Telechaplaincy as Invisible Care Network

IntroductionThe prevalence of mental health issues amongst domestic and foreign students in Slovakian medical schools and any differences between them is currently unknown.ObjectivesThe goals of this paper are to determine the prevalence and extent of mental health issues among medical students at Pavol Jozef Šafárik University (UPJŠ) in Kosice, Slovakia and to determine if there is a difference between domestic and foreign students’ mental health at UPJŠ.MethodsA combined questionnaire utilizing well-known sources was distributed to UPJŠ medical students to self-assess their levels of anxiety, depression and hedonic capacity (Zung, 1965; Zung, 1971; Snaith et al., 1995). Two-tailed T-tests and regression statistical analyses were applied to determine the significance of the data and any differences.Results27% (n=319) and 25% (n=300) responses were collected from domestic and foreign UPJŠ medical students, respectively. 57% of domestic and 74% of foreign students screened positive for either anxiety, depression, or a combination. The 17% increased rate of anxiety and/or depression amongst foreign students when compared to domestic students was statistically significant (P<0.001). The differences between the two groups regarding hedonic tone were not statistically significant.ConclusionsThe prevalence of mental health issues amongst domestic and foreign UPJŠ medical students is much higher than the worldwide average. The higher rate of anxiety and depression observed in foreign UPJŠ medical students when compared to domestic students may be due to a reduced social support system as well as studying in a foreign country. These data suggest special support may be necessary for medical students studying abroad.

Back to table of contents Previous article Next article ProfessionalFull Access988 is Coming, But Most Localities Still Not PreparedKyle Lane-McKinleyKyle Lane-McKinleyPublished Online:22 Jun 2022https://doi.org/10.1176/appi.pn.2022.07.7.45AbstractBest practices for crisis intervention include three crucial components: someone to call when a crisis occurs, someone to show up, and somewhere to go if necessary. If the new national mental health crisis hotline is to work as intended, models like this must be put in place.iStock/PinkypillsThere is broad agreement that current systems in the United States for responding to individuals in crisis not only do not work but have resulted in death. Jails are crowded with people who often have not even been accused of a crime but await psychiatric evaluation. Emergency departments cannot cope with the number of people seeking psychiatric or behavioral care for crisis and sometimes resort to "warehousing" of patients or even turning them away.Many police officers feel that they are ill equipped to handle mental health crises and would rather focus on dangerous crime. Likewise, individuals in crisis and their loved ones cannot find meaningful help, often resulting in prolonged suffering, homelessness, and self-medication.On July 16, a once-in-a-generation change is being launched regarding how America responds to people experiencing mental health or substance use crises. For the first time, they and their loved ones will be able to seek help through a simple, easy-to-remember number: 988.And then what? Who will respond? Where will people go if they need more help?Ideally, those who dial 988 will be connected to a network of local and regional call centers that are part of the National Suicide Prevention Lifeline. Operators trained in suicide prevention and crisis intervention can assess callers' needs and determine what resources might be available and appropriate for them. If a local call center is unavailable or overwhelmed with calls, 988 callers will automatically be redirected to a national call center in an effort to keep wait times to a minimum. Experts estimate that approximately 80% of calls to 988 can be resolved over the phone.What about the remaining 20%? According to the Substance Abuse and Mental Health Services Administration (SAMHSA), best practices indicate that three components of crisis response are needed for effective care: someone to call (such as 988), someone to show up (via mobile crisis response teams and similar co-responder models), and somewhere to go (often referred to as a crisis stabilization center, offering voluntary supports for up to 24 hours). Professional organizations and advocacy groups, including APA, the National Alliance on Mental Illness, the Wellbeing Trust, and the Treatment Advocacy Center, have endorsed this approach. In his State of the Union Address in March, President Joe Biden called for $700 million to staff 988 and build out a broader crisis care continuum across the country.Despite broad consensus and support for this model, it is nowhere near ready to be implemented in most parts of the country and requires much more funding than is under consideration. Oregon, however, is ahead of most other states for a number of reasons: It is one of a few states that have passed legislation supporting 988 and related services, and it is home to a key example of what works.The CAHOOTS (Crisis Assistance Helping Out On The Streets) program, in Eugene and Springfield, Ore., has gained such a significant profile for its non-police crisis response teams that it has become commonplace to refer to the concept of mobile crisis response as being "like CAHOOTS" (see Bill Aimed at Replicating Oregon Mobile Crisis Program). It is one example of "someone to show up."CAHOOTS is a mobile crisis intervention program that was created in 1989 as a collaboration between White Bird Clinic and the City of Eugene. Its mission is to improve the city's response to people who have a mental or a substance use disorder and/or are homeless. CAHOOTS is operated by White Bird Clinic.In the wake of George Floyd's murder, many policymakers began to focus attention on CAHOOTS and similar programs as a way to protect vulnerable or marginalized populations from police violence. If service calls for people experiencing a mental or behavioral crisis could be directed to mobile crisis response teams, the thinking goes, they could be connected with the resources they need, rather than encountering armed law enforcement officers.Many law enforcement organizations agree, in principle, with this approach, having become exhausted by dealing with mentally ill individuals for whom they lack the training to serve well at the expense of focusing on the work they were intended to do. Such agreement, however tentative, is relatively rare in an era in which almost everything concerning law enforcement and public health has become politicized to the point of gridlock. In addition, mobile crisis teams are a solution that most policymakers appear to endorse.Tim Black worked for CAHOOTS in a number of capacities, including as operations director and director of outreach and consulting for the White Bird Clinic. Black agrees that mobile crisis response teams can serve an important role in reducing the practice of asking police to respond to calls concerning people in crisis. Noting that a significant portion of the calls to which CAHOOTS responds originate as "welfare checks" (calls to 911 concerning the safety or well-being of a person, often a person in crisis), Black describes the variety of negative outcomes that mobile crisis can help people avoid, including citations, arrests, and incarceration.Rather than taking a punitive approach to people exhibiting disruptive behaviors associated with crisis, CAHOOTS and similar programs start by attempting to get individuals' basic needs met. "As a crisis responder, I often found that the people I encountered who were contemplating suicide were fundamentally dealing with homelessness," Black said. "Once we could find a safe place for most of those people to lay down and get some sleep, and maybe a way to do their laundry and get some food, we often found that a person was past the point of crisis and could begin a path to recovery."Using a mixture of de-escalation techniques and counseling provided by a crisis intervention worker, providing basic medical care, and connecting individuals with voluntary resources in the community, experts estimate that 70% of calls to which mobile crisis teams respond can be resolved in the field. This means that given an initial volume of 1,000 calls to 988, as few as 60 people would be in need of transport to a facility."Somewhere to go" is the final component of the three-legged stool offered by SAMHSA's best practices for crisis response. Under the current system, a staggeringly large number of people with mental illness are taken to jail, and not only do many fail to receive adequate care, their condition is often made worse.Of course, not all individuals in crisis who have encounters with law enforcement officers are placed in jail. Many people are taken to hospital emergency departments by police or EMTs. But emergency departments lack both the capacity and the expertise to deal with individuals in crisis, which has led to the widespread practice of "boarding." This has been detrimental to patients and staff and takes place at tremendous expense to the health care system. Worse still are reports of emergency departments turning away patients in crisis or patients being arrested by police to get them off the streets.Progressing from the vision of a crisis response system laid out by SAMHSA and countless national, state, and regional entities to a robust and functional system requires continuous improvement and tremendous effort. Yet this system can reduce the harms experienced by individuals experiencing mental or behavioral health crises under the current system. If implemented carefully, it might even begin to heal the decades of understandable distrust and suspicion that many communities have had for crisis services. None of that is possible if there is a failure to enact all three of the components of crisis response: someone to call, someone to show up, and somewhere to go. As it stands, a once-in-a-generation opportunity could be squandered.In addition to working with district branches to advocate for legislation supporting 988 implementation in states that have not yet done so, APA joined a coalition in March to drive awareness and support among state and municipal officials for the nationwide transition to the new 988 hotline. APA urges members in states that have not passed legislation to implement 988 to contact their district branch and get involved in advocacy on this issue. More information is available by emailing Erin Berry Philp at [email protected]. ■Kyle Lane-McKinley is a program manager in the Department of Psychiatry and Behavioral Sciences at Stanford University and is pursuing a master's in public health at San José State University. His research and scholarship focus on uses of arts and creative practices to advance health equity and the role of community stakeholders in sustaining public trust in science. ISSUES NewArchived

BackgroundKerala is a state in south India, appreciated for its education, better health indicators and quality of life. However, there is a proportionately high prevalence of mental health illnesses and suicides reported in the state. It is unclear if there is any disparity in the gender categories in this. With this systematic review, we aim to systematically study the gender disparity in the prevalence of mental health (MH) issues among adolescents, younger and older adults in Kerala.MethodsA search strategy was built and several databases like Pubmed, Cochrane, Scopus, EMBASE, EBSCOhost, Web of Science, and ProQuest were used alongside grey literature to identify relevant articles. The study was conducted according to the PRISMA guidelines following a prespecified protocol. After relevant data extraction, the estimates were pooled using random effects model due to the high heterogeneity assessed by tau-squared, Cochran Q, and prediction interval. Subgroup analyses, and meta-regression were used to reduce heterogeneity. We also identified the influence and heterogeneity contributed by individual studies using influence plots, Baujat plot, clustering, and performed several sensitivity analyses.ResultsTwenty articles were included in the review and meta-analysis. The pooled odds ratio of mental health illnesses amongst females compared to males in Kerala was 1.31 (95% CI: 1.0 − 1.73) and falls within a prediction interval of 0.38 to 4.53. The individual studies showed high heterogeneity (I2 = 92%, p = p < 0.01) and hence, subgroup analysis was done for several prespecified subgroups based on etiology, geography, demography, study settings, and age groups. Heterogeneity was significantly reduced by subgrouping based on etiology, study setting and age (p, 0.001, p < 0.001, p = 0.001). In etiologic subgrouping the highest pooled odds was in comorbidities associated MH issues (2.54) and least in non-specific (0.97). In age subgrouping, the highest pooled odds was in elderly (2.53) and least in adolescents (0.63). The odds was highest in health care facility (2.21) and least in educational institution (0.78) based studies. Meta-regression based on the size of the study failed to reduce heterogeneity.InterpretationsA gender disparity was evident in the prevalence of mental health issues, with a higher Odds in females especially among the elderly and adults. A Gender transformative approach in legislative, health systems and policy frameworks will be the answer to this.

BackgroundDespite the implementation of patient-centred care, mental health issues remain a significant risk factor and comorbidity for Tuberculosis (TB) disease. Mental health issues being co-morbidities to TB are likely to increase the disease burden of the affected population. This study therefore investigated the prevalence and impact of mental health issues in Tuberculosis (TB) patients.MethodsThis cross-sectional study design used mixed methods in data collection. The study used structured questionnaires, key informant interviews and focus group discussions. 127 TB patients were purposively selected from a group of patients who previously recovered successfully, with a history of relapse or are currently on TB treatment in high-volume facilities in Homa Bay, Busia and Kakamega Counties. 30 Key informant interviews were conducted with Healthcare workers. Quantitative data analysis was done using STATA version 14. Thematic analysis was employed to analyze qualitative data using NVivo version 10.ResultsThe findings showed that the most common mental health issues affecting TB patients were anxiety (66%) and depression (55%), which were commonly experienced during the presumptive stage of TB. Qualitative data revealed that stigma was the main barrier that hindered TB patients from accessing care. TB patients articulated the benefits of support structures ranging from positive encouragement, reminders on taking drugs, accompaniment to the clinic, and financial support in TB management. Furthermore, the study established that the majority of Health Care Workers (HCWs) were not prepared to handle TB patients’ mental issues, a gap that is likely to impact the quality of care TB patients receive.ConclusionThe study established that mental health issues impact TB treatment outcomes. Healthcare systems should prioritize the integration of mental health care into TB programs to address the high prevalence of mental health issues among TB patients.

Background: The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems. Objective: This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires. Method: A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis. Results: We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2–4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2–7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact. Conclusions: As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues. HIGHLIGHTS First systematic review of long-term bushfire mental health issues in Australia. Indicating substantial mental health problems among affected populations. Long-term issues were linked to bushfire impact and elevated among firefighters. Highlighting need for further rigorous research on long-term disaster sequalae.

PurposeMental health issues were the fourth leading cause of disease burden in Australia in 2022. About 30% of Australia’s population are migrants, whose mental health is poorly understood. We aimed to report the prevalence and risk factors of common mental health issues among non-refugee migrants in Australia.MethodsWe reviewed studies published between 2000 and 2024 on mental health issues amongst migrants in Australia following the Arksey and O’Malley’s methodological framework and PRISMA-ScR guidelines.ResultsOut of 3122 titles retrieved on mental health issues among migrants in Australia, 30 papers were selected. Migrants from Greece reported the highest prevalence (43.1%) of anxiety disorders than Australian-born (15.8%). The highest prevalence of psychological distress and depression were found amongst migrants from Lebanon (33%) and China (19%), respectively. Migrants from North-Africa, the Middle East, Italy, Greece, and Europe experienced a higher prevalence of psychological distress (18.2–21.9%) than Australian-born (12.4%). Prevalence of depression was higher among migrants from non-English-speaking backgrounds (19.7% vs. 10%), Sub-Saharan Africa (18.8% vs. 9.3%), Italy (18% vs. 10%), Greece (17.1% vs. 4.1%), and China (10% vs. 3%), compared to Australian-born people, respectively. The way that risk factors were reported differed across studies. Anxiety disorders were associated with higher stress (p < 0.05), unemployment (OR 1.8, 95%CI:1.4–2.4), female gender (OR 2.13, 95%CI:1.64–2.76) unmarried status (p < 0.01) and poor physical health status (OR 7.35, 95%CI:3.86–14.01). Psychological distress was associated with being a single woman (OR 6.54, 95%CI:1.18–35.3), holding a temporary visa (p < 0.01), being economically inactive (p < 0.01) and having rare contact with friends (AOR 2.083, p < 0.001). Depression was associated with migrants who were never married (OR 4.11, 95%CI:1.59–10.65), younger or older (p < 0.001), female (OR 2.3, 95%CI:1.9–2.7), from non-English speaking countries (OR 2.41, 95%CI:1.14–5.10) and reported poor physical health (OR 3.55, 95%CI:1.60–7.88).ConclusionThe high prevalence of mental health issues among non-refugee migrants necessitates revisiting strategies to tailor interventions appropriate for their mental health needs.

BackgroundRoughly 40% of those with intellectual/developmental disabilities (IDD) have mental health needs, twice the national average. Unfortunately, outpatient mental health services are often inaccessible, increasing reliance on hospital-based services. While telemental health services hold potential to address this gap, little is known about the effectiveness of telemental health for the diversity of persons with IDD, especially as it relates to crisis prevention and intervention services. Accordingly, the aims of this study are to: (1) compare telemental health versus in-person crisis prevention and intervention services among people with IDD; and (2) understand if outcomes vary across subpopulations, in order to identify potential disparities.MethodsThis study will take place within START (Systemic, Therapeutic, Assessment, Resources, and Treatment), a national evidence-based model of mental health crisis prevention and intervention for people with IDD. A total of 500 youth and adults, located across nine states, will be randomized 1:1 to telemental health vs. in-person. Participant inclusion criteria are ages 12–45 years, living in a family setting, and newly enrolled (within 90 days) to START. Outcomes will be assessed, using a non-inferiority design, for up to 1 year or until discharge. The intervention is comprised of four components: (1) outreach; (2) consultation/coping skills; (3) intake/assessment; and, (4) 24-hour crisis response. The in-person condition will deliver all components in-person. The telemental health condition will deliver components 1 & 2, via telephonic or other communication technology, and components 3 & 4 in-person. Outcomes include mental health crisis contacts, mental health symptoms, emergency psychiatric service use, perceived quality of mental healthcare, and time to discharge.DiscussionTo our knowledge, this will be the first trial of a telemental health crisis program for the IDD population. The study will be executed by an interdisciplinary team of experts that includes persons with lived experience of disability. Understanding the benefits of specific telemental health methods has important implications to the design of interventions. This telemental health study offers promise to address disparities in access to mental health care for people with IDD across diverse racial, ethnic, linguistic, and cultural groups.Trial RegistrationClinicaltrials.gov (#NCT05336955; Registration Date: 4/20/2022).

Over the past decade many developments have taken place in the field of automation of cars, trucks and public transport. The penetration rate of Level 2 partially automated vehicles in mixed traffic is increasing, Level 3 conditional automation is now supported by legislation, and different experimental and commercial applications of Level 4 high automation in mixed traffic exist. This shows that automated driving developments should be considered when making decisions about investments in physical and digital infrastructure. However, there are still many uncertainties regarding future penetration rates, the level of connectivity, the operational design domain, and the expected impacts of automated driving. This paper proposes four scenarios for automated driving developments in the Netherlands in 2040 and 2060: 1) Late transition, 2) Automated vehicles on main roads, 3) Car-topia, and 4) Share-topia. To derive these scenarios, a new “switchboard” method is introduced in which multiple driving forces for automated driving can be varied. The main driving forces were identified based on expert surveys. For each scenario, a modelling approach is used to compute the impact of automated driving on vehicle kilometres driven and congestion. The switchboard method offered more flexibility than existing scenario methods. The model-based impact assessment provided more conservative and probably more accurate insights into the expected impacts of automated driving on vehicle kilometres driven and congestion than expert estimates from the literature. The results show that in all scenarios automation leads to an increase in the number of trips, vehicle kilometres driven and congestion. In the scenarios with autonomous vehicles, congestion is expected to increase up to 17%. The higher the penetration rates of connected automated vehicles, the smaller the increase in congestion (1.5% -11%). The results indicate that investments in digital infrastructure are needed to prevent capacity reduction due to autonomous driving. The scenarios “car-topia” and “share-topia” may require additional physical infrastructure on motorways and regional roads.

The study was aimed at analysing the theoretical and methodological foundations and practical approaches to the formation and improvement of the economic mechanism of e-commerce enterprises’ activities. The methodological basis comprised systemic-structural and comparative approaches to examining the economic mechanism of the functioning of e-commerce enterprises in the context of the digital economy. The economic mechanism was considered as a set of interrelated elements – resources, costs, profit, and managerial decisions – that form an integrated digital ecosystem of the enterprise. In 2024, the share of online sales in the structure of Ukraine’s retail turnover increased to 3.1% (UAH 48.1 billion) compared with 2.1% (UAH 18.3 billion) in 2020, which confirms the consistent digitalisation of the consumer market even under crisis conditions. An analysis of key e-commerce players revealed different development trajectories. During 2020-2024, Rozetka increased its revenue from UAH 17.6 billion to UAH 29.7 billion, however, net profit remained volatile (from UAH 111 million in 2020 to UAH 16.3 million in 2024), which is explained by active investments in logistics and digital infrastructure. Prom demonstrated stable growth: revenue increased from UAH 924.5 million to UAH 2,052.2 million, and profit in 2024 reached UAH 269.2 million, indicating effective cost optimisation and the implementation of innovative solutions. The example of Amazon illustrated the global scale of digital technology integration: the company’s revenue grew from USD 386.1 billion in 2020 to USD 638 billion in 2024, and net profit, after temporary losses in 2022 (-USD 2.7 billion), recovered to USD 59.2 billion. It was determined that enterprises should more actively implement data analytics and machine-learning algorithms for demand forecasting and offer personalisation, automate business processes and logistics, as well as maintain a balanced financial structure and invest in digital infrastructure in order to enhance the effectiveness of managerial decision-making and ensure resilience and competitiveness. The practical significance of the study lies in the fact that the obtained results may be used by e-commerce enterprises to improve the economic mechanism through the integration of digital technologies, cost optimisation, and the enhancement of competitiveness in a dynamic market

PurposeThis study reviews the literature on shadow and gig economy models to highlight their effects on entrepreneurship and business development in emerging markets. In particular, it examines how these models create opportunities for income generation and employment while operating outside formal regulatory frameworks and also assesses the regulatory and socio-economic factors that influence their success.Design/methodology/approachUsing a systematic literature review (SLR) following the PRISMA protocol, 33 relevant and impactful articles published between 2000 and 2024 were analysed. The study synthesises findings on shadow and gig economy practices to answer key research questions about their role in fostering entrepreneurship and innovation.FindingsThe results reveal three key findings. First, the models of the gig and shadow economies encourage economic participation and entrepreneurial innovation, especially among underrepresented groups, but they also present difficulties like job insecurity and unofficial working conditions. The success of these models is also greatly influenced by socio-economic and regulatory factors, with adaptive frameworks enhancing worker protection and innovation. Third, measures like collective efforts, investments in digital infrastructure and flexible regulations are essential for both economic models to grow sustainably.Practical implicationsPolicymakers and stakeholders should create clear regulatory frameworks that protect workers’ rights while promoting business innovation. Investments in technology, digital infrastructure and inclusive skills development can improve participation and productivity. Collaborative initiatives are critical for mitigating risks and ensuring ethical practices in the shadow and gig economies.Originality/valueUnlike previous conceptual and theoretical studies, this study offers new perspectives through a clear conceptual framework that explains the dual role in entrepreneurship and business development. It also provides useful information for scholars and policymakers in emerging markets.

Several countries have committed to improving law enforcement response to behavioral emergencies through mental health crisis response and intervention training as well as by implementing crisis intervention team programs. However, these measures often rely primarily on traditional crisis intervention methods adapted from clinical settings. At the same time, not all behavioral emergencies constitute a mental health crisis and can be responded to with a single generic approach. Psychiatric disorders, intellectual and developmental disabilities, and/or adverse life circumstances can also result in behaviors that are below crisis threshold but still prompt emergency calls. Such presentations reflect maladaptive coping mechanisms rather than a complete loss of coping capacity seen during acute crisis and include, for instance, drug-seeking criminal behaviors in individuals with substance use disorders or self-stimulatory behaviors in individuals with autism spectrum disorder, particularly when such behaviors violate social norms. Crisis intervention alone fails to fully address the complex nature of these incidents. Currently, no existing framework effectively integrates guidelines for first responders to manage both acute crises and maladaptive behaviors that do not stem from a crisis state. To fill this gap, we propose the integrated Behavioral Emergency Assessment and Response (iBEAR) model as a theory-driven framework that equips first responders with evidence-based assessment, decision-making, and response strategies, easy to access while managing potentially dynamic and stressful behavioral emergencies. The model responds to well-documented demand for enhanced training and preparedness in managing behavioral emergencies, while also addressing the increasing burden of such incidents on emergency services.

A comprehensive examination of mental health issues among Bangladeshi college students is essential given the increasing rates of incidence. The purpose of this qualitative study was to examine the mental health concerns experienced by Bangladeshi public university students, identify the causes, and evaluate their support networks. To get insight from the students at five major public institutions in Bangladesh, the study used phenomenological research methods such semi-structured interviews and focus group discussions (FGDs). To guarantee gender, academic, and socioeconomic diversity, participants were purposively sampled and their size was 360. Thematic analysis identified mental health-related patterns and themes in the data. Academic pressure, financial restrictions, and family expectations were the main causes of anxiety, sadness, and stress in tertiary students. Furthermore, mental health stigma, ignorance, and poor university mental health services worsened these concerns. The survey also showed that most students used informal networks like friends and family for emotional support, highlighting a shortfall in mental health assistance. The research emphasises the importance of public universities implementing robust mental health policies and support services. Regular mental health screenings, counselling, and awareness programs can enhance student well-being. These findings shed light on the current state of student mental health in Bangladesh and offer valuable insights for policymakers, university leaders, and mental health experts to create tailored initiatives to address the mental health challenges faced by college students. By addressing these challenges, the project hopes to create a friendly and inclusive academic atmosphere that improves students' mental health and academic performance.

Rural-urban disparities in healthcare access remain a persistent global challenge, with rural populations often experiencing limited availability of health services, shortages of skilled professionals, and long travel distances to healthcare facilities. These inequities contribute to delayed diagnoses, poor health outcomes, and higher mortality rates in rural communities compared to urban counterparts. Telehealth has emerged as a transformative approach to bridging these gaps, leveraging digital platforms and communication technologies to deliver clinical care, health education, and monitoring services remotely. This comprehensive review evaluates the effectiveness of telehealth in addressing rural-urban disparities, synthesizing evidence across domains such as primary care delivery, chronic disease management, mental health services, maternal and child health, and emergency response. Findings indicate that telehealth interventions enhance accessibility by reducing geographic barriers and improving timeliness of care. They also improve continuity of services, particularly for chronic conditions like diabetes, cardiovascular disease, and respiratory illnesses, where regular monitoring is essential. In mental health, telepsychiatry and counseling services expand treatment reach in underserved areas, reducing stigma and improving adherence. Moreover, telehealth enhances maternal and child health outcomes by providing remote prenatal consultations, postnatal follow-up, and nutritional guidance. Importantly, the integration of telehealth into rural health systems has shown potential in reducing unnecessary hospitalizations, lowering healthcare costs, and improving patient satisfaction. However, challenges remain, including infrastructural limitations such as unreliable internet connectivity, digital literacy barriers among patients and providers, and regulatory and reimbursement inconsistencies. Addressing these issues requires investments in digital infrastructure, capacity building, and supportive policies that ensure equitable access. Telehealth demonstrates significant promise in mitigating rural-urban healthcare disparities by improving access, continuity, and quality of care. Future efforts should focus on sustainable integration, equitable deployment, and evidence-based policymaking to maximize its impact in reducing healthcare inequities.

The prevalence of mental health issues among nursing students: An umbrella review synthesis of meta-analytic evidence.

With the rapid development of the Internet and digital technology, digital infrastructure has become an important part of urban infrastructure. Many cities are enacting smart policies to promote the development of digital technology infrastructure. However, what are their mechanisms? There is currently a shortage of literature on the subject. This paper tried to solve this problem and used China as an example. Using panel data from cities in China, this paper used the spatial multiple-period difference-in-difference (SDID) method to investigate the impact of smart city policy (SCP) on digital infrastructure. First, we found that SCP significantly promotes the construction of digital infrastructure, with strong positive spatial spillover effects. This result remained valid after a series of rigorous robustness tests. Second, we discovered that the indirect effects of policy implementation outweigh the direct effects. Furthermore, smart city development enhances local government investment in digital infrastructure, attracts more high-tech enterprises, and consequently drives improvements in urban digital infrastructure levels. Lastly, we observed that the effectiveness of smart city policies is stronger in cities with good fiscal conditions, strong economic development, and a thriving digital economy. This research will not only enrich research on smart cities but also provide policy recommendations for strengthening digital infrastructure.