Abstract Introduction Deconditioning remains a significant challenge for hospital inpatients, particularly the older patients. National campaigns such as ‘End PJ Paralysis’ and ‘Sit Up, Get Drssed, Keep Moving’ endorsed by the British Geriatrics Society, highlight the importance of maintaining mobility during hospital stays. We designed a QIP to raise awareness of deconditioning among nursing staff and resident doctors and to identify barriers preventing mobilisation. Method We conducted a QIP on a geriatric ward at Lincoln County Hospital, collecting quantitative data on the frequency of patients sitting out of bed, sitting up for meals, wearing appropriate footwear, and wearing their own clothes. Qualitative feedback was obtained through short interviews with nurses and healthcare assistants (HCAs) to explore reasons patients remained in bed. Patients receiving end-of-life care, those medically unwell (NEWS>5), or those with baseline immobility (i.e bed bound) were excluded. Following an initial cycle, teaching sessions were delivered to staff and resident doctors over two weeks before repeating data collection. Results In the first cycle, 69% of patients sat out of bed daily, 50% sat up for meals, 42% wore appropriate footwear, and 26% wore their own clothes. After staff education, the second cycle showed no significant improvement: 64% sat out of bed, 48% sat up for meals, 40% wore appropriate footwear, and 36%wore their own clothes. Barriers identified included patient factors (fatigue, lack of motivation and awareness), equipment shortages (e.g. recliner chairs), staffing pressures, and difficulty accessing personal clothing. Notably, some patients who could mobilise independently remained in bed. This showed that the risk of prolonged bedrest is even greater for those needs support. Conclusion Despite increased staff awareness, this QIP showed a neutral impact on outcomes, highlighting that education alone is insufficient. Multifactorial barriers, including patient factors, limited equipment, and staffing constraints, been identified and have to be addressed collectively to improve outcome.

A network analysis to identify possible alterations among different physiological systems induced by head down tilt bed rest

Reductions in plasma volume (PV), a hallmark of spaceflight and its analog head-down-bed rest (HDBR), trigger compensatory releases of renin and aldosterone to promote fluid retention. Artificial gravity (AG) and exercise have been proposed to counteract PV reductions during HDBR, but optimal protocols remain undefined. We investigated how simultaneous exercise and AG affects volume-regulating hormones and PV during HDBR compared to exercise or sedentary control groups. We hypothesized that exercise+AG would protect PV and maintain volume-regulating hormones at pre-HDBR levels, outperforming exercise and sedentary control groups. Twenty-four healthy males (29±6 yr) underwent 60 days of 6° HDBR and were assigned to sedentary control (n=8), exercise (n=8), or exercise+AG (n=8) groups. Exercise group participants performed near daily 30-minute supine moderate-to-high-intensity interval cycling throughout HDBR, while exercise+AG participants performed the same exercise during 30 minutes of short-arm centrifugation with head-to-foot gravitational profiles based on resting G tolerance tests. Changes in PV, fluid-regulating hormones, and erythropoietin were assessed using carbon monoxide rebreathing and biochemical assays. HDBR reduced PV (p<0.001), blood volume (p<0.001), and hemoglobin mass (p<0.001) in all groups, and reductions were inversely correlated with an increase in active renin (all p<0.05; rrm=-0.615, rrm=-0.553, rrm=-0.426, respectively). Erythropoietin was reduced at HDBR day 3 (p<0.001) irrespective of group. Exercise+AG responses did not differ from the exercise or control groups, with countermeasures failing to maintain PV or blunt fluid-regulating hormone release. These results contrast work showing benefit of gravity-like exposure after exercise on PV and suggests that AG should not be applied exclusively during exercise.

Study DesignSystematic review.ObjectiveSurgery remains the gold standard in management of unstable spinal fractures in patients with spinal ankylosing disorders (SAD), especially in the presence neurodeficit. Certain studies have reported the effectiveness of non-surgical treatment in non-displaced and clinically stable fractures.MethodsOur systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted (15th July, 2025) across 4 different databases to identify studies reporting outcomes of conservative treatment of spinal fractures in the context of ankylosed spine. The patients were subclassified as groups A (surgically-unfit) and B (stable fractures) for further analysis.Results13 studies (187 patients) were reviewed. The underlying etiology was DISH (diffuse idiopathic spinal hyperostosis) in 86.4%. Overall, cervical, thoracic/thoracolumbar (TL) and lumbar fractures were observed in 14.1%, 72.7% and 13.2%, respectively. There were 66% in group B; and a majority were neurologically intact (ASIA E: 97.3%). Different conservative strategies are described (combination of bed rest, orthosis and regular surveillance). Overall fracture healing was 69.5% (group A-47.1% and group B-91%). The morbidity and mortality in these fractures are high (particularly, group A). Halo-immobilization was associated with high complications (especially in debilitated individuals).ConclusionIn a selected group of patients with stable fracture patterns, conservative treatment is a viable management option in SAD patients with good healing rates. Based on our analysis of reviewed data, we have put forth criteria for decision-making and protocol for conservative management of these fractures.

Muscle weakness after immobilization often exceeds that explained by loss of muscle mass alone, suggesting a role for neuromuscular synaptic changes. To quantify these adaptations, we developed a composite transcriptomic Neuromuscular Junction (NMJ) Remodeling Score and evaluated its behavior relative to classical atrophy pathways during short-term unloading. We analyzed vastus lateralis RNA sequencing data from adults undergoing 10 days of unilateral lower-limb suspension followed by a 21-day recovery, generating NMJ and atrophy scores for 15 and 10 genes, respectively. Transcriptome-wide testing across more than twenty thousand genes identified a broad pattern of metabolic suppression. The NMJ score showed a large effect increase during unloading and partial normalization with recovery, while the atrophy score rose more strongly and reversed during recovery. The two scores demonstrated weak correlation, consistent with distinct biological processes. Individual NMJ-related genes displayed coordinated regulation, including marked upregulation of several acetylcholine receptor subunits and modest downregulation of muscle signaling kinase (MuSK), reflecting a denervation-like transcriptional pattern. Directional replication in a 60-day bed rest cohort supported generalizability across disuse conditions. Together, these findings indicate that limb unloading elicits measurable transcriptomic remodeling at the NMJ that is only partially aligned with atrophy signaling, providing a framework for investigating neural contributions to immobilization-induced weakness.

Objective: To analyze the risk factors of deep vein thrombosis (DVT) after core decompression in patients with osteonecrosis of the femoral head (ONFH) and construct a predictive model. Method: A retrospective analysis was conducted on the clinical data of 244 patients with ONFH who underwent core decompression and were hospitalized in Guizhou Hospital of Jishuitan, Beijing from January 2020 to May 2025. There were 143 males and 101 females, with an age of (62.2±4.2) years. According to whether DVT occurred within 3 months after the operation, the patients were divided into the non-DVT group (n=167) and the DVT group (n=77), and the differences in various clinical indicators between the two groups were analyzed. After screening for variables through least absolute shrinkage and selection operator (LASSO) regression, a multivariate logistic regression model was conducted to analyze the risk factors of DVT after core decompression in patients with ONFH, and a nomogram of the DVT prediction model was drawn. The predictive ability, accuracy and clinical applicability of the model were evaluated respectively by the area under the receiver operating characteristic curve (AUC), calibration curve and decision analysis curve. Result: The age, ONFH volume, proportion of diabetes, postoperative bed rest time, fibrinogen (FIB), D-dimer, complement C3, complement C4, matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-2 (MMP-2), and Caprini score of patients in the DVT group were greater than those in the non-DVT group (all P<0.05). LASSO regression screened out 10 variables for analysis, namely age, ONFH volume, postoperative bed rest time, FIB, D-dimer, complement C3, complement C4, MMP-1, MMP-2, and Caprini score. The analysis of the multi-factor logistic regression model showed that large ONFH volume (OR=1.90, 95%CI:1.34-2.68), postoperative bed rest time≥3 d (OR=11.22, 95%CI:1.46-16.04), elevated FIB (OR=2.83, 95%CI:1.29-6.21), elevated D-dimer (OR=2.17, 95%CI:1.11-4.25), elevated complement C3 (OR=5.28, 95%CI:4.22-8.08), elevated MMP-1 (OR=18.78, 95%CI:15.90-27.37) and a higher Caprini score (OR=4.44, 95%CI:1.74-11.35) were risk factors for DVT in patients with ONFH after core decompression. Based on the above parameters, a prediction model for DVT after core decompression in patients with ONFH was drawn. The predictive model predicted that the AUC of DVT after core decompression in patients with ONFH was 0.82 (95%CI: 0.77-0.88).The sensitivity was 78.3%, and specificity was 81.2%. The calibration curve has a high degree of fit with the standard model curve (P=0.521) and has good clinical applicability. Conclusions: Large ONFH volume, postoperative bed rest time≥3 d, elevated FIB, elevated D-dimer, elevated complement C3, elevated MMP-1, and high Caprini score are risk factors for DVT after core decompression in patients with ONFH. The nomogram prediction model constructed based on the above parameters has good clinical applicability.

Prolonged microgravity exposure disrupts cerebral hemodynamic homeostasis, yet longitudinal cerebral blood flow (CBF) adaptation remains poorly understood. This study investigated CBF changes under 90 days head-down bed rest (HDBR) in 36 healthy adults using pseudo-continuous arterial spin labeling (pCASL) MRI. Analyses included region-of-interest (global/regional CBF) and voxel-based whole-brain assessments, alongside physiological correlations. Results demonstrated stable global CBF after HDBR but revealed distinct microcirculatory redistribution: the vertebrobasilar (VB) territory exhibited significant perfusion increases, while voxel-based analysis identified elevated CBF in the left fusiform gyrus and reduced perfusion in the right superior frontal gyrus, middle cingulate gyrus, and Heschl's gyrus. Physiological correlations indicated negative associations between VB-CBF and diastolic blood pressure (DBP)/mean arterial pressure (MAP), with pre-HDBR heart rate as a key modulator of VB perfusion changes. A potential relationship between age and altered CBF has been found in the right superior frontal gyrus in young adults. These findings suggest that although global CBF stabilizes during simulated microgravity, posterior circulation-dominated microvascular redistribution occurs, tightly coupled with cardiovascular dynamics, offering critical insights for optimizing countermeasures in spaceflight and terrestrial cerebrovascular diseases.

Prolonged microgravity exposure causes significant cardiac deconditioning through adaptive physiological changes [1]. Head-Down Tilt (HDT) bed rest reproduces these effects on Earth, demonstrating progressive decreases in cardiac volumes and masses during unloading, with subsequent rapid readjustment upon gravity restoration in the head-to-foot direction [2]. This suggests apparent myocardial mass loss may result from transient extracellular matrix fluid shifts rather than true atrophy. However, quantitative studies investigating these mechanisms remain limited.We investigate myocardial extracellular matrix hydration changes during HDT using T2 mapping-based radiomics analysis. T2 mapping quantifies tissue liquid content [3], while radiomics extracts quantitative features from CMR images, enabling detailed myocardial tissue characterization.Radiomic features were extracted from T2-maps by four operators segmenting the myocardium using LIFEX software. Images were acquired at baseline (BDC), HDT day 56 (HDT56), and 4 days post-HDT (R) in 8 control subjects from the 60-day Artificial Gravity Bed Rest European Space Agency (AGBRESA) campaign. To facilitate the comparison, features were normalized using median subtraction and mean absolute deviation division. Feature selection involved identifying highly correlated pairs (r>0.8), retaining the feature among them with higher variance explanation, in this way removing redundant and less informative features. Statistical analysis used Friedman and post-hoc Wilcoxon tests (p<0.05, Bonferroni-corrected p<0.0167) to identify significant radiomic features reflecting hydration changes between epochs. Inter-operator agreement was assessed using coefficient of variation (CV) and intra-class correlation coefficient (ICC).RIM-IntensitySum (ICC 0.67, CV 13.53%), reflecting T2 signal summation in the myocardial rim (or periphery), decreased (p=0.0156) by 18.72% from BDC to HDT56, with 12.40% recovery (p=0.2500) from HDT56 to R. MeanIntensity (ICC 0.77, CV 9.72%), quantifying average myocardial T2 signal, showed similar trends: 11.48% reduction (p=0.0781) and 4.49% recovery (p=0.7422), respectively. RIM-CountingVoxels (ICC 0.96, CV 4.35%), representing voxels count in the rim, decreased (p=0.0078) by 8.22% (BDC to HDT56) and increased (p=0.0156) by 4.48% (HDT56 to R).This study confirmed significant radiomic feature changes across HDT epochs in T2 maps. Intensity-based features reflected myocardial hydration shifts, mirroring trends in myocardial mass. ICC values (0.67–0.972) showed moderate to excellent reproducibility. While RIM-IntensitySum had limited interpretability due to high variability relative to the effect size, other features showed better precision. These findings support T2-based radiomics as a promising tool for detecting myocardial tissue changes during simulated microgravity, suggesting a link to fluid shifts rather than structural atrophy.

Femoral head fractures resulting from hip dislocations are rare injuries resulting from high-velocity trauma. Garrett Pipkin, in 1957, classified these fractures into four types. All varieties are associated with hip dislocations, which are attended to as emergencies. Few cases of isolated femoral head fractures without hip dislocation have been published in the literature; we describe one such atypical variant. A 38-year-old male presented with a history of pain and swelling in his right knee following a traffic accident. After 48 hours of bed rest on ambulating, the patient had mild right hip discomfort, but hip examination was essentially normal. Radiology was repeated with plain radiographs and non-contrast computed tomography (NCCT), followed by contrast-enhanced magnetic resonance imaging (MRI) pelvis with bilateral hips. He had a fracture of the head of the femur and acetabular lip with concentric joint. Without hip dislocation, this was an unusual presentation of Pipkin Type IV fracture of the femoral head &amp; posterior acetabular lip. It was managed with open reduction and lag screw fixation of supra-foveal femoral head fracture approaching through the acetabular bony rim avulsion, which was later fixed with lag screw and spring plates. The patient recovered well. This was an unusual presentation of Pipkin type IV fracture without hip dislocation and can be missed due to a subtle presentation, not yet described in the literature. A high degree of suspicion and advanced radiology helped in the appropriate management of the case.

This study aims to explore the impact of early mobilization on postoperative complications in adult patients after craniocerebral surgery. There is no meta-analysis study on early rehabilitation training in the prevention of postoperative complications of craniocerebral surgery yet. Patients after craniocerebral surgery often face various complications, including infection, hemorrhage and functional disorders, etc., which adversely affect their recovery quality. This study compared the effects of early activities (such as elevating the head of the bed, sitting up, standing, walking, etc.) within a defined postoperative time window, with traditional bed rest (full lying for ≥ 48h after surgery, with the head of the bed elevated ≤ 30°) on patient outcomes. A systematic literature search and screening of randomized controlled trials (RCTs) were performed. Quality assessment was conducted using the ROB2 tool. Data extraction and statistical analyses were carried out using R software and relevant statistical packages. The results showed that the pooled relative risk (RR) of postoperative complications in the early rehabilitation intervention group was 0.51 (95% confidence interval [CI]: 0.35-0.74; P = 0.0005), indicating a significant reduction in the incidence of postoperative complications with early mobilization. Sensitivity analyses demonstrated that excluding any single study did not alter the RR being less than 1 or the P value remaining below 0.05, thereby enhancing the robustness of the findings. The odds ratio (OR) for postoperative recurrence was 1.59 (95% CI: 0.53-4.79; P = 0.4119), and the OR for the Glasgow Outcome Scale-Extended (GOSE) score was 0.92 (95% CI: 0.51-1.63; P = 0.7683). Although the results for GOSE scores and postoperative recurrence rate after surgery was 1.59, the 95% confidence interval (CI) was [0.53,4.79], and P = 0.4119; The OR value of the GOSE score was 0.92, the 95%CI was [0.51,1.63], and P = 0.7683. Although the results of GOSE score and postoperative recurrence rate were not statistically significant, this study provides evidence supporting the safety of early rehabilitation interventions in reducing the risk of postoperative complications. Future research should prioritize high-quality trials to further investigate the potential impact of early mobilization on patient prognosis.

Rationale:Mutations in the vacuolar protein sorting 13 homolog C (VPS13C) gene have been associated with Parkinson disease (PD). However, the mutation of VPS13C in Parkinsonism is uncommon and the clinical characteristics are highly heterogeneous. This study identifies 2 novel pathogenic variants in VPS13C, with particular emphasis on follow-up brain magnetic resonance imaging (MRI) images.Patient concerns:The patient first exhibited resting tremor in the right limb at the age of 26. As the disease progressed, he developed bradykinesia, rigidity, gait instability, cognitive decline, dysarthria, myoclonus, depressed mood, irritability, and aggression. He was treated with levodopa/benserazide, pramipexole, and rasagiline, but the benefit was only temporary. By the age of 32, his gait instability was further aggravated, manifested as frequent falls, requiring bed rest or wheelchair use. Follow-up brain MRI showed progressive cortical atrophy. Whole-exome sequencing of the patient revealed compound heterozygous pathogenic variants (c.1699C > T, chr15: 62156504–62352664) in VPS13C.Diagnoses:VPS13C-related early onset PD.Interventions:The patient was treated with levodopa/benserazide 125 mg 4 times daily, rasagiline 1 mg once daily, donepezil 5 mg once nightly, and quetiapine 50 mg once nightly.Outcomes:After 6 months of follow-up, his symptoms were further aggravated.Lessons:This study identifies 2 novel pathogenic variants in VPS13C, expanding the known mutational spectrum of the gene. Additionally, brain MRI may serve as a potential imaging marker for disease progression. A review of the literature indicates that VPS13C-related Parkinsonism appears as a heterogeneous disorder, including PD and dementia with Lewy bodies. VPS13C mutations are highly diverse, with point mutations being the most common, followed by splice-site variants. Genetic screening is essential for an accurate diagnosis and distinction between different forms of early onset PD. This increases clinicians’ understanding of the clinical and genetic characteristics of VPS13C-related Parkinsonism.

Effectiveness of integrative Korean medicine for traumatic multiple spinal compression fractures: A case report.

ObjectiveThe Braden Skin Score (BSS) is a validated tool for assessing pressure injury risk. This study aimed to investigate whether BSS can also predict the risk of developing Acute Respiratory Distress Syndrome (ARDS) in elderly sepsis patients in the intensive care unit (ICU).BackgroundARDS is a common and serious complication in ICU patients with sepsis, associated with prolonged hospitalization, metabolic disorders, and increased mortality. Elderly sepsis patients are particularly vulnerable to pressure injuries due to prolonged bed rest. Nevertheless, the relationship between BSS and the risk of developing ARDS in this population has not been extensively studied.MethodsElderly sepsis patients from the MIMIC-IV database were chosen and partitioned into quartiles of BSS values. Although the incidence of ARDS was the primary endpoint, hospital mortality in the ARDS subgroup was the secondary endpoint. The correlation between low BSS and risk of ARDS and in-hospital mortality in elderly sepsis patients was assessed using logistic regression models.ResultsMultivariate logistic regression analysis revealed that a lower BSS at ICU admission was significantly associated with an increased risk of ARDS and higher in-hospital mortality among elderly sepsis patients.ConclusionThis study demonstrates that a low BSS at ICU admission is associated with a greater risk of ARDS and higher in-hospital mortality in elderly sepsis patients.

Lumbar spondylolisthesis (LS) with spontaneous fusion (SF) accompanied by sagittal imbalance (SI) poses a practical decision-making challenge in surgical planning. Here, we present a trauma-associated case of lumbar spondylolisthesis with SF and SI, and outline a reproducible, evidence-informed framework for surgical management. A 57-year-old patient developed low back pain after trauma. Lumbar computed tomography (CT) showed L4 anterolisthesis with bilateral pars interarticularis defects. Despite standardized conservative treatment, the back pain progressed, with forward trunk inclination of approximately 40° and concomitant left lower-limb weakness. Lumbar spondylolisthesis with nerve root impairment. After over 20 years of conservative treatment, the symptoms did not achieve meaningful improvement; the patient's back pain progressively worsened, with forward trunk inclination of approximately 40° and progressive weakness of the left lower limb. The patient ultimately underwent pedicle screw instrumentation. The procedure was uneventful; the patient remained on bed rest for 3 days and was discharged on postoperative day 12. LS with SF and SI is encountered clinically but remains under-specified for surgical decision-making; importantly, when LS and SI coexist, symptoms are not invariably attributable to the slipped level - marked forward stooping may instead reflect ligamentum flavum hypertrophy, nerve-root entrapment, adhesions, or other adjacent-level pathology. In selected patients, LS with SI does not require reduction of the slipped vertebra; surgical objectives can be achieved by decompression of the symptomatic level(s) and restoration of segmental lordosis to re-establish global alignment.

Iron is a biologically indispensable yet potentially harmful element: essential for numerous metabolic processes but toxic in excess, potentially leading to organ damage. Under conditions of extreme physical inactivity, such as microgravity or prolonged bed-rest, physical deconditioning occurs, adversely affecting functional capacities and health. Anaemia and muscle atrophy may contribute to systemic iron redistribution, as red blood cells and skeletal muscle collectively concentrate most body iron. Here we summarize a decade of research conducted in rodent and human ground-based models to investigate how extreme physical inactivity alters systemic and cellular iron homeostasis, and explore the underlying mechanisms. During the first days an increase in plasma iron availability occurs in both men and premenopausal women, likely due to accelerated erythrophagocytosis in spleen and redistribution of iron from degraded erythrocytes. Despite the rapid onset of muscle fibre atrophy under these conditions, skeletal muscle appears to accumulate iron rather than release it and therefore may not necessarily contribute to the systemic redistribution of iron. Increased circulating hepcidin levels observed during this early phase could contribute to both redistribution and tissue iron sequestration. After several weeks of exposure plasma iron availability remains elevated in men exposed to extreme physical inactivity, potentially exposing to chronic tissue iron accumulation. In contrast a return to baseline seems to occur in premenopausal women. These findings point to a broad and persistent redistribution of iron metabolism in men in response to extreme physical inactivity. However the long-term effects on iron metabolism in women remain poorly understood and warrant further investigation.

Introduction: This study investigated whether the combination of neuromuscular electrical stimulation (NMES) and exercise therapy can prevent the muscle atrophy and weakness induced by 1 wk of bed rest in older inpatients. Methods: Twenty older female inpatients with a medical order for 1 wk of bed rest were randomly assigned to one of two groups: the exercise therapy group, which received exercise therapy only (age: 80.9 ± 6.2 yr, body mass index [BMI]: 20.8 ± 4.0 kg·m −2 ; n = 10), or the exercise therapy + NMES group, which received both exercise therapy and NMES (age: 85.1 ± 5.7 yr, BMI: 21.4 ± 5.2; n = 10). The intervention period was 1 wk, with daily sessions provided for all participants. Results: In the exercise therapy group, muscle thickness (rectus femoris [RF]: −9.1%, P = 0.0006, 95% confidence interval [CI] = 0.11–0.28; gastrocnemius (GAS): −12.5%, P = 0.004, 95% CI = 0.06–0.21) and muscle strength (RF: −11.1%, P = 0.009, 95% CI = 0.01–0.03; GAS: −21.4%, P = 0.04, 95% CI = 0.01–0.05) decreased, whereas echo intensity increased (RF: +24%, P = 0.008, 95% CI = 5.11–25.99; GAS: +32.7%, P = 0.001, 95% CI = 10.72–31.95). In contrast, the exercise therapy + NMES group showed significant increases in muscle thickness (RF: +30.0%, P = 0.0004, 95% CI = 0.17–0.42; GAS: +50%, P = 0.0002, 95% CI = 0.21–0.47) and strength (RF: +137.5%, P = 0.0006, 95% CI = 0.06–0.15; GAS: +100%, P = 0.0001, 95% CI = 0.07–0.16), with decreases in echo intensity (RF: −16.5%, P = 0.001, 95% CI = 5.37–16.22; GAS: −13.8%, P = 0.02, 95% CI = 3.79–17.4) postintervention. Conclusions: The combination of NMES and exercise therapy prevented muscle atrophy and weakness after 1 wk of bed rest, which could not be achieved with exercise therapy alone.

Short-term 6° head-down tilt bed rest simulating microgravity ameliorates blood pressure and heart rate variability: A quasi-experimental study on healthy adults.

Conservative management of pediatric patients with solid organ injury after blunt abdominal trauma. Consensus sponsored by the Spanish Society of Pediatric Surgery.

Dysmenorrhea is one of the most common menstrual problems among adolescent females. It is defined as painful cramps or pain of uterine origin that happens during or before menstruation. It has a severe impact on day-to-day activities, including school absenteeism and reduced social and physical activity. Hence, this study aimed to assess the prevalence of dysmenorrhea and its associated factors among secondary school female students in Rapti Rural Municipality, Dang, Nepal. A cross-sectional study was conducted from April 2024 to September 2024 among female secondary school students in government schools in Rapti Rural Municipality, Dang, Nepal. Students were selected through a proportionate stratified random sampling technique. A self-administered questionnaire was used to collect data from 316 adolescent girls; however, only 312 were included in the study. Data were checked, coded, and entered into EpiData (version 3.1), and analysed in SPSS version 26 using both descriptive and inferential statistics. The prevalence of dysmenorrhea was found to be 86.2%; among them, half of the respondents experienced severe pain (43.5%), followed by mild (41.6%) and moderate (14.9%). Ethnicity (χ2=12.69, p=0.026), family history of dysmenorrhea (χ2=20.358, p=0.001), menstrual cycle length (χ2=6.729, p=0.035) and experience of spotting in between periods (χ2=8.406, p=0.015) had statistically significant associations with dysmenorrhea. Severity of dysmenorrhea was found to be significantly associated with school absenteeism (χ2=33.428, p=0.001), source of information regarding menstruation (χ2=21.463, p=0.006), coping strategies like taking bed rest (χ2=18.736, p=0.001), self-medication (χ2=10.067, p=0.007), applying massage (χ2=8.86, p=0.012) and being hospitalised due to pain (χ2=7.135, p=0.028). Dysmenorrhea is a serious public health concern among adolescent girls in Rapti Rural Municipality. Factors such as family history, ethnicity, and irregular menstrual cycles significantly contribute to this burden that leads to notable school absenteeism and reliance on inadequate coping methods like self-medication. Dysmenorrhea places a substantial social and educational burden on affected students and their families, highlighting the need for better awareness and improved practical support in schools.

Pressure ulcers are conditions characterized by damage to the anatomical structure and normal function of the skin caused by continuous external pressure on prominent bony areas. This study was conducted to determine the effect of a combination of effleurage massage and Nigella sativa oil on reducing the risk of pressure ulcer development. Pressure ulcers are a common nursing problem, particularly among individuals with limited mobility and those undergoing prolonged bed rest. This study employed a quantitative approach using a quasi-experimental one-group design with post-intervention measurement. The sample consisted of 18 respondents who met the inclusion criteria and were determined using the Federer formula. All respondents received an intervention in the form of a combination of effleurage massage and Nigella sativa oil in accordance with established procedures. The risk of pressure ulcer development was assessed after the intervention using a standardized risk assessment instrument. The data were analyzed using appropriate statistical tests. The results showed a statistically significant reduction in the risk of pressure ulcer development after the intervention, with a p-value of 0.003. This study concludes that the combination of effleurage massage and Nigella sativa oil has a significant effect on reducing the risk of pressure ulcers.