Immersive virtual environments (IVEs) are increasingly used in healthcare research and design to simulate healthcare spaces, test environmental variables, and examine user responses under controlled yet realistic conditions. Compared with conventional 3D visualizations, IVEs offer greater interaction and experiential realism, allowing researchers to collect behavioral, experiential, and physiological data in scenarios that may be difficult, costly, or ethically sensitive to study in real settings. This realism makes IVEs effective for exploring the complex relationship between environmental design and patient well-being. By simulating healthcare settings, IVEs enable safe testing of interventions, design refinement, and evaluation of patient-centered solutions in a cost-efficient, scalable manner. However, despite their growing uptake, IVEs remain underutilized overall in healthcare research and design. A scoping review of studies since 2012 using Google Scholar and CINAHL Complete identified key applications, including navigation and spatial cognition, examining built environment impacts on behavior, pre- and post-occupancy evaluations, supporting space planning and perception studies, and testing environmental factors such as color, acoustics, lighting, and window views. Overall, the review positions IVEs as methodological platforms that can support evidence-based healthcare research and design, while also highlighting the need for stronger reporting standards, clearer outcome frameworks, and better translation of simulation findings into design decisions.
Hysterectomy remains a frequently performed surgical procedure for females with disabilities, despite significant ethical, legal, and health concerns. The present study investigates the socio-demographic and attitudinal factors that influence Jordanian parents’ decisions regarding hysterectomy for their daughters with intellectual disability (ID) and autism spectrum disorder (ASD). A cross-sectional survey design was employed. A total of two hundred parents (100 male, 100 female) of daughters with ID (n = 109) or ASD (n = 91) participated. A researcher-developed forty-four-item questionnaire assessed four dimensions: (1) fear of sexual assault, (2) menstrual management difficulties, (3) knowledge and misinformation about hysterectomy, and (4) perceived lack of institutional and financial support. Cronbach’s alpha for the overall scale was 0.936, indicating excellent internal consistency. Frequencies and chi-square analyses were conducted using SPSS, version 27. Significant gender-based differences were observed across all four dimensions (p < 0.0001 for each), with fathers expressing greater concern about sexual assault and hysterectomy knowledge, while mothers reported greater difficulties with menstrual management. No statistically significant differences were observed between parents of children with ASD versus ID across any dimension. Income level was significantly associated with parental perceptions across all dimensions (p < 0.0001), with lower-income parents reporting higher concern about menstrual management and lack of support. In conclusion, family burden, culture-based stigma, and structural inadequacies are often the primary drivers behind hysterectomy in this context, and not the best interests of the person with the disability. The findings emphasize the need for a legal reform, family education, and integrated disability support services in Jordan.
Bright days and dark nights are required to support the circadian system and nocturnal sleep-wake cycle, but these conditions are missing in most nursing homes (NHs). This study examined how the Centers for Medicare and Medicaid Services (CMS) NH surveyors’ guidelines and Minimum Data Set (MDS) address light and lighting, and how ninety-four NH websites in three US cities communicate the importance of light in the NH environment. Results indicate that the CMS surveyor’s guidance for light and lighting in NHs is general and focused on task illumination and fire safety. Daylight was listed once, with no information regarding light for health (sleep, circadian rhythms, and vitamin D). National lighting standards for aging vision are not required. The MDS evaluation revealed that sleep disturbances and vision impairment are listed as factors that can affect residents’ behavior and social involvement, but no guidance is provided for the practice of care or the NH environment. Content analysis of written and visual information on NH websites revealed that only 49% of the NHs in Sacramento, CA, had planned outdoor spaces followed by Tallahassee, FL (33%), and Austin, TX (28%). A high percentage of NHs showed no visual evidence of access to daylight or views of nature from windows in shared bedrooms (CA = 62%; TX = 53%; FL = 78%). Our evaluation indicates that CMS guidelines and NH websites place little importance on the benefits of light for residents’ health. Lighting for health recommendations are provided for NH providers, policy makers, and the design community.
Physical activity is widely recognized for its beneficial effects on people living with epilepsy, including those with severe forms. However, its practice often remains limited due to perceived risks associated with seizures. In the absence of guaranteed adaptation and safety conditions, opportunities for physical activity tend to be considerably restricted. Consequently, some specialized institutions, such as the Institute La Teppe (ILT), have integrated Adapted Physical Activity (APA) programs into their care provision. This article examines the ways in which APA is mobilized at the ILT, drawing on Corbin and Strauss’s model of illness trajectories to explore its contribution to different types of work. The analysis is based on data from an ethnographic study combining 750 hours of participant observation with forty-six in-depth interviews. The findings show that clinical safety work constitutes a central dimension of APA implementation at the ILT, although it is not its exclusive focus. Other types of work also emerge, particularly those related to self-regulation, comfort, and emotional experience. By highlighting the articulation between these various types of work and the broader lines of work within which they are embedded, this article underscores the multiple contributions of APA to severe epilepsy trajectories.
Alcohol use is often viewed as a primary factor underlying negative consequences among college students. However, many of these commonly cited outcomes may also occur in the broader context of students’ lives beyond alcohol use. This study examined nine unwanted consequences frequently associated with alcohol, comparing their occurrence when alcohol was involved and when alcohol was not involved. Data were drawn from undergraduate students participating in the Alcohol101+ program during the 2023–2024 academic year. Analyses were conducted across three demographic factors, including gender, race/ethnicity, and fraternity or sorority affiliation, and by a drinking risk classification of lower-, moderate-, and higher-risk developed using proxy measures aligned with the AUDIT-C framework. Findings indicate that the relationship between alcohol and negative consequences is not uniform. Certain consequences, such as trouble with police or school, property damage, and injury, were more frequently associated with alcohol-related situations. Other consequences, including sadness or depression and academic challenges, were more commonly reported in situations without alcohol involvement. In addition, higher-risk students experienced greater levels of negative consequences overall, and the relationship between alcohol involvement and consequences was stronger within this group. These findings suggest that while alcohol remains an important factor in many harmful outcomes, it is not the sole context in which such consequences occur. A more comprehensive approach that considers the broader experiences of students, along with targeted attention to those at higher levels of risk, may help campus leaders to more effectively address unwanted consequences and support student success.
This study examines the regulation of pre-implantation genetic diagnosis (PGD) in Germany. PGD, an assisted reproductive technology (ART), was invented in the 1980s and involves testing human embryonic cells for genetic issues as part of in-vitro fertilization (IVF) treatments. Beginning in the 1980s, Germany instituted one of the most restrictive ART policies in the world that outlawed PGD altogether. Importantly, the German policy case includes a federal court of justice ruling involving a fertility doctor who turned himself in to the police to disclose that he had violated existing law. The court’s decision necessitated a parliamentary revision of the federal law that, since 2011, allows PGD under certain circumstances. The in-depth analysis of PGD regulation in Germany between 1989 and 2011 concluded that the policy process was influenced in three important ways: First, it was marked by the institutionalized legal power of the German judiciary branch to change laws; second, it was shaped by existing legal frameworks in Germany regulating human reproduction, which defined the status of a human embryo; and third, it was impacted by the German institutional guarantee that members of parliament may vote on laws based on their personal and moral beliefs, not bound by their political party’s position. This is of particular importance because ART policy making involves questions surrounding the legal status of a human embryo and because Germany’s political party system includes two Christian-based political parties that were in power for almost two-thirds of Germany’s postwar government.
This review examines the integration of health and physical education (HPE) with art therapy in school settings for children with disabilities. Drawing on evidence from fifty high-quality studies, the review evaluates the impact of both traditional and digital art therapy, as well as adapted physical education (PE) programs, across psychosocial, cognitive, physical, and academic domains. Findings indicate that art therapy enhances psychological well-being, self-expression, and social interaction, while also contributing to improved engagement and communication. Inclusive and engaging PE supports motor skills development, participation, and overall physical health, and is associated with increased motivation and social inclusion. Interdisciplinary approaches that combine creative and physical activities show promise for holistic development. However, methodological limitations, including small sample sizes, variability in intervention design, and inconsistent outcome measures, limit the generalizability of findings. Emerging innovations, including digital art therapy and assistive technologies, offer new opportunities but require further empirical validation. This review identifies research gaps and provides practical recommendations to inform educators, therapists, and policymakers in designing inclusive, evidence-based programs that optimize holistic outcomes for children with disabilities.
Thailand’s rapid transition into a super-aged society presents critical challenges for promoting health and well-being among older adults. This study examines how a mandala art-based meditation program can function as a culturally grounded health promotion strategy to enhance happiness and mental wellness in elderly populations. A sequential mixed-method design was employed. In Phase 1, in-depth interviews with nine participants explored elderly perceptions of happiness, which were categorized into four domains aligned with Bhutan’s Gross National Happiness (GNH) framework: physical, cognitive, emotional, and social well-being. Phase 2 involved thirty participants aged 60 and above, who joined an eleven-month intervention of forty-four weekly mandala meditation art sessions, assessed through a pre–post Buddhist Happiness Scale. Phase 3 reflective discussions provided qualitative insights into lived experiences. Results revealed significant improvements across all domains, particularly emotional well-being, with participants reporting greater mindfulness, emotional balance, and social connectedness. These findings suggest that mandala-based meditation, grounded in Buddhist principles, may serve as an effective, low-cost, and culturally relevant approach to promoting elderly well-being in aging societies.
This study adopts a phenomenological approach to explore the lived experience of moving meditation—particularly Tàijí and Qìgōng—in relation to illness. Focused on the concepts of animation, that include, among others, the phenomena of movement and emotions, and body schema, as a pre-reflective awareness, the research investigates how self-movement and affectivity constitute modes of being-in-the-world. The study was conducted using semi-structured micro-phenomenological and focusing interviews with practitioners, with and without medical conditions, to identify generic structures of the experience. Six generic basic units were identified: disposition, nature of movement, natural breathing, pre-reflective bodily awareness, grounding, and emotional flow. These units may form a non-linear diachronic structure that reveals the rhythmic and intentional harmony between movement and emotions. In the experience of illness, the animated organism’s harmony is disrupted, expressed as affective-kinesthetic patterns unique to each existential situation. The findings suggest that through continuous practice, moving meditation promotes the regulation of these patterns and may restore the person’s connection with the world. The study introduces the notion of bodily melodic patterns to describe this integrative process, that highlights the dynamic unity of movement, emotion, and awareness. Emphasizing the first-person perspective, the study offers a framework to explore the lived experience of patients in medical practice, reaffirming the embodied and affective dimensions of human life.
Generative artificial intelligence (GenAI) is transforming healthcare leadership by shifting decision-making from hierarchical control to hybrid human–AI collaboration. This study investigates how senior healthcare and information technology (IT) executives adopt, trust, and govern GenAI within complex decision environments where algorithmic systems influence authority, accountability, and ethical oversight. The study used a mixed-methods design, combining quantitative survey data from 319 healthcare and IT leaders with 27 semi-structured executive interviews. Statistical analyses, including ANOVA (analysis of variance), regression, and factor analysis, examined relationships among digital literacy, ethical governance, and organizational trust, while thematic analysis explored leaders’ perceptions of GenAI’s agency in decision-making. Findings indicate that GenAI functions as an agentic collaborator, shaping how leaders frame problems and justify decisions. Adoption is highest among digitally fluent, mid-career executives in organizations with formal AI ethics frameworks. Trust remains conditional, depending on explainability, bias auditing, and human oversight. Ethical governance—anchored in ethics boards, explainability dashboards, and multidisciplinary review—emerges as the strongest determinant of organizational legitimacy. The study advances a hybrid-intelligence leadership model, extending transformational, complexity, and ethical leadership theories to reflect distributed authority between human and algorithmic actors. Practically, it calls for institutionalizing AI governance, expanding executive digital literacy, and embedding participatory oversight mechanisms across health systems. GenAI’s success in health care will depend less on its technical sophistication than on leaders’ capacity to govern its agency responsibly, ensuring that algorithmic innovation reinforces fairness, transparency, and trust in human-centered care.
Shift work, which encompasses irregular and nocturnal schedules, affects approximately 30% of the workforce in Western countries. Prolonged exposure disrupts circadian rhythms and generates chronodisruption, increasing the risk of hypertension (HTN), myocardial infarction, and other cardiovascular diseases (CVDs). These effects are exacerbated by age, unhealthy lifestyles, and occupational psychosocial factors. Understanding this phenomenon is fundamental to protecting the cardiovascular health of older workers. The objective is to analyze the available scientific evidence regarding the effect of shift work on health, risks, and incidence of CVDs in older workers. This review was registered in PROSPERO. A PICO question was formulated to evaluate the effects of shift work on older workers. Articles published between 2020 and 2025 were searched in international databases, applying predefined inclusion and exclusion criteria. The methodological quality of the studies was assessed using the STROBE guideline, and the main findings, limitations, and conclusions were presented in summary tables. Shift work, particularly prolonged night shifts, increases the risk of metabolic and cardiovascular disorders in older workers. Higher rates of HTN, obesity, and dyslipidemia were reported, with variations according to sex and occupation type. Furthermore, high job demands alter blood pressure patterns and reduce physical activity. Flexible working conditions and psychosocial support mitigate the negative effects on cardiovascular health. We conclude that systematic exposure to shift work, particularly night shifts, disrupts circadian rhythms and contributes to metabolic and cardiovascular disorders in older workers. The evidence underscores the importance of organizational adjustments and work conditions tailored to the aging process.
Registered dietitians serve as the trusted source of food and nutrition information in a variety of professional settings. Whereas clinical practice remains a top priority, dietitians also work in health promotion settings with children and adults across the lifespan. The main aim of this study was to describe and explain searches from the Children’s Picture Book Database at Miami University (CPBD@MU), available and sustained on the internet since 1995, to support dietitians who need educational materials when working with children. Assumptions highlighting the value of using a picture book database for descriptive research will be discussed. Methods—Descriptive data were tallied from the CPBD@MU using 5,900 picture books assigned with 1,300 multidisciplinary tags and sorted by eight disciplines in the elementary school curriculum: health education, physical education, art, music, science, language arts, social studies, and mathematics. Data included 1,339 books with the keyword of food and 895 books with the keyword of nutrition. Results—Nutrition and food storylines represented 15% and23% of the curated collection, respectively, from the census of 5,900 picture books in the CPBD@MU. Investigators also examined Boolean searches using combinations of keywords from 1,300 multidisciplinary tags. Page views in Google Analytics for one year showed that nutrition was the eighth-highest performing category out of fifty-nine topical categories from multidisciplinary searches in the CPBD@MU. Conclusions—Picture books represent a resource for communicating food and nutrition information to children. Dietitians can form partnerships with teachers, librarians, parents, and community health workers to support children’s health by accessing, analyzing, and promoting hundreds of picture books about food and nutrition found in the curated CPBD@MU. Sample search strategies for accessing food and nutrition books by topics, concepts, and skills are shared, including philosophical and educational implications when professionals use picture books with children.
The COVID-19 pandemic influenced a variety of health issues—including physical activity (PA). College students are a particularly interesting population to examine because the pandemic influenced their living space, education experience, access to gyms, and proximity to work-out buddies. The purpose of this study was to use the social ecological theory to examine how COVID-19 influenced PA levels of college students, as well as to examine the facilitators and barriers to exercise. This study uses a sequential explanatory mixed-methods study to examine college students’ PA during COVID-19. The study draws on 489 completed surveys and twenty semi-structured interviews to examine PA experiences during COVID-19. Results indicate that overall PA levels for college students decreased during the initial phase of the pandemic. However, this was due to a multitude of factors that unfolded on multiple levels, including individual factors, interpersonal relationships, communities, and societal decisions. Understanding the complexity of PA participation is needed during precarious times such as pandemic restrictions to help keep university students active for physical and mental health.
Depression often goes undiagnosed because of reluctance by patients to seek professional help. Individuals may seek health care information about depression online in the form of depression inventories for self-reporting, which reflect some of the symptoms listed in the manuals used by mental health practitioners to diagnose patients. Alternatively, patients may turn to online mental health communities (OMHCs) for social support, to seek advice and to engage with similar others. Four topic modeling approaches and a subsequent thematic analysis were employed on 11,975 posts from the r/depression subreddit to develop themes that represent the experiences of people with depression. The results of the topic models were used to identify twenty-three sub-themes that were categorized into four greater themes: (1) depression attributions, (2) manifestations of depression, (3) mechanisms for coping with depression, and (4) expressions of depression. The twenty-three sub-themes encompass the nuanced and diverse ways in which people communicate about depression. The use of a computational topic modeling approach and a qualitative thematic analysis approach, when applied to unstructured text data from an OMHC, led to finding symptoms from the text that mirror the symptoms outlined in established depression diagnostic tools. The criticisms of revisions made to depression inventories and standardized diagnostic tools can be addressed by fine-tuning the diagnostic criteria to consider the aspects of depression expressed by individuals experiencing depression.
The following qualitative study focused on the role of workplace identity in mitigating stress among Canadian medical laboratory professionals. The research highlights three years of peer support sessions with a focus on messaging regarding role, identity, and mental health. The authors propose relationships between professional identity theory, social cognitive career theory (SCCT) and stress buffering theory to demonstrate that medical laboratory professionals’ enjoyment of their role and strong identification with their role act as protective factors against stress and burnout. The authors propose a link between the three theories as an explanation for the results. Clear themes are found within the data, specifically related to love, patient care, and compassion. The study also proposes tangible actions for employers to take to develop these relationships further and assist in empowering medical laboratory professionals. These include showcasing the skills, knowledge, and abilities of medical laboratory professionals. Additionally, within the lab, promotional materials and messaging that outline their strengths could be prominently displayed.
Roger Ulrich’s landmark study of hospital inpatients, “View Through a Window May Influence Recovery from Surgery,” was pivotal in establishing not only the benefits of contact with nature for building occupants but also the value of evidence-based environmental design. A large body of subsequent research has since confirmed its central thesis—that contact with nature is psychologically and physiologically good for us. While that conclusion is now beyond doubt, this follow-up study suggests that there may have been other factors involved in the Paoli Hospital Patient Study beyond the presence and absence of nature. It is postulated that significant differences in both the depth of the two views compared and the amount of visible movement they contained may also have contributed to the results of the Paoli study. Visual evidence of these differences is presented, followed by the results of a series of studies by the authors indicating that both of these factors affect stress. It is suggested that further studies, actively controlling for view depth and visible natural movement would be valuable in order to determine their relative contributions to stress reduction and how they might interact. The potential implications of these findings for the design of windows in general, and those in healthcare spaces in particular, are then discussed.
This research investigation sought to discover the existence of ready-made scales to assist in determining a “first-look” level of suitability for possible participant inclusion in human subject research, but none were located. The researchers, following the advice of journal article authors and predecessors who were in similar circumstances, decided to undertake the task of constructing the required tool. The Human Subject Barrier Scale used the seven components (Awareness, Desire (to engage), Willingness (to Participate), Commitment, Knowledge, Ability, and Epiphany) of the researchers’ Engaged Aging Concept as potential barriers to participation in behavioral research, as well as to assist in determining whether any of these seven barriers may prevent successful participation in human subject research. Based upon their expertise as gerontology researchers, they chose to incorporate mixed methods research into the study framework. Further, the researchers sought to use a multi-national participant base to mirror the projected participant pool. Finally, the researchers conducted a mini-peer-review of both the quantitative and qualitative research methods that were used while constructing the new scale.
The use of artificial intelligence in clinical decision-making poses philosophical challenges with regard to the democratization of science. In today’s clinical culture, patient engagement, a modality of science democratization, is increasingly vital for epistemic, ethical and pragmatical reasons. The traditional reliance on problem-solving strategies such as basic science, applied science, and professional consultation proves less effective in a medical age marked by uncertainties and risks that stem from rapid medical advances. Post-normal medicine calls for a methodology that integrates the perspectives of all stakeholders, and patient engagement seems to fulfill the requirements for such a methodology. This paper analyzes AI’s possible impacts on patient engagement. Serving as an intermediary between patients and healthcare experts, AI possesses the potential to enhance the epistemic, ethical and practical dimensions inherent to patient engagement. Nonetheless, AI also faces limits. Its weak and narrow nature makes it particularly fragile, and even threatening, when seeking to take control of medicine’s distinctive features as a science of design, features that happen to lie at the heart of patient engagement, such as intuition, empathy, and the consideration of individual circumstances.
Ethnic migrant youth in Australia face compounded psychosocial challenges due to the intersection of adolescence, migration, and systemic marginalization. These challenges include cultural dislocation, identity confusion, and limited access to culturally appropriate mental health services. Despite Australia’s multicultural policy commitments, conventional mental health interventions remain largely Western-centric and inadequately address the complex social determinants affecting migrant youth. This study undertakes a systematic qualitative literature review to explore the intersection of art therapy, intersectionality, and acculturation in supporting the psychological well-being of ethnic migrant youths in Australia. Guided by the PRISMA framework and using Braun and Clarke’s thematic analysis, forty-two peer-reviewed studies were synthesized to identify key themes related to non-verbal therapeutic engagement, bicultural identity development, and structural barriers to mental health access. The findings highlight the potential of art therapy as a culturally responsive intervention capable of fostering emotional expression, resilience, and social inclusion. When informed by intersectionality theory, art therapy can more effectively address the unique and layered marginalization experienced by this population. This review offers a holistic framework for integrating intersectionality and creative therapeutic practices into youth mental health services, with implications for policy, education, and clinical practice aimed at enhancing outcomes for culturally diverse young Australians.
Global challenges such as climate change, international conflicts, the COVID-19 pandemic, and civil unrest have intensified the worldwide mental health crisis. This has spurred a demand for effective interventions, particularly in areas related to youth development. The purpose of this article is to explore whether Outdoor Adventure Education (OAE) may be one such effective treatment. To examine the effectiveness of these programs, this study assesses the impact of OAE participation on young adults aged 18 to 22, focusing on the variables of anxiety, depression, hope, and resilience. Employing online surveys and a thirty-item inventory within a retrospective pretest design, the research analyzed changes in these psychological variables through repeated-measure t-tests. Findings reveal significant improvements in anxiety, hope, depression, and levels of resilience. These results suggest that the inclusion of OAE as a component in mental health interventions can bolster resilience and feelings of hope and reduce levels of anxiety and depression among individuals.
