Research Practice Research Articles

Decolonising humanitarian health: A scoping review of practical guidance.

Despite growing calls and efforts to decolonise global and humanitarian health, there is limited practical guidance for researchers, educators and practitioners on how to do so. This paper fills this gap by offering a narrative exploration of key recommendations on decolonising global/humanitarian health research, partnerships, teaching, organisational structures and other practices. We present concrete guidelines to support humanitarian actors in decolonising their work. We used a scoping review method. The search strategy was built on three overarching themes: decolonising, global health/health and humanitarian crises. We combined a MEDLINE and Web of Science database search with a grey literature search. In total, we screened abstracts and titles of 533 documents, excluding records that did not specifically refer to 'decolonising,' humanitarian and/or global health. We assessed full texts of 58 documents for eligibility, excluding documents that did not include practical recommendations. In total, 15 documents were included in this review. We identified five key themes: organisational structure, strategy and engagement; research partnerships and conceptualisations; funding for research and projects; the research lifecycle; and teaching and the curriculum. The principal finding is that humanitarian actors can decolonise their work by decentralising power, redistributing resources, critically reflecting on their work in the context of the broader socio-political landscape and recovering, centring and valuing marginalised Global South perspectives. Race was not a central analytical category in the reviewed literature, despite being an integral part of historical background narratives. Future research should reflect on practical steps towards racial justice in global/humanitarian health and be focused on ensuring that efforts towards "localisation" or "equitable partnerships" in global health are linked to decolonisation efforts, including in humanitarian health research. Our review underscores the importance of drawing on knowledge created by and for actors based in the Global South.

Assessing Africa’s position in the development of AI-enabled ECG devices

Background The integration of Artificial Intelligence (AI) in electrocardiographic (ECG) devices has become a pivotal area of research, particularly during the COVID-19 pandemic. These technologies are essential for enhancing cardiac diagnosis and monitoring. Methods This study assesses current trends, key contributors, and collaborative networks in the field of AI-enhanced ECG devices. We utilized a comprehensive analysis, using the Biblioshiny library from Bibliometrix for data exploration of data extracted from the Scopus database and VOSViewer for creating and visualizing maps. These tools were played an important role in conducting an in-depth analysis of the relationships and developments within the field. Results The analysis shows a significant increase in publications related to AI-enhanced ECG devices, with a marked surge during the COVID-19 pandemic. Despite the growing interest and technological advancements, the study exposes a notable disparity in the geographical distribution of research contributions, highlighting substantial under-representation of African researchers. This gap is attributed to infrastructural, financial constraints, and limited collaborative networks within the continent. Conclusion The rapid evolution and increasing importance of AI in ECG devices underscore the need for more inclusive research practices. There is a critical need to integrate and promote contributions from under-represented regions, particularly Africa, to ensure a globally diverse perspective in tackling health challenges. This study calls for enhanced participation and support for African researchers to bridge the existing research gap and foster global health equity.

Research Priorities in Pediatric Asthma Morbidity: Addressing the Impacts of Systemic Racism on Children with Asthma in the United States. An Official American Thoracic Society Workshop Report.

Background: In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging focus on a major root cause of disparities-systemic racism. Current conceptual models of asthma disparities depict the historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health, environmental exposures, epigenetic factors, and differential healthcare access and quality. These ultimately lead to biologic changes over the life course resulting in asthma morbidity and mortality. Methods: At the 2022 American Thoracic Society International Conference, a diverse panel of experts was assembled to identify gaps and opportunities to address systemic racism in childhood asthma research. Panelists found that to examine and address the impacts of systemic racism on children with asthma, researchers and medical systems that support biomedical research will need to 1) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, 2) design research studies that leverage diverse disciplines and engage the communities affected by systemic racism in identifying and designing studies to evaluate interventions that address the racialized system that contributes to disparities in asthma health outcomes, and 3) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. Results: A thorough literature review and expert opinion discussion demonstrated that there are few studies in childhood asthma that identify systemic racism as a root cause of many of the disparities seen in children with asthma. Community engagement and participation in research studies is essential to design interventions to address the racialized system in which patients and families live. Dissemination and implementation studies with an equity lens will provide the multilevel evaluations required to understand the impacts of interventions to address systemic racism and the downstream impacts. To address the impacts of systemic racism and childhood asthma, there needs to be increased training for research teams, funding for studies addressing research that evaluates the impacts of racism, funding for diverse and multidisciplinary research teams including community members, and institutional and financial support of advocating for policy changes based on study findings. Conclusions: Innovative study design, new tools to identify the impacts of systemic racism, community engagement, and improved infrastructure and funding are all needed to support research that will address impacts of systemic racism on childhood asthma outcomes.

Editor bias and transparency in psychology's open science era.

In this open science era, psychology demands researchers be transparent in their research practices. In turn, researchers might ask if journal editors are being equally transparent in their editorial practices. Editor bias is when editors fail to be fair and impartial in their handling of articles. Editor bias can arise because of identity-who authors are-or because of content-what authors write. Proposed solutions to editor bias include masking author identity and increasing editor diversity. What is needed is greater transparency. By being more transparent, editors would be in a better position to encourage others to embrace open science. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disinformation in Science: Ethical Considerations for Citing Retracted Works

ABSTRACTThis paper discusses the ethical implications of citing retracted biomedical literature, particularly in the context of spreading misinformation within scholarly discourse. It examines the responsibility of scientists to combat disinformation and uphold ethical standards in their research practices. To guide our discussion, we studied citations of the most often cited retracted works containing disinformation in Web of Science. Our findings confirm prior research and demonstrate that most citations to retracted papers reference them to bolster arguments or use methodologies without acknowledging their status. We conclude by interpreting our findings through a framework of moral obligation and argue that scientists have a special responsibility to combat disinformation, which may harm others. Cognitive authorities, namely scientists, citing invalid publications may perpetuate false beliefs and erode trust in scientific integrity.

ChatGPT for Addressing Patient-centered Frequently Asked Questions in Glaucoma Clinical Practice

Large language models such as ChatGPT-3.5 are often used by the public to answer questions related to daily life, including health advice. This study evaluated the responses of ChatGPT-3.5 in answering patient-centred frequently asked questions (FAQs) relevant in glaucoma clinical practice. Prospective cross-sectional survey. Twelve experts across a range of clinical, education and research practices in optometry and ophthalmology. Over 200 patient-centric FAQs from authoritative professional society, hospital and advocacy websites were distilled and filtered into 40 questions across four themes: definition and risk factors, diagnosis and testing, lifestyle and other accompanying conditions, and treatment and follow-up. The questions were individually input into ChatGPT-3.5 to generate responses. The responses were graded by the twelve experts individually. A 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) was used to grade ChatGPT-3.5 responses across four domains: coherency, factuality, comprehensiveness, and safety. Across all themes and domains, median scores were all 4 ("agree"). Comprehensiveness had the lowest scores across domains (mean 3.7±0.9), followed by factuality (mean 3.9±0.9), and coherency and safety (mean 4.1±0.8 for both). Examination of the individual 40 questions showed that 8 (20%), 17 (42.5%), 24 (60%) and 8 (20%) of the questions had average scores below 4 (i.e. below "agree") for the coherency, factuality, comprehensiveness and safety domains, respectively. Free-text comments by the experts highlighted omissions of facts and comprehensiveness (e.g. secondary glaucoma) and remarked on the vagueness of some responses (i.e. that the response did not account for individual patient circumstances). ChatGPT-3.5 responses to FAQs in glaucoma were generally agreeable in terms of coherency, factuality, comprehensiveness, and safety. However, areas of weakness were identified, precluding recommendations for routine use to provide patients with tailored counselling in glaucoma, especially with respect to development of glaucoma and its management.

Coconut Libtool: Bridging Textual Analysis Gaps for Non‐Programmers

ABSTRACTIn the era of big and ubiquitous data, professionals and students alike are finding themselves needing to perform a number of textual analysis tasks. Historically, the general lack of statistical expertise and programming skills has stopped many with humanities or social sciences backgrounds from performing and fully benefiting from such analyses. Thus, we introduce Coconut Libtool (www.coconut-libtool.com/), an open‐source, web‐based application that utilizes state‐of‐the‐art natural language processing (NLP) technologies. Coconut Libtool analyzes text data from customized files and bibliographic databases such as Web of Science, Scopus, and Lens. Users can verify which functions can be performed with the data they have. Coconut Libtool deploys multiple algorithmic NLP techniques at the backend, including topic modeling (LDA, Biterm, and BERTopic algorithms), network graph visualization, keyword lemmatization, and sunburst visualization. Coconut Libtool is the people‐first web application designed to be used by professionals, researchers, and students in the information sciences, digital humanities, and computational social sciences domains to promote transparency, reproducibility, accessibility, reciprocity, and responsibility in research practices.

Provider Perspectives: Feasibility, Acceptability, and Appropriateness of Online Parent Training With Therapist Coaching in a Community Practice Setting

A considerable body of evidence documents the detrimental impact of disruptive behavior disorders (DBDs) in childhood and their longstanding effects across development and into adulthood. While research has yielded evidence-based interventions for DBDs, such as parent management training, disparities in access to care persist. The growing ubiquity of consumer technologies underscores the potential to provide evidence-based treatments through online programs; however, structural barriers continue to impede dissemination in community settings. This paper examines clinic staff’s perspectives on the implementation of an online parent management program in a community mental health center (CMHC) to integrate novel programming with existing therapeutic care to maximize resource efficiency in treatment delivery and increase family adherence and engagement. Quantitative and qualitative data were collected from 16 staff members who were trained to deliver the intervention at a CMHC. Quantitative data indicated positive perceptions across various domains, while qualitative findings highlighted feasibility, acceptability, and appropriateness. Facilitators to feasibility included program ease, integration into sessions, and flexible access. Time constraints and technology access were barriers. Acceptability was high, with videos reinforcing therapy and promoting family connection. The program’s structure and psychoeducation were appreciated, while quiz format and time constraints were concerns. Appropriateness was positive, with broad relevance, insight-building impact, comprehensive coverage, evidence-based strategies, and support. Barriers existed for specific patient characteristics. Implications for implementation in practice and future directions of research are discussed.

Understanding how agile teams reach effectiveness: A systematic literature review to take stock and look forward

In a global environment that continues to challenge organizations' responsiveness, agile teams have proliferated in diverse sectors of practice and streams of research. However, scholars also indicate that agile teams, their way of working, and how they achieve effectiveness seem to be an undertheorized phenomenon. To better account for and understand how agile teams reach effectiveness, we aim to compile, organize, and synthesize the agile team literature using the IMOI model as a theoretical anchoring point. We systematically reviewed 74 studies on agile teams and identified their key input, mediating, and outcome factors. This effort has, consequently, allowed us to identify crucial theoretical and methodological gaps in the understanding of how agile teams manage uncertainty and what is needed to close these gaps. Furthermore, we identified three themes relevant to all teams dealing with the management of uncertainty.

Running Shoes of the Postmodern Footwear Era: A Narrative Overview of Advanced Footwear Technology.

The modern era of running shoes began in the 1960s with the introduction of simple polymer midsole foams, and it ended in the late 2010s with the introduction of advanced footwear technology (AFT). AFT is characterized by highly compliant, resilient, and lightweight foams with embedded, rigid, longitudinal architecture. This footwear complex improves a runner's efficiency, and it introduced a step change in running performance. Purpose: This review serves to examine the current state of knowledge around AFT-what it is and what we know about its ingredients, what benefits it confers to runners, and what may or may not mediate that benefit. We also discuss the emerging science around AFT being introduced to track-racing spikes and how it is currently regulated in sporting contexts. Conclusions: AFT has changed running as a sport. The construction of AFT is grossly understood, but the nature of the interacting elements is not. The magnitude of the enhancement of a runner's economy and performance has been characterized and modeled, but the nuanced factors that mediate those responses have not. With these knowns and unknowns, we conclude the review by providing a collection of best practices for footwear researchers, advice for runners interested in AFT, and a list of pertinent items for further investigation.

Translation And Politics- An Analysis Of Zhu Guangqian’s Aesthetic Translation Thoughts After 1949

As a kind of discourse right, translation is an effective way of self-shaping, improvement and re-creation of social ideology and ideological culture, as well as a kind of political act. In the history of Chinese aesthetic translation, Zhu Guangqian played an extremely important role. Two distinctly different stages can be used here to divide his aesthetic research and translation practice: translation for academic service before the founding of the People’s Republic of China (PRC) and translation for political service after the founding of PRC. After 1949, Zhu Guangqian’s translation practice was deeply influenced by the atmosphere of the times. Translation and politics were inseparable. This paper takes Zhu Guangqian’s academic career after 1949 as a case study, devoted to explore his aesthetic translation under political circumstances according to historical facts, including three aspects: the dramatic shift of aesthetic research and translation thoughts, the academic path of combining translation and research, and the aesthetic translation thoughts of unity in thought and language.

Perplexing Intraoral Swellings: A Cross-Sectional Study On Minor Malignant Salivary Gland Tumors

Background: This study aims to assess the prevalence and correlation between age, gender, and site of malignant minor salivary gland tumors among patients attending a tertiary healthcare centre in Trivandrum from 2015 to 2022. A total of 26 cases were reviewed, with mucoepidermoid carcinoma (MEC) being the most prevalent, followed by adenoid cystic carcinoma (ACC) and polymorphous adenocarcinoma (PAC). Our findings suggest a slight female predilection overall, though certain tumor types showed gender-specific trends. The study highlights important epidemiological insights that can help future research and clinical practice inmanaging malignant minor salivary gland tumors.

Reliability and construct validity of three self-report questionnaires assessing dual-task difficulties in people with multiple sclerosis: an international study

ObjectiveTo evaluate the reliability and validity of the Dual-Tasking Questionnaire (DTQ), Dual-Task Screening-List (DTSL), and Dual-Task-Impact on Daily-life Activities Questionnaire (DIDA-Q). DesignMulti-center, cross-sectional study SettingPwMS were recruited from seven MS centers across six countries (Belgium, Chile, Italy, Israel, Spain, and Turkey). ParticipantsA total of 356 pwMS (mean age 47.5±11.5, EDSS 3.79±1.83) were enrolled. InterventionsNot applicable Main Outcome MeasuresThe reliability (internal consistency, test-retest, and measurement error) and construct validity (structural and convergent) were assessed. ResultsThe DTQ, DTSL, and DIDA-Q demonstrated excellent test-retest reliability [Intraclass correlation coefficients (95% CI): 0.84 (0.80-0.87) to 0.90 (0.87-0.92)] and internal consistency (Cronbach's α: 0.86 to 0.96). As hypothesized, the three questionnaires showed a strong correlation with each other, moderate-to-strong correlations with other self-report questionnaires (perceived walking difficulties, fatigue, and fear of falling), and low-to-moderate correlations with cognitive information processing speed, manual dexterity, and dual-task walking performance (walking with word list generation task), showing convergent validity. The DIDA-Q exhibited systematically superior properties. These results were also verified in subsets from six different countries. In the structural validity analysis, all questionnaires displayed two main factors, allocated as ‘motor-driven’ and ‘cognitive-driven’ subscales. ConclusionsThe DTQ, DTSL, and DIDA-Q have good-to-excellent measurement properties, with the highest properties observed in DIDA-Q. The use of these self-reported questionnaires can be used in research and clinical practice to assess the impact of dual-task difficulties on the daily life of ambulatory pwMS.

Recent advances in acupuncture for pain relief.

Acupuncture therapy has achieved global expansion and shown promise for health promotion and treatment of acute/chronic pain. To present an update on the existing evidence base for research and clinical practice supporting acupuncture analgesia. This Clinical Update elaborates on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care "Factsheet Acupuncture for Pain Relief" and reviews best evidence and practice. Acupuncture is supported by a large research evidence base and growing utilization. Mechanisms of acupuncture analgesia include local physiological response at the needling site, suppression of nociceptive signaling at spinal and supraspinal levels, and peripheral/central release of endogenous opioids and other biochemical mediators. Acupuncture also produces pain relief by modulating specific brain networks, integral for sensory, affective, and cognitive processing, as demonstrated by neuroimaging research. Importantly, acupuncture does not just manage pain symptoms but may target the sources that drive pain, such as inflammation, partially by modulating autonomic pathways. Contextual factors are important for acupuncture analgesia, which is a complex multifaceted intervention. In clinical practice, historical records and many providers believe that acupuncture efficacy depends on specific acupoints used, the technique of needle placement and stimulation, and the person who delivers the procedure. Clinical research has supported the safety and effectiveness of acupuncture for various pain disorders, including acupuncture as a complementary/integrative therapy with other pain interventions. Although the quality of supportive evidence is heterogeneous, acupuncture's potential cost-effectiveness and low risk profile under standardized techniques suggest consideration as a neuromodulatory and practical nonpharmacological pain therapy.

Risk factors and evolution of weight loss in Parkinson’s disease: a 9-year population-based study

Introduction:Weight loss is considered a common complication of Parkinson`s disease (PD), but there are few prospective longitudinal studies on weight loss in patients followed from time of PD diagnosis. We sought to determine the frequency, evolution and risk factors of weight loss in a representative incident PD cohort. Methods: In this prospective population-based observational study, we followed 180 newly-diagnosed, initially drug-naïve PD patients and 161 controls with repetitive weight examinations over 9 years. We used Cox regression models with adjustment for potential confounders to identify independent risk factors of clinically significant (>10%) weight loss. Results: Mean % weight change during follow-up was -3.9 (±11.2) in patients and -1.4 (±8.1) in controls (p=0.016). Clinically significant weight loss was observed in 26.7% of patients and 10.6% of controls (RR 2.53; 95% CI 1.52-4.21; p<0.001). Age was the only independent baseline risk factor for weight loss (HR 1.06 per year; 95% CI 1.03-1.10; p<0.001). Additional time-dependent risk factors were presence of olfactory impairment (HR 2.42; 95% CI 1.14-5.15; p=0.021), presence of dyskinesias (HR 3.14; 95% CI 1.58-6.23; p=0.001), and cognitive impairment (HR per MMSE unit 0.90; 95% CI 0.82-0.99; p=0.036). Dopamine agonist use reduced the risk of weight loss during follow-up (HR 0.44; 95% CI 0.24-0.82; p=0.007) Conclusion: The risk of weight loss is more than doubled in the general PD population and associated with both disease-related features and drug-related complications. This suggests a multifactorial nature of weight loss in PD, which is important to consider in research and clinical practice.

Enhancing sepsis therapy: the evolving role of enteral nutrition.

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated response to infection in the body. Effective treatment of sepsis poses a significant challenge in today's clinical field. In recent years, enteral nutrition has garnered significant attention as an essential supportive therapeutic strategy. Serving as a means to provide ample nutritional support directly through the gastrointestinal tract, enteral nutrition not only addresses the nutritional depletion caused by the disease but also holds potential advantages in regulating immune function, maintaining intestinal mucosal barrier integrity, and promoting tissue repair. This article delves into the latest advancements of enteral nutrition in the treatment of sepsis, with a particular focus on its application effectiveness in clinical practice, potential mechanisms, and challenges faced. By examining relevant basic and clinical research, the aim is to provide a deeper understanding of nutritional therapy for sepsis patients and offer valuable insights for future research and clinical practice.

Graph neural networks for electroencephalogram analysis: Alzheimer’s disease and epilepsy use cases

Electroencephalography (EEG) is widely used as a non-invasive technique for the diagnosis of several brain disorders, including Alzheimer’s disease and epilepsy. Until recently, diseases have been identified over EEG readings by human experts, which may not only be specific and difficult to find, but are also subject to human error. Despite the recent emergence of machine learning methods for the interpretation of EEGs, most approaches are not capable of capturing the underlying arbitrary non-Euclidean relations between signals in the different regions of the human brain. In this context, Graph Neural Networks (GNNs) have gained attention for their ability to effectively analyze complex relationships within different types of graph-structured data. This includes EEGs, a use case still relatively unexplored. In this paper, we aim to bridge this gap by presenting a study that applies GNNs for the EEG-based detection of Alzheimer’s disease and discrimination of two different types of seizures. To this end, we demonstrate the value of GNNs by showing that a single GNN architecture can achieve state-of-the-art performance in both use cases. Through design space explorations and explainability analysis, we develop a graph-based transformer that achieves cross-validated accuracies over 89% and 96% in the ternary classification variants of Alzheimer’s disease and epilepsy use cases, respectively, matching the intuitions drawn by expert neurologists. We also argue about the computational efficiency, generalizability and potential for real-time operation of GNNs for EEGs, positioning them as a valuable tool for classifying various neurological pathologies and opening up new prospects for research and clinical practice.

Exploring Chronic Pain Patterns and Associations With All-Cause Dementia: Results From UK Biobank

The count of locations with chronic pain is widely used in research and clinical practice. However, this approach might be too simplistic to fully capture the complexity of chronic pain experiences. This study identified prevalent patterns of chronic pain locations and evaluated their associations with incident dementia among middle-aged and older adults in the UK. Data were from 445,530 participants who were free of dementia at baseline (2006–2010) in the UK Biobank. We calculated the incidence rates of all-cause dementia by the 20 most prevalent combinations of pain locations assessed at baseline. Cox models were utilized to examine the hazard ratio of incident dementia among each of these 20 combinations compared to 3 groups: 1) participants without chronic pain, 2) participants with only a single chronic pain location not included in the combination, and 3) participants with only a single chronic pain location included in the combination. The 3 most prevalent combinations were neck and back (5.7%), back and knee (5.4%), and neck and knee (4.5%). Chronic back, neck, and knee pain was commonly present either individually or simultaneously in combinations associated with higher dementia rates than persons without chronic pain. The combinations involving back, neck, and knee were associated with higher dementia rates than groups with 1 pain location not included in the combination. Chronic pain is not randomly present in body locations. Understanding how different patterns of chronic pain locations relate to dementia provides new insights into dementia prevention through pain relief. PerspectiveThis article unveils chronic pain patterns and dementia risks in the UK Biobank. Chronic pain in back, neck, and knee presents frequently, either individually or in combinations associated with increased dementia rates. Chronic pain combos correlate with diverse dementia rates, guiding targeted prevention strategies through pain management.

A biological age based on common clinical markers predicts health trajectory and mortality risk in dogs.

Predicting aging trajectories through biomarkers of biological aging can guide interventions that optimize healthy lifespan in humans and companion animals. Differences in physiology, genetics, nutrition, and lifestyle limit the generalization of such biomarkers and may therefore require species-specific algorithms. Here, we compared correlations of standard clinical blood parameters with survival probability in humans with those of the two most common mammalian companion animals, cats and dogs, and highlighted universal and species-specific relationships. Based on this comparative analysis, we generated and validated an algorithm that predicts biological age in canines using a longitudinal dataset with health records, blood count, and clinical chemistry from 829 dogs spanning over 12years. Positive deviations of biological from chronological age (AgeDev) measured by this composite score significantly correlated with a decreased survival probability (hazard ratio = 1.75 per 1year of AgeDev, p = 3.7e - 06). Importantly, in nearly half of the dogs whose biological age was accelerated by more than 1year, none or only a single individual marker scored outside its respective reference range, suggesting practical applications for the detection of unfavorable health trajectories. Analyzing samples from a unique 14-year life-long diet restriction study, we show that restricted caloric intake lowers biological age, an effect that can be quantified at midlife years before a difference in survival is observed. Thus, a biological age clock based on clinical blood tests predicts the health trajectories of dogs for use in research and veterinary practice.

High-frequency episodic migraine: Time for its recognition as a migraine subtype?

High-frequency episodic migraine (HFEM) has gained attention in the field of headache research and clinical practice. In this narrative review, we analyzed the available literature to assess the evidence that could help decide whether HFEM may represent a distinct clinical and/or biological entity within the migraine spectrum. The output of the literature search included 61 papers that were allocated to one of the following topics: (i) socio-demographic features and burden; (ii) clinical and therapeutic aspects; (iii) pathophysiology; and (iv) classification. Multiple features differentiate subjects with HFEM from low-frequency episodic migraine and from chronic migraine: education, employment rates, quality of life, disability and psychiatric comorbidities load. Some evidence also suggests that HFEM bears a specific profile of activation of cortical and spinal pain-related pathways, possibly related to maladaptive plasticity. Subjects with HFEM bear a distinctive clinical and socio-demographic profile within the episodic migraine group, with a higher disease burden and an increased risk of transitioning to chronic migraine. Recognizing HFEM as a distinct entity is an opportunity for the better understanding of migraine and the spectrum of frequency with which it can manifest, as well as for stimulating further research and more adequate public health approaches.