Abstract Background Perinatal mental health issues are widely recognized as a significant public health concern; however, fathers remain underrecognized and underserved within perinatal care systems. Existing reviews have largely focused on mothers, infants, couples, or general paternal mental health interventions, leaving limited synthesis of technology-based and digitally delivered support relevant to paternal perinatal depression. Digital interventions, including SMS programs, online groups, web-based platforms, mobile health apps, and hybrid digital follow-up, may offer flexible ways of engaging fathers; however, their evidence base remains unclear. Objective This scoping review aimed to map the available evidence on technology-based, digitally delivered, and hybrid interventions relevant to paternal postnatal depression and paternal perinatal mental health. Specifically, it examined the types of evidence available; how interventions varied by delivery mode, methodology, and population; how interventions were characterized in terms of format and duration; and what outcomes had been measured across studies. Methods This review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework. A comprehensive search was conducted between February and April 2025 and updated in June 2026 across multidisciplinary electronic databases. Search terms covered 4 concepts: fathers or nonbirthing parents, perinatal mental health, digital or technology-based modalities, and intervention or evaluation purpose. Eligible studies were peer-reviewed English-language articles in which fathers, expectant fathers, new fathers, male partners, or nonbirthing parents were active participants, target users, or reported subgroups, and in which a digital, technology-based, or hybrid support strategy was described or evaluated. Data were charted and synthesized descriptively and comparatively. Results Six studies met the inclusion criteria. The evidence included a feasibility study of an SMS-based, father-specific program, randomized controlled trials of hybrid psychoeducational or paternal support interventions, a pilot randomized feasibility trial of an online cognitive behavioral therapy–based intervention for pregnant people and partners, a mixed methods online group intervention for new fathers, and a feasibility, acceptability, and usability study of a father-specific mobile health app. Delivery modes included SMS messaging, WhatsApp follow-up, online video, telephone follow-up, online groups, web-based intervention content, and mobile app features. Outcomes included depression, anxiety, stress, parenting stress, dyadic adjustment, marital quality, resilience, usability, acceptability, engagement, adherence, and qualitative user experience. Findings were most consistent for feasibility, acceptability, and engagement, while evidence for effectiveness in reducing paternal postnatal depression remained limited and mixed. Conclusions The current evidence base is small, heterogeneous, and preliminary. Digital interventions may offer acceptable ways to engage some fathers and partners during the perinatal period. However, there is insufficient evidence to draw firm conclusions about effectiveness, scalability, or suitability for fathers experiencing perinatal depression. Future research should prioritize father-specific, theory-informed, co-designed digital interventions using validated paternal outcomes, longer follow-up, transparent engagement reporting, and more diverse samples.
Background:Lung transplantation (LTx) is an established treatment for patients with end-stage lung diseases and can substantially improve survival. However, posttransplant recovery involves complex physical, psychological, and functional challenges, making quality of life (QoL) an important outcome beyond survival alone. Evidence on early longitudinal QoL changes after LTx remains limited, particularly in Chinese recipients and when assessed using disease-specific patient-reported outcome instruments. Objective:This study aimed to assess QoL and track its longitudinal changes in patients who underwent LTx using a disease-specific patient-reported outcome instrument. Methods:This single-center prospective cohort study screened 66 patients for enrollment who underwent LTx at the Xi'an Jiaotong University Lung Transplantation Center in China from June 2023 to December 2025. QoL was assessed using the Chinese version of the Lung Transplant Quality of Life questionnaire at baseline (preoperative) and serially at 1, 2, 3, 4, 5, and 6 months after surgery. The Lung Transplant Quality of Life questionnaire comprises 40 items across 7 domains, and each domain score was calculated as the item mean (range 0-4). Random-intercept linear mixed models (LMMs) with both categorical and linear time specifications were fitted separately for each domain to evaluate longitudinal changes, accounting for repeated measures and incomplete follow-up under the missing at random assumption. Results:A total of 203 interviews from 51 eligible patients were included in this study, with a median of 5 (IQR 2-6) interviews for each patient. LMM analysis revealed significant overall time effects in 6 of 7 domains (likelihood ratio test: P<.01 in all cases). Health perceptions showed the earliest and largest improvement (LMM-adjusted mean difference [MD] -1.58 at month 6; β=-0.23 points per month; P<.001), followed by respiratory symptoms (MD -0.95 at month 6; β=-0.15 per month), anxiety and depression (MD -0.82 at month 6; β=-0.13 per month), digestive symptoms (MD -0.50 at month 6; β=-0.10 per month), and cognitive limitations (MD -0.51 at month 6; β=-0.09 per month; P<.001 in all cases). Global well-being was the only domain with a positive trajectory (MD 1.18 at month 6; β=0.13 per month; P=.002), with significant improvement already evident at month 1 (MD 0.71; P=.23). Conclusions:LTx significantly improved QoL in patients with end-stage lung diseases, with the most substantial gains in health perceptions and respiratory symptoms. Patient-reported outcome-based monitoring can capture clinically meaningful QoL changes and should be integrated into routine posttransplant care to identify critical intervention time points and optimize long-term recovery.
Background:Emerging evidence supports that women with histories of abuse have heightened stress and immune dysregulation. Few studies have examined the biological plausibility of this association in US Black women-a population disproportionately affected by gender-based violence (GBV), health disparities, and generally underrepresented in research. Biomarkers of stress and immune health remain challenging to study due to barriers in recruitment, retention, and protocol adherence. Objective:This study developed and examined the feasibility of an at-home, self-collected, and minimally invasive salivary cortisol awakening response (CAR) collection protocol among Black women with histories of abuse in Baltimore City, Maryland. Methods:Black women were recruited from November 2015 to May 2018 from Baltimore City sexually transmitted disease clinics. Participants received in-person instruction and demonstration on saliva self-collection using the passive drool method, and were provided study-issued cell phones for reminders and adherence tracking. Participants self-collected saliva samples upon waking and 30 minutes post waking on 3 consecutive days to assess CAR. Outcomes included protocol completion, self-reported adherence, and experiences (via saliva collection logs), a weighted protocol adherence score, and cortisol measures (waking, post waking, and CAR). Differences in sociodemographic characteristics and outcome measures were assessed by adult forced sex exposure status using chi-square tests and ANOVA. The Pearson correlation coefficient assessed the day-to-day reproducibility of cortisol measures among women with 2 full days of valid samples. Results:Of the 305 women completing the study survey, 228 completed the saliva specimen collection protocol, with no significant differences in completion between women with and without forced sex histories. Protocol feasibility was high, with 84% (191/228) completing at least 1 full day of adherent saliva collection and more than half (132/228) completing 2 full days. While feasibility did not differ by exposure status, women with adult forced sex exposure demonstrated lower protocol adherence scores compared to their unexposed counterparts. Between-day cortisol measures demonstrated variable reproducibility across waking, post waking, and CAR measures. Conclusions:This at-home salivary cortisol collection protocol was feasible in our robust sample of Black women with histories of abuse. The process of at-home collection of salivary biomarkers, including cortisol measures, was well-documented, and participants were able to adhere to it. The protocol yielded usable data that will facilitate the examination of the physiological and health repercussions of GBV.
Background:Cardiac resynchronization therapy with defibrillator (CRT-D) improves survival, reduces hospitalization, and enhances quality of life in patients with heart failure and reduced ejection fraction (HFrEF). As heart failure prevalence increases in aging societies such as Japan, the associated clinical and economic burden continues to rise. Previous cost-effectiveness analyses conducted in multiple countries indicate that CRT-D may be cost-effective in selected patients with HFrEF. However, its cost-effectiveness within the Japanese health care system remains uncertain. Objective:This study aimed to evaluate the cost-effectiveness of CRT-D in patients with HFrEF within the Japanese health care setting. Methods:A partitioned survival model was developed with 3 health states: after treatment (follow-up), hospitalization, and death. Survival for CRT-D was estimated by reconstructing individual patient-level data from the Kaplan-Meier curve of the RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study using the method proposed by Guyot et al followed by fitting multiple parametric models; the gamma distribution was selected for the base case analysis. Survival for optimal medical therapy (OMT), the comparator, was estimated by applying a hazard ratio from a published meta-analysis. Hospitalization rates and device longevity were derived from prior studies. Cost estimates were obtained from the JROAD-DPC (Japanese Registry Of All cardiac and vascular Disease-Diagnostic Procedure Combination) database and the Japanese medical fee schedule. Utility values were assigned according to New York Heart Association class assuming treatment-specific distributions. The analysis was conducted from the public health care payer perspective using a monthly cycle over a 20-year time horizon. Deterministic and probabilistic sensitivity analyses were performed. Additionally, scenario analyses were conducted by varying the duration of treatment effect. Results:In the base case analysis, per capita costs were ¥12,258,410 (¥1=US $0.006 as of July 7, 2026) for CRT-D and ¥640,056.90 for OMT, resulting in an incremental cost of ¥11,618,353. CRT-D generated 7.07 quality-adjusted life years (QALYs) compared with 4.75 QALYs for OMT, yielding an incremental gain of 2.32 QALYs. The incremental cost-effectiveness ratio (ICER) was ¥5,009,880 per QALY. Scenario analyses showed that, when treatment effect waned after 7.5 years, the ICER increased to ¥5,423,235 per QALY. When the time horizon was shortened to 10 years or extended to 30 years, the ICERs were ¥8,523,072 and ¥4,386,803 per QALY, respectively. Deterministic sensitivity analysis identified CRT-D efficacy (hazard ratio), discount rate, and initial treatment cost as primary ICER drivers. Probabilistic sensitivity analysis produced a median ICER of ¥5,022,618 (IQR ¥4,448,306-¥5,760,425) per QALY, with a 95% credible interval of ¥3,804,418 to ¥7,178,795. At a willingness-to-pay value of ¥5,000,000 per QALY, CRT-D had a 49.2% probability of being cost-effective. Conclusions:CRT-D demonstrated acceptable cost-effectiveness in patients with HFrEF in Japan. Treatment efficacy and initial cost were the primary determinants of economic value, emphasizing the importance of appropriate patient selection and strategies to reduce device costs.
Unlabelled:Our study uses the latest Transparency in Coverage data to show that there is wide variation in health care prices for some of the most commonly utilized services in the United States. The findings demonstrate that there is an opportunity for employers, policymakers, and other stakeholders to curb health care spending by choosing cost-efficient health care networks and providers.
Background:In recent years, German long-term care (LTC) insurance has experienced an unprecedented increase in the number of beneficiaries. This raises the question of the role of health care in preventing or delaying the need for LTC. At present, related findings are limited. Addressing this research gap could promote longevity and improve quality of life while reducing the financial strain on the social security system. Objective:This study aimed to investigate the associations between the utilization of health care services and first-time LTC need. Methods:This retrospective cohort study examined nationwide linked claims data from the German statutory health and LTC insurance fund, AOK. The dataset included all individuals aged ≥60 years. Using multiple logistic regression, we investigated the association between health care utilization during the 5-year exposure period from 2016 to 2020 and the occurrence of first-time LTC need during the first quarter of 2021. Physician care, pharmaceutical care, physiotherapy, and medical aids were analyzed while adjusting for age, sex, regional variables, and comorbidities. Metrically scaled variables were categorized using the Fisher-Jenks algorithm to explore possible nonlinearities. Individuals who needed LTC prior to 2021 were excluded. Results:The study population comprised 5.3 million individuals. A total of 54.3% (n=2.9 million) were women, and the mean age was 71.3 (SD 8.16) years. Receiving more than 2 of the 5 recommended screenings and vaccinations examined, compared with receiving none, was associated with a strong reduction in the odds of first-time LTC need (odds ratio [OR] 0.62, 95% CI 0.60-0.64; P<.001). Odds of first-time LTC need were also significantly lower with high numbers of specialist groups and low numbers of specialist days (more than 7 specialist groups consulted and fewer than 48 billing days) compared with no specialist utilization (any specialist utilization: OR 0.82, 95% CI 0.79-0.85; P<.001; more than 7 instead of fewer than 5 specialist groups: OR 0.94, 95% CI 0.92-0.96; P<.001). Likewise, a physiotherapy prescription in between 5 and 10 quarters of the 5-year period instead of none was related to lower odds of first-time LTC need (OR 0.81, 95% CI 0.79-0.83; P<.001). Generalist care, hospitalizations, polypharmacy, and potentially inadequate medication were concomitant with first-time LTC need. Among the disease management programs and medical aids examined, there were both positive and negative relationships with first-time LTC need. Conclusions:Utilization of recommended screenings, vaccinations, specialist physician care, and physiotherapy is substantially and significantly associated with the nonoccurrence of first-time LTC need in the older German population. Our study provides a foundation for future research on orienting health care toward preventing functional decline.
Background:Over the past 2 decades, concerns have arisen about the distinction between health span and lifespan, highlighting that longevity does not necessarily equate to good health, a concept often referred to as "healthy longevity." While various strategies have been explored to promote healthy aging and achieve healthy longevity, it remains uncertain which practices are most effective. Objective:This scoping review identifies the existing and emerging practices and interventions that promote healthy longevity, identifies the key components of these practices and interventions, and considers how stakeholders contribute to these practices and interventions. Methods:A scoping review of the literature was conducted using Arksey and O'Malley's 6-stage framework. The Joanna Briggs Institute Population-Concept-Context framework was used to define the eligibility criteria and select studies reporting practices or interventions aimed at achieving a long health span or promoting healthy longevity carried out in the community. Data were manually extracted by 2 independent reviewers to detail the characteristics of these practices and interventions and guide the data charting process and narrative synthesis. Six databases (PubMed, Web of Science, Embase, Scopus, CINAHL, and Google Scholar) were searched for academic papers published between January 2010 and February 2025. Results:A total of 21 studies met the inclusion criteria. Most studies (n=15, 71%) were published after 2020 and were predominantly conducted in high-income settings (n=17, 81%) across North America, Europe, and Asia. Four study types were identified: interventional (n=7, 33%), intervention development (n=4, 19%), association (n=5, 24%), and descriptive (n=5, 24%). Interventional and intervention development studies primarily described multicomponent programs targeting individual and social determinants of health and generally reported beneficial effects on physical, cognitive, and psychosocial outcomes. Association studies linked micro-, meso-, and macro-level factors (eg, nutrition, household expenditure, housing quality, health insurance, and public financing policy) to healthy longevity indicators. Descriptive studies highlighted themes across the micro and meso levels, including finance, physical activity, mental and spiritual health, digital literacy, independent living, safety, social support, and health care support. Conclusions:The identified community-based strategies, practices, and policies that extend health span represent the joint efforts of multiple stakeholders and disciplines. The implementation of these practices and policies is worthy of being supported. More studies in diverse socioeconomic contexts are needed.
Background:Aging populations worldwide face increasing health care demands, particularly for chronic disease management. While telemedicine offers a viable solution to enhance health care access, significant trust-related barriers hinder its adoption among older adults, warranting a scoping synthesis of available evidence. Objective:This scoping review aims to map the available evidence on trust barriers experienced by older adults in telemedicine, identify underlying vulnerability domains, and chart the evidence base for design and policy recommendations. Methods:We conducted a scoping review in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, analyzing literature from PubMed, Web of Science, and Scopus. Thematic analysis was applied to synthesize findings from 30 included studies. Results:Four primary trust barriers were identified: technophobia and technical difficulties, privacy and data security concerns, negative emotional and social impacts, and a strong preference for in-person care. These barriers mapped onto 4 vulnerability domains: limited telemedicine literacy (particularly low eHealth self-efficacy), declining health status (including sensory and cognitive impairments), psychological and cognitive factors (such as anxiety about losing autonomy), and inadequate social support systems. The review also underscored how rapid technological change amplifies these challenges for older adults. Conclusions:Effective telemedicine implementation for older adults requires multipronged interventions, including age-appropriate interface design, targeted digital literacy training, robust privacy protections, and personalized support systems. These approaches address both technological and psychosocial barriers, potentially increasing engagement while mitigating vulnerabilities. Future research should assess the effectiveness of these interventions across diverse older populations.
Background:Digital medication adherence interventions for individuals diagnosed with chronic conditions have been developed, but their long-term efficacy in improving medication adherence has been limited. Exploring mechanisms and contexts related to outcomes of digital medication adherence interventions is important for these to be effectively tailored for different populations and contexts. A realist review was conducted to assess which intervention components might work for whom, and under what circumstances. Methods:A realist review of literature published between 2002-2024 was conducted. Studies reporting digital medication adherence interventions for people diagnosed with chronic diseases and experiencing unintentional medication nonadherence issues were included. MEDLINE, CINAHL, PsycInfo, Web of Science, Scopus, Embase, and gray literature databases, Overton, and Policy Commons were searched. Data regarding contexts, mechanisms, and outcomes were extracted and synthesized into program theories. Program theories from the realist review were triangulated with findings from two rounds of workshops (three workshops in each round), in which context-mechanism-outcome (CMO) configurations were cocreated with various stakeholders of a project aimed at implementing a digital medication adherence intervention to reduce unintentional nonadherence among people with chronic diseases. There were 12 participants in each round. Results:The analysis of 83 papers and content of the cocreation workshops led to 35 CMOs theories in seven theory areas, which were (1) building and maintaining medication intake habits; (2) solving medication-related barriers to adherence; (3) enabling collection of prescription medications on time; (4) supporting people with unpredictable health conditions and sensory or motor impairments; (5) supporting individuals with high anxiety, low medication self-efficacy, and low social support; (6) supporting individuals who are uncomfortable with technology; and (7) economic, policy, and organizational factors affecting implementation of smart medication devices. Fourteen CMOs came from both the literature and workshops, 7 CMOs from the literature alone, and 14 CMOs from the workshops alone. Conclusions:Analysis of the program theories suggested a range of intervention components considering contextual factors that may improve medication adherence of individuals. These were used to form recommendations for intervention developers and implementers. Further studies are required on policy and economic factors affecting large-scale implementation of digital medication adherence interventions in different settings. Future interventions should report intervention content and delivery in detail and codevelop effective implementation strategies with professionals who can support the implementation of the intervention.
Background:With the ongoing digitalization of health care, digital health literacy (DHL) is becoming increasingly important, requiring appropriate measurement instruments (DHLMIs). However, the wide range of available DHLMIs makes selection difficult and raises questions about their suitability and comparability. Objective:This review aimed to provide an overview of available DHLMIs for adult populations and to compare their dimensions, identifying overlaps and differences to determine which (key) dimensions are most commonly studied and thus define DHL. Methods:A narrative overview of reviews was conducted. The database search was conducted in November 2024, with an updated search in March 2026, in PubMed and Google Scholar using specific search terms and predefined inclusion and exclusion criteria. This was complemented by a forward citation search in Web of Science. All identified records were screened in a multistage process. At the review level, systematic and scoping reviews published since January 1, 2020, were included that analyzed DHLMIs in adult populations. At the primary study level, studies were included in which DHLMIs were used for self-assessment, performance-based evaluation, or a combination of both. Data extraction was performed by one reviewer and verified by a second reviewer. Data on underlying theories, methods of data collection (performance-based or self-reported), and target groups were extracted. DHL dimensions, their definitions, and the associated items were categorized by 2 researchers using qualitative content analysis according to Kuckartz. Results:A total of 12 reviews were included. Of the 170 measurement instruments examined in these reviews, 33 (19%) were selected for detailed analysis after applying the inclusion and exclusion criteria. The majority of the included measurement instruments (n=20, 61%) were not based on a theory, 20 (61%) measured DHL exclusively via self-report, and 21 (64%) addressed specific target groups. The measurement instruments encompassed a total of 209 original dimensions of DHL. The number of dimensions measured per instrument varied between 2 and 22. The qualitative content analysis identified a total of 30 assigned dimensions. Key dimensions captured in almost all instruments, although under different names, include evaluating health information, using health information, researching health information, and the ability to use technology. Conclusions:The large number of measurement instruments and original dimensions makes it difficult to select suitable instruments for measuring DHL and to compare and synthesize study results. Nevertheless, we were able to identify key dimensions as relevant regardless of target groups and types of digital applications, which could be used to develop a core outcome set for DHL. Our findings offer a foundation for refining existing instruments and developing new ones. They provide practical guidance for researchers and health care professionals in selecting suitable DHLMIs. Additionally, our review underlines the importance of theory to ensure content validity and comparability of DHLMIs.
Aged care has recently undergone major transformations due to demographic aging and the concomitant need to manage health care costs. New emerging technologies (ETs) have started to play central roles in the daily management of older adults. For these transformations to effectively promote successful and active aging, it is essential to understand the opinions of older adults on the impact that technology can have on their vulnerabilities and aging process. This work aims to study the ethically related impact of ETs on cognitively healthy older adults’ vulnerabilities. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review of empirical (qualitative) evidence exploring the relationship between ETs and older adults’ vulnerabilities as perceived by older adults (older than 65 years) without cognitive impairments. Five major databases (PubMed, Web of Science, Embase, CINAHL, and Philosopher’s Index) were queried on March 1, 2022. After eliminating duplicates, titles, abstracts, and full texts were screened for relevance. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the Qualitative Analysis Guide of Leuven methodology, which involved carefully reading the publications included, identifying significant themes, and constructing conceptual schemes for each paper. The quality of the publications was evaluated by using the Critical Appraisal Skills Program. A total of 11,631 results were obtained. Eventually, 70 articles were included, and of these, 46 articles had a high level of methodological quality. The remaining 24 articles had moderate quality. ETs appeared to have an ambivalent effect, mitigating some already existing vulnerabilities, and at the same time, worsening already existing vulnerabilities or creating new vulnerabilities. For example, unconventional monitoring techniques (eg, wearables) often mitigated relational vulnerability, helping to maintain independence and remain at home and in one’s community. Conversely, these same devices may negatively affect moral vulnerability, threatening older adults’ privacy linked to data confidentiality. This systematic review, which focused on the perceptions of older adults without cognitive impairments, enriches the vast literature about the everyday management and care of seniors by exploring the ethical implications of ETs. This research is complementary to another systematic review of qualitative evidence, which analyzed the views of older people with cognitive disorders on the same topic. Although a certain ambivalence in the use of ETs was identified by both population groups, it is interesting how cognitively healthy older adults give more importance to some dimensions of vulnerability, such as the moral and relational ones, which, in the case of cognitively impaired older adults, are not as significant. Two important aspects identified were the respect of privacy and data security, and the perceived risk of control and surveillance linked to the use of monitoring technologies.
Background:Inclusive health education content has been shown to increase acceptability and accessibility for lesbian, gay, bisexual, transgender, queer, intersex, and asexual, as well as other sexual and gender minority (LGBTQ+) individuals. However, there has been some backlash among general audiences, with claims that such inclusive content is "woke" or otherwise problematic. Objective:The goal of this study was to test whether individuals across the political spectrum notice when sexual and reproductive health content is written with inclusive language in order to demonstrate the acceptability of inclusive content to a broader audience. Methods:This study included 454 adults assigned female at birth from the United States, one-third of whom identified as LGBTQ+, reviewed 2 sets of reproductive health educational handouts designed for adolescents, with 1 gender-inclusive and 1 gender-specific version in each set, randomized in order. Individuals were asked to rate each document and state a preference within each pair (implicit preference). They were then debriefed on the study's purpose and asked if they had an explicit preference for gender-specific or gender-inclusive content. Results:Preferences for explicit content tended toward gender-specific content: always gender-specific (n=184, 40.5%), sometimes gender-specific (n=59, 13%), no preference (n=131, 28.8%), sometimes gender-inclusive (n=39, 8.6%), and always gender-inclusive (n=41, 9%). However, most people (n=273, 59%) did not notice differences between the first pair of documents they viewed or rate them differently (mean difference -0.19, SD 2.17, range -10 to 12). Furthermore, the majority of individuals who had a stated preference for gender-specific health education documents did not choose the gender-specific document as their preferred version for either the first (n=45, 24%) or second pair of documents (n=69, 38%). Individuals who preferred content to always be gender-inclusive were significantly more likely to choose the concordant version of their document (n=20, 49% for the first pair; n=24, 58% for the second pair). A total of 58% (n=262) of the participants stated they did not notice the study design until the debrief. Conclusions:Most participants did not notice when sexual and reproductive health educational content had been made gender-inclusive-even when they had an explicit preference for gender-specific content. This suggests that when inclusive language is not directly called to readers' attention, inclusive sexual and reproductive health content is broadly acceptable to individuals across a range of political beliefs. The use of inclusive language may therefore be a means of increasing the accessibility and applicability of educational materials to diverse recipients, including LGBTQ+ individuals.
Background:Effective physician-patient communication is essential for building trust and sustaining positive relationships, yet becomes increasingly challenging in China's tertiary hospitals, where physicians face heavy workloads. Objective:This study explored the barriers and facilitators of physician-patient communication by synthesizing perspectives from Chinese hospital-based physicians and patient relations coordinators. Methods:A qualitative study using semistructured interviews was conducted with 17 participants (11 physicians and 6 patient relations coordinators) from tertiary hospitals in China (April-July 2025). Data were analyzed using thematic analysis following Braun and Clarke's framework. Results:Barriers and facilitators of physician-patient communication were organized into a multilevel framework comprising patient-level, physician-level, and system-level factors. Patient-level barriers included individual background differences, inadequate expression and limited health literacy, and psycho-emotional states with expectation misalignment, whereas facilitators included effective expectation management, good health literacy and communication readiness, and trust in physicians with shared decision-making. Physician-level barriers involved communication style deficiencies, empathy gaps, and time pressure constraints; facilitators included active listening and patient-centeredness, empathy and emotional support, and clear explanations with cultural adaptability. At the system level, barriers included hospital environment and medical visit settings, legal and policy deficiencies, insufficient communication training, and media-driven distrust with digitally mediated information challenges, while facilitators included institutional support and security assurance, educational training and policy promotion, process optimization and patient health education, and artificial intelligence-assisted baseline knowledge. Conclusions:Physician-patient communication is influenced by multiple factors, necessitating comprehensive intervention measures: enhancing patient education, improving physician communication skills, and strengthening organizational support systems. Notably, special attention should be directed toward addressing the unique challenges posed by digital technologies while concurrently leveraging the opportunities they present to optimize communication outcomes.
Unlabelled:Deduplication across search results is one of the earliest and most critical steps in the systematic review methodological process; yet, existing solutions often lack the transparency, auditability, and reproducibility required by rigorous systematic review standards. Many automated deduplication tools introduce bias through opaque, nonconfigurable algorithmic decisions, while also potentially removing relevant references through false positive identification. We provide a tutorial on the Rayyan Method, including the Systematic Auto Resolver feature for the deduplication process. This method is defined by an enhanced deduplication approach that combines high-sensitivity duplicate detection with user-controlled resolution criteria. Systematic Auto Resolver enables research teams to define, apply, and document their own deduplication standards rather than relying on predetermined automated decisions. Users apply deduplication criteria, iteratively reviewing results after each pass, maintaining complete control over methodological decisions. The Rayyan Method addresses critical limitations in current deduplication approaches by supporting methodological rigor through user-controlled resolution while enhancing efficiency, transparency, and reproducibility. By empowering research teams to define their own deduplication criteria, this approach supports and aligns with the prescribed methodologically rigorous systematic review process. The method provides a citable framework for researchers to comprehensively document their deduplication methodology.
Background:Long COVID, or postacute COVID-19 syndrome, presents with persistent cognitive and psychological symptoms such as brain fog, anxiety, depression, and fatigue, significantly impacting quality of life and daily functioning. Digital health interventions offer a scalable, accessible solution to bridge care gaps, especially where conventional neuropsychological support is limited. However, evidence regarding their effectiveness for neuropsychiatric symptoms in long COVID remains fragmented. Objective:This scoping review aimed to systematically identify and map the existing evidence on digital interventions targeting cognitive and psychological symptoms in individuals with long COVID. The review also sought to categorize intervention types, assess reported outcomes, and identify methodological gaps to inform future clinical and research priorities. Methods:The review followed the Arksey and O'Malley framework and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Comprehensive searches were conducted in 4 databases (PubMed, Scopus, Web of Science, and ScienceDirect) from December 2024 to February 2025. Eligible studies included peer-reviewed and gray literature published in English or Spanish since 2020. Studies were screened and selected based on predefined inclusion and exclusion criteria. Data were extracted using a standardized charting form and synthesized narratively, with thematic grouping by intervention type. Results:Of 888 records identified, 25 (2.82%) were included. Intervention types encompassed telehealth platforms, mobile health apps, virtual reality, online cognitive and psychological therapies, game-based cognitive training, neuromodulation (transcranial direct current stimulation), and multicomponent programs. Most studies reported improvements in psychological well-being, emotional regulation, and cognitive domains such as attention and memory. However, findings varied, with some interventions showing no significant cognitive gains or sustained effects. Common limitations included small sample sizes, lack of control groups, heterogeneity in outcomes and intervention protocols, and short follow-up durations. The underrepresentation of older adults and underserved populations was also noted. Conclusions:Digital interventions show promise for addressing cognitive and psychological symptoms in long COVID, particularly when delivered as multicomponent programs. Nonetheless, the evidence base remains preliminary. Future research should prioritize high-quality randomized trials with standardized outcome measures, long-term follow-up, and diverse participant samples. Addressing barriers related to digital literacy and access will be essential to ensure equity and real-world effectiveness.
BackgroundThere is a worldwide movement toward competency-based medical education to equip dental students with essential competencies required to meet health care needs. In Syria, dental faculties currently lack a formal competency-based curriculum for endodontics at the undergraduate level. Moreover, the quality of root canal treatment performed by general dentists is frequently described as inadequate or substandard. ObjectiveThis study aimed to develop a national consensus on the required competencies for undergraduate endodontics in Syria in order to establish a foundation for a standardized national curriculum, which can guide educators in adopting best practices in both dental education and clinical endodontics. MethodsThis study was conducted at Syrian Virtual University between April and June 2025. A modified Delphi technique was used to determine endodontic competencies. Initially, a group of 5 Syrian endodontic consultants identified preliminary competencies. In the first round, 53 experts evaluated these competencies by using a 5-point Likert scale. Based on these results, a second round was conducted with 38 experts. Competencies with a weighted average above 4.20 were considered essential. Data analysis was performed using IBM SPSS package 27, and survey reliability was measured by Cronbach α. ResultsFollowing the final Delphi round, a set of 31 competencies was established, comprising 9 knowledge, 13 skills, and 9 attitudes competencies. Cronbach α was more than 0.9 in the first and second round. The standard deviation across all questionnaires was low (≤0.85). The standard error was also minimal (≤0.12). ConclusionsThis study identified a set of core endodontic competencies for the undergraduate level in Syria. These competencies are intended to support students in acquiring the required knowledge, skills, and attitudes, and assisting policymakers in implementing competency-based medical education within Syria and similar contexts.
Background: Observation of COVID-19 rebound after nirmatrelvir plus ritonavir (NPR) has driven important questions surrounding one of the only direct-acting antiviral treatments for COVID-19. Objective: The objective of this study was to examine the epidemiology of COVID-19 rebound among COVID-19-positive outpatients in the United States who independently decided whether or not to take NPR. Methods: This prospective, decentralized observational cohort study was conducted from August 2022 through December 2023 and included frequent proctored COVID-19 rapid antigen tests and self-report symptom surveys for 15 days. The primary outcome was the incidence of viral and symptom rebound. Secondary outcomes included time to initial viral and symptom clearance, rebound probability among patients who cleared by day 15, and symptom frequency. Results: Of 917 consenting participants, 669 (73%) were eligible for inclusion in the analysis (n=443, 66% in the NPR group; n=226, 34% in the control group). The mean age was 46.1 (SD 12.9) years, 62.6% (n=419) of participants were female, and 49.2% (n=329) had at least one preexisting condition. Overall, 15-day cumulative incidence was higher in the NPR group than the control group for both viral (70/443, 15.8% vs 12/226, 5.3%) and symptom (73/443, 16.5% vs 19/226, 8.4%) rebound. Time to initial viral and symptom clearance was similar between groups, and among those who experienced clearance by day 15, the probability of viral rebound (NPR: 19.1%, 95% CI 15.1%-24.0% vs control: 7%, 95% CI 4.0%-12.6%; P<.001) and symptom rebound (NPR: 47.7%, 95% CI 36.1%-60.8% vs control: 16.9%, 95% CI 10.9%-25.7%; P<.001) was higher in the NPR group than the control group. Conclusions: This study demonstrates that while COVID-19 rebound occurs in both NPR-treated and untreated outpatients, the incidence is higher in the NPR group.
BackgroundThe use of artificial intelligence (AI) in medical imaging has been growing exponentially. Understanding patient perceptions and factors influencing their views of AI is critical to develop adequate strategies to support implementation and acceptance. ObjectiveThis study aims to investigate the constructs that influence patients’ perceptions and acceptance of AI’s use in the analysis of their medical images to support screening and diagnosis. MethodsA systematic review was conducted to meet the research objective. Relevant articles were found by searching 5 databases. Data were extracted using an iteratively refined framework and synthesized narratively due to heterogeneity in study designs, populations, health care contexts, and outcomes. ResultsA total of 59 relevant studies were included in the review. Patient acceptance of AI in medical image analysis emerged from multiple interacting factors. The most consistently reported determinant in 48 studies was that AI implementation should prioritize human-in-the-loop models, positioning AI as supportive tools, working in conjunction with health care providers rather than as an autonomous decision-maker. Other factors identified were performance of the AI, clarity of accountability, trust, and ethical factors. Patients’ individual characteristics such as demographics and health history were also noted to influence acceptance indirectly. The review findings were used to draft a conceptual model to draw attention to the complex relationship among the identified factors. ConclusionsThis review informed the development of a conceptual model illustrating the complex and interactive factors shaping patient acceptance of AI in medical imaging, which can be tested prospectively in future studies. Our results highlight that patients’ likelihood of accepting AI cannot be attributed to a few factors. Instead, promoting acceptance will require a holistic approach where multiple factors are considered simultaneously and adapted for each use case.
