To explore eating difficulties, psychological distress and self-management strategies among colorectal cancer (CRC) patients receiving chemotherapy, and to examine how diet-related symptom burden shapes emotional responses, perceived control and coping, guided by Symptom Management Theory (SMT).

A qualitative study was conducted with 22 CRC patients receiving chemotherapy at two tertiary hospitals in Chengdu. Purposive sampling ensured variation in demographic and clinical characteristics. Semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis informed by SMT. The study was reported in line with the Consolidated criteria for reporting qualitative research (COREQ).

Three main themes were identified: (1) Diet-related symptom distress and disrupted eating: patients described complex, fluctuating multisystem symptom clusters that reduced appetite, altered taste, and eroded a sense of control over eating. (2) Dietary self-management as coping and regaining control: patients engaged in flexible dietary adjustments, trial-and-error experimentation, timing and portion modifications, and emotional regulation to alleviate discomfort, preserve daily functioning, and maintain social roles. (3) Uncertainty and unmet psychosocial-nutritional support needs: patients reported confusion about "right" foods and quantities, fear that diet might compromise treatment, exposure to conflicting information, and a desire for structured, accessible, and personalised guidance that addresses both nutritional and emotional concerns.

Eating during chemotherapy is both psychosocial and nutritional, intertwining symptom burden, emotional responses, perceived control, and coping efforts. Integrating patient-centered nutritional care with psycho-oncological support, through multidisciplinary collaboration, may improve symptom control, treatment adherence, and quality of life in CRC patients.

The mortality and morbidity consequences of the COVID-19 outbreak were concentrated among older adults. The health system response was critical to mitigating its negative effects, particularly through the redistribution of healthcare resources across territories. The objective of this study was to analyze inequities in the distribution of health resources in Mexico in relation to life expectancy (LE) and COVID-19 adjusted life expectancy (CALE) in the 60-64 age group at metropolitan level.

We conducted an ecological study covering the period from 2020 to 2023. LE was estimated using abridged life tables, and CALE was calculated using the Sullivan method. Correlation analyses were performed to assess the relationships between these indicators and healthcare resource variables. Inequities were quantified using the concentration index, while the dissimilarity index was used to estimate the proportion of resources that would need to be redistributed across metropolitan areas to achieve an equal distribution.

Our findings reveal an unequal distribution of healthcare resources during the pandemic. Metropolitan areas with greater resource availability achieved more favorable health outcomes. This pattern was particularly evident for resources related with specialized services, technological equipment, and health personnel in training. These are precisely the types of resources that should be distributed across metropolitan areas to advance toward a more equitable healthcare system.

Resource reallocation becomes a central component of health systems adaptation to public health emergencies. Our results highlight the need for more adequate territorial redistribution of healthcare resources to improve preparedness for future epidemiological emergencies.

Noncommunicable diseases (NCDs) account for over 70% of global deaths, with hypertension and diabetes serving as major contributors. The COVID-19 pandemic disrupted traditional health care services for NCDs and highlighted telehealth as a crucial alternative. Telehealth-encompassing synchronous and asynchronous electronic communication to deliver clinical services remotely-can overcome geographical barriers and enhance patient engagement. However, telehealth usability among health care professionals (HCPs) remains under-studied across low-, middle-, and high-income countries.

This study aimed to examine which telehealth engagement patterns, technical infrastructure factors, and user profiles were most strongly associated with usability among HCPs and to descriptively compare these across 4 diverse countries: Brazil (high- to middle-income country), Ghana (low- to middle-income country), Honduras (low- to middle-income country), and the United Kingdom (high-income country).

A multinational cross-sectional survey was conducted with 290 HCPs across 4 countries. Participants completed the System Usability Scale and provided data on telehealth engagement (eg, frequency, duration, and number of systems used), technical infrastructure (connection stability and support satisfaction), and their user profile (demographics, job role, and training received). Descriptive statistics summarized these patterns and usability scores. Multiple linear regression with bootstrap-based sensitivity analyses identified factors associated with telehealth usability. Given the nonprobability design, no formal inferential comparisons were made between countries. Instead, observed patterns were reported descriptively.

Higher telehealth usability scores were associated with greater connection stability (b=5.06, 95% CI 3.06-7.05), higher satisfaction with online support information (b=5.02, 95% CI 3.27-6.75), more frequent use (b=3.05, 95% CI 1.36-4.73), longer duration of use (b=1.59, 95% CI 0.49-2.68), and being a physician by profession (b=3.82, 95% CI 0.23-7.40). Average usability scores were highest among users in Ghana (mean 79.75, SD 14.19) and the United Kingdom (mean 79.00, SD 14.71), followed by Brazil (mean 72.01, SD 14.62) and Honduras (mean 63.09, SD 15.57). According to System Usability Scale guidelines, scores corresponded to "good" usability for users in Ghana, the United Kingdom, and Brazil and were below the "good" threshold for users in Honduras. While most users in Ghana (97/111, 87.4%), Honduras (31/38, 81.6%), and Brazil (57/80, 70.4%) reported using only 1 telehealth system, two-thirds of UK users (40/60, 66.7%) reported using 2 or more systems. User profiles also varied; prepandemic use was highest in Ghana (84/111, 75.7%) and lowest in Honduras (7/38, 18.4%). Other engagement patterns across countries were reported.

Telehealth usability is driven by technical infrastructure reliability, a robust online support infrastructure, and an "experience effect" from frequent and long-term engagement. Descriptive differences in engagement patterns and infrastructure highlight the need for tailored strategies to address setting-specific challenges. These are essential to optimize telehealth integration and improve health care outcomes for patients with NCDs worldwide.

Non-communicable diseases (NCDs), such as hypertension, diabetes, and asthma, require continuous medication management. However, medication adherence remains suboptimal. Telepharmacy-defined as pharmacist-led care delivered remotely via telephone, video, or digital platforms-may improve adherence and clinical outcomes while addressing access barriers, but uncertainty remains regarding clinical effectiveness and generalisability. A systematic review is warranted to assess whether telepharmacy improves medication adherence, safety, and other key outcomes compared with usual care.

To assess the clinical effectiveness of telepharmacy services, compared with usual care, on medication adherence and clinical outcomes in patients with NCDs in ambulatory care settings.

We searched CENTRAL, MEDLINE, Embase, Global Index Medicus, and two trial registries up to 15 December 2025. We also assessed the reference lists of included studies and relevant reviews, conducted citation searching, and contacted study authors to clarify information and identify additional data. No language or publication status restrictions were applied.

We included individually randomised controlled trials (RCTs) and cluster-RCTs comparing pharmacist-led telepharmacy with usual care for people with NCDs (e.g. cardiovascular disease, diabetes, and cancer) in ambulatory care settings.

Critical outcomes were medication adherence, patients' satisfaction, and drug-related problems (DRPs). Important outcomes included mortality rate, worsening of NCDs, clinical measurements, laboratory values, patients' quality of life, healthcare use, and economic outcomes. We included seven outcomes in the summary of findings table.

We assessed the risk of bias for the seven outcomes in the summary of findings table using the Cochrane RoB 2 tool, incorporating both individually RCTs and cluster-RCTs.

We conducted synthesis analyses using random-effects models, calculating summary risk ratios or mean differences (MDs)/standardised mean differences (SMDs) with 95% confidence intervals (CIs). For cluster-RCTs, we used adjusted estimates or applied design effect corrections. Where meta-analysis was not feasible, we used narrative synthesis. We assessed the certainty of the evidence using GRADE.

We included 21 trials (17 individually RCTs and 4 cluster-RCTs) involving a total of 5440 participants with NCDs. Sample sizes ranged from 20 to 1400 participants. Studies were conducted in high-, upper-middle-, and lower-middle-income countries, across hospital, clinic, pharmacy, or insurer-based settings. Interventions targeted conditions such as diabetes, hypertension, and asthma. Telepharmacy interventions varied in delivery modes (e.g. telephone, video, and app), intensity, and components (e.g. adherence support, monitoring, and education). Follow-up durations ranged from one to 18 months, with most studies lasting 12 months or less.

Telepharmacy interventions may improve medication adherence compared with usual care (SMD 0.32, 95% CI 0.10 to 0.55; 10 studies, 2978 participants; low-certainty evidence). For patients' satisfaction, the evidence is very uncertain about the effect of telepharmacy interventions compared with usual care (SMD 0.37, 95% CI -0.11 to 0.85; 3 studies, 422 participants; very low-certainty evidence). One additional study using a 5-point Likert scale reported little to no difference between groups (96.5% versus 97.5%; P = 0.68). Another study lacked a comparator group, and we excluded it from the synthesis. We did not pool the evidence for DRPs due to clinical and methodological heterogeneity. Narrative findings from individual studies showed that one study reported increased detection of DRPs. Other studies reported fewer adverse events, suggesting prevention of DRPs, while the remaining studies found no clear differences. The certainty of the evidence was low. Regarding important outcomes, two studies reported worsening of NCDs. Due to clinical heterogeneity, we did not pool the results and presented them narratively. The effect of telepharmacy on worsening of NCDs remains uncertain. For asthma control, no clear difference was observed (SMD 0.23, 95% CI -0.34 to 0.80; 2 studies, 318 participants). Telepharmacy interventions may reduce systolic blood pressure (SBP) (MD -6.82 mmHg, 95% CI -12.16 to -1.48; 5 studies, 1254 participants; low-certainty evidence) and may reduce diastolic blood pressure (DBP) (MD -2.50 mmHg, 95% CI -4.80 to -0.20; 5 studies, 1254 participants; low-certainty evidence) compared to usual care. Two additional studies reporting clinical measurements found more pain relief with telepharmacy in one study, and no clear difference in thromboembolic events in the other. For glycated haemoglobin (HbA1c), telepharmacy interventions probably have little or no effect (MD -0.10%, 95% CI -0.25 to 0.05; 5 studies, 1771 participants; moderate-certainty evidence). For LDL cholesterol, a meta-analysis of two studies showed no clear difference between the groups (MD -0.84 mg/dL, 95% CI -4.70 to 3.02; 2 studies, 444 participants). One study reported better prothrombin time-international normalised ratio (INR) control in the intervention group. Three studies assessed quality of life using different tools, but did not show consistent evidence of benefit. Hospital admissions and emergency department visits showed no clear differences between groups. Two studies evaluated economic outcomes, with one reporting cost savings and the other showing no difference in total or disease-related costs. No included studies reported data on mortality rate or adverse events attributable to telepharmacy, so potential harms remain uncertain.

Low-certainty evidence suggests that telepharmacy interventions may improve medication adherence, and may reduce both SBP and DBP in patients with NCDs in ambulatory care settings compared to usual care. Moderate-certainty evidence indicates telepharmacy interventions probably have little or no effect on HbA1c. The evidence is very uncertain about the effect of telepharmacy interventions on patients' satisfaction. The evidence base is limited by short follow-up periods, variation in interventions and outcome measures, and lack of equity-related data. Telepharmacy appears promising for ambulatory care, but further high-quality trials with standardised adherence measures and longer follow-up are needed to clarify effectiveness, implementation potential, and equity impacts.

Takeshi Hasegawa and Hisashi Noma were supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (Grant numbers: JP24K06239 and JP23K24811).

Protocol (2023): DOI 10.1002/14651858.CD015136.

Noncommunicable diseases (NCDs) are increasingly becoming a public health challenge, particularly in resource-limited settings, due to limited access to preventive care, early detection, and health literacy. Nevertheless, there is immense potential for digital technologies to enhance the overall community health. Similarly, the World Health Organization (WHO) Package of Essential NCD (PEN) interventions for primary health care in low-resource settings has demonstrated evidence of improving NCD outcomes. Nevertheless, its effectiveness in the Indian setting has not been explored.

This study aims to evaluate the effectiveness of a mobile and web-based digital intervention compared with the WHO PEN approach and a no-intervention control group in improving health-seeking behaviors, risk factor modification, and disease management related to NCD prevention and control in resource-limited settings across 4 Indian sites.

A quasi-experimental, mixed methods study will be conducted across 4 sites in India by using cluster-based allocation. The study will be conducted in 3 phases, where the insights gathered in the first phase will guide the development of a human-centered digital health intervention to help people nudge toward better health-seeking behaviors for common NCDs (diabetes or hypertension/cardiovascular diseases or both). The effectiveness of the digital intervention will be compared against the WHO PEN intervention and a control group that will receive no intervention. Standard validation tools will be used to assess behavior and changes related to modifiable risk factors. Data will be analyzed using descriptive and inferential statistics, with pre-post comparisons and between-group analyses. Qualitative data will be thematically analyzed to complement quantitative findings.

The funding for this study was received from the Indian Council of Medical Research in January 2025. In phase 1, across all sites, a total of 80 in-depth interviews (community and community health workers), 320 Knowledge, Attitude, And Practice questionnaires (community), and 32 focus group discussions with 320 individuals (community) were conducted from July 2025 to December 2025. This will be followed by data analysis, and findings will be used to guide the development of the digital intervention. The results of this study are expected to be published in 2028. This study is expected to demonstrate improved health-seeking behavior, self-management practices, and lifestyle modifications among participants exposed to the digital intervention compared with the WHO PEN and control groups. Findings will illuminate the feasibility and scalability of integrating digital health solutions within community-based NCD prevention frameworks in India.

This protocol outlines a community-based, multi-site comparative study to evaluate the role of digital health interventions vis-à-vis WHO PEN in addressing NCD prevention and management. The results will contribute to evidence-based recommendations for strengthening digital health integration in resource-limited primary care settings.

DERR1-10.2196/89021.

Family medicine has attracted increasing policy and institutional support across the Gulf Cooperation Council (GCC) countries through health system reform, expansion of the healthcare workforce, and sustained public investment. Nevertheless, important challenges continue to affect the strength of primary healthcare systems, access to care, and the management of non-communicable diseases. The aim of the narrative review is to identify future trends, directions, perspectives, and opportunities that can strengthen implementation of family medicine across GCC countries and improve healthcare delivery. This review is based on a structured search of major databases such as PubMed, Scopus, and Google Scholar. The focus was evaluation of literature associated with family medicine and primary healthcare development in GCC countries. Regional priorities now include improving medical education and training, expanding the family medicine workforce, strengthening links with communities, promoting more equitable access to healthcare, and managing treatment costs through workforce development and digital health initiatives. Family medicine practice across the GCC is being supported increasingly by electronic health records, telemedicine, and interprofessional education. Policy directions in the region also suggest growing interest in value-based research, international collaboration, multidisciplinary care, and innovation in healthcare delivery. The future of development of family medicine in the GCC will depend on better integration of digital health, more effective use of data in planning and policy, continued investment in training, and broader adoption of patient-centred models of care. In general, strengthening family medicine through sustained investment in workforce development, primary healthcare infrastructure, research capacity, and digital health integration is essential for achieving resilient, equitable, and patient-centered healthcare systems across the GCC.

The HEARTS model (Healthy-lifestyle counseling, Evidence-based treatment protocols, Access to essential medicines and technologies, Risk-based management, Team-based care, and Systems for monitoring) is recommended by the World Health Organization and the Pan American Health Organization to improve primary care management of hypertension, diabetes, and other cardiovascular disease risk factors in national health systems. The objective of this study is to evaluate HEARTS implementation in the Ministry of Health primary care system in Guatemala, where a scale-up project covering approximately 10% of the country began in 2024.

This is a prospective, observational evaluation using a hybrid type 3 effectiveness-implementation design with three sequential periods: pre-implementation, implementation, and maintenance. The six HEARTS-aligned multilevel implementation strategies are: (1) training and supportive supervision for health workers, (2) standardized treatment protocols, (3) strengthening availability of medications and diagnostics, (4) task sharing with non-physician health workers, (5) quality monitoring systems, and (6) patient engagement and community outreach. The evaluation is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Co-primary outcomes are hypertension and diabetes treatment rates (Reach), estimated from MOH administrative data using a difference-in-differences approach comparing intervention districts with non-HEARTS comparator districts. Additional quantitative outcomes include treatment intensity and retention (Reach), disease control (Effectiveness), district-level uptake (Adoption), strategy-specific fidelity (Implementation), and sustainment of outcomes after external support concludes (Maintenance). To explain variation in quantitative outcomes, semi-structured interviews will be conducted with MOH staff, government officials, international advisors, and civil society stakeholders using an explanatory sequential mixed methods design. The study will include a cost-effectiveness analysis and budget impact analysis to inform policy decisions on scale-up and sustainability.

This study will provide evidence on HEARTS implementation in Guatemala. Findings will inform decisions about national scale-up and contribute to the global evidence base on implementation of hypertension and diabetes management in primary care health systems.

This study is registered on the Open Science Framework (https://osf.io/easm9).

For patients with severe degenerative mitral regurgitation (DMR) at prohibitive or high surgical risk, transcatheter edge-to-edge repair (TEER) has become an effective alternative. The GeminiOne is a novel TEER device featuring a unique groove-cam mechanism.

This study reports the primary, secondary, and 1-year outcomes of the GeminiOne-DMR (Safety and Efficacy of the GeminiOne Transcatheter Valve Edge-to-Edge Repair System in Patients With Moderate-severe or Severe Degenerative Mitral Regurgitation) trial.

A total of 120 patients with prohibitive surgical risk and DMR grade ≥3+ were enrolled and evaluated by an independent echocardiography core laboratory and a clinical event committee. The primary endpoint was clinical success, defined as freedom from all-cause mortality, mitral valve reintervention, and mitral regurgitation >2+ at 1-year follow-up.

At 1 year, the clinical success rate was 89.84% ± 2.78% (95% CI: 84.56%-95.46%), meeting the prespecified primary efficacy endpoint. The rates of freedom from 1-year all-cause mortality, major adverse events, mitral valve reintervention, and heart failure hospitalization were 97.48% ± 1.35%, 91.61% ± 2.54%, 98.31% ± 1.02%, and 94.00% ± 2.20%, respectively. Mitral regurgitation ≤2+ was achieved in 92.24% of patients at 1 year. Significant improvements were observed in functional and quality-of-life outcomes, with the proportion of patients classified as NYHA funcional class I/II increasing from 23.33% at baseline to 94.74% at 1 year (P < 0.001), and Kansas City Cardiomyopathy Questionnaire scores also improving significantly from baseline to 1 year (P < 0.001).

This trial demonstrated the initial safety and efficacy of the GeminiOne TEER system for treating significant symptomatic DMR in patients at prohibitive or high surgical risk. (Safety and Efficacy of the GeminiOne Transcatheter Valve Edge-to-Edge Repair System in Patients With Moderate-severe or Severe Degenerative Mitral Regurgitation; NCT05655897).

Rising global numbers of chronic noncommunicable diseases (NCDs) are commonly interpreted as evidence of a growing epidemic. In 2011, we hypothesised that this perception is partly driven by population ageing, expanding diagnostic criteria, and improved detection rather than a uniform increase in underlying biological risk. This study reassesses that hypothesis using contemporary global data.

We conducted a descriptive, comparative epidemiological analysis using publicly available data sets from the Global Burden of Disease, World Health Organization Global Health Estimates, and the International Diabetes Federation. Absolute case counts and deaths were analysed alongside age-standardised mortality rates to distinguish demographic effects (population growth and ageing), diagnostic expansion, and changes in underlying risk. Trends were evaluated relative to 1990 and 2011 baselines.

Absolute numbers of cases and deaths from major NCDs have continued to rise globally, largely reflecting population growth and ageing. In contrast, age-standardised mortality rates have declined substantially for cardiovascular disease and chronic obstructive pulmonary disease and have stabilised for other conditions. This divergence between increasing absolute burden and stable or declining age-specific risk is consistent across major diseases. Expanded diagnostic criteria, improved detection, and increased survival have further contributed to rising prevalence, particularly in older populations.

Rising absolute counts of NCDs are largely explained by demographic change and diagnostic expansion, while age-standardised trends suggest stable or declining risk for several major conditions. These findings support a more nuanced interpretation of global chronic disease trends, integrating demographic, diagnostic, and risk-factor perspectives. Careful use of age-standardised measures alongside absolute counts is essential for accurate monitoring and for informing public health priorities.

Doxorubicin-induced cardiomyopathy (DIC) remains a dose-limiting clinical challenge. This study reveals that cardiac vascular endothelial cells (CVECs) act as initial sensors of doxorubicin cardiotoxicity: circulating doxorubicin activates the cGAS‑STING pathway in CVECs, triggering NLRP3 inflammasome‑mediated pyroptosis and release of pathogenic extracellular vesicles that induce mitochondrial dysfunction in neighboring cardiomyocytes, establishing a self‑perpetuating injury loop. Leonurine (LEO), a natural alkaloid, is identified as a direct STING inhibitor that specifically binds the TYR261 residue, blocking both STING oligomerization and STING‑TBK1 heterodimer formation-a mechanism distinct from known STING inhibitors. LEO exerts hierarchical dual protection: directly preserving cardiomyocyte mitochondria while primarily inhibiting endothelial STING to disrupt the pathogenic loop. This endothelial‑centric strategy shifts the therapeutic paradigm from direct cardiomyocyte protection to upstream endothelial intervention, establishing LEO as a promising candidate for DIC.