Search Results (157)

Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute liver failure (ALF), early nutritional intervention within 24–48 h and individualized energy–protein prescriptions are essential, even in the presence of hepatic encephalopathy. Chronic liver failure (CLF) and acute-on-chronic liver failure (ACLF) are often associated with severe malnutrition, sarcopenia, and systemic inflammation, necessitating tailored nutritional strategies. Subjective Global Assessment (SGA) and Royal Free Hospital Global Assessment (RFH-GA) tools are instrumental in identifying nutritional risk. Enteral nutrition (EN) is preferred across all stages, with parenteral nutrition (PN) reserved for contraindications. Special considerations include micronutrient repletion, prevention of refeeding syndrome, and perioperative nutritional support in transplant candidates and recipients. This clinical overview summarizes current evidence and guidelines on ICU nutrition in liver failure, emphasizing a multidisciplinary approach to improve outcomes. Full article

Propolis is a natural resinous substance produced by honeybees that has many biological activities. For thousands of years, it has been widely used as a dietary supplement and traditional medicine to treat a variety of ailments due to its antimicrobial, anti-inflammatory, antioxidant, immunomodulatory, and wound-healing properties. Nutritional supplements and foods may interact with drugs both pharmacodynamically and pharmacokinetically, which could raise clinical concerns. Background/Objectives: This study aimed to investigate the effect of propolis on the plasma disposition of enrofloxacin and to assess the potential pharmacokinetic interaction in rabbits. Methods: In this study, enrofloxacin was applied per os (20 mg/kg) and IM (10 mg/kg) and with propolis (100 mg resin/kg) administration in four groups of rabbits (each of six individuals). Heparinized blood samples were collected at 0, 0.1, 0.3, 0.5, 1, 2, 4, 8, 12, and 24 h post-administration. HPLC-FL was used to analyze the plasma concentrations of enrofloxacin and its active metabolite ciprofloxacin following liquid–liquid phase extraction, i.e., protein precipitation with acetonitrile and partitioning with sodium sulfate. Results: The results revealed that propolis coadministration significantly affected the plasma disposition of enrofloxacin and its active metabolite after both per os and intramuscular administration routes. Significantly greater AUC (48.91 ± 11.53 vs. 26.11 ± 12.44 µg.h/mL), as well as longer T_1/2λz (11.75 ± 3.20 vs. 5.93 ± 2.51 h) and MRT (17.26 ± 4.55 vs. 8.96 ± 3.82 h) values of enrofloxacin and its metabolite ciprofloxacin, were observed after the coadministration of propolis compared to enrofloxacin alone following both per os and IM routes in rabbits. Conclusions: The concurrent use of propolis and prescription medications may prolong the half-life (T_1/2λz) and increase the systemic availability of chronically used drugs with narrow therapeutic indices. The repeated use of drugs such as antibiotics, heart medications, and antidepressants, or drugs with a narrow therapeutic index such as antineoplastic and anticoagulant agents, can cause toxic effects by raising blood plasma levels. Considering the varied metabolism of rabbits and humans, further validation of this study may require thorough clinical trials in humans. Full article

The role of vitamin D in reducing cardiovascular disease (CVD) risk remains debated despite growing evidence. Prospective observational studies consistently show that low serum 25-hydroxyvitamin D [25(OH)D] concentrations (below 40–50 nmol/L [16–20 ng/mL]) are associated with the highest risk of CVD incidence. In addition, a large prospective observational study found that serum 25(OH)D concentration was inversely correlated with CVD mortality rate to over 100 nmol/L. Randomized controlled trials have not generally demonstrated benefit due to faulty study designs, such as enrolling participants with baseline 25(OH)D levels > 50 nmol/L. However, a major trial found that 60,000 IU/month of vitamin D₃ supplementation reduced the risk of major cardiovascular events for participants with predicted 25(OH)D concentrations ≥ 50 nmol/L or taking statins or CV drugs by ~13 to ~17%. In addition, vitamin D supplementation studies have found modest reductions in several CVD risk factors. Other observational studies of vitamin D supplementation have reported reduced CVD risks (e.g., ischemic heart disease, hypertension, and myocardial infarction). Temporal ecological studies further support this relationship, revealing that CVD incidence rates are lowest in summer and CVD mortality rates are significantly higher in late winter—when 25(OH)D concentrations are lowest—compared to late summer. A previously reported analysis using eight of Hill’s criteria for causality in a biological system further strengthens the biological plausibility of vitamin D’s role in CVD risk reduction. Its role in modulating inflammation and oxidative stress, improving endothelial function, and reducing several cardiometabolic risk factors supports its inclusion as part of a comprehensive, multi-modal approach to cardiovascular health. Therefore, vitamin D should be considered an integral component in the prevention and management of CVD. Preferably, it should be used in combination with other nutritional supplements, a heart-healthy diet, and prescription medications to reduce the risk of CVD incidence. People should consider vitamin D₃ supplementation with at least 2000 IU/day (50 mcg/day) (more for those who are obese) when sun exposure is insufficient to maintain serum 25(OH)D concentrations above 75 nmol/L. To reduce CVD mortality rates, higher doses to achieve higher 25(OH)D concentrations might be warranted. Full article

Background/Objectives: This study aims to fill gaps in the existing literature through a qualitative evaluation of stakeholders involved in Food Is Medicine (FIM) programs. The primary objective was to examine the structural components, implementation process, and perceived impact of the University of California Los Angeles (UCLA) and Venice Family Clinic (VFC) Emergency Prepared Meal Program (UCLA-VFC Food Program), developed as a collaboration between a university and Federally Qualified Health Center (FQHC) during a period of community crisis. A secondary objective was to compare this program with three other FIM initiatives, identifying convergences and divergences in design and effectiveness. Methods: The methodology involved semi-structured interviews conducted with stakeholders across all four programs. Participants were recruited based on their direct involvement with program ideation, design, or implementation. Interviews were conducted online between July and September 2022, with 11 stakeholders. A thematic analysis was applied to the transcribed responses using an inductive thematic analysis. Results: Key findings highlighted four recurrent themes: (1) the critical role of leadership and a collaborative culture; (2) the importance of community partnerships and health education; (3) challenges related to logistics, funding, and sustainability; and (4) the need for assessment and evaluation. These findings provide valuable insight into the design of future FIM interventions, particularly those embedded in healthcare settings. Conclusions: In conclusion, this study offers preliminary evidence supporting the unique potential of university–community partnerships to address food insecurity. Unlike previous research that emphasized clinical outcomes, our findings provide a contextualized understanding of programmatic implementation. While further quantitative evaluation is necessary, this work lays the groundwork for a collaborative model between various entities including universities, healthcare systems, clinics, and community health/food services aimed at addressing social determinants of health. Full article

Background: Within 10 years of diagnosis, about 50% of patients with Crohn’s disease (CD) require surgery. Repeated small bowel resections can lead to the development of short bowel syndrome (SBS). It is estimated that 65–75% of CD patients are malnourished. This retrospective observational study was conducted in a Polish reference centre for home parenteral nutrition (HPN). The aim of the study was to investigate the nutritional status and characteristics of patients with CD referred to HPN and to analyse the course of their HPN treatment. Methods: The study group consisted of all adult patients (N = 46) with CD who qualified for HPN between November 2004 and April 2022. Results: The most common indication for HPN was SBS (n = 27; 58.70%), followed by ineffective gastrointestinal nutrition causing progressive malnutrition (N = 9; 19.57%), fistulas (N = 6; 13.04%), and short bowel syndrome and fistulas (N = 4; 8.70%). According to the results of Subjective Global Assessment (SGA), 47.83% (N = 22) of patients were diagnosed with severe malnutrition, followed by 15 patients (32.61%) with moderate malnutrition. Global Leadership Initiative on Malnutrition (GLIM) criteria showed that 71.73% (n = 33) of patients were malnourished on admission to the HPN centre. All patients received parenteral formulas based on individually tailored prescriptions. The results showed that patients with a stoma received statistically significantly higher PN volumes (p = 0.027) and higher amounts of amino acids (p = 0.046) and fat emulsion (p = 0.046). Septic complications were twice as common as mechanical or metabolic complications, although 43.47% of patients had no complications. At the time of data analysis, 19 patients (41.30%) had been successfully weaned from HPN, of whom 12 (26%) achieved nutritional autonomy after 136–1419 days (mean: 560 ± 380.9). Conclusions: Malnutrition is a major problem in CD patients, especially those with SBS. Early nutritional intervention and consideration of artificial nutrition in this study group (HPN) are necessary to prevent the long-term consequences of severe malnutrition. To our knowledge, this was the first study to report on Crohn’s patients referred to long-term HPN. Further studies are needed to assess the impact of HPN on functional, laboratory, and anthropometric outcomes with a view to optimising treatment outcomes. Full article

On behalf of the Strength and Conditioning Society (SCS), we are pleased to present the abstracts submitted for the SCS 7th Annual Meeting. The event was held at the Universidad Católica de Murcia (UCAM) headquarters in Murcia, Spain, on 9–11 October 2024, and comprised several invited sessions by international and national speakers on a variety of topics related to biochemistry and exercise physiology, strength and conditioning practices and their application to health, injury prevention, and sports performance. These included strength training in high-performance sports, sport science and training–competition load management in elite environments, biochemistry and exercise physiology and prescription, nutrition and biomechanics, among others. The conference also included practical workshops by renowned academics and practitioners on eccentric training, change of direction ability, and strength and power training in professional team sports, combat sports, and ergospirometry and exercise prescription in specific populations. Finally, the event disseminated up-to-date strength and conditioning research by providing practitioners and researchers with the opportunity to present their most recent findings. All abstracts presented at the SCS 7th Annual Meeting can be found in this Conference Report. Full article

Background: Low back pain (LBP) is a common occupational health issue among nurses, significantly affecting quality of life and work productivity. Despite awareness, it remains a major cause of absenteeism and presenteeism, highlighting the need for targeted interventions. This study aimed to assess the prevalence of LBP among Italian nurses and its impact on quality of life and work productivity. Methods: A cross-sectional, multicenter observational study was conducted from May to October 2024 using an online questionnaire distributed to members of the Provincial Orders of Nursing Professions across Italy. The questionnaire included sociodemographic variables and three validated instruments: the Quebec Back Pain Disability Scale (QBPDS), the Oswestry Disability Index (ODI), and the Work Productivity and Activity Impairment Questionnaire (WPAI). Results: A total of 318 nurses participated, with the majority from Southern Italy (57.1%) and female (74.6%). LBP was reported by 57.5% of respondents. Nurses working in Critical Care and those with 30–40 years of experience had significantly higher QBPDS and ODI scores, indicating moderate disability. Nurses working 12 h shifts and those with job restrictions or medical prescriptions reported significantly higher disability levels (ODI > 29, p < 0.001). Nurses on pharmacological therapy reported moderate pain levels, while those engaging in regular physical activity had significantly lower pain symptoms (<20, p < 0.001). The WPAI results showed that 67.0% of nurses reported impaired work productivity due to LBP. Conclusions: LBP is extremely prevalent among Italian nurses, especially affecting physical well-being and, accordingly, the health care quality provided by them. Factors exacerbating this problem are wrong manual handling of loads, not exercising, poor nutrition, and smoking, as well as wrong posture. Fundamental in order to avoid the occurrence of this problem are preventive programs and ergonomic training. Full article

Background/Objectives: Multi-lumen devices that limit physicochemical incompatibilities (PCIs) are frequently used in neonatal intensive care units where premature infants receive numerous infusions. The aim of the study was to investigate a PCI that occurred despite the use of a device of this type (EDELVAISS^® Multiline NEO, Doran International, Toussieu, France). Case Summary: A 7-week-old preterm infant received ganciclovir at therapeutic dosage for cytomegalovirus (CMV) infection. After the fifth administration of ganciclovir, a PCI occurred, leading to a white precipitate. The peripheral inserted central catheter (PICC) (PREMICATH^®2Fr, Vygon, Ecouen, France) had to be replaced. Laboratory reproduction of the administrations during 72 h, nuclear magnetic resonance (NMR) analysis and particle counting were carried out to analyse the occurrence of events leading to PCIs. The precipitate was linked to a PCI of parenteral nutrition associated with a dilution error of ganciclovir (omission of a 10-fold dilution step, resulting in ganciclovir being administered at 30 mg/L instead of 3 mg/L). Due to the presence of lipids in the parenteral nutrition, visual detection of the white precipitate was difficult. Conclusions: Multi-lumen infusion devices limit but do not prevent the occurrence of PCIs, particularly in the event of a preparation error. Despite the use of this type of device, great vigilance is still required, particularly with regard to prescription analysis and reconstitution procedures. Full article

This study aimed to examine the habits, attitudes, and consumption patterns of food supplements (FS) among gym users in Sarajevo, Bosnia and Herzegovina, with respect to gender, age, and training experience. Understanding these behaviors is essential given the rising global trend in FS use, often without professional guidance, which can have implications for individual health and public awareness. By investigating local patterns, this study seeks to provide valuable insights into the motivations and risks associated with supplement consumption, contributing to evidence-based recommendations and policy-making in the field of fitness and nutrition. Methods: Cross-sectional data were collected from various fitness centers using an online questionnaire composed of 21 questions divided into three segments. A total of 614 participants (mean ± SD: 32.77 ± 9.82 years), including both male (67.8%) and female (32.2%) gym users, took part in the study. Results: Participants predominantly belonged to the 36–45 age group, with 70.0% (p < 0.001) reporting more than one year of regular gym attendance, and 40.4% indicating regular FS consumption (p < 0.05). Supplements were mainly used to support faster recovery (29.1%, p < 0.05) and muscle growth (25%, p < 0.05). Magnesium was the most commonly used supplement, equally favored across genders and age groups. Creatine, fish oil capsules, and multivitamins were also frequently consumed (p < 0.05). Self-prescription emerged as the predominant method of FS use (40.3%, p < 0.05), followed by advice from gym coaches (21.8%), with only 5.6% of participants receiving guidance from a nutritionist. Conclusions: The findings highlight a societal trend toward self-directed FS use, often influenced by informal sources, underscoring the importance of further research and the development of targeted, evidence-based educational strategies. Males reported higher FS consumption, with younger users more focused on muscle gain and older individuals prioritizing health maintenance. The reliance on non-expert recommendations raises concerns about the safety and effectiveness of FS usage in the fitness community. Full article

Background: Interdialytic weight gain (IDWG), defined as the accumulation of salt and water intake between dialysis sessions, is a critical parameter of fluid management and a marker of adherence to dietary and fluid restrictions in hemodialysis patients. Excessive IDWG has been strongly associated with increased cardiovascular risk, including left ventricular hypertrophy, cardiac dysfunction, and cerebrovascular complications. Additionally, it necessitates more aggressive ultrafiltration, potentially compromising hemodynamic stability, impairing quality of life, and escalating healthcare costs. Despite international guidelines recommending an IDWG target of <4–4.5% of body weight, many patients struggle to achieve this due to barriers in adhering to dietary and fluid restrictions. This review explores the current state-of-the-art strategies to mitigate IDWG and evaluates emerging diagnostic and therapeutic perspectives to improve fluid management in dialysis patients. Methods: A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify studies on IDWG in hemodialysis. Keywords and MeSH terms were used to retrieve peer-reviewed articles, observational studies, RCTs, meta-analyses, and systematic reviews. Non-English articles, case reports, and conference abstracts were excluded. Study selection followed PRISMA guidelines, with independent screening of titles, abstracts, and full texts. Data extraction focused on IDWG definitions, risk factors, clinical outcomes, and management strategies. Due to study heterogeneity, a narrative synthesis was performed. Relevant data were synthesized thematically to evaluate both established strategies and emerging perspectives. Results: The current literature identifies three principal strategies for IDWG control: cognitive–behavioral interventions, dietary sodium restriction, and dialysis prescription adjustments. While educational programs and behavioral counseling improve adherence, their long-term effectiveness remains constrained by patient compliance and logistical challenges. Similarly, low-sodium diets, despite reducing thirst, face barriers to adherence and potential nutritional concerns. Adjustments in dialysate sodium concentration have yielded conflicting results, with concerns regarding hemodynamic instability and intradialytic hypotension. Given these limitations, alternative approaches are emerging. Thirst modulation strategies, including chewing gum to stimulate salivation and acupuncture for autonomic regulation, offer potential benefits in reducing excessive fluid intake. Additionally, technological innovations, such as mobile applications and telemonitoring, enhance self-management by providing real-time feedback on fluid intake. Biofeedback-driven dialysis systems enable dynamic ultrafiltration adjustments, improving fluid removal efficiency while minimizing hemodynamic instability. Artificial intelligence (AI) is advancing predictive analytics by integrating wearable bioimpedance sensors and dialysis data to anticipate fluid overload and refine individualized dialysis prescriptions, driving precision-based volume management. Finally, optimizing dialysis frequency and duration has shown promise in achieving better fluid balance and cardiovascular stability, suggesting that a personalized, multimodal approach is essential for effective IDWG management. Conclusions: Despite decades of research, IDWG remains a persistent challenge in hemodialysis, requiring a multifaceted, patient-centered approach. While traditional interventions provide partial solutions, integrating thirst modulation strategies, real-time monitoring, biofeedback dialysis adjustments, and AI-driven predictive tools represent the next frontier in fluid management. Future research should focus on long-term feasibility, patient adherence, and clinical efficacy, ensuring these innovations translate into tangible improvements in quality of life and cardiovascular health for dialysis patients. Full article

A high prevalence of chronic diseases exposes diverse healthcare pain points due to the limited effectiveness of pharmaceutical drugs and biologics, sedentary lifestyles, insufficient health literacy, chronic stress, unsatisfactory patient experience, environmental pollution and competition with commercial determinants of health. To improve patient care and long-term outcomes, the impact of the home environment is overlooked and underutilized by healthcare. This cross-disciplinary work describes perspectives on (1) the home environment as a therapeutic target for the prevention and treatment of chronic diseases and (2) transforming health-centric household goods e-commerce platforms into digital health interventions. We provide a rationale for creating therapeutic home environments grounded in biophilic design (multisensory, environmental enrichment) and supporting physical activities, quality sleep, nutrition, music, stress reduction, self-efficacy, social support and health education, hence providing clinical benefits through the modulation of the autonomic nervous system, neuroplasticity and behavior change. These pleiotropic “active non-pharmacological ingredients” can be personalized for people living with depression, anxiety, migraine, chronic pain, cancer, cardiovascular and other conditions. We discuss prospects for integrating e-commerce with digital health platforms to create “therapeutic home environment” interventions delivered through digital therapeutics and their combinations with prescription drugs. This multimodal approach can enhance patient engagement while bridging consumer spending with healthcare outcomes. Full article

Background: Special low-protein foods are essential in the dietary treatment of phenylketonuria (PKU). In the UK, these are available on prescription through the General Practitioners (GPs) and distributed via nutritional home delivery companies or pharmacies. Methods: A 58-item online non-validated semi-structured questionnaire was emailed to British Inherited Metabolic Disease Group (BIMDG) dietitians and dietetic support workers (DSW)/administrators working in PKU to ascertain the main system issues and errors with the supply of low-protein prescription foods (LPPF). Results: 73% (n = 53/73) of dietitians and 72% (n = 18/25) of DSW/administrators responded. A total of 80 questionnaires (representing 44 paediatric and 36 adult PKU centres) were completed. A total of 50% (n = 40/80) of respondents reported patient/caregiver problems accessing LPPF at least weekly. The most common problems were unavailable products (82%), missing LPPF in deliveries (79%), and delayed deliveries (66%). For 64% of respondents, >25% of their patients had recurring problems accessing LPPF, and 69% of respondents spent ≥1 h/week and 11% >5 h/week correcting LPPF patient supply issues. The most common foods patients experienced supply issues with were bread (96%), pasta/rice (41%) and milk replacements (35%). This was associated with GP prescription errors (65%), LPPF prescriptions sent to incorrect dispensers/suppliers (60%), and manufacturer supply issues (54%). Problems with patients/caregivers included not ordering LPPF in a timely way (81%), not responding to messages from home delivery companies (73%) and poor understanding of the ordering process (70%). The majority (93%) of respondents reported that prescription issues impacted their patients’ blood Phe control. Suggestions for improving access to LPPF included centralisation of the system to one supplier (76%) and apps for ordering LPPF (69%). Conclusions: The supply of LPPF for PKU in the UK is problematic; it may adversely affect the ability of patients to adhere to dietary management, and a review investigating patient access to LPPF is urgently required. Full article

Population growth and urbanization are threatening food security. Urban agriculture is therefore a solution for urban food production and distribution. This paper investigates a multi-level governance framework to evaluate how local authorities implement their prescriptions at different levels of decision-making and objectives for urban agricultural projects and their role in building urban resilience. A qualitative assessment based on interviews and fieldwork over two periods in 2023 and 2024 was conducted with stakeholders from different entities in the Normandy Region of France, including the metropolis, the city, and two projects’ presidents. The findings revealed a positive alignment on polycentric governance between different entities in terms of socio-economic integration, climate improvement, and nutritional diversity, all of which were achieved by the cases evaluated. Additionally, local authorities are seeking to achieve urban food self-sufficiency in order to reduce the scale of food imports, thus highlighting a limitation and challenging aspect of this study, given that urban areas are compromised by population density, limited space capacity, and the impermanence of projects. This investigation clearly shows that using this combined systematic approach of interviews and fieldwork provides an in-depth understanding of authorities’ needs and assesses the existence of polycentric governance compliance across multiple units. Full article

The rising prevalence of diseases linked to factors such as excessive alcohol and tobacco use, sedentary lifestyles, and poor nutrition has led to a greater focus on Personal Health Promotion (PHP) as a preventive measure. PHP emphasizes improving quality of life and well-being, driven by advances in medical technology, including virtual and augmented reality. However, as PHP systems grow in popularity, concerns over personal data security, such as account theft and information breaches, have become increasingly important. To address these concerns, this study proposes a game-based personalized health promotion system that integrates Key-Policy Attribute-Based Encryption (KP-ABE), key insulation, time-bound encryption. These methods ensure data security through hierarchical access control and dynamic time management, protecting personal health records and exercise prescriptions. The system also incorporates key insulation to enhance the security of private keys. This multi-layered security approach provides a robust solution for safeguarding sensitive data within PHP systems while accommodating dynamic subscription needs and legal access requirements. Full article

Background: Malnutrition is a major issue in hospitals, impacting over 25% of patients. It can arise from a range of factors, such as chronic underfeeding, diseases, aging, and inappropriate nutritional care. Unnecessary fasting and the use of incorrect dietary prescriptions can also contribute to malnutrition, regardless of a patient’s underlying health conditions. Methods: A search strategy was applied to identify pertinent articles on the prescription and management of therapeutic diets in hospital settings from the last 10 years (2014–2024) using the PubMed database. The following English terms and their combinations were used: hospital diet, non-evidence-based dietary restriction, hospital food service, and therapeutic diets. Only national or international guidelines published in English were considered. Results: The narrative review was developed through the analysis of two guidelines on the prescription and management of therapeutic diets in hospital settings. The main non-evidence-based therapeutic diets that should have limited prescriptions are low-calorie, low-carbohydrate, low-protein, and low-sodium diets because they inevitably lead to a reduction in caloric and/or protein content, limit menu choices, and make recipes less palatable. The preventive total elimination of lactose without diagnostic confirmation should be avoided in the prescription of hospital therapeutic diets for lactose intolerance without symptoms and confirmation of diagnosis. Fasting after surgery should be avoided. The two guidelines differ in part in terminology and the bromatological composition of the diet. Conclusions: The heterogeneity of terminologies and bromatological composition leads to further confusion in determining the correct procedure for managing and prescribing therapeutic diets. Deepening and increasing research in the field of management and prescription of therapeutic diets is necessary to overcome the problem of hospital malnutrition, as the food provided through hospital food service is a very effective medicine for providing calories, macronutrients, and micronutrients. Full article