Public Health and Healthcare

Abstract: Background/Objectives: Patterns or biases in food preferences are thought to influence eating behavior. However, their associations with obesity remain unclear. We aimed to identify obesity-related food preference characteristics in the general population. Methods: We analyzed a nationwide web-based survey of adults in Japan (7,971 men and 7,524 women). Preferences for carbohydrates, fat, protein, and dietary fiber were assessed using the Japan Food Preference Questionnaire (JFPQ). Associations between food preference scores and BMI were evaluated in individuals with a BMI ≥18.5 kg/m². Moreover, food preference scores were compared between individuals with normal weight (BMI 18.5 to <25.0 kg/m²) and those with obesity (BMI ≥25.0 kg/m²), stratified by time since the last meal (<3 vs. ≥3 h). Results: A higher BMI was associated with a greater preference for non-sweet fat and soft drinks and with a lower preference for dietary fiber, particularly vegetables, in both genders. Compared with individuals with normal weight, meal-timing-related differences in food preference scores were less apparent in individuals with obesity, accompanied by higher carbohydrate, fat, and protein preference scores at <3 h after the last meal. Conclusions: Obesity was associated with distinct self-reported food preference patterns that may influence food choices and weight gain. Food preference profiling could be useful for identifying individuals at risk of future obesity and for guiding nutritional counseling in weight management.

Abstract: Background/Objectives: The Mediterranean diet (MedDiet) is a protective nutritional model against cardiometabolic risk, but current sociodemographic changes have favoured the abandonment of this pattern in favour of sedentary behaviours and increasing digitalisation. Screen-related behavioral addictions represent an emerging challenge for public health and nutritional psychiatry. However, scientific evidence on how different digital dependence profiles influence young adults’ diets remains scarce. The aim of this study was to evaluate the relationship between adherence to the Mediterranean diet and various dimensions of problematic screen use (smartphone dependence, compulsive internet use, and problematic experiences with video games) in a sample of young adults. Methods: Observational, descriptive and cross-sectional study conducted in 496 young adults between 18 and 34 years of age enrolled in the EVA-Adic study. Adherence to the MedDiet was assessed using the 14-item MEDAS questionnaire. Digital addictions were determined using three continuously validated psychometric instruments: the EDAS-18 scale (smartphone), the CIUS questionnaire (internet) and the CERV questionnaire (video games), also generating a Global Digital Addiction index. Hierarchical multivariate linear regression models (adjusted for sociodemographic, anthropometric and lifestyle factors) and binary logistic regression models were performed to analyze each component of the MEDAS individually. Results: The mean age of the 496 subjects analyzed was 26.60 ± 4.41 years. 339 subjects had low-moderate adherence (< 9) and 157 high adherence (≥ 9). The mean values of the psychometric scales of digital addiction were: smartphone dependence: 40.87 ± 12.24 points, for compulsive use of the internet: 13.83 ± 9.89 points, for video game dependence: 3.54 ± 5.22 points, and the global digital addiction index: 58.25 ± 21.76 points. In the multivariate linear regression analysis in the total fit model, smartphone dependence (EDAS-18) was inversely associated with the MEDAS score (β = -0.021 {95% CI} [-0.041 -0.003]). Problematic internet use (CIUS) showed a positive association with dietary adherence (β = 0.025 {95% CI} [0.002, 0.049]). Problematic experiences with video games (CERV) and the global digital addiction index did not demonstrate an association. In the logistic regression analysis of each of the components of the MEDAS: each one-point increase on the EDAS-18 scale reduced the probability of meeting the fruit consumption criterion ≥3 pieces/day (OR = 0.980); the criterion of low consumption of sugary beverages or less than one per day (OR = 0.956) and was linked to a higher probability of meeting the criterion of using olive oil as the main cooking fat (OR = 1.026). Compulsive use of the Internet (CIUS): A higher score on the CIUS scale decreased the probability of registering a low consumption of sugary drinks (OR = 0.955); positive association with compliance with olive oil consumption ≥ 4 tablespoons/day (OR = 1.035) and with the consumption of sofrito ≥ 2 times/week (OR = 1.026). Conclusions: The results of this study suggest that digital addictive behaviors are differentially associated with the quality of the Mediterranean diet. Higher smartphone addiction risk was associated with lower adherence to the Mediterranean diet, which may reflect a less healthy behavioral pattern linked to problematic mobile phone use. In contrast, problematic internet use may represent a different profile in relation to dietary habits, possibly influenced by the type of digital use, the context of exposure, or the characteristics of the participants evaluated. These findings reinforce the need to analyze different forms of digital addiction separately, rather than treating them as a homogeneous phenomenon, and suggest that interventions aimed at improving adherence to healthy dietary patterns should include the assessment of digital behavior.

Abstract: Alzheimer’s disease (AD) care is increasingly communication-intensive, requiring sustained caregiver education, symptom monitoring, behavioral management, and coordination across fragmented clinical settings. Large language models (LLMs) can generate, summarize, and adapt natural language at scale, creating opportunities to support dementia care workflows, but they also introduce safety risks that are amplified in cognitively vulnerable populations. We provide a narrative synthesis of emerging applications of LLMs across the AD care continuum, highlight Alzheimer’s-specific safety challenges, and propose pragmatic implementation pathways for responsible clinical translation. LLM use cases cluster into caregiver-facing support, patient-facing conversational agents (high caution), clinician workflow augmentation (highest near-term feasibility), clinical text intelligence for risk prediction (early-stage), and research/education support. Key safety threats include hallucinations, omission of critical information, over-reliance, bias, privacy leakage, and prompt-injection vulnerabilities. Implementation is most defensible using grounded architectures (e.g., retrieval-augmented generation), tiered deployment, human-in-the-loop verification, continuous monitoring, and security testing.

Abstract: Background/Objectives: Ischemic heart disease (IHD) is the leading cause of cardio-vascular death worldwide, and the emergency medical service (EMS) is frequently the first point of contact for affected patients. In Kazakhstan, ambulance crews must de-cide at the scene whether an IHD patient requires emergency hospitalization or can safely be left at home, yet the clinical factors that drive this decision have rarely been quantified. We aimed to identify the demographic, clinical and comorbidity-related predictors of emergency hospitalization among EMS calls for IHD. Materials and Methods: We conducted a retrospective analysis of 9985 consecutive EMS calls for IHD (ICD-10 I20-I25) attended in Astana, Kazakhstan, over a five-year period. The outcome was emergency hospitalization versus being left at the scene. Group compar-isons used the Mann-Whitney U and Pearson chi-square tests, and independent asso-ciations were estimated with an explanatory multivariable logistic regression model reporting adjusted odds ratios (aOR) with 95% confidence intervals. Results: Overall, 2676 calls (26.8%) resulted in hospitalization. The strongest independent predictors were cardiogenic shock (aOR 15.06), acute/unstable IHD versus chronic I25 (aOR 8.52) and heart failure (aOR 2.46). Other arrhythmias (aOR 1.84), atrial fibrillation (aOR 1.60), male sex (aOR 1.65) and age <45 years (aOR 1.88) independently increased the odds of hospitalization, whereas age ≥75 years (aOR 0.61), specialized crews (aOR 0.84) and high dispatch urgency (categories 1–2; aOR 0.84) were associated with lower odds. Conclusions: Beyond clinical acuity, stable cardiac comorbidities independently shape the EMS hospitalization decision for IHD. With only moderate explanatory per-formance, the model is not a deployable prediction tool; rather, these routinely availa-ble variables are candidate inputs for future field risk-stratification work and for EMS resource planning in urban EMS systems.

Abstract: Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous patient group who need individualized blood glucose targets to avoid hypoglycemia. Since elderly presents with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other co-morbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a Patient and Function Centric Approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and allow for individualized glycemic targets, which improves overall diabetes control and mental well-being.

Abstract: Background/Objectives: Poor bone quality significantly increases the risk of mechanical complications after adult spinal deformity (ASD) surgery, including proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Although teriparatide enhances bone quality, its effectiveness in preventing junctional complications after extensive correction remains unclear. This study investigated whether preoperative teriparatide administration reduces the incidence of PJK and PJF in patients with compromised bone quality undergoing ASD surgery. Methods: This retrospective cohort study reviewed 292 patients (T-score < -1.0) who underwent ASD surgery between 2015 and 2023. Patients were divided into teriparatide (n = 59) and non-teriparatide (n = 233) groups. Propensity score matching (1:2 ratio) was performed using six covariates: age, preoperative pelvic incidence minus lumbar lordosis, preoperative T1 pelvic angle, upper instrumented vertebra (UIV) cementing, UIV screw angle, and fusion length, yielding 153 matched patients (52 teriparatide, 101 non-teriparatide). Results: After matching, all baseline characteristics were well-balanced. The incidence of PJK and PJF did not differ significantly between the teriparatide and non-teriparatide groups (44.2% vs. 52.5%, P = 0.426; 9.6% vs. 9.9%, P = 1.000), nor did PJK subtype distribution (bony vs. soft-tissue). Multivariate analysis identified older age (odds ratio [OR] = 1.058), higher American Society of Anesthesiologists score (OR = 2.603, P = 0.002), UIV at the thoracolumbar junction (OR = 2.786), and greater postoperative thoracic kyphosis (OR = 1.044) as independent risk factors for PJK. Teriparatide use was not an independent predictor (OR = 0.872). Conclusions: Preoperative teriparatide did not significantly reduce the incidence of PJK or PJF after long-segment fusion for ASD. These findings suggest that improving bone quality alone is insufficient to prevent junctional complications, which are driven by complex biomechanical and patient-related factors inherent to extensive deformity correction.

Abstract: The development of bio-based hygiene products offers a sustainable approach to managing infectious topical pathogens while reducing dependence on synthetic antimicrobials. This study evaluated the antibacterial efficacy of soap formulated with Jatropha multifida leaf ethanolic extract (25%, 50%, and 75% v/v) against Staphylococcus aureus and Escherichia coli. Antibacterial activity was determined using the Kirby-Bauer disk diffusion method alongside positive and negative controls. All extract-infused soap formulations exhibited distinct, measurable zones of inhibition (ZOI) ranging from 16.33 mm to 17.67 mm for S. aureus and 16.33 mm to 18.00 mm for E. coli, consistently achieving an "Active" qualitative classification. A one-way Analysis of Variance (ANOVA) demonstrated highly significant differences across the entire dataset (p < 0.001). However, Tukey’s Honestly Significant Difference (HSD) post-hoc test revealed no statistically significant differences in antibacterial performance among the 25%, 50%, and 75% concentrations (p > 0.05). This indicates a performance plateau caused by agar diffusion limits or micellar entrapment within the soap base. J. multifida maintains antibacterial integrity within a soap matrix, offering a viable plant-based antiseptic alternative against S. aureus and E. coli. Formulating at a 25% concentration represents the optimal commercial choice, maximizing antimicrobial performance while minimizing raw material costs.

Abstract: Background/Objectives: Sepsis is responsible for approximately 270,000 deaths annually in the United States. Conventional scoring systems, such as SOFA and qSOFA, are largely reactive and do not effectively leverage longitudinal ICU data for early prediction. This study aimed to develop a deep learning framework capable of predicting sepsis onset up to 6 hours before Sepsis-3 criteria are met, while also providing clinically interpretable temporal explanations. Methods: The PhysioNet/CinC 2019 Challenge dataset, comprising 1,552,210 patient-hours from 40,336 ICU patients, was utilized. A Temporal Transformer Encoder (TTE) was trained using 12-hour look-back windows with 92 engineered features. Severe class imbalance (2.6% positive rate) was addressed through weighted random sampling and focal loss. Five-fold patient-level cross-validation was employed to prevent temporal leakage. Platt scaling was applied for probability calibration. Grad-CAM was adapted for temporal explainability, while SHAP was used for feature-level attribution. BiLSTM-Attention and XGBoost models served as baseline comparators. Results: The TTE model achieved a cross-validated AUROC of 0.8320±0.0032 and an AUPRC of 0.1505±0.0148, significantly outperforming BiLSTM Attention (AUROC: 0.7859) and XGBoost (AUROC: 0.7731; DeLong p < 0.0001). Platt scaling reduced the Expected Calibration Error from 0.3154 to 0.0017. The median alert lead time was 46.5 hours (IQR: 21–84 h), with 95.3% of septic patients receiving alerts at least 3 hours before onset. Grad-CAM analysis identified timesteps t − 10 and t −9 as the most predictive. However, high-severity patients (SOFA proxy ≥ 3)demonstrated substantially reduced performance (AUROC: 0.257). Conclusions: The proposed TTE framework demonstrates strong and well-calibrated early sepsis prediction with substantial clinical lead time. The concentration of predictive signals 10–11 hours prior to alert generation supports the feasibility of continuous automated ICU monitoring from admission onward. Reduced performance in high-severity patients highlights the need for severity-stratified modelling in future research.

Abstract: Background: COVID-19, in addition to its direct detrimental respiratory infection, is associated with multiple systemic complications involving different organs, including the liver. COVID-19 has been associated with liver injury through multiple mechanisms including direct viral effects on liver cells, immune mediated injury, cytokine-driven inflammation, ischemic hepatitis, microvascular thrombosis, and sepsis-related multiorgan dysfunction. Acute liver failure (ALF) is the acute form of liver damage, which has a high mortality, and recovery is dependent on various factors. We studied the effect of COVID-19 on clinical outcomes such as mortality, length of stay, and need for non-invasive and invasive ventilation in patients with acute liver failure. Methods: We performed a retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database from 2020 to 2022. Adult patients admitted to the hospital with acute liver failure were divided into 2 groups based on their COVID-19 infection status. We analyzed the difference in the mortality, length of stay and need for non-invasive or invasive ventilation using odds ratio, to evaluate effects on outcomes, and results were then adjusted to demographic and hospital factors. Results: Patients with acute liver failure with COVID-19 had significantly increased in-hospital mortality (63.7 vs 35.3%), increased use of noninvasive ventilation (15.0% vs 6.5%) and invasive mechanical ventilation (68.5% vs 40.9%), along with a longer hospital stay (17.1 vs 10.7 days). The findings were concurrent with statistical significance after adjusting for demographics and clinical factors. Conclusions: Patients with COVID-19 infection admitted to the hospital with acute liver failure have poor clinical out-comes, with higher in-hospital mortality, higher need for ventilatory support, and longer length of stay. COVID-19 independently is associated with worse outcomes, which was noted even in individuals with less baseline comorbidities. Early recognition of COVID-19 infection and acute hepatic failure and prompt management by the multidisciplinary team is essential for better clinical outcomes.

Abstract: Background/Objectives: Healthcare institutional betrayal (HIB) is a betrayal trauma that occurs when a healthcare organization or system perpetrates wrongdoing against or fails to protect an individual who depends upon that system for care. Known consequences of experiencing HIB include increased healthcare system and provider distrust and anticipated healthcare avoidance, highlighting the public health implications of unaddressed HIB. Little is known about actions that healthcare stakeholders can take to repair HIB. Thus, this study experimentally tested the effects of receiving one of two reparative actions post HIB (empathic apology vs. organizational change) performed by one of two healthcare system stakeholders: healthcare provider or system administrator. Methods: Residual HIB perceptions, trust, expectations for future healthcare, and intentions to avoid future care were assessed post-repair conditions. Initially, undergraduate participants (N = 198) were asked to imagine themselves experiencing a common healthcare scenario which included HIB. After post-HIB baseline measurements, participants were then randomly assigned to one of four conditions (three with HIB repair actions vs. one control). Participants receiving any type of HIB repair reported significantly lower residual HIB, higher positive expectations for future healthcare, and greater trust in healthcare post-repair, with effect sizes ranging from small to large. Results: Generally, two HIB repair conditions (organizational change HIB repair and healthcare provider HIB repair) outperformed the healthcare administrator HIB apology repair condition; all repair conditions outperformed the control condition. Conclusions: Our finding that specific actions can facilitate post-HIB recovery is clinically meaningful. Medical professionals and healthcare administrators need to address patients’ past negative experiences with healthcare and take action to repair HIB to improve patients’ ongoing and future healthcare experiences.

Abstract: Introduction: The phenomenon of fear of infection is a significant challenge for healthcare systems, particularly among personnel working on the front lines. Pre-hospital emergency personnel, as a crucial part of the frontline healthcare workforce, experience the highest level of fear of infection among all healthcare workers worldwide. Investigating the fear of infection and its related occupational factors can be effective in managing this challenge. Objective: This study aims to assess the level of fear of infection and related occupational factors among personnel working in pre-hospital emergency operations. Methods: This cross-sectional study was conducted in Iran in 2024. The sample size consisted of 270 pre-hospital emergency operational staff selected through random sampling. Data collection tools included a demographic questionnaire and the Fear of Infection Evaluation Questionnaire (adult version of the Fear of Infection and Virus Evaluation - FIVE). SPSS software version 23 was used for data analysis. Results: The findings showed that the mean fear of infection score was 69, which is considered moderate. The Kruskal-Wallis statistical test revealed significant relationships between fear of infection and variables such as exposure to blood and secretions, the number of needlestick injuries, and participation in mental health and infection control courses (P < 0.05). In other words, Needlestick injury frequency was significantly associated with fear of infection, with the highest fear levels observed in those with 6-10 injuries. Additionally, participation in mental health and infection control courses was associated with higher mean fear scores. No significant relationships were found between fear of infection and place of service (urban or roadside base), adherence to personal protection principles, work experience, or educational level. Conclusion: Assessing the fear of infection and its related factors can help in planning to reduce occupational challenges among these personnel, which may ultimately lead to improved community health outcomes.

Abstract: Background/Objectives: Alcohol consumption and medication use have increased among the elderly population, raising the risk of alcohol–drug interactions and adverse outcomes. Sex-related biological differences may further influence these effects. This study aimed to assess sex-related differences among older adults with risky alcohol consumption, con-sidering medication use, comorbidities, and hepatic biomarkers. Methods: A cross-sectional, multicenter study was conducted in adults aged ≥65 years. A total of 455 participants with risky alcohol consumption were included. Sociodemographic and clini-cal characteristics, medication prescriptions, and blood analytical parameters were col-lected. Results: Of the participants, 41% were women, with a mean age of 71 years. The mean weekly alcohol consumption was 8.4 ± 8.3 standard drink units. Overall, 71.2% were taking at least one medication, with antihypertensives being the most commonly pre-scribed (62%). Significant sex differences were observed (p ≤ 0.01): men showed higher use of antidiabetic drugs (24%), anticoagulants (8%), and nitrates (4%), whereas women more frequently used anxiolytics (35%), non-steroidal anti-inflammatory drugs (22%), and anti-depressants (18%). Significant differences were also observed in hepatic biomarkers, with higher gamma-glutamyl transferase levels in men and a higher AST/ALT ratio in women (p ≤ 0.01). Although risky alcohol consumption was more prevalent among men, women had a higher overall medication use. Conclusions: A high proportion of older adults with risky alcohol consumption are exposed to concurrent pharmacological treatments, in-creasing the potential for clinically relevant alcohol–drug interactions. The observed sex differences in comorbidities, medication use, and hepatic biomarkers underscore the im-portance of incorporating a sex-based perspective in research and clinical practice.

Abstract: Background/Objectives: Primary care access in Alberta, Canada is dictated by geography, attachment, timeliness, continuity, and local service burdening. Physician and primary care delivery in rural communities are subject to travel burden, workforce fragility, and intermittency, while suburban communities have immediate proximity to facilities, but are also challenged by delayed access, low attachment, and fragmented episodic care. These access challenges are echoed in rural and frontier contexts in the United States including the state of Wyoming. In this systematic review and narrative synthesis we investigated if and how care coordination between community pharmacists and family physicians, increases primary care access in rural and suburban Alberta, and how transferable those findings are to rural Wyoming and other similar frontier settings. Methods: We searched PubMed/MEDLINE, Embase, Scopus, CINAHL, and the Cochrane Library using controlled vocabulary and free-text terms to identify English-language peer-reviewed studies and practice-relevant evidence published from 1 January 2010 to 19 April 2026 related to primary care access, rural, suburban and frontier settings, Alberta, Wyoming, community pharmacy, pharmacist prescribing, physician-pharmacist collaboration, medication management, chronic disease care, continuity, and emergency department use. Earlier landmark primary-care, physician-pharmacist collaboration, and medication-safety studies were retained only when necessary for conceptual framing. Results: We screened 34 eligible records for inclusion in the narrative synthesis, and seven official contextual sources were included for jurisdictional interpretation. Strong evidence demonstrates that pharmacists are accessible primary care extenders where community services are coordinated with family physicians through documentation, referral pathways, red-flag protocols, and shared medication plans. The strongest evidence is specific to hypertension, cardiovascular risk reduction, and medication management and chronic disease monitoring. Direct Alberta-Wyoming comparative intervention evidence is limited. Conclusions: Physician-pharmacist coordinated care should be implemented prospectively as a geographically tailored access model, not a physician replacement model, with evaluation of access, continuity, medication safety, emergency department use and equity.

Abstract: Background/Objectives: Western Canadian and US communities beyond urban centres are routinely underserved by primary, specialist, and emergency care services, whether based in rural, remote, frontier or Indigenous settings. Access issues in these contexts have traditionally been framed by distance, weather, and clinician availability challenges, but also extend to specialist maldistribution, attachment gaps and uneven broadband availability. This systematic review and narrative evidence synthesis scoped the impact of telehealth and other virtual-care models on rural access to services, broadly construed to include timely access, travel burden, specialist input, emergency support, continuity and clinician support, safety, and equity, or impacts on service fairness and effectiveness. Methods: Searches conducted in May 2026 included PubMed/MEDLINE-indexed records, PubMed Central full-text records, the Cochrane Library search interface, publisher platforms, reference chasing, and official sources from Canadian and US health systems. Eligible evidence from 1 January 2016 through 6 May 2026 addressed rural, remote, frontier, Indigenous, underserved, western or northern health-service settings, with earlier landmark sources retained for historical framing where relevant. Results: The search identified 112 records; after de-duplication and screening, 28 eligible peer-reviewed records were included in the evidence synthesis and 7 official sources informed jurisdictional contextualization. Evidence supported virtual care as an access extender in contexts where it can reduce travel, enable specialist input or support rural clinicians, maintain continuity of chronic disease or mental health follow-up. Virtual care is best when paired with on-site physical assessment and in-person escalation pathways. Evidence was weaker for virtual-only models, and for durable effects on emergency department use. Conclusions: Telehealth should therefore be implemented as a hybrid, locally anchored, culturally safe access model rather than as a stand-alone substitute for rural primary care or specialist capacity.

Abstract: Background/Objectives: Registered nurse (RN) prescribing is framed as a strategy to expand primary care access, but the safest, most useful, or most appropriate model may not be autonomous RN prescribing alone. Systematic review of the evidence on how best to understand RN prescribing with respect to collaborative models and supports, outcomes and effect modifiers, and implementation strategy, contingency factors, or conditions. Methods: Searches completed March 30, 2026, included PubMed/MEDLINE-indexed records; PubMed Central full-text records; Cochrane Library search interface; publisher platforms; reference chasing; and Canadian, Alberta government, and professional organization sources for Canadian regulatory, policy, and practice information. Peer-reviewed, eligible evidence comprised systematic reviews, randomized trials, cohort and cross-sectional studies, qualitative studies, mixed-methods studies, and implementation studies related to nurse prescribing, RN-led primary care, nurse-physician/NP collaboration, non-medical prescribing, medication titration, or primary-care team models. CASP-informed appraisal, AMSTAR 2 principles, and GRADE domains were used to rate the methodological quality and certainty. Results: A total of 286 records were identified; following de-duplication, title/abstract and full-text screening, 33 peer-reviewed records were included in the narrative synthesis; and four official contextual sources informed regulatory interpretation. Literature shows nurse, non-medical prescribing can achieve comparable or improved patient outcomes for blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol, medication adherence, satisfaction, and selected access outcomes. Conclusions: The strongest and most transferable model is coordinated RN prescribing, meaning embedded within a primary-care team in which family physicians and nurse practitioners remain available for diagnostic uncertainty, complex multimorbidity, high-risk prescribing, continuity, and escalation. Direct comparative evidence for this exact configuration is still limited, so future evaluations should test coordinated RN prescriber-FP/NP models using prospective implementation designs and patient-level outcomes.

Abstract: Understanding the gene-level changes that occur during post-ischemic neurodegener-ation in the frontal cortex is crucial for the development of dementia. An ischemic model of Alzheimer's disease was used to evaluate changes in the expression of the receptor for advanced glycation end products (RAGE) and low-density lipoprotein receptor-related protein 1 (LRP1), which are associated with amyloid and tau protein, in the frontal cortex after 10 min of cerebral ischemia, with survival at 2, 7, and 30 days and 0.5, 1, 1.5, and 2 years. LRP1 and RAGE expression was assessed by reverse tran-scription-quantitative polymerase chain reaction. On the second day post-ischemia, a significant increase in LRP1 expression level was observed compared to the control group, while RAGE level was significantly decreased. Then, a significant decrease in LRP1 expression was observed at day 7 and 0.5 years, while at day 30 it fluctuated around the control value. The decrease in RAGE expression was statistically signifi-cant, compared to the control group, after 2 and 7 days and after 0.5 years, and after 30 days it oscillated around the control value. RAGE and LRP1 expression showed the same pattern of changes from day 7 to year 2, peaking at 1 and 1.5 years, respectively. Another peak of RAGE overexpression was noted 2 years after ischemia. After 1, 1.5 and 2 years, overexpression of RAGE and LRP1 was observed after ischemia, with the dynamics of LRP1 changes being lower. Overall, the data showed a predominance of RAGE activity over LRP1 activity at 1-, 1.5-, and 2-years post-ischemia. The modifica-tion of LRP1 and RAGE after ischemia is useful in studying the molecular ischemic pathways involved in the development of Alzheimer's disease.

Abstract: Background: Artificial intelligence (AI) is transforming the dental industry by improving diagnostic processes, helping with treatment planning, and increasing the efficiency of patient care through language and advanced image processing. However, the use of AI-powered chatbots in dental practice remains underexplored. This study assessed the potential of chatbots for initial dental symptom assessments and providing accurate triage information to patients. Methods: This cross-sectional study compared the accuracy of three AI systems (ChatGPT, DeepSeek, and a Custom chatbot) with those of 10 dentists for categorizing 100 AI-generated cases based on the American Dental Association guidelines into Emergency, Routine, Urgent, Non-Urgent. Interrater reliability and classification accuracy were analyzed statistically, and ethical standards were observed despite the use of simulated data. Results: ChatGPT achieved the highest accuracy (83%), followed by DeepSeek (82%) and custom chatbot (73%). All chatbots yielded a higher accuracy than the average human accuracy (66%). Conclusion: AI chatbot systems, particularly ChatGPT and DeepSeek, achieved high accuracy for dental triage and outperformed human evaluators. These findings provide valuable insights into the potential role of these systems in supporting clinical decision making in dental care.

Abstract: Background/Objectives: Functional biomarkers of vascular stiffness (FBM-VS) may serve as an effective tool for predicting and monitoring the effectiveness of preventive strategies against accelerated vascular ageing in healthy populations within the framework of P4 medicine. The aim of this study was to perform a comparative analysis of a standardized to hydrostatic column height passive head-up tilt test (stHUTT) and a simplified supine-to-sitting test (SST) for measuring FBM-VS in a paired sample of young healthy subjects. Materials and Methods: This observational cross-sectional study included 95 healthy adults aged 18–20 years (54 women and 41 men). Brachial-ankle pulse wave velocity (baPWV) was measured in three positions: baseline supine position (baPWVb), during stHUTT (baPWVst), and after transitioning to a sitting position (baPWVsit). The functional reserve of orthostatic circulatory regulation (FR) and the functional reserve coefficient (FRC) were calculated for the stHUTT (FRst and FRCst) and during the supine-to-sitting test (FRsit and FRCsit). Results: The results showed unidirectional orthostatic changes in baPWV during both tests (significant increase compared to baseline supine values): baPWVst and baPWVsit in stHUTT and during the SST increased from 8.6 [8.1; 9.1] m/s to 13.4 [12.1; 14.4] m/s and to 15.2 [13.4; 16.1] m/s (p &lt; 0.001), respectively. FBM-VS values in the SST were higher compared to stHUTT: FRsit = 6.4 [5.25; 7.75] m/s vs. FRst = 4.85 [3.7; 5.75] m/s (p &lt; 0.001), and FRCsit = 0.74 [0.59; 0.9] vs. FRCst = 0.55 [0.45; 0.68] (p &lt; 0.001). The variance of these parameters was also significantly higher in the SST. Regression analysis showed a significant positive correlation between the values of functional biomarkers measured in both orthostatic tests. Conclusions: The supine-to-sitting test may be used for the personalized diagnostic assessment of functional biomarkers in healthy populations. To assess their prognostic value and to provide personalized long-term monitoring to control the effectiveness of preventive measures against vascular ageing in healthy individuals within the framework of the P4 medicine, a prospective cohort study is required.

Abstract: Teledermatology has the potential to improve access to dermatological care in resource-limited settings, particularly for infectious skin diseases and Neglected Tropical Diseases (NTDs), where diagnostic capacity is often limited. This study aims to evaluate the feasibility of an artificial intelligence (AI) - based Teledermatology system, to support the classification of infectious versus non-infectious skin lesions. A convolutional neural network based on the ResNet50 architecture was trained on a dataset of dermatological images and optimized for deployment on a low-cost embedded device (Raspberry Pi 3). The system was designed to operate locally and includes a user interface for image acquisition, local storage, and cloud synchronization via Google Drive to enable remote consultation. The proposed model achieved an overall classification accuracy of 96% and a sensitivity of 89% for infectious lesions on the evaluated dataset, indicating its potential usefulness as a triage and decision-support tool for frontline healthcare workers. These findings suggest that AI-enabled Teledermatology systems deployed on affordable hardware may offer a scalable and cost-effective approach to supporting earlier identification of infectious cutaneous conditions, including NTDs, in underserved regions.

Abstract: Introduction: Locally advanced pancreatic adenocarcinoma remains a major therapeutic challenge, with limited curative options. In recent years, several multimodal approaches combining systemic therapies with innovative locoregional treatments such as endoscopic brachytherapy with Phosphorus-32 have shown promising results. Case Presentation: We report the case of a patient diagnosed with locally advanced adenocarcinoma of the pancreatic head who underwent neoadjuvant chemotherapy followed by Phosphorus-32 brachytherapy and subsequent surgical resection. Conclusions: The multimodal approach resulted in a near-complete response on histopathological examination, good local disease control, and acceptable tolerability, thereby suggesting a potential role for brachytherapy in selected patients with locally advanced pancreatic tumors.