Search Results (8,665)

Background/Objectives: Chronic kidney disease (CKD) is a major cause of morbidity and mortality. Evidence on routine management and patient-reported outcomes in Greece is limited. The SPIRIT study assessed real-world treatment patterns, disease management, and quality of life (QoL) among CKD patients in Greece. Methods: This was a prospective, multicenter, observational study in Outpatient Nephrology Clinics of fifteen National Health System (NHS) Hospitals in Greece enrolling adults with estimated glomerular filtration rate (eGFR) calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation (CKD-EPI eGFR) between 15 and <60 mL/min/1.73 m², with a 12-month follow-up. Results: A total of 305 CKD patients participated in the study (40.0% classified as stage G3a, 39.0% G3b, and 21.0% G4), with a mean age of 69.3 years. Antihypertensives were administered to 84.3%, 84.1%, and 85.1% of patients at baseline, 6, and 12 months, respectively, mostly calcium channel blockers, while lipid-lowering agents were administered to 63.3%, 64%, and 63.2% at baseline, 6, and 12 months, respectively, predominantly statins (95.3%, 95.9%, and 96.5% of lipid-lowering users). Interestingly, renin-angiotensin-aldosterone system (RAAS) inhibitors were administered to a total of 160 patients, 91.9% of whom had hypertension, while sodium-glucose cotransporter 2 (SGLT2) inhibitors were administered to 45 patients, with 66.7% of them suffering from CKD and type 2 diabetes. SGLT2i use increased from 15.3% at baseline to 35.4% at 12 months. Mean CKD-EPI eGFR remained stable (mean 40.1, 41.3, and 40.7 mL/min/1.73 m²), while median urine albumin-to-creatinine ratio (UACR) increased from 145.2 mg/g at baseline to 253.4 mg/g at 6 months and 246.6 mg/g at 12 months. Statistically significant improvements (p < 0.05) were observed between 6 and 12 months in specific domains of the Kidney Disease QoL-Short Form (KDQOL-SF) v1.3. Conclusions: The study provides real-world evidence on stage-related treatment patterns, routine management, and QoL in CKD outpatients in Greece. Full article

The opioid epidemic continues to be a major public health crisis in the United States, and nalmefene has recently emerged as an alternative opioid overdose reversal agent. However, little is known about pharmacists’ awareness and beliefs regarding nalmefene use and distribution. Therefore, the purpose of this study was to assess Alabama pharmacists’ knowledge, perceptions, and behavioral intentions related to nalmefene. This study used a cross-sectional survey design. Practicing pharmacists in the state of Alabama were eligible to participate, and were recruited through the Alabama Board of Pharmacy email listserv. An anonymous online survey was distributed via email, and respondents were eligible to enter a lottery for one of five $100 electronic gift cards. The survey instrument was developed by the investigators, adapted from prior overdose reversal literature and informed by the Theory of Planned Behavior. Primary outcome measures included: knowledge of nalmefene (12 items); perceived barriers regarding nalmefene stocking and recommendations (19 items); and Theory of Planned Behavior concepts including attitudes (15 items), subjective norms (perceived social support) (six items), perceived behavioral control (confidence in ability to stock or recommend nalmefene) (11 items), and behavioral intentions surrounding nalmefene stocking and recommendations (13 items). Outcomes were measured via multiple-choice (objective knowledge) and Likert-type scale (1 = strongly disagree, 5 = strongly agree) questions. Differences in mean scale scores across pharmacy setting (pharmacists employed in inpatient versus outpatient settings), community pharmacy type (chain vs. independent), and geographic location (rural vs. urban) were analyzed using two-sided Mann–Whitney U tests for non-parametric data or t-tests for parametric data, as appropriate. Multiple linear regression analyses examined associations between TPB constructs and pharmacists’ intentions to stock or recommend nalmefene over the next six months. All data were analyzed using SPSS statistical software version 29 with an alpha of 0.05. There were 119 pharmacist respondents (n = 25 inpatient, n = 94 outpatient). The majority were female (68.1%), White (94.1%), and worked in community settings (35.3% independent, 10.9% corporate, 10.1% big-box, 5.0% grocery). Median age was 42 years (IQR: 36–51). Awareness of nalmefene was low: only 39.5% had heard of it and 5.9% had seen it in practice. Inpatient versus outpatient pharmacists reported higher subjective norms external to the workplace (median [IQR]: 3.00 [2.33, 3.58] vs. 2.33 [1.67, 3.00]; p = 0.004) as well as subjective knowledge (mean [SD]: 2.96 [0.94] vs. 2.55 [0.74]; p = 0.023), while outpatient versus inpatient pharmacists reported higher perceived barriers related to fiscal/logistical concerns (mean [SD]: 3.45 [0.59] vs. 3.07 [0.66]; p = 0.009). Among community pharmacists, stocking and procurement confidence was higher among independent versus chain pharmacists (3.75 [3.00–4.17] vs. 3.17 [2.67–3.92]; p = 0.026). Furthermore, external workplace norms among urban pharmacists were higher than among rural pharmacists (2.50 [2.00–3.00] vs. 2.33 [1.67, 2.67]; p = 0.027), while stocking and procurement confidence was higher among rural than urban pharmacists (3.83 [2.83–4.50] vs. 3.17 [2.67–4.00]; p = 0.034). In adjusted reduced regression models, perceived behavioral control regarding nalmefene stocking and procurement (B = 0.189, 95% CI: 0.049, 0.329; p = 0.009), subjective norms external to the workplace (B = 0.232, 95% CI: 0.047, 0.418; p = 0.015), and interprofessional recommendation attitudes (B = 0.237, 95% CI: 0.037, 0.437; p = 0.021) positively predicted nalmefene implementation intentions. These findings suggest practice-setting differences that could be further explored for optimal implementation of nalmefene distribution and access, and highlight the need for targeted education, interprofessional collaboration, procurement guidance, and workflow tools to improve pharmacist preparedness for nalmefene services. Full article

Background/Objectives: Frailty is a common geriatric syndrome associated with functional decline, dependency, and adverse health outcomes in older adults. Community-based nursing interventions may help prevent or delay frailty by promoting physical activity, health education, and self-care. This exploratory study aimed to describe pre–post changes in frailty status and functional capacity following a community-based nursing intervention among community-dwelling older women. Methods: An exploratory uncontrolled pre–post study was conducted in Spain. Of 35 community-dwelling, non-institutionalized women aged ≥65 years who underwent baseline assessment, 23 provided complete baseline and post-intervention data and were included in the final pre–post analysis. The intervention consisted of a 16-week nursing programme with weekly group sessions focused on adapted physical exercise, health education, and self-care. Frailty was assessed using the FRAIL Scale. Four available components of the Fried phenotype were examined as secondary frailty-related measures. Functional capacity was evaluated using the Barthel Index and the Lawton and Brody Scale. Results: Among the 23 participants included in the final paired pre–post analysis, the proportion classified as frail according to the FRAIL Scale decreased from 47.8% at baseline to 8.7% at post-intervention assessment, while the proportion classified as robust increased from 17.4% to 30.4%. Nine of the eleven participants classified as frail at baseline moved to a less severe frailty category at follow-up. Frailty status changed significantly across the three FRAIL categories (p < 0.001). Additional analyses showed a decrease in difficulty walking 100 m (43.5% to 8.7%; p = 0.008) and in low physical activity (60.9% to 26.1%; p = 0.021). Functional capacity did not change significantly. Participants reported high levels of satisfaction with the programme. Conclusions: Favourable pre–post changes in FRAIL status and selected frailty-related measures were observed among participants who completed the study, while functional capacity remained stable. Given the exploratory uncontrolled design, small analytical sample, and participant attrition, these findings should not be interpreted as evidence of intervention effectiveness. Larger controlled studies are required to determine whether the observed changes can be attributed to the intervention. Full article

Background: Higher blood pressure (BP) in childhood is an important predictor of cardiovascular disease later in life, and adiposity is an important modifiable factor associated with BP. However, updated national evidence on the associations of general and central adiposity indicators with BP outcomes among Chinese children and adolescents remains limited. Methods: This cross-sectional study was based on physical health data collected from 146,399 children and adolescents across 30 provinces in China between October and November 2019. Height, weight, waist circumference, and BP were measured using standardized procedures, and adiposity was assessed using body mass index (BMI) and waist-to-height ratio (WHtR). Linear mixed-effects models were used to evaluate associations of BMI and WHtR with continuous BP outcomes, and generalized linear mixed-effects models were used for screening-defined hypertension (SDH), adjusting for sociodemographic, dietary, and physical activity variables. Results: Mean systolic BP and diastolic BP were 107.40 (SD 12.65) mmHg and 67.78 (SD 9.66) mmHg, respectively. After multivariable adjustment, each 1-unit increase in BMI was associated with increased odds of SDH (OR = 1.131, 95% CI: 1.123, 1.139), and each 0.1-unit increase in WHtR was associated with increased odds of SDH (OR = 1.798, 95% CI: 1.732, 1.866). Conclusions: Higher BMI and WHtR were associated with higher BP levels and greater odds of SDH among Chinese children and adolescents. These findings highlight the importance of early identification and prevention of adiposity-related BP abnormalities in youth. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with alterations in eating behavior, dietary patterns, and body weight regulation. Although pharmacological treatment is known to suppress appetite, its broader effects on nutrition-related outcomes remain unclear. This scoping review aimed to map the available evidence on dietary intake, eating behavior, nutritional status, growth, and bone health in individuals with ADHD receiving pharmacotherapy. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed and Scopus were searched from January 2010 to June 2026. Studies were eligible if they reported at least one nutrition-related outcome in medicated individuals with ADHD. Following study selection and data charting, the reported outcomes were grouped into four domains: dietary intake/eating behavior, nutritional status/metabolic biomarkers, growth/anthropometric outcomes, and bone health. Results: Twenty-seven studies met the inclusion criteria, the majority of which were observational and conducted in pediatric or mixed-age populations. Growth and anthropometric outcomes were the most frequently investigated domain. Stimulant treatment was associated with reduced appetite; lower energy intake during active treatment periods; and transient reductions in body weight, BMI, and growth velocity. Several studies also reported changes in eating behavior, including both increased risk of disordered eating and improvements in dietary structure. Evidence regarding nutritional biomarkers, metabolic outcomes, and bone health was limited and heterogeneous. Conclusions: ADHD pharmacotherapy is associated with a broad range of nutrition-related effects that extend beyond appetite suppression alone. The available evidence suggests that nutritional outcomes are shaped by a complex interaction of biological and behavioral mechanisms. Important evidence gaps remain regarding adult populations, long-term nutritional consequences, and nutritional biomarkers. Full article

Background: This article introduces a clinically oriented, anatomy-based classification of subgingival margins. The proposed system categorizes margins into distinct zones based on their relationship with gingival and periodontal tissues and links each zone to appropriate restorative strategies. Methods: The classification is based on established principles of periodontal anatomy and restorative dentistry, as well as clinical considerations related to accessibility, isolation, and matrix placement. Three zones are proposed: (1) margins located within the free gingiva, which are generally accessible and manageable with rubber dam isolation; (2) margins extending into the junctional epithelium and supracrestal tissue attachment, where additional measures, including matrices and wedges, are often required to achieve adequate isolation and adaptation; and (3) margins located at or below the alveolar bone crest, which have traditionally required surgical management but may, in selected cases, be managed with advanced matrix techniques. Results: The proposed classification helps clinicians assess the complexity of subgingival margins before performing deep margin elevation (DME) and provides guidance for selecting appropriate clinical procedures according to margin depth and anatomical location. Conclusions: This classification provides a practical framework for selecting appropriate isolation techniques and treatment strategies to improve the predictability of restorative outcomes. Further clinical research is needed to evaluate its validity and its effects on periodontal health and long-term restorative outcomes. Full article

Antimicrobial resistance represents a major One Health challenge affecting human, animal, and environmental health, and responsible antimicrobial use in companion animal medicine has become increasingly important. This narrative review synthesizes current evidence on antimicrobial stewardship interventions aimed at improving antibiotic prescribing in small animal veterinary practice. The review discusses the clinical, behavioral, owner-related, organizational, and regulatory factors that influence prescribing decisions, with emphasis on diagnostic uncertainty, access to microbiological testing, communication with pet owners, and practice-level prescribing culture. Key stewardship strategies include evidence-based clinical guidelines, diagnostic stewardship, education and training, audit and feedback, electronic clinical decision-support systems, antimicrobial resistance surveillance, infection prevention, and multifaceted implementation programs. Evidence from predominantly observational and before-and-after studies suggests that these interventions may be associated with reductions in unnecessary antimicrobial prescribing and improvements in prescribing appropriateness, although the strength of causal evidence remains limited. However, further research is needed because current studies differ in methodology, often have short follow-up periods, include limited data from routine primary veterinary practices, and rarely demonstrate a direct reduction in antimicrobial resistance. Future progress will depend on standardized outcome measures, integration of digital health technologies, rapid diagnostics, artificial intelligence, antimicrobial resistance surveillance, and stronger One Health collaboration. Overall, antimicrobial stewardship in companion animal medicine should be regarded as a continuous quality-improvement process designed to preserve antimicrobial efficacy while maintaining optimal patient care. Full article

Learners with epilepsy experience persistent educational challenges that remain underexplored within inclusive education discourse, particularly in secondary school contexts. Guided by the Capability Approach, this study examines how epilepsy shapes learners’ opportunities to participate meaningfully in schooling and achieve valued educational outcomes. Situated within an interpretivist paradigm, this interpretive qualitative research employed semi-structured interviews with 12 learners diagnosed with epilepsy, recruited from four secondary schools in South Africa. Grounded in learners lived experiences, the data were analysed using reflexive thematic analysis. The findings indicate that seizure episodes disrupt classroom participation and continuity of learning, while stigma and fear of embarrassment constrain learners’ confidence and social inclusion. Recurrent absenteeism, linked to both medical and psychosocial factors, further limits academic engagement and progression. These interconnected challenges restrict learners’ capabilities not only to learn, but also to participate fully and develop a sense of belonging within the school environment. The findings suggest that participants experienced educational disadvantage through the interaction between health-related challenges and contextual barriers rather than through epilepsy alone. It highlights the potential value of inclusive and responsive educational practices that may expand learners’ opportunities for participation and belonging, including enhanced teacher awareness, flexible pedagogical approaches, and psychosocial support. By foregrounding learners’ voices, the study contributes to a more nuanced understanding of how chronic health conditions intersect with inclusive education and calls for systemic efforts to promote meaningful participation and well-being. Full article

Background/Objectives: Inadequate gestational weight gain (GWG), encompassing both low and excessive, is a significant concern because of its association with adverse maternal and neonatal health outcomes. The relationships between maternal lifestyle factors, such as diet, physical activity, prepregnancy body mass index (BMI), and GWG, are complex. This study aims to explore these associations via correspondence analysis (CA), a method that visualizes the relationships between categorical variables. Methods: A CA was conducted using baseline data from the ongoing LIMIT (Lifestyle and Microbiome Interaction Early Adiposity Rebound in Children) prospective cohort study. The analysis included 162 subjects whose complete maternal characteristic data were available to explore associations between maternal features and GWG. Results: The results were visualized through a two-dimensional graphical representation, with the related statistical measures. The horizontal axis of the CA map captures 63.4% of the total inertia of the data, and the vertical axis captures 36.6%. Maternal profiles with lower education, smoking, high meat consumption, and prepregnancy overweight or obesity showed a higher prevalence of excess GWG than did the average profile. Compared with the average profile, medium Mediterranean diet adherence was associated with a greater prevalence of low GWG and underweight and obese mothers with adequate GWG. Conclusions: This study identifies maternal lifestyle factors, such as diet and physical activity, as key determinants of GWG, with excess GWG linked to unhealthy behaviors. Tailored interventions focusing on prepregnancy BMI and dietary habits could optimize pregnancy outcomes. Personalized prenatal care is essential for managing GWG and improving maternal health. Full article

Background: Home-based palliative cancer care coordinated by primary care has been proposed as a strategy to improve access, continuity, and alignment with patient preferences, but its organizational characteristics and effects remain insufficiently synthesized. Aim: The aim was to characterize the organizational components of home-based palliative care models for patients with advanced cancer coordinated by primary care and to evaluate the effects of these models on patient-related and health system outcomes. Methods: Following a Cochrane review protocol, primary studies were searched in MEDLINE, Scopus, LILACS, Web of Science, the Cochrane Library, and CINAHL to identify randomized controlled trials and analytical observational studies published between January 2018 and May 2026. Results: The narrative synthesis included seven analytical observational studies conducted in high-income countries, most classified as 4b—settings with advanced and integrated palliative care. Across these studies, recurrent organizational components included case management, structured care pathways prioritizing home-based care, and mechanisms linking primary care with specialized palliative care teams. Reported outcomes were associated with potential system-level benefits, such as fewer emergency department visits and higher proportions of home death, but these findings are subject to residual confounding, heterogeneity, and indirectness, which limit confidence in the evidence. Conclusion: The available evidence, which was restricted to seven observational studies conducted in countries with highly developed palliative care systems, suggests that certain organizational components may support home-based palliative cancer care coordinated by primary care. However, substantial methodological limitations, the absence of patient-centred outcomes, and the lack of studies from low- and middle-income countries indicate that further research is needed before drawing practice or policy recommendations. Full article

Background/Objectives: Breast cancer (BC) survivors frequently experience persistent psychological and physical symptoms and reduced health-related quality of life (HRQoL). Yoga has emerged as a promising supportive intervention in this context; however, evidence regarding remotely delivered yoga programs remains limited. This systematic review aimed primarily to evaluate the effects of remotely delivered yoga interventions on HRQoL among women with BC. Secondary outcomes included psychological and physical symptoms, as well as feasibility, adherence, and safety. Methods: Randomized controlled trials (RCTs) and non-randomized studies assessing remote, home-based, or hybrid yoga interventions delivered through digital platforms, videos, or remote support were searched in PubMed, Scopus, Web of Science, and the Cochrane Library (PROSPERO registration number: CRD420261362619). Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. A random-effects meta-analysis was performed for HRQoL outcomes from independent RCT populations, using standardized mean differences (Hedges’ g). Results: Twenty-six publications representing 19 independent study cohorts were included. Eighteen publications reported randomized controlled trials and eight reported non-randomized studies. In the meta-analysis, the 9 RCTs that reported effects on HRQoL showed a moderate improvement in this outcome (Hedges’ g = 0.56, 95% CI 0.17–0.96), with substantial between-study heterogeneity (I² = 72.4%). Secondary psychological and physical outcomes showed potential benefits, but findings varied across studies. Feasibility and adherence were generally favorable, while no serious yoga-related adverse events were reported among studies assessing safety. Conclusions: Remote and home-based yoga interventions may improve HRQoL in women with BC; however, the consistency and generalizability of this effect are limited by substantial between-study heterogeneity and variability in intervention delivery. Further standardized and adequately powered RCTs are needed to confirm clinical effectiveness and inform long-term implementation in breast cancer care. Full article

Introduction: Association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and pancreatitis and its long-term complications remains controversial. Using a global electronic health record database, we evaluated pancreatic outcomes following GLP-1 RA initiation in adults with type 2 diabetes mellitus (T2DM). Methods: Adults aged ≥18 years who were alive at the index date; T2DM patients initiating GLP-1 RAs between 2013 and 2025 were identified in the TriNetX network and compared with patients initiating sodium–glucose cotransporter-2 inhibitors (SGLT2i). Sensitivity analyses included comparisons with other second-line diabetes therapies, excluding dipeptidyl peptidase-4 inhibitors, and analyses were restricted to U.S.-based health care organizations. Patients with pre-existing pancreatic conditions were excluded. Cohorts were propensity score-matched for treatment indications, pancreatitis risk factors, and demographics. Kaplan–Meier and Cox proportional hazard models evaluated acute pancreatitis (overall and biliary), chronic pancreatitis, pancreatic pseudocyst, and pancreatic cancer. Results: After matching, 291,152 patients were included in each cohort. GLP-1 RA initiation was not associated with an increased hazard of overall acute pancreatitis compared with SGLT2i initiation (HR 1.095; 95% CI 0.996–1.204), with concordant Kaplan–Meier analyses. A modest, etiology-specific increase in biliary acute pancreatitis was observed in the primary comparison (HR 1.276; 95% CI 1.010–1.612) but was not consistent across sensitivity analyses. No differences were observed in the risks of pancreatic pseudocyst (HR 0.729; 95% CI 0.525–1.014) or pancreatic cancer (HR 1.069; 95% CI 0.940–1.215). Results were similarly consistent in sensitivity analyses. Conclusion: GLP-1 RAs are not associated with an increased risk of acute pancreatitis, pancreatitis-related complications, or pancreatic cancer in T2DM adults; a modest biliary pancreatitis signal was observed, but was not consistent across sensitivity analyses. Full article

The Neonatal Intensive Care Unit (NICU) is a demanding work environment that provides medical care for acutely ill and premature infants while supporting parents experiencing significant stress and psychological distress. This scoping review is the first to examine quantitative research across a broad range of psychological constructs, including burnout, traumatic stress, moral distress, and other distress outcomes such as mental health, somatic symptoms and physiological indicators, among NICU healthcare providers. Following PRISMA-ScR guidelines, PsycINFO, Ovid via MEDLINE, Embase, and CINAHL were searched. Two searches (2021 and 2024) identified 1889 unique records, with 76 publications from 34 countries meeting inclusion criteria (i.e., original quantitative research assessing work-related psychological consequences with NICU healthcare providers) and exclusion criteria (i.e., intervention studies; qualitative studies; NICU provider data inseparable from aggregate results). Most participants were White, female NICU nurses. Across studies, psychological distress was most often reported in the low-to-moderate range, with considerable variability within and across studies making it difficult to clearly summarize the average levels of distress and associations that best predict psychological distress outcomes. Consistent differences by healthcare profession or sociodemographic characteristics were not identified, largely because these factors were infrequently assessed, or findings were inconsistent. Environmental factors were more frequently assessed and reported to be associated with psychological distress in NICU providers. The current evidence base is constrained by cross-sectional designs, inconsistent practices, and conceptual overlap across psychological constructs. Future research should prioritize longitudinal designs, standardized methodologies, and more representative samples across professions. In the interim, unit-level assessment and targeted interventions may help address modifiable work-related stressors, individual responses to stressors, and support NICU healthcare providers’ well-being. Full article

Anemia, a major global public health issue, has been increasingly linked to air pollution. Growing evidence suggests that fine particulate matter (PM_2.5) exposure is associated with reduced hemoglobin concentrations and increased anemia risk, potentially through pathways involving oxidative stress, inflammation, and disrupted hematopoiesis. This review examines whether nutrients or supplements, such as iron, vitamins B, C, and D, and folate, and the social context have a protective effect and can modify PM_2.5-related anemia. Following JBI guidelines, we systematically searched databases such as PubMed and Web of Science to screen 3450 studies. Across diverse geographic settings, the included studies consistently reported the following: (a) an inverse association between PM_2.5 exposure and anemia-related outcomes, including lower hemoglobin concentrations and altered hematologic indicators, and an increased anemia risk; (b) an adequate nutritional status, particularly higher intake or levels of iron, folate, and antioxidant vitamins, may attenuate the adverse hematologic effects of PM_2.5 exposure, but evidence remains limited; and (c) adverse social conditions such as lower income and lower education can amplify vulnerability to PM_2.5-related anemia, but this evidence also remains limited. Further research is needed to better understand how nutritional factors and the social environment modify susceptibility to PM_2.5-related anemia. Full article

Background/Objectives: With population aging, increasing attention has been directed toward family caregivers balancing paid employment and caregiving responsibilities. This study aimed to investigate the association between employment status and self-rated health and stress among family caregivers and to explore associations between caregiving-related factors and these outcomes according to employment status. Methods: This study included 409 family caregivers of patients receiving home-visit nursing services in Japan. Data on caregiver characteristics, self-rated health, stress during the past month, and caregiving-related factors, including caregiving situations, support situations, and negative appraisal of caregiving assessed using the Negative Appraisal of Care (NAC) Scale, were collected. Logistic regression analyses with inverse probability weighting were conducted to examine the association between employment status and health outcomes. Exploratory stratified univariate analyses were performed by employment status to examine associations between caregiving-related factors and self-rated health and stress. Results: Of the 409 participants, 126 were working carers and 283 were non-working carers. After IPW and multivariable adjustment, employment status was not significantly associated with self-rated health, whereas working carers were significantly more likely to report stress than non-working carers. In the exploratory stratified analyses, among working carers, poor self-rated health was more frequently observed among those without additional caregivers, those using short-stay services, and those with higher NAC scores. Stress was also more frequently observed among those without additional caregivers. Among non-working carers, poor self-rated health was more frequently observed among those with higher NAC scores, whereas stress was more frequently observed among female caregivers, those caring for recipients with cognitive impairment, and those using short-stay services. Conclusions: Working carers reported higher levels of stress than those of non-working carers, even after adjustment for caregiving-related factors. Exploratory analyses among working carers suggested that the presence of additional caregivers was associated with both self-rated health and stress, indicating that caregiving support may be an important factor in balancing employment and caregiving responsibilities. Full article