Search Results (1,041)

Background: Management of pediatric anaphylaxis in the emergency department remains clinically important. The research investigated pediatric anaphylaxis medical indicators together with physician adherence to international treatment protocols at a Turkish tertiary medical center. Methods: Between September 2014 and July 2025, 166 pediatric anaphylaxis patients were retrospectively reviewed for triggering factors, clinical findings, treatment approaches, and quality indicators. Results: The mean age of the patients was 7.4 ± 5.6 years. Food allergy was the main cause with 53%, followed by drugs with 24.7%. Food allergy in infants was 85.7%, while drug reactions in adolescents reached 37.2% (p < 0.001). Skin findings were present in 93.4% of the patients, and respiratory symptoms were present in 67.5% of the patients. Epinephrine was administered to 97.6% of patients, 95.2% of whom were given intramuscularly. The rate of epinephrine administration in the first 30 min was 61.1%. Drug-induced anaphylaxis showed the highest proportion of severe cases (81.6%, p < 0.001). A biphasic reaction was seen in 6%. The auto-injector prescription rate was 7.8%, and the allergist referral rate was 15.7%. No deaths were observed. Conclusions: While acute-phase management largely adheres to international guidelines, significant gaps persist in post-discharge care with low auto-injector prescription and allergist referral rates. Full article

Objectives: The present study aimed to explore psychiatrists’ perceptions of duloxetine in routine clinical practice, focusing on its efficacy, tolerability, and treatment adherence in major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: A structured questionnaire was administered to 97 psychiatrists from different regions of Spain. The survey covered demographic and professional data, prescription frequency, perceived clinical efficacy, tolerability, dosing patterns, and factors influencing adherence. Results: Overall, duloxetine was perceived as an effective treatment for both MDD and GAD, particularly in patients with somatic symptoms or comorbid anxiety. Tolerability was also positively rated, with nausea and fatigue identified as the adverse effects most commonly associated with reduced adherence. In addition, patient education and close follow-up were identified as the most effective strategies to improve adherence, whereas digital tools were considered promising but underused. Compared with other antidepressants, duloxetine was viewed as having a favorable balance between efficacy and tolerability, with similar or slightly higher adherence rates. Conclusions: These findings reflect a positive clinical appraisal of duloxetine among psychiatrists, highlighting its role as a versatile therapeutic option for affective and anxiety disorders, within the context of routine clinical practice in Spain, provided that appropriate adherence-support strategies are implemented. Full article

Problem Statement: Two global trends, including aging populations and the acceleration of global warming, are increasing the risk of heat-related illness, challenging the health of populations, and the sustainability of healthcare systems. Global warming refers to the increase in the Earth’s average surface temperature, generally attributed to the greenhouse effect, which is occurring at three times the rate of the pre-industrial era. The global population of older adults, defined here as individuals aged 60 and over, is expected to reach over 2 billion by mid-century. This population is particularly vulnerable to heat-related illness, specifically disruption of thermoregulation from excessive exposure to environmental heat due to metabolic and cognitive changes associated with aging. Objectives: This review examines heat-related illness and its impact on older adults within a socio-ecological framework, considering both drivers and mitigation strategies related to global warming, the built environment, social determinants of health, healthcare system responses, and the individual. The authors were motivated to create a conceptual model within this framework drawing on their lived experiences as healthcare providers interacting with older adults in a large urban area of the southwestern US, known for its extreme heat and extensive heat island effects. Based on this framework, the authors suggest actionable strategies supported by the literature to reduce the risks of morbidity and mortality. Methods: The literature search utilized a wide lens to identify evidence supporting various aspects of the hypothesized framework. In this sense, this review differs from systematic and scoping reviews, which seek a complete synthesis of the available literature or a mapping of the evidence. The first author conducted the literature search and synthesis, while the second and third authors reviewed and added publications to the initial search and conceptualized the socio-ecological framework. Discussion: This study is unique in its focus on a global trend that threatens the well-being of a growing population. The population health focus underscores social determinants of health and limitations of existing healthcare systems to guide healthcare providers in reducing older adults’ vulnerability to heat-related illness. This includes patient education regarding age-related declines in extreme heat tolerance, safe and unsafe physical activity habits, the impact of prescription drugs on heat tolerance, and, importantly, identifying the symptoms of heatstroke, which is a medical emergency. Additional strategies for improving survivability and quality of life for this vulnerable population include improved emergency response systems, better social support, and closer attention to evidence-based treatment for heat-related health conditions. Full article

Background: Breast cancer survivors often experience long-term endocrine- and chemotherapy-related side effects, including sleep disorders, anxiety, and depression. Sleep disorders are particularly prevalent and affect patient adherence and quality of life. This study examined the prevalence and risk factors for sleep disorders in patients with breast cancer based on treatment exposure. Methods: Patients with breast cancer (2009–2015) were identified from the Health Insurance Review and Assessment database. They were categorized by chemotherapy exposure and further by endocrine or taxane use. Sleep disorders, anxiety, and depression were assessed using diagnostic and prescription codes. Propensity score matching and Cox proportional hazard models were applied to adjust confounders and evaluate risk factors. Results: Among the 62,714 patients, those receiving endocrine therapy had a higher risk of sleep disorders (hazard ratio [HR], 1.276; 95% confidence interval [CI], 1.087–1.497; p = 0.003), irrespective of tamoxifen or aromatase inhibitor use. In chemotherapy-treated patients, taxane exposure significantly increased sleep disorder risk (HR, 1.268; 95% CI, 1.159–1.389; p < 0.001). The cumulative incidence of sleep disorders peaked within two years post treatment and remained elevated over time. Anxiety and depression rates did not differ significantly between the treatment groups. Conclusions: Endocrine therapy and taxane chemotherapy are independent risk factors for sleep disorders in patients with breast cancer. Screening and interventions are essential for improving long-term well-being. Future studies should explore personalized approaches for managing treatment-related sleep disturbance. Full article

Background: To overcome the gastrointestinal and hepatic toxicity of oral pirfenidone (PFD) in the treatment of idiopathic pulmonary fibrosis (IPF), this study systematically constructed a minimal-component, buffer-free pirfenidone aerosol inhalation solution (PFD-AIS), achieving lung-targeted delivery, reduced systemic exposure, and maintained antifibrotic efficacy. Methods: Analytical methods for PFD-AIS, covering content, related substances, aerodynamic particle size distribution (APSD), and delivered dose uniformity, were established. The prescription and preparation process of the formulation was optimized by evaluating its key quality attributes. Pharmacodynamic and pharmacokinetic evaluations of PFD-AIS were performed in a mouse lung-fibrosis model and SD rats. Results: The final specification of PFD-AIS was set to 40 mg:4 mL, containing 40 mg of PFD, 28 mg of sodium chloride, and 4 mL of injection water with a preparation process of 40 °C for 60 min and a pH range of 4–8. The PFD-AIS exhibited a fine particle fraction (FPF) of 56.1%, meeting the requirements for deep lung deposition. The delivered dose and delivery rate were 17.52 mg and 2.48 mg/min, respectively, both complying with inhalation formulation standards. In the bleomycin-induced IPF mouse model, the PFD-AIS markedly improved pulmonary fibrosis pathology, reduced the lung coefficient, and significantly lowered serum ALT/AST levels, indicating hepatic protection. In the SD rats, compared with oral dosing, PFD-AIS administration resulted in significantly lower AUC_0−t (−63%) and AUC_0–∞ (−67%) values, demonstrating a substantial reduction in systemic drug exposure. Conclusion: This work presents a complete, systematic chain—from formulation, process, and quality control to pharmacodynamics and pharmacokinetics—of a PFD-AIS. The PFD-AIS is effective and feasible, featuring a stable preparation process and controllable quality. Lung-directed drug delivery enhances PFD’s therapeutic efficacy, reduces systemic exposure and liver toxicity, and offers significant clinical advantages. Full article

Background: Despite widespread proton pump inhibitor (PPI) use in hemodialysis (HD), evidence on cancer risk in high-risk populations remains scarce. We investigated the association between PPI use and incident cancer in a population-based cohort of patients receiving HD. Methods: We used data from the 4th–7th HD quality assessments from South Korea and data linked to claims and death. We classified patients by PPI prescription over 1 year, including No-Prescription (no PPI during the year, n = 37,934); Short (PPI for <60 days, n = 9909); and Long (PPI for ≥60 days, n = 18,108) groups. Any cancer-free survival and overall survival by PPI use were evaluated. Results: The 5-year cancer-free rates for any cancer were 89.6%, 88.5%, and 88.1% in the No-Prescription, Short, and Long groups, respectively. The 5-year patient survival rate was 42.2%, 43.8%, and 40.3% in the No-Prescription, Short, and Long groups, respectively. Patients prescribed PPI had a higher cancer risk than those without a PPI prescription. However, survival among patients with cancer did not differ significantly across the three groups. The Long group had a higher risk of pancreatic and renal cancers than the other two groups. The No-Prescription group had lower risks of thyroid, prostate, and liver cancers than the other groups. Conclusions: In our study, long-term PPI use was associated with higher overall cancer risk, particularly pancreatic and renal cancers, compared with the No-Prescription group. Although PPI prescription did not significantly affect cancer-specific survival, the findings suggest that prolonged PPI use may contribute to cancer development in this population. Full article

Sedentary behavior contributes to obesity and metabolic dysfunction, yet few interventions individualize exercise intensity using fuel-based metrics such as the respiratory exchange ratio (RER; VCO₂/VO₂). This study investigated the effects of metabolically guided walking combined with whole-food, plant-based nutrition on body composition and metabolic outcomes in sedentary overweight and obese women. Forty-four women mean age 43 years; BMI 30.1 kg·m⁻²) were randomized to low-intensity continuous training (LICT; RER ≈ 0.75), moderate-intensity intermittent training (MIIT; RER ≈ 0.85), or high-intensity continuous training (HICT; RER ≈ 0.95). Following a 2-week dietary lead-in with an individualized ~200 kcal·day⁻¹ energy deficit, participants completed an 8-week RER-guided walking program (5 sessions·week⁻¹; 15–50 min·session⁻¹). Assessments included air-displacement plethysmography (BodPod) body composition, resting metabolic rate and substrate utilization, and oxygen uptake at the first ventilatory threshold (VT1). Data were analyzed using ANCOVA, mixed-factorial ANOVA, and Pearson correlations. Percent body fat decreased significantly across participants (p < 0.0001, η² = 0.827), with MIIT demonstrating the most favorable integrated outcomes. MIIT elicited the largest reductions in total body mass (−11.2%), fat mass (−25.9%), and percent body fat (−17.1%), alongside improvements in VT1 VO₂ (Δ = 1.487 ± 0.895 L·min⁻¹; p = 0.038). Resting respiratory quotient (RQ) declined in LICT and MIIT but increased in HICT, corresponding with increased fat oxidation in LICT and MIIT and reduced fat oxidation in HICT. Changes in RQ were significantly associated with changes in percent body fat (r = 0.316, p = 0.039). Metabolically guided moderate-intensity intermittent walking combined with whole-food, plant-based nutrition produced the most consistent improvements in adiposity, substrate utilization, and submaximal fitness, supporting the public-health feasibility of a community-deliverable, substrate-informed walking prescription. Full article

Respiratory infections represent one of the leading causes of pediatric consultations and hospitalizations in Chile, where rapid etiological identification is essential for clinical decision-making. We evaluated the impact of implementing the BIOFIRE^® SPOTFIRE^® Respiratory (R) Panel in the pediatric Emergency Department of a public referral hospital in Santiago, using a pre–post cross-sectional design comparing two winter periods (July 2023 vs. July 2024). Clinical records, laboratory data, and operational indicators were analyzed to assess changes in diagnostic yield, turnaround time, hospitalizations, discharges, supplementary test requests, and antimicrobial use. A total of 470 patients were included (224 in 2023; 246 in 2024). The etiological detection rate increased from 58.0% to 87.8% after the implementation of Spotfire^® (p < 0.0001), with marked increases in the identification of adenovirus, RSV, rhinovirus/enterovirus, and seasonal coronaviruses. Rapid molecular testing was associated with a significant rise in emergency department discharges (23.7% vs. 57.3%; p < 0.0001) and a reduction in hospitalizations (76.3% vs. 42.7%; p < 0.0001) and readmissions (9.2% vs. 0.5%; p < 0.0001). Requests for complete blood counts, chest X-rays, and antimicrobial prescriptions at discharge also decreased significantly. These effects persisted in key subgroups, including infants and children with comorbidities. In this high-demand winter setting, the BIOFIRE^® SPOTFIRE^® R Panel improved diagnostic performance and supported more efficient and targeted clinical management. Full article

Background: China’s rapidly aging population demonstrates the importance of conducting an accurate resting metabolic rate (RMR, kcal/day) assessment to mitigate geriatric nutritional imbalances—amid concurrent undernutrition (e.g., ~1/3 with protein insufficiency) and overnutrition (e.g., high obesity and type 2 diabetes rates). While RMR prediction equations exist for other populations, none are specific to Chinese older adults. This study aimed to develop and validate population-specific RMR prediction equations for community-dwelling Chinese older adults. Methods: A total of 189 healthy participants (Aged 69.5 ± 6.3, range: 60–94 years; BMI: 24.0 ± 3.1 kg/m²) were recruited from the Shanghai, China, community. RMR was measured via indirect calorimetry, and body composition via dual-energy X-ray absorptiometry. Results: Two novel prediction equations were derived: Cai1 (fat-free mass [FFM] + age): RMR = 1393.019 − (11.112 × age) + (11.963 × FFM); R² = 0.572, and Cai2 (sex + age + weight [WT]): RMR = 1537.513 + (91.038 × sex) − (11.515 × age) + (5.436 × WT); R² = 0.528. Both novel prediction equations achieved 82.5% adequacy (predicted RMR within 90–110% of measured values), minimal systematic bias (%) (−0.72% and −1.08%) and strong positive correlations with measured RMR (r = 0.792 and 0.773, both p < 0.001). Bland–Altman analysis confirmed no systematic bias. In contrast, 11 widely used published prediction equations (e.g., Harris–Benedict, Mifflin–St. Jeor) exhibited significant overestimation (systematic bias +8.39% to +38.03%). Conclusions: The novel population-specific RMR equations outperform published ones, providing a clinically reliable tool for individualized energy prescription in nutritional interventions to support healthy aging in Chinese older adults. Full article

Background: Cholinesterase inhibitors (ChEIs) are commonly prescribed for the treatment of Alzheimer’s disease (AD) and achieve long-term benefits for cognition and survival in real-world settings. However, the discontinuation rate is high due to their side effects, with gastrointestinal (GI) symptoms hampering long-term prescriptions. The risk of side effects associated with rivastigmine was previously shown to be lower with transdermal delivery than with oral capsules; however, this has yet to be examined in detail for donepezil, the most widely used ChEI. The daily application of a donepezil transdermal patch was officially approved in Japan in 2023. The incidence of side effects was lower with the donepezil transdermal patch than with oral donepezil in healthy volunteers, but has not yet been assessed in clinical settings. Results: We herein report three AD patients in two different memory clinics who developed GI symptoms with oral ChEIs that were attenuated by switching to the donepezil transdermal patch. Conclusions: The donepezil transdermal patch may improve tolerability and adherence in patients who develop gastrointestinal adverse effects with oral donepezil. Full article

Background: Approximately half of U.S. adults have ≥1 cardiovascular disease (CVD) risk factors. Exercise is universally recommended as a first-line lifestyle therapy to prevent and treat CVD. Objective: We will conduct a feasibility and pilot efficacy randomized controlled trial to test the usability and user satisfaction of an evidence-based digital health tool we developed for physicians—the Prioritizes Personalizes Prescribes EXercise algorithm (P3-EX)—to treat patients with CVD risk factors (ClinicalTrials.gov: NCT07238556). Methods: We will recruit 24 physicians who do not prescribe written exercise prescriptions (ExRx) from two local CT hospitals. Physicians will recruit two patients each (N = 48); both patients must have CVD risk factors. Each physician will deliver a P3-EX ExRx to one patient (n = 24) and the Physical Activity Vital Sign ExRx to the other patient (n = 24) in a random sequence crossover design. Physicians and patients will rate the feasibility and acceptability of each ExRx method using validated questionnaires. Patients will perform their ExRx for 12 weeks and complete an exercise diary to monitor exercise adherence with weekly virtual oversight by Research Assistants. Before and after the exercise intervention, we will measure patient CVD risk factors and physical activity levels via accelerometry. Results: This trial has received Institutional Review Board approval (E-HHC-2025-0198) and will begin in January 2026, with findings published in 2027. Conclusions: This protocol provides the scientific rationale and methodology to test P3-EX within a real-world clinical setting, to inform the feasibility of using P3-EX as a digital health support tool by physicians, and preliminary efficacy of P3-EX to improve patient cardiovascular health and physical activity levels. Full article

Aging involves progressive changes in sensory perception, appetite regulation, and metabolic flexibility, which together affect dietary intake, nutrient adequacy, and health-related outcomes. Meanwhile, current wearable technologies allow continuous, minimally invasive monitoring of physiological and behavioral markers relevant to metabolic health, such as physical activity, sleep, heart rate variability, glycemic patterns, and so forth. However, digital nutrition approaches have largely focused on physiological signals while underutilizing the sensory dimensions of eating—taste, smell, texture, and hedonic response—that strongly drive dietary intake and adherence. This narrative review synthesizes evidence on the following: (1) age-related sensory changes and their nutritional consequences, (2) metabolic adaptation and markers of resilience in older adults, and (3) current and emerging wearable technologies applicable to nutritional personalization. Following this, we propose an integrative framework linking subjective (implicit) sensory perception and objective (explicit) wearable-derived physiological responses into adaptive feedback loops to support personalized dietary strategies for healthy aging. In this light, we discuss practical applications, technological and methodological challenges, ethical considerations, and research priorities to validate and implement sensory–physiological integrated models. Merging together sensory science and wearable monitoring has the potential to enhance adherence, preserve nutritional status, and bolster metabolic resilience in aging populations, moving nutrition from one-size-fits-all prescriptions toward dynamic, person-centered, sensory-aware interventions. Full article

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

Background: Nintedanib and pirfenidone are two anti-fibrotic agents for diseases within the interstitial lung diseases (ILDs) spectrum. Here, we provide a comprehensive analysis regarding treatment persistence and adherence rates for the Greek territory. Methods: This was a retrospective cohort study of patients initiating anti-fibrotic treatment during the period 2019–2023, utilizing data extracted from the National Electronic Prescription Database. Treatment persistence was defined as the duration from the date of the first prescription to the end of follow-up, death, or switching to another agent. Adherence was estimated based on the Medication Possession Ratio (MPR) metric. Results: Overall, 2112 patients were analyzed. The majority were naive, male patients with a diagnosis of idiopathic pulmonary fibrosis (IPF). The overall median treatment persistence was 40.2 months (95% CI: 35.5–44.6). Women and treatment-naive patients demonstrated longer median treatment persistence compared to their counterparts, while older patients demonstrated the lowest median persistence rates. Adherence levels remained high across the follow-up period (90%). Diagnosis of IPF and gastrointestinal comorbidities were associated with a higher risk of discontinuation. Conclusions: We have generated novel data concerning the factors that affect patients’ outcomes under anti-fibrotic therapy. These findings may provide helpful insights for the therapeutic management of ILDs. Full article

Background/Objectives: Adults with intellectual disability (ID) experience high rates of psychiatric comorbidity but often face diagnostic challenges and treatment barriers, leading to inappropriate psychotropic medication use. This study examined the extent to which specialized psychiatric assessment and improved diagnostic accuracy had an impact on medication management and clinical outcomes in adults with ID and co-occurring psychiatric disorders. Methods: This observational retrospective study analyzed medical records from 25 adults with ID who underwent specialized psychiatric assessment at a community-based service in Italy between January 2023 and January 2024. Psychopathological diagnoses were established according to Diagnostic Manual—Intellectual Disability, Second Edition (DM-ID2) criteria, based on clinical observation and a comprehensive assessment using validated instruments. Clinical outcomes were assessed using a psychometric tool encompassing multiple psychopathological and behavioral dimensions. Data on psychotropic prescriptions and side effects were also collected. Non-parametric analyses were performed, with significance set at α = 0.05. Results: The proportion of patients with a psychiatric diagnosis increased from 32% to 96% after specialized assessment (p < 0.001), with notable rises in depressive (0% to 32%), bipolar (8% to 36%), anxiety (4% to 24%), and impulse control (0% to 16%) disorders. First-generation antipsychotic prescriptions decreased (from 36% to 8%, p = 0.023), while antidepressant use increased (from 12% to 52%, p = 0.004). The mean number of side effects per patient declined from 1.6 to 0.5 (p < 0.001), particularly the elevated prolactin level and psychomotor retardation. Significant improvements were observed in symptom intensity and frequency across multiple domains, including aggression, mood disturbances, and compulsions (p < 0.001). Conclusions: In this single-center retrospective study, specialized psychiatric assessment was associated with improved diagnostic accuracy, medication management, and clinical outcomes in adults with ID. The increase in psychiatric diagnoses likely reflects improved identification, addressing key challenges in precision diagnosis for people with neurodevelopmental disorders. Although the overall number of prescribed medications remained stable, optimization of treatment regimens reduced first-generation antipsychotic use and related adverse effects. These findings indicates that access to specialized assessment and precision diagnosis could improve psychopharmacological interventions and outcomes for this vulnerable population, but larger, multi-center and longer-term studies are needed to confirm these results. Full article