Search Results (548)

Sarcopenia is a progressive age-related musculoskeletal disorder characterized by loss of muscle mass, strength, and physical performance, contributing to functional decline and increased risk of disability. Emerging evidence suggests that vitamin D (Vit D) plays a pivotal role in skeletal muscle physiology beyond its classical functions in bone metabolism. This review aims to critically analyze the relationship between serum Vit D levels and sarcopenia in older adults, focusing on pathophysiological mechanisms, diagnostic criteria, clinical evidence, and preventive strategies. An integrative narrative review of observational studies, randomized controlled trials, and meta-analyses published in the last decade was conducted. The analysis incorporated international diagnostic criteria for sarcopenia (EWGSOP2, AWGS, FNIH, IWGS), current guidelines for Vit D sufficiency, and molecular mechanisms related to Vit D receptor (VDR) signaling in muscle tissue. Low serum 25-hydroxyvitamin D levels are consistently associated with decreased muscle strength, reduced physical performance, and increased prevalence of sarcopenia. Although interventional trials using Vit D supplementation report variable results, benefits are more evident in individuals with baseline deficiency and when combined with protein intake and resistance training. Mechanistically, Vit D influences muscle health via genomic and non-genomic pathways, regulating calcium homeostasis, mitochondrial function, oxidative stress, and inflammatory signaling. Vit D deficiency represents a modifiable risk factor for sarcopenia and functional impairment in older adults. While current evidence supports its role in muscular health, future high-quality trials are needed to establish optimal serum thresholds and dosing strategies for prevention and treatment. An individualized, multimodal approach involving supplementation, exercise, and nutritional optimization appears most promising. Full article

Patient involvement in health technology assessment (HTA) processes is increasingly recognized as pivotal for informed, equitable, and patient-relevant health care decision-making. With the implementation of Joint Scientific Consultations (JSCs) and Joint Clinical Assessments (JCAs) under Regulation (EU) 2021/2282, the European Union has a unique opportunity to design harmonized mechanisms that reflect best practices from established HTA systems. This article, drawing on the Acute Leukemia Advocates Network (ALAN)’s comparative analysis of HTA practices across seven countries (Canada, England, Scotland, France, Germany, Spain, and Italy), examines how current patient involvement processes can inform the JCA framework. It identifies opportunities to replicate effective practices and proposes strategies to embed patient voices meaningfully into the JCA process. By prioritizing robust and inclusive patient involvement, the EU can establish a global benchmark for impactful and consistent HTA processes. By leveraging lessons from international HTA systems and prioritizing clear frameworks, early involvement, and capacity building, the EU can set a global standard for meaningful patient participation in HTA processes. ALAN is an independent global network of patient organizations dedicated to improving outcomes for patients with acute leukemia. Full article

According to the World Health Organization (WHO), indoor air quality (IAQ) is becoming a serious global concern due to its significant impact on human health. However, not all relevant health parameters are currently regulated. For example, particle number concentration (PNC) and its associated carbonaceous species, such as black carbon (BC), which are classified as carcinogenic by the International Agency for Research on Cancer (IARC), are not currently regulated. Compared with IAQ studies in other types of buildings, studies focusing on IAQ in hospitals or other healthcare facilities are scarce. Therefore, this study aims to evaluate the impact of these outdoor pollutants, among others, on the indoor environment of a hospital under different atmospheric conditions. To identify the seasonal influence, two different periods of two consecutive seasons (summer 2020 and winter 2021) were selected for the measurements. Regulated pollutants (NO, NO₂, O₃, PM₁₀, and PM_2.5) and nonregulated pollutants (PM₁, PNC, and equivalent BC (eBC)) in outdoor air were simultaneously measured indoor and outdoor. This study also investigated the impact of indoor activities on indoor air quality. In the absence of indoor activities, outdoor sources significantly contribute to indoor traffic-related pollutants. Indoor and outdoor (I-O) measurements showed similar behavior, but indoor concentrations were lower, with peak levels delayed by up to two hours. Seasonal variations in indoor/outdoor ($\mathrm{I}/\mathrm{O}$) ratios were lower for particles than for associated gaseous pollutants. Particle infiltration depended on particle size, with it being higher the smaller the particle size. Indoor activities also significantly affected indoor pollutants. PM_x (especially PM₁₀ and PM_2.5) concentrations were mainly modulated by walking-induced particle resuspension. Vertical eBC profiles indicated a relatively well-mixed environment. Ventilation through open windows rapidly altered indoor air quality. Outdoor-dominant pollutants (PNC, eBC, and NO_X) had $\mathrm{I}/\mathrm{O}$ ratios ≥ 1. Staying in the room with an open window had a synergistic effect, increasing the $\mathrm{I}/\mathrm{O}$ ratios for all pollutants. Higher I/O ratios were associated with turbulent outdoor conditions in both unoccupied and occupied conditions. Statistically significant differences were observed between stable (TKE ≤ 1 m² s⁻²) and unstable (TKE > 1 m² s⁻²) conditions, except for NO₂ in summer. This finding was particularly significant when the wind direction was westerly or easterly during unstable conditions. The results of this study highlight the importance of understanding the behavior of indoor particulate matter and related pollutants. These pollutants are highly variable, and knowledge about them is crucial for determining their health effects, particularly in public buildings such as hospitals, where information on IAQ is often limited. More measurement data is particularly important for further research into I-O transport mechanisms, which are essential for developing preventive measures and improving IAQ. Full article

Background/Objectives: Antimicrobial consumption (AMC) surveillance and antimicrobial stewardship (AMS) constitute effective strategies to combat the increasing antimicrobial resistance rates worldwide. Post-Soviet countries (Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan) implemented various elements of AMC surveillance and AMS to different extents. The limited quantity and quality of data from post-Soviet countries make it difficult to assess health system performance; therefore, this region is a blind spot in global AMR monitoring. This systematic review assesses and characterises AMC surveillance and AMS implementation in post-Soviet countries. Methods: Evidence was compiled via a search in PubMed, Google Scholar, Embase, CyberLeninka, and Scopus. The eligibility criteria included AMC surveillance- and AMS-related papers in human health within defined regions and timelines. Some literature from the official websites of international and national health organisations was included in the search. Results: As a result of the searches, screening, and critical appraisal, three peer-reviewed publications and 31 documents were selected for analysis. Eleven out of fifteen countries with updated national action plans for combating antimicrobial resistance have defined AMC surveillance and AMS as strategic objectives. All 15 examined countries submitted antimicrobial consumption data to international networks and reported the existence of approved laws and regulations on antibiotic sales. However, disparities exist in the complexity of monitoring systems and AMS implementation between high-income and low-income countries in the region. Conclusions: This review provides key insights into the existing AMC surveillance and AMS implementation in former Soviet countries. Although the approach of this review lacks quantitative comparability, it provides a comprehensive qualitative framework for national-level AMC surveillance and AMS system assessment. Full article

Background/objective: Tailoring involves adapting research findings and evidence to suit specific contexts and audiences. This study examines how international stroke guidelines can be tailored to address gait issues after a stroke. Methods: A three-phase consensus method approach was used. A 10-member health experts panel extracted recommendations from three national clinical guidelines in the first phase. In the second phase, 362 physiotherapists completed an online questionnaire to assess the feasibility of adopting the extracted recommendations. In the third phase, a 15-physical therapist consensus workshop was convened to clarify factors that might affect the tailoring process of the extracted recommendations of gait disorder rehabilitation. Results: In phase one, 21 recommendations reached consensus. In the second phase, 362 stroke physiotherapists rated the applicability of these recommendations: 14 rated high, 7 rated low, and none were rejected. The third phase, a nominal group meeting (NGM), explored four themes related to tailoring. The first theme, “organizational factors”, includes elements such as clinical setting, culture, and regulations. The second theme, “individual clinician factors”, assesses aspects like clinical experience, expertise, abilities, knowledge, and attitudes toward tailoring. The third theme, “patient factors”, addresses issues related to multimorbidity, comorbidities, patient engagement, and shared decision-making. The final theme, “other factors”, examines the impact of research design on tailoring. Conclusions: Tailoring international clinical guidelines involves multiple factors. This situation brings home the importance of a systematic strategy for tailoring that incorporates various assessment criteria to enhance the use of clinical evidence. Future research should investigate additional implementation theories to enhance the translation of evidence into practice. Full article

Per- and polyfluoroalkyl substances (PFASs), commonly known as “forever chemicals”, are synthetic compounds with highly stable carbon–fluorine bonds, making them resistant to environmental degradation. These chemicals accumulate in ecosystems and water supplies, posing significant risks to human health, including cancer, immune system dysfunction, and neurological disorders. However, the mental health impacts of PFAS exposure remain underexplored, particularly in marginalized communities. This review examines the emerging evidence linking PFAS exposure to mental health issues such as anxiety, depression, and cognitive decline, with a focus on communities of color who face heightened vulnerability due to environmental and social health disparities. The review highlights the persistence of PFASs in the environment, common exposure pathways, and the disproportionate effects on populations living near contaminated sites. Despite some regulatory progress, U.S. regulations on PFASs are limited, especially compared to international standards. The review calls for stronger policy frameworks and emphasizes the need for environmental justice, health equity, and public awareness. By connecting environmental health, social justice, and mental well-being, the review aims to guide future research and policy reforms to mitigate the mental health consequences of PFAS exposure in vulnerable populations. Full article

The impact of black carbon (BC) emissions on climate change, human health, and the environment is well-documented in the scientific literature. Although BC still remains largely unregulated at the international level, efforts have been made to reduce emissions of BC and Particulate Matter (PM_2.5), particularly in sectors such as energy production, industry, and road transport. In contrast, the maritime shipping industry has made limited progress in reducing BC emissions from ships, mainly due to the absence of stringent BC emission regulations. While the International Maritime Organization (IMO) has established emission limits for pollutants such as SO_x, NO_x, and VOCs under MARPOL Annex VI, as of today, BC emissions from ships are still unregulated at the international level. Whereas it was anticipated that PM_2.5 and BC emissions would be reduced with the adoption of the SO_x regulations, especially within the sulfur emission control areas (SECA), this study reveals that BC emissions are only partially affected by the current MARPOL Annex VI regulations. Based on 886 real-world black carbon (BC) emission measurements from ships operating in the southern North Sea, the study demonstrates that SECA-compliant fuels do contribute to a notable decrease in BC emissions. However, it is important to note that the average BC emission factors (EFs) within the SECA remain comparable in magnitude to those reported for non-compliant fuels in earlier studies. Moreover, ships using exhaust gas cleaning systems (EGCSs) as a SECA-compliant measure were found to emit significantly higher levels of BC, raising concerns about the environmental sustainability of EGCSs as an emissions mitigation strategy. Full article

Epigenetic modifications act as crucial regulators of gene activity and are influenced by both internal and external environmental factors, with diet being the most impactful external factor. On the other hand, cellular metabolism encompasses a complex network of biochemical reactions essential for maintaining cellular function, and it impacts every cellular process. Many metabolic cofactors are critical for the activity of chromatin-modifying enzymes, influencing methylation and the global acetylation status of the epigenome. For instance, dietary nutrients, particularly those involved in one-carbon metabolism (e.g., folate, vitamins B12 and B6, riboflavin, methionine, choline, and betaine), take part in the generation of S-adenosylmethionine (SAM), which represents the main methyl donor for DNA and histone methylation; α-ketoglutarate and ascorbic acid (vitamin C) act, respectively, as a co-substrate and cofactor for Ten-eleven Translocation (TET), which is responsible for DNA demethylation; and metabolites such as Acetyl-CoA directly impact histone acetylation, linking metabolism of the TCA cycle to epigenetic regulation. Further, bioactive compounds, such as polyphenols, modulate epigenetic patterns by affecting methylation processes or targeting epigenetic enzymes. Since diet and nutrition play a critical role in shaping epigenome functions and supporting human health, this review offers a comprehensive update on recent advancements in metabolism, epigenetics, and nutrition, providing insights into how nutrients contribute to metabolic balance, epigenome integrity maintenance and, consequently, disease prevention. Full article

Starting Active Materials for Synthesis (SAMS) represents a critical stage in drug manufacturing, directly influencing the microbiological quality and safety of the final product. The introduction of SAMS marks the point where Good Manufacturing Practices (GMP) begin to apply, which are essential for ensuring sterility and preventing microbial contamination during the synthesis process. However, defining the exact point in the process that qualifies as the SAMS is subject to uncertainties, as earlier stages are not always governed by stringent GMP standards. The regulatory differences between various countries further contribute to this issue. This study explores the implications of SAMS selection and use in relation to sterility and infection control, analyzing the guidelines of major Regulatory Authorities and comparing their approaches to GMP. Regulations from several international regulatory agencies were examined, with a particular focus on microbiological control measures and infection protection in the SAMS manufacturing process. The analysis focused on the microbiological control requirements and safety measures applicable to the stages preceding the introduction of SAMS into the production of the final Active Pharmaceutical Ingredients (APIs). Documents published between 2015 and 2025 were included based on predefined criteria regarding relevance, accessibility, and regulatory authority. The analysis revealed significant discrepancies between regulations regarding the definition and management of SAMS. In particular, the regulations in Mexico and India have notable gaps, failing to provide clear guidelines on SAMS sterility and protection against infectious contamination. Conversely, China has introduced risk-based approaches and early-stage microbiological controls, especially for sterile products, aligning with international standards. The European Medicines Agency (EMA), the U.S. Food and Drug Administration (FDA), the Pharmaceutical Inspection Co-operation Scheme (PIC/S), and the World Health Organization (WHO) have well-established systems for microbiological quality control of SAMS, including rigorous measures for the validation of suppliers and risk management to ensure that SAMS does not compromise the microbiological safety of the final product. The regulations in Brazil and Canada introduce additional measures to protect the microbiological quality of SAMS, with specifications for contamination control and certification of critical stages. The lack of a harmonized language for the definition of SAMS, coupled with a fragmented regulatory framework, presents a challenge for infection protection in pharmaceutical manufacturing. Key issues include the absence of specific regulations for stages prior to the introduction of SAMS and the lack of standards for inspections related to these stages. A desirable solution would be the mandatory extension of GMPs to the stages before SAMS introduction, with centralized control to ensure sterility and protection against infection throughout the entire manufacturing process. Full article

Sweet sensing is a fundamental sensory experience that plays a critical role not only in food preference, reward and dietary behaviour but also in glucose metabolism. Sweet taste receptors (STRs), composed of a heterodimer of taste receptor type 1 member 2 (T1R2) and member 3 (T1R3), are now recognised as being widely distributed throughout the body, including the gastrointestinal tract. Preclinical studies suggest these receptors are central to nutrient and glucose sensing, detecting energy availability and triggering metabolic and behavioural responses to maintain energy balance. Both internal and external factors tightly regulate their signalling pathways, and dysfunction within these systems may contribute to the development of metabolic disorders such as obesity and type 2 diabetes (T2D). Functional magnetic resonance imaging (fMRI) has provided valuable insights into the neural mechanisms underlying sweet sensing by mapping brain responses to both lingual/oral and gastrointestinal sweet stimuli. This review highlights key findings from fMRI studies and explores how these neural responses are modulated by metabolic state and individual characteristics such as body mass index, habitual intake and metabolic health. By integrating current evidence, this review advances our understanding of the complex interplay between sweet sensing, brain responses, and health and identifies key gaps and directions for future research in nutritional neuroscience. Full article

Background/Objectives: High sodium consumption increases the risk of hypertension and cardiovascular disease. Although food remains the primary source of intake, elevated sodium levels in drinking water can further contribute to excessive intake, particularly in populations already exceeding recommendations. This review examines the extent to which national drinking water standards account for sodium-related health risks and aims to inform discussion on the need for enforceable, health-based sodium limits. Methods: National standards for unbottled drinking water in 197 countries were searched for using the WHO 2021 review of drinking water guidelines, the FAOLEX database, and targeted internet and AI searches. For each country, data were extracted for the document name, year, regulatory body, regulation type, sodium limit (if stated), and rationale. Socio-geographic data were sourced from World Bank Open Data. A descriptive analysis was conducted using Microsoft Excel. Results: Standards were identified for 164 countries. Of these, 20% (n = 32), representing 30% of the global population, had no sodium limit. Among the 132 countries with a sodium limit, 92% (n = 121) adopted the WHO’s palatability-based guideline of 200 mg/L. Upper limits ranged from 50 to 400 mg/L. Only twelve countries (9%) cited health as a rationale. Three countries—Australia, Canada, and the United States—provided a separate recommendation for at-risk populations to consume water with sodium levels below 20 mg/L. Conclusions: Globally, drinking water standards give inadequate attention to sodium’s health risks. Most either lack sodium limits or rely on palatability thresholds that are too high to protect health. Updating national and international standards to reflect current evidence is essential to support sodium reduction efforts. Health-based sodium limits would empower communities to better advocate for safe water. Amid rising water salinity, such reforms must be part of a broader global strategy to ensure universal and equitable access to safe, affordable drinking water as a basic human right. Full article

Artificial Intelligence (AI) is reshaping mental healthcare by enabling new forms of diagnosis, therapy, and patient monitoring. Yet this digital transformation raises complex policy and ethical questions that remain insufficiently addressed. In this paper, we critically examine how AI-driven innovations are being integrated into mental health systems across different global contexts, with particular attention to governance, regulation, and social justice. The study follows the PRISMA-ScR methodology to ensure transparency and methodological rigor, while also acknowledging its inherent limitations, such as the emphasis on breadth over depth and the exclusion of non-English sources. Drawing on international guidelines, academic literature, and emerging national strategies, it identifies both opportunities, such as improved access and personalized care, and threats, including algorithmic bias, data privacy risks, and diminished human oversight. Special attention is given to underrepresented populations and the risks of digital exclusion. The paper argues for a value-driven approach that centers equity, transparency, and informed consent in the deployment of AI tools. It concludes with actionable policy recommendations to support the ethical implementation of AI in mental health, emphasizing the need for cross-sectoral collaboration and global accountability mechanisms. Full article

In recent years, functional foods have garnered increasing scientific and public health interest due to their potential to confer physiological benefits beyond basic nutritional value. International bodies such as EFSA, FDA, and WHO define functional foods as those containing bioactive components that may contribute to the prevention and management of chronic non-communicable diseases, including cardiovascular disease, type 2 diabetes, and certain cancers. The evolving paradigm of “food as medicine” reflects a broader shift in nutritional science towards proactive, health-oriented dietary strategies. This article provides a comprehensive, interdisciplinary overview of functional foods by examining their biological mechanisms, clinical evidence, public health significance, regulatory frameworks, and future prospects—particularly in the context of advances in personalized nutrition and nutrigenomics. A thorough literature review was conducted, drawing from recent peer-reviewed studies and guidelines from key health authorities. The review highlights the roles of specific compounds such as probiotics and prebiotics in modulating the gut microbiome, flavonoids and polyphenols in anti-inflammatory processes, omega-3 fatty acids in cardiometabolic regulation, and vitamins and minerals in supporting immune function. While an expanding body of clinical trials and meta-analyses supports the health benefits of these compounds—including reductions in LDL cholesterol, improved insulin sensitivity, and mitigation of oxidative stress—the integration of functional foods into everyday diets remains challenging. Socioeconomic disparities and limited health literacy often impede their accessibility and widespread adoption in public health practice. Functional foods represent a promising component of prevention-focused modern healthcare. To maximize their impact, a coordinated, evidence-based approach is essential, involving collaboration among healthcare professionals, nutrition scientists, policymakers, and the food industry. Looking forward, innovations in artificial intelligence, microbiome research, and genomic technologies may unlock novel opportunities for the targeted and effective application of functional foods in population health. Full article

Background/Objectives: The prevalence of childhood obesity has recently increased, particularly during the COVID-19 pandemic, owing to lifestyle changes as a result of public health regulations and guidelines introduced by governments worldwide. The aim of our study was to evaluate the impact of novel e-Health applications in addressing childhood obesity prior to and during the COVID-19 pandemic. Methods: The study was conducted as part of the four-year European project BigO (Horizon2020, No.727688). A total of 86 children and adolescents with overweight and obesity (mean age ± standard error of the mean: 11.82 ± 0.25 years; 49 males, 37 females; 31 prepubertal, 55 pubertal) were studied prospectively for 1 year prior to the pandemic (non-COVID-19 group, n = 50) and during the pandemic (COVID-19 group, n = 36). Based on the body mass index (BMI), subjects were classified as having morbid obesity (n = 40, 46,51%) obesity (n = 21, 24.42%), overweight (n = 22, 25.58%), and normal ΒΜΙ (n = 3, 3.49%) according to the International Obesity Task Force cut-off points. The data collection system utilized the BigO technology platform, which connects to a smartphone and smartwatch to objectively record each patient’s diet, sleep, and physical activity. Participants used the BigO system continuously for 4 weeks and wore the smartwatch for specific periods during the week. Subsequently, they entered a personalized, multidisciplinary lifestyle intervention program for 4 months and used the system again for 4 weeks. Results: The key finding was a significantly higher improvement rate in BMI category among children and adolescents during the COVID-19 pandemic (58.3%) compared to before the pandemic (36%). Both groups showed significant reductions in BMI, BMI z-score, insulin resistance indices (homeostatic model assessment and quantitative insulin sensitivity check index), blood pressure, gamma-glutamyl transferase, and insulin concentrations, alongside increases in high-density lipoprotein cholesterol (p < 0.01). Notably, the COVID-19 group experienced a significantly greater reduction in BMI z-score at 12 months compared to the non-COVID-19 group (p < 0.05). Conclusions: Our results reveal that the COVID-19 group demonstrated better compliance with lifestyle interventions and experienced more significant improvements in cardiometabolic risk factors. This suggests that the innovative e-Health applications were successful in managing childhood obesity despite the challenges caused by the COVID-19 pandemic. Full article

The acceleration of industrialization and urbanization worldwide has dramatically improved living standards but has also introduced serious environmental and public health challenges. One of the most critical challenges is air pollution, particularly indoors, where individuals typically spend over 90% of their time. Ensuring good Indoor Air Quality (IAQ) is essential, especially in heavily frequented public spaces such as shopping malls. This study focuses on assessing IAQ in a large shopping mall located in Tabuk, Saudi Arabia, covering retail zones as well as an attached underground parking area. Monitoring is conducted over a continuous two-month period using calibrated instruments placed at representative locations to capture variations in pollutant levels. The investigation targets key contaminants, including carbon monoxide (CO), carbon dioxide (CO₂), fine particulate matter (PM_2.5), total volatile organic compounds (TVOCs), and formaldehyde (HCHO). The data are analyzed and compared against international and national guidelines, including World Health Organization (WHO) standards and Saudi environmental regulations. The results show that concentrations of CO, CO₂, and PM_2.5 in the shopping mall are generally within acceptable limits, with values ranging from approximately 7 to 15 ppm, suggesting that ventilation systems are effective in most areas. However, the study identifies high levels of TVOCs and HCHO, particularly in zones characterized by poor ventilation and high human occupancy. Peak concentrations reach 1.48 mg/m³ for TVOCs and 1.43 mg/m³ for HCHO, exceeding recommended exposure thresholds. These findings emphasize the urgent need for enhancing ventilation designs, prioritizing the use of low-emission materials, and establishing continuous air quality monitoring protocols within commercial buildings. Improving IAQ is not only crucial for protecting public health but also for enhancing occupant comfort, satisfaction, and overall building sustainability. This study offers practical recommendations to policymakers, building managers, and designers striving to create healthier indoor environments in rapidly expanding urban centers. Full article