Search Results (261)

Background: Cardiac tumors are rare neoplasms with a wide spectrum of clinical presentations, ranging from asymptomatic cases to fatal outcomes. According to the 2021 thoracic tumor classification of the World Health Organization (WHO), papillary fibroelastoma (PFE) is the most common primary cardiac tumor. This study aimed to aggregate and examine data regarding the prevalence, clinical characteristics, and histological results of cardiac tumors. Methods: This multicenter retrospective study was conducted across seven tertiary care institutions and included 274 patients diagnosed with histopathologically confirmed cardiac tumors between January 2013 and December 2024. Results: This study included 274 patients, with an average age of 52.6 ± 16.6 years. Of the study participants, 120 (43.8%) were male and 154 (56.2%) were female. The most prevalent clinical manifestations were dyspnea (43.7%), thoracic pain (22.5%), and cardiac palpitations (21.1%). Echocardiography was the principal diagnostic method, revealing an average tumor size of 3 cm. The most commonly observed mass was cardiac myxoma (CM) in 192 patients (70.1%). The second most frequently detected mass was PFE (28 cases, 10.2%). The third most common cardiac mass was a metastatic tumor (6.9%). Surgical resection was performed in all patients, with infection being the most prevalent consequence, followed by effusion. Conclusions: Cardiac tumors, albeit uncommon, provide considerable diagnostic and treatment difficulties. Our research is founded on an extensive case series that has been histopathologically validated and sourced from various national tertiary centers. This comprehensive dataset offers epidemiological and clinical insights regarding heart tumors in Turkey. Another key finding of our study is that, even though the 5th edition of the 2021 WHO Classification of Thoracic Tumors lists PFE as the most common primary cardiac tumor, myxoma is actually the most common primary cardiac tumor in our study and in many other studies. This finding demonstrates a significant discrepancy between the current international classification and real-world data and suggests that tumor distribution may be related to regional and demographic differences. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article

Background/Objectives: Neurodegenerative proteinopathies, such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB), are increasingly prevalent worldwide mainly due to population aging. These conditions are marked by complex etiologies, overlapping pathologies, and progressive clinical decline, with significant consequences for patients, caregivers, and healthcare systems. This review aims to synthesize evidence on the healthcare complexities of major neurodegenerative proteinopathies to highlight current knowledge gaps, and to inform future care models, policies, and research directions. Methods: We conducted a comprehensive literature search in PubMed/MEDLINE using combinations of MeSH terms and keywords related to neurodegenerative diseases, proteinopathies, diagnosis, sex, management, treatment, caregiver burden, and healthcare delivery. Studies were included if they addressed the clinical, pathophysiological, economic, or care-related complexities of aging-related neurodegenerative proteinopathies. Results: Key themes identified include the following: (1) multifactorial and unclear etiologies with frequent co-pathologies; (2) long prodromal phases with emerging biomarkers; (3) lack of effective disease-modifying therapies; (4) progressive nature requiring ongoing and individualized care; (5) high caregiver burden; (6) escalating healthcare and societal costs; and (7) the critical role of multidisciplinary and multi-domain care models involving specialists, primary care, and allied health professionals. Conclusions: The complexity and cost of neurodegenerative proteinopathies highlight the urgent need for prevention-focused strategies, innovative care models, early interventions, and integrated policies that support patients and caregivers. Prevention through the early identification of risk factors and prodromal signs is critical. Investing in research to develop effective disease-modifying therapies and improve early detection will be essential to reducing the long-term burden of these disorders. Full article

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

Background/Objectives: There is a need for randomized clinical trials with higher quality, especially for older people at high risk of falls, with interventions that consider individual needs, comprehensiveness of care, and connection with primary health care. We designed a randomized controlled trial to examine the effects of a case management intervention combined with a physical exercise protocol on risk factors for falls, falls data, adherence, satisfaction, costs, and implementation in community-dwelling older adults with high risk of falls. Methods: A minimum of 60 community-dwelling older people with high falls risk will participate in the randomized controlled assessor-blinded trial (MAGIC—v. 2). The trial will be conducted in a regional health department of São Paulo state (Brazil), which includes 6 cities. Participants will be randomized to the Intervention Group (case management intervention based on all individual risk factors for falls identified by a multidimensional assessment, over 16 weeks, once a week, by telephone calls). Both groups will perform a physical exercise protocol based on falls prevention for 16 weeks (twice a week) in Health Units. The assessment will be performed at baseline, after 16 weeks of intervention, after 6-month follow-up, and after 12-month follow-up. Primary outcome measures include falls data and potentially modifiable risk factors for falls. Discussion: This study has the potential to facilitate the future implementation of the intervention based on case management with a focus on fall prevention in the health sectors. Trial registration: Brazilian Registry of Clinical Trials (ReBEC). Full article

Obesity is a global epidemic with substantial health and economic impacts, making scalable weight management strategies essential. A comprehensive synthesis of eHealth interventions for weight management is needed to guide clinical practice. This umbrella review evaluated mobile and web-based interventions for weight loss in adults with overweight or obesity, compared to conventional or non-intervention controls. Systematic reviews were identified across five electronic databases from inception to February 2025. Two reviewers independently selected studies and assessed methodological quality using AMSTAR 2. Pooled estimates were calculated using random-effects models. Eleven systematic reviews (261 primary studies, 62,407 participants) were included. Mobile app interventions yielded a significant reduction in body weight (MD = −1.32 kg; I² = 82%), as did long-term eHealth interventions (MD = −1.13 kg; I² = 76%). Most meta-analyses showed high heterogeneity. Web-based interventions showed no significant effect. In conclusion, mobile apps and long-term eHealth interventions resulted in modest but statistically significant reductions in body weight, body mass index, and waist circumference. The evidence for web-based approaches remains inconclusive. Further research should focus on low-resource settings, primary care, and the integration of emerging technologies such as artificial intelligence. (PROSPERO CRD42025644218). Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with rural populations experiencing higher prevalence and worse outcomes. This paper explores the transformative potential of nurse-led palliative care models in addressing the unique challenges faced by rural patients with COPD and their informal caregivers and synthesizes current evidence on nurse-led palliative care interventions, highlighting their impact on symptom management, advance care planning, and psychosocial support. Methods: This is a comprehensive synthesis of nurse-led palliative care programs, focusing on home-based care, telehealth, community outreach, and primary care integration. Results: Nurse-led interventions significantly improve patient satisfaction, reduce symptom burden, and enhance the likelihood of advance care planning discussions. Home-based care models and telehealth are particularly effective in rural settings, offering accessible and continuous support. Conclusions: Nurses have a critical role in bridging the palliative care gap for rural patients with COPD and their informal caregivers. Expanding nurse-led palliative care services can improve quality of life, reduce healthcare utilization, and promote health equity. Future research should focus on long-term outcomes, cost-effectiveness, and strategies for scaling nurse-led palliative care programs in rural contexts. Full article

Introduction: Visual impairment impacts millions of people around the world, with the vast majority of problems being treatable. Disadvantaged communities are unable to utilize the same resources to treat these problems due to a lack of knowledge or resources, in addition to the presence of barriers preventing access. The objective of this paper is to assess eye health awareness and evaluate the barriers for individuals from disadvantaged communities in order to inform future interventions and increase access to care. Methods: This is a pilot study utilizing an online anonymous questionnaire designed to assess the demographics, eye health awareness, and access to eye care of community-based patients. A comprehensive literature review was also conducted using PubMed, Scopus, and Google Scholar to evaluate barriers to eye care and methods to improve community health outcomes. The primary goal was to improve understanding of eye health awareness and access in order to inform future strategies that can help in improving eye health awareness and service availability. Results: The results indicated that 61.2% of respondents believed that eye exams are very important, and only 7.7% of participants believed that regular eye exams are not important. The majority of participants (75%) agree that regular eye exams help prevent serious eye conditions and 84.5% believe that eye health can affect quality of life. 35.6% of participants reported they had their eyes checked by a healthcare professional within the last year, while 21.2% reported never having an eye exam. Although the majority of participants found access to eye care services in their community somewhat or very easy, 8.6% and 9.5% of participants found access difficult and very difficult, respectively. Even though 45.6% of participants reported not facing any barriers regarding access to eye care, the cost of services, long waiting times, and lack of nearby eye care providers were often cited as barriers from the remainder of the participants. Moving forward, local interventions such as mobile eye clinics, public health workshops, and telehealth are viable options to obtain an understanding of the community’s health status in addition to creating opportunities to educate and provide health screenings. Conclusion: The results indicate that although there is awareness of the importance of eye health for the majority of participants, there is still a sizable minority who have insufficient understanding. Barriers to healthcare such as cost, waiting times, and proximity to providers are common problems that are preventing many from seeking eye care. Future interventions should be created to increase access and literacy amongst the community through telehealth, mobile eye clinics, and public health workshops. Additional efforts should be taken by healthcare stakeholders to enhance care delivery, implement policies, and improve awareness. Full article

Background/Objective: Nurses play a critical role in addressing climate change. They are instrumental in both mitigation and adaptation to its effects. Through care provision, education, management, policy development, and research, nurses can undertake a variety of specific actions in response to climate change. However, their perceptions of this challenge remain under-researched. This study aims to investigate Spanish nurses’ knowledge of climate change and its impact on health. Methods: This is a qualitative descriptive study based on the constructivist paradigm. Purposive and snowball sampling strategies were used to recruit nurses from emergency services, geriatrics, cardiology, respiratory medicine and primary care in nine different regions of Spain. Semi-structured online interviews were conducted. Data analysis was carried out by three researchers via a three-stage inductive thematic analysis approach. Results: The sample consisted of 31 nurses, predominantly women (77.42%), with a mean age of 41 years. Seventy percent of the participants had less than 15 years of experience in the service. Four categories were identified: (i) general knowledge of climate change; (ii) knowledge of climate change and health; (iii) knowledge of actions to address climate change; and (iv) knowledge development. Overall, the nurses demonstrated awareness of the risks posed by climate change as well as actions to respond. However, barriers such as a lack of formal training and eco-anxiety affect their knowledge acquisition. Conclusions: Nurses play an important role in the response to climate change. However, more comprehensive and higher-quality educational programmes, provided by academic institutions, workplaces, and professional associations, are needed. This study was prospectively registered with the Clinical Research Ethics Committee of the Cuenca Health Area on 25 January 2022 (registration number 2021/PI3721). Full article

Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the Western world, predominantly affecting older individuals. Advances in targeted therapies have extended survival, shifting the clinical focus toward the management of chronic health challenges. Patients with CLL often experience immune dysfunction due to both the disease and its treatments, resulting in an increased susceptibility to infections and second primary malignancies. This review outlines evidence-based strategies for preventive care in CLL, including age-appropriate cancer screenings, routine immunizations, and lifestyle modifications. By emphasizing proactive health maintenance, this article aims to support clinicians in delivering comprehensive, long-term care for patients with CLL. Full article

Introduction: Chemotherapy is a primary treatment option in human and veterinary oncology. Like humans, canine patients often develop drug resistance. Comparative oncology is gaining increasing interest, and spontaneous tumors of companion dogs have emerged as a powerful resource for better understanding human cancer. The genetic, molecular, and histological features of tumors in dogs are more closely related to those in humans than the ones in laboratory animals, including complex mechanisms of drug resistance. Methods: A comprehensive literature search was conducted in the electronic database Clarivate Web of Science (WOS): Medical Literature Analysis and Retrieval System Online (MEDLINE) from 1990 to 2025 (updated 22 January 2025). The final set includes 59 relevant full-text English articles. Results: The literature findings suggest that canine spontaneous tumors are valuable model systems with important translational implications for identifying novel mechanisms of chemotherapy resistance shared with humans and may help advance the current standard of care in precision medicine. Conclusions: We have provided an updated overview of the role of canine tumor models to study oncotherapy resistance, focusing on limitations and opportunities for advancement. Despite complementary benefits of such models in translational oncology research, their relevance remains underestimated. Strengthening the collaboration between human and veterinary medicine professionals and comparative medicine researchers, and obtaining the support of interdisciplinary institutions, could contribute to addressing the problem of multidrug resistance for both human and canine patients. Future research may promote using canine spontaneous tumors as translational therapeutic models for human chemoresistance, through a multidisciplinary approach based on the emerging “One Health, One Medicine” paradigm. Full article

Background: European health systems are shifting toward more proactive, person-centered models, thereby highlighting the need to strengthen nurses’ clinical leadership in primary care. Nurse demand management (NDM) has emerged as an innovative practice which allows nurses to autonomously and comprehensively respond to a population’s health needs. However, knowledge on its implementation varies widely, often being intuitive, partly due to the absence of standardized evaluation tools. The xGID instrument aims to measure the degree of NDM adoption in primary care teams (PCTs), activating collective intelligence mechanisms to foster shared diagnosis, organizational reflection, and the generation of targeted recommendations. Methods: We designed and implemented xGID in 47 PCTs in Catalonia, involving 1474 healthcare professionals. Data were collected through structured surveys assessing key dimensions of NDM adoption, including professional autonomy, teamwork, continuity, and accessibility. Results: Overall adoption of NDM was high, with a mean score of 7.6 out of 10. Notable differences emerged between professional groups and practice areas. Nurses tended to be more critical of teamwork, longitudinal care, and accessibility, reflecting the central yet high-pressure role they play in NDM. High-scoring dimensions included professional autonomy and the capacity to act across multiple domains, whereas weaker areas pointed to systemic organizational challenges. Conclusions: The preliminary findings indicate that a standardized tool for NDM evaluation is a cornerstone for identifying contextual barriers and guiding the transformation of care models. Its participatory and strategic approach offers novel pathways to embed data-driven decision-making into daily clinical practice, consolidating NDM as a key pillar of future primary care. Full article

The COVID-19 pandemic disproportionately impacted youth with chronic physical illness (CPI) and their caregivers. Emerging research aimed at understanding the impacts of the pandemic on this population is predominantly quantitative, lacking qualitative insights. This study used a qualitative approach to examine the experiences of COVID-19 among youth with CPI and their families, exploring how the pandemic impacted their mental health and use of mental health services. Using a constructivist paradigm and a phenomenological approach, semi-structured interviews were conducted with youth with CPI (n = 8) and their primary caregiver (n = 13) between March 2021 and May 2021. Thematic analysis was used to identify three key themes: (1) mental health impact on youth, (2) caregiver mental health declines, and (3) variability in the experiences of mental healthcare. The findings highlight the heightened depression, anxiety, and stress among youth with CPI and their caregivers, exacerbated by loneliness, uncertainty, and social restrictions, while also revealing that virtual mental healthcare was perceived as less effective than in-person care, which was valued for its human connection, privacy, and comfort. These results emphasize the need for improved, comprehensive mental healthcare and the adoption of family-centred care models to strengthen caregiver–youth relationships and better integrate physical and mental healthcare to improve health outcomes for this population. Full article

Background: The ageing of the population and the progressive increase in chronic diseases represent a major challenge for healthcare systems. The community nurse case manager (CNCM) is emerging as a key figure to provide comprehensive and continued care for complex and pluripathological chronic patients (CPCPs), especially after hospital discharge. Objective: The aim of this study is to pilot CNCMs in assisting CPCPs and assess their effects on functional capacity, cognitive performance, quality of life, readmissions, clinical parameters, satisfaction with home care, and caregiver overload. Methods: A comparative study will be carried out at two health centres in Salamanca (Spain). In both centres, CPCPs will continue to receive the interventions included in the Castilla y León Health System Portfolio from their primary care (PC) nurses. In the intervention centre, case management provided by a CNCM will be added. We will recruit 212 CPCPs with cardiac or respiratory disease and/or diabetes mellitus who are dependent for basic activities of daily living and have a programmed hospital discharge. An initial assessment will be performed at home after discharge, followed by assessments at 3, 6, and 12 months. Expected results: The intervention is anticipated to improve all study outcomes. Discussion: CNCMs may contribute to more proactive and individualised follow-up care for CPCPs and their caregivers, improving care coordination. Conclusions: This study will help to evaluate the feasibility and clinical relevance of incorporating the CNCM’s role into PC. This study was registered at ClinicalTrials.gov with the identifier NCT06155591. The date of trial registration was 24 November 2023. Full article

Osteoporosis is the most common metabolic bone disorder, characterized by reduced bone mass and abnormal bone microarchitecture, resulting in increased bone fragility and a heightened risk of low-energy fractures. Pediatric osteoporosis may be either primary, due to genetic factors, or secondary, arising from chronic diseases and/or their treatment. Oral health and proper occlusion are integral components of overall health, influencing functionality, nutrition, facial aesthetics, and psychosocial development during childhood. Severe malocclusion can adversely affect speech, mastication, appearance, psychological well-being, and social interactions. The aim of this narrative review is to examine the existing literature on orthodontic anomalies and management strategies in pediatric patients with osteoporosis while highlighting clinical challenges, treatment limitations, and areas necessitating further research. A comprehensive literature search was conducted in the PubMed database, focusing on studies involving human subjects aged 3 to 18 years, published in English between 2002 and 2024. The findings indicate that children with osteoporosis present with more severe dental and occlusal complications compared to their healthy peers, often facing increased orthodontic complexity due to skeletal fragility and systemic comorbidities. These challenges necessitate careful, individualized treatment planning and close multidisciplinary collaboration. Although research in this field remains limited due to the rarity of pediatric osteoporosis, recognizing and addressing the specific needs of this population is critical to improving clinical outcomes and guiding future therapeutic approaches. Full article