Search Results (297)

Introduction: Falls are the leading cause of Emergency Department (ED) presentations among residents from residential aged care facilities (RACFs). While most current studies focus on post-fall evaluations and fall prevention, limited research has been conducted on decision-making in post-fall management. Objective: To develop and internally validate a model that can predict the likelihood of RACF residents being discharged from the ED after being presented for a fall. Methods: The study sample was obtained from a previous study conducted in Shepparton, Victoria, Australia. Consecutive samples were selected from January 2023 to November 2023. Participants aged 65 and over were included in this study. Results: A total of 261 fall presentations were initially identified. One patient with Australasian Triage Scale category 1 was excluded to avoid overfitting, leaving 260 presentations for analysis. Two logistic regression models were developed using prehospital and ED variables. The ED predictor model variables included duration of ED stay, injury severity, and the presence of an advance care directive (ACD). It demonstrated excellent discrimination (AUROC = 0.83; 95% CI: 0.79–0.89) compared to the prehospital model (AUROC = 0.77, 95% CI: 0.72–0.83). A simplified four-variable Discharge Eligibility after Fall in Elderly Residents (DEFER) score was derived from the prehospital model. The score achieved an AUROC of 0.76 (95% CI: 0.71–0.82). At a cut-off score of ≥5, the DEFER score exhibited a sensitivity of 79.7%, a specificity of 60.3%, a diagnostic odds ratio of 5.96, and a positive predictive value of 85.0%. Conclusions: The DEFER score is the first validated discharge prediction model for residents of RACFs who present to the ED after a fall. Importantly, the DEFER score advances personalised medicine in emergency care by integrating patient-specific factors, such as ACDs, to guide individualised discharge decisions for post-fall residents from RACFs. Full article

Vegetables and fruits grown in urban areas pose a potential threat to human health due to contamination with heavy metals (HMs). This study aimed to identify and quantify the concentrations of heavy metals (Fe, Mn, Zn, Cu, Pb, Cd) in tomatoes, leafy vegetables, and fruits collected from 16 allotment gardens (AGs) located in Warsaw. A total of 112 samples were analyzed (72 vegetable and 40 fruit samples). Vegetables from AGs accumulated significantly higher levels of HMs than fruits. Leafy vegetables, particularly those cultivated near high-traffic roads, exhibited markedly elevated levels of Pb, Cd, and Zn compared to those grown in peripheral areas. Lead concentrations exceeded permissible limits by six to twelve times, cadmium by one to thirteen times, and zinc by 0.7 to 2.4 times. Due to high levels of Pb and Cd, tomatoes should not be cultivated in urban environments. Regardless of location, only trace amounts of HMs were detected in fruits. The greatest health risk is associated with the consumption of leafy vegetables. Lettuce should be considered an indicator plant for assessing environmental contamination. The obtained Hazard Index (HI) values indicate that only the tested fruits are safe for consumption. Meanwhile, the values of the Hazard Quotient (HQ) indicate no health risk associated with the consumption of lettuce, cherries, and red currants. Among the analyzed elements, Pb showed a higher potential health risk than other metals. This study emphasizes the need for continuous monitoring of HM levels in urban soils and the establishment of baseline values for public health purposes. Remediation of contaminated soils and the implementation of safer agricultural practices are recommended to reduce the exposure of urban populations to the risks associated with the consumption of contaminated produce. In addition, the safety of fruits and vegetables grown in urban areas is influenced by the location of the AGs and the level of industrialization of the agglomeration. Therefore, the safety assessment of plant products derived from AGs should be monitored on a continuous basis, especially in vegetables. Full article

Background: Falls in residential aged care facilities (RACFs) have a significant impact, often leading to costly and unnecessary emergency department (ED) transfers. This scoping review examined the ED discharge proportions and patient characteristics of RACF residents presenting to the ED following a fall, to identify factors that could reduce unnecessary ED transfers. Methods: The databases MEDLINE, CINAHL, Scopus, and Web of Science were searched, resulting in an initial 1385 articles. Nine of these articles met the inclusion criteria and were included in this review. Results: The median age of patients reported in the nine papers ranged from 80.8 to 88 years. Discharge proportions from ED back to RACF ranged from 36% to 91%, with an average of 63%. The studies that reported on computed tomography of the brain (CTB) showed that CTB findings did not significantly influence discharge decisions. Conclusions: Many RACF residents transferred to EDs following falls are discharged without hospital admission. The heterogeneity of study methods makes it challenging to draw definitive conclusions about factors that may help identify patient groups that do not require transfer to the ED following a fall. However, this scoping review highlights potential opportunities to reduce ED transfers from RCAFs. These findings highlight a need for geriatric-specific, person-centred protocols that reduce unnecessary ED transfers while safeguarding quality of care and respecting residents’ advance care preferences. Full article

Introduction: Air pollution is a risk factor for a variety of cardiopulmonary diseases and is a contributing factor to cancer, diabetes, and cognitive impairment. The impact on mortality is not clearly elucidated. Objectives: The goal of this study is to determine the impact (if any) of air pollution on the 5-year mortality of patients in the American Family Cohort (AFC) dataset. Methods: The AFC dataset is derived from the American Board of Family Medicine PRIME Registry electronic health record data. It includes longitudinal information from 6.6 million unique patients from an estimated 800 primary care practices across 47 states, with 40% coming from rural areas. The Environmental Protection Agency’s Air Quality Index (AQI) measures were downloaded for the study period (2016–2022). Using the Python library pandas, the AFC and EPA datasets were merged with respect to date, time, and location. Cox Regression Models were performed on the merged dataset to determine the impact (if any) of air quality on patients’ five-year survival. In the model, AQI was handled as a time-independent (time-fixed) covariate. Results: The group with AQI > 50 had an adjusted hazard of death that was 4.02 times higher than the hazard of death in the group with AQI ≤ 50 (95% CI: 3.36, 4.82, p < 0.05). The hazard of death was 6.73 times higher in persons older than 80 years of age (95% CI: 5.47, 8.28; p < 0.05) compared to those younger than 80 years of age. Black/African American patients had a 4.27 times higher hazard of death (95%CI: 3.47, 5.26; p < 0.05) compared to other races. We also found that regional effects played a role in survival. Conclusions: Poor air quality was associated with a higher hazard of mortality, and this phenomenon was particularly pronounced in Black/African American patients and patients older than 80 years of age. Air pollution is an important social determinant of health. Public health initiatives that improve air quality are necessary to improve health outcomes. Full article

Background/Objectives: This study aimed to evaluate a regional implementation project for rural emergency care (RuralRescue) and to examine how its components and outcomes may support personalized approaches in emergency medicine. While not originally designed as a personalized medicine intervention, the project combined digital, educational, and organizational innovations that enable patient-specific adaptation of care processes. Methods: Conducted in the rural district of Vorpommern-Greifswald (Mecklenburg–Western Pomerania, Germany), the intervention included (1) standardized cardiopulmonary resuscitation (CPR) training for laypersons, (2) a geolocation-based first responder app for medically trained volunteers, and (3) integration of a tele-emergency physician (TEP) system with prehospital emergency medical services (EMSs). A multi-perspective pre–post evaluation covered medical, economic, and organizational dimensions. Primary and secondary outcomes included bystander CPR rates, responder arrival times, telemedical triage decisions, diagnostic concordance, hospital transport avoidance, economic simulations, workload, and technology acceptance. Results: Over 12,600 citizens were trained in CPR and the responder app supported early intervention in hundreds of cases. TEPs remotely assisted 3611 emergency calls, including delegated medication in 17.8% and hospital transport avoidance in 24.3% of cases. Return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) was achieved in 35.6% of cases with early CPR. Diagnostic concordance reached 84.9%, and documentation completeness 92%. Centralized coordination of TEP units reduced implementation costs by over 90%. Psychological evaluation indicated variable digital acceptance by role and experience. Conclusions: RuralRescue demonstrates that digitally supported, context-aware, and regionally integrated emergency care models can contribute significantly to personalized emergency medicine and can be cost-effective. The project highlights how intervention intensity, responder deployment, and treatment decisions can be tailored to patient needs, professional capacity, and regional structures—even in resource-limited rural areas. Full article

Background/Objectives: Lung cancer remains a major cause of cancer-related mortality, with regional differences in incidence and patient characteristics. This study aimed to verify and quantify a perceived dramatic increase in lung cancer cases at a Romanian center, identify distinct patient phenotypes using unsupervised machine learning, and characterize contributing factors, including demographic shifts, changes in the healthcare system, and geographic patterns. Methods: A comprehensive retrospective analysis of 4206 lung cancer patients admitted between 2013 and 2024 was conducted, with detailed molecular characterization of 398 patients from 2023 to 2024. Temporal trends were analyzed using statistical methods, while k-means clustering on 761 clinical features identified patient phenotypes. The geographic distribution, smoking patterns, respiratory comorbidities, and demographic factors were systematically characterized across the identified clusters. Results: We confirmed an 80.5% increase in lung cancer admissions between pre-pandemic (2013–2020) and post-pandemic (2022–2024) periods, exceeding the 51.1% increase in total hospital admissions and aligning with national Romanian trends. Five distinct patient clusters emerged: elderly never-smokers (28.9%) with the highest metastatic rates (44.3%), heavy-smoking males (27.4%), active smokers with comprehensive molecular testing (31.7%), young mixed-gender cohort (7.3%) with balanced demographics, and extreme heavy smokers (4.8%) concentrated in rural areas (52.6%) with severe comorbidity burden. Clusters demonstrated significant differences in age (p < 0.001), smoking intensity (p < 0.001), geographic distribution (p < 0.001), as well as molecular characteristics. COPD prevalence was exceptionally high (44.8–78.9%) across clusters, while COVID-19 history remained low (3.4–8.3%), suggesting a limited direct association between the pandemic and cancer. Conclusions: This study presents the first comprehensive machine learning-based stratification of lung cancer patients in Romania, confirming genuine epidemiological increases beyond healthcare system artifacts. The identification of five clinically meaningful phenotypes—particularly rural extreme smokers and age-stratified never-smokers—demonstrates the value of unsupervised clustering for regional healthcare planning. These findings establish frameworks for targeted screening programs, personalized treatment approaches, and resource allocation strategies tailored to specific high-risk populations while highlighting the potential of artificial intelligence in identifying actionable clinical patterns for the implementation of precision medicine. Full article

Medicinal mushroom production utilising rural cultivation (solid state fermentation) requires approximately six months compared to culinary mushroom production (7 days). Urban cultivation (submerged liquid fermentation) can be used as a sustainable method of producing medicinal mushroom biomass. In this study, chicken patties were fortified with liquid-fermented Ganoderma lucidum flour (GLF) and Pleurotus djamor mushroom biomass flour (PDF) at concentrations of 3%, 6%, and 9%. These were compared to a negative control (0% mushroom flour chicken patty) and a commercial patty. Chicken patties fortified with 3% PDF and 9% GLF recorded the lowest cooking loss, at 5.55% and 10.3%, respectively. Mushroom chicken patties exhibited lower cooking losses and significant changes in colour and texture compared to control samples. Notably, 3% GLF chicken patty achieved the highest overall acceptability score of 6.55 followed by 9% PDF chicken patty (6.08) (p < 0.05). Biomass flour of liquid-fermented Ganoderma lucidum (ENS-GL) and Pleurotus djamor (ENS-PD) were extracted for their endopolysaccharide and analysed for their functional properties. All elemental, FT-IR, and NMR spectroscopy analyses revealed the existence of a comparable beta-glucan polymer structure, linkages, and absorptions when compared to the Laminarin standard. In addition, ENS-GL also proved to possess higher antimicrobial activities and significant antioxidant levels (DPPH-scavenging activity, ferric reduction potential and total phenolic content) compared to ENS-PD. Overall, this study revealed that sustainable liquid-fermented Ganoderma lucidum, a medicinal mushroom, outperformed Pleurotus djamor, a culinary mushroom, as a potential alternative flour for combating hunger in the future. Full article

Background: Chronic diseases negatively impact health outcomes and are attributed to elevated morbidity and mortality throughout the world. Rural populations are disproportionately affected by chronic diseases and have limited access to health programs and resources. The purpose of this qualitative study was to explore the cognitive impact that a web-based lifestyle medicine intervention had on participants recruited from rural community settings in the southeastern United States. This qualitative study was the second phase of a mixed methods design, which used a randomized controlled trial to evaluate intervention effects. Methods: The descriptive design of this qualitative study included semi-structured interviews to collect information about the impact of a lifestyle medicine intervention. The interviews were transcribed verbatim and analyzed using the grounded theory method of thematic analysis in an iterative process for discovering patterns, central themes, and concepts. Results: The four themes that emerged were (a) gaining awareness and overcoming barriers, (b) encouraging others as a “ripple effect”, (c) realizing actualities, and (d) seeing progress. These themes highlighted the cognitive impact of an online lifestyle medicine program and provided insights about how rural dwellers perceived and processed educational health information. Conclusions: This study shows that the intervention had a positive influence on participants that continued after participation. The findings of this study provide recommendations that can facilitate intervention development and implementation among rural populations. Full article

Objectives: This study aimed to describe the profile and identify the clinical and sociodemographic factors associated with emergency department (ED) use among patients aged ≥65 years. Methods: This was a retrospective cross-sectional study of patients aged ≥65 years who were seen in the emergency department of the Hospital de Mérida (Spain) in 2019, the year before the Coronavirus Disease 2019 (COVID-19) pandemic. Descriptive statistics were calculated for dependent variables such as hours of ED stay, total number of visits, reasons for discharge, and diagnostic specialty, disaggregated by gender, season, age group, day type (work or holiday), shift, and population area (rural or urban). Results: Significant differences in ED hours were found according to gender (p < 0.001), season (p = 0.024), age group (p < 0.001), attention shift (p < 0.001), and population area (p = 0.003). Discharge to home was the most common destination (63.5%), followed by hospital admission (25.7%). Admissions for gastrointestinal surgery and neurology were predominant in men, and admissions for internal medicine and trauma were predominant in women. Patients aged 65–79 years were admitted to internal medicine, and those over 80 years were admitted to cardiology. Among patients who presented to the hospital’s emergency department and required admission, 51.5% were men aged ≥ 75 years, rising to 53.3% among those aged 65 to 74 years. The clinical areas were related to cardiology (27.67%) and pneumology (20.63%). Conclusions: Demands for ED care in those over 65 years of age are associated with sociodemographic and clinical characteristics, which can be used to better plan and manage resources and improve user satisfaction. Full article

Mushroom production, mushroom knowledge and mushroom cultivation have aroused the interest of many researchers, scientists, institutions, cultural and mushroom-loving associations, and ordinary mushroom pickers as well. The contribution of wild mushrooms to the economic, cultural and touristic development and social cohesion of the Greek rural population is considered very important. In addition to their therapeutic and dietary value, they are also valuable for their diverse chemical and medicinal properties. The PubMed—Medline, Web of Science and Cochrane Library databases were searched for relevant articles published up to January, 2025. Even today, some macromycetes are still used in medicine due to their remarkable healing properties. In the form of powders or solutions, they were formerly used as a remedy for epilepsy, tuberculosis, nervous diseases and various severe inflammations. This review documents the benefits of mushroom consumption suggested by health experts for pathological conditions and health improvement and highlights their superiority as non-animal protein sources according to their nutrients. Full article

Indigenous top-priority fruit trees, like Vangueria infausta subsp. infausta. Burch (wild medlar), are essential for food security, climate resilience, and biodiversity. However, they remain underutilized due to limited documentation and integration into agricultural systems. This study presents the first ethnobotanical assessment of the wild medlar in Oyemeni, northeastern KwaZulu-Natal, South Africa. Surveys and interviews were conducted with 100 rural participants to explore its traditional uses, commercialization potential, and knowledge transmission. The findings reveal that the fruit is widely used in porridges, juices, and traditional beer, offering nutritional benefits such as vitamin C. Medicinally, it is valued for promoting oral health, wound healing, and spiritual protection. However, traditional knowledge is declining, particularly among the youth, due to generational shifts and modernization. The study highlights sustainable commercialization opportunities, such as value-added products and agroforestry integration, while emphasizing the need to preserve indigenous knowledge. These findings contribute to food security, biodiversity conservation, and cultural preservation in a changing socio-economic landscape. Future research should focus on biochemical evaluation of the plant’s medicinal properties and cross-regional comparisons. Full article

Background: Antimicrobial resistance (AMR) is a critical global health threat, affecting both human and veterinary medicine. Pigeons are increasingly recognized as potential reservoirs of antibiotic-resistant bacteria due to their widespread presence in urban and rural environments. The aim of this study was to determine the antimicrobial susceptibility profiles of Staphylococcus aureus isolates from pigeons in Hungary. Methods: A total of 73 S. aureus isolates were collected from pigeons across seven regions of Hungary in 2022. Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis included correlation heatmaps, hierarchical clustering, network analysis, decision tree modeling, and Monte Carlo simulations. Results: The multidrug-resistant (MDR) prevalence rate was alarmingly high at 80.8%. Very high resistance rates were observed for doxycycline (97.3%), enrofloxacin (87.7%), and amoxicillin (84.9%). By contrast, low resistance rates were detected for vancomycin (5.5%) and imipenem (8.2%). Decision tree modeling identified tiamulin, enrofloxacin, and amoxicillin-clavulanate resistance as the most significant predictors of MDR status. Monte Carlo simulations predicted a mean MDR prevalence of 78.5%, indicating that the dominance of MDR strains is not merely a random phenomenon but part of a broader epidemiological pattern. Conclusions: These findings confirm that pigeons may serve as critical reservoirs of MDR S. aureus strains, posing a potential risk to public and animal health. Continued monitoring, the genetic characterization of resistant strains, and the development of effective control strategies are urgently needed. This study provides a foundation for future research aimed at understanding the biological, ecological, and epidemiological roles of pigeon-associated MDR strains. Full article

Personalized medicine, including targeted and immunotherapy, has substantially changed the landscape of non-small cell lung cancer (NSCLC). About 30% of NSCLC tumors have targetable mutations, like EGFR, and 28% of tumors will have a PD-L1 score or tumor mutation burden high enough to warrant immunotherapy; a molecular test prior to therapy assesses eligibility. However, the congruence between testing and treatment, and the effect of treatment without testing on outcomes, is understudied. We extracted a cohort of NSCLC patients from the Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data. The primary outcome was survival. Demographic and clinical characteristics of those receiving vs. not receiving a molecular test were compared, and a Kaplan–Meier curve along with a multivariable Cox proportional hazards regression assessed the association of survival with the receipt of molecular diagnostic testing, adjusting for sex, race, age, income tract, metro/urban/rural region, histology, and stage. There were 911 NSCLC patients treated with personalized therapy, of which 513 (56.3%) had received prior molecular testing. Black patients were less likely than White patients to receive testing (36.4% vs. 59.9%; p < 0.001). Testing was significantly more frequent in patients with fewer comorbidities (p < 0.001), adenocarcinoma (p = 0.004), tumors in the lower lobe (p = 0.037), or diagnosed at a later stage (p = 0.026). Only 39.9% of patients receiving EGFR inhibitors were initially tested for an EGFR mutation. Among NSCLC patients treated with personalized therapy, untested patients were at increased mortality risk compared to tested patients (median survival 8.22 vs. 12.79 months, p = 0.024). After adjustment, treated patients not tested beforehand had a significantly higher mortality risk (HRadj: 1.20; 95% CI: 1.04–1.40). Substantial incongruence between receipt of molecular testing and personalized therapies exists according to nationwide claims data, with only about half of treated patients having had an appropriate molecular diagnostic workup. This could explain, in part, the higher mortality among treated patients who did not undergo testing. Before expanding personalized therapies, further addressing these issues through standardized, reflexive testing protocols and improved clinician education is critical to optimizing the integration of molecular diagnostics into treatment planning. Full article

Gastrointestinal parasites have been reported to have negative effects on chickens reared in rural areas in African countries. Hence, smallholder farmers use ethnoveterinary remedies to control these parasites in village chickens. This study used online databases (ScienceDirect, PubMed, and Google Scholar) to search, gather, and review articles published between January 1990 and June 2024 where ethnoveterinary intervention was considered to control gastrointestinal parasites, following PRISMA guidelines. A total of 540 articles were generated, and only 17 articles passed the screening process and were considered for further analysis. The findings of this review indicate that ethnoveterinary remedies are used by smallholder farmers to control gastrointestinal parasites such as Ascaridia galli, Capillaria spp., Choanotaenia infundibulum, Eimeria spp., Heterakis gallinarum, and Raillietina cesticillus in village chickens. Aloe spp., Carica papaya, Musa paradisiaca, and Venonia amygdalina were reported as the most-preferred medicines, and farmers utilized different plant parts ranging from leaves (48.8%), bark and roots (12.2%), tubers (7.3%), and seeds (4.9%). These remedies are administered per os, topically, and dermally. The current review successfully summarized ethnoveterinary intervention used by smallholder farmers to control gastrointestinal parasites in chickens found in African countries. Therefore, there is a need to investigate the efficacy of these identified ethnoveterinary medicines against gastrointestinal parasites in chickens. Full article

In Nigeria, Chromolaena odorata poses significant threats to agriculture by disrupting ecosystem structure and function, thereby altering ecosystem services. However, our understanding of its impact, potential uses, and control measures, particularly from the perspective of local communities who interact directly with the plant, presents opportunities for a balanced approach to sustainable management. The aim of this study was to document the knowledge and perceptions of the introduction and spread of C. odorata, its ethnopharmacological applications, and its effects on crops, livestock, and wildlife, as well as discuss control strategies. Using participatory rural appraisal techniques, we administered semi-structured questionnaires to 150 respondents across six villages in Edo State, Nigeria. The findings reveal that C. odorata is a well-recognized invasive species that has been present for several decades and is commonly referred to by its local name, “Awolowo weed”. Although many respondents were unsure of the reasons behind its introduction, most were familiar with its mode of dispersal. A significant proportion of respondents view the weed as a serious threat to agriculture and a major hindrance to human movement by foot to and from their farmlands where C odorata is dominant. However, many also reported its relative ease of management. Interestingly, 92.7% acknowledged the medicinal value of C. odorata, citing its use in treating fever, wounds, and stomach aches, while 84% reported its ability to enhance soil fertility. Most respondents did not perceive the plant as harmful to livestock or wildlife. Though many believe that the plant has continued to spread, 83.8% oppose its complete eradication. Instead, they highlighted Elephant grass (Pennisetum purpureum Schumach) as a more problematic weed that requires immediate intervention. In summary, exploring the local benefits of C. odorata highlights the importance of leveraging local knowledge and practices to develop a robust, integrated approach for its sustainable long-term management. Full article