Search Results (632)

Background: Treatment Burden (TB) refers to the workload imposed on patients by healthcare-related tasks involved in the management of chronic conditions. Despite increasing evidence on this phenomenon, strategies for its reduction in older adults with multimorbidity remain poorly explored. Aim: To map the factors associated with treatment burden reported for older patients with multimorbidity and to derive implications for potential reduction strategies, regardless of the care setting. Methods: A scoping review was conducted applying the JBI methodology for scoping reviews and reported in accordance with the PRISMA-ScR checklist. The literature search was performed on PubMed, Scopus, and CINAHL; no restrictions on publication year or language were applied. All study designs were eligible if they reported factors associated with TB from which reduction strategies could be derived, in patients aged ≥65 years, or with a mean age ≥ 65 years, with multimorbidity or associated geriatric conditions. Results: Six studies met the eligibility criteria, all of which were observational in design, conducted between 2021 and 2025. Eleven potential strategies for TB reduction, inferred from observational findings, were identified and grouped into three areas: healthcare system and access to care, therapeutic regimen, and patient and psychosocial context. Conclusions: To our knowledge, this review provides the first structured mapping of potential TB reduction strategies specifically in the older population with multimorbidity. The identified strategies, derived by the authors rather than empirically tested, may exclusively inform the design of future interventional studies and offer healthcare professionals preliminary guidance for TB management in this population. Full article

Associated-factor studies constitute a substantial portion of the observational epidemiology literature. However, their proliferation has raised important methodological concerns. Many are published without a clear research question, repeat well-established associations, or use causal language to interpret coefficients from exploratory models. This narrative methodological review and critical reflection provides guidance for determining when associated-factor studies add genuine scientific value, how to plan sample size using events per variable, and how to interpret and report results appropriately. We review the nature of exploratory models and how they differ from predictive and causal models. We examine the Table 2 fallacy and its implications for interpreting adjusted coefficients. We discuss the events per variable criterion as a framework for sample-size planning in multivariable studies, present illustrative examples of both appropriate and inappropriate uses of these analyses, and provide an operational decision and minimum-reporting checklist for authors, reviewers, and editors. Associated-factor studies have a legitimate role when the phenomenon is poorly understood, when there is a genuine evidence gap in a truly different population, or when the explicit aim is hypothesis generation rather than causal inference. Their scientific contribution is limited when they merely confirm well-established associations, use causal language without a causal design, or are conducted simply because data are available. Full article

This study, part of the PRET-study (NCT06579898), investigated changes in body composition, physical fitness, sarcopenia, activities of daily living (ADL), challenging behaviour, and falls in adults with intellectual disabilities (ID) following participation in a 24-week progressive resistance exercise training (PRET) intervention. A repeated-time-series design with one study group was used. We used multilevel linear regression models and non-parametric tests to investigate changes in body composition (bioelectrical impedance), physical fitness (ID-fitscan), sarcopenia, ADL (Barthel Index, Lawton IADL scale), challenging behaviour (Aberrant Behaviour Checklist), and falls. Thirty-six adults with mild to moderate ID (mean age: 55.6 ± 12.9 years; 52.8% male) participated and 26 completed the intervention. Intention-to-treat and per-protocol analyses showed statistically significant improvements in physical fitness and challenging behaviour. As these analyses concerned multiple secondary outcomes from a study powered for cardiovascular risk factors, these findings should be considered exploratory. Intention-to-treat analyses showed improvements in the five-times chair stand (−2.40 s, 95% CI [−4.06; −0.75]), and reductions in irritability (−1.10, 95% CI [−2.21; −0.00]) and inappropriate speech (−0.75, 95% CI [−1.22; −0.28]). No statistically significant changes were observed for body composition, ADL, or falls and no cases of sarcopenia were identified. The findings suggest that participation in PRET may be associated with improvements in lower body functional muscular endurance and challenging behaviour. Full article

Background/Objectives: Combining exercise with cognitive training (Combined Intervention) is a strategy against age-related cognitive decline; however, the best exercise type to maximize the neuroprotective effects of combined intervention remains unclear. Therefore, this systematic review and meta-analysis (SRMA) aimed to compare the effects of combined interventions (exercise plus cognitive training) versus exercise-only on cognitive function and blood biomarkers in older persons across different exercise types. Methods: PubMed, Scopus, PsycInfo, and Web of Science databases were searched without time restriction. Study quality was evaluated using a modified Downs and Black checklist. Extracted data were analyzed using the random-effects model with Comprehensive Meta-Analysis 4.0 software. Results: Twenty-four studies involving 1079 participants (mean age 72.97 ± 5.55 years), with and without mild cognitive impairment (MCI), were included in the present SRMA. Overall, combined interventions demonstrated a small but significant effect size (ES) of 0.335 (95% CI: 0.212 to 0.459; p < 0.001) on cognitive function compared to exercise alone. When categorized by exercise type, significant additional cognitive benefits were observed for aerobic (ES = 0.382; p < 0.001), multicomponent (ES = 0.261; p = 0.005), and resistance exercise (ES = 0.440; p = 0.005) combined with cognitive training compared to exercise alone. However, combined interventions showed no significant additional effect on BDNF levels (ES = 0.457; 95% CI: −0.896 to 1.809; p = 0.508). Conclusions: Incorporating cognitive training into an exercise program showed small but significant additional benefits to overall cognitive function in older persons compared with physical exercise alone. However, the results should be interpreted with caution due to existing limitations. Full article

Background and Objectives: Free flap reconstruction is the gold standard for complex head and neck defects following oncological ablation. While surgical techniques have improved flap success rates, donor site sensory morbidity remains relatively understudied. The radial forearm free flap (RFFF) and fibula free flap (FFF) are the two most commonly used free flaps for head and neck reconstruction and sensory abnormalities at their donor sites represent a significant but underrecognized source of postoperative morbidity. Materials and Methods: The aim of this study is to systematically review and synthesize the existing evidence on the prevalence, characteristics and assessment methods of sensory abnormalities and pain at the donor sites of RFFF and FFF harvests. A systematic review was conducted according to PRISMA 2020 guidance. PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched from inception to 1 October 2025, with additional gray-literature and reference-list screening. Primary studies reporting sensory abnormalities, donor-site pain, neuropathic pain, or cold intolerance after RFFF and/or FFF harvest were included; prior reviews were used for citation tracking and contextual comparison only. Risk of bias was assessed with study-design-specific Joanna Briggs Institute (JBI) checklists, and the level of evidence was classified using the Oxford Centre for Evidence-Based Medicine (OCEBM) framework. Descriptive prevalence summaries and exploratory random-effects pooled estimates were calculated when numerators and denominators could be extracted. Results: From 1247 initially identified records, 73 studies met the inclusion criteria (36 RFFF-specific, 35 FFF-specific, and 2 addressing both flap types). Most studies were observational, and sensory outcomes were frequently secondary endpoints. For RFFF, reported sensory abnormalities ranged from 0% to 100% across extractable studies (median 31.3%; IQR 13.1–55.0%), reflecting differences in definitions, follow-up, and testing; the exploratory pooled prevalence was 34.4% (95% CI 23.6–47.1%; I2 = 88.4%). General donor-site pain ranged from 0% to 36.8% (median 12.0%; pooled 16.0%, 95% CI 9.9–24.8%), whereas Douleur Neuropathique en 4 Questions (DN4)-defined neuropathic pain was 18% in the largest dedicated RFFF study and 18% in a smaller pain-focused study. Cold intolerance ranged from 0% to 40.0% (median 16.2%). For FFF, sensory abnormalities ranged from 0% to 76.3% (median 21.4%; IQR 8.2–46.8%; pooled 24.0%, 95% CI 16.5–33.6%; I2 = 88.6%). General pain ranged from 0% to 72.7% (median 17.5%; pooled 18.8%, 95% CI 13.9–24.9%), and DN4-defined neuropathic pain was 21% in the only dedicated FFF study. Objective testing (quantitative sensory testing [QST], Semmes-Weinstein monofilaments, two-point discrimination, or standardized neurological examination) was used inconsistently, and no included study systematically used nerve conduction studies or electromyography (EMG). Conclusions: Sensory abnormalities and pain after RFFF and FFF harvest appear common, but available estimates remain uncertain because of heterogeneous definitions, follow-up intervals, assessment instruments, and predominantly Level 2b-4 evidence. The literature shows a persistent gap between patient-reported symptoms and objective sensory testing. Future prospective studies would benefit from standardized neuropathic pain screening, structured neurological examination, and QST; however, current data do not support strong causal inferences or a validated treatment algorithm. Full article

Background: Red blood cell (RBC) antibody screening in blood donors is a key component of transfusion safety. However, reported prevalence and antibody specificities vary widely across studies, and a consolidated global estimate remains limited. This study aimed to quantify the prevalence of RBC antibody detection among blood donors, identify factors associated with variation in reported prevalence, and summarize antibody specificities. Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, MEDLINE, Embase, Scopus, and Google Scholar were searched from inception to 27 August 2025 for observational studies reporting RBC antibody detection in blood donors. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Pooled prevalence estimates were synthesized using random-effects models. Subgroup analyses, meta-regression, leave-one-out sensitivity analyses, and publication-bias assessments were performed. Associations between ABO blood group and RBC antibody detection were summarized using pooled odds ratios. The review protocol was registered in PROSPERO (CRD420251181987). Results: Forty-one studies comprising 43 reports and 3,561,088 blood donors from 18 countries were included. The pooled prevalence of RBC antibody detection was 0.2% (95% CI: 0.2–0.3%), with substantial between-study heterogeneity (I²: 99.61%) and a 95% prediction interval of 0.0–1.4%. Prevalence was higher in female donors than in male donors (0.5% vs. 0.1%). Publication year was inversely associated with reported prevalence, although temporal and methodological effects could not be separated. An exploratory analysis based on six studies showed higher estimated odds of antibody detection among blood group AB donors (OR: 1.20, 95% CI: 1.07–1.34). Among clinically significant antibodies, Rh and Kell specificities were predominated. Anti-Mi^a was prominent in Southeast Asian populations. Conclusions: RBC antibody detection among blood donors was uncommon overall but varied considerably across settings. Interpretation is limited by substantial methodological heterogeneity, uneven geographic representation, and incomplete reporting of donor characteristics. The pooled estimate should be interpreted as an international benchmark rather than a uniform prevalence applicable to individual blood services. This large-scale synthesis may inform context-specific donor antibody screening, confirmatory testing, component management, and hemovigilance policies. Full article

Background and Objectives: Vasomotor symptoms (VMS), including hot flushes and night sweats, often co-occur with depressive and anxiety symptoms during the menopausal transition. This systematic review assessed the observational evidence for a quantitative association between VMS burden and affective symptoms in peri- and postmenopausal women. Materials and Methods: PubMed and PubMed Central were searched from database inception to 30 June 2025 for English-language, open-access observational studies reporting VMS and depressive and/or anxiety outcomes in peri- or postmenopausal women. Two reviewers independently screened records and full-text reports, and extracted data were independently verified. Study characteristics, symptom measures, prevalence or severity data, and quantitative association estimates were extracted. Owing to substantial heterogeneity of exposure and outcome measures, a structured narrative synthesis was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) guideline. Risk of bias was appraised at item level using the Joanna Briggs Institute checklists and the Newcastle–Ottawa Scale, and the certainty of the evidence was rated using the GRADE approach. Results: Twelve studies involving approximately 9900 women from seven countries were included. In studies reporting adjusted estimates, greater VMS burden was associated with higher odds of depressive symptoms, with adjusted odds ratios ranging from 1.67 to 2.99; one longitudinal cohort reported an odds ratio of 2.95 for a worsening depressive-symptom trajectory. Evidence for anxiety was directionally concordant but considerably weaker: anxiety was assessed as a distinct outcome in only five of the 12 studies, none of which reported an adjusted effect estimate, and two of which were rated at high concern for risk of bias. Two studies were rated at overall low concern for risk of bias, seven at moderate concern, and three at high concern. Several studies suggested partial mediation through fatigue or poor sleep, whereas others supported direct or bidirectional associations. Conclusions: Greater VMS burden is consistently associated with depressive symptoms and, on a smaller and less certain evidence base, with anxiety symptoms. Certainty of the evidence was rated low for depression and very low for anxiety; the predominance of cross-sectional designs, the heterogeneity of instruments, largely unaddressed confounding, and the possibility of reverse causation preclude any causal inference. Women presenting with bothersome VMS may benefit from case-finding for mood and anxiety symptoms where a pathway to assessment and treatment exists, and prospective studies should test whether VMS-directed interventions improve affective outcomes. Full article

Introduction: The recognition of Complex Post-Traumatic Stress Disorder (CPTSD) as a distinct diagnosis in ICD-11 has intensified the need to clarify its boundaries with Borderline Personality Disorder (BPD), given their symptom overlap and shared traumatic origins. Therefore, this systematic review aimed to examine whether CPTSD is distinct from BPD, assess their comorbidity and symptom overlap, identify key criteria for differential diagnosis, and explore therapeutic implications. Method: A systematic search was conducted in PubMed, Scopus, and Web of Science following PRISMA 2020 guidelines. Seven empirical studies (2015–2025) were included, comprising 2574 adults (mean age 40.4 years; 73.3% women). Methods included latent class analysis, structural equation modeling, and network analysis. The methodological quality of the included studies was evaluated independently by two reviewers using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results: Findings consistently supported that CPTSD and BPD are empirically distinguishable, though substantially correlated, particularly within the ICD-11 framework. High symptom co-occurrence was observed, with affective dysregulation identified as the symptom most centrally connecting the two symptom networks. Self-concept emerged as the most robust differentiator: stable and persistently negative in CPTSD versus unstable and fragmented in BPD. Shame was a key affective marker of more severe presentations, and trauma severity, rather than diagnostic category, was associated with symptom variation across studies. Conclusions: CPTSD and BPD are distinct yet frequently co-occurring conditions. Differential diagnosis should focus on self-concept stability, patterns of behavioral dysregulation, and shame. Treatment requires individualized, trauma-informed, and shame-sensitive approaches, with transdiagnostic emotion regulation strategies across presentations. These conclusions should be interpreted with caution, given the predominantly cross-sectional design and methodological heterogeneity of the available evidence. Full article

Background: Rugby union and rugby league are among the most physically demanding contact team sports, in which playing positions impose distinct physical requirements. The aim of the review was to collect and synthesize available data on positional differences in physical fitness between forwards and backs in adult male rugby players. Methods: The systematic review was conducted in accordance with PRISMA 2020 and SWiM guidelines and was prospectively registered in the OSF database (10.17605/OSF.IO/E4Y37). Four electronic databases were searched: PubMed, SPORTDiscus, Web of Science, and Scopus up to June 2026. The search identified 3058 records, which were reduced to 1343 after language and document-type limits and then screened. Eligibility criteria were applied within the PICOs framework. Methodological quality was assessed using JBI Critical Appraisal Checklists and the AXIS tool as a validation instrument. Due to considerable methodological heterogeneity, narrative synthesis with directional meta-synthesis was applied. Results: Thirty-seven studies were included (n > 2000 players; 15 countries; 1996–2025). Forwards achieved higher values of absolute muscular strength and power, body mass, and sprint momentum, whereas backs performed better in sprint tests (10–50 m), maximum sprint velocity, aerobic fitness (VO₂max, Yo-Yo IRTL1), CMJ height, and relative power. Following normalization to body mass, positional differences in strength and power were attenuated or reversed. In the only study that isolated the change in direction deficit, no clear positional difference was observed. Conclusions: Body mass appears to be the principal explanatory factor underlying positional differences in absolute strength and power. Position-specific fitness profiles are observable as early as the U20 category and become more pronounced with increasing competitive level. Strength and conditioning coaches should compare positional groups using body mass normalized ratio or, where justified, allometrically scaled measures rather than absolute values. Full article

Aging residential buildings constructed under outdated design standards create an urgent need for scalable, evidence-based indoor safety assessment methods. Conventional manual inspections rely on subjective checklists, lack audit trails, and are impractical for widespread deployment. This study presents a vision-based digital twin and AI agent framework that converts a single continuous smartphone video into an explainable, evidence-constrained safety assessment. The pipeline employs MASt3R-SLAM to reconstruct a metric-scale 3D point cloud from monocular video, calibrated with AprilTag fiducials for absolute scale. SpatialLM parses the geometry to extract semantic entities and spatial relationships. Risk guidelines are formalized into a computable Risk Prototype structure, unified within a hierarchical SceneState data structure that binds geometric measurements, semantic labels, image observations, and regulatory knowledge. A LangGraph-based AI agent conducts a dual-pathway assessment: an initial whole-dwelling scan followed by iterative follow-up queries invoking tool calls for measurement, knowledge retrieval, or visual cross-checking. In a pilot validation across five heterogeneous residences, with detailed manual comparison in two representative cases, the framework achieved risk recall rates of 77.8–100% and precision rates of 45.0–70.0% against the single-assessor manual reference. The average judgment closure rate was 71.7%, with spatial granularity enhancement of up to 2.2× in complex environments. These results suggest that the framework can achieve risk coverage comparable to manual checklist inspection while offering enhanced granularity in complex environments and quantitative precision in well-defined spaces. Full article

Frailty is common among older adults with type 2 diabetes mellitus (T2DM). However, simple, objective, equipment-free screening tools for early frailty detection are limited. We evaluated the association between the objective one-leg standing test (OLST) and frailty in older male outpatients with T2DM and defined a clinically relevant OLST cut-off for frailty screening. Males aged ≥65 years with T2DM (n = 335) were included in this single-center, retrospective, cross-sectional study. Frailty was pre-categorized based on a Kihon Checklist (KCL) score ≥ 8. The association of OLST time with frailty was assessed by logistic regression. The Youden Index was used to determine the optimal OLST time cut-off. Frailty was observed in 17.3% of the participants. The KCL-frail group exhibited a shorter OLST time than the KCL-non-frail group (median: 12.1 [7.4–30.6] vs. 45.8 [23.2–60.0] s; p < 0.001). Shorter OLST time was independently associated with frailty (odds ratio 0.955 per 1 s increase; 95% confidence interval 0.939–0.971; p < 0.001). The optimal cut-off for identifying frailty was 34.1 s (area under the curve: 0.768). The OLST is an objective, equipment-free physical performance test that may complement subjective frailty screening to identify frailty in an ambulant male population aged ≥65 years with T2DM. Full article

Salutogenesis is a health-related design paradigm that links physical environmental characteristics to positive well-being by enhancing the Sense of Coherence. The aim of this study was to evaluate the relationship between the manageability factors of the salutogenic theory namely functional design, safety, accessibility, person-centered design, and positive affordances and residents’ well-being in the outdoor spaces of three high-rise residential complexes in Erbil, Iraq. A cross-sectional mixed-methods approach was adopted, combining observation checklists, questionnaire surveys of 60 residents (20 from each residential complex), and statistical analyses using SPSS, including Spearman correlation, one-way ANOVA, and multiple linear regression. The results revealed considerable differences among the three residential complexes. Nawroz City achieved the highest standardized checklist score (61.8%), followed by Cihan City (55.9%), while New Eskan City recorded the lowest score (17.6%). Correlation analysis indicated that all manageability factors were positively associated with residents’ well-being. Multiple linear regression analysis showed that design for positive affordances was the only statistically significant individual predictor of residents’ well-being (β = 0.497, p = 0.003). Overall, the findings suggest that higher levels of manageability are associated with greater residents’ well-being, highlighting the importance of supportive outdoor design features in high-rise residential complexes. Full article

Despite being classified as low-risk workplaces, museums involve tasks that generate demands, chemical exposure, and management-related stress that accumulate over time. This study assesses the relationship between occupational safety and health conditions in museums and task organization within operations to develop a task-based coordination approach grounded in practice. A mixed-methods design was employed in three museums, encompassing conservation, public interaction, and administrative activities. Data included 30 task observations in each museum, collected through on-site observations, posture assessment, checklist evaluation of chemical handling and ventilation practices, task-focused exchanges, and observation of leadership engagement during activities. Task configurations, defined as the combination of technical and organizational conditions under which a task is performed during routine activities, were compared through task scenarios developed as analytical models using a composite task-level safety index. Results suggested that exposure patterns varied with the technical and organizational conditions of task execution. Task configurations combining adjustable equipment, functional ventilation, coordinated task allocation, and regular leadership presence had lower frequencies of ergonomic, chemical, and organizational non-compliance. The findings indicate that occupational safety and health practice in museums depends on how technical and organizational measures operate at the task level. Full article

Background/Objectives: Atopic dermatitis (AD) and food allergy (FA) frequently coexist in the concept of atopic march; however, their combined associations with psychological problems remain poorly understood. This study aimed to investigate the associations of AD and FA with psychological outcomes at age 7 and evaluate whether respiratory allergies account for part of these associations. Methods: We enrolled 1577 children aged 7 years from the Panel Study of Korean Children. The Korean version of the Child Behavior Checklist was used to assess psychological and behavioral problems. Multivariable regression and parallel mediation analyses were used to evaluate independent and interactive associations. Results: AD and FA were associated with psychological and behavioral problems, most consistently with somatic problems on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scale. These associations were more pronounced in children with comorbid AD and FA than in those with single allergies. Among the 9 children with concurrent AD and FA, an interaction between the two conditions on somatic problems was observed (P for interaction = 0.033). The comorbid group showed higher eosinophil counts and total IgE levels, but no differences in SCORAD indices or C-reactive protein levels. Mediation analysis identified a direct association of AD with somatic problems (B = 1.062; 95% CI, 0.601–1.562), with a portion accounted for by allergic rhinitis (AR) (B = 0.656; 95% CI, 0.306–1.241). Conclusions: Comorbid AD and FA were associated with higher odds of somatic problems than either condition alone in 7-year-old children, with a portion of the AD association accounted for by AR. Because exposures and outcomes were assessed concurrently, these associations are exploratory and hypothesis-generating rather than causal. Clinical attention may be warranted for children with both AD and FA. Full article

Background and Objectives: Advanced practice nurses (APNs) play an increasingly important role in improving healthcare quality and outcomes. This systematic review synthesized evidence on APN roles and healthcare outcomes in Thailand. Methods: The review protocol was prospectively registered in PROSPERO (CRD420261331793). Four databases (PubMed, CINAHL, Scopus, and Thai Journals Online) were searched from inception to January 2026. Two independent reviewers performed study selection, data extraction, and methodological quality assessment using the Mixed Methods Appraisal Tool (MMAT, 2018) for mixed-methods studies and the Joanna Briggs Institute (JBI) critical appraisal checklists for quasi-experimental, analytical cross-sectional, and qualitative studies. A narrative synthesis was undertaken because of methodological heterogeneity. Results: Twenty studies were included, comprising eight quasi-experimental studies, six cross-sectional studies, four mixed-methods studies, one retrospective study, and one qualitative descriptive study. APNs performed diverse roles, including direct clinical care, care coordination, consultation, patient education, mentoring, and implementation of evidence-based practice. APN-led models of care were associated with favorable clinical outcomes, enhanced self-care and quality of life, increased patient and caregiver satisfaction, and reduced hospital length of stay and healthcare costs. Conclusions: The available evidence suggests that APN-led models of care may be associated with favorable patient, family, and health system outcomes in Thailand. However, these findings should be interpreted cautiously because the evidence was derived predominantly from non-randomized and observational studies, and the independent effects of APN practice could not always be isolated. Full article