Search Results (2,492)

Hungarian teachers’ reform priorities remain insufficiently mapped, despite their central role in shaping feasible, evidence-based educational change. In a cross-sectional study with 1254 kindergarten, primary, and secondary teachers across Hungary (May 2025), we elicited and analyzed open-ended written responses in which participants identified their top three required reforms. Responses were segmented and coded into 18 mutually exclusive categories via a validated codebook, and prevalence was calculated using respondent-normalized weights. We then examined demographic, well-being, and personality correlates of reform priorities using χ² tests, Mann–Whitney tests, and multivariable logistic models with Benjamini–Hochberg false discovery correction. Teachers most frequently prioritized competency development and pedagogical reform, followed by curriculum flexibility and system governance. Reform priorities were not random: female teachers were substantially more likely to prioritize inclusion and SEN support, while male teachers more often prioritized governance and depoliticization; older age predicted governance priorities. Lower educational system satisfaction robustly predicted prioritizing curriculum reform, autonomy, and governance restructuring, and anxiety and depression were positively related to curriculum concerns. Conscientiousness predicted prioritizing salary and material recognition. The results indicate that teachers’ reform demands function as systematic, psychologically grounded signals that can guide more targeted, teacher-centerd educational policy in Hungary. Full article

Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is increasingly recognized as a significant concern in patients with chronic kidney disease (CKD) and particularly in kidney transplant recipients (KTx-ps). This review explores the complex interplay of pathophysiological mechanisms, prevalence, and management strategies of sarcopenia in the context of kidney transplantation. CKD contributes to sarcopenia through systemic inflammation, malnutrition, uremic toxin accumulation, and metabolic imbalances, all of which persist or are exacerbated after transplantation due to immunosuppressive therapies especially corticosteroids. Notably, the post-transplant period may introduce additional risks, such as altered body composition and reduced physical activity, further aggravating muscle wasting. Sarcopenia affects approximately 26% of KTx-ps, leading to adverse outcomes including decreased quality of life, increased risk of infection, frailty, delayed recovery, and graft loss. The diagnosis remains challenging due to variability in assessment tools and a lack of standardized criteria. Management strategies must be multifactorial, including personalized nutritional support, targeted physical activity, and, where appropriate, pharmacological interventions. Early identification through imaging and functional testing is critical, especially in older patients and those with prolonged dialysis vintage. Emerging therapies, such as myostatin inhibitors, offer promise but require further validation. Additionally, early steroid withdrawal may mitigate muscle loss without compromising graft survival in selected patients. This review underscores the need for heightened awareness and standardized protocols to identify and manage sarcopenia in kidney transplantation, ultimately improving long-term outcomes and patient-centered care. Full article

This systematic review and meta-analysis examined the impact of Pilates-based exercise on mental health, psychological well-being, and quality of life (QoL) across clinical and healthy populations. Thirty-two randomized and quasi-experimental trials (total N = 1264) were included, representing adolescents, adults, and older adults across diverse clinical and non-clinical groups. Outcomes encompassed depressive symptoms, anxiety, QoL, self-esteem, and well-being. The unadjusted random-effects model indicated a suggestive but statistically inconclusive overall effect (p = 0.061). However, adjusting for outcome type via meta-regression yielded a statistically significant pooled effect (g = 0.393, p = 0.023). Substantial heterogeneity remained across studies (I² = 91.7%). Meta-regression identified outcome type as the only significant moderator, whereas age group, delivery mode, and clinical status did not significantly influence the pooled effect. Subgroup analyses suggested comparable benefits between remote and in-person delivery formats in general adult samples. Evidence from individual studies indicated that supervised, face-to-face instruction may be advantageous for older adults. Low-frequency programs, including once-weekly sessions, were also associated with improvements, although variability in intervention duration and structure limits conclusions regarding optimal dosage. Sensitivity analyses confirmed the stability of the pooled effect. Overall, the findings support Pilates as a feasible exercise modality with demonstrated benefits for positive psychosocial outcomes (QoL and self-esteem), while evidence for negative psychological indicators (e.g., depression, anxiety) remains limited or non-significant. Future research should standardize outcome measures, report training parameters consistently, and examine contextual factors contributing to heterogeneity in psychosocial responses. Full article

The aim of this study was to investigate older adults’ engagement in sport through the lens of the Positive Development in Sport (PDS), a framework aimed at fostering human growth in sport environments. This qualitative study involved 80 older athletes (M = 71.91 years, SD = 7.91; 45 women) engaged in regular sport practice and four experienced coaches (37–57-years-old). Data was collected across multiple contexts: brief in-person individual or small-group interviews during a competitive event; five in-person focus groups; and individual interviews. Data was analyzed using reflexive thematic analysis. Findings revealed a central theme, autonomy to engage in sport, supported by three subthemes: competence and confidence, health, and setting priorities. Participants described sport as a meaningful component of their identity, with sustained engagement driven by intrinsic motivation and harmonious passion. They reported increased self-awareness, intentional health management, and the ability to balance sport participation with other life domains, highlighting positive implications for mental health. Coaches who actively supported athletes’ psychological needs played a key role in fostering autonomy and personal development. Participants also emphasized the importance of inclusive relationships and pedagogical strategies tailored to older athletes’ goals and lived experiences. The findings suggest that sport in older adulthood can be a context for personal growth and mental health development. Full article

Clonal hematopoiesis refers to the clonal expansion of hematopoietic stem and progenitor cells, driven by somatic mutations. Major mutated genes in clonal hematopoiesis include genes involved in epigenetic regulation including DNA methylation and/or chromatin modification (e.g., DNMT3A, TET2, and ASXL1), tumor suppressors (e.g., TP53), signal transduction (e.g., JAK2), and RNA splicing (e.g., SF3B1 and SRSF2). Clonal hematopoiesis includes clonal hematopoiesis of indeterminate potential (CHIP), clonal cytopenia of unknown significance (CCUS), and myelodysplastic syndromes/neoplasms (MDS). CHIP occurs when the frequency of the variant allele equals or exceeds 2% (4% for X-linked genes in males) in the absence of cytopenias. CHIP is common among older persons and is associated with an increased risk of hematologic cancer. CHIP is also associated with an increased risk of atherosclerotic disease including acute myocardial infarction, stroke, cardiac failure, and abdominal aneurysm. Increasing evidence suggests that CHIP is associated with venous thromboembolic disease. Somatic mutations lead to proliferation of hematopoietic progenitor cells and their progeny, resulting in excessive activation of granulocytes and monocytes. It could be postulated that chronic inflammation caused by clonal expansion of myeloid cells carrying mutations in DNMT3A, TET2, and ASXL1 (“DTA”) genes may constitute an independent risk factor in clot formation and endothelial-cell damage. DTA mutations correlate with elevated proinflammatory cytokines such as IL-1β and IL-6 and enhanced activation of inflammasomes. Moreover, JAK2 mutations may have a direct role in the activation of platelets and coagulation. In vivo murine studies have demonstrated that activation of the JAK-STAT signaling pathway promotes neutrophil extracellular trap (NET) formation, contributing to a prothrombotic state. Insights from related clonal disorders such as paroxysmal nocturnal hemoglobinuria and the VEXAS syndrome support the concept that mutation-driven innate immune activation can directly perturb hemostatic balance. This review aims to summarize the association between clonal expansion of hematopoietic cells and thrombotic disease, and highlight how somatic mutations in hematopoietic cells may contribute to vascular disease and thrombogenesis. Full article

Background: The optimal method of starting maintenance haemodialysis (HD) in patients with kidney failure is not known. We have compared early treatment characteristics, blood pressure trajectories, and selected dialysis-related safety events in patients who started HD using a stepped and phased approach, with those who received conventional care. Method: A single-centre cohort feasibility study was conducted. Participants with kidney failure, about to start maintenance HD, were enrolled prospectively (intervention arm). They started treatment on a novel regime comprising four pre-specified incremental steps (Phases 1 to 4) over 14 weeks. They were matched using propensity scores with historical controls: patients who had previously started HD on a three-times weekly basis from the outset (control arm). Results: The final cohort comprised 15 and 29 participants in the intervention and control arms respectively (1:2 ratio; one control excluded after matching). Intervention group participants were slightly older with a higher proportion of men. The rate of decline in blood pressure was slower in the intervention group. There were also signals for fewer events of intra-dialytic hypotension (211 vs. 379 per 100 person-year), infections not requiring admission (56 vs. 114 per 100 person-year) and loss of vascular access (56 vs. 79 per 100 person-year) in intervention group. There was a signal for higher incidence of severe hypertension (systolic BP ≥ 180 or diastolic BP ≥ 110 mmHg) in the intervention group. Hospitalisation rates were similar; there were no deaths and one non-fatal major cardiac event (MACE) in the intervention group, and one death and no MACE in the control group. Conclusions: Implementing a short transitional regime of incremental HD may be possible in clinical settings, potentially helping to reduce the gradient of physiological change and burden of early treatment. The findings of this feasibility study are exploratory, and fully powered randomised controlled trials are needed to establish the efficacy and safety of such a programme. Full article

Previous research has found an association between PM_2.5 exposure and worsening depression; however, studies specifically examining the harmful effects of individual PM_2.5 components are relatively limited. This national survey enrolled individuals aged 45 and older in mainland China, collecting personal data and assessing depression. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). Monthly exposure to PM_2.5 and its seven components—black carbon (BC), organic matter (OM), nitrate (NO₃⁻), sulfate (SO₄²⁻), ammonium (NH₄⁺), soil particles (SOIL), and sea salt (SS)—was matched to each participant’s residence. Linear mixed-effects models (LMEs) assessed the association between single pollutants and depression score, while weighted quantile sum (WQS) regression examined the effect of mixed exposure and identified the contribution of each component. Modifying effects of social activity and green space were also evaluated. A total of 9725 participants were included. In single-exposure models, each interquartile range (IQR) increase in PM_2.5 (29.18 μg/m³), BC (2.25 μg/m³), OM (7.18 μg/m³), SOIL (6.04 μg/m³), and SS (0.14 μg/m³) was significantly associated with an increase in depression score of 0.90 (95% CI: 0.59, 1.20), 0.71 (95% CI: 0.42, 1.09), 0.94 (95% CI: 0.61, 1.26), 0.51 (95% CI: 0.38, 0.63), and 0.53 (95% CI: 0.33, 0.73) points, respectively. In mixed-exposure models, each IQR increase in the mixture of all components was associated with a 1.104-point rise in depression score (95% CI: 0.901, 1.307), with BC having the largest weight (33.6%), followed by SOIL (28.59%) and SS (25.05%). The harmful effects of PM_2.5 and specific components on depression were lower among those who participated in social activities or lived in areas with higher levels of green space (p < 0.05). These findings suggest that the harmful effects of PM_2.5 on depression may be influenced by its components, and that social activity and green space could reduce the risk of depression associated with PM_2.5 and its components. Full article

Dementia caregiving represents a major public health challenge, with spousal caregivers assuming the greatest burden. Spouses, themselves typically older adults, provide high intensity, long-term, and largely unpaid care across all stages of cognitive decline. Despite their central role in dementia care, the health consequences experienced by spousal caregivers remain insufficiently characterized in the literature and inadequately addressed in clinical and public health practice. This structured narrative review synthesizes current evidence on the multidimensional impact of dementia caregiving on the physical, psychological, cognitive, social, and financial health of spousal caregivers. It further contextualizes these consequences within the trajectory of dementia progression, and identifies interventions, support systems, and policy considerations necessary to mitigate caregiver burden. Spousal caregivers experience disproportionate burden due to continuous, escalating responsibilities that often mirror the progressive deterioration of their partners. Emotional burdens, including uncertainty during pre-diagnostic stages, role strain, conflict, loss of intimacy, and anticipatory grief. Physically, spouses endure musculoskeletal strain, sleep disruption, poor nutrition, and heightened frailty risk. Psychologically, spousal caregivers exhibit elevated rates of depression, anxiety, loneliness, and stress-related disorders. Socially, caregivers experience substantial isolation, stigma, and erosion of social networks. Financial hardship, including early retirement, reduced employment, and uncompensated care hours, further exacerbate stress. Evidence suggests that chronic caregiving stress contributes to biological changes such as immune dysregulation, inflammation, acceleration, aging, and potential cognitive decline in caregivers themselves. Caregiver burden influences patient outcomes as evidenced by increased emergency department use, falls, and earlier institutionalization in persons with dementia whose caregiver is subjected to a high burden. Current care models rarely include routine, caregiver assessment or structured guidance following diagnosis, resulting in substantial unmet needs. Effective mitigation requires integrated, stage-sensitive interventions, including psychosocial support, caregiver education, respite services, culturally tailored programs, and digital health tools, alongside broader policy reforms to reduce financial and structural barriers. Full article

Objective: This study aimed to evaluate the health-related quality of life (HRQoL) of informal caregivers providing primary care to elderly chronically ill patients receiving home health care services in Türkiye and to identify patient and caregiver characteristics independently associated with HRQoL. Methods: This cross-sectional study included 499 patient–caregiver dyads enrolled in home health care services at a training and research hospital in İzmir, Türkiye. Data were collected through face-to-face interviews using a sociodemographic questionnaire, the Palliative Performance Scale (PPS), and the Short Form 36 (SF-36). One-sample t-tests compared SF-36 scores with Turkish normative values. Multivariate linear regression identified independent predictors of the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Results: Caregivers scored significantly lower than population norms across all SF-36 subdimensions (p < 0.001), with the largest impairments in Role Physical (mean difference: −53.0) and Role Emotional (−42.9). In multivariate analyses, independent predictors of poorer physical health (PCS) were severe patient functional dependence (PPS ≤ 30: β = −0.260, p < 0.001), older caregiver age (≥65 years: β = −0.089, p = 0.044), unemployment (β = −0.118, p = 0.014), additional care recipients (β = −0.095, p = 0.026), and caregiver’s own chronic illness (β = −0.169, p < 0.001). Poorer mental health (MCS) was independently associated with caregiver’s own chronic illness (β = −0.138, p = 0.002), receipt of caregiving payment (β = −0.137, p = 0.004), and university-level education (β = −0.108, p = 0.040), whereas the presence of a support person was protective (β = 0.096, p = 0.038). Conclusions: Informal caregivers of home health care-dependent elderly patients experience significantly reduced quality of life across all health domains compared with the general population. The independent determinants of caregiver health are multidimensional, encompassing patient-related factors, socioeconomic characteristics, and psychosocial resources. These findings underscore the urgent need for health systems to implement tailored interventions that address the distinct physical and mental health needs of caregivers, with particular attention to those who are elderly, chronically ill, socioeconomically disadvantaged, or highly educated. Full article

While South Africa’s recycling chain relies heavily on informal labour, the burden of non-fatal workplace injuries among landfill-based waste pickers remains poorly characterised. This study aimed to estimate the prevalence of self-reported non-fatal workplace injuries and identify associated factors among informal waste pickers at landfill sites in Johannesburg, South Africa. We conducted a cross-sectional study at two purposively selected landfill sites in Johannesburg. Using convenience sampling, 354 waste pickers were enrolled (median age 34 years; 73.2% male). A structured questionnaire captured worker characteristics and self-reported injuries over the preceding six months. Robust (modified) Poisson regression was utilised to determine associations with self-reported workplace injury. Overall, 86.2% of participants reported at least one injury. Lacerations caused by contact with waste materials predominated (82.7%), followed by violence (20.5%) and needle-stick injuries (19.9%). Notably, 94.1% of participants reported using personal protective equipment (PPE), yet the injury prevalence was high. In the multivariable model, each additional year of landfill work experience was associated with a 1.0% higher prevalence of reported injury (adjusted prevalence ratio [aPR] 1.01; 95% CI 1.01–1.02). Conversely, pickers aged 51 years and older had a 32% lower prevalence of injury than those aged 18–28 (aPR 0.68; 95% CI 0.51–0.90). To mitigate these risks, municipal authorities should implement mandatory safety training for site entry, provide industrial-grade, puncture-resistant PPE, and formalise the integration of landfill pickers into institutional occupational health frameworks. Full article

Background/Objectives: Adequate nutrition in older adults is essential to maintaining health, functionality, and quality of life, particularly in long-term care hospitals (HACLEs). Previous studies suggest that dissatisfaction with hospital food is linked to longer stays, more complications, and negative perceptions of care. Given these concerns, this study aimed to assess patients’ experiences with hospital food over a 15-year period in a HACLE in Spain, identify key influencing factors, and validate an updated PREM (Patient Reported Experience Measure) tool for food services. Methods: A retrospective, observational, repeated cross-sectional study was conducted using annual PREM surveys administered between 2011 and 2025 to patients on oral diets. Psychometric validation of the updated 8-item version (2024) was conducted. Results: Out of 1618 surveys, 1540 were included in the final analysis. The updated PREM showed strong internal consistency (α = 0.85, ω = 0.87), a two-factor structure (food quality and service conditions), and adequate model fit. Perceptions worsened after a catering company change in 2022 but improved following the implementation of new food distribution carts in 2025. The PREM total score showed a strong positive association with the global satisfaction item, providing supportive evidence based on a closely related anchor measure (Spearman’s rho = 0.80, 95% CI 0.77–0.82; p < 0.001). Scores differed significantly by diet type: patients receiving a pureed diet reported the highest average satisfaction score, followed by those on a soft diet and a regular diet. The group on a soft diet excluding foods that pose a choking hazard had the lowest mean score. Conclusions: The validated PREM scale is a reliable tool to monitor patient experience with hospital food. It enables early detection of quality issues and supports targeted improvements. Routine use in long-term care settings may foster personalized, patient-centered nutrition strategies and enhance care quality. Full article

Aging is a progressive and heterogeneous biological process influenced by multiple factors that may compromise physical and cognitive capacities and increase the risk of frailty, functional decline, and falls in older adults. Falls represent a major public health concern due to their impact on independence and long-term care demand. Immersive virtual reality (IVR) delivered through active video games (exergames) has emerged as a preventive strategy that integrates sensory, motor, and cognitive stimulation within controlled and engaging environments, particularly where traditional programs face challenges related to adherence and individual adaptation. This study aims to determine the feasibility and implementation of an IVR-based program for falls prevention in older adults at risk of frailty in primary health care (PHC). A quasi-experimental pre–post design will be conducted with an intervention group (IVR/exergames) and a conventional control group, including a total sample of 40 participants (20 per group). The protocol comprises three phases: baseline assessment and IVR familiarization; a 12-week intervention delivered twice weekly; and post-intervention assessment. The primary outcome will be fall risk assessed using the Timed Up and Go (TUG) test. Secondary outcomes include physical performance (Short Physical Performance Battery, SPPB, and handgrip dynamometry) and psychological aspects related to falls (Falls Efficacy Scale International, FES-I, and Activities-specific Balance Confidence Scale, ABC). Feasibility indicators will include recruitment, adherence, retention, and cybersickness. A reduction in TUG time is expected, providing preliminary evidence on the feasibility of integrating IVR-based programs for falls prevention within PHC systems. Full article

The institutional drive to deploy digital assistive technologies—from IoT monitoring to AI companions—as a solution to the aging care crisis functions as an ethical double-edged sword. This article argues that beyond isolated risks, these technologies introduce a systemic tension where gains in safety and efficiency often come at the cost of autonomy, human connection, and equity. We propose a critical framework that diagnoses four interconnected dimensions of this tension: (1) the erosion of privacy and autonomy through pervasive surveillance; (2) the risk of dehumanization in high-tech, low-touch interactions; (3) the “digital grey divide” as a social determinant of health; and (4) the perpetuation of “coded ageism” through algorithmic bias. To bridge the gap between ethical principle and practice, the framework translates this diagnosis into a practical roadmap for “Dignity-by-Design.” It operationalizes person-centered care through three actionable shifts: moving from compliance to commitment, replacing static consent with dynamic engagement, and establishing the lived experience of older adults and caregivers as a core design standard via participatory action research. Ultimately, this work provides a critical tool for researchers, developers, and policymakers to guide the ethically aligned implementation of technologies that truly enhance autonomy, foster trust, and uphold dignity in geriatric care. Full article

This paper examines how mathematics can be approached in the context of Adult Learning and education for older adults. Senior Education in university settings can become a highly motivating, engaging, and meaningful experience for senior learners. Drawing on our teaching practice at the Senior Classroom Program of Pablo de Olavide University (Spain), this study analyzes how andragogical principles such as autonomy, relevance, life experience, and intrinsic motivation can shape powerful learning environments for senior learners (i.e., over 50 years old). By focusing on real-world connections and on historical or philosophical perspectives, the teaching of mathematics may become not only more accessible but also intellectually stimulating, particularly when the classroom climate is supportive and inclusive. From this perspective, mathematical content, often perceived as abstract or disconnected from reality, can be approached as a resource for critical reflection, personal growth, and intergenerational dialog. Our analysis suggests that mathematics does not necessarily constitute a barrier for senior learners; under appropriate pedagogical conditions, it may instead function as a bridge to lifelong learning, fostering curiosity about how the surrounding world works and encouraging engagement with meaningful real-life problems. Full article

Physical activity apps offer significant potential to promote physical activity and active aging; however, their acceptance among older adults remains limited, often due to insufficient digital literacy. This study aimed to examine whether targeted, app-specific digital literacy training can improve eHealth literacy, acceptance of physical activity apps, and behavioral intentions among older women, drawing on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) extended with a personal innovativeness construct. A total of 63 older women (M = 67.0, SD = 4.6) were randomly assigned to an experimental (n = 32) or control group (n = 31). The experimental group participated in a nine-week digital literacy training focused on practical use of physical activity apps. Measures were collected before and after the intervention. Data were analyzed using repeated-measures MANOVA and ANOVAs. A significant Group × Time interaction was observed for technology acceptance (Wilks’ Λ = 0.41, F (7, 54) = 11.14, p < 0.001, η_p² = 0.59). The experimental group showed significant improvements across all measured constructs. The largest effects were found for eHealth literacy (η_p² = 0.39) and intention to use physical activity apps (η_p² = 0.24). App-specific digital literacy training can enhance technology acceptance and support physical activity–related intentions among older women, highlighting its potential to reduce digital barriers and promote active aging. The findings reflect short-term, self-reported changes in technology acceptance and behavioral intentions. Full article