A community-level nutrition intervention was implemented among tribal children (3 to 6 years) in Telangana, India. The one-year intervention involved six nutrient-rich formulations of millet-pulse-groundnut based products, suited to local taste preferences. Anthropometric measurements of height, weight and Mid-Upper-Arm -Circumference (MUAC) along with haemoglobin (Hb) levels were monitored at baseline and endline. The treatment group showed considerable gain in height (3.2 cm), weight (1.68 kg) and MUAC (0.33 cm), over the control group. Paired t-test indicated significant differences (p<.01) between pre- and post-intervention anthropometric measurements. Positive shifts were observed in wasting (WHZ; -1.2 ±1.3 to -0.9± 1), stunting (HAZ; -1.8±1.6 to -0.3±1.3) and underweight (WAZ; -1.9±1.2 to -0.7±1) among treatment group. Hb levels in the treatment group also improved significantly from 9.70 ± 0.14 g/dl (moderately-anaemic) to 11.08 ± 0.13 g/dl (non-anaemic). Post-intervention Focus Group Discussions (FGDs) involving mothers and teachers confirmed the positive impact. Thus, nutritional intervention formulated using climate resilient millets, pulses and groundnut, promotes dietary diversity and improves the nutrition & health status of children.

Globally, bridges fail mostly due to hydrological causes such as scour or flooding. Therefore, under a hydrological approach, this study proposes a methodology that contributes to prioritize the intervention of bridges to prevent their collapse. Through an exhaustive literature review, an evaluation matrix subdivided into 4 dimensions was developed and a total of 18 evaluation parameters were considered, distributed as follows: 4 environmental, 6 technical, 4 social and 4 economic. This matrix was applied to eight bridges with a history of hydrological problems in the same river and validated through semi-structured interviews with specialists. Data were collected through field visits, journalistic information, review of the gauged basin historical hydrological flow rates and consultations with the population. Then, the modeling, which considered the influence of gullies that discharge additional flow, was carried out using HEC-HMS and HEC-RAS and subsequently calibrated. The application of the matrix revealed that five bridges have a high vulnerability, and three bridges have a medium vulnerability. The multidimensional approach can be adapted for studies of other riverine bridges.

Objective: This study investigated the effects of an easily implemented 8-week program centered around jump rope exercise (JRE) on executive function among children with ADHD. Methods: Using the Stroop Color Word Test to assess inhibitory control, the n-back task (1- and 2-back) to assess working memory, and task switching to assess cognitive flexibility. Results: After the intervention, there were within-group effects only for the experimental group, with higher accuracy on the 1-back working memory task (t= -2.79，p= 0.011< 0.05，Cohen’s d= 0.60) and on task switching after compared with before the JRE intervention (t= -4.00，p=0.01<0.05，Cohen’s d= 0.85), but with no change in reaction time. There was no significant within-group difference on the Stroop test (P> 0.05). Additionally, there were no between-group effects as assessed by one-way analyses of variance. Conclusion: 8-week program focused on JRE improved two aspects of executive function, working memory and cognitive flexibility, with no significant effect on a third aspect, inhibitory control, among children with ADHD aged 7 to 12 years.

Background: Community pharmacies are well-placed to deliver well-being interventions; however, to date, nothing has been produced specifically for this setting. The aim of this study was to develop a positive psychology intervention suitable for a community pharmacy setting with the goal of increasing the well-being of community members. Methods: Intervention development consisted of three steps: Step 1- identify the evidence-base and well-being model to underpin the basis of the intervention (Version 1); Step 2 - model the intervention and gather user feedback to produce Version 2, and Step 3 - revisit the evidence-base and refine the intervention to produce Version 3. Results: Findings from nine studies (seven RCTs, one cross-sectional, one N-1 design plus user feedback were applied to model a 6-week ‘Prescribing Happiness (P-Hap)’ intervention, underpinned by the PERMA model plus four other components from the positive psychology literature (Three Good Things, Utilising Your Signature Strengths in New Ways, Best Possible Selves and Character Strengths). A PERMA-based diary was designed to be completed 3-days a week as part of the intervention. Conclusions: This work is an important development which will direct the future implementation of interventions to support well-being in this novel setting. The next stage is to gain the perspectives of external stakeholders on the feasibility of delivering the P-Hap for its adoption into community pharmacy services in the future.

Background: Areca nut and betel quid (ANBQ) chewing is a widespread carcinogenic habit. The BENIT (ClinicalTrials.gov - NCT02942745) is the first known randomized trial designed for ANBQ chewers. Methods: We compared intensive behavioral treatment intervention condition (IC) with control condition (CC) in the BENIT and included a 5-stage early stopping rule. We report the primary analysis at stage 3. English literate adults in Guam and Saipan who self-identified as ANBQ chewers with tobacco were enrolled between August 2016 and August 2020. IC participants (n=88) received five in-person sessions over 22 days and a brochure containing quitting advice. CC participants (n=88) received only the brochure. Participants were assessed at baseline and day-22 follow-up. Self-reported chewing status at day-22 was determined by a composite of two survey items with disparate wording and response options for cross-verification. Results: Cessation rates were 38.6% (IC) and 9.1% (CC). Proportional hazards regression revealed a p=0.0058, which met the Stage 3 criteria for significance and an estimated reduction in ANBQ chewing for IC compared to the CC of 71% (95% CI: 41%-88%). Conclusion: Robust self-reported intervention effects at day-22 suggests that intensive cessation programs such as BENIT should be further developed and implemented on a larger scale.

(1) Background: A set of relevant Police Ergonomics Parameters (PEP) has been used for the assessment and prevention of occupational risks involved in Police Physical Interventions (PITs). Through this set of PEPs, a comparison has been made between 2 traditional PITs against 2 novel OTPs (Operational Tactical Procedures). (2) Method: The data have been collected by means of a motion capture suit fitted with 19 Inertial Measurement Units, IMUs. A specific and powerful software package specific for ergonomic analysis has been used to manage the large amount of data registered and to generate a series of 3-dimensional plots. Traditional PITs and newer OTPs have been performed for their analysis. Specifically, the PEPs corresponding to the implementation of 4 PITs have been analyzed by collecting the measurements provided by a set of IMUs installed on a motion capture suit and their occupational risk assessments have been compared against those corresponding to newer OTPs. (3) Results: For the 4 PITs, the PEPs have been analyzed with the measured values from the IMUs, throughout the duration of each technique. The two traditional intervention techniques have scored higher than the new OTPs in the REBA system, the Assymetry angle, L5-Pelvis Shear and Joint Contac Forces, and the Total Muscle Power measurements. (4) Conclusions: It has been confirmed that the new OPTs minimize the risk of injuries, since their PEPs reached lower values than those corresponding to the traditional PITs, which are still being taught at Police academies.

Since its emergence, COVID-19 has caused a great impact in health and social terms. Governments and health authorities have attempted to minimize this impact by enforcing different mandates. Recent studies have addressed the relationship between various socioeconomic variables and compliance level to these interventions. However, little attention has been paid to what constitutes people's response and whether people behave differently when faced with different interventions. Data collected from different sources show very significant regional differences across the United States. In this paper, we attempted to shed light on the fact that a response may be different depending on the health system capacity and each individuals’ social status. For that, we analyzed the correlation between different societal variables (i.e. education, income levels, population density, etc.) along with healthcare capacity related variables (i.e. hospital occupancy rates, percentage of essential workers, etc.) with regards to people's level of compliance with three main governmental mandates in the United States: mobility restrictions, mask adoption, and vaccine participation. Our aim was to isolate the most influential variables impacting behavior in response to these policies. We found that there was a strong relationship between individuals' educational levels and political preferences with respect to compliance with each of these mandates.

Several studies confirmed the importance of career education interventions since childhood. This study aimed at testing a career education intervention designed for middle school students, conducted, after a specific training on Social Cognitive Career Theory, by students’ teachers. The career conceptions were assessed in both experimental and control groups through the Conceptions of Career Choice and Attainment protocol before and after career education intervention. Result showed that. starting from the same level and increased their conceptions after the intervention. Experimental group increase, in a statistically significant way, more than the control group.

Medical tests' cost-effectiveness analysis reveals a strong correlation between their accuracy and analysis results. Theoretically, we provide two lower bounds that medical tests' accuracy must exceed to be considered cost-effective. Theoretically, we provide two lower bounds that the accuracy of medical tests meeting cost-effectiveness must exceed. First, medical tests' accuracy should surpass the lower bound of matching requirements for each patient to receive the most appropriate intervention based on their test results. Second, the overall lower limit should be exceeded for the medical testing to be cost-effective for the patients as a whole. Furthermore, the conclusions from this model also provide an economic explanation for the under-diagnosis of rare diseases and the challenges faced in implementing precision medicine for minority patients. A numerical simulation example validates the conclusions of this paper.

Promoting diet and physical activity is important for women with recent gestational diabetes mellitus (GDM) and their partners to reduce the risk of future type 2 diabetes (T2D). The study aimed to understand how motivation for changing diet and physical activity behaviors among women with recent GDM and their partners was experienced after participation in the Danish Face-it intervention. Fourteen couple interviews were conducted. Data analysis followed reflexive thematic analysis. Guided by self-determination theory and interdependence theory, we identified four themes affecting couples’ motivation for health behavior change: 1) The need for relatedness after delivery, 2) Promoting competence and autonomy for health behavior change, 3) Individual and mutual preferences for health behaviors, and 4) The health threat of future T2D as a cue to action. We found that the couples in general perceived the Face-it intervention as useful and motivating. Using couple interviews increased our understanding of how the women and partners influenced each other’s perspectives after a GDM-affected pregnancy and thus how targeting couples as opposed to women alone may motivate health behavior change.

Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. This study aimed to test the efficacy of a newly-developed symptom self-management program on health outcomes among inpatients post-AMI. A pilot randomised, controlled trial was utilised. A convenience sample of 90 was recruited from a tertiary hospital in Singapore. Adult inpatients with post-AMI were randomly assigned to the three groups: IManage-HSet, IManage-FF or control group. Sample size was computed using power analysis. Data were collected through self-reported questionnaires and physiological instruments. Data analyses included univariate statistics, analysis of variance and repeated measure analysis of variance. Ninety participants were recruited with 30 in each group. Participants in the IManage-HSet and IManage-FF group had significantly greater relaxation (ηp2 = 0.11), lower objective stress (ηp2 =0.14), and greater knowledge (ηp2 = 0.62) than those of the control group. The two intervention groups had lower subjective stress (ηp2 = 0.04), depression (ηp2 = 0.01), and anxiety (ηp2 = 0.03) than the control but such differences did not achieve statistical significance. Furthermore, most participants reported that they were satisfied with the programs and they provided positive comments on the contents, educational materials and relaxation practice. This pilot study supports the potential benefits and feasibility of the IManage-VR and IManage-FF interventions on stress, perceived relaxation, knowledge and patient satisfaction. Contents of the symptom management interventions could be added into current cardiac rehabilitation programs. Future RCTs with multi-centered sites and larger sample size are required to further test the intervention. This study was prospectively registered with the International Standard Randomised Controlled Trial on the 5th August 2014 with registration number ISRCTN61027816.

This study aimed to introduce a novel machine learning (ML) model designed to predict the need of interventions during endoscopy in patients with upper gastrointestinal bleeding (UGIB). The risk stratification tools in current use, such as the Glasgow Blatchford Score (GBS) and pre-endoscopic Rockall score, have limitations in accurately predicting the need for endoscopic interventions. All patients diagnosed with UGIB from January 2013 to October 2023 who underwent endoscopy were included in the study. Variables extracted included demographics, social history ,clinical history, clinical presentation and symptoms, drug history, management prior to endoscopy, findings during endoscopy, laboratory variables and vitals, and post-endoscopic results. Three machine learning models including Random Forest Classifier (RFC), Gradient Boosting Classifier (GBC), and AdaBoost Classifier were used to evaluate the need for intervention during endoscopy in our study. A total of 1372 patients were included from three major hospitals in Jordan, of whom 242 underwent endoscopic intervention. The GBC outperformed all other models and pre-endoscopic scores in predicting the need for endoscopic intervention with an area under the curve of 0.861. Findings during endoscopy, platelet count, pulse rate and systolic blood pressure during admission were the most contributing features in predicting the need for the need of endoscopic intervention. This study highlights the potential of machine learning models in enhancing decision making for UGIB management.

This academic article examines the effectiveness of international humanitarian intervention in conflict zones. Humanitarian intervention refers to the use of military, diplomatic, or economic measures by external actors to protect civilians, promote human rights, and alleviate suffering in areas affected by armed conflict. The research employs a comprehensive approach, incorporating content analysis, case study, and historical analysis in its methodology. It explores the key challenges faced by international actors in implementing humanitarian interventions and evaluates their impact on conflict resolution and post-conflict reconstruction. Through this thorough analysis of case studies and scholarly literature, this article contributes to the ongoing debate surrounding the efficacy of international humanitarian intervention.

For a subject suffering from complex post-traumatic stress disorder, a psychological intervention program was designed, monitored in real-time during psychotherapy, and evaluated quantitatively and qualitatively after psychotherapy. One male subject participated in this program under consent. The proposed intervention program was designed using cognitive behavioral therapy and stabilization treatments for body-based sensory processes in four sessions of 90 min each. During psychotherapy, a wearable heart sensor and a communication application were utilized to determine the subject’s current psychological state. After the intervention, the effect of the proposed program was analyzed qualitatively and quantitatively using the Impact of Event Scale–Revised (IES-R-K), Athens insomnia scale (AIS), and heart rate variability (HRV). After the intervention program was conducted, the subject reconstructed his traumatic events and trained himself with certain psychological techniques to decrease his negative thoughts and emotions induced by his previous traumatic events. The IES-R-K and AIS ten months after the last session were changed positively by approximately 25% compared with the subject’s state before the first session. During psychotherapy, the HRV exhibited a significant correlation with the subject’s emotional state. The proposed intervention program induced a positive change in the subject. Although the HRV was well utilized in this investigation, more sophisticated statistical analysis will be required for clinical trials.

This study aimed to investigate the characteristics and outcomes of patients who underwent per-cutaneous coronary intervention (PCI) and visited an emergency department (ED) with chest pain in Saudi Arabia. A retrospective analysis of patient data was conducted, focusing on demographics, risk factors, pain assessment, triage, diagnostic testing, and management. The results revealed a young adult population (40-59 years old) at risk for coronary heart disease (CHD), highlighting the need for increased awareness and education. Gender differences in cardiovascular disease (CVD) presentation and underdiagnoses in women also require attention for effective prevention and treatment. Accurate pain assessment during triage was found to be essential to prevent mistriage and negative patient outcomes. Chest pain and shortness of breath were common symptoms, emphasizing the importance of recognizing acute myocardial infarction (AMI) symptoms for proper triage, diagnostic testing, and prompt treatment. The study identified modifiable CVD risk factors, including diabetes (51.1%), hypertension (43.8%), and smoking (25.9%), stressing the importance of lifestyle modifications to reduce CVD risk. Saudi Arabia faces significant challenges in addressing cardiovascular disorders, but efforts to improve healthcare access and establish specialized centers are promising. In conclusion, this study underscores the need for increased awareness of CHD among young adults, accurate pain assessment during triage, and lifestyle modifications to address modifiable CVD risk factors. Furthermore, healthcare teams must stay updated on new chest pain guidelines in the ED and prioritize early detection of implicated arteries and prompt reperfusion. Further research investigating chest pain patient triage and assessments across Saudi Arabia is recommended to identify areas of improvement and implement necessary changes in clinical practice.

The aim of this study is to determine the importance and effectiveness of different interventions aimed at improving social skills in people with autism spectrum disorder (ASD) through theatrical techniques. It aims to establish a direct relationship between the interventions and the benefits for socioemotional reciprocity, nonverbal communication behaviors used for social interactions and the development, establishment and understanding of interpersonal relationships. For this purpose, a systematic review of the literature published from 2011 to 2021 in the ERIC, Web of Science, EuropePMC, PubPsych, Índices-Csic, Redalyc, Roderic, Scopus, PubMed, Scielo and Dialnet databases was carried out, and a total of 29 articles were reviewed. The results indicate that theater creates a safe environment in which people with ASD can engage with their own emotions and those of others, thereby offering a therapeutic setting in which to promote communication, motor development and social coexistence. The implications and limitations of the study are discussed.

This study examines the effectiveness of a comprehensive psychomotor development program combined with adapted football training for adolescents diagnosed with intellectual disabilities in Romania. Twelve participants, with a mean age of 17.42 years underwent a carefully designed intervention program spanning 36 weeks. The program aimed to enhance fundamental movement skills, integrate these skills into specialized football training, and culminate in a Unified 7-a-side Football Match. Results indicate significant improvements in psychomotor skills, including static and dynamic balance, pulse processing speed, and identified stimuli. Moreover, the intervention positively impacted social interaction among participants. Statistical analysis, employing Pearson Correlation Analysis and Paired Samples t-Test (One-Sample), compared assessments. Results revealed significant differences between pre- and post-intervention measurements, providing robust evidence of the program's efficacy. The positive correlations between physical parameters and social interaction highlight the interconnectedness between physical fitness and social engagement. Our findings suggest that improvements in physical abilities may contribute to increased social interaction among children with intellectual disabilities, underscoring the holistic nature of our intervention, which addresses multiple dimensions of development simultaneously. The findings underscore the holistic benefits of integrating psychomotor development and adapted football programs for adolescents with intellectual disabilities, emphasizing the importance of promoting inclusive physical activities for their overall well-being.

Aim: Child-to-parent offenders (CPOs) are commonly specialist offenders and with high rates of recidivism. Thus, a field study was designed to estimate the prevalence in the reference measures of recidivism i.e., dangerousness, risk factors and psychopathy, and compare CPOs with non-child-to-parent juvenile offenders. Method: 136 juvenile offenders (76.5% boys), 76 CPOs and 60 non-CPOs juvenile offenders, aged from 14 to 18 years old, were measured in dangerousness, risk of factors and psychopathic traits. Results: The results showed in CPOs a more than common prevalence (&gt; .50), 75.0%, 95% CI [.653, .847], of dangerousness (caseness); a significant prevalence (&gt; .05) of diagnostic of psychopathy, 25.0%, 95% CI [.150, .350]; and a common prevalence (= .50), 55.3%, 95% CI [.441, .665] of classification as high and very high risk by risk factors. Comparatively, no significant differences were observed between CPOs and non-CPOS juvenile offenders in mental health problems (dangerousness), meanwhile that CPOs exhibited significant more interpersonal and affective psychopathic traits and significant more risk in family circumstances, and personality and behaviour risk factors. Conclusions: The implications for prevention and intervention programs with CPOs are discussed

Modern agriculture requires technology to give precise measures about relevant parameters such as pest control. Here, we developed an algorithm model as base for bait spray intervention, by monitoring the olive fruit fly, Bactrocera oleae (Rossi), with conventional traps, in 24.3 Hectares of non-irrigated Baladi olive cultivars, in Hassbaya region. We installed 49 yellow sticky traps with ammonium bicarbonate. The adults, males and females were monitored, on weekly basis. The traps and the trees were georeferenced, and the parameters such as temperature, relative humidity, tree phenology (BBCH), and fruit load rate were compiled. The results showed that the infested fruits were correlated as much with the fruit load rate as with the number of adults captures which were correlated more to the temperature than the relative humidity. The number of the males captured was higher than the females all over the cultivation period. The first symptoms of the fruits were observed from 22 September when the BBCH was equal to 85%, with an average of adult captures lesser than 5 adults by trap by 7 days.

(1) Background: Acute myocardial infarction in pregnancy (pAMI) is a rare event, often caused by non-classical factors rather than atherosclerosis. The management of pAMI poses unique chal-lenges as it requires considering both maternal and fetal well-being.; (2) Methods: We present the case of a 36-week pregnant woman who presented with antero-lateral ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock. To ensure comprehensive decision-making, an emergency Pregnancy Heart Team meeting was convened, comprising interventional cardi-ologists, gynecologists, and anesthesiologists. The team prioritized interventional treatment for pAMI and opted for primary percutaneous coronary intervention (PCI) due to the unstable ma-ternal condition.; (3) Results: The patient underwent primary PCI as the chosen intervention for pAMI. A rapid response gynecology team closely monitored the procedure and was prepared to intervene in case of irreversible hemodynamic compromise leading to cardiac arrest. A caesarean section was deemed necessary if cardiac activity was not restored within 4 minutes.; (4) Conclusions: Managing pAMI requires a multidisciplinary approach that balances the maternal and fetal well-being. In this particular case, the Pregnancy Heart Team decided to prioritize interventional treatment with primary PCI due to the unstable maternal condition. The presence of a closely monitored gynecology team ensured prompt action in case of complications.

Neck circumference (NC), neck circumference to height ratio (NHtR) and neck circumference to weight ratio (NWtR) appear to be good candidates for the non-invasive management of non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the ability of routine variables to assess and manage NAFLD in participants with obesity and NAFLD included in a 2-year nutritional intervention program. Anthropometric measurements, biochemical variables and imaging techniques were performed at different study time-points (baseline, 6, 12 and 24 months). The nutritional intervention significantly improved all anthropometric measurements as well as the glucose profile and the hepatic enzymes. NC and neck ratios combined with ALT levels and HOMA-IR showed good prediction ability for the hepatic fat content and hepatic steatosis at all the study time-points in a ROC analysis. The prediction ability of the combination panels improved when the weight loss variable was also considered. NC and neck ratios are easy anthropometric measurements that in combination with routine biochemical variables (ALT and HOMA-IR) showed good prediction ability of NAFLD. More research studies are necessary to validate the utility of these simple and easy variables as surrogate markers of NAFLD since their application could improve the prevention and management of this prevalent disease.

Abstract: The purpose of this study is to explore, from the perspective of government interven-tion, behavioral logic and game relationship among farmers, service organizations and the gov-ernment in the pest and disease control outsourcing system, as well as the endogenous motiva-tion of each subject. The results indicate that the stronger the willingness of each subject, the faster the stable state of joint pest and disease control among the three parties can be formed; In the case of implementing a single policy tool, the convergence rate of each party that imple-ments the regulatory policy alone is fast but may be unstable, while the rate is slow but more stable when a guidance- or incentive-based policy is solely applied; The effect of policy tool combination is much better than that of a single policy tool applied. The simultaneous imple-mentation of the three types of policy tools can form a policy system with both positive and negative mechanisms, which can maximize complementary and superposition effect.

This study aimed to evaluate the proliferation and migration of fibroblast cells derived from chronic wounds and investigate the impact of low-level laser therapy (LLLT) on their growth and migration. A total of 60 dermal samples were obtained from three sites of chronic pressure ulcers and diabetic ulcers in 20 patients. Following collection in the operating room, the dermal samples were isolated using the procedure described by Freshney RI. Fibroblasts from the wound base (Site 1) exhibited a slow proliferation rate and a decrease in proliferative capacity. Fibroblasts from wound margins (Site 2) and adjacent healing skin (Site 3) could be successfully isolated and maintained for multiple generations without any morphological changes. Fibroblasts from chronic wounds at Sites 2 and 3 showed slower proliferation rates and reduced migration capabilities compared to normal dermal fibroblasts (control samples). The fibroblast cells were exposed to LLLT at different energy levels (2.5, 3, and 3.5 J/cm2). The laser-treated groups demonstrated a significantly higher increase in cell count compared to the control sample, with the highest increase observed at an energy level of 3 J/cm2. These findings suggest that LLLT at an energy level of 3 J/cm2 could effectively enhance fibroblast migration, indicating its potential as a therapeutic intervention for chronic wounds.

The aim of this prospective study was to examine the issues of these items to evaluate the possibility of their application to clinical practice. This prospective survey was performed on pharmacists of 14 hospitals. The number of confirmation items was 345 and 375 items in the control group and recommended item group, respectively. The mean time required for completing a regimen check (±standard deviation) was 4 minutes and 14 seconds (±1 minute and 50 seconds) and 6 minutes and 18 seconds (±1 minute and 7 seconds) in the control group and recommended item group, respectively. Among the recommended items, the mean number of items that pharmacists confirmed was 12.4 and 18.6 in the control and recommended items, respectively. The number of doubt inquiries was higher in the recommended item group than in the control group (41 vs. 27 cases). The number of doubt inquiries related to dosage, premedication, urinalysis, and a history of hepatitis B virus was higher in the recommended item group than in the control group. In the present study, we created 19 items that should be confirmed in regimen checks and examined the possibility of their application to clinical practice.

Preliminary clinical data suggest pain reduction through fasting in different diagnoses. This uncontrolled observational clinical study examined the effects of prolonged modified fasting on pain and functional parameters in hip and knee osteoarthritis. Patients admitted to the inpatient department of Internal Medicine and Nature-based Therapies of the Immanuel Hospital Berlin between February 2018 and March 2020, answered questionnaires at the beginning and end of inpatient treatment, as well as 3, 6 and 12 months after discharge. Additionally, selected blood and anthropometric parameters were routinely assessed during the inpatient stay. Fasting was performed as part of a multimodal integrative treatment program, with daily caloric intake of <600 kcal for 7.7 ± 1.7 days. N=125 consecutive patients were included. Results revealed an amelioration of overall symptomatology (WOMAC Index score: -14.8±13.31; p<0.001; d=0.78), and pain alleviation (NRS Pain: -2.7±1.98, p<0.001, d=1.48). Pain medication was reduced, stopped, or replaced by herbal remedies in 36% of patients. Improvements were also observed in secondary outcome parameters, including increased quality of life (WHO-5: +4.5±4.94, p<0.001, d=0.94), reduced anxiety (HADS-A: -2.1±2.91, p<0001, d=0.55) and depression (HADS-D: -2.3±3.01, p<0.001, d=0.65), decreases in body weight (-3.6 kg ± 1.65, p< 0.001, d=0.21), and blood pressure (systolic: -6.2±15.93, p<0.001, d= 0.43; diastolic: -3.7±10.55, p<0.001, d=0.43). Results suggest that patients with osteoarthritis of the lower extremities may profit from a prolonged fast embedded in a multimodal integrative treatment regarding quality of life, pain, and disease-specific functional parameters. Confirmatory RCTs are warranted to further investigate these hypotheses.

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of chronic disease among vulnerable populations. This study tested a novel food insecurity intervention called FINDING-Food, which stands for Frequent Informational Nudges Directing Individuals to Needed Goods. Informational nudges in the intervention promoted food security through the elimination of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity. The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group at the end of the study. Qualitative findings revealed how the intervention group found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.

Drowning remains a prominent global pediatric health concern, necessitating preventive measures such as educational initiatives for children and caregivers. This study aimed to assess the feasibility and educational effectiveness of an interactive puppet show centered on water safety for children and parents. A 30-minute original theater performance, featuring two actors and three puppets (a girl, a crab, and a lifeguard), was conducted. Subsequently, 185 children (aged 4 to 8) and their 160 parents (134 mothers and 26 fathers) participated in this quasi-experimental study. Pre- and post-show tests were administered to evaluate knowledge and behaviors in aquatic environments. Prior to the puppet show, 78% of children exhibited basic aquatic competency. Only 33% considered swimming alone risky. Following the intervention, 81.6% of children changed their perception of the risks of solo beach activities, showing improved knowledge of emergency number activation (from 63.2% to 98.9%, p&lt;0.001). The intervention increased parents' intention to visit lifeguard-patrolled beaches and improved their CPR knowledge for drowning victims by 58.8%. In conclusion, a drowning prevention puppet show positively impacts children and parents, potentially enhancing safety behaviors during water-related leisure activities, warranting consideration as part of comprehensive drowning prevention strategies.

The purpose of this work was to investigate whether two-months supplementation with 100% sea buckthorn juice (SBJ) would modify blood lipids, LDL subfractions and other markers of cardiovascular risk in hypercholesterolemic women. A group of 28 hypercholesterolemic non-medicated adult women with a mean age of 50.58 ± 5.76 years consumed 50 mL of 100% SBJ daily for two-months. We observed a significant reduction of body weight (BW; p < 0.05), body mass index (BMI; p < 0.05), body fat mass (BFM; p < 0.001) and visceral fat area (VFA; p < 0.001), on the contrary, a significant increase of skeletal muscle mass (SMM; p < 0.05) and fat-free mass (FFM; p < 0.05). Supplementation with 100% SBJ significantly increased the level of high-density lipoprotein (HDL; p < 0.05), reduced the level of low-density lipoprotein (LDL; p < 0.05), atherogenic LDL subfractions (LDL3–7; p < 0.05) and improved LDL/HDL ratio (p < 0.001). After the SBJ consumption, significant reduction of C-reactive protein (CRP; p < 0.001), orosomucoid (ORM; p < 0.001) and interleukin 6 (IL-6; p < 0.05) were found. In conclusion, consumption of SBJ showed an indication of beneficial effects on cardiovascular risk factors in hypercholesterolemic women.

In this follow-up study, we aimed to assess the effectiveness of the “I do not smoke, I exercise”, anti-smoking preventive health education program. The program was based on the Theory of Planned Behavior supplemented with life-skills teaching and targeted at high school students. The intervention comprised ten one-hour online sessions, administered by physical education instructors. The study cohort comprised 222 students (109 boys, 113 girls) from 11 secondary schools, with an average age of 16.42 ± 1.36 years. Data collection involved pre- and post-intervention self-assessment questionnaires. The examined variables included attitudes towards smoking, intention to smoke, subjective norm, perceived behavioral control (PBC), knowledge about smoking, smoking behavior, exercise behavior, attitudes toward the program's implementation, and satisfaction with the program. Separate paired samples t-test revealed a significant improvement in students' knowledge about smoking, perceived behavioral control, and overall program satisfaction following the intervention. However, no significant changes were observed in the remaining variables. These findings suggest that the health education smoking prevention intervention incorporates techniques and strategies that influence the Perceived Behavioral Control variable, emphasizing students' strong interest in educationally theorized programs integrating technology into their design. Future studies should consider further examination of tobacco control strategies within the high school context.

Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is the cornerstone of post-percutaneous coronary intervention treatment to prevent stent thrombosis and reduce the risk of adverse cardiovascular events. The selection of an optimal DAPT regimen, considering the interplay of various antiplatelet agents, patient profiles, and procedural characteristics, remains an evolving challenge. Traditionally, a standard duration of 12 months has been recommended for DAPT in most patients. While contemporary guidelines provide general frameworks, DAPT modulation with longer or shorter treatment courses followed by aspirin or P2Y12 inhibitor monotherapy are evolving towards an individualized strategy to optimize the balance between efficacy and safety. This review comprehensively examines the current landscape of DAPT strategies after coronary stenting, with a focus on emerging evidence for treatment individualization.

This article delves into the complex tension between national self-rule and international involvement, in the context of global politics, examining the inherent challenges of upholding both principles when confronted with human rights abuses and the pursuit of global peace. The introduction presents the fundamental dilemma: self-governance versus moral obligations. The problem statement calls for a nuanced approach to address the intricate complexities of sovereignty and intervention, acknowledging the potential misuse by oppressive regimes and the ongoing challenges of determining when and how intervention is warranted. The article advocates for a more responsible and effective approach to global conflicts and human rights violations, balancing national sovereignty with judicious intervention when required. The methodology employs both literature review and case analysis to construct a framework for objectively assessing when international intervention is justified in instances of human rights abuses. The conclusion stresses the criticality of objective intervention criteria, transcending cultural, political, and economic biases, and advocates for a globally accepted approach that celebrates diversity while promoting global stability.

Traumatic events, especially massive trauma resulting from catastrophic incidents, wars, or severe abuse, can elicit significant neuropsychological alterations, with profound implications for cognitive, emotional, and behavioral functioning. This mini review delineates the primary neural changes post-trauma and underscores the importance of timely neuropsychological and clinical interventions. Specific brain regions, including the amygdala and prefrontal cortex, undergo physiological changes that can lead to memory impairments, attention deficits, and emotional disturbances. PTSD, a commonly diagnosed condition post-trauma, exemplifies the intricate relationship between trauma and memory processing. Furthermore, the concept of neuroplasticity, the brain's inherent ability to adapt and rewire, offers hope for recovery. Current clinical interventions, such as cognitive-behavioral therapy, mindfulness practices, and biofeedback, leverage this neuroplastic potential to foster healing. The review underscores the vital importance of early intervention to mitigate long term neuropsychological impacts, emphasizing the role of timely and targeted clinical interventions. The synthesis of this knowledge is crucial for clinicians, allowing for informed therapeutic approaches that holistically address both the physiological and psychological dimensions of trauma.

Purpose: To explore parents’ perceptions of the educational intervention programme regarding their children’s postoperative pain management. Design and Methods: A qualitative descriptive study was conducted. Thirty-two parents whose children underwent inpatient elective surgery were recruited from the two intervention groups (received an educational booklet and a video, with or without an hour of face-to-face teaching session) for this qualitative evaluation of the intervention. Participants were asked to comment on the content and delivery methods of the intervention via individual face-to-face semi-structured interviews. Thematic analysis was used to identify themes from the data. Results: Three themes were generated from 32 participants’ interview data: current pain management practices, experiences and benefits of the educational intervention, and suggestions to improve pain management. Conclusions: Our findings suggested that the educational intervention in children’s postoperative pain management was helpful for parents and their children. However, it is necessary to improve educational materials and equip healthcare professionals with non-pharmacological pain relief methods. Practice Implications: Our findings reveal the current challenges in extensively adopting non-pharmacological pain relief methods. Healthcare professionals can do more to routinely integrate pharmacological and non-pharmacological pain management strategies in relieving pain effectively. Future research could develop technology-based programmes to increase ease of access. Trial Registration Number: ISRCTN24910957.

To resolve problems in the dietary life of university athletes, education is essential for enabling athletes to change their own dietary behavior. The purpose of this research, it was decided to verify the effectiveness of sports nutrition education based on self-determination theory (SDT). Methods, the subjects were thirty-six male university rowers. A stratified randomized comparison test was conducted by student year (SDT group and control group). Sports nutrition education was held three times, via an Internet conferencing system. Furthermore, group work over social media was used for the SDT group. Four evaluations were carried out based on anthropometric measurements, brief-type self-administered diet history questionnaire (BDHQ),sports nutrition knowledge (SNK), and treatment self-regulation questionnaire (TSRQ). Results, for the intra-group factor "Protein," a significant difference was evident in the self-determination theory group (50.0±28.5, 78.6±28.1, 81.0±21.5, p<0.000, units: %), and there were significant differences between after and before, and between three months after and before (p=0.002, p=0.002). For BDHQ, significant differences were evident for green/yellow vegetables, fruits, and dairy between after and before for the self-determination theory group (159.1±74.2-126.7±70.6, p=0.009, 306.0±196.2-195.2±146.1, p=0.020, 257.0±147.0-183.3±167.9, p=0.040, units: g). In conclusion, sports nutrition education based on SDT improved dietary knowledge and increased dietary intake.

The study's objective was to assess the impact of Mediterranean diet/lifestyle interventions for weight loss on Positive airway pressure (PAP) adherence, Body mass index (ΒΜΙ), sleepiness, and blood pressure measurements (BP) in patients with obstructive sleep apnea (OSA). We designed a randomized, controlled trial, including overweight and obese patients with moderate-to-severe OSA, randomized to standard care (SCG, n=37) and Mediterranean diet group (MDG, n=37). SCG received healthy lifestyle advice, while MDG underwent a 6-month behavioral intervention aiming to enhance weight loss and adherence to Mediterranean diet. PAP adherence, BMI, Epworth Sleepiness Scale (ESS) and BP measurements were evaluated pre- and post-intervention. Post-intervention PAP use was higher in MDG compared to SCG (6.1 vs 5.4, p=0.02). Diet/lifestyle intervention was one of the most significant predictive factors for PAP adherence (OR = 5.458, 95% CI = 1.144-26.036, p=0.03). The SCG demonstrated a rise in BMI, while the MDG displayed a decline (0.41 vs -0.75, p=0.02). The MDG also demonstrated a substantial reduction in adjusted SBP (-5.5 vs 2.8, p=0.014) and DBP (-4.0 vs 2.5, p=0.01). Ultimately, incorporating a dietary/lifestyle intervention with standard care yields superior PAP adherence, BMI, and BP measurements in contrast to standard care alone, underscoring the potential benefits of allocating increased time and support within the MDG group. Trial registry: ClinicalTrials.gov; No.: NCT05881824; URL: www.clinicaltrials.gov.

Background: The high prevalence of learning disabilities among children confirm that learning disabilities are surprisingly common. In absence of routine screening, many children still go undetected with a huge individual and family burden, while at the same time existing interventions are conflicting. The purpose of the study is to report on the design, implementation and evaluation of an innovative pilot intervention aiming to improve the quality of life of the family of students with specific learning disabilities. Method: For the purposes of this study, we used an experimental research design, using two groups (intervention and control). The intervention included four meetings with parents of children from the intervention group. To assess the quality of life of the students' family and the parenting style, the following measuring tools were used. They conducted at times and locations convenient to each participant. The instruments used to measure outcomes were two standard weighted questionnaires, the parenting style questionnaire and the family quality of life questionnaire. Findings: The results showed that the intervention program had significantly positive effects on both parenting style and children’s quality of life. Specifically, a decrease in parental authoritarianism and an increase in parental support were observed. Also, an increase in child-parent interaction, emotional and general well-being was found. Conclusion: The intervention program did improve the quality of life of the children by increasing all the variables related to the measurement of their quality of life.

The focus of this article is the evaluation of the quality and the degree of community engagement in an expert-based, public-health communicative intervention for Alcohol Use Disorder (AUD). In 2023 the Canadian Alcohol Use Disorder Society collaborated with a grass-roots community health group, a regional health authority, and an academic participatory researcher to organize a working group to mount a social-marketing campaign to increase community support for AUD medical treatment in family-practice settings in a rural community in British Columbia. The partnership working group conducted a series of activities in the school system, the town council, and the community. This article covers the formative evaluation and the summative evaluation of the working group's effectiveness. The formative evaluation ("lessons learned" and "recommendations") consists of consensus evaluations of the quality of each activity using a variety of data sources. The formative evaluation followed improvement science methods and used consensus meetings to provide and reflect on formal and informal feedback. Formative results reflect the consensus of the participants in the working group and they record the reactions in the community. The summative evaluation measures evidence of community engagement found in transcribed text from meeting minutes. The summative evaluation used theory-based frameworks and text data visualization to assess the engagement dynamics of the working group. The summative evaluation helps to put the formative evaluation into perspective as communicative action. The summative evaluation validates the formative evaluation by revealing the communicative dynamics of engagement which resulted in the community’s increased capacity to understand and support Alcohol Use Disorder Treatment options. The working group and the entire intervention was seen by the participants and the public as a success and capable of replication. In a small community, it instilled new understandings and attitudes, bringing an emerging awareness of medication as an optional health mitigation strategy for Alcohol Use Disorder. Our study furthers this overall assessment by using theoretical constructs and analysis of communicative records to trace engagement characteristics of interest to researchers, societies, and community groups contemplating similar interventions in the future. The study also validates the effectiveness of communicative analysis as a measure of social-marketing for expert-based public health interventions.

Neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease, are caused by a combination of multiple events that damage neuronal function. A well-characterized biomarker of neurodegeneration is proteinaceous aggregates accumulation in the brain. However, the gradually worsening symptoms of neurodegenerative diseases are unlikely to be solely due to the result of a mutation in a single gene, but rather a multi-step process involving epigenetic changes. Multiple epigenetic studies have revealed that modification of histones accompanied by both the local and global remodeling of the chromatin structure and alternations in transcriptional patterns are closely associated with the pathogenesis of neurodegenerative diseases. Unlike DNA mutations, epigenetic alterations are reversible, and therefore raise the possibilities for therapeutic intervention including dietary modifications. Additionally, reactive oxygen species may contribute to the pathogenesis of Alzheimer’s disease and Parkinson’s disease. Given that the antioxidant properties of plant-derived phytochemicals are likely to exhibit pleiotropic effects against ROS-mediated epigenetic alternation, dietary intervention may be promising for the management of neurodegeneration in these diseases. In this review, the state-of-the-art applications using single-cell multi-modal omics approaches including genetics, and epigenetics, and dietary approaches for the identification of novel biomarkers and therapeutic approaches for the treatment of neurodegenerative diseases are discussed.

Objective: To explore the application effect of Atropine injection combined with nursing intervention on the interventional treatment of PATENTS with ST-segment elevation myocardial infarction. Methods: A total of 60 patients with ST-segment elevation myocardial infarction treated in our hospital from January 2022 to January 2023 were selected as the research objects. According to different nursing methods, they were divided into conventional group (n = 30) and systematic group (n = 30), both groups were treated with percutaneous coronary intervention (PCI). The conventional group received routine nursing before and after operation. On the basis of routine nursing, systematic nursing cooperation was given in the system group. The time of opening infarct vessels, the incidence of total adverse reactions during interventional treatment, mortality, success rate of treatment, improvement of cardiac function and length of hospital stay were compared between the two groups. Results: The time of opening infarct vessel in system group was significantly better than that in routine group (P < 0.05). The total adverse reaction rate in system group was significantly lower than that in routine group (P < 0.05); The mortality of routine group was significantly higher than that of system group (P < 0.05). The success rate of system group was significantly higher than that of routine group (P < 0.05); The number of patients with improved cardiac function and length of hospital stay in system group were significantly better than those in routine group (P < 0.05). Conclusion: Good intraoperative cooperation and nursing is an important guarantee for patients with ST-segment elevation myocardial infarction, which can effectively reduce the occurrence of adverse reactions during interventional treatment, improve the success rate of treatment, and reduce the death of patients during interventional treatment.

Background: Laparoscopic cholecystectomy has gained popularity. The goal of this study was to evaluate outcome differences between open vs laparoscopic cholecystectomy. Method: Using a large NIS database and ICD-9 coding for open vs laparoscopic cholecystectomy, we compared inpatient outcomes for these two procedures regarding the occurrence of myocardial infarctions and mortality using uni- and multivariate analysis by studying 5 years of data from 2010 to 2015. Results: Open cholecystectomy was inferior to laparoscopic procedure with a higher occurrence of non-ST-elevation myocardial infarction (Non-STEMI), ST-elevation myocardial infarction (STEMI), and mortality in comparison to laparoscopic cholecystectomy. For example, using 2010 database, the occurrence of STEMI was 0.2 vs 0% (OR 3.1, CI 1.7-5.5, p<0.001), for Non-STEMI 1 vs 0.4% (OR 2.5 CI 2.0-3.0, p<0001) and for mortality 0.4 vs 0.4% (OR 9.2, CI 7.9-10.6, p<0001). After adjustment for age, obesity, diabetes, and hypertension, the occurrence of STEMI, Non-STEMI, and mortality remained higher in the open cholecystectomy cohort (mortality multivariate OR 6.4, CI 5.5-7.4, p<0001). Conclusion: Open cholecystectomy is associated with a higher rate of STEMI, Non-STEMI, and a markedly higher rate of mortality in comparison to the laparoscopic approach. Our study suggests that laparoscopic cholecystectomy should remain the first choice for patients needing gallbladder surgery.

The use of substances to improve sports performance is a widespread phenomenon among adolescents. Several anti-doping programs have been developed, mainly based on knowledge-based evidence. The main aim of the present study was to implement an anti-doping intervention in sports high school students, based on psychological framework, such as Socio-Cognitive Theory, through the development of a Serious Game (SG), i.e., a digital learning based on the game. The experimental design included an intervention group (n=167; F=37.7%; Meanage=17.5 years) and a control group (n=112; F=42%; Meanage=17.6). Both of groups completed the same questionnaire in two different occasions (i.e., time 1 and time 2), for measuring doping intention, self-regulatory efficacy to resist social pressure for the use of substances, moral disengagement, and doping knowledge. Data were analyzed through repeated measures of Group X Time ANOVA, demonstrating some degree of efficacy of the intervention, in particular, in terms of decrease of doping intention and the strengthening of doping knowledge. Moreover, we demonstrated that the score obtained during the implementation of the Serious Game partially could represent a coherent measure of the participants’ beliefs regarding doping. These results could be considered a starting point for future research to better develop technological anti-doping interventions.

Background: Health management is gaining importance as a business resource to enhance employee well-being. The rise of remote work during COVID-19 impacted lifestyle habits. This study explores the impact of tele-exercise intervention on remote workers' lifestyle habits, aiming to improve health and productivity. Methods: This study divided into remote (G1) and face-to-face (G2) groups. Over three months, G1 followed a 30-minute weekly exercise program. Measurements and questionnaires were collected at three time points covering areas like presenteeism, weight, sleep, stress, job satisfaction, and happiness. Data underwent Two-way repeated measures ANOVA, Autocorrelation, Correlation Analysis, and Correspondence Analysis to assess differences and relationships between G1 and G2. Results: ANOVA showed that a significant difference was observed in Daily Stress (DS) between G1 and G2, with G1 exhibiting higher DS. Autocorrelation Analyses showed for G1 that strong relationships each of BMI, Presenteeism (PST), Daily Stress (DS), Stress Relief (SR), Sleep Quality (SQ), Purpose of Work (PW), and Satisfaction of Life (SL) in the time frame. Correlation Analysis showed for G1 that the pairs of PRS and SQ, and DS and SL had strong positive relationships, and the pairs of BMI and PRS, and BMI and SQ had strong negative relationships. Autocorrelation Analyses showed for G2 that strong relationships each of SR, Stress due to Remote Work (SRW), ST, SQ, and PW in the time frame. Correspondence Analysis showed that that G1 was encompassed in a job and life satisfaction area, and G2 was encompassed in a sleep and stress for weight control area.

Introduction: Physiotherapy exercises administered to preterm infants in the NICU can enhance motor skills and expedite the discharge process for infants born before 30 weeks of gestational age. The research delves into the influence of physiotherapy programs on these preterm infants' activity and participation levels. Methods: The intervention group received a one-month physiotherapy program including massage around the mouth, mobilization and weight-bearing exercises, and massage therapy for the extremities, while the control group did not. The motor skills were evaluated by the Test of Infant Motor Performance (TIMP), Dubowitz Neurological examination, and Preterm Oral Feeding Readiness Scales (POFRAS). Results: There was a significant difference in The TIMP, Dubowitz Optimal Score, Type of Non-Invasive Ventilation, TIMP Range, and POFRAS scores in the physiotherapy group rather than the control group (p<0.05). There were no differences in the length of stay in the NICU, respiration rate, heart rate, body temperature, oxygen saturation, body weight on the evaluation day, body weight at discharge, head circumference at discharge between the groups (p>0.05) Discussion: We conclude that physiotherapy in NICU improves the motor outcomes, activity and participation in preterm infants rather than the body functions and structure like vital signs and infants’ body weight.

Introduction: The aim of our study was to assess the role of ECG-gated Coronary CT Angiography (CCTA) in the diagnosis, imaging follow-up, and treatment guidance in post-procedural/surgical interventions of the heart and thoracic aorta (PTCA, TAVI, PMK/ICD placement, CABGs).

Background: As a relatively high number of ST-segment elevation myocardial infarction (STEMI) patients develop major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI), our aim was to determine the significance, and possible predictive value of QRS complex width and ST-segment elevation. Methods: Our patient sample included 200 PCI-treated STEMI patients, which were divided into two groups, based on the duration of symptoms: (I) less than 6 hours, and (II) 6-12 hours. For every patient, ECG was performed at 6 different time points. Long-term follow-up lasted 6 years from the STEMI onset. Statistical analysis was performed. Results: The mean age was 60.6±11.39 years, and 142 were male. Wider QRS complex, more pronounced ST-segment elevation, and more frequently absent ST-segment resolution were more common in the second group. Presentation of MACE was more frequent in this group. An increase of pre-PCI QRS complex width by 1 msec increases the risk of 6-year MACE by 3%, and an increase in pre-PCI ST-segment elevation by 1mm increases the risk of 6-year MACE by 3.26 times. Conclusion: To the best of our understanding, this study represents a pioneer research that utilized these ECG elements in the context of predicting a 6-year MACE. A wider QRS complex and a more pronounced ST-segment elevation were associated with longer total ischemic time. More research is needed to confirm these findings.

Headache is considered to be one of the most common causes of medical treatment and evaluation worldwide in both acute and outpatient settings. It is the most common neurological symptom seen worldwide affecting all genders, ages, ethnicities, and socioeconomic levels. It’s impact is noted in educational decline in school-aged children and decreased productivity through sick leave in adults. Its overall burden is well documented in well-resourced countries but limited data is seen low resourced countries. While many underlying causes bring about secondary headaches, primary headaches and more specifically migraines have been more widely explored. Migraines have a distinct criterion that is inclusive of one day duration (4 hours to 7 days, unilateral distribution, nausea and vomiting and disability as a few examples. However, migraines can vary and proper documentation through a migraine diary can help to guide treatment. Management of migraines can vary. Lifestyle modification is a key factor in the overall prevention and reduction of triggers in migraines. In addition to this, pharmacotherapy can be given in a tier-based approach based on overall severity and frequency of the migraine. Interventions have progressed from botox injection and have seen the advent of new medications such as nasal sprays to novel formulations of pre-existing drug formulations. Nonetheless, there is great room for further studies of headaches and migraines. Research specifically in low-resource countries can prove to beneficial.

Abstract: Cherubism is a rare genetic disorder characterized by painless bilateral expansion of the mandible and maxilla. We present an unusual case of a 50-year-old female patient with Ramon syndrome, a rare variant of cherubism, accompanied by gingival fibromatosis. The patient exhibited symptoms of short stature, mental retardation, rheumatoid arthritis, epilepsy, hirsutism, and gingival enlargement. Clinical examination revealed generalized gingival inflammation with plaque and attachment loss. Radiographically, bilateral defined multilocular radiolucencies were observed in the mandibular body and ramus. The patient underwent a non-surgical phase, including oral hygiene motivation and periodontal debridement, followed by a surgical phase involving gingivoplasty and internal bevel gingivectomy with open flap debridement. Histopathological analysis confirmed the presence of fibroblasts, multinucleated giant cells, and fibrous connective tissue. The patient's son also presented with bilateral facial swelling and similar radiographic findings, indicating familial inheritance of cherubism. The case demonstrates the clinical, radiographic, and histopathological features of cherubism associated with gingival fibromatosis and highlights the challenges in diagnosis and management. Regular follow-up and maintenance are essential for long-term stability and prevention of recurrence. This report contributes to the limited literature on cherubism in older patients and emphasizes the importance of early identification and intervention in affected individuals.

Physical activity (PA) is a modifiable factor that may have an influence on the course of Parkinson’s disease (PD). This study aimed to apply a simple behavioral intervention to encourage PD sufferers to increase their everyday physical activity and assess which parameters of motor functions will be improved. The research covered 50 PD patients (28 men and 22 women) aged 40-81 years (65.38 ± 9.23), with a duration of the disease 2-4 years, in stages 1-3 on the Hoehn and Yahr scale. The patients were randomly divided into two groups: the experimental group with behavioral therapy, and the control group without intervention. During 12 weeks the patients from the experimental group had five phone conversations. Each conversation lasted 15 minutes and was an interview about the subjects’ physical activity in the last month. The results were assessed by the Timed Up and Go test (TUG), Unified Parkinson's Disease Rating Scale (UPDRS) – part III, FIR (Functional Index “Repty” – own modification of Functional Independence Measure (FIM)), Functional Ambulation Category (FAC) and International Physical Activity Questionnaire (IPAQ). The results showed that spontaneous physical activity increased in the experimental group and motor functions improved. Physical activity improvement depended on age, body mass index, and gender.

Purpose: This study evaluates the performance of the Early Intervention Physiotherapist Framework (EIPF) for injured workers. This study provides a proper follow-up period (3 years) to examine the impacts of the EIPF program on injury outcomes such as return to work (RTW) and time to RTW. This study also identifies the factors influencing the outcomes. Methods: The study was conducted on data collected from compensation claims of people who were injured at work in Victoria, Australia. Injured workers who commenced their compensation claims after the first of January 2010 and had their initial physiotherapy consultation after the first of August 2014 are included. To conduct the comparison, we divided the injured workers into two groups: physiotherapy services provided by EIPF-trained physiotherapists (EP) and regular physiotherapists (RP) over the three-year intervention period. We used three different statistical analysis methods to evaluate the performance of the EIPF program. We used descriptive statistics to compare two groups based on physiotherapy services and injury outcomes. We also completed survival analysis using Kaplan-Meier curves in terms of time to RTW. We developed univariate and multivariate regression models to investigate whether the difference in outcomes achieved after adjusting for significantly associated variables. Results: The results showed that physiotherapists in the EP group on average dealt with more claims (over twice as many) than those in the RP group. Time to RTW for the injured workers treated by the EP group was significantly lower than for those who were treated by the RP group, indicated by descriptive, survival and regression analyses. Earlier intervention by physiotherapists led to earlier RTW. Conclusion: This evaluation showed that the EIPF program achieved successful injury outcomes three years after implementation. Motivating physiotherapists to intervene earlier in the recovery process of injured workers by initial consultation helps to improve injury outcomes.

The prevalence of Noncommunicable Diseases (NCDs) in South Africa is increasing annually, with the burden projected to escalate by 2030. Devastatingly, factors such as lifestyle changes, urbani- sation, and an aging population significantly contribute to a rising burden of Cardiovascular disease (CVDs), diabetes, and cancer which directly impact the mortality and morbidity rates seen in South Africa. Recognising this, the South African government has seen the need for emphasis on developing policies and interventions tar- geting physical inactivity to prevent and manage NCD, particularly cost-free and easy to administer training protocols. However, phys- ical inactivity remains a significant issue, leading to various health concerns in rural communities, including injuries and Fetal Alcohol Spectrum Disorders (FASD). Despite effort to promote physical ac- tivity, the prevalence of NCDs continues to rise, necessitating target- ed interventions to ensure equitable healthcare among South African citizens. On the Contrast, preservation and promotion of traditional games is vital as they offer indigenous populations accessible and culturally relevant means to maintain health and wellness. In this regard, it is important to recognize the importance of preserving and promoting traditional games as they potentially serve as a method for indigenous people to maintain their health and wellness in a way that is accessible and culturally relevant to them. These games have gained popularity in South Africa, with initiatives underway to show- case them globally fostering cultural exchange. Further, revitalizing and conserving these games can cultivate a culture of health and wellbeing in South Africa.

This work deals with a systematic review of literature data concerning the theme of the integrated approach to occupational health and safety management, with particular reference to the programming of assistance plans, which guide the company's organizational choices also by aiming at the principles of the Total Worker Health. In the current regulatory framework on this issue, the UNI ISO 45001: 2018 standard assumes particular relevance, which defines the dynamic approach to occupational health and safety management systems, paying particular attention to external contextual factors that may influence corporate organizational decisions. The adoption of these systems is not mandatory, but allows companies to fulfill their duties in terms of health and safety at work, through an organizational approach aimed at awareness, involvement and participation of all subjects of the company prevention system, overcoming the phase of the mere technological and prescriptive approach, towards a holistic vision of prevention, which places the person at the center of preventive actions. In this context, the role of institutional networks and socio-economic partnerships assumes particular importance, in the activation of territorial assistance interventions to support companies for the improvement of risk management levels. To this end, the importance of verifying the effectiveness of assistance interventions emerges from the scientific debate, through the use of indicators such as quantitative ones for measuring the performance of all phases of the intervention with particular attention to the effects in terms of improved solutions developed.

Background: This study aimed to develop and evaluate a dietary self-care promotion program for hemodialysis patients based on Hurley's self-efficacy model. Methods: The needs of hemodialysis patients were identified, and an online community-based dietary self-care promotion program was developed with expert evaluations. 44 hemodialysis patients were randomly assigned to an experimental group (n=22) and a control group (n=22). The program was applied to the experimental group for four weeks. Before and after the intervention, as well as four weeks after the intervention, dietary self-efficacy, dietary self-care behavior, interdialytic weight gain, serum phosphorus, and serum potassium were assessed in both groups. Results: Significant differences over time and between groups were observed in dietary self-efficacy, interdialytic weight gain, serum phosphorus, and serum potassium. The interaction between time and group was also significant. While no significant differences were found over time in dietary self-care behavior, significant group differences and interaction effects between time and group were identified. Conclusions: The results indicate that the dietary self-care promotion program using an online community for hemodialysis patients is more effective in enhancing dietary self-efficacy and dietary self-care behavior compared to conventional treatment. This suggests the clinical applicability of the proposed dietary self-care promotion program.

Background The prognostic value of estimated pulse wave velocity (ePWV) has been infrequently explored in high-risk patient groups. Our study aimed to evaluate the prognostic significance of ePWV among patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Methods A total of 4,119 consecutive subjects who underwent PCI with DES (mean age, 67.1 ± 11.6 years and 33.1% were female) were retrospectively analyzed. ePWV was calculated based on the patient’s age and mean blood pressure. Major adverse cardiovascular event (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke, were evaluated. Reults During a median follow-up duration of 3.51 years (interquartile range, 1.35 ~ 6.37 years), there were 746 MACE (18.1%). Multivariable analysis showed that higher ePWV was associated with higher MACE incidence (middle tertile vs. the lowest tertile: hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.81-3.42; P < 0.001; the highest tertile vs. the lowest tertile: HR, 6.18; 95% CI, 4.33-8.80; P < 0.001) The inclusion of ePWV data significantly increased the global chi-square values when added to the clinical information (from 96 to 128; P < 0.001). Conclusion ePWV demonstrated a significant association with MACE in patients who underwent DES implantation. Given its relative simplicity to calculate, ePWV could potentially serve as a valuable instrument for stratifying cardiovascular risk within this high-risk patient population.

In response to a threefold increase in osteoporotic vertebral fractures (OVF) at our institution over the past decade and the subsequent development of new fractures within a year in a third of cases, we evaluated the effectiveness of STIR MRI scans in conjunction with CT scans for initial OVF diagnosis. This study, conducted over five months, involved full spine sagittal STIR MRI scans alongside CT scans for patients over 50 with minor injury-related vertebral fractures. The independent assessments by radiologists and neurosurgeons of 64 patients revealed that while CT scans identified 161 fresh fractures, of which only 68 were previously reported, MRI detected 266 fractures, 1.65 times more than CT. CT scans showed single fractures in 27% of patients and multiple fractures in 73%, whereas MRI identified single fractures in 9% and multiple fractures in 91% of patients. Additionally, MRI demonstrated a 1.5-fold increase in adjacent fracture detection. The use of MRI influenced treatment plans in 67% of cases. Given these findings, we advocate for including a STIR MRI of the entire spine alongside CT scans in OVF cases, as it significantly enhances fracture detection and can alter treatment strategies.

Objective: To evaluate the effect of propofol combined with psychological intervention on pain and emotional evaluation in painless colonoscopic colonic polypectomy patients undergoing endoscopic mucosal resection (EMR).Methods: A total of 80 patients who underwent painless colonoscopic colonic polypectomy with EMR treatment between June 2020 and June 2022 were selected in order of admission and divided into two groups. The control group received conventional analgesia, while the observation group received propofol combined with psychological intervention. Pain visual analog scale (VAS) and emotional scale were used to evaluate pain and emotions in both groups of patients. Adverse reactions and clinical efficacy were also compared between the two groups.Results: The two groups of patients were generally comparable with no significant differences (P > 0.05). The VAS score in the observation group was significantly lower than that in the control group (P < 0.05), and the emotional scale score was also improved compared to the control group (P < 0.05). The number of patients with adverse reactions in the observation group was less than that in the control group. The clinical effective rate in the observation group was significantly higher than that in the control group (P < 0.05).Conclusion: Propofol combined with psychological intervention can effectively alleviate pain and improve emotional status in painless colonoscopic colonic polypectomy patients undergoing EMR treatment, thereby increasing the comfort and success rate of the surgery. The number of patients with adverse reactions in the observation group was less than that in the control group, and the clinical effective rate in the observation group was significantly higher than that in the control group (P < 0.05).

The sympathetic restoration and conservation of built cultural heritage play a significant role in the management and preparedness for future climate scenarios by facilitating adaptive reuse, enhancing cultural resilience, preserving traditional knowledge, and boosting tourism. The importance of restoring damaged heritage sites after an earthquake drew international attention to Nepal after the 2015 Gorka Earthquake. UNESCO established an office in Kathmandu to promote the restoration of tangible and intangible heritage in the area. This included developing structural analyses of buildings with historical and cultural value that due to their nature cannot be intervened with the same methodology as modern buildings. In this paper, the case study of the earthquake-damaged Gopinath temple, is discussed. First, an initial visual inspection phase and the following diagnosis of the structure are discussed. Then, the results from a series of static and dynamic structural analyses performed to determine the safety level of the structure, together with a sensitivity analysis, are presented. A sympathetic intervention proposal capable of increasing the temple safety level and based on the addition of timber plates, has resulted in substantial improvements of the lateral behavior of the structure. The proposed intervention is deemed sustainable and able to increase the resilience of the temple in the face of future hazards.

Background: Best Possible Medication History (BPMH) collected by clinical pharmacists is crucial for effective medication review but, in Italy, it is often left to the nursing staff. This study aims to compare the quality and accuracy of a clinical pharmacist-documented BPMH with the current standard practice of ward staff-collected BPMH at an Italian perioperative surgical setting. Methods: A 20-week prospective observational non-profit study was conducted in a major University hospital. The study comprised a feasibility, an observational, and an interventional phase. During the feasibility phase, 10 items for obtaining a correct BPMH were identified. The control group consisted of retrospectively analyzed BPMHs collected by the ward staff during the observational phase, while interventions included BPMHs collected by the clinical pharmacist during the third phase. Omissions between the two groups were compared. Results: 14 (2%) omissions were found in the intervention group, compared with 400 (57.4%) found in the controls (p<0.05); data collection was more complete when collected by pharmacists compared to the current modalities (98.0% versus 42.6%; p<0.05). Conclusions: The involvement of a pharmacist significantly reduced the number of omissions in perioperative surgical-collected BPMHs. This intervention holds the potential to decrease the risk of medication errors associated with inaccurate or incomplete BPMHs prior to surgical hospitalization.

A clinical simulation web-based program, known as FIRST2ACT (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends) is designed to increase the efficacy of cli-nicians’ actions in the recognition and immediate response to a patient’s deterioration. This study, which was nested in a larger mixed method project, used ten focus groups (n=65) of graduate, enrolled, registered nurses, Associate Nurse Unit Managers, and general manag-ers/educators/coordinators from four different institutions to investigate whether nurses felt their practice was influenced by participating in either a face-to-face or web-based simulation educa-tional programme about patient deterioration. Results indicate individuals who were less ‘tech-savvy’ appreciated the flexibility of web-based learning, which increased their confidence. Face-to-face students appreciated self-reflection through performance evaluation. While face-to-face simulations were unable to completely duplicate symptoms, they did show nurses' adaptability. Both interventions enhanced clinical practice by improving documentation and re-plies while also boosting confidence and competence. Web learners initially experienced tech-related anxiety, which gradually subsided, demonstrating healthcare professionals' resilience to new learning approaches. Overall, the study highlighted the advantages and challenges of web-based and face-to-face education in clinical practice, emphasising the importance of adapta-bility and reflective learning for healthcare professionals. Further exploration of specific topics is required to improve practice, encourage knowledge sharing among colleagues, and improve early detection of patient deterioration.

In this paper, we consider an economy, in which consumers exhibit unrealistic optimism, and show that such an economy is more likely to undergo early recessions and underinvestment rather than experiencing bubbles or overinvestment. In this model, each consumer incorrectly believes that a negative aggregate preference shock will hit all other consumers, but not herself. When consumers have such an unrealistic optimism, the output price must fall prematurely before the aggregate shock occurs. The reason is that if the price does not plummet today, all consumers would postpone making purchases by falsely expecting that an arbitrage opportunity will arise in the future when the aggregate shock hits the economy, in which case, the output market cannot clear. We also show that the government has the potential to improve welfare of the economy by providing subsidies, if the government judiciously selects the right timing for intervention.

The article discusses early diagnosis and intervention for developmental delays in children, emphasizing the role of specialized services and personnel in supporting recovery and development. It presents findings from a pilot project initiated in Bucharest, aiming to assess the incidence of developmental delays in children aged 1-3 years in selected kindergartens, including ASD. The study involved children, parents, and specialists, utilizing systematic behavior observation (SBO) and semi-structured interviews. Results indicate that out of 613 evaluated children, 81 received specialized control recommendations, with 4 cases showing potential risk of ASD. Additionally, 8 children were diagnosed with autism. The incidence of autism in children aged 1-3 years was 1 in 51. Although exploratory, these findings suggest a model of good practice for future early diagnosis campaigns nationally. Conclusively, the study underscores the importance of early diagnosis and intervention for developmental delays, advocating for a responsive community and emphasizing the significance of national-level efforts to address these issues effectively.

Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment ele-vation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital car-diac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges.

Undernutrition and micronutrient deficiencies such as anemia are considered significant public health challenges in Bangladesh, which enhancing fish consumption is a well-established food-based intervention to address these. This paper documents the establishment of community-based fish chutney production and reports the impact of its consumption on mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels among targeted 150 pregnant and lactating women (PLW) in rural Bangladesh. A fish chutney was developed using locally available ingredients followed by a series of laboratory tests, including nutrient composition, shelf-life and food safety. A community-based fish chutney production process was designed to: 1) supply locally available ingredients for processing; 2) establish two fish drying sites; 3) initiate a community-based production site, and 4) distribute fish chutney to PLW by six women nutrition field facilitators for one year. Then a pre- and post-intervention study was designed for a selected 150 PLW to receive 30g of fish chutney daily for 12 months. Differences in mean mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels pre- and post-consumption were analyzed using one-way analysis of variance. Consumption of 30g of fish-chutney resulted in significant increases of the mean values of Hb levels and MUAC among the targeted PLW.

The most important prognostic factors in curatively treated prostate cancer at the initial diagnosis are T and N stage, histological subtype, Gleason score, initial PSA, PSA density and percentage of core biopsy positivity. Newer, but non-standard prognostic factors are urine PCA3 and genetic markers of prostate cancer. A simple, but seemingly underestimated standard test is serum Calcium (Ca) level, which has been shown by a previous study group to be a good predictor of lethal prostate cancer, but there is scarce evidence regarding the prognostic value of calcium levels at diagnosis. We aimed to determine whether a Ca level in the upper part of normal values has a prognostic value in curatively treated prostate cancer. We have retrospectively included 84 consecutive patients with prostate cancer, who underwent curative radiotherapy (primary or adjuvant; external beam RT with or without brachytherapy). We have performed statistical analysis of available prognostic factors. Ca level at diagnosis was found to be a statistically significant predictor of disease-free survival.