Search Results (5,695)

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory condition that significantly impairs health-related quality of life (HRQoL), particularly sleep quality. Beyond mechanical nasal obstruction, type 2 cytokines (IL-4, IL-13) are thought to directly disrupt sleep architecture. Dupilumab, an IL-4Rα antagonist, is approved for severe CRSwNP, but its specific effect on sleep quality remains under investigation. This systematic review aims to evaluate the impact of dupilumab on sleep quality in patients with severe, uncontrolled CRSwNP. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Google Scholar, and Web of Science up to June 2026. We included adult studies (≥1 month of dupilumab 300 mg every 15 days) reporting sleep outcomes using validated tools (Epworth Sleepiness Scale [ESS], Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], or the SNOT-22 sleep domain). Risk of bias was assessed using ROBINS-I and RoB 2 tools. Results: Seven studies (n = 2164 patients) met inclusion criteria. Across observational and post hoc RCT analyses, dupilumab consistently improved the SNOT-22 sleep domain (mean reduction up to −7.02 points at 24 weeks; p < 0.001), PSQI, ESS, and ISI scores. One study reported a decrease in poor global sleep quality from 88.9% at baseline to 5.7% at 12 months. However, most observational studies had a serious risk of bias due to unaddressed confounding and lack of blinding. No polysomnographic data were reported. Conclusions: Dupilumab was associated with significant improvements in patient-reported sleep quality in CRSwNP patients across seven included studies. However, the evidence is limited by the absence of objective sleep measures, the serious risk of bias in most observational studies, and the lack of comparative head-to-head data. High-quality randomized controlled trials with prespecified sleep endpoints and polysomnographic assessments are needed before definitive conclusions can be drawn. Full article

Adolescence is a critical developmental period marked by the interaction of health behaviors, psychosocial functioning, and peer relationships. This scoping review mapped quantitative evidence on the associations between health behaviors, emotional and behavioral problems, and peer-related factors among adolescents, accounting for sociodemographic characteristics. An electronic literature search was conducted in November 2025 using the ProQuest Summon Discovery Service, in line with PRISMA-ScR reporting guidance. Studies published between 2015 and 2025 that focused on adolescent populations and examined at least two key variables were considered; the included samples collectively spanned ages 10–18 years. Thirteen studies met the inclusion criteria. Across the included studies, health behaviors, particularly physical activity, diet, sleep, and screen use, were examined both individually and as co-occurring lifestyle patterns. Less favorable behavioral patterns were generally associated with poorer mental health and psychosocial indicators, whereas healthier patterns were associated with better well-being and quality of life. Associations with screen and internet use varied according to the type and intensity of digital engagement, with evidence of dose–response patterns for internet use and divergent associations across different screen activities. Peer relationships and related social factors were most often operationalized through social support, friendship quality, bullying, or victimization rather than through direct measures of peer attachment security. Within this limited and heterogeneous evidence base, supportive peer contexts were generally associated with more favorable behavioral and emotional outcomes, whereas bullying and victimization were associated with poorer outcomes. The mapped evidence is consistent with a biopsychosocial perspective but remains predominantly cross-sectional, underscoring the need for longitudinal research and more precise measurement of peer attachment processes. Full article

Hypophosphatasia (HPP) encompasses a group of inherited metabolic bone disorders characterized by defective skeletal mineralization and variable clinical severity in childhood. Substantial allelic heterogeneity contributes to a broad pediatric clinical spectrum, ranging from life-threatening perinatal disease to milder phenotypes characterized by chronic functional impairment. Historically, management relied primarily on supportive interventions aimed at sustaining survival, without modifying the underlying enzymatic defect. The introduction of enzyme replacement therapy (ERT) with asfotase alfa has fundamentally altered the natural history of pediatric HPP by supplementing deficient alkaline phosphatase activity at sites of active mineralization, thereby improving skeletal integrity, enhancing survival in severe forms, and supporting long-term functional gains. This therapeutic shift has redirected clinical priorities from survival alone toward sustained functional development and health-related quality of life. Nevertheless, variability in disease expression and therapeutic response persists, reflecting both diagnostic timing and the molecular heterogeneity of ALPL variants, whose phenotypic consequences cannot be predicted with complete certainty. Growing recognition of the importance of early diagnosis has prompted exploratory efforts toward systematic identification strategies, including neonatal screening initiatives reported in selected populations, which suggest the potential for earlier therapeutic intervention during active skeletal development. Together, these considerations highlight pediatric HPP as a model of precision-oriented management in rare metabolic bone disease, where timely diagnosis and targeted enzyme replacement must be aligned with long-term, multidisciplinary care to optimize outcomes. Full article

Background: Patient-reported outcome measures are important for capturing health-related quality of life and treatment-specific concerns in adolescent idiopathic scoliosis (AIS). Objective: This narrative review aimed to summarize the validity, reliability, responsiveness, minimal clinically important difference, floor and ceiling effects, cross-cultural adaptation, and clinical utility of commonly used quality of life and treatment-specific patient-reported outcome measures in AIS. Methods: A narrative literature review was conducted focusing on frequently used AIS-related instruments, including the SRS-22/SRS-22r, SRS-7, QLPSD, ISYQOL, SJ-27, BSSQ-Brace/BSSQ-Deformity and BrQ. Evidence regarding psychometric properties and clinical applicability was synthesized narratively. Results: Most instruments demonstrated acceptable to high internal consistency and test–retest reliability. Reported Cronbach’s alpha values generally ranged from 0.71 to 0.96 for SRS-22/SRS-22r, 0.87 to 0.94 for QLPSD, 0.75 to 0.88 for ISYQOL, 0.898 to 0.991 for SJ-27, 0.80 to 0.87 for BSSQ-Brace/BSSQ-Deformity, and 0.82 to 0.96 for BrQ. Treatment-specific tools such as BSSQ and BrQ provide additional information on brace-related quality of life, stress, and coping. However, evidence on responsiveness, minimal clinically important difference, and conservative treatment-specific interpretability remains limited for most instruments. Conclusions: No single instrument appears sufficient to capture the multidimensional impact of AIS. General quality of life measures should be selected according to the clinical or research question, and treatment-specific tools should be added when brace-related burden or stress is relevant. Future studies should further define responsiveness, minimal clinically important change, and longitudinal utility in conservative AIS management. Full article

Background: Population ageing has increased the importance of maintaining the quality of life (QOL) of community-dwelling older adults. Resilience and social participation are considered important determinants of well-being in later life. However, little is known about how social participation involving mutual support relates to subjective QOL in Japanese community settings. This study examined associations between resilience and social participation, including mutual support and subjective QOL, among community-dwelling older adults. Methods: This cross-sectional survey was conducted in December 2021 among community-dwelling older adults in Japan. The study sample mainly comprised socially active older adults recruited through senior citizen clubs. Anonymous self-administered questionnaires were distributed to 434 individuals aged 65 years and older, and 258 valid responses were analysed. Subjective QOL was assessed using the Subjective QOL Scale, resilience using the Resilience Scale for Older Adults, and social participation, including mutual support, using a composite score based on neighbourhood relationships and participation in community activities. Results: Subjective QOL was positively correlated with resilience (ρ = 0.475, p < 0.001) and social participation including mutual support (r = 0.163, p = 0.009). After adjustment for self-rated health, the number of outpatient visits per month, and the number of daily medications, the association between subjective QOL and social participation including mutual support was no longer significant (pr = 0.104, p = 0.096), while resilience remained significantly associated with subjective QOL (pr = 0.417, p < 0.001). Participants with higher levels of social participation had significantly higher subjective QOL and resilience scores than those with lower levels of participation. Conclusions: In this study sample, resilience was more strongly associated with subjective QOL than social participation including mutual support. These findings highlight the importance of individualised community-based approaches that address both psychological resilience and opportunities for social participation when promoting well-being among older adults. Full article

Background/Objectives: Long COVID is characterised by persistent symptoms such as fatigue, pain, cognitive impairment, sleep disturbances, and reduced quality of life (QoL) following SARS-CoV-2 infection. Proposed mechanisms include persistent immune activation, chronic inflammation, oxidative stress, endothelial dysfunction, mitochondrial disturbances, and virus-induced cellular senescence. Current management is largely supportive, highlighting the need for complementary strategies targeting these pathways. Natural polyphenols such as quercetin and curcumin possess anti-inflammatory, antioxidant, immunomodulatory, and potential senolytic properties that may modulate multiple pathways implicated in Long COVID. This study aimed to explore the potential complementary effects of oral quercetin–curcumin co-supplementation, administered alongside usual symptomatic management, in adults with persistent Long COVID symptoms. Methods: This single-centre, open-label, single-arm, pragmatic exploratory study enrolled 15 adults with Long COVID in an outpatient real-life clinical practice setting. Participants received a nutraceutical formulation containing quercetin (65 mg) and Curcuma longa extract standardised to provide 42 mg curcumin (Nasafytol^®), administered as two capsules twice daily for 8 weeks in addition to standard care. The primary endpoint was change in overall symptom burden assessed using the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS). Secondary outcomes included fatigue (Fatigue Severity Scale, FSS), pain (Brief Pain Inventory—Short Form, BPI-SF), cognitive function (Patient-Reported Outcomes Measurement Information System Cognitive Function Short Form 8a, PROMIS-CF-8a), mood (Hospital Anxiety and Depression Scale, HADS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), autonomic symptoms (Composite Autonomic Symptom Score-31, COMPASS-31), and health-related QoL (Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36). Results: After 8 weeks, overall symptom burden significantly decreased (C19-YRS median 50 to 32; q = 0.018). Significant reductions were observed in patient-reported fatigue (q = 0.006), pain severity and interference (q = 0.006), and improved physical health-related QoL (SF-36 PCS; q = 0.025). Numerically favourable changes were also observed in cognitive function, anxiety, sleep quality, and autonomic symptoms, although these did not reach statistical significance. The supplementation was generally well tolerated with no serious adverse events. Conclusions: Quercetin–curcumin co-supplementation was associated with lower patient-reported symptom burden, fatigue, and pain and better physical health-related QoL after 8 weeks of supplementation in adults with Long COVID. These observed findings represent treatment-associated changes within this uncontrolled exploratory study and should be interpreted cautiously. Further evaluation in adequately powered randomised placebo-controlled trials is warranted. Trial registration: ClinicalTrials.gov (ID NCT06974058). Full article

Background/Objectives: Exercise is increasingly recognized as an effective supportive intervention in breast cancer (BC), with substantial evidence demonstrating benefits on cancer-related fatigue, physical function, and quality of life. However, despite this strong scientific basis, its implementation in routine clinical practice remains inconsistent. Existing exercise oncology frameworks have primarily focused on screening, risk stratification, and referral, with limited availability of practical tools to guide individualized exercise prescription across the BC continuum. Accordingly, this narrative review aimed to synthesize current evidence to develop a clinically applicable, stepwise algorithm for individualized exercise prescription in women with BC. Methods: Current evidence from randomized controlled trials, systematic reviews, meta-analyses, and international clinical guidelines on exercise interventions in women with BC was synthesized narratively, with emphasis on exercise modality, intensity, progression, safety considerations, treatment phase, and patient-specific factors. Results: Aerobic and resistance exercise are safe and effective across different phases of BC care, including active treatment, survivorship, and advanced disease, with consistent improvements in fatigue, physical function, cardiorespiratory fitness, and health-related quality of life. However, heterogeneity in interventions, patient populations, and clinical contexts limits direct translation into clinical practice. To address this implementation gap, the available evidence was translated into a structured clinical algorithm based on the FITT principle (frequency, intensity, time, and type), treatment phase, risk stratification, patient-specific characteristics, treatment-related toxicities, and safety considerations, allowing individualized adaptation to different clinical scenarios. Conclusions: Exercise should be considered a core component of BC care rather than a general lifestyle recommendation. Bridging the evidence-to-implementation gap requires structured, individualized, and clinically applicable approaches to exercise prescription. The proposed algorithm translates current evidence into a structured clinical decision-support framework that may facilitate the routine implementation of individualized exercise prescription across the BC continuum. Full article

In metastatic prostate cancer, there have been pronounced survival gains driven by the introduction of combination and intensification strategies. Consequently, many patients now experience prolonged survival with metastatic disease. While these advances represent a major therapeutic success, prolonged exposure to systemic therapies is associated with a broad spectrum of adverse effects. These side effects affect multiple domains, including bone health, cardiovascular risk, physical function, and psychological well-being. As a result, survivorship has emerged as a critical and increasingly relevant aspect of care in metastatic prostate cancer. In parallel, the importance of patient-reported outcomes in clinical trials, alongside traditional oncologic endpoints, is increasingly acknowledged. Overall, survivorship care in metastatic disease remains incompletely conceptualized as the long-term impact of cumulative treatment burden is often underrecognized. This narrative review examines key survivorship challenges in metastatic prostate cancer in an era of improving survival, with a focus on treatment-related toxicities, quality of life, and unmet needs in supportive care. We highlight current evidence, identify gaps in knowledge, and discuss future directions for integrating survivorship into routine clinical practice. Full article

Background/Objectives: Femicide-related orphanhood exposes children and adolescents to psychological distress and may disrupt their health-related quality of life (HRQoL). This study examined the relationships between anxiety, depression, and HRQoL among children and adolescents orphaned by femicide and tested whether depressive symptoms mediate the association between anxiety and HRQoL. Methods: A cross-sectional study was conducted with 57 children and adolescents aged 8 to 18 years who had been orphaned by femicide and were residing in the Federal District of Brazil. Participants completed the Revised Child Anxiety and Depression Scale (RCADS-25) to assess anxiety and depressive symptoms and the KIDSCREEN-27 to evaluate HRQoL. Data were analyzed using Spearman correlation coefficients, linear regression models with bootstrap procedures, and mediation analyses to explore direct and indirect relationships among variables. Results: Depressive symptoms were negatively associated with HRQoL, while anxiety symptoms showed a weaker negative association with HRQoL. In the regression analysis, depression emerged as the only significant predictor of HRQoL. Mediation analysis indicated that the relationship between anxiety and HRQoL was largely explained by depressive symptoms, suggesting a partial indirect effect of anxiety through depression. Conclusions: The findings indicate that depressive symptoms may play a central role in the relationship between anxiety and perceived quality of life among children and adolescents orphaned by femicide. These results highlight the importance of assessing both anxiety and depression in this population and suggest that interventions addressing depressive symptomatology may contribute to improving psychosocial well-being and HRQoL following exposure to severe family violence. Full article

Background and objectives: Cancer survivors continue to face significant psychological and quality-of-life challenges following the COVID-19 pandemic. This study aimed to investigate levels of depression, anxiety, stress, quality of life, and perceived social support among patients with cancer during the post-COVID-19 period and to examine their interrelationships. Materials and Methods: A cross-sectional study was conducted among 162 Greek adults with cancer. Participants completed questionnaires assessing psychological distress (Depression Anxiety Stress Scale-21), health-related quality of life (EORTC QLQ-C30), and perceived social support. Descriptive statistics, factor analysis, group comparisons, and correlation analyses were performed. Results: High levels of psychological distress were observed, with 32.1% of participants reporting severe or extremely severe depression, 40.1% severe or extremely severe anxiety, and 29.0% severe or extremely severe stress. Quality of life was moderate, with emotional and social functioning being the most impaired domains, while fatigue, insomnia, and financial difficulties were the most prominent symptoms. Depression, anxiety, and stress were strongly associated with poorer quality of life and greater symptom burden. Higher perceived social support, particularly from family and friends, was associated with better quality of life and lower psychological distress. Conclusions: These findings highlight the need for comprehensive oncology care that incorporates routine psychological assessment and psychosocial support to improve cancer survivorship outcomes. Full article

Retirement is a major later-life transition, yet existing reviews have often examined selected dimensions of well-being rather than integrating evidence across physical, mental, social, financial and spiritual or meaning-related domains. This umbrella review synthesised systematic review evidence on factors and interventions influencing well-being among retired older adults. Following Joanna Briggs Institute methodology and Preferred Reporting Items for Overviews of Reviews guidance, five databases were searched for systematic reviews published from 2015 onward. The protocol was registered in PROSPERO (CRD420251158970). Screening, quality appraisal and data extraction were completed independently by two reviewers, with disagreements resolved by a third reviewer. Eleven systematic reviews met the inclusion criteria. Findings showed that retirement well-being is multidimensional and context-dependent, shaped by social participation, physical health, psychological resources, retirement preparation, voluntary retirement, financial security and meaningful engagement. Social participation and social integration were among the most consistent determinants, while financial and spiritual or meaning-related well-being were less frequently examined. Intervention evidence was limited and focused mainly on physical activity, health behaviours and volunteerism. Retirement well-being is influenced by interacting personal, social and structural factors, highlighting the need for multidimensional interventions and more consistent measurement across well-being domains. Full article

Background/Objectives: After menopause, hormonal, age-related, and lifestyle factors may adversely affect physical functioning and psychological well-being. This study compared immediate changes in physical function, psychological health, and health-related quality of life following a five-day Combined Marine Treatment Program (CMTP) with those observed under a usual-routine control condition. Methods: A parallel-group randomized controlled trial was conducted with 62 postmenopausal women allocated equally to the CMTP and control groups. The CMTP included coastal walking, resistance exercises, mindfulness meditation, and visits to local natural attractions. Participants in the control group continued their customary daily activities. The co-primary outcomes were the Timed Up and Go test and the Short Form-36. Secondary outcomes were grip strength, pinch strength, static balance, the 10-item Perceived Stress Scale, and the Beck Depression Inventory-II. Mixed repeated-measures analysis of variance was used to test whether temporal changes differed between groups. Trial registration was completed through the Clinical Research Information Service of the Republic of Korea (KCT0009741). Results: Changes over time differed significantly between groups for the Timed Up and Go test, grip strength, pinch strength, eyes-open sway area, eyes-closed sway area, eyes-closed sway velocity, and all self-reported outcomes. Post-intervention values differed significantly between groups for the Timed Up and Go test, pinch strength, both eyes-closed balance measures, and all self-reported outcomes. No adverse events were reported during the trial. Conclusions: Relative to the usual-routine condition, the five-day CMTP was associated with immediate changes in selected performance-based physical outcomes and broader changes across self-reported psychological and health-related quality-of-life outcomes. Brief multicomponent coastal health programs therefore warrant further study in postmenopausal women. Full article

Background and Objectives: Individuals with heroin-related opioid use disorder are at high risk of poor oral health and impaired oral health-related quality of life (OHRQoL). However, data on the determinants of OHRQoL in this population remain limited. This study aimed to assess oral health status and OHRQoL and to identify key predictors of OHRQoL among hospitalized patients with heroin-related opioid use disorder. Materials and Methods: A cross-sectional study was conducted among 97 hospitalized patients with heroin-related opioid use disorder. Data were collected through structured interviews and clinical oral examinations, including the Decayed, Missing, and Filled Teeth (DMFT) index and the Simplified Oral Hygiene Index (OHI-S). OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14). Spearman correlation and multiple linear regression analyses were performed to examine associations and identify predictors of OHRQoL. Results: Participants had poor oral health, with high DMFT (19.1 ± 6.1) and OHI-S (2.0 ± 1.2) scores. OHRQoL was markedly impaired, with a mean OHIP-14 score of 29.6 ± 7.0, particularly in the psychological and social domains. OHIP-14 scores were strongly correlated with DMFT (r = 0.754, p < 0.001) and OHI-S (r = 0.552, p < 0.001). Longer duration of heroin use was associated with higher DMFT scores, poorer oral hygiene, and greater OHRQoL impairment. Multiple linear regression analysis identified unstable housing/homelessness (β = 0.166, p = 0.012), DMFT (β = 0.624, p < 0.001), and OHI-S (β = 0.272, p = 0.007) as significant predictors of poorer OHRQoL. Conclusions: Individuals with heroin-related opioid use disorder experienced substantial oral health burden and impaired OHRQoL, strongly associated with caries experience, poor oral hygiene, and housing instability. These findings highlight the need to integrate prevention-oriented dental care into addiction treatment services and to address the broader social determinants of oral health. Full article

Background: Lumbar radicular pain, commonly referred to as sciatica, is a prevalent musculoskeletal condition that negatively impacts patients’ quality of life. Evidence regarding the use of foot orthoses in patients with sciatica secondary to lumbar disc herniation remains limited. Objectives: To determine the influence of custom-made foot orthoses on health-related quality of life and perceived pain in patients with chronic radicular pain secondary to non-traumatic lumbar or lumbosacral disc herniation. Methods: A randomized, controlled, double-blind clinical trial was conducted. Fifty-two patients (mean age: 46.12 ± 9.37 years; 53.8% men, 46.2% women) were allocated to either a customized functional foot orthoses group or a cushioning flat insole group. Pain, foot-related disability, low back disability, and health-related quality of life were assessed at baseline and after three months using the 11-point Numeric Pain Rating Scale (NPRS), Manchester Foot Pain and Disability Index (MFPDI), Oswestry Disability Index (ODI), and Short Form-12 (SF-12) questionnaire. Results: No statistically significant differences were observed between treatment groups in foot pain ($p=0.821$), lower-limb pain ($p=0.244$), low back pain ($p=0.497$), low back disability ($p=0.684$), or physical quality of life ($p=0.069$) after follow-up. However, participants treated with customized functional foot orthoses showed significant intragroup improvements in foot function (MFPDI-Function: $p=0.046$; MFPDI-Total: $p=0.033$) and in the physical component of health-related quality of life (SF-12 Physical: $p=0.031$), whereas no significant changes were observed in the cushioning insole group ($p>0.05$). Conclusions: Customized functional foot orthoses may improve foot function and physical health-related quality of life in patients with chronic radicular pain secondary to lumbar or lumbosacral disc herniation. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings. Full article

Background: Post-COVID-19 syndrome represents a global health problem, manifesting with persistent multiple organ symptoms, including respiratory ones. This review aimed to evaluate the efficacy of different pulmonary rehabilitation interventions in the management of the disease, including its particularities. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement and prospectively registered in the PROSPERO database (CRD420261292824). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 2021 to January 2026. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Cochrane Risk of Bias 2 (RoB 2) tool. Twenty randomized controlled trials involving 2101 adult patients with post-COVID-19 syndrome met the eligibility criteria and were included in the qualitative synthesis. Results: Pulmonary rehabilitation (PR) demonstrated significant improvements in exercise capacity, with notable increases in 6MWT and VO₂max. Respiratory and peripheral muscle strength significantly increased. The quality of life, dyspnea and fatigue consistently improved. The results for intrinsic pulmonary function, anxiety, and depression were heterogeneous, suggesting benefits more related to reconditioning. Conclusions: Pulmonary rehabilitation is an essential and efficient component in post-COVID-19 syndrome, improving physical function, respiratory and peripheral muscle strength, the quality of life, fatigue and dyspnea. Telerehabilitation is a viable alternative. Adapting protocols is crucial, recognizing that most benefits derive from physical reconditioning and muscle training, not necessarily from major structural pulmonary changes. Full article