Abstract: Background. Tuberculosis (TB) remains a major global health problem, and WHO central Africa region continues to bear the heaviest disease burden. Identifying and mapping high TB and MDRTB burden areas for targeted public health interventions was our objective. Methods. A region-wide eco-epidemiological study and a desk-review carried out with the use of medical records from TB diagnosis and care units in 12 health facilities located across the capital Libreville, Republic of Gabon, from January 1st through December 2022. Libreville is the region that bears the heaviest TB burden in Gabon. With the collaboration of the Agency for Space Studies and Observations (AGEOS, Gabon), collected data were transferred to and analyzed using Q.GIS software in order to develop satellite images. Results. In Libreville health region, there were 4,560 cases diagnosed in 2022, representing 77.9% of all cases in the country, with an annual incidence of 509 per 100,000. Spatial mapping of incident cases by county of residence showed that a large majority of the TB cases diagnosed at CHUL care center in 2022 were from Nzeng-Ayong (range: 36 -50 cases) and Owendo (26-35 cases), whereas higher TB incidence at Nkembo care center was at Nzeng-Ayong (range: 356-455 cases), Owendo (256-355 cases), followed by Nkembo, Akebe ville, Akebe Baraka, Akebe Plaine/plateau, Angondje, Angondje village, Charbonnages, Bikele, Pk11, Pk12, Pk9, Mindoube I, Mindoube II (66-255 cases), Sotega and Nkok (46-65 cases). Other counties accounted for less than 45 TB cases. Considering MDRTB cases, higher incidence was observed at Pk9 county, which accounted for 6 cases (14.6%), followed by Owendo, 4 (9.7%). Discussion. Findings suggest that Nzeng-Ayong and Owendo were high TB burden counties in Libreville in 2022, whereas Pk9 and Owendo counties were counties categorized as hotspots for MDR-TB. They should be subject to targeted to public health interventions in order to enhance TB control in Libreville.

Abstract:

Extremely low birth weight (ELBW) neonates (< 1000 g) contribute significantly to global neonatal and under-five mortality, with heightened vulnerability in resource-limited settings. The overall aim of this manuscript is to evaluate the survival outcomes and associated factors among ELBW infants in a resource-limited tertiary care setting in South Africa. This retrospective cohort study examined survival outcomes, causes of death, and associated morbidities among 192 ELBW infants admitted to Frere Hospital, South Africa (SA), between January 2020 and February 2025. Kaplan-Meier survival analysis and multivariable Poisson regression were used to identify predictors of mortality. Overall, 42% of neonates survived discharge. Common morbidities included respiratory distress syndrome (78%) and extreme prematurity (30%). Extreme prematurity (< 28 weeks) was associated with a markedly increased risk of mortality (adjusted IRR = 0.20; 95% CI: 0.08–0.53; p < 0.001), while caesarean section conferred a protective effect compared to vaginal delivery (adjusted IRR = 0.38; 95% CI: 0.23–0.64; p < 0.001). These findings support strengthening antenatal interventions, timely respiratory support, equitable access to neonatal intensive care, and protocols tailored to reduce neonatal mortality in resource-limited settings.

Abstract: Although the estimated TB incidence in Gabon has been declining, there have been challenges with treatment coverage, the HIV status documentation and the treatment outcomes. It is why the National TB Program (PNLT) conducted an innovative data review in Nkembo Health Treatment Center, Libreville, which manages more than 60% of Gabonese TB patients. Objective: since our hypothesis was that the Nkembo treatment center was struggling with the data mismanagement due to the workload, the objective was to assess data quality and identify aspects that need to be addressed to improve data quality, to inform more accurate estimates of disease burden and to improve patient management. Methods: the study used the data reconciliation method. This is a process that involves comparing and aligning data from multiple sources to ensure consistency, accuracy, and integrity. The primary purpose of data reconciliation is to identify and resolve discrepancies or differences between data sets and make them consistent. Using the "TB onion model", analysis identified data mismanagement as a key contributor to underreporting. A data review compared TB registry data with patient folders from January to August 2023. A third data source used was TB medicine registry. The study focused on notified TB cases, HIV status documentation, and TB treatment outcomes. Discrepancies were reconciled, and treatment outcomes re-evaluated. Results: the review significantly improved the programmatic performance concerning the targeted indicators. The number of TB cases increased by 22%, from 2156 to 2623. Documented HIV status increased by 141%, from 730 to 1762. And the successfully treated cases increased by 104%, from 824 to 1678. Discussion: This data reconciliation showed the usefulness of triangulation across data sources to improve completeness of data. Also, current reported data underestimate the number of reported cases, documentation of HIV status, and treatment success. Conclusion and Recommendations: Data reconciliation exercises should be continued in Nkembo and other high-burden facilities. Reviewing data recording procedures and extending data improvement initiatives are crucial for accurate reporting and effective TB management in Gabon.

Abstract: Background: Compassion is a cornerstone of woman-centred maternity care and a critical determinant of women’s experiences of childbirth. When dignity, empathy, and effective communication are upheld, women perceive childbirth as safe, empowering, and affirming. However, evidence from many settings highlights the persistence of disrespect, neglect, and abuse during facility-based intrapartum care, undermining trust in health services and contributing to poor maternal outcomes. Objectives: This scoping review explored and synthesized evidence on women’s experiences and per-ceptions of care, with a focus on how compassionis are experienced and enacted in healthcare settings. Methods: A systematic search was conducted across EBSCOhost databases, ScienceDirect, CINAHL, PubMed, Web of Science, Medline, and PsycINFO. Fifteen studies met the inclusion criteria. Data was charted and thematically analyzed to identify the role of compassion and related interpersonal factors in shaping wom-en’s intrapartum experiences. Results: The review of fifteen studies identified two main themes and 12 sub-themes related to childbirth experiences. Compassionate care, characterized by respect, empathy, effective communication, and support for autono-my, led to positive childbirth outcomes and encouraged future use of health services. Conversely, care encounters lacking relational elements, including neglect, mistreat-ment, discrimination, and unconsented care, resulted in feelings of humiliation and disempowerment, discouraging women from seeking facility-based care in future. Conclusion: Compassion during intrapartum care is both a fundamental human right and an essential component of quality maternal health services. Addressing persistent mistreatment requires systemic reform, provider training in compassionate, rights-based care, stronger accountability, and the active inclusion of women’s voices in shaping maternity services.

Abstract: Objective: The implications of strictly vegan diets during pregnancy remains insufficiently understood, we aimed to determine the impact of specific components of vegan diet on pregnancy outcomes, with particular emphasis on ne-onatal birthweight. Methods: This secondary analysis of a prospective observational study included women with singleton pregnancies who delivered at a single medical center and adhered to a consistent diet. Participants were classified as vegan or non-vegan and reported demo-graphic data and supplement use. During the third trimester, women completed a validated Food Frequency Questionnaire. Pregnancy outcomes were retrieved from a computerized database. SGA was defined as birthweight < 10th percentile. Results: Among 230 participants, 54 followed a vegan diet. Vegan diet had lower protein intake (60 vs. 82 g/day, p < 0.001). Higher protein percentage was associated with lower risk of SGA (RR=0.8, 95% CI: 0.673-0.956, p < 0.014). Amino acids profile differed significantly, with Leucine showing the strongest association with birthweight (p=0.003). vegan diets included higher carbohydrate (256 vs. 217 g), fiber (48 vs. 30 g), folate (627 vs. 416 µg), and iron (17 vs. 12 mg) intake, and lower fat (72 vs. 79 g), calcium (764 vs. 1053 mg), vitamin D (0.24 vs. 5.5 µg), vitamin B12 (1.5 vs. 4.6 µg), DHA (0 vs. 0.07 g), and choline (270 vs. 394 mg) (all p< 0.05). Conclusions: Vegan diet during pregnancy may increase the risk of SGA, possibly due to inadequate protein intake and composition, particularly leucine. Vitamin D, calcium, B12, and choline deficiencies are more common in vegan pregnant women.

Abstract: Background: In response to the growing emotional support needs of patients in oncology, peer support was introduced into clinical teams in Quebec, Canada in 2018. These peers, called accompanying patients (APs), are former cancer patients who use their experiential knowledge to provide support to patients during their oncology trajectory. This paper aims to identify APs' perceptions on the program and compare the perspectives of inexperienced and experienced APs, APs in different facilities, and APs in different cancer programs. Methods: We conducted a qualitative cross-sectional study based on 12 semi-structured interviews of APs between June and August 2024 in Quebec, Canada. We explored four themes, building on the Practice Change Model for qualitative analysis: APs’ sources of motivation, influences and environmental factors, resources available for AP integration, and the program’s effects. Results: 12 APs from 5 different facilities participated in an interview. All the APs, both experienced and inexperienced, were highly motivated to participate in the program. Their motivations included a desire to give back to society, to help people and to give meaning to their illness. Both experienced and inexperienced APs were confident in their ability to accompany others. They were aware of their responsibilities and its limits regarding their role as an AP. They pointed out the program’s positive impact on their own emotional well-being and that of the patients. The program also benefited the clinical team, by limiting unhelpful demands from patients and time saved for clinicians. However, experienced APs did not feel well integrated in the healthcare team. Conclusion: We concluded that APs are highly motivated to be in the program. They perceived a need for the program in the current health system. They noted its beneficial effects on patients, on themselves, and on the clinical team. However, more resources need to be directed toward AP integration into the healthcare team.

Abstract: One Health (OH) envisions integrated governance across human, animal, and envi-ronmental systems to prevent and respond to complex health threats. Despite its global endorsement, OH implementation often falters due to institutional fragmentation, power asymmetries, and ethical tensions that erode trust and cooperation. This paper proposes the integration of medical-bioethics mediation within OH governance as a structured, relational mechanism to manage conflict, foster ethical deliberation, and strengthen trust among sectors and communities. We develop a conceptual framework to apply the me-diation principles of neutrality, confidentiality, respect, and shared problem-solving- beyond clinical ethics toward multisectoral OH contexts. The framework is illustrated through domain-specific examples from zoonotic disease control, antimicrobial resistance, and environmental health. Medical-bioethics mediation can advance conflict transfor-mation, ethical reflection, participatory decision-making, and policy alignment, thereby supporting transparent negotiation of values and institutionalized dialogue of different OH actors. Future research should pilot mediation-based governance models and assess their effects on intersectoral trust, collaborative capacity, and integrated health outcomes.

Abstract: Background: Chordomas are rare malignant tumors derived from notochordal remnants, accounting for 1–4% of skeletal malignancies. These slow-growing tumors most commonly affect the sacrum, skull base, and spine, posing significant challenges due to their anatomical location near critical neural structures. Despite their low metastatic potential, chordomas have a high local recurrence rate, necessitating aggressive surgical intervention. Methods: A narrative review of the literature was conducted, analyzing studies on the surgical management and adjuvant radiotherapy (RT) of spinal chordomas. Electronic databases, including MEDLINE, Scopus, ProQuest, and Google Scholar, were searched using relevant keywords. The retrieved studies were reviewed to assess surgical approaches, complications, outcomes, and the role of RT in treatment. Results: En-bloc resection with negative margins remains the primary treatment approach for cervical spinal chordomas, though achieving complete excision is challenging due to anatomical constraints. Sacrectomy and en bloc spondylectomy have been considered for sacral and thoracolumbar chordomas, respectively. Advances in RT, including proton beam and carbon ion therapy, have shown promise as adjunct treatments, especially when gross total resection is not possible. However, the benefit of adjuvant radiation remains debated. Postoperative complications, such as infections, neurological deficits, and mechanical instability, highlight the need for a multidisciplinary approach in patient management. Conclusion: The management of spinal chordomas requires an individualized treatment approach, balancing surgical feasibility, functional preservation, and disease control. While en bloc resection remains the gold standard, newer RT techniques may improve outcomes in select cases. A multidisciplinary team is essential to optimize prognosis and quality of life for affected patients.

Abstract: Tuberculosis remains a major public health concern in Uganda and one among the thirty high TB burden countries globally. Despite national progress, gaps persist due to asymptomatic infections, diagnostic limitations, and uneven access to healthcare within the country. This study implemented the Epi-Control platform, an AI-driven predictive modelling tool, to predict community level hotspots and support data driven active case finding (ACF). Using retrospec-tive chest x-ray screening data, we integrated demographic, environmental and human development indicators from open-source databases to model TB risk at sub-parish level. A proprietary Bayesian modelling framework was deployed and validated by comparing TB yields between predicted hotspots and non-hotspot locations. Across Uganda, the mod-el identified significantly higher TB yields in hotspot areas (risk ratio= 1.69, 95% CI 1.41-2.02; p< 0.001). The Central and Western regions showed the highest concentrations of hotspots, consistent with their population density and urbaniza-tion patterns. The results demonstrate that AI-based predictive modelling can enhance the efficiency of ACF by targeting high-risk areas for screening. Integrating such predictive tools within national TB programs can optimize resource allo-cation and accelerate progress toward Uganda’s TB elimination goals.

Abstract:

Background: Oral health issues in school-aged children persist as a global concern, particularly in underdeveloped nations. Despite numerous school-based health promotion initiatives, Indonesia still has a high rate of dental cavities and poor oral hygiene among elementary school kids. Objective: This study sought to assess, via a mixed-methods comparative design, the efficacy of a multimedia-enhanced microteaching training model for primary school educators in enhancing students’ oral health knowledge, behavior, and clinical outcomes. Methods: A mixed-methods sequential explanatory design was utilized, integrating quantitative and qualitative data. A total of 582 students and their teachers from public elementary schools in Pohuwato District, Gorontalo, Indonesia, were recruited and divided into three groups: (1) multimedia + microteaching training (intervention 1), (2) multimedia-only training (intervention 2), and (3) a control group (no training). The Oral Hygiene Index Simplified (OHI-S), DMFT scores, and Knowledge–Attitude–Practice (KAP) questionnaires were utilized for quantitative evaluation. Friedman and Wilcoxon tests were used to look at the data. Focus Group Discussions (FGDs) qualitatively examined teachers’ experiences. Results: The multimedia-enhanced microteaching group exhibited the most significant enhancement in students’ oral hygiene (p < 0.001) and knowledge–attitude–practice scores (p < 0.05) when compared to both the multimedia-only and control groups. Qualitative studies indicated enhanced teacher confidence, improved communication with students, and increased sustainability of oral health behaviors. Conclusion: The multimedia-enhanced microteaching methodology was far better than traditional training at improving both behavioral and clinical oral health outcomes in primary school kids. This new idea provides a scalable mechanism for adding teacher-centered oral health education to health promotion programs in Indonesian schools.

Abstract: Preliminary evidence suggests air pollution, particularly fine particulate matter 2.5 (PM2.5), poses a significant threat to maternal health and women of reproductive age. While emerging evidence suggests a link between air pollution and maternal anemia, the specific effect of PM2.5 exposure on hemoglobin levels among reproductive-aged women (15-49 years) remains insufficiently studied. Maternal hemoglobin decline is a known risk factor for adverse pregnancy outcomes with potentially long-term consequences. Understanding the impact of PM2.5 exposure is crucial in regions like Sub-Saharan Africa, where both anemia rates and air pollution levels are significantly elevated. This population-based study investigates the association between ambient PM2.5 concentrations and maternal hemoglobin levels across 43 Sub-Saharan African countries from 2000-2019. Using generalized linear regression models adjusted statistically significant negative association between PM2.5 exposure and hemoglobin levels were observed in Central Africa, while no significant associations were found in Eastern, Western, or Southern Africa. These results suggest that PM2.5 may be an environmental determinant of maternal anemia, with effects that vary by geography. Further research is needed in understudied regions to validate and expand on these findings.

Abstract: Objective. To evaluate the prevalence, risk factors, aetiology, and management of traumatic dental injuries (TDIs) among children aged 1–18 years attending the De-partment of Pediatric Dentistry, Damascus University, Syria, during 2023–2024, and to illustrate representative clinical cases with documented outcomes. Methods. This ret-rospective cross-sectional study reviewed 2,716 patient records (2023–2024) and identi-fied 301 children with TDIs. Demographic, clinical, and behavioural variables were ex-tracted and analysed using χ², t tests, ANOVA, and binary logistic regression (IBM SPSS v26). Results. The overall TDI prevalence was 11.08%. Males were over twice as likely as females to experience TDIs (OR = 2.30; 95% CI = 1.76–3.01; p < 0.001). Older age acted as a protective factor (OR = 0.56; 95% CI = 0.43–0.74; p < 0.001). Falls were the most common cause (63.7%), and injuries most often occurred at home (48.9%). The maxillary central incisors were most frequently affected (68.5% of cases). Children with special healthcare needs had significantly more traumatised teeth (mean = 2.61 ± 1.13) than healthy chil-dren (1.66 ± 0.92; p < 0.001). Nearly half of the patients (45.3%) presented > one month after injury, and asymptomatic apical periodontitis and reversible pulpitis were the most frequent diagnoses. Representative case presentations demonstrated multidisci-plinary management using restorative, endodontic, and orthodontic approaches with favourable follow-up outcomes. Conclusions. TDIs affected about one in nine children in this Syrian cohort. Male gender, younger age, and previous trauma were key risk factors. The predominance of delayed presentation underscores the need for community education, early referral systems, and targeted preventive programs within school and home environments.

Abstract: Breast ultrasound image segmentation and classification are the two crucial steps for early diagnosis of cancer. In this work we developed a breast cancer segmentation and multiclass classification artificial intelligence tools based on pretrained models. The proposed workflow includes both the development of a segmentation model architecture and second the development of a series of classification models to classify the ultrasound greyscale images into normal, benign or malignant. The training and testing of the pretrained models were performed using the Breast Ultrasound Images (BUSI dataset). For the image segmentation task, the models were trained on the images while using masks as target variable. In the multiclass classification, each image was provided with accurate label “benign”, “normal” or “malignant” and used to train a multiclass classifier. Optuna was used for hyperparameter optimization and for the testing of various pretrained models to determine the best encoder (ResNet18, EfficientNet-B0 & MobileNetV2)-decoder (U-Net, U-Net++, DeepLabV3) image segmentation architecture. For multiclass classification, five different pretrained models (ResNet18, DenseNet121, InceptionV3, MobielNetV3, GoogleNet) were optimized and tested for their ability to classify breast cancer images. The developed Image segmentation models performed well in terms of delineating the lesion in the breast ultrasound images. DeepLabV3 outperformed other segmentation architectures with consistent performance across train, validation and test images with Dice Coefficients of 0.87, 0.80 and 0.83 respectively. ResNet18:DeepLabV3 achieved an Intersection over Union score of 0.78 during training. ResNet18: U-net++ achieved best Dice coefficient (0.83) and IoU (0.71) and AUC score of 0.91 on the test (unseen) dataset when compared to other models. For classification of breast cancer images, ResNet18 achieved an F1 score of 0.95 and an accuracy of 0.90 on the train dataset, while InceptionV3 outperformed other models on the test dataset with an F1 score of 0.75 and accuracy of 0.83. We demonstrate a comprehensive approach to automate the image segmentation and multiclass classification of breast cancer ultrasound images into benign, malignant or normal using transfer learning models on an imbalanced ultrasound image dataset.

Abstract: Anemia is a major public health concern in South Asia, a region where febrile illnesses and nutritional deficiencies are prevalent. While the environment is a key contributor to maternal anemia, there is limited availability of research on the association between ambient temperature and maternal anemia. This longitudinal population-based study with multiple covariates, utilizing population-level data, examines the relationship between climate change and maternal anemia over the period of 2010 to 2022. Using a negative binomial regression model adjusted for covariates, we modeled the region-specific (n = 8 nations) relationships between annual anemia prevalence in women of reproductive age (15-49 years old) and annual maximum temperatures. After adjustment, the statistical analysis revealed distinct regional differences, with an overall statistically significant but weak association between maternal anemia and maximum temperature. These findings underscore ambient temperature as a determinant of anemia risk in women of reproductive age in South Asia. Further research with larger datasets is needed to clarify causal mechanisms and strengthen evidence for developing climate-specific strategies to address the temperature-related anemia risk. Climate-centered approaches would reduce the large-scale impact of climate-related diseases and improve overall reproductive health.

Abstract: Background: caring for a child with Autism Spectrum Disorder (ASD) entails consid-erable emotional, social, and economic demands for families, who frequently experi-ence high levels of stress. Such parental stress can affect caregivers’ mental health and family dynamics, making its early detection and management essential. Objective: to analyse the level of parental stress among parents of children with ASD affiliated with the Ánsares Association (Huelva, Spain), taking into account relevant sociodemo-graphic variables. Methods: a quantitative, descriptive, cross-sectional study was conducted with 57 relatives of children with ASD (75.4% women, 22.8% men). The Parenting Stress Index – Short Form (PSI-SF) and a sociodemographic questionnaire collecting information on age, marital status, educational level, occupation, number of children, religious beliefs, and external caregiving support were used. Descriptive and bivariate analyses were performed using correlation and mean comparison tests. Re-sults: a total of 13.7% of participants showed clinically significant stress levels and 9.8% presented high levels. No statistically significant associations were found with sociodemographic variables, although trends toward greater stress were observed among women and parents without external support. Conclusion: these findings are consistent with previous literature and highlight the importance of providing psy-choeducational and emotional support programmes for families. They also emphasise the role of nursing in the early detection of distress and the comprehensive support of caregivers, thereby contributing to improved family quality of life.

Abstract: Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that causes progressive disability and psychosocial burden. Understanding how MS affects patients’ quality of life (QoL) is essential for developing patient-centered rehabilitation and psychosocial support interventions. Methods: A cross-sectional study was conducted among adults diagnosed with MS residing in Western Greece. Data were collected using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire. Demographic and clinical variables (age, gender, disease duration, and functional status) were analyzed using descriptive and inferential statistics. Pearson correlation and multiple regression analyses were performed to identify factors associated with QoL domains. Additionally, a systematic literature review following PRISMA guidelines was integrated to contextualize findings within the broader evidence base on MS-related QoL. Results: The study included 128 participants (72% female, mean age 39.8 ± 9.4 years). Overall QoL scores indicated moderate impairment (mean composite physical score = 53.6; mental health = 57.4). Fatigue, pain, and depressive symptoms were strongly correlated with lower QoL (p < 0.001). Longer disease duration and higher disability (EDSS ≥ 4) predicted poorer physical functioning. Conversely, higher perceived social and family support predicted better psychological adaptation and higher mental health scores (β = 0.42, p < 0.01). The PRISMA review synthesized 45 studies, confirming disability, fatigue, and depression as universal risk factors, while social support and resilience-building interventions emerged as protective elements. Conclusion: MS substantially impacts both physical and psychosocial dimensions of life. The findings emphasize the importance of integrated care models that combine medical treatment with psychosocial and rehabilitation programs focusing on resilience, coping, and social support. Early interventions may mitigate QoL deterioration and promote holistic well-being. Regional disparities in Western Greece highlight the need for tailored, accessible services.

Abstract: The Nepal Pharmacy Council (NPC) Act, 2057 BS (2000 AD), established the statutory body responsible for regulating pharmacy education, professional standards, and ethical practice in Nepal. Since its inception, pharmacy education has expanded significantly, from the initial PCL programs in 1972 to widespread Diploma, B. Pharm, M. Pharm, Pharm D, and Ph.D. programs across public and private institutions. Similarly, Nepal’s pharmaceutical industry and hospital pharmacy services have grown, yet challenges remain, including workforce shortages, uneven professional distribution, limited clinical integration, and underdeveloped regulatory enforcement. This study critically analyzes the NPC Act using a qualitative, document-based approach, employing SWOT analysis and international comparisons with legal frameworks from countries including the USA, UK, Australia, India, Japan, South Korea, and EU nations. Key findings indicate that while the Act provides foundational regulation, it lacks provisions for modern pharmacy roles, continuing professional development (CPD), research promotion, digitalization, and integration of pharmacists into public health and clinical services. Suggested amendments include revising the Council’s functions, enhancing merit-based governance, instituting mandatory CPD, clarifying roles of pharmacists and assistants, strengthening inspection and accreditation, and aligning with global standards. Implementing these reforms would modernize pharmacy regulation in Nepal, ensure high-quality education, strengthen healthcare integration, and enhance public safety.

Abstract: Background: Approximately one quarter of community-dwelling older adults experience at least one fall each year. Falls can result in soft tissue injuries, fractures, or even death. Given this high prevalence, it is essential to identify fall-related risk factors, develop predictive models, and prescribe effective exercise-based interventions to prevent falls. Objective: To analyze risk factors, predictors, and therapeutic interventions for falls in older adults. Methods: A literature search was conducted in SCIELO, PUBMED, and PEDro databases between October 15–20, 2025. Inclusion criteria comprised peer-reviewed, open-access studies in English published from 2020 onward. Findings were categorized into three domains: (1) fall risk factors, (2) predictive models, and (3) exercise-based interventions. Twenty studies met the inclusion criteria. Results: Falls among older adults arise from multifactorial interactions involving physical, clinical, cognitive, and social factors such as impaired mobility, comorbidities, polypharmacy, and cognitive decline. Lower-limb strength and functional performance are key determinants of fall risk. Current predictive models show limited accuracy, with fall history as the strongest predictor. Exercise-based interventions, particularly multicomponent and home-based programs, improve balance, strength, and mobility but show variable effects on fall rates. The absence of standardized parameters for exercise prescription limits the development of evidence-based guidelines. Conclusion: Falls in older adults are multifactorial events influenced by physical and cognitive decline. Predictive models remain imprecise, and although exercise interventions improve functional outcomes, their impact on reducing falls is inconsistent. Standardized exercise protocols are needed to optimize fall prevention strategies.

Abstract: Objective: To analyze the correlation between clinical and subjective oral health indicators and quality of life in pediatric patients with Complex Chronic Conditions (CCC). Methods: A cross-sectional study was conducted with 63 pediatric patients with CCC. Data collection in a hospital setting involved oral clinical examinations using the Simplified Oral Hygiene Index, caries experience (DMFT/dmft), gingival bleeding, and Dental Aesthetic Index. Oral health-related quality of life (OHRQoL) was measured using the Parental-Caregivers Perceptions Questionnaire (P-CPQ), completed by caregivers. Correlations between indicators and quality of life scores were analyzed using Spearman's correlation coefficient (ρ), with a significance level of p < 0.05. Results: Poor oral hygiene was observed in 34.9% of participants (mean OHI = 2.03) and a dmft index of 1.67. Gingival bleeding was present in more than 30% of sites in 47.6% of children, and severe or very severe malocclusion was observed in 47.6%. Overall oral health-related quality of life (OHRQoL) had a mean score of 26.38, with the functional limitation domain being the most affected. There were no correlations between objective clinical indicators and quality of life domains. However, the subjective perception of "difficulty biting or chewing" showed a strong and significant correlation with the functional limitation domain (ρ = 0.823; p < 0.001) and with overall quality of life (ρ = 0.812; p < 0.001). Conclusion: Functional perception (chewing difficulty) proved to be a more sensitive indicator of the impact on OHRQoL in children with chronic heart disease (CHD) than traditional clinical indices. These findings underscore the importance of incorporating subjective and functional assessments into oral health care strategies for this vulnerable population.

Abstract: Background: Financial stress can lead to emotional and psychosocial distress among informal caregivers of older adults and can have a profound impact on their overall wellbeing. While social support may buffer financial stress, the role of gender in moderating these relationships is less understood. This study examined whether gender moderates the associations between psychosocial distress, social support, and financial well-being among informal caregivers of older adults. Methods: A cross-sectional survey was conducted with a sample of N=589 caregivers; after listwise deletion, N=533 with complete data were analyzed. Financial well-being was measured using the Consumer Financial Protection Bureau (CFPB) Financial Well-Being Scale, psychosocial distress with a five-item distress scale, and social support with the OSSS-3. Gender, sociodemographic characteristics, and caregiving status were also collected. Independent t-tests, ANOVA, Pearson correlations, and multivariable linear regressions with interaction terms were used to assess the relationships among the study variables. Results: Male caregivers reported significantly higher financial well-being than females (52.66 vs. 50.12, p = 0.036). Stronger social support was associated with greater financial well-being (mean difference = 11.80, p < 0.001). Psychosocial distress was negatively correlated with financial well-being (r = –0.49, p < 0.001). Regression analyses revealed significant gender moderation: distress reduced financial well-being more sharply for males, while strong social support benefited females more substantially than males. Older age, higher income, and better self-rated health were also positively associated with financial well-being. Conclusion: Findings highlight gender-specific patterns in how psychosocial distress and social support influence financial well-being among caregivers. Intervention should be tailored to gender specific needs while addressing stress reduction and social support enhancement to improve financial well-being of informal caregivers of older adults.