Search Results (5,302)

The harms associated with substance use continue to disproportionately affect marginalized populations. This study presents a retrospective program evaluation of a mobile health unit that delivers integrated clinical and harm reduction services to marginalized populations in Eastern Puerto Rico. Methods: A secondary data analysis was conducted using administrative data from a mobile health unit, capturing client encounters, service utilization (e.g., mental health support, health screenings, safe injection counseling, and case management), visit frequency, and demographic characteristics. This study is framed as an implementation-focused program evaluation. Descriptive and exploratory analyses were conducted to assess service delivery, program reach, utilization patterns, and selected program outcomes over a 1.5-year period. Results: Between January 2022 and October 2023, the mobile health unit served 279 participants across eight municipalities. Participants exhibited higher rates of intravenous drug use, mental health disorders, homelessness, and incarceration history compared with previously published estimates for the general Puerto Rican population, although these comparisons are indirect. The program delivered multidisciplinary services and facilitated referrals addressing key social determinants of health, including housing, nutritional assistance, identification services, in-patient treatment, and medication-assisted treatment. Model-based estimates using the Mobile Health Map Impact Tracker tool suggest that, in 2023, mobile health screenings may be associated with a return on investment of approximately 6:1, 259 avoided emergency department visits, 29 life-years saved, and approximately USD 2.4 million in healthcare cost savings. Conclusions: This evaluation demonstrates the feasibility of a mobile health model integrating harm reduction and clinical services to reach highly marginalized populations and facilitate connections to health and social services. Findings reflect program implementation, service reach, and engagement rather than causal effectiveness. Mobile health approaches may represent a feasible and potentially beneficial strategy for expanding access to care, although further research incorporating patient-level outcomes is needed to assess effectiveness. Full article

Chronic diseases drive healthcare costs, and employers seek scalable strategies to improve health outcomes and control expenses. Telehealth behavioral care shows promise for managing chronic conditions, but its long-term economic value in employer populations is still unclear. We assessed the cost-effectiveness and ROI of a behavioral care (LBC) model using a Markov model in a custom analytic tool. The model simulated disease progression, healthcare utilization, and QALYs over five years from the employer perspective. Transition probabilities, costs, and mortality risks were obtained from the InHealth program, national sources, and published literature. Employees in the behavioral care model were compared with a control group receiving usual care. Among 4461 employees aged 40, intervention participants had five-year costs of $41,431, versus $47,834 for controls, saving $6403 per member and $28.6 million overall. Treated members gained 4.7 QALYs compared to 4.6 in controls, equivalent to 36.5 extra days of full health. The program had a ROI of 6.53, showing significant cost savings. Telehealth behavioral care is a cost-effective way to improve health outcomes and provide financial benefits to employers. These results support incorporating behavioral care into value-based benefits and highlight potential long-term savings through prevention and management of lifestyle-related chronic diseases. Full article

Oral cancer remains a major global health problem with high morbidity and mortality rates, and despite advances in therapeutic approaches, challenges persist in early diagnosis and effective disease management. MicroRNAs (miRNAs) are endogenous, small non-coding RNAs that regulate gene expression at the post-transcriptional level and play fundamental roles in maintaining cellular homeostasis, as well as in the initiation and progression of multiple malignancies, including oral cancer. Dysregulation of miRNAs contributes to oral carcinogenesis by modulating key cellular processes such as cell proliferation, apoptosis, invasion, metastasis, and angiogenesis. Altered miRNA expression profiles have been consistently identified in oral cancer tissues and body fluids, including saliva and blood, supporting their potential utility as reliable biomarkers for early detection, prognosis, and disease monitoring. Circulating miRNAs, in particular, represent a promising non-invasive diagnostic tool for assessing disease progression and therapeutic response. Moreover, miRNAs are actively involved in regulating sensitivity and resistance to chemotherapy and radiotherapy, with specific miRNAs either enhancing treatment efficacy or promoting therapeutic resistance. This review aims to highlight the critical role of miRNAs in oral cancer pathogenesis, diagnosis, prognosis, and treatment, exploring their potential as biomarkers and therapeutic targets to improve early detection, patient outcomes, and personalized treatment strategies. Full article

Providing dietary feedback is important for promoting healthy behaviors in weight management, but the rapid development of obesity and the shortage of medical nutrition human resources have limited this health service. The rise of large language models (LLMs) offers the possibility of using artificial intelligence (AI) to simulate the behavior of human dietitians. However, existing studies have only explored LLM performance when generating answers to common nutrition-related questions; the use of LLMs to generate situation-adapted dietary feedback in practical weight management scenarios still needs further research. In this study, we collected dietary records and dietary feedback from primary dietitians through an mHealth weight management application. We conducted topic modeling to generalize how dietitians deliver nutrition guidance in real-world dietary feedback scenarios. Combining the in-context learning capability of LLMs with real-world data, we proposed a synthetic data generation approach (HDI-SDG) and trained an LLM for dietary feedback with the synthetic data (LLMDF-EXP). Experiments on automatic and manual evaluation of LLMDF-EXP and an LLM trained directly with the real-world data as well as generalized LLMs illustrated that LLMDF-EXP performed most similarly to human experts. Notably, there were no significant differences from human experts in terms of professionalism (p-value = 0.510) and usefulness (p-value = 0.498). The study highlights that integrating LLMs with real-world data in health management processes can enhance the situational adaptability of LLMs in practical health management environment applications. Full article

Background: The use of contraceptive methods is a key component of public health and reproductive health, contributing to family planning, maternal well-being, and social stability. However, contraceptive use is often influenced by the availability and continuity of medical counseling. Limited evidence exists on how regular specialist counseling affects informed contraceptive use in real-world community settings. Methods: A cross-sectional study was conducted between January 2025 and January 2026 using a structured questionnaire. A total of 2400 participants aged 18–55 years were included. The study population was divided into two groups: 1000 women who had been regular patients or receiving consultation for at least one year at the Gynecology and Endocrinology Department of the General Hospital in Ferizaj, and 1400 community participants who had not received regular medical counseling related to reproductive health during the previous year. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: The prevalence of current contraceptive use was significantly higher among women receiving regular medical counseling compared with those without regular consultations (72.4% vs. 41.8%; p < 0.001). Modern contraceptive methods were more frequently used in the counseled group, including oral hormonal contraceptives (38.5%), intrauterine devices (21.4%), and implants (7.8%), whereas condom use (49.3%) and traditional methods (18.4%) predominated among participants without counseling (p < 0.001). Use of contraceptives based on medical recommendation was reported by 81.2% of counseled women compared to 29.6% in the non-counseled group (p < 0.001). Long-term contraceptive use (≥12 months) was significantly more common among counseled participants (64.9% vs. 33.5%; p < 0.001). After adjustment for age, education, and marital status, regular medical counseling was independently associated with higher odds of modern contraceptive use (OR = 3.62; 95% CI: 3.01–4.35; p < 0.001). Conclusions: Regular medical counseling by gynecologists and endocrinologists is strongly associated with informed, consistent, and modern contraceptive use among adults aged 18–55 years. These findings underscore the importance of strengthening structured counseling services as an integral component of public health strategies aimed at improving reproductive health outcomes. Full article

Titanium alloys are widely used in dental implants due to their excellent mechanical properties. However, their inertness and poor antibacterial activity cause interfacial loosening and failure, shortening service life. This study integrates surface microtexturing with coating technologies, employing modified light-curing composite resins to boost the bioactivity of medical titanium alloys via surface modification. The results reveal that surface microtexturing enlarges the coating-substrate contact area by 42.5% compared with rough surfaces, concurrently diminishing stress per unit area, and the coating on microtextured Ti-6Al-4V (TC4) surfaces achieves adhesion with a damaged area of only 0.5%, thereby notably enhancing adhesion between the coating and TC4 matrix. In comparison, with rough surfaces (surface roughness of 0.658 μm), smooth TC4 planes (surface roughness of 0.014 μm) show a significantly reduced bacterial colony count (from 130 ± 6 to 42 ± 3) with an antibacterial rate of 67.7%, as the water contact angle on TC4 surfaces increases with decreasing roughness (reaching 80.95° on the smoothest surface), making bacterial adhesion more challenging and reducing colonization. The composite resin coating based on a mixture of titanium-doped hydroxyapatite and titanium dioxide (Ti-HA/TiO₂) further improves the antibacterial rate to 74.6% through a photocatalytic synergistic effect and endows TC4 with excellent remineralization capacity—mineralization deposits appear on the coated surface after 3 days of immersion in artificial saliva, while no obvious deposits are found on uncoated rough and smooth surfaces even after 7 days—thereby enhancing its bioactivity effectively. This study on the modification of Ti-based implant surfaces will enrich the field by introducing new technologies and methodologies. These advancements provide a theoretical basis for improvement of the remineralization capacity and antibacterial properties of Ti-based dental implants, thereby promoting broader biomedical applications. Full article

Anorexia nervosa is a clinically complex and ethically challenging psychiatric disorder. Clinicians are frequently confronted with ethical dilemmas arising from conflicts between core ethical principles in everyday clinical practice. Professional codes of ethics and legal frameworks often fail to provide a stable basis for resolving these dilemmas due to the fluctuating medical risk and the ego-syntonic nature of anorexia nervosa. Under conditions of heightened responsibility and medical risk, clinicians’ cognitive and emotional responses may be activated and may mediate ethical decision-making. Although such internal processes have been described in the literature, limited attention has been paid to their role in shaping ethical judgment in routine clinical care. The aim of this article is to conceptualize the decision-making processes that unfold in response to ethical dilemmas in the clinical context of anorexia nervosa and propose a sequential multi-level framework. A focused conceptual literature review was conducted to develop a reflective framework for clinical practice, drawing on selected studies in clinical ethics, healthcare law, anorexia nervosa care, and cognitive theory. Clinicians’ internal cognitive and emotional processes play a significant role in ethical decision-making in complex clinical contexts such as anorexia nervosa and should be explicitly recognized and brought into reflective awareness through supervision and reflective practice. Ethical decision-making is therefore conceptualized as a dynamic process linking clinical events, clinicians’ internal responses, ethical and legal considerations, and reflective clinical judgment. Incorporating structured reflection into clinical, educational, and supervisory settings may support more ethically informed and context-sensitive clinical judgment within multidisciplinary eating disorder services. Full article

Objectives: Complex patients in need of an urgent medical assessment can contribute to crowding in the Emergency Department (ED). Optimising access to geriatric expertise for this patient group is known as ‘Geriatric Emergency Departments’. Methods: A parallel care pathway was designed to redirect frail older patients to an Urgent Geriatric Care (UGC) service rather than the ED. The UGC has access to the diagnostic facilities of the ED. This descriptive analysis reports on delivered care, diagnostics, admissions rates, discharge policy, and 30-day and 6-month outcomes concerning hospital (re)admissions, ED visits, and mortality. Results: 269 patients were analysed. The median age was 83 years, 68% had polypharmacy, 51% cognitive disorders, and 83% a gait disturbance. A median of four conclusions was drawn per patient. Evaluation at the UGC often leads to medication regimen changes (81%), initiation or expansion of care at home (46%), and initiation of dementia care (18%). The hospital admission rate was 13%; the rate of ED visits within 30 days was 5% and, within 6 months, an additional 16%; the rate of hospital readmissions within 30 days was 7%, and 11% after 6 months. The mortality rates were 9% within 30 days and 12% within 6 months. Conclusions: Evaluation of patients at the UGC led to a high degree of medication regimen changes, initiation of care at home, and multiple conclusions or diagnoses per patient. Readmission or revisiting rates were low. A direct comparison to care delivered at the ED should be made in a future study. Full article

Background: Acute lymphoblastic leukemia (ALL) requires intensive induction, but implementation of pediatric-inspired regimens in low- and middle-income countries is constrained by diagnostic gaps, procurement instability, and limited supportive-care capacity. We evaluated the feasibility, safety, and affordability of a pragmatically adapted pediatric-inspired induction regimen for adults with Philadelphia chromosome-negative Ph(−) ALL in a Pakistani tertiary hospital. Methods: In this prospective single-center cohort study at the Pakistan Institute of Medical Sciences (December 2024–June 2025), consecutive adults aged 18–50 years with newly diagnosed Ph(−)ALL received an adapted pediatric-inspired induction regimen. The primary outcome was complete remission (CR) after induction, with or without extended induction. Secondary outcomes were early mortality, treatment abandonment, grade 3–4 toxicities, and service delivery feasibility indicators. Affordability was assessed against household income. Results: Among 200 adults (mean age 30.3 ± 8.8 years; 65.5% male), 39.5% presented with WBC ≥ 30 × 10⁹/L and 88.0% with platelets < 50 × 10³/µL. CR was achieved in 83.0% of patients. Early mortality was 2.0%, and treatment abandonment was 1.5%. Grade 3–4 toxicities included febrile neutropenia (15.0%) and sepsis (7.5%). The Day-30 evaluability was high (96.5%). Observed out-of-pocket diagnostic costs were USD 119, whereas a guideline-complete diagnostic package would cost USD 929, equivalent to 3–6 months of income for households in the poorest quintile. Conclusions: This adapted pediatric-inspired induction regimen was operationally deliverable in a resource-restricted hospital and produced favorable induction-phase outcomes. Limited diagnostic capacity and a lack of financial protection for testing remain barriers to risk-adapted care. Expanding subsidies for essential diagnostics and stabilizing the procurement of critical agents may yield the greatest implementation gains. Full article

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of emergency department (ED) presentation, hospitalisation, and preventable healthcare utilisation worldwide. Although guidelines advocate coordinated, preventative, and community-based management, care within ED settings often remains reactive and crisis-driven. Nurses occupy a central role in COPD management; however, the experiential dimensions of nursing practice and its contribution to improving patient outcomes are insufficiently understood. Objectives: To explore the lived experiences of patients, nurses and medical officers regarding COPD presentations to the ED, with particular focus on the nursing role in assessment, coordination, education, and identification of unmet and comorbid care needs. Methods: A qualitative phenomenological approach was undertaken across three regional Australian EDs. Purposive sampling recruited patients presenting with acute exacerbations of COPD and nursing and medical officers involved in their care. Semi-structured interviews were conducted and transcribed verbatim. Data were analysed using Braun and Clarke’s thematic analysis framework, supported by reflexive discussion and audit trails to enhance rigour. Results: Six interrelated themes were identified: (1) nursing within a “crisis first” model of care; (2) holistic assessment and translation of complexity; (3) education and care coordination as preventative nursing work; (4) relational care and therapeutic connection; (5) nurses as sentinels for undiagnosed comorbidities, particularly obstructive sleep apnoea; and (6) system pressures constraining optimal nursing practice. Participants consistently described nurses as the clinicians who stabilised acute episodes, interpreted contextual risks, coordinated services, and provided relational and educational support, yet whose preventative contributions were limited by time and organisational demands. Conclusions: ED nurses function as critical integrators between acute stabilisation and chronic disease management for patients with COPD. Formalising nurse-led assessment, education, coordination, and sleep-disordered breathing screening may reduce avoidable ED presentations and enhance patient-centred outcomes. Investment in structured nursing models represents a key opportunity for improving COPD care delivery. Full article

Background: Access to reliable medicines information is essential to support safe medicine use during pregnancy and breastfeeding, where concerns regarding fetal and neonatal safety complicate clinical decision-making. Analgesics are widely used during these periods, yet uncertainty regarding safety persists due to evolving evidence, regulatory changes, and inconsistent information sources. Obstetric medicines information services play a critical role in addressing these information needs. This study aimed to evaluate patterns of analgesic-related enquiries to a pharmacist-led specialist obstetric medicines information service over a 20-year period. Methods: A retrospective observational study was conducted using enquiry data from the King Edward Memorial Hospital Obstetric Medicines Information Service (KEMH OMIS), Western Australia. All enquiries recorded between 1 January 2001 and 31 December 2020 were extracted from the Microsoft Access^® database. Records with incomplete data were excluded. Data were standardised, coded, and analysed using Microsoft Excel^® and SPSS^® Version 25. Descriptive statistics were used to summarise enquiry characteristics, caller type, the timing of exposure, and analgesic medicines involved. Trends over time were analysed. Results: A total of 48,458 enquiries were analysed, of which 4,978 (10.3%) related to analgesics, making this the third most common medicine class. Most enquiries related to breastfeeding (62.1%), followed by pregnancy (32.7%). The public accounted for 60.9% of calls, while health professionals contributed 39.1%. The highest frequency of breastfeeding enquiries occurred within the first four weeks postpartum, and pregnancy enquiries were most common in the second trimester. Paracetamol was the most frequently enquired analgesic (24.5%), followed by codeine (19.8%), ibuprofen (14.4%), diclofenac (7.2%), and tramadol (9.3%). Analgesic-related enquiries declined significantly over time (p < 0.001), particularly codeine-related enquiries following regulatory safety warnings. Conclusions: Analgesics represent a substantial proportion of medicines information enquiries in pregnancy and breastfeeding, reflecting widespread use and ongoing safety concerns. Pharmacist-led medicines information services play a critical role in supporting safe analgesic use. Full article

With the rapid advancement of exoskeletons and rehabilitation robotics, modern healthcare increasingly demands high dynamic accuracy and reliability from medical devices. However, the dynamic response and durability of mechanical systems are greatly influenced by the inevitable existence of clearances in kinematic joints. Existing studies predominantly focus on simplified planar or spatial mechanisms, offering limited guidance for complex mechanical structures in medical applications. To address this issue, a unified modeling framework is proposed in this study to explore the nonlinear dynamic behavior and wear properties of bionic humanoid rigid mechanisms incorporating revolute joint clearances. A dynamic model that accounts for revolute joint clearances is established, employing the Lankarani–Nikravesh contact model alongside a refined Coulomb friction approach to characterize contact behavior. To characterize the wear progression between the shaft and the bushing, the Archard wear model is employed, while the system’s dynamic equations are formulated using the Lagrange multiplier approach. Systematic simulations are conducted to examine the effects of clearance size, location, and multi-clearance coupling on dynamic response and wear behavior. The results reveal that clearances at the hip joint have the most pronounced impact on system performance, tibiofemoral joint clearances exacerbate precision disturbances, and foot-end clearances considerably undermine system robustness. Increased clearance sizes and the coexistence of multiple clearances aggravate wear and induce more severe nonlinear dynamic phenomena. Phase portraits and Poincaré maps further illustrate that the system may exhibit complex or chaotic behavior under certain conditions. This study offers theoretical insights into performance degradation mechanisms in humanoid robots with joint clearances and introduces a modular “driving–mid–terminal” structure that enhances model generality, enabling its application to exoskeletons and rehabilitation devices for design optimization, service life prediction, and health monitoring. Full article

Background: Artificial intelligence (AI) is increasingly embedded in routine primary care, yet how the levels of integration might affect its acceptability is unknown, especially in relationship-based service models where patients expect visible human stewardship. Prior experimental studies often treat AI adoption as a binary condition, leaving the “intensity gradient” of automation and the role of model specialization under-explored. We examine whether increasing AI integration in the clinical encounter erodes patients’ intention to seek care from family doctors in China, and whether labeling the AI as a medical-specific model buffers such erosion. Methods: We conducted a nationwide online survey experiment in China (N = 2790). Participants were randomly assigned to vignettes that varied by (i) the level of AI integration (low, medium, high) and (ii) the AI type (general-purpose vs. medical-specific large language model), with a human-only care scenario as a reference. Care-seeking intention from family doctors was assessed immediately after exposure. We estimated treatment effects using OLS regression with heteroskedasticity-robust standard errors, and examined the buffering hypothesis through an interaction term between AI integration intensity and AI type. Results: Care-seeking intention declined steadily as AI integration increased (p < 0.001), with the sharpest drop under high-intensity AI integration where clinical decisions were delegated to the AI system. Across all intensity levels, framing the system as a medical-specific AI consistently resulted in higher care-seeking intention than a general-purpose model. However, the interaction between AI intensity and the AI type was not statistically significant (p = 0.508). Conclusions: Patient acceptance of AI in primary care depends not only on whether AI is involved, but on how deeply AI is positioned in the encounter. Medical-specific AI labeling may enhance acceptance across all AI integration levels. The findings underscore the need to preserve human clinical agency in AI-embedded primary care. The results contribute to research on healthcare systems, digital health, and AI–patient interaction. Full article

Objective: This retrospective observational four-year review (2019–2022) evaluated neonatal admissions to Malta’s NICU and their outcomes. Study Design: Data from neonates up to 28 days meeting NICU admission criteria with available EMRs were analyzed, focusing on demographic data such as gestation and birth weight, need for resuscitation at birth, admission reasons, and outcomes related to nutrition, respiratory support, congenital anomalies, prematurity-related complications, phototherapy, and infection. Results: Total admissions numbered 1303 (7.3% of total births), out of which 1234 had available electronic medical records and were included in the final analysis. The main reasons for admission were respiratory distress syndrome (27.7%), transient tachypnoea (16.3%), and sepsis (13.5%). Among preterm infants, conditions related to prematurity were observed at expected frequencies and are reported descriptively. Feeding practice resulted in delayed attainment of full enteral nutrition compared to international standards, with an exclusive breastfeeding rate below the EU average. Sepsis and CLABSI rates were low, indicative of robust infection prevention and control measures. Conclusions: This study provides a descriptive overview of NICU admissions and outcomes stratified by gestational age at a single tertiary center in Malta, and highlights areas for improvement. The findings highlight expected patterns of prematurity-related morbidity and differences in clinical management, particularly in nutritional and respiratory support. Future prospective studies incorporating standardized data collection and detailed maternal and demographic variables are needed to better inform neonatal care and service planning. Full article

This study was carried out to investigate the antimicrobial performance and color stability of silver (Ag)-modified polyurethane and waterborne coating systems applied to Oriental beech (Fagus orientalis L.) wood after the specimens were subjected to UV aging for 24 h. Antimicrobial activity and color stability were evaluated before and after aging against Escherichia coli (E. coli, ATCC 25922), Staphylococcus aureus (S. aureus, NCTC 13552), and Candida albicans (C. albicans) in accordance with the JIS Z 2801 standard. Color changes were determined using CIELab parameters (ΔL*, Δa*, Δb*, and ΔE*) in accordance with the TS EN ISO 16474-3 standard. Prior to UV exposure, the highest antibacterial activity against E. coli occurred in Ag-modified waterborne varnish coatings, whereas the highest antifungal activity against C. albicans occurred in Ag-modified polyurethane paint systems. After UV aging, antimicrobial performance varied depending on the coating type. Particularly, Ag-modified waterborne varnish coatings retained significant antibacterial activity against E. coli and S. aureus and exhibited the highest antifungal performance against C. albicans. Color analysis revealed that UV exposure also caused significant changes in all coating systems. The most pronounced variations were observed for the lightness difference (ΔL*), red–green color difference (Δa*), and yellow–blue color difference (Δb*) parameters, while the lowest total color difference (ΔE*) values were observed for Ag-modified polyurethane and Ag-modified waterborne varnish coatings. Overall, Ag-modified waterborne varnish systems demonstrated superior performance in both antimicrobial activity and color stability after UV aging. Full article