Search Results (971)

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

Almost one in three firefighters develop mental health disorders at some point during their careers, a rate double that in the general population. Frequent exposures to potentially traumatic situations can contribute to symptoms of these disorders, two of the most common being depression and post-traumatic stress disorder (PTSD). While various psychological interventions have been implemented among this group, reports of their effectiveness include mixed results. To this end, the current study endeavored to test the effectiveness of a 12-week intervention combining occupationally-tailored high-intensity functional training (HIFT) and psychological resilience training (RES) in reducing depressive and post-traumatic stress symptoms (PTSSs), as well as increasing psychological resilience and mental wellbeing, in career firefighters. Thirty career firefighters completed four mental health measurements over 17 weeks while anthropometrics and physical performance (i.e., number of stations completed in 20 min during an eight-station simulated job-task circuit workout [T-CAC]) were measured pre- and post-intervention. Pre to post comparisons were made via repeated-measures t-tests. Significant mean differences were observed for T-CAC stations completed, PTSSs, and psychological resilience between pre- and post-intervention. In future interventions, researchers should actively engage firefighters, maximize integration with daily operations, and employ culturally-relevant practices to explore the links between physical and mental health. Full article

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusion: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

Cardiovascular disease (CVD) remains Europe’s leading cause of mortality, responsible for >45% of deaths. Beyond established risk factors (hypertension, diabetes, dyslipidaemia, smoking, obesity), psychosocial elements—depression, anxiety, financial stress, personality traits, and trauma—significantly influence CVD development and progression. Behavioural Cardiology addresses this connection by systematically incorporating psychosocial factors into prevention and rehabilitation protocols. This review examines the HEARTBEAT model, developed by Greece’s first Behavioural Cardiology Unit, which aligns with current European guidelines. The model serves dual purposes: primary prevention (targeting at-risk individuals) and secondary prevention (treating established CVD patients). It is a personalised medicine approach that integrates psychosocial profiling with traditional risk assessment, utilising tailored evaluation tools, caregiver input, and multidisciplinary collaboration to address personality traits, emotional states, socioeconomic circumstances, and cultural contexts. The model emphasises three critical implementation aspects: (1) digital health integration, (2) cost-effectiveness analysis, and (3) healthcare system adaptability. Compared to international approaches, it highlights research gaps in psychosocial interventions and advocates for culturally sensitive adaptations, particularly in resource-limited settings. Special consideration is given to older populations requiring tailored care strategies. Ultimately, Behavioural Cardiology represents a transformative systems-based approach bridging psychology, lifestyle medicine, and cardiovascular treatment. This integration may prove pivotal for optimising chronic disease management through personalised interventions that address both biological and psychosocial determinants of cardiovascular health. Full article

Background/Objectives: Correction surgery for adult spinal deformity (ASD) reduces disability but may lead to spinal stiffness. Cultural diversity may also influence how this stiffness affects daily life. We aimed to evaluate the impact of correction surgery on Japanese patients with ASD using a newly developed questionnaire and to clarify how these patients adapt to their living environment postoperatively in response to spinal stiffness. Methods: This retrospective study included 74 Japanese patients with operative ASD (mean age: 68.2 ± 7.5 years; fusion involving >5 levels) with a minimum follow-up of 1 year. Difficulties in performing various activities of daily living (ADLs) were assessed using a novel 20-item questionnaire tailored to the Oriental lifestyle. The questionnaire also evaluated lifestyle and environmental changes after surgery. Sagittal and coronal spinal parameters were measured using whole-spine radiographs, and clinical outcomes were assessed using the ODI and SRS-22 scores. Results: Coronal and sagittal alignment significantly improved postoperatively. Although the total ADL score remained unchanged, four trunk-bending activities showed significant deterioration. The lower instrumented vertebrae level and pelvic fusion were associated with lower scores in 11 items closely related to trunk bending or the Oriental lifestyle. After surgery, 61% of patients switched from a Japanese-style mattress to a bed, and 72% swapped their low dining table for one with chairs. Both the ODI and SRS-22 scores showed significant postoperative improvements. Conclusions: Trunk-bending activities worsened postoperatively in Japanese patients with ASD, especially those who underwent pelvic fusion. Additionally, patients often modified their living environment after surgery to accommodate spinal stiffness. Full article

Early printed books, particularly incunabula, are invaluable archives of the beginnings of modern educational systems. However, their complex layouts, antique typefaces, and page degradation caused by bleed-through and ink fading pose significant challenges for automatic transcription. In this work, we present a modular pipeline that addresses these problems by combining modern layout analysis and language modeling techniques. The pipeline begins with historical layout-aware text segmentation using Kraken, a neural network-based tool tailored for early typographic structures. Initial optical character recognition (OCR) is then performed with Kraken’s recognition engine, followed by post-correction using a fine-tuned ByT5 transformer model trained on manually aligned line-level data. By learning to map noisy OCR outputs to verified transcriptions, the model substantially improves recognition quality. The pipeline also integrates a preprocessing stage based on our previous work on bleed-through removal using robust statistical filters, including non-local means, Gaussian mixtures, biweight estimation, and Gaussian blur. This step enhances the legibility of degraded pages prior to OCR. The entire solution is open, modular, and scalable, supporting long-term preservation and improved accessibility of cultural heritage materials. Experimental results on 15th-century incunabula show a reduction in the Character Error Rate (CER) from around 38% to around 15% and an increase in the Bilingual Evaluation Understudy (BLEU) score from 22 to 44, confirming the effectiveness of our approach. This work demonstrates the potential of integrating transformer-based correction with layout-aware segmentation to enhance OCR accuracy in digital humanities applications. Full article

Background/Objectives: International students pursuing higher education in the United States face unique challenges that increase their risk of food insecurity, including limited financial resources, employment restrictions, and cultural barriers. While food insecurity among domestic students has been widely studied, limited research focuses on the lived experiences of international graduate students. This study explores the challenges, perceptions, and coping strategies related to food insecurity among international graduate students at a large public university in North Texas. Methods: This qualitative, ethnographic study involved 20 semi-structured interviews with international graduate students who were clients of the university’s food pantry. Participants were recruited using purposive convenience sampling. Interviews focused on students’ experiences with food access, financial constraints, campus resources, and cultural food preferences. Data were analyzed using thematic coding in MAXQDA. Two standardized food insecurity measures—the USDA and FAO scales—were also administered and analyzed using SPSS. Results: Findings revealed that 85% of participants experienced limited access to nutritious and culturally appropriate foods, with 70% reporting hunger due to financial constraints. Themes included lack of cooking skills, limited campus food options, difficulty accessing familiar groceries, and limited job opportunities. Students expressed that food insecurity significantly impacted their physical health, mental well-being, and social lives, though many continued to prioritize academics over personal nourishment. Conclusions: Food insecurity among international graduate students is multifaceted, shaped by financial, cultural, and institutional barriers. Addressing this issue requires culturally sensitive interventions, improved access to diverse food options, tailored student support services, and institutional efforts to better understand and meet the needs of international students. Full article

The present research examines the intersections of giftedness, disability status, and cultural identity through the case of Kent, a nine-year-old Asian American boy who is not only profoundly gifted but has also been diagnosed with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and possibly developmental coordination disorder (DCD). This study offers a comprehensive exploration of how these overlapping factors shape Kent’s early talent development and educational experiences, while also highlighting the challenges faced by his family and their need for a personalized, holistic support system tailored to his unique combination of abilities and disabilities. While Kent’s case is not generalizable, it underscores the critical importance of understanding the dynamic interplay among giftedness, disability status, and cultural identity in developing effective educational strategies. Furthermore, we advocate for personalized interventions that extend beyond conventional approaches, such as applied behavior analysis (ABA), to adequately address the complex needs of multi-exceptional individuals like Kent. Full article

Background/Objective: Dry eye syndrome affects 16 million Americans with USD 52 billion in annual healthcare costs. With large language models (LLMs) increasingly used for healthcare information, understanding their performance in delivering equitable dry eye guidance across diverse populations is critical. This study aims to evaluate and compare five major LLMs (Grok, ChatGPT, Gemini, Claude.ai, and Meta AI) regarding dry eye syndrome information delivery across different demographic groups. Methods: LLMs were queried using standardized prompts simulating a 62-year-old patient with dry eye symptoms across four demographic categories (White, Black, East Asian, and Hispanic males and females). Responses were analyzed for word count, readability, cultural sensitivity scores (0–3 scale), keyword coverage, and response times. Results: Significant variations existed across LLMs. Word counts ranged from 32 to 346 words, with Gemini being the most comprehensive (653.8 ± 96.2 words) and Claude.ai being the most concise (207.6 ± 10.8 words). Cultural sensitivity scores revealed Grok demonstrated highest awareness for minority populations (scoring 3 for Black and Hispanic demographics), while Meta AI showed minimal cultural tailoring (0.5 ± 0.5). All models recommended specialist consultation, but medical term coverage varied significantly. Response times ranged from 7.41 s (Meta AI) to 25.32 s (Gemini). Conclusions: While all LLMs provided appropriate referral recommendations, substantial disparities exist in cultural sensitivity, content depth, and information delivery across demographic groups. No LLM consistently addressed the full spectrum of dry eye causes across all demographics. These findings underscore the importance for physician oversight and standardization in AI-generated healthcare information to ensure equitable access and prevent care delays. Full article

Introduction: The sodium-to-potassium (Na:K) ratio in the diet is a critical biomarker for cardiovascular and metabolic health, yet global adherence to recommended levels remains poor. Objectives: The objective of this study was to identify dietary determinants of the dietary Na:K ratio and its associations with micronutrient intake and diet quality. Methods: An observational cross-sectional survey was conducted in a representative sample of manufacturing workers through a combined stratified proportional and two-stage probability sampling plan, with strata defined by company size and industrial sector from the state of Rio Grande do Norte, Brazil. Dietary intake was assessed using 24 h recalls via the Multiple Pass Method, with Na:K ratios calculated from quantified food composition data. Diet quality was assessed with the Diet Quality Index-International (DQI-I). Multiple linear regression was used to analyze associations of Na:K ratio with the study variables. Results: The survey was conducted in the state of Rio Grande do Norte, Brazil, in 921 randomly selected manufacturing workers. The sample mean age was 38.2 ± 10.7 years, 55.9% males, mean BMI 27.2 ± 4.80 kg/m². The mean Na:K ratio was 1.97 ± 0.86, with only 0.54% of participants meeting the WHO recommended target (<0.57). Fast food (+3.29 mg/mg per serving, p < 0.001), rice, bread, and red meat significantly increased the ratio, while fruits (−0.16 mg/mg), dairy, white meat, and coffee were protective. Higher Na:K ratios were associated with lower intake of calcium, magnesium, phosphorus, and vitamins C, D, and E, as well as poorer diet quality (DQI-I score: −0.026 per 1 mg/mg increase, p < 0.001). Conclusions: These findings highlight the critical role of processed foods in elevating Na:K ratios and the potential for dietary modifications to improve both electrolyte balance and micronutrient adequacy in industrial workers. The study underscores the need for workplace interventions that simultaneously address sodium reduction, potassium enhancement, and overall diet quality improvement tailored to socioeconomic and cultural contexts, a triple approach not previously tested in intervention studies. Future studies should further investigate nutritional consequences of imbalanced Na:K intake. Full article

Background: Accelerated demographic aging in Hungary and across Europe presents significant public health and socioeconomic challenges, particularly in preserving cognitive function and preventing neurodegenerative diseases. Modifiable lifestyle factors—especially dietary habits—play a critical role in brain aging and cognitive decline. Objective: This narrative review explores the mechanisms by which Western dietary patterns contribute to cognitive impairment and neurovascular aging, with specific attention to their relevance in the Hungarian context. It also outlines the rationale and design of the Semmelweis Study and its workplace-based health promotion program targeting lifestyle-related risk factors. Methods: A review of peer-reviewed literature was conducted focusing on Western diet, cognitive decline, cerebrovascular health, and dietary interventions. Emphasis was placed on mechanistic pathways involving systemic inflammation, oxidative stress, endothelial dysfunction, and decreased neurotrophic support. Key findings: Western dietary patterns—characterized by high intakes of saturated fats, refined sugars, ultra-processed foods, and linoleic acid—are associated with elevated levels of 4-hydroxynonenal (4-HNE), a lipid peroxidation product linked to neuronal injury and accelerated cognitive aging. In contrast, adherence to Mediterranean dietary patterns—particularly those rich in polyphenols from extra virgin olive oil and moderate red wine consumption—supports neurovascular integrity and promotes brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) activity. The concept of “cognitive frailty” is introduced as a modifiable, intermediate state between healthy aging and dementia. Application: The Semmelweis Study is a prospective cohort study involving employees of Semmelweis University aged ≥25 years, collecting longitudinal data on dietary, psychosocial, and metabolic determinants of aging. The Semmelweis–EUniWell Workplace Health Promotion Model translates these findings into practical interventions targeting diet, physical activity, and cardiovascular risk factors in the workplace setting. Conclusions: Improving our understanding of the diet–brain health relationship through population-specific longitudinal research is crucial for developing culturally tailored preventive strategies. The Semmelweis Study offers a scalable, evidence-based model for reducing cognitive decline and supporting healthy aging across diverse populations. Full article

Offsite construction (OSC) offers a promising alternative for accelerating refurbishment projects across Italy and Europe. However, its adoption remains limited due to technical, regulatory, and cultural barriers. This study, conducted as part of the OFFICIO project, maps the current European OSC landscape, with a focus on wood and light-steel technologies for sustainable building refurbishment. Combining a literature review, analysis of funded projects, and market data for 541 OSC products, the study develops tailored KPIs to assess these products’ technical maturity, prefabrication level, and environmental integration. The results reveal that wood-based OSC, although less widespread, is more mature and centered on the use of multi-layer panels, while steel-based systems, though more prevalent, remain largely tied to semi-offsite construction, indicating untapped development potential. Research efforts, especially concentrated in Mediterranean regions, focus on technological integration of renewable energy systems. A significant literature gap was identified in information concerning panel-to-wall connection, critical for renovation, limiting OSC’s adaptability to regeneration of existing buildings. The findings highlight the need for cross-sector collaboration, legislative clarity, and better alignment of public procurement standards with OSC characteristics. Addressing these issues is essential to bridge the gap between research prototypes and industrial adoption and accelerate the sustainable transformation of Europe’s construction sector to help meet climate neutrality targets. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

Background: Infectious complications are common after percutaneous nephrolithotomy (PCNL). Clinical guidelines recommend, previous to surgery, prolonged antibiotic regimens in patients with preoperative positive urine cultures to reduce infectious risk. However, such strategies may increase selective pressure and promote antimicrobial resistance. Evidence supporting the use of a single antibiotic dose tailored to culture sensitivity in these cases is limited but emerging. Methods: We conducted a retrospective observational study including 187 PCNL procedures performed between 2021 and 2023 under an individualized antibiotic prophylaxis protocol. Patients with negative or contaminated urine cultures received a single empirical dose, while those with recent positive cultures received a single dose based on antimicrobial susceptibility testing. Postoperative complications—including fever, sepsis, and a composite outcome—were analyzed through multivariable logistic regression, comparing high- and low-risk patients. Results: A total of 67.9% of procedures were performed in patients meeting at least one high-risk criterion, including a positive preoperative urine culture in 32.1%. The overall incidence of infectious complications was 11.9% (fever 8.7%, sepsis 3.2%), with no significant differences between risk groups. A low concordance was observed between preoperative and intraoperative urine cultures (Spearman = 0.3954). Conclusions: A single preoperative antibiotic dose adjusted to the antibiogram, even in patients with a positive urine culture, was not associated with increased infectious complications. This approach is an initial step that supports a rational and individualized prophylactic strategy aligned with the goals of antimicrobial stewardship programs (ASPs). Full article

Background/objective: Tailoring involves adapting research findings and evidence to suit specific contexts and audiences. This study examines how international stroke guidelines can be tailored to address gait issues after a stroke. Methods: A three-phase consensus method approach was used. A 10-member health experts panel extracted recommendations from three national clinical guidelines in the first phase. In the second phase, 362 physiotherapists completed an online questionnaire to assess the feasibility of adopting the extracted recommendations. In the third phase, a 15-physical therapist consensus workshop was convened to clarify factors that might affect the tailoring process of the extracted recommendations of gait disorder rehabilitation. Results: In phase one, 21 recommendations reached consensus. In the second phase, 362 stroke physiotherapists rated the applicability of these recommendations: 14 rated high, 7 rated low, and none were rejected. The third phase, a nominal group meeting (NGM), explored four themes related to tailoring. The first theme, “organizational factors”, includes elements such as clinical setting, culture, and regulations. The second theme, “individual clinician factors”, assesses aspects like clinical experience, expertise, abilities, knowledge, and attitudes toward tailoring. The third theme, “patient factors”, addresses issues related to multimorbidity, comorbidities, patient engagement, and shared decision-making. The final theme, “other factors”, examines the impact of research design on tailoring. Conclusions: Tailoring international clinical guidelines involves multiple factors. This situation brings home the importance of a systematic strategy for tailoring that incorporates various assessment criteria to enhance the use of clinical evidence. Future research should investigate additional implementation theories to enhance the translation of evidence into practice. Full article