To explore the experiences of mothers who completed the care pathway following a diagnosis of congenital diaphragmatic hernia and identify implications for nursing and midwifery practice.

A qualitative descriptive phenomenological study.

Semi-structured interviews were conducted in February 2023 with 21 mothers who had completed the congenital diaphragmatic hernia care pathway between 2019 and 2022 at an academic referral hospital for fetal surgery in Northern Italy. Women whose pregnancy was not carried to term, those who experienced fetal or neonatal loss, and those receiving ongoing psychological support were not included. Data were analysed thematically using a descriptive phenomenological approach.

Five themes were identified across diagnosis, decision-making, specialised care, childbirth, and the postnatal transition home. Mothers experienced the pathway as interconnected transitions characterised by uncertainty, repeated adaptation, and changes in the maternal role. Specialist counselling improved clarity but did not eliminate prognostic uncertainty. Midwives emerged as central relational figures during childbirth, while mothers highlighted communication, parental involvement, continuity, and preparation for discharge.

Among mothers represented in this study, informational, emotional, relational, and practical needs evolved from prenatal diagnosis to home care but remained closely interconnected.

Nursing and midwifery priorities may include reinforcing complex information, preparing women for childbirth and possible neonatal separation, facilitating parental involvement, and supporting readiness for home care.

The study addresses limited understanding of how maternal needs evolve across the congenital diaphragmatic hernia care continuum. Uncertainty, adaptation, and changes in the maternal role persisted across successive transitions. Findings may inform nursing, midwifery, and multidisciplinary support across fetal, maternity, neonatal, and community care.

The COREQ checklist guided reporting.

Mothers contributed as study participants by sharing their experiences; they were not involved in study design, analysis, or manuscript preparation.

Rapid digitalization has led to the generation of vast volumes of health data across diverse sources, including public health surveillance, electronic health records from hospitals, primary care facilities, and telemedicine. However, it often remains fragmented across multiple domains and systems due to siloed data collection practices and a lack of interoperability standards, limiting its potential to generate actionable public health insights.

In this study, we examined publicly available health data portals and assessed their scope, user engagement features, and implementation of interoperability standards.

We conducted an environmental scan to profile publicly available health data portals. We identified portals through systematic web searches, expert consultation using the Delphi technique, and snowball sampling from initial sources. We assessed each portal for the type of data hosted, the scope of user engagement, and the implementation of interoperability standards (Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT]) or adopted Fast Healthcare Interoperability Resources (FHIR) as a data exchange standard.

We identified 17 data portals in total, of which 9 (53%) hosted global data and 1 (6%) hosted regional data. Portals hosted data across diverse domains including communicable diseases and noncommunicable diseases, maternal and child health, injuries, and others. Most portals supported basic user interactions such as data querying (n=15, 88%) and downloading (n=15, 88%), but none offered in-portal analytics. While 3 (18%) portals used International Classification of Diseases (ICD) coding systems, none implemented SNOMED CT or adopted FHIR.

Our study highlighted substantial fragmentation and a lack of interoperability across health data portals, which limits the ability to conduct integrated analysis and obtain comprehensive public health insights. Realizing the full potential of health data will require accessibility and interoperability, intelligent analytics, and seamless integration across domains.

Tobacco is one of the major risk factors for non-communicable diseases (NCDs) in the Indian population. The decreasing trend of tobacco use reflects significant progress in tobacco control, which can be attributed to key policies like price rise, smoke-free areas, ban on advertising and promotion and pictorial warnings on tobacco products. This narrative review was undertaken to assess effectiveness of these four policies in reducing tobacco burden in India.

Articles were obtained by searching through all major databases. Peer-reviewed articles published in the last 20 years, reports of the Government of India and nationally representative surveys focusing on at least one intervention were included. Selected publications and reports went through two-stage screening process before inclusion. Findings were grouped according to the four policies under evaluation.

Twenty-three articles and reports were selected to derive the results. Inverse association was found between product price and consumption/affordability. Smoke-free laws in public spaces were associated with reduced second-hand smoke (SHS) exposure at home. Point of sale (POS) advertising remains prominent in India, which is a cause for concern. Awareness about pictorial warnings was significantly high among both consumers and non-consumers who believed they heightened awareness about health hazards and assisted in reducing or quitting use. However, high-dependence users were not influenced by statutory warnings or price increases.

To achieve full compliance with COTPA (The Cigarettes and Other Tobacco Products [Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution] Act), 2003, multisectoral interventions will require partnership of government agencies, civil society organisations and the community. While tobacco products are taxed heavily to make them less affordable and smoke-free legislation have reduced SHS exposure, advertising in all forms should be prohibited and pictorial warnings mandated on cigarette sticks. Implementing tobacco endgame strategies may provide the critical breakthrough.

Large Language Model (LLM)-enabled artificial intelligence (AI) chatbots are increasingly shaping health communication by mediating how patients, health professionals, researchers, and health institutions seek, interpret, produce, and act on health information. Existing reviews have largely focused on a single stakeholder group or clinical domain, leaving unclear how these systems are applied and evaluated across stakeholder groups and health purposes.

This scoping review mapped empirical studies of LLM-enabled AI chatbot applications and evaluations for health purposes across four stakeholder groups: the public or patients, health professionals, health researchers and students, and health institutions. We characterized the purposes and evidence patterns associated with these applications and evaluations.

We searched nine databases for peer-reviewed, English-language empirical studies available through July 2025. After screening, 286 articles were coded for study characteristics, methodology, evidence type, chatbot modality, LLM type, health topic, stakeholder group, and health purpose.

The included articles were published between 2023 and 2025. Most examined general-purpose LLMs (n = 267, 93.4%). Studies were concentrated in the United States and China and primarily examined text-based chatbots. Noncommunicable or chronic diseases and general health information were the most common health topics. Ten health-related purposes were identified across four stakeholder groups and two umbrella categories. Public-facing applications involved the general public or patients and encompassed four purposes: (1) seeking health information, (2) symptom assessment and self-care management, (3) emotional support, and (4) preventive and transitional care support. Professional and organizational applications involved health professionals, health researchers and students, and health institutions, and encompassed six purposes: (5) clinical decision support, (6) improving administrative efficiency, (7) supporting patient interaction and doctor-patient communication, (8) enhancing continuing education, (9) facilitating health research, and (10) institutional workflow support and care navigation.

This review provides a stakeholder-purpose mapping of AI chatbot applications and evaluations in health care. The evidence base is concentrated in text-based, lower-acuity, and information-oriented contexts and derives primarily from output evaluations and self-reported perceptions or use. Key gaps concern institutional integration and governance, higher-stakes and longitudinal contexts, and evidence across populations, languages, and interaction modalities.

One of Ghana's most significant yet under-recognized public health issues is hypertension, which is driving, increases in cardiovascular disease, disability and premature mortality. Despite ongoing improvements in primary healthcare and increased access through the National Health Insurance Scheme, the prevalence of hypertension remains high, and knowledge, treatment and management levels remain unacceptably low. In this perspective, we examine Ghana's hypertension crisis from three interrelated perspectives: the changing epidemiology and population distribution of hypertension; the barriers to effective prevention and long-term control at the individual, community and health-system levels; and priority policy and implementation pathways for improving hypertension management. Drawing on data from regional studies, national surveys and facility-based research, we argue that Ghana's hypertension burden reflects broader structural changes linked to urbanization, dietary change and the ongoing fragmentation of the health system. We argue that present trends cannot be reversed by relying simply on fragmented, episodic hypertension care models that prioritize treatment over holistic prevention, follow-up and long-term management. To achieve long-term progress, primary health care must be strengthened through the implementation of the World Health Organization's (WHO) HEARTS Technical Package, which includes standardized treatment protocols, reliable access to essential medicines and validated blood pressure devices, team-based care, population-level prevention strategies and robust health information systems. Effectively managing hypertension is consequently crucial for lowering cardiovascular morbidity and mortality and for demonstrating Ghana's ability to respond fairly and sustainably to the expanding problem of non-communicable diseases.

CRISPR-Cas9 DNA cleavage requires R-loop extension to activate the histidine-asparagine-histidine (HNH) nuclease domain, yet how heteroduplex maturation gates catalytic commitment remains unclear. Using extensive molecular dynamics simulations across seven experimentally trapped heteroduplex states (6-18 nt), we define a three-stage activation pathway: unlocking, preorganization, and precatalytic gating. At the 18-nt checkpoint, HNH and REC2 regain mobility but do not adopt a fully cleavage-competent orientation; this dynamically frustrated metastate is consistent with a conformational-proofreading model. Here, dynamic frustration is used operationally to describe renewed mobility and weakened directional coupling without commitment to the cleavage-competent state, rather than a formal energetic frustration calculation. Two sensors, Y450 at the sgRNA: DNA hybrid interface and K1200 in the PI domain, respond to distinct maturation milestones, encoding heteroduplex length into domain-specific conformational outputs. Integrating these insights with two deep-learning analyses and deep mutational scanning recovers known high-fidelity positions and prioritizes three unannotated residues for testing. In a cellular cleavage reporter assay, R1210D reproduces the attenuated low-completion phenotype of eSpCas9, identifying it as a candidate for direct specificity testing, while destabilizing L1-linker substitutions increase cleavage efficiency. These results connect atomic-level dynamics to experimentally testable, structure-mechanism-informed engineering hypotheses; direct matched-versus mismatched validation is required to establish effects on discrimination fidelity.

Immune checkpoint inhibitor-associated myocarditis (ICIAM) is one of the immune-related adverse events (irAEs) with low incidence but extremely high mortality. High-dose glucocorticoid pulse therapy remains the recommended initial treatment for patients with ICIAM. However, an inadequate response to corticosteroid therapy is observed in some patients, who are subsequently classified as having steroid-resistant immune checkpoint inhibitor-associated myocarditis (srICIAM). Early combination of second-line immunosuppression may represent an effective therapeutic strategy. However, Biomarkers capable of identifying such patients before treatment are currently lacking. We therefore sought to characterize circulating inflammatory proteins associated with corticosteroid responsiveness and to derive a preliminary serum-based prediction model for steroid-resistant ICIAM (srICIAM).

Serum specimens obtained from patients with ICIAM at baseline and after methylprednisolone treatment were analyzed to quantify circulating immune-related proteins using an antibody-based proteomic assay. We developed a preliminary model for the early identification of patients at risk of srICIAM using proteins selected by three complementary machine-learning algorithms and evaluated its discriminatory performance in an internal hold-out cohort.

Pretreatment serum samples from 47 patients with ICIAM were used to establish a protein-based prediction model, with 33 patients assigned to model development and 14 to internal validation. Patients with a high srICIAM predictive score (≥.5625) based on CXCL9, TRANCE and MMP1 were more likely to show an inadequate early response to corticosteroid therapy and may warrant closer clinical monitoring and further evaluation. The analysis also revealed that several serum immune proteins decreased in patients with ICIAM after methylprednisolone therapy. Serum CXCL9 levels were positively correlated with lactate dehydrogenase (LDH) and cardiac troponin T (cTnT).

Serum immune proteins were dynamically altered in patients with ICIAM after methylprednisolone therapy. The preliminary score may enable earlier recognition of patients at risk of an inadequate corticosteroid response.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and progressive pancreatic β-cell dysfunction, leading to persistent hyperglycemia. Delayed diagnosis is a major public health challenge because many patients are recognized only after developing chronic complications, yet evidence on this problem remains limited in Central Ethiopia.

To assess the prevalence and associated factors of delayed diagnosis of T2DM among patients attending Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital (WUNEMMCSH), Central Ethiopia.

A facility-based cross-sectional study was conducted among 390 adult T2DM patients attending follow-up care at WUNEMMCSH between January 2021 and December 2025 (data collection: February 2026), selected by simple random sampling from medical records. Delayed diagnosis was defined as an interval exceeding three months between the first chart-documented fasting plasma glucose (FPG) ≥126 mg/dL and formal physician-documented diagnosis. Bivariable and multivariable binary logistic regression analyses were performed in SPSS version 25, with significance declared at p < 0.05 using adjusted odds ratios (AOR) and 95% confidence intervals (CI).

The prevalence of delayed diagnosis of T2DM was 25.4% (95% CI: 21.1-29.7). In the multivariable model, rural residence (AOR = 2.37; 95% CI: 1.32-4.24), alcohol consumption (AOR = 3.91; 95% CI: 2.27-6.76, i.e., alcohol users had higher odds of delay than non-users), absence of a history of regular medical check-up (AOR = 3.93; 95% CI: 1.69-9.14), and travel distance to a health facility of one hour or more (AOR = 6.55; 95% CI: 3.16-13.58) were significantly associated with delayed diagnosis. Family history of diabetes, educational status, symptoms at first visit, hypertension, and smoking history were not independently associated with delayed diagnosis in the adjusted model.

Approximately one in four adults with T2DM attending WUNEMMCSH experienced delayed diagnosis. Strengthening opportunistic blood glucose screening, promoting regular preventive check-ups, expanding diagnostic access for rural and geographically distant populations, and targeted outreach for alcohol-using populations are essential to reduce delayed diagnosis and its downstream complications.

Clinical evidence supports the safety and efficacy of imeglimin, a new oral antidiabetic medication that increases insulin secretion and reduces insulin resistance. However, comparative real-world safety data with dipeptidyl peptidase-4 inhibitors, widely used in Japan, remain limited. This retrospective, pharmacy-based cohort study compared the incidence of adverse events (gastrointestinal events and hypoglycemia) among patients newly prescribed imeglimin or sitagliptin in real-world settings. Using a new-user design, we analyzed the 2022-2024 community pharmacy data across Japan, including 1,140 and 990 new imeglimin and sitagliptin users, respectively. Primary outcome (incidence of treatment-related events classified using Medical Dictionary for Regulatory Activities terminology) was evaluated using Cox proportional hazards models. Unadjusted and multivariable-adjusted hazard ratios (aHRs) for events during a 4-month follow-up were estimated. At least one adverse event was reported among 31% of imeglimin users versus 22% of sitagliptin users. Hypoglycemia risk differed non-significantly between groups (aHR: 0.66; 95% confidence interval [CI]: 0.20-2.22). However, imeglimin was associated with substantially higher risks of gastrointestinal events than sitagliptin (aHR: 5.44; 95% CI: 3.44-8.61), particularly nausea (aHR: 15.34; 95% CI: 3.50-67.23), diarrhea (aHR: 7.90; 95% CI: 2.54-24.62), and abdominal discomfort (aHR: 6.02; 95% CI: 1.47-24.58). Sensitivity analyses in patients receiving monotherapy yielded increased risk (hazard ratio (HR): 5.36; 95% CI: 2.63-10.92). Imeglimin use was associated with a higher incidence of gastrointestinal events than sitagliptin in Japanese clinical practice, closely approaching our prespecified threshold for clinical significance. Conversely, no significant difference was observed in hypoglycemia risk, although this finding should be interpreted with caution owing to the limited number of events. Involving community pharmacists allowed for active monitoring and identification of events that are often underreported in large-scale claims databases. Clinicians should prioritize gastrointestinal monitoring during initial stages of imeglimin therapy, particularly in older patients with complex treatment regimens.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) improve cardiovascular, kidney, and metabolic outcomes, but equitable access remains a major challenge. This review synthesizes U.S. evidence on disparities in their use and proposes an Equity-First Framework for cardiovascular-kidney-metabolic care to advance pharmacoequity.

Across 100 U.S.o studies published from 2013 to 2026, the most consistent inequities involved race and ethnicity, socioeconomic status, insurance coverage, age, and access to specialty care, while geographic and sex-related patterns were more heterogeneous. Black and Hispanic patients, Medicaid beneficiaries, lower-income populations, and older adults frequently experienced lower prescribing or initiation. Although use increased following landmark trials and guideline updates, uptake remained well below the eligible population, and disparities persisted or widened for some newer agents. Barriers spanned societal and policy, health-system, provider, patient, and therapy-related domains. Achieving pharmacoequity will require coordinated, multilevel implementation. Our framework links equity-relevant factors and implementation determinants to actionable strategies, including equity monitoring, identification and engagement of eligible patients, equitable care pathways, reduction of structural access barriers, and support for clinicians and patients.