Search Results (94)

Background/Objectives: Multifactorial prevention of falls in persons with dementia has minimal or non-significant effects. Personalised prevention is recommended. We have previously shown that gait speed, basic activities of daily living (ADL), and depression (high Cornell scores) were independent predictors of falls in persons with mild and moderate cognitive impairment. This study explored person-specific risks of falls related to physical, mental, and cognitive functions and types of dementia: Alzheimer’s disease (AD), vascular dementia (VD), mixed Alzheimer’s disease/vascular dementia (MixADVD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB). Methods: The study used data from “The Norwegian Registry of Persons Assessed for Cognitive Symptoms” (NorCog). Differences between the dementia groups and predictors of falls, gait speed, ADL, and Cornell scores were analysed. Results: Among study participants, 537/1321 (40.7%) reported a fall in the past year, with significant variations between dementia diagnoses. Fall incidence increased with age, comorbidity/polypharmacy, depression, and MAYO fluctuation score and with reduced physical activity, gait speed, and ADL. Persons with VD and MixADVD had high fall incidences and impaired gait speed and ADL. Training of physical fitness, endurance, muscular strength, coordination, and balance and optimising treatment of comorbidities and medication enhance gait speed. Improving ADL necessitates, in addition, relief of cognitive impairment and fluctuations. Relief of depression and fluctuations by psychological and pharmacological interventions is necessary to reduce the high fall risk in persons with DLB. Conclusions: The fall incidence and fall predictors varied significantly. Personalised interventions presuppose knowledge of each individual’s fall risk factors. Full article

Gastrointestinal (GI) malignancies are diverse and particularly challenging in terms of current immunotherapy but hold great opportunity for impact given that they constitute the highest cancer incidence and mortality rates worldwide. Traditional treatment options for solid GI malignancies include surgical intervention, chemotherapy, radiation, or a combination of these treatments. Emerging modalities within immunotherapy are anticipated to extend the results with conventional therapy by stimulating the patient’s own intrinsic potential for tumor-specific immunologic rejection. Combination regimens of chemotherapy and tumor-infiltrating lymphocyte (TIL) therapy in advanced colorectal cancer and pancreatic cancer, autologous monocyte therapy in advanced gastric cancer, and CAR-T therapy trained against GI-selective tumor antigens such as carcinoembryonic antigen are currently being studied. Clinical trials are underway to study the combination of various chemotherapeutic agents along with immunotherapy in the management of cholangiocarcinoma, hepatocellular carcinoma, and esophageal cancer. Alternative therapies are needed based on the tumor immune microenvironment, which can lead to a personalized approach to treatment. In this review, we discuss the current status of various modalities of immunotherapy in common GI malignancies, along with their mechanisms of immune activation and cancer suppression. We will also discuss the use of immunotherapy in less common solid GI malignancies and touch on recent advancements and clinical trials. Full article

Endurance training induces significant cardiac remodeling, with evidence suggesting that prolonged high-intensity exercise may increase the risk of atrial fibrillation (AF). However, physiological responses differ by event type. This review compares AF-related markers in marathon and ultramarathon runners, focusing on structural adaptations, inflammatory and endothelial biomarkers, and the incidence of arrhythmias. A systematic analysis of 29 studies revealed consistent left atrial (LA) enlargement in marathon runners linked to elevated AF risk and fibrosis markers such as Galectin-3 and PIIINP. In contrast, ultramarathon runners exhibited right atrial (RA) dilation and increased systemic inflammation, as indicated by elevated high-sensitivity C-reactive protein (hs-CRP) and soluble E-selectin levels. AF incidence in marathoners ranged from 0.43 per 100 person-years to 4.4%, while direct AF incidence data remain unavailable for ultramarathon populations, highlighting a critical evidence gap. These findings suggest distinct remodeling patterns and pathophysiological profiles between endurance disciplines, with implications for athlete screening and cardiovascular risk stratification. Full article

Background: Infection control is fundamental in dental practice, especially following the COVID-19 pandemic, which highlighted the variability in students’ adherence to disinfection protocols. This study aimed to evaluate the knowledge, attitudes, and practices of the fifth-year dental students at the National and Kapodistrian University of Athens regarding antisepsis and infection control, and to assess the effectiveness of an educational intervention. Methods: A pre-post interventional study was conducted involving two in-person seminars, supplementary e-learning material, and a structured questionnaire administered before and after the intervention. The survey assessed the knowledge, clinical practices, and attitudes toward infection control, including vaccination history and prior exposure incidents. Results: The intervention led to statistically significant improvements in infection control knowledge, especially in risk-based sterilization strategies, disinfectant classification, and PPE use. Students with prior hepatitis B vaccinations and antibody testing demonstrated higher baseline scores and more significant knowledge gains. However, some misconceptions, particularly regarding surface disinfection and prosthetic care, persisted after the intervention. Conclusions: The findings support the effectiveness of structured educational interventions in improving infection control awareness among dental students. Practical, simulation-based training and earlier curriculum integration are recommended to enhance compliance and ensure safe clinical practice. Full article

The growing complexity and risk profile of fire and emergency incidents necessitate advanced training methodologies that go beyond traditional approaches. Live-fire drills and classroom-based instruction, while foundational, often fall short in providing safe, repeatable, and scalable training environments that accurately reflect the dynamic nature of real-world emergencies. Recent advancements in immersive technologies, including virtual reality (VR), augmented reality (AR), mixed reality (MR), extended reality (XR), and simulation-based systems, offer promising alternatives to address these challenges. This review provides a comprehensive overview of the integration of VR, AR, MR, XR, and simulation technologies into firefighter and incident commander training. It examines current practices across fire services and emergency response agencies, highlighting the capabilities of immersive and interactive platforms to enhance operational readiness, decision-making, situational awareness, and team coordination. This paper analyzes the benefits of these technologies, such as increased safety, cost-efficiency, data-driven performance assessment, and personalized learning pathways, while also identifying persistent challenges, including technological limitations, realism gaps, and cultural barriers to adoption. Emerging trends, such as AI-enhanced scenario generation, biometric feedback integration, and cloud-based collaborative environments, are discussed as future directions that may further revolutionize fire service education. This review aims to support researchers, training developers, and emergency service stakeholders in understanding the evolving landscape of digital training solutions, with the goal of fostering more resilient, adaptive, and effective emergency response systems. Full article

Background: This study aimed to analyze the challenges faced by professionals and volunteers in search and rescue operations after the earthquake that struck the southeastern region of Turkey, with its epicenter in Kahramanmaraş, on 6 February 2023. Method: This research was conducted using a qualitative approach; specifically, a phenomenological method. It presents the results of semi-structured individual interviews with eight sampled volunteers who participated in the search and rescue activities following the earthquake. Participants were between the ages of 24 and 45, and three were nurses, three were journalists, and two were civilian volunteers with no formal training in search and rescue. In terms of nationality, five participants were citizens of the Turkish Republic of Northern Cyprus (TRNC) only, while three had both TRNC and Turkish citizenship. Field duties included providing medical support, documenting incidents, and assisting survivors in collaboration with civil society organizations. The research data were analyzed using MAXQDA Analytic Pro 2020. Results: Within the scope of this research, four main themes and twenty-one sub-themes were identified. The first theme is related to the nature of the traumatic events and reflects the characteristics of the traumatic experiences of the participants. The second theme is secondary trauma symptoms, showing that the participants experienced symptoms such as overstimulation, intrusive thoughts, sleep problems, anger, and concentration difficulties. The third theme focuses on post-traumatic growth symptoms. Participants reported experiencing developmental changes following trauma, such as changes in self-perception, the ability to recognize new situations, understanding the value of life, and positive relationships related to personal growth. Finally, the fourth theme is related to the coping skills used to cope with traumatic events; participants shared their coping strategies and the impact of these strategies. Conclusions: This study highlights the need to assess individuals in search and rescue operations in terms of secondary trauma. Our findings may be used as a reference to develop post-disaster psychosocial support services for volunteer search and rescue teams. Additionally, the findings can be used to renew the content of pre-field preparation training. Full article

Background: The aging population is increasing rapidly, with individuals aged 65 and older now representing more than 15% of the global population. This demographic shift is associated with a rising incidence of age-related cardiovascular diseases (CVDs). Early prediction and prevention of cardiovascular aging are essential to improve health outcomes among elderly patients. Objective: This study aimed to develop and externally validate a mathematical model for predicting cardiovascular aging in individuals aged 65 and older, based on general clinical and behavioral data. Methods: The model was built using data from 800 individuals aged 65+ from Almaty, Kazakhstan. Predictors included sex, marital status, education, smoking, alcohol use, disability, physical activity, total cholesterol, hypertension, BMI, coronary artery disease (CAD), myocardial infarction, diabetes mellitus, and chronic heart failure. A system of ordinary differential equations was used to simulate the dynamic interactions of these factors. Numerical integration was performed using the Runge–Kutta, Adams–Bashforth, and backward Euler methods. The model was verified statistically using Pearson correlation analysis and externally validated on independent age cohorts. In addition, we applied k-means clustering to identify hidden patterns and risk profiles within the dataset. A Random Forest classifier was trained to distinguish between high-risk and low-risk individuals using the same feature set. These machine learning approaches were used as complementary tools to enhance the robustness and interpretability of the modeling results. Results: The model trained on the 65–74 age group achieved an external validation accuracy of 98.8% and an AUC of 0.989 when applied to the 75–89 group. Risk modeling showed that in the 65–74 group, smoking and alcohol increased the risk of myocardial infarction, hypertension, and obesity by up to 53%. In the 75–89 group, these factors increased the likelihood of hypertension by 21%, chronic heart failure by 16%, and CAD by 14%. Among individuals aged 90+, hypercholesterolemia increased the risk of chronic heart failure by 17%, while hypertension increased myocardial infarction risk by 16%. Conclusions: The proposed model demonstrated high accuracy in predicting cardiovascular aging and identifying high-risk individuals across elderly subgroups. The integration of clustering and classification methods (k-means and Random Forest) provided additional insights and confirmed the consistency of the findings. This multi-method approach may serve as a valuable tool for developing personalized prevention strategies in geriatric care and improving healthy life expectancy. Full article

Objective: Psychological safety (PS) is essential for health and social care professionals (HSCPs) working in high-stress environments. While much of the existing research focuses on PS within teams, less is known about HSCPs’ lived experiences across diverse health and social care settings. This scoping review aims to synthesise the qualitative literature on PS, identifying key barriers and enablers to its development in health and social care workplaces. Methods: A systematic search was conducted across MEDLINE, PsycINFO, Embase, CINAHL, Scopus, Web of Science, and the Cochrane Library, covering a 20-year period (2004–2024). Eligible studies included primary qualitative research exploring HSCPs’ experiences of PS. Screening and data extraction were managed using Rayyan. An inductive thematic synthesis approach was applied to identify key patterns in the data. Results: The review identified several enablers and barriers to PS. The main enablers included (1) feeling safe within the team and (2) personal factors, which encompassed professional skills, experience, social support, and self-care. Conversely, key barriers were identified: (1) the normalisation of traumatic incidents, (2) unsupportive team and management structures, (3) organisational constraints, and (4) a lack of knowledge and training on PS. Conclusions: Understanding the enablers and barriers of PS is critical for improving workplace culture, resilience, and wellbeing among HSCPs. These findings provide a foundation for future research and interventions aimed at strengthening PS at individual, team, and organisational levels across diverse health and social care settings. The results also offer valuable insights for informing policies and practice to ultimately enhance both staff wellbeing and patient care quality. Full article

Many Black, Asian, and ethnic minoritised students on university courses leading to professional qualifications face racism on placement. Our own institutional review at one UK university highlighted differential placement outcomes for students in the Schools of Social Work, Education, and Health Sciences. To investigate, a qualitative study was conducted between April to October 2024, using focus groups and interviews with 20 students and 19 staff (lecturers and placement supervisors from the NHS, County Council, and schools). Researchers used NVivo to support the thematic analysis of the qualitative data. Key findings identified various enabling factors, including the significance of supervisory placement support and the quality of placement environment. However, our data further confirmed several inhibiting factors, including power dynamics, systemic failures, and broken trust, contributing to racialised and oppressive placement conditions. We recommend that the university and placement providers have a dedicated system for reporting race-specific incidents to a dedicated person/team who are trained and accountable for tackling and preventing racists incidents on placements. Full article

Trauma, mental illnesses, and substance use disorders (SUD) are well-documented contributors leading to women’s incarceration; however, less is known about how these factors also influence women’s pathways through prison once incarcerated. To address this gap, we examined (1) women’s pathways to and through prison-based mental health services, (2) summarized their sociodemographic and diagnostic profiles, and (3) examined how mental health and addiction relate to indicators of within-prison functioning, intervention receipt, and recidivism. Data derived from routine administrative and treatment records of women incarcerated between January 2015 and December 2023 in the Washington Corrections Center for Women (WCCW). The full sample comprised 5775 women who entered WCCW during the study period. The majority (53.2%) of women admitted to prison in the study period had at least one mental health diagnosis requiring at least moderate mental health intervention. Substance use (62.73%), trauma-related (61.11%), and mood (47.71%) disorders were most common. Individuals with at least a diagnosis of psychosis, neurocognitive disorders, and personality disorders had greater rates of close observation stays, crisis events, and non-suicidal self-injury risk assessments. Psychosis was associated with the highest rate of crisis events, while personality disorders were associated with the highest rate of non-suicidal self-injury risk assessments. Three-year recidivism rates were highest amongst those with a diagnosis of psychosis or ADHD. Trauma-focused and substance use treatments were associated with lower rates of crisis interventions and other critical incidents in their post-treatment period, but no relationship was observed for reductions in post-release recidivism. Overwhelmingly, women enter prison with significant mental health care needs and require a high-level of care that is largely reflective of the nearly ubiquitous nature of trauma, psychological distress, and addiction. The level of care needed, in response to the varied and complicated diagnostic profile of incarcerated women (e.g., ADHD, psychosis, trauma), as well as the number of critical incidents stemming from symptoms, reflects the need for more clinical staff to expand reach along with training in a wide range of modalities. Full article

Swimming is a widely practiced sport with significant physical demands, placing athletes at a considerable risk of injury, particularly in the shoulder, due to repetitive high-intensity movements. The aim of this systematic review was to analyze the patterns and frequency of injuries associated with swimming. Methods: A systematic search of the Web of Science, PubMed, Scopus, and SportDiscus databases identified nine relevant studies. Results: The findings revealed a higher incidence of injuries in female swimmers compared to males, with the shoulder being the most frequently affected joint. This disparity is partially attributed to the Female Athlete Triad, a syndrome characterized by low energy availability, menstrual dysfunction, and poor bone health, which increases injury susceptibility. Other commonly affected regions include the knee, often associated with the biomechanical demands of breaststroke, and the lumbar spine, which is impacted by degenerative changes resulting from high training volumes. However, variability in the injury measurement protocols across studies limits their comparability and highlights the need for standardized methods. Conclusions: Based on these findings, professionals in the field can identify injury patterns to enhance diagnosis and treatment, design personalized prevention programs, implement early interventions, and innovate equipment and training methods to improve swimmer safety and performance. Full article

Background/Objectives: A person-under-train (PUT) incident is a traumatic event for train drivers that can result in serious health consequences. This systematic review aimed to identify and synthesize evidence on these health effects, including post-traumatic stress disorder (PTSD), sickness absence (SA), and other related mental health outcomes. Methods: Following the PECO scheme, we searched the PubMed, Web of Science, and Embase databases for studies published between 1980 and 2021. We included cross-sectional, case–control, prospective, and interventional studies focusing on train drivers exposed to PUT incidents. Data synthesis followed PRISMA guidelines, with quality appraisal using the Downs and Black checklist. Results: The search was conducted on 22 September 2022, resulting in 3673 records. Nine studies were included, involving a total of 3425 participants. PTSD prevalence ranged from 0% to 55.3%, depending on study design and timing of data collection. Risk factors included repeated exposure, lack of social support, and proximity to the victim. SA varied widely, with durations ranging from 1 day to over 6 months. Drivers frequently reported depression, somatoform disorders, and other long-term psychological impacts. Conclusions: PUT incidents significantly affect the mental health of train drivers and their ability to return to work, frequently leading to extended sickness absence. The timely identification of at-risk individuals and the implementation of best-practice interventions could mitigate long-term effects. Future research should explore standardized follow-up periods to improve comparability. Full article

The spread of panic can swiftly trigger group behaviors, leading to public security incidents and significant social hazards. Increasing attention is being paid to the impact of human psychology and behavior on the evolution and management of emergencies. Drawing on the Weber–Fechner Law, we proposed an emotional contagion model to explore the dynamics of crowd panic during metro emergencies, focusing on the interplay of emotional levels and stimuli. Key influencing factors such as crowd density, personality traits, official interventions, and evacuation rates are analyzed. Additionally, a case study is conducted to validate the model’s effectiveness in quantifying emotions and characterizing the emotional contagion of crowd panic. Numerical results reveal that the initial intensity of panic stimuli significantly impacts peak panic levels, while contagion duration plays a minor role. Panic intensifies with increased crowd density, with sensitive individuals being more susceptible to extreme emotions, escalating negative contagion. Official intervention proves crucial in mitigating panic, though its effect is transient in enclosed environments. Evacuation rate minimally affects emotional contagion during the train’s motion but becomes pivotal post-arrival. Highly panicked passengers evacuate quickly, necessitating timely interventions to prevent secondary panic on platforms. This highlights the importance of immediate, effective control measures to manage panic dynamics and ensure public safety. Full article

Background/Objectives: The annual incidence of falls is high in older adults with impaired cognitive function and dementia, and injuries have a detrimental effect on disability-adjusted life-years and public health spending. In this registry-based study, fall incidence and characteristics of the fallers were explored in a large population with cognitive impairment. Methods: NorCog, “The Norwegian Registry of Persons Assessed for Cognitive Symptoms”, is a national research and quality registry with a biomaterial collection. This study included 9525 persons from the registry who had answered the question about falls. Fall incidence was studied, and the characteristics of fallers and non-fallers were compared. Results: The annual fall incidence was 3774/9525 (39.6%). The incidence varied between types of dementia, from 22.4% in persons with the debut of Alzheimer’s disease before 65 years of age to 55.3% in persons with vascular dementia and with increasing degrees of cognitive impairment. A wide range of personal characteristics, symptoms, signs, laboratory tests, and physical, psychological, and cognitive tests differed between fallers and non-fallers, most in disfavour of the fallers. Age, reduced Personal Activities of Daily Living, reduced gait speed, delayed recall, use of a walking aid, and depression were independent predictors of falls. Conclusions: Among cognitively impaired persons with a history of falls, frailty was an independent predictor of falls. Neither the type of dementia nor the degree of cognitive impairment were independent predictors of falls. Prevention of frailty by physical training and social activity may be important in mitigating fall risk among older adults with impaired cognition. Full article

Background/Objectives: Numerous studies have examined nursing students’ academic dishonesty; however, there is still a gap in understanding the predictors of such behavior. This study aimed to identify personal (intrapersonal and interpersonal) and contextual factors predicting nursing students’ dishonesty during clinical training. Methods: A two-phase, prospective, predictive study was conducted at a nursing faculty in Croatia. The validated “Mentor Support Evaluation Questionnaire” was used in the first phase to assess students’ evaluations of the quality of mentor support during clinical training. The validated instruments “Optimism/Pessimism Scale” and “Nursing Student Perceptions of Dishonesty Scale” were used in the second phase to examine self-reported dishonesty and its contributing factors. The second phase also investigated the students’ knowledge of the university’s ethical and disciplinary regulations. Results: Of 398 participants, 195 (48.9%) reported engaging in clinical dishonesty. Hierarchical regression analysis identified critical predictors of frequent clinical dishonesty: lack of fear of consequences (β = −0.072), positive attitudes toward dishonesty (β= −0.081), higher incidence of academic dishonesty in the classroom (β = 0.221), lack of knowledge of the university’s regulations (β = −0.349), and low quality of mentor support (β = −0.430). The final model explained 60.7% of the variance in participants’ clinical dishonesty (p < 0.001). Conclusions: The identified predictors indicate that interpersonal factors, i.e., the quality of mentor support, influence students’ clinical dishonesty more than intrapersonal factors (e.g., attitudes or knowledge). Contextual factors (healthcare employment and study overload) were unrelated to clinical dishonesty. This finding can help develop strategies to reduce nursing students’ dishonesty and improve patient safety. Full article