Wenru Wang

Background: Physical inactivity increases the risk of developing chronic illnesses. However, the effectiveness of Zumba among women who are physically inactive remains understudied. This review aims to evaluate the effectiveness of Zumba in improving cardiorespiratory fitness and anthropometric measures (body mass index, body fat, and waist circumference) among women with low physical activity levels. Methods: PubMed, EMBASE, Cochrane, Scopus, Web of Science, CINAHL, and ProQuest Education Collection were systematically searched until June 8, 2025. Eligibility criteria were as follows: (1) randomized controlled trials involving insufficiently active adult women (< 150 min moderate or < 75 min vigorous activity/week); (2) Zumba or its variations as the intervention; (3) no intervention or usual care as the comparator; and (4) reporting of cardiorespiratory fitness, body mass index, body fat percentage, or waist circumference. Quality appraisal for included studies was performed using the revised Cochrane Risk of Bias tool. Meta‐analyses were performed using the random‐effects model where possible. Results: Seven randomized controlled trials (eight reports) were included. Zumba significantly improved cardiorespiratory fitness (MD = 3.63; 95% CI 2.00, 5.26; p < 0.01) and body fat percentage (MD = −5.11; 95% CI −8.77, −1.46; p < 0.01) compared to no intervention/usual care. No statistically significant differences were observed in body mass index between groups (MD = −0.97; 95% CI −2.49, 0.54; p = 0.21). Narrative synthesis of three reports found positive improvements in waist circumference after completion of Zumba interventions. Conclusion: Zumba effectively improves cardiorespiratory fitness and reduces body fat percentage among women with low physical activity levels. Further high‐quality research is warranted to determine optimal intervention dosage, assess other Zumba modalities, and explore Zumba's implementation and sustainability.

Aim: To develop and examine the feasibility and preliminary effectiveness of a multicomponent diabetes prevention programme, Preventing Diabetes Via Volunteers Engaging Residence using Technology (P‐Divert), in improving intentions to prevent diabetes and promoting healthy lifestyle behaviours. Design: Pilot quasi‐experimental study with matched controls. Methods: The P‐Divert programme was developed following the UK Medical Research Council framework for developing and evaluating complex interventions. Field testing with lay participants and relevant experts informed programme refinement prior to implementation. A pilot quasi‐experimental study with matched controls was conducted among adults aged 21–69 years at risk of developing diabetes in Singapore. Data were collected at baseline and 12 weeks using validated instruments. Outcomes included the Diabetes Intentions, Attitudes and Behaviour Questionnaire (DIAB‐Q), Generalized Self‐Efficacy Scale (GSES), Multidimensional Health Locus of Control Form C (MHLC‐C), Exercise Goal Setting Scale (EGS), Weight‐Related Eating Questionnaire (WREQ), and clinical outcomes. Results: The programme demonstrated acceptable feasibility, with an 80% retention rate and a 70% adherence rate. Compared with the control group, participants in the intervention group reported significantly higher DIAB‐Q subjective norm and planning scores, exercise goal setting scores, and WREQ compensatory restraint scores, as well as significantly lower MHLC‐C Chance scores. Conclusion: The P‐Divert programme was feasible and showed preliminary potential to improve intentions to prevent diabetes and promote the adoption of healthy lifestyle behaviours among individuals at risk of developing diabetes. Implications to Nursing: The P‐Divert programme can potentially enhance at‐risk individuals' intentions to adopt healthier behaviours, possibly lowering diabetes prevalence and healthcare burden in Singapore. Its integration into community nursing services could strengthen diabetes prevention efforts and may also have potential applications in the prevention of other chronic diseases, thereby reducing long‐term disease management burdens. Patient or Public Contribution: Members of the public were recruited as participants in this study.

Background and Aims Current diagnostic criteria for metabolic syndrome (MetS) may inadequately capture underlying metabolic heterogeneity and associated cardiovascular risks. We aimed to use expanded cardiometabolic variables to identify new cardiometabolic phenogroups with relevance to prognosis and risk stratification. Methods Latent class analysis (LCA) was applied to a discovery cohort (RESET; n=1,034), using the six conventional MetS measures and eight additional variables. A decision tree model was constructed using the most important variables to enable practical phenogroup classification and facilitate external validation. External validation was conducted in three independent cohorts, PICMAN (n = 120), UK Biobank (n = 344,817), and CHARLS (n = 12,145), analysing for proteomic signatures and cardiovascular outcomes. Results Five latent phenogroups were identified in the discovery cohort: Metabolically Preserved with and without isolated hypertension (each n=244; 23.6%), Lean-Insulin Resistant (IR) (n=140; 13.5%), Obese-Insulin Sensitive (IS) (n=211; 20.4%), and Obese-IR (n=195; 18.9%). Lean-IR and Obese-IS showed discordant adiposity and insulin/glycemic status, and a low prevalence of MetS (21.4% and 31.3%, respectively), whereas MetS was high (75.9%) only in the Obese-IR group. A decision tree model using four binary indicators (visceral adiposity, IR, elevated SBP, and HbA1c) accurately classified individuals into the five latent phenogroups and was subsequently deployed for external validation. Validation in PICMAN showed significantly higher liver fat (Mean 9.0% [SD 6.3%]) in Lean-IR versus Metabolically Preserved (Mean 2.8% [SD 1.8%], P=0.002). Plasma proteomic analyses further reflected unique metabolic-inflammation signatures across the 5 groups. Validation in the UK Biobank showed significant association between the latent phenogroups with outcomes of myocardial infarction and stroke. Hazard ratios for the composite outcome after adjusting for age and sex were 1.52 (95% CI, 1.43-1.61) for isolated hypertension, 1.86 (1.75-1.98) for Lean-IR, 1.85 (1.75-1.97) for Obese-IS, and 2.75 (2.56-2.95) for Obese-IR, compared with the Metabolically Preserved group. Conclusion Expanded cardiometabolic risk factors reveal metabolic heterogeneity obscured by current MetS criteria. Incorporating visceral adiposity and IR into a novel classification system refines cardiovascular risk stratification for the management of cardiometabolic disease.

Families remain central to later‐life support, yet evidence on intergenerational caregiving is fragmented across dyads, generations, and cultural contexts. This scoping review maps how caregiving is organized and negotiated across structural, associational, affectual, functional, consensual, and normative dimensions. Following PRISMA‐ScR and Arksey and O’Malley's framework, seven databases and Google Scholar were searched. Eligible studies reported empirical findings on care exchanged between family members of different generations, sampled at dyadic, triadic, or family levels, and published in English since 2000. Data were charted to Intergenerational Solidarity dimensions and intergenerational ambivalence and synthesized using a framework approach. Forty‐nine studies met criteria, largely qualitative and Western. Proximity and co‐residence structured caregiving intensity, while distance prompted mediated contact, remittances, rotational arrangements, and formal services. Care flows were multidirectional and networked, moderated by affectual climate and consensual governance. Policy should recognize caregiving as networked and multidirectional, while research must broaden samples and adopt longitudinal designs.

Given persistent and unpredictable delays in antiretroviral therapy (ART) initiation globally, this study develops a decision preference scale to identify

The prevalence of HIV is on the rise among older adults, necessitating insights into their distinct characteristics and survival outcomes. This study aims

Aims: Adults with implantable cardioverter defibrillators (ICDs) frequently experience psychological distress, characterized as elevated symptoms of anxiety and depression; this significantly compromises their health-related quality of life (HRQoL). This review aims to synthesize the evidence on telemedicine interventions and evaluates their effectiveness on anxiety, depression, and HRQoL among adults with ICDs. Methods and results: A comprehensive search was conducted across eight databases including Embase, PubMed, Cochrane Library, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and ProQuest Dissertations and Theses. The quality of the studies was assessed using the revised Cochrane risk of bias tool for randomized trials (RoB2). Meta-analyses were performed using the Review Manager Web, employing a random-effects model. Nine studies encompassing a total of 1147 participants were included. Telemedicine interventions included phone calls, web-based platforms, mobile application, and remote monitoring. The meta-analysis results showed no significant differences between telemedicine interventions and standard care in perceived anxiety [standardized mean difference (SMD): −0.21; 95% confidence interval (CI): −0.64, 0.22; P = 0.34, very low certainty], perceived depression (mean difference: −0.40; 95% CI: −2.14, 1.34; P = 0.65, very low certainty), and HRQoL (SMD: 0.01; 95% CI: −0.18, 0.20, P = 0.92, low certainty). Conclusion: Although no statistically significant differences were observed between telemedicine and standard care interventions in improving anxiety, depression, and HRQoL in adults with ICDs, telemedicine should continue to serve as a valuable complement to existing standard care. Future high-quality randomized controlled trials are needed to establish its effectiveness. Registration: PROSPERO: CRD42025648188.

Aims: Heart failure (HF) is a complex syndrome marked by the heart’s insufficient pumping ability, and it is frequently complicated by prevalent sleep problems such as initiating and maintaining sleep. Aromatherapy via inhalation is a safe, non-pharmacological therapy that may improve sleep. Lavender oil, a type of essential oil, is reputed for its calming and sedative properties, but evidence of its effectiveness in patients with chronic HF remains limited. This study aimed to assess the efficacy and safety of lavender essential oil inhalation in improving sleep quality and reducing fatigue levels among patients with chronic HF. Methods and results: An open-label, parallel randomized controlled trial was conducted between March and August 2023. A total of 80 participants were randomized 1:1 to receive either lavender essential oil or fractionated coconut oil (placebo) inhalation for 8 h nightly over 4 weeks, in addition to standard care. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and fatigue using the Fatigue Assessment Scale (FAS), at baseline, Day 3, Week 1, Week 2, and Week 4 (immediate post-intervention). Patient satisfaction and adverse events were assessed. Of 80 participants, 68 completed the study. The experimental group demonstrated significantly greater improvement in sleep quality vs. control group at all time points. Participants who had lavender essential oil inhalation therapy also exhibited significantly lower FAS scores at Week 2 (β = −3.825, 95% CI: −4.955 to −2.695, P < 0.001) and 4 (β = −7.900, 95% CI: −9.725 to −6.075, P < 0.001). Patient satisfaction was higher in the experimental group (9.06 ± 1.24 vs. 6.03 ± 1.10, P < 0.001). No adverse events were reported. Conclusion: Lavender essential oil inhalation is a safe and well-accepted intervention for improving sleep quality and reducing fatigue in patients with chronic HF. Larger multicentre trials with objective sleep measurements and longer follow-up are warranted. Registration: ClinicalTrial.gov: NCT05862350.