Search Results (895)

Chronic pancreatitis (CP) precipitates complex malnutrition through synergistic mechanisms: exocrine pancreatic insufficiency–driven maldigestion, duodenal or pancreatobiliary strictures limiting nutrient flow, cholestasis impairing micelle formation, alcohol-related anorexia, pain-induced hypophagia, proteolytic catabolism from type 3c diabetes, and a chronic inflammatory milieu that accelerates sarcopenia and bone demineralisation. Consequent calorie–protein depletion, micronutrient and fat-soluble vitamin deficits, and metabolic derangements markedly amplify morbidity. Pancreatic enzyme replacement therapy (PERT) with targeted micronutrient repletion is foundational; high-protein regimens co-administered with PERT curb muscle loss, and medium-chain triglycerides (MCTs) can augment caloric delivery by bypassing lipase dependence, although their benefit over personalised dietetic counselling is marginal. Optimal dietary fat thresholds and timing of escalation from oral to enteral or parenteral feeding remain unresolved. Comprehensive care also demands alcohol abstinence, effective analgesia and stringent glycaemic control. Serial monitoring—biochemical indices, densitometry, dual-energy X-ray absorptiometry and imaging-based body-composition metrics—permits early detection of high-risk patients and precision tailoring of interventions. Intensified multidisciplinary programmes already improve prognostic endpoints and are unveiling biomarkers of nutritional resilience. A structured, evidence-based strategy integrating PERT, macronutrient engineering, micronutrient repletion and metabolic surveillance is essential to mitigate nutrition-related morbidity, enhance long-term outcomes and optimise quality of life in CP. Full article

Background: This systematic review aims to summarize the most recent data from the literature on the psychological aspects of parents of children prenatally diagnosed with congenital heart defects (CHDs). Methods: A comprehensive literature search was conducted to identify relevant studies on the psychological issues faced by parents of children prenatally diagnosed with CHD. Searches were performed in multiple scientific databases, including PubMed, Science direct, Embase, Scopus, Medline, Clarivate, to ensure the broad coverage of the literature. The search was limited to studies published up until February 2025. The search strategy included the following terms and combinations: “congenital heart defect” OR “CHD” AND “prenatal diagnosis” AND “psychological impact” OR “parental distress” OR “coping”. Results: Eighteen studies involving the 673 parents of fetuses diagnosed with congenital heart defects were included. Studies spanned four continents and employed both qualitative (n = 14) and quantitative (n = 4) designs. Key psychological outcomes reported were anxiety, depression, stress, post-traumatic stress, coping strategies, maternal–fetal attachment, and life satisfaction. Anxiety and depression were the most frequent issues, with maternal anxiety reaching 65% and depression up to 45.7%. Stress related to diagnostic uncertainty was common. While some parents used adaptive coping (social support, emotional regulation), others experienced maladaptive patterns such as avoidance. One study reported increased maternal–fetal attachment following prenatal CHD diagnosis. Predictors of psychological distress included time of diagnosis, parental gender, education level, social support, and severity of the defect. Recommended interventions included early psychological screening, empathetic communication, structured counseling, and long-term emotional support. Despite heterogeneity in design and moderate overall bias, findings highlight a consistent psychological burden among parents, underscoring the need for integrated psychosocial care following a prenatal CHD diagnosis. Conclusions: Parents whose children have been prenatally diagnosed with a congenital heart defect are at an increased risk for psychological distress. To improve the quality of care, a multidisciplinary team is needed to provide parents with the necessary information on diagnosis, interventions, and potential outcomes. Full article

Background: Unplanned pregnancy is a public health issue and understanding women’s decision making aids practitioners in assessing fertility trends, contraception use, and family planning counselling. In Italy, Catholicism reinforces ‘natural reproduction’ and ‘traditional’ contraception, making it an ‘Imperfect Contraceptive Society.’ A valid and reliable measure of pregnancy intentionality is increasingly important, and the London Measure of Unplanned Pregnancy (LMUP) has proved effective. Objectives and Methods: This study comprised four stages: (1) English–Italian translation and back-translation to create the Italian version [LMUP-IT]; (2) online data collection from postnatal women; (3) evaluation of its psychometric properties (targeting, reliability, construct validity via CFA and measurement invariance with a UK sample, ‘known groups’ hypothesis testing); and (4) exploratory analysis of its associations with perinatal mental health. The sample comprised 450 postnatal women (M_age = 33.6 ± 4.5). Results: The LMUP-IT was shown to be reliable (ωT = 0.81, α = 0.76), with acceptable targeting. Measurement invariance testing confirmed consistency with the UK sample in factor structure, loadings, intercepts, and errors. LMUP-IT scores significantly correlated with well-known indicators of perinatal mental health. Conclusions: Overall, the LMUP-IT is a reliable measure of pregnancy intention in Italian for postpartum women. Understanding pregnancy intention will help healthcare professionals tailor interventions to better support women’s mental health during the transition to motherhood. Full article

Background: University students are vulnerable to depression due to the transitional nature of their life stage, which often involves increased academic pressures and social changes. This study aims to examine the prevalence, symptoms, and associated risk factors for depressive symptoms among undergraduate students at non-medical universities. Methods: This cross-sectional study was conducted at non-medical universities in Mwanza Region, Tanzania. A self-administered, structured questionnaire was used to collect the data. The presence and severity of depressive symptoms were assessed using the Beck Depression Inventory (BDI-II). Results: A total of 768 students participated in the study. The prevalence of depressive symptoms was 35.7%. A significant proportion experienced loss of interest and pleasure (n = 516; 67.2%), felt easily tired (n = 373; 48.6%), and had difficulty making decisions (n = 303; 39.4%). A significant relationship was observed between age and depressive symptoms, with participants aged 25 and above reporting higher rates of depressive symptoms (53.2%) compared to those aged 18–24 (28.8%) (p < 0.001). Similarly, the year of study was significantly associated with depressive symptoms; fourth-year students had the highest proportion of depressive symptoms (64.3%), while first-year students had the lowest proportion (26.2%) (p < 0.001). Conclusion: This study found that over one-third of undergraduate students in non-medical universities suffer from depressive symptoms. This high prevalence rate highlights an urgent need for targeted mental health interventions within university settings to prevent long-term academic, social, and psychological consequences. Campus counseling services should prioritize screening for key symptoms while developing stress-management programs tailored to academic progression challenges. Full article

Background/Objectives: Women with Polycystic Ovary Syndrome (PCOS) often report difficulties adhering to dietary interventions due to a combination of physiological and psychological barriers. Therefore, this study explores the feasibility of a Mediterranean diet (MedDiet) intervention as an effective and acceptable dietary approach for managing PCOS. Methods: Women with PCOS and a BMI ≥ 25 kg/m², aged 18–45 years were randomized to an ad libitum MedDiet or Healthy Eating (HE) diet (control). The 12-week intervention incorporated fortnightly, personalized dietary consultations and tailored resources. Primary outcomes were measures of feasibility, including recruitment metrics, data collection methods, and intervention adherence. Acceptability was examined using semi-structured interviews and surveys for those randomized to the MedDiet. Results: Study promotion resulted in n = 380 interested individuals; a total of n = 26 were randomized to either a MedDiet (n = 12) or HE (n = 14) group. Data collection was mostly appropriate as demonstrated by the collection of 100% of anthropometric and biochemical data; however, only 69% of the 4-day food records were returned. Participants reported the intervention was acceptable, and adherence was enhanced through individualized counselling and the provision of practical resources. At week 12, adherence was significantly greater in the MedDiet group compared to HE (8.1 ± 2.4 vs. 4.6 ± 1.0; p = 0.002). Adherence significantly improved from baseline to week 12 in both groups (MedDiet: 3.67 ± 1.32; 8.11 ± 2.37; p ≤ 0.001; HE: 3.57 ± 1.27; 4.57 ± 0.98; p = 0.02). Conclusions: We showed that a 12-week pilot MedDiet intervention is feasible and acceptable for women with PCOS and a BMI ≥ 25 kg/m². Future investigation warrants a larger, adequately powered study which addresses challenges to recruitment, attrition and collection of dietary intake data. Full article

Background/Objectives: Orchialgia following kidney donation is an underrecognized complication with reported incidence varying dramatically between retrospective (2–3%) and prospective (44–55%) studies, suggesting significant underreporting. This study aimed to determine the incidence, characteristics, and clinical relevance of orchialgia in male kidney donors within 2 years post-donation using direct patient assessment. Methods: This is a cross-sectional study of 100 male donors (64.5% response rate) from 155 eligible donors approached who underwent left laparoscopic donor nephrectomy between February 2021 and 2023. Donors completed a literature-based 15-item questionnaire at routine follow-up visits assessing testicular pain characteristics, timing, and impact. Results: Orchialgia occurred in 48% (48/100) of donors. Early onset (≤14 days) occurred in 47%, with median onset at day 2 (range 1–14). At 3-month follow-up, 37% reported persistent pain; by 1 year, only 0.8% experienced persistent pain based on our 10-year institutional database. No significant difference in incidence between altruistic (54%) and related donors (33%), though pain severity was lower in altruistic donors (mean 3.6 vs. 4.2, p = 0.04, independent t-test). Conservative management was effective in all cases; no invasive interventions were required. Conclusions: Orchialgia affects nearly half of male kidney donors when directly assessed, though it follows a benign, self-limiting course with minimal long-term clinical impact. These findings support enhanced preoperative counseling while reassuring donors about favorable outcomes. Full article

Sexual dysfunction affects an estimated 50–70% of cancer survivors but remains underrecognized and undertreated, impacting quality of life and emotional well-being. This narrative review involves a comprehensive search of PubMed/MEDLINE, CINAHL, Scopus, Web of Science, and ScienceDirect for English-language publications (January 2010–May 2025), using combined MeSH and free-text terms for ‘sexual health’, ‘cancer’, ‘nursing’, ‘roles of nurses’, ‘immunotherapy’, ‘targeted therapy’, ‘sexual health’, ‘sexual dysfunction’, ‘vaginal dryness’, ‘genitourinary syndrome of menopause’, ‘sexual desire’, ‘body image’, ‘erectile dysfunction’, ‘climacturia’, ‘ejaculatory disorders’, ‘dyspareunia’, and ‘oncology’. We used the IMRAD (Introduction, Methods, Results, and Discussion) approach to identify 1245 records and screen titles and abstracts. Fifty studies ultimately met the inclusion criteria (original research, reviews, and clinical guidelines on oncology nursing and sexual health). Results: All the treatments contributed to reduced libido, erectile dysfunction, dyspareunia, and body image concerns, with a prevalence of 57.5% across genders. Oncology nurses can provide sex education and counseling. Barriers (limited training, cultural stigma, and the absence of protocols) hinder effective intervention. Addressing these issues through sexual health curricula, formal referral systems, and policy reforms can enhance nursing care. Future research should assess the impact of targeted nurse education and the institutional integration of sexual health into cancer care. Full article

Background: Genomic information is becoming integral to nursing practice, yet undergraduate curricula often provide limited opportunities to apply this knowledge in realistic settings. Objective: To evaluate the impact of a clinical simulation-based intervention on nursing students’ learning of genetic counseling, with a focus on knowledge acquisition, communication skills, and student satisfaction. Methods: A sequential mixed-methods study was conducted with 30 third-year nursing students enrolled in the elective Genetics Applied to Health Sciences. Quantitative data comprised (i) pre-/post-simulation knowledge tests, (ii) a satisfaction questionnaire, and (iii) final course grades, which were compared with grades of a cohort from the previous academic year that had no simulation component (n = 28). Qualitative insights were gathered through field notes and semi-structured interviews with six purposively selected participants. During the intervention each student rotated through the roles of genetic-counseling nurse, patient, and observer, followed by a facilitated debriefing. Results: Post-simulation knowledge scores and final course grades were significantly higher than both baseline values and the historical comparison cohort. Students reported very high satisfaction, highlighting the authenticity of the scenarios and the usefulness of immediate feedback. Qualitative analysis showed that role rotation fostered deeper understanding of counseling complexities, improved empathic communication, and bolstered self-confidence when discussing hereditary risk. Conclusions: Embedding standardized-patient simulation into undergraduate genetics courses measurably improves students’ knowledge, communication proficiency, and satisfaction. These findings support incorporating similar simulation-based learning activities to bridge the gap between theoretical genetics content and real-world nursing practice. Full article

Background: Lateral tibial hemiepiphysiodesis with tension band plates is an established method for correcting genu varum in skeletally immature patients. However, outcomes may vary depending on underlying pathology and patient characteristics. Methods: This retrospective cohort study evaluated 31 patients (53 knees) treated between 2011 and 2024 at a tertiary pediatric orthopedic center. Patients were categorized as idiopathic or non-idioathic genu varum based on diagnosis. Inclusion criteria required open physes, absence of previous or concomitant knee surgeries for alignment correction, and availability of standardized long-standing radiographs. Radiographic parameters, including mechanical axis deviation (MAD), hip–knee–ankle angle (HKA), and medial proximal tibial angle (MPTA), were assessed pre-operatively and at implant removal. Outcomes were classified as complete correction, partial correction, absent correction, overcorrection, or progression of deformity. Results: Overall, 64.2% of knees achieved complete correction. Success was significantly higher in idiopathic cases (82.1%) than in non-idiopathic deformities (44%). Success was also more frequent in males (p = 0.040). In multivariable analysis, non-idiopathic patients (β = 351.9; p = 0.002), HKA improvement (β = 1.4; p = 0.010) and change in BMI z-score (β = 202.4; p = 0.009) independently predicted surgical success. No major complications (Clavien–Dindo–Sink grade > 2) were observed. Conclusions: Lateral tibial hemiepiphysiodesis is effective for idiopathic genu varum, offering minimally invasive correction with low complication rates. However, outcomes in non-idiopathic deformities are less predictable, emphasizing the need for individualized treatment planning and counseling. Early intervention, careful implant positioning, and rigorous follow-up are essential to optimize results and prevent unintended overcorrection. Full article

Background: Immunocompromised and clinically fragile individuals are at increased risk of herpes zoster (HZ), but vaccine uptake remains low due to organizational barriers and vaccine hesitancy (VH). This study aimed to evaluate the impact of a multidisciplinary hospital-based counseling model on attitudes toward the recombinant adjuvanted zoster vaccine (RZV). The primary objective was to assess changes in VH over time using the Vaccination Attitudes Examination (VAX) scale; secondary objectives included identifying factors associated with VH, evaluating vaccine safety, and monitoring post-vaccination HZ incidence. Methods: A prospective cohort study was conducted in a large research hospital in Rome, in collaboration with the Local Health Authority. Eligible patients were offered individualized counseling and administered two doses of the RZV. VH was assessed using the 12-item VAX scale at baseline and at one-year follow-up. Multivariable linear regression analysis was performed to investigate associations between baseline characteristics and VH scores. Results: Between July 2022 and July 2023, 178 patients were enrolled, of whom 90 completed the one-year follow-up. Baseline VH was moderate (mean VAX: 2.291/6.000); higher scores were significantly associated with younger age, female sex, and rheumatologic disease (p < 0.05). After the intervention, VAX scores improved significantly across all subscales, particularly in trust in vaccine safety and benefits (p < 0.001). RZV was well tolerated; adverse events were mild and transient. Breakthrough HZ occurred in 3.33% of cases during follow-up. Conclusions: A multidisciplinary hospital-based model effectively improved vaccine attitudes and acceptance in fragile patients. Tracking VH over time with validated tools offers insights for scaling targeted interventions in high-risk groups. Full article

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

Prostate cancer (PCa) is the second most frequently diagnosed malignancy in men worldwide. Although traditionally considered a disease of older men, the incidence of early-onset PCa (diagnosis < 55 years) is steadily rising. Advances in screening and therapy have significantly improved survival, creating a growing cohort of younger survivors for whom post-treatment quality of life—notably reproductive function—is paramount. Curative treatments such as radical prostatectomy, pelvic radiotherapy, androgen-deprivation therapy (ADT), and chemotherapy often cause irreversible infertility via multiple mechanisms, including surgical disruption of the ejaculatory tract, endocrine suppression of spermatogenesis, direct gonadotoxic injury to the testes, and oxidative sperm DNA damage. Despite these risks, fertility preservation is frequently overlooked in pre-treatment counseling, leaving many patients unaware of their options. This narrative review synthesizes current evidence on how PCa therapies impact male fertility, elucidates the molecular and physiological mechanisms of iatrogenic infertility, and evaluates both established and emerging strategies for fertility preservation and restoration. Key interventions covered include sperm cryopreservation, microsurgical testicular sperm extraction (TESE), and assisted reproductive technologies (ART). Psychosocial factors influencing decision-making, novel biomarkers predictive of post-treatment spermatogenic recovery, and long-term offspring outcomes are also examined. The review underscores the urgent need for timely, multidisciplinary fertility consultation as a routine component of PCa care. As PCa increasingly affects men in their reproductive years, proactively integrating preservation into standard oncologic practice should become a standard survivorship priority. Full article

Despite the increasing adoption of a syndemic approach in HIV research, few health communication campaigns have used a syndemic approach in messaging to improve health outcomes for persons living with HIV (PWH). This paper introduces a framework for practitioners and researchers developing health communication messages in support of a syndemic approach to HIV care for PWH in the United States. Grounded in insights from a review of counseling and psychosocial interventions that demonstrated significant positive effects on HIV clinical outcomes, the C4H Framework emphasizes four components: compassion, comprehensive messaging, capacity-building, and coordination. Compassion ensures that messages resonate with individuals experiencing the intertwined challenges of HIV, substance abuse, and mental health issues. Comprehensive messaging integrates a holistic view of the barriers faced by PWH. Capacity-building empowers individuals to effectively engage with and act upon health information. Coordination promotes alignment between stakeholders and resources to ensure consistent and supportive messaging. The C4H Framework bridges the gap between research and practice, offering a foundation for crafting effective communication messages that resonate with individuals facing the complex challenges inherent in HIV syndemics. Future research should explicitly test the effectiveness and acceptability of messages developed using the C4H Framework with people living with HIV. Full article

In the original randomised Dietary Intervention to Stop Coronary Atherosclerosis (DISCO-CT) trial, a 12-month Dietary Approaches to Stop Hypertension (DASH) project led by dietitians improved cardiovascular and metabolic risk factors and reduced platelet chemokine levels in patients with coronary artery disease (CAD). It is unclear whether these benefits are sustained. Objective: To determine whether the metabolic, inflammatory, and clinical benefits achieved during the DISCO-CT trial are sustained six years after the structured intervention ended. Methods: Ninety-seven adults with non-obstructive CAD confirmed in coronary computed tomography angiography were randomly assigned to receive optimal medical therapy (control group, n = 41) or the same therapy combined with intensive DASH counselling (DASH group, n = 43). After 301 ± 22 weeks, 84 individuals (87%) who had given consent underwent reassessment of body composition, meal frequency assessment, and biochemical testing (lipids, hs-CRP, CXCL4, RANTES and homocysteine). Major adverse cardiovascular events (MACE) were assessed. Results: During the intervention, the DASH group lost an average of 3.6 ± 4.2 kg and reduced their total body fat by an average of 4.2 ± 4.8 kg, compared to an average loss of 1.1 ± 2.9 kg and a reduction in total body fat of 0.3 ± 4.1 kg in the control group (both p < 0.01). Six years later, most of the lost body weight and fat tissue had been regained, and there was a sharp increase in visceral fat area in both groups (p < 0.0001). CXCL4 decreased by 4.3 ± 3.0 ng/mL during the intervention and remained lower than baseline values; in contrast, in the control group, it initially increased and then decreased (p < 0.001 between groups). LDL cholesterol and hs-CRP levels returned to baseline in both groups but remained below baseline in the DASH group. There was one case of MACE in the DASH group, compared with four cases (including one fatal myocardial infarction) in the control group (p = 0.575). Overall adherence to the DASH project increased by 26 points during counselling and then decreased by only four points, remaining higher than in the control group. Conclusions: A one-year DASH project supported by a physician and dietitian resulted in long-term suppression of the proatherogenic chemokine CXCL4 and fewer MACE over six years, despite a decline in adherence and loss of most anthropometric and lipid benefits. It appears that sustained systemic reinforcement of behaviours is necessary to maintain the benefits of lifestyle intervention in CAD. Full article

Background: The relationship between sports participation and food preferences in adults, as well as the influence of gender, is still unclear. Objective: The objective of this study was to investigate the association between sports participation and individual food preferences and to explore potential gender differences among sports participants in a large group of Italian adults. Methods: This cross-sectional study involved 2665 adults (aged ≥ 18 years) who lead normal lives and underwent a routine lifestyle and dietary assessment at a clinical centre specialising in nutrition, metabolic health, and lifestyle counselling in Rome. Participants completed an online questionnaire on food preferences (19 foods) and sports practice. Multivariate logistic regression models, adjusted for age, sex, and smoking, were used to assess associations. Results: Sports participation was defined as engaging in structured physical activity at least once per week and was reported by 53.5% of subjects (men: 60.1%; women: 49.0%; p < 0.0001). After adjustment, active individuals were significantly more likely to prefer plant-based drinks, low-fat yoghurt, fish, cooked and raw vegetables, fruit, whole grains, tofu, and dark chocolate (all p < 0.05) and less likely to prefer cow’s milk (p = 0.018). Among sport participants, males were more likely to prefer meat (general, white, red, processed) and eggs, while females preferred plant-based drinks. No significant gender differences were observed for dairy products, legumes, or fish. Differences in food preferences were also observed according to the type of sport, with bodybuilders showing higher preference for tofu and dark chocolate. The strongest associations were found in the 25–44 age group. Conclusions: Sports participation is independently associated with specific food preferences, characterised by greater preference for plant-based and fibre-rich foods, and gender differences in food choices persist even among active adults. These findings highlight the need to consider both sports participation and gender when designing nutritional interventions. Full article