Introduction Nearly four million LGBTQ+ adults aged 50 and older live in the U.S., with up to 40,000 currently living with Parkinson's disease (PD). However, little is known about PD-related symptoms in this population.Methods From 2022 to 2025, we conducted a national cross-sectional study using a convenience sample of LGBTQ+ and non-LGBTQ+ individuals living with PD (n = 254). We administered validated PD and health-related measures to examine physical, mental and social health symptoms. Bivariate and regression models examined differences in symptom burden between LGBTQ+ and non-LGBTQ+ participants, as well as associations with sociodemographic characteristics and social determinants of health.Results The sample included 89 LGBTQ+ and 165 non-LGBTQ+ individuals living with PD. On average, LGBTQ+ participants were 5.3 years younger than their non-LGBTQ+ counterparts (mean age: 62.9 vs. 68.3). Compared with non-LGBTQ+ participants, LGBTQ+ individuals living with PD were more likely to report anxiety (53.9% vs. 33.3%, p = 0.002), moderate-to-severe motor impairments (32.2% vs. 19.4% p = 0.024), and loneliness (18.8% vs. 8.5%, p = 0.037). Regarding social determinants of health, younger age, identifying as a person of color, and experiencing healthcare discrimination were associated with higher odds of reporting moderate-to-severe PD-related symptoms.Discussion This study highlights potential disparities in PD-related symptoms, with LGBTQ+ individuals, persons of color, and those experiencing healthcare discrimination being more likely to report physical, mental and social health challenges. There is a need for further research on the health needs of diverse populations living with PD, including LGBTQ+ adults, as well as the development of tailored and inclusive healthcare strategies.
BackgroundLarge language models (LLMs) are increasingly used for health information delivery, but comparative evidence on their quality, readability, and factual reliability in heart failure (HF) education remains limited.ObjectiveTo compare four publicly accessible chatbot systems under prespecified access and retrieval configurations in answering common heart failure–related questions.MethodsWe evaluated 108 standardized English HF questions, yielding 432 responses. Content quality was assessed using modified DISCERN (mDISCERN) and Ensuring Quality Information for Patients (EQIP), readability was assessed using established English-language readability indices, including the Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease Score (FRES), Flesch–Kincaid Grade Level (FKGL), Automated Readability Index (ARI), Gunning Fog Index (GFOG), and Coleman-Liau Index (CLI), and factual reliability was evaluated by auditing all responses against the 2022 AHA/ACC/HFSA guideline and relevant clinical evidence. Continuous outcomes were analyzed using linear mixed-effects models. Hallucination outcomes were defined as clinically meaningful statements that were inconsistent with guidelines, unsupported by evidence, overgeneralized beyond the relevant population, or potentially misleading for patient education, and were analyzed using Wilson 95% confidence intervals (CIs), Cochran’s Q test, and generalized estimating equation (GEE) logistic regression.ResultsDeepSeek generally showed the most favorable content-quality profile across the evaluated domains. In the primary readability analysis, Perplexity generated the most complex text, whereas sensitivity analysis using a second calculator showed partially different rankings. Hallucinations were identified in 6/108 (5.56%) DeepSeek responses, 8/108 (7.41%) ChatGPT responses, 10/108 (9.26%) Copilot responses, and 16/108 (14.81%) Perplexity responses. Paired binary analyses showed significant differences among chatbot systems (Cochran’s Q p = 0.002; GEE p = 0.006).ConclusionUnder the tested conditions and evaluated model versions, DeepSeek generally showed the most favorable content-quality profile and the lowest observed hallucination rate. However, hallucinations occurred across all systems, and pairwise factual-reliability differences were mainly driven by the higher hallucination rate of Perplexity. Guideline-aligned verification and clinician oversight remain necessary before patient-facing use.
Background Digital learning resources (DLRs) are now core teaching tools in health professions education, yet quality evaluation remains constrained by subjective weighting bias and a persistent gap between educational importance and operational measurability. Because DLRs increasingly mediate what and how students learn, deficiencies in resource quality propagate directly into competency attainment, making quality evaluation a proximal determinant of student competency outcomes. This study aimed to develop and validate a practical DLR quality evaluation framework for medical and public health education. Methods A sequential mixed-methods design was employed. First, a modified Delphi procedure with 26 experts was used to construct the hierarchical indicator system. Second, an expert-based and data-derived integrated weighting model combining AHP and EWM was developed to balance expert judgment and data discriminatory power. Third, a measurability correction mechanism and a four-quadrant prioritization matrix were established. The framework was validated with 10 DLRs across 10 medical courses, involving 309 students. Results The final system comprised 4 primary dimensions, 9 secondary indicators, and 14 tertiary indicators. Content Quality had the highest integrated weight (0.469), with Data Visualization (0.136) and Updated Content and Frontier Knowledge (0.103) as the top tertiary indicators. The four-quadrant matrix classified 7 indicators for direct implementation and 2 for targeted methodological development. Validation confirmed high internal consistency (Cronbach’s α = 0.987) and satisfactory content validity (S-CVI = 0.951); absolute-agreement inter-rater ICCs were near zero, indicating substantial between-student variability in scoring levels. Conclusion This study provides a reliable, implementable DLR quality evaluation framework. By converting evaluation results into ranked, measurable improvement priorities, the framework directs resource revision toward the attributes that bear most directly on student competency development. The methodological workflow shows potential for transferability across nursing, pharmacy, public health and other health-related disciplines via contextual calibration, pending formal cross-context validation.
IntroductionMedical inflation is a central health-system cost pressure, yet little is known about whether economic policy uncertainty (EPU) affects medical prices differently across timescales and historical periods.MethodsThis paper examines the multi-scale and time-varying relationship between EPU and medical inflation in China using quarterly data from 2004Q1 to 2026Q1, wavelet filtering, and an SV-TVP-FAVAR model. Posterior uncertainty is summarized by the posterior mean and the 16th and 84th percentiles.ResultsPositive responses are present in both frequency-specific baseline models. The full-sample posterior-mean maxima for the higher- and lower-frequency EPU components are 0.297 and 0.108; they are 0.214 and 0.208 when the sample ends in 2025Q4. In the three-factor model, aggregate health-care CPI reaches 0.237 for a shock dated 2020Q2 at an eight-quarter horizon (central 68% credible interval [0.063, 0.412]). The eight-quarter posterior band overlaps those at several earlier dates, and the estimated magnitude varies with factor count. In the baseline full-sample specification, western medicine prices have the largest consumer-side posterior-mean maximum, reaching 0.424 for a shock dated 2020Q3 at six quarters (central 68% credible interval [0.231, 0.618]), although the exact peak date varies across specifications. Traditional Chinese medicine prices and medical service CPI show smaller positive responses, while pharmaceutical manufacturing PPI provides complementary evidence from the production side.DiscussionOverall, the results show that the EPU-medical inflation relationship varies across EPU frequency scales, historical dates, and health-price components.
BackgroundContemporary emerging adults are navigating the transition to adulthood under conditions of prolonged societal uncertainty associated with multiple concurrent global crises. Although psychological stress has been extensively linked to poorer mental health, considerably less is known about its prospective associations with identity development and adulthood attainment.ObjectiveThis longitudinal study examined whether baseline psychological stress burden prospectively predicted identity development, adulthood attainment, and resilience-related resources over 1 year, and whether baseline resilience-related resources prospectively predicted identity and adulthood attainment independently of stress burden.MethodsData were drawn from a nationwide longitudinal panel of 831 Polish emerging adults (18–29 years) assessed at two time points separated by 1 year. Psychological stress burden was modelled as a latent factor indicated by perceived stress, adjustment-disorder symptoms, and polycrisis-related adjustment difficulties. Identity development was assessed using the five-dimensional model of identity formation, alongside measures of resilience-related resources and subjective and objective adulthood. Longitudinal hypotheses were examined using autoregressive structural equation models controlling for baseline levels of the respective outcomes and relevant sociodemographic covariates. Subjective adulthood was modelled as a binary outcome using probit structural equation modelling.ResultsAll developmental outcomes showed significant rank-order stability across the follow-up period, while mean-level changes were generally small. Higher baseline psychological stress burden prospectively predicted greater ruminative exploration, lower commitment making, and lower identification with commitment, but was not significantly associated with exploration in breadth, exploration in depth, resilience-related resources, objective adulthood, or subjective adulthood. Higher baseline resilience-related resources prospectively predicted greater exploration in breadth, commitment making, exploration in depth, and identification with commitment, independently of baseline psychological stress burden, but did not significantly predict ruminative exploration, objective or subjective adulthood.ConclusionPsychological stress burden and resilience-related resources showed distinct prospective associations with identity development, whereas neither significantly predicted objective or subjective adulthood after accounting for baseline levels and covariates. Higher psychological stress burden was associated with greater ruminative exploration and weaker commitment-related processes, whereas resilience-related resources were associated with both adaptive exploration and commitment processes. These findings suggest that, over the one-year interval examined, prospective associations with psychological stress burden and resilience-related resources were concentrated primarily within identity development rather than broader adulthood attainment. Longer multiwave studies are needed to determine how these associations unfold across the transition to adulthood.
