Slavko Rogan

Background and Aim: This study synthesizes value‑related patterns of strategic health communication across macro, meso and micro levels and analyses their relevance for functional, interactive, critical, digital and organizational health literacy (HL). Methods: A narrative, theory‑informed synthesis was conducted, integrating 15 empirical and conceptual articles from Austria, Germany and Switzerland. Evidence from population surveys, organizational assessments, digital content analyses, qualitative youth studies and crisis‑communication research was categorized across system levels and analysed for explicit and implicit value dimensions. Results: Five value configurations emerged across contexts: clarity–safety–rights, participation–appreciation–co‑production, trust–transparency–consistency, inclusion–equity–accessibility and digitality–risk literacy–source criticism. Structural obstacles such as low readability of health websites, organizational gaps in patient involvement and marked digital HL inequalities among adolescents and multimorbid older adults were consistently documented. Discussion: Strategic health communication succeeds when systemic, organizational and interpersonal values align. Misalignments create HL gradients, while value‑driven practices such as plain language, teach‑back, multimodal formats and empathetic crisis communication enhance comprehension, trust and engagement. Value‑oriented communication frameworks are therefore essential for equitable HL promotion.

Assessing students’ perceptions of learning environments (LEs) requires psychometrically sound instruments that capture key psychosocial, cultural, institutional, and physical dimensions of the LE. This psychometric validation study examined the structural validity, reliability, and temporal measurement invariance of the German-language Health Education Learning Environment Survey (HELES) across two successive samples of Swiss undergraduate health professions students (2025: n = 525; 2026: n = 405). Structural validity was evaluated using confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM), internal consistency using omega coefficients, and test-retest reliability by administering the HELES twice to a subsample of students in 2026. Measurement invariance across annual evaluations was assessed using multi-group ESEM. The original factor structure showed inadequate fit. A refined 27-item, six-factor ESEM model demonstrated acceptable fit in the 2025 sample (robust CFI = 0.92, robust RMSEA = 0.068, SRMR = 0.031) and somewhat lower fit in the 2026 cross-sample evaluation (robust CFI = 0.89, robust RMSEA = 0.085, SRMR = 0.036). Internal consistency was acceptable to good across samples (2025: ω = 0.72-0.84; 2026: ω = 0.75-0.82), and test-retest reliability ranged from moderate to good (ICC = 0.61-0.84). Measurement invariance analyses showed no evidence against configural, threshold, or threshold-plus-loading invariance. Overall, the findings support the HELES_D-27 as a valid and reliable multidimensional instrument for assessing students’ perceptions of the LE in undergraduate health professions education. The instrument may support educational evaluation, quality assurance, curriculum development, and longitudinal monitoring of LEs across successive annual evaluations. Trial registration: Clinical trial number not applicable.

Background Evaluating the learning environment (LE) is crucial for health professions training. Currently, only one measurement tool with various limitations is available for examining the LE in German-speaking Swiss health professional universities. The study aims to (1) translate the Health Education Learning Environment Survey (HELES) for validated use with a German-speaking interdisciplinary sample of undergraduate health professions students, and (2) develop a shortened version of the translated and culturally adapted HELES. Methods This cross-sectional study was conducted at the School of Health Professions at Bern University of Applied Sciences, between April and July 2024. The HELES was translated into German using a forward and backward translation process, involving native speakers of both English and German, and was cross-culturally adapted. Exploratory and confirmatory factor analyses were performed to develop and validate the underlying structure of the German version of the HELES. Additionally, convergent and discriminant validity, as well as construct reliability, were assessed. Results A total of 271 undergraduate health professions students from all years of study participated. The original six-factor model of HELES has been replaced by a five-factor model in the short German version identified by exploratory factor analysis, which showed a good fit in the Swiss-German context. Factor loadings ranged from 0.46 to 0.89, with model fits indices: standard χ 2 = 373.5 and scaled χ 2 = 410.3 (df = 199), standard CFI = 0.97 and scaled CFI = 0.93, RMSEA = 0.06 (90% CI: 0.05, 0.07), and SRMR = 0.08. All subscales demonstrated acceptable to good internal consistency. Conclusion The study results confirm the reliability and suitability of the HELES_D for evaluating health professions students’ perceptions of the LE in Swiss-German health professional education. Trial registration: Clinical trial number not applicable.

Non‑specific low back pain (NSLBP) is highly prevalent among golfers and complicates return‑to‑activity (RTA) decisions. Existing return‑to‑sport (RTS) approaches often focus narrowly on biomedical criteria and lack golf‑specific, theoretically grounded frameworks. This study presents a preliminary conceptual framework (Phase 1) for RTA and RTS in golfers with NSLBP. A hermeneutic systematic literature review was combined with qualitative expert interviews to integrate scientific evidence and clinical expertise. Seven studies on RTA/RTS and NSLBP were analyzed iteratively, and three experts in physiotherapy, sports science, and back pain research were interviewed using a theory-driven Phase 1 sampling approach. Data were analyzed via qualitative content analysis and triangulated to develop a context-sensitive conceptual model. Psychosocial and functional variables such as motivation, self-efficacy, fear avoidance, and functional mobility appeared to be particularly important within the available literature and expert interviews, whereas biomedical indicators alone seemed insufficient to guide RTA/RTS decisions. Experts described RTA as an individualized, goal oriented, biopsychosocial process. The combined evidence yielded a three-stage RTA framework (pain relief, mobility restoration, return to meaningful activity) and a five-phase golf-specific RTS model (clinical stability, functional capacity, golf movement integration, performance readiness, competition readiness). This Phase‑1 conceptual framework provides an evidence‑informed, context‑sensitive structure for RTA and RTS in golfers with NSLBP. It integrates biopsychosocial factors with golf‑specific performance demands. Future work (Phase 2) will validate this framework with golfer populations and objective performance metrics.

Balance training is a core component of physiotherapy. Despite extensive research, education, practice, and guidelines continue to be dominated by the assumption of a general balance ability that can be improved through non-specific training and measured using standardized assessments. The empirical evidence consistently shows that training effects are largely task‑specific and concentrate on the trained demands, while transfer to other tasks remains limited. Building on this evidence, the present paper adopts a discursive-analytic perspective to reflect on how the notion of a general balance ability nevertheless remains professionally stable. It illustrates how standardized assessments, guidelines, and curricular frameworks promote particular interpretations of balance and become guiding-action in practice. Balance thus emerges not only as motor performance but as a normatively framed category of professional action. Finally, implications for assessment, training, and research are derived from a context-specific understanding of functional ability that aligns with the World Health Organization’s vision of healthy ageing.

Healthy Aging is defined by the World Health Organization (WHO) as the process of developing and maintaining the functional ability that enables wellbeing in older age (Rudnicka et al., 2020; World...

Purpose: The clinical learning environment (CLE) is a crucial component of health professions education, providing the foundation for developing profession-specific clinical skills. This systematic review aimed to identify evaluated assessment tools for the CLE in health professions education and to report their measurement properties.Methods: This systematic review was preregistered (IDESR000098), and its protocol was published previously. Eligible studies were peer-reviewed articles in English that developed and validated tools for assessing the CLE among undergraduate health professions students and followed the COSMIN guidelines for systematic reviews of patient-reported outcome measures. Multiple electronic databases, including MEDLINE, the Cochrane Library, ERIC, Education Research Complete, and CINAHL, were searched; studies were independently screened, and data were extracted. Data were synthesized using best-evidence synthesis according to COSMIN guidelines.Results: Of the 6,236 articles included in title and abstract screening, 55 were eligible for full-text screening. A supplementary search identified 13 additional articles, resulting in 40 included articles. Overall, 28 tools were identified, with 4 tools (PET, PET-Midwifery, DECLEI, and MidSTEP) demonstrating sufficient content validity. Only MidSTEP demonstrated sufficient structural validity.Conclusion: Only a minority of the included tools provided sufficient evidence of content and structural validity according to the COSMIN criteria. This finding indicates a systemic need for higher standards in monitoring clinical placements and identifies tools that should be re-evaluated and supported by additional research. Limitations include the exclusion of EMBASE and gray literature and the reliance on studies that predominantly used psychometric-first rather than content-validity-first designs.

Background/Objectives: Older patients with fractures often present with a complex interplay of factors associated with frailty and functional decline. The emerging concept of Orthogeriatric Fracture Syndrome (OFS) aims to characterize these distinct relationships of pathologies and outcomes. Despite increasing recognition of OFS in clinical practice, due to the distributed nature of fragility factors across medical disciplines, it remains poorly defined in the literature. Methods: We used large-scale text mining of 26 million PubMed abstracts to quantify the occurrence and interrelationship of OFS-related concepts across all disciplines in biomedical research. Results: OFS terms were more prevalent in fragility fractures than in other fracture types, particularly osteoporosis (0.52 vs. 0.09, p < 0.05). In pairwise keyword correlation (Pearson φ), the correlations presented between OFS keywords are comparable to the ones in the more established metabolic syndrome (e.g., φ = 0.07 between stroke and hypertension, p < 0.05). For OFS, osteoporosis emerged as the central node linking OFS outcomes and pathologies, correlating with fragility fracture (φ = 0.176, p < 0.05) and sarcopenia (φ = 0.03, p < 0.05). Sarcopenia in turn correlated with gait (φ = 0.04, p < 0.05), malnutrition (φ = 0.05, p < 0.05), and frailty (φ = 0.032, p < 0.05). Old age keywords showed substantially higher association with OFS keywords (e.g., φ = 0.06 for elderl* and hip fracture, p < 0.05) than with metabolic syndrome terms (elderl* and insulin resistance, p > 0.05). Conclusions: Overall, the analysis showed statistically significant associations between keywords representing OFS outcomes, pathologies and old age. The combined occurrence of osteoporosis, sarcopenia, frailty and risk of falls may help conceptually identify older adults at risk and inform preventive measures. This large-scale bibliometric analysis supports OFS as a conceptually coherent, proposed theoretical framework for cross-disciplinary awareness and coordinated care, with a literature-level organizational pattern comparable to metabolic syndrome, however, pending prospective clinical validation. This study reframes fragility fractures as the endpoint of a broader, potentially modifiable risk constellation and underscores the need for further clinical and epidemiological validation.