Healthcare, Volume 12, Issue 6 (March-2 2024) – 102 articles

Fibromyalgia is a chronic condition characterized by musculoskeletal pain. The aim of this study was to synthesize scientific evidence on the effects of aquatic exercise programs on pain and quality of life in individuals with fibromyalgia. This review was carried out using the following databases in January 2024: Cochrane Library, PEDro, PubMed, SCOPUS, and Web of Science. Four clinical trials focusing on aquatic exercise as a treatment for patients with fibromyalgia were selected. These trials were published in English between 2019 and 2024. Pain recorded using the Visual Analog Scale (VAS) and quality of life with the Short Form-36 Health Survey (SF-36) or Fibromyalgia Impact on Quality of Life (FIQ) were the most commonly analyzed variables. This review was carried out according to the PRISMA statement and was registered in PROSPERO (CRD42024510219). The results in terms of pain and quality of life were positive. In conclusion, these findings support the incorporation of aquatic exercise into fibromyalgia physical therapy treatment. However, the benefits could be equivalent to those of other exercise modalities, underscoring the need for individualized adaptation to each patient’s needs. Full article

Sarcopenic obesity refers to the coexistence of sarcopenia and obesity. This study assessed the prevalence of and risk factors for sarcopenic obesity in community-dwelling older males in Korea. This cross-sectional study analyzed data from 1060 community-dwelling participants. The participants were screened for sarcopenia and obesity. This study examined various risk factors, composed of somatometric, biochemical, and behavioral traits, including age; height; weight; body mass index; waist circumference; skeletal muscle mass index; fasting glucose, triglycerides, and cholesterol levels; systolic and diastolic blood pressure; and smoking and drinking traits. The prevalence of sarcopenic obesity in men had a weighted value of 9.09% (95% CI: 7.20–11.41). The clinical risk factors included short height, as well as high weight, body mass index, waist circumference, skeletal muscle mass index, triglyceride levels, systolic blood pressure, and diastolic blood pressure. Specific prevalence and clinical risk factors for sarcopenic obesity were found among community-dwelling older men. These findings may be beneficial for primary care clinicians and healthcare professionals for identifying individuals with sarcopenic obesity and referring them for early detection and treatment. Full article

This study investigated the association of job stress, quality of sleep, and near-miss error experiences among nurses working in general hospitals. A convenience sample of 195 nurses with over 3 months of work experience in a general hospital participated in the study. Statistical analyses were performed using SPSS 27.0. Factors influencing experiences of near-miss errors were examined through univariable and multivariate logistic regression. In total, 58.5% of nurses in a general hospital had experienced near-miss errors. Nurses in the upper job stress tertile (≥118) were 2.24 times more likely to encounter near-miss errors (95% CI: 1.07–4.69) and particularly 2.58 times (95% CI: 1.26–5.26) in falls and medical equipment-related near-miss errors. Nurses working more than 3 h of overtime per week had a 2.72 times higher (95% CI: 1.35–5.48) likelihood of experiencing near-miss errors related to falls and medical equipment and 4.03 times higher (95% CI: 1.92–8.45) likelihood of experiencing near-miss errors associated with examination procedures. To prevent near-miss errors among nurses in general hospitals, effective management of organizational job stress is crucial. Particularly for departments with a high level of overtime work (more than 3 h/week), it is essential to provide and manage educational programs on patient safety. Full article

Study Objectives: The aim of this cross-sectional study is to explore the association between serum 25-hydroxyvitamin D [25(OH)D] levels, a marker of Vitamin D status, and excessive daytime sleepiness (EDS), expressed as increased scores of the Epworth Sleepiness Scale (ESS), in a group of prospectively enrolled patients with obstructive sleep apnea (OSA). Methods: Newly diagnosed patients with OSA, divided into two groups, those with EDS (ESS > 10) and those without EDS (ESS < 10). All patients underwent night polysomnography. Measurement of serum 25(OH)D vitamin was performed using a radioimmunoassay. Results: In total, 217 patients with OSA (197 males and 20 females) were included. Patients with EDS had higher AHI (p < 0.001) values and lower mean serum 25(OH)D levels, compared with those of non-somnolent patients [17.4 (12.2–25.7) versus 21.1 (15.3–28.8) ng/mL, respectively, p = 0.005]. In patients with EDS, serum 25(OH)D levels correlated with average oxyhemoglobin saturation during sleep (r = 0.194, p = 0.043), and negatively with ESS score (r = −0.285, p = 0.003), AHΙ (r = −0.197, p = 0.040) and arousal index (r = −0.256, p = 0.019). Binary regression analysis identified Vit D serum levels (β = −0.045, OR: 0.956, 95% CI: 0.916–0.997, p = 0.035), total sleep time (β = 0.011, OR: 1.011, 95% CI: 1.002–1.021, p = 0.016) and AHI (β = 0.022, OR: 1.022, 95% CI: 1.003–1.043, p = 0.026) as independent predictors of EDS in patients with OSA. In patients with EDS, multiple regression analysis indicated that ESS score was negatively associated with Vit D serum levels (β = −0.135, p = 0.014) and minimum oxyhemoglobin saturation during sleep (β = −0.137, p = 0.043). Conclusions: In the present study, EDS in patients with OSA is associated with low levels of Vitamin D, while sleep hypoxia may play a role in this process. Full article

This study aimed to examine the physical activity and exercise status of stroke patients in the community after discharge and the need for community-based exercises. This study included 100 community-dwelling patients with stroke in South Korea. The survey investigated the self-assessment of health status and physical activity, demand for community-based exercise after discharge, quality of life, and social participation. Overall, 96% of the respondents recognized the need to exercise, and two-thirds exercised. The third who did not exercise cited disability (29%), lack of facilities (22%), and health concerns (13%); only 21% of participants had ever used a community exercise facility, and their satisfaction with the facility was low. The main reasons for not using community exercise facilities were concerns about accidents during exercise and accessibility issues. Among real-world community stroke patients, those who exercised regularly had higher EuroQol-5D and reintegration to normal living indices than those who did not exercise (p < 0.05). Although community-dwelling stroke patients were highly aware of the need for physical activity and exercise, few engaged in adequate exercise. This lack of engagement is directly linked to identifiable personal and socio-structural barriers. Addressing these barriers will improve the quality of life and social participation of patients with stroke. Full article

Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for patients with limited-stage muscle-invasive bladder cancer. RC is associated with a complication rate of approximately 50–88%. Immunonutrition (IMN) refers to the administration of substrates, such as omega-3 fatty acids, arginine, glutamine, and nucleotides, that modulate the immune response. IMN has been associated with improved outcomes following surgery for esophagogastric, colorectal and pancreatic cancer. In this paper, we describe a study protocol for a multicentre, randomised, open-label clinical trial to evaluate the effect of IMN in patients undergoing RC for bladder cancer. A 7-day preoperative course of IMN is compared with a standard high-calorie high-protein oral nutritional supplement. The primary outcome of this study is the rate of complications (infectious, wound-related, gastrointestinal, and urinary complications) in the first 30 days after RC. Secondary outcomes include time to recovery of bowel function and postoperative mobilisation, changes in muscle strength and body weight, biochemical modifications, need for blood transfusion, length of stay, readmission rate, and mortality. The results of this study may provide new insights into the impact of IMN on postoperative outcomes after RC and may help improve IMN prescribing based on patient nutritional status parameters. Full article

The experience of chronic non-cancer pain differs between women and men due to gender-related factors. This study (1) assessed the difference in responses to the impact of chronic non-cancer pain on daily life in women and men using the PAIN_Integral Scale© and (2) evaluated its invariance through multigroup confirmatory factor analysis. This was conducted by means of an analysis of invariance through a multigroup confirmatory factor analysis. A cross-sectional sample of 400 participants over 18 years of age with Chronic Non-Oncological Pain in Pain Units and Primary Care Centres belonging to the Spanish Public Health System was recruited (January to March 2020). An analysis was performed to assess whether any of the items in the instrument showed different behaviours. All analyses were performed using AMOS^® v.26 software. The results showed that the structure of the PAIN_Integral© Scale remained adequate when analysing its invariance in women and men, showing no metric, scalar and/or strict invariance. Therefore, these results indicated that the PAIN_Integral Scale© instrument has a different interpretation for women and men, identifying eight items with a singular functioning in both sexes and belonging to the subscales of proactivity, resilience and support network. These findings can be explained by gender stereotypes, since the dimensions where there are differences have an important social burden. Full article

During health emergencies, non-pharmaceutical interventions (NPIs) are adopted in various combinations until a vaccine can be produced and widely administered. Containment strategies, including the closure of schools, churches, and dance halls; banning of mass gatherings; mandatory mask wearing; isolation; and disinfection/hygiene measures, require reasonable compliance to be successfully implemented. But what are the most effective measures? To date, few systematic studies have been conducted on the effects of various interventions used in past epidemics/pandemics. Important contributions to our understanding of these questions can be obtained by investigating the historical data from the great influenza pandemic of 1918, an event widely considered one of the greatest natural disasters in human history. Taking on particular importance is the study of the possible role played by the behaviour of the population and the lack of public obedience to the non-pharmaceutical interventions in a Mediterranean country like Italy—one of the most affected countries in Europe—during that pandemic, with special attention paid to the weight of the socio-cultural factors which hindered the ultimate goal of containing the spread of the virus and preventing excess deaths in the country. Full article

Bone calcium turnover is aggravated in pregnant women recommended to bed rest. In the present cross-sectional study, we aimed to clarify whether preterm neonates would benefit from calcium supplementation during pregnancy. Forty-two mothers (37.5 ± 6.7 years), recommended bed rest at home, and 42 preterm neonates (24–37 weeks gestational age) were enrolled. Neonates’ serum calcium was quantified at birth. Mothers’ calcium intake from foods and supplements during pregnancy was assessed. Serum 25-OH-D was measured in both mothers and neonates at birth. Results showed that mothers’ calcium intake from foods was significantly lower than the recommended daily reference value (p < 0.001), while total calcium intake including supplements was close to the calcium reference value of 1000 mg/day (p = 0.648). Neonates’ serum calcium concentration was significantly higher in mothers receiving calcium supplementation during pregnancy compared to mothers who did not (p < 0.001). A significant association between neonates’ serum calcium levels and mothers’ calcium supplementation was evident, even when adjusted to mothers’ age, pre-pregnancy BMI, gestational age, and neonates’ birth weight (beta = +0.460, p = 0.025). A statistically significant correlation between neonates’ and mothers’ serum 25-OH-D levels was found (r = 0.891, p < 0.001). In conclusion, calcium status in preterm neonates, born by bedridden women, could be enhanced after calcium supplementation during gestation. Full article

Background: Quality of life (QOL) is frequently utilized in clinical medicine and research to assess a patient’s health status and treatment effectiveness. Objectives: This study investigates the impact of vocational training on the QOL of visually impaired individuals. Methods: We employed the brief Taiwan version of the World Health Organization QOL Questionnaire (WHOQOL-BREFTW) to assess four domains: physical, psychological, social, and environmental, using a nonequivalent pretest–posttest control group design. The experimental group participated in 6 months of vocational training, including life and career reconstruction. After completing the vocational training, the average QOL score for the experimental group was 3.34 ± 0.18, while the control group had a score of 3.10 ± 0.85. The generalized estimating equation (GEE) results revealed a notable improvement of 10.81 (1.10) in the posttest overall QOL scores compared to the pretest scores in the control group. Conclusion: Vocational training significantly improves the overall QOL for visually impaired individuals. It is noteworthy that the psychological, social relationship, and physical health domains of WHOQOL-BREF TW exhibited the most significant improvements. This emphasizes the following: 1. professional knowledge and technical learning can enhance the abilities of the visually impaired. 2. The improvement in QOL occurs primarily at physical, psychological, and social levels. These levels involve maintaining physical health, reducing dependence on medical care, and enhancing self-care abilities for life reconstruction. 3. Integrating electronics with directional action can help to mitigate the risks associated with outdoor activities. Full article

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has required a complete change in the management of patients with gastrointestinal disease who needed to undergo endoscopic procedures. In the second year of the COVID-19 pandemic, due to restrictions for elective endoscopic procedures, a large number of cancer patients were prevented from early diagnosis of several digestive cancers, which has led to a serious burden in the health system that now needs to be dealt with. We designed a prospective study that included patients in whom access to elective endoscopic examinations during the COVID-19 pandemic had been delayed. Our aim was to investigate the impact of the COVID-19 pandemic on the diagnosis rate of digestive tract malignancies in the context of health crisis management that generates an ethical dilemma regarding the balance of utilitarianism versus deontology. Our study shows that the decrease in the number of newly diagnosed gastrointestinal cancers by endoscopy and biopsy during the pandemic restrictions and the delay in diagnosis have had a clear impact on stage migration due to disease progression. Full article

Foreign domestic workers (FDWs) face challenges that impact their psychosocial well-being and health behaviours. This study utilized bibliometric analyses to examine research trends on the psychosocial and health-related behaviours of FDWs in the Asia Pacific region. The bibliometric analysis comprised citation analysis and co-occurrence analysis. A systematic literature search in academic databases, including Scopus, identified 73 relevant articles published from 1996 to 2023. The growth trend revealed a steady increase in the number of publications on FDWs’ psychosocial and health-related behaviours in Asia over the years, with significant growth from 2018 to 2023, indicating an increasing interest in this research area. The citation analysis identified influential studies, active authors, and sources with high publication numbers in this research area. The analysis also examined the geographical distribution of studies, identifying the countries and organizations in Asia that contributed significantly to FDW research. The co-occurrence analysis of keywords identified key themes and concepts in the literature. The most active keywords identified include “COVID-19”, “Depression”, “Foreign Domestic Workers”, “Mental Health”, and “Quality of Life”. In conclusion, this study provides a comprehensive understanding of the current trends and state of knowledge on the psychosocial and health-related behaviours of FDWs in the Asia Pacific region. Full article

Background and Objectives: The objective of this study was to determine the correlation between the prognosis of patients admitted to a tertiary intensive care unit (ICU) and the admitted patient population, intensive care conditions, and the workload of intensive care staff. Materials and Methods: This was a retrospective cross-sectional study that analyzed data from all tertiary ICUs (a minimum of 40 and a maximum of 59 units per month) of eight training and research hospitals between January 2022 and May 2023. We compared monthly data across hospitals and analyzed factors associated with patient prognosis, including mortality and pressure injuries (PIs). Results: This study analyzed data from 54,312 patients, of whom 51% were male and 58.8% were aged 65 or older. The median age was 69 years. The average number of tertiary ICU beds per unit was 15 ± 6 beds, and the average occupancy rate was 83.57 ± 19.28%. On average, 7 ± 9 pressure injuries (PI) and 10 ± 7 patient deaths per unit per month were reported. The mortality rate (18.66%) determined per unit was similar to the expected rate (15–25%) according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score. There was a statistically significant difference among hospitals on a monthly basis across various aspects, including bed occupancy rate, length of stay (LOS), number of patients per ICU bed, number of patients per nurse in a shift, rate of patients developing PI, hospitalization rate from the emergency department, hospitalization rate from wards, hospitalization rate from the external center, referral rate, and mortality rate (p < 0.05). Conclusions: Although generally reliable in predicting prognosis in tertiary ICUs, the APACHE II scoring system may have limitations when analyzed on a unit-specific basis. ICU-related conditions have an impact on patient prognosis. ICU occupancy rate, work intensity, patient population, and number of working nurses are important factors associated with ICU mortality. In particular, data on the patient population admitted to the unit (emergency patients and patients with a history of malignancy) were most strongly associated with unit mortality. Full article

Law enforcement is a stressful occupation that places significant psychological demands on those serving in this role. However, little is known about the severity of work-related stress and psychological distress among law enforcement officers (LEOs) in North Carolina (NC). This cross-sectional study examined the severity of work-related stress and psychological distress among 283 LEOs in NC. The Maslach Burnout Inventory, the Operational Police Stress Questionnaire, the Depression, Anxiety, and Stress Scale, and the Post-Traumatic Stress Disorder (PTSD) Checklist were used to assess burnout, operational police stress, depression, anxiety, stress, and PTSD among LEOs. Descriptive statistics, independent t-tests, Mann–Whitney U tests, one-way ANOVA, and Kruskal–Wallis tests were performed. Rural and male LEOs reported higher burnout levels related to depersonalization (i.e., increased mental distance from one’s job) compared with their urban and female counterparts. LEOs exposed to toxic materials or performing patrol duties exhibited higher operational police stress levels than those who did not. Caucasian LEOs exhibited higher depression, anxiety, and stress than their African American counterparts. Rural LEOs and LEOs who were exposed to toxic materials displayed higher levels of PTSD than their counterparts. Our findings highlight the need for increased mental health support and better working environments for LEOs. Full article

COVID-19 disease is characterised by a wide range of symptoms that in most cases resemble flu or cold. Early detection of infections, monitoring of patients’ conditions, and identification of patients with worsening symptoms became crucial during the peak of pandemic. The aim of this study was to assess and compare the performance of common early warning scores at the time of admission to an emergency department in predicting in-hospital mortality in patients with COVID-19. The study was based on a retrospective analysis of patients with SARS-CoV-2 infection admitted to an emergency department between March 2020 and April 2022. The prognostic value of early warning scores in predicting in-hospital mortality was assessed using the receiver operating characteristic (ROC) curve. Patients’ median age was 59 years, and 52.33% were male. Among all the EWS we assessed, REMS had the highest overall accuracy (AUC 0.84 (0.83–0.85)) and the highest NPV (97.4%). REMS was the most accurate scoring system, characterised by the highest discriminative power and negative predictive value compared to the other analysed scoring systems. Incorporating these tools into clinical practice in a hospital emergency department could provide more effective assessment of mortality and, consequently, avoid delayed medical assistance. Full article

Social connection is a core dimension of health and wellness among all populations, yet the experience of moving to and living in a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Using hybrid (inductive/deductive) qualitative analysis, we identified seven domains of social connection from the perspective of the interviewed participants: (1) lens of the individual; (2) immigrant experience; (3) interpersonal support; (4) community belonging; (5) community capital; (6) community navigation; and (7) social acceptance. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of social connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. Additionally, these results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess the social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants. Full article

This qualitative study explored the experiences of nursing students whose clinical practice in mental health nursing had been substituted with virtual simulation programs due to the COVID-19 pandemic. The participants were ten nursing students who had undergone a virtual simulation program-centered practice, replacing the traditional clinical practice in mental health nursing and previous clinical practice in mental health nursing. The data were collected through in-depth individual interviews from January to February 2021. Following Braun and Clarke’s method, the thematic analysis identified five themes and ten sub-themes. The five themes included the following: (1) lack of vibrancy in the actual clinical setting, (2) limited direct and indirect practical experience, (3) performing diverse roles in a virtual setting, (4) learner-directed practicum, and (5) sense of relief due to a safe virtual practicum environment. The participants recognized the limitations of the practice, particularly regarding communication with patients with mental disorders in the virtual simulation program. However, their perception of nursing underwent a positive change through the indirect clinical practice experience. Accordingly, it is necessary to develop a platform for the mental health nursing practicum that can easily interact with clients and to establish a hybrid practice that combines the clinical practice and virtual simulation practice. Full article

Background: Substance use disorders pose unique challenges, affecting individuals physiologically and socially. This study addresses the fundamental question of how adherence to exercise programs impacts those with substance use disorders, examining both in-person and online interventions. Methods: A 12-week analysis involving 26 participants assessed physical fitness, strength, and quality of life. Participants were categorized into in-person and online exercise groups, with their adherence tracked through attendance and a dedicated app. Results: The in-person group exhibited higher adherence rates and significant improvements, in contrast to the challenges encountered by the online groups, particularly in substance use disorder cohorts. Statistical analyses highlighted these differences, emphasizing the pivotal role of the exercise program delivery format. Conclusions: This research advocates for hybrid models, blending professional supervision with online flexibility, recognizing the distinct challenges of substance use disorders. Insights from this study will contribute to shaping more effective, personalized interventions in the complex landscape of substance use disorders, offering guidance for advancing treatment strategies. Full article

This study explores the integration of large language models (LLMs), like ChatGPT, to improve attention deficit hyperactivity disorder (ADHD) treatments. Utilizing the Delphi method for its systematic forecasting capabilities, we gathered a panel of child ADHD therapy experts. These experts interacted with our custom ChatGPT through a specialized interface, thus engaging in simulated therapy scenarios with behavioral prompts and commands. Using empirical tests and expert feedback, we aimed to rigorously evaluate ChatGPT’s effectiveness in therapy settings to integrate AI into healthcare responsibly. We sought to ensure that AI contributes positively and ethically to therapy and patient care, thus filling a gap in ADHD treatment methods. Findings show ChatGPT’s empathy, adaptability, and communication strengths, thereby highlighting its potential to significantly improve ADHD care. The study points to ChatGPT’s capacity to transform therapy practices through personalized and responsive patient care. However, it also notes the need for enhancements in privacy, cultural sensitivity, and interpreting nonverbal cues for ChatGPT’s effective healthcare integration. Our research advocates for merging technological innovation with a comprehensive understanding of patient needs and ethical considerations, thereby aiming to pioneer a new era of AI-assisted therapy. We emphasize the ongoing refinement of AI tools like ChatGPT to meet ADHD therapy and patient care requirements more effectively. Full article

Background: Healthcare students’ health and wellbeing have been seriously affected worldwide. Research studies highlighted the need to establish health promotion strategies to improve them. Methods: A mixed method feasibility with a randomized controlled trial study followed by qualitative focus-group interviews to evaluate the effect of a 24 h online health promotion program improving healthcare students’ health and wellbeing was performed in mid-2022. The study also illustrated the program’s effect, contents, and activity arrangements. Healthcare students from two large tertiary institutions were randomly assigned to intervention and waitlist-control groups. Outcomes were measured by self-completed online questionnaires at three-time points (baseline, week four, and week eight), and in-depth focus-group interviews followed. Results: Among 70 enrolled and 60 eligible students, 54 completed the study, with a 10% attrition rate. Results demonstrated a significant difference between groups at week eight. Within the intervention group, there were significant differences were found from baseline to week eight for depression (p = 0.001), anxiety (p = 0.004), and stress (p < 0.001). The program also improved certain domains of personal wellbeing and quality of life. Qualitative findings further illustrated the program contents and activities’ feasibility, acceptability, and suitability. Most participants welcomed the online mode’s flexibility and convenience. They enjoyed diversified and complementary content and activities. They had increased self-awareness of health and wellbeing. Besides, mental health knowledge enables them to ‘self-care’ and help those in need in the future. Conclusions: The results indicate the feasibility of performing full-scale research in the future and may provide more support for the students of higher education institutions. Full article

Background: Shared decision-making is one key element of interprofessional collaboration. Communication is often considered to be the main reason for inefficient or ineffective collaboration. Little is known about group dynamics in the process of shared decision-making in a team with professionals, including the patient or their parent. This study aimed to evaluate just that. Methods: Simulation-based training was provided for groups of medical and allied health profession students from universities across the globe. In an overt ethnographic research design, passive observations were made to ensure careful observations and accurate reporting. The training offered the context to directly experience the behaviors and interactions of a group of people. Results: Overall, 39 different goals were defined in different orders of prioritizing and with different time frames or intervention ideas. Shared decision-making was lacking, and groups chose to convince the parents when a conflict arose. Group dynamics made parents verbally agree with professionals, although their non-verbal communication was not in congruence with that. Conclusions: The outcome and goalsetting of an interprofessional meeting are highly influenced by group dynamics. The vision, structure, process, and results of the meeting are affected by multiple inter- or intrapersonal factors. Full article

Perinatal exposure to pollutants, including persistent organic pollutants (POPs) and heavy metals, poses significant risks to both mothers and children, marking this period as highly vulnerable. Despite the well-acknowledged benefits of breastfeeding, there exists a gap in comprehensive understanding regarding the impact of environmental pollutants on breast milk, underscoring the critical need for this study. Our research addresses this gap by exploring the intersection of environmental health and lactation, situated within the broader ‘One Health’ concept, thus contributing a novel perspective to the existing body of knowledge. This scoping review aims to examine recent research on the persistent presence of organic pollutants (POPs) and heavy metals in breast milk, thereby elucidating the environmental setting’s impact on milk quality. We seek to highlight the innovative angle of our study by emphasizing the ‘One Health’ concept, which has not been thoroughly explored in the context of lactation and environmental pollutants. We performed a scoping review, consulting two online databases to identify articles published from 1995 to 2023 that reported on pollutants in breast milk, using the PRISMA checklist. This methodological approach underlines the comprehensive and up-to-date nature of our literature review, ensuring the relevance and timeliness of our findings. From a total of 54 relevant articles, findings indicate that POPs are present in higher concentrations in breast milk the longer the lactation period. These findings highlight the persistent and bioaccumulative nature of such contaminants, offering new insights into their long-term implications for maternal and infant health. This exposure does not appear time-sensitive, suggesting pollutants accumulated in maternal fat compartments can be excreted into human milk years after exposure, a novel finding that underscores the importance of considering long-term environmental exposures in lactation research. The presence of POPs and heavy metals in both infant formula and maternal milk underscores a critical need for further comparative studies to understand the health implications better. Our discussion extends the current dialogue on the safety of breastfeeding in polluted environments, providing a new framework for assessing risks and benefits. While breastfeeding remains the WHO-recommended nutrition for optimal infant growth, the findings emphasize the importance of continued risk reduction policies to protect mothers and infants from environmental contaminants in breast milk. Our conclusion calls for an integrated approach, combining public health, environmental science, and clinical practice to develop effective strategies for reducing exposure to environmental pollutants. This multidisciplinary perspective is a significant contribution to the field, paving the way for future research and policy development. Full article

Objectives: The aim of this study was to evaluate the clinical effectiveness of craniosacral therapy (CST) in the management of any conditions. Methods: Two independent reviewers searched the PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases in August 2023, and extracted data from randomized controlled trials (RCT) evaluating the clinical effectiveness of CST. The PEDro scale and Cochrane Risk of Bias 2 tool were used to assess the potential risk of bias in the included studies. The certainty of the evidence of each outcome variable was determined using GRADEpro. Quantitative synthesis was carried out with RevMan 5.4 software using random effect models. Data Synthesis: Fifteen RCTs were included in the qualitative and seven in the quantitative synthesis. For musculoskeletal disorders, the qualitative and quantitative synthesis suggested that CST produces no statistically significant or clinically relevant changes in pain and/or disability/impact in patients with headache disorders, neck pain, low back pain, pelvic girdle pain, or fibromyalgia. For non-musculoskeletal disorders, the qualitative and quantitative synthesis showed that CST was not effective for managing infant colic, preterm infants, cerebral palsy, or visual function deficits. Conclusions: The qualitative and quantitative synthesis of the evidence suggest that CST produces no benefits in any of the musculoskeletal or non-musculoskeletal conditions assessed. Two RCTs suggested statistically significant benefits of CST in children. However, both studies are seriously flawed, and their findings are thus likely to be false positive. Full article

Introduction: Self-managed exercise and nutrition interventions can alleviate pre-frailty and frailty but understanding of adherence to them is lacking. This study aimed to explore the experiences of, and barriers and enablers to, a hospital-to-home self-managed combined exercise and nutrition program for hospitalised older adults living with pre-frailty and frailty. Methods: A hybrid approach to data- and theory-driven descriptive thematic analysis identified experiences, barriers, and enablers to participation in a 3-month, self-managed, exercise–nutrition, hospital-to-home frailty-support program. Pre-frail and frail older adult patients ≥ 65 years admitted to the acute medical unit at a South Australian tertiary hospital were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim, and analysed descriptively, using the Theoretical Domains Framework. Results: The nutrition component of the program found 11 common barriers and 18 common enablers. The exercise component included 14 barriers and 24 enablers. Intentions, Social influences, Environmental context/resource and Emotions served as primary barriers towards adherence to both components. Common enablers for both components included Knowledge, Social identity, Environmental context/resource, Social influences, and Emotions. Conclusions: This research revealed important factors affecting adherence to a self-managed exercise–nutrition program in pre-frail and frail older adults within the environment, resources, and emotion domains that should be considered when designing other intervention programs in this population group. Full article

Women’s knowledge about perimenopause plays a crucial role in shaping their perception of related illnesses, influencing coping strategies, treatment adherence, and the overall management of this life stage. This cross-sectional study assessed the awareness, knowledge, attitudes, and practices regarding perimenopause among 409 Saudi women attending primary healthcare centers. Participants completed a structured questionnaire addressing demographic data, awareness, knowledge, attitudes, and practices related to perimenopause. While 75.3% of the participants were aware of perimenopause, only 17.4% could identify more than 10 out of 20 perimenopause symptoms. Commonly recognized symptoms included menstrual irregularity (67.7%), mood swings (66.0%), and mood fluctuations (50.4%). Only 23.0% had optimal knowledge about perimenopause complications. Additionally, 73.3% had not consulted a doctor for perimenopause-related issues. An analysis of the overall knowledge score showed a mean (SD) = 14.82 (5.64) out of 34. The level of knowledge was independently associated with a higher educational level, more frequent perimenopause symptoms, and regular doctor visits. This study reveals high awareness but insufficient knowledge among Saudi women regarding perimenopause symptoms and complications associated with higher perimenopause morbidity and a lack of engagement with healthcare professionals. It underscores the need for early and continued education on perimenopause, improved doctor–patient communication, and specific interventions to boost knowledge and attitudes toward perimenopause. Full article

Wellness-centric proactive healthcare is increasingly sought after, with individuals frequently embracing complementary modalities to achieve this goal. In this six-month study, healthy adult participants (n = 25) received specific therapies, including whole-body cryotherapy, infrared sauna, and photobiomodulation, along with guidance on physical activity, diet, and alcohol intake. Serum biomarkers were measured for all participants, while a subset also received biometric assessments for body composition (n = 10) and heart rate variability (n = 7). Over the course of the study (mean (SD) follow-up days = 174 (130)), participants exhibited significant improvements in health. LDL cholesterol (−9.77 (15.43) md/dL) and hsCRP (−1.75 (2.66) mg/L) decreased significantly (p < 0.05). HbA1c increased slightly (p < 0.05), but the effect size was small (0.12 (0.13)%). The body composition subset lost overall body weight (−3.29 (3.75) kg), primarily body fat, while preserving lean muscle mass (p < 0.05). Heart rate variability increased for those with existing cardiovascular risk factors (p < 0.05). In conclusion, participation in the multimodal Healthspan protocol is associated with substantial improvements in health-related biomarkers and biometrics. Full article

Background: This article investigates the determinants of the intention to migrate of nursing students at a major medical university in Romania and relates them to major international developments, specifically the Brexit referendum and the COVID-19 pandemic. Methods: An online survey about the intention to migrate was made available to nursing students at the University of Medicine and Pharmacy “Iuliu Hațieganu”, Cluj-Napoca, Romania, in 2016 (before Brexit) and again in 2016 (after Brexit), 2017, 2018, and 2021 and 2022 (during the pandemic). A total of 549 students responded (response rate: 84.6%). Results: Before the Brexit referendum, 62.6% of the respondents had a plan to seek employment abroad, whereas after the Brexit referendum, only 34.7% indicated that they had such a plan after graduation. Before the pandemic, 43.6% of the students expressed an intention to work abroad, while during the pandemic, only 19.8% had such plans. Conclusions: This study documented the effect of significant international developments—such as the Brexit referendum and the COVID-19 pandemic—on decreasing the intention to migrate. As expected, the change in preference for the UK as a destination country changed dramatically. Additionally, the study provides both theoretical and empirical insights into the types of and the consistency of preparation for migration of nursing students. Full article

Background: Therapeutic climbing (TC) has emerged as a prospective rehabilitation approach for individuals with multiple sclerosis (MS). The existing literature primarily focuses on the physical and psychological benefits of TC across diverse populations but is limited concerning its application and efficacy for patients with MS. Objectives: This study aimed to delineate the experiences, subjective effects, and perceptions of both individuals with MS and therapists regarding TC, highlighting the potential benefits and challenges of this therapeutic approach. Methods: Using a qualitative design, semi-structured interviews were conducted with patients living with MS (N = 5) and therapists (N = 7) involved in TC sessions at a rehabilitation facility. The interviews were recorded, transcribed verbatim, and subjected to thematic qualitative text analysis. Results: Our analysis resulted in the identification of five main categories: (1) motivational factors, (2) training conditions, (3) training content, (4) observed effects, and (5) safety protocol. Our findings primarily centred around the motivational aspects of TC. Participants consistently reported experiencing feelings of accomplishment, success, enjoyment, and increased self-confidence. Furthermore, TC was often perceived as a comprehensive intervention, addressing endurance, strength, flexibility, neuromotor functions, cognition, and mental health while having a low-risk profile. However, due to the demanding nature of TC, careful fatigue management is crucial. This entails personalised intensity adjustments during sessions and coordinating TC with other physically demanding therapies when implementing TC within a rehabilitation environment. Conclusions: TC shows promise within MS rehabilitation and can be considered safe under certain framework conditions. This research sheds light on its potential benefits, facilitators, and barriers and provides insights for practical integration into rehabilitation programs. Full article

Endometriosis is a chronic gynecological disease characterized by ectopic endometrial tissue outside the uterus that can cause chronic pain, dysmenorrhea, fatigue, and infertility. The aim of this study was to assess diet quality and nutritional knowledge of women with endometriosis. A questionnaire was used to collect data on lifestyle, dietary habits and nutritional knowledge from 90 women. More than 80% of women with endometriosis (82.2%) confirmed that diet and lifestyle are related to the progression of endometriosis. After being diagnosed with endometriosis, 77.3% of respondents reported a change in their dietary habits and made various changes to their diet by increasing or eliminating the consumption of certain foods. The majority declared reducing pro-inflammatory products, increasing anti-inflammatory foods, including the consumption of vegetables and fruits, avoiding white/or red/or processed meat, and avoiding sweets. Nevertheless, diet quality as assessed by the pro-healthy diet index (pHDI-10) and the Mediterranean Diet Score (MDS) showed a low intensity of consumption of pro-healthy food (average pHDI-10 value 31.4%; MDS 7.55/14 points, p = 0.0001). Women with endometriosis reported lower than recommended consumption of fruits, vegetables, dairy products and whole grains. A higher percentage of healthy controls had a “good” level of nutritional knowledge than women with endometriosis. The results of our study highlight the need to improve diet quality and nutritional knowledge among women with endometriosis as well as developing targeted dietary recommendations to help improve well-being and reduce the pain symptoms of endometriosis. Full article

(1) Background: Healthy aging is the process of developing and maintaining functional capacity and optimizing involvement in order to improve one’s quality of life as people age. This study aimed to encourage healthy aging in people with cognitive impairment, as well as a control group, via the use of the Nintendo Switch combined with occupational therapy sessions, aiming to improve gross and fine motor skills, functionality, quality of life, and cognitive status. (2) Methods: A randomized clinical trial was undertaken. The sample was randomized using the OxMar software program Attribution 4.0 International, facilitating the division into a control group (CG), who received conventional occupational therapy sessions, and an experimental group (EG), who received therapy incorporating the Nintendo Switch, in addition to conventional occupational therapy sessions. The intervention period with the Nintendo Switch lasted for 8 weeks. (3) Results: Thirty-two participants were included in the study. Significant differences were found in the vast majority of the variables analyzed, which shows an improvement following the intervention; these improvements were mainly observed in measures of skill and the perception of quality of life. (4) Conclusions: An eight-week intervention with the Nintendo Switch alongside conventional occupational therapy helps to maintain cognitive status and functional independence. Following 8 weeks of intervention with the Nintendo Switch, improvements in gross motor dexterity, fine motor dexterity, and quality of life were observed in older people with cognitive impairment. Full article