Search Results (1,933)

Hypertension is the leading risk factor for cardiovascular disease. Epidemiologic studies have demonstrated that pediatric hypertension may increase the risk of premature heart disease. Pediatric hypertension affects about 4% of children and clusters with other risk factors and social disparities in health. In addition to observed target organ damage, there is evidence for tracking blood pressure from childhood to adulthood. Ambulatory blood pressure monitoring is the recommended method for diagnosis, and echocardiography is used to assess target organ damage. A diagnostic workup in children depends on the age at presentation, severity of hypertension, diurnal pattern, evidence of target organ damage, and response to treatment. Treatment follows a similar framework to adult hypertension and studies demonstrate improvement in intermediate outcomes with treatment. However, further studies are needed to establish benefit in hard outcomes. This review focuses on studies evaluating the epidemiology of pediatric hypertension and its association with cardiovascular outcomes. Relevant domains included prevalence, blood pressure tracking, and cardiovascular sequelae. To compile data for this narrative review, a PubMed/MEDLINE database search was performed for studies published between 1997 and April 2026. Full article

Introduction: Offloading adherence (OA) is critical for diabetic foot ulcer (DFU) healing. This report investigated whether DFU patients with low overall OA (<20%) limit offloading device usage to days they come to the clinic. Methods: Activity monitors measured OA 24 h/day. Daily walking and standing OA were calculated for up to four weeks, and participants self-reported their cumulative adherence. Each day was classified as to whether a DFU-related clinic visit occurred. Results: Four participants from an ongoing RCT were identified with <20% overall adherence, despite self-reporting 65–80% adherence. Most days they did not wear their devices at all, while the majority of wear-days coincided with footcare visits. Conclusions: This report describes a cohort that had low daily OA yet consistently wore their devices to the clinic and self-reported inflated OA. To improve OA and DFU healing, more research is needed to understand this phenomenon and help clinicians ascertain adherence during patient encounters. Full article

Patients with diabetes and/or peripheral artery disease (PAD) are at risk for lower limb amputation and a subsequently higher mortality risk. Peer support interventions have been shown to increase diabetes self-management and glycemic control. This scoping review aims to synthesize the current literature on peer support interventions in reducing lower limb amputations. A PubMed search was conducted in June of 2023, excluding publications prior to 2000, focusing on two themes: (1) peer support and (2) the patient population of interest (i.e., individuals with diabetic foot disease and/or PAD). Studies were included if they addressed the population of interest, involved a peer support intervention to improve lower extremity health, and had outcomes pertaining to the health of the lower extremities or programmatic metrics such as participant satisfaction or program adherence. Out of 1730 publications initially identified, six met the inclusion criteria. These six studies were categorized as group foot care education studies (n = 4) or group cognitive behavioral studies (n = 2). The group foot care education studies showed mixed results, which varied from no effect to significant improvements in foot care, self-management, and complications. There was a trend of improvement in self-management behaviors and physical activity in cognitive behavioral interventions. Despite showing promise in other settings, there have been limited investigations of peer support interventions to improve lower extremity outcomes and avert amputations in persons with diabetes and/or PAD. Further studies are required to conclusively determine the efficacy of peer support interventions to reduce lower extremity amputation rates. Full article

Background/Objectives: Frailty and congestion are highly prevalent in patients with heart failure (HF) and are independently associated with adverse outcomes. However, their interrelationship and combined prognostic significance remain incompletely understood. We aimed to investigate the association between frailty and congestion phenotypes in older patients with HF and to evaluate their combined impact on clinical outcomes. Methods: We prospectively included 308 ambulatory patients aged ≥65 years with chronic HF from a specialized HF clinic between 2022 and 2024. Frailty was assessed using the Fried phenotype. Congestion was defined by clinical signs and/or elevated NT-proBNP (≥1000 pg/mL) and CA125 (≥35 U/mL). Associations between congestion and frailty were evaluated using logistic regression and restricted cubic spline analyses. The primary endpoint was a composite of all-cause mortality or HF hospitalization at 1 year. Results: Frailty was present in 49.7% of patients and congestion in 79.9%. Frailty prevalence increased progressively across congestion phenotypes, from 21.0% in patients without congestion to 70.8% in those with combined clinical and biochemical congestion (p < 0.001). Congestion was also associated with worse nutritional status and reduced muscle strength. In multivariable analyses, frailty and congestion remained independently associated with adverse outcomes. Their coexistence identified the subgroup with the highest risk of death or HF hospitalization (HR 25.54, 95% CI 3.46–188.26; p = 0.001). Conclusions: In older ambulatory patients with HF, frailty and congestion frequently coexisted and identified patients at increased risk of adverse outcomes, particularly when clinical and biochemical congestion were present. These findings support combining frailty evaluation with congestion assessment for prognostic stratification. Full article

Background and Objectives: Recent studies suggest that remimazolam, a novel ultra-short-acting benzodiazepine, has an excellent pharmacokinetic and safety profile, favourable for ambulatory procedures. Although remimazolam has been studied as a sole agent for anaesthesia in day case gynaecological surgery, studies assessing its use in combination with other anaesthetics remain scarce. The aim of this study was to investigate the effects of a low-dose remimazolam adjunct on the characteristics of an intravenous propofol–remifentanil anaesthesia regimen. Materials and Methods: A single-centre retrospective observational cohort study was conducted on patients who underwent brief day case gynaecological surgery under general intravenous anaesthesia using remifentanil and propofol from November 2024 to January 2025. The patients were divided into two groups depending on whether they received remimazolam as an adjunct. To account for confounding, propensity scores (PSs) were estimated from baseline characteristics and used to derive stabilised inverse probability of treatment weights (IPTWs). Weighted regression models were then applied to estimate treatment effects on postoperative recovery time measures, consumption of anaesthetics, and incidence of any adverse effects intraoperatively and postoperatively. Cost effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER). Results: The clinical data of 51 patients were retrospectively examined: 32 patients were assigned to the intervention group, and 19 patients were assigned to the reference group; after IPTW and PS trimming, the sum of weights was 22 in the intervention group and 58.8 in the reference group. The use of remimazolam as an adjunct was associated with 3.5 min shorter time to eye opening (p < 0.001) and 3.6 min shorter time to full consciousness (p = 0.002); the total consumption of propofol was decreased by 3 mg/kg (p < 0.001); the median dose of remimazolam adjunct was 0.12 mg/kg, or 10 mg per case. There were no statistically significant adverse effects. ICER was 2.35 € per minute of operating room (OR) time saved. Conclusions: In the setting of day case gynaecological surgery, the addition of remimazolam to a propofol–remifentanil regimen reduced propofol requirements and shortened recovery time without an increase in adverse effects. This may represent a more efficient anaesthetic approach for ambulatory procedures with a comparable safety profile. Full article

Background: Many patients with heart failure with reduced ejection fraction (HFrEF) remain undertreated in routine practice. Delayed treatment intensification, poor adherence, and fragmented follow-up are common barriers. Low-cost digital support may help reduce this implementation gap. Objective: This study evaluated whether a simple digital support pathway was associated with better 6-month treatment adherence and guideline-directed medical therapy (GDMT) optimization in ambulatory patients with stable HFrEF. Methods: This single-center matched cohort study compared a prospective digital-support cohort with a historical usual-care cohort. The intervention combined smartphone-based telemanagement, home blood pressure and heart-rate reporting, daily weight surveillance, and scheduled video consultations. The co-primary endpoints were treatment adherence at 6 months and GDMT optimization, assessed by change in foundational HFrEF drug classes and by a prespecified exploratory GDMT optimization score. Results: After 1:1 propensity-score matching, 200 patients were included, with 100 patients in each cohort. Treatment adherence at 6 months was higher in the digital-support cohort than in usual care (82.0% vs. 64.0%, p = 0.004). The intervention cohort also had more frequent class addition, more dose escalation, a greater increase in foundational drug classes, and a larger improvement in GDMT optimization score (all p < 0.001). Heart failure hospitalization and the composite of heart failure hospitalization or all-cause death were less frequent in the digital-support cohort, but these clinical outcomes were exploratory. Conclusions: A pragmatic low-cost digital support pathway was associated with better adherence and more complete GDMT optimization in ambulatory patients with HFrEF. The findings support further prospective multicenter evaluation. Full article

Background/Objectives: Children of families facing unmet social needs experience higher rates of adverse outcomes compared to those not experiencing unmet social needs. This study aimed to identify factors associated with families’ unmet social needs as reported by parents or guardians at their children’s primary care visits. Methods: This cross-sectional study recruited English-speaking primary caregivers of children less than 18 years of age from the Southwestern Ohio Ambulatory Research Network (SOAR-Net) who were surveyed between January 2023 and August 2024. Surveys included the Maternal Social Support Index, Social Capital Scale, RAND Depression Screener, Children with Special Health Care Needs Screener, Medical Expenses of Children Survey, a 10-item social needs screener, and demographics. Data were analyzed with chi-square or Fisher’s exact tests, adjusted logistic regression, and ANOVA. Results: Among 1167 respondents (78% response rate), 1114 provided complete data. Primary caregivers were predominantly mothers (79.9%) or fathers (13.6%), White (72.0%) or Black (16.0%), and had an associate’s degree or less (65.1%). The mean (SD) index child’s age was 6.4 (5.3) years, and 52.4% were female. Underinsurance, positive depression screens, and poor child health were positively associated with unmet social needs. Higher scores for social support and social capital were associated with fewer social needs. Multinomial logistic regression revealed significant relationships with reporting two or more unmet social needs with the following variables: childhood underinsurance, household annual income < $50,000, positive depression screens, raising a child with a chronic health condition, and Black race/ethnicity. Conclusions: Several significant social factors were independently associated with a greater number of unmet social needs. These findings highlight the complex interplay among social factors in children’s healthcare. Future research should explore the putative longitudinal stability of these relationships. Full article

Background: Cancer-associated thrombosis (CAT) is a leading cause of morbidity and mortality in cancer patients. Although international guidelines provide comprehensive recommendations for venous thromboembolism (VTE) prevention and treatment, the degree to which clinicians adhere to these guidelines in routine practice remains unclear, particularly in countries with limited national data such as Turkey. Methods: A cross-sectional, descriptive survey was conducted among oncology specialists (medical oncologists, radiation oncologists, and surgical oncologists) and cardiologists practicing across Turkey. A structured, case-based questionnaire comprising 21 multiple-choice questions was distributed electronically via SurveyMonkey. The questionnaire assessed perioperative VTE prophylaxis approaches, VTE risk assessment practices in ambulatory patients, primary and long-term secondary thromboprophylaxis preferences, acute VTE treatment strategies, and management of special clinical scenarios. Responses were analyzed using descriptive statistics and compared between oncologist and cardiologist groups. Results: A total of 84 physicians participated (34 oncologists [40.5%], 50 cardiologists [59.5%]). Perioperative and inpatient VTE prophylaxis practices were largely concordant with guideline recommendations, with 67.9% individualizing prophylaxis decisions and 66.7% initiating prophylaxis in hospitalized immobile patients when not contraindicated. However, only 33.7% routinely performed VTE risk assessment in ambulatory patients, and 64.6% did not use any validated risk scoring system. Low-molecular-weight heparin (LMWH) was the preferred agent for acute VTE treatment (72.6%), while direct oral anticoagulants (DOACs) gained preference in long-term secondary thromboprophylaxis (42.2%). No statistically significant differences were observed between oncologists and cardiologists across all survey items (all p > 0.05). Notably, 94.1% of respondents expressed a need to update their knowledge regarding CAT management. Conclusions: While oncologists and cardiologists in Turkey demonstrate general awareness of CAT guidelines, significant gaps persist in VTE risk stratification and primary prophylaxis for ambulatory cancer patients. The near-universal self-reported need for knowledge updates highlights the urgency for structured multidisciplinary education programs, integration of validated risk scoring tools into clinical workflows, and development of nationally adapted clinical practice guidelines. These findings reflect self-reported practices and may not fully represent actual clinical behavior; future studies incorporating medical record reviews or prescription data are needed to validate these observations. Full article

Physical activity is a key lifestyle factor for mental health prevention, yet the influence of accelerometer placement on mood prediction remains unclear. We merged high-resolution acceleration data and Ecological Momentary Assessment (EMA) mood reports from 259 healthy participants across three ambulatory studies (SedMood, 24 hrCog, HO). Additionally, 15 min pre-assessment movement windows consisting of raw triaxial acceleration (64 Hz) from hip, thigh, chest, and wrist sensors were paired with six-item mood EMA queries. Features (e.g., mean, entropy, spectral power) were extracted and fed into gradient-boosted decision tree models (XGBoost), trained separately for energetic arousal, valence, and calmness. Performance was measured using the metrics MAE, RMSE and R². Within individual studies, chest and hip sensors achieved the highest performance, followed by wrist and thigh. In the combined dataset, hip sensors again outperformed thigh (R² 0.38 vs. 0.20). Multi-sensor models rarely surpassed the best single-sensor configuration and sometimes reduced accuracy. These results suggest that sensor location modestly impacts mood-prediction performance, with hip and chest offering the most reliable signals, while adding sensors does not reliably enhance predictive power. Future work should explore larger, homogenous datasets and location-specific feature engineering to refine wearable-based mental health monitoring. Full article

Background: Socio-cognitive deficits constitute a core and persistent feature of adolescent-onset schizophrenia, significantly impairing functional outcomes. However, the interplay between genetic metabolic markers such as CYP2D6 and specific socio-cognitive phenotypes remains poorly understood. Methods: This cross-sectional study included 73 adolescents with schizophrenia and 58 matched healthy controls. Theory of Mind (ToM) was evaluated using the Reading the Mind in the Eyes Test (RMET), while empathy was assessed with the Cambridge Empathy Quotient. Symptom severity was measured via the Positive and Negative Syndrome Scale (PANSS). CYP2D6 polymorphisms were genotyped using RT-PCR, classifying participants as Normal or Reduced (Intermediate) metabolizers. Hierarchical multiple regression analyses were performed, controlling for sex, IQ, and psychosocial factors. Results: Patients demonstrated significantly lower RMET and empathy scores compared to controls. Reduced CYP2D6 metabolizers exhibited poorer ToM performance and more severe negative symptoms. The final RMET model accounted for 88.8% of variance (p < 0.001), with CYP2D6 status emerging as a significant independent predictor (β = 0.178, p = 0.005), alongside IQ and negative symptoms. In contrast, the empathy model explained 49.0% of variance, with CYP2D6 effects fully mediated by negative symptom severity. Conclusion: Adolescents with reduced CYP2D6 metabolic activity exhibit greater negative symptom burden and impaired social-cognitive functioning. Our findings reveal a double dissociation: ToM functions as a stable, biologically anchored trait, while empathy serves as a state-dependent construct primarily driven by the negative syndrome. These insights advocate for the integration of pharmacogenetic stratification in the treatment of early-onset schizophrenia. Full article

Children with developmental disabilities are less physically active and at increased risk for chronic conditions that physical activity might ameliorate. This study examined the relationships between the impact of physical activity (e.g., muscles burning, body tiredness), physical activity time and fatigue in children with Cerebral Palsy (CP) and Down Syndrome (DS) in comparison to typically developing (TD) children. A convenience sample of children and parents was enrolled. All children were between 4 and 10 years, ambulatory, medically stable, not taking sleep-aid medications and were either TD (n = 20) or diagnosed with CP (n = 14) or DS (n = 5). Children and parents separately answered questionnaires about participation in physical activity and fatigue during the past week, yielding retrospective data. Additionally, they completed prospective questionnaires for 3 consecutive days. Repeated measures multivariate and univariate analyses (post hoc) of variance, along with correlations between variables were completed. Analyses of retrospective data yielded no specific findings. Prospectively, all groups of parents reported that as the impact of physical activity increased, perceptions of fatigue decreased (r = −0.349; p < 0.001). Parents of children with Cerebral Palsy noted a negative relationship between the time spent doing physical activity and perceptions of fatigue (r = −0.553; p < 0.001). Between-group differences in perceptions of fatigue occurred for children with CP compared to TD (F = 8.248; p < 0.001). Parent-reported findings suggest potential associations between physical activity participation and perceptions of fatigue across diagnostic groups. Full article

Emotion recognition (ER) in human–computer interaction (HCI) holds immense potential for real-world applications, but traditional approaches based on electroencephalography (EEG) face challenges due to the complexity and impracticality of collecting and analyzing EEG data in ambulatory settings. This study explores electrodermal activity (EDA), a simpler measure of the sympathetic nervous system response that can be collected at multiple peripheral body sites, as a potential alternative for ER. We investigated the variable frequency complex demodulation (VFCDM) technique to analyze EDA and EEG signals and used deep learning models (ResNet50 and MobileNetV2) to classify arousal states (high arousal, HA vs. low arousal, LA). Our results show that EDA signals analyzed by VFCDM and classified by MobileNetV2 achieve promising performance, with an accuracy of 91.45%, comparable to the best EEG-based model (91.98%), in arousal classification. This suggests that EDA offers a viable and more practically accessible approach to ER in HCI compared to traditional EEG-based methods. Future work should explore larger and more diverse datasets, incorporate valence classification through multimodal fusion, and investigate the neural mechanisms underlying EDA-EEG interactions during emotional processing to further advance robust ER for HCI applications. Full article

Real-time physiological state awareness is central to next-generation wearable computing, yet most existing electrophysiological signal acquisition platforms remain limited to single-modality sensing, high component cost, or bulky form factors that hinder everyday deployment. Here, we present a compact, low-cost wearable platform for simultaneous electroencephalography (EEG), electromyography (EMG), and electrocardiography (ECG) acquisition. The system integrates an analog front-end, a microcontroller, and a Bluetooth wireless link on a compact single-board platform (5.6 × 3.8 cm, approximately 12.8 g with the selected lithium-polymer battery installed), with an estimated bill-of-materials cost of 67.40 USD. Experimental validation across three healthy subjects, with the ECG channel additionally benchmarked against a commercial clinical-grade ambulatory ECG recorder, demonstrates that the platform captures ECG waveforms with recognizable P-QRS-T morphology under controlled recording conditions, supports reliable R-peak detection and heart rate estimation, records stable resting-state EEG spectral features, and distinguishes EMG activation from resting baseline in both time-domain amplitude and time-frequency structure. Leveraging the real-time wireless data link between the wearable hardware and a PC-hosted MATLAB environment, we further explore application-oriented signal processing scenarios. As an offline algorithm-pipeline compatibility demonstration, a CNN-based seizure detection pipeline is applied to the Bonn EEG benchmark for five-class epileptic state classification, achieving 86.60% mean classification accuracy. The proposed system offers a scalable and affordable foundation for wearable human-state-aware interaction, with potential applications in clinical monitoring, rehabilitation, and brain–computer interfaces. Full article

Real-time simultaneous monitoring of cardiac and respiratory signals in wearable systems remains challenging due to motion artifacts under varying body postures. This paper proposes an edge wearable integrated with novel methods to acquire and process cardiac and respiratory signals simultaneously from the chest. For respiration monitoring, the system captures chest motion using an IMU and applies dynamic filtering with real-time axis selection in a custom mobile application. It automatically selects the best respiratory axis from six IMU vectors: x, y, z, xy, yz, and zx, improving robustness across body postures and device placements. The proposed system can also capture and process electrocardiogram (ECG) data simultaneously for cardiac monitoring. Cardiac and respiration data were taken from eight healthy subjects, including males and females, followed by five protocols. The overall mean absolute error (MAE) for eight subjects is found to be 0.64 breath per minute (BrPM) after validation by a commercial sensor. In real time, the wearable continuously provides ECG and breathing signal streaming, ECG beat detection, and cardiac and breathing rates with an overall latency of 13.8 ms. The results indicate that the system can monitor the cardio-respiratory signals in real time under static and light-movement conditions. Full article

Background and Objectives: Schizophrenia in adolescence severely impairs quality of life (QoL) and disrupts critical social, academic, and neurodevelopmental periods. Beyond symptom remission, functional recovery and subjective well-being have become central therapeutic goals; however, the specific contributions of pharmacogenetic, social–cognitive, and residual clinical factors to QoL in early-onset schizophrenia remain largely unexplored. This study investigated the contribution of CYP2D6 metabolizer status, social cognition (theory of mind and empathy), residual psychopathology, and family factors to subjective QoL in adolescents with schizophrenia. Materials and Methods: A cross-sectional study of 52 adolescents with DSM-5 schizophrenia (PAT-SCZ) and 51 matched healthy controls. QoL was measured with the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Social cognition was assessed using the revised Reading the Mind in the Eyes Test (RMET). Residual symptoms were rated with the Positive and Negative Syndrome Scale (PANSS). CYP2D6 genotyping classified patients as normal metabolizers (NMs) or reduced-function metabolizers (RM: intermediate/poor). Two multivariable OLS regression models examined predictors of QoL. Results: Patients showed markedly lower QoL, impaired theory of mind, lower empathy, and higher residual symptoms than controls (all p < 0.0001). Within patients, reduced-function metabolizer (RM) status was associated with poorer QoL, weaker social cognition, higher negative/general psychopathology, and lower IQ. Two multivariable regression models explained 84.2–84.3% of the variance in QoL (adjusted R²). Social cognition (RMET scores) and CYP2D6 reduced-function metabolizer status emerged as the strongest predictors (β = 0.363 and β = −0.362, respectively, both p < 0.0001), followed by negative symptom severity and dysfunctional family relationships (all p < 0.05). Conclusions: Pharmacogenetic (CYP2D6), social–cognitive, and clinical factors strongly determine QoL in adolescent schizophrenia. Routine CYP2D6 genotyping, social-cognition remediation, and family interventions should be integrated into early treatment to improve long-term well-being. Full article