Search Results (2,416)

Background: Work-related musculoskeletal disorders (WMSDs) have been reported to be very common among hospital workers and particularly nurses. They are assumed or found to be a result of physical workload or poor posture at work and only secondarily a consequence of (general) stress. Due to the increasing workload, more and more digestive endoscopy nurses have WMSDs, but there is still a lack of comprehensive research on the specific factors and patterns of WMSDs in China. Methods: A cross-sectional study was conducted among 400 digestive endoscopy nurses from 35 cities across 10 provinces in China. Data were collected using the Nordic Musculoskeletal Questionnaire (NMQ) and analyzed using multivariable logistic regression and latent class analysis (LCA) to identify associated factors and WMSD occurrence patterns. Results: The overall 12-month prevalence of WMSDs was high (82.5%), particularly in the neck, shoulder, and lower back. Frequent participation in complex endoscopic procedures (adjusted OR range 1.6–1.7) and 6–10 years of work experience (adjusted OR range 1.7–2.5)—rather than daily procedure volume alone—were independently associated with an increased likelihood of WMSDs (p < 0.05). BMI, analyzed using three categories (<24, 24–27.9, ≥28 kg/m²), was not significantly associated with WMSDs in any body region. The LCA revealed three distinct WMSD patterns characterized by multisite pain: a Full-body Pain group (19.0%), a Neck–Shoulder–Lower Back–Upper Back Pain group (42.25%), and a Mild Pain group (38.75%). Conclusions: This study found that digestive endoscopy nurses were at high risk for WMSDs, mainly due to repetitive physical strain and ergonomic challenges. As this was a cross-sectional study, the reported associations should not be interpreted as causal. Ergonomic training, improved workstation design, and workload optimization are important measures to ensure nurses’ health and improve the quality of care. Full article

Background/Objectives: Patella alta contributes to patellofemoral (PF) maltracking and anterior knee pain, but the agreement of patellar-height indices across imaging modalities and their clinical relevance remain uncertain. We aimed to estimate the prevalence of patella alta when using each index, quantify inter-method agreement, and quantify patella alta’s associations with Hoffa’s fat-pad impingement, patellar chondromalacia, and tibial tubercle–trochlear groove (TT–TG) distance. Methods: This retrospective cross-sectional study included 250 patients aged 18–38 years who underwent both knee radiography and MRI. Patellar height was assessed using the Insall–Salvati (IS) and modified Insall–Salvati (mIS) ratios on radiographs and MRI, and the Patellotrochlear Index (PTI) on MRI. Associations with fat-pad impingement, chondromalacia grade, and TT–TG abnormality were analyzed using the chi-square or Fisher’s exact test and as odds ratios (ORs) adjusted for age, sex, and imaged side; agreement was assessed with Cohen’s kappa (κ). Results: Patella alta prevalence was 13.2% using IS on radiographs and 10.8% using IS on MRI, but markedly lower with mIS (≤1.6%). Patella alta was more frequent in patients with Hoffa’s fat-pad impingement (31.1% vs. 5.7% on IS radiography; adjusted OR 8.83, 95% CI 3.82–20.45) and advanced chondromalacia (p = 0.025). Agreement was moderate between IS radiography and IS MRI (κ = 0.47, 95% CI 0.33–0.61) and between IS MRI and the PTI (κ = 0.43). Conclusions: The prevalence and clinical relevance of patella alta depend strongly on the measurement method. The IS ratio was the most consistent index, but radiography–MRI agreement was moderate rather than high, so the two are not interchangeable. The PTI adds information on trochlear engagement from the same MRI examination. These cross-sectional associations do not establish causation. Full article

Background/Objectives: Depression is a leading cause of disability among middle-aged and older adults, with its burden markedly amplified by multimorbidity. In rapidly aging China, distinct multimorbidity phenotypes interact with depressive symptoms through complex, non-linear pathways that traditional models struggle to capture. Interpretable machine learning offers high predictive accuracy alongside clinically transparent explanations, yet few studies have applied this approach to large national Chinese cohorts while stratifying by empirically derived multimorbidity patterns. The aim of this study was to identify the pattern-specific determinants of depression among middle-aged and older adults with multimorbidity using explainable machine learning techniques based on data from the China Health and Retirement Longitudinal Study (CHARLS). Methods: In this cross-sectional analysis of the China Health and Retirement Longitudinal Study (CHARLS) 2020 data, 14,981 participants were divided into a multimorbidity group (≥2 of 12 physician-diagnosed chronic conditions; n = 8265) and a matched control group (0 or 1 condition; n = 6716). Depressive symptoms were defined as a CES-D-10 score ≥ 10 (binary outcome). Forty-four candidate predictors were screened via LASSO regression, the Boruta algorithm, and univariate logistic regression. Fifteen supervised machine learning models were trained separately for each group using SMOTE for class imbalance, nested 5-fold cross-validation for hyperparameter tuning, and an independent 20% test set for external validation. Model performance was ranked by the composite AB Score (equal weighting of AUROC and Brier score). The champion models were interpreted globally via SHAP summary plots, directional waterfall diagrams, and novel impact-intensity network diagrams. The same pipeline was repeated across four literature-derived multimorbidity patterns within the multimorbidity group. Results: Depressive-symptom prevalence was 42.96% (3551/8265) in the multimorbidity group versus 27.01% (1814/6716) in the control group. The Gaussian process classifier achieved the highest AB Score (0.7782) in the multimorbidity group (external AUROC of 0.7545, Brier score of 0.1981); the generalized additive model was optimal in the control group (AB Score 0.7856, external AUROC 0.7387, Brier score 0.1676). Across both groups, the top contributors by mean absolute SHAP were IADL disability, abnormal sleep duration, ADL disability, rural residence, and lower education level. Pattern-specific SHAP networks revealed clinically meaningful heterogeneity: cardio-metabolic clusters were driven by marital status and headache; digestive–joint clusters by IADL disability and shoulder–knee pain synergy; respiratory clusters by gender and multisite pain; and cardiovascular–digestive clusters by sleep duration and vigorous activity. Conclusions: Interpretable machine learning models demonstrated clinically useful discrimination and excellent calibration while revealing universal drivers (functional disability and sleep disturbance) and cluster-specific synergistic interactions underlying depressive symptoms in multimorbid Chinese adults. These phenotype-tailored insights provide a practical roadmap for precision screening and targeted interventions in aging populations. Full article

Background/Objectives: Low back pain (LBP) is highly prevalent among dentists, although the relationship between lumbar magnetic resonance imaging (MRI) findings and symptoms remains unclear. This study aimed to identify lumbar MRI-derived structural profiles in actively practicing dentists and to examine their relationship with LBP, pain-related disability, demographic characteristics, occupational factors, and individual MRI findings. Methods: A cross-sectional observational study was conducted in 57 actively practicing dentists. Demographic, occupational, and clinical data were collected, and lumbar MRI examinations were performed using standardized protocols. MRI findings included disc bulging, disc herniation, annular fissure, Modic changes, osteophytes, facet joint degeneration, and spinal canal stenosis. Cluster analysis was used to identify MRI-derived structural profiles. Associations between profiles, LBP, disability, demographic characteristics, occupational factors, and individual MRI findings were assessed using chi-square tests and correspondence analysis. Results: Two distinct MRI-derived structural profiles were identified: a disc–facet degenerative profile (n = 38) and a non-osseous degeneration profile (n = 19). Disc bulging (100% vs. 52.6%, p < 0.001), facet joint degeneration (94.7% vs. 10.5%, p < 0.001), and osteophytes (23.7% vs. 0%, p = 0.022) significantly contributed to profile differentiation, whereas disc herniation, Modic changes, and annular fissure did not. Neither MRI-derived profile was associated with the presence of LBP or pain-related disability (p > 0.05). Younger dentists were more frequently classified within the disc–facet degenerative profile with LBP, whereas older dentists with similar structural findings were more commonly classified within the same profile without LBP (p = 0.007). No significant associations were observed between MRI-derived profiles and occupational characteristics. Conclusions: Two distinct lumbar MRI-derived structural profiles were identified in dentists, but neither was associated with LBP or pain-related disability. Age appeared to influence the clinical expression of the disc–facet degenerative profile, suggesting that lumbar MRI findings should be interpreted within a broader, age-sensitive clinical context rather than as isolated determinants of symptoms. Full article

Background: Bone Marrow Edema Syndrome (BMEs) encompasses primary clinical conditions characterized by pain and high-intensity signals on fluid-sensitive magnetic resonance imaging at the subchondral bone level. This study aimed to evaluate bone mineral density (BMD) and turnover markers in BMEs patients compared to a healthy control group. Methods: We selected from the records 165 patients—comprising Complex Regional Pain Syndrome type 1 (CRPS-1, n = 61), hip BMEs (n = 42), and knee BMEs (n = 62)—alongside 150 age- and sex-matched healthy controls. Assessments included bone turnover markers, vitamin D levels, and BMD at the lumbar spine and femur by Dual-Energy X-ray Absorptiometry. Trabecular Bone Score (TBS) was calculated to estimate bone microarchitecture. Results: BMEs patients demonstrated significantly lower BMD across all skeletal sites and reduced TBS values compared to controls. Osteoporosis prevalence was significantly higher in all BMEs subgroups, with CRPS-1 and hip BMES patients showing higher rates than those with knee BMEs. No significant differences were observed in vitamin D or bone turnover markers between groups. Conclusions: Patients with CRPS-1 and BMEs of the hip or knee exhibit a higher prevalence of osteoporosis and compromised bone microarchitecture. These findings highlight a significant association between BME-related conditions and altered BMD/TBS parameters, suggesting a potential shared pathophysiological link. Full article

Background: The directional relationship between epigenetic age acceleration (EAA) and musculoskeletal disease remains unresolved. This study integrated bidirectional Mendelian randomization (MR) with multi-layer genomic evidence to evaluate directionality, shared genetic architecture, and robustness to instrument definition. Methods: Four EAA clocks (IEAA, PhenoAA, HannumAA, and GrimAA) and ten musculoskeletal phenotypes were analyzed in a 10 × 4 bidirectional two-sample MR design. EAA instruments underwent GRCh37 functional annotation, genome-wide-significant external-association screening for the index variants and European linkage-disequilibrium proxies, pair-specific Steiger filtering, and conservative Set A/B/C sensitivity analyses. The juvenile-arthritis reverse models underwent instrument-flow reconstruction, strength assessment, liability-scale directionality testing, and minimum-detectable-effect analysis. Additional analyses comprised LD score regression (LDSC), PLACO+ cross-trait locus mapping, Bayesian colocalization, multivariable MR (MVMR) with exact-SNP matched univariable comparators, and integrated evidence synthesis. Results: Forward MR yielded two nominal HannumAA associations. The inverse HannumAA–spondyloarthritis estimate remained directionally consistent across the original, Steiger-filtered, and conservative external-association-filtered sets, whereas the HannumAA–pain-in-thoracic-spine estimate lost nominal significance in the conservative set; no forward result survived correction across 40 tests. GrimAA forward estimates were sensitive to use of the fallback instrument threshold. Reverse MR identified ten nominal associations. For juvenile arthritis, three harmonized instruments had F statistics of 51.25–102.35; liability-scale Steiger comparisons supported the tested direction under all 16 outcome-by-prevalence combinations, although the 788-case discovery GWAS and possible winner’s curse remained important limitations. LDSC identified FDR-significant positive genetic correlations of GrimAA with hip osteoarthritis (r_g = 0.267, p = 8.49 × 10⁻⁵, q = 0.0019) and knee osteoarthritis (r_g = 0.269, p = 9.52 × 10⁻⁵, q = 0.0019). PLACO+ identified 738 genome-wide-significant cross-trait variants and 65 independent loci; six of 37 evaluable loci showed strong colocalization. Of 96 MVMR models, 43 had primary-exposure conditional F ≥ 10, and 32 also had candidate-trait conditional F ≥ 10. After exact-SNP matching, the 43 primary-strength models were operationally classified as 35 partially attenuated and eight independent-signal models, with no fully attenuated model; no adjusted association survived multiplicity correction. Conclusions: The results support a prioritized genomic map with substantial instrument- and model-specific uncertainty. Disease-to-clock signals were richer than clock-to-disease signals, GrimAA shared polygenic architecture with osteoarthritis, and selected loci showed strong shared-variant evidence, while the MR and MVMR findings remained unsuitable for definitive causal or mediation claims. Full article

Background: Lumbar radicular pain, commonly referred to as sciatica, is a prevalent musculoskeletal condition that negatively impacts patients’ quality of life. Evidence regarding the use of foot orthoses in patients with sciatica secondary to lumbar disc herniation remains limited. Objectives: To determine the influence of custom-made foot orthoses on health-related quality of life and perceived pain in patients with chronic radicular pain secondary to non-traumatic lumbar or lumbosacral disc herniation. Methods: A randomized, controlled, double-blind clinical trial was conducted. Fifty-two patients (mean age: 46.12 ± 9.37 years; 53.8% men, 46.2% women) were allocated to either a customized functional foot orthoses group or a cushioning flat insole group. Pain, foot-related disability, low back disability, and health-related quality of life were assessed at baseline and after three months using the 11-point Numeric Pain Rating Scale (NPRS), Manchester Foot Pain and Disability Index (MFPDI), Oswestry Disability Index (ODI), and Short Form-12 (SF-12) questionnaire. Results: No statistically significant differences were observed between treatment groups in foot pain ($p=0.821$), lower-limb pain ($p=0.244$), low back pain ($p=0.497$), low back disability ($p=0.684$), or physical quality of life ($p=0.069$) after follow-up. However, participants treated with customized functional foot orthoses showed significant intragroup improvements in foot function (MFPDI-Function: $p=0.046$; MFPDI-Total: $p=0.033$) and in the physical component of health-related quality of life (SF-12 Physical: $p=0.031$), whereas no significant changes were observed in the cushioning insole group ($p>0.05$). Conclusions: Customized functional foot orthoses may improve foot function and physical health-related quality of life in patients with chronic radicular pain secondary to lumbar or lumbosacral disc herniation. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings. Full article

Background/Objectives: Although the etiology and pathomechanism of temporomandibular joint osteoarthritis (TMJ OA) and rheumatoid arthritis (RA) are different, they can both lead to serious structural and functional changes in the masticatory system. This study aimed to assess and compare the prevalence and characteristics of functional changes in the masticatory system in RA and OA TMJ patients. Materials and Methods: This cross-sectional study included 40 RA patients meeting the 2010 ACR/EULAR criteria and 40 TMJ OA patients. Research diagnostic criteria for TMD (RDC/TMD) were used to assess functional changes. Results: Orofacial pain was a predominant TMD reported in 80% of RA patients and in 67.5% of OA TMJ patients. There was no difference in the orofacial pain intensity and degree of somatization between RA and OA TMJ patients (p = 0.114). Orofacial pain duration was statistically longer in OA TMJ patients than in RA patients (p = 0.003). The ranges of mandibular movement were limited but without any statistically significant differences between the groups compared for maximum active opening (p = 0.349) and maximum passive opening (p = 0.461). Patients with RA presented with more muscles affected with pain. The most painful muscles were the medial pterygoid muscles and the anterior belly of the digastric muscle for the right side (p = 0.006) and for the left side (p = 0.004), and the tendon of the temporal muscle (p = 0.011) and (p = 0.004). The pain intensity of these muscles was statistically higher in RA patients in comparison to OA TMJ patients. Predominant TMJ sounds were slight crepitations in both RA and OA TMJ patients, mainly during laterotrusion in OA (p = 0.000). Conclusions: Laterotrusion was the key movement differentiating TMD manifestations between the two groups. Early functional diagnosis of the temporomandibular joint and an interdisciplinary therapeutic approach, combining treatment of the underlying disease with therapy of the masticatory system disorders, are crucial to limit the progression of changes and improve masticatory function. Full article

Background: Acute rheumatic fever (ARF) is a clinical syndrome triggered by group A streptococcal (GAS) infections and characterized by fever, carditis, and arthritis as its main manifestations. Diagnosis relies on the revised Jones criteria. We report a rare case of ARF diagnosed in Switzerland. Case Presentation: An 18-year-old woman presented to the emergency department five days after returning from a one-week stay in Egypt with intermittent fever and a transient sore throat, followed by migratory joint pain. Laboratory testing revealed leukocytosis, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Chest X-ray, urine analysis, and (travel-associated) pathogen-testing (Epstein–Barr virus, Cytomegalovirus, human immunodeficiency virus, Malaria, Dengue, Zika, Chikungunya) were unremarkable. Blood cultures remained negative. Initially, a viral respiratory infection was suspected and symptomatic treatment established. Days later the patient was re-evaluated due to persistent symptoms. Leukocyte count (Lc) and CRP further increased and subcutaneous nodules appeared. The antistreptolysin-O (ASO)-titer was elevated more than three times higher than the normal upper limit and proofed serological evidence of a preceding streptococcal infection (GAS throat culture had not been performed). ARF was diagnosed according to the Jones criteria. Treatment with amoxicillin and a high dose of acetylsalicylic acid (ASA) led to a rapid clinical improvement. Secondary prophylaxis with depot penicillin (benzathine penicillin G; 1.2 million units; once monthly) was initiated to prevent rheumatic heart disease. Conclusions: This case highlights a rare occurrence of ARF following travel to Egypt, with probable acquisition of group A streptococcal infection during the trip. It emphasizes consideration of ARF even in Western countries with low ARF-prevalence if clinical history is suggestive. Early recognition and initiation of antimicrobial and anti-inflammatory therapy is crucial to prevent cardiac involvement. To the best of our knowledge, this represents one of the first cases diagnosed in Switzerland in the past 20 years. Full article

Dental caries is one of the most prevalent chronic diseases affecting older adults and remains an important, underrecognized contributor to pain, impaired nutrition, systemic illness, and reduced quality of life. Older adults access medical care more often than dental care, positioning non-dental clinicians to identify risk, initiate prevention, and facilitate timely referral. A narrative review of English-language literature was conducted using PubMed and Google Scholar. Search terms included “dental caries,” “root caries,” and “older adults.” Sources included original studies, clinical guidelines, consensus statements, and high-quality reviews, with an emphasis on relevance to older adults and applicability to non-dental clinicians. Dental caries in older adults commonly presents as root and recurrent decay and isstrongly associated with xerostomia, polypharmacy, chronic disease, functional impairment, cognitive decline, and limited access to dental care. The literature supports fluoride-based prevention, management of salivary dysfunction, dietary counseling, minimally invasive therapies such as silver diamine fluoride, and interprofessional care models. Non-dental providers play a critical role in screening, risk assessment, preventive counseling, symptom triage, and referral. Integrating oral health into routine medical care is an essential and achievable strategy to reduce morbidity and improve health outcomes in older adults. Full article

Background: Ear piercing is one of the most commonly performed forms of body modification worldwide. While generally considered a simple procedure, it may be associated with a range of local and cosmetic complications. Objective: To evaluate current ear-piercing trends, determine the prevalence of ear-piercing complications, and identify factors independently associated with the development of these complications among females residing in Riyadh. Methods: A cross-sectional survey was conducted among females residing in Riyadh, Saudi Arabia. Participants were recruited through an online self-administered questionnaire distributed via social media platforms. Multivariable logistic regression was used to identify independent predictors of complications. Results: A total of 1018 participants were included. Ear piercing for aesthetic purposes was reported by 52.8% of respondents. Most participants (87.8%) reported not receiving information regarding procedural risks or aftercare instructions. Complications were reported by 26.5% of participants, with infection (57.0%) and ear pain (54.1%) being the most frequent. Independent predictors of complications included having multiple piercings, cartilage piercing, student status, and the use of piercing guns. Undergoing the first ear piercing before one year of age was associated with a lower risk of complications. Conclusions: Our findings indicate that nearly one-quarter of females reported experiencing complications from ear piercings and are associated with several potentially modifiable factors. This emphasizes the importance of informed consent before the procedure, along with proper education on associated risks. Full article

Background: Functional somatic disorder (FSD) is prevalent, but pathological pathways have not yet been identified. Cross-sectional studies suggest an association between FSD and lipid and glucose metabolism. The aim of the present prospective study was to assess whether metabolic factors represent possible risk factors for development of FSD. Methods: A population-based cohort of 9656 men and women aged 18–76 years was established in 2011–2015, and 5738 participated in a re-examination after a median of 65 months. At both baseline and follow-up, participants answered questionnaires on lifestyle and various delimitations of FSD including bodily distress syndrome (BDS), chronic fatigue (CF), chronic widespread pain (CWP), irritable bowel (IB), and multiple chemical sensitivity (MCS). Fasting values of cholesterol, triglycerides, glucose, HbA1c, insulin, and insulin resistance were assessed at baseline and analyzed in relation to incidence of FSD using logistic regression models, adjusted for age, sex, lipid- and glucose-lowering medications, obesity, social status, lifestyle, and sleep quality. Results: Several small, although significant, effects were observed. Lower levels of cholesterol were associated with development of BDS (OR: 0.982 (95% CI: 0.971–0.993)), CF (OR: 0.980 (95% CI: 0.964–0.996)), and CWP without co-morbid FSS among men. Higher levels of triglycerides were associated with development of CF (OR: 1.022 (95% CI: 1.003–1.041)). Glucose and HbA1c levels were not associated with development of FSD. Insulin and HOMA-IR levels were associated with development of CF in a non-linear relation, being negative at lower levels and changing to a positive relation at higher levels. Conclusions: More large-scale cohort studies are necessary to explore whether metabolism could play a role in the pathological pathway of FSD as indicated in the present study. Full article

Background/Objectives: Neuropathic pain (NP) after traumatic spinal cord injury (SCI) is highly prevalent, markedly impairs quality of life, and remains difficult to treat because available therapies show limited efficacy and may cause relevant adverse effects. Because oxidative stress and glutamate-mediated excitotoxicity contribute to central sensitization after SCI, this study evaluated the antinociceptive and antioxidant effects of dapsone (DDS), N-acetylcysteine (NAC), and their combination in rats with SCI. An isobolographic analysis was also performed to determine the pharmacodynamic interaction between the two drugs. Methods: Female Wistar rats with SCI that developed stimulus-dependent hypersensitivity from day 15 after injury were treated once daily for 7 days with DDS (1.5–12.5 mg/kg, i.p.), NAC (9.3–75 mg/kg, i.p.), or 1:1 fixed-ratio combinations. Mechanical allodynia and hyperalgesia were assessed with Von Frey filaments, whereas lipid peroxidation (LP) and reduced glutathione (GSH) were quantified in injured spinal cord tissue. Results: DDS and NAC produced dose-dependent antinociceptive effects, with DDS being more potent than NAC in both endpoints. The individual ED₅₀ values were 4.92 and 33.47 mg/kg for allodynia, and 4.06 and 27.74 mg/kg for hyperalgesia, for DDS and NAC, respectively. The DDS/NAC combination showed synergistic interactions in allodynia (ED₅₀ = 7.45 mg/kg vs. Zadd = 19.19 mg/kg; γ = 0.388) and hyperalgesia (ED₅₀ = 4.21 mg/kg vs. Zadd = 15.90 mg/kg; γ = 0.265), with stronger synergism in hyperalgesia. Combined treatment also improved LP and GSH levels. Conclusions: These findings indicate that DDS and NAC exert complementary actions and that their combination produces a synergistic antinociceptive effect associated with diminished oxidative stress after SCI. Full article

Background: Work-related musculoskeletal disorders (WRMSDs) are highly prevalent among construction workers. Ergonomics training and exercise are both used for their management, but the incremental benefit of adding exercise to ergonomics training in this population is unclear. Our aim was to evaluate whether adding a supervised exercise programme to ergonomics training provides additional benefit over ergonomics training alone in construction workers with WRMSDs. Methods: In this single-centre, two-arm randomized controlled trial, 52 male construction workers with musculoskeletal complaints were allocated to an ergonomics training plus exercise group (n = 26) or an ergonomics training alone group (active comparator, n = 26) for 12 weeks. The primary outcome was pain intensity (Visual Analogue Scale—VAS); secondary outcomes were musculoskeletal symptom burden (Extended Nordic Musculoskeletal Questionnaire, NMQ-E), fatigue (Fatigue Severity Scale—FSS), sleep quality (Pittsburgh Sleep Quality Index—PSQI), and occupational burnout (Maslach Burnout Inventory—MBI). The pre-specified primary contrast was the baseline-adjusted between-group difference at 12 weeks (ANCOVA), with a responder analysis as a sensitivity check. Results: Both groups improved significantly from baseline in terms of pain, fatigue, sleep quality, and musculoskeletal symptom burden (all p < 0.001) and in personal accomplishment (p < 0.001); emotional exhaustion and depersonalization were unchanged in both arms. Baseline-adjusted between-group comparisons showed no statistically significant incremental effect of added exercise on pain (adjusted difference −0.34, 95% CI −0.99 to 0.32), fatigue, sleep, symptom burden, or any burnout dimension. The exercise arm showed numerically greater improvements in pain, fatigue, and symptom burden and a higher proportion achieving ≥30% pain relief (96% vs. 77%; odds ratio 7.5), but these differences did not reach statistical significance (p = 0.099). Conclusions: Over a period of 12 weeks, ergonomics training with or without added exercise was associated with significant improvements in musculoskeletal and related outcomes; however, adding exercise to ergonomics training produced no statistically significant incremental benefit. A non-significant trend toward greater pain response with added exercise warrants confirmation in larger, longer trials. Full article

Background: With the worsening of global population aging, individuals aged 45 and above face numerous challenges, including disability, pain, cognitive impairment, hearing, and depression. This study aims to utilize machine learning and deep learning methods to develop predictive models for forecasting the health outcomes and disease risk among middle-aged and elderly individuals, while identifying the key factors influencing disease prevalence and quality of life in this demographic. Methods: This research is grounded in the China Health and Retirement Longitudinal Study (CHARLS) database (2015–2018), encompassing 20,967 participants. Machine learning and deep learning techniques were employed to create predictive models for disability, pain, cognitive impairment, hearing, and depression, utilizing 69 variables. A minimum redundancy maximum relevance (MRMR) feature selection strategy and incremental feature selection (IFS) were applied to identify key variables. The optimal predictive models were evaluated for accuracy using the area under the receiver operating characteristic curve (ROC-AUC). Results: The analysis resulted in 15 predictive models, with TabPFN showing the highest performance in predicting disability, pain, cognitive impairment, hearing, and depression, achieving AUCs of 0.802, 0.860, 0.814, 0.769, and 0.856, respectively. Shapley interpretability analysis identified the top five critical features affecting these health outcomes. Conclusions: The proposed models can assess the disease risk of various conditions in middle-aged and elderly individuals, suggesting that early prevention and effective intervention may reduce incidence rates. Additionally, the study provides insights into key factors influencing health, offering a scientific foundation for tailored health management and precision intervention strategies. Full article