Search Results (4,256)

Non-invasive monitoring technologies are increasingly being explored to support cancer care, yet most existing approaches focus on isolated parameters and fail to provide a comprehensive view of patients’ health. This study presents a feasibility evaluation of an IoT-based system designed to detect treatment-related problems in oncology patients through the integration of wearable sensors, physiological measurements, and patient-reported outcomes. A monitoring kit, including a smartwatch, tensiometer, weighing scale, and mobile device, was deployed in a cohort of 26 patients undergoing oncological treatment. Data acquisition followed a structured schedule: continuous physiological recording via the smartwatch, daily blood pressure measurements, weekly weight monitoring, and structured surveys capturing treatment-related side effects. These heterogeneous data were transformed into binary clinical metrics using rule-based feature extraction algorithms, covering conditions such as insomnia, nausea, diarrhea, abdominal pain, headache, weight loss, hypertension, and fever. Clinical specialists labeled the dataset to ensure medical validity. Machine Learning models were then trained to analyze the features and generate alerts for potential treatment complications. The results demonstrate the feasibility of integrating IoT and Artificial Intelligence techniques for continuous, patient-centered monitoring in oncology, paving the way for intelligent decision-support systems that enhance early detection and clinical management. Full article

Aim: Infections and multidrug-resistant (MDR) pathogens are concerns in pediatric palliative care (PPC) units, where children with life-limiting conditions undergo invasive procedures and prolonged hospitalization. This study evaluated clinical characteristics, microbiological profiles, and factors associated with MDR infections among pediatric patients hospitalized in a PPC unit. Methods: This retrospective observational study included 66 children aged 1 month to 18 years who were admitted to the PPC unit of our hospital due to infection between June 2023 and January 2024. Demographic data, comorbidities, device use, infection sites, and microbiological results were reviewed. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek2 system and interpreted according to EUCAST. Results: The median age was 48 months (IQR 19–106); 63.6% were male. Lower respiratory tract infection was most common (68.2%), followed by sepsis (13.6%) and urinary tract infection (12.1%). Pseudomonas aeruginosa (36.4%) and Klebsiella pneumoniae (27.3%) predominated. MDR organisms represented 15.2% of isolates. MDR infections were significantly associated with percutaneous endoscopic gastrostomy or mechanical ventilation use (p = 0.033). Prolonged hospitalization and multiple comorbidities tended to increase the MDR risk but did not reach statistical significance. Conclusions: Gram-negative MDR infections constitute an important problem in PPC units. Frequent exposure to invasive devices and antibiotics increases susceptibility to resistant pathogens. Reinforcing infection prevention, optimizing antimicrobial stewardship, and monitoring device-related infections are essential to reduce morbidity and improve care quality in pediatric palliative care. Full article

(1) Background: Medication-related problems (MRPs) are a significant burden on health care systems. Pharmacists play an important role in preventing and reducing MRPs through clinical review, education, and policy governance. This study analyzed pharmacist interventions within a 92-bed neonatal clinical care unit to better understand MRPs and guide targeted medication safety initiatives. (2) Methods: All pharmacist interventions documented in REDCap^® between 1 July 2022 and 30 June 2025 were analyzed identifying MRP incidence, types, and acceptability following interventions. (3) Results: A total of 873 pharmacist interventions were recorded during the study period. The most common MRPs were related to dosing errors (320/873, 36.7%), compliance with hospital policy (152/873, 17.4%), no indication apparent (106/873, 12.1%), drug interactions (66/873, 7.6%), and inadequate laboratory monitoring (40/873, 4.6%). Of these, 545/873, 62.4% were accepted by prescribers, while 228/873, 26.1% had unknown outcomes at the time of data entry. 343/873, 39.3% of interventions documented were from the Neonatal Intensive Care Unit, involving medications such as gentamicin (n = 46/343, 13.4%), benzylpenicillin (n = 37/343, 10.8%), caffeine (n = 34/343, 9.9%), parenteral nutrition (n = 23/343, 6.7%), and morphine (n = 16/343, 4.7%) and meropenem (n = 16/343, 4.7%)). (4) Conclusions: Regular analysis of pharmacist interventions provides valuable insights into local MRP trends and highlights opportunities for quality improvement and education. Full article

Diabetes mellitus is one of the most common health problems worldwide; however, increased blood glucose alone cannot adequately explain its pathophysiology. Although high blood glucose is a defining feature, evidence increasingly proves that diabetes arises from systemic disturbances involving the gut microbiome, immune system, and metabolic control. From this perspective, diabetes can be viewed as a systemic condition shaped by the dynamic interactions between the gut microbiome, the immune system, and metabolic pathways. Alterations in gut microbiome composition and function can influence nutrient metabolism, microbial metabolite production, bile acid signaling, and intestinal barrier integrity. Any damage of the gut barrier allows movement of microbiome-derived molecules that activate innate immune pathways and provoke chronic low-grade inflammation. This inflammatory state interferes with insulin signaling, contributes to immune maladaptation, and exacerbates metabolic dysfunction. Over time, these processes contribute to the advance of multisystem complications, including cardiovascular disease, diabetic nephropathy, neuropathy with cognitive impairment, delayed wound healing, and increased susceptibility to infection. The review also integrates environmental and public health factors, demonstrating how diet, antibiotic exposure, circadian disruption, and social conditions shape the microbiome, immune function, metabolic regulation, and disease risk across the life course. By bringing together clinical, experimental, and population-based evidence, this review illustrates the limitations of care models that concentrate only on glucose. It also points out how integrated approaches targeting the microbiome, immune system, and metabolic pathways can improve diabetes prevention, management, and guide future research. Full article

Type 2 diabetes mellitus (T2DM) is a major global public-health problem, and physical inactivity contributes to poor disease control. In settings with limited access to health services, as in the Brazilian Amazon, interventions delivered by Community Health Workers (CHWs) within Primary Health Care (PHC) may offer a pragmatic strategy to increase physical activity (PA). We aimed to evaluate the effect of a CHW-led, theory-based intervention on PA among adults with T2DM in PHC in a cluster-randomized, community-based trial. A total of 274 participants were enrolled (intervention: n = 140, control: n = 134). CHWs in the intervention group completed a blended training (e.g., asynchronous modules, printed educational materials, and hands-on guidance). They conducted six home visits over six months to support behavior change, including increased PA. PA was measured using the International PA Questionnaire (IPAQ-LF), which assessed active commuting, walking, moderate-to-vigorous PA (MVPA), and total PA. Group-by-time effects were examined using mixed-effects zero-inflated Gamma models. No significant intervention effects were observed for the conditional mean of minutes or the probability of participation in active commuting, walking, or total PA. However, for MVPA, the zero-inflated Gamma model revealed a significant intervention effect on the probability of engaging in activity. The intervention group showed a marked reduction in the likelihood of remaining at zero minutes of MVPA (Odds Ratio = 0.08; 95% CI = 0.01–0.79; p = 0.001) compared to the control group, indicating effective behavioral activation among previously inactive participants. These findings suggest that empowering CHWs to deliver structured, theory-driven interventions within PHC can reduce inactivity among high-risk adults with T2DM in underserved communities. Full article

Background: Iron deficiency (ID) is common among people with chronic kidney disease (CKD) and/or heart failure (HF). Despite the additional burden ID causes among people with CKD and HF, there is considerable uncertainty surrounding the best way to diagnose it and, subsequently, identify who is most likely to benefit from receiving iron therapy. Methods: This manuscript reports the markers and thresholds used in ID diagnosis, treatment, and management in the UK by nephrologists and cardiologists who manage people with chronic kidney disease or heart failure, as well as investigating future challenges and questions that remain unanswered. The research involved three stages: an online questionnaire, individual interviews, and a panel meeting, which discussed the findings from the first two stages. Results: The panel concluded that there is no robust definition of iron deficiency that can be applied to chronic kidney disease and heart failure. Existing methods of diagnosing iron deficiency come with various problems; a transferrin saturation of <20% is the most popular, but it is not regarded as a perfect solution. Transferrin saturation is also the most popular way of assessing the success of iron deficiency treatment. Clinicians generally do not vary treatment regimens based on severity or subgroups. There are large variations in monitoring and the ability to administer iron therapy in secondary care. Conclusions: There is a clear need to consolidate current approaches to diagnosing and treating iron deficiency in people with chronic kidney disease and/or heart failure. Simple markers and thresholds, and simple strategies to implement them are required. Full article

Introduction: Ceramic-on-ceramic (CoC) articulation in total hip arthroplasty (THA) offers excellent wear characteristics but carries risks such as liner malseating and ceramic fracture. To solve these problems, monoblock acetabular cups with preassembled ceramic liners were developed to minimize technical errors and allow the use of larger femoral heads. This study aimed to evaluate the mid-term clinical and radiological outcomes of a ceramic monoblock acetabular cup system. Methods: A retrospective analysis was performed on 106 primary THAs in South Korean patients using the Maxera monoblock cup (Zimmer Biomet) between 2015 and 2018, with a minimum follow-up of 5 years. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS). Radiologic evaluation included osteolysis and radiolucent lines. Normality of clinical variables was confirmed, and pre-to-postoperative comparisons were performed using paired t-tests. Results: The mean follow-up was 6.8 ± 1.4 years. The most common preoperative diagnosis was avascular necrosis (66.0%). Cups sized ≤52 mm were used in 80.2% of hips, allowing the frequent use of large femoral heads (32–40 mm). Clinical scores improved significantly: HHS from 37.0 ± 13.4 to 90.8 ± 6.2, WOMAC from 66.6 ± 11.5 to 7.6 ± 6.7, and VAS from 6.45 ± 1.1 to 1.1 ± 0.8 (p < 0.001). No osteolysis was observed. Radiolucent lines was appeared in four hips (3.7%) without evidence of migration or loosening. One cup fixation failure (0.9%) required revision. No cases of ceramic fracture, squeaking, or dislocation occurred. Conclusions: The ceramic monoblock acetabular cup demonstrated excellent mid-term clinical and radiological outcomes with a very low complication rate. The ability to reliably use large femoral heads likely contributed to enhanced joint stability. However, the absence of screw fixation and inability to directly visualize cup insertion require careful attention during cup impaction. Long-term studies with comparative cohorts are warranted. Full article

Background and objectives: Antiseizure medications are essential for epilepsy management but often cause adverse effects that impact treatment adherence and quality of life. This study investigates the incidence rate and determinants of high-burden adverse effects of antiseizure medications. Materials and Methods: This study was a cross-sectional study including data extraction by a medical record review and administration of a standardized scale. It was conducted at an epilepsy outpatient clinic in Saudi Arabia and included adult patients on antiseizure medications. The validated Arabic version of the Liverpool Adverse Events Profile (LAEP) was used. The total LAEP scores ranged from 19 to 76. In this study, LAEP scores ≥ 45 were classified as high-burden adverse effects. Results: Of 153 included patients, 84 (54.9%) had high-burden adverse effects. The overall mean (SD) LAEP score was 45.63 (21.04). The most frequently rated adverse effects were difficulty in concentrating, with a mean score of 2.71 out of 4, followed closely by disturbed sleep (2.69), sleepiness (2.63), and memory problems (2.56). Of examined variables, generalized seizure and polytherapy were significantly associated with increased adverse effects. Likewise, uncontrolled seizure and presence of depression comorbidity were also associated with increased risk of adverse effects, but not statistically significant. Conclusion: The study reported a high rate of adverse effects of antiseizure medications and identified patients at high risk of adverse effects. Early recognition of these patients is important to provide appropriate care, including counselling, regular monitoring, and management of psychiatric comorbidities. Central nervous system symptoms were the most frequently reported adverse effects. Initiation of antiseizure medications with low doses and gradual titration may improve tolerability. Future research should focus on prediction adverse effects using pharmacogenomic AI-based decision-making tools. Full article

Background and objective: Depression is the most common mental health problem in women during pregnancy, associated with psychological, social, and medical factors characteristic of this stage. However, a lack of knowledge and limited attention to this condition can aggravate its consequences and restrict access to appropriate treatment. This research seeks to fill a gap in the scientific literature by exploring the association between eating habits and dietary diversity with depressive symptomatology in a group with high psychosocial vulnerability: pregnant adolescents. Material and methods: A cross-sectional analytical study was conducted with a sample of 344 pregnant adolescents attending prenatal care at the National Institute of Perinatology (INPer), a tertiary care center. Non-probabilistic sampling was used for recruitment. Relevant information was collected using a pre-validated structured questionnaire administered via interview. Depressive symptomatology was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a score of ≥12 considered indicative of a higher risk of depression. Eating habits were evaluated based on meal omission, activities performed during meals, and dietary diversity, comparing them with national recommendations. Food group consumption was assessed using a semi-quantitative Food Frequency Questionnaire (FFQ). Robust variance Poisson regression models were employed to evaluate the independent association between undesirable eating habits, inadequate food group intake, and the presence of depressive symptomatology. Results: A significant association was observed between the presence of depressive symptoms (EPDS ≥ 12) and the omission of main meals. Specifically, skipping breakfast was associated with a higher prevalence of EPDS scores ≥ 12 (aPR = 1.55; 95% CI: 1.10–2.19; p = 0.013). Similarly, adolescents who skipped lunch showed a higher prevalence of depressive symptomatology compared to those who did not (aPR = 2.02; 95% CI: 1.11–3.68; p = 0.022). Regarding food groups, only insufficient intake of milk and dairy products was significantly associated with the presence of depressive symptoms (aPR: 1.78; 95% CI: 1.16–2.73; p = 0.008). Conclusions: This cross-sectional study found a significant association between breakfast skipping, distraction while eating, and inadequate dairy intake with a higher prevalence of depressive symptoms in socially vulnerable pregnant adolescents treated at a tertiary care center. However, due to the study’s design, causality or the direction of the relationship cannot be established (it could be bidirectional), and it cannot be affirmed that modifying the diet will necessarily reduce depression. Furthermore, the results are not generalizable to all pregnant adolescents, and future research (longitudinal or interventional) is needed to better understand these associations before developing specific dietary interventions. Full article

Background: Indeterminate renal masses (IRMs) frequently require biopsy for characterization and often lead to unnecessary surgical interventions. ⁸⁹Zr-girentuximab is a positron emission tomography (PET) radiopharmaceutical targeting carbonic anhydrase IX, a biomarker overexpressed in clear-cell renal cell carcinoma (ccRCC). This real-world experience demonstrates the impact of ⁸⁹Zr-girentuximab PET on the clinical management of patients with IRM and its role in differentiating primary and metastatic ccRCC from other etiologies. Methods: This prospective single-center study, part of an expanded access program (NCT06090331), investigated patients with IRM on conventional imaging who underwent ⁸⁹Zr-girentuximab PET/computed tomography (PET/CT). Qualitative and quantitative PET/CT features of each lesion were assessed. Pathologic or clinical diagnosis was determined for all lesions. Referring physicians were surveyed to evaluate the impact of PET on patient management. Results: Seven male patients (age range, 57–78 years) were included; four had ccRCC (including two with metastatic disease) and three had oncocytoma (including one with Birt-Hogg-Dubé syndrome). Across all 32 lesions identified, ⁸⁹Zr-girentuximab PET/CT accurately characterized each lesion based on pathologic or clinical diagnosis. ⁸⁹Zr-girentuximab PET/CT identified ccRCC tumor thrombi in the inferior vena cava and renal vein branches (SUV_max 12.0–13.0), a perinephric deposit (SUV_max 36.4), and intramuscular (SUV_max 103.0), pulmonary (SUV_max 4.0–10.5), and osseous (SUV_max 10.2) metastases. ⁸⁹Zr-girentuximab PET/CT enabled the diagnosis of oncocytomatosis in one patient and detected a renal lesion with positive uptake that was occult on MRI. According to referring physicians, ⁸⁹Zr-girentuximab PET/CT changed clinical management in six of seven patients and improved patient care in all cases. Conclusions: ⁸⁹Zr-girentuximab PET/CT provides a noninvasive tool for characterizing indeterminate renal masses and metastatic ccRCC and may improve clinical problem-solving in complex scenarios. Full article

Oral health in older adults is a critical component of overall well-being requiring integrated, interdisciplinary approaches to address its complex interplay of medical, functional, and psychosocial challenges. The aim of this is to examine strategies to enhance interdisciplinary collaboration among dental professionals, physicians, nurses, nutritionists, and caregivers to improve oral health outcomes in aging populations. Older adults commonly face dental problems such as periodontal disease which can be exacerbated by polypharmacy, systemic diseases, and barriers to accessing care. These multifaceted needs necessitate coordinated efforts across dentistry, geriatric medicine, nursing, and social support systems. Strategies of effective interdisciplinary care include: (1) Medical-dental integration, enabling physicians to screen for oral health issues during routine assessments; (2) Nursing and caregiver engagement in daily oral hygiene support and early problem identification; (3) Nutritional interventions tailored to address chewing difficulties and prevent malnutrition; (4) Social support systems to improve access to affordable care; and (5) Technology-driven solutions such as tele-dentistry to enhance communication, early detection, and care coordination. Despite these opportunities, systemic barriers persist, including fragmented healthcare systems, financial constraints, workforce shortages, cultural biases, and technological gaps. Progress requires commitment from policymakers, healthcare institutions, and health care professionals to prioritize geriatric oral health as a public health imperative. In conclusion, interdisciplinary collaboration enhances older adults’ oral-systemic health via cross-sector policies and healthcare workforce education. Implementing these strategies can mitigate oral health disparities, reduce the burden of chronic diseases, and improve quality of life for aging populations through holistic, patient-centered care. Full article

Background: The aim of this study was to examine the relationship between anxiety levels, emotional intelligence, and stress coping strategies in individuals diagnosed with personality disorders. According to Lazarus and Folkman’s transactional model of stress, the appraisal of stressors and available psychological resources determines the selection of coping strategies—whether adaptive or maladaptive. Material and Methods: This observational case series study involved 30 individuals diagnosed with personality disorders (ICD-10 codes F60 and F61). Psychological assessments were conducted at two time points: upon admission to a day-care psychiatric unit and after three months of standard therapeutic intervention. The following standardized instruments were administered: the State-Trait Anxiety Inventory (STAI), the Emotional Intelligence Questionnaire (INTE), and the Mini-COPE Inventory for Coping with Stress. Results: Elevated levels of anxiety—particularly trait anxiety—were significantly associated with maladaptive coping strategies, including denial and self-blame. Conversely, higher emotional intelligence was positively correlated with the use of adaptive coping mechanisms, such as planning and proactive problem-solving. Conclusions: The findings support the hypothesis that both anxiety and emotional intelligence are significant predictors of stress coping styles in individuals with personality disorders. The results underscore the importance of considering these psychological variables in the design and implementation of therapeutic programs. Enhancing emotional intelligence may substantially improve treatment outcomes and overall psychological functioning in this clinical population. However, further studies with larger sample sizes are needed. Full article

Background/Objectives: Assessing psychosocial burden in families can help identify those at risk and prevent negative effects on children’s well-being. This study (1) describes the longitudinal stability of psychosocial risk patterns; (2) examines group differences in the home learning environment as protective factors and in child behavior problems as an outcome; and (3) tests the moderating role of home learning activities on child behavior problems. We further explore associations with the use of institutional childcare. Methods: Data from 1459 children aged 0–6 years from the representative longitudinal study AID:A 2019 were analyzed across two time points (T1: 2019, T2: 2023). We tested differences in children’s behavioral problems according to risk patterns, home learning environment, and control variables, including institutional care and support service use. Results: The shares of families categorized as low-burdened, economically burdened, parenting-stress-and-conflict-burdened and multiple-burdened remained stable over time, even though individual stability was only moderate. Children in families with parenting stress and conflict as well as those from multiple-burdened families more frequently displayed behavioral problems at T2 than other groups. Educational activity was a protective factor for behavioral problems for most groups, but was a risk factor in conflict-and-stress-burdened families. Similar results were found for the use of universal social/educational prevention services. Conclusions: For most families, a better home learning environment appears to act as a buffer against the effect of risk group membership on children’s emotional well-being. However, in families marked by stress and conflict, the frequency of time together might not be beneficial—possibly because the quality of interactions matters more than the quantity. Universal social and educational services might be a place to address these families and develop targeted support. Full article

With more renewables being integrated into distribution grids, the problem of voltage fluctuation has become prominent. Effective Volt/VAR regulation is a commonly used method to ensure the safe operation of distribution networks. Model-based approaches tend to work well only if detailed network parameters are available, while data-driven approaches can suffer from overfitting and may not generalize well. We created the PHY-GAT-SAC framework to address these issues. Physics-regularized reinforcement learning uses bidirectional graph attention, which combines a physics-informed model with a safety projection method that relies on sensitivity matrices. This makes it so that the voltage regulation is practical, interpretable, and secure. The framework works with two combined branches. One branch takes care of the nonlinear mapping from power injections to voltage states using a forward graph encoder and a reverse consistency constraint. At the same time, another branch extracts features directly from the voltages to improve the perception of system violation risk. The framework has a sensitivity-based safety layer as well. This layer projects every control action into a feasible area formed by linearized voltage restrictions, thus securing operation safety. Experiments on an IEEE 33-node system show that the framework works well. A safety layer guarantees a safe operating range without exact impedance values. And PHY-GAT-SAC greatly lowers voltage violations compared to multi-agent deep reinforcement learning. By successfully combining physics with learning, this study gives a unified framework for merging graph neural networks and reinforcement learning within intricate grid management. Full article

Objectives: Anticipated telehealth use is an important determinant of whether telehealth can function as a durable component of hybrid care models. However, there are limited practical tools to identify patients at risk of discontinuing telehealth. We aim to (1) identify factors associated with anticipated telehealth use; (2) develop a risk stratification tool (CONTEST); (3) compare its performance with machine learning (ML) models; and (4) evaluate model fairness across sex and race/ethnicity. Methods: We conducted a retrospective cross-sectional analysis of the 2024 Health Information National Trends Survey 7 (HINTS 7), including U.S. adults with ≥1 telehealth visit in the prior 12 months. The primary outcome was anticipated telehealth use. Survey-weighted multivariable logistic regression informed a Framingham-style point score (CONTEST). ML models (XGBoost, random forest, logistic regression) were trained and evaluated using the area under the receiver operating characteristic curve (AUROC), precision, and recall. Global interpretation used SHAP values. Fairness was assessed using group metrics (Disparate Impact, Equal Opportunity) and individual counterfactual-flip rates (CFR). Results: Approximately one-third of adults reported at least one telehealth visit in the prior year. Among these users, nearly one in ten expressed an unwillingness to continue using telehealth in the future. Four telehealth experience factors were independently associated with unwillingness to continue: lower perceived convenience, technical problems, lower perceived quality compared to in-person care, and unwillingness to recommend telehealth. CONTEST demonstrated strong discrimination for identifying individuals with lower anticipated telehealth use (AUROC 0.876; 95% CI, 0.843–0.908). XGBoost performed best among the ML models (AUROC 0.902 with all features). With the same four top features, an ML-informed point score achieved an AUROC of 0.872 (95% CI, 0.839–0.904), and a four-feature XGBoost model yielded an AUROC of 0.893 (95% CI, 0.821–0.948, p > 0.05). Group fairness metrics revealed disparities across sex and race/ethnicity, whereas individual counterfactual analyses indicated low flip rates (sex CFR: 0.024; race/ethnicity CFR: 0.013). Conclusions: A parsimonious, interpretable score (CONTEST) and feature-matched ML models provide comparable discrimination for stratifying risk of lower anticipated telehealth use. Sustained engagement hinges on convenience, technical reliability, perceived quality, and patient advocacy. Implementation should pair prediction with operational support and routine fairness monitoring to mitigate subgroup disparities. Full article