Search Results (1,154)

The increase in the elderly population globally reflects a change in the population’s mindset regarding preventive health measures and necessitates a rethinking of healthcare strategies. The integration of machine learning (ML)-type algorithms in geriatrics represents a direction for optimizing prevention, diagnosis, prediction, monitoring, and treatment. This paper presents a systematic review of the scientific literature published between 1 January 2020 and 31 May 2025. The paper is based on the applicability of ML techniques in the field of geriatrics. The study is conducted using the Web of Science database for a detailed discussion. The most studied algorithms in research articles are Random Forest, Extreme Gradient Boosting, and support vector machines. They are preferred due to their performance in processing incomplete clinical data. The performance metrics reported in the analyzed papers include the accuracy, sensitivity, F1-score, and Area under the Receiver Operating Characteristic Curve. Nine search categories are investigated through four databases: WOS, PubMed, Scopus, and IEEE. A comparative analysis shows that the field of geriatrics, through an ML approach in the context of elderly nutrition, is insufficiently explored, as evidenced by the 61 articles analyzed from the four databases. The analysis highlights gaps regarding the explainability of the models used, the transparency of cross-sectional datasets, and the validity of the data in real clinical contexts. The paper highlights the potential of ML models in transforming geriatrics within the context of personalized predictive care and outlines a series of future research directions, recommending the development of standardized databases, the integration of algorithmic explanations, the promotion of interdisciplinary collaborations, and the implementation of ethical norms of artificial intelligence in geriatric medical practice. Full article

Oncology physiotherapists frequently provide care for patients experiencing severe immunosuppression. Exercise immunology, the science that studies the effects of exercise on the immune system, is a rapidly evolving field with direct relevance to oncology physiotherapists. Understanding oncology physiotherapists’ perspectives on the subject of immune functioning is essential to explore its possible integration into clinical reasoning. This study aimed to assess the perspectives of oncology physiotherapists concerning immune functioning in oncology physiotherapy. For this qualitative research, semi-structured interviews were performed with Dutch oncology physiotherapists. Results were analyzed via inductive thematic analysis, followed by a validation step with participants. Fifteen interviews were performed. Participants’ ages ranged from 30 to 63 years. Emerging themes were (1) the construct ‘immune functioning’ (definition, and associations with this construct in oncology physiotherapy), (2) characteristics related to decreased immune functioning (in oncology physiotherapy), (3) negative and positive influences on immune functioning (in oncology physiotherapy), (4) tailored physiotherapy treatment, (5) treatment outcomes in oncology physiotherapy, (6) the oncology physiotherapist within cancer care, and (7) measurement and interpretation of immune functioning. In conclusion, oncology physiotherapists play an important role in the personalized and comprehensive care of patients with cancer. They are eager to learn more about immune functioning with the goal of better informing patients about the health effects of exercise and to tailor their training better. Future exercise-immunology research should clarify the effects of different exercise modalities on immune functioning, and how physiotherapists could evaluate these effects. Full article

This study presents and discusses evidence on the value of biomarker testing and precision medicine in Latin America through a health equity lens. It is essential to explore how to harness the benefits of precision medicine to narrow the health equity gap, ensuring all patients have access to the best cancer treatment. The methodology employed to develop this document consists of a non-systematic literature review, followed by a process of validation and feedback with a group of experts in relevant fields. Precision medicine could help reduce health inequities in Latin America by providing better diagnosis and treatment for everyone with cancer. However, its success in achieving this depends on the implementation of policies that promote equitable access. Findings indicate that the current policy landscape in the Latin American region is not conducive to improving access, reach, quality, or outcome-related problems in cancer care, nor to realizing the full potential of precision medicine. The study explores how precision medicine can advance health equity, concluding with an analysis of the challenges and recommendations for overcoming them. Full article

Background/Objectives: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector. University Departments of Rural Health (UDRH), academic centres based in regional, rural, and remote (RRR) locations across Australia, are uniquely positioned to foster a culturally safe rural health workforce through training, education, and engagement with Indigenous communities. This narrative review examines the contributions of UDRHs to health workforce issues through analysis of their publications focused on Indigenous health. Methods: Research articles relating to workforce were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Of 46 articles identified across the 12 years, 19 focused on developing the understanding and cultural safety skills of university students studying in a health field, including campus-based Indigenous health education and support for students undertaking rural clinical placements. Twelve articles investigated cultural safety skills and recruitment and retention of the rural health workforce. Fifteen articles focused on Indigenous people in the health workforce, examining clinical training and resources, and the enablers and barriers to retaining Indigenous students and workers. Conclusions: This analysis highlights the sustained efforts of UDRHs to improve Indigenous health through multiple areas within their influence, including curriculum design, health student training on campus, and rural placement opportunities to transform understanding of Indigenous strengths and disadvantages and rural health workforce development. A continuing effort is needed on ways UDRHs can support Indigenous health students during their studies and while on placement, how to improve cultural safety in the health workforce, and ways to better support Indigenous health professionals. Full article

Students, particularly those in the medical field, are exposed to various stressors that can affect their health-related behaviors, including smoking habits, with implications for oral health and quality of life. Background and Objectives: to analyze the relationship between smoking, oral health, perceived stress level, and self-assessed quality of life in a sample of dental students. Materials and Methods: The cross-sectional study included 338 students, who completed validated questionnaires and were clinically examined. Lifestyle was assessed using a smoking behavior questionnaire, stress levels were measured with the Student Stress Inventory (SSI), and quality of life was evaluated using the EQ-5D-5L instrument. The DMFT index was calculated to determine oral health status. Results: Among the 338 participating students, 53.8% were smokers. The lifestyle analysis revealed slightly higher average scores among non-smokers across all domains—social (3.26 vs. 3.09), attitudinal (2.75 vs. 2.97), and behavioral (3.82 vs. 3.49), but without statistically significant differences (p > 0.25). The mean DMFT score was 12.48, with no significant differences between smokers and non-smokers (p = 0.554). The SSI total score averaged 83.15, indicating a moderate level of perceived stress, again with no statistically significant differences between the groups (p > 0.05). However, slightly higher average stress scores among smokers may suggest the use of smoking as a coping mechanism. In contrast, quality of life as measured by EQ-5D-5L showed significantly worse outcomes for smokers across all five dimensions, including mobility (78.6% vs. 95.5%, p = 0.000) and self-care (93.4% vs. 100%, p = 0.001). Multivariable logistic regression identified smoking (OR = 1.935; p = 0.047) and moderate stress levels (OR = 0.258; p < 0.001) as independent predictors of oral health status. Conclusions: The results obtained suggest that smoking may function as a stress management strategy among students, supporting the relevance of integrating specific psychobehavioral interventions that address stress reduction and oral health promotion among student populations. Full article

Self-medication is a subject of global importance. If practiced responsibly, self-medication represents a part of self-care or positive care of an individual or a community in promoting their own health. However, today’s practices of self-medication are often inappropriate and irresponsible, and as such appear all over the world. Inappropriate self-medication can be connected with possible serious health risks and consequences. Therefore, it represents a global health issue. It can even generate additional health problems, which will eventually become a burden to healthcare systems and can induce significant costs, which also raises socioeconomic concerns. Hence, self-medication attracts the attention of researchers and practitioners globally in efforts to clarify the current status and define feasible measures that should be implemented to address this issue. This narrative review aims to give an overview of the situation in the field of self-medication globally, including current practices and attitudes, as well as implications for actions needed to improve this problem. A PubMed/MEDLINE search was conducted for articles published in the period from 1995 up to March 2025 using keywords “self-medication” or “selfmedication” alone or in combinations with terms related to specific subthemes related to self-medication, such as COVID-19, antimicrobials, healthcare professionals, and storing habits of medicines at home. Studies were included if self-medication was their main focus. Publications that only mentioned self-medication in different contexts, but not as their main focus, were excluded. Considering the outcomes of research on self-medication in various contexts, increasing awareness of responsible self-medication through education and informing, together with surveillance of particular medicines and populations, could lead to more appropriate and beneficial self-medication in the future. Full article

Although intracranial hypertension (ICH) has traditionally been framed as simply a numerical escalation of intracranial pressure (ICP) and usually dealt with in its clinical form and not in terms of its complex underlying pathophysiology, an emerging body of evidence indicates that ICH is not simply an elevated ICP process but a complex process of molecular dysregulation, glymphatic dysfunction, and neurovascular insufficiency. Our aim in this paper is to provide a complete synthesis of all the new thinking that is occurring in this space, primarily on the intersection of glymphatic dysfunction and cerebral vein physiology. The aspiration is to review how glymphatic dysfunction, largely secondary to aquaporin-4 (AQP4) dysfunction, can lead to delayed cerebrospinal fluid (CSF) clearance and thus the accumulation of extravascular fluid resulting in elevated ICP. A range of other factors such as oxidative stress, endothelin-1, and neuroinflammation seem to significantly impair cerebral autoregulation, making ICH challenging to manage. Combining recent studies, we intend to provide a revised conceptualization of ICH that recognizes the nuance and complexity of ICH that is understated by previous models. We wish to also address novel diagnostics aimed at better capturing the dynamic nature of ICH. Recent advances in non-invasive imaging (i.e., 4D flow MRI and dynamic contrast-enhanced MRI; DCE-MRI) allow for better visualization of dynamic changes to the glymphatic and cerebral blood flow (CBF) system. Finally, wearable ICP monitors and AI-assisted diagnostics will create opportunities for these continuous and real-time assessments, especially in limited resource settings. Our goal is to provide examples of opportunities that exist that might augment early recognition and improve personalized care while ensuring we realize practical challenges and limitations. We also consider what may be therapeutically possible now and in the future. Therapeutic opportunities discussed include CRISPR-based gene editing aimed at restoring AQP4 function, nano-robotics aimed at drug targeting, and bioelectronic devices purposed for ICP modulation. Certainly, these proposals are innovative in nature but will require ethically responsible confirmation of long-term safety and availability, particularly to low- and middle-income countries (LMICs), where the burdens of secondary ICH remain preeminent. Throughout the review, we will be restrained to a balanced pursuit of innovative ideas and ethical considerations to attain global health equity. It is not our intent to provide unequivocal answers, but instead to encourage informed discussions at the intersections of research, clinical practice, and the public health field. We hope this review may stimulate further discussion about ICH and highlight research opportunities to conduct translational research in modern neuroscience with real, approachable, and patient-centered care. Full article

The widespread and persistent occurrence of micropollutants—such as pesticides, pharmaceuticals, heavy metals, personal care products, microplastics, and per- and polyfluoroalkyl substances (PFAS)—has emerged as a critical environmental and public health concern, necessitating the development of highly sensitive, selective, and field-deployable detection technologies. Microfluidic sensors, including biosensors, have gained prominence as versatile and transformative tools for real-time environmental monitoring, enabling precise and rapid detection of trace-level contaminants in complex environmental matrices. Their miniaturized design, low reagent consumption, and compatibility with portable and smartphone-assisted platforms make them particularly suited for on-site applications. Recent breakthroughs in nanomaterials, synthetic recognition elements (e.g., aptamers and molecularly imprinted polymers), and enzyme-free detection strategies have significantly enhanced the performance of these biosensors in terms of sensitivity, specificity, and multiplexing capabilities. Moreover, the integration of artificial intelligence (AI) and machine learning algorithms into microfluidic platforms has opened new frontiers in data analysis, enabling automated signal processing, anomaly detection, and adaptive calibration for improved diagnostic accuracy and reliability. This review presents a comprehensive overview of cutting-edge microfluidic sensor technologies for micropollutant detection, emphasizing fabrication strategies, sensing mechanisms, and their application across diverse pollutant categories. We also address current challenges, such as device robustness, scalability, and potential signal interference, while highlighting emerging solutions including biodegradable substrates, modular integration, and AI-driven interpretive frameworks. Collectively, these innovations underscore the potential of microfluidic sensors to redefine environmental diagnostics and advance sustainable pollution monitoring and management strategies. Full article

At diagnosis, metastatic prostate cancer (PC) is sensitive to androgen deprivation therapy (ADT), and patients are usually referred to as having castration-sensitive prostate cancer (mCSPC). The combination of ADT and androgen receptor pathway inhibitors (ARPI) is the current standard of care for mCSPC. This study aimed to review the literature on economic evaluations and health economic models related to mCSPC. A literature search was performed covering Medline, Embase, and Scopus with additional grey literature sources. Studies with data on health economic evaluations focusing on Europe or North America were relevant. 18 peer-reviewed articles and 10 grey literature documents were included. The majority (n = 23) had a deterministic Markov structure and applied either Markov cohort or partitioned survival models. Evaluations investigated various types of ADT-based combinations, comparing the addition of ARPI, chemotherapy agents, or radiation therapy to ADT alone. We concluded that economic evaluations in the field of PC are widely published, and there are a large number of publications even in the specific subgroup of mCSPC. Regardless of the investigated interventions, most studies applied similar methodologies and simulated patients from the mCSPC state until the development of mCRPC or death. Full article

Background/Objectives: Reinforcement learning (RL), a subset of machine learning, has emerged as a promising tool for supporting precision medicine and dynamic treatment regimes by enabling adaptive, data-driven clinical decision making. Despite its potential, challenges such as interpretability, reward definition, data limitations, and clinician adoption remain. This review aims to evaluate the recent advancements in RL in precision medicine and dynamic treatment regimes, highlight clinical fields of application, and propose practical frameworks for future integration into medical practice. Methods: A systematic review was conducted following PRISMA guidelines across PubMed, MEDLINE, and Web of Science databases, focusing on studies from January 2014 to December 2024. Articles were included based on their relevance to RL applications in precision medicine and dynamic treatment regime within healthcare. Data extraction captured study characteristics, algorithms used, specialty area, and outcomes. Results: Forty-six studies met the inclusion criteria. RL applications were concentrated in endocrinology, critical care, oncology, and behavioral health, with a focus on dynamic and personalized treatment planning. Hybrid and value-based RL methods were the most utilized. Since 2020, there has been a sharp increase in RL research in healthcare, driven by advances in computational power, digital health technologies, and increased use of wearable devices. Conclusions: RL offers a powerful opportunity to augment clinical decision making by enabling dynamic and individualized patient care. Addressing key barriers related to transparency, data availability, and alignment with clinical workflows will be critical to translating RL into everyday medical practice. Full article

In the era of precision medicine, effective data visualisation plays a pivotal role in supporting clinical decision-making by translating complex, multidimensional datasets into intuitive and actionable insights. This paper explores the foundational principles of visual perception, with a specific focus on pre-attentive attributes such as colour, shape, size, orientation, and spatial position, which are processed automatically by the human visual system. Drawing from cognitive psychology and perceptual science, we demonstrate how these attributes can enhance the clarity and usability of medical visualisations, reducing cognitive load and improving interpretive speed in high-stakes clinical environments. Through detailed case studies and visual examples, particularly within the field of oncology, we highlight best practices and common pitfalls in the design of dashboards, nomograms, and interactive platforms. We further examine the integration of advanced tools—such as genomic heatmaps and temporal timelines—into multidisciplinary workflows to support personalised care. Our findings underscore that visually intelligent design is not merely an aesthetic concern but a critical factor in clinical safety, efficiency, and communication, advocating for user-centred and evidence-based approaches in the development of health data interfaces. Full article

Obesity is a chronic, relapsing disease with multifactorial origins and significant global health implications. Historically, bariatric surgery has been the most effective intervention for achieving sustained weight loss and metabolic improvement, especially in individuals with moderate to severe obesity. However, the therapeutic landscape is rapidly evolving. Recent advances in pharmacotherapy—including GLP-1 receptor agonists, dual and triple incretin agonists, and amylin-based combination therapies—have demonstrated unprecedented efficacy, with some agents inducing 15–25% weight loss, approaching outcomes once exclusive to surgical intervention. These developments challenge the continued applicability of existing bariatric surgery criteria, which were established in an era of limited medical alternatives. In this narrative review, we examine the evolution of surgical eligibility thresholds and critically assess the potential role of novel pharmacotherapies in redefining treatment algorithms. By comparing the efficacy, safety, metabolic benefits, and cost-effectiveness of surgery versus next-generation drugs, we explore whether a more stepwise, pharmacotherapy-first approach may now be justified, particularly in patients with BMI 30–40 kg/m². We also discuss future directions in obesity management, including personalized treatment strategies, perioperative drug use, and the integration of pharmacologic agents into long-term care pathways. As the field advances, a paradigm shift toward individualized, minimally invasive interventions appears inevitable—necessitating a timely re-evaluation of current bariatric surgery guidelines to reflect the expanding potential of medical therapy. Full article

Agroecological transitions in collective urban gardens in Toulouse region were studied through the prism of global health (2011–2022). The specific meaning of “global health” in the context of urban gardens concerns the health of gardeners (well-being and physical health), plants, soil, and animals, as well as the interactions between humans and non-humans, which are crucial for gardeners. A sociotechnical research project was developed on four different collective gardening sites, consisting of the following: 1. surveys issued to 100 garden stakeholders to highlight issues and practices, participation in meetings with the social centers in charge of events, and focus groups; 2. participative agronomic and environmental measurements and field observations, including soil quality analyses; and 3. analysis of the available documentary corpus. In order to produce the results, these three research methods (surveys, agronomy, document analysis) were combined through a transdisciplinary approach, in that both the field experimentation outcomes and retrieved scientific publications and technical documents informed the discussions with gardeners. Consideration of the four different sites enabled the exploration of various contextual factors—such as soil or air quality—affecting the production of vegetables. A rise in the concerns of gardeners about the impacts of their activities on global health was observed, including aspects such as creating and enjoying landscapes, taking care of the soil and biodiversity, developing social connections through the transmission of practices, and regular outside physical activity and healthier eating. The increased consideration for global health issues by all stakeholders promotes the implementation of agroecological practices in gardens to improve biodiversity and adherence to circular economy principles. Four concepts emerged from the interviews: health, production of vegetables, living soil, and social interactions. Notably, nuances between the studied sites were observed, according to their history, environment, and organization. These collective gardens can thus be considered as accessible laboratories for social and agroecological experimentation, being areas that can strongly contribute to urban ecosystem services. Full article

Urinary incontinence is characterized by the involuntary leakage of urine. The primary cause of stress urinary incontinence in women is the weakening of the pelvic floor muscles. Stress urinary incontinence (SUI) is a significant global health problem that impacts mainly middle-aged women, with a severe impact on their quality of life. Traditional diagnostic methods and treatments often fail, although technological innovations have improved diagnostic accuracy, such as specific questionnaires or transperineal ultrasound. While medical therapies and surgical procedures are continuously being developed, controversies about the correct choices regarding diagnostic and treatment methods continue to exist. The aim of our review was to identify the innovative diagnostic tools and effective treatment procedures for SUI. A narrative review was conducted due to the heterogeneity of the studies. New methods for diagnosis and treatment have gained ground, and we have covered them in our review; however, the field continues to expand. A personalized approach to diagnosis is also a requirement because of the limitations of conventional urodynamic studies, and we emphasize the importance of such personalization in enhancing clinical decision making. Future medical strategies that combine both preventive and therapeutic care are desirable. Newer technologies were brought to light in this review, including stem cell therapy and laser therapy. Full article

Sepsis-associated acute kidney injury (S-AKI) represents a significant health problem associated with adverse outcomes. Our study aimed to assess the value of serum cystatin-C (sCysC) and TNF-α (rs361525) in combination for diagnosing S-AKI patients and predicting their adverse outcomes. The study included 100 critically ill neonates and 100 controls. Patients were categorized into an S-AKI group and a non-AKI group. TNF-α (−238, rs361525) genotyping was performed using RT-PCR, and sCysC was assessed using ELISA. Our study showed a fundamental difference in the genotype frequencies of TNF-α (−238, rs361525) and SNP between S-AKI and non-AKI patients. Furthermore, there was a significant relationship between cystatin C and TNF-α (−238, rs361525), where cystatin C was higher in patients with AA alleles than in patients with GA and GG alleles. Combining GA + AA genotypes with elevated serum cystatin-C levels can serve as a potential diagnostic and prognostic biomarker for AKI development in this population. The GA/AA genotypes independently predicted S-AKI risk (OR = 6.64, p < 0.001). At the same time, elevated sCysC (>9.4 mg/L) emerged as a sensitive biomarker (AUC = 0.848) and independent predictor of adverse outcomes. Collectively, these findings contribute to the growing field of personalized medicine and represent a strategic advantage, enabling prevention-focused care rather than the treatment of established disease. Full article