Search Results (1,084)

Background/Objectives: The aim of this study was to assess the short-term and long-term effectiveness of group voice therapy in changing vocal behaviour and improving voice quality (VQ) among teachers with hyperfunctional voice disorders (HFVD), using both subjective and objective measures. Methods: Thirty-one teachers participated in a structured group voice therapy programme. Participants underwent videoendostroboscopic evaluation of laryngeal morphology and function, perceptual assessment of voice, acoustic analysis of voice samples, and aerodynamic measurements of phonation. Patients’ self-assessment of VQ and its impact on quality of life were measured using a Visual Analogue Scale (VAS) and the Voice Handicap Index-30 (VHI-30). Evaluations were conducted at four time points: pre-therapy (T0), immediately post-therapy (T1), and at 3-month (T3) and 12-month (T12) follow-up visits. Results: Significant improvement was observed between T0 and T1 in perceptual voice evaluations: grade, roughness, asthenia, strain, loudness, fast speaking rate, as well as in neck muscle tension, shimmer, patients’ most harmful vocal behaviours, VHI-30 scores, patients VQ evaluation, and its impact on quality of life (all p < 0.05). Almost all parameters of subjective and objective voice assessment improved over the 12-month observation period, with the greatest improvement between T0 and T12 (all p < 0.05), indicating lasting reduced laryngeal tension and improved phonatory efficiency. Conclusions: Group voice therapy has been shown to be an effective treatment for teachers with HFVD, leading to significant and long-lasting improvements in perceptual, acoustic, and self-assessment outcomes. Therapy also promoted healthier vocal and lifestyle behaviours, supporting its role as a successful and cost-effective rehabilitation and prevention method for occupational voice disorders. Full article

Suicide in children and young adults is a leading cause of premature mortality, and there is a need to develop a more profound understanding of the factors that contribute to these deaths. This study is part of the nationwide Retrospective Investigation of Health Care Utilization in Individuals who died by Suicide in Sweden 2015, conducted at Lund University, Sweden. The aim was to examine symptoms and diagnoses in children and young adults who died by suicide, as documented in their medical records at their last visits for primary care, somatic specialist care, or psychiatric care 24 months prior to suicide, and to apply contemporary psychological research in youth suicidality to the findings to formulate clinical implications. The proportions of symptoms and diagnoses in children (0–17 years), young adults (18–24 years), males, and females are described. The main symptoms noted in the cohort were depressive symptoms (28%), anxiety symptoms (26%), and pain (25%). The diagnoses predominately covered mental and behavioural disorders, and the most frequent of the mental and behavioural diagnoses were neurotic, stress-related, and somatoform disorders (32%) and mood (affective) disorders (29%). The diagnoses and symptoms were not sufficient to uncover suicidality in children and young adults. The clinical implications for alternative assessments and preventive interventions are discussed. Full article

Background and Clinical Significance: Furuncular myiasis is a tropical parasitic skin infestation caused by dipterous fly larvae, most commonly affecting travellers to endemic regions. While returning travellers typically present with one or few lesions, extensive parasitism is rare. Increased global mobility and expanding ecological range of myiasis-causing species underscores the need for clinicians in endemic and non-endemic regions to recognise, diagnose, and manage this condition promptly. Awareness of exposure risks—including soil contact, infested clothing, and poor living conditions—is essential to reducing morbidity and preventing complications like secondary bacterial infection. Case Presentation: A healthy male in his forties returned to the UK after a month-long visit to rural Ethiopia, during which he slept on dirt floors and hung his washing on a line. He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement. The patient self-extracted 12 larvae in Ethiopia and subsequently sought local medical attention, receiving Albendazole, after which emerging larvae were non-motile. On UK presentation, he had 27 lesions at varying stages, 3 with signs of secondary infection. Laboratory investigations revealed elevated inflammatory markers, and wound swabs grew scanty Streptococcus pyogenes. Management included wound occlusion and systemic antibiotics. No further larvae were retrieved, precluding definitive speciation. All lesions improved over subsequent reviews. Conclusions: This case illustrates an unusually extensive presentation of presumed Cordylobia spp. myiasis in a returning traveller, highlighting potential complications following larvicidal therapy. Clinicians should maintain a high index of suspicion for myiasis in patients with compatible cutaneous lesions and relevant history. Increasing travel and shifting vector distributions make familiarity with tropical dermatoses and provision of effective safety measures essential in clinical practice. Full article

This narrative review examines how immersive virtual and mixed-reality (VR/MR) technologies, combined with AI-driven virtual agents, can support the prevention and long-term management of chronic illness. Chronic diseases represent a significant global health burden, and conventional care models often struggle to sustain patient engagement, motivation, and adherence over time. To address this gap, we conducted a narrative review of reviews and meta-analyses. We selected empirical studies published between 2020 and 2025, identified through searches in PubMed, Web of Science, and Google Scholar. The aim was to capture the state of the art in the integrated use of VR/MR and AI in chronic illness care, and to identify key opportunities, challenges, and considerations relevant to clinical practice. The reviewed evidence indicates that VR/MR interventions consistently enhance engagement, motivation, symptom coping, and emotional well-being, particularly in rehabilitation, pain management, and psychoeducation. At the same time, AI-driven conversational agents and virtual therapists add adaptive feedback, personalization, real-time monitoring, and continuity of care between clinical visits. However, persistent challenges are also reported, including technical limitations such as latency and system dependence, ethical concerns related to data privacy and algorithmic bias, as well as psychosocial risks such as emotional overattachment or discomfort arising from avatar design. Overall, the findings suggest that the most significant clinical value emerges when VR/MR and AI are deployed together rather than in isolation. When implemented with patient-centered design, clinician oversight, and transparent governance, these technologies can meaningfully support more engaging, personalized, and sustainable chronic illness management. Full article

Objective: This is the first population-based study to separately examine whether preventive and treatment dental visits modify the association between stressful life events and toothache. Psychological stress may alter health-seeking behaviors and pain perception, potentially leading to symptom-driven rather than preventive dental visits. Methods: Cross-sectional data were obtained and analyzed from the 2019 wave of the Japan Gerontological Evaluation Study (JAGES), including 19,314 community-dwelling adults aged 65 years and older. Poisson regression analyses were conducted to examine the associations between stressful life events, dental visit history, and self-reported toothache. Results: Higher stressful life events were associated with greater toothache prevalence (PR = 1.189; 95% CI: 1.117–1.264). Preventive dental visits within the past six months were linked to the lowest risk, whereas recent treatment visits were associated with higher risk. Conclusion: Promoting regular preventive dental visits, particularly among individuals under high stress, may help reduce the likelihood of experiencing toothache among older adults. Full article

Access to healthcare is a crucial factor in achieving health equity. In rural South Africa, geographical isolation and inadequate transportation systems continue to hinder access to healthcare services, despite the existence of progressive national health policies. This study examines the impact of transportation on healthcare access in Mt Elias, uMshwathi Municipality, KwaZulu-Natal. Using a qualitative, exploratory design, semi-structured interviews were conducted with 52 community members. The data were analyzed thematically using ATLAS.ti. The findings reveal several structural barriers, including high transportation costs, long distances to clinics, unreliable ambulance services, poorly maintained roads, and unsafe travel conditions. In Mt. Elias, even when mobile clinics are available, their infrequent visits and fixed locations prevent access for individuals who are sick or those with a disability or living in widely scattered homesteads. Access to healthcare in rural communities is fundamentally shaped by transportation. To achieve universal health coverage, it is essential to improve rural road infrastructure, expand mobile clinic services, subsidize transportation costs, and integrate transportation planning into healthcare policies. Addressing these transportation barriers is not only a matter of service delivery but also of equity, justice, and human rights. Full article

Background/Objectives: Cardiovascular (CV) diseases remain the leading cause of morbidity and mortality across Europe. Despite substantial progress in prevention, diagnostics, and therapeutics, outpatient cardiology care continues to face systemic challenges, including limited consultation time, workforce constraints, and incomplete clinical information at the point of care. The primary objective of this study is threefold. First, to evaluate whether AI-enhanced telemedicine improves clinical control of hypertension, dyslipidemia, and heart failure compared to standard ambulatory care. Second, to assess the impact on physician workflow efficiency and documentation burden through AI-assisted clinical documentation. Third, to determine patient satisfaction and safety profiles of integrated telemedicine–AI systems. Clinical control will be measured by a composite endpoint of disease-specific targets assessed at the 12-month follow-up visit. Methods: The TeleAI-CVD Concept Study aims to evaluate the integration of telemedicine and artificial intelligence (AI) to enhance the efficiency, quality, and individualization of cardiovascular disease management in the ambulatory setting. Within this framework, AI-driven tools will be employed to collect structured clinical histories and current symptomatology from patients prior to outpatient visits using digital questionnaires and conversational interfaces. Results: Obtained data, combined with telemonitoring metrics, laboratory parameters, and existing clinical records, will be synthesized to support clinical decision-making. Conclusions: This approach is expected to streamline consultations, increase diagnostic accuracy, and enable personalized, data-driven care through continuous evaluation of patient trajectories. The anticipated outcomes of the TeleAI-CVD study include the development of optimized, AI-assisted management protocols for cardiology patients, a reduction in unnecessary in-person visits through effective telemedicine-based follow-up, and accelerated attainment of therapeutic targets. Ultimately, this concept seeks to redefine the paradigm of outpatient cardiovascular care by embedding advanced digital technologies within routine clinical workflows. Full article

Background/Objectives: Longitudinal metabolomics analysis offers valuable insights into how metabolic pathways change according to age and health status. However, metabolite levels can fluctuate due to biological factors (e.g., age, diet, and health status) and technical factors (e.g., sample handling, storage times, and instrument performance), with some metabolites exhibiting greater sensitivity to these sources of variability than others. This study aimed to characterize the longitudinal and technical stability of untargeted plasma and cerebrospinal fluid (CSF) metabolites and to identify a subset that remains reliable over the extended time scales required for epidemiological research. Methods: Untargeted ultrahigh-performance liquid chromatography–mass spectrometry (LC-MS) metabolomic profiles were available from multiple visits in the Wisconsin Registry for Alzheimer’s Prevention (WRAP) and Wisconsin Alzheimer’s Disease Research Center (ADRC) studies. For this analysis, we constructed a subset of generally healthy participants with samples drawn at four time points (~2.5 years apart): two visits analyzed in 2017 and two visits analyzed in 2023, corresponding to two distinct analytical waves. We computed Rothery’s intraclass correlation coefficients (ICCs) to quantify intra-wave and inter-wave stability, evaluated pooled quality-control (QC) variation, classified metabolite stability by established thresholds, and developed a composite score integrating longitudinal stability and susceptibility to technical variance. Results: Across all metabolites, median stability was classified as ‘fair’ (Rothery’s ρ > 0.40 to ≤0.75) for both plasma and CSF. Although analytical batches were bridged using pooled QC samples, inter-wave stability was significantly lower than intra-wave stability, reflecting increased technical variability across waves. Using the composite score, we identified subsets of metabolites with ‘excellent’ stability and low susceptibility to batch effects in plasma and CSF. Stability patterns varied across biochemical super pathways. Conclusions: This work highlights metabolites suitable for long-term epidemiological studies and informs experimental design and analytical strategies for combining data across cohorts and analytical batches. Full article

This study aimed to identify and evaluate the risk factors associated with Giardia spp. infection among generally hospitalized patients with various conditions specific to infectious diseases in Western Romania. A total of 312 patients, ranging in age from 2 months to 90 years and originating from both urban and rural settings, were included in the analysis. Fecal specimens were collected and analyzed using the Rapid-VIDITEST Crypto Giardia antigen test, a qualitative chromatographic assay for the detection of Giardia spp. Infection-related risk factors were assessed through a standardized questionnaire completed by adult patients or by the guardians of pediatric patients. The overall prevalence of Giardia spp. infection was 4.8%. Of the risk factors analyzed, only age demonstrated a statistically significant association with infection status (p < 0.05). Notably, the highest prevalence (12.5%) was recorded in the <1-year age group (2–11 months), with a marked decrease in prevalence observed among patients aged ≥60 years. Other evaluated risk factors—including area of residence, gender, contact with animals, pet ownership, hand hygiene after animal contact, type of housing (house or apartment), fruit washing practices, use of potable water, use of public transportation, international travel, and visits to playgrounds or swimming pools—did not show a statistically significant association with Giardia spp. infection among the study participants. The lack of statistical significance for several expected factors may be related to limited statistical power resulting from the low number of positive cases. These findings contribute to the current understanding of Giardia spp. transmission dynamics and may inform future research efforts aimed at elucidating relevant risk factors. Furthermore, the results may support the development of targeted public health interventions (focusing on infants and their caregivers) and prevention strategies. Full article

Background/Objectives: This study aimed to examine awareness and behaviors related to injury prevention in the home among community-dwelling older adults according to age and gender. Methods: In this cross-sectional descriptive study, 299 adults aged ≥65 years who visited 10 senior welfare centers in Korea were included. Data were collected through structured face-to-face interviews using a questionnaire assessing general characteristics, awareness, and behaviors related to home injury prevention. Descriptive statistics, the chi-squared test, independent t-test, and one-way analysis of variance were used for data analysis. Results: Levels of interest in home injuries and awareness of first aid differed significantly by age and gender. The possession of a home emergency kit and participation in regular health check-ups varied by age, while the intention to participate in injury-prevention education differed by gender. Overall, female participants demonstrated higher levels of injury-prevention behavior than male participants. Conclusions: Older adults showed lower awareness and practice of specific home injury–prevention strategies, while women exhibited greater awareness and preventive behaviors than men. These findings suggest that tailored home injury–prevention interventions that consider age and gender characteristics may yield more effective and positive outcomes. Full article

Pre-eclampsia affects several physiological systems, often changing the course of pregnancy and manifesting with both maternal and foetal adversities, with a higher burden in rural Sub-Saharan African settings. This study presents maternal and foetal adverse outcomes associated with pre-eclampsia at a rural tertiary hospital in the Eastern Cape Province of South Africa. A prospective analytical case-control study was conducted with 250 pregnant women planned for delivery at the study setting’s labour unit. Pregnant women with pre-eclampsia were considered cases, whereas pregnant women without pre-eclampsia were considered controls. Cases were enrolled first, followed by a matched pair of controls based on their gravidity. A consecutive sampling technique was used to recruit eligible cases and controls. Data was collected using a self-designed questionnaire followed by descriptive and inferential analysis. Adverse foetal outcomes associated with pre-eclampsia were low birth weight [Adjusted odds ratio (AOR) = 2.1, p = 0.006] and foetal distress (AOR = 2.5, p < 0.001). Maternal outcomes associated with pre-eclampsia were haemolysis, elevated liver enzymes, and low platelets syndrome (AOR = 42.7, p < 0.001), as well as preterm delivery (AOR = 3.0, p = 0.001). Early antenatal visits, continuous monitoring of pre-eclamptic pregnant women, and implementation of preventive and curative measures to reduce the possibilities of this condition and its adverse outcomes are needed. Full article

Background: Antipsychotic medication (APM) can cause weight gain, insulin resistance, dyslipidemias, and an increased risk of developing type-2 diabetes and cardiovascular disease among youth. The study sought to increase water consumption, reduce sugar-sweetened beverage (SSB) intake, and prevent unhealthy weight gain via a healthy lifestyle intervention among youth newly started on a second-generation APM for psychiatric treatment. Methods: This randomized controlled trial enrolled 148 Medicaid-insured youth (ages 8–17) recently starting APM. The treatment group received both a biweekly home-delivery of bottled water and parental phone support from a family navigator. In-home visits conducted at baseline, three months, and six months assessed the participants’ height/weight and dietary intake. All participants received basic healthy lifestyle education emphasizing increased water intake and decreased SSB consumption. Longitudinal linear mixed models were conducted to examine between-group and within-group changes in BMI z-scores, and water/SSB intake. Results: No significant between-group differences in BMI z-score were found at three (p = 0.908) and six months (p = 0.919). However, the within-group increase in BMI z-score in the control group was significant from baseline to three months (p = 0.029). A between-group comparison found the treatment group significantly increased their water intake at three (p = 0.006) and six months (p = 0.002). No between-group differences were identified at three and six months for the reduction in SSB, although the treatment group did demonstrate a decrease from baseline to three months (p = 0.004). Conclusions: Neither group experienced unhealthy increases (>0.5%) in BMI z-score over the six months. Providing a safe/free water supply showed a superior improvement in water consumption in the treatment group, and an initial decrease in SSB. Further studies are needed to identify feasible, effective, and sustainable lifestyle interventions tailored to this at-risk population. Full article

Background and Objectives: Sjögren’s syndrome (SS) causes destructive salivary gland dysfunction with substantial oral morbidity. To synthesize practical, evidence-based approaches for early recognition, initial oral management, and timely referral to dental care. Materials and Methods: Narrative review of English-language literature from the Web of Science Core Collection and PubMed, prioritizing systematic reviews, randomized trials, and consensus guidelines. Results: Early oral signs include rapid multifocal root and cervical caries, burning sensations, and rising dental treatment needs. Unstimulated whole saliva ≤ 0.1 mL/min supports significant hypofunction and complements the 2016 ACR/EULAR criteria. Preventive care should combine dietary counseling, salivary stimulation, and topical remineralization. Adjuncts include high-fluoride toothpaste, biomimetic hydroxyapatite dentifrices, and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP). However, evidence for fluoride varnish in SS remains mixed. Pharmacologic sialogogues require screening for contraindications. Conclusions: Embedding oral screening, simple salivary metrics, and a structured referral pathway into rheumatology visits can reduce preventable tooth loss and improve comfort, function, and treatment adherence. Full article

Background: Referrals to the Stroke prevention clinic with incomplete preliminary investigations decrease clinic capacity due to additional workload and the need for multiple follow-ups. We aimed to improve the efficacy of the initial visit by increasing the completion rate of vascular imaging in a quality improvement (QI) project. Methods: This is a quasi-experimental study with three phases: Phase 1: Surveillance; Phase 2: Stakeholder feedback-informed intervention development (physicians and clinic staff); and Phase 3: Intervention. Interventions included a new standardized specific physician triage form listing required investigations (brain imaging, vascular imaging, cardiac tracing), and a nurse-led pre-visit via telephone. The primary outcome measure was the completion of vascular imaging by the time of visit, assessed using multivariable logistic regression adjusted for age (in years), sex, and triage category. Results: The study’s inclusion criteria were met by 397 patients, with a mean age of 67.7 ± 13.2 years; 47.8% were female, and 62.9% (250) were diagnosed with vascular events. An increase in vascular imaging before the initial visit was observed in Phase 3 (148/199, 75.5%) compared to Phase 1 (121/198, 61.1%), with an adjusted Odds ratio of 1.77 (95% CI 1.2–2.8; p = 0.01). A trend toward fewer follow-up visits was observed in Phase 3 (23.1%) compared with Phase 1 (31.8%; p = 0.052). Conclusions: Implementing a standardized triage process and a nurse-led pre-visit may improve completion of vascular imaging before patients visit the stroke prevention clinic. Further QI studies are required to improve the completion rate of rhythm monitoring in this patient group to enable early detection and management of atrial fibrillation. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent among adolescents, especially those with obesity. It is the leading cause of liver-related morbidity and mortality and can progress to metabolic dysfunction-associated steatohepatitis, and eventually irreversible cirrhosis. There is currently no medical treatment recommended for MASLD in adolescents. Nutritional interventions, such as polyphenol supplementation, could be a non-pharmacological option to improve metabolic outcomes. Objectives: This pilot study aimed to preliminarily assess the impact of a 60-day polyphenol supplementation on measured resting energy expenditure (mREE) by indirect calorimetry (IC) in adolescents with MASLD. It also compared mREE by IC with predicted resting energy expenditure (pREE) using the WHO and Schofield formulae. Methods: This single-blind randomized controlled trial enrolled 23 adolescents with MASLD, of which 11 completed IC assessments before and after the 60-day polyphenol supplementation (intervention group, n = 5) or no supplementation (controls, n = 6). There was no placebo. Caloric intake was assessed to evaluate its impact on mREE and mREE was compared to pREE using the WHO and Schofield equations. Results: Participants in the intervention group had a statistically significant increase in mREE between the two visits (+89.6 kcal/day, p = 0.037), while no difference was found in the control group. When compared to the control group, the intervention group had a greater variation in mREE between visits (+100.4 kcal/day, p = 0.021). No significant changes were observed when adjusting mREE for body weight. Also, there were no significant changes in body weight in the two groups between the visits. Both the WHO and Schofield equations overestimated pREE with an average percentage of pREE of 88.8% and 91.0%, respectively. Conclusions: Although several methodological limitations prevent clear conclusions from being drawn at this stage, this study suggests that polyphenol supplementation could increase REE in adolescents with MASLD and that the WHO and Schofield equations tend to overestimate REE in obese patients. Full article