Search Results (3,240)

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, with comparatively limited attention given to how individual reminiscence is implemented and sustained within care home practice. Methods: This study was an implementation-focused qualitative exploration of staff experiences of introducing and embedding individualised reminiscence in care home practice. Care home staff participated in four monthly workshops that introduced principles of individualised reminiscence and supported them to plan and implement reminiscence with at least one resident. Participants used either the InspireD digital reminiscence app (n = 19) or non-digital approaches such as life story books (n = 2), depending on local preferences and perceived suitability. Three focus groups were conducted with 21 care home staff to explore experiences of implementing individualised reminiscence and perceptions of its impact on residents, staff, and families. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were identified: (1) reminiscence within pressured systems; (2) resident experience and identity; (3) adapting and sustaining practice; and (4) families as partners in reminiscence. Participants described challenges associated with workload pressures, role expectations, and variability in family involvement, which influenced how reminiscence was adopted in practice. Despite these constraints, participants described perceived benefits for residents, including perceived improvements in mood, engagement, and expressions of identity. Participants also discussed perceived increased staff confidence, strengthened staff–resident relationships, and enhanced awareness of person-centred care practices. Conclusions: Findings highlight the perceived potential of individualised reminiscence to support person-centred and relational care in care homes, while identifying key contextual influences on implementation. Further research is needed to examine sustainability and effectiveness using comparative and mixed-method designs. Full article

Background/Objectives: Physical activity benefits women with metastatic breast cancer. Past trials are typically well-resourced and supervised, but home-based interventions may be preferable and more accessible. This pilot trial evaluated the feasibility and preliminary efficacy of a remotely delivered behaviour change intervention aiming to increase physical activity for women with metastatic breast cancer. Methods: A 12-week, two-arm trial involved 20 women with metastatic breast cancer randomised 1:1 to a generic recommendation group or behaviour change group. Both groups received a physical activity recommendation, Fitbit^® watch, diary, and nine phone/video call sessions. The behaviour change group received individualised advice around physical activity benefits, motivation, barriers, and social support; the generic recommendation group completed a recurring symptom questionnaire. Feasibility outcomes were recruitment, retention and adherence rates. Acceptability was evaluated with a structured interview at trial completion. Preliminary efficacy outcomes included 5-day Actigraph wear, 6 min walk distance, 30 s sit-to-stands, and questionnaires for self-reported physical activity, quality-of-life, fatigue, behavioural factors, and patient-specific function. Results: Recruitment, retention, and adherence rates were 63% (n = 20/32), 80% (n = 16/20), and 76% (137/180 sessions), respectively. Participants across both groups reported that participation was acceptable, and their behaviour change was perceived as sustainable. Preliminary change scores for efficacy measures favoured the behaviour change group, except some quality-of-life and behavioural factor subscales. Conclusions: Participants were receptive to the trial, and feasibility and efficacy measures were positive. This indicates that a behaviour change intervention for unsupervised physical activity is acceptable and can be beneficial to women with metastatic breast cancer, warranting further exploration. Full article

It is imperative to continuously monitor public awareness, attitudes, and environmental actions to adjust policy to promote and support transition processes given the ongoing phenomenon of climate change. Insights into poorly investigated domains, such as rural areas, are particularly valuable in this context. Responding to this challenge, we aimed to diagnose the efforts in which individuals engage for the benefit of their local communities in rural areas of a selected region of Poland (Małopolskie Voivodeship) in the context of climate change and the energy transition. The study concerns a specific region, one with the most intensive deployment of climate and energy policy in Poland. It is also highly diversified in terms of the environment and population, from the densely urbanised Kraków Metropolitan Area to scattered rural areas where institutional resources are scarce. This diversity affects how local populations engage in climate and energy efforts. The study involves a literature review and an original 2024 survey among 300 people from five rural districts of Małopolskie Voivodeship selected to reflect the region’s diversity. The CAPI (Computer-Assisted Personal Interviewing) survey sample was built with chain referral. The in-depth analyses were performed in IBM SPSS, v.25. We employed statistical analyses, including one-way ANOVA to assess between-group variance, χ2 tests, Sidak tests, and Fisher’s tests. The results show that most respondents recognised an association between energy and climate, but the awareness is fragmented and varied. These conclusions call for amplifying environmental awareness, particularly regarding energy transition. We have also confirmed a significant spatial diversification of environmental attitudes and practices among the public regarding the energy transition. It has been confirmed by all indicators, from the state of the environment to the perceived agency to the structure of home heating systems. Additionally, the importance of local governments in pro-climate activities was indicated. This is particularly important in the context of the ‘Anti-smog resolution for Małopolska’, which has been in force in the Małopolska Province since 2019 and plays a leading role in climate policy in the region. What is particularly important is that the vast majority of respondents from all districts declared their support for these changes, for which local governments are responsible. Full article

Background: Gastric cancer (GC) is one of the most common malignancies, requires aggressive treatment, as has a high incidence of complications. The high prevalence of cachexia and comorbidity among GC patients has led to the development of the “prehabilitation” concept. We aimed to investigate the prognostic value of cachexia in the “Western” patient population with resectable GC and to evaluate its utility as an indicator for a home-based prehabilitation program. Methods: This cohort study included 147 patients who underwent surgical treatment for GC from 2019 to 2023. A multivariable analysis was conducted to study the impact of cachexia on postoperative outcomes in 122 patients with resectable GC. The prehabilitation group included 25 patients with cachexia who underwent a 2-week-long multimodal prehabilitation program prior to surgery. The functional results, as well as the 30-day incidence of postoperative complications and 90-day mortality, were evaluated. Results: There were 76 (51.7%) patients with cachexia. Multivariate analysis revealed that cachexia was a significant predictor of all postoperative complications (OR = 5.48, 95% CI 1.85–18.39, p = 0.001), severe postoperative complications (OR = 15.87, 95% CI 3.05–131.81, p < 0.001) and surgical site infection (SSI) (OR = 8.03, 95% CI 1.89–49.09, p = 0.038). Patients in the prehabilitation group had a lower incidence of SSI than in the control group (8.3% vs. 23.5%, p = 0.049). Conclusions: Preoperative cachexia is a potentially modifiable predictor of complications after gastric cancer surgery, and its identification may help define high-risk patients for proactive multimodal prehabilitation. Full article

One of the challenges post-COVID-19 is reducing the negative impacts on quality of life, performance, and independence in activities of daily living. Assessing functional dependence in adults one year after acute infection can help to understand the long-term consequences, evaluate the impact on quality of life, plan rehabilitation and healthcare, identify the most vulnerable groups, measure the socioeconomic impact, and support public policies and clinical decisions. Objectives: The objectives of this study are as follows: (a) to assess the prevalence of functional dependence in Brazilian adults with COVID-19; (b) to analyze the association between the study variables; and (c) to determine the factors associated with functional dependence. Methods: This was an observational, cross-sectional study with 987 adults (18 to 59 years old) living in the State of Paraná (Brazil) hospitalized for COVID-19 between March and December 2020. Data were collected by telephone 12 months after the acute infection using an instrument to retrieve sociodemographic and health information, and a functional dependence scale to assess dependence before COVID-19 retrospectively (using participant recall information) and at the time of the interview. Data were analyzed using penalized logistic regression after imputing missing data. Data were analyzed using penalized logistic regression after imputing missing data. Results: Functional dependence after COVID-19 was 5.0% and was associated with low levels of education, not having a partner, living with someone, not owning a home, experiencing job changes, requiring care, obesity, smoking, multimorbidity, ICU admission in the acute phase, use of invasive ventilation, or having Long COVID. Individuals who required care or used invasive ventilation support were, respectively, 9.3 and 6.5 times more likely to develop dependence after COVID-19. Despite adjustment for multiple factors, the magnitude of the observed effects warrants cautious interpretation, as unmeasured or residual confounding effects may still be present. Sample recall bias due to collection after 12 months and the presence of the alpha variant without COVID-19 vaccination coverage may limit data generalization. Conclusions: The results highlight the need to emphasize the public health implications of identifying functional dependence. In this vein, it is necessary to implement preventive measures, identify and monitor more vulnerable groups, plan rehabilitation programs, and develop public health policies. Full article

Mesenchymal stem cells (MSCs) are multipotent adult cells that are highly valued for their immunomodulatory potential and intrinsic ability to home to inflamed sites. This study specifically utilized human dental pulp stem cells (hDPSCs), a unique MSC subtype derived from the neural crest, due to their reported superior anti-inflammatory capacity. To rigorously test their efficacy, we employed the AIRmax murine model, which exhibits a genetically determined high-inflammatory phenotype. Acute inflammation was induced by subcutaneous injection of the polyacrylamide suspension Biogel P-100. Two hours post-induction, AIRmax mice were treated intravenously with hDPSCs. Our results demonstrate that hDPSC treatment produced significant anti-inflammatory effects evident at 24 h. The treated group showed a pronounced reduction in leukocyte migration and decreased protein extravasation in the inflammatory exudate. Crucially, hDPSCs also modulated molecular mediators, significantly decreasing the pro-inflammatory cytokine TNF-alpha and reactive oxygen species (ROS) production. Furthermore, while hDPSCs efficiently and rapidly homed to the inflammation site within 2 h, their maximal therapeutic benefits only manifested after 24 h. This suggests that their robust capacity to modulate acute inflammatory responses relies not only on rapid migration but also on a paracrine “hit-and-run” mechanism that suppresses cellular infiltration and oxidative stress over time. This study reinforces the potential of hDPSCs as a powerful, multi-target therapeutic agent for inflammatory conditions, supporting further investigation into their precise mechanisms and clinical application. Full article

Understanding how contextual variables shape differences in match demands in youth football is essential for optimising performance and player development. Objective: This study aimed to compare physical and competitive performance according to playing position, match location, match result, and opponent quality in the physical and competitive performance of U21 football players from a professional Chilean club. Methods: Twenty male U21 players (19.2 ± 1.2 years) were monitored during 11 official matches using 10 Hz GPS devices (WIMU Pro™) and post-match Rating of Perceived Exertion (RPE). Variables included total distance (TD), high-speed running (HSR > 20 km/h), metres per minute (MM), accelerations/decelerations (N°AC/N°DC > 3 m·s⁻²), player load (PL), and peak velocity (PV). Contextual variables were classified by playing position, home/away, win/loss, and opponent quality (higher vs. lower rank). Results: Significant between-group differences were found across all contextual factors (p < 0.05). Midfielders (MFs) covered greater TD and reported higher RPE, while full-backs (FBs) and wingers (WGs) reached higher HSR and PV. Away and lost matches showed greater RPE, PL, and N°AC/N°DC, alongside more goals conceded. Facing higher-ranked opponents increased RPE and HSR but reduced explosive actions. Conclusions: Physical performance in U21 football is strongly modulated by contextual factors. Coaches should adjust training load and tactical strategies according to match conditions and positional roles to optimise adaptation and competitive readiness in developmental categories. Full article

The global rise in nursing home (NH) populations presents substantial challenges, as residents frequently experience physical and cognitive decline, low physical activity, and high fall risk. This study evaluates the effectiveness of the BeSt Age App, a tablet-based, staff-supported mHealth intervention designed to promote physical activity and prevent falls among NH residents. Primary outcomes were fall incidence and fall risk (assessed using Berg Balance Scale [BBS] and Timed Up and Go [TUG]); fear of falling was a secondary outcome. In a cluster-randomized controlled trial across 19 German NHs, 229 residents (mean age = 85.4 ± 7.4 years; 74.7% female) were assigned to an intervention group (IG) or control group (CG). The 12-week intervention comprised twice-weekly, tablet-guided exercise sessions implemented by NH staff. Mixed models and generalized estimating equations were used under an intention-to-treat framework. The IG showed significantly greater improvement in BBS scores than the CG (group × time: F(1, 190.81) = 8.25, p = 0.005, d = 0.22), while group × time changes in TUG performance, fear of falling, and fall incidence were nonsignificant. These findings demonstrate the feasibility of a staff-mediated mHealth approach to fall prevention in NH residents, showing significant improvements in BBS scores as one functional indicator of fall risk, while TUG, fall incidence and fear of falling showed no change. Full article

Georgia is recognized as one of the world’s earliest known centers of grape cultivation and wine production, as well as the home of 525 indigenous grape varieties. Phenolic compounds are a diverse group of secondary metabolites which are present in both grapes and wine, with the phenolic derivatives determining the organoleptic properties and the antioxidant activity of the resulting wines. Remarkably, the content and composition of phenolic compounds in wine are mainly influenced by the grape variety and the winemaking method. In this context, herein we review the present knowledge on the phenolic composition of the most common Georgian grape varieties and discuss available molecular insights on the resulting wines. The comparison of traditional European and traditional Georgian “qvevri” winemaking methods revealed that this method provides high antioxidant activity of Georgian wines, as well as a unique phenolic composition of red and white Georgian wines. Full article

Background/Objectives: Despite the known benefits of cardiac rehabilitation, it remains underutilized among women. In particular, little is known about the effectiveness of hybrid comprehensive telerehabilitation (HCTR) in women with heart failure (HF). The purpose of this study was to assess effectiveness and safety of HCTR in women with HF. Methods: This analysis formed part of the TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO₂peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were taken before and after intervention/observation. Results: Women constituted 11.5% of the TELEREH-HF study population. Forty women in the HCTR group and 44 women in the UC group completed program and observation, respectively. HCTR resulted in a significant improvement in VO₂peak (13.4 ± 4.3 vs. 14.3 ± 4.6; 95%CI 0.91 [0.05; 1.77], p = 0.038), workload duration (301 ± 162.3 vs. 334 ± 156.6; 95%CI 33 [5; 60], p = 0.022) and SF-36 overall score (85.9 ± 13.6 vs. 89.9 ± 13.5; 95%CI 4.0 [0.6; 7.4], p = 0.024). These favorable results were not observed in the UC group VO₂peak (14.2 ± 4.8 vs. 14.2 ± 4.8; 95%CI 0.02 [−1.20; 1.24], p = 0.971) and SF-36 overall score (89.1 ± 17.4 vs. 89.5 ± 15.8; 95%CI 4.0 [−2.1; 2.8], p = 0.796), except for an increase workload duration (268 ± 138.4 vs. 300 ± 130.1; 95%CI 32 [2; 62], p = 0.036). The HCTR group showed a significantly greater improvement in the physical component of QoL than the UC group. In neither group were there deaths nor major adverse events related to exercise training. Conclusions: Among women with heart failure, hybrid comprehensive telerehabilitation appears safe and leads to statistically significant although moderate improvements in physical capacity and quality of life. However, due to the small sample size, further studies in larger female populations are needed to confirm these findings. Full article

Indoor air quality (IAQ) is a critical determinant of respiratory health and plays an essential role in asthma management. Exposure to indoor pollutants such as particulate matter (PM_2.5), volatile organic compounds (VOCs), and biological allergens can exacerbate asthma symptoms. This pilot quasi-experimental, one-group pretest–posttest study evaluated the combined effect of high-efficiency particulate air (HEPA) purifiers and tailored asthma education on the IAQ and asthma outcomes of 30 adults diagnosed with asthma. Indoor PM_2.5, total VOCs (tVOC), temperature, and relative humidity were monitored using low-cost air quality monitors across three home locations for 30 days, and participants completed baseline and follow-up assessments of asthma control (ACQ) and quality of life (AQLQ). The intervention reduced PM_2.5 concentrations from 21.32 µg/m³ to 18.19 µg/m³ (p < 0.001), while tVOC levels increased slightly from 237.05 ppb to 251.81 ppb (p = 0.02). The median ACQ scores improved from 1.17 to 0.50 (p < 0.001), the proportion of participants with well-controlled asthma (ACQ ≤ 0.75) rose from 30% to 66.7%, and the median AQLQ scores increased from 5.75 to 6.30 (p < 0.001). Participants in the intervention experienced significantly improved asthma control, quality of life, and indoor PM_2.5 levels, which underscores the significance of integrating environmental and educational strategies in adult asthma management. Full article

Background: The prognostic relevance of surgical timing at glioblastoma recurrence remains uncertain, and definitions of early versus delayed reoperation vary widely. Whether earlier surgery provides meaningful survival or functional benefit has not been clearly established. Methods: Databases including PubMed, Embase, Scopus, and Web of Science were searched from inception to May 2025. Eighteen observational studies met the inclusion criteria, fourteen of which provided extractable hazard ratios for survival. The primary outcome was overall survival after reoperation; secondary outcomes included functional status (ΔKPS or discharge home) and major postoperative complications. Random-effects models with Hartung–Knapp adjustment were used, with subgroup analyses stratified by KPS, extent of resection, and eloquence. Results: Across 2267 reoperated patients from 14 survival studies, earlier reoperation was associated with significantly longer survival (pooled HR 0.86; 95% CI 0.78–0.95). Subgroup analyses showed stronger effects in patients with KPS ≥ 70 (HR 0.81; 95% CI 0.72–0.92), non-eloquent tumors (HR 0.84; 95% CI 0.75–0.94), and near-total/gross-total resection (HR 0.79; 95% CI 0.68–0.93). Functional outcomes were pooled from 9 studies (n = 1182), demonstrating higher odds of postoperative stability or improvement with early surgery (OR 1.28; 95% CI 1.12–1.46). Major complications were reported in 9 studies (n = 1344) and did not differ between groups (OR 0.98; 95% CI 0.81–1.19). Sensitivity analyses and influence diagnostics showed consistent effect estimates and no undue single-study influence. Conclusions: Earlier reoperation for recurrent glioblastoma is associated with improved survival and better functional outcomes without increased morbidity in appropriately selected patients. Surgical timing should be incorporated into multidisciplinary planning. Prospective studies with standardized timing definitions and time-dependent modeling are needed to validate these findings. Full article

Background/Objectives: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to pose a significant global health challenge due to its high transmissibility and potential for severe clinical outcomes. Early identification of patients at risk of hospitalization is essential for effective triage in emergency departments and for the optimal allocation of healthcare resources. Methods: This prospective study included 84 patients aged over 18 years who presented to the emergency department on 23 December 2020, with suspected SARS-CoV-2 infection. Initially, 100 patients were evaluated, and 16 were excluded based on predefined exclusion criteria. The mean age of the participants was 53.65 ± 13.62 years, and 39 (46.4%) were women. Results: At admission, the mean signal peptide, CUB domain, EGF (SCUBE-1) level among SARS-CoV-2 patients was 0.16 ± 0.08 ng/mL. There was no significant difference in SCUBE-1 levels between patient and control groups (n = 59 vs. 25), but levels differed significantly between hospitalized and home-treated patients (n = 37 vs. 22; p = 0.001). Neutrophil count (p = 0.001) and NLR (p = 0.010) were higher in patients than controls and also higher in hospitalized than home-treated patients (p = 0.003 and p = 0.015). ROC analysis revealed that SCUBE-1 predicted hospitalization with 84.6% sensitivity and 88.9% specificity. A positive correlation was observed between SCUBE-1 levels and length of hospital stay (p = 0.007, r = 0.554), with a median stay of 9.0 (5.0–11.0) days. Conclusions: SCUBE-1 levels were significantly associated with disease severity in SARS-CoV-2 patients and may serve as a promising biomarker to support clinical decision-making for hospitalization versus home-based management. Full article

Objectives. To integrate clinical and economic evidence on the main non-pharmacological interventions aimed to reduce the burden of caregivers of people with dementia, with specific attention to stated preference measures (SPM), Willingness-to-Pay (WTP) and Willingness-to-Accept (WTA), alongside other cost-effectiveness indicators (ICER, QALY). Methods. A systematic review was conducted on randomized and quasi-experimental evaluations, economic models, and preference studies concerning psychoeducational/coping interventions, activity-centered/occupational programs (TAP), technological solutions and tele-support, and goal-oriented cognitive rehabilitation (CR). For each study, the following indexes were extracted: design, sample size, psychological outcomes (anxiety/depression, burden, engagement), utility per QALY, costs per perspective (the health–social and the broader societal perspectives), ICER, WTP/WTA, and sensitivity results. Results. Psychoeducational programs and CR show consistent benefits on distress, anxiety/depression, and caregiver quality of life; TAP reduces caregiver burden and patient behavioral problems, with favorable signs of cost–effectiveness; results on the effects of technologies are heterogeneous, but online modules with telephone support improve psychological morbidity. QALY improvement is generally modest, but the probability of cost-effectiveness remains high when costs do not differ significantly from treatment as usual, or when, from a societal perspective, the unpaid caregiving time of the caregiver is valued. Preference studies indicate positive WTP for additional hours of home care, health–social integration, and facilitated groups; evidence on WTA is scarcer and methodologically variable. Conclusions. Short, structured interventions with a human support component offer good value-for-money; the adoption of societal perspectives and the systematic use of WTP/WTA can better capture the value perceived by caregivers. Heterogeneity issues persist. Full article

Background and Objectives: Hypertension affects more than 27% of adults in China, and despite ongoing public health efforts, substantial gaps remain in awareness, treatment, and blood pressure control, particularly among older adults and patients with multiple comorbidities. Conventional clinic-based care often provides limited opportunity for frequent monitoring and timely treatment adjustment, which may contribute to persistent poor control in routine practice. The objective of this study was to evaluate changes in blood pressure control and related clinical indicators during implementation of a mobile-enhanced remote patient monitoring (RPM)–supported care model among hypertensive patients with comorbidities, including patterns of medication adjustment, adherence, and selected cardiometabolic parameters. Methods: We conducted a multicenter, pre–post evaluation of a mobile-enhanced remote patient monitoring (RPM) program among 6874 adults with hypertension managed at six hospitals in Chongqing, China. Participants received usual care during the pre-RPM phase (April–September 2024; clinic blood pressure measured using an Omron HEM-7136 device), followed by an RPM-supported phase (October 2024–March 2025; home blood pressure measured twice daily using connected A666G monitors with automated transmission via WeChat, medication reminders, and clinician follow-up). Given the use of different devices and measurement settings, blood pressure comparisons may be influenced by device- and setting-related measurement differences. Monthly blood pressure averages were calculated from all available readings. Subgroup analyses explored patterns by sex, age, baseline BP category, and comorbidity status. Results: The cohort was 48.9% male with a mean age of 66.9 ± 13.7 years. During the RPM-supported care period, the proportion meeting the study’s blood pressure control threshold increased from 62.4% (pre-RPM) to 90.1%. Mean systolic blood pressure decreased from 140 mmHg at baseline to 116–118 mmHg at 6 months during the more frequent monitoring and active treatment adjustment period supported by RPM (p < 0.001), alongside modest reductions in fasting blood glucose and total cholesterol. These achieved SBP levels are below commonly recommended office targets for many older adults (typically <140 mmHg for ages 65–79, with individualized lower targets only if well tolerated; and less stringent targets for adults ≥80 years) and therefore warrant cautious interpretation and safety contextualization. Medication adherence improved, and antihypertensive regimen intensity increased during follow-up, suggesting that more frequent monitoring and active treatment adjustment contributed to the early blood pressure decline. Subgroup patterns were broadly similar across age and baseline BP categories; observed differences by sex and comorbidity groups were exploratory. Conclusions: In this large multicenter pre–post study, implementation of an RPM-supported hypertension care model was associated with substantial improvements in blood pressure control and concurrent intensification of guideline-concordant therapy. Given the absence of a concurrent control group, clinic-to-home measurement differences, and concurrent medication changes, findings should be interpreted as associations observed during an intensified monitoring and treatment period rather than definitive causal effects of RPM technology alone. Pragmatic randomized evaluations with standardized measurement protocols, longer follow-up, and cost-effectiveness analyses are warranted. Full article