Search Results (8,452)

Background and Objectives: Rare diseases collectively affect large populations and require coordinated, patient- and caregiver-informed health and social support. This study had an overarching descriptive objective to characterize patient- and caregiver-reported experiences of living with rare diseases in Türkiye and a secondary exploratory objective to assess differences across broad disease categories. Materials and Methods: This cross-sectional, anonymous, voluntary non-probability online survey recruited affected individuals and relatives/caregivers through patient-organization networks. The 44-item questionnaire covered sociodemographic and caregiving context, diagnostic experiences, psychosocial support, healthcare access, and service-improvement priorities. Descriptive analyses, exploratory disease-group comparisons, Cramér’s V, and selected multivariable logistic regression models were used. Results: A total of 1642 responses were analyzed; 76.7% were completed by relatives/caregivers, and 66.4% concerned patients younger than 18 years. Among participants diagnosed after symptom onset (n = 1388), 34.4% reported an incorrect or alternative diagnosis and 64.0% sought at least one additional specialist opinion. Psychosocial support was needed by 74.2%, whereas 34.5% reported receiving professional support. Access to current treatment services was perceived as moderately adequate by 29.3% and adequate by 13.0%. The leading service-improvement priorities were increasing healthcare professionals’ knowledge (82.9%) and establishing specialized rare-disease centers (79.5%). Conclusions: This patient-organization-recruited survey provides a large descriptive account of the experiences and priorities reported by participating patients and caregivers. The findings identify perceived priorities, particularly clinician education and specialized centers, while not constituting nationally representative estimates. Full article

Telemedicine is increasingly transforming pediatric cardiology by expanding access to specialized care, supporting early diagnosis, and improving longitudinal monitoring of children with cardiovascular disease. This narrative review summarizes current applications of digital health in pediatric cardiology, with emphasis on congenital heart disease, pediatric hypertension, and arrhythmia management. Tele-echocardiography represents one of the most established telehealth tools, enabling remote interpretation of fetal, neonatal, and pediatric echocardiographic images and improving referral appropriateness, particularly in peripheral or resource-limited settings. In infants with complex congenital heart disease, especially those with single-ventricle physiology during the interstage period, home monitoring programs using mobile applications, pulse oximeters, digital scales, and structured caregiver reporting may facilitate early recognition of clinical deterioration and reduce avoidable transfers. In non-congenital cardiovascular disease, home blood pressure monitoring can improve diagnostic accuracy by reducing white-coat effects and supporting repeated measurements in real-life settings. Smartphone-enabled electrocardiographic devices and wearable technologies may enhance detection of intermittent arrhythmias and strengthen outpatient management. Despite these advantages, challenges remain, including data fragmentation, limited pediatric validation of consumer devices, interoperability issues, privacy concerns, and socioeconomic disparities in technology access. Properly integrated telemedicine may promote more timely, equitable, and patient-centered pediatric cardiovascular care. Full article

Cognitive function is central to healthy aging and is an important health outcome for evaluating long-term care policy. This study examines whether exposure to China’s long-term care insurance (LTCI) pilot is associated with cognitive function among adults aged 45 years and older. Using five waves of the China Health and Retirement Longitudinal Study (CHARLS) from 2011, 2013, 2015, 2018, and 2020, we estimate difference-in-differences (DID) models with individual and survey-wave fixed effects. Ten first-batch pilot cities are retained on the basis of implementation timing, with 2011–2015 classified as pre-policy and 2018–2020 as post-policy. Cognitive function is measured by a 0–21 composite score of episodic memory and mental intactness. In the preferred parsimonious specification, LTCI pilot exposure is associated with a 0.478-point reduction in the composite score (city-clustered SE = 0.168), equivalent to approximately 0.128 standard deviations; wild cluster bootstrap inference yields p = 0.008. The estimate remains negative under alternative covariate specifications, exclusion of the 2018 wave, pre-policy PSM-DID, and province-by-wave fixed effects. Event-study estimates are close to zero before the policy and negative thereafter, while city-level placebo estimates are centered near zero. Formal interaction tests indicate heterogeneity by baseline age, marital status, and hukou after false discovery rate adjustment but not by gender or number of children. The interaction with 2015 baseline CES-D is marginally significant (p = 0.063) and is therefore interpreted as exploratory. Overall, the findings suggest a modest negative association between LTCI pilot exposure and the composite cognitive-function score and highlight the value of monitoring domain-specific cognitive outcomes within long-term care policy. Domain-specific estimates diverged: episodic memory increased (beta = 0.300, p < 0.001), whereas mental intactness decreased (beta = −0.812, p < 0.001). In an age-stratified sensitivity analysis based on 2015 pre-policy age, the estimate was not statistically significant among adults aged 45–59 years (beta = 0.168, p = 0.380) but was negative among those aged 60 years or older (beta = −0.362, p = 0.003); the between-group interaction was significant (beta = −0.530, p = 0.040). Full article

Water scarcity is driving increasing interest in potable water reuse, particularly in arid regions. However, inadequately treated reclaimed water may pose health risks from waterborne pathogens, including gastrointestinal infections. This study applied quantitative microbial risk assessment (QMRA) to estimate infection risks associated with Escherichia coli (E. coli), Cryptosporidium, rotavirus, and adenovirus using pilot-scale data from El Paso Water’s Pure Water Center advanced purification facility. Pathogen concentrations in source and treated water were fitted to probability distributions and incorporated into a probabilistic Monte Carlo QMRA framework to estimate exposure doses, daily and cumulative infection risks, and treatment performance (expressed as log reduction values (LRVs)) and were compared to U.S. Environmental Protection Agency (EPA) drinking water risk thresholds. E. coli demonstrated the greatest treatment effectiveness, with a median daily treated water infection risk of 1.45 × 10⁻⁶ and a median LRV of 3.32. Cryptosporidium demonstrated limited reduction in infection risk (median LRV = 0.976), while rotavirus demonstrated minimal reduction following treatment. Although adenovirus infection risk decreased after treatment, the residual risk remained high. Viral risk estimates were strongly influenced by non-detects and limited observations. These findings highlight the importance of robust monitoring and probabilistic QMRA approaches for evaluating uncertainty and treatment performance in advanced potable reuse systems. Full article

Background/Objectives: School-based food and nutrition education is an important public health strategy for developing healthy dietary behaviors during childhood and adolescence. However, limited qualitative evidence describes how nutrition teachers, who are simultaneously responsible for school meals, perceive established educational priorities and emerging needs. This study explored current and future priorities for school-based food and nutrition education in South Korea. Methods: Two online focus group interviews were conducted with eight nutrition teachers working in elementary, middle, and high schools. The interviews were transcribed and analyzed using qualitative content analysis procedures. Results: Current priorities included foundational nutrition and food-related knowledge, balanced eating, environmental issues, low-sodium and low-sugar diets, understanding school meals, prevention of eating disorders and chronic diseases, and table manners and picky eating. Future needs centered on food choice and food literacy, sustainable diets, interdisciplinary education, and understanding diverse food cultures. Across themes, participants described a shift from primarily knowledge-focused instruction toward applied dietary competence, a broadening from individual disease prevention toward health and sustainability, and stronger integration of classroom education with school meals and other subjects. Conclusions: From the perspectives of the participating nutrition teachers, the findings provide formative evidence for curricula and interventions that combine foundational nutrition science with food-choice skills, age-appropriate preventive messages, sustainable dietary practices, and opportunities for behavioral application in the school meal setting. Future quantitative and intervention studies, including nationally representative samples, are needed before robust national priorities can be established. Full article

The gut microbiome is positioned at the center of a hub that contributes to both the physiology and pathology of multiple distant organs. It does this by releasing beneficial signaling molecules that are synthesized by various microbial species. Beneficial metabolites that cross from the gut lumen into the circulation include the short-chain fatty acids (SCFAs), a range of tryptophan metabolites (TRPMs), the major polyamines, and certain secondary bile acids. The SCFAs act on G-protein-coupled receptors (GPRs) and on histone deacetylases (HDACs) and, in so doing, suppress inflammation. Tryptophan metabolites act mainly through the nuclear receptor AhR, enhancing gut barrier and blood–brain barrier integrity. The polyamines stabilize nucleic acids and regulate cell proliferation. The secondary bile acids have varied effects on the liver, brain, and lung. In addition, the microbiome contributes to deleterious cometabolites, such as trimethylamine N-oxide, p-cresyl sulfate, and indoxyl sulfate. We predict that clinical laboratories in the future will assay patient samples for an amalgamation of beneficial and detrimental microbiota metabolites as biomarkers of both health and disease risk. Full article

Maternal smoking during pregnancy (MSDP) remains a significant public health concern. The molecular mechanisms underlying smoking-induced maternal-fetal impact remain incompletely understood. Newer omics platforms, such as cord blood adductomics, can provide preliminary insight into the “perinatal exposome” leading up to birth. The objective of this study is to explore the adductomic signatures of oxidant stress in cord blood associated with MSDP. In a cohort of mother-infant dyads enrolled at a single birth center in Chicago, IL (2008–2021), we conducted a secondary analysis of self-reported maternal smoking exposure data that was linked to an existent adductomics database of 105 addition products (adducts) measured in cord blood plasma. Principal component analysis (PCA), volcano plots and PERMANOVA were used to visualize the variability in adductomic profiles and to compare significantly increased and decreased adduct concentrations according to self-reported current-smokers, former-smokers, and never-smokers. N = 158 participants (N = 6 current-smokers, 26 former-smokers, and 126 never-smokers) had documented self-reported smoking status and were included in the analysis. PCA demonstrated separation between current-smokers and the other groups (R² = 0.026 for current vs. never-smokers, R² = 0.115 for current vs. former-smokers; Padj = 0.0075 for both) and no difference between former vs. never-smokers. Among 56 annotated adducts, 27 were increased in current vs. never-smokers, and 32 in current vs. former-smokers. Mode of delivery (p = 0.02) and maternal hypertension (p = 0.001) were significantly different among the three groups. Matched analysis by chronic hypertension (yes/no) supported the main finding that current-smoker adductomic profiles were distinct from both former (p = 0.015) and never-smoker (p = 0.0225) profiles. Self-reported MSDP appears to be associated with cord blood adductomic signatures of oxidant stress. Further studies are needed to determine how the duration, extent and timing of exposure correlate with exposomic changes at birth. Full article

Background/Objectives: Trauma remains a leading global cause of mortality and morbidity, particularly in low- and middle-income countries. Multitrauma patients often require intensive care and exhibit high mortality rates. Prognostic scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Revised Trauma Score (RTS) are widely used to predict outcomes; however, their performance in middle-income settings like Turkey has not been well established. This study aimed to evaluate the prognostic accuracy of APACHE II and RTS in predicting intensive care unit (ICU) mortality among multitrauma patients. Methods: This retrospective observational study was conducted in the General ICU of Diyarbakır Gazi Yaşargil Training and Research Hospital between January 2022 and December 2024. Adult patients (≥18 years) with multitrauma involving at least two anatomical regions were included. Demographic data, clinical scores (APACHE II, RTS, Sequential Organ Failure Assessment [SOFA], Injury Severity Score [ISS], Trauma and Injury Severity Score [TRISS]), laboratory parameters, complications, and outcomes were recorded. Univariate and multivariate logistic regression analyses identified independent predictors of ICU mortality. Receiver operating characteristic (ROC) analysis assessed the discriminatory ability of prognostic scores. Results: A total of 145 patients were analyzed, with an ICU mortality rate of 13.1%. Non-survivors had significantly higher APACHE II (27 ± 4 vs. 13 ± 6, p < 0.001) and SOFA scores (7 [4–13] vs. 2 [1–6], p < 0.001) and lower RTS (4.2 ± 1.7 vs. 7.2 ± 1.1, p < 0.001). Acute kidney injury, sepsis, septic shock, and mechanical ventilation were more frequent among non-survivors (p < 0.01 for all). In multivariate analysis, APACHE II (odds ratio [OR]= 1.54, 95% confidence interval [CI] 1.16–2.04, p = 0.003) and RTS (OR = 0.36, 95% CI 0.16–0.81, p = 0.013) were independent predictors of ICU mortality. ROC analysis showed excellent prognostic performance for APACHE II (area under the curve [AUC] = 0.959) and RTS (AUC = 0.888). Conclusions: In this retrospective single-center cohort, APACHE II and RTS were independently associated with ICU mortality and demonstrated good discriminatory performance for early risk stratification in critically ill multitrauma patients. The lower mortality observed in our cohort should be interpreted cautiously, as it may also reflect differences in case-mix, injury severity, ICU admission practices, and referral patterns. These findings require external validation in larger multicenter cohorts before broader generalization. Future studies should also validate the identified cut-off values and further investigate the prognostic role of biomarkers such as procalcitonin. Full article

Hemoglobin (Hb) and its glycated variant (HbA1c) are essential clinical biomarkers for diagnosing anemia, acute hemorrhage, and long-term glycemic control. The growing demand for decentralized point-of-care (POC) testing has accelerated the development of rapid, inexpensive, and portable electrochemical sensing platforms. These technologies exploit the intrinsic redox activity of the heme prosthetic group, yet achieving efficient direct electron transfer (DET) remains a fundamental challenge because the electroactive iron center is deeply embedded within the globin structure. This review critically examines recent advances in electrochemical Hb sensing, tracing the evolution of electrode architectures from conventional carbon substrates to nanostructured materials, including graphene, MXenes, metal–organic frameworks (MOFs), and molecularly imprinted polymers (MIPs). We compare the advantages and limitations of non-enzymatic biomimetic platforms and affinity-based sensing strategies, including aptamer- and antibody-based biosensors, with emphasis on electron-transfer efficiency, molecular selectivity, analytical performance, and suitability for POC implementation. Beyond analytical performance, we evaluate the principal barriers to clinical translation, including biofouling, whole-blood matrix effects, viscosity-dependent mass transport, manufacturing scalability, and the persistent gap between validation in synthetic media and performance in clinical samples. Finally, we discuss emerging applications in wearable menstrual health monitoring and ingestible gastrointestinal bleeding sensors, highlighting the integration of advanced electrochemical materials with miniaturized electronics as a pathway toward practical, consumer-oriented diagnostics. Full article

Background/Objectives: While Lebanon’s Vision 2030 prioritizes strengthening Lebanon’s chronically constrained, fragmented, and shocked primary healthcare system, implementation is hindered by weak sensing mechanisms, misaligned spatial distribution, and poorly integrated referral pathways. This study develops a preliminary, context-specific, systems-level healthcare policy assessment and framework for primary healthcare reform by applying biomimicry principles derived from the drought-resistant root architecture of grapevine (Vitis vinifera). Methods: Publicly available data from the Lebanese Ministry of Public Health, national assessments, and non-governmental organization registries were synthesized to examine mismatches between healthcare need and service capacity. We developed a preliminary healthcare Need Score for Lebanon’s eight governorates based on clinical demand, capacity strain, and socioeconomic vulnerability. An Agent-Based Approach within a biomimicry framework was used to translate grapevines’ biological strategies into healthcare policy design principles. Results: Structural deficiencies were identified in Lebanon’s primary healthcare system, including absence of standardized need-based sensing, uneven geographic service distribution, weak-referral integration, and limited adaptive feedback. Our preliminary Need Score was used four clinical demand indicators for iron deficiency, neonatal and maternal deaths, pre-mature births and birth defects, and disease incidence. Service-capacity strain indicators were primary healthcare center density and staffing. Finally, socioeconomic vulnerability indicators were percentages for non-Lebanese population and food insecurity. The proposed policy framework can translate frontline stress signals to rule-based responses, guide adaptive redistribution of capacity, and structurally anchor primary healthcare centers to referral hubs through defined catchments and electronic referral loops. Conclusions: Biomimicry can shed insight into how to improve primary healthcare governance under chronic scarcity. Need Scores and biological resilience principles can strengthen primary healthcare systems in low-resource settings while aligning with healthcare policy objectives like those in Lebanon’s Vision 2030. Full article

Background: Kazakhstan is among the most highly endemic countries for hepatic echinococcosis worldwide, yet no study systematically characterised the national hepatobiliary surgical burden of cystic (CE) and alveolar (AE) echinococcosis using administrative health data. Methods: National operative data from the Guaranteed Volume of Free Medical Care (GOBMP) and Compulsory Social Health Insurance (OSHI) Systems (1 January 2023–31 December 2025) were combined with institutional case series from the National Research Oncology Center (NROC), Astana (2021–2025). Cases were identified using ICD-10 diagnosis codes and ICD-9-CM procedure codes. Regional and species-specific differences in surgical approach were assessed using Pearson’s chi-square test; continuous variables were compared using the Mann–Whitney U test. Results: A total of 143 hepatic echinococcosis surgeries were performed nationally over the three-year period, with a 12.8% increase in annual volume (47 in 2023, 43 in 2024, 53 in 2025), though this year-to-year variation was not statistically significant (χ² = 1.06, df = 2, p = 0.59). CE accounted for 74.8% of cases (n = 107), AE for 18.9% (n = 27), and unspecified hepatic echinococcosis for 6.3% (n = 9); the proportion of AE rose from 17.0% in 2023 to 26.4% in 2025. Astana performed 46.2% of all operations nationally, with its share increasing from 34.0% to 58.5% over the study period; together with Almaty, it accounted for 92.6% of all AE cases. Partial hepatic resection was the predominant procedure overall (81.1%), while AE was managed exclusively by resectional or lobar procedures (χ² = 15.37, p = 0.004), with no percutaneous approaches used. In the NROC case series (n = 63), AE patients were older (median 43.5 vs. 33 years, p = 0.036) and had longer postoperative hospital stays (median 12 vs. 10 days, p = 0.015) than CE patients. Conclusions: Surgical management of hepatic echinococcosis in Kazakhstan is increasingly centralised in Astana and Almaty, with AE consistently requiring more extensive resectional surgery and greater healthcare resource use than CE. These findings support the development of a national echinococcosis registry and formal referral pathways to guide resource allocation and surgical planning. Full article

Background/Objectives: Unhealthy diets and poor lifestyle choices can increase athlete’s risk of low energy availability (LEA) and its negative consequences. Conversely, optimal nutrition, such as the Mediterranean Diet (MedDiet), promotes health, recovery, and performance. This study evaluates MedDiet adherence among athletes and physically active individuals, exploring its relationship with nutrition knowledge (NK), dietary intake, eating behaviors, and sleep quality. Methods: This single-center observational study evaluated Italian healthy active adults/athletes (18–65 years) categorized into four performance Tiers. Validated questionnaires analyzed MedDiet adherence (MEDI-LITE), NK (GeSNK), eating behaviour (EAT-26 and TOS), sleep quality (PSQI), and physical activity (IPAQ). Dietary intake was estimated via a 7-day food diary. Body composition (skinfolds/BIVA), and resting energy expenditure (indirect calorimetry) were assessed. Results: Analysis included 169 participants (32.3 ± 11.9 years; 52.7% females; 56.8% Tier 1), practicing 2.0 ± 0.9 sports with 7.1 ± 3.7 h/week of training. Mean MEDI-LITE score was 10.6 ± 2.2 (moderate adherence) across all Tiers and was significantly, positively associated with NK (p = 0.002). Mean EA was 31.3 ± 8.6 kcal/kg FFM/day; sex-specific cut-offs revealed a substantial proportion of high-tier participants with low/suboptimal EA. Eating disorder risk and orthorexic tendencies were low, sleep quality was generally good; none significantly correlated with MEDI-LITE score. Conclusions: Higher NK was positively associated with MedDiet adherence. However, high-tier athletes showed low or suboptimal EA. Targeted nutrition education must integrate MedDiet principles with sport-specific fueling strategies, optimizing diet quality and energy adequacy. Full article

Background: Polypharmacy remains a significant challenge, often leading to adverse drug events and increased healthcare costs. One effective strategy to mitigate these risks is deprescribing, the systematic and intentional discontinuation or reduction of medications. Despite growing recognition of deprescribing’s importance, limited research has examined the impact of interprofessional education interventions on developing deprescribing competencies among healthcare professional students. This study aims to examine the perspectives of healthcare students, including student pharmacists, medical students, and nurse practitioner students, regarding their roles and responsibilities in the deprescribing process. Methods: Following completion of a Deprescribing Interprofessional Education Simulation activity (DIPE-SA), participants were invited to join focus groups. The study included students from the University of Tennessee Health Science Center (UTHSC) Colleges of Medicine, Nursing, and Pharmacy. Constructivist Grounded Theory (CGT) underpinned the qualitative research approach, informing the development of the study framework. Each focus group was facilitated by two researchers and recorded. Recruitment continued until saturation was achieved. Data were transcribed verbatim and analyzed for themes using Dedoose, qualitative analysis software. Results: A total of 19 participants attended four focus groups. Three major themes emerged and guided the development of the Roles–Collaboration–Communication (RCC) interprofessional framework. The first theme, roles, focuses on the unique responsibilities and functions healthcare professionals assume within the team and throughout the deprescribing process. The second theme, collaboration, emphasizes coordinated efforts and shared decision-making among members of the interprofessional healthcare team in deprescribing. Finally, the third theme, communication, highlights the importance of effective information and intention exchange, serving as both a mediator and connector, linking roles and collaboration, and ultimately enabling successful deprescribing. Conclusions: This study’s findings, together with the RCC interprofessional framework, demonstrate the interplay of roles, collaboration, and communication in medication management. The RCC framework highlights the value of dynamic team processes for achieving safe and effective deprescribing, which in turn improves patient care and health outcomes. Full article

Background: In-center hemodialysis is the dominant kidney replacement therapy modality in Greece and generates substantial recurring expenditure for the public payer. Home hemodialysis is not currently implemented at national scale, but it may reduce long-term public expenditure if early investment in training capacity, equipment and home support is recovered over time. Objective: To evaluate, from the Greek public-payer perspective, the discounted budget impact and net present value (NPV) of implementing a national home hemodialysis program for 300 patients. Methods: We developed a deterministic investment-appraisal model comparing gradual implementation of home hemodialysis with continued in-center hemodialysis for the same projected cohort over 10 years. The in-center comparator was informed by a 2022 Greek patient-level micro-costing study. Home hemodialysis expenditure was constructed from explicit patient-flow equations, resource quantities, unit costs, capital purchases and hospital-tariff offsets. Annual incremental savings were discounted at 3% in the base case. Alternative discount rates, deterministic one-way sensitivity analyses and program-scale scenarios were examined. Fiscal benefit–cost ratio (BCR) and return on investment (ROI) were also calculated. Results: Undiscounted 10-year public expenditure was EUR 69,681,804 for home hemodialysis and EUR 86,700,267 for continued in-center hemodialysis, yielding savings of EUR 17,018,463. During the first 5 years, the program required EUR 1,724,012 in additional expenditure. At a 3% discount rate, NPV was EUR 12,696,564, the fiscal BCR was 2.89, fiscal ROI was 189.3% and discounted payback occurred during year 6. NPV remained positive at 5% (EUR 10,391,382) and across all tested one-way scenarios (range EUR 706,179 to EUR 24,686,948). Conclusions: The modeled national home hemodialysis program generated a positive 10-year public-payer NPV under the base-case and tested sensitivity assumptions. A positive NPV is not, however, a formal Greek health-system decision rule and does not capture health outcomes, patient and family costs, or equity. The findings support staged pilot implementation and prospective collection of Greek real-world data before wider rollout. Full article

Background: The COVID-19 pandemic exacerbated longstanding social and health inequities in predominantly Black and Latino communities in North and Central Brooklyn, in the form of disproportionately high hospitalization and mortality rates. Community organizations served as critical sources of information and resources during this period. Methods: The Bureau of Brooklyn Neighborhood Health within the NYC Health Department, conducted semi-structured virtual interviews with 19 representatives from 15 organizations that had partnered with the Bureau within the past five years. Interviews were conducted between November 2021 and February 2022. Transcripts were coded and analyzed using a hybrid deductive–inductive approach incorporating constant comparative techniques. Results: Partners described worsening food insecurity, inequitable vaccine and testing access, digital divide challenges, funding instability, staffing shortages, and escalating mental health needs. Organizations pivoted from routine operations to provide emergency food distribution, virtual programming, mental health support, advocacy, and disseminating information as trusted messengers in the community. Conclusions: Findings underscore the essential role of local community organizations in crisis response and recovery. Future preparedness efforts must center community expertise, strengthen cross-sector collaboration, streamline funding processes, and investments in social and digital infrastructures to advance health equity and community resilience. Full article