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Background/Objectives: This article presents the feasibility and preliminary outcomes of an international cooperation project between the University of Valencia (Spain) and the University and health authorities of Pinar del Río (Cuba), designed to implement and evaluate an innovative rehabilitation protocol. Aligned with the United Nations Sustainable Development Goals (SDGs 3, 4, and 10), the initiative aims to implement a low-cost, evidence-based rehabilitation program combining mirror-neuron stimulation via Virtual Walking and therapeutic exercise. Methods: The program included multidisciplinary meetings and both digital and on-site training for healthcare professionals, caregivers, and educators, aimed at strengthening local capacities in evidence-based practice. The transferred protocol consisted of Virtual Walking (10 min) and therapeutic exercise (30 min), implemented three times per week, for eight weeks. Outcomes assessed included gait speed and endurance (10-Minute Walking Test, 6-Minute Walking Test), lower limb function (Timed Up and Go Test), frailty status (Fried criteria), pain (Visual Analog Scale), and satisfaction with the training program. Pre-post comparisons were conducted using the Wilcoxon signed-rank test for continuous data. Results: The program was successfully implemented in two polyclinics with high levels of participant satisfaction. Eleven patients completed the program, showing significant improvements in gait endurance (p < 0.05), while lower limb function and pain did not change significantly. Noteworthily, severe infrastructural and connectivity limitations were found. Overall, results demonstrate the feasibility, adaptability, and acceptability of the proposed protocol, which integrates technological innovation, clinical training, and community engagement to promote health quality and equity. Conclusions: This project provides a replicable framework for rehabilitation initiatives in low-resource settings and demonstrates the potential to achieve meaningful clinical results.

Background: Preoperative fasting is one of the most difficult stages of hospitalization for children and their caregivers. The popularization of preoperative oral polycarbohydrate preparations is an important element influencing the comfort of hospitalized children. The aim of the study was to assess the effect of carbohydrate administration on perioperative blood glucose (PBG), the occurrence of complications in the pre- and postoperative periods, and satisfaction in children and adolescents.

Material and methods: The study was a comparative-observational one, and the following research methods were used: an author's diagnostic questionnaire, observation, and analysis of medical documentation. The research group consisted of 50 patients from the Pediatric Orthopedic Department who received an oral polycarbohydrate solution up to 2 h before anesthesia. The control group consisted of 50 patients who fasted for more than 6 h before anesthesia. The study was conducted between February and May 2024.

Results: The patients were assessed using a measurement of venous blood glucose taken immediately before the administration of premedication. Parents completed a questionnaire regarding their child's perioperative period.

Conclusions: The glucose level in patients who received a polycarbohydrate preparation is higher than in children who did not. The administration of polycarbohydrate preparations influences the feeling of thirst and hunger in the postoperative period in children and adolescents. Oral administration of a polycarbohydrate preparation up to 2 h before anesthesia does not cause regurgitation in children and adolescents. Patients who received an oral polycarbohydrate preparation tolerated the waiting period before anesthesia better. Preoperative fasting is, apart from the insertion of venous access, the most stressful situation for children and adolescents during hospitalization. The supply of oral polycarbohydrate preparations has a positive effect on pediatric patients in the perioperative period.

Objective: To evaluate the effectiveness of a pharmacist-led educational intervention in reducing premenstrual syndrome (PMS) symptoms and improving self-care practices. Methods: A mixed-design study was conducted in community pharmacies in Spain between January and June 2025. First, a cross-sectional analysis determined PMS prevalence. Second, a longitudinal pre-post study was performed with women suffering from PMS. The intervention involved personalized guidance and an evidence-based educational infographic. Primary outcomes included symptom severity (measured by a numeric rating scale) and quality of life. Results: 350 women participated in the study. The mean age of participants was 23.7 ± 6.3 years (range: 17-51 years). At the six-month follow-up, the PMS group showed a significant reduction in mean pain intensity (from 6.86 to 3.26; p < 0.001) and a smaller reduction in the control group (from 4.82 to 2.88; p < 0.001), alongside improvements in irritability, insomnia, and fatigue. The proportion of women reporting a negative impact on quality of life decreased from 97.0% to 60.8% (p < 0.001). Oral contraceptive use was identified as a protective factor (OR: 0.33; 95% CI: 0.17-0.65). Conclusions: Educational interventions led by community pharmacists are effective in significantly alleviating PMS symptoms and enhancing women's quality of life. Practice Implications: Community pharmacists are strategically positioned to identify women with PMS and provide evidence-based education. Implementing structured protocols and visual tools in pharmacies can optimize symptom management and promote self-care.

Background/Objectives: Human papillomavirus (HPV) is a major cause of cervical, penile, anal, and oropharyngeal cancers. HPV vaccination is the most effective public health strategy for its prevention. Understanding the factors influencing vaccination intentions is critical for developing effective public health policies and improving population-level vaccine uptake. Therefore, in this scoping review, we aimed to examine HPV vaccination research conducted in Korea, identify common trends and gaps in study populations and influencing factors, and provide evidence-based recommendations for public health policies. Methods: We systematically searched four Korean databases-Research Information Sharing Service (RISS), DBpia, Korean Studies Information Service System (KISS), and National Digital Science Library (NDSL)-for studies published from their respective inception dates to January 2025, using "human papillomavirus," "HPV," "vaccination," and "intention" as keywords. Thirty-six studies were ultimately included. Study characteristics, populations, theoretical frameworks, and key variables were extracted and analyzed using descriptive statistics and content analysis. Results: Of the included studies, 61.1% and 38.9% targeted vaccination-eligible individuals (adolescents and adults) and parents/guardians, respectively, with 50% focusing exclusively on women. The major factors influencing HPV vaccination intention were attitude (47.2%), subjective norms (38.9%), and perceived behavioral control (30.9%). Attitude and knowledge were critical for vaccination-eligible individuals (Direct group), whereas subjective norms were key for parents/guardians (Indirect group). Conclusions: Korean HPV vaccination intention research has predominantly focused on women and parents, with insufficient attention to adolescents and men. Public health strategies must employ multilevel interventions tailored to each group's decision-making structures, including school-based programs for adolescents, gender-inclusive policies for men, and community-based approaches to address social norms among parents. These findings provide evidence for policy development aligned with the WHO cervical cancer elimination goals.

Background/Objectives: Inpatient falls are widely used patient safety indicators, yet their behavior under periods of large-scale health system stress remains insufficiently understood. This study aimed to evaluate whether risk-adjusted inpatient fall indicators can capture changes in hospital safety performance during such periods, using a prolonged system disruption as an empirical context. The study period was a priori divided into three phases (pre-pandemic, initial pandemic, and later pandemic) according to changes in COVID-19 admission burden and system stress intensity. Methods: We conducted a retrospective observational time-series analysis using daily inpatient fall events and census data from a Japanese acute care hospital between December 2018 and March 2023 (50,140 inpatients; 962 falls). Expected fall rates were estimated using a validated pre-disruption prediction model, and observed/expected (O/E) ratios were calculated to assess risk-adjusted safety performance. Ordinary least squares regression models adjusted for calendar month and seasonal Fourier terms were used to examine temporal associations between fall outcomes and indicators of hospital-level system burden. Results: Both observed and expected fall rates increased during the study period, whereas O/E ratios declined only in the later phase, indicating improvement in risk-adjusted safety performance despite rising intrinsic patient risk. Seasonal patterns in fall outcomes were disrupted during the early phase of system stress but re-emerged over time. Associations between system burden indicators and fall outcomes were most pronounced in the early phase and attenuated in later phases. Conclusions: Risk-adjusted monitoring of inpatient falls provides insight into dynamic changes in hospital safety performance during periods of large-scale system stress and subsequent adaptation. This indicator can also be interpreted as a benchmarking scale for future month-to-month and seasonal safety surveillance beyond crisis contexts.

Background: The term immigrant health paradox describes how immigrants often have better health outcomes than their American-born counterparts. While existing literature treats this phenomenon as broadly generalizable, emerging research indicates that its expression varies across cultural and migration contexts. Understanding how the immigrant health paradox may appear across specific ethnic groups requires research that maps variation rather than assumes uniformity. Objectives: This study seeks to describe patterns, explore variation by nativity, and identify factors associated with well-being among the Vietnamese population in the United States (US). By focusing on descriptive trends and contextual influences, the study aims to generate new insights into how the paradox may manifest-or diverge-in the Vietnamese context. Methods: We conducted an online survey asking participants about their depressive disorders, physical and mental health status, demographics, socioeconomic status, social networks, and experiences with daily discrimination. Descriptive statistics were used to describe the study sample. Linear regression and ordinal logistic regression were performed to explore the relationships. Results: In this exploratory analysis, we did not observe indications of the Vietnamese immigrant health paradox. Material factors, especially perceptions of financial needs, as well as psychological factors, were somewhat associated with how Vietnamese people living in the US assess their health. Conclusions: The absence of the Vietnamese immigrant health paradox in the US underscores the need for nuanced health models that reflect diversity within immigrant groups. Their experiences reveal how migration histories, structural barriers, and racialization shape health outcomes in ways that differ from expectations.

Background/Objective: Hand hygiene is a cornerstone of infection prevention; however, compliance is inconsistent in intensive care units (ICUs), particularly in resource-constrained settings. This study evaluated whether a low-cost, multimodal quality improvement intervention could improve process-level hand hygiene compliance using routine, episode-based audits embedded in the ICU practice. Methods: We conducted a single-cycle Plan-Do-Study-Act quality improvement project in a 12-bed mixed medical-surgical ICU in Pakistan (December 2023-January 2024). Hand hygiene performance was assessed using the unit's routine weekly episode-based audit protocol, aligned with the WHO Five Moments framework. A targeted multimodal intervention comprising education, point-of-care visual reminders, audit feedback, and leadership engagement was implemented between the pre- and post-intervention phases (four weeks each). Non-applicable moments were scored as "compliant by default" according to the institutional protocol. A sensitivity analysis was performed excluding these moments to calculate pure adherence. Compliance proportions were summarized using exact 95% Clopper-Pearson confidence intervals without inferential testing. Results: A total of 942 audit episodes (471 per phase) generated 4710 moment-level assessments were generated. Composite hand hygiene compliance increased from 63.1% pre-intervention to 82.0% post-intervention [absolute increase: 18.9 percentage points (pp)]. Sensitivity analysis excluding non-applicable moments demonstrated pure adherence improvement from 54.2% to 82.5% (+28.3 pp), confirming a genuine behavioral change rather than a measurement artifact. Compliance improved across all five WHO moments, with the largest gains in awareness-dependent moments targeted by the intervention: before touching the patient (+27.0 pp) and after touching patient surroundings (+40.0 pp). Week-by-week compliance remained stable within both phases, without immediate post-intervention decay. Conclusions: A pragmatic, low-cost multimodal intervention embedded in routine ICU workflows was associated with substantial short-term improvements in hand hygiene compliance over a four-week observation period, particularly for awareness-dependent behaviors. Episode-based audit systems can support directional process monitoring in resource-limited critical care settings without the need for electronic surveillance. However, its long-term sustainability beyond one month and generalizability to other settings remain unknown. Sensitivity analyses are essential when using "compliant by default" scoring to distinguish adherence patterns from measurement artifacts.

Background/Objectives: Cystic fibrosis (CF) is a genetic condition with an increasing life expectancy in recent years. As a result, addressing psychosocial aspects in this population has become an increasingly important concern. This mixed-methods systematic review aimed to update the current knowledge on the psychosocial aspects of living with CF in adults. Methods: Following PRISMA guidelines, a literature search was conducted in November 2024 across several databases, including Scopus, ScienceDirect, Academic Search Complete, MEDLINE, Supplemental Index, Complementary Index, APA PsycInfo, Business Source Complete, SciELO, and the Directory of Open Access Journals via EBSCO. Results: Of the 701 articles retrieved, 24 were analyzed, including a total of 2023 participants (mean age: 31.2 years; 57.2% female). Quantitative findings identified optimistic coping as the most frequent strategy associated with improved survival. High social support and gratitude emerged as key factors for treatment adherence and quality of life, while depression remained the primary mental health concern. Qualitatively, the findings highlighted concerns with adult life transitions and financial stressors. Participants described experiences of social stigma and embarrassment linked to chronic symptoms, often leading to selective disclosure to avoid discrimination. Conclusions: This review confirms that psychosocial factors are central to the adult CF experience, shifting the focus beyond biological survival and highlighting areas that require clinical intervention. As life expectancy increases, clinical care must evolve to incorporate interventions that address these factors to improve mental health and overall quality of life (QoL), ensuring that patients are supported through the unique challenges of extended adulthood.

Introduction: Parkinson's disease can influence oral health by impairing motor function and altering salivary composition, potentially affecting the oral microbiome. Materials and Methods: The objectives of this study are fourfold: (a) to compare the prevalence of bacterial species associated with periodontal disease in patients with and without Parkinson's disease (PD), (b) to assess whether the coexistence of periodontal disease in PD patients contributes to an imbalance in the oral microbiome, (c) to evaluate the correlation between periodontal clinical indices (plaque index, tartar index, bleeding index, and probing depth) and the concentrations of specific periodontopathogenic bacterial species, and (d) to explore the potential implications of these evidences for clinical management and preventive strategies in Parkinson's patients. The main objective of this study is to compare periodontal clinical indices (plaque index, tartar index, bleeding index, and probing depth) and the bacterial profile of patients with periodontal and Parknson's disease. Two groups were included: 15 patients with periodontal disease (control group) and 16 patients with both periodontal and Parkinson's disease (study group). Microbial samples were collected from the periodontal pockets at baseline and analyzed using the Polymerase Chain Reaction (PCR) Perio-Ident 12 kit to detect major periodontal pathogens. Results: Periodontal indices showed no statistically significant differences between groups, although the study group presented lower mean tartar index (49.31% vs. 67.4%, p = 0.069), bleeding on probing (44.31% vs. 56.67%, p = 0.137), and plaque index (66% vs. 68.93%, p = 0.754). Median bacterial loads were generally higher in control group, with Tannerella forsythia, but without statistically significant difference (p = 0.072). Significant correlations between plaque index and multiple pathogens occurred only in control gorup, suggesting disrupted plaque-pathogen dynamics (p < 0.05). Conclusions: The results highlight the potential value of integrating clinical and microbiological assessment when managing periodontal disease in patients with Parkinson's disease.

Introduction: Gestational diabetes (GD) screening remains limited in many low- and middle-income countries (LMICs) due to resource constraints, limited training, and low community awareness. Although community-centered approaches may improve access to screening in rural and Indigenous settings, the implementation processes through which such approaches are designed and operationalized are rarely documented. Methods: This study presents a community-based implementation process report describing the development, adaptation, and early implementation of a GD screening program in rural Guatemala, guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework. Using a participatory approach, international screening guidelines were systematically adapted to the local context through iterative protocol refinement, structured stakeholder engagement, and ongoing feedback from community health educators and partner institutions. Aggregate program data were used descriptively to characterize early screening uptake and feasibility. Results: Key implementation challenges included patient no-shows, community skepticism, and difficulties among health educators in interpreting screening procedures. Iterative adaptations were introduced to simplify protocols, reduce loss to follow-up, and strengthen community engagement. Over time, the program expanded from point-of-care screening to more comprehensive prenatal services and increased collaboration with the Ministry of Health and local community outlets. A total of 103 Indigenous Mayan Tz'utujil women were screened (mean age: 26.9 years; range: 15-46), of whom, 12 were diagnosed with GD. Conclusions: This implementation process report demonstrates the scientific value of systematically documenting real-world adaptation, feasibility, and stakeholder engagement when introducing GD screening in rural Indigenous LMIC settings. The implementation lessons described may inform similar maternal health initiatives in comparable contexts.