Search Results (69)

The accelerating global population aging has brought increasing attention to the loneliness and emotional needs experienced by older adults due to shrinking social networks and the loss of relatives and friends, which significantly impair their quality of life and psychological well-being. In this context, companion robots powered by artificial intelligence are increasingly regarded as a scalable and sustainable form of emotional intervention that can address older people’s affective and social requirements. This study systematically reviews research trends in this field, analyzing the structure of emotional needs among older users and their acceptance mechanisms toward robot functionalities. First, a keyword co-occurrence analysis was conducted using VOSviewer on relevant literature published between 2000 and 2025 from the Web of Science database, revealing focal research topics and emerging trends. Subsequently, questionnaire surveys and in-depth interviews were carried out to identify emotional needs and functional preferences among elderly users. Findings indicate that the field is characterized by increasing interdisciplinary integration, with affective computing and naturalistic interaction becoming central concerns. Empirical results reveal significant differences in need structures across age groups: the oldest-old prioritize safety monitoring and daily assistance, whereas the young-old emphasize social interaction and developmental activities. Regarding emotional interaction, older adults generally prefer natural and non-intrusive expressive styles and exhibit reserved attitudes toward highly anthropomorphic designs. Key factors influencing acceptance include practicality, ease of use, privacy protection, and emotional warmth. The study concludes that effective companion robot design should be grounded in a nuanced understanding of the heterogeneous needs of the aging population, integrating functionality, interaction, and emotional value. Future development should emphasize adaptive and customizable capabilities, adopt natural yet restrained interaction strategies, and strengthen real-world cross-cultural and long-term evaluations. Full article

Aging involves a progressive decline in physiological functions, increasing vulnerability to disorders, functional decline, and disability. Emphasizing resilience and intrinsic capacity offers a proactive framework for promoting successful aging and quality of life. This narrative review selected significant articles published within the last five years on resilience, especially physical resilience, and intrinsic capacity, along with earlier relevant works. Articles were primarily searched in English using PubMed, Google Scholar, and Scopus, employing relevant terms with Boolean operators (“AND”, “OR”). Inclusion criteria included peer-reviewed conceptual, observational, and interventional studies on resilience and/or intrinsic capacity in adults over 60, published between 2020 and 2025, highlighting how the inclusion of geriatric evaluation improves health outcomes. Studies not focused on older adults, outside the date range, or non-English articles were excluded. Out of 145 references, 43 articles met the inclusion criteria. ResEvidence suggests that resilience (a dynamic response to stressors) and intrinsic capacity (baseline reserves across locomotion, vitality, cognition, sensory, and psychological domains) are interconnected, with resilience being associated with better health outcomes, a lower prevalence of chronic diseases, and greater mental health stability. Incorporating assessments of resilience and intrinsic capacity into clinical workflows could support targeted interventions; routine screening may guide personalized exercise and psychosocial plans to help prevent functional decline. Utilizing brief, validated tools (e.g., Short Physical Performance Battery, handgrip strength, Geriatric Depression Scale, brief cognitive tests, and resilience scales) can inform interventions such as physical activity, nutritional support, deprescribing, and psychosocial engagement, which may support healthier aging trajectories. Full article

Pelvic organ prolapse (POP) affects millions of women around the world, with age-standardized prevalence rates of 2769 per 100,000 women in 2021. Although it greatly affects quality of life (QoL), only 18–50% of women experiencing this issue seek medical attention, largely due to a lack of knowledge, misunderstandings about the condition, and obstacles to accessing healthcare. This narrative review explores the progression of POP management towards a focus on patient-centered care, highlighting the importance of personalized treatment strategies that prioritize patient-reported outcomes (PROs) over solely anatomical factors. The approach to treatment has transitioned from being centered on anatomy to focusing on the patient, emphasizing the relief of symptoms and enhancement in QoL. Existing research indicates that monitoring without intervention is advisable for asymptomatic patients, as long-term studies have revealed that up to 40% of women experience stable or improved prolapse over a period up to 60 months. Pessary treatment has a fitting success rate above 90% and a treatment persistence rate of 60%, providing an effective non-surgical option for management. The approach to selecting surgical treatments has progressed to prioritize sufficient apical support as a key factor for achieving lasting results. For primary POP, native tissue repair (NTR) is now recommended as the first-line surgical option. Mesh-augmented repairs are used only in certain high-risk situations, whereas sacrocolpopexy offers the best anatomical stability for particular cases, such as those involving post-hysterectomy prolapse and recurrences. Contemporary POP management involves personalized, patient-focused decision-making that emphasizes addressing symptom severity and functional objectives rather than solely aiming for anatomical precision. The evidence suggests that NTR should be the primary surgical approach, while other procedures should be reserved for specially chosen patients. Success should primarily be evaluated based on PROs instead of anatomical factors, ensuring that treatments align with each patient’s preferences and expectations while reducing complications. Full article

Background/Objectives: Ischemia with non-obstructive coronary arteries (INOCA) remains an underdiagnosed and undertreated condition due to the extensive diagnostic testing required and heterogeneous pathophysiology of different endotypes, each of which require tailored treatment. This study aimed to explore the effect of intracoronary physiology testing-based endotype-specific medical therapy on quality of life in patients with INOCA. Methods: Intracoronary physiology testing was performed in patients presenting with cardiac symptoms, evidence of significant ischemia on non-invasive testing, and non-obstructive epicardial coronary arteries. Microvascular angina (MVA) was defined as coronary flow reserve ≤ 2.5 and an index of microvascular resistance ≥ 25. Vasospastic angina (VSA) was defined as a >90% vasoconstriction of an epicardial artery during acetylcholine provocation test in the presence of ischemic electrocardiogram changes and chest pain. Quality of life was evaluated using the Seattle Angina Questionnaire 7 (SAQ-7) before the start of new treatment and at the three months follow-up. Results: The total study population consisted of 35 patients (80% women), of whom MVA was observed in 19 (54.3%), VSA in 9 (25.7%), and the combination of MVA and VSA in 3 (8.6%) cases. Four patients (11.4%) had no pathology on intracoronary physiology testing detected. High rates of dyslipidemia (100%), arterial hypertension (85.7%), diabetes (17.1%), and depression and anxiety (34.3%) were documented. In the isolated MVA and VSA groups, adjustment of medical therapy resulted in an improvement in the SAQ-7 summary score at 3 months (p < 0.001 and p = 0.007, respectively). There was no change of SAQ-7 summary score in the mixed endotype group (p = 0.11). Conclusions: Adjustment of medical therapy according to intracoronary physiology testing-based phenotype resulted in improved quality of life as assessed by the SAQ-7. Our findings highlight the importance of invasive testing in patients with clinically suspected INOCA. Full article

Background: Cardiopulmonary exercise testing (CPET) is increasingly recognized as a key tool for evaluating patients with congenital heart disease (CHD). While traditional assessments focus on resting parameters, CPET provides dynamic, integrated insight into cardiovascular, respiratory, and muscular function during exertion. Objectives: This review explores the clinical value of CPET across the spectrum of CHD, with dedicated focus on its applications in both adult and paediatric populations. We analyse the prognostic significance of key CPET parameters—particularly peak oxygen consumption (peak VO₂), ventilatory efficiency (VE/VCO₂ slope), and heart rate dynamics—within distinct anatomical and physiological categories of CHD. Findings: CPET reliably detects exercise intolerance, guides intervention timing, informs exercise prescription, and stratifies risk. Peak VO₂ and heart rate reserve are consistently associated with adverse outcomes across most CHD types. However, the prognostic utility of other variables, such as the VE/VCO₂ slope, varies with pathophysiology—being less reliable in cyanotic lesions like Eisenmenger syndrome. In paediatric patients, CPET must be adapted to growth-related physiological variability and is increasingly used to assess quality of life, functional limitation, and response to therapy. Conclusions: CPET is a powerful, non-invasive tool that should be integrated into routine management of CHD patients across all ages. It enhances risk assessment, supports tailored care, and promotes safe physical activity, ultimately contributing to improved long-term outcomes and quality of life. Full article

In this review, we summarize current insights into the treatment of functional constipation (FC) in children. Constipation is a global issue in the pediatric population, with a prevalence of approximately 9.5%. Initial management involves a combination of non-pharmacological and pharmacological interventions. However, a significant number of children continue to experience therapy-resistant FC despite optimal non-pharmacological and pharmacological treatments. While studies on novel pharmacological options in children are limited, adult trials have shown promising results. New agents such as lubiprostone, prucalopride, linaclotide, and plecanatide have demonstrated improved outcomes compared to placebo or conventional therapies, particularly in increasing spontaneous bowel movements. Neurostimulation presents an additional treatment modality. Posterior tibial nerve stimulation appears to be a promising new option, offering high treatment satisfaction and a favorable safety profile with a low rate of severe adverse events. For children who do not respond to optimal conservative therapy, the impact on quality of life can be substantial. In such cases, surgical interventions may be considered, including intrasphincteric botulinum toxin injections, antegrade continence enema surgery, and, in severe cases, colonic resection or a diverting ostomy. The choice of surgical treatment remains a subject of ongoing debate. Therapy-resistant FC in children is a complex and impactful condition. An individualized, stepwise approach is essential, with surgical options such as colonic resection reserved as a last resort. Full article

Background and Objectives: Up to 40% of patients undergoing a coronary angiogram due to angina pectoris have no obstructive coronary artery disease, also known as angina with non-obstructive coronary arteries (ANOCA). ANOCA is associated with significant impairment in patients’ quality of life, increased risk of myocardial infarction and all-cause mortality. Approximately 25% of patients with ANOCA have persisting symptoms despite optimal medical therapy. There is a lack of in-depth knowledge regarding tailored treatment for patients with ANOCA due to a scarcity of trials designed to assess the effect of treatment modalities. The aim of this systematic review and meta-analysis is to give clinicians an overview of the efficacy of current treatment modalities for patients with ANOCA. Methods: PudMed/MEDLINE, Embase, the Cochrane Library and clinical trial registries were searched for randomised controlled and cohort studies regarding treatment modalities for ANOCA. The main outcome was change in angina pectoris frequency for each treatment modality. Secondary outcomes included changes in exercise capacity, quality of life, Canadian Cardiovascular Society (CCS) class, coronary flow reserve (CFR) and survival. Results: In total, 80 studies were included and used in the meta-analysis, of which ten studies met the current definition of ANOCA. Angina pectoris frequency improved significantly in the majority of the treatment modalities, with neuromodulation resulting in −3.35 standardised mean difference (SMD) (95% CI: −5.13; −1.56), trimetazidine in −1.74 SMD (−2.63; −0.85), traditional Chinese medicine in −1.55 SMD (−2.36; −0.75), beta-blockers in −1.32 SMD (−1.88; −0.77), enhanced external counterpulsation in −1.27 SMD (−2.04; −0.49), stem cell therapy in −1.04 SMD (−1.51; −0.57), lifestyle interventions in −0.86 SMD (−1.15; −0.57), RAAS-inhibitors in −0.83 SMD (−1.31; −0.35) and calcium channel blockers in −0.64 SMD (−0.92; −0.35). Conclusions: This meta-analysis into treatment modalities for patients with ANOCA shows a significant improvement in angina pectoris frequency in the majority of included treatment modalities. However, these results should be interpreted cautiously, as only ten of the studies included in the meta-analysis meet the current definition of ANOCA. This review underlines the importance of undertaking new studies with existing treatment modalities to determine the efficacy in patients with ANOCA. Full article

If modern Western disciplinary structures, laid forth by Dilthey and others in the 19th century, have helped structure the world in ways that bring about climate change and gross economic inequities (along with many “good” things such as vaccines and some modern comforts), how might we re-structure our thinking and learning in ways that address these violent lacunae? What does it mean to educate in a truly globalized world that is facing climate change, extinction, and growing injustice? The answer to that surely cannot be “more of the same”. Following the work of critical theorists and the ideas of Paulo Freire and bell hooks, among others, this essay argues that education should be about imagining and working toward a more just and ecologically sound version of the planetary future in a way that is attentive to as much input as possible from multiple perspectives (human and non). The goals of such an education are connective, grounding, and encountering “others” rather than reductive, productive, and geared toward technology transfer. What would it mean to undiscipline or open our disciplinary categories in ways that reattune us to the changing, entangled planet of which we are a part? What will it take to develop planetary humanities and technologies? If humans are not exceptions to the rest of the natural world, and if the nonhuman world is not just dead matter to be used toward human ends, then how do we go about re-grounding our epistemologies within the planet, rather than continuously thinking “out of this world”? The first part of this essay offers a critique of the reductive and productive model that turns the world into a “standing reserve” for use by some humans. The second part of the essay outlines some principles for knowledge that are more connective, grounding and enable us to counter the multiple others within the planetary community. Such “planetary” knowledge reminds humans of the humus of our humanity, connects us to other life found through compassion (to suffer with), reminds us of the justice of good company (sharing of bread/resources), and focuses on the playfulness of public, political conversations (the ability to be converted to another’s point of view). In the third part, I suggest some grounded metaphors for planetary thinking: wild and slow thinking, elemental and grounded thinking, and creaturely and mycelium thinking. Full article

Childhood glaucoma encompasses a group of rare but severe ocular disorders characterized by increased intraocular pressure (IOP), posing significant risks to vision and quality of life. Primary congenital glaucoma has a prevalence of one in 10,000–68,000 people in Western countries. More worryingly, it is responsible for 5–18% of all childhood blindness cases. According to the Childhood Glaucoma Research Network (CGRN), this spectrum of disease is classified into primary glaucoma (primary congenital glaucoma and juvenile open-angle glaucoma) and secondary glaucomas (associated with non-acquired ocular anomalies, non-acquired systemic disease, acquired conditions, and glaucoma after cataract surgery). They present very specific ocular characteristics, such as buphthalmos or progressive myopic shift, corneal modifications such as Haab striae, corneal edema or increased corneal diameter, and also glaucoma findings including high intraocular pressure, specific visual fields abnormalities, and optic nerve damage such as increased cup-disc ratio, cup-disc ratio asymmetry of at least 0.2 and focal rim thinning. Surgical intervention remains the cornerstone of treatment, and initial surgical options include angle surgeries such as goniotomy and trabeculotomy, aimed at improving aqueous outflow. For refractory cases, trabeculectomy and glaucoma drainage devices (GDDs) serve as second-line therapies. Advanced cases may require cyclodestructive procedures, including transscleral cyclophotocoagulation, reserved for eyes with limited visual potential. All in all, with appropriate management, the prognosis of PCG may be quite favorable: stationary disease has been reported in 90.3% of cases after one year, with a median visual acuity in the better eye of 20/30. Immediate recognition of the specific signs and symptoms by caregivers, primary care providers, and ophthalmologists, followed by prompt diagnosis, comprehensive surgical planning, and involving the caregivers in the follow-up schedule remain critical for optimizing outcomes in childhood glaucoma management. Full article

A significant proportion of childhood cancer survivors experience persistent health problems related to cancer or cancer treatment exposures, including accelerated or early onset of aging. Survivors are more likely than non-cancer peers to present a frail phenotype suggestive of reduced physiologic reserve and have symptoms that interfere with function in daily life, including pain. Studies in the general population, mostly among older adults, suggest that pain is a significant contributor to development and progression of frail health. This association has not been explored among childhood cancer survivors. In this narrative review, we highlight this gap by summarizing the epidemiologic evidence on pain and frailty, including their prevalence, common risk factors, and correlates in childhood cancer survivors. We further discuss associations between pain and frailty in non-cancer populations, likely biological mechanisms in survivors, and potential interventions targeting both domains. Full article

Odontoid fractures (OFs) represent up to 15% of all cervical fractures encountered and present most commonly amongst elderly patients, typically in the setting of low energy trauma such as falls. The Anderson and D’Alonzo classification and Roy-Camille subtype description are the most clinically noteworthy descriptions of OFs used. Even though most patients will not present with neurological injury, mechanical instability can occur with type II and type III (Anderson and D’Alonzo) fractures, particularly if the transverse ligament of the atlas is ruptured; however, this is very rare. Conservative treatment is usually employed for type I and type III injuries, and to a varying degree for non-displaced type II injuries. Surgical treatment is typically reserved for type II fractures, patients with neurological injury, and in the setting of other associated fractures or ligamentous injury. Anterior screw fixation is a viable option in the setting of a favorable fracture line orientation in type II fractures, whereas posterior C1–C2 screw fixation is an option for any type II or type III fracture presentation. There is evidence that surgery for type II fractures has higher rates of union and lower mortality than nonoperative treatments. While surgical options have increased over the decades and the management of OF has been optimized by considering fracture subtypes and patient factors, there remains a significant morbidity and mortality associated with OFs. The aging population and changing demographics suggest that there will be an ongoing rise in the incidence of OFs. Therefore, the appropriate management of these cases will be essential for ensuring optimization of health care resources and the quality of life of affected patients Full article

Background and Objectives: Atherosclerotic disease is a major contributor to heart failure, stroke, and myocardial infarction, significantly lowering the quality of life and life expectancy and placing a significant burden on healthcare. Not all lesions deemed non-significant are benign, and conversely, not all significant lesions are causative of ischemia. Fractional flow reserve (FFR) provides a functional assessment of coronary lesions, while optical coherence tomography (OCT) offers detailed imaging of plaque morphology, aiding in therapeutic decision-making. The objective of this study was to evaluate the utility of OCT and FFR as adjunctive tools in the catheterization laboratory for guiding therapeutic decisions in patients with multivessel disease for non-culprit vessels. Specifically, we aimed to assess how OCT and FFR influence therapeutic decision-making in patients with multivessel coronary artery disease. Materials and Methods: A total of 36 patients with acute coronary syndrome (ACS) and multivessel disease were randomized 1:1 into two groups: one guided by FFR alone and the other by a combination of FFR and OCT. For the FFR group, revascularization decisions for non-culprit lesions were based solely on FFR measurements. If the FFR was >0.8, the procedure was concluded, and the patient received maximal medical treatment. If the FFR was ≤0.8, a stent was placed. For the FFR + OCT group, if the FFR was >0.8, the revascularization decision was based on OCT findings. If there were no vulnerable plaques (VP), the procedure was concluded, and the patient received maximal medical treatment. If OCT imaging indicated VP, then the patient underwent revascularization. If the FFR was ≤0.8, the patient underwent revascularization regardless of OCT findings. Results: OCT imaging altered the therapeutic decision in 11 cases where FFR measurements were above 0.8, but the lesions were characterized as VP. Analyzing the total change in the decision to stent, 4 cases in the FFR group and 15 cases in the FFR and OCT groups (4 based on FFR and 11 on OCT) revealed a statistically significant difference (p = 0.0006; Relative Risk = 0.2556; 95% CI: 0.1013 to 0.5603). When analyzing the change in the total decision both to stent and not to stent, we observed a statistically significant difference, with Group 1 having 7 cases and Group 2 having 15 cases (p = 0.0153; Relative Risk = 0.4050; 95% CI: 0.2004 to 0.7698. Conclusions: Based on the findings of this study, OCT significantly increases the percentage of stenting procedures by identifying vulnerable lesions. The use of intracoronary imaging facilitates the timely identification and treatment of these vulnerable lesions. This underscores the crucial role of OCT in enhancing the precision of coronary interventions by ensuring timely intervention for vulnerable lesions, thereby potentially improving patient outcomes. Full article

Background: Older adults with bipolar disorder (OABD) are individuals aged 50 years and older with bipolar disorder (BD). People with BD may have fewer coping strategies or resilience. A long duration of the disease, as seen in this population, could affect the development of resilience strategies, but this remains under-researched. Therefore, this study aims to assess resilience levels within the OABD population and explore associated factors, hypothesizing that resilience could improve psychosocial functioning, wellbeing and quality of life of these patients. Methods: This study sampled 33 OABD patients from the cohort at the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. It was an observational, descriptive and cross-sectional study. Demographic and clinical variables as well as psychosocial functioning, resilience and cognitive reserve were analyzed. Resilience was measured using the CD-RISC-10. Non-parametric tests were used for statistical analysis. Results: The average CD-RISC-10 score was 25.67 points (SD 7.87). Resilience negatively correlated with the total number of episodes (p = 0.034), depressive episodes (p = 0.001), and the FAST (p < 0.001). Participants with normal resilience had a lower psychosocial functioning (p = 0.046), a higher cognitive reserve (p = 0.026), and earlier onset (p = 0.037) compared to those with low resilience. Conclusions: OABD individuals may have lower resilience levels which correlate with more psychiatric episodes, especially depressive episodes and worse psychosocial functioning and cognitive reserve. Better understanding and characterization of resilience could help in early identification of patients requiring additional support to foster resilience and enhance OABD management. Full article

The digitalization of the high-tech economy is complicated due to several issues. One can mention non-synchrony and imbalance in the development of industrial enterprises and their integrations; changes in the elements and relations between enterprises and the external environment; as well as contradictions between the actors. Therefore, a new institutional system for industrial integrations needs to be formed. This article proposes a concept and scenario of the institutional change needed to bolster industrial integrations in the digital economy. The structural logic and algorithm of the process provides for the gradual progress through seven phases of institutional transformation. The authors have developed an institutional change management platform for strategic transformation, the core of which is a decision-making system. The platform supports the management of digital and material business processes of industrial integrations. The conceptual approach is based on a comparison of the life cycles of enterprises and their markets. The article proposes a methodology for assessing the readiness of industrial integrations to implement institutional change strategies using modified Shewhart control charts. The methodology is based on a two-criterion approach to the analysis of finances, production reserves, human resources, organizational structures, management technologies, corporate institutions, and a personnel motivation system. This approach allows determining the level of compliance of the resources available with the requirements of the transformation strategy implementation plan. The methodology has been tested at 14 enterprises functioning as industrial integration actors. According to the dynamics of the level of readiness to implement the transformation strategy, enterprises within the framework of industrial integrations are divided into three groups: enterprises with consistently high, medium, and low levels of readiness to implement the strategy. Full article

Estimating loss reserves is a crucial activity for non-life insurance companies. It involves adjusting the expected evolution of claims over different periods of active policies and their fluctuations. The chain-ladder (CL) technique is recognized as one of the most effective methods for calculating claim reserves in this context. It has become a benchmark within the insurance sector for predicting loss reserves and has been adapted to estimate variability margins. This variability has been addressed through both stochastic and possibilistic analyses. This study adopts the latter approach, proposing the use of the CL framework combined with intuitionistic fuzzy numbers (IFNs). While modeling with fuzzy numbers (FNs) introduces only epistemic uncertainty, employing IFNs allows for the representation of bipolar data regarding the feasible and infeasible values of loss reserves. In short, this paper presents an extension of the chain-ladder technique that estimates the parameters governing claim development through intuitionistic fuzzy regression, such as symmetric triangular IFNs. Additionally, it compares the results obtained with this method with those derived from the stochastic chain ladder by England and Verrall. Full article