The COVID-19 pandemic amplified social injustices through institutional system disruption among marginalized communities in Canada. This study fills an important literature gap by providing the first holistic systematic review with a theoretically grounded framework to anticipate and mitigate social injustices in future public health crises.

Using PRISMA 2020 framework and the databases of Web of Science, Scopus, and PubMed (n = 58, 2020-2023), the study analyzed the pandemic-induced inequities through the PEO framework.

Discrimination was identified as the most pervasive social injustice during the pandemic. Immigrants, Refugees, and Women were identified as the most vulnerable group impacted with various forms of social injustices due to the intersection between different social identities.

The novel PISIIM framework was developed to equip policy makers, social workers, and other stakeholders in anticipating and mitigating injustices in future public health crises.

https://www.prisma-statement.org/prisma-2020-flow-diagram.

Chinese medicine (acupuncture and herbal medicine) is widely used in post-stroke rehabilitation in Southeast Asia. However, evidence on its effectiveness and optimal timing remains inconclusive. This study aimed to determine whether early integration (≤ 6 months post-stroke) of individualized Chinese medicine rehabilitation (CMR) improves functional outcomes compared with delayed integration (> 6 months) in stroke survivors.

This prospective pragmatic study enrolled stroke survivors aged 35-90 years from five Hong Kong community centers following hospital discharge. All subjects received a 24-week individualized CMR scheme comprising acupuncture and Chinese herbal medicine (CHM) granules (administered thrice weekly for 24 weeks, totaling 72 sessions). Outcomes included the changes in activities of daily living (ADL; primary), mini-mental state examination (MMSE), and traditional Chinese medicine syndrome score scale (TCMSSS). Effectiveness was assessed using linear mixed-effect models for repeated measures. Multivariate logistic regression identified factors associated with treatment response. In a post hoc nested case-control analysis, early CMR integration (≤ 6 months post-stroke) was compared with delayed integration (> 6 months) using 1:1 propensity score matching (age, sex, stroke number/type, baseline ADL, hypertension, diabetes, dyslipidaemia, acupuncture sessions, CHM duration).

A total of 398 patients were recruited, of whom 344 (86.6%) completed ≥ 75% of the treatments (≥ 54 sessions). After 24 weeks of treatment, significant improvements were observed in ADL (mean change 5.99, 95% confidence interval [CI] 4.50 to 7.48), MMSE (1.21, 95% CI 0.87 to 1.55), and TCMSSS (-2.89, 95% CI -3.30 to -2.47). Multivariate logistic regression identified baseline ADL dependence (odds ratio [OR] 13.45, 95% CI 7.01 to 25.81), early CMR initiation (OR 2.03, 95% CI 1.23 to 3.35), and lower baseline TCMSSS (OR 0.94, 95% CI 0.91 to 0.98) as independent predictors of response. Kaplan-Meier analysis showed that patients with baseline ADL < 90 had markedly higher responder proportions (46.8% at 60 sessions, 53.6% at 72 sessions) than those with ADL ≥ 90 (9.4% and 12.3%, respectively; log-rank Ps < 0.001). Patients who initiated CMR within 6 months had significantly higher responder proportions at 72 sessions (42.9%) compared with those starting later (25.0%; log-rank p = 0.005). Propensity score matching confirmed that early integration yielded superior ADL (mean difference 3.89, 95% CI 1.30 to 6.48; p = 0.003) and TCMSSS (-0.86, 95% CI -1.69 to -0.04; p = 0.041) outcomes at Week 24. CMR scheme was well-tolerated, with no treatment-related adverse events observed.

Initiating CMR within 6 months post-stroke significantly enhances functional and neurological recovery compared with delayed initiation. These findings support integrating early, individualized CMR into standard stroke rehabilitation protocols.

Hypertensive disorders of pregnancy (HDP) affect 10% to 16% of US pregnancies and increase the risk of developing cardiovascular disease. Guidelines recommend that individuals who experience this diagnosis attend a primary care visit within 12 months post partum to evaluate and manage cardiovascular health.

To evaluate the preliminary effectiveness of a postpartum health coaching intervention in improving health care engagement and blood pressure (BP) control among individuals with hypertension during pregnancy.

This randomized clinical trial was conducted from February 2023 to April 2025 at a community hospital in the Midwestern US. Eligible participants were postpartum women aged 18 years or older with an HDP diagnosis who met one of the following criteria: (1) confirmed diagnosis of chronic hypertension (high BP [≥130/80 mm Hg] before pregnancy or before 20 weeks' gestation), (2) continued use of antihypertensive medications at 6 weeks post partum, and (3) persistent uncontrolled hypertension not managed with antihypertensive drugs (≥130 and/or ≥80 mm Hg) at 6 weeks post partum. All participants completed a remote BP monitoring program. Participants were randomly assigned to receive a health coaching intervention (Staying Healthy After Childbirth-My Hypertension Education And Reaching Target Post Partum; intervention group) or standard of care (control group). The primary analysis followed the intention-to-treat principle.

Participants in the intervention group performed self-measured BP monitoring and received telephone calls from a health coach biweekly for 2 to 6 months post partum and then monthly for 6 to 12 months post partum. Participants were encouraged to create health goals and were supported in their efforts with evidence-based health information. Coordination of care with the participant's primary care physician occurred as needed. Participants in the control group received usual care as indicated by their designated clinician.

The primary outcome was attendance at a primary care visit by 12 months post partum. Secondary outcomes included BP control (<130/<80 mm Hg) and engagement in health-promoting behaviors, such as eating a healthy diet and exercising, by 12 months post partum.

A total of 140 postpartum participants were randomly assigned 1:1 to the intervention group (n = 70; mean [SD] age, 33.4 [5.0] years) or control group (n = 70; mean [SD] age, 33.3 [5.1] years). Two participants had missing primary outcome data. At the time of trial enrollment, 44 participants (63.8%) in the control group and 40 (57.1%) in the intervention group were using an antihypertensive medication. At 6 weeks post partum, the mean (SD) self-measured systolic BP and diastolic BP measurements were 118.8 (8.3) mm Hg and 78.9 (6.9) mm Hg, respectively, in the control group and 119.0 (9.6) mm Hg and 79.3 (7.3) mm Hg, respectively, in the intervention group. Primary care visit attendance was significantly higher in the intervention group than the control group (49 of 69 [71.0%] vs 27 of 69 [39.1%]; relative risk [RR], 2.00 [95% CI, 1.34-2.97], P < .001). The intervention group also demonstrated greater reductions from baseline to 12 months post partum in systolic BP (mean difference, -5.6 [95% CI, -9.4 to -1.7] mm Hg, P = .005) and diastolic BP (mean difference, -4.5 [95% CI, -7.7 to -1.3] mm Hg, P = .006). BP control (<130/80 mm Hg) was significantly more likely among the participants in the intervention compared with the control group (26 of 47 [55.3%] vs 19 of 61 [31.1%]; RR, 1.73 [95% CI, 1.13-2.66]; P = .02). No significant differences in health behaviors were observed between groups.

The health coaching intervention combined with self-measured BP monitoring significantly increased health care engagement and BP control by 12 months post partum. These findings support health coaching as an effective strategy for reducing long-term uncontrolled hypertension among patients with HDP.

ClinicalTrials.gov Identifier: NCT05685251.

Systolic anterior motion (SAM) is a known complication of mitral valve repair characterized by displacement of the anterior leaflet to the left ventricle outflow tract (LVOT) during systole leading to mitral regurgitation (MR) and LVOT obstruction. However, the value of the previously reported risk factors in robotically assisted mitral valve repair (RAMVR) is unknown. We reviewed the peri-operative parameters of 197 consecutive isolated RAMVRs. Patients were retrospectively stratified into low-risk (0-4) and high-risk (5-9) groups based on the total numbers of previously reported risks factors. Operative details and outcomes were compared between groups and the predictive value of the risk factors was analyzed. The overall SAM rate after RAMVR was 3.0% (6/197) with no significant differences between low-risk and high-risk patients (2.4% vs. 4.1%, p = 0.79). Distance from coaptation to interventricular septum (C-sept distance) was the only significant univariable predictor. Both anterior mitral leaflet length and C-sept distance were shown to be discriminatory for SAM in receiver operating characteristic (ROC) analysis. Flexible annuloplasty bands were used more often in the high-risk group (98.6% vs. 91.1% p = 0.034). The peri-operative outcomes between low-risk and high-risk patients were similar. The incidence of SAM after RAMVR was relatively low. Anterior mitral leaflet length and C-sept measured on pre-operative echocardiography appear to be of some predictive value. Use of flexible bands was potentially a viable preventive surgical strategy. Most of the SAM incidences could be managed with medical management and did not persist post-operatively.

To investigate the associations of traditional and novel lipid parameters with the hemorrhagic phenotype in adults with primary moyamoya disease (MMD) and to evaluate their value for phenotype discrimination and stratification. This retrospective dual-center cross-sectional study included 1,176 adults with primary MMD treated at Beijing Hospital and Beijing Tiantan Hospital between January 2022 and January 2026, including 857 patients with a non-hemorrhagic phenotype and 319 with a hemorrhagic phenotype. Traditional and derived lipid parameters were analyzed. Missing body mass index values were handled using multiple imputation. Multivariable logistic regression, restricted cubic spline analysis, receiver operating characteristic analysis, incremental discrimination analysis, sensitivity analyses, subgroup analyses, and exploratory mediation analysis were performed. Compared with patients with the non-hemorrhagic phenotype, those with the hemorrhagic phenotype had lower body mass index and higher levels of several cholesterol-related lipid parameters. In fully adjusted models, total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol were significantly associated with the hemorrhagic phenotype, with odds ratios for the highest versus lowest quartile of 3.435, 3.197, and 3.150, respectively. These indicators showed modest individual discriminative ability and provided limited incremental improvement when added to the basic clinical model. Sensitivity and subgroup analyses were generally consistent. Exploratory analyses identified BMI-related negative indirect effects. Cholesterol-related lipid parameters, particularly total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol, were associated with the hemorrhagic phenotype in adult primary MMD and may serve as supplementary markers for phenotype stratification.

The prevention and treatment of stroke in China remain challenging, and long-term standardized use of secondary prevention medications is of great significance. Overall medication adherence among patients with ischemic stroke is suboptimal and shows a gradual decline after discharge, indicating an urgent need for improvement. This study aims to identify the categories and predictors of developmental trajectories of medication adherence in patients with ischemic stroke, thereby providing a reference for developing precision intervention programs.

A total of 373 patients with ischemic stroke admitted to the Third Xiangya Hospital of Central South University from January to December 2024 were selected using purposive sampling. Baseline data were collected during hospitalization using a general information questionnaire, the Brief Illness Perception Questionnaire (BIPQ), the Self-efficacy for Appropriate Medication Use Scale (SEAMS), the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version (FACES Ⅱ-CV), and the Connor-Davidson Resilience Scale (CD-RISC). Medication adherence was assessed at 2 weeks, 1 month, 3 months, and 6 months after discharge using the 8-item Morisky Medication Adherence Scale (MMAS-8). A latent growth mixture model (LGMM) was used to identify developmental trajectories of medication adherence in patients with ischemic stroke, and multivariate Logistic regression analysis was used to analyze predictors of different trajectory classes.

Four developmental trajectory classes of medication adherence were identified among patients with ischemic stroke: the sustained moderate-adherence group (22.8%), the low-adherence declining group (17.2%), the low-adherence improving group (26.2%), and the moderate-adherence declining group (33.8%). Multivariate Logistic regression analysis showed that, with the low-adherence declining group as the reference, each 1-point increase in SEAMS score increased the odds of being classified into the sustained moderate-adherence group, moderate-adherence declining group, and low-adherence improving group by 48.3%, 33.9%, and 36.5%, respectively (all P<0.05). Each 1-point increase in FACES Ⅱ-CV score increased these odds by 9.2%, 4.3%, and 5.6%, respectively (all P<0.05). Each 1-point increase in BIPQ score decreased these odds by 18.9%, 15.7%, and 16.3%, respectively (all P<0.05). Each 1-point increase in CD-RISC score increased the odds of being classified into the sustained moderate-adherence group and low-adherence improving group by 9.1% and 6.2%, respectively (both P<0.05). Patients aged 18-59 years were 3.537 and 4.032 times more likely than those aged ≥60 years to be classified into the sustained moderate-adherence group and low-adherence improving group, respectively (both P<0.05). Patients taking 1-5 medications were 5.405 and 3.010 times more likely than those taking >5 medications to be classified into the sustained moderate-adherence group and low-adherence improving group, respectively (both P<0.05). With the sustained moderate-adherence group as the reference, each 1-point increase in SEAMS, FACES Ⅱ-CV, and CD-RISC scores, taking 1-5 medications, and being aged 18-59 years reduced the odds of being classified into the moderate-adherence declining group by 9.7%, 4.5%, 9.1%, 77.5%, and 55.8%, respectively (all P<0.05).

The developmental trajectories of medication adherence in patients with ischemic stroke show significant population heterogeneity. Healthcare professionals should actively identify the trajectory types of medication adherence in patients with ischemic stroke and implement stratified intervention strategies based on predictive factors to reverse unfavorable adherence trends.

In the context of prenatal counseling, the factors influencing pregnancy decision-making among parents of fetuses with congenital heart disease (CHD) remain unclear. This study aims to investigate the factors influencing pregnancy decision-making among parents of fetuses with CHD, with a particular focus on the roles of non-medical factors such as psychological status, socioeconomic status, and the degree of fetal expectation.

A prospective cohort study design was adopted. Expectant parents whose fetuses were prenatally diagnosed with CHD at the Second Xiangya Hospital of Central South University and Hunan Provincial Maternal and Child Health Care Hospital from July 2021 to December 2025, and who received multidisciplinary counseling led by CHD specialists, were enrolled. According to the prognostic risk scoring system, the fetuses were classified into a mild group (0-3 points), a moderate group (4-6 points), and a severe group (7-9 points).Information on the fetuses and parents was collected through questionnaires, and follow-up files were established. Standardized follow-up was conducted at 1 week after counseling, 1 to 2 weeks before the expected date of delivery, and 2 weeks after the expected date of delivery to record the pregnancy outcomes. Multivariate Logistic regression analysis was used to identify independent factors influencing pregnancy decision-making.

A total of 834 families with fetuses prenatally diagnosed with CHD were included. Among them, 522 families (62.6%) chose to continue the pregnancy, whereas 312 families (37.4%) chose to terminate the pregnancy. The severity of fetal disease was the strongest predictor of pregnancy termination. Compared with the mild group, the risk of pregnancy termination in the moderate group increased by 6-fold [adjusted odds ratio (aOR)=6.04, 95% confidence interval (CI) 3.98 to 9.15, P<0.01], and the risk in the severe group increased by 53-fold (aOR=52.97, 95% CI 14.73 to 190.44, P<0.01). Multivariate Logistic regression analysis showed that, after controlling for disease severity, earlier gestational age at diagnosis (aOR=0.76, 95% CI 0.72 to 0.81, P<0.01), older maternal age (aOR=0.96, 95% CI 0.92 to 0.99, P=0.039), multiple pregnancy (aOR=0.24, 95% CI 0.09 to 0.65, P=0.005), higher annual household income (≥200 000 yuan; aOR=0.05, 95% CI 0.01 to 0.21, P<0.01), and a higher degree of fetal expectation (aOR=0.66, 95% CI 0.47 to 0.94, P=0.019) were independent protective factors for continuing pregnancy.

Pregnancy decision-making among parents of fetuses with CHD is a complex process jointly influenced by fetal medical factors, family socioeconomic status, and psychosocial factors. In addition to disease severity, family economic status, and par ental expectations regarding the fetus have important effects on decision-making.

Chronic heart failure (CHF) is characterized by high prevalence, high mortality, and high readmission rates. Optimized combination pharmacotherapy is the main approach to controlling clinical symptoms and reducing mortality and readmission rates. Ensuring medication safety is a top priority in disease management for patients with CHF, and adequate medication literacy is essential for medication safety. At present, there is a lack of disease-specific tools for assessing medication literacy in patients with CHF. This study aims to develop a Medication Literacy Scale for patients with CHF and to test its reliability and validity, thereby providing a reference for medication use in patients with CHF.

An initial item pool was established through literature analysis and group discussion. Items were optimized using qualitative methods, including Delphi expert consultation and cognitive interviews, and quantitative methods, including item analysis and exploratory factor analysis. Reliability was then evaluated using the Kuder-Richardson formula 20 (KR-20), split-half reliability, and test-retest reliability. Validity was assessed in terms of content validity, criterion-related validity, and construct validity.

The Medication Literacy Scale for patients with CHF consisted of 4 dimensions and 13 items, including 4 items for functional literacy and 3 items each for communicative literacy, critical literacy, and numeracy. A dichotomous scoring method was used, with a total score of 13; higher scores indicated higher levels of medication literacy among patients with CHF. The KR-20 coefficient of the total scale was 0.794, the split-half reliability was 0.701, and the test-retest reliability was 0.842. The item-level content validity index ranged from 0.90 to 1.00, the scale-level content validity index was 0.92, and the criterion-related validity coefficient was 0.739. The chi-square/degrees of freedom ratio was 1.472, the root mean square residual was 0.009, the root mean square error of approximation was 0.049, the goodness-of-fit index was 0.942, the adjusted goodness-of-fit index was 0.908, and both the comparative fit index and incremental fit index approached 0.9.

The Medication Literacy Scale for patients with CHF has a scientific theoretical basis, a standardized development process, and good reliability and validity. It can be used to assess medication literacy in patients with CHF. Clinical practitioners may use this scale to evaluate the overall level of medication literacy and the levels of each dimension among patients with CHF, thereby providing targeted medication guidance and ensuring medication safety in this population.

Plant-based vegan diets (PBVDs) improve cardiometabolic risk markers, hence are recommended as an adjunct treatment by some cardiologists. To complete a service evaluation, practical measures of dietary adherence are required, and perceptions of patients need to be considered.

A single-arm, mixed-methods design was used to assess the feasibility of using two diet indices to assess adherence to a PBVD and the acceptability of adopting a PBVD in a cardiac outpatient setting. Diet adherence was measured via absence of proscribed foods (APF) and a plant-based vegan diet score (PBVD-S). Acceptability of the PBVD was assessed via individual interviews and a food acceptability questionnaire.

Twenty patients completed the dietary assessment. After 8 weeks, 55% (n = 11) were classified as fully adherent to the PBVD. Mean score for the PBVD-S increased from 20.3 ± 8.7 at baseline to 38.9 ± 5.8 at Week 8. Mean total cholesterol (TC), body mass index (BMI), body mass, and waist circumference significantly decreased (p < 0.001) after 8 weeks on the PBVD. The PBVD-S satisfied the feasibility criteria of alignment with diet education and assessment of adherence. The PBVD was rated as either "moderately" or "extremely" acceptable by 80% of patients.

The PBVD-S is a feasible option for assessing adherence and diet quality of a PBVD in a cardiology outpatient setting.

Emerging research has associated non-conventional lipid indices with hypertension risk; however, the joint contribution of these lipid metrics and inflammatory biomarkers to hypertension susceptibility remains unclear. Using a nationally representative cohort, we aimed to examine the independent associations of non-conventional lipid indices and their inflammatory composites with incident hypertension.

We included 6891 participants from the China Health and Retirement Longitudinal Study (2011-2020). We used multivariable Cox proportional hazards regression to assess the association between baseline and cumulative non-conventional lipid-inflammatory parameters and incident hypertension. We used restricted cubic spline modelling to characterise dose-response relationships. We evaluated receiver operating characteristic curves, net reclassification improvement, and integrated discrimination improvement as secondary conditional analyses.

Over a median follow-up of 7.79 years, 2532 incident hypertension cases occurred. Higher tertiles of non-conventional lipid indices were associated with progressively increased hypertension risk. In the primary model, elevated baseline and cumulative non-conventional lipid metrics were associated with a higher risk of hypertension across all composite indices. The lipoprotein combine index-C-reactive protein showed the largest effect size (hazard ratio = 1.59; 95% confidence interval = 1.44-1.75). Composite indices demonstrated modest incremental discrimination over individual measures (area under the curve range = 0.55-0.58).

Non-conventional lipid indices are independently associated with incident hypertension among middle-aged and older Chinese adults. Composite lipid-inflammatory markers provide modest incremental prognostic information beyond conventional lipids, though their standalone discriminatory performance is weak.