The aim of this study is to understand the factors contributing to patients' non-adherence to lifestyle modification plans among visitors of the Lifestyle Clinics in King Abdul-Aziz Medical City, Jeddah. Adherence to these plans is crucial for improving health outcomes and preventing chronic diseases. A cross-sectional study was conducted at the Lifestyle Clinics within the Primary Healthcare department of King Abdulaziz Medical City, Jeddah. Participants were adults referred for weight reduction. Data were collected using a questionnaire covering sociodemographic characteristics, adherence to lifestyle modifications, and barriers to adherence. The adherence level was assessed using a validated 13-item questionnaire, and the data were analyzed using IBM SPSS Statistics. A total of 380 participants were included, with a median age of 42 years (IQR: 32-50 years). Approximately 45.5% were adherent to the lifestyle modification plan, while 54.5% were non-adherent. Significant positive correlations were found between age and adherence (Correlation Coefficient=.205, p<.001), with healthcare workers showing higher adherence levels (p=0.027). Common barriers to adherence included lack of willpower (74.5%), energy (70.8%), and time (68.9%). Statistically significant associations were identified between lack of energy (p=0.019) or time (p=0.023) and non-adherence. This study identified key factors associated with non-adherence to lifestyle modification plans, particularly younger age, non-healthcare occupations, and perceived barriers such as lack of energy and lack of time. Despite high levels of knowledge regarding healthy lifestyle practices, adherence remained suboptimal, highlighting the gap between awareness and behavioral implementation. Addressing practical barriers through targeted, behavior-focused interventions may improve adherence and long-term health outcomes.
In addition to pharmacological treatments, self-care education is crucial for managing chronic conditions such as rheumatoid arthritis. Concept mapping, a visual and learner-centered educational strategy, has shown potential in improving self-care engagement. However, evidence for its effectiveness in rheumatoid arthritis populations remains limited. Therefore, this study aimed to evaluate the effect of concept map-based self-care education on quality of life in patients with rheumatoid arthritis. Following the intervention, participants in the experimental group showed significantly better outcomes compared to the control group in overall quality of life (P < 0.001) and most domain-specific measures, including Activities, Movement, and Energy (P = 0.007); Mood/Emotions (P < 0.001); and Physical Contact (P = 0.015), with moderate to large effect sizes. However, no significant difference was observed in the Self-Care domain (P = 0.300). Within-group analyses revealed significant improvements in quality of life across all domains in the intervention group (all P < 0.05), whereas no changes were observed in the control group (all P > 0.05). Therefore, concept mapping, as a structured and visual educational strategy, may enhance patients' understanding of complex self-care information and improve quality of life among individuals with rheumatoid arthritis. The protocol of this clinical trial has been registered in the Iranian Clinical Trial Registration Center (registration code: IRCT20230405057828N1). Registered 23 June 2023- registered while recruiting, https://www.irct.ir/.
The Health and Social Care Professionals' Knowledge and Attitudes towards Later-Life Intimacy and Sexuality (HSCP-KALLIS) is designed to assess health and social care professionals' knowledge and attitudes toward later-life intimacy and sexuality. Additional care considerations are included for older adults with dementia and those from diverse gender backgrounds. This study aimed to evaluate the reliability and validity of the HSCP-KALLIS scale. This methodological study was a subsequent phase of the HSCP-KALLIS scale development undertaken between 2022 and 2023, using an online survey approach with participants who were health and social care professionals. Internal consistency was assessed using McDonald's Omega and Cronbach's alpha, while the underlying factor structure of the scale was examined through exploratory factor analysis. A total of 98 participants were recruited for the study. Participants primarily were females, registered nurses, worked in aged care, and demonstrated high levels of knowledge and positive attitudes towards later-life intimacy and sexuality. The final HSCP-KALLIS Scale consists of 30 knowledge items across two factors and 25 attitude items across three factors, with satisfactory internal consistency demonstrated. This study provides preliminary evidence that the HSCP-KALLIS scale is a reliable tool for measuring health and social care professionals' knowledge and attitudes towards later-life intimacy and sexuality. This scale shows potential for identifying staff training needs, evaluating training effectiveness, and informing policy and guidelines development. The primary study limitations include methodological constraints and a small sample size. Future research should involve a larger sample size to enable confirmatory factor analysis. Not applicable.
A 3-year-old male passenger developed acute respiratory distress approximately 30 minutes after takeoff during an international flight from the United States to Addis Ababa. Despite multiple rounds of nebulized albuterol and escalating oxygen therapy, his respiratory status progressively deteriorated. A multidisciplinary team of onboard physicians administered epinephrine and hydrocortisone from the emergency medical kit while coordinating with ground medical control. The aircraft was subsequently diverted to Athens, Greece, where the child was handed over to emergency services and later stabilized. This case highlights the challenges of managing pediatric respiratory distress in-flight and the critical importance of prompt coordination, adequate medical supplies, and crew preparedness.
Early identification and initiation of therapy for life-threatening hemorrhage is essential to minimize patient morbidity and mortality. In primary hemostasis, platelet function is integral to reach this goal, but major hemorrhage leads to impaired platelet mechanical activation and aggregation. Current devices for measuring platelet function are cumbersome or not promptly available for clinical decision making in this setting. Within this manuscript we prospectively evaluate a novel, rapid assay utilizing measures of platelet aggregation to predict hemorrhage. In this prospective cohort study at an academic regional Level I trauma center, we included adult (> 16 years old) participants who were triaged as level I or II trauma activations. The primary exposure studied was platelet aggregation analyzed on a prototype device. The primary and secondary outcomes measured were life-threatening hemorrhage (death from hemorrhage or need for hemorrhage control procedure) and transfusion requirements of > 2 units of blood components, respectively. Standard descriptive statistics were used to characterize the cohort. Predictive outcomes were analyzed using multivariable regression to compare: (1) the platelet aggregation assay; (2) clinical parameters (systolic blood pressure, heart rate, and injury mechanism); and (3) a combined model. Of 761 patients, 482 patients met inclusion criteria for our study, 36 (7.5%) had life-threatening hemorrhage and 43 (8.9%) patients required > 2 units of blood transfusion. For life-threatening hemorrhage, platelet aggregation had an area under the curve (AUC): 0.61 (95% confidence interval [CI] 0.53-0.69); clinical parameters AUC: 0.83 (CI 0.75-0.91); and the combined model AUC: 0.85 (CI 0.79-0.92) which was not significantly improved when compared to clinical parameters alone (p = 0.32). For transfusion of > 2 units, the platelet aggregation model had AUC: 0.68 (CI 0.61-0.76); clinical parameters AUC: 0.84 (CI 0.79-0.90); and combined model AUC: 0.88 (CI 0.83-0.93), improving transfusion prediction over clinical parameters alone (p = 0.013). In a cohort of traumatically injured patients, a novel, rapid measure of platelet aggregation enhanced well-established clinical parameters to predict the need for blood transfusion but not life-threatening hemorrhage. Future work should validate the clinical utility of this technology in a larger cohort and patients with significant non-traumatic hemorrhage.
Early adolescence is key for adopting healthier lifestyles, yet disadvantaged communities often lack resources to support these changes, perpetuating health inequities. Schools play a crucial role in promoting physical activity and healthy eating. eHealth solutions, like online platforms, offer scalable, cost-effective ways to deliver interventions. These platforms can also enhance adolescent engagement and help bridge health resource gaps. The ePro-Schools project aims to co-design and test an eHealth platform to promote healthy habits among adolescents in socially disadvantaged settings. A randomized controlled trial (RCT) will be carried out with the participation of 6 secondary schools (three controls and three intervention), with a sample size estimated at 1000 students of Central Catalonia (Spain). In the intervention schools, focus groups sessions and meetings with stakeholders have been conducted to co-create the ePro-Schools eHealth platform. Students and school staff are pilot testing the platform to assess the platform's usability, functionality, and layout. Finally, the RCT will be conducted, in which the intervention group will have full access to the ePro-Schools platform (an interactive and informative platform), while the control group will only have access to the informative platform with health literacy content on physical activity, nutrition, and healthy habits. In both groups, adolescents will complete validated questionnaires at baseline, post-intervention, and at the six-month follow-up to assess their physical activity and eating habits, including depressive symptoms, quality of life, social isolation, and mental health. Sociodemographic characteristics will also be collected. Implementation, effectiveness, and cost-effectiveness analysis will be performed. The ePro-Schools project introduces a co-designed eHealth platform that integrates physical activity and healthy eating promotion within schools. The intervention aims to enhance adoption, relevance, and sustainability across diverse settings. ePro-Schools project could reduce health inequalities, improve adolescents' physical and mental well-being, and strengthen daily health habits. The model's scalability and embedded implementation planning may support long-term integration into school systems, informing future policies and contributing to educational engagement, reduced disease risk, and broader population health impact. This trial is registered in ClinicalTrials.gov, with the registration number NCT06792461.
Children born small for gestational age (SGA) face elevated risks of metabolic, cardiovascular, respiratory, and neurodevelopmental disorders, as well as premature mortality, yet the underlying mechanisms remain only partly understood. We analyze blood proteomic data from multiple birth cohorts to identify molecular pathways linked to SGA and to later-life lung function. We find that approximately one-third of SGA children exhibit a distinct molecular endotype marked by dysregulation of axon-guidance proteins in cord blood. In peripheral blood collected later in life, these proteins are inversely associated with contemporaneous spirometric restriction. Using GWAS data and an experimental sheep model, we obtain convergent evidence that axon-guidance genes are associated with spirometric indices (FEV1/FVC) at genome-wide significance and are broadly expressed during fetal development across multiple organs. These findings offer new insight into the developmental origins of chronic disease and highlight axon-guidance pathways as promising targets for investigating multiorgan morbidity.
Mental health conditions account for 18% of years lived with disability worldwide. 1-in-6 adults are affected in England, with most mental health conditions beginning in childhood and adolescence. Mental distress and ill health are unequally distributed in the UK, with strong associations with wider determinants of health, and higher prevalence among systemically disadvantaged groups. Currently, there is a lack of evidence to inform effective and timely policymaking for primary prevention in the UK. In recognition of these challenges, a national Population Mental Health (PMH) Consortium was established, as part of Population Health Improvement UK (PHIUK). PHIUK is a national research network which works to transform health and reduce inequalities through change at the population level. Our aim is to establish an interdisciplinary PMH Consortium, focussing on upstream determinants and the prevention of risks and onset of mental health conditions through interdisciplinary stakeholder engagement, to create new opportunities for population-based improvement of mental health in the UK.The PMH Consortium brings together leading interdisciplinary representation in population mental health, spanning from sciences to the arts, across the UK. Membership includes six academic institutions, third sector organisations, lived experience expertise, and strong links with national bodies to ensure integrated cross-national and regional policy impact. The PMH Consortium comprises four cross-cutting platforms (Partners in policy, implementation, and lived experience; Data, linkages, and causal inference; Narrowing inequalities; Training and capacity building) and three challenge areas (Children and young people's mental health; Prevention of suicide and self-harm; Multiple long-term conditions) which are highly integrated and interdependent. The work will be underpinned by a Theory of Change across an initial four-year life cycle. This paper describes the aim, objectives, and approach of the PMH Consortium, as well as anticipated challenges and strengths. The goal of the PMH Consortium is to develop a model for population mental health research and policy translation that is both scalable and sustainable. It is critical to ensure continued impact and viability beyond the initial four years, contributing to the prevention of mental health conditions in the UK, with personal, economic, social, and health benefits.
With increasing global life expectancy, population aging has become a major public health issue. Poor sleep quality and fatigue are prevalent among older adults, negatively impacting their quality of life and daily functions. While pharmacological interventions for sleep disorders are common, they carry significant side effects, especially in the older individuals. Non-pharmacological alternatives like white noise are simple, safe, and cost-effective, yet evidence for their effectiveness among community-dwelling older adults remains limited. This study aims to evaluate the effectiveness of white noise on improving sleep quality and reducing fatigue among community-dwelling older adults. This parallel RCT was conducted among 60 individuals 65 years and older attending healthcare centers in Mashhad, Iran. After the initial screening, eligible participants were randomly assigned into two groups. Both groups received standard sleep hygiene recommendations based on provincial guidelines. Additionally, the intervention group was provided with audio options and were instructions to use them over the next 30 consecutive nights. Constant follow-ups ensured adherence. Sleep quality and fatigue were measured using PSQI and IFS pre- and post-intervention. Group differences over time were examined using repeated measures and baseline adjusted analyses. Descriptive and inferential data analysis was performed using SPSS 27 at a significance level of p < 0.05. Post-intervention results show that there is a statistically significant difference between the two groups in both PSQI and IFS scores. Our results show significant improvement in the intervention group's PSQI (from 11.5 ± 2.8 to 9.2 ± 3.1, P < 0.001) and IFS scores (from 35.1 ± 3.5 to 32.4 ± 4.9, P < 0.001), with no significant changes in the control group. Our findings suggest that the use of white noise can result in improving sleep quality and may be helpful in reducing fatigue in community-dwelling older adults and can be recommended as an low effort, low-cost and safe strategy to enhance sleep and reduce fatigue in older individuals. (IRCT20240812062732N1), Date of registration August 28, 2024.
Human papillomavirus (HPV) is a well-established oncogenic virus implicated in the development of several epithelial cancers, most notably cervical, anogenital, and oropharyngeal carcinomas. In contrast, neuroendocrine neoplasms (NENs)-a heterogeneous group of malignancies arising from neuroendocrine cells across various organ systems-have not traditionally been linked to HPV infection. In this study, we performed extensive genomic and transcriptomic profiling to compare HPV-positive NENs to HPV-positive non-NENs across anatomical sites, aiming to uncover biologically and clinically actionable differences. HPV16- and HPV18-positive tumors were identified from 101,343 solid tumors profiled at Caris Life Sciences (Phoenix, AZ) with DNA and RNA sequencing. Prevalence of pathogenic mutations and copy number amplifications were calculated. Fisher's exact/χ2 tests were applied appropriately with p-values adjusted for multiple comparisons (p < 0.05). HPV positivity was most frequent in cervical carcinomas (70%, 1200/1716). Importantly, 6% (96/1620) of NENs from all tissues were positive for HPV16 or HPV18. Among HPV-positive NENs, 93% were high-grade compared to 54% observed in HPV-negative NENs (p < 0.001), highlighting a strong association between HPV and tumor aggressiveness in this subset. Analysis of HPV-associated sites (cervix, anorectal region, and head and neck) revealed that HPV-positive NENs possess distinct genomic and transcriptomic landscapes compared to HPV-positive non-NENs. Notably, interferon signaling was significantly suppressed in HPV-positive NENs, suggesting a unique tumor-immune microenvironment. Our findings indicate that HPV-positive NENs form a distinct subset with unique genomic features, including reduced interferon signaling, compared to HPV-positive non-NENs. Thus, future studies focused on evaluating HPV status, along with genomic and transcriptomic characteristics, may uncover biologically and clinically actionable distinctions for this rare yet clinically significant tumor subgroup. Not applicable.
Therapeutic plasma exchange (TPE) is being increasingly utilized in the clinical management of severe rheumatic immune diseases, providing an effective means for rapidly removing pathogenic autoantibodies and inflammatory mediators. However, the non-selective nature of this technique can also lead to the unintended clearance of concomitantly administered antirheumatic drugs, potentially compromising therapeutic efficacy and disease control. Therefore, effective management of potential drug removal process during TPE and the implementation of individualized risk assessment are crucial for optimizing treatment outcomes in patients undergoing TPE. The variability in the extent of drug removal during TPE is primarily determined by their distinct pharmacokinetic characteristics, necessitating the establishment of a systematic, evidence-based strategy for adjusting drug administration regimens in patients receiving TPE treatment. This review synthesizes current evidence from 65 studies on the removal of antirheumatic drugs during TPE, identifying key determinants influencing clearance rates, including volume of distribution, protein binding, molecular size, and elimination half-life. Our analysis reveals that the risk of drug removal exists as a continuous spectrum: large monoclonal antibodies (e.g., rituximab, natalizumab), characterized by a large molecule size, low volume of distribution, with which mostly confined to the vascular space, are cleared with high efficiency. This finding supports the clinical recommendation of administering such drugs after TPE. For drugs with limited direct evidence, we propose a predictive model based on fundamental pharmacokinetic parameters to estimate their removal risk and guide clinical decision-making. Based on this evidence, we have constructed a stratified clinical management framework. It aims to maintain effective therapeutic drug exposure levels during chronic TPE therapy and to provide a rationale for the judicious application of TPE in overdose scenarios. Implementing this pharmacokinetic-informed, risk-adapted individualized strategy is important for ensuring treatment continuity, enhancing patient safety, and advancing empiricism-based therapy towards precision medicine.
Patient-centered outcomes (PCOs) are health indicators that reflect what is meaningful and impactful to patients and are foundational to the success of learning health systems. PCO measures for rehabilitation learning health systems offer granular insights into patients' functional goals and quality of life, enabling clinicians to personalize care and researchers to evaluate what truly matters to patients. Despite their value, selecting appropriate PCO measures remains complex, requiring careful consideration of multiple shareholder perspectives. This paper, informed by discussions from the LeaRRn and CoHSTAR Summit on "The Power of Patient-Centered Outcomes in Rehabilitation Learning Health Systems," presents a framework for navigating these challenges in rehabilitation. We examine key considerations from the vantage points of patients, researchers, clinicians, and administrators ranging from feasibility, burden, and interpretability to psychometric rigor, workflow integration, and organizational priorities. Case examples illustrate how projects have engaged diverse shareholders to select PCO measures for use in clinical practice and research. The paper concludes with practical guidance for rehabilitation researchers seeking to align outcome selection with shareholder needs, optimize data utility across the learning health system cycle, and advance patient-centered care in complex rehabilitation contexts.
Seizures exist on a clinical spectrum, and providers must adopt a nuanced yet assertive treatment approach, as the transition from benign to life-threatening can occur rapidly. Critical care transport teams are moving these patients more frequently as neuro-specialty care continues to concentrate at quaternary centers and rural health facilities face resource challenges. Patients with seizures can have a variety of physical and physiologic symptoms, and transport crews must be aware of the more subtle symptoms as to intervene appropriately. The priority in seizure management is stopping the seizure, starting with benzodiazepine administration and then escalating to second-line anti-epileptics if benzodiazepines are ineffective. The longer seizure activity continues, the more difficult it is to stop, and the risk of permanent neuronal damage increases. Additional priorities include patient safety/positioning and airway management. Critical care transport crews should be prepared to perform advanced airway management in patients who present in status epilepticus and should get the patient to a facility with magnetic resonance imaging, electroencephalography, and neurocritical care resources. The unique environment of air transport makes management and assessment of these patients especially challenging, and we provide updated guidance to consider.
Novel invasive genotypes can arise through polyploidisation, hybridisation, or gene flow between populations of distinct origins or related species. Solidago gigantea, a notorious European invader, has long been reported exclusively as tetraploid in its invasive range. Recently, mixed-ploidy populations, including tetraploid and pentaploid plants, were discovered; yet the potential role of the novel pentaploid cytotype (and its progeny) in S. gigantea invasions remains poorly understood. This study aims to elucidate the origin of pentaploids and the cytotype and genetic structure of mixed-ploidy populations, characterise the reproductive mode and mating interactions of pentaploid plants, and assess their fitness and potential contribution to invasiveness using relative DNA content screening, ddRADseq population genetics, and reproductive potential and fitness assessments. Molecular analyses revealed that pentaploids constitute a genetically distinct lineage within S. gigantea. Our results rule out both an autopolyploid origin from the common tetraploid cytotype and an allopolyploid origin via hybridisation with co-occurring native or invasive Solidago species. The pentaploid cytotype reproduces exclusively through clonal propagation; its low genetic variability suggests that the two studied populations may belong to a single extensive clonal genet. Pentaploids produce viable gametes but appear to exhibit strict self-incompatibility, preventing the formation of offspring within the same genotype. However, pentaploid S. gigantea engages in bidirectional mating with co-occurring tetraploid plants, yielding well-developed seeds with offspring ploidy ranging from 4x to 5x (predominantly aneuploid). Despite this cytological variability, progeny from mixed-ploidy populations displayed germination rates and early growth comparable to those from pure tetraploid populations. Notably, at least some tetraploid offspring from 4x-5x crosses successfully established, flowered, and backcrossed with pentaploid plants to produce viable seeds of subsequent introgressed generations. The pentaploid cytotype of S. gigantea introduces a new post-invasion dynamic to its invasive populations. Rather than being an evolutionary dead-end, this cytotype may potentially enhance the species' invasiveness through three evolutionary pathways: (1) a highly successful clonal life strategy enabling both local and long-distance spread; (2) genetic enrichment of tetraploid populations via ongoing interploidy crosses; and (3) establishment of novel aneuploid genotypes due to the remarkable tolerance of chromosomal instability observed in S. gigantea.
Leaf and seed traits are key determinants of plant growth and reproduction, mediating how plants respond to environmental change. Leaf and seed traits can also covary. For example, species with larger seeds tend to have larger leaves. However, the covariation between leaf and seed traits has not been fully resolved due to the confounding effects of plant functional groups and climate variability. Using a sample of 33 common herbs in Songnen grassland, we explored whether seed traits were associated with leaf traits, and whether the correlations between leaf and seed traits were constrained by life history (or growth form) and climate change. We found significant interspecific trait variation (≥ 95%) and functional group differences in most traits. Annual species and forbs exhibited strong positive correlations between leaf and seed traits (e.g., leaf number vs. seed number), while relationships were decoupled for perennial grasses. Unexpectedly, the relationships between leaf and seed traits differed between sampling years. For species in 2017, seeding intensity increased with leafing intensity; while, in 2016, this positive trend was not significant. The relationships between leaf and seed traits are influenced by functional groups, and affected by interannual climate variability mediated by changes in plant individual size. Our results highlight species-specific traits and their correlations in response to environmental conditions, providing critical insights for predicting grassland community responses to climate change.
Therapeutic resistance to chemotherapy or radiotherapy is a significant issue in several cancers, including head and neck squamous cell carcinoma (HNSCC). One pathway associated with therapeutic resistance is the NFκB pathway, which promotes survival in response to the cytokine TNFα, a key mediator of chemotherapy and radiotherapy-induced cytotoxicity. However, direct targeting of the NFκB pathway is associated with significant toxicity and thus targeting the regulation of this pathway is a promising therapeutic target. We recently demonstrated that the USP14/UCHL5 inhibitor b-AP15 inhibits NFκB activity, inhibiting proliferation and inducing apoptosis in HNSCC cells. Furthermore, b-AP15 treatment sensitised HNSCC cells to the cytotoxic effects of TNFα, as well as TNF-inducing radiation treatment. Here, we investigated if b-AP15 sensitised HNSCC cells to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), a cancer selective member of the TNF family. b-AP15 treatment sensitised HNSCC cells to TRAIL treatment. Mechanistically, we show that b-AP15 induced expression of the TRAIL receptor Death Receptor 5 (DR5)/TRAIL Receptor 2 (TRAILR2), which was required for b-AP15-mediated TRAIL sensitisation. b-AP15 induced reactive oxygen species (ROS) and activated the JNK signalling pathway and both ROS and JNK signalling were required for the induction of DR5 expression and TRAIL sensitisation. We further show that b-AP15-mediated reduction of the NFκB-dependent gene XIAP induced DR5 expression and TRAIL sensitisation and that combination between b-AP15 and IAP antagonists was synergistic in HNSCC cells in vitro. Our data further define the mechanism of b-AP15-mediated cytotoxicity and highlight potential combination treatments that warrant further exploration in pre-clinical studies in HNSCC.
Heart failure (HF) remains one of the most prevalent and burdensome chronic conditions worldwide, with rising incidence and poor prognosis despite major therapeutic advances. Effective management requires a comprehensive, multidisciplinary approach that ensures diagnostic accuracy, therapeutic optimization, and continuity of care from hospital to community settings. This consensus document outlines an integrated model for HF care in Italy, developed to improve patient outcomes and resource efficiency. HF should be diagnosed and phenotyped through clinical evaluation, electrocardiography, echocardiography, biomarkers, and, when indicated, advanced imaging. Guideline-directed medical therapy, including sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, β-blockers, and mineralocorticoid receptor antagonists, remains the cornerstone of treatment across the ejection-fraction spectrum. Device therapy, cardiac rehabilitation, and iron supplementation complement pharmacological management. Telemedicine and remote monitoring enable early detection of clinical deterioration and strengthen hospital-community integration, while multidisciplinary HF clinics coordinate pharmacological care, rehabilitation, and patient education. Structured training of healthcare professionals and caregivers, along with therapeutic education programs, enhances adherence, empowers patients, and promotes self-management. Community-based associations further support cardiovascular prevention through educational and screening initiatives. The integration of hospital, community, and digital health resources, combined with continuous professional training and patient empowerment, represents a sustainable and effective model to improve survival, reduce hospitalizations, and enhance quality of life for patients with HF.
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1DM) and a leading cause of pediatric mortality. Prevention depends on caregivers' ability to recognize early signs and initiate proper sick-day management. However, data on DKA awareness among Iranian parents remains limited. This study aimed to evaluate both subjective self-ratings and objective calculated knowledge regarding DKA among parents of children with T1DM. This cross-sectional study was conducted among 217 parents at a pediatric diabetes clinic in Shiraz, Iran. A validated questionnaire (Cronbach's alpha = 0.8), adapted through forward-backward translation, assessed demographics, disease duration, HbA1c, and DKA knowledge. Data were analyzed using descriptive statistics, Kruskal-Wallis tests, and Spearman's correlations (rs) to identify predictors of awareness. Most participants were mothers (80.6%), and 38.7% reported DKA as the initial presentation at diagnosis. Subjective knowledge scores (0-10) were 1.86 ± 3.07 for mothers and 0.89 ± 2.16 for fathers (P = 0.06). Mothers demonstrated significantly higher calculated objective awareness than fathers (P = 0.007). Higher objective knowledge significantly correlated with higher education levels (rs=0.280, P = 0.01), longer disease duration (P = 0.01), and prior DKA admission (P = 0.02). Awareness showed no significant relationship with the child's most recent HbA1c levels (P = 0.98). Parental DKA knowledge is critically inadequate. As DKA mortality is preventable through early detection, targeted educational interventions and accessible resources are urgently needed to empower parents and improve clinical outcomes for children with T1DM.
Post-traumatic stress disorder (PTSD) frequently emerges following early-life trauma, yet the temporal dynamics of PTSD-like phenotypes and their pharmacological modulation during development remain poorly understood. In the present study, we investigated time-dependent behavioral and endocrine alterations in a peripubertal rat stress-restress model and assessed the effects of fluoxetine across early and delayed post-treatment stages. Male peripubertal rats were exposed to a combined stress-restress paradigm and treated with fluoxetine for 21 days. Anxiety-like behavior, social behavior, stress-coping behavior, and spontaneous locomotor activity were assessed immediately after treatment completion and again after a drug-free washout period, the duration of which (3-4 weeks) depended on the behavioral parameter evaluated. Serum corticosterone levels were measured as an index of hypothalamic-pituitary-adrenal axis activity. PTSD-like stress induced robust but domain-specific behavioral alterations that evolved over time. Anxiety-like behavior persisted across both observation phases but was expressed through different behavioral components at early versus delayed stages. Basal sociability was markedly reduced following stress exposure and was largely normalized by fluoxetine, whereas social novelty-related alterations were more selective and resistant to pharmacological modulation. Stress-exposed animals exhibited increased activity and reduced immobility in the forced swim test, reflecting altered stress-coping strategies rather than reduced depressive-like behavior. Consistently, spontaneous locomotor activity was elevated at early stages, indicating hyperarousal, which attenuated over time but was not robustly normalized by fluoxetine. Endocrine assessment revealed a biphasic corticosterone profile, with elevated levels in the early phase and reduced levels at the delayed stage; fluoxetine did not normalize corticosterone concentrations. These findings demonstrate that PTSD-like phenotypes induced during the peripubertal period are dynamic and strongly time-dependent, and that fluoxetine exerts selective, domain-specific effects rather than uniform normalization. The study highlights the importance of developmental stage and timing of assessment when evaluating behavioral outcomes and pharmacological efficacy in preclinical models of PTSD.
Physical performance impairments are common in cancer survivors and can limit daily activities, quality of life, and long-term health. Although structured exercise programs have proven beneficial for improving physical performance, maintenance of these benefits is unclear. This study aimed to systematically evaluate whether improvements in physical performance are maintained following structured exercise oncology interventions. A systematic search was conducted for randomized controlled trials (RCTs) published between January 1990 and March 2025. Eligible trials engaged adult cancer survivors in structured exercise interventions and reported objective measures of cardiorespiratory fitness, muscular strength, and/or walking capacity at the end of the intervention and ≥ 3 months after program completion. Data were pooled using random-effects meta-analyses with weighted mean differences (WMD) used to summarize effects. Twenty-four RCTs (2289 participants; mean follow-up post-intervention = 8 months) were included. Exercise significantly improved cardiorespiratory fitness at post-intervention (WMD =  + 1.76 ml/kg/min; p = 0.008); however, improvements were attenuated at follow-up (WMD =  + 1.24 ml/kg/min; p = 0.130). Similarly, upper and lower body strength improved post-intervention (WMD = + 3.35 kg; p = 0.001; WMD =  + 12.7 kg; p = 0.045), but effects diminished at follow-up (WMD =  + 1.80 kg; p = 0.081; WMD =  + 10.0 kg; p = 0.093). In contrast, walking capacity increased post-intervention (WMD = + 40.3 m; p = 0.002) and remained elevated at follow-up (WMD =  + 49.4 m; p = 0.006). Certainty of evidence ranged from very low to low across outcomes, primarily due to risk of bias, inconsistency, and imprecision in effect estimates. Structured exercise interventions were found to produce short-term improvements in physical performance among cancer survivors. Although gains in cardiorespiratory fitness and muscular strength appeared to persist at follow-up, they were attenuated compared with post-intervention and supported by very low certainty evidence. In contrast, walking capacity demonstrated sustained improvements at follow-up, though the certainty of evidence remained low. Future work is needed to identify longer-term effects (> 12 months) and develop strategies to better maintain improved physical performance. While exercise programs can improve physical performance, these benefits may not persist without ongoing support. Cancer survivors should be encouraged to continue self-directed exercise after program completion, and exercise programs should incorporate strategies to maintain longer-term improvements in physical performance.