Search Results (2,196)

Background: Depression remains a major global health burden, yet fragmented care often leads to waiting times and unmet needs. Therefore, the Belgian collaborative Integrated Depression Care (IDECA) project strengthened primary care depression management by introducing a Reference Person Mental Wellbeing (RPMW) who functions as a case manager, supported by shared-care tools, structured psychoeducation modules, and targeted training for general practitioners (GPs). This study examines normalization in primary care practice. Methods: A single-arm, mixed-method study was implemented over 18 months in two Flemish Primary Care Zones (PCZ). Implementation outcomes were assessed every four months using the NoMAD questionnaire and analyzed using Wilcoxon signed-rank tests. Peer review sessions with professionals and interviews with patients were analyzed thematically. Caseload and service delivery were assessed using process evaluation logs. Results: Twenty-two professionals (17 GPs, two RPMWs, and three PCZ staff members) completed the NoMAD questionnaire. Intervention familiarity increased during the first eight months (T0–T1: p < 0.001; T1–T2: p = 0.022) and continued to rise thereafter (T3–T4: p = 0.008). Integration into daily practice and perceived impact on professional work improved progressively, reaching near-ceiling scores. Peer review sessions highlighted the RPMW’s central role in trust-building and care coordination. Over 12 months, one full-time equivalent RPMW supported 175 patients (mean age 40.7 years; 75% female), with an average of five consultations per patient. Patients reported high satisfaction, emphasizing accessibility, empathy, and practical support. Conclusions: Sustained results suggest successful normalization and support the potential of collaborative, low-threshold depression care. Future work will assess clinical and economic outcomes. Full article

Background: Despite major advances in antiretroviral therapy, HIV transmission remains an important public health challenge. Pre-exposure prophylaxis (PrEP) is a highly effective prevention strategy, offering a significant opportunity to further reduce new HIV infections through expanded access and optimized implementation. Methods: A national multidisciplinary consensus process was conducted to define principles and operational pathways for PrEP referral and linkage in Romania. Experts from different medical fields, professional societies, academic institutions, and community-based organizations participated in structured discussions. Results: The consensus highlighted relevant knowledge gaps related to HIV prevention and PrEP among specialists working outside the field of infectious diseases, including difficulty recognizing risk factors for HIV, uncertainty about next steps after identifying risk factors, and uneasiness discussing sexual health. The consensus also emphasized a shared commitment of these professional societies to address these gaps through pragmatic, specialty-adapted training. Key priorities included improved HIV risk recognition in routine care, development of communication skills, and clear referral pathways to PrEP services. Existing barriers were also discussed, underscoring the importance of multidisciplinary networks and community engagement. Conclusions: This consensus provides a structured, context-adapted framework to support the upcoming nationwide implementation of PrEP in Romania. By strengthening provider education, clarifying clinical pathways, and fostering interdisciplinary collaboration, it offers a foundation for equitable and sustainable HIV prevention. Full article

Background/Objectives: Oral mucositis (OM) is a common complication in onco-hematological patients undergoing chemotherapy and hematopoietic stem cell transplantation, negatively affecting comfort, nutrition, and quality of life. Despite existing assessment tools and recommendations, OM management—particularly non-pharmacological approaches—remains inconsistent, and evidence on nurses’ perspectives and contextual factors is limited. This study explored nurses’ perceptions and experiences regarding non-pharmacological treatments for OM, including educational needs and barriers and facilitators to implementation in clinical practice. Methods: A qualitative descriptive study using inductive content analysis was conducted. Semi-structured interviews were carried out with nurses working in onco-hematological settings in Italy. Data were analysed according to the Elo and Kyngäs framework. Results: Twelve nurses with extensive experience in onco-hematology and transplant care participated in the study. Five main themes emerged: (1) education and training pathways; (2) approaches to mucositis management; (3) nursing competence in OM care; (4) interprofessional collaboration; and (5) governance of practice, including protocols and guidelines. Findings highlighted strong experiential competence, high levels of nursing autonomy in assessment and patient education, and effective interprofessional collaboration, particularly in specialised settings. However, training pathways were predominantly informal, and the availability and use of protocols varied widely across clinical contexts. Conclusions: Non-pharmacological management of OM appears to be sustained primarily by advanced nursing competence and a specialised clinical culture rather than by structured education and standardised governance. Addressing educational gaps and promoting shared protocols may enhance the consistency, quality, and equity of supportive care while ensuring that the findings are clearly reflective of nurses’ experiences. Full article

Background/Objectives: Patients after cardiac surgery admitted to the intensive care unit (ICU) are exposed to environmental, procedural, and psychological stressors that may affect comfort and recovery. This study aimed to assess perceived ICU stressors in postoperative cardiac surgery patients, identify the most and least distressing factors, and examine associations between stressor intensity and selected clinical and organizational variables. Methods: A single-center cross-sectional survey was conducted in an ICU in Poland (January 2024–February 2024). Adult patients after cardiac surgery who provided informed consent and had no cognitive impairment were included; cognitive status was screened using the Montreal Cognitive Assessment (MoCA). Perceived stressors were measured using the Intensive Care Unit Environmental Stressor Scale (ICUESS; 40 items; 4-point Likert scale). Results: The highest-rated stressors were sleep problems (M = 2.30; SD = 0.86) and hearing heart monitor alarms (M = 2.16; SD = 0.82). The lowest-rated stressors were not knowing what day it was (M = 1.46; SD = 0.54) and nurses not introducing themselves (M = 1.50; SD = 0.54). Longer respiratory support and higher pain intensity were associated with higher stressor ratings for multiple ICUESS items, whereas age showed no significant association. Higher room occupancy was linked to higher perceived stress related to environmental disturbances. ICU length of stay showed only limited item-level associations. Conclusions: Postoperative cardiac surgery patients experience a multifactorial burden of ICU stressors, with sleep disruption and alarm-related noise among the most distressing. Prioritizing modifiable environmental factors, symptom control (particularly pain), and patient-centered communication may help reduce perceived stress, especially in shared-room settings and among patients requiring longer respiratory support. Full article

Mental health disorders (MHDs) and acute coronary syndromes (ACSs) demonstrate reciprocal pathophysiological connections with substantial prognostic implications. Despite robust evidence linking MHDs to adverse cardiovascular outcomes, the bidirectional relationship remains inadequately characterized in clinical practice, with limited integration of mental health screening into routine cardiac care pathways. The present narrative review comprehensively presents contemporary data on epidemiology, shared biological mechanisms, clinical consequences, and integrated management strategies across the MHD–ACS continuum. A synthesis of peer-reviewed literature, meta-analyses, observational cohorts, randomized trials, and international guideline documents was performed, focusing on depression, anxiety, post-traumatic stress disorder, bipolar disorder, schizophrenia, and suicidality in relation to ACSs. MHDs are highly prevalent in ACS populations and independently predict increased mortality, major adverse cardiac events, and poorer functional recovery. Shared mechanisms include chronic low-grade inflammation, autonomic imbalance, hypothalamic–pituitary–adrenal axis hyperactivation, platelet hyperreactivity, and endothelial dysfunction. Selective serotonin reuptake inhibitors and cognitive behavioral therapy demonstrate the strongest evidence for treating depression in cardiac populations. Collaborative, stepped-care, and integrated cardiac rehabilitation models consistently improve psychological outcomes, with variable effects on cardiovascular endpoints. MHDs and ACSs form a self-reinforcing clinical continuum. Routine mental health screening and integrated cardio-psychiatric care represent essential components of secondary prevention and long-term outcome optimization. Full article

Background/Objective: Mind–body programs teaching mindfulness-based techniques have benefits for incarcerated people, as do programs in which individuals teach yoga to their incarcerated peers. However, there are no studies of comprehensive programs that combine a variety of self-care techniques with group support and enable people in prison to enhance their own well-being and then share what they have learned with their peers. This study evaluated the effects of such a training program in the United States. Methods: Thirty-eight incarcerated men and women began the 8-day mind–body medicine training and 31 completed the training. Mind–body techniques taught included soft belly breathing, meditation, autogenics and biofeedback, guided imagery, mindful eating, self-expression through drawings and writing, and genograms. Outcomes included resilience, depression, anxiety, stress, coping self-efficacy, optimism, meaning in life, and purpose in life. Outcomes were measured before and after the training, and at a 6-month follow-up. Results: There were significant improvements in resilience, depression, anxiety, stress, coping self-efficacy, optimism, the presence of meaning in life, and purpose in life after the training. All of these improvements were maintained at follow-up. The most frequently practiced skills both after the training and at follow-up were soft belly breathing, meditation, and mindful eating. Conclusions: The training provided participants with skills that had a lasting positive benefit on numerous aspects of their own well-being and trained them to teach the skills to their incarcerated peers. The results of this uncontrolled study suggest that the mind–body medicine training program may be helpful to incarcerated people in other prison systems. Full article

Background: Fibromyalgia (FM) and eating disorders (ED) represent distinct clinical entities traditionally managed within separate medical specialties, yet emerging evidence suggests significant comorbidity and potential shared pathophysiological mechanisms. Both conditions disproportionately affect women, involve complex multifactorial etiologies and substantially impair quality of life. Despite documented clinical overlaps, the mechanistic connections linking these conditions remain poorly characterized, and integrated treatment approaches are lacking. Objective: This narrative review examines the role of oxidative stress and nuclear factor erythroid 2-related factor 2 (Nrf2) pathway dysfunction as a unifying molecular mechanism connecting fibromyalgia and eating disorders, with emphasis on implications for integrated rehabilitation strategies. Methods: We synthesized current evidence on oxidative stress pathophysiology in fibromyalgia and eating disorders, focusing on Nrf2-Keap1 pathway function, clinical comorbidity patterns and rehabilitation interventions targeting antioxidant defense mechanisms. In PubMed, representative search strings included “(fibromyalgia [MeSH] OR fibromyalgia [Title/Abstract]) AND (“eating disorders” [MeSH] OR “anorexia nervosa” [MeSH] OR “bulimia nervosa” [MeSH])” and “fibromyalgia AND (“oxidative stress” OR Nrf2 OR “redox”)”. Articles in English published through December 2025 were considered, with additional records identified by manually screening reference lists. Results: Fibromyalgia patients exhibit elevated oxidative stress markers, impaired antioxidant enzyme function and compromised Nrf2 activity correlating with disease severity, with studies reporting approximately 30–50% reductions in coenzyme Q10 levels compared with healthy controls. Similarly, eating disorders demonstrate mitochondrial dysfunction and oxidative stress dysregulation, though patterns differ across eating disorder phenotypes. Nrf2 serves as the master regulator of cellular antioxidant defense, coordinating expression of over 500 genes involved in detoxification, cytoprotection, inflammation modulation and metabolic regulation. Evidence suggests Nrf2 activity is regulated by energy balance, potentially linking nutritional status with cellular stress responses. Rehabilitation interventions, including graduated exercise and nutritional optimization with Nrf2-activating foods (cruciferous vegetables, polyphenols, omega-3 fatty acids), offer mechanism-based therapeutic approaches through hormetic Nrf2 activation and direct Keap1 modification. Conclusions: Multidisciplinary rehabilitation programs integrating physical therapy, exercise prescription and nutritional strategies targeting Nrf2 activation offer evidence-based, mechanism-driven approaches to address shared oxidative stress pathophysiology. Nrf2 pathway dysfunction represents a promising and biologically plausible molecular target that may help to unify our understanding of fibromyalgia and eating disorders pending confirmation from prospective clinical studies in comorbid populations. Future research should prioritize prospective clinical trials testing Nrf2-targeted interventions in comorbid populations and collaborative patient-centered care models. Full article

Background: Health and social care workers (HSCWs) experience high levels of stress, burnout and emotional strain. Psychological safety is increasingly recognised as a protective factor, yet limited research has examined how individual psychological safety and team psychological safety jointly contribute to mental health outcomes in frontline care environments. Methods: A total of 821 HSCWs completed validated measures assessing individual psychological safety (NPSS), team psychological safety (TPSS), well-being, burnout and acute stress. Correlational analyses and hierarchical regression models were used to evaluate the unique and shared contributions of individual and team psychological safety to each outcome. Results: Both NPSS and TPSS were significantly associated with well-being, burnout and acute stress. Team psychological safety emerged as the strongest predictor of burnout and acute stress, accounting for substantial additional variance beyond individual psychological safety, with increases in explained variance ranging from 0.14 to 0.16. For well-being, NPSS (β = 0.38) and TPSS (β = 0.36) were both significant predictors. TPSS demonstrated large effects for burnout (β = 0.67) and acute stress (β = 0.72). Conclusions: Psychological safety plays a central role in the mental health of HSCWs. Team-based psychological safety was particularly influential in protecting against burnout and acute stress, while individual neuroceptive safety remained important for supporting overall well-being. Strengthening both individual and team-level psychological safety may enhance resilience and reduce psychological risk within health and social care settings. Implications: Incorporating NPSS and TPSS within workforce assessment may support early identification of psychological vulnerability, inform trauma-informed organisational interventions and promote more resilient, supportive workplace cultures. Full article

Duchenne muscular dystrophy (DMD) is a severe X-linked neuromuscular disorder caused by loss-of-function mutations in the dystrophin gene, leading to progressive muscle degeneration, motor decline, respiratory compromise, and cardiomyopathy. Diagnosis typically occurs in early childhood following recognition of motor delays, markedly elevated creatine kinase, and confirmatory genetic testing. Over the past decade, the therapeutic landscape for DMD has expanded substantially, evolving from exclusively supportive care to patient-centric multifaceted treatment paradigms, including corticosteroids, mutation-specific therapies, small molecule disease-modifying approaches, and gene replacement strategies. Despite these advances, no currently available therapy restores full-length dystrophin or completely halts disease progression. This review provides a clinically oriented comprehensive overview of currently Food and Drug Administration (FDA)-approved medications for DMD, with particular emphasis on corticosteroids, exon-skipping therapies, nonsense mutation readthrough agents, recently approved gene therapy, and select ongoing gene therapy trials. We summarize mechanisms of action, clinical efficacy, safety considerations, regulatory status, and highlight the challenges of integrating these therapies into longitudinal care. Through illustrative clinical vignettes, we highlight the real-world complexity of treatment selection, shared decision-making, and longitudinal care planning in contemporary DMD management. Full article

Background: Despite the widespread implementation of treat-to-target strategies and modern disease-modifying antirheumatic drugs, a substantial proportion of patients with rheumatoid arthritis (RA) continue to report unmet needs (UNs), defined as a mismatch between patient expectations and symptom burden on the one hand and outcomes achieved with current care on the other. Patient–physician discordance in global assessments may reflect multidimensional influences, including pain mechanisms, psychosocial factors, functional impairment, and communication gaps, extending beyond inflammatory disease activity. Methods: In this cross-sectional study, 133 patients with RA and 57 healthy controls were included. UNs were operationalized as the signed difference between patient global assessment and physician global assessment (ΔPGA–PhGA). Clinical variables, patient-reported outcomes, and Short Form-36 (SF-36) domains were incorporated into two regularized partial correlation network models estimated using the extended Bayesian information criterion graphical least absolute shrinkage and selection operator (EBICglasso). Node centrality indices (strength, signed strength, betweenness, and closeness) were calculated. Network stability was evaluated using 2000 bootstrap resamples and correlation stability (CS) coefficients. Results: In the clinical network, pain intensity demonstrated the highest strength centrality and the strongest direct association with UNs. In contrast, Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP) showed no direct association with UNs after accounting for shared variance. In the SF-36-based quality-of-life network, UNs exhibited inverse associations, particularly with perceived health change and role–emotional functioning. Stability analyses indicated acceptable to good robustness (clinical network: CS = 0.59 for edge weights and 0.44 for strength; SF-36 network: CS = 0.59), supporting the reliability of the estimated network structures. Conclusions: UNs in RA are not solely determined by inflammatory disease activity but are embedded within interconnected clinical and psychosocial domains. Pain occupies a structurally central position in the clinical network, whereas perceived health change and emotional role limitations characterize the quality-of-life context of UNs. These findings underscore the importance of multidimensional and patient-centered assessment strategies in RA management. Full article

Background/Objectives: Nurse–mother communication is central to maternal participation in Neonatal Intensive Care Units (NICUs), yet high acuity and workflow rhythms can compress dialogue and weaken shared understanding. This study used Communication Accommodation Theory and the Transactional Model of Stress and Coping to explain multilevel drivers of communication barriers and to co-produce feasible improvement strategies. Methods: A dyadic qualitative design was conducted across four Level III NICUs. Data were triangulated from 37 semi-structured interviews (18 mothers and 19 nurses, recruited through purposive maximum-variation sampling), approximately 40 h of non-participant observation, and 12-unit documents. A team-based codebook thematic analysis was applied, integrating observational logs with interview and document data to refine patterns and mechanisms. Results: A context-produced pattern of interactional compression was identified. Mothers contributed 2 or fewer speaking turns in 21/30 logged bedside encounters and were present in 13/16 observed round episodes, speaking in 5/13 of those episodes. Interpretability and language access gaps were common: unexplained technical terms occurred in 24/46 logged interactions; teach-back prompts occurred in 7/18 education encounters; professional interpreters were present in 3/9 language-discordant events. Three participation configurations described coping-linked engagement: threat–compression (n = 8), convergence-to-coping (n = 6), and resource-scaffolded participation (n = 4). In co-production, stakeholders co-produced (i.e., collaboratively identified and prioritized) three mechanism-targeted changes: protected post-round question-and-answer time incorporating teach-back, standardized visual “mini-packs,” and 24/7 interpreter access. Conclusions: Nurse–mother communication in NICUs can be structurally compressed by workload rhythms and uneven interpretability supports. Co-produced organizational scaffolds may expand opportunities for accommodation, comprehension verification, and equitable maternal participation. Full article

Glioblastoma (GBM) is a universally fatal cancer for which the standard of care has remained largely unchanged for the last 20 years. Recent work has demonstrated that most therapeutic trials for GBM fail due to complex mechanisms of immunosuppression mediated by both the innate and adaptive immune systems. Various metabolic alterations in the tumor microenvironment help maintain this local and systemic immunosuppression, of which the axis of hypoxia-driven tryptophan degradation has garnered substantial attention over the last decade. This paper synthesizes a much-needed elucidation of the immunometabolic reshaping of glioma, myeloid, endothelial, and lymphoid cell lineages induced by hypoxia. The current paper critically evaluates the role of IDO1/TDO2-mediated breakdown of tryptophan and the consequent accumulation of kynurenine, a metabolite that triggers GCN2- and AHR-mediated CD8+ T-cell exhaustion and supports regulatory T-cell differentiation and expansion. Furthermore, we propose a synthesis of mechanistic evidence that establishes a role for the Trp-GCN2-ATF4-VEGFA axis in hypoxia-induced immunosuppression, supporting that pro-tumoral metabolic dysregulation is directly linked to angiogenesis. In GBM, hypoxia and tryptophan–kynurenine pathway dysregulation operate as an integrated metabolic circuit that drives widespread immunosuppression. These mechanisms can be captured by a metabolic signature shared across nearly every cell type in the GBM microenvironment. Drawing on recent spatial transcriptomic, metabolomic, and pharmacologic studies, we outline how this metabolic axis shapes disease biology and how it can be targeted to restore effective antitumor immunity. Full article

Background/Objectives: Simple frailty assessments, such as the clinical frailty scale (CFS), are prognostic for worse outcomes in older adults with cancer and could support treatment decision-making. This interview study aims to explore clinicians’ experiences of using simple frailty assessments in oncology, including the impacts on patient care and barriers and facilitators to successful implementation. Methods: Semi-structured individual interviews were conducted with clinicians at three UK sites that had implemented CFS screening in lung cancer clinics as part of a national pilot, to explore how frailty assessments are applied and are impacting care. Purposive sampling targeted a range of professionals involved in assessing frailty and making treatment decisions. Recordings were transcribed verbatim and analysed thematically. Results: Ten clinicians participated, and four main themes were identified. ‘Assessing fitness and frailty’ explores the central role of performance status (PS), as well as its limitations, and what frailty assessments add. ‘Scoring and interpreting CFS’ describes the ease and relative yield of CFS use, particularly for patients with ‘borderline’ PS scores (e.g., PS 1–2 or 2–3), and the importance of contextual interpretation. ‘Role of frailty and impacts of assessment’ highlights how frailty assessments can enhance patient-centered care and support, and clinical and shared decision-making, with potential for streamlined care and system-level benefits. ‘Barriers and facilitators to implementation’ are described, including time, culture, guidance, and training, with recommendations provided. Conclusions: Assessing frailty has wide-ranging potential benefits for patients, oncology teams, and the wider system, but barriers must be overcome. Specific recommendations are provided to support the routine implementation of frailty assessments, which is a key step towards the benefits of frailty-informed care being realised at scale. Full article

Background/Objectives: The coexistence of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) poses significant clinical challenges due to overlapping mechanisms of systemic inflammation, oxidative stress, hypoxia, and metabolic dysregulation. Patients with both conditions face higher risks of exacerbations, prolonged hospitalizations, cardiovascular events, and reduced quality of life. This review aims to summarize current evidence on the pathophysiological interplay between COPD and T2D and to evaluate the impact of lifestyle and pharmacologic interventions. Methods: A narrative review of the literature was conducted to evaluate the pathophysiological links between COPD and T2D, assess the effects of pharmacologic and lifestyle interventions, and highlight key gaps and priorities for future research, with an emphasis on integrated, evidence-based management for this high-risk population. Results: Lifestyle interventions, including smoking cessation and structured physical activity, remain foundational to management. Emerging evidence indicates that antidiabetic therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter-2 inhibitors (SGLT-2is), may confer additional pulmonary, metabolic, and cardiovascular benefits. These agents modulate systemic inflammation, oxidative stress, endothelial function, and insulin sensitivity, potentially reducing COPD exacerbations, improving lung function, and enhancing survival. Safety concerns, including glucocorticoid-induced hyperglycaemia and hypoxia-related metabolic complications, underscore the need for careful monitoring and individualized therapy COPD patients. Conclusions: Optimal care requires a multidisciplinary, patient-centred approach integrating pulmonology, endocrinology, primary care, nutrition, and rehabilitation, alongside shared decision-making and patient education. Despite promising findings, critical knowledge gaps remain. Large, well-designed randomized controlled trials and standardized definitions are needed to guide personalized therapeutic strategies. Full article

Inflammatory bowel diseases (IBDs) and metabolic disorders are increasingly recognized as interconnected conditions that frequently coexist and influence each other’s clinical course. Accumulating evidence indicates that patients with IBD face a substantial burden of obesity, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, osteoporosis, and type 2 diabetes. These associations appear to be driven by shared and interacting mechanisms, including intestinal barrier disruption, gut microbiota dysbiosis, chronic systemic inflammation, and adipose tissue-mediated immunometabolic pathways. Metabolic comorbidities may worsen IBD activity, reduce response to therapy, increase complications, and contribute to higher health care utilization. Conversely, intestinal inflammation and commonly used treatments, particularly corticosteroids, can adversely affect glucose metabolism, lipid metabolism, body composition and bone homeostasis. Advanced therapies have demonstrated variable metabolic effects, some of which may be beneficial through suppression of systemic inflammation. Recognition of these bidirectional interactions highlights the importance of routine metabolic screening and integrated, multidisciplinary management. Lifestyle interventions, nutritional optimization and individualized therapeutic strategies represent central parts of comprehensive management. Full article