Robust Health Research Articles

The impact of Zika emergence in remote communities in northwestern Ecuador.

The Zika virus (ZIKV) epidemic in Latin America (2015-2016) has primarily been studied in urban centers, with less understanding of its impact on smaller rural communities. To address this gap, we analyzed ZIKV sero-epidemiology in six rural Ecuadorian communities (2018-2019) with varying access to a commercial hub. Seroprevalence ranged from 19% to 54% measured by NS1 blockade of binding ELISA. We observed a decline in ZIKV seroprevalence between 2018 and 2019 that was greater among younger populations, suggesting that the attack rates in the 2015-16 epidemic were significantly higher than our 2018 observations. These data indicate that the 2015-16 epidemic included significant transmission in rural and more remote settings. Our observations of high seroprevalence in our area of study highlights the importance of surveillance and research in rural areas lacking robust health systems to manage future Zika outbreaks and vaccine initiatives.

Relationship between family function and anxiety among nurses during the COVID-19 pandemic: a mediating role of expressive suppression

BackgroundThe aims of the present study were to investigate the incidence of nurses who suffered anxiety during the COVID-19 pandemic and to explore how expressive suppression influences the relationship between family function and anxiety.MethodsThis study used cross-sectional research and simple random sampling. A total of 300 questionnaires were distributed and 254 questionnaires were qualified after invalid questionnaires were proposed, thus a total of 254 female nurses from a tertiary hospital were included in this study. The measurement included General demographic questionnaires, the Self-Scale Anxiety, Scale (SAS), Emotion Regulation Strategies Questionnaire (ERQ), and Family Function Assessment (FAD). T-test, nonparametric Wilcoxon or Kruskal-Wallis test, χ2 test, Pearson or Spearman correlation analysis, multiple stepwise regression and bootstrap methods was performed to analyze the data.ResultsIn this study, 22.4% of the nurses exhibited anxiety symptoms, with 17.7% eliciting mild anxiety symptoms, 4.3% showing moderate anxiety symptoms and 0.4% with severe anxiety symptoms. Family function and expressive suppression were positively associated with anxiety severity. And family function influenced anxiety among nurses via direct and indirect (Expressive suppression -mediated) pathways.ConclusionsExpressive suppression partially mediated the influence of family function on anxiety symptom. To this end, nurse administrators should establish a robust mental health support system encompassing psychological counseling and emotional support groups. Furthermore, nurse administrators should consistently inquire about nurses’ family situations, encourage nurses to articulate their emotions and needs candidly, both within the domestic sphere and the workplace, while refraining from excessive self-repression.

Harnessing Community Coalition Action Theory (CCAT) for Building Resilient Communities: A Case Study of the NV Minority Health and Equity Coalition

Developing sustainable research and health equity partnerships is crucial for creating long-term solutions that address systemic disparities and improve community well-being. Coalition building, a fundamental strategy in this process, unites diverse stakeholders to collaborate on shared goals, amplifying collective impact. The importance of such an approach led to the development of the Nevada Minority Health and Equity Coalition (NMHEC). This study aims to achieve two primary objectives: first, to identify and integrate networked resources into the community coalition action theory (CCAT) framework to advance an understanding of community resilience; second, to share NMHEC strategies that incorporate community participation within each CCAT construct. The article outlines a generalizable process for establishing a robust health equity coalition through a community-based participatory research (CBPR) approach framed by CCAT and Community Resilience Theory (CR) principles. Documenting the narrative, facilitators, and barriers through an analysis of archival documents — including coalition recruitment materials, meeting minutes, and partnership and event evaluations — the study maps activities and resources to CCAT constructs. Findings highlight six foundational areas of NMHEC operations: 1) aligning fiscal agency with the coalition’s mission and vision; 2) implementing tiered membership to ensure participation equity; 3) co-developing operational norms to shape culture and interactions; 4) building capacity based on member feedback to assess available skills and resources; 5) sharing resources such as grant awards and staff time with coalition partners; and 6) seeking external advice from national experts to learn from other partnerships. This application of CCAT, CR, and CBPR illustrates effective strategies for fostering, maintaining, and sustaining partnerships to address health inequities.

Enhancing Community Health Programs: Roles, Operations and Data-Driven Innovations

Aims: To examine how data-driven strategies can be integrated into community health programs as innovative approaches for effective operation. Problem Statement: Numerous government engagements in different crucial sectors have limited her concerns about health provision and distribution to many citizens living in remote communities. Health provision characterized with easy accessibility and low cost should not be marginalized and should be the right of every citizen. However, many lives have been lost due to lack of this in some communities. Significance of Study: To curb this, non-profit sectors are now engaging in community health programs to ameliorate the difficulties faced by distanced citizens living in remote localities. With the advent of this program, it is imperative to incorporate data-driven strategies as innovative approaches to improve and enhance the current state of operations in community health programs. Discussion: A medical practice that addresses the well-being of people within a particular geographical location is referred to as community health. This technical review paper discusses the concepts, roles and mode of operations of community health workers and the programs that are embedded. The attributes of a robust well-functioning health system as stated by World Health Organisation (WHO) were discussed alongside program components that are often executed by village workers. Value-based care, patient-centered care and P4 medicine were identified as the major ideologies behind data-driven strategies and the characteristic features of each were adequately discussed. Conclusion: A data-driven healthcare innovative approach must put into consideration the real definition of data management policies, organize training for health care workers who are handling health data and also support the implementation in order to secure the designed information systems.

Comparing healthcare systems between the Netherlands and Australia in management for children with acute gastroenteritis.

Acute gastroenteritis is a highly contagious disease demanding effective public health and clinical care systems for prevention and early intervention to avoid outbreaks and symptom deterioration. The Netherlands and Australia are both top-performing, high-income countries where general practitioners (GPs) act as healthcare gatekeepers. However, there is a lower annual incidence and per-case costs for childhood gastroenteritis in Australia. Understanding the systems and policies in different countries can lead to improvements in processes and care. Therefore, we aimed to compare public health systems and clinical care for children with acute gastroenteritis in both countries. A cross-country expert study was conducted for the Netherlands and Australia. Using the Health System Performance Assessment framework and discussions within the research group, two questionnaires (public health and clinical care) were developed. Questionnaires were delivered to local experts in the Netherlands and the state of Victoria, Australia. Data synthesis employed a narrative approach with constant comparison. In Australia, rotavirus vaccination is implemented in a national program with immunisation requirements and legislation for prevention, which is not the case in the Netherlands. Access to care differs, as Dutch children must visit their regular GP before the hospital, while in Australia, children have multiple options and can go directly to hospital. Funding varies, with the Netherlands providing fully funded healthcare for children, whilst in Australia it depends on which GP (co-payment required or not) and hospital (public or private) they visit. Additionally, the guideline-recommended dosage of the antiemetic ondansetron is lower in the Netherlands. Healthcare approaches for managing childhood gastroenteritis differ between the Netherlands and Australia. The lower annual incidence and per-case costs for childhood gastroenteritis in Australia cannot solely be explained by the differences in healthcare system functions. Nevertheless, Australia's robust public health system, characterized by legislation for vaccinations and quarantine, and the Netherland's well-established clinical care system, featuring fully funded continuity of care and lower ondansetron dosages, offer opportunities for enhancing healthcare in both countries.

Implementation of the Physica Education Curriculum and Physical Literacy of the College Students in China

With the rapid economic development and improved living standards in China, health and physical activity have gained increasing importance. Physical Education (PE) courses, as a vital component of higher education, play a crucial role in cultivating well-rounded talents with robust physical health. However, the current implementation of PE curricula faces numerous challenges, including inadequate university emphasis, imperfect facilities, weak faculty strength, monotonous teaching content, and outdated teaching methods, resulting in unsatisfactory physical literacy outcomes among college students. Meanwhile, factors such as changing lifestyles, academic and employment pressures, and misconceptions about sports further hinder the improvement of physical literacy. This study aims to explore the relationship between PE curriculum implementation and physical literacy cultivation among college students, propose targeted improvement suggestions based on assessments and analyses of the current status, and delve into the cultivation mechanisms and development patterns to optimize PE courses and enhance college students' physical literacy. Theoretically, this research will enrich the theoretical framework of physical education; practically, it will promote the all-round development of college students, elevate their overall quality and competitiveness, and contribute to China's modernization drive.

Neonatal sepsis-a peek into our findings in Northwest Nigeria: a prospective study

BackgroundNeonatal sepsis is still a global health concern as it contributes to a high burden of neonatal morbidity and mortality especially in developing countries. The aim of the study is to give an insight into neonatal sepsis: risk factors, sepsis types, clinical features, pathogen burden with their antibiotic sensitivities, and outcome of admission in our facility. The study was a prospective hospital-based study conducted over 10 months, October 2018–July 2019.ResultOf the 248 term neonates with features of sepsis enrolled in the study 94 (37.9%) were confirmed to have sepsis. Late-onset sepsis LOS (68%) was found to be the most common, and most of the neonates were delivered elsewhere. Clinical features were non-specific for both early-onset (EOS) and LOS and include fever, jaundice, poor suck, and depressed primitive reflexes. Infections were mostly caused by gram-negative bacteria, and while Staphylococcus aureus was the single most common isolate for both EOS and LOS. Antibiotic sensitivity was highest with ciprofloxacin for both EOS and LOS. Mortality was high at 14.9% and was mostly contributed to by Staphylococcus aureus infection.ConclusionNeonatal sepsis is still a burden with mostly non-specific clinical features. The local prevalent organisms were Staphylococcus aureus, Enterobacter agglomerans and Klebsiella pneumonia with good antibiotic susceptibility to ciprofloxacin. Most presented with late-onset sepsis and therefore infection is likely to be community-acquired which to a great extent can be prevented with robust public health interventions.

Analysis of the effectiveness and user experience of employing virtual reality to enhance the efficacy of occupational safety and health learning for electrical workers and graduate students

IntroductionThe integration of engineering approaches in education and training is pivotal for reducing workplace incidents. Effective safety education increases workers' awareness of potential risks and fosters a robust Occupational Safety and Health (OSH) culture. Virtual reality (VR) offers immersive experiences that enhance the efficacy of safety training. MethodThis study evaluated VR's effectiveness through two experiments that demonstrated improved learning capacities. The first study employed quantitative methods and quasi-experiments with electrical sector technical support professionals. The second study used a qualitative approach with scenario case studies involving graduate students. ResultsThe quantitative study revealed significant improvements in OSH understanding among electrical workers, highlighting VR-based training's superiority over traditional methods. The qualitative study found positive outcomes in VR usability and user experience among graduate students, affirming VR's effectiveness in OSH education. ConclusionVR has proven to be an effective and efficient training tool for both graduate students and experienced workers. It significantly advances skills, knowledge, and proficiency in electrical engineering by providing realistic, immersive, and tailored learning experiences. As VR technology continues to evolve, its role in shaping the future of electrical technical education and training appears increasingly promising.

Telehealth development in the WHO European region: Results from a quantitative survey and insights from Norway

BackgroundThe COVID-19 pandemic sent shock waves through societies, economies, and health systems of Member States in the WHO European Region and beyond. During the pandemic, most countries transitioned from a slow to a rapid adoption of telehealth solutions, to accommodate the public health and social measures introduced to mitigate the spread of the disease. As countries shift to a post-pandemic world, the question remains whether telehealth’s importance as a mode of care provision in Europe continues to be significant. ObjectiveThis paper aims to present, synthesize, and interpret results from the Telehealth Programmes section of the 2022 WHO Survey on Digital Health (2022 WHO/Europe DH Survey). We specifically analyze the implementation and use of teleradiology, telemedicine, and telepsychiatry. Norwegian telehealth experiences will be used to illustrate survey findings, and we discuss some of the relevant barriers and facilitators that impact the use of telehealth services. MethodsThe survey tool was revised from the 2015 WHO Global Survey on eHealth, updated to reflect recent progress and policy priorities.The 2022 WHO/Europe DH Survey was conducted by WHO and circulated to Member States in its European Region from April to October 2022. ResultsThe data analysis revealed that teleradiology, telemedicine, and telepsychiatry are the telehealth services most commonly used in the WHO European Region in 2022. Funding remains the most significant barrier to the implementation of telehealth in the Region, followed by infrastructure and capacity/human resources. The survey results highlighted in this study are presented in the following sections: (1) telehealth strategies and financing, (2) telehealth programmes and services offered by Member States of the WHO European Region, (3) barriers to implementing telehealth services, and (4) monitoring and evaluation of telehealth. ConclusionBased on WHO’s 2022 survey, the use of telehealth in the WHO European Region is on the rise. However, merely having telehealth in place is not sufficient for its successful and sustained use for care provision. Responses also uncovered regional differences and barriers that need to be overcome. Successful implementation and scaling of telehealth requires rethinking the design of health and social care systems to create robust, trustworthy, and person-centred digital health and care services.

Detection of Multiple Human Viruses, including Mpox, Using a Wastewater Surveillance Approach in Brazil.

Sewage surveillance can be used as an effective complementary tool for detecting pathogens in local communities, providing insights into emerging threats and aiding in the monitoring of outbreaks. In this study using qPCR and whole genomic sewage surveillance, we detected the Mpox virus along with other viruses, in municipal and hospital wastewaters in Belo Horizonte, Brazil over a 9-month period (from July 2022 until March 2023). MPXV DNA detection rates varied in our study, with 19.6% (11 out of 56 samples) detected through the hybrid capture method of whole-genome sequencing and 20% (12 out of 60 samples) through qPCR. In hospital wastewaters, the detection rate was higher, at 40% (12 out of 30 samples) compared to 13.3% (4 out of 30 samples) in municipal wastewaters. This variation could be attributed to the relatively low number of MPXV cases reported in the city, which ranged from 106 to 341 cases during the study period, and the dilution effects, given that each of the two wastewater treatment plants (WWTP) investigated serves approximately 1.1 million inhabitants. Additionally, nine other virus families were identified in both hospitals and municipal wastewaters, including Adenoviridade, Astroviridae, Caliciviridae, Picornaviridade, Polyomaviridae, Coronaviridae (which includes SARS-CoV-2), Herspesviridae, Papillomaviridae and Flaviviridae (notably including Dengue). These findings underscore the potential of genomic sewage surveillance as a robust public health tool for monitoring a wide range of viruses circulating in both community and hospitals environments, including MPXV.

Developing a robust soil health indicator selection framework

Developing a robust soil health indicator selection framework The EU Soil Health Monitoring Law proposes twelve main soil indicators for reporting soil health. There is a need to ensure that these indicators and other subsequent measures are robust for their purpose. Since there is no single indicator for soil health, a robust framework for selecting indicators using agreed-upon criteria is needed(1,2). A summary of the selection framework criteria is discussed below and summarized in Figure 1. This framework is based on synthesizing accepted and tested methods to assess current indicators and provide a basis for selecting new ones in the future. Selected indicators will be dependent on their ability to assess soil ecosystem functions and services(3).

Healthcare Use and Costs in Children Receiving Home Mechanical Ventilation in Ontario: A 14-Year Cohort Study.

Rationale: Home mechanical ventilation (HMV) is an advanced medical therapy offered to children with medical complexity. Despite the growing pediatric HMV population in North America, there are limited studies describing healthcare use and predictors of highest costs using robust health administrative data. Objectives: To describe patterns of healthcare use and costs in children receiving HMV over a 14-year period in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study (April 1, 2003, to March 31, 2017) of children aged 0-18 years receiving HMV via invasive mechanical ventilation or noninvasive ventilation. Paired t tests compared healthcare system use and costs 2 years before and 2 years after HMV approval. We developed linear models to analyze variables associated with children in the top quartile of health service use and costs. Results: We identified 835 children receiving HMV. In the 2 years after HMV approval compared with the 2 years prior, children had decreased hospitalization days (median, 9 [interquartile range, 3-30] vs. 29 [6-99]; P < 0.0001) and intensive care unit admission days (6.6 [1.9-18.0] vs. 17.1 [3.3-70.9]; P < 0.0001) but had increased homecare service approvals (195 [24-522] vs. 40 [12-225]; P < 0.0001) and outpatient pulmonology visits (3 [1-4] vs. 2 [1-3]; P < 0.0001). Total healthcare costs were higher in the 2 years after HMV approval (mean, CAD$164,892 [standard deviation, CAD$214,187] vs. CAD$128,941 [CAD$194,199]; P < 0.0001). However, all-cause hospital admission costs were reduced (CAD$66,546 [CAD$142,401] vs. CAD$81,578 [CAD$164,672]; P < 0.0001). The highest total 2-year costs were associated with invasive mechanical ventilation (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.24-5.31; reference noninvasive ventilation), number of medical devices at home (OR, 1.63; 95% CI, 1.35-1.96; reference no technology), and increased healthcare costs in the year before HMV initiation (OR, 2.23; 95% CI, 1.84-2.69). Conclusions: Children progressing to the need for HMV represent a worsening in their respiratory status that will undoubtedly increase healthcare use and costs. We found that the initiation of HMV in these children can reduce inpatient healthcare use and costs but can still increase overall healthcare expenditures, especially in the outpatient setting.

Cognitive reserve modulates mental health in adulthood

Cognitive Reserve (CR) reflects acquired knowledge, skills, and abilities throughout life, and it is known for modulating cognitive efficiency in healthy and clinical populations. CR, which was initially proposed to explain individual differences in the clinical presentation of dementia, has subsequently been extended to healthy ageing, showing its role in cognitive efficiency also during middle age. Recently, CR has been linked to affective processes in psychiatric conditions such as schizophrenia, major depressive and anxiety symptoms, and psychological distress, suggesting its potential role in emotional expression and regulation. Whether the role of CR in mental health extends to non-pathological adults, and whether this is only relevant in older age is not yet clear. The aim of this work was therefore to explore the relationship between CR and mental health in healthy adults, with a focus on middle adulthood (40–60). In a sample of 96 participants, we found a positive association between CR and mental health outcomes, such that a higher cognitive reserve index corresponded to fewer mental health reported symptoms. Specifically, a higher CR reflecting professional activities was associated with lower stress levels, especially in middle agers. Taken together, these data therefore suggest that engaging occupations may help maintain a robust mental health, especially by reducing stress symptoms during middle age. These results broaden previous findings suggesting that CR relates to affective components of mental health in middle aged and older adults.

Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol.

A robust Health Technology Assessment (HTA) framework is crucial to address the rising burden of healthcare costs and to inform decision-making to promote high-quality health systems. This research aims to describe the HTA methods and mechanisms for the successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings. Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines. To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.

Evaluation of Ammonia Co-fuelling in Modern Four Stroke Engines

Ammonia is emerging as a promising alternative fuel for longer range decarbonised heavy transport, particularly in the marine sector due to highly favourable characteristics as an effective hydrogen carrier. This is despite generally unfavourable combustion and toxicity attributes, restricting end use to applications where robust health and safety protocols can be upheld. In the currently reported work, a spark ignited thermodynamic single cylinder research engine equipped with gasoline direct injection was upgraded to include gaseous ammonia port injection fuelling, with the aim of understanding maximum viable ammonia substitution ratios across the speed load operating map. The work was conducted under overall stoichiometric conditions with the spark timing re-optimised for maximum brake torque at all stable logged sites. The experiments included industry standard measurements of combustion, performance and engine-out emissions (including ammonia ‘slip’). With a geometric compression ratio of 12.4:1, it was possible to run the engine on pure ammonia at low engine speeds (1000–1800 rpm) at low to moderate engine loads in a fully warmed up state. When progressively dropping down below a threshold load limit, an increasing amount of gasoline co-firing was required to avoid engine misfire. Due to the favourable antiknock characteristics, pure ammonia operation was up to 5% more efficient than pure gasoline operation under stable operating regions. A maximum net indicated thermal efficiency (ITE) of 40% was achieved, with efficiency tending to increase with speed and load. For the co-fuelling of gasoline and ammonia in a pure ammonia attainable operating region, it was found that addition of gasoline improved the combustion, but these improvements were not sufficient to translate into improved thermal efficiency. Emissions of ammonia slip reduced with increased gasoline co-fuelling, albeit with increased NOx. However, the reduction in ammonia slip was nearly ten times the increase in NOx emissions. Comparing pure ammonia and pure gasoline operation, NOx reduced by ~60% when switching from pure gasoline to pure ammonia (as the latter is associated with longer and cooler combustion). Results were finally compared to those obtained a modern multicylinder Volvo ‘D8’ turbo-diesel engine modified for dual-fuel operation with ammonia port fuel injection (PFI), with the focus of the comparison being ammonia slip and NOx emissions.

COVID-19 health information system assessments in eight European countries: identified gaps, best practices and recommendations.

Global threats, such as the coronavirus disease 2019 (COVID-19) pandemic, have highlighted the critical importance of robust and well-functioning health information systems (HIS) in effectively addressing public health emergencies. To enhance the understanding and the functioning of such systems, it is crucial to perform HIS assessments. This article explores key gaps and identifies best practices in the COVID-19 HIS of eight European countries. Furthermore, it provides recommendations to strengthen European systems for better pandemic preparedness. Assessments were carried out in eight European countries using an adapted version of the WHO support tool to strengthen HIS and the Joint Action on Health Information assessment tool. The assessments took place between January 2022 and April 2023. Four main themes emerged regarding the gaps and best practices identified in the various HIS: organizational, technical, legal and resources. The results of these assessments show different approaches implemented by countries to improve their HIS and respond to the demands of the pandemic. It is imperative for countries to draw valuable insights from the COVID-19 pandemic and strengthen their HIS. This involves the adaptation or development of pandemic preparedness plans, strengthening legislative framework for data sharing and privacy protection, promotion of data standards and international definitions and implementation of a unique person identifier. Additionally, countries will have to act in this post-pandemic era and integrate the newly developed systems and innovations into existing structures, maintain and develop trust by citizens through transparent communication and engage in infodemic management and address resource gaps in the workforce.

Robust Structural Health Monitoring of CFRP Structures under Varying Loads using NSFD and Machine Learning with Combined Usage of Acceleration and Strain Data

Structural health monitoring (SHM) of objects in situ often requires a suitable combination of different methods and measurement techniques. In the field of aerospace applications, the previous research project "Combined acoustic and modal structure monitoring" dealt with the development of a robust SHM system for damage detection in carbon-fibre-reinforced polymer (CFRP) structures under varying realistic loads. The methods combined within the project were based on guided waves, acoustic emission, different vibration monitoring techniques and strain measurement. The present paper deals with the application of the nullspace-based fault detection algorithm (NSFD) combined with a machine learning approach based on strain measurements to classify different load conditions of the structure. Due to the high sensitivity to changes in the statistical properties of the measurement data, the NSFD algorithm reacts very sensitively to structural changes, but also to changes in the environmental conditions, such as changes in the external loads and the resulting stress state of the structure. In the paper, the impact of varying external loads on the NSFD damage indicator is analysed and shown. To prevent the NSFD algorithm from causing false alarms due to changes in the load conditions, but still being sensitive to small structural changes due to impact damages, the strain sensor data is used to predict the external loads on the structure. For this, machine learning is used to create clusters of similar stress states. For every cluster, a baseline for the NSFD algorithm must be made. The resulting approach is robust against changes in external loads and sensitive to small changes in the structure due to damages at the same time. The theory and the algorithms are successfully tested with measured data sets from a CFRP-airplane structure.

Consumer adoption of digital health services: A systematic literature review and research agenda

AbstractDigital health services (DHSs) have revolutionized the healthcare sector to provide quality care facilities that are affordable, efficient, and universally accessible. By making patients the focus of the healthcare delivery process, these services can offer more personalized and effective health solutions and thus facilitate a more robust and resilient health ecosystem. The adoption of these services increased manifold during the COVID‐19 pandemic and gained immense attention from researchers across the globe. Despite this, there is limited knowledge about the facets of DHS adoption from the consumers' perspective. Thus, it is imperative to synthesize the extant literature to provide a holistic view of DHS adoption. This article offers an organized, retrospective view of the DHS literature, using a framework‐based systematic review approach to identify factors contributing to DHS adoption from the consumers' perspective. To do this, 63 articles from the Web of Science database over the last 23 years were systematically reviewed using two well‐known organising frameworks. The Antecedents‐Decisions‐Outcomes framework uncovers the known associations of constructs in the DHS literature. Followed by the theories‐contexts‐methods framework that offers information on the theoretical, contextual, and methodological approaches applied in the DHS research. Additionally, the article identifies the major gaps in the existing body of literature and offers a few recommendations for future investigation for researchers and practitioners in the fields of consumer behaviour, technology, and health management. The global perspective of this review has multiple ramifications that can foster a more sustainable healthcare system by giving insight into consumers' perspectives.

Addictive behavior and mental health of adolescents aged 11-17 years in Bangladesh in 2014: A cross-sectional study.

This study aimed to evaluate the factors associated with addictive behavior and mental health in adolescents aged 11-17 years in Bangladesh. This study analyzed data from the Bangladesh Global School-based Health Survey (GSHS) conducted in 2014. Adolescents aged 11-17 years studying government schools were considered as respondents for this survey. A two-phase group sample design was utilized to deliver illustrative information of all understudies in grades (classes) 7-10 in Bangladesh. Bivariate analyses followed by a weight-adjusted multiple logistic regression was fitted to a sample of size 2989 adolescents. One in ten and one in four adolescents had different substance addictions and some forms of mental health conditions, respectively. Sex of participants (adjusted odds ratio [AOR]: 4.49; confidence interval [CI]:2.28-8.84), being bullied (AOR: 3.08; CI:1.46-6.49), use of tobacco among parents (AOR: 5.82; CI:3.16-10.75), parental understanding of adolescents' problems (AOR: 0.45; CI:0.23-0.82), and food affordability (AOR: 1.24; CI:1.09-1.42) were associated with addictive behaviors of adolescents. Bullied males with nonempathetic parents were found to be more vulnerable to addictive behaviors and bullied females showed higher tendencies to mental health issues. Considering the elevated prevalence of reported mental health concerns, identifying vulnerable groups and formulating intervention-oriented policies engaging youths can pave the way towards achieving robust health and well-being for them in Bangladesh.

CLINICAL PSYCHOLOGY IN THE EU: A COMPARATIVE ANALYSIS OF BEST PRACTICES

Clinical psychology plays a vital role in promoting mental health and well-being across the European Union (EU). With diverse cultural, social, and systemic contexts, understanding the best practices in clinical psychology is crucial for improving mental health care services. This article provides a comprehensive comparative analysis of clinical psychology practices across various EU member states, highlighting effective methodologies, training standards, and systemic frameworks. The primary aim of this article is to explore and evaluate the therapeutic approaches, training and professional development standards, and systemic frameworks utilized in clinical psychology across different EU countries. By identifying and comparing these practices, the article seeks to highlight the most effective methods and propose recommendations for enhancing mental health care in the region. The study employs a mixed-methods approach, including a thorough literature review, structured surveys, and semi-structured interviews with clinical psychologists, policymakers, and experts from various EU member states. Additionally, case studies from selected countries provide detailed insights into practical applications and outcomes. Quantitative data is analyzed using statistical methods, while qualitative data is interpreted through thematic analysis. The analysis reveals significant variation in therapeutic approaches, with the UK and Germany emphasizing evidence-based practices such as Cognitive Behavioral Therapy (CBT), while Sweden focuses on preventive strategies and public health integration. Training and professional development standards are most rigorous in Germany and the UK, ensuring high-quality practice. The Netherlands and Italy showcase the benefits of innovative and community-based care models. Overall, countries with robust mental health policies and integrated care systems tend to achieve better clinical outcomes. The findings underscore the importance of adopting evidence-based practices, enhancing training standards, and fostering therapeutic diversity to address complex mental health issues. Cross-border collaboration and knowledge exchange among EU member states can further refine and harmonize clinical psychology practices.