Search Results (2,366)

Background and Aim: Type 2 diabetes (T2D) continues to pose a significant public health challenge worldwide. Among therapeutic options, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven effective in optimizing glycemic control and improving cardiometabolic profiles. Semaglutide, now available in an oral formulation, represents a modern strategy to improve patient adherence while supporting glucose and weight regulation. This study primarily investigated the effects of oral semaglutide on key metabolic indicators and secondary endpoints included cardiovascular risk markers (blood pressure and lipid profile) and patient-reported quality of life (QoL). Study Design and Methods: A longitudinal, prospective observational study was conducted involving patients with T2D across two Italian healthcare facilities. Participants were assessed at baseline (T0) and at three subsequent intervals—6 months (T1), 12 months (T2), and 18 months (T3)—following the initiation of oral semaglutide use. Key Findings: Out of 116 participants enrolled, 97 had complete and analyzable data. Across the 18-month follow-up, significant improvements were observed in glycemic parameters, with a notable reduction in HbA1c levels (T0 vs. T3, p = 0.0028; p ≤ 0.05, statistically significant). Self-reported outcomes showed enhanced quality of life, especially in treatment satisfaction and perceived flexibility (T0 vs. T3, p < 0.001). Conclusions: Daily administration of 14 mg oral semaglutide in individuals with T2D resulted in substantial benefits in glycemic regulation, weight reduction, cardiovascular risk management, and overall patient satisfaction. These findings reinforce its potential role as a sustainable and effective option in long-term diabetes care from both a clinical and public health perspective. Full article

Introduction: The wellbeing of humans and the planet is negatively impacted by unhealthy eating behaviors and excessive food waste. Mindfulness approaches have the potential to help people modify their behavior to achieve healthier outcomes. Pilot testing methods to sustainably support healthy eating and reduce food waste are essential for identifying effective ways to promote human and planetary health. Methods: A pilot study was conducted to test a virtual mindful eating program to improve eating behaviors and reduce food waste among a small sample of U.S. adults. Mixed-methods approaches were used to identify the efficacy of the piloted intervention on mindfulness, eating behaviors, and food waste while identifying participant perspectives of the mindful eating program. Results: Quantitative study outcomes indicated positive intervention effects on hunger/satiety cues and food appreciation. No significant intervention effects were detected on mindfulness or food waste. Qualitative findings highlighted participant reports of experiencing greater self-awareness, an improved relationship with food, and a sense of creativity with meal preparation. Conclusions: This pilot study tested a novel mindful eating program that improved eating behaviors related to hunger/satiety and increased food appreciation. The program was accepted by participants, but it did not increase mindfulness or reduce food waste. Future iterations of this mindful eating program will require modifications to test different approaches for increasing mindfulness and reducing food waste while expanding the positive effects on healthy eating. Full article

Background: Seiza, a traditional sitting posture requiring deep ankle plantarflexion and knee flexion, often becomes difficult after ankle fracture surgery because of restricted mobility. Increased stiffness of the tibialis anterior (TA) muscle, particularly in its deep and superficial fibres, may limit plantarflexion and affect functional recovery. This study aimed to investigate the relationship between TA muscle stiffness, assessed using shear wave elastography (SWE), and the ability to assume the seiza posture after ankle fracture surgery. We also sought to determine whether the stiffness in the deep or superficial TA fibres was more strongly correlated with seiza ability. Methods: In this cross-sectional study, 38 patients who underwent open reduction and internal fixation for ankle fractures were evaluated 3 months postoperatively. Seiza ability was assessed using the ankle plantarflexion angle and heel–buttock distance. The shear moduli of the superficial and deep TA fibres were measured using SWE. Ankle range of motion, muscle strength, and self-reported seiza pain were also measured. Multiple linear regression was used to identify the predictors of seiza performance. Results: The shear moduli of both deep (β = −0.454, p < 0.001) and superficial (β = −0.339, p = 0.017) TA fibres independently predicted ankle plantarflexion angle during seiza (adjusted R², 0.624). Pain during seiza was significantly associated with reduced plantarflexion, whereas muscle strength was not a significant predictor. Conclusions: TA muscle stiffness, especially in the deep fibres, was significantly associated with limited postoperative seiza performance. Targeted interventions that reduce deep TA stiffness may enhance functional outcomes. Full article

This study examined data from participants who completed the SLeep Education for Everyone Program (SLEEP) to explore how various demographic variables affected sleep outcomes and to determine which participant characteristics predicted success. A total of 104 individuals participated. The Sleep Hygiene Index (SHI) measured undesirable sleep behaviors; the Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality and self-reported sleep duration. Participant demographic information was collected at baseline. A mixed ANOVA evaluated group differences, and a multiple linear regression model identified predictors of sleep improvements. Change in SHI scores from pre- to post-intervention demonstrated a significant time × group interaction between Black and white participants (p = 0.024); further analysis indicated Black participants improved more. Better baseline scores predicted more favorable post-intervention outcomes for SHI, PSQI, and sleep duration. Fewer chronic conditions predicted better post-intervention SHI and PSQI scores. Older age also predicted better SHI scores. More favorable initial scores, fewer chronic conditions, and older age were the strongest predictors of positive outcomes following SLEEP. Improved sleep hygiene, sleep quality, and sleep duration were observed over time within subjects across all groups. In summary, SLEEP appears to be effective. Further work exploring challenges experienced by younger participants or those with multiple co-morbidities is warranted. Full article

The main objective of this study was to compare the long-term outcomes of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis, focusing on differences between self-expanding valve (SEV) versus balloon-expandable valve (BEV) prostheses and the influence of balloon pre- and post-dilatation on clinical results. The secondary objective was to report the long-term outcomes after TAVI in Romania. All patients who underwent a TAVI procedure for severe AS between November 2016 and May 2025 at a tertiary center in Romania were included in the present study. A total of 702 patients were included, of which 455 (64.8%) and 247 (35.1%) patients received a BEV (Sapien3 platform) and a SEV (Accurate, Boston, Portico, Evolut, or Navitor platforms), respectively. Pre-dilatation was performed in 514 (73.2%) cases, and post-dilatation was performed in 189 (26.9%) cases. There were 10.5 and 7.8 all-cause and cardiovascular-cause mortality event rates per 100 patient years, respectively. In regard to the univariable Cox regression, a BEV has significantly lower mortality than an SEV (HR = 0.67[0.46–0.96], p = 0.03), pre-dilatation did not influence mortality (HR = 0.71[0.48–1.04], p = 0.08), and post-dilatation significantly increased mortality (HR = 1.51[1.05–2.19], p = 0.03). In regard to the multivariable Cox regression, survival was not influenced by pre-dilatation or the valve platform, while post-dilatation had a trend towards higher mortality (p = 0.06). The BEV and SEV have similar survival rates, with no heterogeneity among a large number of TAVI platforms. While pre-dilatation had no impact on mortality, post-dilatation was associated with a trend towards increased mortality (p = 0.06), which was independent of the transprosthetic gradient. Survival after TAVI in Romania is comparable to that reported in Western registries. Full article

Background: The use of lower limb prosthesis can impact all aspects of daily life, activities and participation. Various studies have compared the microprocessor-controlled knee (MPK) to the non-microprocessor-controlled knee (NMPK) using a variety of different outcome measures, but results are inconsistent and raise the question of which type of knee is most effective. Therefore, we aimed to assess the effect of MPKs compared to NMPKs across all classified ICF domains in adult prosthesis users. Methods: Participants performed baseline measurements with the NMPK (T0). One week later, they started a four-to-six-week trial period with the MPK. Afterward, measurements were repeated with the MPK (T1). Functional tests (6MWT, TUG-test and activity monitor) and questionnaires (ABC, SQUASH, USER-P and PEQ) were used. For statistical analyses, paired t-tests, Wilcoxon signed-rank tests and Chi² test were applied. The Benjamini–Hochberg procedure was applied to correct for multiple testing. Results: Twenty-five participants were included. Using an MPK compared to an NMPK significantly resulted in improvements in balance and walking confidence, safety, walking distance and self-reported walking ability, as well as a decrease in number of stumbles and falls. Additionally, participants using an MPK were significantly more satisfied with their participation, experienced fewer restrictions, reported greater satisfaction with the appearance and utility of the MPK, experienced less social burden and reported better well-being, compared to using an NMPK. Conclusions: Using an MPK instead of an NMPK can lead to significant improvements in all classified ICF domains, such as improved walking ability, confidence and satisfaction and reduced fall risk. Full article

Three-dimensional printing is commonly used to fabricate provisional dental restorations. Studies have reported that changes in printing orientation affect the physical and mechanical properties of 3D-printed polymeric provisional restorations; however the findings have been inconsistent. Therefore, this systematic review and meta-analysis aims to analyze the articles evaluating the influence of printing orientation on the physical and mechanical properties of 3D-printed polymeric provisional dental restorations. Recommendations provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to structure and compose the review. The PICO (Participant, Intervention, Comparison, Outcome) question ordered was: ‘Do 3D-printed provisional dental restorations (P) printed at various orientations (except 0°) (I) exhibit similar physical and mechanical properties (O) when compared to those printed at a 0° orientation (C)?’. An electronic search was conducted on 28 and 29 April 2025, by two independent researchers across four databases (MEDLINE/PubMed, Scopus, Cochrane Library, and Web of Science) to systematically collect relevant articles published up to March 2025. After removing duplicate articles and applying predefined inclusion and exclusion criteria, twenty-one articles were incorporated into this review. Self-designed Performa’s were used to tabulate all relevant information. For the quality analysis, the modified CONSORT scale was utilized. The quantitative analysis was performed on only fifteen out of twenty-one articles. It can be concluded that the printing orientation affects some of the tested properties, which include fracture strength (significantly higher for specimens printed at 0° when compared to 90°), wear resistance (significantly higher for specimens printed at 90° when compared to 0°), microhardness (significantly higher for specimens printed at 90°and 45° when compared to 0°), color stability (high at 0°), and surface roughness (significantly higher for specimens printed at 45° and 90° when compared to 0°). There were varied outcomes in terms of flexural strength and elastic modulus. Full article

Background/Objectives: Despite the importance of parent mental health for child health, there are no global prevalence data on parental mental health symptoms when children are hospitalized. We aimed to describe depression and anxiety symptom prevalence and associated factors among parents of hospitalized children. Methods: We conducted this 14-country prospective cohort survey with parents/primary caregivers staying at a nearby Ronald McDonald House^® during their child’s hospital treatment. We used the Hospital Anxiety and Depression Scale to measure depression and anxiety symptoms and validated scales and theory-based questions to measure parent, family, and child covariates. We calculated the prevalence of clinically significant or concerning symptoms of depression and anxiety, and used multivariable regression analyses to examine associations between covariates and outcomes. Results: Among 3350 participants, 1789 (49.7%) reported depression symptoms and 2286 (69.0%) reported anxiety symptoms. Worry about housing and poorer ratings of their child’s health were associated with increased risk of depression symptoms. Poorer rating of the child’s health, living with a partner, and discrimination in daily life were associated with increased risk of anxiety symptoms. Higher levels of self-care, hospital family-centered care, and social support were associated with reduced risk of depression symptoms. Higher levels of self-care and social support were associated with reduced risk of anxiety symptoms. Conclusions: Clinically significant or concerning depression and anxiety symptoms are common among parents of hospitalized children globally. Hospitals should consider offering routine mental health symptom screening and preventative mental health and support services to all parents. Full article

Background/Objectives: Pharmacists are highly accessible healthcare providers who have frequent, repeated contact with diverse patient populations. They are poised to offer expanded and comprehensive healthcare, including mental health services. One potential barrier to this is a lack of knowledge, confidence, or training in mental health, which may be overcome with a program like Mental Health First Aid (MHFA) training. The aim of this systematic review and meta-analysis is to fill this gap in knowledge by critically evaluating all studies of MHFA training for pharmacists or pharmacy students that report on knowledge, attitudes, or self-efficacy outcomes. Methods: A systematic review was performed to identify all relevant studies. Data was extracted and a random-effects meta-analysis was performed for knowledge and attitudes/self-efficacy outcomes, respectively. Subgroup analyses were performed based on survey question type, geographic location, and population studied. Results: Overall, MHFA training significantly increased pharmacists’ and pharmacy students’ knowledge (Hedges’ g = 0.228) and combined attitudinal/self-efficacy measures (Hedges’ g = 0.376). Subgroup analyses based on question type, study quality, design, population studied, and location showed similar, significant effects. Conclusions: MHFA training appears to have significant effects on pharmacist and pharmacy student knowledge, attitudes, and self-efficacy. Future work should establish the durability of these effects. Full article

Compassion Focused therapy (CFT) is designed to reduce shame (internal and external) and self-criticism while enhancing the three flows of compassion (compassion to others, from others, and for the self). This systematic review evaluated the effectiveness of CFT on these core theoretical constructs in adult clinical populations. A systematic search of three databases (2000–2024) identified 21 studies (N = 450) meeting the inclusion criteria. The studies were narratively synthesised, and quality was assessed using the EPHPP tool. Consistent improvements in self-compassion (g = 0.23–4.14) and reductions in self-criticism (g = 0.29–1.56) were reported. Reductions in external shame were also observed (g = 0.54–1.22), though this outcome was examined in fewer studies. Limited and inconsistent evidence was found for internal shame and interpersonal compassion flows (compassion to and from others), with only a small number of low- to moderate-quality studies addressing these outcomes. Follow-up effects were rarely assessed, and comparator groups were limited. Most interventions were group-based and of variable methodological quality, with frequent selection bias, small sample sizes, and limited demographic diversity. Overall, CFT shows promise for targeting self-directed processes in clinical populations, though stronger evidence is needed to understand its effects on relational components of compassion. Future research should adopt standardised measures, improve methodological rigour, and recruit more diverse samples. Full article

Background: Intermediate care units face growing complexity due to aging populations and chronic illnesses. Non-technical skills such as empathy and communication are crucial for quality care. We aimed to examine the relationship between communication skills, self-efficacy, and sense of coherence among intermediate care nurses. Methods: We conducted an observational, cross-sectional study with 60 intermediate care nurses from three units in a Catalan hospital, Spain. Participants engaged in high-fidelity simulation using geriatric end-of-life scenarios with an ultra-realistic manikin representing a geriatric patient at the end of life. NTSs were measured using validated tools: the Health Professionals Communication Skills Scale (HP-CSS), the General Self-Efficacy Scale, and the Sense of Coherence Questionnaire (OLQ-13). Sessions followed INACSL standards, including prebriefing, simulation, and debriefing phases. Results: Post-simulation outcomes revealed significant gains in interpersonal competencies, with men reporting higher assertiveness (p = 0.015) and greater satisfaction with both the simulation experience (p = 0.003) and the instructor (p = 0.008), underscoring gender-related perceptions in immersive training. Conclusions: Ultra-realistic clinical simulation is effective in enhancing NTS among intermediate care nurses, contributing to improved care quality and clearer professional profiles in geriatric nursing. Full article

Background/Objectives: Falls are recognized as a leading cause of injury, with approximately one in ten incidents resulting in physical injury. Although virtual reality (VR)-based interventions have been explored for fall prevention, systematic reviews and meta-analyses remain limited. This study aimed to assess research trends and evaluate the effectiveness of VR-based fall prevention through a systematic review and meta-analysis. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out in PubMed, EBMASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Korean databases from their inception through 31 December 2024. A total of 49 studies met the inclusion criteria, and a meta-analysis was conducted on 37 studies with available data using “R” 4.4.1 software. Effect sizes (ESs) and 95% confidence intervals (CIs) were calculated for key outcomes. Results: The VR-based interventions showed a statistically significant positive effect on falls self-efficacy, as measured by the Falls Efficacy Scale (FES) (ES = 0.28, 95% CI: 0.17–0.39, p < 0.001). However, no significant reduction was observed in the number of falls (ES = −0.31, 95% CI: −0.80–0.17, p = 0.20). Subgroup analysis by participant medical condition for the FES revealed the largest effects in the Parkinson’s disease (PD) group (ES = 0.61), followed by the multiple sclerosis (MS) (ES = 0.34), the “other” group (ES = 0.25), and “healthy” participants (ES = 0.24). A statistically significant reduction in the number of falls was observed only in the MS group (ES = −0.56). Conclusions: VR-based interventions are effective in improving falls self-efficacy, particularly among individuals with neurological conditions, such as Parkinson’s disease and multiple sclerosis. However, evidence for a reduction in actual fall incidence remains limited. Further large-scale, long-term studies are needed to evaluate the sustained impact of VR interventions on fall prevention outcomes. 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

Background and Objectives: Emotional intelligence (EI) plays a critical role in safeguarding the emotional and psychological well-being of healthcare workers, acting as a buffer against burnout, and influencing the quality of patient care. Despite its significance, there remains a need to understand how EI levels correlate with burnout and what factors predict burnout in high-stress healthcare environments. This study, conducted at King Khaled Hospital in Al-Majmaah, Saudi Arabia, aims to assess the EI levels of healthcare staff, to determine the relationship between EI and burnout, and to identify key predictors of burnout to inform targeted interventions for improving workforce resilience and patient outcomes. Materials and Methods: Both self-reporting and standardized tests were integrated using cross-sectional surveys to evaluate the EI of each participant and the burnout they experience by averaging the rating of a 30-item questionnaire, allowing comparison of the interaction between EI, burnout, and work factors. Results: A significantly moderate level of EI was identified, while a high level of well-being was associated with a low level of burnout, and a high level of emotionality was associated with a high level of burnout. Results indicated that high job demands, call rotation, or casual work, and insufficient staff support were organizational correlates of burnout. Conclusions: Improving EI with a focus on the well-being sub-dimension may prevent burnout, and, for that, the interventions must be specific at both personal and organizational levels. Full article

The aim of this study was to evaluate the relationship between visual functions and road traffic accidents (RTAs) by meta-analysis of observational studies. The analysis included all drivers of motor vehicles, regardless of age, and those using private or public transport. Self-reported visual outcomes were excluded. The risk of RTA in patients with reduced visual acuity was observed in commercial drivers in cross-sectional studies (PR 1.54, 95% CI 1.26–1.88), but not in private drivers in cohort (RR 1.04, 95% CI 0.74–1.46) or case–control studies (OR 1.04, 95% CI 0.78–1.40). A non-statistically significant association between colour vision defects and RTA was observed in cross-sectional studies (PR 1.50, 95% CI 0.91–2.45). No evidence was found for an increased risk of accidents in people with reduced stereopsis. In older adults with abnormal contrast sensitivity, a weak risk of RTA was observed in cohort studies. Evidence from low-quality cross-sectional studies suggests an increased risk of RTAs among commercial drivers with reduced visual acuity. The few case–control and cohort studies identified did not show an association between accident occurrence and visual function. Attention needs to be paid to this issue to facilitate the conduct of high-quality research that can support the development of road safety policies. Full article