Search Results (45,761)

Background: Metabolic syndrome (MetS) is a cluster of pathologies (obesity, dyslipidemia, insulin resistance, hypertension) that affects over one quarter of old adults. MetS is a condition that markedly increases the susceptibility of various organs to dysfunctionality and is associated with the development of oxidative stress. The existing guidelines point out that exercise is highly advantageous for patients with MetS. However, there is a need for specific guidance and clinical evidence. Objective: This study aimed to investigate the effects of a moderate aerobic exercise program on older women without and with MetS. Methods: A total of 120 women aged 60–70 years old were recruited and divided into two groups: healthy old women (HOW, N = 60) and old women with MetS (OW-MetS, N = 60). Anthropometric values, biochemical parameters and markers of oxidative damage were evaluated before and after moderate aerobic exercise. Exercise was performed five days per week for three months (64 sessions). Each exercise session consisted of 40 min and included the following: (a) five minutes of warm-up exercise; (b) ten minutes of flexibility exercise with resistance using own weight and coordination; (c) twenty minutes of moderate-intensity aerobic exercise (heart rate max between 60% and 70%); and (d) five minutes to cool down/stretching with respiratory techniques. Results: A significant decrease in anthropometric variables was generated by the exercise program [waist circumference 4.35 cm (p < 0.05) in OW-MetS, body fat −1.55, −1.39% (p < 0.05) and muscle mass 0.8, 1.1% (p < 0.05) in HOW and OW-MetS, respectively]. The exercise program resulted in beneficial changes in all biochemical parameters in both groups. Importantly, HOMA values showed a significant decline of −0.85 and −6.17 in HOW and OW-MetS, respectively. Furthermore, oxidative stress was present in the OW-MetS group, which was reduced by the exercise program, resulting in a decrease in protein damage [formazan 45% and 42% in HOW and OW-MetS respectively] and an increase in antioxidant defenses (thiol groups 36%, 99% and GPx 55%, 20% in HOW and OW-MetS, respectively). Conclusions: The data of this study show that moderate aerobic exercise may be potentially useful in treating and preventing MetS in older patients. Full article

Background: Recent studies suggest that prunes are one of the most effective fruits for preventing and reversing bone loss. Objectives: The purpose of the present systematic review was to summarize the evidence from the randomized controlled studies on the effect of prunes on bone health in humans and to pool the results in a meta-analysis. The hypothesis of the present review was that bone mineral density of the pulled intervention group would be higher than that of the control group. Methods: We conducted a systematic review of randomized controlled studies with a three-level mixed-effects meta-analysis. Results: Of two hundred and eighty-four studies that were initially identified in PubMed, Scopus, and Web of Science using the search words, eleven papers (747 participants) were considered eligible. The effect of prune intervention in postmenopausal women was borderline significant at the lumbar spine, with BMD slightly higher in the intervention group (SMD [95% CI] = 1.30 [−0.03, 2.63]; I² = 98%; p < 0.001). No significant differences were observed at other individual BMD sites. Heterogeneity across studies was high for all measured sites. The difference between the intervention and control groups in the levels of bone formation and resorption markers was not significant. The risk of bias of the included randomized controlled studies, assessed by the RoB v.2 tool, was low. Conclusions: Our meta-analysis provides preliminary evidence of modest skeletal benefits associated with consumption of 50–100 g of prunes, particularly at the lumbar spine, a trabecular-rich site. However, the overall body of research remains limited. Full article

Background/Objectives: Adenomyosis is a common disorder of the uterus in those of reproductive age. Robotic-assisted surgery has been adopted to address the technical challenges of adenomyomectomy. This systematic review evaluated the current evidence regarding the feasibility, safety, and clinical outcomes of robotic-assisted conservative surgery for uterine adenomyosis. Methods: A systematic review of literature was performed on five databases, from the beginning to 21 December 2025, to identify studies reporting robotic-assisted uterus-sparing surgical approaches to adenomyosis. Data were collected on patient characteristics, surgical techniques used, pre- and post-operative pain, fertility outcomes, and complications. Risk of bias was evaluated using the ROBINS-I framework. Results: A total of 514 articles were found; six studies met the inclusion criteria. Most included studies were small and retrospective. The operative time ranged from 279 to 147 min. Mean blood loss ranged between 25 and 296 mL with a low rate of conversion and perioperative complications. Dysmenorrhea improved after surgery as reflected by the post operative visual analog scale pain score and serum CA-125 level. Few reproductive data were collected about successive spontaneous pregnancies. Risk of bias was serious or moderate in all studies included. Conclusions: Robotic-assisted conservative surgery for adenomyosis may represent a feasible and safe option for women with symptomatic adenomyosis who wish preserve the uterus, with a positive impact on patients’ symptoms. Large prospective, multicenter studies with standardized protocols and long-term follow-up are needed to clarify the real impact of robotic surgery in adenomyosis management. Full article

Background/Objectives: Malnutrition and undernutrition are critical health concerns associated with increased mortality and costs. Although these are distinct clinical concepts, they are often used interchangeably in clinical practice and are inconsistent with the diagnostic frameworks. This diagnostic ambiguity may obscure true patient profiles. This study aimed to clarify the real-world diagnostic patterns of malnutrition and undernutrition and identify associated drug prescription trends using a patient estimation database in Japan. Methods: We analyzed the AHI partners database of 2024. Patients were identified using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, code E46. Sex differences were analyzed and stratified according to age group: older adults (≥65 years) and younger adults (15–39 years). Odds ratios (ORs) were used to identify associated drugs. Results: Of 96,673,453 patients, 216,652 were diagnosed with malnutrition and 77,100 with undernutrition. In both categories, older adults accounted for more than half of the patients. Notably, distinct diagnostic labeling patterns were observed by sex. Malnutrition predominated in women (58.8%), whereas undernutrition was more prevalent in men (70.6%). This male predominance of undernutrition was reversed in younger adults, where women showed higher proportions in both categories. Prescription analysis identified 31 drugs frequently prescribed to the study population. Enteral elemental formulas had the highest OR (89.7). Some psychotropic drugs were frequently prescribed to women. Conclusions: Diagnostic patterns varied by sex and age, potentially reflecting distinct practices in diagnostic labeling. These findings highlight the need for standardized frameworks to ensure consistent assessments and effective nutritional interventions. Full article

The aim of this study was to investigate older adults’ engagement in sport through the lens of the Positive Development in Sport (PDS), a framework aimed at fostering human growth in sport environments. This qualitative study involved 80 older athletes (M = 71.91 years, SD = 7.91; 45 women) engaged in regular sport practice and four experienced coaches (37–57-years-old). Data was collected across multiple contexts: brief in-person individual or small-group interviews during a competitive event; five in-person focus groups; and individual interviews. Data was analyzed using reflexive thematic analysis. Findings revealed a central theme, autonomy to engage in sport, supported by three subthemes: competence and confidence, health, and setting priorities. Participants described sport as a meaningful component of their identity, with sustained engagement driven by intrinsic motivation and harmonious passion. They reported increased self-awareness, intentional health management, and the ability to balance sport participation with other life domains, highlighting positive implications for mental health. Coaches who actively supported athletes’ psychological needs played a key role in fostering autonomy and personal development. Participants also emphasized the importance of inclusive relationships and pedagogical strategies tailored to older athletes’ goals and lived experiences. The findings suggest that sport in older adulthood can be a context for personal growth and mental health development. Full article

Premature ovarian insufficiency (POI) is a clinical condition characterized by loss of ovarian function indicated by amenorrhea or irregular menstrual cycles for at least 4 months and elevated gonadotrophins (FSH > 25 IU/L, measured on one occasion) and low estrogen serum levels in women under the age of 40. Premature ovarian insufficiency can be non-iatrogenic or spontaneous (idiopathic or due to genetic, autoimmune, or metabolic reasons, or infections) and iatrogenic (a consequence of oophorectomy, chemotherapy, radiotherapy, or uterine artery embolization). Women with POI are faced not only with estrogen deficiency but also with infertility and psychological implications. Hormonal replacement therapy is effective in treating the symptoms of premature ovarian insufficiency as well as in lowering the health risk of long-term consequences of premature ovarian insufficiency. Currently, oocyte donation is the standard treatment for patients with POI desiring pregnancy. Recently developed methods for the regeneration of ovarian tissue, such as stem cell therapy, platelet-reach plasma therapy and in vitro activation of ovarian tissue, are still under research and further adequate multicentric clinical studies are needed to develop standardized effective and safe protocols for the infertility treatment of patients with premature ovarian insufficiency. Full article

Multiple sclerosis (MS) is a debilitating neurological condition that affects several domains of individuals’ lives, making those affected particularly vulnerable to psychological distress. The visible nature of many MS symptoms may increase self-consciousness, thereby fostering feelings of shame and perceived stigma. Previous research has shown that self-related perceptions are shaped by early interpersonal relationships, rendering emotional trauma particularly relevant in this context. The present study sought to test whether an association between emotional abuse and psychological distress (Depression, Anxiety, and Stress) in individuals with MS would be mediated by internalized shame and perceived stigma. A total of 171 individuals with a clinical diagnosis of MS (85% women; M = 30.04, SD = 10.01) were recruited and completed a set of validated questionnaires assessing the variables of interest. Structural Equation Modeling was used to test the proposed model. Significant paths emerged from emotional abuse to internalized shame and from emotional abuse to internalized shame. In addition, internalized shame was significantly associated with psychological distress, and a further significant path was observed from perceived stigma to psychological distress. Moreover, significant indirect effects were found from emotional abuse to psychological distress via internalized shame and via perceived stigma. Full article

Introduction: Placental malaria increases the risk of adverse birth outcomes. Current preventive measures are undermined by poor coverage, growing resistance to chemo-preventive and therapeutic drugs, and vector eliminating insecticides. Candidate placental malaria (PM) vaccines (PAMVAC and PRIMVAC) have shown safety and immunogenicity in Phase I trials, but empirical evidence on their potential population-level value is lacking. This study modelled the expected cost-effectiveness of a PM vaccine administered before pregnancy. Methods: A decision-analytic model compared two strategies from the provider’s perspective: vaccinating women of childbearing age versus no vaccination. The model incorporated gravidity-specific risks of PM, neonatal mortality and the malaria attributable fractions from the literature. Since the efficacy of a PM vaccine for malaria prevention is unknown, we assumed a 40% efficacy and varied this estimate widely in sensitivity analyses. Primary outcomes were incremental cost-effectiveness ratios (ICERs) per perinatal disability adjusted life years (DALYs) averted. Baseline, best-case, and worst-case scenarios were analysed. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. Cost-effectiveness was defined as an ICER below half of sub- Saharan Africa’s 2025 GDP per capita ($1556). Results: The vaccine was most cost-effective among primigravidae. Under baseline assumptions (40% efficacy; 30% uptake; $5 dose price), the ICER was $321 per perinatal DALY averted for primigravidae versus $4444 for multigravidae. Best-case assumptions further improved cost-effectiveness ($225 vs. $3148). Sensitivity analyses showed robust cost-effectiveness for primigravidae across all plausible parameter ranges, while ICERs in multigravidae were highly sensitive to programme costs and vaccine efficacy. Cost-effectiveness acceptability curves demonstrated that vaccination becomes favourable for primigravidae at relatively low willingness-to-pay thresholds. Conclusions: A placental malaria vaccine delivered before pregnancy has high potential to be cost-effective in endemic areas when targeted to protect primigravidae. These findings support prioritised deployment strategies and highlight the value of early economic modelling to inform vaccine development and policy planning. Full article

Background: Older adults hospitalized with acute heart failure frequently present with multimorbidity, frailty, and reduced physiological reserve. This makes accurate prognostic assessment particularly challenging in internal medicine. Traditional heart failure risk models often fail to capture this multidimensional vulnerability. The PROFUND index, developed to estimate medium-term mortality in multimorbid patients, and serum albumin, an established biomarker of nutritional and inflammatory status, may provide complementary prognostic information. This formed the aim of the present study. This study’s objective is to evaluate the individual and combined prognostic value of the PROFUND index and serum albumin for one-year mortality in patients admitted with AHF. Methods: We conducted a prospective, multicenter cohort study within the PROFUNDIC registry. We included consecutive adults hospitalized with AHF or decompensated chronic heart failure who met European Society of Cardiology diagnostic criteria and had NT-proBNP levels >1500 pg/mL. PROFUND scores were obtained at admission, and hypoalbuminaemia was dichotomized as ≤3.5 g/dL. The primary outcome was one-year mortality, analyzed using Kaplan–Meier survival estimates, Cox proportional hazards models, and time-dependent ROC curves. Results: Among 544 included patients (mean age 85 years; 60% women), high PROFUND scores (>7) were present in 39% and hypoalbuminaemia in 55%. Both variables independently predicted one-year mortality, with the highest risk observed in patients presenting both high PROFUND scores (HR 2.26; 95% CI 1.66–3.09; p < 0.001) and hypoalbuminaemia (HR 1.70; 95% CI 1.18–2.46; p = 0.0046). The combined use of these markers modestly improved discriminatory performance compared with the PROFUND index alone (HR 2.83; 95% CI 1.72–4.64; p < 0.000). Conclusions: These findings suggest that integrating clinical complexity, assessed by the PROFUND index, with serum albumin provides a simple and clinically meaningful approach to early risk stratification in very elderly multimorbid patients treated in internal medicine wards. Full article

We aimed to evaluate the clinical characteristics of male and female patients with sepsis and to investigate their potential sex-specific differences in the prognostic weight. Retrospective analysis, including all patients with sepsis admitted to the Emergency Department High-Dependency Unit, between June 2008 and October 2025. Clinical data were collected using a standardized template. The endpoints were day-7 and day-28 mortality rates. The study population included 1527 patients, with a mean age of 74 ± 13 years, and female sex comprising 44%. Women were older (77 ± 13 vs. 73 ± 13 yrs, p ≤ 0.001), with a lower prevalence of cancer (19% vs. 27%, p = 0.009) than men. Conversely, a pulmonary (34% vs. 66%) or abdominal (40% vs. 60%) sepsis source was more frequent in men (both <0.05). The SOFA score was significantly lower in women than in men (5 [3–6] vs. 5 [3–7], p < 0.05), whereas day-7 and day-28 mortality rates were 11% and 22%, respectively, in both sexes. Multivariate analysis identified several independent predictors of 7-day mortality for both sexes. Women and men showed similar clinical characteristics and short- and medium-term mortality, despite a lower grade of organ dysfunction among women. Full article

Gender-based violence constitutes a major public health and social concern, with particularly complex implications in structurally vulnerable contexts such as rural settings. However, empirical evidence regarding the specific profile and risk perception of women experiencing gender-based violence in small municipalities remains limited. The aim of this study was to analyze the sociodemographic characteristics of women victims of gender-based violence residing in small rural municipalities and to examine their associations with mental health indicators and perceived risk of future violence. The sample comprised 30 women receiving support at a Specialized Care Centre for Victims of Gender-Based Violence (CAVI) serving three small municipalities in the Vega Media region (Region of Murcia, Spain). Standardized measures of depression, anxiety, and stress were administered, together with an assessment of perceived risk. The findings suggest a specific sociodemographic profile characterized by moderate levels of depression, anxiety, and stress symptoms and generally low perceived risk. Women without children reported higher levels of psychological distress and perceived risk than those with children, although these differences should be interpreted with caution given the sample size. Overall, these findings provide preliminary insights into the characteristics and risk perception of women experiencing gender-based violence in rural settings and highlight the need for context-sensitive prevention and intervention strategies. Full article

Background/Objectives: Zinc deficiency has been associated with increased cancer-related mortality, yet its prognostic relevance in patients with breast cancer and comorbid diabetes remains unclear. This study evaluated the association between zinc deficiency and adverse 5-year clinical outcomes in this population. Methods: This retrospective cohort study used the TriNetX database to identify women aged ≥20 years with breast cancer and type 2 diabetes who had recorded serum zinc levels within 3 months before the index date during the period from 1 January 2013 to 4 April 2026. Patients were categorized into zinc-deficiency, normal-zinc, or high-zinc groups. Outcomes included all-cause mortality, hospitalization, intensive care unit admission, and emergency department visits at the 1-, 3-, and 5-year follow-ups. Cox proportional hazards regression models were applied after 1:1 propensity score matching across 12 demographic and clinical variables. Results: Among 648 eligible patients, 282 had zinc deficiency, 311 had normal zinc levels, and 55 had high zinc levels. After matching, 218 remained in each of the zinc-deficient and control groups. Zinc deficiency was associated with higher all-cause mortality at 1 year (hazard ratio [HR], 2.45; 95% CI, 1.41, 4.28), 3 years (hazard ratio [HR], 2.09; 95% CI, 1.34, 3.28), and 5 years (HR, 1.92; 95% CI, 1.27, 2.92), as well as increased risks of emergency department visits, hospitalization, and ICU admission across follow-up periods. No significant differences were observed between the high-zinc and zinc-normal groups, possibly due to limited sample size. Subgroup analyses identified several exploratory subgroup-specific associations. Conclusions: Zinc deficiency was associated with poorer clinical outcomes in women with breast cancer and type 2 diabetes. However, because low serum zinc may also reflect malnutrition, systemic inflammation, frailty, or disease burden, these findings should be interpreted as hypothesis-generating rather than causal. Full article

Research on how patients and family carers experience their relationships with physicians and healthcare staff is limited, particularly regarding the gap between ideal expectations and actual care. This study explored patients’ and carers’ perceptions of the ideal care relationship, their lived experiences, and factors shaping discrepancies between expectations and reality. A total of 143 individual, face-to-face semi-structured interviews (mean age = 56.7 ± 13.2; 61.4% women) were conducted with 57 cancer patients and 86 family carers in outpatient oncology clinics in Southern Italy. Participants were recruited through purposive sampling and interviewed separately, with carers recruited as an independent group. Transcripts were analysed using Thematic Analysis of Elementary Contexts (TAEC), a mixed-methods approach combining qualitative and quantitative techniques. Methodological rigor and trustworthiness were ensured in line with COREQ reporting guidelines. Four thematic clusters emerged: “Variability in the experience,” “The ideal care relationship,” “Waiting times and delays in care,” and “The luck of being cared for by a good physician.” Oncology care experiences emerge as inherently ambivalent: supportive in interactions with clinicians, yet tension-laden due to systemic and organizational constraints. These findings suggest that strengthening patient- and family-centered care requires both relational improvements and organizational interventions aimed at reducing waiting times, enhancing care integration across fragmented pathways, and improving continuity of care. Full article

Most demographic studies of fertility use data from surveys of women, not men. These studies have shown that, in the U.S., nonmarital births are more common among women from lower rather than higher socioeconomic (SES) backgrounds and higher among Black than White women. Using panel data, which have been shown to reduce men’s under-reporting of nonmarital births, we show that these generalizations also hold for men. Our analysis of nonmarital births for Black and White men and women distinguishes between nonunion and cohabiting births and shows that nonunion births are predicted by racial and SES disadvantage for both women and men. By contrast, cohabiting births are not higher for Black individuals, and they are higher among women whose mothers had less education only among White, and not Black individuals. The effects of race and mothers’ education on having a nonunion first birth are partly mediated by the income and family structure of one’s family of origin, high school grade point average, and school enrollment. We use NLSY-97 panel data from U.S. men and women born in 1980–1984 and present descriptive statistics, double decrement life tables, and event history models. We conclude that disadvantaged racial and SES backgrounds are strongly predictive of having a nonunion first birth for men as well as women. Full article

The latest research on tax avoidance indicates that the number of female directors on a board increases the accounting accuracy and company performance by decreasing tax avoidance. The empirical research illustrates that women’s higher risk aversion and more conservative characteristics are key for company decision-making, especially when considering a tax strategy. We posit that the risk avoidance of women and other board attributes that enhance diversity influence the company’s sustainability through their effects on the company’s taxpaying activities. To verify this relationship, an empirical analysis was conducted using data for the period from 2009 to 2025 for the non-financial enterprises listed on the Pakistan Stock Exchange. The results showed that enhancing diversity on the board by attributes such as gender inclusion paves the way for firms to achieve firm performance. The results showed that tax avoidance partially mediates the relationship between corporate board attributes and firm performance. Effective board diversity encourages firms to engage in more tax-paying activities, which leads to positive firm performance. The research outcomes strengthen the existing proof of the link between board diversity and company financial performance, with tax avoidance behavior serving as an intervening factor. This also provides insights for policy-making authorities, encouraging them to make tax-related regulations that better promote long-term growth and prosperity. This study fills a gap in the research by highlighting the influence of board diversity on tax avoidance behavior and corporate financial performance. Full article