Search Results (268)

Introduction: This document presents recommendations of the Polish Respiratory Society on discharge instructions following hospitalization for an exacerbation of chronic obstructive pulmonary disease (COPD). Methods: The Delphi method was applied to achieve consensus among independent experts. Results: Fourteen recommendations were formulated. Experts emphasized that discharge summaries require clear graphical and editorial design to ensure readability for both patients and healthcare professionals. The involvement of a multidisciplinary team was recommended to provide coherent and comprehensive documentation. Discharge instructions should be discussed with the patient during hospitalization and supplemented with standardized educational materials provided separately. These materials should cover inhaler technique, smoking cessation, physical activity, pulmonary rehabilitation, and vaccination. For patients with respiratory failure, home oxygen therapy or non-invasive ventilation must be addressed. Discharge recommendations should highlight modifications in baseline COPD treatment and management of comorbidities. A personalized action plan for future exacerbations is essential, and dietary consultation is advised. Finally, discharge summaries should specify follow-up appointments and include prescriptions for inhaled medications. Conclusions: The Polish Respiratory Society recommends that discharge instructions be provided to all patients hospitalized for a COPD exacerbation. Full article

Across East Asia, rapid population aging and regional decline threaten the sustainability of rural and island communities. Yeonpyeong Island provides a critical context for examining how spatial infrastructure shapes older residents’ daily challenges. The aim of this study is to identify how older adults evaluate their housing and community environments and to determine whether these perceptions signal a transition toward more integrated and community-based care settings. Using a primary quantitative survey of 102 older residents, supplemented by contextual input from a local representative, the study analyzes how health decline, mobility constraints, and housing obsolescence interact with aspirations for service-integrated and socially connected living. Composite scores for perceived home modification needs remained consistently in the mid-to-upper range (approximately 3.5–4.0 on a 5-point scale). Acceptance of alternative, cohousing-type community housing also remained above the midpoint (approximately 3.5–4.1), reflecting an unusually high level of openness in a setting traditionally characterized by low receptivity to residential change and limited local housing alternatives. Safety risks, poor accessibility, and inadequate facilities function as push factors, while preferences for shared programs, proximity-based reassurance, and integrated hubs operate as pull factors, together signaling readiness for more supportive communal living. By integrating Push–Pull Theory with Environmental Press and Life-Space perspectives, the study contributes theoretically by extending these frameworks to the community scale and empirically by providing resident-level evidence from an under-researched island context. The findings highlight how older adults act as evaluators of their environments, articulating practical signals for spatial restructuring and integrated care planning. Full article

Asthma continues to affect millions of adults in the United States, with indoor environmental exposures playing a major role in symptom burden and control. Limited research has examined the combined influence of multiple household and environmental determinants on adult asthma morbidity, particularly in diverse states such as Texas. We analyzed pooled data from 1596 Texas adults with asthma who completed the Asthma Call-Back Survey between 2019 and 2022. Multivariable logistic regression models, adjusted for survey design and demographic covariates, were used to examine associations between household and environmental determinants and four morbidity outcomes: asthma attacks, recent symptoms, sleep difficulty, and limited activity due to asthma. Current smoking, lack of bathroom or kitchen ventilation, and absence of air purifier use were consistently associated with higher odds of morbidity. Protective associations were observed for homes without mold, rodents, or furry pets. Disparities were also evident, with older adults, women, and non-Hispanic Black respondents reporting greater morbidity. These findings highlight the importance of addressing modifiable exposures such as indoor smoking, ventilation, and allergen control within comprehensive asthma management strategies. Targeted interventions that combine environmental modifications with health education may help reduce asthma disparities and improve the quality of life for adults with asthma. Full article

Background: Overweight and obesity frequently occur as comorbid conditions in people with asthma, particularly among those with poor disease control or more severe clinical profiles. However, the extent to which exposure to grey spaces may influence the link between overweight/obesity and asthma remains insufficiently explored. Aim: To assess the association between overweight/obesity and asthma in an Italian general population sample and the influence of residential grey space on such relationship. Methods: A total of 2841 individuals (54.7% women; age range 8–97 years) residing in Pisa, Italy, were surveyed in 1991–1993 using a standardised questionnaire on health conditions and relevant risk factors. The proportion of grey space within a 1000 m buffer around each participant’s home was quantified using the CORINE Land Cover database. Multinomial logistic regression models were applied to assess the association between asthma status (1. asthma symptoms without doctor diagnosis, 2. diagnosis ± symptoms, 3. no diagnosis/symptoms − reference category) and overweight/obesity, adjusting for sex, age, educational level, smoking, physical activity and grey space exposure. Analyses were further stratified according to high vs. low grey space exposure (above vs. below 63%, corresponding to the second tertile). Mediation and interaction analyses were also performed. Results: The prevalence of asthma diagnosis ± symptoms, overweight and obesity was 18.7%, 35.8% and 12.8%, respectively. In the full sample, asthma symptoms without medical diagnosis were positively associated with overweight (Odds Ratio—OR 1.43; 95% Confidence Interval—CI 1.08–1.88), obesity (OR 1.99; 95% CI 1.38–2.88) and residential grey space (OR 1.06; 95% CI 1.01–1.13). Stratified models showed that, among participants with high exposure to grey areas, asthma symptoms were linked to both overweight (OR 2.03; 95% CI 1.29–3.19) and obesity (OR 2.57; 95% CI 1.36–4.86). In individuals with low grey space exposure, an association was observed only with obesity (OR 1.80; 95% CI 1.15–2.82). Mediation analysis did not reveal any weight-related effect modification. Measures of additive interaction indicated that 32% of asthma symptoms were attributable to the interaction between excess body weight and high grey space exposure. Conclusions: This study showed that overweight/obesity and grey space exposure are factors associated with asthma symptoms. These findings advocate for an early identification of overweight/obese-asthma symptom phenotype since it may help prevent the onset or worsening of asthma, particularly in urban environments. These insights highlight the need for integrated public health and urban planning strategies to promote more sustainable, health-supportive environments. Full article

Background: Population aging represents a growing public health challenge, with falls being one of the leading causes of morbidity, mortality, and loss of autonomy among older adults. In nursing homes, the risk is exacerbated by physical, cognitive, and environmental factors, yet which interventions are most actionable in nursing homes remains unclear, requiring effective and evidence-based prevention strategies. Objective: We aimed to map the evidence on interventions in fall risk management among institutionalized older adults, highlighting assessment, exercise, environmental, and educational strategies. Methods: A scoping review was conducted according to JBI guidelines. The search was carried out in MEDLINE, CINAHL, Scopus, Cochrane, and Web of Science. The review included studies, published between 2019 and 2024, involving older adults (≥65 years) in nursing homes, focusing on nursing interventions for fall risk management. Results: The initial search identified 1146 records across electronic databases and gray literature sources. After removing duplicates and screening titles, abstracts, and full texts, 18 studies met the inclusion criteria and were included in this scoping review. The inclusion criteria were as follows: (i) fall risk assessment, using functional and clinical scales such as the Timed Up and Go (TUG), Berg Balance Scale (BBS), Morse Fall Scale, to identify predisposing factors; (ii) exercise programs, such as the Otago Exercise Program and multicomponent training, which demonstrated benefits in strength, balance, and mobility; (iii) environmental modifications, aimed at reducing extrinsic risks and promoting safer surroundings; and (iv) educational programs, targeting professionals, residents, and families, with positive effects on adherence to preventive practices and on strengthening the safety culture. Conclusions: Effective fall risk management in nursing homes requires an integrated, multidisciplinary, and person-centered approach, with nurses playing a central role in assessment, coordination, and implementation of interventions. However, gaps remain regarding standardization, validation of assessment tools specific to the institutional context, and evaluation of long-term outcomes. Full article

Cow’s milk protein allergy (CMPA) is one of the most common food allergies in early childhood. Although a strict elimination diet effectively prevents allergic symptoms, it does not promote the development of tolerance to cow’s milk proteins (CMPs). The milk ladder is a stepwise approach to the reintroduction of CMPs, starting with extensively heated forms and gradually progressing to unheated cow’s milk, according to the individual tolerance levels. The rationale for this approach lies in the reduced allergenicity of heated forms, mainly due to the food matrix effect. The milk ladder was originally developed to gradually expand the diet in children with non-IgE-mediated CMPA. However, recent evidence suggests that it can also be applied in IgE-mediated CMPA to accelerate tolerance development. In children with high-risk IgE-mediated CMPA, this approach may be more challenging. Even minor recipe modifications, particularly those affecting composition or heating conditions, can alter the allergenicity of heated foods. Moreover, barriers to reintroducing food allergens, including parental anxiety or the child’s food aversion, may be more pronounced in this group. Although for high-risk patients, reintroduction is usually performed in hospital settings, increasing evidence indicates that, in selected cases, it may also be safely conducted at home. Several emerging strategies, including early low-dose exposure and oral immunotherapy, show promise in further enhancing tolerance development. Despite these challenges, early reintroduction of CMPs appears to play a crucial role in modulating the immune response and promoting tolerance. This review provides the summary of evidence and practical insights into the implementation of the milk ladder in children with IgE-mediated CMPA. Full article

Background: Cow’s milk protein allergy (CMPA) is among the most common pediatric food allergies. Understanding tolerance acquisition and diagnostic approaches is critical for optimizing care, particularly in Spain, where regional differences may impact management. This study analyzed real-world practices for determining CMPA oral tolerance acquisition by Spanish pediatricians. Methods: A questionnaire was distributed to healthcare providers in primary and hospital pediatric settings across various Spanish provinces. The survey addressed demographic profiles, diagnostic approaches, tolerance acquisition, and dietary modifications. Results: Among the 269 health professionals included (mean age 48.3 ± 11.0 years, 62.3% women), most worked in primary care (55.4%), 20.4% in public hospitals, and 17.8% in private practice. Overall, 35.5% routinely referred CMPA cases to specialists. Specific IgE testing (27.9%) and elimination diets (41.3%) were the main diagnostic tools. Diagnostic dairy-exclusion duration varied, mainly in non-IgE cases. Hospital-based diagnostic oral food challenges (OFC) were preferred for suspected IgE-mediated cases (95.7%), while home-based protocols were used for non-IgE suspected cases (80.7%). Guideline adherence for home-based OFC varied by specialty. Tolerance acquisition was evaluated annually by 67.7% of participants, with a mean success rate of 80%. Therapeutic dairy-exclusion duration varied, with 64.7% excluding CMP for 6–12 months. Minimum age for CMP reintroduction was considered dependent on phenotype and severity, with 12 months of age mentioned most frequently (17.1%). Conclusions: Despite general alignment with international guidelines, relevant variability exists in CMPA management in Spain. Harmonizing diagnostic and therapeutic practices across specialties and care levels may help standardize care and improve patient outcomes. Full article

Hepatocellular carcinoma (HCC) ranks as the second most lethal malignancy worldwide, presenting formidable therapeutic challenges including tumor heterogeneity, complex microenvironment, and inefficient drug delivery. Conventional therapies such as surgery, chemotherapy, and immunotherapy are limited by systemic toxicity, drug resistance, and poor targeting specificity. Mesenchymal stem cells (MSCs) have emerged as promising drug delivery vehicles, leveraging their innate tumor-homing capacity, immunomodulatory properties, and exosome-mediated cargo transport. Preclinical studies demonstrate that MSC-based systems triple drug accumulation in tumors and synergize with immunotherapy, extending survival in HCC models. This review systematically examines recent advances in MSC-based delivery systems for HCC, focusing on engineering strategies to enhance targeting precision and controlled drug release, including genetic modification, exosome engineering, and stimuli-response systems. Despite progress, challenges such as MSC heterogeneity and scalable production persist. Emerging solutions like single-cell RNA sequencing for subpopulation selection and 3D bioprinting for standardized culture are highlighted. This work provides a roadmap for developing MSC-based precision therapies, bridging translational gaps in HCC treatment. Full article

Background: Swallowing is a complex biomechanical process, and its impairment (dysphagia) poses major health risks for older adults. Current diagnostic methods such as videofluoroscopic swallowing (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) are effective but invasive, resource-intensive, and unsuitable for continuous monitoring. This study proposes a novel end-to-end RGB–D framework for automated swallowing event localization in continuous video streams. Methods: The framework enhances the AdaTAD backbone through three key innovations: (i) finding the optimal strategy to integrate depth information to capture subtle neck movements, (ii) examining the best adapter design for efficient temporal feature adaptation, and (iii) introducing a Kolmogorov–Arnold Network (KAN) decoder that leverages Chebyshev polynomials for non-linear temporal modeling. Evaluation on a proprietary swallowing dataset comprising 641 clips and 3153 annotated events demonstrated the effectiveness of the proposed framework. We analysed and compared the modification strategy across designs of adapters, decoders, input channel combinations, regression methods, and patch embedding techniques. Results: The optimized configuration (VideoMAE + GRNConvNeXtAdapter + KAN + RGD + boundary regression + sinusoidal embedding) achieved an average mAP of 83.25%, significantly surpassing the baseline I3D + RGB + MLP model (61.55%). Ablation studies further confirmed that each architectural component contributed incrementally to the overall improvement. Conclusions: These results establish the feasibility of accurate, non-invasive, and automated swallowing event localization using depth-augmented video. The proposed framework paves the way for practical dysphagia screening and long-term monitoring in clinical and home-care environments. Full article

This paper presents a noninvasive system for identifying water flow sources with the final goal of supporting human activity recognition (HAR) in activities of daily living (ADL). The system employs a single microphone to capture ambient sounds within a room and detects active water sources based on their acoustic signatures. The audio signals are converted into time-resolved spectrograms, which are processed via time- and frequency-domain convolution and subsequently classified using a neural network. This approach enables both the identification of specific water sources, even combined, and the measurement of their usage duration with an overall accuracy of 90.6%. The study focuses on four common bathroom fixtures: toilet, bidet, shower, and washbasin. The proposed system is adaptable to various environments, requires no modifications to plumbing infrastructure, making it suitable for smart home and digital health applications. Full article

Multiple sclerosis (MS) is a chronic neurological disease often resulting in motor and autonomic dysfunction. This case report investigates the acute and subacute effects of the EXOPULSE Mollii Suit (EMS), a wearable device capable of delivering transcutaneous electrical nerve stimulation to multiple anatomical regions, in a 43-year-old woman with MS. The patient underwent a clinical evaluation before the EMS treatment, during which central nervous system (CNS) and autonomic nervous system (ANS) responses were monitored using electroencephalography (EEG), heart rate variability (HRV), and infrared thermography (IRT). Immediately after the first EMS application, the clinical evaluation was repeated. The intervention continued at home for one month, followed by a post-treatment evaluation similar to the pre-intervention assessment. Functional evaluations showed improvements in sit-to-stand performance (from 8 s to 6 s), muscle tone (MAS scale for the right side from 3 to 2 and for the left side from 2 to 1), clonus, and spasticity (from 3 to 2). EEG results revealed decreased θ-band power (on average, from 0.394 to 0.253) and microstates’ reorganization. ANS activity modifications were highlighted by both HRV (e.g., RMSSD from 0.118 to 0.0837) and IRT metrics (e.g., nose tip temperature sample entropy from 0.090 to 0.239). This study provides the first integrated analysis of CNS and ANS responses to EMS in an MS patient, combining functional scales with multimodal instrumental measurements, emphasizing the possible advantages EMS for MS treatment. Although preliminary, these results demonstrated the potentiality of the EMS to deliver effective and personalized rehabilitative interventions for MS patients. Full article

Background: Falls are a leading cause of morbidity and loss of independence among older adults, and occupational therapy (OT) offers a unique, multidimensional approach to fall prevention. This systematic review evaluates the effectiveness of OT-based interventions for improving balance, mobility, functional performance, and psychological outcomes related to fall risk in older adults. Methods: This review followed PRISMA (2020) guidelines. A comprehensive search of PubMed, Scopus, Dialnet, and OTseeker was conducted from March to May 2025. The inclusion criteria targeted studies involving non-pharmacological, OT-led interventions in adults aged ≥65. Seventeen studies were selected, including randomized controlled trials, pilot studies, and quasi-experimental designs. The data extraction and quality appraisal were performed independently by two reviewers. Results: The included interventions varied among exercise-based programs (e.g., Tai Chi, Pilates), virtual reality training, home safety modifications, cognitive–behavioral therapy, and wearable technologies. Most of the studies reported significant improvements in postural balance, fear of falling, and functional independence. Environmental adaptations and educational strategies also yielded positive outcomes. However, a real-world fall incidence reduction was inconsistently reported, and the methodological heterogeneity limited the meta-analytic synthesis. Conclusions: Occupational therapy contributes significantly to fall prevention through multimodal, person-centered strategies that integrate physical, cognitive, and environmental components. Future research should aim to standardize the outcome measures, include high-risk populations, and assess the long-term efficacy and cost-effectiveness of OT-led programs. Full article

The rapid development of smart home and building technologies requires educational methods that facilitate the integration of theoretical knowledge with practical, system-level design skills. Computer-assisted tools play a crucial role in this process by enabling students to experiment with complex Internet of Things (IoT) and building automation ecosystems in a risk-free, iterative environment. This paper proposes a pedagogical framework that integrates simulation-based prototyping with collaborative and spatial design tools, supported by elements of design thinking and blended learning. The approach was implemented in a master’s-level Smart Building Systems course, to engage students in interdisciplinary projects where virtual modeling, digital collaboration, and contextualized spatial design were combined to develop user-oriented smart space concepts. Analysis of project outcomes and student feedback indicated that the use of simulation and visualization platforms may enhance technical competencies, creativity, and engagement. The proposed framework contributes to engineering education by demonstrating how computer-assisted environments can effectively support practice-oriented, user-centered learning. Its modular and scalable structure makes it applicable across IoT- and automation-focused curricula, aligning academic training with the hybrid workflows of contemporary engineering practice. Concurrently, areas for enhancement and modification were identified to optimize support for group and creative student work. Full article

Jordan’s aging population faces a critical challenge: a strong cultural preference for aging at home, rooted in Islamic ethics of familial care (birr al-wālidayn), conflicts with housing stock that is largely unsafe and inaccessible. This first national mixed-methods study examines the intersection of home modifications, socio-economic barriers, and cultural constraints to aging in place. Data from 587 surveys and 35 interviews across seven governorates were analyzed using chi-square tests, linear regression, and thematic coding. Results indicate that while physical modifications significantly improve accessibility to key spaces like kitchens and reception areas (majlis) (χ² = 341.86, p < 0.001), their adoption is severely limited. Socio-economic barriers are paramount, with 34% of households unable to afford the median modification cost of over $1500. Cultural resistance is equally critical; 22% of widows avoid modifications like grab bars to prevent the ‘medicalization’ of their home, prioritizing aesthetic and symbolic integrity over safety. The study reveals a significant gendered decision-making dynamic, with men controlling 72% of structural modifications (β = 0.27, p < 0.001). We conclude that effective policy must integrate universal design with Islamic care ethics. We propose three actionable recommendations: (1) mandating universal design in building codes (aligned with SDG 11), (2) establishing means-tested subsidy programs (aligned with SDG 10), and (3) launching public awareness campaigns co-led by faith leaders to reframe modifications as preserving dignity (karama) (aligned with SDG 3). This approach provides a model for other rapidly aging Middle Eastern societies facing similar cultural-infrastructural tensions. Full article

Aim: To explore the experiences, beliefs, and values of patients who participated in a two-arm randomized clinical trial assessing a nurse-led intervention program for chronic pain self-management, which demonstrated positive effects on pain reduction, depression, and anxiety, and on health-related quality of life 24 months after completion of the program. Design: Descriptive phenomenological qualitative study. Methods: Patients were recruited via telephone, informed about the study, and invited to participate in an individual interview at a place of their choice (hospital or home). All interviews were audiotaped, and an inductive thematic analysis was performed. Results: Seven interviews were carried out between both groups. Six emerging categories were found: effective relationship with the healthcare system, learning to live with pain, family and social support, behaviors regarding pain, resources for self-management, and concomitant determinants. Conclusions: Patients report key aspects that help us to understand the impact of this type of nurse-led group intervention: the intrinsic therapeutic effect of participating in the program itself, the ability to learn to live with pain, the importance of family and social support, the modification of pain-related behaviors, and the identification of resources for self-care. The findings highlight the need for gender-sensitive, individualized care approaches to chronic pain, addressing stigma and social context. Expanding community-based programs and supporting caregivers is essential, as is further research into gender roles, family dynamics, and work-related factors. Full article