Exergames, which combine physical exercise with interactive gameplay, are increasingly being incorporated into fall prevention programs for older adults. Gamified elements, such as real-time feedback and progress tracking, may enhance motivation, engagement, and adherence. Although several systematic reviews have examined the effects of exergaming on balance and physical function, fewer have focused specifically on clinically meaningful outcomes, such as falls and injurious falls, or on indicators that may influence real-world adoption of exergames. This study aimed to evaluate the effectiveness of exergaming interventions for preventing falls and injurious falls in people aged ≥60 years and to synthesize evidence on implementation-related outcomes, including adherence, acceptability, concerns about falling, quality of life, adverse events, and cost-effectiveness. MEDLINE, Embase, CINAHL Plus, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to February 2025 for randomized controlled trials evaluating exergaming interventions in older adult populations across all settings. Outcomes included fall rate, number of fallers and injurious falls, and implementation-related secondary outcomes. Risk of bias was assessed using RoB 2.0, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were synthesized narratively and, where appropriate, pooled using meta-analysis. Nine studies (N=1385) met the inclusion criteria. Comparator-specific analyses suggested that exergaming may reduce fall rates compared with active intervention comparators, although the magnitude and certainty of effect varied, and substantial heterogeneity was present across analyses. Moderate-certainty evidence also suggested that exergames reduced the number of older adults experiencing one or more falls at 12-month follow-up compared with usual care (risk ratio 0.75, 95% CI 0.61-0.92). Evidence for injurious falls, quality of life, concerns about falling, adherence, acceptability, and cost-effectiveness was limited or inconsistent. When pooled across all control groups, exergaming interventions were associated with a lower overall fall rate than comparator interventions (incidence rate ratio 0.53, 95% CI 0.41-0.68), although substantial heterogeneity was present (I²=76%). Low- to moderate-certainty evidence suggests that exergames may reduce fall rates, particularly in comparisons with active intervention control groups, and may reduce the number of fallers compared with usual care. These findings indicate that exergaming may offer a useful adjunct to established fall prevention strategies for older adults, particularly where sustained engagement with conventional exercise is challenging. However, substantial heterogeneity, modest sample sizes, and limited long-term follow-up reduce confidence in these estimates, and more rigorous, large-scale trials are needed before routine implementation can be recommended. This review extends previous exergaming syntheses by focusing on clinically meaningful outcomes, including falls and injurious falls, while also considering implementation-related factors relevant to real-world uptake.
Falls occur across all stages of Huntington's disease (HD) and are associated with poor quality of life and injury. However, there is limited information on falls in HD. The aim was to investigate the clinical features potentially associated with falls in HD. We conducted a cross-sectional, analytical observational study, including consecutive patients with genetically confirmed symptomatic HD, and assessed clinical features, fall characteristics, fear of falling, movement disorder phenomenology, gait characteristics, balance, and cognitive and neuropsychiatric symptoms. Those who had experienced ≥2 falls in the past 6 months were considered fallers. Stepwise forward logistic regression was performed to determine the variables related to recurrent falls. We included 40 individuals, of whom 24 (60%) were considered recurrent fallers. The nonfallers (75%) and fallers (79%) had high fear of falling rates. Seventy-two percent of falls occurred indoors, and 76% were classified as intrinsic. The dose of neuroleptics was higher in the fallers group (10.0 vs. 5.85, P = 0.028). This group also exhibited a higher prevalence of balance disorders, chorea, and executive cognitive impairment than the nonfallers group. No significant differences were observed in the spatiotemporal gait parameters studied. The regression analysis revealed that only the Berg Balance Scale scores were retained in the model (odds ratio: 0.87, 95% confidence interval: 0.78-0.97). Falls and fear of falling were frequent in HD. High doses of neuroleptics, chorea, cognitive and behavioral symptoms, and particularly balance disorders contribute to falls in HD.
This study aimed to clarify whether concern about falls contributes to inducing emotional and postural responses when threatened in older adults while standing on an elevated platform. Seventy-four older adults (mean age: 78.8 ± 5.8 years, 65 female) were exposed to fear while standing on the floor and on an elevated 0.6 m surface. We examined the changes in self-reported fear of falling, physiological measures, postural sway, and muscle activity. The older adults were classified as having lower (n = 11), moderate (n = 24), and higher concern about falls (n = 39), based on the Falls Efficacy Scale International. All groups significantly shifted their posture backwards, and increased tibialis anterior activity and co-contractive activity with the soleus was noted when standing at a height, which is a rational behavior to decrease the risk of falling and maintain safety. The participants with higher and moderate concern about falls had significantly increased self-reported fear and pulse rate on the elevated surface compared to the floor condition. Older adults with greater concern about falling also increased their sway velocity in the elevated condition. These findings reveal an underlying relationship between concern about falls and emotional and postural responses in fear-inducing situations.
To examine the joint associations of magnetic resonance imaging-based total cerebral small vessel disease burden and sleep-disordered breathing with Stroop-based executive performance, balance, and in-hospital falls after subacute supratentorial ischemic stroke. Retrospective cohort study of 1,050 adults with first-ever supratentorial ischemic stroke admitted for inpatient rehabilitation. The apnea-hypopnea index was measured using portable sleep monitoring, and total cerebral small vessel disease burden was scored on brain magnetic resonance imaging. Low Stroop-based executive performance occurred in 437 patients (41.6%), and 110 patients (10.5%) experienced in-hospital falls. Apnea-hypopnea index per 10 events/h (β, -0.80; 95% CI, -1.26 to -0.34; P<0.001) and total cerebral small vessel disease burden per 1-point increase (β, -1.62; 95% CI, -2.25 to -0.99; P<0.001) were associated with lower Stroop-based executive composite scores; the interaction term was negative and modest (β, -0.23; 95% CI, -0.46 to -0.01; P=0.042). The dual-risk phenotype was associated with low Stroop-based executive performance (OR, 5.99; 95% CI, 4.03 to 8.88) and in-hospital falls (OR, 3.72; 95% CI, 1.91 to 7.24). Sleep-disordered breathing and cerebral small vessel disease burden were jointly associated with poorer Stroop-based executive and balance outcomes and an increased risk of in-hospital falls.
The oral frailty index-8 (OFI-8) is a measure of oral frailty to identify impaired oral function. However, its validity and associations with health outcomes remain unclear. We aim to evaluate its construct validity and associations with appetite, muscle health, falls, functional outcomes, and quality of life (QoL). Cross-sectional analysis of 300 community-dwelling older adults (mean age 67.4 ± 7.10 years; 68.7% female). Exploratory factor analysis (EFA) assessed OFI-8's factor structure. Participants were classified as oral non-frail (ONF), pre-frail (OPF), or frail (OF) based on total scores. Associations with outcomes were assessed using logistic regression, adjusted for relevant covariates. Outcomes included appetite (SNAQ), muscle health (DEXA muscle mass, handgrip strength, SARC-F), falls risk (STEADI), function (IADL), life-space mobility (LSA), mood (GDS), and QoL (EQ-5D-5L). EFA revealed OFI-8's 3-factor structure: swallowing and oral conditions, dental care, and dietary and social habits. Prevalence of ONF, OPF, and OF was 62%, 16%, and 22%, respectively. Compared to ONF, OF showed worse appetite, handgrip strength, SARC-F scores, falls risk, IADL function, and mood (all p < 0.05). In adjusted models, OF was associated with poor appetite (OR = 1.97, 95% CI: 1.07-3.65), increased falls risk (OR = 2.64, 95% CI: 1.21-5.74), and low mood (OR = 5.51, 95% CI: 2.07-14.69). OPF was not associated with any outcomes. No differences were observed across groups in muscle mass, LSA, or QoL. Our findings provide preliminary support for OFI-8's validity as a multi-dimensional tool to identify community-dwelling older persons with oral frailty, which is associated with adverse outcomes. Further research is needed to refine cut-offs and evaluate longitudinal predictive validity.
Reported in-hospital fall rates largely rely on subjective incident reporting, and objective verification is rarely used. Evidence on the effectiveness of bed-exit monitoring systems in patients with delirium is limited, and prospective data on digital contactless systems that do not rely on video-based monitoring are lacking. This prospective, monocentric, non-randomized controlled study was conducted on a specialized delirium care unit. Analogue bed-exit monitoring using a contact mat (CareMat) in front of the bed was compared with a digital contactless 3D-radar bed-exit monitoring system (QUMEA), which does not generate or record video data. Patients aged ≥ 65 years with delirium were allocated by room availability to analogue or digital bed-exit surveillance. Bed-exit-related falls, daily bed-exit warnings and nurse presence time were analyzed. Falls were identified using institutional records, electronic health records and system logs. For research purposes only, event-triggered thermal camera recordings were used for objective fall verification. In 119 patients contributing 1799 patient days, bed-exit-related fall rates were 22.6 per 1000 patient days with CareMat and 11.5 with QUMEA adjusted OR, 3.76 (95% CI, 1.25-11.27). The analogue CareMat device generated more bed-exit warnings adjusted OR, 1.89 (95% CI, 1.41-2.53) and longer nurse presence times adjusted OR, 1.60 (95% CI, 1.21-2.11). Under conditions of objective fall verification independent of the bed-exit monitoring systems, digital contactless 3D-radar bed-exit monitoring was associated with lower bed-exit-related fall rates and reduced nursing workload compared with an analogue contact mat.
Falls are a common geriatric syndrome in older adults and are associated with functional decline, disability, hospitalization, and increased mortality. Exercise has been shown to improve fall-related outcomes, but the comparative effectiveness across different exercise modalities remains to be clarified. This study aimed to assess the comparative effectiveness of different exercise interventions on the number of fallers, recurrent fallers, fall-related injuries, and fall-related fractures in older adults. Network meta-analysis of randomized controlled trials. Systematic searches were conducted in five databases, including PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL Plus with Full Text, from database inception to October 21, 2025, and were updated to April 18, 2026. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0 for randomized controlled trials. A frequentist network meta-analysis was performed using Stata 17 and R 4.2.1. Heterogeneity was assessed using τ2, Q statistics, and I2, and interventions were ranked according to the surface under the cumulative ranking curve. A total of 45 randomized controlled trials involving 16,240 older adults were included, evaluating five types of exercise interventions. Compared with usual care, multicomponent exercise (OR = 0.78, 95% CI: 0.67 to 0.91) and mind-body exercise (OR = 0.62, 95% CI: 0.46 to 0.85) were associated with fewer fallers among older adults (Q = 89.27, P < 0.05, I2 = 55.2%, τ2 = 0.08), while mind-body exercise (OR = 0.57, 95% CI: 0.38 to 0.85) was also associated with fewer recurrent fallers (Q = 32.95, P = 0.02, I2 = 45.4%, τ2 = 0.06). In addition, mind-body exercise (OR = 0.68, 95% CI: 0.47 to 0.99) and balance training (OR = 0.76, 95% CI: 0.61 to 0.96) may reduce the risk of fall-related injuries (Q = 4.03, P = 0.67, I2 = 0%, τ2 = 0). No statistically significant differences were observed between exercise interventions and usual care for fall-related fractures. Sensitivity analyses indicated that the results were stable. Multicomponent exercise, mind-body exercise, and balance training may reduce fall-related outcomes in older adults and may inform clinical decision-making regarding exercise interventions. However, these findings should be interpreted with caution because the certainty of evidence ranged from moderate to very low across outcomes. Further high-quality randomized controlled trials are needed to confirm these findings.
暂无摘要（点击查看详情）
Falls are the leading cause of facial fractures in the elderly, contributing to significant morbidity and mortality. This study aimed to identify the trends, epidemiology, characteristics, and outcomes of facial fractures in the elderly resulting from mechanical falls. The 2018 to 2020 NEDS HCUP database was queried for facial fracture encounters using the ICD-10 codes. Demographics, causes of injury, concomitant injuries, and cost data were evaluated. Multivariable logistic regression analysis was performed to ascertain the factors associated with facial fracture from etiology and mortality. Of 420,105 geriatric facial fractures, 320,209 (76%) resulted from falls. Fall-related facial fractures occurred in older patients (mean age, fall: 79 y versus non-fall: 75 y, P < 0.001). Mortality was lower following falls compared with non-fall mechanisms (fall: 2.2% versus non-fall: 4.3%, P < 0.001), though falls were associated with substantial morbidity, with 43.7% requiring discharge to skilled nursing facilities and 30.6% requiring hospital admission. Increasing age, higher injury severity score, skull vault, skull base, and occipital fractures independently predicted mortality (all P < 0.001). Injury severity score ≥25 was associated with 9-fold increased odds of death (OR: 9.03, 95% CI: 7.98-10.20). Mechanical falls account for the majority of geriatric facial fractures and are associated with significant morbidity and mortality, particularly among older individuals with high injury severity and cranial fractures. These findings highlight the need for early risk stratification and targeted fall-prevention strategies to reduce adverse outcomes in the elderly. Findings may supplement a clinician's judgment in cases where the mechanism and severity of a patient's injuries are ill-defined.
Recent studies associate computed tomography (CT) measurements of the quadriceps femoris with fall risk. However, no study has examined the relationship between falls and each individual quadriceps component. This study longitudinally investigated the association between CT values and cross-sectional areas of individual quadriceps components and the occurrence of falls 1 year later. Single-slice CT images of the right mid-thigh were obtained at the initial visit from 246 patients (Age: 77.4 ± 6.6, Male: 80) who returned for follow-up after 1 year. The quadriceps femoris was segmented into the whole muscle, rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. For each compartment, cross-sectional area and mean CT value (average pixel value within a segmented region, representing muscle quality) were calculated. Participants were categorized into fall and non-fall groups based on new falls during the one-year follow-up. Associations between baseline measurements and subsequent falls were analyzed. Among females in the fall group, CT values of the whole quadriceps femoris, vastus lateralis, and vastus intermedius were significantly lower (p < 0.01, p < 0.05, and p < 0.01, respectively). Binary logistic regression analysis showed that among all CT values, only that of the vastus intermedius was a predictor of falls (p < 0.01; odds ratio, 0.92; 95% confidence interval, 0.862-0.978). The cutoff value was 49.1 Hounsfield units. Cross-sectional area was not associated with falls, whereas the CT value of the vastus intermedius was significantly associated with fall occurrence. These findings suggest that the condition of the vastus intermedius may play an important role in fall risk.
The relationship between social participation and health-related outcomes remains underexplored among individuals with multiple sclerosis (MS). This study aimed to examine associations between social participation and self-reported outcomes, and to explore whether these relationships varied by age and sex. A total of 1162 adults with MS (mean age: 52.3 years, 80.6% female) completed an online survey. Social participation was assessed using the short form of the ability to participate in social roles and activities of the Quality of Life in Neurological Disorders. Outcomes included self-reported ambulation difficulty (Multiple Sclerosis Walking Scale-12), cognitive deficit (Perceived Deficits Questionnaire), fatigue (Modified Fatigue Impact Scale), dual-task difficulty (Dual-Task Impact on Daily Living Questionnaire), fear of falling (Fall Efficacy Scale-International), and recurrent falls (>1 fall). Linear and logistic regression models were used to examine the associations between social participation and self-reported outcomes. Greater social participation is associated with reduced fatigue (B [95% CI] = -2.04 [-2.38, -1.70]), ambulation difficulty (-1.79 [-2.19, -1.38]), cognitive deficit (-0.40 [-0.50, -0.30]), dual-task difficulty (-1.30 [-1.59, -1.01]), fear of falling (-0.75 [-0.91, -0.60]), and recurrent falls (OR [95% CI] = 0.89 [0.83, 0.95]). Significant age and social participation interactions were observed for cognition, ambulation, and fatigue, with older adults showing smaller magnitudes of benefits from social participation. Only cognition showed significant sex and social participation interaction, with a stronger association among females than males with MS. This study supports the clinical relevance of social participation as a factor associated with health-related outcomes in people with MS.
PurposeTo determine the accuracy of nursing diagnoses at hospital admission and discharge for patients with heart failure (HF).MethodsThis comparative study examined the documentation in 155 medical records of patients with an admitting diagnosis of HF during August 2018 and July 2019. An audit tool was used to record the diagnoses made by nurses during routine care at the time of admission and discharge. Two researchers (L.S. and A.C.) examined the records and evaluated the documented nursing diagnoses using the Nursing Diagnosis Accuracy Scale version 2. Kappa was used for agreement between them. Patient social and clinical characteristics were described using percentages, absolute frequencies, means, and standard deviations.FindingsA total of 18 unique nursing diagnoses were identified across the 155 patients. Among the 754 nursing diagnoses recorded, 85% of those identified at admission (n = 644) were deemed highly accurate. At discharge, of the 527 diagnoses recorded, 66% (n = 349) were rated as highly accurate. Excess fluid volume was the most common diagnosis (85% at admission, 49% at discharge). Three risk diagnoses were frequent at both points: risk for infection, risk for falls, and risk for decreased cardiac output. Agreement between evaluators ranged from Κ = 0.234 to 1.00.ConclusionsGreater agreement in nursing diagnoses at discharge likely reflects ongoing patient monitoring. Persistent diagnoses at discharge highlight the need for continued nursing care post-discharge.Implications for nursing practiceThis study encourages nurses to improve clinical evaluation for HF patients from admission to discharge. As key clinical indicators are identified, nurses can improve the accuracy of their diagnoses and plan more effective interventions to achieve positive health outcomes and reduce unnecessary hospitalization.
The emergence of the Abrikosov lattice in the normal phase of type-II superconducting films as the magnetic field approaches the critical field H_{c2} from above was predicted in Glatz et al. [Fluctuation spectroscopy of disordered two-dimensional superconductors, Phys. Rev. B 84, 104510 (2011)PRBMDO1098-012110.1103/PhysRevB.84.104510]. In the quantum fluctuation regime [Galitski and Larkin, Superconducting fluctuations at low temperature, Phys. Rev. B 63, 174506 (2001)PRBMDO0163-182910.1103/PhysRevB.63.174506], it is characterized by the formation of relatively large (ξ_{QF}∼ξ_{BCS}/sqrt[h[over ˜]], h[over ˜]=H/H_{c2}-1) and long-lived (τ_{QF}∼τ_{Δ}/h[over ˜], τ_{Δ}=ℏ/Δ) clusters of rotating fluctuation Cooper pairs, representing precursors of Abrikosov vortices. We show that these fluctuation-induced vortex clusters can be detected through their high-frequency electromagnetic response. Specifically, they produce a pronounced enhancement of the imaginary part of the ac conductivity at characteristic frequencies ω_{QF}∼h[over ˜]/τ_{Δ}, arising directly from quantum fluctuations, being well below the superconducting threshold at 2/τ_{Δ}. For niobium, ω_{QF} falls within the experimentally accessible microwave range, making this effect directly testable using modern microwave spectroscopy.
Falls constitute a leading cause of injury-related mortality among older adults globally. Chinese short-video platforms collectively reach over 900 million users, presenting unprecedented opportunities for health education, but the quality of fall prevention content and its relationship with user engagement have not been systematically evaluated. To evaluate fall prevention video quality across major Chinese short-video platforms, identify content creator characteristics associated with higher-quality information, and examine whether user engagement metrics correlate with video quality. We conducted a cross-sectional analysis of 216 fall prevention videos from five platforms (Douyin, Kuaishou, Bilibili, Xiaohongshu, Xigua Video) during October-November 2025. Two independent medical-school graduates with formal medical education and research expertise in medical informatics assessed video quality using the modified DISCERN instrument (mDISCERN; range 5-25) and Global Quality Scale (GQS; range 1-5). Interrater agreement was quantified using both intraclass correlation coefficients (ICC) and Cohen's weighted κ. User engagement metrics were extracted and analyzed using both Pearson and Spearman correlations. Interrater reliability was excellent for mDISCERN (ICC=0.890; weighted κ=0.890) and good for GQS (ICC=0.723; weighted κ=0.722). Mean mDISCERN score was 17.61 (SD 2.87), with 48.1% achieving high quality. Uploader type demonstrated the strongest quality association (ε²=0.64): healthcare professionals substantially outperformed self-media creators (Cohen d=3.42). Platform verification strongly predicted quality (88.7% vs 9.1% high-quality; φ=0.79). Engagement metrics showed weak association with quality in this sample (Spearman ρ=0.149 for likes, explaining only 2.2% of variance), with detection power constrained by severe right-skewness and floor effects (e.g., 30.1% of videos had zero comments). Content creator credentials and platform verification effectively discriminate video quality, while engagement metrics show only weak association in this sample. These findings support platform policies prioritizing verified professional content and indicate that engagement-based metrics, despite their algorithmic prominence, do not reliably signal health information quality in this dataset.
This study aimed to characterise the epidemiology, clinical features and outcomes of adults with severe traumatic brain injury (sTBI) managed by emergency medical services (EMS) in New Zealand. Objectives included describing demographics, event and clinical characteristics, estimating national incidence, and 30-day mortality. This retrospective observational study analysed EMS data from the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) between 1 January 2020 and 31 December 2022. Patients aged ≥16 years with head injury and a Glasgow Coma Scale score ≤8 were included. Descriptive statistics and age-standardised incidence rates were calculated by sex, ethnicity, age, rurality and socio-economic deprivation. EMS attended 630 sTBI patients over 3 years; most were male (n=430, 68.3%) and of European/Other ethnicity (n=398, 63.2%). sTBI incidence was higher among Māori than non-Māori (44.5-68.7 versus 28.6-35.6 per 100,000 person-years). Younger adults (≤45 years) had the highest rates. sTBIs in urban areas (n=485, 77%) and the most deprived quintile (n=213, 33.8%) were over-represented. Falls (n=217, 34.4%) and road traffic incidents (n=196, 31.0%) were the leading mechanisms. Thirty-day mortality was 37.8% (n=238). EMS working diagnoses of sTBI provide a valuable perspective on patient needs at the point of injury, capturing cases that may be missed in hospital-based datasets yet still influence transport decisions, destination selection and tertiary healthcare capacity. The data indicate that sTBI disproportionately affects Māori, younger adults, individuals living in socio-economically deprived areas and urban populations, highlighting health inequities and the need for targeted interventions, informed service planning and further research.
To provide a practical guide on when to suspect endogenous hypercortisolism, how to use the overnight 1-mg dexamethasone suppression test (DST) for targeted case-finding, and which patients are most likely to benefit from treatment. This narrative review synthesizes evidence from clinical practice guidelines, prospective prevalence studies, randomized controlled trials, systematic reviews, and meta-analyses addressing the recognition, diagnosis, and management of endogenous hypercortisolism in patients with treatment-resistant type 2 diabetes (T2D), resistant hypertension, and adrenal incidentalomas. Confirmed endogenous hypercortisolism is found in 0.6%-3.4% of broader T2D cohorts after stepwise biochemical evaluation, but recent prospective studies-including CATALYST and MOMENTUM-report abnormal cortisol suppression in approximately one in four patients within selected high-risk groups. Mild autonomous cortisol secretion (MACS), defined as ACTH-independent cortisol production with post-dexamethasone serum cortisol > 50 nmol/L (> 1.8 μg/dL) in the absence of classic Cushingoid features, is associated with clinically meaningful increases in hypertension, T2D, visceral adiposity, and all-cause mortality. Routine screening of all patients with diabetes or hypertension is not recommended; testing should be reserved for those with multiple, progressive, or atypical cardiometabolic features, or with adrenal incidentalomas. Attention to test timing, drug interactions, and physiologic non-neoplastic hypercortisolism is essential for accurate interpretation. When etiology and laterality permit, surgical resection offers the best chance for durable remission. When surgery is not feasible, not curative, or declined, medical alternatives-including glucocorticoid-receptor antagonists (e.g., mifepristone) and steroidogenesis inhibitors (e.g., osilodrostat, ketoconazole)-can reduce cortisol activity or lower cortisol production, each with specific efficacy, tolerability, and safety considerations warranting endocrinologist involvement. As cortisol activity falls, glucose- and blood-pressure medications often require down-titration. Monitoring for adrenal insufficiency, cortisol withdrawal syndrome, and drug-specific adverse effects requires coordinated multidisciplinary follow-up. Through careful evaluation and targeted treatment, hypercortisolism can be recognized and managed as a modifiable contributor to cardiometabolic risk. Many people with type 2 diabetes or high blood pressure do not reach their treatment goals even when they take several medicines as prescribed. In some of these patients, the body produces too much of a hormone called cortisol (sometimes called the body's stress hormone). This can raise blood sugar and blood pressure, increase abdominal fat, speed up muscle and bone loss, and increase the risk of heart and blood vessel disease. Cortisol excess exists on a spectrum. Some patients have classic outward signs—such as a rounded face, purple stretch marks, and severe muscle weakness—that are easier to recognize. However, many others have no obvious physical changes and mainly have diabetes, high blood pressure, or other metabolic problems that remain difficult to control despite multiple medications. Without targeted testing, these patients often go undiagnosed. Not everyone with diabetes or high blood pressure needs to be tested for cortisol problems. However, if a patient has an incidental adrenal mass on imaging, or diabetes and hypertension that remain difficult to control despite several medicines—especially when accompanied by unexplained weight gain, muscle weakness, or bones that break easily—it is reasonable to consider excess cortisol as a possible cause and discuss testing with a clinician. A simple test called the overnight 1‐mg dexamethasone suppression test (DST) can help. Patients take a small pill (1 mg dexamethasone) at night, and their cortisol levels are checked the next morning. If levels remain high, further testing is needed to confirm excess cortisol. It is important to rule out certain factors that can affect test accuracy—including some medications (such as oestrogen‐containing pills), heavy alcohol use, and untreated sleep apnea—and to interpret the test together with a health care professional. If confirmed, treatment can help. Options include surgery to remove an adrenal or pituitary tumour when present, or medicines that reduce cortisol production, reduce cortisol activity at the receptor level, or both. These treatments require specialist supervision and regular monitoring for side effects, including a temporary withdrawal reaction (such as fatigue, body aches, or low mood) that can occur as the body adjusts to lower cortisol. When cortisol is effectively reduced—whether through lower production or by reducing its activity at the receptor level—blood sugar and blood pressure often become easier to control, and some patients can reduce the number of medicines they take. Regular follow‐up with a care team is important to ensure the best results and to watch for side effects.
Rapid population aging and a worsening shortage of care workers necessitate the identification of older adults who require proactive interventions. Although machine learning (ML) has been increasingly applied in gerontology, existing studies have predominantly focused on social isolation, loneliness, depression, falls, and frailty in isolation rather than on the integrated construct of care needs. This study aimed to develop and interpret an explainable ML model that identifies care needs in community-dwelling Korean older adults. Beyond physical health indicators such as disease and functional status, this study adopted a comprehensive approach that included mental health, cognitive function, health behaviors, and socioenvironmental determinants, such as social participation, social support, and the housing environment, to present an integrated model encompassing both health and social care needs. Data were obtained from the 2023 Korea Senior Survey, a nationally representative sample of 10,078 community-dwelling adults aged 60 years and older. The data were split 70:30 into training (n=7054) and held-out test (n=3024) sets. Seven algorithms were compared (logistic regression, decision tree, support vector machine, random forest, gradient-boosted decision trees, extreme gradient boosting, and light gradient boosting machine) using stratified 5-fold cross-validation on the training set. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC). Model interpretability used Shapley additive explanations with bootstrap stability assessment across folds. Model A (excluding activities of daily living or instrumental activities of daily living [IADL]) achieved good discrimination (AUC 0.892, 95% CI 0.866-0.918), adequate calibration (calibration slope=0.826), and positive clinical net benefit, demonstrating that upstream factors alone can identify older adults with care needs without relying on functional status. Shapley additive explanations analysis identified age, nutritional risk, employment status, depressive symptoms, self-rated health, cognitive function, household income, and home modification as the leading predictors, with high rank stability across cross-validation folds. Model B (including activities of daily living or IADL) yielded a higher AUC (0.976, 95% CI 0.962-0.989), but this reflected the near-tautological relationship between IADL and self-reported care needs rather than genuine upstream predictive value. Using an objective composite outcome yielded equivalent discrimination (AUC 0.892), supporting robustness to the outcome definition. Explainable ML models offer high predictive accuracy and strong interpretability for identifying care needs among older adults. Care needs in community-dwelling Korean older adults can be identified with good discrimination, calibration, and clinical net benefit using multidimensional nonfunctional factors alone. By highlighting the significant roles of health, social, and environmental factors, this study provides empirical evidence to support evidence-based decision-making for the Long-Term Care Insurance system and integrated community care policies.
Miller Fisher syndrome (MFS) is an uncommon variant of Guillain-Barré syndrome (GBS) classically characterized by ophthalmoplegia, ataxia, and areflexia. Overlap forms with GBS are rare in early childhood and may be difficult to recognize, particularly in toddlers in whom neurological examination is limited. We report the case of a 20-month-old girl who presented with a seven-day history of progressive gait disturbance, repeated falls, refusal to walk, and convergent strabismus. Neurological examination showed severe axial ataxia, inability to sit or stand without support, generalized areflexia, symmetrical limb weakness, and right abducens nerve palsy. Brain and spinal magnetic resonance imaging (MRI) were normal. Cerebrospinal fluid (CSF) analysis showed mild albuminocytologic dissociation. Electroneuromyography demonstrated an acute motor-predominant polyradiculoneuropathy with preserved sensory responses. Anti-ganglioside antibody testing was positive for anti-ganglioside GQ1b (anti-GQ1b) and anti-ganglioside GT1a (anti-GT1a) immunoglobulin G (IgG) antibodies, supporting a diagnosis within the anti-GQ1b antibody syndrome spectrum. Campylobacter jejuni serology was positive despite the absence of preceding gastrointestinal symptoms, suggesting a possible antecedent exposure rather than a confirmed active infection. The diagnosis of MFS with GBS overlap was retained. The patient was treated with intravenous immunoglobulin at a total dose of 2 g/kg, with close respiratory, bulbar, and autonomic monitoring and early rehabilitation. The outcome was favorable, with recovery of independent walking at one month and complete neurological recovery at six months. This case highlights the importance of considering MFS with GBS overlap in very young children presenting with acute gait disturbance and ocular motor signs.
Agricultural workers are at increased risk for skin cancer due to prolonged ultraviolet (UV) exposure, yet many underutilize sun protection. Brief, community-based educational interventions may improve knowledge and preventive behaviors. To provide targeted skin cancer education and promote sun protection behaviors among agricultural workers in South Dakota. Twenty agricultural workers attending the Vermillion and Sioux Falls Farm Shows participated in a pre- and post-educational survey. Inclusion criteria included: ≥18 years old, English-speaking, and working in agriculture. Participants completed a seven-question pre-survey assessing sun exposure, sun protection habits, and knowledge of skin cancer. They then received a 10-minute tutorial on skin cancer risk factors, sun protection, and self-examinations. A post-survey assessed knowledge gained and intended behavior changes. Paired t-tests and Wilcoxon signed-rank tests evaluated pre- to post-intervention changes, with significance set at p < 0.05. Post-intervention, participants showed significant improvements in recognizing melanoma warning signs (mean Δ = 0.90; p < 0.001) and identifying the most common type of skin cancer (mean Δ = 0.65; p < 0.001). Intent to use sunscreen increased significantly (mean Δ = 0.38; p = 0.009), though no meaningful changes were observed for wide-brim hat or protective clothing use. Participants reported a high likelihood of engaging in sun protection behaviors (mean 4.38/5). Brief, targeted educational sessions at farm shows effectively increase skin cancer awareness and self-reported intent to adopt sun-protective behaviors among South Dakota agricultural workers.
In mode-locked lasers with filters, the interaction between dissipative soliton molecules (DSMs) is strongly determined by spectral interference and the filter profile, which is a complexity absent in single-pulse dynamics. Here, we experimentally and numerically demonstrate a filtering-induced soliton repelling effect in a Mamyshev oscillator. We show that when the temporal separation of DSMs falls below a critical value, the molecules experience increased filtering loss, leading to a progressive increase in their separation until it stabilizes at a fixed plateau. By varying the intracavity loss, we observe that DSMs adapt their spacing to enhance filter transmittance, thereby maintaining gain-loss balance. Our findings provide a new, to the best of our knowledge, mechanism with which to control multi-pulse regimes in mode-locked lasers.