Search Results (3,475)

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide. Full article

Background/Objectives: Physical activity is a cornerstone of diabetes mellitus (DM) management and is strongly recommended in the American Diabetes Association (ADA)’s guidelines. This study aims to investigate the self-reported physical activity levels of individuals with DM in Germany, as well as the barriers and facilitators they encounter. Methods: Individuals with type 1 DM (T1DM) and type 2 DM (T2DM) were asked to fill out an online questionnaire that was partly based on the International Physical Activity Questionnaire (IPAQ). Results: The questionnaire was completed by 338 persons with either T1DM (57.1%) or T2DM (42.9%) (females: 56.2%, males: 42.0%, gender diverse persons: 1.8%) of all age groups (at least 18 years). In total, 80.5% of respondents were aware of the current physical activity recommendations. Among the respondents, 58% reported meeting the recommendations for endurance-type physical activity, while only 30.5% reported meeting those for strength training. The three most frequently cited barriers to physical activity were lack of time, lack of motivation and current state of health. Supporting factors included coverage of costs, availability of exercise programs in close proximity to the patient’s home and target group specific exercise programs. Conclusions: The results imply that many individuals with DM in Germany do not meet ADA’s physical activity recommendations, especially considering that self-reports often overestimate actual behavior. In particular, the actual number of individuals who regularly engage in strength training may be too low. There is a clear need to better communicate the benefits of different forms of physical training and to provide physical activity programs aligned with patients’ individual needs. Full article

Artificial intelligence has taken a seat at the executive table and is threatening the fact that human beings are the only ones who should be in a position of power. This article gives conjectures on the future of leadership in which managers will collaborate with learning algorithms in the Neural Adaptive Artificial Intelligence Leadership Model, which is informed by the transformational literature on leadership and socio-technical systems, as well as the literature on algorithmic governance. We assessed the model with thirty in-depth interviews, system-level traces of behavior, and a verified survey, and we explored six hypotheses that relate to algorithmic delegation and ethical oversight, as well as human judgment versus machine insight in terms of agility and performance. We discovered that decisions are made quicker, change is more effective, and interaction is more vivid where agile practices and good digital understanding exist, and statistical tests propose that human flexibility and definite governance augment those benefits as well. It is single-industry research that contains self-reported measures, which causes research to be limited to other industries that contain more objective measures. Practitioners are provided with a practical playbook on how to make algorithmic jobs meaningful, introduce moral fail-safes, and build learning feedback to ensure people and machines are kept in line. Socially, the practice is capable of minimizing bias and establishing inclusion by visualizing accountability in the code and practice. Filling the gap between the theory of leadership and the reality of algorithms, the study provides a model of intelligent systems leading in organizations that can be reproduced. Full article

Background/Objectives: Cannabidiol (CBD) is a non-intoxicating cannabinoid touted for a variety of medical benefits, including alleviation of anxiety. While legalization of hemp-derived products in the United States (containing ≤0.3% delta-9-tetrahydrocannabinol [d9-THC] by weight) has led to a rapid increase in the commercialization of hemp-derived CBD products, most therapeutic claims have not been substantiated using clinical trials. This trial aimed to assess the impact of 6 weeks of treatment with a proprietary hemp-derived, full-spectrum, high-CBD sublingual solution similar to those available in the marketplace in patients with anxiety. Methods: An open-label pilot clinical trial (NCT04286594) was conducted in 12 patients with at least moderate levels of anxiety. Patients self-administered a hemp-derived, high-CBD sublingual solution twice daily during the 6-week trial (target daily dose: 30 mg/day CBD). Clinical change over time relative to baseline was assessed for anxiety, mood, sleep, and quality of life, as well as changes in cognitive performance on measures of executive function and memory. Safety and tolerability of the study product were also evaluated. Results: Patients reported significant reductions in anxiety symptoms over time. Concurrent improvements in mood, sleep, and relevant quality of life domains were also observed, along with stable or improved performance on all neurocognitive measures. Few side effects were reported, and no serious adverse events occurred. Conclusions: These pilot findings provide initial support for the efficacy and tolerability of the hemp-derived, high-CBD product in patients with moderate-to-severe levels of anxiety. Double-blind, placebo-controlled studies are indicated to obtain robust data regarding efficacy and tolerability of these types of products for anxiety. Full article

Minimally invasive cosmetic procedures, such as dermal fillers, botulinum toxin injections, autologous fat grafting, intense pulsed light (IPL) treatments, and platelet-rich plasma (PRP) treatments, are increasingly popular worldwide due to their convenience and aesthetic benefits. While generally considered safe, these procedures can result in rare but serious ophthalmological complications. The most catastrophic adverse events include central retinal artery occlusion and ischemic optic neuropathy, which may lead to irreversible vision loss. Other complications include diplopia, ptosis, dry eye, and orbital cellulitis, with varying degrees of severity and reversibility. Awareness of potential ocular risks, appropriate patient selection, and adherence to safe injection techniques are crucial for preventing complications. This narrative review summarizes the incidence, mechanisms, clinical features, risk factors, diagnostic approaches, and management strategies of ocular complications associated with aesthetic medical procedures. A narrative literature review was conducted, emphasizing data from clinical studies, case series, and expert consensus published between 2015 and 2025. Special attention is given to anatomical danger zones, the pathophysiological pathways of filler embolization, and the roles of hyaluronidase and hyperbaric oxygen therapy in acute management. Although many complications are self-limited or reversible, prompt recognition and intervention are critical to prevent permanent sequelae. The increasing prevalence of these procedures demands enhanced education, informed consent, and interdisciplinary collaboration between aesthetic providers and ophthalmologists. Full article

Objectives: Nasal reconstructive surgery following skin cancer resection is challenging, with esthetic concerns impacting patients’ quality of life. Non-surgical rhinoplasty may be an alternative to repeated surgeries. This study aimed to evaluate non-surgical rhinoplasty esthetic benefits and subjective patient outcomes after skin cancer resection. Methods: We conducted a retrospective study on patients with post-operative esthetic dissatisfaction after nasal skin cancer surgery, who underwent non-surgical rhinoplasty with hyaluronic acid. Subjective benefits were evaluated with the FACE-Q Rhinoplasty self-questionnaire at three consultations: before injection (baseline), and at one and two months after. Two-dimensional and three-dimensional Vectra H2 photographs were used to assess subjective esthetic concerns and objective volumetric changes. Results: The study included six female patients with an average age of 58.3 years. They had undergone, on average, five nasal surgeries for cancer. The mean FACE-Q scores were 53.3 (±10.31), 77.5 (±4.18), and 79.7 (±6.76), respectively, at baseline, one month, and two months. Significant differences were observed between baseline and one month (p < 0.001) and between baseline and two months (p < 0.001), but not between one and two months. The was a mean volumetric gain of 1.13 mL at one month and 1.19 mL at two months. Conclusions: This preliminary study suggested that hyaluronic acid-based non-surgical rhinoplasty could improve esthetic outcomes and quality of life in patients who had undergone nasal skin cancer surgery. These findings highlight a potential role for this minimally invasive technique in selected post-reconstructive cases, although the small sample size limited the generalizability of the results and underlined the need for further prospective evaluation. Full article

Background/Objectives: Pain assessment scales provide a clear clinical benefit in patients who are unable to self-report. The Nociception Coma Scale-Revised—adapted for Intubated patients (NCS-R-I) was developed to assess pain in patients with acquired brain injury who are unable to self-report. However, this instrument has not yet been translated and validated for use in Spain. The objective was to translate the Nociception Coma Scale-Revised—adapted for Intubated patients (NCS-R-I) into Spanish and to assess the reliability and validity of the Spanish version in patients with brain injury. Methods: This study was carried out in two phases. First, the scale was translated into Spanish. Next, a psychometric analysis was performed to determine the reliability and validity of the Spanish version of the NCS-R-I in 207 critically ill patients with acquired brain injury and disorders of consciousness. Two blinded observers administered the scale at three time points: 5 min before, during, and 15 min after a series of nociceptive and non-nociceptive procedures. Results: The internal consistency of the NCS-R-I was acceptable (ordinal alpha = 0.60–0.90). Interobserver agreement was good (kappa = 0.80; intraclass correlation coefficient = 0.90). In terms of discriminant validity, the AUC was 0.952 (95% CI: 0.931–0.973). NCS-R-I scores increased significantly during performance of nociceptive procedures compared to scores obtained before and after these procedures, confirming the scale’s sensitivity to change. Similarly, during the performance of nociceptive procedures, scores on the NCS-R-I were significantly higher (p < 0.001) than those observed during non-nociceptive procedures. Conclusions: The results of this study demonstrate that the NCS-R-I is a valid, reliable tool for the assessment of pain in patients with acquired brain injury who are unable to self-report. Full article

The incorporation of digital health into the medical curricula is becoming more important to better prepare doctors in the future. Digital health comprises a wide range of tools such as electronic health records, health information technology, telemedicine, telehealth, mobile health applications, wearable devices, artificial intelligence, and virtual reality. The present study aimed to explore the medical and biomedical students’ perspectives on the integration of digital health in medical curricula. A cross-sectional study was conducted on the medical and biomedical undergraduate students at the College of Medicine and Health Sciences at Sultan Qaboos University. Data was collected using a self-administered questionnaire. The response rate was 37%. The majority of respondents were in the MD (Doctor of Medicine) program (84.4%), while 29 students (15.6%) were from the BMS (Biomedical Sciences) program. A total of 55.38% agreed that they were familiar with the term ‘e-Health’. Additionally, 143 individuals (76.88%) reported being aware of the definition of e-Health. Specifically, 69 individuals (37.10%) utilize e-Health technologies every other week, 20 individuals (10.75%) reported using them daily, while 44 individuals (23.66%) indicated that they never used such technologies. Despite having several benefits, challenges exist in integrating digital health into the medical curriculum. There is a need to overcome the lack of infrastructure, existing educational materials, and digital health topics. In conclusion, embedding digital health into medical curricula is certainly beneficial for creating a digitally competent healthcare workforce that could help in better data storage, help in diagnosis, aid in patient consultation from a distance, and advise on medications, thereby leading to improved patient care which is a key public health priority. Full article

Background/Objectives: Chickenpox is an ongoing health threat for young children. This study aimed to investigate varicella vaccination uptake among children and its determinants at both the individual and interpersonal levels. Methods: A cross-sectional survey of parents of children aged 0–15 years and with administrative health records was conducted between September and October 2024 in Shenzhen, China. Participants were recruited through multistage random sampling. This analysis was based on a subsample of 996 parents whose children were 1–10 years old and without a prior history of chickenpox. Multivariate logistic regression models were fitted. Results: Among the participants, 47.0% reported that their children had received a varicella vaccination. Parents who believed that chickenpox was highly contagious (adjusted odds ratios [AOR]: 1.62, 95% confidence interval [CI]: 1.23, 2.13), perceived more benefits (AOR: 1.22, 95% CI: 1.05, 1.41) and cues to action (AOR: 1.33, 95% CI: 1.04, 1.69), and exhibited greater self-efficacy (AOR: 1.40, 95% CI: 1.09, 1.80) related to children’s varicella vaccination reported higher varicella vaccination uptake for their children. Greater perceived barriers related to vaccination (AOR: 0.89, 95% CI: 0.83, 0.95) and dysfunctional interactions with children (AOR: 0.97, 95% CI: 0.94, 0.99) were associated with lower varicella vaccination uptake for children. In addition, higher exposure to information encouraging parents to vaccinate their children against chickenpox (AOR: 1.24, 95%CI: 1.08, 1.41) and thoughtful consideration of the veracity of the information were associated with higher varicella vaccination uptake among children (AOR: 1.19, 95% CI: 1.05, 1.36). Conclusions: There is a strong need to promote varicella vaccination for children in China. Full article

Background/Objectives: Despite the health benefit of regular physical activity, many adults often discontinue it within 3–6 months due to various obstacles. The purpose of this study was to investigate factors affecting physical activity adherence of male office workers based on self-determination theory by constructing a structural equation model. Methods: In total, 257 full-time male office workers who engage in regular physical activity participated. The participants from 15 companies completed a survey asking about perceived physical activity barriers, autonomy support, psychological need satisfaction in physical activity, autonomous motivation, and physical activity adherence. Data analysis was performed using the SPSS 28.0 and the AMOS 26.0 programs to verify the fit of the hypothetical model and identify the direct and indirect effects of variables on physical activity adherence for male office workers. Results: As a result, the path significance test results for the hypothetical model showed that five of the nine paths were significant. The results show that psychological need satisfaction in physical activity and autonomous motivation were significant variables that had a direct effect on physical activity adherence, while autonomy support from significant others and perceived physical activity barriers had a significant indirect effect through psychological need satisfaction and autonomous motivation, explaining 62.0%. Conclusions: Based on these findings, it is recommended to implement customized workplace-specific physical activity interventions to enhance autonomous motivation and the autonomy, competence, and relatedness aspects of psychological need satisfaction in physical activity. Full article

Demand for mental health support has exerted unprecedented pressure on statutory services. Innovative solutions such as Green or Nature-Based Social Prescribing (NBSP) programmes may help address unmet need, improve access to personalised treatment, and support the sustainable delivery of primary services within a prevention model of population health. We piloted an innovative health economics-informed Social Return on Investment (SROI) analysis and forecast of a ‘Making Well’ therapeutic craft and horticulture programme for mental health between October 2021 and March 2022. Quantitative and qualitative outcome data were collected from participants with mild-to-moderate mental health conditions at baseline and nine-weeks follow-up using a range of validated measures, including the Short Warwick–Edinburgh Mental Well-being Scale, ICEpop CAPability measure for Adults (ICECAP-A), General Self-Efficacy Scale (GSES), and a bespoke Client Service Receipt Inventory (CSRI). The acceptability and feasibility of these measures were explored. Results indicate that the Making Well programme generated well-being-related social value in the range of British Pound Sterling (GBP) GBP 3.30 to GBP 4.70 for every GBP 1 invested. Our initial pilot forecast suggests that the programme has the potential to generate GBP 5.40 to GBP 7.70 for every GBP 1 invested as the programme is developed and delivered over a 12-month period. Despite the small sample size and lack of a control group, our results contribute to the evidence-base for the effectiveness and social return on investment of NBSP as a therapeutic intervention for improving health and well-being and provides an example of the use of health economic well-being outcome measures such as ICECAP-A and CSRIs in social value analysis. Combining SROI evaluation and forecast methodologies with validated quantitative outcome measures used in the field of health economics can provide valuable social cost–benefit evidence to decision-makers. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent disorder that significantly impacts quality of life and daily functioning. While continuous positive airway pressure (CPAP) therapy is effective, long-term adherence remains a challenge. This single-arm observational study aimed to evaluate clinical outcomes and adherence patterns during telemedicine-supported CPAP therapy and identify distinct phenotypic response clusters in Romanian patients with OSA. Methods: This prospective observational study included 86 adults diagnosed with OSA, treated with ResMed Auto CPAP devices at “Victor Babeș” University Hospital in Timișoara, Romania. All patients were remotely monitored via the AirView™ platform and received monthly telephone interventions to promote adherence when necessary. Clinical outcomes were assessed through objective telemonitoring data. K-means clustering and t-distributed stochastic neighbor embedding (t-SNE) were employed to explore phenotypic response patterns. Results: During telemedicine-supported CPAP therapy, significant clinical improvements were observed. The apnea–hypopnea index (AHI) decreased from 42.0 ± 21.1 to 1.9 ± 1.3 events/hour. CPAP adherence improved from 75.5% to 90.5% over six months. Average daily usage increased from 348.4 ± 85.8 to 384.2 ± 65.2 min. However, post hoc analysis revealed significant concerns about the validity of self-reported psychological improvements. Self-esteem changes showed negligible correlation with objective clinical measures (r < 0.2, all p > 0.1), with only 3.3% of variance being explained by measurable therapeutic factors (R² = 0.033). Clustering analysis identified four distinct adherence and outcome profiles, yet paradoxically, patients with lower adherence showed greater self-esteem improvements, contradicting therapeutic causation. Conclusions: Telemedicine-supported CPAP therapy with structured monthly interventions was associated with substantial clinical improvements, including excellent AHI reduction (22-fold) and high adherence rates (+15% after 6 months). Data-driven phenotyping successfully identified distinct patient response profiles, supporting personalized management approaches. However, the single-arm design prevents definitive attribution of improvements to telemonitoring versus natural adaptation or placebo effects. Self-reported psychological outcomes showed concerning patterns suggesting predominant placebo responses rather than therapeutic benefits. While the overall findings demonstrate the potential value of structured telemonitoring for objective CPAP outcomes, controlled trials are essential to establishing true therapeutic efficacy and distinguishing intervention effects from measurement bias. Full article

The dramatic increase in urban construction waste poses severe environmental challenges. Utilizing waste concrete to produce recycled aggregates (RA) for manufacturing recycled concrete (RC) represents an effective strategy for resource utilization. However, inherent defects in RA, such as high porosity, microcracks, and adherent old mortar layers, lead to significant performance degradation of the resulting RC, limiting its widespread application. Traditional methods for enhancing RA often suffer from limitations, including high energy consumption, increased costs, or the introduction of new pollutants. MICP offers an innovative approach for enhancing RC performance. This technique employs the metabolic activity of specific microorganisms to induce the formation of a three-dimensionally interwoven calcium carbonate gel network within the pores and on the surface of RA. This gel network can improve the inherent defects of RA, thereby enhancing the performance of RC. Compared to conventional techniques, this approach demonstrates significant environmental benefits and enhances concrete compressive strength by 5–30%. Furthermore, embedding mineralizing microbial spores within the pores of RA enables the production of self-healing RC. This review systematically explores recent research advances in microbial mineral gel network for improving RC performance. It begins by delineating the fundamental mechanisms underlying microbial mineralization, detailing the key biochemical reactions driving the formation of calcium carbonate (CaCO₃) gel, and introducing the common types of microorganisms involved. Subsequently, it critically discusses the key environmental factors influencing the effectiveness of MICP treatment on RA and strategies for their optimization. The analysis focuses on the enhancement of critical mechanical properties of RC achieved through MICP treatment, elucidating the underlying strengthening mechanisms at the microscale. Furthermore, the review synthesizes findings on the self-healing efficiency of MICP-based RC, including such metrics as crack width healing ratio, permeability recovery, and restoration of mechanical properties. Key factors influencing self-healing effectiveness are also discussed. Finally, building upon the current research landscape, the review provides perspectives on future research directions for advancing microbial mineralization gel techniques to enhance RC performance, offering a theoretical reference for translating this technology into practical engineering applications. Full article

Background/Objectives: Depression is a major disorder that has been described in terms of its underlying neurological characteristics, often measured via EEG. However, almost all previous research into the EEG correlates of depression has used a unitary model of Major Depressive Disorder (MDD), whereas there is strong evidence that MDD is heterogeneous in its symptomatology and neurological underpinnings. Methods: To investigate the EEG signatures of four subtypes of depression defined according to the previous literature, the Zung Self-rating Depression Scale was administered to 54 male and 46 female volunteers (M age = 32.53 yr). EEG data were collected during an Eyes Closed condition and examined for differences in connectivity across brain networks in the alpha- and beta-bands. Results: The results were examined in terms of the number and direction of connectivity differences between depressed and non-depressed participants within each depression subtype, the alpha- and beta-band connectivities, the regions of the brain that were connected, and the possible functional reasons why specific brain regions were differently connected for depressed and non-depressed participants within each MDD subtype. Conclusions: The results suggested some differences in the alpha- and beta-band connectivity between some of the MDD subtypes that are worth considering as representing different neurological signatures across the depression subtypes. These findings represent an initial challenge to defining depression as a unitary phenomenon, and suggest possible benefits for further research into the underlying neurological phenomena of depression subtypes. Full article

Burn injuries result in complex physiological and psychological sequelae, including hypermetabolism, muscle wasting, mobility impairment, scarring, and disrupted body image. While advances in acute care have improved survival, comprehensive rehabilitation strategies are critical for restoring function, appearance, and psychosocial well-being. Structured physical activity, including resistance and aerobic training, plays a central role in counteracting muscle atrophy, improving cardiovascular function, enhancing scar quality, and promoting psychological resilience and body image restoration. This narrative review synthesizes the current evidence on the effects of exercise-based interventions on post-burn recovery, highlighting their therapeutic mechanisms, clinical applications, and implementation challenges. In addition to physical training, emerging technologies such as virtual reality, aquatic therapy, and compression garments offer promising adjunctive benefits. Notably, artificial intelligence (AI) is gaining traction in burn rehabilitation through its integration into wearable biosensors and telehealth platforms that enable real-time monitoring, individualized feedback, and predictive modeling of recovery outcomes. These AI-driven tools have the potential to personalize exercise regimens, support remote care, and enhance scar assessment and wound tracking. Overall, the integration of exercise-based interventions with digital technologies represents a promising, multimodal approach to burn recovery. Future research should focus on optimizing exercise prescriptions, improving access to personalized rehabilitation tools, and advancing AI-enabled systems to support long-term recovery, functional independence, and positive self-perception among burn survivors. Full article