Search Results (8,880)

Background: Multiple sclerosis (MS) involves complex physical, cognitive and behavioral challenges that collectively affect quality of life. Integrating lifestyle components such as sleep optimization, dietary behaviors, stress management, and self-management strategies into rehabilitation may enhance outcomes beyond traditional approaches. This scoping review aimed to map rehabilitation interventions that combine psychomotor, cognitive, lifestyle-focused, or multimodal elements and assess quality of life in adults with MS. Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines, which guided the identification, screening, and selection of studies. Screening and data extraction were conducted independently by two reviewers. From 135 records, nine primary studies and four secondary evidence sources were included. Results: Most studies involved adults with mild-to-moderate disability and predominantly relapsing–remitting multiple sclerosis. Physical or motor rehabilitation interventions were examined in five studies, while two studies evaluated multimodal rehabilitation programs, one study focused on cognitive rehabilitation, and one study investigated lifestyle-oriented or self-management-integrated approaches. Quality of life was assessed in all included studies, with improvements reported across multiple domains. Fatigue-related outcomes were reported in four studies, sleep-related outcomes in three studies, and digitally delivered or hybrid rehabilitation interventions were implemented in three studies, indicating an emerging trend toward technology-supported rehabilitation approaches. Conclusions: Contemporary MS rehabilitation is moving toward multidimensional, holistic models that integrate lifestyle components. Standardized outcomes, inclusion of more diverse MS phenotypes, and rigorous evaluation of integrated frameworks are required to strengthen the evidence base and inform clinical practice. Full article

Background/Objectives: People suffering from mental illnesses are more likely to experience adverse social and health outcomes. Various interventions have been shown to help people with mental illness achieve better results in terms of symptom reduction, functional status, and quality of life. Psychiatric rehabilitation interventions integrate evidence-based practices, promising approaches, and emerging methods that can be effectively implemented to enhance health outcomes in this population. This study aims to examine whether the rehabilitative treatment provided to a group of patients with mental illness leads to improvements in health outcomes and psychiatric symptomatology. Methods: This study employed a retrospective quasi-experimental design. Data were collected between 2023 and 2025 within the Partial Hospitalization Program of the Psychiatry and Mental Health Service of Soria (Spain). The sample consisted of 58 participants who received rehabilitative treatment in this setting. Data were collected at the time of patients’ admission and at discharge. Gender, age, psychiatric diagnosis according to ICD-10, and the average length of stay in the rehabilitation program were assessed. The questionnaires administered were psychometrically validated scales related to heteroaggressiveness, perceived quality of life, global functioning, attitudes toward medication, and the risk of suicide. Results: A significant improvement was observed in the Global Assessment of Functioning (GAF) Scale (t = −7.1, p < 0.001), with mean scores increasing from 42.17 at admission to 69.13 at discharge. Additionally, reductions in suicidal risk and hetero-aggressive behavior were noted, alongside improvements in quality of life and treatment adherence. Conclusions: The findings highlight the effectiveness of implementing activities and programs focused on psychiatric rehabilitation processes to promote positive health outcomes. Future research directions and practical implications are discussed to support the continued development and optimization of psychiatric rehabilitation programs. Full article

Cardiogenic pulmonary edema (CPE) is a life-threatening manifestation of acute heart failure characterized by rapid accumulation of fluid in the interstitial and alveolar spaces, leading to severe dyspnea, hypoxemia, and respiratory failure. The condition arises from elevated left-sided filling pressures that increase pulmonary capillary hydrostatic pressure, disrupt alveolo-capillary barrier integrity, and impair gas exchange. Neurohormonal activation further perpetuates congestion and increases myocardial workload, creating a vicious cycle of hemodynamic overload and respiratory compromise. Respiratory support is a cornerstone of management in CPE, aimed at stabilizing oxygenation, reducing the work of breathing, and facilitating ventricular unloading while definitive therapies, such as diuretics, vasodilators, inotropes, or mechanical circulatory support (MCS), address the underlying cause. Among available modalities, non-invasive ventilation (NIV) with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) has the strongest evidence base in moderate-to-severe CPE, consistently reducing the need for intubation and providing rapid relief of dyspnea. High-flow nasal cannula (HFNC) represents an emerging alternative in patients with moderate hypoxemia or intolerance to mask ventilation, and should be considered an adjunctive option in selected patients with less severe disease or NIV intolerance, although its efficacy in severe presentations remains uncertain. Invasive mechanical ventilation is reserved for refractory cases, while extracorporeal membrane oxygenation (ECMO) and other advanced circulatory support modalities may be necessary in cardiogenic shock. Integration of respiratory strategies with hemodynamic optimization is essential, as positive pressure ventilation favorably modulates preload and afterload, synergizing with pharmacological unloading. Future directions include personalization of ventilatory strategies using advanced monitoring, novel interfaces to improve tolerability, and earlier integration of MCS. In summary, respiratory support in CPE is both a bridge and a decisive therapeutic intervention, interrupting the cycle of hypoxemia and hemodynamic deterioration. A multidisciplinary, individualized approach remains central to improving outcomes in this high-risk population. Full article

Background/Objectives: Self-care is central to chronic illness management and is particularly relevant in osteoporosis to prevent complications and improve quality of life. Grounded in Riegel’s middle-range theory of self-care of chronic illness, the study sought to understand the contextual, emotional, and structural influences shaping self-care in people living with osteoporosis. Aim: The aim of this study was to explore patient-reported barriers and facilitators to self-care behaviors among individuals living with osteoporosis. Methods: A qualitative descriptive design was conducted using in-depth, semi-structured interviews with 20 patients with osteoporosis recruited via convenience sampling. Data were coded deductively and analyzed using Mayring’s qualitative content analysis with a deductive approach. Results: Participants identified several factors related to both barriers and facilitators of self-care behaviors. Four barrier sub-themes emerged: ineffective coping strategies, difficulties in osteoporosis management, inadequate physical activity, and ineffective self-efficacy. Six facilitator sub-themes were identified: self-care management strategies, osteoporosis management after a fracture, osteoporosis control, osteoporosis treatment, exercise, and confidence in one’s ability. Main barriers included fear of falling, ineffective self-efficacy, and poor care continuity, whereas key facilitators included support networks, motivation, and tailored care. Conclusions: Self-care behaviors in individuals with osteoporosis are influenced by emotional, contextual, and structural factors. Person-centered interventions integrating emotional and educational components may strengthen patients’ engagement and enhance self-care behaviors in osteoporosis. Identifying barriers and facilitators enables nurses to design empathetic, tailored strategies that enhance empowerment and disease management. Understanding these factors can improve autonomy for patients and adherence, promoting long-term health outcomes across clinical and community settings. Full article

Background: The management of pediatric inflammatory bowel disease (PIBD) has evolved significantly over the past two decades, transitioning from corticosteroids and immunomodulators to biologic and small-molecule therapies. These advances have aimed not only to control inflammation but also to promote mucosal healing, improve growth, and enhance long-term quality of life. Objectives: This narrative review summarizes current evidence on the efficacy, safety, and clinical applications of biologic and novel small-molecule therapies in PIBD, highlighting emerging trends in personalized and precision-based management. Methods: A literature search was performed across PubMed, Embase, and the Cochrane Library, focusing on studies published within the last five years. Additional data were retrieved from key guidelines and position papers issued by ECCO–ESPGHAN, SIGENP, the FDA, and the EMA. Results: Anti–tumor necrosis factor (TNF) agents such as infliximab and adalimumab remain first-line biologics with proven efficacy in remission induction and maintenance. Newer biologics—vedolizumab, ustekinumab, risankizumab, and mirikizumab—offer alternatives for anti-TNF-refractory cases, showing encouraging short-term results and favorable safety profiles. Although many are approved only for adults with limited pediatric evidence, emerging small molecules—including Janus kinase (JAK) inhibitors (tofacitinib, upadacitinib) and sphingosine-1-phosphate (S1P) modulators (etrasimod)—provide oral, rapidly acting, and non-immunogenic treatment options for refractory disease. Furthermore, the gut microbiome is increasingly recognized as an emerging therapeutic target in PIBD, with growing evidence that host–microbiome interactions can influence both the efficacy and safety of biologics and small-molecule therapies. Conclusions: While biologics and small molecules have transformed PIBD management, challenges remain, including high treatment costs, limited pediatric trial data, and variable access worldwide. Future directions include multicenter pediatric studies, integration of pharmacogenomics, and biomarker-guided precision medicine to optimize early, individualized treatment and improve long-term outcomes. Full article

Background: Millions of people have died from AIDS-related illnesses since the start of the epidemic. The objective of this study is to determine the relationship between life years lost and demographic factors in the subset of individuals in Puerto Rico with advanced HIV disease, i.e., who received a diagnosis of AIDS, and to evaluate trends in poverty, age, and number of diagnoses and deaths over this timeframe. Methods: We identified 3624 individuals diagnosed with AIDS who received services under the Eligible Metropolitan Area (EMA) of San Juan, Puerto Rico, between 2000–2020, and correlated demographic factors with AIDS descriptive statistics using a retrospective cohort study design. We used socioeconomic characteristics to describe the population, estimated the life years lost (LYL) compared with the life expectancy of the general population of Puerto Rico at a given age as the null model, and evaluated the relationship of demographic variables with LYL, as well as trends in poverty and age/number of deaths/diagnoses over time. Results: More life years are lost with earlier AIDS onset, and there is also an association between LYL and the level of poverty, documented mode of transmission, and insurance status. LYL were higher among AIDS patients with lower income, with perinatal transmission, and among those without insurance in the age bracket of 40–49 years. No relationship between LYL and gender was detected. Moreover, over the years included in the timeframe of this study, certain trends emerged: we observed a greater proportion of AIDS to HIV diagnoses over time; HIV/AIDS diagnoses and deaths occurred on average at a higher age; the number of diagnoses per year initially rose over time and then declined; and the number of deaths per year as well as the poverty level in those diagnosed with HIV/AIDS increased over time. Conclusions: This study demonstrates the continued recent impact of the HIV epidemic specifically on those with advanced disease (AIDS), and further reaffirms the importance of treatment and prevention as well as demographic and social determinants of health, including age, poverty level, insurance status, and lifestyle, highlighting the disproportionate burden of HIV/AIDS among those with greater levels of poverty. Full article

During production, storage, and administration, drug products (and their intermediates) are in contact with many different types of materials, which include manufacturing components, container closure systems, and administration materials; therefore, there is a potential for their interactions and the introduction of leachables. The presence of leachables may impact key quality attributes of drug products in many ways. These include potential alterations in drug product stability, resulting in a reduced shelf-life, compromised drug product efficacy due to degradation or inactivation of active pharmaceutical ingredients, and impaired drug product physical acceptability due to precipitation, discolouration and/or change in odour or flavour. Moreover, some leachables may be inherently toxic (mutagenic, carcinogenic, immunogenic, etc.) posing direct risks to patient safety. Comprehensive toxicological evaluation of extractables and leachables is therefore essential. Documented cases demonstrate that presence of leachables can lead to serious and clinically significant adverse effects, underscoring the importance of their identification, quantification, and toxicological assessment during pharmaceutical development. This paper provides an overview of the toxicological limits used in the analyses of extractables and leachables and illustrates how they are translated into analytical limits. It also outlines the workflow for toxicological risk assessment of extractables and/or leachables, including evaluations of mutagenicity and other relevant toxicological endpoints. Special attention is given to the interpretation of the draft ICH Q3E guideline, which represents a pivotal development in harmonizing global expectations for extractables and leachables safety assessments. Understanding and correctly applying ICH Q3E is crucial, as it will shape regulatory strategies, analytical approaches, and risk management practices across the pharmaceutical industry. The paper concludes by highlighting emerging challenges that demand sustained advancements in both scientific methodologies and regulatory frameworks. Full article

Accurate diagnosis of aero-engine faults and precise signal characterization are crucial to ensuring operational reliability and service life prediction. The structural complexity of engines and the variability of operating conditions pose significant challenges for fault diagnosis and identification. Based on an analysis and emphasis on the critical importance of aero-engine fault signal recognition and diagnosis, this paper comprehensively reviews and discusses the classification and evolution of aero-engine fault signal recognition techniques. The review traces this evolution along its developmental trajectory, from classical methods to emerging approaches such as quantum signal processing for weak feature extraction. It also examines characteristics of different types of aviation engine failures and the progression of diagnostic research over time. This review provides multiple tables to compare the applicability, advantages, and limitations of various signal recognition methods and deep learning diagnostic architectures. Detailed discussions synthesize the relative merits of different approaches and their selection trade-offs. Based on this overview, the paper outlines the complexity of real aero-engine faults and key research directions. Building on these developments in fault signal recognition and diagnosis, the paper addresses the complexity and the research areas receiving particular attention within real aero-engine faults. It highlights key research areas, including handling data imbalance, adapting to variable and cross-domain conditions, and advancing diagnostic and data enhancement methods for weak composite faults. Finally, the paper analyzes the multifaceted challenges in the field and identifies future trends in aero-engine fault signal recognition and intelligent diagnosis. Full article

Background: Immune checkpoint inhibitors (ICIs), such as anti-programmed death (PD)-1 and anti-cytotoxic T-lymphocyte-associated protein (CTLA)-4 agents, have revolutionized oncology but are associated with immune-related adverse events (irAEs). Among these, ICI-associated myocarditis (ICI-M) is a rare but life-threatening complication, with mortality rates ranging from 27% to 50%. Objective: This narrative review summarizes the pathogenesis, epidemiology, clinical presentation, diagnostic methods, and management strategies for ICI-induced myocarditis, specifically highlighting emerging biomarkers and immunosuppressive therapeutic approaches. Results and Discussion: ICI-M typically presents within the first 65 days of treatment and is significantly more frequent with combination therapies. Pathologically, it is characterized by myocyte necrosis and massive infiltration of cluster of differentiation (CD)4+ and CD8+ T-cells, often overlapping with myositis (irM/M). Diagnosis relies on a multimodal approach. Management requires immediate ICI cessation and initiation of high-dose corticosteroids as first-line therapy. For steroid-refractory cases, second-line options include mycophenolate mofetil (MMF), intravenous immunoglobulin (IVIG), and emerging therapies like abatacept and ruxolitinib. Rechallenge with ICIs after high-grade ICI-M must be approached with extreme caution by the multidisciplinary team (MDT). Emerging biomarkers and omics techniques hold promise for earlier diagnosis and risk stratification. Conclusions: ICI-M is a rare yet highly lethal cardiac complication demanding high clinical vigilance and timely diagnosis. Management hinges on an aggressive multidisciplinary approach, aiming to minimize toxicity while balancing oncological efficacy. Full article

Background: Polycystic ovary syndrome (PCOS) is commonly associated with psychological disorders, including depression and anxiety. Women with PCOS also tend to experience poorer sleep quality and greater daytime sleepiness than healthy individuals. To the best of our knowledge, no systematic reviews have investigated the impact of probiotic supplementation on mental health and sleep patterns in women with PCOS. Emerging evidence indicates that probiotic therapy may be a promising adjunct for enhancing mental well-being and sleep quality within this population. Objectives: This systematic review aimed to evaluate the effects of probiotic supplementation on depression, anxiety, and sleep quality in adult women with PCOS. Methods: PubMed, Cochrane, and Scopus were searched for randomized controlled trials (RCTs) involving women aged 18–45 years old, with diagnosed PCOS, who received probiotic/synbiotic supplements and enriched foods compared with placebo. Studies had to assess mental health, depressive symptoms, or sleep disorders using validated questionnaires. Five publications met the Population, Intervention, Comparison, and Outcome inclusion criteria (PICO) and were included in the final analysis. Results: Probiotic supplementation was associated with significant improvements in sleep quality (assessed by Pittsburgh Sleep Quality Index, PSQI), depressive symptoms (assessed by Depression, Anxiety and Stress Scale, DASS 21) and quality of life (measured by Polycystic Ovary Syndrome Health Related Quality of Life Questionnaire, PCOSQ-26). Conclusions: Although probiotic supplementation may benefit mental health and sleep parameters in women with PCOS, this evidence is limited due to the small number of studies, modest sample sizes, and methodological variability. Further research with larger, more rigorous studies is needed to confirm these findings. Full article

Achieving the ambitious EU goals of zero-waste manufacturing requires innovative tools and methodologies that address both efficiency and environmental sustainability. This study presents a comprehensive methodology for assessing the efficiency and eco-efficiency of industrial processes, in order to support zero-waste manufacturing strategies. The proposed approach assesses critical performance metrics while integrating environmental-impact analysis to provide a holistic view of process optimization. The methodology was applied to two industrial use cases in the composites sector, a field with significant environmental impact due to the resource-intensive nature of composite manufacturing and challenges associated with the end-of-life management. By implementing this dual assessment, the study identifies key areas for improvement in operational performance and sustainability, offering actionable insights for process optimization and waste reduction. The results reveal that labor costs emerged as the primary contributor to the total costs for both use cases, more than 50%. On the other hand, the resin infusion phase accounts for the majority of the environmental impacts, accounting for more than 70% of the total impacts. This analysis highlights that eco-efficiency assessments, integrating environmental and cost data, allow the identification of inefficiencies, helping industries to prioritize improvement areas. In this specific case, the high environmental impact of resin infusion needs enhanced waste monitoring and process optimization, while the labor-intensive operations need streamlined workflows to reduce operational time and associated costs. The present methodology intends to serve as a practical tool for industries aiming to balance high-performance manufacturing with reduced environmental impact. Full article

Plant–pollinator interactions are essential to ecosystem functioning, yet the mechanisms that determine why some plant species become highly connected within interaction networks remain insufficiently understood, particularly in tropical coastal systems. Here, we examine how multiple plant traits predict the interactive role of species within a bee–plant network in a coastal ecosystem in the Gulf of Mexico. Using an existing dataset comprising 35 plant species and 47 bee species, we quantified each plant’s interactive role through species degree, betweenness, and closeness centrality. We then evaluated how six traits (i.e., flower number, flower size, flower color, number of stamens, plant height, and life form) influence these network positions. Our results show that four traits significantly predicted plant interactive roles. Plants surrounded by more open flowers and those with larger flowers interacted with a greater diversity of bee species, indicating that resource detectability and accessibility strongly shape visitation patterns. Herbaceous species also exhibited higher interactive roles than woody plants, likely due to their rapid growth, abundant and synchronous flowering, and predictable resource availability in dynamic coastal environments. Additionally, yellow-flowered species received disproportionately more visits and achieved higher interactive roles, consistent with known sensory biases of bees toward yellow wavelengths. In contrast, plant height and stamen number showed no detectable influence on network position. Overall, our findings demonstrate that a combination of vegetative and floral traits (particularly those signaling abundant, accessible, and visually detectable resources) drives the emergence of key plant species within bee–plant networks. Integrating plant traits with network metrics provides a powerful framework for identifying species that sustain pollinator diversity and for predicting community responses to environmental change. Full article

Background: Gastrointestinal discomfort affects up to 70% of individuals with spinal cord injury (SCI), largely due to gut dysbiosis caused by altered transit time and reduced gastrointestinal motility from autonomic disruption. Emerging evidence links prebiotics and probiotics to improved microbiome balance and reduced inflammation, yet data in SCI remain limited. Methods: Individuals aged ≥ 18 years, with a chronic SCI (≥1 year) experiencing significant gastrointestinal symptoms, will be invited to participate in this single-center randomized controlled crossover trial. Persons currently taking antibiotics, who have relevant eating or digestive disorders, or who have undergone a recent diet change will be excluded from the study. Participants will be randomized (1:1) into two groups. The first group will take a probiotic (Biotics-G, Burgerstein AG, Rapperswil-Jona, Switzerland) supplement for eight weeks, then after a four-week washout period, they will take a prebiotic (Oat Bran, Naturaplan, manufactured by Swissmill, Zurich, Switzerland) supplement for another eight weeks. The second group will receive the supplements in reverse order. The primary outcome is the Gastrointestinal Quality of Life Index, a questionnaire to assess quality of life related to gastrointestinal disorders. Secondary outcomes consist of gastrointestinal transit time, inflammatory blood markers, and gut microbiome composition. Ethics: The study will be conducted in accordance with the Declaration of Helsinki. The study was approved by the Ethics Committee for Northwest/Central Switzerland (EKNZ, ID: 2025-00238, 24.02.2025, Version 2.0). The study is registered at ClinicalTrials.gov (ID: NCT06870331, 02.04.2025). Written informed consent will be obtained from all participants involved in the study. Full article

Problematic Internet use is a major health issue among adolescents, underscoring the need for further research on the variables related to this dysfunctional usage pattern. This study examined the predictive capacity of four indicators of psychosocial adjustment (depressed mood, perceived stress, loneliness, and life satisfaction) for different dimensions of problematic Internet use (preference for online social interaction, Internet use for mood regulation, deficient self-regulation of Internet use, and negative consequences) in male and female adolescents. A sample of 628 adolescents, aged 12 to 18 years (M age = 14.11; SD = 1.52), participated. The results indicated that all dimensions of problematic Internet use were positively correlated with depressive mood, perceived stress, and loneliness, and negatively correlated with life satisfaction. However, notable differences emerged in how these psychosocial variables related to the four PIU dimensions. Loneliness and life satisfaction showed the strongest and most consistent associations. Loneliness predicted Internet use for mood regulation in both males and females and, additionally, predicted preference for online social interaction and negative consequences among males. Life satisfaction was a significant negative predictor of three PIU dimensions among females. Perceived stress stood out as the only predictor of deficient self-regulation in males and females. Finally, depressive mood predicted only the Internet-use-for-mood-regulation dimension among males. These findings may be useful for developing intervention programs aimed at reducing problematic Internet use among adolescents. Full article

Background: Nurses’ clinical reasoning is increasingly being recognized as a core competence that enhances the quality and safety of care across diverse healthcare settings. Nurses with refined clinical reasoning skills contribute significantly to improved health outcomes and broader health gains. In emergency departments, this competence is essential to rapidly assessing complex problems, anticipating complications, and preventing the deterioration of patients’ clinical conditions. Such expertise enables nurses to discern the severity of clinical situations quickly and intervene effectively. Objectives: The aims of this study were to analyze the clinical reasoning process of nurses and develop a theory that explains this process in emergency care settings. Methodology: This qualitative study explored the following research question: “How do nurses enact the clinical reasoning process in emergency departments?” The Grounded Theory methodology was used, with a theoretical sample of 20 nurses. Data collection methods included in-depth interviews, participant observation, and field notes. Results: The theoretical analysis identified clinical reasoning as a substantive theory composed of two subprocesses: Diagnostic Nursing Assessment and Therapeutic Nursing Intervention. Nurses’ clinical reasoning determines two levels of patient severity—Level I, life-threatening situations (immediate risk), and Level II, non-life-threatening situations (expressed problems)—according to which nursing interventions are adjusted. Conclusions: The Nursing Clinical Reasoning Model is a dynamic and continuous process that involves both Diagnostic Nursing Assessment and Nursing Therapeutic Intervention. It is deeply rooted in the nurse–patient–family relationship and is shaped by the specific care context, which influences nurses’ assessments and interventions and patients’ responses and behaviors. Full article