Search Results (30)

Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon’s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population. Full article

Against the backdrop of China’s urban transformation from incremental expansion to stock regeneration, community regeneration has emerged as a critical mechanism for enhancing urban governance efficacy. As fundamental units of urban systems, the regeneration of communities requires comprehensive approaches to address complex socio-spatial challenges, with public participation serving as the core driver for achieving sustainable renewal goals. However, significant regional disparities persist in the effectiveness of public participation across China, necessitating the systematic institutionalization of participatory practices. Guangzhou, as a pioneering city in institutional innovation and the practical exploration of urban regeneration, provides a representative case for examining the evolutionary trajectory of participatory planning. This research employs Arnstein’s Ladder of Participation theory, utilizing literature analysis and comparative case studies to investigate the evolution of participatory mechanisms in Guangzhou’s community regeneration over four decades. The study systematically examined the transformation of public engagement models across multiple dimensions, including organizational frameworks of participation, participatory effectiveness, diversified financing models, and the innovation of policy instruments. Three paradigm shifts were identified: the (1) transition of participants from “passive responders” to “active constructors”, (2) advancement of engagement phases from “fragmented intervention” to “whole-cycle empowerment”, and (3) evolution of participation methods from “unidirectional communication” to “collaborative co-governance”. It identifies four drivers of participatory effectiveness: policy frameworks, financing mechanisms, mediator cultivation, and engagement platforms. To enhance public engagement efficacy, the research proposes the following: (1) a resilient policy adaptation mechanism enabling dynamic responses to multi-stakeholder demands, (2) a diversified financing framework establishing a “government guidance + market operation + resident contribution” cost-sharing model, (3) a professional support system integrating “localization + specialization” capacities, and (4) enhanced digital empowerment and institutional innovation in participatory platform development. These mechanisms collectively form an evolutionary pathway from “symbolic participation” to “substantive co-creation” in urban regeneration governance. Full article

Energy poverty is a significant barrier to sustainable development, limiting access to modern energy solutions and exacerbating socioeconomic inequalities in South Africa. This research identifies key socioeconomic factors contributing to energy poverty among off-grid households using the household-specific energy poverty line. A cross-sectional study was conducted using a well-structured questionnaire among 53 households. The findings reveal significant gender disparities, with female-headed households being more vulnerable to energy poverty, which continues to subject them to economic hardship and social marginalization. Additionally, while larger households generally face higher energy demands, they were found to be less likely to experience energy poverty. The findings also challenge the ‘energy ladder hypothesis’ by showing that education, while potentially enabling better energy awareness, does not guarantee improved energy access in off-grid areas due to infrastructural limitations. Social grant dependency was found to be strongly correlated with energy poverty, underscoring the inadequacy of income transfers in addressing the systemic barriers to energy access. The findings emphasize the need for multidimensional, gender-responsive policy interventions that address both infrastructural and socioeconomic barriers to energy access, particularly in rural South Africa. These insights are crucial for developing targeted interventions to alleviate energy poverty and foster sustainable development in off-grid communities. Full article

Background/Objectives: Over the past 25 years, reconstructive techniques and patient management advancements have significantly improved outcomes in mangled lower extremity injuries. Functional results of limb salvage have been demonstrated to surpass those of primary amputations. Developments such as local fasciocutaneous flaps, vacuum-assisted closure, and hyperbaric oxygen therapy have enhanced the reconstructive ladder. Despite progress, the utility of the Mangled Extremity Severity Score (MESS) and Gustilo–Anderson classification remains debated, particularly in their prognostic value for limb salvage decisions. In the study, we aimed to evaluate the outcomes of optimizing mangled lower extremity reconstruction in 93 patients, focusing on their functional scores retrospectively. Methods: This retrospective study analyzed 93 patients treated for mangled lower extremities between January 2015 and October 2022. Patients were assessed for age, gender, injury location, MESSs, Gustilo–Anderson classifications, surgical methods, and functional outcomes using the Lower Extremity Functional Scale (LEFS). Surgical interventions included internal and external fixation, skin grafts, local flaps, muscle flaps, and free tissue transfer. LEFS scores were categorized into disability levels for functional evaluation. Correlations were drawn between LEFS and variables such as MESS, Gustilo–Anderson types, and nerve injuries. Results: Among the 93 patients, 16 had MESSs ≥ 7, and 77 had MESSs < 7. Reconstruction methods included local fasciocutaneous and muscle flaps (37 patients), free tissue transfer (29 patients), and skin grafting with vacuum-assisted closure (27 patients). Smoking was associated with delayed union and increased infection rates. LEFS scores were significantly lower in patients with MESSs ≥ 7, Gustilo grade 3C fractures, and tibial nerve injuries. Flap failures and a higher number of surgeries (>3) also correlated with poorer functional outcomes. The average soft tissue healing time was 18 days, and bone union time was 17 weeks. Conclusions: Lower extremity reconstruction demands precise surgical planning and execution, prioritizing functional restoration. MESSs and Gustilo–Anderson classifications provide practical frameworks but have limitations in predicting long-term functionality. Factors such as joint involvement, nerve injuries, and flap selection significantly influence outcomes. Smoking and delayed healing remain critical challenges. While free flaps are essential for complex defects, more straightforward methods yield better outcomes in suitable cases. LEFS emerged as a reliable tool. Full article

Background: Dialysis patients face multidimensional challenges that affect their quality of life. This study aimed to evaluate the association between dialysis duration and various physical, cognitive, and psychosocial parameters, including fatigue, pain, sexual satisfaction, bowel control, vision, cognitive deficits, mental health, social support, quality of life, and life satisfaction, while incorporating sociodemographic data for greater context. Methods: A cross-sectional study was conducted using validated instruments such as the Modified Fatigue Impact Scale (MFIS), Pain Effect Scale (PES), Sexual Satisfaction Scale (SSS), Bowel Control Scale (BWCS), Impact of Visual Impairment Scale (IVIS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), Modified Social Support Survey (MSSS), WHOQOL-BREF, and Cantril Ladder. Associations between dialysis duration and these parameters were analyzed. Correlations between current and future life satisfaction were also examined. Results: Dialysis duration significantly affected sexual satisfaction, with scores worsening over time (p = 0.029). Cognitive deficits in planning and organization exhibited a near-significant trend (p = 0.072). Patients with low current life satisfaction anticipated significant future declines (p = 0.001). However, no significant associations were observed between dialysis duration and fatigue, pain, bowel control, vision, mental health, social support, overall quality of life, or life satisfaction. Conclusions: Prolonged dialysis negatively influences sexual satisfaction and may impact specific cognitive domains. The relationship between current and expected life satisfaction highlights the importance of addressing psychological health in this population. While other parameters remained unaffected, individualized care strategies focusing on sexual, cognitive, and psychological support could improve outcomes. Future research should focus on exploring these relationships further and developing targeted interventions to address vulnerable areas, such as sexual, cognitive, and psychological health. Full article

This study aimed to quantify and compare ladder use ability and behavior in younger and older men and women from three ladder use behavior experiments. The experimental tasks comprised (1) changing a lightbulb on a household stepladder under two cognitive demands (single and dual task), (2) clearing a simulated roof gutter on a straight ladder and (3) querying ladder choice in different exigency scenarios. Ladder use ability and behavior data were captured from recorded time, performance, motion capture and user choice data. In addition, this study surveyed ladder use frequency and habitual behaviors. The experimental findings indicate that older adults require more time to complete ladder tasks; younger adults display riskier ladder use behaviors; men and women display similar ladder use ability; and men are more willing to climb riskier ladders. The survey found older adults to report more frequent ladder use than younger adults, and men use straight ladders more frequently than women. These results suggest that the reported higher ladder fall rates experienced by older adults and men are linked to increased ladder use exposure and riskier ladder choice. This knowledge can help guide population-specific interventions to reduce ladder falls in both young and older people. Full article

Adequate cannulation technique (CT) methods and successful puncture are essential for hemodialysis (HD) and arteriovenous fistula (AVF) maintenance. This systematic review and meta-analysis was designed to identify which CT allows better AVF primary patency and lower rates of complications in HD patients. The search was carried out on the CINAHL, MEDLINE, Cochrane Library, and Joanna Briggs Institute Library databases to identify all randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of buttonhole (BH) versus rope ladder cannulation (RL) from 2010 to 2022. The Risk-of-Bias (Rob 2) tool was used for RCTs and the ROBINS-I was used for non-randomized studies. RevMan 5.4 was used for the meta-analysis. A total of five RCTs, one quasi-randomized controlled trial, and six observational studies were included. When compared with RL cannulation, BH cannulation significantly increased bacteremia (RR, 2.76, 95% CI (1.14, 6.67), p = 0.02) but showed no differences in AVF primary patency (HR, 1.06, 95% CI (0.45, 4.21), p = 0.90). There was no thrombosis reduction (RR, 0.51, 95% CI (0.23, 1.14), p = 0.10) or intervention number reduction (RR, 0.93, 95% CI (0.49, 1.80), p = 0.84) with BH. Outcomes like pain, hematoma, and aneurism could not be merged due to a lack of data, reported as medians, as well as due to different definitions. The quality in general was poor and the heterogeneity among the studies prevented us from merging the outcomes. Full article

The purpose of this study was to examine the factors that predict life satisfaction in a large representative sample of Koreans by analyzing data from the Gallup World Poll. The primary objective was to identify important predictors and suggest strategies to improve quality of life in Korea. The study used available Korean data from 2006 to 2017, which included 14,101 participants (mean age = 46.42). Predictors included demographic and psychological variables, with the Cantril Ladder of Life Scale serving as the outcome variable. The results show a decline in life satisfaction with advancing age, and that the relationship between life satisfaction and age varied by gender. Among the predictors examined, satisfaction with the standard of living and household income emerged as the most influential factors in determining life evaluation; other strong predictors included positive affect and negative affect, social support, gender, and education level. These results imply that, to increase life satisfaction, it is imperative to provide job opportunities and social services specifically targeted to individuals in low-income groups. In addition, it is crucial to implement tailored psychosocial interventions that address the unique developmental tasks and psychological challenges experienced by individuals according to their gender and life cycle stage. Full article

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work–life balance among academics and suggesting effective interventions to improve their mental health outcomes. Full article

The coronavirus disease 2019 (COVID-19) pandemic has led to overcrowding in many emergency departments (EDs). The present single-center, prospective, interventional study (conducted at Bichat University Medical Center (Paris, France)) was designed to assess the impact of self-administered, inhaled, low-dose methoxyflurane on trauma pain in a pre-ED fast-track zone dedicated to the management of lower-acuity non-COVID-19 patients. In the first phase of the study, the control group consisted of patients with mild-to-moderate trauma pain, for whom the triage nurse initiated pain management (based on the World Health Organization (WHO)’s analgesic ladder). In the second phase, the intervention group consisted of similar patients who self-administered methoxyflurane as an adjuvant to the standard analgesic ladder. The primary endpoint was the numerical pain rating scale (NPRS) score (from 0 to 10) recorded at different time points during the patient’s care (T0: arrival in the ED, T1: exit from the triage box, T2: in the radiology department, T3: clinical examination, and T4: discharge from the ED). The level of agreement between the NPRS and the WHO analgesic ladder was assessed by the calculation of Cohen’s kappa. Pairwise comparisons of continuous variables were performed with Student’s t-test or a non-parametric Mann–Whitney U test. Changes over time in the NPRS were analyzed in an analysis of variance (with Scheffe’s post hoc test if a pairwise comparison was significant) or a non-parametric Kruskal–Wallis H test. In all, 268 and 252 patients were included in the control and intervention groups, respectively. The two groups had similar characteristics. The level of agreement between the NPRS score and the analgesic ladder was high in both the control and intervention groups (Cohen’s kappa: 0.74 and 0.70, respectively). The NPRS score decreased significantly between T0 and T4 in both groups (p < 0.001), but the decrease between T2 and T4 was significantly greater in the intervention group (p < 0.001). The proportion of patients still in pain on discharge was significantly lower in the intervention group than in the control group (p = 0.001). In conclusion, a combination of self-administered methoxyflurane and the WHO analgesic ladder improves pain management in the ED. Full article

Across their lifespans, and in many clinical settings, patients have spiritual care needs. Many nurses lack competence related to providing spiritual care. Popular educational strategies, such as simulated educational programs and objective structured clinical examinations (OSCE), have not been widely adopted in nursing spiritual care education. The purpose of this study was to explore the effects of a scenario-based spiritual care course on spiritual care competence in nurses. This quasi-experimental study employed a repeated-measures pre-test/post-test design with assessments immediately before, immediately after, and 3 months post-intervention. Nurses providing direct patient care in diverse clinical settings were recruited from a large medical foundation in northern Taiwan. The intervention was a one day scenario-based spiritual care course and OSCE. The experimental group (n = 53) and controls (n = 85) were matched for their similar units, ages, working experience, and clinical ladder status. The Spiritual Care Competence Scale (SCCS), Spiritual Perspective Scale (SPS), Spiritual Care Perspective Scale-Revised (SCPS-R), and reflection logs were completed by both experimental and control groups. The Course Satisfaction Scale, OSCE Checklist, and Standardized Patient Feedback Scale (SPFS) were completed by the experimental group only. The experimental group had significantly higher SPS scores and self-evaluated SCCS scores, and lower SCPS-R scores (more positive spiritual perspectives), than controls at 3 months post-intervention. The experimental group showed significant within-subject effects at three time points on SPS scores, SCPS-R scores, and self-evaluated SCCS scores. Mean global performance of OSCE was 3.40 ± 0.91, and SP feedback indicated strengths and areas for improvement. In conclusion, the scenario-based spiritual care course effectively enhanced nurses’ spiritual care competence, competence, and skills. Blended education techniques can therefore enhance nurses’ ability to support patients with spiritual care needs. Full article

Shoulder pain is regularly associated with limited mobility and limitations in activities of daily living. In occupational therapy, various interventions, including active isokinetic training with a Baltimore Therapeutic Equipment (BTE) Work Simulator, help the patient improve shoulder mobility and alleviate pain. This randomized controlled cohort study aims to evaluate the impact of different isokinetic movement patterns on the DASH score, pain, and objective performance measures, such as range of motion (ROM) and hand grip strength. Patients that participated in a specific 3-week inpatient orthopedic rehabilitation were divided into two groups. The first group (UNI-group, n = 9) carried out uniplanar exercises for shoulder flexion, abduction, and external rotation. The patients in the second group (ADL-group, n = 10) imitated multiplanar everyday movements, such as climbing on a ladder, loading a shopping cart, and raising a glass to their mouth. Compared to the UNI-group, the ADL-group improved significantly in DASH scores (mean −10.92 ± 12.59 vs. −22.83 ± 11.31), pain (NPRS −1.11 ± 2.37 vs. 3.70 ± 2.00), and shoulder abduction (+2.77 ± 15.22 vs. +25.50 ± 21.66 degrees). In conclusion, the specific BTE exercise program with multiplanar movement patterns contributed considerably to the therapeutic improvement. Full article

Intensive care unit (ICU) patients experience highly complex health problems, such as pain, agitation, delirium, immobility, and sleep disruption (PADIS), and require professional nursing care. The assessment of PADIS is critically important for ICU nurses, and therefore, PADIS education programs need to be conducted for these nurses to update and improve their caring knowledge, attitudes, and skills. The aims of this study are to bridge this gap by evaluating the effects of PADIS education programs on the knowledge, attitudes, and skills of these nurses, and compare the difference between novice and advanced nurses after receiving the PADIS education programs over a short period of time. In this quasi-experimental study, 112 nurses in ICUs were recruited by researchers and participated in the PADIS education programs. The PADIS education intervention was performed in a teaching hospital in Taipei. A demographic and self-developed PADIS care knowledge questionnaire was used. A baseline (T1) was measured before the interventions, followed by post-test (T2) immediately after the programs, and subsequently a follow-up (T3) test one month later. The results indicated that knowledge and skill scores between novice and advanced nurses varied significantly in T1 but not in T2 and T3. Thus, education programs can significantly assist novice ICU nurses to improve their short-term knowledge, attitudes, and skills, and PADIS education programs are strongly suggested for clinical nursing practice. Full article

This study examined the gender differences in the main and interactive effects of subjective social status and area deprivation on health among older adults in Hong Kong. Data for this study came from the baseline of MrOs and MsOs studies, including 4000 Chinese men and women ≥ 65 in Hong Kong. Subjective social status was assessed using the MacArthur Scale of subjective social status scale. Our results reaffirm that subjective social status is an independent indicator of health after adjusting for objective SES measures (e.g., education and income). Perceived rank on the community ladder was more closely related to health among older people than was the society ladder, particularly for women. Although area-level social deprivation was not significantly associated with the health of older people, it may moderate the effect of subjective social status on health. Women with a lower perceived status in the community were more likely to experience depressive symptoms but better grip strength when living in more deprived neighborhoods. The findings suggested that subjective social status provides important information for the physical and mental health of the older population. Policymakers may implement interventions to enhance the subjective social status of older adults. Given the greater contribution of relative status in the community to the health of women, these policies and interventions should target to improve women’s perceived status in the community. Full article

One of the main reasons for the collapse of the European eel (Anguilla anguilla L.) is habitat loss resulting from the severe obstruction of rivers throughout the species’ range. Specific fish passes (i.e., eel ladders) can be installed in weirs and dams to mitigate this impact and to promote the upstream movement of eels. In the Mondego River, one of the most important basins for diadromous species in Portugal, an eel ladder was installed in 2015 at the Coimbra weir, the first obstacle to fish migration in this basin. This ladder is equipped with a monitoring trap at the upstream exit, where the eels that have successfully overcome the eel ladder are counted and measured before being released. The timing and environmental variables that promote the upstream movement of these individuals (counts at the eel trap were considered as a proxy for upstream movement activity) were assessed between January 2017 and August 2019. A total of 12,019 eels with a length ranging from 60 mm to 287 mm (median = 138 mm) used the eel ladder to move upstream the obstacle. The upstream movement occurred throughout the year, but a clear peak in activity was observed between May and June (~74%). Eels < 150 mm appeared mainly in early summer (May–June), with 64% of the total number of individuals counted in the eel trap belonging to this size class, but no differences in total body length were found between these years. Generalized Additive Models (GAMs) were used to determine the environmental factors that explained these upstream movements. Among the predictors considered (river flow, precipitation, water temperature and photoperiod), minimum water temperature had the strongest explanatory power. The results from this study are crucial for the management of the species, particularly at obstacles where no transposition equipment exists, and human intervention may be required to assist in their upstream progression. Full article