Healthcare, Volume 13, Issue 5 (March-1 2025) – 138 articles

Background: The long-term effects of hormone replacement therapy (HRT) on inflammatory bowel disease (IBD) remain unclear, necessitating further investigations of the association between HRT and the development of ulcerative colitis and Crohn’s disease in postmenopausal women. Methods: This retrospective cohort study utilized Taiwan’s National Health Insurance claims (2001–2018) to identify postmenopausal women aged ≥ 50 years with HRT use. A one-year washout period was applied before the index date to ensure new HRT users. To address the immortal time bias, follow-up for HRT users began at HRT initiation. The non-HRT group was selected by 1:1 propensity score matching. Cox proportional hazards models with adjustments for comorbidities and medications were used to estimate hazard ratios. Results: A total of 10,126 postmenopausal women (5063 per group) were included. During a mean follow-up of 11.1 years, the incidence rates of ulcerative colitis were 0.14 and 0.11 per 1000 person-years in the HRT and non-HRT groups, respectively. The adjusted hazard ratios were 1.33 (95% CI, 0.46–3.83; p = 0.600) for ulcerative colitis and 0.72 (95% CI, 0.45–1.16; p = 0.177) for Crohn’s disease. Conclusions: This longitudinal study suggests that HRT use is not significantly associated with the risk of IBD among postmenopausal women. These findings indicate that IBD risk may not need to be a primary concern when considering HRT in this population. Full article

Background/Objectives: Initiation and progression of periodontal disease include oxidative stress. Systemic application of antioxidants may provide clinical benefits against periodontal disease including gingivitis. Recently, a jelly containing a high concentration of hydrogen (40 ppm) was developed. We hypothesized that oral intake of this hydrogen-rich jelly may be safe and effective on gingivitis. This clinical trial was designed to investigate the safety and efficacy of oral intake of hydrogen-rich jelly against gingival inflammation. Methods: Participants with gingivitis were instructed to orally ingest 30 g of hydrogen-rich jelly (experimental group) or placebo jelly (control group) three times a day for 14 consecutive days. The primary outcome of this trial was the percentage of bleeding on probing (BOP) sites. Secondary outcomes were oral parameters, serum reactive oxygen metabolites, antioxidant capacity, oxidative index, concentrations of cytokine (interleukin [IL]-1β, IL-6, IL-10, IL-17, and tumor necrosis factor-alpha) in gingival crevicular fluid, and adverse events. For all parameters, Mann–Whitney U test was used for comparison between experimental and control groups. Analysis of covariance, controlling for baseline periodontal inflamed surface area, was performed to evaluate the association between the effect of the hydrogen-rich jelly and gingival inflammation. Results: In the experiment and control groups, the percentage of sites with BOP and PISA significantly decreased at the end of the experiment compared to the baseline. However, no significant differences were found between groups (p > 0.05). Conclusions: Administration of hydrogen-rich jelly for 14 days decreased gingival inflammation. However, no significant differences were identified compared to the control group. Full article

Background/Objectives: Prenatal physical activity (PA) offers numerous health benefits for both the mother and her child, yet few pregnant women are sufficiently active enough to obtain these benefits. Midwives play an important role in promoting prenatal PA. However, little is known about the content of the information they share with their clients regarding prenatal PA, how they communicate it, and the personal factors that might influence their counseling. In the context of prenatal PA guidance, the aim of this study was to describe the knowledge, attitudes, professional practices, and communication methods used by midwives. Methods: A cross-sectional descriptive study was conducted between February and June 2024 among midwives working in the Province of Quebec. An electronic questionnaire including both closed (quantitative data) and open-ended (qualitative data) questions was developed. Results: Fifty midwives were included in the analysis. Only 28 (56%) reported being aware of the latest Canadian guidelines for PA throughout pregnancy. The recommendations provided varied in terms of content and accuracy but were often conservative (i.e., not focused on increasing PA). Forty-five (90%) mentioned providing information on PA to their pregnant client, and eighty-four (84%) said they used bidirectional communication to share this information. The vast majority (84%) did not consider their counseling to be optimal, primarily due to a lack of training and knowledge. Conclusions: Our finding allowed us to gain a better understanding of current midwifery knowledge, attitudes, and professional practices regarding prenatal PA and to initiate a reflection on how to improve their knowledge, skills, and confidence in guiding their client toward prenatal PA. Full article

Background: Adequate levels of leisure-time exercise (LTE) are associated with mental health benefits. Despite increased research in recent years through randomized controlled trials (RCTs), a systematic literature review summarizing these findings is lacking. Here, we examined publication trends, impact, and research gaps regarding LTE’s effects on mental health in the form of a bibliometric analysis. Methods: Five electronic databases (PubMed, EMBASE, Web of Science, Ovid Medline, and the Cumulative Index for Nursing and Allied Health Literature) were searched from their inception until 20 November 2024. Citations were independently screened by two authors and included based on pre-determined eligibility criteria. Bibliometric analysis was conducted using SciVal and VOSviewer under five themes: (1) descriptive analysis, (2) network analysis, (3) thematic mapping, (4) co-citation and co-occurrence analysis, and (5) bibliometric coupling. Results: The systematic search identified 5792 citations, of which 78 RCTs met the inclusion criteria. Only one study was conducted in a low- or middle-income country. Sixty-four percent of studies were published in quartile-one journals. Most studies were conducted in the United States, followed by Australia, Canada, and the United Kingdom. National collaborations yielded the highest citation rates, reflecting the influence of cultural and social norms on exercise and mental health. Research gaps were identified with regards to the validity of mental health measures, the paucity of data from low- and middle-income countries, and emerging research sources. Conclusions: This bibliometric analysis highlights the existing evidence on LTE’s impact on mental health and identifies areas for future research and policy. Trials exploring valid mental health outcomes, biomarkers such as mood and oxidative stress, and collaborative research are needed, particularly in underrepresented regions of the world. Full article

Background/Objectives: The recent COVID-19 pandemic posed a significant psychological challenge for healthcare workers. Resilience and the extent of psychological stress varied across professional groups and individual circumstances. This study aims to longitudinally capture the trajectories of psychological stress and resilience among medical personnel during the pandemic and identify various contributing factors. Methods: Over a period of three years, healthcare workers from five locations (Bonn, Cologne, Ulm, Erlangen, and Dresden) were surveyed regarding their psychological stress (PHQ-4) and other aspects of mental health. Data were collected at five different points during the pandemic. Using Growth Mixture Modeling (GMM), various stress trajectories during the crisis were modeled without initial adjustment for covariates to allow for an unbiased identification of latent classes. Differences in demographic and occupational factors (e.g., age, gender, profession) were analyzed across the identified trajectory groups in subsequent steps. Results: The application of GMM revealed three distinct profiles of psychological stress and resilience among the respondents, largely consistent with the literature. The largest group was the ‘resilience’ group (81%), followed by the ‘recovery’ (10%) and ‘delayed’ groups (9%). Group membership was consistent with self-reported trajectories over the course of the pandemic. It was not possible to predict individual trajectories based on the results of a short resilience questionnaire (RS-5). Conclusions: The COVID-19 pandemic had multiple psychological impacts on healthcare workers, manifesting in clearly differentiated group trajectories of distress over time. While a majority of respondents in this sample exhibited a stable trajectory with low distress, other groups showed varying stress responses over time. These findings highlight the necessity of longitudinal approaches to understand the complex interplay of stressors and coping mechanisms during prolonged crises. Full article

Background/Aims: This study was conducted with the aim of assessing the mental well-being of general practitioners (GPs) amidst the COVID-19 pandemic in Serbia. These findings are intended to provide valuable insights to primary care stakeholders about the potential need for support interventions. Materials and Methods: In the context of the international cross-sectional survey on primary health care during the COVID-19 pandemic (PRICOV-19), our initial focus was on evaluating the appropriateness of employing the Mayo Clinic Well-Being Index (MWBI) for Serbian GPs. The Spearman test validated the correlation between the GPs’ scores of the MWBI and Depression Anxiety Stress Scales-21 (DASS21) in the Serbian context. The univariate and multivariate linear regressions modeled the personal and job-related potential predictors of higher MWBI scores (p < 0.05). Results: A strong, positive, and significant correlation was found between the MWBI score; the total DASS21 score; and the scores for depression, anxiety, and stress (p < 0.001). In this pilot study, 71.3% of the GP respondents had poor mental well-being indicated with MWBI scores ≥ 2 (the mean was 3.3 ± 2.7). The likelihood of experiencing poor mental well-being among the GPs was found to be associated with decreases in their socioeconomic statuses (B = −0.893; p = 0.021). Furthermore, inadequate allocation of time for the review of scientific evidence and guidelines has been correlated with a decline in mental well-being among respondents (B = −1.137; p = 0.033). Conclusions: The MWBI effectively assessed GPs’ mental well-being amidst COVID-19 in Serbia. GPs with low socioeconomic statuses might most benefit from mental well-being support during crises. For better mental well-being, GPs need adequate time in their agendas to assess scientific evidence and adhere to established guidelines. Full article

Background: Pelvic girdle pain (PGP) is described in the literature as a subgroup of low back pain (LBP), characterized by pain localized between the posterior iliac crest and the gluteal fold, particularly near the sacroiliac joints. This condition can manifest in different forms non-specific PGP, occurring during pregnancy or postpartum (pregnancy-related PGP), which represents the most prevalent form and non-pregnancy-related PGP, resulting from mechanical alterations caused by trauma or microtrauma. Specific PGP, associated with identifiable causes such as fractures, infections, or arthritis. Over the years, research has focused on identifying the most effective approaches for managing this condition and addressing its associated biopsychosocial impairments. The aim of this narrative review is to determine the types of motor control exercises (MCEs) used to reduce short-term pain in patients with PGP and to assess whether these exercises are designed in accordance with the principles of motor control (MC) theories. Methods: A narrative review was conducted through searches in various medical and rehabilitation databases, including MEDLINE (via PubMed), PEDro, Scopus, and Web of Science. The inclusion criteria of the review encompassed case studies, case reports, editorials, original research articles, randomized controlled trials (RCTs), and systematic reviews (SRs). Results: Six articles met the eligibility criteria, comprising two SRs and four RCTs, all of which were included in the qualitative analysis. Among these, two studies examine MCEs for non-pregnancy-related PGP, while all the other studies focus on pregnancy-related PGP. The exercises described focused on lumbar–pelvic stabilization or deep spinal muscle activation. Among the six included studies, five did not report statistically significant changes in pain outcomes, while only one study demonstrated a statistically significant improvement. Conclusions: The analysis highlighted that the exercises currently employed are generally unspecific and not systematically structured according to the principles outlined in MC theories. The available evidence, combined with the incorrect design of these exercises, does not allow for definitive conclusions regarding the efficacy of MCEs in reducing short-term pain in patients with both pregnancy-related and non-pregnancy-related PGP. Full article

Background: Artificial Intelligence (AI)-driven training systems are becoming increasingly important in surgical education, particularly in the context of laparoscopic suturing. This systematic review aims to assess the impact of AI on skill acquisition, long-term retention, and clinical performance, with a specific focus on the types of machine learning (ML) techniques applied to laparoscopic suturing training and their associated advantages and limitations. Methods: A comprehensive search was conducted across multiple databases, including PubMed, IEEE Xplore, Cochrane Library, and ScienceDirect, for studies published between 2005 and 2024. Following the PRISMA guidelines, 1200 articles were initially screened, and 33 studies met the inclusion criteria. This review specifically focuses on ML techniques such as deep learning, motion capture, and video segmentation and their application in laparoscopic suturing training. The quality of the included studies was assessed, considering factors such as sample size, follow-up duration, and potential biases. Results: AI-based training systems have shown notable improvements in the laparoscopic suturing process, offering clear advantages over traditional methods. These systems enhance precision, efficiency, and long-term retention of key suturing skills. The use of personalized feedback and real-time performance tracking allows learners to gain proficiency more rapidly and ensures that skills are retained over time. These technologies are particularly beneficial for novice surgeons and provide valuable support in resource-limited settings, where access to expert instructors and advanced equipment may be scarce. Key machine learning techniques, including deep learning, motion capture, and video segmentation, have significantly improved specific suturing tasks, such as needle manipulation, insertion techniques, knot tying, and grip control, all of which are critical to mastering laparoscopic suturing. Conclusions: AI-driven training tools are reshaping laparoscopic suturing education by improving skill acquisition, providing real-time feedback, and enhancing long-term retention. Deep learning, motion capture, and video segmentation techniques have proven most effective in refining suturing tasks such as needle manipulation and knot tying. While AI offers significant advantages, limitations in accuracy, scalability, and integration remain. Further research, particularly large-scale, high-quality studies, is necessary to refine these tools and ensure their effective implementation in real-world clinical settings. Full article

Background and Aim: Current evidence suggests that both arthritis and hypertension (HTN) can contribute to an increase in pain severity, potentially owing to shared pathophysiological pathways. However, the extent to which these conditions jointly affect pain severity has not been well studied. The aim of this study was to explore the association between the coexistence of HTN and arthritis and their impact on pain severity among community-dwelling older adults. Methods: A cross-sectional design was used. Data from the Wave 2 (2010–2011) of the National Social Life, Health, and Aging Project (NSHAP) were used. Participants were community-dwelling older adults and categorized based on self-reported diagnoses into four groups: combined HTN and arthritis, HTN only, arthritis only, and neither. Pain severity was measured using the Verbal Descriptor Scale (VDS). Multiple generalized linear regression analyses were conducted with adjustments for age, sex, race, body mass index, educational level, and the use of pain and hypertension medications. Results: Data for 1754 participants were analyzed. The prevalence of combined HTN and arthritis was 28.4%. The prevalence of HTN only and arthritis only was 35.2% and 14.2%, respectively. Participants with both HTN and arthritis had higher pain severity compared to those with neither or only one of these conditions. After covariate adjustment, the combined HTN and arthritis group showed a significant association with higher pain severity (B = 0.39, p < 0.001). Similarly, the arthritis-only group also demonstrated a significant association with increased pain severity (B = 0.26, p = 0.002). However, the HTN alone showed no significant associations with pain severity (B = 0.014, p = 0.83). Compared to the arthritis-only group, combined HTN and arthritis showed a significant association with pain severity (B = 0.16, p = 0.049) in an unadjusted model only, and this association disappeared after adjusting for covariates (B = 0.15, p = 0.08). Conclusions: This study found no significant association between coexisting HTN and arthritis compared to arthritis alone after adjusting for covariates among community-dwelling older adults. The influence of covariates highlights the multifaceted nature of pain determinants, which emphasize the need for a multidisciplinary approach to pain management to enhance their functional capacity and overall quality of life. Full article

Background/Objectives: the COVID-19 pandemic accelerated the adoption of remote work, blurring the boundaries between professional and personal life. This shift resulted in longer working hours, negative emotional outcomes, and health issues, particularly among Generation Z employees. This study investigates the links between working overtime, tobacco dependence, night shifts, and chronic disease risk in Generation Z employees during the pandemic while also examining the roles of depression risk and health awareness. A quantitative research approach was used to administer a questionnaire and employ the chi-square test, t-test, and logistic regression analysis to compare overtime-related factors and chronic disease risks. Results: the overtime workers are 1.39 times more likely to develop chronic diseases than those who do not work overtime. The odds ratio (OR) for overtime workers is 1.41, indicating that working overtime is a major risk factor for chronic disease. Among overtime workers, tobacco dependence and depression risk are significantly correlated with the risk of chronic disease, while night shift work is not. Overtime workers’ health awareness is significantly correlated with chronic disease risk and has a partial mediating effect on the relationship between tobacco dependence and chronic disease risk. This is due to the strong correlation (p < 0.001) between tobacco dependence and chronic disease, which limits the extent to which health consciousness can mitigate the negative effects of tobacco dependence. Conclusions: these findings highlight the importance of smoking cessation and mental health interventions in reducing the risk of chronic disease for Generation Z workers, particularly in the post-pandemic era. Full article

Background: Blood transfusion is a highly critical life-saving factor in neonates, especially in extremely low birth weight infants. There is a significant lack of consensus on optimal blood transfusion methods for neonates. Aim: To investigate and analyze blood transfusion practice in neonates among neonatologists and neonatal nurses in a multi-country pattern. Methods: From September 2023 to June 2024, a cross-sectional questionnaire-based study was conducted to collect data on global blood transfusion practices in neonates. A questionnaire, developed through an extensive literature review, was distributed to neonatologists and neonatal nurses primarily via e-mail, with additional distribution via social media platforms. Results: This study included a total of 180 neonatologists and neonatal nurses from 27 different countries. Almost 37.7% were working in a level 3 NICU. Approximately 37.7% of the participants stated that they transfuse blood within three hours, and approximately 45.5% stated they usually use 15 mL/kg of blood. After receiving a transfusion, 99.4% of the participants mentioned that they continue to check the vital signs. More than half (72.2%) of NICU practitioners use filters when giving blood. Regarding written instructions and guidelines in the unit for blood transfusion, the majority (84.4%) stated having them in their units, of which, 86.8% mentioned that blood transfusion threshold stated in the guidelines either using hemoglobin or hematocrit. Conclusions: This study found variability in blood transfusion practices around the world. While most have developed neonatal blood transfusion guidelines, certain countries still lack national protocols. Establishing comprehensive guidelines is essential to standardizing procedures, thereby minimizing the risk of inappropriate or unsafe blood transfusions in this neonatology practice. Full article

Background/Objectives: Transepithelial accelerated corneal crosslinking (TE-ACXL) is a minimally invasive approach for stabilizing progressive keratoconus while preserving the corneal epithelium. This study aims to evaluate changes in visual acuity, refractive error, and corneal parameters before and six months after TE-ACXL. Methods: A retrospective analysis was conducted on 30 eyes from 20 patients who underwent TE-ACXL between May 2021 and June 2023. Variables included were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), spherical and cylindrical refractive error, and corneal tomography parameters such as maximum keratometry (Kmax), the symmetry index (Si), the keratoconus vertex (KV), Baiocchi–Calossi–Versaci index (BCV), thinnest corneal thickness (TCT), and central corneal thickness (CCT). Results: CDVA improved from 0.20 ± 0.22 to 0.06 ± 0.11 LogMAR (p = 0.004), while UDVA improved from 0.47 ± 0.35 to 0.29 ± 0.30 LogMAR (p < 0.001). Spherical and cylindrical refractive error showed significant reductions from −2.18 ± 3.05 D to −1.31 ± 1.84 D (p < 0.001) and −3.33 ± 1.98 D to −2.33 ± 1.52 D (p < 0.001), respectively. Pachymetry values decreased significantly, with TCT reducing from 466.43 ± 31.24 µm to 438.63 ± 30.54 µm (p < 0.001) and CCT from 480.80 ± 33.24 µm to 451.23 ± 29.26 µm (p < 0.001). Kmax showed a modest reduction (52.33 ± 3.51 D to 51.19 ± 3.63 D, p < 0.001), while other topographic indices, including Si, KV, and BCV, exhibited minor, non-significant changes, except for BCV back (p = 0.031). Conclusions: TE-ACXL was associated with significant improvements in visual acuity and refractive stability at six months postoperatively while maintaining a favorable safety profile. The procedure may serve as an effective option for early intervention in progressive keratoconus. Full article

Background/Objectives: Female sexual dysfunction (FSD) involves persistent issues with desire, arousal, orgasm, or pain during intercourse. The Female Sexual Function Index (FSFI), a validated 19-item questionnaire, is widely used to assess FSD. Childbirth, particularly vaginal delivery with perineal trauma, can increase FSD risk, with 41–83% of women affected at six months postpartum. However, early postpartum FSD remains underexplored. This study examines FSD risk factors in first-time mothers delivering vaginally, using longitudinal FSFI assessments before and after the delivery. Methods: A prospective observational study was conducted involving 80 primiparous women who delivered vaginally. The FSFI questionnaire was provided before childbirth and three months postpartum. We compared the group of women who developed early FSD after delivery (N = 45) with those with a normal FSFI score (>26.6). Results: Three months after vaginal delivery, participants exhibited a significant decrease in overall FSFI scores (−9.61 [95%CI: −11.6; −7.6]; p = 0.008). A total of 45 patients (56.2%) developed early FSD. Marital status emerged as a significant factor, with marriage acting as a protective factor (OR 0.27 [95%CI 0.05–1.24]; p = 0.044). Clitoral and periclitoral tears were associated with a higher risk of FSD than high-degree perineal lacerations (OR 3.02 [95%CI 1.56–6.24]; p = 0.021). Conclusions: At three months post vaginal delivery, primiparous women face a relevant risk of developing transient sexual dysfunction. Marital status and type of perineal tears are identified as key factors influencing postpartum sexual function. Further research is warranted to explore these factors comprehensively and provide timely clinical and psychological support to couples navigating the challenges of early family life. Full article

The diaphragm is the primary muscle involved in the ventilatory pump, making it a vital component in mechanical ventilation. Various factors in patients who require mechanical ventilation can lead to the deterioration of the diaphragm, which is associated with increased mortality. This deterioration can arise from either excessive or insufficient support due to improper adjustment of ventilation programming variables. It is essential for healthcare professionals to make appropriate adjustments to these variables to prevent myotrauma, which negatively impacts muscle structure and function. One recognized cause of muscle injury is eccentric work of the diaphragm, which occurs when muscle contractions continue after the expiratory valve has opened. Current evidence suggests that these eccentric contractions during mechanical ventilation can be harmful. This brief review highlights and analyzes the existing evidence and offers our clinical perspective on the importance of properly adjusting ventilation programming variables, as well as the potential negative effects of eccentric diaphragm contractions in routine clinical practice. Full article

Background: Increasing evidence shows that the COVID-19 pandemic has disproportionately impacted certain populations, particularly those facing structural marginalization, such as immigrants and refugees. Additionally, research highlights that structurally marginalized populations living with chronic conditions, such as cancer and/or mental health and addiction (MH&A) disorders, are more vulnerable to the adverse effects of COVID-19. These individuals face higher susceptibility to infection and worse health outcomes, including increased rates of hospitalization, severe illness, and death. To better understand the challenges faced by people living at the intersection of social and clinical disadvantages, we organized a series of Think Tank sessions to engage stakeholders in exploring barriers and identifying community-based solutions for immigrants and refugees living with cancer and/or MH&A disorders during the current and future pandemics. Objectives: Our main objectives were to gauge how earlier findings resonated with stakeholders, to identify any gaps in the work, and to co-develop actionable solutions to safeguard health and well-being during COVID-19 and future crises. Methods: Two virtual Think Tank sessions were held in September 2023 as integrative knowledge exchange forums. The Cancer Think Tank was attended by 40 participants, while the MH&A disorders Think Tank included 41 participants. Each group comprised immigrants and refugees living with or affected by cancer (in the Cancer Think Tank) or MH&A disorders (in the MH&A disorders Think Tank), alongside service providers, policymakers, and researchers from Ontario. This paper presents the key discussions and outcomes of these sessions. Results: Participants identified and prioritized actionable strategies during the Think Tank sessions. In the Cancer Think Tank, participants emphasized the importance of leveraging foreign-trained healthcare providers to address workforce shortages, creating clinical health ambassadors to bridge gaps in care, and connecting immigrants with healthcare providers immediately upon their arrival in Canada. In the MH&A disorders Think Tank, participants highlighted the need to remove silos by fostering intersectoral collaboration, empowering communities and building capacity to support mental health, and moving away from one-size-fits-all approaches to develop tailored interventions that better address diverse needs. Conclusions: The Think Tank sessions enhanced our understanding of how the COVID-19 pandemic has impacted immigrants and refugees living with cancer and/or MH&A disorders. The insights gained informed a series of actionable recommendations to address the unique needs of these populations during the current pandemic and in future public health crises. Full article

Background: Respiratory infections pose a significant public health challenge, particularly among healthcare workers (HCWs). The COVID-19 pandemic exacerbated absenteeism due to respiratory illnesses, affecting healthcare workforce stability. Identifying factors influencing absenteeism is crucial for workforce resilience and effective care. Methods: This retrospective longitudinal study analyzed HCW absenteeism due to respiratory diseases from 2017 to 2023 at the “Sf. Maria” Children’s Emergency Hospital in Iași, Romania. Data from 3827 HCWs were examined, including demographic and occupational variables (age, gender, job role) and disease types. Statistical analyses (chi-square tests, ANOVA, and regression models) were conducted using SPSS to assess absenteeism trends and associated risk factors. Results: Sick leave peaked in 2020 (8322 days) and remained high in 2021 (8134 days), gradually decreasing in 2022–2023 but not returning to pre-pandemic levels (~5000 days/year). Nurses accounted for most leave days, while male staff and HCWs aged 41–50 were most affected. Seasonal variations showed higher absenteeism in transitional months and lower rates in summer. COVID-19 was the leading cause of absenteeism during the pandemic, with quarantine measures further increasing sick leave duration. Conclusions: Pediatric hospitals must strengthen infection control measures to protect HCWs and sustain care continuity. Preventive actions such as immunization, staff training, and health monitoring are critical in reducing absenteeism, maintaining a resilient workforce, and ensuring quality care during health crises. Full article

Background/Objectives: Low physical activity (PA) and excessive sedentary time negatively impact health, contributing to obesity. Physical education (PE) can help reduce the risk of obesity in schoolchildren. This cross-sectional study objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time during PE in Türkiye, examining the influence of weight status and gender. Method: Accelerometers measured MVPA in 274 children and adolescents (ages 10–14, 49.6% girls). Sedentary time and MVPA were classified based on accelerometer count per 15 s (sedentary: <25; MVPA: ≥574). A two-way Analysis of Covariance (ANCOVA) assessed body mass index (BMI) and gender effects on MVPA and sedentary time. Results: Students spent 44.5% of PE time sedentary and 43.2% in MVPA, below the recommended 50% of PE in MVPA. Only 45.6% met this target (44.2% males and 47.1% females). Overweight/obese students had higher sedentary time, while normal-weight students engaged in more MVPA (p < 0.05). Conclusions: Students did not meet the recommended 50% of PE in MVPA. Increasing MVPA and reducing sedentary time during PE is particularly important for overweight/obese students. Physical education intervention should target students in co-educational classes. Full article

Objectives: The aim of this study was to evaluate the oral health-related quality of life of patients with chronic graft-versus-host disease. Methods: A total of 22 patients with graft-versus-host disease aged 45.05 ± 14.66 years were enrolled in a single-centre cross-sectional study. Data from questionnaires on general health and diet, clinical examinations, and salivary tests were used to assess caries risks using the Cariogram computer programme. The Slovenian version of the Oral Health Impact Profile Questionnaire (OHIP-SVN) was used to determine the oral health-related quality of life. Results: Compared to healthy individuals, patients with chronic graft-versus-host disease had a lower oral health-related quality of life and a lower stimulated salivary flow rate (in both cases p < 0.001). The OHIP summary score correlated with stimulated salivary pH (R = 0.4916, p = 0.0277) and caries risk (R = 0.5420, p = 0.0111). Conclusions: In conclusion, our results confirm that cGVHD has a negative impact on oral health-related quality of life due to lower stimulated salivary pH and elevated caries risk (reduced salivary pH, flow rate, buffering capacity, and elevated Streptococcus mutans and Lactobacillus bacteria count). These findings emphasise the importance of a comprehensive assessment of oral health and preventive care in patients with cGVHD and suggest that the integration of clinical and quality of life measures could lead to improved patient care strategies. Full article

Background: Physical activities in childhood are important. However, a lack of exercise among children and adolescents is becoming a global reality. Moreover, following the coronavirus disease 2019 pandemic, the increase in time spent at home has led to qualitative changes, such as at-home exercises and the use of YouTube content. This study aimed to conduct qualitative assessments of YouTube-based exercise education programs, such as video content and exercise education programs. Methods: A Python-based (version 3.11.6) video data crawl of YouTube using the keywords “children + exercise”, “kid + exercise”, “child + physical activity”, and “kid + physical activity” was conducted on 27 November 2023. Duplicate, non-English, outdated (over 5 years old), short (<60 s) or long (>30 min) videos, and irrelevant content were excluded. Basic video characteristics, video popularity metrics, and qualitative analyses (m-DISCERN, GQS, i-CONTENT, CONTENT, CERT) were collected and assessed. Results: Of the 2936 retrieved videos, 126 were selected. Approximately 10% of the videos were uploaded by health professionals, and most videos covered aerobic and muscle-strengthening exercises. A qualitative analysis of the video content showed moderate to high quality, while only a few videos satisfied the criteria of an effective exercise program, especially in terms of “Type and timing of outcome assessment”, “Qualified supervisor”, “Patient eligibility”, “Adherence to the exercise program”, and “Dosage parameters (frequency, intensity, time)”. In the correlation analysis of video content and exercise program quality, only a few items showed a statistically significant correlation. Conclusions: YouTube exercise-related educational content targeting children may be inadequate and is not correlated with video popularity. Although an overall weak to moderate correlation was observed between the quality evaluation of exercise education and video content, the use of video quality assessment tools to evaluate exercise program quality was insufficient. Full article

Background. The SARS-CoV-2 pandemic had a significant impact on sexual health and human behavior, revealing a widespread decline in sexual function and behaviors. Objective. To summarize these findings and highlight their importance for public health, this article discusses the changes observed in sexual function and behavior during the pandemic, as well as potential explanations for these trends. Methods. This study followed the PRISMA-ScR guidelines, using the keyword search commands: “sexual function” AND (“SARS-CoV-2” OR “COVID-19” OR coronavirus) and “sexual behavior*” AND (“SARS-CoV-2” OR “COVID-19” OR coronavirus) in the Scopus and PubMed databases. The search was conducted on 10 March 2024, including articles published from January 2019 to March 2024. Inclusion criteria required studies focusing on sexual health/function during the SARS-CoV-2 pandemic, excluding non-English articles and non-adult populations. Studies were screened based on relevance, methodological rigor, and sample size, with data extraction focusing on sexual behavior/function metrics. Results were synthesized to identify trends and propose explanatory models. Results. While some individuals experienced reductions in sexual desire and activities, others reported increases, indicating varied individual responses to stressors such as a pandemic. Two hypotheses are presented to explain these changes: terror management theory and the dual control model of sexual response. The critical role of public health in addressing sexual health and well-being needs during a health crisis is discussed, emphasizing the importance of providing clear information, ensuring access to remote sexual health services, and reducing stigma. The need to integrate sexual health into the global response to future health crises is highlighted to ensure a comprehensive approach to human well-being. Conclusions. This review shows the multifaceted impact of the pandemic and social distancing in people’s sexual function and behaviors, underscoring the importance of considering sexual health as an integral part of the emergency health planning and response, to promote the physical and mental well-being of the population during crises such as the SARS-CoV-2 pandemic. Full article

Backgrounds: Korean society is entering an aging society, and this phenomenon indicates the need for preparation for aging in Korean society. In such a situation, exploring the characteristics of the elderly can be considered important for preparation. The objective of this study is to identify the determinants of medical expenses among older adults in South Korea. The key factors analyzed include food, leisure, and housing expenses, as well as lifestyle choices such as drinking and smoking. Method: Data from the Korean Longitudinal Study of Aging, covering 7374 observations from the years 2018 and 2020, are adopted for statistical analysis. This research explores the inverted-U-shape effect of food, leisure, and housing expenditures on medical costs, grounded in the concepts of diminishing marginal utility and mental accounting. A quadratic panel regression analysis is used to test the hypotheses, controlling for variables such as birth year, gender, and personal assets. Results: The results show that food and housing expenses have an inverted-U relationship with medical expenditures based on diminishing marginal utility and mental accounting as the theoretical foundation. However, leisure expenses, drinking, and smoking do not significantly affect medical expenses. Furthermore, this study identifies the optimal expenditure levels for maximizing medical spending through the first-order condition. Conclusions: These findings provide important insights for the development of policies aimed at improving the financial well-being of older adults in South Korea. Moreover, this study contributes to the literature by applying the concepts of mental accounting and the law of diminishing marginal utility to better understand the financial behavior of older adults. Full article

Background/Objectives: The initiation and continuation of breastfeeding are just as crucial as its conclusion. This study aimed to explore the connection between maternal depression and readiness for weaning. Although previous studies have examined maternal depression in the context of breastfeeding initiation and continuation, limited research has explored its role in weaning readiness. This study seeks to address this gap by investigating the psychological and emotional aspects of weaning in primiparous mothers. Methods: This descriptive cross-sectional study was conducted between May and July 2024 through online interviews. The descriptive information form, Readiness for Weaning Scale (RWS), and Beck Depression Inventory-II (BDI-II) were used for data collection. The sample included 83 primiparous mothers with a healthy pregnancy, no prior depression diagnosis or breastfeeding experience, and a baby aged 18 months or older. Statistical analyses were conducted to examine the correlation between RWS and BDI-II scores. Results: Participants’ mean age was 31.95 ± 5.25 years, and the average breastfeeding duration was 17.83 ± 9.79 months. Among the mothers, 63.9% reported readiness to wean, with a significant relationship between the RWS and readiness. Emotional challenges included sadness (62.7%), fear of damaging the maternal bond (45.8%), and feelings of deprivation (34.9%). The mean RWS score was 65.64 ± 11.31, while the mean BDI-II score was 9.67 ± 7.02. Higher depression scores were associated with lower readiness for weaning. Conclusions: Midwives play a crucial role in supporting mothers during weaning. This study highlights the need for targeted interventions to address maternal emotional well-being during this transition. Future research should explore culturally sensitive approaches to improve support mechanisms for mothers experiencing psychological distress while weaning. Full article

The integration of artificial intelligence (AI) into assistive technologies is an emerging field with transformative potential, aimed at enhancing autonomy and quality of life for individuals with disabilities and aging populations. This overview of reviews, utilizing a standardized checklist and quality control procedures, examines recent advancements and future implications in this domain. The search for articles for the review was finalized by 15 December 2024. Nineteen review studies were selected through a systematic process identifying prevailing themes, opportunities, challenges, and recommendations regarding the integration of AI in assistive technologies. First, AI is increasingly central to improving mobility, healthcare diagnostics, and cognitive support, enabling personalized and adaptive solutions for users. The integration of AI into traditional assistive technologies, such as smart wheelchairs and exoskeletons, enhances their performance, creating more intuitive and responsive devices. Additionally, AI is improving the inclusion of children with autism spectrum disorders, promoting social interaction and cognitive development through innovative devices. The review also identifies significant opportunities and challenges. AI-powered assistive technologies offer enormous potential to increase independence, reduce reliance on external support, and improve communication for individuals with cognitive disorders. However, challenges such as personalization, digital literacy among the elderly, and privacy concerns in healthcare contexts need to be addressed. Notably, AI itself is expanding the concept of assistive technology, shifting from traditional tools to intelligent systems capable of learning and adapting to individual needs. This evolution represents a fundamental change in assistive technology, emphasizing dynamic, adaptive systems over static solutions. Finally, the study emphasizes the growing economic investment in this sector, forecasting significant market growth, with AI-driven assistive devices poised to transform the landscape. Despite challenges such as high development costs and regulatory hurdles, opportunities for innovation and affordability remain. This review underscores the importance of addressing challenges related to standardization, accessibility, and ethical considerations to ensure the successful integration of AI into assistive technologies, fostering greater inclusivity and improved quality of life for users globally. Full article

Background: Infertility is a neglected global public health issue, particularly in the Global South, where policy interventions and research remain limited. In China, rising public demand and declining birth rates have renewed interest in integrating fertility care into reproductive health policies, though operational challenges and systemic gaps persist. Objectives: This study aims to explore the perceptions of health system professionals regarding the opportunities and barriers to integrating fertility care into China’s reproductive health policy. Methods: This qualitative study involved 31 interviewees, including health system leaders (n = 5), health practitioners (n = 21), and civil society advocates (n = 5), from November 2023 to October 2024. The transcribed and anonymized data were thematically analyzed using MAXQDA version 2020, guided by the World Health Organization’s health system building blocks framework. Results: Interviewees reported that integrating fertility care has markedly improved service accessibility and quality, driven by strong governmental leadership. They identified opportunities for further progress through focused government initiatives, expanded public–private partnerships, and the adoption of international best practices, while also noting obstacles such as operational challenges, systemic policy gaps, uneven resource distribution, and persistent cultural stigma. Conclusions: The findings underscore the need for a robust national policy framework, sustainable funding mechanisms, and enhanced primary healthcare capabilities, along with cultural advocacy and awareness campaigns to reduce stigma and foster equitable access. Full article

Background: Joint manipulation is commonly used to manage musculoskeletal dysfunctions. Joint manipulation can result in audible sounds. The clinical significance and cause of manipulation sound remain unclear. This study aimed to identify intra-articular distance following a metacarpophalangeal (MCP) II and metatarsophalangeal (MTP) II joint manipulation in healthy subjects. Additionally, the cortical response pattern was measured. Methods: Twenty-five subjects completed this quasi-experimental repeated-measures study protocol. Musculoskeletal ultrasound was used to measure intra-articular joint distance, and a portable EEG device captured brainwave activity. The environment was controlled during testing. Initially, the joint distance of the MCP II and MTP II was measured followed by the recording of initial brainwaves. Following a pre-manipulation hold, a second brainwave measure was taken. After this, each subject underwent a thrust manipulation of either MCP II or MTP II, immediately followed by the next brainwave measurement. One minute later, the final and fourth measurement took place. Results: All subjects regardless of audible sound increased in joint space following both the MCP and MTP joint manipulation. The audible group had more significant EEG changes (p < 0.05) following the MCP manipulation but less following the MTP manipulation. Conclusions: This study supports the tribonucleation theory explaining audible joint manipulation sounds. The manipulation of the MCP II joint resulted in increased Theta wave activity, indicating a state of relaxation, which was larger in the audible group. The MTP II manipulation had decreased cortical effects regardless of the presence of a sound. Despite these findings, the clinical usefulness of audible sounds remains questionable. Full article

Background: Diabetes is a major chronic disorder that significantly impacts life expectancy and imposes substantial economic burdens on individuals and healthcare systems. Internet-based health management has emerged as an innovative approach to support diabetes care by facilitating sustainable behavioral change and improving health outcomes. Objective: This longitudinal study aims to evaluate the impact of internet-based health management on blood glucose control in type 2 diabetes (T2D) patients over four years. Methods: A total of 30,333 participants were recruited from five provinces in China in 2013, including 2307 T2D patients. Participants utilized a comprehensive internet-based health management platform that provided personalized diet plans, exercise recommendations, and psychological support. Data were collected through regular health examinations and questionnaires, and logistic regression was conducted to identify key factors associated with effective blood glucose control. Results: After four years, the diabetes awareness rate among T2D patients increased from 17.72% to 19.84%, and the control rate rose from 7.22% to 26.91%. Notable improvements were observed in health-related behaviors, including smoking cessation, increased physical activity, and healthier dietary habits, particularly in the consumption of vegetables, fruits, soybeans, and nuts. Clinical outcomes also showed significant improvement, with reductions in fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C). Key factors contributing to effective blood glucose control in T2D patients included smoking cessation, increased intake of soybeans, nuts, and fruits, and reduced sedentary time. Conclusions: Internet-based health management significantly improved blood glucose control and health behaviors in T2D patients. This study confirms the potential of internet-based health management strategies to overcome geographical and healthcare access barriers, providing evidence for diabetes care in underdeveloped regions. Full article

Background: Emotional exhaustion, a central component of burnout syndrome, affects social workers due to adverse work factors such as excessive workload, work–family conflict, and a lack of social support. The job demands–resources and conservation of resources models explain how chronic stress influences these professionals. Methods: A systematic review was carried out using the recommendations of the PRISMA guidelines as a reference for the selection and identification of studies and the Joanna Briggs Institute guidelines, registering the protocol in PROSPERO. Cross-sectional studies published from 1 January 2019 to 30 September 2024 were included and five main databases―Web of Science, Scopus, PubMed, Medline, and PsycInfo—were used to search for specific studies written in English, Spanish, French, and Portuguese. Results: Of 361 initial records, 21 studies involving more than 24,000 social workers from diverse global settings were analyzed. The main risk factors identified were workload, work–family conflict, and work victimization. Resilience, self-care, and social support were highlighted as protective factors. Emotional exhaustion was associated with low job satisfaction, turnover intention, and mental health problems such as anxiety and depression. Conclusions: Emotional burnout requires specific strategies, such as work flexibility, wellness programs, and organizational support. These measures can mitigate its impact, improving work–life balance and fostering resilience. Full article

Background and Purpose: Previous studies have shown that socioeconomic status influences cognitive health in adults. Therefore, it is important for the development of healthy aging policies to further investigate the effect of specific socioeconomic factors on cognitive function in older people and the possible mechanism. In this study, three specific socioeconomic factors (i.e., income, occupation, and education) were used as independent variables, and social support and social participation were used as the parallel or serial mediating variables to investigate the effect on cognitive function in community-dwelling older adults and the specific pathway of influence. Methods: A cross-sectional study was conducted in the Pudong New District of Shanghai, China. A total of 970 community-dwelling older adults aged over 60 years old who had lived in their current location for more than 5 years were enrolled. Socioeconomic factors in older adults, including income, education level, and occupation before retirement, were investigated, and their cognitive function and social support and social participation levels were measured using the MoCA, MSPSS, and the quantity of participation in social activities, respectively. Covariates, including lifestyle, health status, sleep quality, and nutritional status, were assessed using a self-designed questionnaire, the PSQI, and the MNA-SF scale. Omnibus mediation effect analysis was adopted to examine the mediation effect, and the mediation analysis was performed using the SPSS PROCESS program. Results: Community-dwelling older adults with higher income, more complex occupation, or higher education level had a better cognitive function, with β_{medium income} = 1.949 and β_{high income} = 3.799 compared to low-income level (all p < 0.001), β_{medium occupational complexity} = 1.262 and β_{high occupational complexity} = 1.574 compared to low occupational complexity level (all p < 0.01), and β_{medium education} = 1.814 and β_{high education} = 1.511 compared to low education level (all p < 0.001). Social participation significantly mediated the above relationship (all p < 0.001); the relative indirect effect of medium and high income through social participation was respectively β_{medium income} = 0.356 and β_{high income} = 0.777 compared to low income, accounting for 18.36% and 20.45% of the total effect; the relative indirect effect (β) of medium and high occupational complexity compared to low level of occupational complexity was 0.358 and 0.561, accounting for 28.36% and 35.64% of the total effect; while the relative indirect effect (β) of medium and high education compared to low education level was 0.311 and 0.562, with 17.14% and 39.19% of the total effect. Social support significantly mediated the relationship of income and education with cognitive function (all p < 0.001), with the indirect effect (β) of medium and high levels of income or education compared to their low levels being 0.132 and 0.160, or 0.096 and 0.156, respectively, accounting for 4.21% and 6.77%, or 5.29% and 10.32%, of their total effects. Serial mediation analysis showed that income and education significantly affected social participation through social support and subsequently cognitive function (all p < 0.01), with the relative serial indirect effects (β) of medium and high levels of income or education compared to their low levels being 0.065 and 0.078, or 0.043 and 0.070, respectively, accounting for 3.3% and 2.0%, or and 2.4–4.6% of their total effects. Conclusions: This study demonstrates that social support and social participation independently and cumulatively mediate the relationship between socioeconomic conditions and cognitive function in community-dwelling older adults. Therefore, improving the social support systems and encouraging older adults to actively participate in social activities may be beneficial in preventing or improving cognitive decline in community-dwelling older adults. The findings also provide new insights for the future improvement of cognitive function in community-dwelling older adults in the future. Full article

Biofeedback rehabilitation for facial palsy is not yet routinely available for patients. Methods: To improve evidence, the effect of an intensive two-week facial training combining electromyography (EMG) and visual biofeedback training of 30 patients (76.7% female; median age: 48.6 years) with post-paralytic facial synkinesis was objectively evaluated. At the beginning of each training day, EMG amplitudes of both halves of the face were recorded during relaxation using the EMG system that was synchronously used for the EMG biofeedback training. A single-factor analysis of variance was performed for the change over time, and a t-test was used to evaluate the side differences. Results: At the end of the training program, there was a significant decrease in the EMG amplitudes of both halves of the face (synkinetic side: p < 0.001; contralateral side p = 0.003), indicating an improved voluntary muscle relaxation. There was also a significant improvement in Sunnybrook Facial Grading System, Facial Disability Index and Facial Clinimetric Evaluation scores, which were assessed before the start of training and at the end (p < 0.001). Conclusion: Electrophysiological improvements can be objectively measured using surface EMG. Full article

Background/Objectives: Postpartum hemorrhage (PPH) is the most prevalent complication of childbirth and the most preventable cause of maternal mortality worldwide. Maternity nurses and midwives are often the first-line providers responding to PPH. As a result, maternity nurses have the potential to save the lives of women who are clinically deteriorating because of PPH. Simulation-based training is an effective way to develop maternity nurses’ knowledge, skills, and experience to save a woman’s life after PPH. Aim: to investigate the effect of simulation-based training on nurses’ knowledge and performance about primary postpartum hemorrhage management. Design: an experimental design (pre-test/post-test control group). Setting: the study was conducted in the labor and delivery room at KAUH in Jeddah, Saudi Arabia. Sample: A convenient sample of 54 nurses and midwives who were working in the labor and delivery room and the postnatal unit was randomly divided into two equal groups, the control group and study group. Tools: A structured tool was used for data collection and consisted of four parts: I—sociodemographic data, II—assessment of nurse’s/midwives’ knowledge about prevention and management of primary PPH, III—nurse’s/midwives’ performance observational checklist for primary PPH management, and IV—nurse’s/midwife’s satisfaction of the simulation-based training session. Results: The study group had a significantly higher knowledge level immediately after training (X² = 9.39, p = 0.002) and one month after training (X² = 5.51, p = 0.02). Regarding the performance level and total practice level immediately after the intervention, the study group had statistically significantly better practices (X² = 50.143, p = 0.000 *) and this continued one month later (X² = 50.143, p = 0.000 *). Conclusions: The nurses’ knowledge and performance skills related to primary postpartum hemorrhage care improved after receiving simulation-based training. We recommend that all the maternity nurses and midwives participate in an ongoing in-service simulation training program to enable nurses to demonstrate an active role in PPH prevention and management. Full article