800 for motor impairment recovery, 0.958 for gross manual dexterity recovery, and 0.888 for functional strength recovery. Baseline motor severity and corticospinal tract integrity were the dominant biological determinants of recovery. Earlier rehabilitation initiation and greater upper-limb robot-assisted therapy exposure were also associated with improved outcomes; however, these findings should be interpreted as observational associations subject to treatment-selection bias rather than evidence of causal effects. Conclusions: Probabilistic ML prediction integrating neural reserve and rehabilitation-related exposure variables can support individualized precision rehabilitation planning and improve functional outcome stratification in early subacute stroke. Full article