Search Results (797)

Background: Increasing evidence suggests that breast milk and its bioactive components, including short-chain fatty acids and the milk microbiome, are influenced by maternal nutrition and body mass index (BMI). Bioactive components transferred to the infant through breast milk play a pivotal role in infant growth and development and have indications in the child’s future short- and long-term health outcomes. This study aimed to assess the impact of maternal pre-pregnancy BMI (PP-BMI) on human breast milk macronutrient composition, short- and long-chain fatty acid profiles, and breast milk microbiome profiles. Approach: This was an exploratory cohort study of forty-four lactating Caucasian women, two to fourteen weeks postpartum, divided into groups based on pre-pregnancy body mass index (BMI). Study participants signed informed consent, completed health and nutritional surveys, and provided a breast milk sample. Breast milk samples were subjected to proximate analysis, microbiome identification and short- and long-chain fatty acid extraction and analysis. Results: Maternal age, maternal physical activity, infant birth weight, and time of lactation at sample collection were not significantly different between the maternal PP-BMI groups. PP-BMI was significantly different between the two maternal groups. No significant differences were found between the maternal BMI groups concerning nutritional intake. No differences in breast milk microbiomes were observed in alpha diversity and beta diversity between the maternal PP-BMI groups. For long-chain fatty analysis in breast milk samples, myristic acid was significantly higher in the PP-BMI overweight/obese group while stearic acid was significantly higher in the PP-BMI normal-weight group. Butyric, valeric, and isocaproic acid concentrations in HBM were significantly higher in the PP-BMI normal-weight group and lower or undetectable in the PP-BMI overweight/obese group. Conclusions: Data from this exploratory cohort study indicate that maternal diet and pre-pregnancy BMI may be associated with differences in selected HBM fatty acids. There were no significant differences in microbiomes for alpha and beta diversity in breast milk between maternal PP-BMI groups; however, lower relative abundance was observed in the breast milk of the PP-BMI overweight/obese group. These findings should be interpreted in the context of the study’s limitations, including convenience recruitment from a Facebook group, the modest sample size, and restriction to Caucasian women from a single geographic region. Full article

This study examined the associations of self-reported emotional intelligence and self-regulation with children’s well-being among fourth-grade elementary school students in Mersin, Türkiye. The sample comprised 627 students, predominantly aged 9 to 10 years, from seven public elementary schools selected to reflect different district and school contexts. Data were collected in person after ethics committee approval, institutional permissions from the Turkish Ministry of National Education, and written parental consent. The Children’s Emotional Intelligence Scale, the Self-Regulation Scale, and the Stirling Children’s Well-Being Scale were administered. Descriptive statistics, Pearson correlations, simple and multiple linear regressions, and a cross-sectional indirect association analysis using PROCESS Model 4 with 5000 bootstrap resamples were conducted. Emotional intelligence was positively associated with children’s well-being and self-regulation, while self-regulation showed a weaker positive association with well-being. Emotional intelligence explained 31.4% of the variance in well-being, self-regulation explained 8.6% when examined alone, and both variables jointly explained 31.9%, indicating only a marginal increase over emotional intelligence alone. Thus, most of the explained variance was accounted for by emotional intelligence, whereas self-regulation made a very small incremental contribution beyond it. The indirect association analysis indicated a small but statistically supported pattern of indirect association between emotional intelligence and well-being through self-regulation within this cross-sectional design; the association between emotional intelligence and well-being remained significant after self-regulation was included in the model. The findings suggest that emotional intelligence is the stronger socio-emotional correlate of children’s well-being in this sample, whereas self-regulation shows a limited complementary association. Given the cross-sectional design and reliance on self-report measures, the findings should be interpreted as correlational associations rather than evidence of causal effects, temporal ordering, or developmental change. Future studies should use longitudinal, intervention-based, and multi-informant designs to further examine these associations. Full article

Background/Objectives: To compare the incidence of postoperative acute urinary retention (AUR) between traditional open laminectomy and percutaneous endoscopic lumbar surgery (PELS) using a large-scale real-world database, with specific stratification by urologic status, age, and sex. Methods: A retrospective, propensity score-matched analysis was conducted using the TriNetX Global Health Research Network (2015–2024). Adult patients undergoing PELS were compared to those undergoing open laminectomy. To rule out the confounding effect of routine intraoperative catheterization, the primary outcome was defined as de novo AUR occurring between 24 h and 3 months postoperatively. Subgroup analyses were performed for patients with benign prostatic hyperplasia (BPH), females, and age-stratified cohorts (<70 vs. ≥70 years). This study was approved by the Institutional Review Board (IRB/REC: CE25727C) and conducted under a waiver of informed consent. Results: In the matched cohorts of non-BPH males, females, and patients aged < 70 years, PELS was associated with a statistically significant reduction in AUR risk (Hazard Ratios: 0.445, 0.649, and 0.403, respectively) compared to open surgery. However, in males with BPH, the protective benefit of the endoscopic technique was attenuated and did not reach statistical significance (p = 0.0744), suggesting the study was underpowered for this subgroup or that baseline obstruction remains a dominant risk factor. Conclusions: Percutaneous endoscopic lumbar surgery was associated with a significantly lower risk of postoperative AUR compared to open laminectomy, particularly in patients without preexisting urologic obstruction. This benefit is likely attributable to minimized tissue trauma and the anti-inflammatory effects of continuous saline irrigation. However, in patients with BPH, baseline pathology outweighs surgical factors, necessitating medical prophylaxis regardless of the surgical approach. Full article

Background: The use of sports supplements among adolescents is rising globally, driven by fitness trends and social media influence, yet knowledge gaps persist. This study aimed to assess supplement usage patterns, knowledge, attitudes, information sources, and the impact of a social media educational intervention among Serbian secondary school students. Methods: A single-group pre–post educational intervention study was conducted in secondary school students (aged 14–18) in Vojvodina, Serbia. A 21-question anonymous questionnaire was distributed to 1000 students along with parental informed consent forms. Pre-intervention survey assessed sociodemographics, physical activity and social media habits, supplement use information sources, and awareness of risks and banned substances. Based on the initial findings, an educational campaign delivered 56 short videos (≈70 s each) on Instagram and TikTok covering most frequently used supplements (e.g., creatine, proteins, caffeine, energy drinks). After, the intervention survey was repeated. The data were analyzed using the McNemar–Bowker test of symmetry. Results: In this study, 65% of Serbian secondary school adolescents reported being physically active, engaging predominantly in gym workouts and team sports. The majority of participants initiate dietary supplement use independently, without consulting healthcare professionals or adults. The most commonly used supplements were vitamins and minerals, while energy drinks ranked notably high. Social media intervention had a limited impact due to its short duration; however, certain changes were detected. Conclusions: Serbian adolescents frequently use sports supplements without adequate professional guidance. Long-term TikTok/Instagram interventions could be used in the future in order to influence behaviors and improve knowledge about sport supplement use. Full article

Creativity has been a key driver of innovation; thus, cultivating creative problem solvers is a central goal of STEM education. Making and tinkering practices supported by 3D printing offer a promising avenue for fostering creativity, particularly because the relatively low cost and accessibility of 3D printing make such opportunities feasible in rural educational settings. However, empirical evidence linking these practices to measurable gains in rural students’ creativity remains limited. To address this gap, this study investigated whether integrating making and tinkering experiences through 3D printing affected rural school students’ creativity. A convergent mixed method design was employed in which quantitative and qualitative data were collected in parallel, combining quantitative data from a single-group pretest–posttest design with qualitative insights from semi-structured interviews. After receiving institutional review board approval, parental consent and student assent, this study involved eleven students (ages 16–18) from a rural public high school in the southeastern United States, seven of whom participated in semi-structured interviews. The results indicated a significant increase in students’ creativity scores after participating in the 3D printing session, with a moderate effect size (Cohen’s d = 0.58). Qualitative findings revealed that the hands-on, iterative nature of the 3D printing process fostered students’ creative thinking, in particular, originality and usefulness. The makerspace program provided a tangible platform that allowed students to translate abstract ideas into physical products via rapid prototyping. These findings added preliminary evidence for the potential of integrating 3D printing into educational settings as a means of cultivating creativity, particularly among rural students. Full article

First-trimester sonographic examination remains a fundamental part of antenatal care, providing crucial information for the well-being of both the mother and fetus and leading to the best possible perinatal outcomes. This study aimed to review and compare the most recently published guidelines on first-trimester ultrasound. Therefore, a descriptive review of guidelines from the American Institute of Ultrasound in Medicine (AIUM), the Australasian Society of Ultrasound in Medicine (ASUM), the Association of the Scientific Medical Societies in Germany (AWMF), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the Society of Obstetrician and Gynecologists of Canada (SOGC) and the World Association of Perinatal Medicine (WAPM) regarding first-trimester scans was conducted. There is a consensus regarding the main parameters that should be evaluated, the qualifications of the examiner and specifications of the ultrasound machine, as well as the importance of informed consent. Additionally, the importance of careful visualization of fetal anatomy is discussed, with minor discrepancies regarding the appropriate protocol used. The use of combined first-trimester examination is encouraged by all the reviewed medical societies, although cell-free DNA testing is addressed only by a few, with similar indications. Controversy exists regarding the indications and appropriate gestational age at which the first-trimester scan should be performed, as well as the proper establishment of pregnancy dating. Notably, recommendations regarding fetal growth restriction (FGR) and diagnostic invasive procedures are made only by few medical societies, with the AWMF and SOGC addressing screening for FGR. Furthermore, invasive diagnostic testing is discussed by the AIUM, AWMF and SOGC, with differentiations among them regarding the indications for pursuing such procedures. First-trimester sonographic examination is essential for assessing fetal viability, establishing accurate pregnancy dating, evaluating fetal and maternal anatomy and calculating the risk of various fetal and maternal conditions. The implementation of evidence-based, unified protocols would advance both maternal and fetal outcomes. Full article

Clinical governance is a systematic approach to maintaining and improving the quality of patient care within health systems. This research assessed nurses’ perceptions of the availability of clinical governance protocols and quality improvement activities at Grey Hospital, a district hospital in the Eastern Cape Province of South Africa. A descriptive cross-sectional study was used to collect quantitative data from doctors and nurses across various disciplines using a structured questionnaire. Data were captured using Microsoft Excel and analysed using STATA. Of the 105 participants who consented to participate, the majority were female (66.4%) and aged between 37 and 47 years (48.6%), with a mean age of 43.9 years. Most participants were professional nurses (59.8%), with enrolled nurses (20.6%) and enrolled nursing assistants (17.8%) comprising the remainder of the sample. The findings show that nurses perceived most clinical governance protocols to be present at Grey Hospital. However, only 54.3% reported occurrence of regular morbidity and mortality (M&M) meetings. These results suggest that while nurses perceive clinical governance protocols to be available at Grey Hospital, the gap in regular M&M meetings indicates that perceived availability does not automatically translate to effective implementation. Strengthening accountability mechanisms, ensuring adequate resources, and establishing systematic monitoring are essential to translate protocols into sustained quality improvement. Full article

Background: During the firing stage of artisanal brick production, particulate matter and other pollutants are released into the air, to which children are particularly vulnerable. Objective: To compare the frequency of allergic diseases and impaired lung function among children exposed and unexposed to artisanal brick production. Methods: A cross-sectional comparative study was conducted among 386 children aged 6 to 14 years, recruited from a primary and a secondary school in Guanajuato, Mexico. Participants were classified as exposed (n = 193) or unexposed (n = 193) to artisanal brick production. Once parents and children voluntarily consented to participate, study procedures were initiated. Forced spirometry and anthropometric measurements were performed, and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered. We assessed the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. We measured the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. Results: The mean age of the 386 children was 9.7 ± 1.7 years. Each group consisted of 103 girls and 90 boys. The most important risk factors for impaired lung function were living in the brickyard (OR = 6.9, 95% CI: 4.3–11.1; p = 0.001) and being male (OR = 3.6, 95% CI: 2.3–5.7; p = 0.001). The prevalence of impaired lung function was 13.5% in exposed and 4.1% in unexposed children (OR = 3.6, 95% CI: 1.5–8.1; p = 0.001). Most of the respiratory symptoms observed were obstructive and we found no difference in the frequency of allergic diseases, but respiratory symptoms were more frequent in exposed children. Conclusions: Respiratory symptoms and obstructive abnormalities in pulmonary function are more prevalent among children living in brickyards. Male sex and residence in the brickyard were the principal risk factors for impaired lung function. Full article

Introduction: SGLT2 inhibitors reduce renal composite endpoints and proteinuria, yet RCTs uniformly show an acute eGFR dip within 2 weeks to 2 months after initiation. However, demographic and clinical predictors of an acute eGFR dip demonstrate considerable heterogeneity across studies. This study aims to identify urinary protein biomarkers of this early eGFR dip and integrate them with routine variables to build a clinically actionable prediction model. Methods and analysis: This three-stage proteomics study includes retrospective discovery, prospective internal validation, and external validation cohorts (total n ≈ 600–700). DIA mass spectrometry will screen for urinary proteins associated with ≥10% eGFR decline at 1 month post-SGLT2i initiation in CKD stages 3–4. Top candidates (FDR < 10%, FC > 1.5, ion intensity > 1 × 10⁴, unique gene families) will be validated by ELISA. A LASSO-logistic regression model will integrate the top three proteins with seven routinely available clinical variables: age, BMI, diabetes status, heart failure, systolic blood pressure, baseline eGFR, and diuretic use. Model performance will be assessed using the C-statistic, NRI, IDI, and calibration metrics. Adaptive stopping rules are pre-specified. Ethics and dissemination: Approved by the Ethics Review Committee at Chinese PLA General Hospital (S2025-859-02, 2025KY126-KS002), all participants will provide written informed consent prior to enrollment, and the study will adhere to the Declaration of Helsinki. Data will be pseudonymized and stored securely according to institutional regulations. Findings will be published in peer-reviewed journals and presented at international nephrology conferences. Trial Registration: Registered Report Identifier: ChiCTR2600119772. Date of registration: 3 March 2026. Full article

Purpose: Autopsy remains an important diagnostic and research modality in pediatric oncology. This study examined demographic and clinical factors associated with parental acceptance or decline of autopsy in childhood cancer. Patients and Methods: This study was a retrospective chart review of autopsy consent acceptance or decline patterns between 2007 and 2017 for inpatient pediatric oncology deaths in a large single-site oncology hospital. Demographic factors (age, race, gender), diagnostic factors (primary cancer, transplant history, and neurologic status 24 h prior to death), interventions (intensive care unit location, dialysis, ventilator, chemotherapy, medically administered nutrition), and code status in the 24 h prior to death were obtained. Analysis included descriptive and statistical correlations. Results: Among 344 inpatient decedents, 34% of families consented to autopsy. There was a difference in consent rate according to race (p = 0.015). Diagnosis, transplant status, age, and neurologic status showed no association. Use of dialysis (p < 0.001), ventilation (p < 0.001), and intensive care unit (ICU) location (p < 0.001) correlated with higher consent rates. Chemotherapy and assisted nutrition were not associated with decisions. Presence of a Do Not Resuscitate (DNR) order predicted lower consent (p < 0.001), while receipt of cardiopulmonary resuscitation (CPR) at death predicted higher consent (p < 0.001). Conclusion: One-third of families of inpatient pediatric oncology decedents with cancer agreed to autopsy. Demographic and diagnostic factors were not universally strong predictors, underscoring the personal nature of autopsy decisions. Further research should include multisite prospective designs and direct engagement with bereaved families. Full article

Objectives: Real-world information on relapsed and/or refractory multiple myeloma (rrMM) clinical management in Portugal is scarce. The CharisMMa Portugal study aimed to characterize rrMM patients through socio-demographic and clinical parameters and describe treatment patterns. Methods: This was an observational, cross-sectional, multicenter study with 62 rrMM patients routinely treated at seven hospitals in Portugal. Data were collected from medical records during clinical appointments (2020–2022) after written informed consent was obtained (ClincialTrials.gov ID-NCT04135963). Patients who were diagnosed with a symptomatic MM episode in the 6 months prior to study initiation and who received treatment before their last relapse episode were enrolled. Results: Most patients were male (54.8%) and living with relatives (90.3%), and almost 50% were independent. Roughly 70% of patients were classified as Revised MM International Staging System (R-ISS) Stage II at diagnosis, with a mean age of 65.76 (±9.24) years old. Most common SliM-CRAB (SLIM: sixty percent or more clonal plasma cells in the bone marrow (S), light chain ratio ≥100 (Li), and MRI-detected focal lesions (M); CRAB: hypercalcemia (C), renal insufficiency (R), anemia (A), and bone lesions (B)) signs were bone lesions (59%), and 62.9% of the patients had at least one comorbidity. At study initiation, 70.5% of patients were on second-line treatment, with monoclonal antibodies and proteasome inhibitors (PIs) + immunomodulators (IMiDs) as leading agents. Triplet regimens were the most common across all lines, while oral and oral + subcutaneous were the most prevalent routes of administration. Conclusions: Triple treatment combinations are common in rrMM management, with PIs and IMiDs frequently used, especially in first-line settings. The use of oral formulation is substantial, suggesting a step toward more patient-centric options. This characterization underscores the complexity of rrMM management and should inform stakeholders of strategies to standardize patient care across reference centers in Portugal. Full article

Background/Objectives: Anterior open bite (AOB) is a multifactorial malocclusion often associated with dysfunctional orofacial habits, such as tongue thrusting and lip incompetence. Early functional interventions aim to restore muscular balance; however, evidence supporting orofacial exercise therapy as a preventive measure remains limited. This pilot study evaluated the effectiveness of targeted orofacial physical exercises in reducing anterior open bite and improving tongue and lip function in school-aged children. Methods: A controlled clinical trial was conducted following ethical approval (COD-EC-24-0036). A total of 1531 children were screened, of whom 24 presented with AOB; 14 consented to participate. Participants were allocated to a tongue exercise group, a lip exercise group, or a control group receiving verbal advice only. Orofacial exercises focused on tongue posture, swallowing function, and lip seal. Measurements were obtained at baseline and 6 months using intraoral scans and clinical assessments. Treatment adherence was monitored using monthly exercise charts. Data were analyzed using repeated measures ANOVA (α = 0.05). Results: AOB prevalence among screened children was 1.57%. Descriptive analysis showed that both intervention groups demonstrated numerical reductions in anterior open bite over 6 months, whereas minimal changes were observed in the control group. However, no statistically significant differences were detected between groups (p > 0.05). Children with higher cooperation exhibited greater improvement, suggesting adherence may influence treatment response. Conclusions: Orofacial physical exercises demonstrated a trend toward improving anterior open bite and orofacial function; however, changes were not statistically significant. These exercises may serve as supportive early therapeutic management, but larger, adequately powered trials are needed to clarify their therapeutic potential. Full article

Background and Objectives: To evaluate ocular findings in women with cervical HPV positivity undergoing loop electrosurgical excision procedure (LEEP) for cervical dysplasia and to assess conjunctival/eyelid papilloma and other ocular findings in this cohort. Materials and Methods: This single-center, prospective, cross-sectional observational study was conducted at a tertiary referral hospital between September 2021 and October 2023. Women in whom LEEP was planned because of cervical dysplasia were eligible for inclusion. Patients who consented to ophthalmologic evaluation underwent preoperative eye examination and were included in the study. For the final analysis, women with cervical HPV negativity were excluded. Demographic characteristics, cervical HPV status and subtype, colposcopic biopsy histopathology, final LEEP histopathology, and ophthalmologic findings were recorded prospectively. Ocular findings were classified as normal ocular findings, conjunctival/eyelid papilloma, or other ocular findings. Results: A total of 75 women were included in the final analysis. Normal ocular findings were observed in 66 women (88.0%), conjunctival/eyelid papilloma lesions were identified in 3/75 (4.0%), and other ocular findings were identified in six (8.0%). There were no significant differences among the ocular finding groups in age, gravida, or parity. Alcohol use differed across ocular finding groups (p = 0.039), although this finding was based on only three patients in the papilloma group and should be regarded as exploratory. Ocular findings were associated with colposcopic biopsy histopathology (p = 0.016) but not with final LEEP histopathology. In exploratory adjusted analyses, no independent predictor of conjunctival/eyelid papilloma or any other ocular pathology was identified. Conclusions: In this cohort, the majority of patients had normal ocular findings, and conjunctival/eyelid papilloma lesions were identified in only three patients. The observed ocular findings did not support a clinically meaningful cervical–ocular association in this cohort. Further studies with ocular tissue-based HPV testing are needed to investigate whether HPV is present in ocular lesions and whether these findings correspond to cervical HPV results. Full article

This qualitative study examined college-aged client perceptions of artificial intelligence (AI) in counseling services. AI technologies are beginning to appear in mental health treatment; it is important to understand client voices and perceptions. A generic qualitative descriptive design was used. Fourteen participants with recent counseling experience were recruited through purposive sampling from university channels. Data was collected via open-ended survey questions and analyzed using a six-phase reflexive thematic analysis. Trustworthiness was established through multiple strategies including peer debriefing, audit trails, reflexivity practices, and prolonged engagement with data. Six major themes emerged: (1) conditional acceptance of AI for non-clinical tasks, (2) concerns about data security and privacy, (3) valuing the human core of counseling, (4) preference for human judgment in crisis situations, (5) expectation of informed consent and transparency, and (6) cautious optimism contingent on evidence and safeguards. Findings suggest that AI implementation in counseling should follow an adjunctive rather than replacement model, with careful attention to maintaining therapeutic alliance and protecting client privacy. Implications for counseling practice, training, and policy development are discussed. Full article

Introduction: Electronic nicotine delivery systems (ENDSs), also known as e-cigarettes or vapes, have shown popularity among the adolescent population. Compared to adults, less is known regarding the impacts of ENDS and nicotine on the adolescent brain. Adolescent research related to nicotine and other illicit substances can be difficult due to the requirement of parent/guardian consent, adolescent hesitancy for disclosure of product use, and the continually evolving vaping and nicotine products on the market. Despite these challenges, further research is needed to explore the impact of ENDS on the developing adolescent brain. The objective of the study was to evaluate reward sensitivity and cognitive flexibility in the adolescent population using functional magnetic resonance imaging (fMRI) through a probabilistic reversal learning task. Methods: This pilot study recruited participants aged 13–19 years old to complete fMRI testing. We specifically adapted a probabilistic reversal learning task that was previously used to measure reward sensitivity and cognitive flexibility in adults (including nicotine users). We were unable to recruit enough ENDS users to complete the planned analysis; therefore, we evaluated non-users as proof of concept for the use of the probabilistic reversal learning task in adolescents to support future research. Participants completed four blocks of a probabilistic reversal learning task, each lasting 6 min. During each block of the task, blood-oxygenation-level-dependent (BOLD) fMRI images were collected. The reward sensitivity and cognitive flexibility contrasts of parameter estimates were entered into a group analysis model. Due to the small sample size and exploratory nature of the study, we were interested in computing population-level estimates of brain activation that could be attributed to reward sensitivity (win-stay minus lose-stay trials) and cognitive flexibility (lose-shift trials minus lose-stay trials). Results: A total of twelve participants completed fMRI testing—ten non-users, one intermittent user, one regular user. Four of these participants (three non-users and one intermittent user) were excluded from the fMRI analysis due to excessive head movement and/or poor task performance. With the seven remaining non-users, we found no evidence of significant BOLD activation when strictly controlling the Type I error rate. Using a more liberal statistical threshold that did not control the Type I error rate, both contrasts resulted in suprathreshold clusters in occipital and posterior parietal regions, and the reward sensitivity contrast also resulted in suprathreshold clusters in the prefrontal cortex (bilateral middle occipital gyrus). Discussion/Conclusions: We did not find statistically significant BOLD activation, which is likely due to the small sample size. Suprathreshold clusters using the liberal statistical threshold may be feasible for use as regions of interest in future studies using this task. Notably, the prefrontal regions where the reward sensitivity contrast exceeded the liberal statistical threshold in our study were similar to those observed in previous studies of reward sensitivity in adults (including nicotine users) and adolescents. This pilot study explores the use of an fMRI reward-learning paradigm in the adolescent population, which can serve as a catalyst for future research related to nicotine use. Full article