Public Health and Healthcare

Abstract: Background/Objectives: Familial resilience is essential for the well-being of households raising children with Autism Spectrum Disorder (ASD), yet its determinants remain insufficiently understood in Greece. Methods: A cross-sectional study of 517 mothers used validated self-report measures, including the Family Resilience Scale. Descriptive statistics, correlation analyses, and multivariate linear regression models were applied to identify factors associated with Family Pride and Family Cohesion. Results: Families reported high Family Pride and average Family Cohesion. Family composition, maternal age, and birth order predicted Family Pride, while paternal family history and child functional level predicted Family Cohesion. Conclusions: Findings show that resilience in ASD families is multidimensional and shaped by structural and child-related factors, highlighting the need for targeted family-centered supports.

Abstract: This contribution offers a transdisciplinary examination of West Nile virus (WNV) infection, articulating bio‐epidemiological data through the lens of the hermeneutics of care and embodied cognition. Through an analysis of seroprevalence rates among blood, organ, cell, and tissue donors—with particular reference to the endemic Italian context—we highlight the critical issues surrounding iatrogenic transmission and the imperative for stringent molecular biosurveillance protocols. Furthermore, we dissect the mechanisms of immune evasion, susceptibility markers derived from systems immunology, and therapeutic perspectives offered by neutralizing human monoclonal antibodies isolated from convalescent patients. Finally, the investigation extends to the clinical spectrum—from the diagnostic ICD‐10 code A92.3 to atypical manifestations such as acute flaccid paralysis, myocarditis, and bullous dermatoses with keratinocyte tropism—interpreting the clinical trajectory from comatose states to functional recovery as a path of generative teleology and somatic proprioception.

Abstract: International leave indicators can describe weeks of entitlement without establishing whether the same worker can obtain protected absence, income replacement and job continuity during a newborn’s hospitalization. This Policy Analysis operationalizes a Same-Claimant Protection Test as a reproducible comparative legal-policy audit that traces claimant eligibility, clinical trigger, protected time, payment, employment continuity and administrative access as distinct but interacting gateways. It applies the method to three purposively selected mechanism tests—Great Britain, France and Illinois—using operative legal texts as of October 2026. The cases expose different forms of institutional fragmentation: separate leave and pay conditions; a narrowly triggered hospitalization extension embedded in paternity leave; and employer-size-conditioned unpaid neonatal intensive-care leave. They do not estimate global prevalence or real-world benefit take-up. The paper links administrative-burden theory to observable legal information and compliance requirements and proposes a transferable rights-pathway schedule for legislators, statistical agencies and international data producers. The central policy implication is that entitlement duration should be accompanied by dated, claimant-specific metadata and explicit uncertainty codes rather than treated as a sufficient proxy for usable protection.

Abstract: Background: Total gastrectomy (TG) for gastric cancer induces severe metabolic stress, altered gastrointestinal function, and rapid post-surgical immunonutritional decline. This study evaluated the clinical efficacy of a structured perioperative nutritional intervention on clinical recovery, overall malnutrition (GLIM criteria), and immunonutritional reserves (PNI and CONUT scores) in post-TG patients. Methods: A controlled, non-randomized interventional study was conducted on 76 gastric cancer patients undergoing TG at Vietnam National Cancer Hospital (2023–2024), divided equally into an intervention group (n = 38) and a matched control group (n = 38). The intervention arm received 1 month of individualized nutritional counseling, a disease-specific diet, and an immunonutrient-enriched hydrolyzed peptide supplement (arginine, glutamine, nucleic acids, omega-3 fatty acids). Clinical recovery metrics (time to first flatus, oral feeding initiation, length of stay), GLIM-defined malnutrition, and immunonutritional indicators (PNI and CONUT scores) were evaluated. Results: Baseline demographic and clinical characteristics were homogeneous between groups. The structured intervention significantly accelerated functional gastrointestinal recovery: time to first flatus (56.4 ± 12.1 vs. 128.1 ± 80.6 hours, p < 0.001) and time to initiate oral feeding (48.2 ± 8.4 vs. 141.0 ± 76.7 hours, p < 0.001) were markedly reduced. Consequently, length of hospital stay was shortened by nearly four days (8.4 ± 1.8 vs. 12.2 ± 3.9 days, p < 0.001). Postoperative malnutrition progression at follow-up was significantly attenuated in the intervention group (86.8% vs. 100%, p = 0.0135). Furthermore, in elderly patients (≥60 years), the intervention preserved immunonutritional status, resulting in significantly lower rates of abnormal PNI (33.3% vs. 81.0%, p = 0.0043) and high-risk CONUT scores (47.6% vs. 90.5%, p = 0.0063). Conclusions: Early structured perioperative nutritional intervention accelerates gastrointestinal recovery, shortens hospital stay, mitigates post-gastrectomy catabolic malnutrition, and preserves visceral protein and immunological reserves in elderly patients following total gastrectomy.

Abstract: Background/Objectives: This study examined whether adding trunk neuromuscular training to knee-focused rehabilitation offers additional pain reduction in adults with knee osteoarthritis (OA) and sway-back posture. The study also assessed effects on muscle strength, knee range of motion, and postural alignment. Methods: Thirty adults with symptomatic knee OA and sway-back posture were randomized to knee-focused rehabilitation (KNEE; n = 15) or the same intervention with added trunk neuromuscular exercises (KNEE-CORE; n = 15). Twenty-four participants completed the study and were included in the analysis (12 per group). Both groups completed 12 supervised sessions, twice weekly. Outcomes included pain, muscle strength, knee range of motion, and postural alignment. Results: Both interventions resulted in substantial pain reduction. By session 6, pain decreased from 7.67 ± 1.07 to 3.75 ± 1.06 in KNEE and from 7.42 ± 1.68 to 1.58 ± 0.67 in KNEE-CORE, with a significant group-by-time interaction favouring KNEE-CORE (β = −1.92, 95% CI −2.80 to −1.04; p < 0.001). By session 12, pain was low in both groups (0.92 ± 0.67 and 0.17 ± 0.39), and the difference in change from baseline was no longer significant (p = 0.378). No consistent additional benefits were observed for knee range of motion or muscle strength. Some postural outcomes favoured KNEE-CORE, but these findings were exploratory. Conclusions: Trunk neuromuscular training accelerated early pain reduction but did not produce a clearly greater overall reduction by the end of treatment. Proximal neuromuscular training may influence the timing of symptomatic response rather than the final level of improvement.

Abstract: Short-form videos are a familiar source of entertainment and information for children and young people. Although individual videos are brief, personalized recommendations and easy access to the next clip can extend viewing. In serialized stories, curiosity about what happens next may encourage continued viewing and purchases of paid episodes. Children are still developing the ability to balance immediate enjoyment with future goals. This narrative review considers how this developmental process interacts with smartphone-based viewing and summarizes evidence on sleep, mental health, attention, cognition, and school functioning. Existing studies report associations between problematic use and poor sleep, depressive and anxiety symptoms, and lower academic engagement. However, causal relationships remain uncertain, and evidence for preschool and primary-school children is limited. Assessment should address difficulties stopping, reasons for viewing, and interference with daily life, rather than viewing duration alone. Prevention should not depend solely on children’s self-control or parental supervision. The responsibilities of service providers and content producers also deserve attention when continued viewing and purchasing contribute to revenue. Family, school, and healthcare support should be combined with developmentally appropriate design that makes stopping easier and prices and purchase conditions clearer. These approaches require evaluation using outcomes that matter to children’s health and daily functioning.

Abstract: Large language models (LLMs) are increasingly used in qualitative data analysis, introducing reporting considerations not explicitly addressed by COREQ or SRQR. This study used a structured literature review–informed methodological synthesis to develop preliminary COREQ-AI and SRQR-AI extensions. Of 2,127 records identified, the synthesis included 65 studies. The proposed extensions address model specification, prompt transparency, algorithmic reflexivity, human-in-the-loop validation, AI auditability, data governance, and ethical accountability. Five independent researchers appraised the extensions; 80% considered them relevant and clear, 100% applicable, and 60% indicated that further refinement was needed. Illustrative applications further demonstrated their potential to identify AI-specific reporting information not captured by the original guidelines. COREQ-AI and SRQR-AI are preliminary, literature-informed reporting extensions intended to improve transparency and critical appraisal of LLM-assisted qualitative analysis; they are not validated or consensus-derived standards. Further empirical evaluation, stakeholder consultation, and consensus development are required.

Abstract: Background Concerns regarding risk compensation following initiation of oral HIV pre-exposure prophylaxis (PrEP) remain an important consideration in HIV prevention programmes. However, evidence on behavioural changes following PrEP initiation within pharmacy-delivered models particularly among adolescents and young adults. in sub-Saharan Africa remains limited. This study evaluated short-term changes in sexual risk behaviours among young adults receiving pharmacy-delivered oral PrEP in Nigeria. Methods We conducted a prospective implementation study among young adults aged 18–24 years initiating oral PrEP through two community pharmacies in Abuja, Nigeria. Participants completed behavioural assessments at baseline and one month following PrEP initiation. Risk compensation behaviours assessed included condomless sex, transactional sex, sex under the influence of alcohol or drugs, sexually transmitted infection (STI) diagnosis, and number of sexual partners. Paired behaviour changes between baseline and Month 1 were assessed using McNemar’s test for categorical variables and Wilcoxon signed-rank test for continuous variables. Firth penalized logistic regression guided by the Health Belief Model evaluated predictors of increased sexual risk behaviours following PrEP initiation. Results Among 197 participants initiating PrEP, 90 completed paired behavioural assessments at Month 1. Median age was 24 years (IQR: 22–24), 71% were female, and 93% were single. No significant increase in sexual risk behaviours was observed following PrEP initiation. Condomless sex remained stable between baseline and Month 1 (21.2% vs 19.0%; p = 1.000), while transactional sex (41.1% vs 32.2%; p = 0.080) and sex under the influence of alcohol or drugs (51.1% vs 42.2%; p = 0.170) did not significantly increase. STI diagnosis significantly decreased from 37.8% at baseline to 11.1% at Month 1 (p < 0.001), and the distribution of partner numbers shifted downwards significantly from baseline to Month 1 (median 2 [IQR: 1–4.75] vs 2 [IQR: 1–3]; p = 0.011). In Health Belief Model-based regression analyses, High perceived HIV risk was significantly associated with lower odds of increased transactional sex following PrEP initiation (OR = 0.13; 95% CI: 0.01–0.85; p = 0.034). Conclusion This study found no evidence of substantial short-term risk compensation following initiation of pharmacy-delivered oral PrEP among young adults in Nigeria. Sexual risk behaviours remained stable or decreased after PrEP initiation, suggesting that pharmacy-delivered PrEP can be implemented without significant behavioural risk escalation in this population. Larger longitudinal studies are needed to evaluate longer-term behavioural outcomes.

Abstract: Introduction Digitized archives and health records offer growing opportunities for research, but approaches to extracting unstructured data remain heterogeneous. Large language models (LLMs) and generative artificial intelligence (GenAI) may facilitate extraction and synthesis, yet reporting guidance remains limited. This study develops CLEAR-Arch, a preliminary framework for transparent and reproducible reporting of LLM-assisted research. Method A scoping review–informed conceptual synthesis identified methodological and reporting considerations relevant to AI-assisted extraction, archival research, health informatics, and evidence synthesis. Candidate items were consolidated into reporting domains and used to develop performance indicators and a preliminary checklist. Results CLEAR-Arch proposes domains covering model specification, prompt design, document processing, extraction procedures, human validation, auditability, and data governance. Candidate indicators include precision, recall, F1-score, contextual accuracy, temporal fidelity, source-groundedness, inter-coder reliability, cross-source consistency, validation accuracy, and auditability. Conclusions CLEAR-Arch provides a preliminary, literature-informed framework for improving transparency, reproducibility, and methodological rigour in LLM-assisted research. Its domains, indicators, and reporting items are provisional, not established standards. Empirical validation, stakeholder consultation, content-validity assessment, and formal consensus development are needed before it can be considered standardized reporting guidance.

Abstract: Pre-symptomatic genetic and genomic testing can identify individuals at increased disease risk before symptoms emerge, but implementation depends on patient, clinician, organisational and system factors. This updated systematic review examined barriers and facilitators to implementation after the search period of Shen et al. (through 22 May 2020). PubMed was searched on 3 August 2026 using three independently constructed search sets for genetic/genomic testing, presymptomatic/asymptomatic screening, and implementation-related evidence, combined as #1 AND #2 AND #3. English-language records from 2020–2026 were screened, with publication dates audited against the update boundary. One reviewer conducted screening, eligibility assessment, design-appropriate JBI critical appraisal, extraction and narrative thematic synthesis. Of 824 records identified before filtering, 347 were screened, 91 reports were sought, 80 full texts were assessed, and 63 studies were included. Across 424 extracted barrier/facilitator findings, system-level determinants were most frequent (141 findings across 47 studies), followed by patient-level determinants (103 across 40). Thirty-four of 58 themes from Shen et al. were confirmed, while 17 additional themes were identified, including care-pathway design and follow-up, health equity and representativeness, workforce capacity, organisational readiness, logistics, and family dynamics. The post-2020 evidence places greater emphasis on operational delivery and health-system capacity, although comparisons with the earlier review are limited by PubMed-only coverage and a single-reviewer workflow. Implementation should therefore be understood as a care pathway extending beyond the genetic test itself.

Abstract: Background: Systematic and scoping reviews rely on established frameworks such as PICO (Population, Intervention, Comparator, Outcome), SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type), and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) to structure research questions, guide evidence synthesis, and ensure transparent reporting. These frameworks were developed for linear, human-driven workflows involving manual searching, screening, and data extraction. The emergence of large language models (LLMs) and Generative AI (Gen-AI) introduces new capabilities for semi-automated literature discovery, screening, data extraction, and thematic synthesis. However, the methodological implications of AI-assisted evidence synthesis remain underexplored. Methods: This manuscript employed a scoping review–informed methodological analysis of empirical and methodological literature located through structured searches of PubMed and Google Scholar. Preliminary conceptual extensions to PICO, SPIDER, and PRISMA were developed, retrospectively applied to published studies, and independently evaluated by five researchers for applicability, relevance, and clarity. Results: LLMs enable dynamic and iterative processes across evidence synthesis stages, including automated question formulation, large-scale qualitative analysis, and hybrid human–AI screening and extraction. These developments challenge the linear assumptions of PICO, SPIDER, and PRISMA. In response, PICO-AI, SPIDER-AI, and PRISMA-AI incorporate dimensions including prompt transparency, model specification, human-in-the-loop validation, Human–AI workflow classification, data governance, and AI auditability. Independent evaluation showed 80% item agreement, with overall mean relevance and clarity ratings of 3.2/4. Conclusions: LLMs and Gen-AI do not replace systematic review frameworks; rather, they extend them by introducing adaptive, data-driven workflows. Integrating AI into evidence synthesis requires revised methodological guidance to ensure transparency, reproducibility, and rigour. The proposed preliminary extensions provide a model for incorporating machine intelligence into systematic and scoping review practices.

Abstract: The increasing prevalence of neurodegenerative diseases (NDs), especially Alzheimer's and Parkinson's, is a major public health concern in the Gulf countries (GCs) due to the rapid increase in life expectancy and population aging. This research explores the impact of radio, podcasts, and YouTube on raising awareness about NDs and publicizing media's focus on policy in four GCs: Oman, Qatar, the UAE, and Saudi Arabia, in light of media and technological limitations and restrictions, alongside cultural and religious contexts. It is observed that while radio would help to engage elderly people and rural populations, podcasts enable in-depth health education. YouTube provides an effective channel for visually clear communication of health-related information, the evidence for media to communicate specific knowledge about NDs is not strong. The lack of evidence and normalization of cognitive decline have remained an obstacle. It concludes that effective communication channels that build on existing cultural and social factors show promise for informing and increasing health awareness of NDs, but evidence is still lacking to show that receiving information alone affects health or policy. It emphasizes the necessity for future study into whether improved knowledge at the community level leads to earlier help-seeking, improved caregiver support, and access to services.

Abstract: Background. Non-communicable diseases account for most outpatient visits, long-term prescriptions, and elective surgery, yet practical models for delivering structured lifestyle correction within routine care remain scarce. This report describes the design, delivery, and early dissemination of a doctor-supervised outpatient programme. Programme. The Clinically Supported Lifestyle Correction with Cell Activation Protocol (CSLC-CAP), delivered at a private hospital in Kochi, India, corrects four interdependent lifestyle domains — nutrition, physical and mental activity, rest and sleep, and toxin exposure — through a six-stage pathway from objective baseline assessment to long-term maintenance. Implementation. A small team (consultant doctor, counsellor, activity trainer, pharmacist) delivers a 90-day active phase with daily charting of all four domains, telemedicine follow-up throughout, and serial laboratory and body-composition measurement. Medication is reduced under supervision, guided by test reports in asymptomatic conditions and by symptoms in symptomatic ones. Adaptations include resistance-based activity performed seated or lying down and removal of non-nutritive dietary load. Early insights. Adherence is the rate-limiting step; the first month is the most monitoring-intensive; and benefit persists only while the practice continues, so relapse and restart are built into the pathway. The model is teachable and transferable; formal evaluation is planned.

Abstract: Background. Silver diamine fluoride (SDF) can support caries control, but lesion-level arrest alone does not restore tooth form, sustain function, protect pulpal health, or complete a child’s care. The Preservation-to-Precision (3P) Pathway organizes treatment around these separate responsibilities. [1,2 ] Purpose. This toolkit consolidates clinical, consent, behavioral, home-care, restorative, and administrative documents into a single implementation resource for dental teams caring for children with caries, including children facing barriers to timely treatment. Approach. We consulted selected professional guidance to qualify clinical instructions and update coding terminology. The document is an operational synthesis, not a systematic review or a prospective evaluation. Framework. Care begins with diagnosis, shared decision-making, and a documented purpose for SDF. A 2–4-week response review is followed by risk-adjusted monitoring and explicit 6- and 12-month pathway reviews. These later milestones are proposed accountability checkpoints, not biological expiry dates or universal mandates for restoration. SMART or other treatment can be provided earlier when indicated. Printable templates support consent, aftercare, clinical recording, tracking, and audit. Conclusion. The proposed pathway seeks to prevent temporary stabilization from becoming unexamined deferral. Assess its value through child- and tooth-level outcomes, timely access to indicated care, and transparent reporting of failures and missed follow-up, rather than application counts alone.

Abstract: Shamonda virus (SHAV), an emerging orthobunyavirus recently detected in Europe, was investigated in dairy water buffaloes (Bubalus bubalis) following reports of reduced milk production in Campania, southern Italy. In September 2026, 23 buffaloes from four farms in Salerno province were sampled, including EDTA blood from 15 animals and individual milk from eight. Samples were tested by RT-qPCR for SHAV and, in parallel, for Schmallenberg virus, bluetongue virus and epizootic haemorrhagic disease virus. SHAV RNA was detected in 10 of 15 blood samples and in all eight milk samples examined, whereas the other viruses were not detected. Three samples with the lowest Cq values were subjected to whole-genome sequencing. Phylogenetic analysis of the L, M and S segments showed that all three strains clustered within the SHAV-EU1 clade and were closely related to viruses detected in cattle in France, Germany and Switzerland in 2026. Although detection of viral RNA in milk does not demonstrate the presence of infectious virus or replication in the mammary gland, these findings document SHAV infection in water buffaloes and support the inclusion of this species in surveillance during the ongoing European emergence of SHAV.

Abstract: Background: Family and unpaid caregivers play an essential role in supporting individuals with cancer and frequently navigate complex health information related to treatment, symptoms, supportive care, and healthcare services. Difficulty obtaining, understanding, and evaluating cancer information may contribute to psychological distress among caregivers. However, nationally representative evidence examining the association between cancer information burden and caregiver psychological well-being remains limited. Objective: This study examined the association between cancer information burden and psychological distress among U.S. adults who reported providing care to an individual with cancer. Methods: We conducted a cross-sectional analysis of pooled data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) Cycles 6 and 7. Cancer caregivers were identified based on respondents reporting caregiving for an individual with cancer. Cancer information burden was measured using four items assessing the effort required to obtain cancer information, difficulty understanding cancer information, frustration during cancer information seeking, and concern about information quality. Item responses were averaged to create a composite cancer information burden score, with higher scores indicating greater burden. Psychological distress was measured using the Patient Health Questionnaire-4 (PHQ-4), a validated 4-item measure of depressive and anxiety symptoms ranging from 0 to 12. Survey-weighted linear regression examined the association between cancer information burden and PHQ-4 scores while accounting for the complex survey design. Adjusted models included age, sex, race and ethnicity, education, and household income. Results: We identified 241 respondents as cancer caregivers, with 124 included in the fully adjusted complete-case analysis. In the common analytic sample, higher cancer information burden was associated with greater psychological distress in unadjusted analysis (β=1.57, 95% CI 0.17-2.98; p=.028). After adjustment for age, sex, race and ethnicity, education, and household income, the association remained statistically significant (β=0.89, 95% CI 0.03-1.75; p=.042). Older age was associated with lower psychological distress in the fully adjusted model (β=-0.06, 95% CI -0.11 to -0.01; p=.013). Several education and income categories were also associated with psychological distress. Diagnostic analyses supported an approximately linear relationship between information burden and PHQ-4 scores, although heteroskedasticity was present. Conclusions: Greater cancer information burden was associated with higher psychological distress among U.S. cancer caregivers. These findings suggest that caregiver well-being may be influenced not only by access to cancer information but also by the effort, complexity, frustration, and uncertainty involved in navigating that information. Interventions and digital health resources designed for cancer caregivers should therefore consider strategies to reduce information burden and improve caregivers' ability to identify, understand, and evaluate cancer-related information.

Abstract: Non-invasive aesthetic technologies, such as cryolipolysis (CLL), radiofrequency (RF), and ultrasound cavitation, have become standard therapeutic approaches for the management of localized adiposity and gynoid lipodystrophy (cellulite). While these technologies effectively induce adipocyte apoptosis or lipolysis, the subsequent clearance of cellular debris and free fatty acids (FFAs) heavily relies on the body’s lymphatic and metabolic pathways. This article explores the therapeutic synergy between applied physical activity and non-invasive body contouring. We hypothesize that integrating targeted exercise—specifically aerobic training and targeted muscle contractions—may act as a therapeutic adjunct to aesthetic sections. Physiologically, exercise-induced muscle pumps accelerate lymphatic drainage, facilitating the rapid removal of metabolic byproducts, while increased energy expenditure promotes the oxidation of released FFAs, preventing their re-esterification. By bridging aesthetic science and applied physical activity, this paper proposes a theoretical framework for combined protocols, intended to guide future clinical investigation and offer a holistic, therapeutic approach to body sculpting.

Abstract: Background: Primary healthcare (PHC) is essential for depression management. However, system navigation remains under-explored in the lived experiences of service recipients in non-Western aging contexts. Objective: To explore experiences, perceptions, and barriers among Thai older adults with depression and family caregivers navigating the PHC depression surveillance network. Methods: Guided by COREQ, this qualitative study spanned six geographic regions in Thailand. Using purposive sampling within a multiphase framework, semi-structured face-to-face interviews were conducted with 60 older adults diagnosed with depression and 12 family caregivers (N = 72). Data were transcribed verbatim and analyzed using qualitative content analysis supported by componential analysis principles. Results: Navigation unfolded across three interconnected domains: (1) Recognizing Emotional Distress: Older adults framed symptoms as physical ailments or normal aging, whereas caregivers identified behavioral withdrawal and functional decline. (2) Interacting with PHC Services: Initial screening by Village Health Volunteers and nurses via 11Q tools enabled system entry, but interactions were constrained by limited consultation time, stigma, and fragmented communication. (3) Sustaining Care Continuity: Referral disconnects between subdistrict health-promoting hospitals and community hospitals’ psychiatric units shifted the burden onto caregivers to maintain treatment adherence without adequate psychosocial support. Conclusions: Navigating primary depression care involves multidimensional challenges. Strengthening community-based care requires transforming routine screening into continuous, person- and family-centered surveillance, streamlining referral pathways, and formally empowering family caregivers as care partners.

Abstract: Background: Dental caries is the most prevalent noncommunicable disease worldwide. Within the DCIEH framework it is a dysbiosis of the dental biofilm microbiome that is regulated by biology, modulated by behavior and conditioned by the environment. It is also a trans-complex disease whose outcome emerges from the interaction of biological, behavioral and socio-environmental factors. Behavioral sciences offer mature theories to explain and change oral health behaviors, but a persistent gap separates these theories from routine chairside care. In 2024 we proposed ELIGE/CHOOSE, a theoretical framework that integrates Social Cognitive Theory (SCT) and the Capability-Opportunity-Motivation-Behavior (COM-B) model into three clinical phases: Identify, Articulate and Plan.Objective: To report the systematic development of ELIGE AI, a clinical decision support tool that operationalizes the ELIGE/CHOOSE framework through an evidence-based, author-designed deterministic algorithm combined with a large language model (LLM).Methods: Development was guided by the Medical Research Council framework for complex interventions, the ORBIT model and the IDEAS framework for digital behavior change interventions. Reporting draws on TIDieR, DECIDE-AI and TRIPOD-LLM. Development proceeded in five phases: (1) theoretical integration of SCT, COM-B, the Transtheoretical Model, the Health Action Process Approach, motivational interviewing and Intervention Mapping; (2) translation into a stepwise clinical protocol; (3) formalization of the first author's clinical reasoning as an explicit decision algorithm, with every rule traceable to theory or evidence; (4) integration of an LLM restricted to bounded language tasks; and (5) iterative build-and-refine cycles across versions informed by clinical use.Results: ELIGE AI (v3.9) is a web application with seven screens across the three ELIGE/CHOOSE phases plus a follow-up module. In about 20 to 25 minutes it produces a specified behavior, a principal COM-B determinant with a displayed rationale, a graded goal ladder, Behaviour Change Technique Taxonomy v1 techniques matched to the determinant, rule-based referrals and personalized patient materials. At follow-up it re-measures the same constructs, behavior frequency and dental caries risk, and recommends the next step on the same behavioral route. The algorithm makes every clinical decision; the LLM only drafts and classifies; the clinician validates and can override every output.Conclusions: ELIGE AI shows how a published behavioral framework and its author's clinical reasoning can be encoded as a transparent algorithm and safely combined with generative AI. The tool now enters a three-stage evaluation of usability, feasibility and validity, and efficacy on dental caries outcomes.

Abstract: Error enhancement (EE), also referred to as error augmentation (EA), represents a distinctive ap-proach to motor rehabilitation in which errors are not minimized but deliberately magnified in a controlled manner. The underlying premise is derived from contemporary theories of motor learning and sensorimotor adaptation: when the nervous system detects a discrepancy between the intended and actual consequences of a movement, this error provides a powerful teaching signal that can modify subsequent motor commands. Robotic systems make it possible to manipulate this error precisely by applying externally generated forces that deviate the limb from its intended trajectory. This review examines the theoretical basis of error enhancement, its development as a rehabilitation strategy in particular attention is given to studies conducted in healthy individuals and stroke survivors. The available evidence is then considered in relation to sensorimotor inte-gration, virtual reality, constraint-induced movement therapy, and the Bobath concept. Finally, the emergence of the BioXtreme/deXtreme robotic platform is discussed as a translational development that combines robotic force-field manipulation, three-dimensional movement, virtual reality and adaptive error enhancement. Although the evidence remains preliminary and larger controlled trials are required, error enhancement provides a compelling framework for converting movement error from a problem to be suppressed into a signal that can actively drive motor adaptation and rehabilitation.