Public Health and Healthcare

Abstract: Far-UVC radiation for disinfection in the presence of people in public indoor spaces through unshielded open radiation sources has been promoted for several years, claiming to be a simple solution to reduce infections from airborne pathogens such as bacteria and viruses. This literature review summarizes the existing research on the effectiveness of far-UVC radiation for inactivating pathogens, as well as potential risks to skin and eyes associated with exposure to far-UVC radiation. Further, it discusses radiation protection aspects of using far-UVC radiation in the presence of people, and addresses possible effects of far-UVC radiation on the human environment as well. The literature review shows that despite its antimicrobial and antiviral effectiveness, there is so far no sufficient evidence that far-UVC radiation can be used for disinfection in the presence of people in public indoor spaces without risks for humans and the environment. There are particular concerns about the safety of vulnerable groups such as children, the elderly and people with pre-existing medical conditions. The authors recommend further and extended studies in this field concerning potential risks of far-UVC radiation.

Abstract: Occupational exposure to hazardous chemicals remains a major concern across several industrial sectors, including, among others, manufacturing, agriculture, mining, and healthcare. Conventional exposure assessment methods, typically based on stationary environmental monitoring or periodic biological sampling, often fail to capture the dynamic and individualized nature of workplace exposures. In this context, wearable chemical sensors have emerged as promising tools for continuous and real-time exposure monitoring. This exploratory review provides an overview of recent advances in wearable chemical sensing technologies and discusses their potential applications in occupational exposure monitoring. Attention is given to electrochemical, optical, and hybrid sensing systems, as well as to the role of nanomaterials and flexible electronics in improving sensor sensitivity, selectivity, and wearability. Current applications in occupational settings, including monitoring of volatile organic compounds, toxic gases, and heavy metals, are discussed. The review also examines key challenges limiting the practical implementation of wearable sensors in occupational health programs, including long-term stability, environmental interference, power consumption, data integration, regulatory acceptance, and user compliance. Although wearable chemical sensors represent a rapidly evolving field with significant potential for improving occupational risk assessment and preventive strategies, further interdisciplinary research and long-term field validation studies are required before widespread implementation can be achieved.

Abstract: Background: Postural problems such as head forward posture, thoracic hyperkyphosis and lumbal hyperlordosis, when seen together, further complicate postural control, increasing the importance of comprehensive approaches in treatment. This study aims to examine the effect of 6 weeks telerehabilitation with web-based exercises and compare the home based exercises in individuals with postural problems. Trial Design: A Randomized Controlled Study. Methods: 34 volunteers with postural deformity among young adults were randomly divided into telerehabilitation (n=17) and control (n=1) groups. Craniovertebral, thoracic kyphosis, and lumbal lordosis angles of all individuals were evaluated with a smartphone application (Clinometer+ Bubble), hamstring, and pectoral muscle shortness with a goniometer, and trunk muscle endurance with endurance tests created by McGill and Sorenson. Whilst the tele-rehabilitation group was provided with a videobased exercise programme, the control group was advised to follow the same exercise programme at home. Exercises were performed 3 days a week for 6 weeks, 1 hour session. Participants in the telerehabilitation group were followed up with synconised video conference. Results: A significant difference was observed in the telerehabilitation group in muscle shortness and the endurance tests (p<0.05). Only a significant difference in left (p=0.03) and right (p=0.04) muscle shortness was observed in the home exercise group. Significant differences were observed in Craniovertebral and lumbal lordosis angles between groups (p<0.05), with the telerehabilitation group showing better outcomes. When examined kyphosis angle, muscle shortness, and endurance tests between groups were found to be similar (p>0.05). Conclusions: Six weeks of telerehabilitation can improve muscle shortness and trunk endurance in young adults with postural deformities. Both the exercise program using telerehabilitation and the home exercise program were beneficial for individuals with postural problems, with more favorable effects observed in the telerehabilitation group.

Abstract: Female rugby league performance is influenced by multiple interacting systems; however, the extent to which sensory and autonomic function differentiates playing level remains unclear. This study investigated whether visual, vestibular, somatosensory, and auto-nomic performance differ by playing level and positional group in female rugby league athletes. Elite and sub-elite athletes completed lower-limb proprioception testing using an Active Movement Extent Discrimination Assessment protocol, alongside visual–vestibular and autonomic measures obtained via a virtual-reality eye-tracking system. Bayesian hierarchical models were used to examine the effects of playing level, positional group (adjustables, backs, forwards), and their interaction, with posterior inference based on probability of direction and region of practical equivalence analyses. Interaction effects between level and position were observed for selected variables across somatosensory, vestibulo-oculomotor, and autonomic domains. Elite adjustables demonstrated higher ankle proprioceptive acuity than sub-elite adjustables (PD = 0.94), with additional interaction effects identified for vestibulo-oculomotor time on target (PD = 0.95) and autonomic dilation velocity (PD = 0.98). However, findings were not consistent across positional groups or outcome measures, and substantial within-group variability was evident. Overall, sensory and autonomic performance did not consistently differentiate playing level, suggesting limited utility for cross-sectional discrimination but potential value for longitudinal, individualised athlete monitoring.

Abstract: Academic stress is a growing public health concern in higher education, particularly during examination periods, when increased anxiety and psychological distress negatively affect students’ wellbeing and academic performance. In this context, scalable and accessible interventions that promote emotional regulation and reduce stress are increasingly relevant within university health promotion strategies. This study examines the perceived benefits, conditions, and limitations of dog-assisted interventions in higher education, based on the implementation of the StressLess pro-gramme at the University of Costa Rica. A mixed exploratory design was used, combining qualitative narratives with quantitative content analysis. A total of 51 videoecorded testimonies were analysed, including university students (n = 22) and professionals from diverse disciplines (n = 29). Results indicate predominantly positive perceptions across all dimensions, particularly in emotional support and stress reduction. The only statistically significant difference be-tween groups was found in emotional support, with higher ratings among students. Professionals were more likely to identify implementation conditions, risks, and potential cognitive benefits. These findings support the integration of dog-assisted interventions as complementary strategies within university public health frameworks and contribute to the limited evidence available in Latin American contexts.

Abstract: Background: Registered nurses (RNs) working in Primary Health Care (PHC) settings in South Africa (SA) are experiencing burnout, and it is a growing concern. Early recognition of signs and support methods is vital for effective prevention strategies. If burnout is left unattended, it will negatively impact the well-being of RNs, and patient care will be compromised. Aim: The study aims to explore early detection of burnout and the available support systems for RNs working in PHC settings in a district based in Gauteng Province, South Africa.Objectives: To identify signs and symptoms of burnout among RNs, examine contributing organisational stressors, assess awareness and recognition of burnout, and explore existing mitigation and support strategies. Methods: The study followed an exploratory qualitative design approach. In-depth face-to-face semi-structured interviews were conducted with 17 participants, with data saturation reached after the 12 interviews. The data was coded and analyzed using thematic content analysis, which included five interrelated steps. Results: The results revealed that RNs are experiencing burnout. Four main themes emerged: manifestations of burnout among registered nurses, organizational stressors, poor recognition and awareness of burnout, and mitigation and organizational support. Conclusion: Burnout is a reality among RNs in a District in Gauteng Province, South Africa, and it is often neglected until symptoms worsen. Promoting early detection through screening RNs and providing burnout education and awareness, coupled with organizational changes, will benefit RNs' well-being and the quality of care for patients.

Abstract: Since 2020, the Swiss Personalized Health Network has adopted Semantic Web technologies to standardize health-related data for research in Switzerland. The SPHN Semantic Interoperability Framework promotes semantic interoperability, following the FAIR principles. Within this framework, the SPHN RDF Schema has evolved over five years to define more than 200 concepts across domains such as patient demographics, diagnoses, and laboratory results, enabling the representation of structured and machine-interpretable datasets. This study evaluates the evolution of schema versions from 2021 to 2025 and their adoption, examining structural and semantic changes, and analyzing quantitative metadata from projects in the SPHN Metadata Catalog. Results show consistent reuse of core concepts, especially demographics, diagnoses, and laboratory-related concepts, with 67% of SPHN concepts used in projects. The SPHN framework has proven to be a viable national standard for FAIR health data representation. Nonetheless, semantic modeling alone does not guarantee full interoperability. Future efforts must enhance data structuring and quality at the source, promote RDF adoption in research workflows, and develop user-friendly tools for querying and visualizing data.

Abstract: Background: The Toscana Virus is a little-known virus, present in Italy, transmitted by sandflies and associated with cases of meningitis and meningoencephalitis in humans. this study compared three statistical models (SARIMA, Poisson, and Negative Binomial) to forecast monthly Toscana virus (TOSV) cases in Italy for the period 2023–2024. Materials and Methods: data were extracted from the epidemiological bulletins of the Italian National Institute of Health for the period January 2016–December 2024. The 2016–2022 training set was used to estimate the models, while the 2023–2024 test set validated the predictions. Results: in the model comparison, SARIMA showed the best predictive ability, with the lowest MAE (3.46) and RMSE (5.05), demonstrating that seasonality and temporal de-pendence were well captured. The Poisson and Negative Binomial models, although use-ful, showed lower performance in terms of accuracy (higher RMSE). Conclusions: the results indicate that the SARIMA model is the best suited for forecasting monthly TOSV cases, but it is not perfect, highlighting the need for more complex ap-proaches that also integrate exogenous variables to improve forecast quality.

Abstract: Background:Chronic musculoskeletal pain is a common condition, for which pain self-management is recommended. Digital tools offer potential to support individuals with chronic pain, but it is unknown to what extent existing tools are responsive to the social context of Pakistanis living with chronic pain and are engaging for them. Objective: This study aimed to explore strategies to enhance engagement with digitally enabled pain self-management tools among people with chronic musculoskeletal pain.Methods: A mixed-methods sequential explanatory design was used. We first reviewed Android app store and published literature to identify content and engagement strategies incorporated in digital tools. Following this, we conducted a narrative study involving adults with chronic musculoskeletal pain to capture their lived experiences and requirements for pain self-management. Review findings were synthesised descriptively, qualitative data were analysed thematically, and overall findings were combined to generate design and content recommendations.Results: Literature and app reviews revealed that digital tools commonly included components related to patient education and physical or mental therapy. They often included engagement features such as personalization and reminders. Dietary advice and peer or social support were less commonly included in digital tools but were commonly discussed during group discussions by individuals living with chronic pain. Nineteen individuals with chronic pain participated in group discussions and described how their pain self-management practices were shaped by cultural beliefs and perceptions and digital health information. These factors also influenced their decision making related to treatment choices and adoption of non-pharmacological strategies. Although participants trusted healthcare professionals but expressed concerns about limited guidance on how to apply clinical advice in their daily lives. Moreover, they identified several requirements for pain self-management tools, including evidence based audio-visual content and incorporating aspects related to symptom monitoring, symptom relief and physical rehabilitation, psychological wellbeing, lifestyle management, social support, patient education. Conclusion:Existing pain self-management tools rarely address the social context of South Asians. While pain self-management is shaped by digital information and cultural beliefs and perceptions, participants valued evidence-based digital resources. Therefore, future research should focus on co-developing these resources to ensure they are clinically meaningful, culturally responsive, and supportive of patient-centred and equitable pain self-management.

Abstract: Objective: To characterize the structural fragility of installed health-service capacity in Barranquilla, Atlántico, Colombia, using absolute capacity, supply concentration, reserve or transitory capacity, and service-line clinical sensitivity as structural-risk dimensions. Methods: An ecological health-services study was conducted using a local installed-capacity dataset traceable to the Colombian Special Registry of Health Service Providers and SISPRO, together with two contextual World Bank series for Colombia: physicians per 1,000 population and premature mortality from noncommunicable diseases. Traceable data cleaning, functional normalization, separation of baseline versus transitory capacity when allowed by the source fields, and exploratory estimation of a relative structural fragility proxy index using a normalized Poisson-type transformation were performed. This index was interpreted exclusively as a comparative structural-fragility ranking and not as an observed probability of saturation. Results: The analytical capacity of the Barranquilla node included 5,397 installed capacity slots. Adult ICU accounted for 707 slots and neonatal ICU for 160. Reserve capacity was low in neonatal ICU (2.5%) and higher in adult ICU (32.2%). The largest service lines were adult general hospitalization, adult ICU, and pediatric general hospitalization, whereas the highest relative structural fragility was observed in low-scale and highly concentrated services, including burn care, acute mental health, and selected highly specialized lines. Conclusion: Barranquilla has a broad but markedly heterogeneous structural health-service capacity network. The critical pattern is not determined only by the absolute number of slots, but by the interaction between limited capacity, high concentration, low stable reserve, and clinical sensitivity. The evidence generated is structural and should not be interpreted as observed occupancy, real-time saturation, or operational collapse.

Abstract: Background/Objectives: Acute ischemic stroke (AIS) care depends on rapid, coordinated workflows. This study compared two real-world in-hospital stroke models—a neurohospitalist-led model and a stroke practitioner–led multidisciplinary model—in terms of time metrics, radiological outcomes, and 3-month clinical outcomes in patients undergoing reperfusion therapy. Methods: This retrospective, single-center cohort study evaluated patients across two sequential workflow periods. In the practitioner-led model, trained non-neurologist clinicians coordinated care with a stroke nurse under neurologist supervision. Time metrics included door-to-needle time (DNT) and door-to-puncture time (DPT). Clinical outcomes included intensive care unit (ICU) transfer and 3-month functional outcomes assessed by the modified Rankin Scale (mRS). Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. The proportion achieving DNT <60 minutes was significantly higher in the practitioner-led period (74.0% vs. 52.5%, p<0.001), while mean DNT and DPT were comparable. Early radiological outcomes at 24 hours were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p=0.002). Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was as safe and efficient as a neurohospitalist-led model. Improved adherence to DNT targets and reduced ICU transfers highlight the importance of system-level organization in optimizing AIS care.

Abstract: Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial colorectal neoplasms, offering superior en bloc resection rates compared with conventional endoscopic mucosal resection (EMR). While ESD has been the standard of care in East Asian countries for over two decades, its adoption in Western countries has been considerably slower, hampered by the steep learning curve, prolonged procedural times, limited training infrastructure, and differences in disease epidemiology. However, recent years have witnessed a paradigm shift, with growing evidence from Western multicenter studies demonstrating outcomes that increasingly approach those reported from high-volume Eastern centers. The landmark RESECT-COLON randomized trial provided level-1 evidence supporting the superiority of ESD over piecemeal EMR for large colorectal polyps. Concurrently, novel training paradigms, technological innovations including traction-assisted devices and artificial intelligence (AI)-guided systems, and evolving societal guidelines from the American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) are accelerating Western adoption. This state-of-the-art review comprehensively examines the current landscape of colorectal ESD in Western practice, highlighting the evolution of outcomes, training pathways, guideline recommendations, technological advances, and future directions. We provide a critical appraisal of the East–West outcome gap and discuss strategies to bridge this divide, positioning colorectal ESD as an increasingly viable first-line therapy for appropriate lesions in Western endoscopy centers.

Abstract: Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when same-day physician or nurse practitioner appointments are unavailable. A meaningful proportion of emergency department visits involve conditions that could potentially be managed in primary care [1,2], and the Canadian Institute for Health Information reported that 15% of Canadian emergency department visits between April 2023 and March 2024 involved conditions that could potentially have been managed in primary care [3]. This article describes the Registered Nurse Prescriber-led Triage-Treatment-Continuity model developed at Cranston Ridge Medical Clinic in Calgary, Alberta, Canada. Methods: The manuscript is reported as a clinic-based practice innovation and service evaluation using aggregate, non-identifying operational service data. The model includes medical office assistant emergency recognition, RN prescriber-led structured triage, a traffic-light urgency classification system, a booking algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, and communication with the patient's primary care provider through the electronic medical record. No patient-identifiable information, patient-level chart review, interviews, surveys, biological samples, or experimental interventions were used. Under TCPS 2 Article 2.5, quality improvement and program evaluation activities conducted exclusively for assessment, management, or improvement purposes do not constitute research for that policy and do not fall within Research Ethics Board review [4]. Results: During a 12-month service evaluation period from April 2025 to April 2026, 5032 patient calls or encounters were managed through the RN prescriber-led pathway. These encounters are interpreted as internal urgent and semi-urgent primary care capacity and potential diversion, not as confirmed emergency department avoidance. Conclusions: The model reframes triage as an integrated primary care intervention rather than a passive sorting process. Further ethics-approved research is required to evaluate patient-level outcomes, safety events, comparative effectiveness, confirmed health-system utilization effects, and cost-effectiveness.

Abstract: Background: Early childhood caries remains a major public health burden in Thailand, particularly among preschool children, despite the implementation of national oral health policies. With the decentralization of child development centers (CDCs) to local adminis-trative organizations (LAOs), understanding system-level determinants of oral health ser-vice effectiveness has become critical. This study aimed to identify key determinants in-fluencing the effectiveness of oral health care systems for preschool children within CDCs in northeastern Thailand. Methods: A cross-sectional analytical study was conducted among 270 stakeholders across urban, peri-urban, and rural CDCs in Ubon Ratchathani Province. Participants were selected using multi-stage random sampling. Data were col-lected between November 2023 and January 2024 using a structured questionnaire with established content validity (IOC > 0.50) and reliability (Cronbach’s alpha = 0.71–0.77). Variables were organized within an Input–Process–Output (IPO) framework. Descriptive statistics, Pearson’s correlation, and multiple linear regression analyses were performed to identify significant predictors of system effectiveness. Results: The oral health care system demonstrated strong performance in preventive service delivery, including universal oral health examinations and fluoride varnish application (100%), and high personnel readi-ness (99.63%). However, critical gaps were identified in monitoring and evaluation sys-tems (8.15%), budget adequacy (60.37%), and continuity of treatment follow-up (48.89%). The prevalence of dental caries among preschool children was 57.83%. Multiple regression analysis revealed that service delivery processes (β = 0.458, p < 0.001) and home visits by public health and dental personnel (β = 0.303, p = 0.008) were significant determinants of system effectiveness, jointly explaining 11.1% of the variance (R² = 0.111). Conclusions: The effectiveness of preschool oral health care systems in decentralized settings is driven pri-marily by the quality of service delivery processes and the integration of proactive commu-nity outreach through home visits. Strengthening monitoring and evaluation mechanisms, ensuring sustainable financing, and enhancing continuity of care between CDCs and households are essential for improving oral health outcomes. These findings provide ac-tionable evidence for policymakers and local health administrators seeking to optimize oral health systems under decentralized governance structures.

Abstract: Background: Seasonal influenza prevention in young adults is influenced by access, trust, and vaccine information exposure, but local evidence linking vaccination uptake with illness and economic burden is limited. Methods: We conducted a cross-sectional electronic survey of adults aged 18-49 years who lived, worked, or studied in the San Francisco Bay Area during the 2025 to 2026 influenza season. Measures included vaccination uptake, influenza-like illness, recovery, functional and economic burden, vaccination sites, and vaccine information exposure. Multivariable logistic regression examined factors associated with vaccination uptake; Kaplan-Meier and Cox models examined time to recovery. Results: Of 554 responses, 463 were included. Vaccination uptake was 86.2% (n=399; 95% confidence interval [CI], 82.7%-89.2%), and 38.4% reported influenza-like illness. Among those with illness, median recovery time was 5 days, median missed work or school was 2 days, and median direct out-of-pocket cost was US$20. Prior season vaccination (adjusted odds ratio [aOR], 2.24; 95% CI, 1.15-4.34) and greater trust in Centers for Disease Control and Prevention or public health agencies (aOR, 1.46; 95% CI, 1.05-2.02) were associated with vaccination. Pharmacies were the second most common vaccination site and preferred future site. Conclusion: Influenza prevention for young adults may benefit from pharmacy-inclusive, multichannel access paired with trusted communication.

Abstract: Physical activity is a safe and effective intervention for chronic musculoskeletal pain. However, a literature search revealed a lack of synthesis of evidence on the extent to which physical therapists in Saudi Arabia incorporate physical activity as part of health promotion in the management of such pain. This review aims to identify, map and report literature related to physical activity for health promotion in people with chronic musculoskeletal pain presenting to physical therapy settings in Saudi Arabia. A six-step approach will be followed to conduct the scoping review. Step 1, the primary research question is: What is the scope and nature of the existing literature in this research area? The secondary research question is: What insights does the existing literature reveal regarding physical therapy clinical practice? Step 2, a comprehensive search will be conducted for relevant literature using the following electronic databases: Scopus, Medline, PubMed, Cochrane library, CINAHL, ScienceDirect and PEDro. In addition, supplementary search methods will be conducted for identifying additional relevant literature via screening process of the reference lists of all included literature and screening process of the included studies of retrieved systematic reviews through electronic databases. A parallel search including the main keywords will also be undertaken on the website of the Saudi Ministry of Health, the website of Saudi Physical Therapy Association, Google and Google Scholar for grey‑literature searching. Step 3, records will be screened by two independent reviewers and managed using Rayan software. Step 4, the nature of included literature, including study characteristics and outcomes where appropriate, will be documented using a data extraction. Step 5, the characteristics and outcomes of included records will be collected, summarised and reported. Step 6, Stakeholders will be consulted to interpret the scoping review findings from their perspective and assess the findings’ relevance and applicability.

Abstract: Background: Medical training is characterized by high academic demands and sustained exposure to stressors. Although the literature suggests robust links between personality and mental health, fewer studies have examined how broad personality traits relate to multidimensional psychological well-being (PWB) among medical students. Methods: In a cross-sectional paper–pencil survey conducted among 115 Polish medical students, personality was assessed with the NEO-FFI (Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness) and psychological well-being with the 84-item Ryff Psychological Well-Being Scales (autonomy, environmental mastery, personal growth, purpose in life, positive relations, self-acceptance). Descriptive statistics, Pearson/Spearman correlations, and multiple linear regression were applied (α = 0.05). Results: Mean global PWB was moderate-to-high (M = 4.22, SD = 0.57; 1–6 scale). The highest subscale means were personal growth (M = 4.48), purpose in life (M = 4.44), and positive relations (M = 4.41); the lowest were autonomy (M = 3.98), environmental mastery (M = 3.91), and self-acceptance (M = 4.09). Conscientiousness and Extraversion correlated positively with PWB dimensions, whereas Neuroticism showed consistent negative associations. In regression models, Conscientiousness (β = 0.482, p < 0.001) and Extraversion (β = 0.347, p < 0.001) jointly explained 38.7% of global PWB variance; Neuroticism alone predicted 32.4% of variance (β = −0.569, p < 0.001). No significant sex differences in PWB were observed. Conclusions: Personality traits—especially lower Neuroticism and higher Conscientiousness and Extraversion—are strongly linked with better psychological well-being among medical students. Screening and tailored, trait-informed preventive programs (e.g., emotion regulation for high Neuroticism; study planning for lower Conscientiousness; social connectedness for lower Extraversion) may support mental health in medical schools.

Abstract: Background and Objectives: Suicide represents a major global public health concern, involving complex interactions between sociodemographic and clinical factors. Understanding these characteristics at a regional level is essential for the development of targeted prevention strategies. Materials and Methods: We conducted a retrospective observational study including 210 confirmed suicide deaths recorded at a single forensic center between 2023 and 2025. Sociodemographic variables (age, sex, education, marital status, and employment) and toxicological findings (alcohol presence) were collected. Descriptive statistics and inferential analyses, including chi-square tests and multivariate logistic regression, were performed to examine associations between these variables and suicide characteristics, particularly the method of suicide. Results: The study population was predominantly male (82.86%). Hanging was the most frequent method of suicide. Alcohol was detected in 43.81% of cases. Although variations were observed across demographic groups, multivariate logistic regression did not identify statistically significant independent predictors of suicide method (male sex: OR = 1.98, p = 0.122; age: p = 0.579; alcohol presence: p = 0.728). Conclusions: Sociodemographic and toxicological factors contribute to the characterization of suicide deaths; however, no independent predictors of suicide method were identified. These findings highlight the complexity of suicide behavior and underscore the importance of integrating clinical, behavioral, and public health approaches to suicide prevention, including the responsible communication of suicide-related findings.

Abstract: Background: During menopause, many women deal with a "double whammy" of hot flashes and depression. While we know each issue drives up doctor visits and costs, we still don't have a clear picture of the total financial toll when they occur together. Using nationwide U.S. data to break down this combined economic burden is an area that's wide open for more research. Methods: We conducted a retrospective cross-sectional analysis of pooled 2017–2022 Medical Expenditure Panel Survey (MEPS) data, including 22,042 U.S. women. Participants were categorized as VMS with depression, VMS without depression, or no VMS/no depression (reference). Outcomes included total annual healthcare expenditures, outpatient, emergency, and prescription expenditures, and healthcare utilization (outpatient visits, emergency department visits, inpatient hospitalizations). Survey-weighted generalized linear models with a gamma distribution and a log link were used for expenditures. In contrast, survey-weighted linear and count models were used for utilization, adjusting for demographic, socioeconomic, insurance, regional, year, and comorbidity burden. Results: Among 22,042 women, 529 (2.4%) had VMS with depression, and 268 (1.3%) had VMS without depression. The sample included 22,042 women with no VMS or depression, 529 with VMS and depression, and 268 with VMS without depression. Women with VMS and depression had the highest annual healthcare expenditures compared with women without VMS or depression. In multivariable analyses, women with VMS and depression had healthcare costs approximately 1.90 times higher than the reference group (β=0.64, SE=0.08, p< 0.0001; $11,404 vs. $6,002). Those with VMS without depression faced costs approximately 55% higher (β = 0.44, SE = 0.10, p < 0.0001; $9,303 vs. $6,002). Outpatient costs were also significantly higher among women with VMS and depression (β=0.31, SE=0.05, p< 0.0001), corresponding to approximately 36% higher outpatient costs over those with no VMS/no depression, respectively; $2,354 vs. $1,730). Women with both vasomotor symptoms (VMS) and depression had prescription drug spending that was about 2.61 times higher than those without VMS or depression (β = 0.96, SE = 0.13, p < 0.0001; $3.452 vs $1,323). Emergency department costs did not differ significantly between groups. Older age, unemployment, and higher comorbidity burden were also associated with increased healthcare costs. In utilization models, women with VMS and depression had 4.80 additional outpatient visits per year (SE = 0.50, p < 0.0001) and higher emergency department visit rates (β = 0.26, SE = 0.11, p < 0.05), corresponding to approximately 28% higher ER use, whereas inpatient hospitalizations were not significantly different. Women with VMS without depression also had more outpatient visits (β = 3.77, SE = 0.66, p < 0.0001) but no significant differences in emergency or inpatient utilization. Conclusions: VMS and depression are strong independent predictors of increased healthcare expenditures and outpatient utilization among midlife women in the United States. The excess economic burden is driven primarily by outpatient care and prescription use rather than hospitalization, suggesting that integrated menopause and mental health care may improve efficiency and reduce healthcare costs.

Abstract: Background/Objectives: Artificial intelligence (AI) is integrated into diagnostic, thera-peutic, administrative, and communicative healthcare domains in Italy under regulations requiring human oversight. Empirical evidence on AI attitudes, acceptance, and per-ceptions in Italian healthcare is rapidly accumulating but not systematically mapped. This scoping review aimed to (i) map empirical evidence on AI attitudes, acceptance, and perceptions in Italy by population and domain; (ii) identify measurement instruments used in studies and their origins; and (iii) characterize determinants, themes, and methodological gaps in the Italian evidence base. Methods: The review used Joanna Briggs Institute methodology, reported via PRISMA-ScR (protocol Open Science Framework doi: 10.17605/OSF.IO/TZRVF). PubMed and Embase were searched on 27 April 2026 from January 2018 in English, Italian, or German, combining controlled vo-cabulary and free-text terms across AI, attitudes-acceptance, and healthcare delivery, with an Italian-context qualifier. Eligibility criteria used the Population–Concept–Context mnemonic. Results: Of 1,510 unique records screened, 35 empirical studies were retained, comprising seven studies of Italian patients and the general population, 22 studies of healthcare professionals, three psychometric validation studies of AI-acceptance instru-ments, one mixed-population study and two international comparator studies with sub-stantial Italian sub-samples. Acceptance was consistently positive but conditional on physician oversight, training and regulatory clarity. A recurrent optimism–knowledge gap and an absence of probabilistic, population-representative evidence were identified as principal gaps. Conclusions: Italian evidence on AI attitudes is expanding but methodologically narrow. Three Italian-validated acceptance instruments are now available. Population-representative, multilingual and longitudinal evidence is required.