Search Results (6,887)

Background/Objectives: Older adults with cancer are at high risk of developing delirium. Comprehensive geriatric assessment (CGA) is a fundamental tool for prioritizing problems and establishing appropriate interventions in older patients. This study aimed to identify risk factors for delirium through a CGA in older adults receiving palliative cancer care in hospital. Methods: This longitudinal observational study included people aged 65 years or over who were hospitalized in medical wards with an advanced stage of cancer. Clinicians performed a CGA and screened for delirium using the Confusion Assessment Method (CAM). Diagnosis of delirium was based on criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). We calculated odds ratios (ORs) with 95% confidence intervals (CIs) to compare different variables in people with versus without delirium. Results: The study included 105 participants, of whom 67 (63.81%) developed delirium during follow-up. The mean age was 71.33 years in the delirium group and 72.24 years in the non-delirium group. Risk factors for delirium were dysphagia (OR 2.45, 95% CI 1.01–5.99; p = 0.045), urinary catheterization (OR 2.97, 95% CI 1.09–8.13; p = 0.029), and having at least one delirium episode in the last year (OR 5.68, 95% CI 1.97–16.34; p = 0.001). The predictive model showed that older male cancer patients with a urinary catheter and dysphagia are most likely to develop delirium in hospital (area under the curve [AUC] = 0.679, 95% CI 0.577–0.780; p = 0.002). Conclusions: The prevention and effective management of delirium require a person-centered, interdisciplinary approach that considers both clinical and psychosocial aspects. Including variables such as male sex, dysphagia, and urinary catheterization in delirium risk assessment enables more comprehensive and personalized management. Full article

Dental plaque, if not regularly removed through proper oral hygiene, can lead to tooth decay, gingivitis, and more severe periodontal disease. Effective plaque removal is essential in preventing gingivitis, the precursor to periodontitis. Propolis, a bee product known for its antibacterial, anti-inflammatory, and antioxidant properties, has shown potential in dental applications. This systematic review and meta-analysis was conducted to evaluate the efficacy of propolis-containing mouthwashes and toothpastes in reducing dental plaque and gingival inflammation. Materials and Methods: The study protocol was registered in PROSPERO (CRD42023467573), and the review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, PubMed Central, Embase, Scopus, and Web of Science was performed up to 10 May 2025 to identify randomized controlled trials and observational studies assessing propolis-based mouthwashes or toothpastes. Data synthesis used random-effects meta-analysis due to anticipated heterogeneity among studies. Results: Seven randomized controlled trials were included in the meta-analysis, evaluating the efficacy of propolis alcohol-free mouthwash on plaque index (PI) and gingival index (GI). For PI, the pooled standardized mean difference (SMD) was 1.74 (95% CI: 0.19–3.29; p = 0.036), with low between-study heterogeneity (I² = 13.7%). For GI, the pooled SMD was 2.19 (95% CI: 1.10–3.29; p = 0.005), with no observed heterogeneity (I² = 0.0%). Propolis mouthwashes demonstrated large effect sizes, significantly reducing plaque accumulation and gingival inflammation compared to baseline. Conclusions: The evidence supports the potential of propolis-containing mouthwashes and toothpastes in managing dental plaque and gingival health. Propolis-based oral care products could be a valuable addition to preventive strategies in dental hygiene, offering an alternative for reducing dental plaque and gingival inflammation. Full article

Background and Objectives: Type 2 diabetes mellitus (T2DM) remains a significant public health problem across Gulf Cooperation Council (GCC) nations because of advancements in urbanization alongside behavioural lifestyle changes and genetic predispositions. Specific self-management methods are fundamental in T2DM management because they provide better glycaemic control and decrease complications. Achieving a synthesis of updated evidence about self-management strategies and patient perception within GCC nations represents the primary objective of this narrative review. Materials and Methods: The studies included in the present review were retrieved from the Web of Science, Scopus, Medline, Saudi Digital Library, and Embase. We included peer-reviewed studies that were published from January 2020 to March 2025. The selected studies measured the self-management practices of adult T2DM patients by examining medication adherence, dietary patterns, blood glucose monitoring, and treatment barriers. Results: Research data indicate that patients demonstrate different levels of self-care management behaviours, where medication compliance is fair, but dietary patterns and physical activities remain areas of concern. High levels of knowledge deficits, cultural elements, and economic background substantially impact patients’ self-management practices. Patients indicate their need for enhanced and personalized care, better connections with healthcare providers, and interventions that consider their cultural backgrounds. Conclusions: Patients throughout the GCC region encounter ongoing difficulties that prevent them from performing their best at self-management, even though advanced healthcare facilities exist in this region. Therefore, it is critical to develop culturally sensitive patient-centered care, individualized educational programs, and adopt supportive digital solutions to enhance diabetes-related self-care management. Full article

Growing evidence highlights the pivotal role of the gut microbiota in cancer development, progression, response to therapy, and survivorship. Diet plays a central role in shaping gut microbiota composition, influencing the immune system and overall host health. Plant-based diets and the Mediterranean diet promote health-associated microbial communities that increase the production of several metabolic-end products, including short-chain fatty acids that support mucosal barrier integrity, anti-inflammatory effects, and modulation of the immunity of the host. Conversely, Western dietary patterns promote cancer progression and negatively impact the response to standard treatments. Furthermore, gut microbiota influences the effectiveness of cancer therapies, including chemotherapy, radiotherapy and, mainly, immunotherapy. Modulating microbial species, their metabolites, or their activities in the cancer microenvironment through dietary interventions, common or engineered probiotics, prebiotics, postbiotics, antibiotics or fecal microbial transplant are emerging as promising strategies for cancer prevention and tailored management in survivorship. In this review, we explore the intricate interplay between diet, gut microbiota, and cancer, focusing on how specific microbial communities’ impact therapeutic outcomes, and the challenges in the modulation of the microbiota environment through several interventions, including diet. This emerging paradigm paves the way for integrating nutrition and microbiota-targeted strategies as innovative tools in the context of precision medicine. Full article

Background/Objectives: South Korea is rapidly transitioning into a super-aged society, increasing the importance of care services to ensure the health and quality of life of older adults. Although the number of professional caregivers has steadily grown, these workers face a high risk of depression due to the emotional labor inherent to their roles. This study aimed to analyze factors influencing depression among female professional caregivers by employment type (full-time and part-time) and to explore policy and practical intervention strategies to promote their mental health. Methods: Using data from the Korea Occupational Safety and Health Agency, we selected 223 professional caregivers with at least 1 year of work experience. After excluding insincere responses and male participants, 217 participants were included in the final analysis: 121 full-time and 96 part-time professional caregivers. Results: We found that full-time workers experienced higher levels of depression when they lacked access to health and safety education and could not use paid leave. Part-time workers experienced high levels of depression when engaging in physical activity <3 days per week and when exposed to violence. Conclusions: Based on these findings, the study recommends regular and systematic health and safety education, the establishment of substitute worker support to facilitate paid leave use, promotion of physical activity through education and community programs, regular violence prevention education, and comprehensive support systems for victims. This study is significant in empirically identifying depression risk factors by employment type among female professional caregivers. Future research should include male professional caregivers and employ more advanced measurement tools and longitudinal designs. Full article

Background: Stunting remains a major public health issue globally and in Indonesia, often linked to inadequate complementary feeding, cultural practices, and limited family empowerment. Objective: This study aimed to develop and evaluate a family empowerment model based on transcultural care theory to improve quality and prevent stunting among children aged 6–24 months. Methods: A cross-sectional explanatory survey was conducted among 324 mother–child pairs from 11 primary healthcare centers in Kediri, East Java. Data were collected using a validated questionnaire covering demographic, educational, technological, economic, and cultural factors, as well as family empowerment and quality. Structural Equation Modeling with Partial Least Squares (SEM-PLS) was applied for hypothesis testing and model development. Results: The model showed moderate explanatory power (R² = 0.223 for family empowerment; R² = 0.115 for complementary feeding quality). Demographic, educational, technological, economic, and cultural factors significantly influenced family empowerment (p < 0.05), which in turn had a strong positive effect on quality (β = 0.340, p < 0.001). Family empowerment mediated the relationship between these factors and quality. Key contributors included knowledge, technology access, income level, and cultural practices. Conclusions: The proposed transcultural care-based family empowerment model effectively improves quality. Strengthening health education, supporting community health volunteers, and integrating culturally sensitive practices, such as encouraging paternal involvement and shared meals, should be prioritized in stunting prevention programs. The model may be adapted for use in similar community settings to enhance program effectiveness. Full article

Dental care is a well-established marker of both oral and systemic health, driven by behavioral, socioeconomic, and geographic factors. This study aimed to develop and evaluate machine learning models to classify the presence and severity of permanent tooth loss in U.S. adults using the 2022 Behavioral Risk Factor Surveillance System (BRFSS) dataset. We analyzed responses from 365,803 adults after recoding demographic, behavioral, socioeconomic, and access variables. Ten supervised classifiers were trained and evaluated using stratified 80/20 train–test splits, with ANOVA-based selection for the binary task and Pearson correlation plus engineered features for the multiclass task. Performance was assessed by accuracy, AUC, precision, recall, and specificity. For binary classification (any loss vs. none), XGBoost achieved the highest performance (AUC = 0.786; accuracy = 71.4%), with CatBoost close behind (AUC = 0.711). For multiclass severity (none, 1–5, 6+, all teeth removed), an ensemble of gradient-boosting models achieved strong discrimination (macro-AUC = 0.752). Key predictors included age, smoking, education, income, and general health. These findings demonstrate that large-scale survey–based ML models can support oral health surveillance by identifying high-risk groups and informing targeted prevention strategies. Full article

Acute kidney injury is a common complication in the perioperative setting, especially among patients undergoing high-risk surgeries such as cardiac, abdominal, or orthopedic procedures. Characterized by a sudden decline in renal function, perioperative acute kidney injury is typically diagnosed based on rising serum creatinine or reduced urine output. Its incidence varies depending on the surgical type and patient risk factors, but even mild cases are linked to significant consequences, including prolonged hospital stays, enhanced healthcare costs, and higher mortality rates. Despite advances in surgical and anesthetic care, acute kidney injury remains a major cause of morbidity. The development of acute kidney injury in the perioperative period often results from a complex interplay of hypoperfusion, ischemia–reperfusion injury, inflammation, and exposure to nephrotoxic agents. While some predictive models and biomarkers, such as neutrophil gelatinase-associated lipocalin (NGAL), have shown promise in identifying patients at risk, widespread adoption remains inconsistent, and standardized prevention protocols are lacking. This narrative review synthesizes current evidence on the pathophysiology, risk factors, and prevention strategies for perioperative acute kidney injury. It explores emerging tools for risk stratification and early diagnosis, including novel biomarkers and learning-based models. Additionally, it highlights pharmacologic and non-pharmacologic measures to reduce acute kidney injury incidence, such as balanced fluid management, renal-protective anesthetic strategies, and bundle-based care approaches. Emphasizing a multidisciplinary and personalized model of care, this review highlights the need for coordinated efforts between anesthesiologists, surgeons, and nephrologists to identify modifiable risks and improve outcomes. Reducing the incidence of perioperative acute kidney injury has the potential to enhance recovery, preserve long-term kidney function, and ultimately improve surgical safety. Full article

The human gut microbiome is a metabolically active and ecologically dynamic consortium that profoundly influences host physiology, in part by modulating epigenetic mechanisms such as DNA and RNA methylation. These modifications regulate gene expression and phenotypic plasticity and are shaped by a combination of environmental factors, such as diet, stress, xenobiotics, and bioactive microbial metabolites. Despite growing evidence linking microbial signals to host epigenetic reprogramming, the underlying molecular pathways remain incompletely understood. This review highlights recent mechanistic discoveries and conceptual advances in understanding microbiome–host epigenome interactions. We discuss evolutionarily conserved pathways through which gut microbiota regulate host methylation patterns, including one-carbon metabolism, polyamine biosynthesis, short-chain fatty acid signaling, and extracellular vesicle-mediated communication. We also examine how host factors such as aging, diet, immune activity, and sociocultural context reciprocally influence microbial composition and function. Beyond basic mechanisms, we outline translational frontiers—including biomarker discovery, live biotherapeutic interventions, fecal microbiota transplantation, and adaptive clinical trial designs—that may enable microbiome-informed approaches to disease prevention and treatment. Advances in high-throughput methylation mapping, artificial intelligence, and single-cell multi-omics are accelerating our ability to model these complex interactions at high resolution. Finally, we emphasize the importance of rigorous standardization and ethical data governance through frameworks such as the FAIR and CARE principles. Deepening our understanding of how the gut microbiome modulates host epigenetic programs offers novel opportunities for precision health strategies and equitable clinical translation. Full article

Background: Urgent care clinics (UCCs) embedded within primary healthcare settings play a vital role in managing acute, non-life-threatening conditions in children. However, limited data exist on medication prescribing patterns in such settings in the Kingdom of Saudi Arabia (KSA), particularly regarding antibiotic use. This study aimed to describe the epidemiology of pediatric urgent care visits and identify factors associated with prescribing within a model primary healthcare (PHC) center. Methods: A retrospective chart review was conducted for all urgent care visits made by pediatric patients (<14 years) at a model PHC center in the KSA for all visits in 2024. Sociodemographic variables, visit timing, diagnosis, and prescription data were extracted from electronic health records. Multivariable logistic regression was used to analyze predictors of medication prescribing. Results: Of the 1016 pediatric urgent care visits, 62.5% resulted in medication prescriptions, and 23.62% of those visits included at least one antibiotic, primarily penicillins (71.33%). Cephalosporins and tetracyclines were not prescribed. Prescriptions were 67% more likely among adolescents and 70% less likely among infants when compared to school-aged children (95% CI = 1.04–2.67 and 95% CI = 0.15–0.61, respectively). Respiratory and ENT-related diagnoses accounted for most prescriptions. No significant sex-based differences in prescribing were observed. Conclusions: The epidemiological patterns observed indicate that respiratory and ENT conditions, as well as seasonal peaks in autumn and winter, are the main drivers of prescribing in pediatric urgent care. These findings have implications for strengthening disease surveillance, anticipating service demand, guiding preventive interventions such as vaccination and health education, and supporting evidence-based planning of primary care resources. Full article

India’s vast and diverse population presents significant healthcare challenges owing to its scale, heterogeneity, and rapid growth. The Indian healthcare system, spanning the public, private, and non-profit sectors, shows marked inter-state variation in health indicators. Persistent gaps include variable quality of service, fragmented data, and uneven access to affordable care. Health information technology (HIT), particularly clinical decision support systems (CDSSs) integrated with electronic health records (EHRs), offers a path to more consistent evidence-based decisions. When implemented effectively, CDSSs can improve patient outcomes, reduce medical errors, and enhance quality through support for diagnosis, treatment, patient management, and prevention. Although India is rapidly adopting digital health tools, CDSS uptake remains limited because of infrastructure constraints, low awareness, data quality issues, integration challenges with EHRs, professional resistance, and insufficient training. Strategic action is required to overcome these barriers. Priorities include investment in robust IT infrastructure, comprehensive training programs, and public awareness initiatives, along with tighter integration of CDSSs with EHR platforms. With coordinated efforts by government agencies, healthcare institutions, and technology providers to address these barriers, India can leverage CDSSs to improve patient care and outcomes. Full article

Background: Hypertension remains the leading global risk factor for cardiovascular morbidity and mortality, with suboptimal control rates despite guideline-directed therapies. Digital health and artificial intelligence (AI) technologies offer novel approaches for improving diagnosis, monitoring, and individualized treatment of hypertension. Objectives: To critically review the current landscape of AI-enabled digital tools for hypertension management, including emerging applications, implementation challenges, and future directions. Methods: A narrative review of recent PubMed-indexed studies (2019–2024) was conducted, focusing on clinical applications of AI and digital health technologies in hypertension. Emphasis was placed on real-world deployment, algorithmic explainability, digital biomarkers, and ethical/regulatory frameworks. Priority was given to high-quality randomized trials, systematic reviews, and expert consensus statements. Results: AI-supported platforms—including remote blood pressure monitoring, machine learning titration algorithms, and digital twins—have demonstrated early promise in improving hypertension control. Explainable AI (XAI) is critical for clinician trust and integration into decision-making. Equity-focused design and regulatory oversight are essential to prevent exacerbation of health disparities. Emerging implementation strategies, such as federated learning and co-design frameworks, may enhance scalability and generalizability across diverse care settings. Conclusions: AI-guided titration and digital twin approaches appear most promising for reducing therapeutic inertia, whereas cuffless blood pressure monitoring remains the least mature. Future work should prioritize pragmatic trials with equity and cost-effectiveness endpoints, supported by safeguards against bias, accountability gaps, and privacy risks. Full article

Hand hygiene (HH) is universally recognized as a pillar of infection prevention and control (IPC), both in hospitals and long-term care facilities such as nursing homes (NHs). An annual national survey based on the voluntary notification of purchased alcohol-based hand rubs (ABHRs) has been set up in France since 2019 to appraise the compliance to HH in NHs. The results pertaining to the Hauts-de-France (HdF) region were analyzed over the 2018–2023 period. The impact of factors such as the year, structure status, availability of an infection control link (ICL) nurse and/or an IPC team as well as constant participation in the survey was evaluated. A clear rise in the consumption of ABHRs was witnessed in 2020 followed by a progressive return to the 2018 baseline by 2023 for most NHs. This decrease was significantly less marked in NHs constantly participating in the survey. The ABHR indicator’s annual values were significantly higher in public NHs than in associative ones and in NHs with available ICL nurses/IPC teams. Finally, even though less than 50% of regional NHs reached the target of four daily ABHR uses per resident, they more frequently met it than French ones as a whole. This result underscores the need for ceaselessly reiterating the importance of HH and for pursuing training efforts in NHs with the help of ICL nurses and IPC teams. Full article

Background: Asthma is the most prevalent chronic illness in children worldwide, contributing to significant morbidity, health care utilization, and economic burden. In the United States, approximately five million children are affected by asthma. This review explores the environmental contexts and lifestyle determinants of pediatric asthma, with a focus on the Inland Empire (IE) region of Southern California. The IE’s unique geographic landscape and importance as a major transportation hub highlights its critical role for understanding how both environmental and structural factors exacerbate asthma burden within the pediatric population. Variables such as household income, parental education levels, and lack of community-based asthma programs were explored. Despite significant burdens, the IE remains under-represented in asthma research, contributing to persistent disparity. Methods: A narrative literature review and regional data analysis were conducted via PubMed, Scopus, and Google Scholar (2000–2025), alongside data from the CDC, CDPH, and American Lung Association. Key words used included “pediatric asthma, Inland Empire, air pollution, asthma disparity, emergency department utilization, socioeconomic status.” Inclusion criteria were: (1) studies or reports focusing on pediatric asthma (ages 0–17), (2) articles addressing environmental, socioeconomic, or health care-related risk factors, and (3) research with either national, state-level, or IE-specific data. Exclusion criteria were: (1) articles not in English, adult-only asthma studies, and (3) publications without original data or reference to pediatric asthma burden, management, or outcomes. Titles and abstracts were screened for relevance, and full texts were reviewed when abstracts met inclusion criteria. A total of 61 studies, reports, and data sources met this criterion and were included into this review. Results: The IE—comprised of San Bernardino (SB) and Riverside Counties— is home to four of the top five most polluted cities in North America. Vehicle emissions and industrial waste are concentrated in the region due to limited air circulation from surrounding mountains that entrap pollutants. Pediatric asthma ED visit rates in SB and Riverside were 60.5% and 59.3%, compared to California’s average of 56.7%. Hospitalization rates for children aged 0–4 were also higher in SB (24.4%) compared to the state average (17.3%). The elevated rates among school-aged children underscore the crucial need for interventions aimed at improving air quality, enhancing asthma management, and increasing access to preventive health care. Conclusions: Pediatric asthma in the IE reflects heightened environmental risks, socioeconomic barriers, and gaps in health care access. Addressing these disparities requires targeted interventions, policies, and region-specific research to enhance long-term management strategies and outcomes for vulnerable pediatric populations. Full article

Background/Objectives: Maternal depression, anxiety, perceived stress, and resilience are recognized determinants of perinatal health, yet routine psychological screening is still uncommon in Romanian obstetric practice. This study examined how these four psychological factors relate to preterm birth, gestational hypertension, intra-uterine growth restriction (IUGR), and low birth weight in primiparous women. Methods: In a cross-sectional study at a tertiary maternity center in Timișoara (February 2024–February 2025), 240 women at 20–28 weeks’ gestation completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale-10 (PSS-10), and Connor–Davidson Resilience Scale-25 (CD-RISC-25). Obstetric outcomes were abstracted from medical records. Pearson correlations described bivariate associations; multivariate logistic regression assessed independent effects after mutual adjustment. Results: Preterm birth occurred in 21% of pregnancies, gestational hypertension in 17%, IUGR in 15%, and low birth weight in 21%. Higher EPDS, GAD-7, and PSS-10 scores correlated positively with each complication (r = 0.19–0.36; p < 0.02), whereas CD-RISC-25 scores showed inverse correlations (r = −0.22 to −0.29; p ≤ 0.012). In the fully adjusted model, GAD-7 remained the only independent psychological predictor of the composite obstetric outcome (β = 0.047; 95% CI 0.010–0.083; p = 0.013). Perceived stress approached significance; depression and resilience were no longer significant after adjustment. Conclusions: Generalized anxiety was the most robust psychological determinant of adverse obstetric outcomes, with perceived stress, depression, and lower resilience showing contributory roles at the unadjusted level. Incorporating brief instruments such as the GAD-7, PSS-10, and CD-RISC-25 into routine prenatal care could facilitate early identification of at-risk pregnancies and inform targeted preventive interventions. Full article