Correctional healthcare is delivered at the intersection of two institutional mandates: protection of health and maintenance of custody and security. This commentary develops an experience-based operational re-engineering model for prison healthcare, building on the Italian transition of penitentiary medicine to the National Health Service (NHS) and on direct executive management within a Prison Medical Center. Rather than proposing a new regulatory architecture, the model translates existing legal, ethical, and clinical-governance requirements into operational processes. Particular attention is given to the practical implementation of Article 11 of the Italian Penitentiary Law, equivalence of care and Essential Levels of Care, informed consent and treatment refusal, clinical risk management, medication governance, electronic traceability, dedicated clinical pathways, telemedicine, gender-responsive care, and continuity at transfer or release. The central organizational premise is that the healthcare-custody interface should be governed through shared procedures, explicit responsibilities, and auditable clinical documentation, while preserving clinical independence and patient autonomy. The proposed framework is intended as an adaptable, experience-informed operational model that may support improvements in safety, appropriateness, continuity, accountability, and equity in correctional healthcare, including in other jurisdictions.
Background/Objectives: Effective heart failure (HF) self-management requires sustained engagement in symptom management, dietary behaviors, and medication adherence. This randomized controlled trial evaluated Pender’s Health Promotion Model (HPM)-informed online education combined with telephone reinforcement in adults with HF. Methods: In this single-center, parallel-group trial, 60 adults were randomized 1:1 to intervention (n = 30) or usual care (n = 30). The intervention comprised individualized synchronous online education and telephone reinforcement at 2 weeks and 1 month. Self-reported dietary behaviors, symptom burden, and medication adherence were assessed at baseline and 2 months. Linear mixed-effect models evaluated group-by-time effects, with Holm adjustment for three prespecified primary outcomes. Age-adjusted sensitivity analyses were conducted. The trial was prospectively registered (NCT07017751). Results: All 60 participants completed follow-up. Group-by-time effects favored the intervention for all outcomes (Holm-adjusted p < 0.001 each). Between-group differences in change were 12.77 points (95% CI, 10.22 to 15.31) for dietary behaviors, −17.27 (95% CI, −24.56 to −9.97) for symptom burden, and −2.33 (95% CI, −3.37 to −1.30) for medication adherence. Findings remained significant after age adjustment. Conclusions: HPM-informed online education combined with telephone reinforcement improved self-reported dietary behaviors and medication adherence and reduced symptom burden compared with usual care over 2 months. Although the unblinded design and reliance on self-report warrant cautious interpretation, these findings support the potential value of this combined nursing intervention for short-term HF self-management. Larger trials with longer follow-up and objective clinical outcomes are needed.
Background/Objectives: Chronic kidney disease (CKD) is frequently associated with malnutrition and protein-energy wasting. Nephrology nurses (NNs) contribute to nutritional education, counseling, screening, and monitoring, but their roles and competencies remain poorly defined. This scoping review mapped NNs’ nutritional roles and competencies in adult CKD care. Methods: This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA-ScR reporting guidelines. The protocol was registered on the Open Science Framework (OSF) 10.17605/OSF.IO/YMW4F. The research question used the Population–Concept–Context framework: NNs as the population, nutritional nursing competencies as the concept, and adult nephrology care settings as the context. Eligible studies involved nurses in adult nephrology settings and addressed nutritional nursing roles, competencies, counseling, assessment tools, or related care processes. Searches were conducted on 23 May 2026 across PubMed/MEDLINE, Embase, CINAHL, Scopus, Web of Science, Cochrane Library, and Google Scholar. Two reviewers independently charted data using a structured form and synthesized findings into thematic domains. Results: Of 4699 identified records, 20 studies were included. Evidence encompassed nursing roles and activities, assessed or perceived competencies, knowledge gaps, and outcomes of nurse-led interventions, organized into five thematic domains: educational and communicative, clinical and advanced, collaborative and professional, general or basic nutritional, and guidance and counseling. The evidence was heterogeneous, predominantly derived from dialysis settings, and no formal critical appraisal was undertaken. Conclusions: NNs may contribute to nutritional CKD management, although the evidence does not uniformly reflect directly assessed competence. Structured training and standardized competency assessment may warrant further evaluation. No external funding was received.
Background: Obstetric violence ranges from verbal abuse to non-consensual physical interventions, violating women’s fundamental rights during childbirth. Despite its prevalence, it is often analyzed as an isolated instance of individual misconduct, neglecting the structural and cultural determinants that normalize it. Objective: To analyze the scientific literature on obstetric violence, examining its associated factors from the theoretical lens of Heise’s social–ecological model. Method: A scoping review was conducted following the methodology of Arksey and O’Malley. Scientific literature on obstetric violence published between 2015 and 2025 was identified in PubMed, SciELO, CINAHL, Scopus, ScienceDirect, MEDLINE, and Taylor & Francis. A Braun and Clarke deductive thematic analysis was applied to categorize the findings into the four levels of the Heise model: ontogenetic, microsystem, exosystem, and macrosystem. Results: A total of 48 articles from 23 countries was included, predominantly from Africa 13 (27%) and South America 12 (25%), with Ethiopia 6 (13%) and Brazil 5 (10%) standing out. The studies revealed 38 factors associated with obstetric violence, distributed across the ontogenetic level (18), microsystem level (8), exosystem level (10), and macrosystem level (2), demonstrating the multifactorial and intersectional nature of the issue, where institutional failures undermine maternal autonomy. Conclusions: Obstetric violence goes beyond poor individual care, emerging as a systemic and structural phenomenon. Using Heise’s model the factors were organized into dimensions, highlighting problems such as service overload and resource constraints that create environments associated with greater exposure to abuse among the most vulnerable women. Therefore, strategies are needed to address structural failures, anticipate violence, and ensure a respectful and safe childbirth experience.
Background/Objectives: The independent associations between baseline psychological factors and subsequent exercise adherence in chronic low back pain remain uncertain. This exploratory secondary analysis examined these associations while accounting for intervention allocation. Methods: Sixty participants from a randomized trial completed an eight-week exercise program with or without the Move Quiz app. Baseline depression, anxiety and stress were assessed using the Depression Anxiety Stress Scales-21 (DASS-21), kinesiophobia using the Tampa Scale for Kinesiophobia (TSK) and catastrophizing using the Pain Catastrophizing Scale (PCS). Adherence was self-reported using the Exercise Adherence Rating Scale (EARS) at Week 8. Analyses included Spearman correlations, simultaneous regression adjusted for allocation, HC3 robust inference, sensitivity analyses and leave-one-out cross-validation (LOOCV). Results: All five baseline scores correlated inversely with EARS (Spearman rs = −0.55 to −0.78; all p < 0.001). In the allocation-adjusted model, TSK remained associated with lower EARS (B = −0.228, HC3 95% confidence interval [CI] −0.323 to −0.133; p < 0.001). The PCS estimate was negative but less certain (B = −0.082, HC3 95% CI −0.167 to 0.003; p = 0.058); DASS-21 subscales showed no clear independent associations. The model including allocation had R2 = 0.807, LOOCV R2 = 0.757 and root mean squared error = 1.75 EARS points. These are internal performance estimates. Conclusions: Kinesiophobia showed the most consistent association with subsequent self-reported adherence. The small sample, self-reported outcome and uncertain catastrophizing and distress findings support cautious interpretation. Statistical associations and internal model performance do not establish causality, clinical utility or accuracy in independently recruited patients.
