Search Results (3,037)

Keratoconus is a progressive corneal ectasia that results in substantial visual impairment and imposes a significant functional and psychosocial burden on affected individuals. Despite evidence suggesting earlier onset and a potentially more aggressive disease course of keratoconus in Saudi populations, there is a significant lack of region-specific data evaluating vision-related quality of life (VRQoL) in Riyadh. This cross-sectional study conducted in Riyadh, Saudi Arabia, evaluated VRQoL in individuals with keratoconus using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Data were obtained from January to March 2025 through an online, structured, self-administered questionnaire. A total of 1007 participants were included, of whom 299 (29.7%) reported a diagnosis of keratoconus. The mean composite NEI-VFQ-25 score among participants with keratoconus was 61.0 ± 15.8, reflecting moderate impairment in VRQoL. Reduced VRQoL was significantly associated with eye-rubbing behavior, including both frequency (p = 0.027) and method (p = 0.026). The results highlight the importance of early detection and the relevance of eye-rubbing behavior in relation to reduced VRQoL, while supporting the need for longitudinal research to further clarify these associations. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with substantial impact on quality of life. The introduction of biologics and Janus kinase (JAK) inhibitors has markedly transformed systemic treatment strategies. However, long-term prospective real-world registries evaluating drug survival, safety, phenotype-specific treatment response, and post-discontinuation outcomes remain limited, particularly in Asian populations. Methods: The Western Japan Atopic Dermatitis Registry (WJADR) is a multicenter, prospective, observational registry coordinated by Kyushu University and collaborating institutions across western Japan. Patients initiating or currently receiving systemic therapy for AD are enrolled. Longitudinal data collection includes clinical phenotype classification, disease course classification, treatment exposure, physician-assessed severity scores, patient-reported outcomes, biomarkers, and safety information. The primary outcome is drug survival, while secondary outcomes include clinical improvement, adverse events, phenotype–treatment interactions, biomarker–treatment correlations, and treatment-switch patterns. Results: WJADR was designed as a phenotype-integrated real-world registry to evaluate comprehensive systemic treatment strategies and post-discontinuation outcomes in AD prior to the completion of patient enrollment and outcome analyses. Unlike existing registries primarily focused on biologic initiator cohorts or treatment burden, WJADR integrates clinical phenotypes, biomarkers, and longitudinal outcomes to support precision medicine approaches. Conclusions: WJADR represents the first large-scale multicenter prospective AD registry in western Japan and may provide ethnicity-specific real-world evidence to support long-term safety evaluation, treatment optimization, and phenotype-guided therapeutic strategies in AD. Full article

Sarcoidosis is a multisystem disease characterised by a heterogeneous clinical presentation and variable disease course. Despite low mortality, the burden of sarcoidosis extends beyond organ involvement, with many patients reporting significant impairment in quality of life (QoL). Fatigue, chronic cough, and small fibre neuropathy (SFN) are among the most prevalent and debilitating symptoms reported by patients, often demonstrating poor correlation with conventional markers of disease activity and frequently persisting despite apparent disease control. This review examines the impact of sarcoidosis on QoL and highlights the limitations of traditional assessment tools, including imaging and pulmonary function testing, in capturing the full extent of disease burden. The role of patient-reported outcome measures (PROMs) is discussed, including generic instruments and sarcoidosis-specific tools such as the King’s Sarcoidosis Questionnaire (KSQ), Sarcoidosis Health Questionnaire (SHQ), and Sarcoidosis Assessment Tool (SAT), alongside symptom-specific measures targeting fatigue, neuropathic symptoms, and cough. Current and emerging management strategies aimed at improving QoL are reviewed, including immunosuppressive therapies, biologic agents, and non-pharmacological interventions. Despite increasing recognition of QoL as a key outcome, its integration into clinical trials remains inconsistent. Incorporating PROMs into routine clinical practice and research is essential to enable comprehensive assessment and support patient-centred care. Greater emphasis on QoL outcomes may improve therapeutic decision-making and overall disease management in sarcoidosis. Full article

Background: The rehabilitation of patients who have undergone extensive maxillectomy for neoplastic lesions is a significant clinical challenge. The resulting anatomical and functional defects severely impact quality of life, and traditional removable prostheses often lack stability. Zygomatic implants offer a viable solution by providing stable anchorage in the zygomatic bone, bypassing the need for bone reconstruction. Methods: This case report details the rehabilitation of a 62-year-old female patient with a history of recurrent oral squamous cell carcinoma. A fully digital workflow, including CBCT and CAD/CAM technology, was used for meticulous surgical and prosthetic planning. The surgical procedure involved a guided maxillectomy, a free forearm flap reconstruction, and the simultaneous placement of two zygomatic implants and one conventional implant. The procedure was done with EZGOMA guided surgery, which, starting from the EZPLAN software design of zygomatic and traditional implants, allowed us to determine the implant’s position in the three-dimensional axes and also the position of the internal hexagon. This allowed us to design the implant beneath the diagnostic wax-up in the three axes, and also to calculate the degrees of inclination of the multi-unit abutment. Results: All implants achieved primary stability with a torque exceeding 45 Ncm. The patient received an immediate provisional prosthesis, which allowed for the rapid restoration of phonetic and esthetic function. The post-operative course was uneventful, with no complications. Follow-up imaging confirmed the successful integration of the implants and the absence of any prosthetic or surgical issues at 24-month successful follow-up. Conclusions: This case suggests that implant-supported rehabilitation with zygomatic implants can be a highly effective treatment for patients with severe maxillary defects following cancer surgery. By using an integrated surgical and prosthetic strategy, along with advanced digital technology, we can achieve fast, safe, and predictable results. This approach successfully restores both function and esthetics, even in challenging anatomical situations. The auxilium of guided plates is a helpful aid for both implant placement and managing bone resection during cancer surgery. Full article

Collaboration is increasingly treated as a core capability in contemporary working life, yet leadership-development research suggests that developmental efforts often remain too generic, weakly contextualized, and insufficiently connected to the conditions under which participants must learn and perform. This theory-informed exploratory study examines how Norwegian union representatives define, operationalize, and reflect on collaborative capability development within a semester-long university course. The study adopts a qualitative document design based on 25 written course reports produced by Parat union representatives enrolled in the course Collaboration for the Future Working Life at Kristiania University of Applied Sciences in autumn 2025. The reports are analyzed as structured reflective development documents using cross-case thematic analysis. Conceptually, the article draws on collaboration research, leadership development, self-directed learning, self-leadership, and job demands–resources theory. The findings indicate that participants conceptualized collaborative capability as a multidimensional professional capability combining dialogic competence, trust-building, psychological safety, role-based bridge-building, assertive boundary-setting, and self-regulation under pressure. Development was typically organized through iterative practice cycles of self-evaluation, feedback, goal setting, monitoring routines, micro-practices for attention and stress regulation, environmental redesign, implementation, reflection, and adjustment. At the same time, the reports suggest that collaborative development was constrained by time pressure, emotional exposure, cumulative role demands, and fluctuating energy. Reported outcomes were typically incremental, including clearer communication, increased awareness of triggers, stronger boundary-setting, more sustainable role professionalism, and improved presence under strain. The article contributes a bounded, context-sensitive account of collaborative capability development as a self-directed, self-regulated, and resource-sensitive process of professional becoming. It further develops two connected practical–theoretical models: the Performance Pyramid, which clarifies the developmental architecture from identity awareness to energy and capability regulation and performance enactment, and the Self-Leadership Wheel of Becoming, which functions as an operational scaffold for self-evaluation, goal setting, feasible program design, implementation, reflection, and revision. Rather than presenting these models as universally validated, the article positions them as heuristic and processual contributions for understanding and supporting capability development in collaboration-intensive roles. Full article

Objectives: This study investigated the sequential mediating roles of protein intake and handgrip strength (HGS) in the association between socioeconomic status (SES) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk within the social determinants of health (SDOH) framework. Methods: We conducted a complex survey analysis using data from 6281 adults without baseline ASCVD from the Korea National Health and Nutrition Examination Survey (2016–2018), accounting for stratification, clustering, and weighting. The 10-year ASCVD risk was estimated using the pooled cohort risk equations. SES was classified into three groups based on educational attainment and household income. Relative HGS was calculated as the sum of maximal grip strength in both hands divided by body mass index. Indirect effects were assessed using bootstrap-based confidence intervals (CIs). Results: Compared with the low-SES group, the high-SES group showed a lower 10-year ASCVD risk in both the total effect model (B = −1.630, 95% CI: −2.250 to −1.010) and the direct effect model (B = −1.550, 95% CI: −2.170 to −0.927). The total indirect effect was also significant in both the high-versus-low and middle-versus-low SES comparisons. Protein intake and relative HGS partially mediated the association between SES and 10-year ASCVD risk, and the sequential mediation pathway was also significant. Conclusions: Within the SDOH framework, these findings suggest that nutritional and muscle-strength-related pathways may link socioeconomic disadvantage to ASCVD risk and support integrated interventions targeting nutritional support and muscle-strength improvement for life-course prevention. Full article

Stigma, including ageism and dementia-related stigma, operates as a behavioral determinant shaping beliefs, expectations and actions across the life course. This narrative conceptual synthesis draws on World Health Organization frameworks and selected literature to examine how stigma influences behavior at individual and professional levels. Ageism reinforces assumptions of decline and dependency, which may be internalized, reducing engagement in health-promoting behaviors. Dementia stigma contributes to delayed help-seeking, underdiagnosis, and therapeutic nihilism, influencing clinical decision-making and access to rehabilitation and psychosocial interventions. Addressing stigma is critical to modifying behavior, improving care engagement, and supporting inclusive, person-centered approaches to healthy aging and dementia. Full article

Background: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke (IS) and adverse long-term outcomes. The impact of pre-existing versus newly diagnosed AF on prognosis after endovascular thrombectomy (EVT) is uncertain. Methods: We conducted a retrospective analysis of patients with IS admitted to Mersey and West Lancashire Teaching Hospitals NHS Trust between January 2016 and November 2023 who underwent EVT. Data were extracted from the Sentinel Stroke National Audit Programme and cross-referenced with hospital medical records. Patients were categorised into three groups based on AF status: no-AF, pre-existing AF, and new-AF. Outcomes included prolonged hospital length of stay (LOS) [≥75th percentile], poor functional outcome (modified Rankin Scale [mRS] ≥ 3 at discharge), and all-cause mortality (in-hospital, at 30-day, and at 6-month mortality). Logistic regression and Cox proportional hazards models were used for analysis. Results: A total of 138 patients were included (mean ± SD for age: 67.9 ± 13.9 years; 45.7% female). Hospital LOS was longest in the new-AF group (median 35.0 days [IQR: 6.0–53.0]) compared with the pre-existing AF group (18.0 days [6.0–42.0]), and the no-AF group (7.0 days [3.0–28.0]), p = 0.024. In adjusted logistic regression, new-AF was significantly associated with prolonged LOS (OR = 2.55, 95%CI: 1.01–6.45, p = 0.048) but showed no association with poor functional prognosis (p = 0.851). Cox regression analysis showed that AF status was not associated with mortality (p = 0.325). Conclusions: Newly diagnosed AF after stroke is associated with prolonged hospitalisation despite comparable rates of successful EVT results but had no effect on functional prognosis or risk of death. Full article

State sequence analysis of longitudinal categorical data seeks to synthesize pathways through different dimensions of the life course for descriptive, associative and predictive purposes. Given the number and variety of patterns in such data, measures of the dynamic features of sequences are used to characterize them. One, based on the information-theoretic notion of entropy, measures the uncertainty in the state that will be active at a given time. We customize its use to establish the extent to which we are ignorant, or unsure, of what happens next in a dynamic process, conditional on its past. Relying on different Markov chain models for nominal state sequences, we establish multiple measures of uncertainty that allow us to adjust expectations to reflect individual-specific differences and historical information. We establish complementary measures to assess the predictive power of the models in the context of this uncertainty. In so doing, we can summarize and contrast the change in uncertainty associated with different models. As is common in this field, we consider ways in which data can be stratified through demographics and clustering, and how this additional level of partitioning builds a more complete narrative of the social process. Full article

Fuel poverty is shaped by interacting social, environmental and housing conditions, yet these links remain underexplored at city scale. The analysis is framed as an ecological, cross-sectional assessment of spatial associations rather than as a causal proof of a closed feedback mechanism. This study examines the relationship between fuel poverty, deprivation, particulate air pollution and housing typology across 54 wards in Liverpool, UK. Ward-level fuel poverty and Index of Multiple Deprivation (IMD) data were integrated with 2023–2024 annual mean particulate matter (PM_2.5 and PM₁₀) from 58 low-cost air-quality sensors and classified housing types. Regression models were used to compare individual, additive and interaction effects. Fuel poverty ranged from 12.4% to 25.29%, while PM_2.5 and PM₁₀ frequently exceeded World Health Organization guideline values. IMD was the strongest individual predictor of fuel poverty (R² = 0.281, $p<0.001$). The preferred additive model including IMD, PM_2.5, PM₁₀ and housing type explained 43.5% of the variance, with Victorian Terraces emerging as a significant risk factor. Although interaction models suggested pollution-deprivation coupling, model selection and uncertainty diagnostics favoured the simpler additive specification. The findings support targeted retrofit, fuel-poverty and emissions-control policies in deprived urban neighbourhoods where inefficient housing and environmental stressors compound energy insecurity and where local action can contribute to more equitable urban sustainability. Full article

Background: Early-onset neonatal listeriosis is a rare, life-threatening infection of vertical origin caused by Listeria monocytogenes. First-line therapy is intravenous ampicillin combined with an aminoglycoside; acquired β-lactam resistance is exceptionally uncommon. Case Presentation: A 34-week preterm female neonate (birth weight 1990 g, appropriate for gestational age) was born to a febrile primigravida with fetid greenish amniotic fluid at a regional secondary maternity and transferred at 30 h of life to our tertiary NICU with respiratory failure requiring mechanical ventilation. L. monocytogenes was recovered from blood, gastric aspirate, pharyngeal exudate, ocular secretion, and skin swab. Gradient strip susceptibility testing reported ampicillin and trimethoprim–sulfamethoxazole non-susceptibility, although confirmatory broth microdilution was unavailable. Broad-spectrum empirical therapy was revised on Day 5 to include ampicillin–sulbactam, with piperacillin–tazobactam and gentamicin continued. A follow-up blood culture on Day 9 remained sterile through 7 days. The hospital course was complicated by thrombocytopenia, transiently elevated aminotransferases, and a Grade I subependymal hemorrhage; tertiary NICU length of stay was 25 days. Conclusions: Recovery under a multi-agent regimen precludes attribution of effect to any single component. Discordant gradient strip susceptibility results in L. monocytogenes should be confirmed by broth microdilution before any therapeutic change; survivors of severe early-onset listeriosis require structured multidisciplinary follow-up. Full article

Background and Clinical Significanc: Neuropathic corneal pain is a debilitating condition characterized by ocular pain disproportionate to clinical signs, often resulting from peripheral and central sensitization of the corneal somatosensory pathway. Emerging evidence suggests that chronic involuntary muscle contraction in blepharospasm may lead to irritation of trigeminal afferents and corneal neurogenic inflammation, potentially predisposing patients to neuropathic corneal pain. Given its debilitating nature, early recognition can prevent the progression of neuropathic sequelae. This study examines the potential role of blepharospasm as a predisposing factor contributing to neuropathic corneal pain. Case Presentation: This retrospective case series describes three cases (median age: 50 years) of neuropathic corneal pain in association with blepharospasm and their clinical course following multimodal treatment over a median follow-up period of one year. Ocular surface was evaluated using slit-lamp biomicroscopy, while corneal nerve structure and morphology were assessed with in vivo confocal microscopy. All the three subjects presented with minimal ocular surface staining but disproportionate ocular pain characterized by burning sensation and photophobia. Proparacaine challenge testing was performed to determine the subtype of neuropathic corneal pain. Pain symptoms and quality of life were evaluated using the Ocular Pain Assessment Survey and Ocular Surface Disease Index questionnaires. In vivo confocal microscopy demonstrated characteristic corneal nerve abnormalities including reduced corneal nerve density, increased nerve tortuosity, and the presence of microneuromas. Treatment included oral Pregabalin or Gabapentin, topical lubricants, Cyclosporine 0.05% (1 case), and 20% autologous serum eye drops (1 case). Two of the three cases received four to five injections of botulinum toxin for blepharospasm, whereas one had undergone a single injection prior to review. All patients also received weekly periorbital quantum molecular resonance electrotherapy for two months. Improvements were observed across multiple domains of the Ocular Pain Assessment Survey and Ocular Surface Disease Index evaluation, including ocular pain, photophobia, non-ocular pain, and quality-of-life measures following multimodal treatment. The co-existence of blepharospasm and neuropathic corneal pain observed in our cases supports a possible association between chronic periocular muscle hyperactivity and corneal nociceptor sensitization. Proposed mechanisms include chronic trigeminal nerve irritation, neurogenic inflammation, and sensitization mediated by pro-inflammatory neuropeptides. Multimodal treatment targeting both motor hyperactivity and neuropathic pain pathways appeared to provide symptomatic relief, including the use of quantum molecular resonance electrotherapy, which might modulate pain pathways, block nociceptor neurotransmission, and accelerate corneal nerve regeneration. Given the complexity of the neural pathways responsible for ocular discomfort, further studies are required to elucidate the relationship between neuropathic corneal pain and blepharospasm in larger cohorts, as well as refine existing therapeutic approaches, including evaluating the therapeutic role of electrotherapy. Conclusions: Blepharospasm may represent a potential predisposing factor of neuropathic corneal pain. Early recognition and concurrent treatment of blepharospasm and neuropathic corneal pain can effectively relieve symptoms and improve quality of life. Adopting a multimodal treatment approach is therefore recommended. Full article

The Cambodian genocide occurred between April 1975 and January 1979. Over one-third of Cambodia’s population perished, and many survivors suffer physical and mental health consequences. This study examines lasting influences of the Cambodian genocide on Cambodia’s population structure and on adult health and health behavior. To illustrate the legacy of decreased fertility and increased mortality during the genocide, population pyramids (1975, 1985, 2014, 2022) were generated using data from the United Nations Population Division. For comparison, population pyramids for the neighboring country of Thailand were generated. To examine the enduring health sequelae of the genocide, nationally representative Demographic and Health survey data (2014, 2021–2022) were used to compare smoking behaviors and stunted growth of women born shortly before and during the genocide (1972–1979) with women born shortly after the genocide (1980–1987). Cambodia’s population pyramids reveal a long-term paucity of individuals in the 1970s birth cohorts not observed for Thailand. Compared to women born shortly after the genocide, women with early-life exposure to the genocide were more likely to report smoking in adulthood and to have experienced stunted growth. The genocide impacted Cambodia’s population structure and affected the health and health behaviors of early childhood genocide survivors into adulthood. These findings imply life course and intergenerational impacts. Full article

Sickle cell disease (SCD) is one of the most common inherited blood disorders worldwide. Clinical manifestations are variable, but include hyposplenism, renal impairment, cardiovascular disease, respiratory complications, and cerebrovascular disease. Frequent painful vaso-occlusive crises, hospitalisations, and other physical and psychological ramifications can have profound effects, including children missing school time resulting in impaired academic performance and adults missing work leading to employment loss. This narrative review examines the possible risks and benefits of exercise in the SCD population. Regular exercise plays an important role in improving physical and mental health, but fears around the potential consequences of exercise for the SCD population are present in children, their families, schools, and other organisations. This can result in children not taking part in as much regular exercise as their peers and being excluded from group activities. Studies have suggested that healthcare professionals often do not discuss the possible benefits of physical exercise with patients, likely because there are no guidelines regarding a safe level of activity. An acute increase in inflammation secondary to exercise could increase the risk of vaso-occlusive crises, but regular physical activity is known to play an important role in disrupting chronic inflammation across a wide range of pro-inflammatory diseases. Indeed, studies have demonstrated positive responses to exercise in the SCD population, from improvements in skeletal muscle microvasculature to performance in cardiovascular tests. It is important that recommendations are developed regarding types of exercise and the ideal amount of exercise for maximum benefit with minimum risk in SCD individuals. Full article

Persisting ethnic disparities in pre-eclampsia (PE), cardiovascular disease (CVD), and maternal mortality call for a paradigm shift in how ethnicity is understood as a risk factor for PE. Starting from a migrant perspective, we argue that the transgenerational experience of maternal stress within shared, yet dynamic ecosocial contexts can be linked to core pathophysiological features of PE. A growing body of evidence suggests how a vicious cycle of chronic maternal stress, cardiovascular dysfunction, placental ER stress, and endothelial dysfunction may serve as a catalyst for the transmission of altered cardiovascular and neuro-endocrine stress reactivity patterns across generations, with a seemingly important role for foetal programming and epigenetics. As these alterations in stress reactivity patterns have in turn been associated with an increased risk of PE and CVD later in life, the resulting transgenerational chain reaction may ultimately allow for ethnic disparities in PE to be traced back to historic, stressful moments in the shared ecosocial contexts of ethnic minority women. Reconceptualising ethnicity as a proxy for the stratified and embodied experience of transgenerational maternal stress within its unique ecosocial contexts, rather than a stand-alone, non-modifiable risk factor, will therefore open new directions for future research, clinical care, and policy interventions aimed at advancing maternal health equity. Full article