Public Health and Healthcare

Abstract: The authors examined the psychophysiological effects before and after the treatment with the aim of clarifying the effects on the mind and body of continuous treatment on the head (hereinafter referred to as head-therapy). As a result, psychologically, negative emotions such as fatigue, stress awareness, depression, and anxiety decreased significantly immediately after the treatment, and positive emotions such as a feeling of clarity of mind, concentration, and exhilaration were significantly increased. Thirty minutes after the treatment, these positive emotions were even higher. Physiologically, immediately after the head-therapy, the parasympathetic nervous system activity was significantly higher than before the treatment. On the other hand, no noticeable changes were observed in central nervous system activity. Furthermore, 30 minutes after the head-therapy, the parasympathetic nervous system activity dominant state seen immediately after the treatment was maintained. It was suggested that the central nervous system activity, which did not show significant changes immediately after the treatment, was more active than before the head-therapy.

Abstract: Background:Mixed methods reviews are increasingly used to address complex healthcare and social research questions; however, their methodological diversity has led to fragmentation in terminology, design, and execution. This lack of clarity presents challenges for both methodological choice and reproducibility.Aim:To systematically map and critically examine the range of mixed methods review approaches, with a focus on their methodological characteristics, integration processes, and operational guidance.Methods:A scoping review was conducted to identify methodological papers and applied examples of mixed methods reviews. To be included, studies had to primarily identify instructional content on how to undertake a mixed methods review, including information on integration or synthesis of data. Data were extracted on review type, synthesis processes, integration mechanisms, data transformation, and use of frameworks or guidance tools. Findings were analysed using an extraction map which provided the basis for synthesis of information.Results:Ninety-two methodological contributions were identified. A wide range of review types were identified, including realist, meta-narrative, mixed methods systematic, integrative, framework, rapid, scoping and QCA-informed approaches. Mixed methods systematic reviews and framework synthesis approaches were the most identified approaches. Despite this diversity, four dominant integration mechanisms emerged: narrative, comparative, mapping-based, and mixed-evidence integration. Operational clarity varied substantially, with theory-driven and structured approaches (e.g., realist synthesis, QCA) demonstrating clearer procedural guidance than integrative and rapid approaches. Iterative processes and theoretical engagement were key differentiators between descriptive and explanatory review outputs.Conclusion:Mixed methods review approaches are characterised by both methodological richness and conceptual fragmentation. Greater emphasis is needed on standardising reporting, clarifying integration and transformation processes, and aligning methodological choices with review purpose. This review provides a structured framework to support methodological decision-making and enhance transparency in mixed methods evidence synthesis.

Abstract: Background/Objectives: In the Democratic Republic of the Congo (DRC), cervical cancer (CC) ranks as the leading gynecological cancer. This study assesses the physicians’ knowledge and clinical practices regarding CC screening in both university and non-university hospitals across four provinces in the northeast of the country. Methods: This cross-sectional study was conducted from April 15, 2025 to June 15, 2025, in Kisangani, Buta, Isiro, and Bunia, the respective capitals of the provinces of Tshopo, Bas-Uele, Haut-Uele, and Ituri, in the DRC. We collected data using a self-administered questionnaire completed by 26 physicians from university hospitals and 106 physicians from non-university hospitals. Data analysis was performed using R software, version 4.3.2. Results: Of the 175 eligible physicians, 132 (75.4%) were surveyed. Regardless of the hospital where they worked, respondents demonstrated similar knowledge regarding most CC screening modalities. However, physicians working in university hospitals had significantly better knowledge of the targeted age range (p-value=0.001). Overall, 41 respondents (31.1%) had sufficient knowledge. Physicians at university clinics and those living in Bunia/Ituri province (p-value=0.047 and p-value=0.017 respectively) were more susceptible to have sufficient knowledge. In both university and non-university hospitals, the majority of physicians (57.7% and 49.1% respectively), reported having screened 1–10 women in the previous 12 months, using the VILI (57.7 % and 32.1% respectively). Good screening practices were observed in six participants (4.5%), including some obstetrician-gynecologists (p-value=0.037). Conclusion: Most physicians in northeastern DRC lack adequate knowledge of CC screening, and their screening practices remain suboptimal. Improving their knowledge and clinical practices may require stronger involvement from obstetrician-gynecologists and university hospitals, as well as a cooperation with experienced healthcare providers from other provinces or neighboring countries.

Abstract: Modern nutritional science, aims to provide information reffering to mechanisms of production of specific food components, and their implications on human body. In respect of daily diet, for diseases prevention and for health promotion, of nutritional biotechnologies play a great role For the purpose of healthy and safety food production in diet, recent discoveries in gene science are making it possible to manipulate the components in preparing foods, using also nanotechnology methods. This research direcyin is important for applicability in medical practice, for diseases prevention.

Abstract: Adolescence is a sensitive period for anxiety symptoms, yet evidence on repeated forest therapy in secondary-school populations remains limited. This school-based quasi-experimental pilot study examined acute affective responses and follow-up anxiety-symptom trajectories after four therapist-guided forest therapy sessions in a coastal pine forest. The primary analytical sample comprised 24 intervention-classroom and 28 usual-activities control-classroom students aged 17–18 years. Anxiety symptoms were assessed with the Spence Children’s Anxiety Scale (SCAS) at baseline and four follow-ups over approximately eleven weeks; acute mood was assessed with the Profile of Mood States—Adolescents (POMS-A) before and after each session. SCAS reductions were directionally larger in the intervention classroom at every follow-up. The largest baseline-adjusted difference occurred at the eight-to-nine-week assessment (coefficient = −5.30 points, 95% confidence interval [−10.69, 0.09]; two-sided p = 0.054) and attenuated at the final follow-up. Acute total mood disturbance improved most clearly during the third scheduled session (mean improvement = 9.75, false-discovery-rate-adjusted q = 0.002, Cohen’s dz = 1.26). Exploratory analyses suggested larger differences at higher baseline anxiety, whereas school-performance and post-intervention nature-connectedness outcomes did not parallel the anxiety pattern. These preliminary findings support feasibility and justify preregistered, cluster-randomized studies with active comparators.

Abstract: Background: To compare biochemical, micronutrient-related and complete blood count (CBC)-derived inflammatory profiles among children with obesity, undernutrition and normal weight, and to explore the discriminatory performance of selected routine laboratory markers for the obesity phenotype. Methods: In this single-centre retrospective comparative study, medical records of children aged 2–17 years evaluated between January 2023 and December 2025 were reviewed. Participants were classified as obese, undernourished or normal weight using World Health Organization (WHO) body mass index-for-age (BMI-for-age) references. Liver enzymes, lipid parameters, iron-related indices, micronutrient levels, zinc, insulin and CBC-derived inflammatory indices were compared across groups using non-parametric omnibus tests. Exploratory receiver operating characteristic (ROC) analyses were performed for selected markers. Results: A total of 690 children were included: 100 with obesity, 90 with undernutrition and 500 with normal weight. The obesity group was significantly older than the normal-weight group (median 11.0 vs 7.5 years; P < 0.001). Obesity was characterised by higher alanine aminotransferase (ALT), insulin, triglycerides, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), together with lower high-density lipoprotein (HDL) cholesterol, 25-hydroxyvitamin D [25(OH)D] and aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratio (all P < 0.05). In age-unadjusted exploratory ROC analysis, the AST/ALT ratio showed the strongest discriminatory performance for obesity (area under the curve [AUC] 0.859; 95% confidence interval [CI] 0.823–0.895; optimal cut-off ≤1.52; sensitivity 77.0%; specificity 77.6%), followed by SIRI (AUC 0.751; 95% CI 0.700–0.802). Conclusions: Paediatric obesity was associated with a distinct liver enzyme-metabolic-inflammatory laboratory profile, whereas undernutrition exhibited a different micronutrient-biochemical pattern. Because the study was retrospective and age-unadjusted, these findings should be interpreted as exploratory and hypothesis-generating. Prospective studies with age-balanced sampling, pubertal staging and liver imaging are required before clinical implementation.

Abstract: Background/Objective: In the multifactorial genesis of asthma, environmental factors are critical, including sun exposure, either measured by sunshine hours (SH) or global solar surface irradiance (GSSI). The objective of this study is to estimate the association between sun exposure and the prevalence of asthma in Spanish schoolchildren (6-7 year-old) and adolescents (13-14 year-old) from 6 geographic centers of Spain (A Coruña, Bilbao, Canta-bria, Cartagena, Pamplona and Salamanca) included in the Global Asthma Network (GAN) study during the period 2016-2019. Methods: Measurements of SH and GSSI were obtained from the Spanish “Agencia Estatal de Meteorología”. A semi-individual design was used, and multilevel logistic regression models were employed with adjustments for age, sex, temperature, relative humidity and gross domestic product, considering center as the reference level. Results: Increments of SH and GSSI were associated with decreases of the prevalence of “asthma ever” in both the 6-7 and 13-14 year-old groups. An increase of 100 hours of an-nual sunshine was associated with a decline in “asthma ever” in schoolchildren (adjusted odds ratio [aOR] = 0.82; 95% confidence interval [CI] 0.79-0.85), and adolescents (aOR = 0.90; 95% CI 0.87-0.94). An increase of one kWh m-2 day-1 in GSSI was associated with a decrease in the prevalence of “asthma ever” in schoolchildren (aOR = 0.15; 95% CI 0.10-0.23) and adolescents (aOR = 0.37; 95% CI 0.25-0.54). Conclusions: The results suggest that sun exposure, either measured by SH or GSSI, might be a protective factor for the prevalence of asthma in schoolchildren and adolescents. This information could be useful in the prevention of this condition.

Abstract: Background/Objectives: Healthcare professionals are exposed to chronic occupational stress and allostatic overload, with significant consequences for both workforce well-being and healthcare system sustainability. Within the framework of the Health Promoting Hospitals and Health Services (HPH&HS) network, the Friuli Centrale Healthcare University Trust (ASUFC) progressively developed a dual-level salutogenic approach aimed at promoting healthcare professionals’ resilience and psychophysiological well-being through integrated organizational and individual-oriented interventions. The present study describes the theoretical rationale, organizational implementation, and preliminary findings associated with this approach. Methods: The study adopted a practice-based and non-randomized implementation design conducted in a real-world healthcare setting. The model integrated two complementary interventions: the Mindfulness-Oriented Professional Resilience (MOPR) program, a structured group-based educational intervention, and the “Aver cura di chi ci cura” (“Caring for Those Who Care”) service, focused on individualized psychophysiological assessment, lifestyle counseling, and respiratory biofeedback. Results: Across the different implementation phases, the interventions were associated with preliminary improvements in psychological well-being, stress regulation, autonomic functioning, and resilience-related processes, while also supporting the progressive development of integrated organizational well-being pathways within the healthcare system. Conclusions: Preliminary findings suggest that integrated salutogenic interventions combining scalable group-based training with individualized multidimensional support may represent a feasible organizational strategy for promoting healthcare professionals’ well-being within large healthcare systems. Further controlled and longitudinal studies are needed to clarify long-term effectiveness, mechanisms of action, and organizational impact.

Abstract: We performed a focused review to better understand the pathogenesis of Agent Orange (AO)-associated myelodysplastic syndrome (MDS). We first examined the mechanisms underlying conventional (de novo) MDS, a clonal hematopoietic neoplasm that typically develops in later life and integrated these findings with our recent analysis of obesity-associated carcinogenesis. Accordingly, we propose that genomic instability in de novo MDS results from selective inhibition of the DNA polymerase proofreading exonuclease. In obesity associated carcinogenesis, impaired AMP-activated protein kinase (AMPK) activity disrupts mitochondrial ATP production, increasing intracellular AMP concentrations. Elevated AMP selectively inhibits the proofreading exonuclease while preserving polymerase activity, allowing replication errors to escape correction, and become fixed as somatic mutations. Molecular studies demonstrate that AO-associated MDS exhibits essentially the same mutational profile as de novo disease despite arising after dioxin exposure in young, otherwise healthy military personnel. Because TCDD is highly lipophilic, it accumulates in adipose tissue and is released slowly over decades, producing sustained mitochondrial dysfunction, reduced ATP synthesis, and chronic elevation of intracellular AMP. We propose that this metabolic disturbance converges on the same end-point—selective inhibition of the proofreading exonuclease—thereby promoting mutagenesis and clonal evolution. Recent studies further strengthen the central role of proofreading by demonstrating that many mutations, including many found in MDS, previously attributed to spontaneous cytosine deamination, instead arise from DNA polymerase misincorporation of thymidine opposite cytosine, particularly at CpG dinucleotides, emphasizing the critical importance of fully active proofreading in preventing such misincorporations from accumulating as mutations in the genome of the cell.

Abstract: In the last two decades, there have been remarkable advances in the diagnosis and treatment of lung cancer, resulting in improved quality of life and increased survival. Despite that, lung cancer remains the leading cause of cancer death worldwide. The diagnosis, staging and management of lung cancer are dictated by guidelines that constitute a clear path for patients. However, the emotional and psychological challenges faced by patients with lung cancer may be overlooked and can affect the well-being of these patients. This can also negatively impact the patient adherence to therapy and the ultimate patient outcomes. In this article, we address the emotional and psychological manifestations in patients who are diagnosed with lung cancer. We highlight the importance of recognizing these symptoms early to ensure they are managed alongside the stressful and challenging lung cancer therapy, with the goal of improving the patients’ quality of life and general outcome.

Abstract: Background: Isometric resistance training (IRT) has emerged as a promising non-pharmacological intervention for blood pressure (BP) management. Although current hypertension guidelines primarily recommend aerobic and dynamic resistance exercise, growing evidence indicates that IRT is an effective, feasible, and time-efficient alternative. This narrative review summarizes the current evidence on the efficacy, physiological mechanisms, and clinical applications of IRT. We reviewed randomized controlled trials, systematic reviews, and meta-analyses evaluating the effects of different IRT modalities, including isometric handgrip (IHG), isometric wall squat (IWS), and isometric leg exercise (ILE), on BP in normotensive individuals, patients with hypertension, and those with cardiovascular disease. Results: IRT consistently reduces resting systolic BP by approximately 5–8 mmHg and diastolic BP by 3–4 mmHg, effects comparable to those achieved with first-line antihypertensive therapy and at least equivalent to those of other exercise modalities. These benefits have been demonstrated across normotensive and hypertensive populations and appear largely independent of age, sex, medication use, and the muscle groups involved. Preliminary evidence also supports the feasibility and safety of appropriately prescribed IRT in selected patients with ischemic heart disease and heart failure with preserved ejection fraction. Proposed mechanisms include improvements in endothelial function, nitric oxide bioavailability, autonomic regulation, oxidative stress, arterial baroreflex sensitivity, and myocardial efficiency. In conclusion: IRT is an effective, safe, and practical adjunct to lifestyle modification for BP control, particularly in older adults and individuals with limited ability to perform conventional exercise. However, further large-scale randomized trials are needed to define the optimal exercise prescription, clarify the underlying mechanisms, and establish the role of IRT in patients with cardiovascular disease.

Abstract: Background/Objectives: Anaphylaxis is a severe systemic allergic reaction that may compromise multiple organ systems and requires prompt recognition and treatment. In childhood and adolescence, food allergy is one of the leading triggers, and clinical presentation may vary according to biological factors, including sex. This study aimed to analyze sex-related differences in pediatric patients with suspected anaphylaxis treated in a tertiary hospital. Methods: A retrospective, observational, descriptive ep-idemiological study was conducted in the pediatric emergency department of a ter-tiary hospital in Madrid, Spain, between 2015 and 2022. Sociodemographic variables, clinical history, symptoms, triage level, Pediatric Assessment Triangle classification, suspected allergens, hospital admission, and final diagnosis were analyzed. Results: A total of 368 patients were included; 65.2% were boys and 57.3% were younger than five years. In the unadjusted analyses, several differences emerged between boys and girls—in pharyngeal involvement, diarrhea, triage priority, and the allergens egg and shellfish. However, none of these differences remained statistically significant once corrected for multiple comparisons. Tree nuts, cow's milk protein, and egg were the most frequently suspected triggers overall. Conclusions: After correction for multiple comparisons, no robust evidence of sex-related differences was found in clinical presentation, triage severity, short-term management, or suspected triggers. The novel contribution of this study is that several apparently plausible sex-related signals were not robust to multiplicity adjustment. Pediatric emergency nursing assessment and triage should therefore remain primarily guided by the child’s clinical presentation and severity rather than by sex alone, while future adequately powered studies should examine whether more subtle sex-related patterns have clinical relevance.

Abstract: Background: The clinical adoption of large language models (LLMs) in public healthcare faces a structural impasse. On one side stands the prohibitive capital expenditure of centralised high-performance computing infrastructure; on the other, the substantial privacy risks involved in routing sensitive patient data through third-party cloud APIs. Italian Local Health Authorities (Aziende Sanitarie Locali, ASL) operate hundreds of thousands of clinical workstations that remain idle outside peak administrative hours—an untapped computational reserve that, if put to use, could power local AI inference without any external dependency. Objective: We propose and evaluate OmniMed Federated, a decentralised, browser-native architecture that uses the WebGPU API and the WebLLM framework to build a self-organising peer-to-peer (P2P) network for LLM inference across institutional workstations. The primary goal is absolute data sovereignty: patient-identifiable information must never leave the institutional network perimeter under any operational condition. Unlike established federated approaches that require dedicated edge servers, containerised infrastructure, or native software installation, OmniMed Federated operates entirely within the browser on hardware already deployed in ASL workstation fleets—eliminating procurement overhead and enabling immediate institutional adoption without administrative privilege requirements. Methods: We designed an "Edge-First" orchestration layer that harvests idle compute cycles from existing clinical hardware without requiring software installation, administrative privileges, or infrastructure modification. A five-tier escalation model, managed by a lightweight PHP backend (OmniMed Backend Prototype), coordinates node discovery, task assignment, and graceful fallback. The system is optimised for the hardware homogeneity typical of Italian regional procurement frameworks, which produces predictable performance profiles across ASL workstation fleets. Results: A three-node experimental testbed operating on a shared institutional Wi-Fi network achieved a federated throughput of 19.5 tokens/second—a 137% improvement over single-node execution—while reducing peak per-node VRAM consumption by 62%. Node discovery latency was 140 ms. Patient data residency remained 100% local at all times. The system maintained operational continuity during simulated internet blackout conditions. Conclusions: A federated, browser-based compute-sharing model is technically feasible on existing NHS hardware and offers a scalable, GDPR-compliant pathway to meaningful AI capability in resource-constrained public health environments. The architecture described here is operationally live and openly accessible.

Abstract: Background: Indoor air quality (IAQ) represents a key public health and accessibility concern. Improving IAQ through policies and practices that reduce exposure to fragranced products and other indoor air contaminants may enhance accessibility and support equitable participation for individuals with MCS. Despite the widespread adoption of fragrance-free policies across sectors, evidence regarding their effectiveness remains limited. Methods: Using a mixed-methods design, we examined IAQ accessibility barriers and the effectiveness of fragrance-free policies in practice among sixty individuals with MCS across ten focus groups. Qualitative and quantitative data were collected in parallel, with thematic analysis conducted in NVivo. A structured IAQ and policy survey was administered to quantify reported experiences and policy impacts. Results: Approximately 63% of participants reported dissatisfaction with the indoor environments they encountered. Qualitative findings highlighted indoor environments as inaccessible, inadequately controlled, and associated with ongoing exposure to fragranced products as well as other indoor pollutants. These findings indicate that current approaches often fail to ensure accessibility, leaving individuals with MCS exposed and excluded from full participation in workplaces, healthcare settings, and other public spaces. Conclusion: Comprehensive fragrance-free policies incorporating source control, education, ventilation, and accountability mechanisms may reduce exposure while improving accessibility and inclusion across the built environment.

Abstract:

Background: Toxoplasma gondii infection during pregnancy may lead to congenital toxoplasmosis and serious pregnancy complications. In Kenya, however, toxoplasmosis is not screened during routine antenatal care, and there is limited local data on maternal seroprevalence and associated risk factors. This study determined the seroprevalence of T. gondii infection and examined its association with socio-demographic characteristics, awareness levels, and exposure behaviours among pregnant women visiting the antenatal clinic at Pumwani Maternity Hospital in Nairobi, Kenya. Methods: A cross-sectional study was conducted among 298 pregnant women consecutively recruited at Pumwani Maternity Hospital in Nairobi County between July and October 2025. Data on socio-demographic characteristics, knowledge, and exposure practices were collected using a pre-tested structured questionnaire. Blood specimens were obtained from consenting prenatal patients, and anti-T. gondii IgG antibodies were detected by indirect enzyme-linked immunosorbent assay (ELISA). Associations between seropositivity and risk factors were assessed using Pearson's chi-square or Fisher's exact tests, followed by multivariable logistic regression. Results: The overall anti-T. gondii IgG seroprevalence was 24.5% (73/298). In the adjusted analysis, unemployment (AOR = 2.95, 95% CI: 1.25–7.22; p = 0.02) and parity ≥4 (AOR = 3.25, 95% CI: 1.27–8.39; p = 0.01) were independently associated with seropositivity. Awareness of risk groups was associated with seropositivity in the univariable analysis but not independently after adjustment. Stratified analyses identified significant demographic differences in exposure practices, including consumption of undercooked meat in the third trimester of pregnancy (p = 0.021) and consumption of unwashed vegetables by pregnant women from Kamkunji Sub-County (p = 0.005). Parity of three (p = 0.007) increased the risk of infection. Conclusions: Approximately one-quarter (24.5%) of pregnant women showed evidence of exposure to T. gondii. Socioeconomic predictors, including unemployment, and obstetric history (parity ≥4) were independently associated with seropositivity, whereas awareness of risk groups showed only a univariable association that didn't persist after adjustment for confounders. Behavioural exposures varied across trimesters and regions, signalling a need for integrated antenatal education and food safety steps within a One Health framework. The results support integrating maternal health, food safety, and environmental health programs into Kenya's antenatal care to reduce the risk of congenital toxoplasmosis through a comprehensive One Health approach.

Abstract: Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection and hospitalization in infants. Nirsevimab, a long-acting monoclonal antibody, provides single-dose protection during the RSV season, but the effectiveness of prophylaxis programs depends on sustained parental acceptance and high uptake. This study evaluated changes in parental knowledge, perceptions, and willingness to accept nirsevimab across two consecutive RSV seasons in Emilia-Romagna, Italy. Methods: A prospective, multicenter, observational survey was conducted during the 2024–2025 and 2025–2026 RSV seasons. Parents or legal guardians of infants eligible for nirsevimab completed a semi-structured questionnaire during routine counseling in neonatal units. Survey 1 included 1042 respondents and survey 2 included 867 respondents. Sociodemographic characteristics, RSV awareness, knowledge and perception of nirsevimab, willingness to accept prophylaxis, trust in healthcare providers and the healthcare system, preferred information sources, and willingness to pay were compared between seasons. Results: Willingness to administer nirsevimab remained high and stable, 87.04% in survey 1 and 88.00% in survey 2. Awareness of RSV-related risks increased from 68.23% to 73.47% (p < 0.05), and correct identification of nirsevimab as an antibody increased from 65.93% to 71.74% (p < 0.01). Explicit refusal rose slightly from 2.21% to 3.81% (p < 0.05). In survey 2, acceptance was associated with higher education, awareness of RSV risks, perceived child susceptibility, confidence in efficacy, lower concern about side effects, trust in pediatricians and the healthcare system, and willingness to pay. Notably, acceptance in 2025–2026 was higher among infants born in September–December than among those born in January–March, indicating a late-season decline. Conclusion: Parental acceptance of nirsevimab remained high across two seasons. Future campaigns should address residual knowledge gaps, reinforce communication on safety and efficacy, and sustain high coverage throughout the entire RSV season, particularly among infants born in its final months.

Abstract: Background: Wastage as a Percentage of Issue (WAPI) is a widely used parameter for benchmarking blood product disposal rates and a quality indicator commonly reported across institutions and studies using various time frames. Because of the proportional calculation, the number of issued blood products is closely related to the statistical variability. Therefore, in this study, the aim was to evaluate the influence of reporting intervals across different blood components and to determine statistical reporting frequencies for transfusion medicine. Material and Methods: A three-year dataset from the institutional blood bank was used for testing. WAPI was calculated using different time intervals: weekly, monthly, quarterly, and yearly. Statistical reliability was evaluated in confidence interval–based analysis for precision. After the model was developed and the precision of the values was tested, independent verification was performed by the statistical department and an independent AI model. Results: The precision of the values demonstrated a volume-dependent pattern across blood components. WAPI calculations for high-volume products maintained high precision across all time intervals. A consistent ±1 % reliability was achieved in weekly reporting. Intermediate-volume products, such as fresh-frozen plasma, showed progressive improvement in stability with increasing aggregation and were highly reliable in monthly reporting. Apheresis platelet suspension required longer periods for stable reporting. Low-volume products showed greater variability over shorter intervals and were suggested for reporting on a quarterly or yearly basis. Discussion: Widening the time frame reduced variability and improved interpretability across all products. Reliability is primarily dependent on the issuance volume more than the reporting interval. Independent verification converged on the findings, supporting the robustness of the statistical methods. Equal reporting frequencies may not be appropriate for all blood components and are not recommended for quality improvement. Adapting reporting intervals according to product may improve the interpretability, comparability, and clinical utility of transfusion quality metrics.

Abstract: Background/Objectives: Children with spastic hemiplegic cerebral palsy commonly experience impaired upper extremity function, which limits daily activities and participation. Augmented reality (AR)-based rehabilitation has recently emerged as a promising adjunct to conventional therapy; however, evidence directly comparing AR with Bobath-based therapy remains limited. This pilot randomized controlled trial investigated the additional effects of AR-based upper extremity training combined with Bobath therapy on balance, motor development, and upper extremity function in children with spastic hemiplegic cerebral palsy. Methods: Twenty children with spastic hemiplegic cerebral palsy (GMFCS levels I–II) were randomly assigned to either an AR group (n = 10) or a Bobath group (n = 10). Both groups received conventional Bobath therapy for 40 minutes, three times weekly for four weeks. The AR group additionally received 15 minutes of AR-based upper extremity training during each session. Outcomes included the Korean Pediatric Balance Scale (K-PBS), Gross Motor Function Measure (GMFM-88), Quality of Upper Extremity Skills Test (QUEST), and Jebsen–Taylor Hand Function Test (JTHFT). Two-way mixed repeated-measures ANOVA and between-group comparisons of change scores were performed. Result: The AR group demonstrated significantly greater improvements in the QUEST total score than the Bobath group (mean change: 38.38 ± 18.72 vs. 9.59 ± 5.15, p < 0.001), with a significant time × group interaction (F = 21.99, p < 0.001, partial η² = 0.550). Significant between-group differences were also observed in all QUEST subdomains, including dissociated movement, grasp, weight-bearing, and protective extension (all p < 0.05). No significant group-by-time interactions were found for K-PBS, GMFM-88, or JTHFT outcomes (all p > 0.05), although both groups showed improvements in several functional measures over time. Conclusions: AR-based upper extremity training combined with Bobath therapy may provide additional benefits for improving the quality of upper extremity movement in children with spastic hemiplegic cerebral palsy. However, its effects on balance, gross motor function, and functional hand performance appear limited over a four-week intervention period. Larger randomized controlled trials with longer follow-up are warranted to confirm these preliminary findings.

Abstract: Purpose: To quantify income-related inequalities in the prevalence of major cardiometabolic diseases among Korean adults and to determine whether patterns differed by outcome and sex from 1998 to 2023.Methods: We conducted a repeated cross-sectional analysis of publicly available aggregate statistics from the Korea National Health and Nutrition Examination Survey. Age-standardized prevalence estimates by household income quintile, sex, outcome, and survey year were extracted for adults aged 19 years or older. Outcomes were obesity, hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia. We estimated low-minus-high income gaps, prevalence ratios, slope and relative indices of inequality, grouped concentration indices, and inverse-variance weighted trends with robust standard errors and false-discovery-rate adjustment.Results: The analysis included 1,355 records from 271 complete outcome-sex-year cells. In 2023, obesity showed the largest inequality: prevalence was 39.2% in the lowest-income quintile and 30.4% in the highest-income quintile, an 8.8-percentage-point gap. Among women, the obesity gap was 14.6 percentage points, and the relative index of inequality was 1.92. Hypertension, diabetes, and hypertriglyceridemia showed smaller low-income disadvantages, whereas hypercholesterolemia did not. The total adult obesity gap changed from -2.3 percentage points in 1998 to 8.8 percentage points in 2023.Conclusions: Korean cardiometabolic inequalities are disease-specific and sex-specific, dominated by widening obesity inequality among lower-income women.

Abstract: Background: Multiple chemical sensitivity (MCS), a recognized disability, is a chronic, multisystem condition in which exposure to common chemical substances provokes adverse health effects and functional impairment. Although population-level data and emerging clinical research support the pathophysiological basis of MCS, individuals living with the condition frequently encounter barriers to recognition and accommodation across employment, healthcare, and housing systems. This study examines patterns of accommodation requests, refusals, and associated socioeconomic impacts among adults living with MCS in Canada, with particular attention to how institutional recognition shapes access to supports. A national cross-sectional survey of 119 Canadian adults living with MCS was conducted between January and February 2021. Quantitative data were analyzed descriptively to assess accommodation requests, outcomes, employment status, income, and housing stability. Qualitative responses were analyzed thematically to contextualize participants’ experiences of disclosure, denial, and exclusion. Participants were predominantly female (87%) with post-secondary education (90%). Among participants who reported being unemployed (29%), 94% attributed it primarily to MCS-related limitations. Accommodation denial was common: 85% of respondents reported requesting accommodations, and 78% of those experienced refusals. On housing conditions, 52% reported living in unsafe housing (defined as housing with the presence of mould or symptom-triggering exposures), while 17% reported being homeless (e.g., moving frequently, personal vehicle, tent). The findings indicate that the lack of institutional recognition of MCS functions as a structural barrier to accommodation, contributing to health, economic, and social inequities. Addressing these barriers requires accommodation frameworks that prioritize functional accessibility and inclusion across employment and housing contexts.