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PubMed2026

Effects of a programmed reflexology therapy on sleep quality, insomnia, and fatigue among individuals with poor sleep quality: evidence for autonomic nervous system modulation.

Poor sleep quality is closely associated with autonomic dysregulation and increased risks of cardiovascular, metabolic, and mental disorders. Foot reflexology is a widely used complementary therapy; however, its physiological mechanisms and comparative efficacy remain insufficiently explored. This study aimed to compare the effects of manual reflexology treatment (MRT) and foot massage equipment (FEM) on autonomic nervous system function, sleep quality, insomnia severity, and fatigue in adults with poor sleep quality. Using a randomized crossover design, 32 participants with poor sleep quality received MRT and FEM interventions for 6 weeks each (once weekly, 30-40 min/session). Heart rate (HR), blood pressure, and heart rate variability (HRV; time- and frequency-domain indices) were assessed at weeks 1 and 6 before and after each intervention. Subjective outcomes included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Fatigue Assessment Scale (FAS). Following MRT, participants demonstrated significantly greater reductions in global PSQI scores and all PSQI components compared with FEM. MRT also resulted in larger improvements in insomnia severity and both mental and physical fatigue. In contrast, FEM primarily improved physical fatigue. Physiologically, MRT induced an immediate decrease in HR and significant increases in HRV time-domain indices (SDNN, RMSSD, pNN50), which were sustained after 6 weeks. Frequency-domain analysis further revealed reduced LF, increased HF, and a lower LF/HF ratio, indicating enhanced parasympathetic activity and cumulative autonomic modulation. In conclusion, programmed manual reflexology, delivered according to the TIDieR framework, is more effective than mechanical foot massage in improving autonomic balance, sleep quality, insomnia severity, and fatigue in individuals with poor sleep quality. These findings support MRT as a feasible and evidence-based non-pharmacological complementary intervention for sleep health promotion. TRIAL REGISTRATION: clinicaltrials.gov; NCT Number: NCT07402460; Registered 3 February 2026.

Adult↗

PubMed2004

Why some kids do well in bad situations: relation of parental alcohol misuse and parentification to children's self-concept.

Between 1991 and 1994 a sample of high- and low-functioning 10-18-year-old children of alcohol misusing and nonalcohol misusing parents were assessed on degree of problematic parental role functioning (parentification) and global self-concept. The high functioning children had been chosen by their teachers to receive training as peer counselors, whereas the low functioning children were in either psychiatric facilities or the custody of family and children services. The parentification scores of the latter significantly exceeded those of the former. Children of alcoholic parents also scored higher on the parentification measure than did those with nonalcoholic parents. Within the high functioning group hierarchical regression analysis revealed that while parental alcohol misuse status accounted for a small but significant amount of the variance in self-concept, the effect of this variable was substantially reduced after entering level of parentification into the equation. By contrast, within the low functioning group parental alcohol misuse status was not significantly related to self-concept whereas level of parentification was. The results are discussed within a family systems framework.

Adaptation, Psychological↗

PubMed1975

Teaching nursing management by programmed instruction.

Student and faculty dissatisfaction with lectures prompted several revisions of teaching methods for nursing management. Revisions centered around a programmed text for business plus various methods of application to nursing. One part of management (control) was also programmed in nursing terms. Data collected revealed that students who used the programmed business text and participated in small group discussions achieved significantly higher scores than either students who attended lectures or used the programmed business text in conjunction with a tutorial system. Data also demonstrated that students who used the unit programmed specifically for nursing management achieved significantly higher scores than students who used the programmed text for business management. This data suggest students level of achievement is increased when the transfer step from business to nursing is eliminated. For this reason, two faculty members completed the writing of a programmed text for nursing management. This text has been tested over the past two years and will be published in the near future. We were unable to collect objective data regarding the actual application of management principles to nursing practice. Subjectively, we felt the students had a stronger framework of principles unique to nursing management and were able to transfer this knowledge to leading a team with greater ease than previously. Without student dissatisfaction originally, and student acceptance and participation throughout the changes, this study would not have evolved. It was student encouragement which prompted the program specific to nursing.

Education, Nursing, Baccalaureate↗

PubMed2026

A multiancestry polygenic risk score for Alzheimer's disease is associated with cognitive decline and neuropathological hallmarks in diverse populations.

Previously derived polygenic risk scores (PRSs) for Alzheimer's disease (AD) perform inconsistently across diverse ancestries. We developed an APOE-independent multiancestry AD PRS using genome-wide association study summary statistics applied to European ancestry, African American, Caribbean Hispanic and East Asian cohorts. PRS performance was evaluated in a large independent multiancestry dataset and validated in several additional multiancestry cohorts. The PRS was significantly associated with AD in European ancestry, African American, Caribbean Hispanic and Native American Hispanic groups with adjusted odds ratios between 1.14 and 1.52 per PRS standard deviation. PRS performance was validated in the replication cohorts (odds ratios: 1.21-1.65). The PRS was also associated with poorer memory, executive function and language performance, greater AD-related neuropathological burden, reduced hippocampal volume, lower cerebrospinal fluid amyloid-β42 and elevated total tau and phosphorylated tau, with stronger phosphorylated tau associations observed in women. Our findings support the value of ancestry-aware PRSs as a component of broader multimodal risk stratification frameworks.

Aged↗

PubMed1999

Theory of Reasoned Action predicts milk consumption in women.

OBJECTIVE: To determine the factors influencing the consumption or avoidance of milk in women. SUBJECTS/SETTING: One hundred women completed food frequency questionnaires and a milk attitudes questionnaire framed within the Theory of Reasoned Action and performed sensory evaluations of different milk samples. STATISTICAL ANALYSES: Differences among milk types were assessed using 2-way analysis of variance and least-significant-difference mean comparison procedures. Correlation and multiple regression analyses, and standardized partial regression coefficients, were used to determine the contribution of each component of the model in predicting behavior. RESULTS: Mean age of the 100 subjects was 39 years (range = 20-70 years). Milk consumption among subjects was low; 23 subjects indicated that they seldom or never drank milk. Data from the dairy frequency questionnaire showed that the primary milk for 42%, 36%, 27%, and 18% of the milk drinkers was skim, 2%, 1%, and whole, respectively (subjects could indicate more than 1 type of milk consumed). The Theory of Reasoned Action indicated that health and familiarity belief items were most associated with attitudes toward milk consumption. Skim milk had significantly lower scores for taste and texture belief items than 1%, 2%, and whole milk (P < .05), yet more subjects reported that they drank skim milk (42%) than the other milk types. Sensory evaluation demonstrated that subjects linked whole milk significantly more than skim milk (P < .05). CONCLUSIONS/APPLICATIONS: Some people continue to consume skim milk for reasons other than beliefs about taste and texture or actual sensory preference. This study identifies important factors contributing to milk consumption such as beliefs, attitudes, and sensory evaluation, which can be used to develop a specific framework in which to examine other components of milk consumption behavior.

Adult↗

PubMed2026

PMGen: from peptide-MHC structure prediction to peptide generation.

MOTIVATION: Accurate structural modeling of peptide-major histocompatibility complex (pMHC) complexes is essential for structure-driven immunotherapy design, yet current prediction tools suffer from narrow class coverage, restricted peptide lengths, insufficient accuracy, and a lack of built-in structure-aware peptide sampling. Consequently, most mimotope and altered peptide ligand designs rely solely on sequence substitution, leaving spatial and biophysical insights from pMHC structures largely unexploited. RESULTS: We introduce peptide-MHC generator (PMGen), an integrated framework for structure prediction and structure-guided design of variable-length peptides across MHC Class I and II. PMGen enforces anchor constraints within AlphaFold2 through two complementary strategies, initial guess and template engineering, achieving state-of-the-art structural fidelity without model fine-tuning. On a comprehensive benchmark, PMGen outperforms all existing methods, yielding median peptide-core Cα RMSDs of 0.62 Å for MHC-I and 0.33 Å for MHC-II. We show that PMGen can recover incorrectly predicted anchor positions and that AlphaFold pLDDT scores enable sequence-independent binding-core identification. Applied to a published neoantigen/wild-type pair, PMGen accurately captures mutation-induced conformational changes. Beyond structure prediction, we show that ProteinMPNN sampling on PMGen-predicted backbones yields higher affinity peptides while preserving the parental 3D conformation. Using PMGen to generate 63 817 high-confidence pMHC structures as training data, we further improve ProteinMPNN's peptide sequence recovery from 0.14 to 0.64 on a test set of 85 unseen MHC-I alleles, highlighting the value of accurate predicted structures for downstream machine learning tasks. AVAILABILITY AND IMPLEMENTATION: PMGen is freely available at https://github.com/soedinglab/PMGen, with an interactive Colab notebook at https://colab.research.google.com/github/soedinglab/PMGen/blob/master/colab.ipynb.

Peptides↗

PubMed2005

A descriptive study of the implementation of the EFQM excellence model and underlying tools in the Basque Health Service.

OBJECTIVE: To describe the implementation of the European Foundation for Quality Management (EFQM) excellence model as a common framework for quality management in a regional health care service. DESIGN: Prospective, descriptive observational study. SETTING: Thirty-one organizations (hospitals, primary care organizations, mental health institutions, and emergency services) of the Basque Health Service (serving a population of 2200000 inhabitants) in Basque Country, Spain. METHODS: Since 1995, the experiences with the EFQM excellence model were initiated by training, the design of quality tools and application guidelines, and actions related to criteria of the EFQM model. RESULTS: Four assessment cycles in which most of the organizations have participated were completed. Scores for most of the criteria improved, particularly in 'processes'. The overall patients' satisfaction was higher than 89% in all settings, in most of the cases higher than 95%. Ten organizations (32%) exceeded 400 points in an external evaluation with the EFQM excellence model, and 2 (6%) 500 points. Eighty-three percent of hospitals have some ISO-certified areas of activity. In the primary care setting, 40% of people were attended in a certified center. CONCLUSIONS: Stimulating actions towards quality have resulted in progressive implementation of the EFQM model, this approach being possibly related to positive evolution of some outcomes. Key factors identified have been pursuing the objective of total quality management during several years and the assignment of the resources for training and implementation of quality systems.

Benchmarking↗

PubMed2026

Effects of single-injection vs. continuous brachial plexus blocks for shoulder surgeries on patient-reported outcomes: a systematic review and meta-analysis with trial sequential analysis of randomised controlled trials.

INTRODUCTION: Single-injection and continuous brachial plexus block techniques are used widely for postoperative analgesia in patients undergoing shoulder surgery. Although patient-reported outcomes are described in individual studies, their effects have not been synthesised comprehensively using a patient-centred framework. We sought to compare the effects of single-injection vs. continuous brachial plexus block techniques on patient-reported outcomes in adult patients following elective shoulder surgery. METHODS: Databases were searched from inception to October 2025 and randomised controlled trials reporting patient-reported outcomes were included. Co-primary outcomes were postoperative patient-reported pain intensity at rest and during movement at 12 h, 24 h and 48 h post-surgery. Secondary outcomes included nausea and vomiting; sleep quality; patient satisfaction; opioid requests; and functional scores. Random-effects meta-analysis and trial sequential analysis were performed, with risk of bias and quality of patient-reported outcome reporting assessed. RESULTS: Twenty randomised controlled trials that included 1198 patients were analysed. Continuous brachial plexus blocks were associated with lower pain at rest at 12 h, 24 h and 48 h, with mean differences (MD) of -1.96 (95%CI -2.81 to -1.11, p < 0.001), -1.66 (95%CI -2.27 to -1.05, p < 0.001) and - 1.18 (95%CI -1.84 to -0.53, p < 0.001), respectively. Pain on movement could only be pooled at 24 h and 48 h and showed MD -2.04 (95%CI -4.26-0.19, p = 0.07) and - 1.30 (95%CI -3.67-1.07, p = 0.28) respectively. The co-primary outcomes approached or exceeded the predefined minimal clinically important difference for pain scores after shoulder surgery, in favour of continuous techniques. DISCUSSION: Continuous brachial plexus blocks are associated with better pain at rest and other patient-centred outcomes following shoulder surgery, while effects on dynamic pain and long-term functional recovery remain uncertain.

Humans↗

PubMed1995

Self-care styles in military veterans.

Understanding of self-care behaviors in veterans has been hampered by lack of a framework by which to describe styles or patterns of individual self-care. The primary purpose of this study was to identify consciously performed health practices in 69 U.S. military veterans and to categorize these behaviors into styles. Four categories of self-care were described based on the nature and extent of health concerns addressed by individual health regimens and on the types of resources utilized. Membership in the various categories was not related to age, sex, race, or health status of veteran subjects, but was significantly related to scores on Kearney and Fleischer's Exercise of Self-Care Agency Instrument.

Analysis of Variance↗

PubMed2026

A doubly robust framework for addressing outcome-dependent selection bias in multi-cohort EHR studies.

Selection bias can hinder accurate estimation of association parameters in binary disease risk models using non-probability samples like electronic health records (EHRs). The issue is compounded when participants are recruited from multiple clinics/centers with varying selection mechanisms that may depend on the disease/outcome of interest. Traditional inverse-probability-weighted (IPW) methods, based on constructed parametric selection models, often struggle with misspecifications when selection mechanisms vary across cohorts. This paper introduces a new Joint Augmented Inverse Probability Weighted (JAIPW) method, which integrates individual-level data from multiple cohorts collected under potentially outcome-dependent selection mechanisms, with data from an external probability sample. JAIPW offers double robustness by incorporating a flexible auxiliary score model to address potential misspecifications in the selection models. We outline the asymptotic properties of the JAIPW estimator, and our simulations reveal that JAIPW achieves up to 6 times lower relative bias and 5 times lower root mean square error (RMSE) compared to the best performing joint IPW methods under scenarios with misspecified selection models. Applying JAIPW to the Michigan Genomics Initiative (MGI), a multi-clinic EHR-linked biobank, combined with external national probability samples, resulted in cancer-sex association estimates closely aligned with national benchmark estimates. We also analyzed the association between cancer and polygenic risk scores (PRS) in MGI to illustrate a situation where the exposure variable is not measured in the external probability sample.

Selection Bias↗

PubMed2000

An original accelerated radiotherapy schedule in stage III to IV head and neck cancers. Results in a multicenter setting.

BACKGROUND: Accelerated radiotherapy delivery has recently been shown to be effective in overcoming repopulation during fractionated radiotherapy. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the feasibility and results of a particular accelerated schedule in Stage III to IV head and neck carcinomas used in a multicenter setting. PATIENTS AND METHODS: Seventy-four patients with Stage III (26 patients) or IV (48 patients) head and neck carcinomas were treated with a 5-week accelerated schedule (69.6 to 69.8 Gy in 41 to 40 fractions over a period of 35 to 36 days). Treatment began with 20 Gy in 10 daily fractions to initial involved sites, followed by bi-fractionated radiotherapy (2 x 1.6 Gy to 1.66 Gy/day) to a larger head and neck volume. Thirty-six (49%) patients received induction chemotherapy (median 3 cycles, range 1 to 4 cycles). RESULTS: Grade 3 or 4 (RTOG) confluent mucositis was observed in 57 patients (77%) and Grade 3 dysphagia in 33 patients (44%). Grade 3 or 4 (RTOG-EORTC) late complications were scored in 10.5% of cases. The 5-year actuarial locoregional control rate was 56% (95% CI: 42 to 71). The 5-year overall actuarial survival was 32% (95% CI: 18 to 46). Induction chemotherapy was not associated with a more favorable outcome. CONCLUSIONS: This study demonstrates the feasibility of this schedule in a multicenter setting. The oncologic results appear similar to those obtained by other accelerated regimens, while the rate of late complications seems acceptable. Five-week accelerated regimens warrant further evaluation, particularly in conjunction with concomitant chemotherapy, in the framework of prospective trials.

Actuarial Analysis↗

PubMed1996

Sexual risk behavior among urban women of childbearing age: implications for clinical practice.

Cox's interaction model of client health behavior was used as an organizing framework to describe the demographic characteristics, motivation, problem-solving, self-esteem, and sexual risk behaviors among urban women of childbearing age (N = 125; average age = 32 years). Eighty-five percent of the women were African American. Sexual risk behaviors were defined as more than one sex partner and not using a condom. Eight women were at the highest risk in that they reported having more than one sex partner and not using condoms. Participants reported low self-esteem, intrinsic motivation, and adequate problem-solving abilities. Motivation scores were significantly different based on number of sex partners (t = 2.26, p = .03). Women with more than one partner had lower scores compared to women with only one partner. There was a significant variation in reported self-esteem among women who used condoms (t = 2.36; p = .22). Women who did not use condoms reported lower self-esteem than women who said that they used condoms.

Adult↗

PubMed2000

Consensus and comprehensive linkage maps of bovine chromosome 7.

The objective of this project was to integrate the currently available linkage maps for bovine chromosome 7 (BTA7) by combining data sets from eight research groups. A total of 54 unique markers were typed in eight pedigrees. Multilocus linkage analysis with CRI-MAP produced a bovine chromosome 7 consensus framework map of 27 loci ordered with odds greater than 1000:1. Furthermore, we present a bovine chromosome 7 comprehensive map integrating 54 loci. The locus order is in general agreement with the recently published linkage maps except for one discrepancy. The order of loci BM9289, BMS713, and ILSTS001 was reversed in the consensus framework map relative to the published USDA-MARC bovine chromosome 7 linkage map.

Animals↗

PubMed1996

Measurement of quality of life in localized prostatic cancer patients treated with radiotherapy. Development of a prostate cancer-specific module supplementing the EORTC QLQ-C30.

The purpose of this study was to construct a multidimensional self-administered quality of life questionnaire specific to prostate cancer within the EORTC framework and to test its applicability, clinical relevance and psychometry. A proposed prostate cancer-specific module and the standardized EORTC QLQ-C30 version 1.0 were tested in 192 post-irradiated patients. Psychometric analyses comprised item convergent and discriminant validity for scaling success, analysis of the internal consistency of the multi-item scales and the validity of the scales. The clinical relevance was explored by correlation analysis including disease and treatment related parameters. The minimum psychometric criteria were met. The measurements revealed problem areas in sexuality with a mean score of 54 (SD = 33) on a 0-100 scale, and in bowel functioning, scoring 25 on average (SD = 17). Urinary complaints only reached a mean score of 6 (SD = 19). Compared to earlier measurements on untreated or irradiated localized cancer patients using the same core questionnaire, the physical and psychological scales showed higher values and the symptom scales lower symptom burden. The constructed questionnaire seems applicable and clinically relevant. The psychometric analysis revealed a few items to be revised. Patients with localized prostatic carcinoma treated with radiotherapy have a high quality of life compared to patients with localized cancer of other origin.

Aged↗

PubMed2006

The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective.

INTRODUCTION: Risedronate, a bisphosphonate for treatment and prevention of osteoporosis, has been shown in several clinical trials to reduce the risk of fractures in postmenopausal women with osteoporosis. The cost-effectiveness of risedronate treatment has previously been evaluated within different country settings using different model and analysis approaches. The objective of this study was to assess the cost-effectiveness of risedronate in postmenopausal women in four European countries -- Sweden, Finland, Spain, and Belgium -- by making use of the same modelling framework and analysis setup. METHODS: A previously developed Markov cohort model for the evaluation of osteoporosis treatments was used to estimate the cost-effectiveness of risedronate treatment. For each country, the model was populated with local mortality, fracture incidence, and cost data. Hip fractures, clinical vertebral fractures, and wrist fractures were included in the model. RESULTS: The incremental cost per quality-adjusted life years (QALY) gained from a 5-year intervention with risedronate compared to "no intervention" in 70-year-old women at the threshold of osteoporosis [T-score = -2.5 based on National Health and Nutrition Examination Survey (NHANES) III data] and previous vertebral fracture was estimated to be euro 860, euro 19,532, euro 11,782, and euro 32,515 in Sweden, Finland, Belgium, and Spain, respectively. Among 70-year-old women at the threshold of osteoporosis without previous fracture the estimated cost per QALY gained ranged from euro 21,148 (Sweden) to euro 80,100 (Spain). The differences in cost-effectiveness between countries are mainly explained by different costs (fracture and treatment costs), fracture risks, and discount rates. Based on cost per QALY gained threshold values found in the literature, the study results indicated risedronate to be cost effective in the treatment of elderly women with established osteoporosis in all the included countries. CONCLUSIONS: At a hypothetical threshold value of euro 40,000 per QALY gained, the results in this study indicate that risedronate is a cost-effective treatment in elderly women at the threshold of osteoporosis (i.e., a T-score of -2.5) with prevalent vertebral fractures in Sweden, Finland, Belgium, and Spain.

Age Factors↗

PubMed1997

Arthroscopic anterior cruciate ligament reconstruction using a patellar tendon graft in press-fit technique: surgical technique and follow-up.

A modified endoscopic technique for anterior cruciate ligament (ACL) reconstruction using an autologous patellar tendon graft is described using the early results for 120 patients. A special technique using an oscillating hollow saw allows for the rapid and standardized harvest of cylindrical bone plugs, ensuring safe and adequate femoral press-fit fixation. The complications encountered included one fracture of a bone back on plugging in as well as two cases with revision procedures for interference screw fixation due to insufficient femoral anchorage. Within the framework of a prospective study, all 120 patients underwent a control arthroscopy after the first postoperative year showing viable and mechanically stable grafts in 64 (53.3%) of the patients. In 44 patients (36.7%), viable though somewhat lax grafts were found, whereas the remaining 12 patients (10%) only showed insufficient tissue residues. All of these cases were the result of a ventral misplacement of the femoral insertion site representing the primary complication of transtibial technique. The results of the control arthroscopies showed a highly significant correlation with the clinical results for the IKDC score obtained in a follow-up after an average 29 (18 to 36) months. The results for stability according to the IKDC rating scale showed a normal or near-normal knee function in 76.7%. With regard to the subjective results in the IKDC rating scale, 83.3% of the patients (n = 100) assessed their knee function as normal or almost normal. The location and positioning of the femoral and tibial tunnel were evaluated in an exact radiographic evaluation showing an "ideal position" of the graft in only 94 cases (78.3%). Statistically, a significant correlation of stability with the femoral fixation site could be shown.

Adult↗

PubMed2005

Biological monitoring of ozone: the twenty-year Italian experience.

Tropospheric ozone is a growing environmental menace in Italy and in the whole Mediterranean basin. The importance of active biomonitoring of this pollutant with hypersensitive Bel-W3 tobacco plants is stressed, and several examples of field studies carried out in Italy with this technique are presented. Current limitations are discussed, with special emphasis on data quality assessment and the opportunity of adopting easy-to-use kits based on tobacco germlings instead of adult plants. A standardization of methodologies (from cultivation to scoring and data elaboration), also at an international level, is strongly felt to be needed, in order to get official acknowledgement of biomonitoring procedures. Potential educational implications, with the active involvement of students and environmentalists, are shown. Other biological indicators are used, namely sensitive and resistant white clover (Trifolium repens) clones (as descriptors of biomass reduction in crops species) and Centaurea jacea (brown knapweed) as a model species to evaluate the relationship between ozone exposure and effects on the performance and injury symptoms of native plants which are largely used in the framework of European programmes.

Environmental Monitoring↗

PubMed1992

An industrial hygiene methodology developed in support of a retrospective morbidity case-control study.

An industrial hygiene methodology that was developed in support of an epidemiologic case-control study is described. This study was conducted to investigate a potentially increased incidence of colorectal cancer among employees who worked at a unit that manufactured polypropylene by a heavy diluent process. Retrospective epidemiologic case-control studies typically have exposure assessment problems because industrial hygiene monitoring data are often not available. Misleading job titles are another problem that can provide a poor framework for estimating exposures. In addition, a job title-based exposure assessment assumes individual work patterns are not important in assessing worker exposures, although this is contradictory to industrial hygiene experience. The design of the case-control study provided an innovative industrial hygiene approach to circumvent these typical exposure estimating problems. The industrial hygiene methodology of the case-control study included assessing historical exposures, developing an exposure estimating matrix, selecting candidate etiologic agents based on a joint toxicologic and industrial hygiene review, administering a work activity questionnaire, calculating exposure scores, and conducting a statistical analysis. The study design also provided an additional exposure measurement independent of the toxicologic and industrial hygiene review. This provided an opportunity to compare the likelihood of exposure misclassification and, as expected, showed that a more detailed exposure estimate resulted in less misclassification.

Colorectal Neoplasms↗