Search Results (2,869)

Objectives: Early death after trauma has been described several times. Little is known about it after traumatic brain injury (TBI) and decompressive craniectomy (DC). The aim of this study was to characterize patients who die after a TBI and DC during their in-hospital stay. Methods: In a subgroup analysis of a retrospective, multicenter, and observational study, non-survivors from in-hospital stays treated for severe TBI and DC were included. Propensity score matching (PSM) was used. Results: A total of 223 patients with severe TBI were treated with DC, and there were 65 (29.1%) patients who did not survive. Of these, 22 (33.8%) died within the first 24 h. Non-survivors were older (p = 0.010), and pupillomotor dysfunction and a higher heart rate on admission were more common (p < 0.001). PSM patients for overall survival (41, 18.4%) differed in mean heart rate from the deceased (p = 0.030). In a multivariate model, age (OR: 1.045, p = 0.013, CI95%: 1.010 to 1.082), Quick value (OR: 0.965, p = 0.049, CI95%: 0.931 to 1.000), and heart rate (OR: 1.099, p = 0.030, CI95%: 1.009 to 1.197) were confirmed as predictive factors. Conclusions: Even after DC, known factors, such as chronological age and comorbidities, have a significant influence on mortality. The value of DC in an aging society for a particular severity of TBI should be further assessed on the basis of prospective studies. Full article

(1) Background: People living with spinal cord injury (SCI) face numerous challenges in their lives in terms of health conditions, everyday activity, and participation in society, which are not fully recognized. To address such issues, a community survey with 125 questions for people living with SCI was conducted and the response rates, population characteristics, health and functioning problems are reported. (2) Methods: The survey questionnaire comprised 125 questions on SCI characteristics, health conditions, activities, participation, and environmental and personal factors. The survey response rates were calculated, and demographics and health and functioning characteristics were analyzed. (3) Results: A total of 890 individuals responded to the survey. The median age of the participants was 48 years (interquartile range (IQR), 39–56), and 76% of the population were males. Paraplegia (60%) and complete injury (58%) were the most common injury type, and the cause was mostly traumatic (92%). More health problems and lower quality of life were more frequent with older age and in patients without paid work. (4) Conclusions: The Ko-InSCI study provides valuable information in terms of health needs and service gaps for people with SCI in the community. Full article

Background: Plantar fasciitis (PF) is a common enthesopathy in patients with ankylosing spondylitis (AS). Shear wave elastography (SWE) and the Belgrade ultrasound enthesitis score (BUSES) may detect PF, but their comparative diagnostic performance is unclear. Objective: To compare SWE with the BUSES for identifying PF in individuals with and without AS. Methods: In this cross-sectional study, 96 participants were stratified into AS and non-AS populations, each further divided based on the presence or absence of clinical PF. Demographic data, the American Orthopedic Foot and Ankle Society Score (AOFAS), and the BASDAI score were recorded. All subjects underwent grayscale ultrasonography, the BUSES scoring, and SWE assessment of the plantar fascia. Logistic regression models were constructed for each population, controlling for age, body mass index (BMI), and fascia–skin distance. ROC curve analyses were performed to evaluate diagnostic accuracy. Results: In both AS and non-AS groups, SWE and the BUSES were significant predictors of PF (p < 0.05). SWE demonstrated slightly higher diagnostic accuracy, with area under the curve (AUC) values of 0.845 (AS) and 0.837 (non-AS), compared to the BUSES with AUCs of 0.785 and 0.831, respectively. SWE also showed stronger adjusted odds ratios in regression models. The interobserver agreement was good to excellent for both modalities. Conclusions: Both SWE and the BUSES are effective for PF detection, with SWE offering marginally superior diagnostic performance, particularly in AS patients. SWE may enhance the early identification of biomechanical changes in the plantar fascia. Full article

Background/Objectives: Feigning spectrum behavior (FSB) is the exaggeration, fabrication, or false imputation of symptoms. It occurs in compensable injury with great cost to society by way of loss of productivity and excessive costs. The aim of this study is to identify feigning by developing cut scores on the long and short forms (SF) of the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ and OMPSQ-SF) and the Perceived Stress Scale (PSS and PSS-4). Methods: As part of pre-screening for a support program, 40 injured workers who had been certified unfit for work for more than 2 weeks were screened once with the OMPSQ and PSS by telephone by a mental health professional. A control sample comprised of 40 non-injured community members were screened by a mental health professional on four occasions under different aliases, twice responding genuinely and twice simulating an injury. Results: Differences between the workplace injured people and the community sample were compared using ANCOVA with age and gender as covariates, and then receiver operator characteristics (ROCs) were calculated. The OMPSQ and OMPSQ-SF discriminated (ρ < 0.001) between all conditions. All measures discriminated between the simulation condition and workplace injured people (ρ < 0.001). Intraclass correlation demonstrated the PSS, PSS-4, OMPSQ, and OMPSQ-SF were reliable (ρ < 0.001). Area Under the Curve (AUC) was 0.750 for OMPSQ and 0.835 for OMPSQ-SF for work-injured versus simulators. Conclusions: The measures discriminated between injured and non-injured people and non-injured people instructed to simulate injury. Non-injured simulators produced similar scores when they had multiple exposures to the test materials, showing the uniformity of feigning spectrum behavior on these measures. The OMPSQ-SF has adequate discriminant validity and sensitivity to feigning spectrum behavior, making it optimal for telephone screening in clinical practice. Full article

Neurodegenerative disorders, including Alzheimer’s disease (AD), are a growing problem in aging society. The amyloid cascade hypothesis has recently been questioned, and therapies based on it have not yielded the expected results. However, the role of amyloid-β (Aβ) in AD pathogenesis cannot be rejected. It appears that some of the key players in the pathogenesis of the disease are the soluble amyloid-β oligomers. Soluble amyloid-β oligomers have neurotoxic effects by disrupting intracellular Ca²⁺ homeostasis and impairing mitochondrial function. The glymphatic system is an important pathway for the removal of soluble amyloid forms from the brain. The decline in the activity of this system is observed in aging brains, which is correlated with the occurrence of Alzheimer’s disease, primarily among the elderly population. Therefore, the question arises as to whether the glymphatic system could be another potential target for therapeutic interventions in Alzheimer’s disease. In this regard, it is imperative to pay attention to the factors that contribute to the pathogenesis of Alzheimer’s disease and also impact the glymphatic system, such as sleep, physical activity, alcohol consumption, and supplementation with polyunsaturated fatty acids. The question remains whether the glymphatic system will become the key to treating Alzheimer’s disease. Full article

With the arrival of an aging society and the continuous extension of the human lifespan, the quality of life has not improved in a corresponding manner. People’s demand for happiness and health is increasing. As a result, a model emerged that integrates tourism and medical services, which is health tourism. This growing demand has prompted many service providers to see it as a business opportunity and enter the market. Tourism can help travelers release work stress and restore physical and mental balance; meanwhile, health check-ups and disease treatment can help them regain health. Consumers have long favored health and medical tourism because it helps relieve stress and promotes overall well-being. As people age, some consumers experience a gradual decline in physical functions, making it difficult for them to participate in regular travel services provided by traditional travel agencies. Therefore, this study aims to explore the service needs of health and medical tourism customers (tourists/patients) and the interrelationships among these service needs, so that health and medical tourism service providers can develop more customized and diversified services. This study identifies four key drivers of medical tourism services: medical services, medical facilities, tour planning, and hospitality facilities. This study uses the APA (attention and performance analysis) method to assess each dimension and criterion and utilizes the DEMATEL method with the NRM (network relationship map) to identify network relationships. By combining APA and NRM techniques, this study develops the APA-NRM technique to evaluate adoption strategies and identify suitable paths for health tourism services, providing tailored development strategies and recommendations for service providers to enhance the service experience. Full article

(1) Background: Physical inactivity is a major public health concern in modern society. Group fitness programs are widely used to promote physical activity, combining choreographed movements with various dance steps and music. This study aimed to examine the effects of Zumba and MoFit group fitness programs on body composition parameters in women. (2) Methods: The study included 98 female participants (Mean age = 27.8 ± 2.9 years), divided into three groups: E1 (n = 33), which followed the experimental Zumba program; E2 (n = 31), which followed the experimental MoFit program; and a control group (n = 34), which continued with their usual daily activities for 10 weeks. Body composition was assessed using 14 variables measured with the InBody 270 analyser. Statistical analyses included paired t-tests, MANCOVA, and ANCOVA. (3) Results: The findings confirmed the positive effects of both group fitness programs on most body composition parameters in women (p < 0.001). However, Bonferroni post hoc test results indicated that the Zumba program led to significantly greater improvements in most body composition variables compared to the MoFit program. (4) Conclusions: Both Zumba and MoFit programs were effective in reducing body fat, increasing muscle mass, total body water, and mineral content, whereas the control group did not achieve positive changes. Full article

Enhancing farmers’ digital literacy is both an inevitable requirement for adapting to the digital age and an important measure for promoting the sustainable development of livestock and poultry manure resource utilization. This study surveyed and obtained data from 1047 farm households in Ningxia and Gansu, two provinces in China that have long implemented livestock manure resource utilization policies, from December 2023 to January 2024, and employed the binary probit model to analyze how digital literacy influences farmers’ willingness to adopt two livestock manure resource utilization modes, as well as to analyze the moderating role of three policy regulations. This paper also explores the heterogeneous results in different village forms and income groups. The results are as follows: (1) Digital literacy significantly and positively impacts farmers’ willingness to adopt both the “household collection” mode and the “livestock community” mode. For every one-unit increase in a farmer’s digital literacy, the probability of farmers’ willingness to adopt the “household collection” mode rises by 22 percentage points, and the probability of farmers’ willingness to adopt the “livestock community” mode rises by 19.8 percentage points. After endogeneity tests and robustness checks, the conclusion still holds. (2) Mechanism analysis results indicate that guiding policy and incentive policy have a positive moderation effect on the link between digital literacy and the willingness to adopt the “household collection” mode. Meanwhile, incentive policy also positively moderates the relationship between digital literacy and the willingness to adopt the “livestock community” mode. (3) Heterogeneity analysis results show that the positive effect of digital literacy on farmers’ willingness to adopt two livestock manure resource utilization modes is stronger in “tight-knit society” rural areas and in low-income households. (4) In further discussion, we find that digital literacy removes the information barriers for farmers, facilitating the conversion of willingness into behavior. The value of this study is as follows: this paper provides new insights for the promotion of livestock and poultry manure resource utilization policies in countries and regions similar to the development process of northwest China. Therefore, enhancing farmers’ digital literacy in a targeted way, strengthening the promotion of grassroots policies on livestock manure resource utilization, formulating diversified ecological compensation schemes, and establishing limited supervision and penalty rules can boost farmers’ willingness to adopt manure resource utilization models. Full article

Background: Thailand is rapidly transitioning into an aging society, creating an intergenerational caregiving gap that strains existing support systems. Objective: This study evaluated the effectiveness of “Young Care,” a community-based intervention designed to enhance youth knowledge, attitudes, and caregiving practices (KAP) toward older adults. Methods: A two-day structured training was conducted in Maha Sarakham Province in 2023 using a pre-post mixed-methods design. Middle and high school students participated in lectures, multimedia sessions, and experiential learning activities related to caregiving. Quantitative data were collected using validated KAP questionnaires, while qualitative insights were obtained from focus group discussions involving students, older persons, caregivers, and local leaders. Results: Post-intervention analysis revealed significant improvements in knowledge and attitudes (p < 0.001), accompanied by increased empathy, caregiving initiative, and a sense of moral responsibility among participants. Conclusions: The initiative fostered formal partnerships among schools, local governments, healthcare providers, and universities through memoranda of understanding. These collaborations enabled budgetary support and outreach to out-of-school youth, positioning “Young Care” as a scalable, youth-centered strategy to address Thailand’s long-term care challenges. Full article

As Thailand transitions into a super-aged society, falls are a rising public health issue. However, limited research focuses specifically on independent older adults in rural areas. This study examined intrinsic and extrinsic factors associated with falls among independent older adults in a rural district of southern Thailand, contributing to localized fall prevention strategies. A cross-sectional study was conducted using multi-stage probabilistic sampling with 325 older adults aged 60–79 years residing in Nakhon Si Thammarat. Data were collected through structured interviews, and multivariate logistic regression was used to identify fall predictors. A fall was defined as an unintended fall to a lower level within the previous 12 months. The fall prevalence was 29.8%, with the majority resulting in minor injuries. Multivariate analysis revealed protective factors, including sociodemographic factors such as higher monthly income (adjusted OR = 0.47; 95% CI: 0.30–0.74) and agricultural employment (adjusted OR = 0.50; 95% CI: 0.27–0.95), as well as the extrinsic factor of pet ownership (adjusted OR = 0.53; 95% CI: 0.35–0.81), were significantly associated with reduced fall risk. The study highlights context-specific protective factors that could inform community-based interventions. Future research should assess causality and intervention effectiveness in broader populations. Full article

Background: This study aims to compare the logistical challenges of Home Health Care (HHC) services in Portugal and Brazil, highlighting the structural and operational differences between both systems. Methods: Guided by an abductive research approach, data were collected using a semi-structured survey with open-ended questions, applied to 13 HHC teams in Portugal and 18 in Brazil, selected based on national coordination recommendations. The data collection process was conducted in person, and responses were analyzed using descriptive statistics and qualitative content analysis. Results: The results reveal that Portugal demonstrates higher productivity, stronger territorial coverage, and a more integrated inventory management system, while Brazil presents greater multidisciplinary team integration, more flexible fleet logistics, and more advanced digital health records. Despite these strengths, both countries continue to address key logistical aspects, such as scheduling, supply distribution, and data management, largely through empirical strategies. Conclusions: This research contributes to the theoretical understanding of international HHC logistics by emphasizing strategic and systemic aspects often overlooked in operational studies. In practical terms, it offers insights for public health managers to improve resource allocation, fleet coordination, and digital integration in aging societies. Full article

Background: Uterine fibroids (UFs) and endometriosis are gynecological conditions that significantly increase morbidity among women of reproductive age. Relugolix, a novel gonadotropin-releasing hormone receptor antagonist, is approved in combined therapy for the management of symptoms related to these disorders. However, its potential impact on bone mineral density (BMD) and osteoporosis risk should be considered when using a gonadotropin-releasing hormone (GnRH) antagonist. This systematic review aims to evaluate the effects of daily relugolix intake in monotherapy and combination therapy on BMD, ensuring safe long-term management. Methods: A systematic literature review was conducted following PRISMA 2020 guidelines. Searches were performed in PubMed, Medline, and the Cochrane Library. Relevant clinical guidelines from international societies were also reviewed. Studies assessing the impact of relugolix on BMD were selected, and data on treatment efficacy, adverse effects, and bone health outcomes were synthesized. Results: Relugolix monotherapy has been associated with significant BMD loss due to its potent estrogen-suppressing effect. To mitigate this, combination therapy with estradiol and norethisterone acetate has been developed. Although initial monotherapy before transitioning to combination therapy results in transient BMD reduction, clinical trials have demonstrated that relugolix combination therapy maintains BMD over two years while effectively reducing endometriosis- and UF-related symptoms. Conclusions: Relugolix combination therapy is an effective and well-tolerated treatment for UFs and endometriosis, minimizing the risk of hypoestrogenism-related bone loss while maintaining clinical benefits. Although monotherapy may lead to transient BMD reduction, combination therapy appears to stabilize bone health. Full article

Background: Achieving meaningful community integration (engagement in meaningful activity, independent living, and social connectedness) after a traumatic brain injury (TBI) requires addressing persistent barriers limiting its fulfillment. This qualitative study explored the perceptions and experiences of community integration for individuals living with TBI in the community. Methods: Using semi-structured interviews, four focus groups of individuals with TBI were conducted. Data were analyzed using codebook thematic analysis. Findings: There were 13 participants between the ages of 25 and 64, who had acquired their injury at least three years earlier. Community integration was illustrated through three themes: (1) ‘Am I left on my own?’ explored the support systems after TBI, (2) ‘One size fits all’ described the response of society to TBI, and (3) ‘Adapting to a new normal’ highlighted responses to a changed reality. Conclusions: Individuals with TBI reported decreased community integration in multiple facets of life. Understanding the experiences of community integration after TBI can create room for future rehabilitation interventions that consider new abilities and adaptation to barriers. Full article

Society’s adaptation to shared mobility services is a growing topic that requires detailed understanding of the local circumstances of potential and current users. This paper focuses on analyzing barriers to the adoption of urban bike-sharing systems in post-industrial cities, using a case study of the Silesian agglomeration in Poland. Methodologically, the article integrates quantitative survey methods with multivariate statistical analysis to analyze the demographic, socioeconomic, and motivational factors that underline the adoption of shared micromobility. The study highlights a detailed segmentation of users by income, age, professional status, and gender, as well as the observation of profound disparities in access and perceived usefulness. Of note is the study’s identification of a highly concentrated segment of young, low-income users (mostly students), which largely accounts for the general perception of economic and infrastructural barriers. These include the use of factor analysis and regression to plot the interaction patterns between individual user characteristics and certain system-level constraints, such as cost, infrastructure coverage, weather, and health. The study’s findings prioritize problem-specific interventions in urban mobility planning: bridging equity gaps between user groups. This research contributes to the current literature by providing detailed insights into the heterogeneity of user mobility behavior, offering evidence-based recommendations for inclusive and adaptive options for shared transportation infrastructure in a changing urban context. Full article

Modern Western societies are “aging” at a very high rate, and more and more people require assistance and care. Old age has different faces, which is due to genetic conditions, as well as the different contexts and lifestyles of people. To ensure good adaptation of seniors, it is important to determine the conditions for “successful aging”. Therefore, the purpose of the conducted study was to determine the importance of selected predictors, including the level of religiosity, assessment of health, and the intensity of motivational needs of seniors—students of the University of the Third Age—for the level of their well-being. A total of 115 people were surveyed, including 93 women and 21 men who were students in the first year of the Third Age University at the Pontifical University of John Paul II in Krakow. The surveyed seniors represented an autonomous type of religiosity, a high level of realization of the needs of self-determination, namely autonomy and competence, declared an average assessment of the state of their health, and revealed an increased level of eudaimonic well-being. Predictors of the level of well-being of the surveyed seniors turned out to be the variables religious experience, need for autonomy and competence, and health status, as assessed by the seniors. Full article