Search Results (21,109)

The following article investigates the way in which popular media in Western culture reinforces a shared imagination linked to the treatment and care of people experiencing mental health conditions that are often associated with horror, violence, and crime. These representations haunt our vision of what it means to receive a mental health diagnosis, instilling fear and negative perceptions of mental illness in our psyche. The violent and disturbing imagery that is often used to portray mental illness, and made for entertainment purposes, reinforces a shared subconscious fear that haunts our imagination. These portrayals of mental illness fail to bridge the gap between human trauma, a medical diagnosis and a positive return to the community. This article uses examples of popular media from the twenty-first century to demonstrate how imagery linked to the age of asylums persists in today’s representations of mental health experiences. These images are reinforced by mainstream news stories, which draw on the most sensational and frightening incidents of mental health episodes. In summary, this article will highlight the way that popular media is influenced by society and has the power to reshape our understandings of mental health experiences for the better. To do this, there is a need for positive change within the mental health system, and more balance within news stories about mental health conditions. Full article

(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities—systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2) Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3) Results: Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4) Conclusions: Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety—the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions. Full article

Perioperative management of antirheumatic medications in adults with rheumatoid arthritis (RA) undergoing orthopedic surgery requires balancing postoperative infection and impaired wound healing against disease flare, pain, and delayed rehabilitation. This systematic review aimed to evaluate how perioperative continuation, withholding, interruption timing, restart timing, dose modification, or exposure to antirheumatic medications relates to postoperative outcomes in adults with RA undergoing arthroplasty and non-arthroplasty orthopedic procedures. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from database inception to 18 April 2026 for English-language full-text clinical studies. The primary outcomes were surgical site infection/periprosthetic joint infection, delayed wound healing, and postoperative RA flare. Secondary outcomes included reoperation, revision, readmission, mortality, venous thromboembolism, dislocation, and other procedure-specific complications. Original studies were classified as direct perioperative strategy evidence, medication-exposure evidence, or supportive clinical-context evidence. Forty-three original clinical studies were included, together with six non-original contextual sources. The evidence was predominantly observational, clinically heterogeneous, and of very low certainty. Methotrexate continuation was not associated with an evident increase in early postoperative complications, whereas direct evidence for other conventional synthetic agents was limited. Longer interruption of biologic or targeted synthetic therapy did not consistently reduce infection or wound-healing complications, while several studies associated treatment interruption with postoperative flare. Chronic baseline glucocorticoid exposure was associated with adverse outcomes but was clinically distinct from short-term perioperative administration; stress-dose supplementation was not directly evaluated. Medication decisions should therefore be individualized according to drug class, disease control, glucocorticoid burden, surgical procedure, and patient risk profile. Full article

Intensive Care Unit-Acquired Weakness (ICU-AW) is a secondary neuromuscular disorder diagnosed during a critical illness and related to ICU stay and intensive treatments, once other possible etiologies have been excluded. Micronutrients are essential components of human nutrition that are needed in small amounts to maintain pivotal organ functions, but their role in critical care nutrition and in prevention and treatment of ICU-AW is unclear. This narrative review aimed to provide a synthesis of the current evidence on the potential role of micronutrients in ICU-AW, with a glance at what is known in medical settings outside the ICU. Available evidence is fragmented, showing controversial results. Studies on vitamin K1 and vitamin D suggest potential benefits on handgrip strength, skeletal muscle mass and mobility, while Coenzyme Q10 may have a role in improving skeletal muscle composition. Moreover, zinc homeostasis may influence muscle degradation, whereas copper levels may represent a risk factor. Evidence on iron and carnitine showed uncertain results. Conversely, more robust evidence on muscle weakness is available for medical settings outside the ICU. Larger observational studies and RCTs are needed to further evaluate the possible efficacy of micronutrient supplementation in the critical care setting. Full article

Background/Objectives: Degenerative musculoskeletal diseases represent a major cause of chronic pain and disability worldwide and are increasingly associated with dysregulated oxidative stress and impaired redox signaling. Conventional therapeutic strategies are often limited to symptomatic management, prompting interest in adjunctive approaches that target underlying biological mechanisms. Among these, medical ozone therapy has been proposed as a redox-modulating intervention in various musculoskeletal conditions. Methods: A narrative clinical–mechanistic review of the literature was conducted using PubMed/MEDLINE, Scopus, and Google Scholar to identify experimental and clinical studies examining oxidative stress, redox signaling, and the application of medical ozone therapy in degenerative musculoskeletal disorders. Preclinical models published between 2000 and 2025 and randomized controlled trials published between 2020 and 2025 were critically evaluated and synthesized qualitatively, with attention to biological plausibility, clinical outcomes, and methodological limitations. A PRISMA-style flow diagram was used to document study selection. Results: Evidence from experimental studies supports a role for controlled oxidative stimuli in activating adaptive cellular defense pathways, including redox-sensitive signaling mechanisms involved in inflammation and tissue homeostasis. Clinical studies across conditions such as intervertebral disc disease, knee osteoarthritis, and other degenerative or overuse-related disorders report short- to mid-term improvements in pain and function following ozone therapy. However, substantial heterogeneity in study design, treatment protocols, and outcome measures limits comparability. Critically, many trials report statistically significant differences that do not consistently exceed the minimal clinically important difference (MCID) for pain and disability indices, and no trial has validated the proposed Nrf2-mediated mechanism in human tissue at clinically administered doses. Conclusions: Current evidence suggests that ozone therapy may exert biologically plausible effects through hormetic redox modulation and may provide symptomatic benefit in selected patients with degenerative musculoskeletal diseases. Nonetheless, the lack of standardized protocols, high-quality long-term data, and mechanistic biomarker validation warrants cautious interpretation. Ozone therapy should be regarded as an investigational adjunct rather than a disease-modifying or standalone standard of care. Further rigorous clinical trials integrating mechanistic biomarkers, sham-controlled designs, and standardized methodologies are needed to clarify the therapeutic role and safety profile of ozone therapy in musculoskeletal medicine. Full article

Background: Endometriosis is a condition that is very challenging to diagnose and manage. Objectives: The purpose of this study is to assess the impacts of diagnosis and treatments in the journeys of endometriosis patients in Aotearoa New Zealand. Methods: Two online surveys were conducted with cohorts of 616 and 679 endometriosis patients to assess diagnosis and treatments, respectively. Results: In this exploratory study, the diagnosis cohort self-reported a median delay from symptom onset to confirmation of the diagnosis of 10 years, with a median delay from symptom onset to first seeing a doctor (“doctor delay”) of 4 years. Upon receiving their diagnosis, 53.7% indicated the “number one” emotion they felt was relief. In the treatment cohort, the only medical management strategy perceived as “effective” by over 75% of users was hysterectomy (84.3%), despite this not being a cure for endometriosis. Common first-line treatments were viewed poorly for their perceived effectiveness, with over-the-counter pain relief viewed as effective by 25.8% of users, combined oral contraceptive pills by 23.2% of users, progesterone-only pills by 42.8% of users, and intrauterine contraceptive devices by 49.7% of users. Conclusions: Endometriosis is a condition typified by challenges for patients with its delayed diagnosis, resistance to management, and a high prevalence of discouraging experiences in medical care settings. These large-sample cohorts highlight that improvements in the diagnosis and management of endometriosis warrant urgent attention by clinicians and policymakers alike. Full article

Background: A substantial proportion of patients with chronic migraine (CM) with previous failures among oral standard-of-care migraine medications do not respond to monoclonal antibodies targeting the calcitonine gene related peptide pathway (CGRP-mAbs), leaving limited evidence-based options for subsequent preventive strategies. The present multicentre real-world study evaluated the effectiveness of onabotulinumtoxin-A (BoNT-A) in CM patients with previous CGRP-mAb failure and multiple prior oral preventive failures. Methods: This prospective, observational, non-randomized multicentre study enrolled patients with CM who had failed ≥3 classes of oral preventive treatments and ≥1 CGRP-mAb due to lack of efficacy or intolerance. Participants received BoNT-A according to the PREEMPT “follow-the-pain” paradigm every three months and were followed for 6 months. Co-primary outcomes were change in monthly headache days (MHD) after three and six months and ≥50% MHD responder rates at both time points. Results: Fifty-three patients were analysed (85% female, aged 48.5 ± 15.2 years, range 20–73). Compared to the baseline, at the third month and sixth month, MHD decreased from 22.83 (SD 6.74) to 15.38 (SD 7.91; p < 0.001) and 14.55 (SD 9.35; p < 0.001), respectively. The percentages of participants achieving the response status in MMD at the third month and sixth month were 30% and 45%, respectively. In the third and sixth months, 22 patients (41.5%) and 27 patients (50.9%), respectively, converted from chronic to episodic migraine, while the prevalence of medication-overuse headache decreased from 81.1% of patients at baseline to 45.3% and 43.4%, respectively. Migraine-related impact and disability scores improved over follow-up, alongside improvements in anxiety and depressive symptoms and in migraine-specific quality of life. Conclusions: The present findings support the use of BoNT-A in difficult-to-treat patients with CM following CGRP-mAb failure and provide further evidence that its therapeutic effects may rely on mechanisms that are at least partially distinct from, and potentially complementary to, those of CGRP-targeted therapies. Full article

Background: Relevant studies have demonstrated that patient adherence is one of the most important factors influencing treatment effectiveness. Failure to adhere to medical prescriptions can significantly hinder the achievement of desired therapeutic outcomes. Doctor empathy is presumed to correlate with patient adherence. However, the underlying pathways are not well understood. This study explores the associations linking doctor empathy to doctor-rated patient adherence using interaction ritual chains (IR chains), which provide a framework for investigating this process. Methods: From April 2023 to July 2023, a cross-sectional survey was administered to doctors from primary-level clinics in Zhejiang Province, China. Structural equation modeling was used to test the research hypothesis. Results: A total of 459 valid data entries from doctors were included in the analysis. The analysis result indicated that hypothesis H1: doctor empathy is positively correlated with doctor-rated patient adherence was supported. The standardized regression coefficient was 0.17 (p = 0.009). Hypothesis H2: emotional energy is hypothesized to mediate the correlational linkage between doctor empathy and doctor-rated patient adherence (standardized regression coefficient = 0.02, p > 0.05). Hypotheses H3: doctor treatment behavior is hypothesized to mediate the correlational linkage between doctor empathy and doctor-rated patient adherence (standardized regression coefficient = 0.02, p > 0.05), and hypothesis H4: emotional energy and treatment behavior are hypothesized to mediate the correlational linkage between doctor empathy and doctor-rated patient adherence (standardized regression coefficient = 0.02, p > 0.05) were not supported. Conclusions: The IR chains theory can be used to primarily explore how doctor empathy relates to doctor-rated patient adherence in healthcare settings. Doctor empathy shows a positive correlation with doctor-rated patient adherence. Full article

Background: Provincial pooling of the Urban–Rural Resident Basic Medical Insurance (URRBMI) fund has been promoted in China to reduce fragmentation and improve system performance, yet its impact on the efficiency of medical resource allocation remains unclear. Objective: To evaluate the impact of provincial pooling on medical resource allocation efficiency and to examine its heterogeneity across regions and institutional arrangements. Methods: Using provincial panel data from 2010 to 2022, this study measures efficiency with a super-efficiency slack-based measure (SBM) model and applies a staggered difference-in-differences (DID) design to estimate policy effects. Results: Provincial pooling is associated with a statistically significant reduction in medical resource allocation efficiency among adopting provinces. In baseline specifications, the estimated effect ranges from −0.021 to −0.024 (p < 0.01), corresponding to a decline of 0.021–0.024 points in the efficiency score, equivalent to about 2.4–2.7% of the sample mean efficiency level. Heterogeneity analysis suggests that the negative effect is concentrated in western provinces, whereas no statistically significant effect is observed in eastern provinces. No treatment effect is estimated for central provinces because none implemented provincial pooling during the study period. Institutional heterogeneity analysis shows negative estimates across pooling and management models, but the revenue–expenditure pooling estimate is not statistically significant. These results are robust across alternative specifications and sensitivity analyses. Conclusions: These findings suggest that, among adopting provinces, provincial pooling may involve substantial transitional adjustment costs, implying that efficiency gains should not be expected automatically in the short to medium term. Instead, outcomes depend on institutional conditions and the alignment of complementary governance mechanisms. Policymakers should adopt regionally differentiated and phased strategies and strengthen incentive-compatible design to improve reform effectiveness. Full article

Background/Objectives: Chronic lower extremity ulcers are a major cause of morbidity in older adults. However, real-world data on clinical characteristics, microbiological findings, treatment patterns, and outcomes in older adults remain limited. The objective of this study was to evaluate the clinical characteristics and factors associated with healing in older adult patients with chronic lower extremity ulcers. Methods: This retrospective cohort study included patients aged ≥65 years with chronic lower extremity ulcers treated at a tertiary dermatology center between January 2016 and March 2025. Demographic, clinical, microbiological, treatment, and outcome data were collected from medical records. Factors associated with healing outcomes were evaluated using regression analyses. Results: A total of 191 patients were included. Venous ulcers were the most common ulcer subtype (37.2%), followed by diabetic ulcers (19.4%). Wound cultures were positive in 48.2% of patients, with Staphylococcus aureus being the most frequently isolated organism. Complete healing was achieved in 18.8% of patients, while 29.6% experienced partial healing. Peripheral arterial disease (adjusted OR 0.25, 95% CI 0.09–0.64) and greater ulcer depth (adjusted OR 0.45, 95% CI 0.20–0.91) were independently associated with a lower likelihood of complete healing. Greater ulcer depth and positive wound cultures were independently associated with non-healing. Peripheral arterial disease and greater ulcer depth were also associated with delayed healing. Conclusions: Chronic lower extremity ulcers in older adults are associated with poor healing outcomes. Peripheral arterial disease, ulcer depth, and wound infection emerged as key determinants of healing and may help identify patients requiring closer monitoring and multidisciplinary management. Full article

The demand for mental health services is rising, and given the continued shortage of mental health specialists, primary care remains a critical setting for mental health treatment. Training emerging leaders in primary care to integrate interprofessional behavioral health services into care teams can help meet this demand. The Community Primary Care Champions fellowship developed a curriculum for primary care physicians and physician associates to lead primary care teams in addressing mental health within their clinical settings. This mental health curriculum for twenty-four fellows was led by a single faculty member during a part-time year-long fellowship. Seven modules (each 50–110 min long) covered critical topics through a mix of didactic learning, group learning, and a case-based summative independent activity. Evaluation included a pre- and post-assessment of knowledge and confidence, a one-year post-fellowship assessment, and focus groups. Self-assessed knowledge and confidence in key knowledge/skills/behavior improved after the fellowship with large effect sizes, and self-assessed knowledge about the Collaborative Care model for behavioral health integration and confidence in assessing suicide risk persisted one year after the fellowship compared to pre-fellowship. Our mental health curriculum demonstrates increases in self-assessed knowledge and confidence. It can be adapted for other graduate medical education settings to prepare learners to lead primary care transformation. Full article

Background/Objectives: Vitamin D deficiency is commonly observed in patients with breast cancer and may affect disease course and treatment outcomes. The determinants of vitamin D status in this population remain incompletely understood, particularly with respect to lifestyle, psychosocial, and tumour-related factors. The aim of this study was to identify environmental and clinical factors associated with serum 25-hydroxyvitamin D [25(OH)D] concentrations in women with breast cancer, with particular emphasis on dietary patterns, psychological distress, sleep quality, and tumour molecular subtype. Methods: A cross-sectional observational study was conducted among 101 women with histopathologically confirmed invasive breast cancer, recruited at the St. John of Dukla Oncology Centre of the Lublin Region (COZL) in Lublin, Poland, between 2018 and 2019. Serum 25(OH)D concentrations were measured by electrochemiluminescence immunoassay (ECLIA; Roche Diagnostics) within 2–8 weeks after surgical treatment. Clinical and lifestyle data were collected using standardised questionnaires and medical records. Dietary patterns were assessed with the KomPAN questionnaire (pro-healthy diet index pHDI-10 and non-healthy diet index nHDI-14). Psychological distress was measured with the Distress Thermometer. Multiple linear regression with backward stepwise elimination was applied to identify factors independently associated with of 25(OH)D concentration. Results: Insufficient vitamin D status (25(OH)D < 30 ng/mL) was found in 56.4% of participants. The multivariable regression model was statistically significant (F(6,92) = 15.298; p < 0.001), explaining 49.9% of the variance in 25(OH)D concentrations. Factors independently associated with lower 25(OH)D included higher BMI (b = −0.715; p = 0.005), sleep disturbances (b = −6.257; p = 0.020), higher psychological distress score (b = −2.263; p < 0.001), and luminal B versus luminal A subtype (b = −5.909; p = 0.025). A higher pro healthy diet index (pHDI-10) was independently associated with higher 25(OH)D (b = 0.245; p = 0.040). Conclusions: Vitamin D status in patients with breast cancer is shaped by complex interactions among modifiable lifestyle factors and tumour characteristics. Targeted interventions addressing diet quality, psychological well-being, sleep health, and weight management may improve vitamin D status in this population. The association between molecular subtype and 25(OH)D concentrations warrants further prospective investigation. These findings should be interpreted with caution, as vitamin D supplementation and direct measures of sun exposure—both established determinants of 25(OH)D—could not be included as covariates and may account, at least in part, for the associations reported. Full article

Objective: Extracorporeal Membrane Oxygenation (ECMO) has long been used in the treatment of acute respiratory and circulatory failure by providing time for damaged organs to recover. The aim of this study was to evaluate the safety and feasibility of interhospital transport of pediatric patients with acute respiratory failure who had undergone venovenous extracorporeal membrane oxygenation (VV ECMO) initiated at the referring facilities. Subjects and methods: Because of the critical condition of these patients, the high risk associated with transport, and the failure of conventional therapies, ECMO was initiated at the referring center. After cannulation, the patients were transported by ground ambulance to the Pediatric Intensive Care Unit in Poznań for further treatment. Results: Fourteen patients aged 2 months to 11 years with acute respiratory failure were transferred to our ECMO center. The mean time from decision to departure was 7.62 h, and the mean ICU stay before transfer was 4.14 days. The mean transport distance was 157.5 km. No mortality occurred during transport, and no serious adverse events were reported. Two technical complications were noted. Conclusions: Interhospital transport of pediatric patients on VV ECMO initiated at referring centers was feasible and safe, with favorable outcomes in patients who have exhausted conventional intensive care options. Effective collaboration between referring hospitals, ECMO centers, and emergency medical services was essential for optimal results. Full article

Burning Mouth Syndrome (BMS) is a chronic orofacial pain condition characterized by persistent burning sensations in the absence of consistently identifiable pathology. This mismatch between severe symptoms and inconclusive findings challenges conventional diagnostic reasoning, which presumes that subjective complaints reflect underlying biological lesions—leading to repeated investigations, diagnostic delay, and uncertainty about symptom legitimacy. This paper uses BMS as a paradigmatic case to question a core assumption of clinical reasoning: that objective pathology constitutes primary evidence. In this Perspective, drawing on phenomenology and medical anthropology, we argue that when pathology is indeterminate, illness—the lived experience of suffering—must be treated as primary clinical evidence rather than as a secondary expression of disease. We propose a bidirectional conceptual framework in which physiological processes, psychological states, and lived experience interact dynamically, with symptoms actively participating in the maintenance of the condition. This framework explains persistent diagnostic uncertainty, heterogeneous treatment responses, and the clinical significance of validation and meaning-making. Reframing BMS in this way supports earlier recognition, reduces reliance on exclusion-based strategies, and justifies multimodal interventions addressing both biological and experiential dimensions of pain. More broadly, it suggests that clinical reasoning must expand to incorporate lived experience as indispensable evidence wherever pathology is indeterminate. Full article

Medication-related osteonecrosis of the jaws (MRONJ) remains a challenging complication associated with antiresorptive therapy, highlighting the need for effective adjunctive preventive strategies. This study evaluated the effects of systemic ozone therapy, alone or combined with topical 10% metronidazole paste or 2% chlorhexidine gel, on alveolar repair in a zoledronate-induced rat model of MRONJ. Forty-two ovariectomized female Wistar rats were allocated into seven experimental groups. Following mandibular first molar extraction, animals received systemic ozone therapy and/or topical antimicrobial treatment according to the experimental protocol. Clinical, histomorphometric, micro-computed tomography (micro-CT), Picrosirius Red, and immunohistochemical analyses were performed. Zoledronate treatment markedly impaired alveolar repair, resulting in reduced new bone formation, increased non-vital bone, epithelial disorganization, and unfavorable bone microarchitecture. Systemic ozone therapy significantly increased new bone formation and improved bone microstructural parameters compared with untreated zoledronate animals. Ozone-treated groups also exhibited more organized collagen fibers and increased VEGF and osteocalcin immunostaining. Topical metronidazole and chlorhexidine were associated with favorable tissue repair findings, while combined therapies showed more favorable outcomes than zoledronate treatment alone. These findings suggest that systemic ozone therapy, particularly when associated with topical antimicrobial treatments, improves alveolar repair and represents a promising adjunctive strategy for preventing MRONJ. Full article