Search Results (5,255)

Background: Mobility assessment is a crucial aspect of rehabilitation for individuals with lower limb amputation, as it directly influences their independence and quality of life. The objective of this study was to translate and cross-culturally adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility grades questionnaire in the Persian language and to investigate its psychometric properties. Methods: The SIGAM mobility scale was translated into Persian according to international guidelines for cross-cultural adaptation of self-reported measures and was administered to forty Persian-speaking people with lower limb amputations. Measurement properties were evaluated following COSMIN (COnsensus-based Standards for the Selection of Health Measurement INstruments) recommendations and included internal consistency, test–retest reliability, and hypotheses testing for construct validity by comparing SIGAM mobility grades to the Locomotor Capabilities Index-5 (LCI-5), Houghton scale, Activities-specific Balance Confidence (ABC) scale, the 2-Minute Walk Test (2-MWT), and the Timed Up and Go (TUG). Results: SIGAM mobility scale demonstrated acceptable internal consistency (Kuder-Richardson 20 coefficient = 0.72) and excellent test–retest reliability (Cohen Kappa coefficient = 0.85). Hypothesis testing for construct validity confirmed the good to very good correlations of the Persian SIGAM mobility scale with the LCI-5 (r = 0.63, 0.55, and 0.63 for the general, basic, and advanced activities components, respectively), Houghton scale (r = 0.63), ABC scale (r = 0.73), 2-MWT (r = 0.50), and TUG test (r = −0.51). Conclusion: The Persian version of the SIGAM mobility scale demonstrated preliminary evidence of acceptable psychometric properties, supporting its clinical applicability. Full article

Background/Objectives: This cross-sectional study aimed to identify predictors of parent-reported health-related quality of life (HRQOL) in young children with early brain damage and severe motor dysfunction. It used baseline data from the PIH Multi Study, a randomized controlled trial evaluating an intensive, family-centered habilitation program for preschool children and their parents. Methods: Parent-reported HRQOL were measured using the CPCHILD questionnaire. Potential predictors included adaptive function (PEDI-CAT), gross motor function (GMFM-66), postural control and balance (ECAB), and communication function (FOCUS). These were selected to reflect the domains of the ICF-CY framework. Data were collected by professionals and by parents. Linear regression analyses were conducted to identify significant predictors. Results: Analyses included 65 children. Better adaptive skills, gross motor function, postural control, and communication all predicted higher parent-reported HRQOL. Adaptive skills—particularly in self-care and mobility—and gross motor function emerged as the strongest predictors. Conclusions: The study highlights the importance of targeting basic functional skills in early habilitation efforts for children with severe disabilities. The findings support a multidimensional understanding of health in line with the ICF-CY framework and underline the value of early, individualized, and family-centered interventions. Future research should investigate these predictors longitudinally and explore ways to integrate children’s own perspectives in assessment of HRQOL. Full article

EPS module buildings are prefabricated, low-rise systems with high thermal insulation that are widely used in rural self-built houses in northern China, yet their indoor thermal environments often suffer from instability. This study experimentally verified the effectiveness of microcapsule phase change mortar (PCM plaster) in improving winter indoor temperatures of EPS module houses. In addition, based on simulation data from 350 design combinations across five representative cold-climate cities and four envelope design variables, the study provides quantitative design guidance for EPS module walls and PCM plaster in rural houses, offering a practical approach to improve indoor thermal stability that has not been previously reported. The main findings are as follows: (1) The thermal transmittance of EPS module walls is the dominant factor influencing indoor thermal performance. For climate adaptability, Type II walls are recommended for severely cold regions, while Type I walls are suitable for cold regions. The application of PCM plaster is not recommended in solar-rich cold regions such as Lhasa due to limited effectiveness. (2) Optimal PCM plaster parameters exist, with the phase change temperature recommended to be 2–4 °C higher than the average indoor operative temperature during the heating period. Specifically, 18 °C is optimal for Type I walls in Yinchuan, Beijing, and Dalian, while 15 °C is more appropriate for Type II walls in Shenyang and Harbin. The corresponding optimal thicknesses are 20 mm for Harbin, Shenyang, and Dalian; 30 mm for Yinchuan; and 40 mm for Beijing, achieving a balance between indoor temperature improvement and construction cost. (3) Operative temperature and discomfort hours are introduced to assess indoor thermal stability, especially in buildings with interior PCM plaster. Full article

Background: Sports vision training improves perceptual–motor skills crucial for performance and injury prevention. Despite proven benefits, little is known about its perception and use among coaches in Portugal. Methods: A cross-sectional online survey was completed by active coaches from various sports, gathering sociodemographic data, awareness of visual training, perceived importance of ten visual skills, and implementation in training plans. Statistical analyses included descriptive tests to summarize sample characteristics, t-tests and two-way ANOVA to compare perceived importance of visual skills across sex and sport modalities, Spearman correlations to assess associations with age, and Firth-corrected logistic regression to identify predictors of incorporating visual training into practice plans. Results: Among 155 participants (88.5% men; mean age 36.9 ± 11.8 years), 73.2% reported incorporating visual training, with no association with self-reported knowledge (p = 0.413). Regarding perceived importance, reaction time was rated highest (1.20 ± 0.44), followed by hand–eye/body coordination (1.61 ± 0.71) and anticipation (1.34 ± 0.55). Age negatively correlated with importance given to visual memory, peripheral vision, concentration, depth perception, coordination, and moving-object recognition (p < 0.05). Multivariable analysis showed age (OR = 1.05; p = 0.0206) and volleyball (OR = 2.45; p = 0.031) positively associated with implementation, while higher perceived importance for visual concentration was negatively associated (OR = 0.54; p = 0.0176). Conclusions: Visual training implementation is high but not always linked to formal knowledge. Adoption is influenced by sport and demographics, and the counterintuitive role of visual concentration underscores the need for tailored educational programs to enhance performance and reduce injury risk. Full article

This study examined how cognitive, affective, and sociocultural factors shape teachers’ readiness for inclusive education, focusing on the interplay between attitudes, emotional concerns, and self-efficacy. A survey of 149 elementary school teachers from diverse communities employed three validated instruments to assess these constructs. Overall, teachers expressed moderately positive attitudes toward inclusion and relatively high levels of self-efficacy, yet emotional concerns were consistently present. Importantly, correlational analyses revealed that emotional concerns fully mediated the relationship between attitudes and self-efficacy, underscoring the central role of affective dimensions in shaping teachers’ professional confidence. Teachers with prior training or direct experience with students with disabilities reported lower emotional concerns, suggesting the value of practice-based professional learning opportunities. Sociocultural differences also emerged, with differences across communities, pointing to the influence of communal norms on emotional readiness for inclusion. These findings highlight the need to reconceptualize teacher professionalism in inclusive education as integrating cognitive, emotional, and contextual dimensions. Implications include designing professional development programs that combine knowledge, practice, and emotional preparedness, alongside culturally responsive approaches tailored to minority communities. Full article

Background: Communication difficulty restricts education, healthcare, and social participation, yet population-level data for Saudi Arabia have been scarce. This study analysed the 2017 Saudi National Disability Survey to estimate prevalence, describe severity and demographic patterns, and identify factors linked to these difficulties. Objectives: We aimed to estimate national and regional prevalence, assess severity, and gender differences, and identify socio-demographic and disability-related correlates. Methods: A cross-sectional, two-stage stratified cluster sample of 33,575 households (weighted N = 20,408,362 citizens) provided self-reported data on communication difficulty and socio-demographics. Weighted frequencies described prevalence and multivariable logistic regression identified independent correlates. Results: Among all Saudi citizens, 7.1% reported at least one functional difficulty, and of this group 15.7%—equivalent to 1.1% of the total population (n = 226,510)—had a communication difficulty; within that communication difficulty stratum, (n = 185,508) (0.9% of all citizens) experienced it alongside additional impairments, whereas (n = 41,002) (0.2% of all citizens) reported communication difficulty in isolation. The communication difficulties exhibit significant regional variation, ranging from 0.45% in Najran to 1.55% in Aseer. Most cases were classified as being associated with some difficulty (72%); females were over-represented in the extreme category despite a modest male excess overall (adjusted odds ratio [AOR] = 1.09). Higher education, married status, and bilateral first-cousin marriage (AOR = 1.22) were associated with greater risk. Chronic disease (44%) and perinatal causes (13%) predominated, and 84% of cases co-occurred with at least one other disability. Independent predictors included a long duration (AOR = 4.18), disease or delivery-related cause, and consanguinity. Conclusions: Findings highlight geographically clustered need, genetic risk factors, and substantial multimorbidity, indicating the importance of region-specific screening, premarital counselling, and integrated rehabilitation within chronic disease services. Full article

Background: Adherence to tyrosine kinase inhibitors (TKIs), the first-line treatment for renal cell carcinoma (RCC), is critical to ensure intended treatment outcomes. However, 75% of patients with RCC have persistency gaps (>7 days) within the first 90 days after initiating TKIs. This study explored factors affecting TKI adherence in RCC patients to inform future interventions. Methods: A retrospective cohort study was conducted at a specialist oncology hospital in Northwest England from October 2020 to October 2022 on patients with RCC treated with TKIs. TKI prescriptions and persistence gaps (>7 days) were identified from electronic dispensing records. Factors associated with persistence gaps were retrieved by reviewing patients’ clinical records. We used descriptive statistics to summarise the results and Kaplan–Meier analysis to assess the probability and the time to the first gap, stratified by adverse drug effect (ADE)-related and non-ADE-related gaps. Results: Among 165 included patients, 611 persistence gaps were identified. ADEs accounted for 59% (n = 464) of 787 recorded factors, with diarrhoea being the most frequent ADE (9.5%). Patients holding leftover TKIs were the primary (15.1%) non-ADE factor for persistency gaps. At least one gap was observed with 82% of patients (n = 135); 19% had ≥5 ADE-related gaps, and 25% had ≥5 non-ADE-related gaps. ADE-related gaps typically occurred within the first three months (50%), while non-ADE-related gaps were not time-dependent. Conclusions: ADEs, including diarrhoea and pain-related reactions, were the most frequently reported issues affecting TKI persistency in patients with RCC. These ADEs are likely to impact patients’ quality of life and adherence. Future qualitative research is warranted to explore patients’ care needs and additional factors such as health literacy and self-efficacy. Full article

Background: Patient satisfaction with diabetes technology is increasingly recognized as a key factor in therapeutic success. Patient-reported outcomes (PROs) are gaining importance in diabetes care and in the evaluation of advanced insulin delivery systems. Objectives: This study aimed to design and validate a new questionnaire, the Insulin Pump Infusion Sets Satisfaction Scale (IPISS), to assess satisfaction with insulin infusion sets among individuals with type 1 diabetes. Methods: The questionnaire was developed by our Diabetology Unit in two versions: one for patient self-reporting and one for caregivers when the patient is too young to complete it autonomously. Content validity was assessed by six healthcare professionals (three diabetologists and three nurses) based on Polit and Beck’s methodology. The Item Content Validity Index (I-CVI) was calculated for both relevance and comprehensibility and was considered satisfactory if expert agreement reached ≥83%. The Scale Content Validity Index (S-CVI) was computed as the average of I-CVIs, with a cut-off value > 90% deemed acceptable. Results: Almost all items achieved 100% positive agreement for both relevance and comprehensibility, except one item in the caregiver version, for which one rater did not provide a rating for comprehensibility (I-CVI = 83.3%). The S-CVI was 100% for relevance in both versions, 99.24% for comprehensibility in the caregiver version, and 100% in the patient version. Conclusions: The IPISS is a content-validated, self-reported tool, suitable for evaluating satisfaction with infusion sets in individuals using insulin pumps, with versions adapted for both patients and caregivers. Full article

Background: Children in underdeveloped rural areas of China often face socioeconomic disadvantages, which are associated with low confidence and self-esteem. While SEL programs have shown benefits internationally, evidence from Mainland China is limited. This study examined whether a school-based SEL intervention could improve confidence and self-esteem among children in economically disadvantaged rural areas. Methods: The intervention was a quasi-experimental study conducted in a rural, underdeveloped region of central China. It involved 16 weekly sessions, each lasting 90 min. A total of 230 children aged 8–12 years participated in the intervention school, while 325 children from another school served as the control group. The study used a mixed-methods design, including a quantitative survey administered at baseline, post-intervention, and a 5-month follow-up, as well as qualitative interviews with 83 children, nine caregivers, and eight teachers following the intervention. A linear mixed-effects model was employed to evaluate the effectiveness of the intervention, while interview data were analyzed using an inductive thematic approach. Results: The findings suggested (1) children from lower socioeconomic backgrounds consistently reported lower levels of self-esteem and self-efficacy across all three assessment points. (2) There was a short-term intervention effect on self-esteem, with greater improvements among children from poorer families. (3) The increase in children’s confidence meant they were more able to express themselves and mix with others. (4) Children’s improvements were not sustained up to a 5-month follow-up. Conclusions: The program may be effective in improving children’s confidence and self-esteem in underdeveloped rural areas of China. Such a program may contribute not only to educational outcomes but also to broader efforts aimed at social mobility and poverty reduction. Full article

Older adults are vulnerable to changes in sleep with age. Poor sleep quality is associated with self-reported cognitive changes, which can occur before the onset of objective cognitive decline associated with Mild Cognitive Impairment and Alzheimer’s disease. The objective of this study was to examine associations between self-reported sleep complaints, objective sleep quality, and self-reported cognitive changes and their relations to symptoms of depression and anxiety in a group of community-dwelling older adults. Adults aged ≥ 50 without dementia (n = 45) were recruited and completed 1–2 weeks of rest-activity monitoring using a wrist-worn device, underwent a test of global cognitive functioning (Mini-Mental State Examination; MMSE), and completed questionnaires assessing insomnia (Insomnia Severity Index; ISI), subjective sleep quality (Pittsburgh Sleep Quality Index; PSQI), self-reported cognitive changes (Cognitive Function Instrument; CFI), and symptoms of depression and anxiety (Beck Depression Inventory-II; BDI-II and Generalized Anxiety Disorder 7-item assessment; GAD-7). Pearson partial correlations assessed relations among subjective and objective sleep quality, insomnia ratings, CFI ratings, and global cognition, while controlling for BDI-II and GAD-7 ratings. Exploratory analyses examined the correlation between PSQI component scores and CFI ratings and global cognition. Greater ISI (r = 0.50, p ≤ 0.001) ratings significantly correlated with higher CFI scores. PSQI total ratings and actigraphy-based measures (n = 41) did not significantly correlate with CFI scores. Exploratory PSQI subscale analyses revealed that worse subjective sleep quality (r = 0.31, p = 0.048), shorter sleep duration (r = 0.32, p = 0.04), and greater use of sleep medications (r = 0.31, p = 0.048) correlated with higher CFI scores. Poorer sleep quality due to less time spent asleep, fragmented or disturbed sleep, and requiring medications to sleep, may be associated with greater memory concerns. Alternatively, worries about cognition may deleteriously affect sleep. Subjective measures of sleep quality may be useful to identify older adults at increased risk of cognitive decline. Full article

Background: The 4CMenB vaccine (Bexsero^®) contains surface proteins from Neisseria meningitidis serogroup B and is recommended from 2 months of age. The most frequently reported adverse events are fever, injection site pain, and fatigue. Thus, this study aimed to estimate the incidence of local and systemic adverse events associated with the administration of the 4CMenB (Bexsero^®) vaccine. Methods: A systematic review and meta-analysis of clinical trials published up to 28 February 2025 were conducted using PubMed, ScienceDirect, and Web of Science. Human studies available in English, Spanish, French, German, or Italian were exclusively included. Adverse events following the first dose of the vaccine were analyzed. Pooled proportions with 95% confidence intervals were calculated, and heterogeneity across studies was assessed using the I² statistics. Results: Ten clinical trials comprising 13,345 participants were included. The most common adverse event was local pain (occurring in up to 94% of cases), followed by induration, erythema, and edema, with frequencies ranging from 25% to 45%. The most frequently reported systemic events were irritability (up to 75%), fatigue (51–59%), fever (up to 60%), headache (42–49%), and persistent crying (50–65%). Most adverse events were mild and self-limiting. Conclusions: The 4CMenB (Bexsero) vaccine exhibits a favorable safety profile, characterized by a predominance of mild and transient local adverse events. Although several systemic events were reported, their overall frequency was generally low. These findings support the continued inclusion of Bexsero^® in routine childhood immunization programs. Full article

As the global economy undergoes rapid digital transformation, cryptocurrencies have emerged as a prominent alternative class of financial assets. Their decentralized nature, pseudonymity, and lack of centralized oversight have attracted considerable interest among investors while simultaneously raising significant concerns among regulators and compliance professionals. While cryptocurrencies offer benefits such as enhanced accessibility and transactional privacy, they also pose notable risks, particularly their potential misuse in financial crimes, including money laundering. This study explores the perceived risks associated with cryptocurrencies in the context of money laundering, drawing on insights from a survey conducted among 50 financial sector professionals. A quantitative research design was employed, using a structured online questionnaire to assess participants’ awareness, investment behavior, and perceptions of the role of cryptocurrencies in illicit finance and financial system security. The results reveal a complex perspective: while 70% of respondents acknowledged the potential for cryptocurrencies to facilitate money laundering, 60% expressed support for their wider adoption. Notably, statistically significant correlations emerged between active investment in cryptocurrencies and the belief that they could enhance financial market security and reduce laundering risks. However, self-reported knowledge levels and general awareness did not show a significant relationship with perceived risk. The findings underscore the importance of a balanced approach to regulation, one that fosters innovation while mitigating illicit finance risks. The study recommends increased investment in user education, the development of blockchain analytics, the adoption of global regulatory standards and enhanced international cooperation to ensure the responsible evolution of the cryptocurrency ecosystem. Full article

Background/Objectives: Type 2 diabetes (T2D) is a pressing public health challenge in the United States (U.S.). Community-based diabetes education programs equip individuals with T2D with the knowledge and skills to improve dietary behaviors, build confidence, and better manage their condition to reduce complications. However, few studies evaluate self-care adherence and self-efficacy together. This study examined participant adherence to diabetes self-care practices and confidence in managing diabetes through a community-based education program. Methods: Do Well, Be Well with Diabetes (DWBWD) is a 5-week program focused on reinforcing the best practices in diabetes management through dietary practices, physical activity, and gaining self-confidence in managing T2D. The program was evaluated among 137 participants across 14 Texas counties using pre- and post-surveys that assessed the number of days per week participants engaged in diabetes self-care practices, as well as their confidence in performing these behaviors (rated on a scale from 1 = not at all confident to 5 = extremely confident). Results: Participants were mostly male (75.9%), White (60.6%), and over 65 years (58.4%). Most participants had T2D (57.7%) or prediabetes (27.0%). Compared to the program entry, participants reported improvements (p < 0.001) in self-care practices, as reflected by their mean differences (MD), including following a healthful eating plan (MD −1.46), consuming five servings of fruit and vegetables (MD −0.87), spacing carbohydrate intake evenly throughout the day (MD −1.64), engaging in at least 30 min of daily physical activity (MD −0.74), testing blood glucose (MD −1.08), and checking their feet (MD −1.09). Confidence in performing all self-care behaviors significantly improved (p < 0.001), with MDs between −0.53 and −1.13, indicating higher post-program scores. Conclusions: Participation in the DWBWD program increased confidence in diabetes management and enhanced engagement in key health behaviors associated with reducing diabetes complications. Full article

Artificial Intelligence (AI) applications in sports dentistry have the potential to improve early detection and diagnosis. We aimed to validate the diagnostic performance of AI-assisted software in detecting dental caries, periodontitis, and tooth wear using panoramic radiographs in elite athletes. This cross-sectional validation study included secondary data from 114 elite athletes from the Sports Dentistry department at Egas Moniz Dental Clinic. The AI software’s performance was compared to clinically validated assessments. Dental caries and tooth wear were inspected clinically and confirmed radiographically. Periodontitis was registered through self-reports. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), as well as the area under the curve and respective 95% confidence intervals. Inter-rater agreement was assessed using Cohen’s kappa statistic. The AI software showed high reproducibility, with kappa values of 0.82 for caries, 0.91 for periodontitis, 0.96 for periapical lesions, and 0.76 for tooth wear. Sensitivity was highest for periodontitis (1.00; AUC = 0.84), moderate for caries (0.74; AUC = 0.69), and lower for tooth wear (0.53; AUC = 0.68). Full agreement between AI and clinical reference was achieved in 86.0% of cases. The software generated a median of 3 AI-specific suggestions per case (range: 0–16). In 21.9% of cases, AI’s interpretation of periodontal level was deemed inadequate; among these, only 2 cases were clinically confirmed as periodontitis. Of the 34 false positives for periodontitis, 32.4% were misidentified by the AI. The AI-assisted software demonstrated substantial agreement with clinical diagnosis, particularly for periodontitis and caries. The relatively high false-positive rate for periodontitis and limited sensitivity for tooth wear underscore the need for cautious clinical integration, supervision, and further model refinements. However, this software did show overall adequate performance for application in Sports Dentistry. Full article

Background/Objectives: Pain neuroscience education (PNE) has demonstrated efficacy in adults with chronic pain, but the pediatric evidence is still developing, despite its increasingly frequent use. Evidence for the effectiveness of PNE in pediatrics remains fragmented across settings and outcomes, which justifies a systematic evaluation focused on children and adolescents. Methods: Following PRISMA, two reviewers independently screened records (PubMed, Web of Science, PEDro; through 21 July 2025), extracted data, and assessed risk of bias (RoB 2 for randomized controlled trials; NIH/CASP for non-randomized studies). Given the heterogeneity, we conducted a structured narrative synthesis (SWiM) and rated the certainty of evidence with GRADE. PROSPERO: CRD420251062922. Results: Eleven studies met the inclusion criteria. PNE consistently improved pain-related knowledge, with effects maintained at follow-up (moderate certainty); effects on pain intensity, function, and emotional outcomes were small and inconsistent (low certainty), with more favorable patterns when PNE was combined with exercise and/or booster sessions. Digital and gamified formats proved feasible and engaging; parental outcomes showed small improvements where measured. Conclusions: PNE is a promising, low-cost, and scalable component of pediatric chronic pain care, strengthening self-efficacy and adaptive coping. Integration into biopsychosocial, multidisciplinary programs—particularly alongside exercise and family involvement—may optimize outcomes. Larger, standardized trials with long-term follow-up and systematic adverse-event reporting are needed to solidify guidance for clinical practice. Full article