Pediatric specialist shortages and rapidly rising autism prevalence rates have compelled primary care clinicians to consider playing a greater role in the autism diagnostic process. The ECHO Autism: Early Diagnosis Program (EDx) prepares clinicians to screen, evaluate, differentiate, diagnose, and provide longitudinal care for children with autism in primary care settings. Canvas Dx is a prescription-only Software as a Medical Device designed to support clinical diagnosis or rule out of autism, including in primary care settings. It is authorized by the Food and Drug Administration for use, in conjunction with clinical judgment, in 18- to 72-month-olds with indicators of developmental delay.

This study aims to assess the feasibility and impact of integrating the device into the ECHO Autism: EDx workflow. Time from the first clinical question of developmental delay to autism diagnosis is the primary endpoint. Secondary endpoints explore clinician and caregiver experience of device use.

Children aged 18 to 72 months with concern for developmental delay indicated by either a caregiver or health professionals were eligible to participate in this prospective observational study. Experienced ECHO Autism: EDx clinicians were recruited to evaluate the inclusion of the device as part of their diagnostic evaluations. Outcome data were collected via a combination of electronic questionnaires, standard clinical care record reviews, and analysis of device outputs. Institutional review board approval was provided by the University of Missouri-Columbia (project number 2075722).

Eighty children and 7 clinicians completed the study. On average, time from clinical concern at study enrollment to final autism diagnosis was 39.22 days, compared to 180- to 264-day waits at adjacent specialist referral centers. The vast majority (93%, 50/54) of caregivers reported being satisfied with the ECHO Autism: EDx plus device evaluation their child received and endorsed that they would recommend it to others and that they felt comfortable using the device. The device produced determinate autism predictions or rule-outs for 52.5% of participants, and in all cases, these were consistent with the final clinical determination. Participating clinicians reported that device use was feasible and reduced several challenges associated with their previous diagnostic process; however, they noted it did not obviate the need for additional structured observation in every case.

The ECHO Autism: EDx plus device workflow offers considerable time savings compared to specialty center referral and was strongly endorsed by caregiver participants. Embedding the device into the ECHO Autism: EDx workflow was feasible and helped streamline several workflow efficiencies. Clinicians still utilized their training and application and interpretation of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria when formulating the diagnosis for indeterminate cases.

Appropriate sleep duration is essential for maintaining normal cognitive function, but evidence is scarce in rural elderly population. This study aims to determine the associations between sleep duration and cognitive function among older adults in rural China.

This population-based cross-sectional study used data from the Confucius Hometown Aging Project in Shandong, China. Data on demographics, lifestyles, and chronic health conditions were collected through questionnaire surveys, clinical examinations, and laboratory tests. Sleep duration per day was classified into four groups (≤5 h, 6 h, 7 h, and ≥8 h). The Mini-Mental State Examination (MMSE) was used to assess the global and domain-specific cognitive function. Linear and logistic regressions were performed to determine the associations between sleep duration and cognitive function.

Compared with 6 h sleep per day, sleep ≤5 h per day was associated with a higher odd of cognitive impairment with odds ratio (95% confident interval) being 1.70 (1.05, 2.74), but the association was attenuated and insignificant after the adjustment of covariates. Compared to those with 6 h sleep, individuals reporting short (≤5 h) or long (≥ 8 h) sleep duration per day had a lower MMSE score, and the adjusted β coefficient (95% confidence interval) was -0.36 (-0.71, -0.02) for sleep ≤5 h and -0.68 (-1.06, -0.30) for sleep ≥8 h. The patterns were similar for cognitive subdomains in orientation, attention and calculation.

Our study showed that abnormal sleep duration was associated with poor cognitive function in older adults in China. Specifically, longer or shorter sleep duration was associated with lower cognitive function.

The dramatic rise in high-speed internet access and smartphone usage has made multiplayer online gaming increasingly prevalent among young adults. While moderate gaming can confer cognitive benefits, excessive gaming is linked to sleep disruption, addiction, and a spectrum of adverse mental health outcomes-including depression, anxiety, stress, and impaired academic performance. In 2018, the World Health Organization formally recognized Gaming Disorder (GD) as an addictive mental health condition, before that Internet Gaming Disorder (IGD) had been added to DSM-5 in 2013. Despite growing concern, data remain scarce on IGD's prevalence and psychological correlates in Georgian university students. This study therefore assessed the relationship between IGD, gaming duration, and key psychosocial variables (burnout, loneliness, life satisfaction, religiosity, and substance use) in a representative Georgian student sample.

From November 2024-January 2025, an anonymous online survey was administered to students at four major Georgian universities, yielding 506 responses (157 complete). Participants reported weekly gaming hours and completed validated scales: Internet Gaming Disorder Scale, Burnout Scale, Loneliness Scale (emotional/social), Satisfaction with Life Scale, and Financial Wellbeing Scale. Self-reported religiosity, substance use patterns, and demographic data were collected. Statistical analyses (SPSS v26) included Pearson correlations, independent samples t-tests, ANOVA, chi-square tests, and eta coefficients; significance was set at p < 0.05.

Among 506 respondents (mean age 22.1; 33.4% male), mean weekly gaming duration was 8.26 h and mean IGD score was 15.04. Males reported significantly longer gaming duration and higher IGD scores than females (p < 0.001). Weekly gaming duration showed a weak positive correlation with IGD scores (r = 0.31, p < 0.001), explaining ~ 10% of variance. MANOVA indicated that gaming duration retained its statistical significance inside the model (P < 0.001). ANCOVA indicated religiosity (p = 0.016, partial η² = 0.05) and gender (p = 0.040, partial η² = 0.03) remained significant predictors of IGD after adjusting for continuous covariates.

Excessive gaming among Georgian university students is associated with higher IGD severity, greater burnout, and reduced life satisfaction, with religiosity serving as a potential protective factor. These findings underscore the need for targeted interventions-such as psychoeducation and time management strategies-to promote balanced gaming habits. The high attrition rate is the primary limiting factor to generilizing the findings of the study.

Few studies have concurrently examined the biological and social reproductive factors in relation to women's cognitive aging.

We analyzed 8577 women and 7872 men ≥45 years of age from the China Health and Retirement Longitudinal Study. Biological reproductive factors included reproductive span, age at menarche, and age at menopause; social reproductive factors included number of children and age at first live birth. Multivariable regression models were sequentially adjusted for age, childhood cognition proxy, education, and current health and lifestyle factors.

Longer reproductive span was associated with better cognitive performance in women, whereas a higher number of children were linked to poorer cognition in both sexes, particularly in women. These associations remained robust after full adjustment, compared with age at menarche, age at menopause, and age at first birth.

Integrating biological and social reproductive factors provides insights into sex-specific cognitive aging patterns and may inform tailored dementia prevention strategies.

A longer reproductive span was linked to better cognition in older Chinese women. More children were linked to poorer cognition in both sexes, especially in women. Reproductive span and number of children showed robust associations with late-life cognition, stronger than other reproductive factors.

Caring for a child with a complex rare condition is widely acknowledged to have a significant impact on mental health and wellbeing. However, carers often report a lack of appropriate evidence- and strengths-based resources and services that can pre-emptively support their wellbeing. Rare epilepsies are a group of highly complex, typically childhood-onset conditions, characterised by unpredictable seizures, multi-morbidities, lack of targeted treatments, and reduced life expectancy and quality of life. We evaluated the acceptability, feasibility and early effectiveness of a 6-week online group wellness program for Australian carers of a child with rare epilepsy. We co-designed the evaluation with a multidisciplinary team with lived experience and expertise in consumer engagement, medicine, psychology, and implementation science.

The acceptability, feasibility and impact of the program on carers' self-reported wellbeing, self-efficacy and social inclusion was evaluated using a mixed-methods pilot study. The primary outcomes of acceptability and feasibility were assessed post-intervention using a survey measure with 15 purpose-designed items. Secondary outcomes including participant wellbeing, quality of life, and social inclusion were assessed using validated measures pre- and post-intervention. Semi-structured interviews with retreat participants explored in more depth the study's perceived strengths, limitations and value. Recordings were transcribed verbatim and analysed for emergent themes.

Ten participants completed both the pre- and post-intervention questionnaires, with six of these participants also completing an interview. The retreat was considered highly acceptable and feasible; nine out of ten participants rated the quality of the retreat as 'Excellent' and agreed that the sessions were relevant to their experience. There was provisional evidence of early effectiveness, with improvements in wellbeing, self-efficacy, and social inclusion over the course of the study. Qualitative interviews revealed that participants highly valued the retreat's flexible online delivery and practical nature, and the facilitator's authentic knowledge of the carer role.

This pilot study supports the potential benefits of this flexible, online program on carer wellbeing and social inclusion. Larger controlled evaluations are needed to further investigate the program's impact over the short, medium and long-term, including potential enhancements to accommodate more diverse carers and in different settings.

Flexor tendon injuries are common and lead to over 3200 admissions for specialist surgical repair annually in England and Wales. Surgery to repair complete division of both flexor tendons in zone 2 of the hand is technically challenging. There is variation in surgical repair techniques with no high-quality evidence to support decision-making. In particular, the decision to repair both tendons or just one is contested. Surgery is followed by specialist rehabilitation, which takes at least 12 weeks. The resulting hand function can impact the patient's income, life satisfaction, well-being, self-worth, and mental health. The FLARE trial aims to determine the clinical and cost-effectiveness of repairing the flexor digitorum profundus (FDP) alone (intervention) versus the repair of both FDP and flexor digitorum superficialis (FDS) (control) for the treatment of complete zone 2, single-digit flexor tendon injuries in adults.

A multi-centre, two-arm, blinded, non-inferiority, parallel group, randomised controlled trial with an internal pilot, economic evaluation, and nested qualitative study. Participants will be randomised 1:1 to receive either repair of FDP alone or repair of both FDP and FDS. A total of 310 adults will be recruited from NHS Trusts within the UK, randomised at surgery, and followed up within 7 days, 6 weeks, 3 months, and 6 months post-randomisation. The primary outcome measure is the patient evaluation measure (PEM) administered 6 months post-randomisation. Secondary outcomes include the PEM at other timepoints, Patient Related Wrist/Hand Evaluation (PRWHE), EuroQol 5 Dimensions Score (EQ-5D-5L), complications, total range of motion, grip strength, adherence to splint and therapy regimens, work outcomes, treatment and outcome satisfaction, and healthcare resource use.

FLARE is designed with sufficient power and rigour to provide evidence on the clinical and cost-effectiveness of two surgical repair methods for single-digit, complete zone 2 flexor tendon injuries in adults. If the repair of FDP alone is as beneficial to the patient as the repair of FDP and FDS, this could save the NHS £1.8 million annually through reduced time and material costs. Furthermore, the trial findings will facilitate better shared decision-making discussions between clinicians and patients.

ISRCTN 10918157. Prospectively registered: 12.01.2023.

Few studies have systematically examined the barriers and facilitators to buprenorphine uptake, despite increasing opioid-related harms and guideline recommendations for use. The aim of the study was to use behaviour change frameworks to investigate barriers and facilitators to buprenorphine access and use from diverse perspectives in Ontario, Canada.

We conducted semi-structured face-to-face or telephone interviews with Ontarians including: people with living/lived expertise of opioid use (including family members), healthcare professionals, and organizational and system-level representatives. We used purposive sampling via existing professional networks to recruit participants with diverse experiences. The Theoretical Domains Framework (TDF) guided the data collection tool and analysis. Interviews were recorded, transcribed, coded, and underwent thematic analysis involving three study team members.

We interviewed 28 participants between September 2019 and January 2020. Three predominant TDF domains were identified across all 4 levels: (1) environmental context/resources; (2) beliefs about consequences; (3) social influences. Key cross-cutting themes included access to comprehensive care, medication and treatment characteristics, confidence and experiences with buprenorphine, as well as supportive relationships and stigma/discrimination.

Multi-level barriers to optimal buprenorphine implementation continue in the face of the drug toxicity crisis. To counter the identified barriers and enhance facilitators, there is need for mentorship models of support for prescribing, flexibility in buprenorphine treatment requirements, better recognition of mental health and the social determinants of health in buprenorphine treatment, and comprehensive and integrated systems of care.

The online version contains supplementary material available at 10.1186/s13722-025-00610-w.

Although natural disasters pose a threat to everyone, they do not affect all members of society equally. It is now recognized that disasters have gendered dimensions, with different effects on men and women. Resilience is a challenging concept that has become a concern for researchers in the field of health during disasters and emergencies. This study was conducted to identify the resilience characteristics of Iranian women in natural disasters.

This study used a qualitative approach, employing conventional content analysis based on Lindgren's (2020) method. Purposeful sampling was used to conduct individual interviews with 11 women aged 18 and older who were affected by natural disasters, as well as 10 experts in disaster management and resilience.

The resilience of Iranian women in natural disasters was categorized into four main categories: individual resilience (demographic factors, personality traits, physical and mental aspects, knowledge, skills, and previous experiences), cultural resilience (gender discrimination, norms, religious beliefs and practices), social resilience (social interactions, social support, and community security), and economic resilience (assets and income).

To improve the resilience of women in natural disasters, it is necessary to address gender discrimination in policies and planning, including ensuring women's equitable access to education, property ownership, employment, and leadership positions. The root causes of discrimination in various cultural, social, political, and economic dimensions must be addressed. We recommend that disaster management policies include specific components to guarantee the protection of women's legal rights in different communities.

Telehealth has emerged as a promising solution for improving global healthcare delivery by leveraging telecommunications and information technology in remote nursing practice.

This study aimed to evaluate the knowledge, attitude, and readiness of nursing staff toward telehealth.

A cross-sectional study design was employed, conducted across three hospitals affiliated with Assiut University: El-Rajehy, Al Orman, and the Neurology and Psychiatry Hospital. A convenience sample of 250 staff nurses participated in the study. Data were collected using four tools: a demographic and work-related characteristics questionnaire, the Health Professionals' Knowledge toward Telemedicine Technology scale, the Health Professionals' Attitude toward Telemedicine Technology scale, and the Telehealth Readiness Assessment Tool (TRA).

The study identified a significant positive correlation between nurses' knowledge and their attitude and readiness for telehealth. Multiple regression analysis revealed that knowledge was a significant predictor of both attitude and readiness. Nurses with good knowledge demonstrated a higher proportion of positive attitudes (47.8%) compared to those with poor knowledge (2.7%). Notably, nurses with poor knowledge were more likely to report low readiness for telehealth (58.0%) compared to those with good knowledge (26.8%).

These findings highlight the critical role of knowledge in shaping nurses' attitudes and readiness for telehealth. Nurses with higher levels of knowledge were more likely to exhibit positive attitudes and higher readiness for telehealth implementation. Based on these results, it is essential to develop and implement comprehensive educational programs to enhance nursing staff's knowledge and attitudes toward telehealth.

Academic thriving encompasses students' cognitive engagement, emotional well-being, and sense of belonging. The educational environment plays a vital role in supporting thriving, particularly in the demanding context of medical education. Limited multinational data exists on how educational environments influence thriving in MENA region. This study was designed to investigate the relationship between the educational environment and academic thriving among medical students across Arabic-speaking countries, using validated assessment tools.

A cross-sectional, descriptive-correlational design was employed. A total of 1,246 undergraduate medical students from five Arab countries participated in an online survey conducted between February and March 2025. The Dundee Ready Education Environment Measure (DREEM) assessed perceptions of the educational environment, while the Thriving Quotient (TQ) evaluated students' academic engagement and well-being. Data were analyzed using descriptive statistics, inferential tests, correlation, and regression analyses.

Participants reported generally positive perceptions of their educational environment (mean DREEM score: 113.79 ± 27.76) and moderate levels of thriving (Overall TQ mean was 95.38 ± 18.22). Strongest correlations with academic thriving were found in the domains of academic self-perception and social self-perception. Regression analysis revealed that educational environment variables explained 38.7% of the variance in thriving outcomes (p < 0.001). Socio-demographic variables, including gender, financial status, and awareness of student support services, significantly influenced both DREEM and TQ scores.

The educational environment plays a significant role in shaping academic thriving among medical students. Institutions should focus on improving academic support, fostering inclusive environments, and strengthening student-centered teaching strategies to enhance both learning and psychological outcomes.

Not applicable.