Search Results (1,991)

Remote work, as a technologically possible and widely applicable working mode, gained renewed attention during lockdowns amidst the COVID-19 pandemic. On one hand, remote work ensured that working remained sustainable; on the other hand, the unexpected and widespread nature of the immediate shift to remote work led to issues in terms of practicing and adapting to the process. Moreover, remote work can have strong social, economic, and environmental effects that have to be comprehensively understood. The high interest of employees in continuing with full or hybrid remote work calls for effective coping strategies at the individual and organizational levels in the future. This article focuses on academic studies documenting the peculiarities of remote work during the COVID-19 lockdowns. The aim is to identify the issues relating to remote work during the COVID-19 lockdowns that are documented in academic studies and thematically classify them into a range of factors. In this study, bibliometric and content analyses were employed, leading to comprehensive insights into the following areas: (1) remote work as a cause for changes in physical and psychological health; (2) remote work as a cause for changes in daily behavior, routine, and lifestyle; (3) factors that affect the process and productivity of remote work; (4) societal, economic, and environmental consequences of remote work; and (5) the distribution of the effects of remote work on individuals, economic subjects, and sectors. In conclusion, this study on working practices during the COVID-19 lockdowns that were documented in academic studies offers several benefits and areas of novelty: first, a comprehensive overview of the widespread process of adjusting to this new working mode; second, a classification of factors that affected the process at different stages and in different areas; and third, common factors that had more widespread effects during the remote working period. The findings also offer the following theoretical and practical implications: For researchers, this article can be a reference offering a holistic view of remote working during these lockdowns. For practitioners, it can provide an understanding of the impacting factors and their contextualization in terms of health, sociodemographic, and sectoral aspects can allow for more accurate human resource management strategies. Full article

During the last decade, artificial intelligence (AI) has enabled key technological innovations within the modern dementia and frailty healthcare and prevention landscape. This has boosted the impact of technology in the clinical setting, enabling earlier diagnosis with improved specificity and sensitivity, leading to accurate and time-efficient support that has driven the development of preventative interventions minimizing the risk and rate of progression. Background/Objectives: The rapid ageing of the European population places a substantial strain on the current healthcare system and imposes several challenges. COMFORTage is the joint effort of medical experts (i.e., neurologists, psychiatrists, neuropsychologists, nurses, and memory clinics), social scientists and humanists, technical experts (i.e., data scientists, AI experts, and robotic experts), digital innovation hubs (DIHs), and living labs (LLs) to establish a pan-European framework for community-based, integrated, and people-centric prevention, monitoring, and progression-managing solutions for dementia and frailty. Its main goal is to introduce an integrated and digitally enabled framework that will facilitate the provision of personalized and integrated care prevention and intervention strategies on dementia and frailty, by piloting novel technologies and producing quantified evidence on the impact to individuals’ wellbeing and quality of life. Methods: A robust and comprehensive design approach adopted through this framework provides the guidelines, tools, and methodologies necessary to empower stakeholders by enhancing their health and digital literacy. The integration of the initial information from 13 pilots across 8 European countries demonstrates the scalability and adaptability of this approach across diverse healthcare systems. Through a systematic analysis, it aims to streamline healthcare processes, reduce health inequalities in modern communities, and foster healthy and active ageing by leveraging evidence-based insights and real-world implementations across multiple regions. Results: Emerging technologies are integrated with societal and clinical innovations, as well as with advanced and evidence-based care models, toward the introduction of a comprehensive global coordination framework that: (a) improves individuals’ adherence to risk mitigation and prevention strategies; (b) delivers targeted and personalized recommendations; (c) supports societal, lifestyle, and behavioral changes; (d) empowers individuals toward their health and digital literacy; and (e) fosters inclusiveness and promotes equality of access to health and care services. Conclusions: The proposed framework is designed to enable earlier diagnosis and improved prognosis coupled with personalized prevention interventions. It capitalizes on the integration of technical, clinical, and social innovations and is deployed in 13 real-world pilots to empirically assess its potential impact, ensuring robust validation across diverse healthcare settings. Full article

Background/Objectives: Despite the bidirectional relationship between diabetes and periodontal disease, dental hygienists’ role in diabetes screening remains underexplored in Japan. Previous studies have not examined the relationship between attitudes and actual screening practices. This study aimed to assess dental hygienists’ attitudes regarding diabetes screening and medical–dental collaboration, examine current practices, and investigate the association between attitudes and practices. Methods: A nationwide cross-sectional survey was conducted among dental hygienists from 1340 dental clinics using stratified random sampling. Participants completed an anonymous questionnaire assessing attitudes (4-point Likert scale) and screening practices (4-point frequency scale). Exploratory factor analysis and multiple regression analysis examined attitude–practice associations. Results: Of 1340 surveys distributed, 95 valid responses were obtained (response rate: 7.2%). Participants showed low implementation rates for lifestyle and physical sign assessment in diabetes (below 35%, except thirst: 68.4%) but moderate-to-high rates for medical history evaluation (44.2–75.8%). Multiple regression analysis revealed that lack of confidence and knowledge in diabetes management was negatively associated with both lifestyle assessment (β = −0.38; 95% CI −0.72 to −0.23) and medical history evaluation (β = −0.55; 95% CI −0.63 to −0.32). Desire to participate in diabetes education was positively associated with medical history evaluation (β = 0.21; 95% CI 0.24 to 4.38). Conclusions: Despite low response rate limiting generalizability, this first nationwide Japanese survey indicates that confidence and knowledge deficits significantly hinder diabetes screening practices. Targeted educational interventions could enhance screening implementation and strengthen medical–dental collaboration, improving early diabetes detection. Full article

Diabetes is a chronic and complex pathological syndrome that includes a series of disorders and imbalances, whose first characterization is hyperglycemia, although, as it is a multifactorial phenomenon, it requires risk reduction strategies beyond glycemic control. Continuous education and support for diabetes self-management are essential to prevent acute complications and reduce the risk of long-term complications. Therefore, the guidelines for the treatment of diabetes emphasize the importance of lifestyle changes, including a reduced-calorie diet and increased physical activity. However, for many people, these changes can be difficult to maintain in the long term and eventually they must resort to pharmacological treatment that in most cases requires the combined use of two or more antidiabetic drugs with different mechanisms of action. This review explores the different pharmacological agents, authorized and used therapeutically, for the control of diabetes, especially type 2 diabetes, and analyzes the development strategies of multi-target agents whose effects, through distinct mechanisms and by acting on more than one receptor, could represent a promising alternative in the treatment of a multifactorial disease such as diabetes. As regards therapeutic uses, from metformin to glucose transporter inhibitors (SGLT2i), the potential mechanisms of action, pharmacological and clinical effects, safety, and use in therapeutics are described, presenting, as far as reasonably possible, diverse comparisons between them. In conclusion, although metformin remains the first-line agent for the treatment of type 2 diabetes, the choice of a second-line agent depends on several factors, in particular the cardiovascular risk profile, weight, and renal function of the patient; moreover, the ideal pharmacological treatment, although expected and desired, has in fact not been achieved so far, and physicians must consider not only the glycemic efficacy of the agent but also all the other potential benefits, balanced by the possible adverse effects. Compounds modulating multiple signaling pathways are a promising approach to manage this multifactorial disorder, with the primary objective of maintaining the therapeutic efficacy observed in several clinical studies, alongside reducing adverse effects, the main reason for the discontinuation of developments, to levels that enable a favorable risk–benefit balance. Full article

Background: Self-directed lifestyle modifications are essential for managing symptoms in individuals diagnosed with irritable bowel syndrome (IBS). This study incorporated longitudinal multi-omics profiling to estimate the mechanisms underlying responses to a nurse-led person-centered self-management intervention in young adults with IBS. Methods: This pre-post study was nested within a 12-week parent randomized controlled trial (NCT03332537). Biospecimens (stool and blood) and clinical outcomes were collected at baseline and post-intervention. Symptoms were assessed using the Brief Pain Inventory and PROMIS^® short forms. Host transcriptomic profiling was performed using RNA sequencing, and gut microbial composition was analyzed via 16S rRNA sequencing. Host transcriptomic co-expression and microbial co-abundance modules were identified via weighted gene co-expression network analysis. Associations between multi-omics modules and symptoms were evaluated using linear mixed-effect models. Results: Among the 20 participants, most were non-Hispanic (75%), White (75%), and female (65%). The intervention significantly reduced self-reported pain severity (p = 0.019) and pain interference (p = 0.013). Decreased associations were observed between pain phenotypes and a microbial module enriched in core metabolic pathways (interference: β = −4.7, p < 0.001; severity: β = −2.4, p = 0.02). Anxiety strengthened associations with host transcriptomic cellular energy metabolism pathways post-intervention (p < 0.05). The intervention attenuated associations between fatigue, sleep disturbance, and immune–inflammatory transcriptomic and microbial adaptation modules (p < 0.05). Conclusions: Findings suggest that the IBS self-management intervention induces symptom-specific biological responses, implicating distinct host–microbe pathways. Larger longitudinal studies are warranted to validate these omics-based symptom signatures. Full article

Background: Several studies have examined the prevalence of musculoskeletal pain (MSP) among university students internationally. We aimed to assess the prevalence, pattern, and potential risk factors for MSP among Majmaah University students in Saudi Arabia. Methods: A cross-sectional questionnaire was administered to students from different faculties at Majmaah University. We collected data via the validated Arabic versions of the Standardized Nordic Musculoskeletal Questionnaire, the International Physical Activity Questionnaire, and the Perceived Stress Scale. Bivariate and multivariate logistic regression analyses were performed to explore associations between MSP and demographic, ergonomic, lifestyle, and psychosocial variables. Results: A total of 257 students (n = 195, 75.9% female; n = 62, 24.1% male) were included in this study. The 12-month prevalence of MSP was 225 (87.5%), with the lower back (n = 119, 46.3%) and neck (n = 113, 44.0%) regions being the most affected. Compared with male students, female students reported a higher MSP prevalence (90.3% vs. 79.0%, p = 0.035). The multivariable model was significant (likelihood-ratio χ² = 26.042, df = 7, p < 0.001), accounted for Nagelkerke R² = 0.182 of variance, and showed good calibration (Hosmer–Lemeshow χ² = 8.505, df = 8, p = 0.386). Perceived stress was the only independent predictor of 12-month MSP (β = 0.084, adjusted OR = 1.087, 95% CI 1.034–1.143, Wald χ² = 10.732, p = 0.001), while sex, smoking, academic workload, and sleep duration were non-significant (all p > 0.127). Conclusions: MSP appears to be prevalent among Majmaah University students, with psychological stress emerging as a key independent risk factor. Preventive strategies should include stress management prioritization and ergonomic and physical activity education to support university student well-being. Full article

Background/Objectives: Breast cancer-related lymphedema (BCRL) is more prevalent and severe in women with overweight or obesity. This study evaluated the effect of a comprehensive lifestyle intervention—comprising supervised exercise, a hypocaloric Mediterranean diet, and optional meal replacement—on lymphedema outcomes in this population. Methods: In this pilot randomized controlled trial, 112 women with BCRL and BMI 25–40 kg/m² were assigned to an intervention group—receiving supervised resistance and aerobic training, dietary counseling, and optional high-protein meal replacement—or to a control group with standard advice. The primary outcome was change in affected limb volume at 3 and 6 months. Secondary outcomes included morphofunctional parameters, muscle strength, dietary intake, and serum levels of cytokines (IL-1β, IL-6, IL-10, and TNF-α). Analyses also explored outcomes according to whether participants achieved ≥ 5% weight loss. Results: Ninety-four participants completed the trial (intervention n = 43, control n = 51). At 6 months, women who achieved ≥5% weight loss had greater reductions in affected limb volume (−664.9 ± 362.1 mL vs. −395.6 ± 596.9 mL). The intervention group showed significantly greater improvements in BMI (−1.14 ± 1.22 kg/m²), waist circumference (−3.59 ± 4.6 cm), triceps skinfold (−4.61 ± 3.02 mm), fat mass (−2.38 ± 2.75 kg), extracellular water (−0.58 ± 0.85 L), and quadriceps strength (+7.1 ± 9.7 kg). No significant changes were observed in circulating cytokines. Conclusions: In this pilot randomized controlled trial, a structured dietary and exercise intervention improved morphofunctional outcomes in overweight women with BCRL. Weight loss of ≥5% emerged as a potentially relevant therapeutic target that may inform the design of future studies aimed at optimizing lymphedema management. Full article

Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease linked to type 2 diabetes (T2D), obesity, and dyslipidaemia, which are all parts of the metabolic syndrome. In 2024, for non-cirrhotic MASH with mild to advanced fibrosis, resmetirom, a selective thyroid hormone receptor-β agonist, became the first FDA-approved treatment for this condition. By increasing β-oxidation and lipid metabolism, it minimises systemic thyroid or cardiac effects while reducing hepatic fat, inflammation, and fibrosis. Resmetirom is being developed for use in combination with lifestyle interventions, such as diet and exercise, to maximize patient benefit. Nevertheless, the lack of congruence between clinical trial populations and real-world payer criteria underscores access obstacles that necessitate policy reform. The successful delivery of screening programs depends on the education of providers from various disciplines and the establishment of uniform screening standards. Future studies should investigate the clinical application of resmetirom in combination with agents that may provide additional benefits, such as GLP-1 receptor agonists, SGLT2 inhibitors, and statins. These results are significant in light of recent long-term safety monitoring of these agents, particularly regarding the thyroid axis. Ensuring equitable uptake will be crucial, as it involves defining fair access through payer endpoints, conducting cost-effectiveness analysis, and considering patient-reported outcomes. Resmetirom represents a breakthrough in MASH management, offering potential metabolic benefits in conjunction with comprehensive clinical and lifestyle approaches. Full article

Adherence to medications is a significant challenge in chronic disease management. Poor adherence can lead to adverse patient outcomes including disease progression, increased morbidity, reduced quality of life, higher hospitalization rates, increased medical costs, and mortality. Medical adherence is a complex issue, influenced by multiple factors, including patient-related, medication-related, and healthcare system-related barriers. This review explores reasons for both intentional non-adherence, such as patients underestimating the consequences of the disease, inadequate education or poor healthcare provider–patient communication, and unintentional non-adherence, including forgetfulness, pathophysiological barriers, socioeconomic barriers (including lifestyle and patient factors), or healthcare resource limitations. Multifaceted, patient-tailored interventions that could improve adherence are discussed, including promoting health education, enhancing healthcare provider–patient engagement, and exploring alternative medical solutions and emerging technological advances. No single approach fits all; this review aims to deepen the understanding of intentional and unintentional non-adherence and to inform targeted interventions to empower patients, foster trust, and improve adherence for those with chronic conditions. Full article

Background/Objectives: Pharmacists’ roles are shifting from dispensing medications to managing chronic diseases and prevention. Diabetes is a growing public health issue requiring early detection and management, where pharmacists can play a key role. The SMART Pharmacist Program promotes continuing education and expanded care, and a nationwide blood sugar screening campaign in North Macedonia was conducted to evaluate the impact of pharmacists in detecting undiagnosed diabetes and supporting glycemic control. Methods: This descriptive observational cross-sectional study was conducted mainly on 14 November 2024, in 98 community pharmacies across 14 cities. Participants over 18 years old were recruited via voluntary sampling. A total of 998 measurements were performed on the campaign day, with additional screening extending to 24 January 2025, totaling 1085 participants. Blood glucose was measured by finger prick testing and classified according to national and NICE guidelines. A structured questionnaire collected demographic, medical, and lifestyle data. Results: Among 1085 participants (65.1% female, mean age 57.6 ± 14.5 years), 258 (23.8%) had diagnosed diabetes, mostly Type 2 (226; 20.8%), while 827 (76.2%) were undiagnosed. Males had 1.7 times higher odds of diabetes. Diabetes prevalence correlated with physical inactivity, higher BMI, smoking, and chronic diseases. Among the undiagnosed, 17.8% were prediabetic and 4.3% diabetic. Of diagnosed patients, 57% had well-controlled and 42% poorly controlled diabetes. Metformin-based therapies were most common for Type 2 diabetes. Conclusions: Community pharmacists can effectively support early detection of diabetes and identify patients with suboptimal glycemic control, enhancing diabetes management in the community. Full article

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 day/week), medium (2–4 days/week), or high (≥5 days/week). All-cause mortality was tracked through verified records. Cox proportional hazards models were used to estimate hazard ratios (HRs), with adjustments for demographics, lifestyle factors, and baseline health conditions. Results: A total of 2092 participants (mean age = 63.7 ± 10.4 years) were included in the final analytic sample. Higher physical activity frequency was significantly associated with lower mortality in unadjusted models. Participants engaging in activity ≥5 days/week had a 67% reduced mortality risk compared to the low-frequency group (HR = 0.33, p < 0.001). However, after adjusting for health-related covariates, the protective effect was attenuated and no longer statistically significant. In the fully adjusted model, advanced age, current smoking, and ADL limitations emerged as the strongest independent risk factors for mortality, while being married and residing in a rural area were significantly protective effects. Conclusions: The association between frequent physical activity and reduced mortality risk among Chinese older adults is profoundly mediated by baseline health status and functional capacity. These findings highlight the importance of integrated, multifactorial public health interventions that address chronic disease management and functional rehabilitation alongside physical activity promotion. Full article

The notion of the usual environment is a key factor in distinguishing tourism activities from a demand-side perspective, yet applying it in practice presents persistent difficulties when estimating tourism’s physical and monetary scale. These challenges are particularly pronounced in nautical tourism, and especially in the case of domestic same-day boat trips. Focusing on Croatia, a country where yachting makes up a substantial share of overall tourism flows, this study examines criteria for classifying domestic nautical same-day trips from the demand perspective. Qualitative research on the population of residents who are recreational boat owners was conducted. The aim of the research was to assess residents’ perception of the usual environment when on a same-day boat trip from the criteria of trip frequency, distance, motives, and activities. Seventeen in-depth interviews were conducted, providing insight into subjective and objective determinants of trip classification. Although the analysis revealed a blurred understanding of the distinction between boating as a lifestyle and as a tourism activity, the results indicate that official statistics likely underestimate the number of recreational same-day boat trips. This finding underscores the need for more precise measurement of total physical flows in nautical tourism as a prerequisite for effective sustainability assessment and informed management policies. Full article

For a few decades, Type 2 Diabetes (T2D) has been recognized as a worldwide public health issue. T2D relies on systemic insulin resistance leading to Beta cell dysfunction. Nowadays, lifestyle modifications, such as improving eating habits and increasing physical activity, represent the first recommendations for managing T2D. Physical exercise, as a structured physical activity, is now considered as a non-pharmacological treatment with a wide range of beneficial effects, especially for people living with T2D. The review intends to summarize the current knowledge of physical exercise benefits in a context of T2D: from “unwanted” adipose tissue reduction to Beta cell health improvement. Moreover, we try to suggest an underlying mechanism explaining physical exercise beneficial effects in the context of T2D focusing on exerkines, molecules secreted in response to physical exercise. With this review, we highlight the beneficial impact of post-exercise secretions on Beta cell health and encourage research to continue in this direction. Identifying new exerkines with beneficial effects in the context of T2D could represent a promising approach for managing metabolic diseases. Full article

Background: Circus arts are gaining popularity across the globe and lifespan. Despite growing participation rates, there is limited high-quality evidence describing the physical therapy evaluation and management of injury within this population. The purpose of this scoping review was to identify and summarize evidence related to the injury characteristics and management of circus artists. Methods: With a research librarian, computerized searches were developed and performed using online databases (PubMed, CINAHL, Scopus, SPORTDiscus and Cochrane), gray literature and non-medical databases. Two authors independently voted on article inclusion with a third author blinded to previous voting used in case of conflict. Concept mapping identified five primary themes related to circus injuries and physical therapy treatment. Data was extracted from each article based on content relevant to the classification. Results: In total, 1095 titles were retrieved from electronic searches, of which 49 studies were included. Overall, 20 studies related to injury characteristics, 10 to risk factors, 9 to each psychosocial variables and interventions, and 8 to screening. Acrobats with required ground elements were the most commonly injured discipline, particularly at the shoulder, ankle and spine. Intrinsic and extrinsic risk factors were identified and numerous psychosocial and lifestyle contributing factors were reported. Literature guiding treatment is limited. Conclusions: This scoping review mapped and synthesized evidence related to the evaluation and management of circus artist injuries. While injury patterns and characteristics are generally understood, the treatment of this population is poorly described. Clear gaps in screening, injury prevention strategies, and interventions for this group were identified. Full article

Urinary incontinence (UI) is a widespread worldwide gynecological pathology with a negative impact on women’s quality of life. We performed a narrative review and present a general, descriptive, and comprehensive perspective about surgical techniques for urinary incontinence in young women. Even though parity and vaginal births represent important risk factors for the occurrence of UI, it is also common among young women who are nulliparous. Lifestyle, obesity, smoking, alcohol consumption, and excessive stretching exercises can contribute to the occurrence of UI. Correct diagnosis and treatment may reduce the negative effects of UI on daily activities. Disease management varies depending on the three types of UI: stress, urge, and mixed. Conservative treatment involves lifestyle changes, pharmacological therapy, and pelvic floor muscle training. If symptoms persist, surgical techniques such as midurethral/suburethral slings, anterior colporrhaphy, and retropubic/laparoscopic colposuspension are necessary. Transvaginal tension-free vaginal tape obturator (TVT-O) is the most common surgical technique for the treatment of UI. Its effectiveness has been proven by reducing symptoms and improving quality of life. Alternative modern treatment methods are vaginal laser therapy, periurethral bulking agents injection, or local injection with autologous platelet-rich plasma. Surgical techniques for the treatment of UI are in continuous development and improvement considering the increased incidence of this pathology and the need of patients to improve symptoms and quality of life. Full article