Search Results (3,209)

CR is a cornerstone of secondary prevention for cardiovascular disease, offering well-established benefits across mortality, hospital readmission, functional capacity, and quality of life. Despite Class I guideline endorsements and decades of supporting evidence, CR remains vastly underutilized, particularly among women, racial and ethnic minorities, older adults, and individuals in low-resource settings. This review synthesizes the current evidence base for CR, with emphasis on disease-specific benefits across different cardiovascular diseases, and highlights recent data on its role in expanding populations, including patients with HFpEF, older adults, patients with advanced heart failure, and those undergoing transcatheter interventions. We also examine persistent barriers to CR access and participation, including system-level and referral limitations, as well as patient-level disparities by age, sex, race and ethnicity, and socioeconomic status. Building on this, we explore innovative delivery models and recent policy initiatives such as hybrid programs and reimbursement reform, all designed to expand access, promote equity, and modernize CR delivery. The findings underscore the need for continued investment, advocacy, and innovation to ensure equitable access to CR and its life-saving benefits across the full cardiovascular care continuum. Full article

(1) Background and aim: The benefit of surgical treatment compared to conservative management is unclear in degenerative cuff tears, and there is limited evidence regarding midterm functional outcomes. This study sought to compare the midterm functional outcomes of surgical versus conservative treatment for rotator cuff tears. (2) Methods: All patients on the waiting list for arthroscopy of cuff tears in a single center between 2013 and 2015 were analyzed. They were divided into two groups: those who underwent surgery (arthroscopy group) and those who declined the procedure (orthopedic group). The primary endpoint was shoulder functionality, evaluated with the CMS, SST, and SPADI-SP questionnaires. Inverse probability of treatment weighting (IPTW) was used to account for differences between the groups. (3) Results: Of 57 patients (67 (62–71) years old, 47% women), 32 were in the arthroscopy group and 25 in the orthopedic group. Functionality was assessed at a median of 7 (7–8) years after diagnosis. The patients in the arthroscopy group were younger (p = 0.023) and more frequently women (p = 0.074). No significant differences were observed in the type of tear (p = 0.205) or laterality (p = 0.164). Functional outcome analysis showed more favorable scores in the surgical group: constant (74.5 ± 16.6 vs. 58.4 ± 23, p = 0.016), SST (7.3 ± 3.1 vs. 4.9 ± 4.2, p = 0.016), and SPADI-SP (35.7 ± 26.6 vs. 56.1 ± 30.4, p = 0.006). (4) Conclusions: In this cohort of patients with cuff tears, arthroscopic repair was associated with better clinical and functional midterm results compared to conservative treatment, although the benefit was less evident in older patients and those with complete tears. Full article

Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated with VI in Duhknah, a rural area in Qassim Province, Saudi Arabia. Methods: This cross-sectional study, conducted in May 2024, included 929 participants aged 6–90 years from Duhknah, a rural area in Qassim Province, Saudi Arabia. Refractive errors (REs) were measured using a non-cycloplegic autorefractometer. Anterior and posterior eye examinations were performed using slit lamp biomicroscopy, direct ophthalmoscopy, and 90 D fundus biomicroscopy. VI was classified based on the International Classification of Diseases 11th revision (ICD-11), 2018. Results: The findings revealed that 671 (72.2%) participants had never undergone an eye examination. The overall prevalence of presenting VI was 370 (39.8%), comprising 21.6% with mild VI, 11.0% moderate, 4.1% severe, and 3.1% classified as blind. The prevalence of hyperopia, myopia, and astigmatism was 20.6%, 36.9%, and 13.2%, respectively. Uncorrected REs were the most common cause of VI (81.4%), followed by amblyopia (13.5%) and cataracts (3.2%). Regression analysis showed that women had 1.58 times higher odds of VI (p = 0.001). Participants with eye examinations for one year or more had 3.64 times higher odds (p < 0.001). Additionally, the risk of VI was significantly lower among older participants (ages 18–90) compared to younger ones (ages 6–17), (p < 0.001). Conclusions: This study found most participants had never had an eye exam, and VI was highly prevalent in the rural community. These findings underscore the need to strengthen primary eye care in rural Saudi Arabia. Regular vision screening, particularly for children, and better access to refractive services could significantly reduce VI and support the goals of Saudi Vision 2030. Full article

Background and Objectives: Sarcopenic obesity, or the coexistence of sarcopenia and obesity, carries an additional load of health risks, including functional decline and metabolic disorders. Despite its increasing importance, data on Korean adults’ prevalence and risk factors are poor. The objective of this study was to estimate the prevalence of sarcopenic obesity, sarcopenia, and obesity to identify factors associated with each condition using the most recent nationally representative data. Materials and Methods: This study analyzed data from 4332 adults aged ≥ 40 years who participated in the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES). Sarcopenia was defined using the appendicular skeletal muscle index (SMI) via bioelectrical impedance analysis (BIA), and obesity by waist circumference per Korean criteria. Participants were categorized into four body composition groups. Complex sample logistic regression was used to identify factors independently associated with each condition. Results: The prevalence rates of sarcopenic obesity, sarcopenia-only, and obesity-only were 1.9%, 14.4%, and 35.5%, respectively. Sarcopenic obesity was significantly more common among older women with low education level, poor subjective health, diabetes, and low HDL-C. They were associated with older age, lower physical activity, lower education level, past smoking, and poor health condition. Obesity was associated with male sex, diabetes, hypertension, dyslipidemia, and moderate-to-poor perceived health. Conclusions: Sarcopenic obesity, while less prevalent, is relatively uncommon and represents a high-risk phenotype associated with metabolic and functional deficits. These results highlight the importance of identifying vulnerable subgroups and implementing targeted strategies that address both muscle loss and adiposity in aging Korean adults. Full article

Metagenomic studies have provided deeper insights into the complex interactions between the skin and its microbiota. However, limited research has been conducted on the skin microbiota of Brazilian women. Given that Brazil ranks as the fourth-largest consumer of cosmetics worldwide, the development of new tools to analyze skin microbiota is crucial for formulating cosmetic products that promote a healthy microbiome. Skin samples were analyzed using the Illumina platform. Biometrology assessments were applied. The results showed pH variations were more pronounced in the older age group, along with higher transepidermal water loss values. Metagenomic analysis showed a predominance of Actinobacteria (83%), followed by Proteobacteria (7%), Firmicutes (9%) and Bacteroidetes (1%). In the older group (36–45 years old), an increase in Actinobacteria (87%) was observed and a decrease in Proteobacteria (6%). Moreover, the results differ from the international literature, since an increase in proteobacteria (13.9%) and a decrease in actinobacteria (46.7%) were observe in aged skin. The most abundant genus identified was Propionibacterium (84%), being the dominant species. Interestingly, previous studies have suggested a decline in Cutibacterium abundance with aging; although there is no significant difference, it is possible to observe an increasing trend in this genus in older skin. These studies can clarify many points about the skin microbiota of Brazilian women, and these findings could lead to the development of new cosmetics based on knowledge of the skin microbiome. Full article

Background: Breast cancer is the most prevalent malignancy among women globally. In Romania, it is the most frequent form of cancer affecting women, with approximately 12,000 new cases diagnosed annually, and the second most common cause of cancer-related mortality, second only to lung cancer. Methods: This study looked at 79 breast cancer patients from Oltenia, concentrating on epidemiology, histology, diagnostic features, and treatments. Patients were chosen based on inclusion criteria such as histopathologically verified diagnosis, availability of clinical and treatment data, and follow-up information. The analyzed biological material consisted of tissue samples taken from the breast parenchyma and axillary lymph nodes. Even though not the primary subject of this paper, all patients underwent immunohistochemical (IHC) evaluation both preoperatively and postoperatively. Results: We found invasive ductal carcinoma to be the predominant type, while ductal carcinoma in situ (DCIS) and mixed types were rare. We performed cross-tabulations of metastasis versus nodal status and age versus therapy type; none reached significance (all p > 0.05), suggesting observed differences were likely due to chance. A chi-square test comparing surgical interventions (breast-conserving vs. mastectomy) in patients who did or did not receive chemotherapy showed, χ² = 3.17, p = 0.367, indicating that chemotherapy did not significantly influence surgical choice. Importantly, adjuvant chemotherapy and radiotherapy were used at similar rates across age groups, whereas neoadjuvant hormonal (endocrine) therapy was more common in older patients (but without statistical significance). Conclusions: Finally, we discussed the consequences of individualized care and early detection. Romania’s shockingly low screening rate, which contributes to delayed diagnosis, emphasizes the importance of improved population medical examination and tailored treatment options. Also, the country has one of the lowest rates of mammography uptake in Europe and no systematic population screening program. Full article

Objective: This retrospective observational study evaluated the efficacy and safety of an ovarian stimulation protocol for embryo banking that involves continuous administration of clomiphene citrate (CC) in combination with gonadotropins, without the use of GnRH antagonists. Methods: Conducted at the Serum IVF Clinic in Athens, Greece, the study included 250 women aged 25–45 who underwent IVF for embryo banking. The protocol involved administering 150 mg of CC daily from day 2 of the menstrual cycle until the day before hCG trigger, alongside 150 IU/day of Meriofert. Outcomes assessed included oocyte yield, fertilization rates, incidence of ovarian hyperstimulation syndrome (OHSS), and hormonal correlations. Comparative and regression analyses explored differences between age groups and predictors of success. Results: The protocol demonstrated a favorable safety profile with no cases of OHSS and yielded a mean of 10.25 oocytes per patient. Group analysis showed significantly more oocytes retrieved in women under 40 (mean: 12.5) versus those over 40 (mean: 8.43), while fertilization rates were paradoxically higher in the older cohort (59.16% vs. 30.68%, p < 0.0001). Regression models revealed basal FSH to be a significant inverse predictor of oocyte yield, but it was positively associated with fertilization rate. Continuous CC use effectively suppressed premature LH surges without compromising oocyte or embryo quality, allowing flexible and cost-effective stimulation with minimal monitoring. Conclusions: Continuous administration of clomiphene citrate in combination with gonadotropins presents a promising, antagonist-free ovarian stimulation protocol for embryo banking. The approach is economically efficient, reduces monitoring requirements, and maintains safety and effectiveness and is particularly notable in women over 40. Further studies are warranted to validate these findings and refine protocol mechanisms. Full article

Background: Delays in breast cancer treatment negatively affect prognosis and have increased over time. Data on waiting times in Switzerland are limited. Patients and Methods: This study analyzed cancer registry data from 2003 to 2005 (2628 patients) and 2015 to 2017 (421 patients) to evaluate waiting times for diagnosis, surgery, and radiotherapy; temporal trends; and survival in women with stage I–III invasive breast cancer treated with surgery without chemotherapy. Associations with demographic/clinical factors and overall survival (OS) were assessed using ANOVA, uni-/multivariable regression, Kaplan–Meier, and Cox regression. Results: From 2003 to 2005, mean intervals were biopsy-to-diagnosis 4.3 days, diagnosis-to-surgery 18.8 days, biopsy-to-surgery 26.8 days, and surgery-to-radiotherapy 56.7 days. Longer diagnosis-to-surgery times were associated with metropolitan areas, public hospitals, basic insurance, mastectomy, and older age (all p < 0.001). Radiotherapy delays were also longer in metropolitan areas and after mastectomy (p < 0.001). Between 2003–2005 and 2015–2017, diagnosis-to-surgery times rose in Eastern Switzerland (from 21.3 to 31.2 days), while radiotherapy timing remained stable. Five-year overall survival improved (from 76.7% to 88.4%), but was not significantly impacted by diagnosis-to-surgery intervals. Conclusions: Despite timely surgery in Switzerland (2003–2005), disparities existed, and time to surgery increased by 2015–2017. Reducing waiting times remains important despite no significant short-term OS impact. Full article

Background/Objectives: Aging is associated with a gradual decline in physical capabilities, often leading to impaired balance and reduced functional status, which are major contributors to falls in older adults. Although many studies have assessed these variables independently, a limited amount of research has explored the direct relationship between balance and functional status in a healthy geriatric population. The aim of this study was to investigate the relationship between balance and functional capacity and to assess the influence of demographic factors such as age, comorbidities, smoking status, and history of falls. Methods: A sample of community-dwelling older adults (19 women, 16 men) (n = 35), aged 60 years and above (M = 78 years; SD = 9.23) from Sparta, Greece, took part in the present study. Participants were assessed using three validated tools: (a) the Five Times Sit-to-Stand test, (b) the Timed Up-and-Go test, and (c) the Berg Balance Scale. Spearman’s rank correlation coefficient was used for statistical analysis (α = 0.05). Results: Age was positively correlated with poorer performance in the Five Times Sit-to-Stand (r = 0.40; p < 0.01) and the Timed Up-and-Go test (r = 0.47; p < 0.01) and negatively correlated with Berg Balance Scale scores (r = −0.51; p < 0.01). Comorbidities and smoking were also associated with the Berg Balance Scale. A strong negative correlation was observed between balance and the other two functional tests (Five Times Sit-to-Stand: r = −0.51; Timed Up-and-Go: r = −0.66; both p < 0.01). Conclusions: The findings highlight the importance of evaluating both balance and functional capacity in older adults as interrelated factors that can significantly influence quality of life and fall risk. Future research with larger and more diverse populations is recommended to confirm the present findings and to use exercise programs to prevent falls in the geriatric population. Full article

Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the gold standard method, and explores its prognostic value in old patients undergoing surgery for hip fractures. Patients and Methods: In this prospective, single-center study, 126 patients aged ≥ 70 years and hospitalized with hip fractures were included. Sarcopenia was defined according to the revised 2018 EWGSOP2 criteria. Muscle mass was assessed by the Appendicular Skeletal Muscle Mass Index (ASMI) using DXA and by the thickness of the rectus femoris (RF) muscle using POCUS. Results: Of the 126 included patients, 52 had both DXA and POCUS assessments, and 43% of them met the diagnostic criteria for sarcopenia or severe sarcopenia. RF muscle thickness measured by POCUS was significantly associated with ASMI (R² = 0.30; p < 0.001). POCUS showed a fair diagnostic accuracy in women (AUC 0.652) and an excellent accuracy in men (AUC 0.905). Optimal diagnostic thresholds according to Youden’s index were 5.7 mm for women and 9.3 mm for men. Neither RF thickness, ASMI, nor sarcopenia status predicted mortality or major postoperative complications. Conclusions: POCUS is a promising, accessible tool for diagnosing sarcopenia in old adults with hip fractures. Nonetheless, its prognostic utility remains uncertain and should be further evaluated in long-term studies. Full article

Endometriosis is a benign and often underdiagnosed condition that affects women of reproductive age, typically between 18 and 45 years. It can cause infertility and pain, including radicular pain and low back pain (LBP). The aim of this case report is to emphasize the importance of making a differential diagnosis when facing LBP and radicular symptoms. We report the case of a 17-year-old female patient, R.A., presented with a significant LBP (NPRS 8/10) radiating from her lumbar spine to her right buttock and occasionally to both legs, accompanied by weakness. She revealed exacerbation of pain during menstruation, despite being under hormonal contraceptive treatment. After three physiotherapy sessions that included education, manual therapy and exercise, the patient’s pain persisted so her physiotherapist recommended an evaluation in the emergency department, where standard radiography did not reveal any significant findings. Physiotherapy continued until the fifth session, when the patient agreed to undergo evaluation at a specialized endometriosis centre. Further investigations revealed endometriotic tissue on the uterosacral ligament, leading to hormonal therapy adjustment, with which pain gradually decreased to a manageable level (NPRS 2/10). This case report highlights the importance of an early differential diagnosis in patients with LBP, as endometriosis can present not only in older women but also in younger patients, including those already on oral contraceptives. Therefore, to mitigate the risk of pattern recognition bias, clinicians must maintain a high index of suspicion for endometriosis, even in atypical or unlikely clinical presentations. Full article

Background: The waist–calf circumference ratio (WCR) is an index that combines waist and calf circumference measurements, offering a potentially effective method for evaluating the imbalance between abdominal fat and leg muscle mass in older adults. Objective: To assess the association between WCR and indicators of body composition, muscle strength, and physical performance in community-dwelling older women. Methods: This was a cross-sectional study involving 133 older women (≥65 years) from an urban-marginal community in Guayaquil, Ecuador. The WCR was categorized into quartiles (Q1: 2.07–2.57; Q2: 2.58–2.75; Q3: 2.76–3.05; Q4: 3.06–4.76). Body indicators included fat-free mass (FFM), skeletal muscle mass (SMM), appendicular muscle mass (ASM), appendicular muscle mass index (ASMI), visceral fat (VF), fat mass (FM), and fat mass index (FMI). Handgrip strength (HGS) and the Short Physical Performance Battery test (SPPB) score were used to assess muscle strength and function, respectively. Results: The median age of the participants was 75 [IQR: 65–82] years. The mean WCR was 2.92 ± 0.93. Statistically significant associations were found between WCR and VF (p < 0.001), WCR and SMM (p = 0.039), and WCR and ASM (p = 0.016). Regarding muscle function, WCR was associated with HGS (p = 0.025) and SPPB score (p = 0.029). Conclusions: A significant association was observed between WCR and body composition, and muscle strength and function in older women. Full article

Background: Non-communicable diseases (NCDs) are a leading cause of mortality globally, contributing significantly to the burden on healthcare systems. Understanding the spatiotemporal patterns of NCD mortality is crucial for identifying vulnerable populations and regions at high risk. Objectives: Here, we evaluated the spatiotemporal patterns of NCD mortality in the Metropolitan Area of the Valley of Mexico (MAVM) from 2000 to 2019 for five International Classification of Diseases chapters (4, 5, 6, 9, and 10) at two spatial scales: the municipal level and metropolitan region. Methods: Mortality rates were calculated for the total population and stratified by sex and age groups at both spatial scales. In addition, the relative risk (RR) of mortality was estimated to identify vulnerable population groups and regions with a high risk of mortality, using women and the 25–34 age group as reference categories for population-level analysis, and the overall MAVM mortality rate as the reference for municipal-level analysis. Results: Mortality trends showed that circulatory-system diseases (Chapter 9) are emerging as a concerning health issue, with 45 municipalities showing increasing mortality trends, especially among older adults. Respiratory-system diseases (Chapter 10), mental and behavioral disorders (Chapter 5) and nervous-system diseases (Chapter 6) predominantly did not exhibit a consistent general mortality trend. However, upon disaggregating by sex and age groups, specific negative or positive trends emerged at the municipal level for some of these chapters or subgroups. Endocrine, nutritional, and metabolic diseases (Chapter 4) showed a complex pattern, with some age groups presenting increasing mortality trends, and 52 municipalities showing increasing trends overall. The RR showed men and older age groups (≥35 years) exhibiting higher mortality risks. The temporal trend of RR allowed us to identify spatial mortality hotspots mainly in chapters related to circulatory, endocrine, and respiratory diseases, forming four geographical clusters in Mexico City that show persistent high risk of mortality. Conclusions: The spatiotemporal analysis highlights municipalities and vulnerable populations with a consistently elevated mortality risk. These findings emphasize the need for monitoring NCD mortality patterns at both the municipal and metropolitan levels to address disparities and guide the implementation of health policies aimed at reducing mortality risk in vulnerable populations. Full article

The present study aimed to provide Congolese refugee women with an opportunity to narrate firsthand experiences coping with resettlement challenges in the United States. Translator-assisted, face-to-face semi-structured individual interviews were conducted with newly resettled Congolese refugee women (n = 20) aged 18 and older who arrived in the United States between 2011 and 2018. All participants were receiving assistance from a resettlement agency, located in the Midwestern US, at the time of the study. Data were analyzed using descriptive coding and thematic analysis. Three overarching themes were developed, indicating that Congolese refugee women adopt three main coping mechanisms to deal with challenges they face after resettling in the United States: (1) use of social support, (2) acceptance of the situation, and (3) spirituality. Resettlement support services, such as those provided by resettlement agencies, mental health providers, and community-based organizations, should integrate both economic and cultural dimensions into their services to address the complex physiological, mental, and emotional impacts of resettlement. These services should prioritize culturally and spiritually sensitive techniques that are linguistically accessible. Full article

Background/Objectives: Accurately assessing the independence level of older adults using useful assessment tools is an important step toward providing them with the necessary care while preserving their dignity. These tools allow older adults to receive effective, personalized home care, which improves their quality of life. This study aimed to clarify the current prevalence of severe and complete functional dependence and associated factors among Kazakhstan’s older adults aged >60 years. Methods: This cross-sectional study was conducted in several polyclinics and geriatric service care centers in two cities of Kazakhstan from March to May 2024. Functional status was assessed by the Barthel Index. We combined the selection into two categories: total dependency and severe dependency in the category “dependent”, and moderate dependency, slight dependency, and total independence in the category “active patients”. Results: Among the 642 older people in this study, 43.3% were dependent patients, and 56.7% were active patients. The odds of severe and total functional dependence are significantly higher for frail participants (adjusted odds ratio (AOR) = 2.96, 95% confidence interval (CI) [1.70, 5.16], p < 0.001) compared to those that are not frail; eleven times higher for those at home (AOR =11.90, 95% CI [5.77, 24.55], p < 0.001) than those in nursing homes; two times higher for participants with sarcopenia (AOR =2.61, 95% CI [1.49, 4.55], p < 0.001) compared to those with no sarcopenia; and three times higher for participants with high risk of fracture (AOR =3.30, 95% CI [1.94, 5.61], p < 0.001) compared to those with low risk. The odds of having severe and total functional dependence are significantly higher for participants with low dynamometry (AOR =1.05, 95% CI [1.03, 1.07], p < 0.001) compared to those with normal dynamometry. Conclusions: Old age, low dynamometry (for men ≤ 29 kg, for women ≤ 17 kg), frailty, being at home, high risk of fracture and osteoporosis, and sarcopenia were associated with increased risk of severe and total functional dependence. Full article