Background: Exercise interventions are commonly considered as non-pharmacological approaches to support cognitive and functional outcomes in older adults with dementia. However, the effects reported in the literature remain heterogeneous, and commonly used time-based dose markers may be insufficient to explain variability across trials. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020 guidelines. Eligible trials described benefits with cognitive, functional or behavioral changes associated with structured exercise interventions in older adults with dementia. Random-effects meta-analysis and meta-regression models were used to derive pooled effects and assess if linear dose indicators (e.g., duration of intervention, session length, frequency and total cumulative dose) reflected heterogeneity. Results: Twenty-two studies were analyzed. Based on our pooled analyses, a small but statistically significant improvement was observed under the fixed-effects model (g = 0.106, 95% CI 0.015–0.197; p = 0.023), but this was not significant for random-effects models (g = 0.117, 95% CI −0.021–0.254; p = 0.097), while suggesting moderate between-study heterogeneity (Q(21) = 43.530, p = 0.003; I2 = 51.757%; τ2 = 0.052). For the main random-effects meta-regression, standard linear dose indicators did not significantly explain between-study heterogeneity (Qm(3) = 1.06, p = 0.7867; R2_analog ≈ 0), while significant residual heterogeneity remained (I2 ≈ 56.03%). Conclusions: In the literature so far, there are limited and heterogeneous effects of exercise interventions on cognition and functions in older adults with dementia. These findings in all literature suggest that the current evidence does not support a consistent linear dose–response relationship but rather will likely depend to some extent on feasibility and supervision (again, quality of the interventions), thus emphasizing that exercise strategies must be contextually sensitive rather than dose-dependent.

Background: The use of physical restraints in hospital settings remains a controversial practice due to its ethical, legal, and safety implications. Although restraints are intended to prevent falls or manage agitation, their inappropriate use may compromise patient dignity, autonomy, and quality of care. Current healthcare policies emphasize restraint reduction, appropriate documentation, and professional training as key elements of humanized and safe care. Methods: A descriptive cross-sectional study based on an anonymous self-administered survey was conducted in a tertiary university hospital as the diagnostic phase of a quality improvement project aimed at evaluating healthcare professionals’ knowledge, perceptions, and documentation practices related to physical restraint use. A structured ad hoc questionnaire was distributed to registered nurses and nursing assistants working in adult inpatient units using a non-probabilistic convenience sampling strategy. The survey explored training, clinical decision-making, communication with patients and families, awareness of institutional protocols, and use of the electronic health record (EHR). Descriptive analyses and Pearson’s chi-square tests were performed using IBM SPSS Statistics. Results: A total of 241 professionals participated. More than half of respondents (54.8%) reported no formal training in physical restraint use, and only 27.4% considered their training sufficient. Although 86.3% stated they were familiar with restraint indications, only 53.5% were aware of the existence of a structured EHR restraint registry, and just 31.0% consistently completed it. Documentation of restraint removal was particularly low (32.9%). Furthermore, significant discrepancies were observed between regulatory definitions of restraints and professionals’ perceptions regarding practices requiring formal documentation. Statistically significant associations were identified between professional category, perceived training adequacy, and knowledge of physical restraint indications. Conclusions: This diagnostic phase identified substantial gaps between regulatory requirements, professional knowledge, and real-world documentation practices related to physical restraint use. The findings highlight the need for competency-based training strategies, standardized documentation processes, and strengthened institutional leadership to promote patient safety, regulatory compliance, and the humanization of hospital care.

In the original publication [...]

Background/Objectives: Positive Psychotherapy (PPT) is an empirically supported treatment that directly targets positive resources and personal strengths as its primary logic. PPT is effective in amplifying happiness and well-being as an additional way to enhance positive mental health while also ameliorating symptoms of negative affect, especially in depression, anxiety disorders, and stress disorders. However, few studies have been conducted to investigate these effects in the long run. This study extends our previously published findings on the short-term efficacy of PPT by extending the follow-up period to 18 months and comparing its long-term effects with those of Cognitive Behavioral Therapy (CBT) within the same randomized controlled trial. Methods: Forty-nine out-patient participants with a DSM-IV diagnosis for depressive disorder (MDD, Dysthymia) were treated with 14 sessions of manualized PPT (n = 23) or CBT (n = 26) group therapy. In a randomized controlled two-center-study, questionnaires on depressive symptoms (BDI-II, MADRS, DHS), psychological distress (BSI), and well-being related outcomes (FS, PPTI, SWLS) were administered at baseline and 18-month follow-up. Results: Analyses using linear mixed models indicated significant differences in long-term treatment outcome for depressive symptoms (BDI-II, DHS, MADRS) and satisfaction with life (SWLS), depicting better outcomes for the PPT group. Between group effect sizes at 18-month follow-up were primarily in the middle range for all outcome measures, in favor of PPT. Conclusions: This study provides support for the long-term efficacy of PPT in the treatment of depression and improvement of positive resources.

Background: Vascular access is a core component of hemodialysis and may influence both clinical outcomes and patient-reported quality of life. This study examined the association between vascular access type and quality of life among patients receiving maintenance hemodialysis in multiple nephrology centers. Methods: We conducted a multicenter, cross-sectional observational study of 152 adults with end-stage kidney disease undergoing hemodialysis in public and private dialysis units in the Attica region, Greece (January–May 2022). Data were collected using a demographic/clinical questionnaire, the 36-Item Short Form Health Survey (SF-36), the Dialysis Patient Satisfaction Questionnaire (SDIALOR), and the Missoula VITAS Quality of Life Index (MVQOLI). Multivariable linear regression models were fitted for SF-36 and MVQOLI domain scores. Results: Most participants reported being very (40.8%) or quite (53.3%) satisfied with their current vascular access, and 69.5% considered an arteriovenous fistula (AVF) the most appropriate option. SF-36 scores were generally lower than those reported for the general population, except for the mental health domain. Compared with AVF, permanent catheter use was associated with lower SF-36 physical functioning scores, and graft use was associated with lower vitality scores. Lower vascular access satisfaction was consistently associated with lower HRQoL: compared with being “very” satisfied, being “quite” satisfied was associated with lower general health, vitality, social functioning, mental health, and lower PCS/MCS scores, while being “a little/not at all” satisfied was associated with lower general health and worse bodily pain scores. On MVQOLI, living alone and lower access satisfaction were associated with lower interpersonal relationships, transcendence/spirituality, and overall quality-of-life scores, while obesity was associated with lower function scores. Conclusions: Vascular access type, particularly AVF versus catheter, is associated with meaningful differences in quality of life among hemodialysis patients. Patient satisfaction with access and sociodemographic characteristics should be considered in patient-centered access planning and follow-up.

Background: Postoperative arrhythmias, especially atrial fibrillation (AF), are common complications of coronary artery bypass grafting (CABG) associated with prolonged hospitalization and adverse outcomes. This study aimed to assess the incidence of postoperative AF and identify demographic, clinical, and intraoperative predictors in CABG patients in Cyprus. Methods: This prospective, multicenter observational study was conducted in three cardiac surgery centers in Cyprus between September 2022 and April 2023. Adult elective CABG patients in preoperative sinus rhythm were included; emergency cases and those with prior arrhythmias or conduction disturbances were excluded. Data on demographic, clinical, intraoperative, and postoperative variables, including norepinephrine infusion duration, were collected daily. Postoperative arrhythmias were systematically recorded during hospitalization. Statistical analyses included descriptive statistics, bivariate tests, and multivariable logistic regression to identify independent predictors of postoperative atrial fibrillation. Results: Among 102 patients (mean age 66.8 years, 78.4% male), postoperative arrhythmias occurred in 26.5%. AF was most frequent (20.6%), followed by ventricular tachycardia (2.9%), atrial tachycardia (1.0%), atrioventricular block (1.0%), and one fatal asystole. Key independent predictors of AF were increasing age, atrial enlargement, severely reduced left ventricular ejection fraction (<30%), and prolonged norepinephrine infusion. Conclusions: Postoperative AF remains a prevalent and clinically significant complication after CABG. The association with norepinephrine duration underscores the importance of careful hemodynamic management. Further studies and AI-based prediction models may enhance individualized prevention strategies.

Background/Objectives: Physical literacy (PL) is globally recognized as a foundational determinant of health status in children, but the effects of interventions based on PL were rarely studied in preadolescent children. The aim of this quasi-experimental, school-based study was to evaluate the potential effects of a PL intervention delivered during regular school hours on physical fitness (PF), physical literacy (PL), and physical activity (PA) in children aged 9 to 11 years from southern Croatia. Methods: Participants were 125 preadolescents (57 girls), and were grouped into a control group (C = 70), and an experimental group (E, n = 55). The E group participated in a specific PL-focused education, integrated into regular physical education (PE) lessons as a 5–6 min substitute for standard PE content, over 12 weeks (36 PE classes in total). The C group participated in the standard PE curriculum. A pre–post–retention design was used, and the observed variables included anthropometrics (height, weight, BMI), PF (jumping power, abdominal strength, upper body strength, flexibility, mobility, and cardiovascular endurance), PL (evaluated by the PLAYself questionnaire), and indirectly measured PA (estimated via the PAQ-C questionnaire). Multivariate (MANOVA and univariate (ANOVA) analyses of variance for repeated measurements were used with time, gender, and group as the main effects, including their interactions. Results: MANOVA calculated for a set of PF variables revealed significant main effects for time (F = 1361, p < 0.001) and a significant time × group interaction (F = 2.98, p < 0.05). Univariate ANOVA indicated specific intervention effects for jumping power and abdominal strength, favoring the E group. No significant differential effects were observed for PL or PA. Conclusions: The study demonstrated small, but statistically significant, improvements in PF indicators among children exposed to the PL-based intervention. Notably, the intervention was conducted in authentic school settings using standard resources, supporting the ecological validity and real-world applicability of the findings.

Introduction: Religious practices can shape lifestyles, influence health choices, and help individuals cope with illness and suffering. Understanding which aspects of religiosity support health-promoting attitudes is particularly important. This study explores how belonging to a religious community affects health and well-being among religious sisters. Materials and Methods: An anonymous survey was conducted among 463 women from international, apostolic Catholic congregations in Poland and 33 other countries. The questionnaire included questions on lifestyle, physical health (including diet, physical activity, sleep, chronic conditions, and medication use), and perceptions of how community life influences health and encourages health-conscious behaviors. Results: Overall, 57% of participants reported following a healthy lifestyle, most commonly sisters aged 65 and older (73%). Non-Polish sisters and those living outside Poland were more likely to report healthy habits. Among sisters who saw their community as beneficial for health, 69% led a healthy lifestyle. Retreats, a sense of belonging, communal prayers, and vacations were consistently rated as having the most positive impact on well-being, particularly among older sisters and missionaries. Conclusions: Life in a religious community appears to support health both directly, through structured daily routines and shared responsibilities, and indirectly, by providing social support and fostering a sense of purpose. Spiritual practices, rest, and close interpersonal relationships emerge as the most influential factors for well-being, while formal obligations such as wearing religious attire or attending formation meetings were rated as less impactful. These findings highlight the important role of communal life in promoting both physical and spiritual health among religious sisters.

Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson’s disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson’s disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long-term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of APs for PDP is common, with up to 35% of PD patients prescribed at least one AP within 7 years of PD diagnosis. Methods: Four electronic databases (Ovid MEDLINE, Embase, PsycINFO, PubMed) were systematically searched for double-blind, randomised, placebo-controlled clinical trials for the use of APs in the treatment of PDP and their effects on PD motor symptoms, according to PRISMA guidelines. Results: Eleven studies from ten publications were identified and included in this review. Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Quetiapine showed no significant improvement for PDP over placebo in three of the four studies, with both olanzapine studies also showing no improvement. Olanzapine studies also showed significant motor worsening compared to placebo. Clozapine significantly improved psychosis compared with placebo in both studies, with large effect sizes in primary outcome measures; (−0.82, 95% CI −1.37 to −0.26), −0.89 (95% CI −1.42 to −0.36). Pimavanserin also showed significant improvement (−0.48, 95% CI −0.77 to −0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores compared with placebo groups. Conclusions: Data from the studies included in this review suggest that the use of quetiapine for the management of PDP may not be evidence based. Clozapine may improve PDP symptoms with low doses however significant side-effects may limit usability. The findings from this review support the use of clozapine as an alternative AP for the management of PDP when clinically appropriate.

Background/Objectives: Quality of life is conceptualized as a multidimensional construct encompassing subjective well-being, health, and social functioning. Evidence suggests that engagement in physical activity contributes to higher quality of life scores among older adults, indicating that structured exercise programs can positively influence both physical and psychological domains in this population. The present study examined the impact of an 18-week structured physical exercise program on the quality of life of older adults, assessed through the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument, which consists of four domains: physical health, psychological, social relationships and environment. A total of 86 participants were allocated to three groups: individual exercise (n = 31), collaborative exercise (n = 32), and a control group (n = 23). Quality of life was evaluated before and after the intervention using the WHOQOL-BREF. Results: Correlation analysis indicated strong relationships among the WHOQOL-BREF domains, both before and after the program. Repeated-measures analysis revealed no significant Group × Time interaction effects for any WHOQOL-BREF domain. A significant main effect of Time was observed for the Environment domain, indicating a small overall decrease across all groups during the study period. Conclusions: The structured exercise protocol did not lead to greater changes in quality of life compared to the control condition. Perceived environmental quality of life showed a small overall decrease over time across participants.