Digital Commons Network^™

Symposium Day Reflection Paper - Burnout In Medicine: Understanding The Student & Resident Experience, Souraha Longo

Introduction to Public Health

A brief summary & reflection of a Symposium Day presentation (from a public health perspective).

Reflection On ‘Adolescence’ And Mental Health, Souraha Longo

Introduction to Public Health

A brief summary & reflection of the Netflix Drama Adolescence (from a Public Health perspective).

Structural Empowerment And The Work Environment Of Nursing Home Care Workers In China, Yawen Ou

Lingnan Theses (MPhil & PhD)

China is experiencing a profound demographic transformation as its population ages rapidly, driven by declining fertility, increased longevity, and long-term effects of the One- Child policy. Traditional family-based elderly care has become increasingly unsustainable due to the pressures of the “4-2-1” family structure and the rising prevalence of empty-nest households. In this context, there is an increasing trend in institutionalized elderly care, accompanied by a growing demand for Nursing Home Care Workers (NHCWs). In spite of their vital importance, NHCWs often face heavy workloads, poor compensation, low recognition, and limited professional autonomy. This study explores the work environment and structural …

Analysis Of Activated Carbon Fiber (Acf) As Particulate Filtration And Volatile Organic Compound (Voc) Media For The Development Of A Dual-Air Purifying Facepiece Respirator, Brie Mcmahan

ETDs from 2020-2029

Exposure to particulate matter (PM) and volatile organic compounds (VOCs) in occupational or public settings poses adverse health outcomes such as respiratory, cardiovascular, reproductive, neurological, carcinogenic morbidity and mortality. Many occupational settings expose workers to PM and VOC concurrently, yet most commercially available respirators are designed to address either particulates or vapors alone. This includes air-purifying respirators (APRs), powered air-purifying respirators (PAPRs), and filtering facepiece respirators (FFRs) with nuisance-level vapor protection, often limited by bulk, discomfort, high pressure drop, and misuse. We identified a need for alternative dual-exposure media and a respiratory protection device that is lighter, and more comfortable …

Surviving Staten Island: Black Women’S Narratives Of Resilience, Motherwork, And Embodied Trauma, Jazmin Rivera

Student Theses

This oral history dissertation centers the experiences of six Black women who had formative experiences navigating hostile school and community-based settings on Staten Island during the 1970s, 1980s, and early 1990s. Guided by a conceptual framework that draws on Black orality, Black feminist thought, and endarkened feminist epistemology, this study demonstrates how Black women were required to cross geographic and social boundaries to survive hostile conditions in Staten Island communities and schools. Findings from this study highlight Black women’s use of community cultural wealth to inform their survival strategies and resilience. At the same time, their experiences indicate the potential …

Pandemic Mask Mandates And Closures Were Linked To Increased Gun Violence, Douglas A. Wolf, Emily W. Wiemers, Iliya Gutin, Jennifer Karas Montez, Shannon M. Monnat

Population Health Research Brief Series

Gun violence worsened substantially during the COVID-19 pandemic. This brief summarizes findings from a study using weekly gun violence casualty data from 2016-2021 for 304 U.S. counties from the Gun Violence Archive and COVID-19 policy data from county-level measures of activity restrictions and masking requirements. The authors find that policies requiring masking and activity restrictions were associated with significant increases in gun violence. Indoor masking requirements were linked to a 28% increase in gun violence, while activity restrictions were associated with a 4.2% increase.

Development And Validation Of A Theoretically Informed Instrument To Measure The Antecedents Of Microbreaking Intentions (I-Mami) Of Procedural Healthcare Workers, Robin Riddle

ETDs from 2020-2029

ABSTRACT Work-related musculoskeletal disorders (WMSD) affect 77% of nurses and 60% of surgeons, exceeding rates in other occupational sectors and threatening healthcare workforce sustainability. Microbreaking is brief, strategic pause of 20 seconds to five minutes performed every 20 to 40 minutes during medical procedures. It has demonstrated effectiveness in reducing fatigue, improving accuracy, and lowering physiological stress markers without extending medical procedure duration. Despite this evidence, adoption remains limited, and no theoretically informed instruments exist to measure the behavioral determinants of microbreaking intentions among procedural healthcare workers. Investigators of this three-manuscript dissertation developed and established content and construct validity as …

Handling Missing Data In Copd Research, Chia-Ying Chiu

ETDs from 2020-2029

Chronic Obstructive Pulmonary Disease (COPD) remains a major global health concern and one of the leading causes of death in the United States, affecting approximately 4.6% of adults and reaching a prevalence of 9.4% in Alabama according to 2024 National Health Interview Survey. The disease imposes a substantial burden on quality of life and healthcare costs and contributes to increased disability-adjusted life years and years of life lost, as highlighted by the 2022 Lancet Commission report. Despite its im-pact, COPD is frequently diagnosed only after irreversible lung damage has occurred, largely due to under-recognized symptoms and limited diagnostic tools. Early …

A Community Conversation Process To Establish Resident And Service Provider Perspectives On Needs Related To Use And Treatment Of Opioids And Substances, Jennifer Shepheard, Thomas Mundy, Ashlie Watts, Jana Pushkin, Leteisha Gordon, Patrice Shelton, Courtney Blondino, Katherine Werner, Elizabeth Prom-Wormley, Melissa Viray

Health Studies Faculty Publications

Introduction:

Rates of fatal overdose due to opioid and substance use in Richmond, Virginia increased from 44.6 in 2018 to 129.5 per 100,000 city residents in 2023. The underlying contexts surrounding the increase in substance use and overdoses in Richmond, Virginia remains poorly understood.

Methods:

Using community based participatory research principles (CBPR), a series of “community conversations” with neighborhood residents were conducted between May–December 2023. These events included educational information, resource connection, and facilitated qualitative focus group discussion on factors contributing to substance use and overdose, as well as resource needs of people engaged in substance use. Participants also completed …

Fact Sheet: Kratom, Cadence Johnnie, Ashley Yaugher, Aaron Hunt, Cara Murray, Timothy Keady

All Current Publications

There are many common myths and misunderstandings associated with kratom. Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia. In recent years, kratom use has grown in the United States. It is sold in various forms, including capsules, powders, and most commonly as liquid extracts or “shots." These kratom products are promoted as health supplements, advertised for benefits such as boosting energy, enhancing mood, or producing opioid-like effects. However, most users may not fully understand what they are consuming or the potential risks it carries. Commercial kratom products vary widely in their chemical composition. Synthetic (human-made) or …

Multilevel Analysis Of The Food And Physical Activity Environment And Adult Obesity Across U.S. Counties And States

Faculty, Staff and Student Publications

Adult obesity rates have risen steadily across the United States over the past decade, with more than 40% of adults affected. Persistent geographic and demographic disparities exist in obesity prevalence across the nation. While prior research has examined individual or environmental associated factors of obesity, limited studies have addressed both physical activity and food environments across the nation using multilevel approaches. This cross-sectional ecological study (2014-2024) used a two-level random intercept model to assess the association between county- and state-level factors and adult obesity prevalence across over 3000 U.S. counties nested within 51 states. County-level associated factors included food insecurity, …

Community And Individual Risk Factors Associated With Tuberculosis Treatment Outcomes: Ca, Md, And Oh, [2017-2021]., Kadiatu Banjoko

Walden Dissertations and Doctoral Studies

There are unsuccessful treatment outcomes with Tuberculosis (TB) disease, although effective therapies exist. This study aimed to identify predictors of unsuccessful treatment using the socioecological model. A quantitative cross-sectional study and multinomial logistic regression analysis were used to measure the associations between long-term care (LTC), homelessness, correctional facility, Human Immunodeficiency Virus (HIV), diabetes, excess alcohol, illicit drug use, and TB treatment outcomes of death, lost to follow-up, and treatment refusal. The sample consisted of 7,589 individuals aged 15 and older with pulmonary TB between 2017 and 2021, residing in California, Ohio, and Maryland. Findings indicated a correlation between community factors …

Obesity And Long Covid: Intersecting Epidemics?, Michael Gottlieb, Huihui Yu, Ji Chen, Erica S. Spatz, Nicole L. Gentile, Rachel E. Geyer, Michelle Santangelo, Caitlin Malicki, Kristyn Gatling, Kelli N. O'Laughlin, Kari A. Stephens, Joann G. Elmore, Lauren E. Wisk, Michelle L'Hommedieu, Robert M. Rodriguez, Juan Carlos C. Montoy, Ralph C. Wang, Kristin L. Rising, Efrat Kean, Jonathan W. Dyal, Mandy J. Hill, Arjun K. Venkatesh, Robert A. Weinstein, Inspire Group

Jefferson Center for Connected Care Faculty Papers

BACKGROUND: Obesity affects over 10% of the world population and has significant public health implications. With rising recognition of the long-term effects of Long COVID (LC) coupled with new agents to facilitate weight loss, it is critical to understand the influence of obesity on LC. This study assessed the association of obesity with rates of LC and degree of LC-related mental and physical health outcomes among participants up to three years after initial infection.

METHODS: This was a cross-sectional, multisite study of participants with SARS-CoV-2 infection from 12/11/2020–8/29/2022, with data collected through 4/2/2024. Surveys included validated tools for physical and …

Dietary Inflammatory Index And Risk Of Colorectal Cancer In Japanese Men, Ayaka Kotemori, Kumiko Kito, Motoki Iwasaki, Taiki Yamaji, James Hébert Scd, Junko Ishihara, Manami Inoue, Shoichiro Tsugane, Norie Sawada On The Behalf Of Jphc Study Group

Faculty Publications

Background/Objectives: Unhealthy lifestyles lead to chronic low-grade inflammation, increasing the risk of colorectal cancer. Few studies in East Asia have examined the association between the dietary inflammation potential and colorectal cancer incidence. Therefore, we aimed to investigate this association further in the Japanese population. Methods: This study included 38,807 men aged 45–74 years who participated in the Japan Public Health Center-based prospective study (JPHC Study). The energy-adjusted dietary inflammatory index (E-DII) was derived from a food frequency questionnaire. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. Differences in risk due to a …

Early Atopic Dermatitis And Risk Of Later Autism Spectrum Disorders, Annissa Courtney Heslope-Mathieu

Walden Dissertations and Doctoral Studies

Early-onset atopic dermatitis (AD) affects approximately 10-20% of children in the United States, and emerging evidence suggests potential links between early immune dysregulation and neurodevelopmental outcomes. Limited research has examined whether early AD serves as a specific risk factor for later ASD diagnosis. Guided by life course theory, the purpose of this study was to examine whether AD diagnosed within the first two years of life predicts later diagnosis of ASD among U.S. children younger than five years. A secondary analysis of the Fragile Families and Child Wellbeing Study was conducted using a retrospective cohort design. The sample included 2,949 …

Clinical, Imaging And Blood Biomarker Outcomes In A Phase 3 Clinical Trial Of Tau Aggregation Inhibitor Hydromethylthionine Mesylate In Mild Cognitive Impairment And Mild To Moderate Dementia Due To Alzheimer’S Disease, Claude Wischik, Richard G. Stefanacci, Peter Bentham, Serge Gauthier, Henrik Zetterberg, Gordon Wilcock, Lutz Froelich, Alistair Burns, Emer Macsweeney, Clive Ballard, Jin-Tai Yu, Tay Siew Choon, Vahe Asvatourian, Natalia Muehlemann, Jan Priel, Karin Kook, Tenecia Sullivan, Diane Downie, Sonya Miller, Carol Pringle, John Storey, Tom Baddeley, Charles R Harrington, Lewis Penny, Mohammad Arastoo, Roger Staff, Anca-Larisa Sandu, Helen Shiells, Serena Lo, Nafeesa Nazlee, Emily Evans, Claire Hull, Bjoern Schelter

College of Population Health Faculty Papers

BACKGROUND: Hydromethylthionine mesylate (HMTM) targets tau pathology and has tau-independent symptomatic activity.

OBJECTIVES: To evaluate the safety and efficacy of HMTM in participants with mild cognitive impairment (MCI) and mild to moderate dementia due to Alzheimer's disease (AD).

SETTING: 82 centres in Canada, European Union, United Kingdom and United States of America.

PARTICIPANTS: A total of 598 amyloid β-PET positive participants were included; 44% (263) met clinical criteria for MCI due to Alzheimer's disease and 56% (335) were diagnosed with mild to moderate dementia due to AD.

INTERVENTION: HMTM 16 mg/day and 8 mg/day were compared with methylthioninium chloride (MTC) …

Long-Term Mpox Sequelae 11 To 18 Months After Acute Illness : A Cohort Study In Two Us Cities, Paul J Weidle, Dana L Haberling, Agha Ajmal, Agam K Rao, Anyelina Cantos, Sarah Anne J Guagliardo, Max Flanagan, Gilhen H Rodriguez, Irene Tamí-Maury, Siobhán M O'Connor

Faculty, Staff and Student Publications

Background: Little was known about persistent sequelae of mpox before the 2022 multinational clade II mpox virus outbreak.

Objective: To characterize post-mpox sequelae 11 to 18 months after acute mpox diagnosis and compare outbreak-associated psychosocial and behavioral impact between at-risk persons who had or did not have mpox.

Design: Cohort study.

Setting: New York City, New York, and Houston, Texas.

Participants: Adults attending HIV, pre-exposure prophylaxis, or sexually transmitted infection clinics diagnosed with mpox during May 2022 to January 2023 (post-mpox) or at risk for but never diagnosed with mpox (no-mpox).

Measurements: All participants completed psychosocial and behavioral self-assessments. A …

Plans4care, A Web Application Providing Caregivers Personalized Solutions To Manage Dementia-Related Care Challenges: Proof Of Concept And Efficacy Trial, Laura N. Gitlin, Eric Jutkowitz, Catherine V. Piersol, Sokha Koeuth, Taylor Sivori, Melinda J. Webster, Rachel N. Barnett, David L. Roth

Department of Occupational Therapy Faculty Papers

OBJECTIVE: Few dementia caregivers have access to evidence-based support programs. Web applications (app) may address this gap. Plans4Care, a web app, provides caregivers with on-demand personalized solutions to address care challenges. We present results of a proof-of-concept study and describe a trial protocol to test efficacy.

METHODS: To use Plans4Care, caregivers respond to brief onboarding questions, assess dementia patients' cognitive function, identify care challenges, and generate "action plans" (personalized strategies). Telehealth sessions with dementia-trained care advisors are available. A proof-of-concept study evaluated a clickable prototype using standardized technology scales to determine if >75 % scored positively on four criteria (acceptability, …

Forecasting (Nano)Medical Technologies: Lessons From The Covid-19 Pandemic For Science And Society, Vuk Uskoković

Administration and Staff Articles and Research

Successful translation of medical devices from the bench to the bedside is conditioned by the accurate estimation of market opportunities. Because market conditions can change significantly over time, this assessment is challenging in the early stages of technological development. In this study a qualitative analysis of market trends and regulatory frameworks was conducted to assess how transient market conditions influence the development and distribution of nanomedical technologies, using nanotechnologies developed for COVID-19 as the example. The findings demonstrate that the unpredictable nature of the COVID-19 pandemic has led to a volatile market for nanomedical solutions, discouraging private sector investment and …

Reflection Paper: What We Make Together: Art, Adolescence, And Collaborative Research In Action, Natepy Vann

Introduction to Public Health

No abstract provided.

Development Of The Self-Administered Health Complexity Screening Instrument, Sheila Specker, Rachel Andrew, Emily Drexler, Emily Koithan, Steven Thurber, Steven Frankel

School of Medicine Faculty Publications

PURPOSE: The purpose of the study was to develop a self-administered screening tool to assist case managers, primary care physicians, and other clinicians in quickly and accurately identifying patients with complex health needs who require a definitive and detailed case management evaluation. In addition to medical and psychiatric items, this tool incorporates multiple social determinants of health (SDOH), known to add to clinical complexity. PRIMARY PRACTICE SETTING: This instrument is most appropriate for identifying patients with high complexity in the primary care sector. Due to the abundance of such patients with high biopsychosocial complexity and costs of treating these patients, …

Whole Genome Sequence Analysis Of Pulmonary Function And Copd In 44,287 Multi-Ancestry Participants, Peter Orchard, Aabida Saferali, Francois Aguet, Lucinda Antonacci-Fulton, Pallavi P Balte, Traci M Bartz, Wardatul Jannat Anamika, Xiaobo Zhou, Junyi Duan, Jennifer A Brody, Brian E Cade, Martha L Daviglus, Harshavadran Doddapaneni, Shannon Dugan-Perez, Susan K Dutcher, Christian D Frazar, Stacey B Gabriel, Sina A Gharib, Brian D Hobbs, Silva Kasela, Laura R Loehr, Ginger A Metcalf, Donna M Muzny, Elizabeth C Oelsner, Laura J Rasmussen-Torvik, Colleen M Sitlani, Joshua Smith, Tamar Sofer, Hanfei Xu, Bing Yu, David Zhang, John Ziniti, R Graham Barr, April P Carson, Myriam Fornage, Lifang Hou, Ravi Kalhan, Robert Kaplan, Tuuli Lappalainen, Stephanie J London, Alanna C Morrison, George T O'Connor, Bruce M Psaty, Laura M Raffield, Susan Redline, Stephen S Rich, Jerome I Rotter, Edwin K Silverman, Ani Manichaikul, Michael H Cho

Faculty, Staff and Student Publications

Background: Whole genome sequence (WGS) data in multi-ancestry samples supports discovery of low-frequency or population-specific genetic variants associated with chronic obstructive pulmonary disease (COPD) and lung function.

Results: We performed single variant, structural variant, and gene-based analysis of pulmonary function (FEV1, FVC and FEV1/FVC) and COPD case-control status in 44,287 multi-ancestry participants from the NHLBI Trans-Omics for Precision Medicine (TOPMed) Program. We validated findings using the UK Biobank and assessed implicated genes using lung single-cell RNA-seq (scRNA-seq) data sets. Applying a genome-wide significance threshold (P < 5 × 10-9), we replicated known loci and identified novel associations near LY86, MAGI1, GRK7, and LINC02668. Colocalization with gene expression quantitative trait loci (eQTL) from the Lung Tissue Research Consortium highlighted known candidate genes including ADAM19, THSD4, C4B, and PSMA4, which were not identified through other eQTL sources. Multi-ancestry analysis improved fine-mapping resolution (e.g., HTR4 and RIN3). Gene-based analysis identified and replicated HMCN1. In human lung scRNA-seq data sets, lung epithelial cells and immune cell types showed enriched expression, while fibroblasts showed higher expression for HMCN1. CRISPR targeting HMCN1 in IMR90 demonstrated reduced expression of collagen genes.

Conclusions: Large-scale multi-ancestry WGS analysis improves variant discovery and fine-mapping resolution for lung function and …

Rab5c Increases Endothelial Release Of Vwf By Regulating Vesicle Trafficking, D Brian Foster, Nunzio Alcharani, Claudia Gonzalez-Cucharero, William O Osburn, Alanna C Morrison, Alisa S Wolberg, Nicholas L Smith, Marios Arvanitis, Charles J Lowenstein

Faculty, Staff and Student Publications

Background: Abnormal levels of VWF (von Willebrand Factor) are a risk factor for venous thromboembolism (VTE) and bleeding. Genome-wide association studies for VWF have identified novel candidate genes that may regulate VWF levels in humans, including RAB5C (RAS-associated protein RAB5C). We hypothesized that RAB5C regulates VWF release from endothelial cells.

Methods: We studied the effect of RAB5C on vesicle trafficking in human endothelial cells. We performed CRISPR (clustered regularly interspaced short palindromic repeats) interference targeting 2 genetic variants linked to altered VWF levels and evaluated RAB5C expression by reverse transcription-quantitative polymerase chain reaction. We silenced RAB5C or overexpressed RAB5C wild-type, …

Socioecological Stressors During Covid-19 Among Urban Refugee Youth In Kampala, Uganda: A Qualitative Descriptive Analysis, Sikky Shiqi Chen, Carmen H. Logie, Frannie Mackenzie, Moses Okumu, Robert Hakiza, Brenda Katisi, Daniel Kibuuka Musoke, Aidah Nakitende, Isha Berry, Bay Bahri, Peter Kyambadde

Journal of Social, Behavioral, and Health Sciences

Limited studies have examined pandemic-related stressors among urban refugee youth in low and middle-income humanitarian countries (LMICs), such as Uganda. We explored the lived experience of COVID-19-related stressors among urban refugee youth in Kampala, Uganda. We analyzed qualitative data (text messages, WhatsApp chats, photos) collected in an interactive mobile health intervention with 346 refugee youth aged 16–24 in Kampala. Findings revealed stressors across socioecological levels: individual (e.g., financial-related distress), social (e.g., limited social interactions), community (e.g., food insecurity), and policy (e.g., unprecedented lockdowns). Findings can inform social work organization pandemic preparedness strategies for economic empowerment and social cohesion with youth.

A196: Prediction Of Cardiovascular Function Improvement Based On Wearable Device Motion Monitoring And Otnmanba-Bilstm Model, Yixuan Li, Lan Zheng

International Journal of Physical Activity and Health

Cardiovascular diseases are among the leading chronic health conditions worldwide, with prolonged physical inactivity or improper exercise increasing the risk of their occurrence. Existing studies suggest that well-structured exercise interventions can significantly enhance cardiac function and improve the adaptability of the cardiovascular system. However, accurately predicting the long-term impact of different exercise durations and intensities on heart health remains challenging due to individual physiological differences, exercise habits, and lifestyle factors. This study employs a data-driven approach to develop a predictive model based on wearable device motion monitoring data, aiming to elucidate the dynamic relationship between exercise and cardiovascular health and …

A197: Perceptual Behavior And Social Interaction Of Chinese College Students Toward Esports, Xianhua Luo

International Journal of Physical Activity and Health

Social exchange theory (SET) has been extensively used to recognize students’ perceptual behavior (PB) and social interaction (SI). Research has examined the potential factors of recognition and socialization against the economic factors in individual evaluation, seeking rewards or avoiding costs in relationships. The positive impact of PB and SI is a significant experimental approach to studying social psychology. Therefore, the processes of individuals’ perceptual behavior and their social interactions in Esports might address this research gap. Hence, the purposes of this study were to explain the PBs and SIs toward Esports among college students in China. Method: 341college students were …

A214: Effects Of Tai Chi And Brisk Walking On Sensation In Pn Elders, Qiongqiu Zhao, Qipeng Song

International Journal of Physical Activity and Health

Peripheral neuropathy (PN) is a prevalent neurological disorder, affecting 26–39.2% of adults aged 65 and older due to peripheral nerve degeneration and associated conditions like diabetes. PN leads to sensory impairments, including diminished tactile sensation, increased fall risk, and mobility issues. Tai Chi (TC) is a low-impact exercise shown to enhance sensory function and balance in healthy older adults, but its effects on PN patients remain unclear. Brisk walking (BW) is a widely recommended exercise for older adults, yet its impact on sensory function in PN is not well-established. This study compares TC and BW interventions on tactile sensation in …

Unseen But Felt: Exploring The Emotional And Developmental Impacts Of Father Absence On The Lives Of African American Daughters, Michelle Laniece Mayberry

Doctoral Dissertations and Projects

This phenomenological study explored the lived experiences of African American daughters who grew up with absent fathers, examining how this experience influenced development, relationships, identity formation, and resilience. Through in-depth interviews and thematic analysis, six central themes emerged: (1) father-daughter relationship, (2) emotional and psychological impact, (3) identity and development, (4) social and relational outcomes, (5) decision-making and achievement, and (6) resilience and adaptation. Each theme was interpreted through the lens of attachment and social learning theories with a biblical worldview. The findings revealed that father absence often left emotional and developmental wounds in the lives of the participants. The …

A088: Best Core Stability Training Program For Lower Limb Dysfunction In Stroke Patients: A Network Meta-Analysis, Kaiqi Zheng, Dan Wang, Guoliang Liang, Chunyun Deng

International Journal of Physical Activity and Health

Stroke is the third leading cause of disability and the second leading cause of death among adults. Lower limb dysfunction caused by stroke significantly impairs patients' quality of life. Numerous studies have demonstrated that core stability training (CST) can effectively improve lower limb function in stroke patients, and combining CST with other rehabilitation approaches may yield better therapeutic outcomes. This study aims to identify the most effective CST-based combined intervention for treating lower limb dysfunction in stroke patients. Method: Randomized controlled trials (RCTs) published up to July 22, 2024, were searched from PubMed, Embase, Cochrane Library, Web of Science, CNKI, …

A090: Development And Efficacy Evaluation Of Virtual Reality (Vr)-Based Personalized Exercise Prescriptions For Perimenopausal Women, Runze Zhu, Zekai Wu

International Journal of Physical Activity and Health

Perimenopausal women (aged 45–54) frequently experience climacteric symptoms such as vasomotor disturbances, osteoporosis, and cardiovascular risks due to declining ovarian function and estrogen levels. Approximately 75% of women report varying degrees of discomfort, with 80% exhibiting at least one symptom (e.g., sleep disorders, mood fluctuations). Conventional exercise prescriptions often lack specificity to address individual health disparities and comorbidities (e.g., osteoporosis, metabolic dysfunction). This study aimed to develop a virtual reality (VR)-based personalized exercise prescription system to enhance exercise adherence through immersive experiences and evaluate its efficacy in alleviating perimenopausal physiological and psychological symptoms. A personalized exercise prescription generation system was …