Search Results (8,102)

Background: Parkinson’s disease (PD) is a prevalent neurodegenerative disorder characterized by progressive impairments in balance, gait, and quality of life (QoL). Exercise interventions have emerged as complementary therapies, but their effectiveness remains unclear. This meta-analysis aimed to systematically evaluate the effects of exercise interventions on balance, gait speed, QoL, and symptom relief among older adults with PD. Methods: Following Cochrane Collaboration and PRISMA guidelines, randomized controlled trials (RCTs) published in peer-reviewed journals up to November 2023 were identified (n = 388) through PsycINFO, Scopus, PubMed, and Web of Science databases. Studies included adults aged ≥60 with PD, assessing exercise interventions compared to control conditions. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Random-effects models with standardized mean differences (SMD) were used to analyze the effectiveness of exercise interventions on balance, gait speed, QoL, and symptom relief. Results: Eleven RCTs were analyzed. Exercise interventions showed no significant effect on balance (SMD = −0.06, p = 0.41), QoL (SMD = 0.06, p = 0.33), or PD symptom relief (SMD = 0.10, p = 0.45). However, a significant improvement in gait speed was observed (SMD = −0.90, p = 0.001). Conclusions: In older adults with PD, exercise significantly enhances gait speed only; evidence for balance, QoL, and symptom relief is non-significant, and interpretation is limited by between-study heterogeneity and small samples. Since various measurement tools across studies may have influenced the outcomes, future research should incorporate repeated measurements using more specific and consistent assessment tools to clarify the effectiveness of exercise interventions for older adults with PD. Full article

Background: Splenic arterial embolization (SAE) is a well-established technique in the non-operative management of splenic trauma and aneurysms. While its short-term safety and efficacy have been widely documented, medium- and long-term impacts on splenic volume and function remain under-investigated. This study aimed to evaluate volumetric changes and hematological parameters following SAE, with emphasis on its role in preserving splenic integrity and potential integration with AI-enhanced imaging technologies. Methods: We retrospectively analyzed 17 patients treated with SAE between January 2014 and December 2023. Volumetric measurements were performed using computed tomography (CT) with 3D reconstructions before and after SAE. Patients were divided into two groups based on indication: polytrauma (n = 8) and splenic artery aneurysm (n = 9). Hematological parameters including white blood cells (WBCs), red blood cells (RBCs), and hemoglobin (Hb) were evaluated in correlation with clinical outcomes. Statistical significance was assessed using Student’s t-test, and power analysis was conducted. Results: Among the trauma group, mean splenic volume decreased from 190.5 ± 51.2 cm³ to 147.8 ± 77.8 cm³ (p = 0.2158), while in the aneurysm group, volume decreased from 195.4 ± 78.9 cm³ to 143.7 ± 81.4 cm³ (p = 0.184). Though not statistically significant, these changes suggest post-procedural splenic remodeling. The technical success of SAE was 100%, with no cases of late follow-up infarction, abscess, immunological impairment, or secondary splenectomy required. Hematologic parameters remained within normal limits in follow-up assessments. Conclusions: SAE represents a safe and effective intervention for spleen preservation in both traumatic and aneurysmal conditions. Although a reduction in splenic volume has been observed, white blood cell counts, a reliable indicator of splenic function, have remained stable over time. This finding supports the preservation of splenic function following SAE. Full article

This study examined the removal efficiency of microplastics (MPs) in a wastewater treatment plant (WWTP) in Zhengzhou, China. A three-point sampling approach (influent, process effluent, and final effluent) was employed, with samples collected across three seasons (summer, winter, and autumn) to investigate seasonal variations in MPs. The abundance of MPs in influent ranged from 184.3 ± 4.0 to 145.3 ± 24.0 n/L, while in the process effluent it decreased to 79.3 ± 18.7 to 62.3 ± 15.0 n/L. Furthermore, in final effluent it was further reduced to 26.0 ± 7.0 to 38.7 ± 5.1 n/L. Fragments and granule-shaped MPs predominated (>80%), with polypropylene (PP, 42.6%) and polyethylene terephthalate (PET, 31.8%) emerging as the dominant polymer types. The removal efficiency of MPs in the WWTP was 86%, 81%, and 73% in summer, autumn, and winter, respectively. Additionally, the plant exhibited differing removal efficiencies for MPs of varying sizes. Notably, residual sludge retained substantial MPs loads, with seasonal abundances measuring 22.3 ± 3.2, 14.2 ± 2.4, and 29.1 ± 6.7 n/g in summer, autumn, and winter samples, respectively. The findings underscore the importance of implementing effective management strategies and interventions in wastewater systems to mitigate MP pollution. Full article

Frailty reduces resilience to surgical stress, increasing vulnerability to adverse outcomes. While recovery efforts traditionally focus on the postoperative phase, the preoperative period offers better opportunities for lifestyle interventions. Prehabilitation aims to increase functional reserve and surgical tolerance, especially in frail older adults. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the effectiveness of multimodal prehabilitation on aerobic capacity—measured by the 6 min walk test (6MWT)—and the length of hospital stay (LOS). A literature search was conducted up to August 2025. Eligible RCTs reported the effects of prehabilitation on functional capacity and LOS. A pairwise meta-analysis was used to calculate pooled mean differences (p-MDs) with 95% confidence intervals (CIs). The risk of bias was assessed via the Cochrane RoB tool, and evidence quality was assessed via the GRADE system. Five studies involving 400 participants were included. The p-MD for the 6MWT showed no significant improvement at any time point: (T1–T2) 9.71 (CI: −38.92; 58.36), (T2–T3) −3.27 (CI: −71.21; 64.65), and (T1–T3) 15.01 (CI: −22.05; 52.07). The LOS was also not significantly reduced (p-MD: −0.464, CI: −0.960; 0.031). Prehabilitation did not significantly improve aerobic capacity or reduce hospital stay. Future research should explore long-term benefits and adherence. Full article

Background: Digital self-efficacy is a crucial determinant of healthcare professionals’ ability to adapt to technological innovations. Understanding its predictors among nurses and nursing students is essential for workforce readiness. Objectives: To assess the level of digital self-efficacy and examine demographic, educational, and experiential factors associated with inadequate self-efficacy. Methods: This cross-sectional study involved 1081 Italian nurses and nursing students. The Digitech-S scale was used to measure digital self-efficacy, with ≥70/100 indicating adequacy. Logistic regression was performed to identify predictors of inadequate self-efficacy. Results: Only 47.1% of participants demonstrated adequate self-efficacy. Females had twice the odds of inadequate self-efficacy compared to males (OR = 2.038, p < 0.001). Nurses with bachelor’s degrees had 2.5 times higher odds than students (OR = 2.450, p < 0.001), while post-graduate education showed no effect. Early technology adoption before age 14 reduced the odds (OR = 0.675, p = 0.027). Each additional year of work experience decreased the odds by 4% (OR = 0.955, p < 0.001). Conclusions: Gender disparities persist in digital self-efficacy, and unexpectedly, students outperformed bachelor-level nurses. Findings highlight educational gaps and the importance of early exposure to technology. Tailored interventions are needed to strengthen digital readiness, which may improve care quality and healthcare system efficiency in the digital era. Full article

We examined the effects of a digital reflection and feedback intervention for pre-service teachers during a five-month school placement (Praxissemester) in Germany. Three reflection formats were compared: text-based memory protocols (control), unguided viewing of self-recorded lessons, and a structured digital video annotation (DVA) format. Fifty-five secondary teacher candidates were randomized into the three conditions and completed a validated, video-based Analysis-Competence Test before and after the semester. Repeated-measures ANOVA and mixed models showed robust overall improvement in global analysis competence across all groups. For process-oriented reasoning (whole-lesson reflection), both video-based formats showed significant within-group gains that were descriptively larger than those of the text-based control, although between-condition differences were not statistically significant; for synthetic competence (focused on specific lesson situations), the annotation group and the text-only control improved significantly, whereas the video-only condition did not, with the structured annotation group achieving the largest within-group gains and a trend-level advantage in higher-order reflection. Between-group effects did not reach conventional significance in either rmANOVA or the mixed models, though trends favored the annotation scaffold. These findings suggest that time-stamped, theory-aligned scaffolds can help pre-service teachers move beyond surface-level description toward deeper, theory-informed reflection in practicum settings. Full article

Background/Objectives: Many community-dwelling Americans with Alzheimer’s disease and related dementias rely on family caregivers to help meet their increasing care needs. These caregivers experience increased stress related to caregiving as well as more sedentary lifestyles that lead to the development of chronic non-communicable disease (NCD) and poorer health outcomes. Physical activity interventions for both the caregiver and person living with dementia have the potential to address these issues. We aimed to identify key factors that should be considered in tailoring physical activity interventions for dementia family caregivers. Methods: Two case studies of dementia family caregivers are presented that describe the role of physical activity as it relates to their own health and the effects of caregiving. One caregiver was in the early stages of caregiving while the other provided the perspective of a caregiver after the death of the person with dementia. Results: While both caregivers participated in physical activity, their case studies reveal opportunities to optimize physical activity interventions to support members of the caregiving dyad: (1) targeting mitochondrial fitness—the ability of mitochondria to maintain energy homeostasis with aging—so participants can mitigate the onset of NCDs, fatigue, and overall health outcomes; (2) promoting the self-care and psychological benefits of physical activity such as improved mood and social connectedness; and (3) improving the accurate perceptions of participants’ health and physical activity with specific measurable markers of physical activity. Conclusions: These case studies demonstrate the key features in the development of psychoeducational interventions to promote physical activity in dementia caregiving and will be used in future intervention development. Full article

Background/Objectives: Preventive oral health education plays a key role in preparing future healthcare professionals to promote and maintain good oral hygiene. Individually Trained Oral Prophylaxis (iTOP) is a structured, personalized educational program that emphasizes correct brushing techniques and interdental cleaning. This study aimed to evaluate the long-term effectiveness of a single-session iTOP intervention on clinical oral health outcomes among medical and dental students. Methods: A 2-year prospective cohort study included 82 first- and fourth-year medical and dental students at the University of Mostar, Bosnia and Herzegovina. The researchers randomly assigned participants to an iTOP intervention group or a control group. The primary analysis used multivariable linear mixed-effects models for repeated measures, adjusted for study program, academic year, smoking status, and baseline oral-hygiene habits, with effect sizes reported alongside 95% confidence intervals. Clinical periodontal parameters—plaque index, bleeding on probing, and probing depth—were assessed at baseline, three months, and two years. All participants received professional cleaning and oral hygiene kits. Only the intervention group received personalized iTOP training, consisting of a single session with brief reinforcement at the 3-month follow-up. This study was registered at ClinicalTrials.gov (NCT07085013). Results: Seventy-six students completed the follow-up. The iTOP group had significantly lower plaque index and bleeding scores at both follow-up points (p < 0.001) compared to the control group. Baseline differences were observed between subgroups (medical vs. dental; younger vs. older students), but these diminished over time. At the 2-year follow-up, only the plaque index remained significantly improved, while other clinical parameters returned to values comparable to baseline. Conclusions: The iTOP program resulted in significant short-term improvements in oral health among medical and dental students. For sustained long-term outcomes, iTOP or similar structured oral health education programs should be integrated into medical and dental curricula. Enhancing oral health awareness among healthcare providers may ultimately contribute to improved public oral health outcomes. Given the single-center design and the single-session nature of the intervention, the results should be interpreted with caution. Full article

Background/Objectives: Post-activation performance enhancement (PAPE) is an acute neuromuscular phenomenon influenced by training status, yet evidence regarding its response to isometric conditioning activity (ICA) across different athletic populations remains inconclusive. This study investigated the acute effects of ICA on countermovement jump (CMJ) performance in trained (T) versus highly trained (HT) male participants. Methods: A total of 32 participants (T: n = 16; HT: n = 16) completed two randomized sessions: a control condition (CTRL) and an isometric protocol (ICA; three sets of three maximal isometric back squat contractions, 3 s each). CMJ height was assessed at baseline and at 3-, 6- and 9-min post-intervention using a force platform. Repeated-measures ANOVA examined interactions between time, condition, and training status. Results: A significant improvement in jump height was observed only in the HT-ISO group at 3 min post-ICA (mean difference: +3.0 ± 2.3 cm; p < 0.005; d = 0.65). No significant changes were detected in the T group across conditions. Peak power and modified reactive strength index showed no significant differences, though effect trends favored the HT group. Conclusions: ICA elicits short-term PAPE effects in highly trained, but not moderately trained, individuals. These findings underscore the importance of tailoring warm-up protocols to the athlete’s training level for optimal performance enhancement. Full article

This scoping review study examines seven governments and some non-governmental organisations’ youth development mechanisms in response to drug and alcohol abuse among their youth. This scoping review, including sources from 39 studies and 16 government or organisational reports, are reviewed to investigate youth development measures to mitigate drug and alcohol abuse. This study revealed that youth development mechanisms, such as outreach youth work, digital youth work, and detached youth work, lead to significant changes in risky behaviours. The study further revealed that non-governmental organisations play a critical role in solving drug- and alcohol-related challenges among youth by deterring local merchants from selling drugs and alcohol to underage customers and by strictly regulating their promotion and advertising. Effective mechanisms to develop self-efficacy, purpose, and meaning in life among youth are needed. This study also highlights the need for a joint effort between government departments, local municipalities, non-governmental youth-focused organisations, and schools to come up with effective youth work strategies. This study concludes by proposing the establishment of a Southern African Development Community (SADC) Youth Work Association and the professionalisation of youth work in the region. This will ensure that intervention programmes are implemented by professional youth workers who have the skills and knowledge to work with vulnerable young people. Full article

Background: Patients with early-stage (I–IIIA) resectable non-small cell lung cancer (NSCLC) often experience reduced physical activity (PA) after surgery. PA telecoaching may support a more active lifestyle, but evidence in this population is limited. Objective: To evaluate acceptability, feasibility, safety, and actual usage of an automated and manual PA telecoaching program following surgery for NSCLC. Methods: In this multicenter, single-blind study, patients received either an eight-week automated coaching program (ACP) with a customized smartphone app or a manual coaching program (MCP) with weekly phone calls from a coach. Both groups used an activity tracker, linked to their smartphone, to monitor steps and receive feedback. Primary outcomes included acceptability, feasibility, safety and usage, assessed via questionnaires and interviews. Secondary outcomes included objectively measured PA (accelerometry), functional exercise capacity (six-minute walk distance) and symptoms (dyspnea, fatigue) and quality of life, evaluated via questionnaires. Results: Nineteen patients (12 males; 68 ± 6 years; baseline daily steps 7820 ± 2799) were included. The majority (18/19) found the intervention enjoyable, and a minority (6/19) reported minor smartphone issues. All patients wore the activity tracker consistently. No adverse events occurred. The ACP required significantly less coach contact time compared to the MCP (25 ± 14 vs. 54 ± 15 min, p = 0.0003). No other differences in primary outcomes were observed between groups. Changes in secondary outcomes were limited in both groups. Conclusion: PA telecoaching is feasible, well accepted, and safe in patients with NSCLC post-surgery, with excellent activity tracker adherence. The ACP required less coach involvement. However, increasing PA remains challenging, and no conclusions can be made about the effectiveness of telecoaching. Future research should explore longer interventions in larger populations to assess efficacy and long-term outcomes. Full article

Background/Objectives: Vitamin D deficiency is linked to muscle loss and fat changes in older adults, but data regarding palliative patients are limited. Ultrasound offers a practical tool to assess these changes. This study explores the relationship between vitamin D levels and ultrasound-measured muscle, fat, and their ratio in older adult palliative patients. Methods: This prospective cross-sectional study was conducted in a tertiary palliative care unit (June–September 2024). A total of 187 patients were grouped by serum vitamin D levels (<50 vs. ≥50 nmol/L). Demographic and clinical variables included sex, BMI, Activities of Daily Living (ADLs), calf circumference (CC), and comorbidities. Ultrasonography assessed muscle thickness (MT), subcutaneous fat thickness (SFT), and cross-sectional area (CSA) of Rectus Femoris (RF) and Biceps Brachii (BB). MT/SFT ratio was calculated. Logistic regression identified independent predictors. Results: Mean age was 75.1 ± 14.4 years; 55.6% of participants were female. Vitamin D deficiency (67.9%) was significantly associated with female sex (p = 0.037), ADL dependency (p < 0.001), lower BMI (p = 0.020), and reduced CC (p = 0.006). RF-MT, RF-SFT, RF-CSA, BB-MT, and BB-CSA were lower in the deficient group. RF-MT/SFT ratio was higher (p = 0.049). ADL dependency (p = 0.002) and RF-MT/SFT (p = 0.015) were independent predictors. Conclusions: Vitamin D deficiency was linked to a higher muscle-to-fat ratio, mainly due to fat loss rather than muscle gain. This may misrepresent muscle preservation and should be interpreted cautiously. Although vitamin D levels appear to be associated with physical function, additional prospective cohort and interventional supplementation studies are warranted to determine whether routine screening and targeted vitamin D supplementation can effectively support physical function in this population. Full article

Background: Inpatient palliative care consultation services operate with an interdisciplinary team, where effective handoffs are crucial for coordinated patient care. We aimed to replace encrypted email handoffs with a more concise and uniform handoff using I-PASS (illness severity, patient summary, action list, situational awareness, contingency planning, and synthesis by receiver) integrated within the electronic medical record (EMR). Aim and Measures: Within six months of launch, our goal was to achieve 90% I-PASS utilization for hospitalized acutely ill patients with cancer receiving palliative care consultation. Intervention: In January 2021, our quality improvement team, consisting of physicians, advanced practice providers, and trainees, began implementing I-PASS using the plan–do–study–act cycle. After providing training sessions for all palliative care clinicians, I-PASS went live on October 1, 2021. I-PASS utilization was tracked via random and monthly audits of EMRs. Through anonymous surveys, both pre- and post-implementation, we gathered clinician feedback and concerns about the handoff system. Survey responses were compared using the Mann–Whitney test. Outcomes: Within six months of implementation, the I-PASS utilization rate reached > 99%. The survey participation rates were 70% (45/64) and 82% (49/60) for the pre-and post-implementation periods, respectively. Respondents provided answers on one to five scale (mean, standard deviation, SD): lower accuracy with email (3.53, SD = 0.98) vs. I-PASS (4.20, SD = 0.83), p < 0.001; handoff lengthier with email (4.17, SD = 1.05) vs. I-PASS (2.1, SD = 1.15), p < 0.001; the time required was longer with email (3.0, SD = 1.22) vs. I-PASS (1.71, SD = 0.73), p < 0.001. Overall, respondents found I-PASS to be significantly better (4.69, SD = 0.58). Conclusion: I-PASS was fully adopted by the team, with nearly 100% utilization and strong clinician endorsement as an effective communication tool. Future efforts should focus on optimizing usability, particularly by educating clinicians on smartphone EMR access and enabling the timely and streamlined editing of I-PASS. Full article

Background: Addressing Intensive Care Unit (ICU) patients’ psychological well-being is crucial, yet psychosocial support interventions that can facilitate effective coping, ultimately decreasing stress-related physiological, mental health, and cognitive sequelae, are not currently included in clinical practice guidelines and standards. Objective: To identify and synthesize research evidence on psychosocial support interventions in the ICU, including types of outcomes and measures of effectiveness, and to explore research gaps and barriers to implementation. Method: The review was directed by a protocol based on current guidance for scoping reviews. The quality of studies was assessed using the National Institute for Health and Clinical Excellence. The review focused on articles containing evaluations of psychosocial interventions through an experimental or quasi-experimental design or pretest-posttest comparisons. Databases searched included Medline, CINAHL, PubMed, PsychInfo, and the Cochrane Library. Results: Ten highly heterogeneous studies were identified, encompassing diverse interventions (e.g., relaxation, psychotherapy, spirituality, and positive suggestions) and patient populations. Across the 10 studies, no intervention type was replicated, and most samples were small and quasi-experimental, limiting internal validity and preventing quantitative synthesis. Despite these limitations, the evidence reviewed supports that various psychosocial interventions, including positive suggestions (constructive, reassuring thoughts), relaxation techniques, psychotherapy (emotional, behavioral guidance), and spiritual and/or religious support can alleviate psychological sequelae, such as depression, anxiety, and Post Traumatic Stress in ICU patients. Conclusions: This review highlights the positive impact of psychosocial interventions on alleviating psychological distress in ICU patients. However, a critical gap exists in understanding their effects on other clinical and physiological outcomes, necessitating comprehensive research. Full article

The 4E Cognition paradigm offers a novel theoretical framework for understanding how acoustic environments influence cognitive processes in university learning spaces. This research integrates objective characterization of environmental parameters with comprehensive subjective evaluation of student experience to explore how aural conditions relate to cognitive processes and physiological stress responses in university learning environments. The study recruited 126 university students from the Engineering Faculty of “G. D’Annunzio” University, with final analysis including 66 valid responses from 28 participants in the acoustically treated classroom and 38 from the control condition. The results revealed modest associations between environmental conditions and cognitive performance measures, with small to moderate effect sizes (Cohen’s d ranging from 0.02 to 0.31). While acoustic treatment produced measurable improvements in speech intelligibility and acoustic quality ratings, differences in cognitive load and allostatic load indices were minimal between conditions. These findings provide preliminary empirical insights for applying the 4E Cognition framework to educational settings, suggesting that acoustic interventions may require extended exposure periods or more intensive treatments to produce substantial physiological and cognitive effects. This work contributes to the emerging field of cognitive architecture by introducing an innovative theoretical approach that reconceptualizes acoustic environments as potential cognitive extensions rather than mere background conditions. The findings offer initial evidence-based insights for integrating environmental considerations into educational facility design, while highlighting the need for longitudinal studies to fully understand how acoustic environments function as cognitive scaffolding in learning contexts. Full article