Search Results (164,017)

Type 2 diabetes is increasingly prevalent among children and adolescents with overweight or obesity, and although lifestyle interventions remain first-line preventive strategies, long-term adherence and effectiveness are often limited. Metformin has demonstrated efficacy in delaying type 2 diabetes onset in adults at high risk, but its preventive role in pediatric populations remains unclear. This systematic review and meta-analysis aims to evaluate the effectiveness of metformin, alone or in combination with lifestyle interventions, in preventing or delaying type 2 diabetes among children and adolescents with overweight or obesity. The protocol is registered in PROSPERO (CRD42024615622), MEDLINE (PubMed), Embase, Cochrane Library, Scopus, and Web of Science and will be searched from inception to June 2025. Eligible studies include randomized controlled trials, quasi-experimental studies, and prospective cohort studies involving individuals under 18 years of age. The primary outcome is incidence of type 2 diabetes, with secondary outcomes including fasting plasma glucose, HbA1c, insulin resistance, BMI z-score, adherence, and adverse events. Where appropriate, random-effects meta-analyses will be conducted. This review will synthesize current evidence on metformin for pediatric type 2 diabetes prevention and inform future preventive strategies and clinical decision-making. Full article

Background and Objectives: Evidence on motor performance in children with autism spectrum disorder (ASD) is scarce and inconsistent. The association of motor impairments with autism severity and intelligence remains insufficiently studied. We aimed to examine motor performance parameters in children with ASD compared with typically developing (TD) peers. Materials and Methods: In this cross-sectional study, a convenience sample of 26 children with ASD, aged 4–10 years, was recruited from specialized centers in KSA, alongside 27 age- and sex-matched TD children. For the ASD group, severity (Childhood Autism Rating Scale, CARS-2) and intelligence quotient (Stanford–Binet Intelligence Scale, SB5) were extracted from medical records. CARS-2 score was utilized to categorize children with ASD into two groups (mild-to-moderate and severe groups). All study children were assessed for gross and fine motor skills using the Movement Assessment Battery for Children-2 (MABC-2), balance, muscle strength, endurance, and flexibility. Results: ASD groups recorded significantly lower scores in all MABC-2 component areas when compared to the TD group (p < 0.001). Aiming and catching percentile was significantly lower in the severe ASD group compared to the mild-to-moderate group (p = 0.05). Furthermore, children with ASD exhibited increased hypermobility, predominantly at the elbow joints, reduced grip strength, shorter distance in the modified 6 min walk test, and lower standing long-jump performance (p < 0.001) when compared to TD group; however, no significant difference was recorded between the ASD groups. Spearman correlation revealed that aiming and catching was negatively correlated with autism severity (CARS-2) (r = −0.38, p = 0.05) and positively with IQ (r = 0.51, p = 0.03). Aiming and catching was positively correlated with grip strength (r = 0.55, p = 0.003), endurance (r = 0.58, p = 0.002), and jump distance (r = 0.44, p = 0.03), while balance was positively correlated with grip strength (r = 0.44, p = 0.02). Conclusions: Children with ASD exhibit significant impairments in gross and fine motor performance compared with TD peers, accompanied by hypermobility, reduced strength, and diminished endurance. Notably, aiming and catching ability correlated with both IQ and autism severity as well as specific motor parameters, suggesting its potential as a clinical marker of motor–cognitive interaction in ASD. Full article

Background/Objectives: Population aging increases the healthcare burden of chronic diseases. We aimed to characterize the sociodemographic and clinical characteristics of Aged Madrid, a cohort comprising 98.6% of the population aged 75 years and older in Madrid, Spain. Methods: Observational study with a five-year retrospective baseline period (2015–2019) to assess baseline vascular and metabolic risk. Data were taken from primary care electronic medical records, hospital discharge summaries, and pharmacy records. Results: 587,603 individuals (mean age: 84 years ± 5.8 years, 61.3% women) were analysed. Obesity affected 31.3% (more frequent in women), while type 2 diabetes occurred in 23.8% (predominantly in men). Hypertension (52.8%), dyslipidaemia (61.6%), and chronic kidney disease (21.7%) were more frequent in women. Atrial fibrillation was the leading cardiovascular condition in women (15.1%), while acute myocardial infarction predominated in men (8.2%). The most prescribed drug classes were antihypertensives (53.8%), statins (44.2%), and oral antidiabetics (26.4%). Among antihypertensives, diuretics (53.9%), ACE inhibitors (27.4%), and ARBs (25.3%) were most used, often in combinations such as diuretics + ACE inhibitors (30.1%). Diabetes treatments favoured metformin and DPP-4 inhibitors; 5.2% received insulin. Conclusions: Sex-based differences emerged in biochemical, anthropometric, and lifestyle variables. Men showed a higher prevalence of cardiovascular diseases and several cardiometabolic risk factors, while women used fewer lipid-lowering and antidiabetic agents. Diuretics were the predominant antihypertensives, and antidiabetic therapy largely followed guideline recommendations. Although 60% of statin users had no prior cardiovascular disease, and their use was concentrated mainly among individuals with major cardiometabolic risk conditions and declined with advancing age, suggesting an age- and risk-sensitive prescribing pattern rather than indiscriminate use. Full article

Background/Objectives: The study aimed to investigate the presence of worry, rumination, and metacognitive beliefs in adolescents with maladaptive eating behaviours. Methods: The study involved 37 adolescents (10 males, 27 females, mean age ± SD: 15.4 ± 1.53 years) with obesity (Body Mass Index, BMI > 97th centile) associated with binge eating disorder (BED) (BES score ≥ 17) and 30 age-matched adolescents (13 males, 17 females, mean age ± SD: 15.2 ± 1.98 years) with essential obesity (i.e., without BED, BES score < 17). Participants completed self-report questionnaires—Penn State Worry Questionnaire (PSWQ), Ruminative Response Scale (RRS), Anger Rumination Scale (ARS), and Metacognitions Questionnaire for Children (MCQ-C)—to assess binge eating, worry, rumination, and metacognitive beliefs, respectively. Results: Patients with obesity and BED showed higher scores on the PSWQ (p = 0.006), RRS (p < 0.001), ARS (p < 0.001), negative Metaworry (p = 0.011), and total MCQ-C (p = 0.027) than those with essential obesity, with a medium-to-large effect size, indicating that the differences between subgroups were meaningful. Conclusions: Our findings highlight that BMI alone is not associated with metacognitive processes and beliefs. The presence of BED in adolescents with obesity is linked to increased levels of worry, rumination, and maladaptive metacognitive beliefs, in comparison with age-matched adolescents with essential obesity. The results of the study underline the need for different psychological approaches in these clinical conditions going forward. Full article

Graphene oxide (GO) is a carbon-based nanomaterial explored for agricultural and forestry uses, but plant responses are strongly subject to both the dose and the route of exposure. We summarized recent studies with defined graphene oxide (GO) exposures by seed priming, foliar delivery, and root or soil exposure, while comparing annual crops with woody forest plants. Mechanistic progress points to a shared physicochemical basis: surface oxygen groups and sheet geometry reshape water and ion microenvironments at the soil–seed and soil–rhizosphere interfaces, and many reported shifts in antioxidant enzymes and hormone pathways likely represent downstream stress responses. In crops, low-to-moderate doses most consistently improve germination, root architecture, and tolerance to salinity or drought stress, whereas high doses or prolonged root exposure can cause root surface coating, oxidative injury, and photosynthetic inhibition. In forest plants, evidence remains limited and often relies on seedlings or tissue culture. For forest plants with long life cycles, processes such as soil persistence, aging, and multi-seasonal carry-over become key factors, especially in nurseries and restoration substrates. The available data indicate predominant root retention with generally limited root-to-shoot translocation, so residues in edible and medicinal organs remain insufficiently quantified under realistic-use patterns. This review provides a scenario-based framework for crop- and forestry-specific safe-dose windows and proposes standardized endpoints for long-term fate and ecological risk assessment. Full article

Background/Objective: Pulmonary impairments have been identified as some of the most complex and debilitating post-acute sequelae of SARS-CoV-2 infection (PASC) or long COVID. This study identified and characterised the specific forms of pulmonary impairments detected using pulmonary function tests (PFT), chest X-rays (CXR), and computed tomography (CT) scans in patients with long COVID symptoms. Methods: We conducted a single-centre retrospective study to evaluate 60 patients with long COVID who underwent PFT, CXR, and CT scans. Pulmonary function in long COVID patients was assessed using defined thresholds for key test parameters, enabling categorisation into normal, restrictive, obstructive, and mixed lung-function patterns. We applied exact binomial (Clopper–Pearson) 95% confidence intervals to calculate the proportions of patients falling below the defined thresholds. We also assessed the relationships among spirometric indices, lung volumes, and diffusion capacity (DLCO) using scatter plots and corresponding linear regressions. The findings from the CXRs and CT scans were categorised, and their prevalence was calculated. Results: A total of 60 patients with long COVID symptoms (mean age 60 ± 13 years; 57% female) were evaluated. The cohort was ethnically diverse and predominantly non-smokers, with a mean BMI of 32.4 ± 6.3 kg/m². PFT revealed that most patients had preserved spirometry, with mean Forced Expiratory Volume in 1 Second (FEV1) and Forced Vital Capacity (FVC) above 90% predicted. However, a significant proportion exhibited reductions in lung volumes, with total lung capacity (TLC) decreasing in 35%, and diffusion capacity (DLCO/TLCO) decreasing in 75%. Lung function pattern analysis showed 88% of patients had normal function, while 12% displayed a restrictive pattern; no obstructive or mixed patterns were observed. Radiographic assessment revealed that 58% of chest X-rays were normal, whereas CT scans showed ground-glass opacities (GGO) in 65% of patients and fibrotic changes in 55%, along with findings such as atelectasis, air trapping, and bronchial wall thickening. Conclusions: Spirometry alone is insufficient to detect impairment of gas exchange or underlying histopathological changes in patients with long COVID. Our findings show that, despite normal spirometry results, many patients exhibit significant diffusion impairment, fibrotic alterations, and ground-glass opacities, indicating persistent lung and microvascular damage. These results underscore the importance of comprehensive assessment using multiple diagnostic tools to identify and manage chronic pulmonary dysfunction in long COVID. Full article

Particulate atmospheric pollution poses a global threat to human health. Metals enter the body through inhalation attached to these particles. Certain vulnerable groups are more susceptible to toxicity because of age, physiological changes, and chronic and metabolic diseases and also workers because of high and cumulative exposure to metals. A narrative review was conducted to examine the effects of key metals—arsenic, cadmium, chromium, copper, lead, mercury, manganese, nickel, vanadium, and zinc—on vulnerable populations, analyzing articles published over the past decade. Some of these metals are essential for humans; however, excessive levels are toxic. Other non-essential metals are highly toxic. Shared mechanisms of toxicity include competing with other minerals, oxidative stress and inflammation, and interacting with proteins and enzymes. Prenatal and childhood exposures are particularly concerning because they can interfere with neurodevelopment and have been associated with epigenetic changes that have long-term effects. Occupational exposure has been studied, but current exposure limits for specific metals appear dangerous, emphasizing the need to revise these standards. Older adults, pregnant women, and individuals with metabolic diseases are among the least studied groups in this review, underscoring the need for more research to understand these populations better and create effective public health policies. Full article

Background/Objectives: This study aimed to examine the effects of changes over time during multicomponent training (MCT) combined with multiprofessional interventions at different time points [baseline (T0), 12 weeks (T1), 24 weeks (T2) and 36 weeks (T3)] on body composition; blood pressure (SBP and DBP); biomarkers [fasting glucose, total cholesterol, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), and triglycerides]; and physical improvement [maximal isometric handgrip strength (MIHS), arm curl, 30 s chair stand, six-minute walk test (6MWT), and timed up-and-go (TUG)] in hypertensive and normotensive older women. Methods: This longitudinal and experimental study was conducted in hypertensive (n = 23, mean age 69.7 ± 7.21 years) and normotensive (n = 17, mean age 71.3 ± 5.92 years) older women, with three 90 min sessions per week for 36 weeks, including 60 min of MCT, 30 min of nutritional education (twice a week) and 30 min of psychoeducation (once a week). Results: Significant decreases in SBP at T1 and T3 and DBP at T3 were detected in both groups, and only SBP at T2 was detected in normotensive women (p < 0.05). Significant reductions in fasting glucose at T1-T2-T3 and LDL-c and total cholesterol at T3 and triglycerides at T2 were detected in hypertensive patients (p < 0.05). Significant improvements in arm curl at T1 and the 30 s chair stand at T1–T3 were observed for both groups, and improvements at T2–T3 were detected only in hypertensive patients (p < 0.05). Conclusions: MCT and multiprofessional interventions improve blood pressure, biomarkers and physical improvement in hypertensive and normotensive older women. Full article

Osteoarthritis (OA) is the most common form of arthritis and represents a major clinical and socioeconomic burden. Epidemiological data consistently show that OA affects women more frequently and, in several joints, more severely than men. Nevertheless, current in vitro models rarely consider sex-specific variables, limiting their ability to capture the biological mechanisms that shape the pathogenesis and progression of OA. Increasing evidence indicates that age-related hormonal fluctuations and subchondral bone remodeling strongly influence OA evolution, and that these processes differ between the sexes. For instance, the decline in estrogen levels during menopause has been associated with accelerated cartilage degeneration, increased osteoclastic activity, and a higher susceptibility to subchondral bone alterations, which may contribute to more aggressive clinical manifestations in women. These mechanisms are only partially reproduced in widely used experimental systems, including traditional biomaterial scaffolds and simplified osteochondral constructs, leaving important sex-dependent pathways unresolved. While advanced biomaterials enable precise control of stiffness, porosity, and biochemical cues, most current in vitro OA models still rely on sex-neutral design assumptions, limiting their ability to reproduce the divergent disease trajectories observed in men and women. By integrating material properties with dynamic loading and tunable hormonal conditions, next-generation in vitro systems could improve mechanistic understanding, increase the reliability of drug screening, and better support the development of sex-specific therapies through the combined efforts of bioengineering, materials science, cell biology, and translational medicine. Full article

Dementia is a progressive condition that affects cognition, communication, mobility, and independence, posing growing challenges for individuals, caregivers, and healthcare systems. While traditional care models often focus on symptom management in later stages, emerging artificial intelligence (AI) technologies offer new opportunities for proactive and personalized support across the dementia trajectory. This concept paper presents the Assistive Intelligence framework, which aligns AI-powered interventions with each stage of dementia: preclinical, mild, moderate, and severe. These are mapped across four core domains: cognition, mental health, physical health and independence, and caregiver support. We illustrate how AI applications, including generative AI, natural language processing, and sensor-based monitoring, can enable early detection, cognitive stimulation, emotional support, safe daily functioning, and reduced caregiver burden. The paper also addresses critical implementation considerations such as interoperability, usability, and scalability, and examines ethical challenges related to privacy, fairness, and explainability. We propose a research and innovation roadmap to guide the responsible development, validation, and dissemination of AI technologies that are adaptive, inclusive, and centered on individual well-being. By advancing this framework, we aim to promote equitable and person-centered dementia care that evolves with individuals’ changing needs. Full article

Introduction: Nocturnal enuresis is defined as involuntary urination during sleep in children, particularly those aged 5 years or older. Primary monosymptomatic nocturnal enuresis (PMNE) involves nighttime wetting without daytime symptoms, and although factors like reduced bladder capacity, nocturnal polyuria, and impaired arousal contribute, predictors of long-term relapse remain uncertain. Methods: This retrospective cohort study included 227 children aged ≥5 years with strictly defined PMNE who achieved complete remission following a standardized 3-month treatment protocol (alarm therapy, desmopressin, or desmopressin plus oxybutynin). All children underwent ICCS-based assessment, including physical examination, urinalysis, ultrasonography, UFM, a 48 h frequency/volume (F/V) diary, and post-void residual measurement. One year after treatment discontinuation, patients were reassessed using a 14-day wet-night diary. Predictors of relapse were analyzed using comparative statistics. Result: At 1-year follow-up, 48.5% of children experienced relapse. Age, sex, treatment modality, family history, and baseline wet-night frequency were not associated with relapse (p > 0.05). Diary-based FBC was significantly higher than UFM-based capacity (p < 0.001). Reduced diary-based mean FBC/EBC ratios were significantly more common among relapsing children (p < 0.001), whereas UFM-derived ratios showed no significant difference (p = 0.052). ROC analysis demonstrated moderate discriminatory performance for diary-based FBC/EBC (AUC 0.671). A ratio > 79% predicted sustained remission with 83.6% specificity and a positive predictive value of 73.5%. Conclusions: Diary-derived bladder capacity is the strongest predictor of long-term relapse in PMNE and outperforms UFM-based assessment. A mean FBC/EBC ratio > 79% provides a clinically useful threshold for identifying children at low risk of recurrence. Those with reduced diary-based capacity may benefit from closer follow-up or extended maintenance therapy. Full article

Background: Chronic pain, which affects over 50 million adults in the United States, has stimulated growing interest in natural and nutrition-based remedies as adjuncts to pharmacologic therapies. Evidence suggests that turmeric and related extracts (i.e., curcuminoids) may provide pain relief, albeit often at levels above dietary ranges, while piperine from black pepper exhibits bioenhancer characteristics of relevance with dietary exposures. Objective: To test the effectiveness of dietarily relevant amounts of turmeric with and without black pepper on self-reported pain ratings among adults with chronic pain. Methods: A randomized, crossover clinical trial tested the effectiveness of turmeric only (one of three amounts within culinary ranges) or turmeric with black pepper to influence pain in adults ≥ 40 years of age. Participants (n = 30, with moderate pain: 4–7 on 0–10-point scale) were enrolled in a 21-day trial, and an experience sampling methodology approach was used. Participants were prompted to report current pain using the numeric pain rating scale (NPRS; 0–10) via text message three times per day for the full study period. Data were averaged and analyzed via linear mixed effects models for repeated measurements. Results: Pain ratings from baseline to week 3 were reduced and statistically significant (p < 0.001) but not statistically different between groups. The provided turmeric, both with and without black pepper, and varying amounts of turmeric (300 mg, 1 g, and 3 g, n = 10 participants/amount) did not show statistically significant differences in pain ratings (p = 0.157 and p = 0.338, respectively). Conclusions: Consuming dietarily relevant amounts of turmeric, either alone or with black pepper, appears to improve average pain ratings. This result suggests a feasible dietary option for further study of nutritional interventions for chronic pain management. Full article

Exposure to plant protection products (pesticides) is common among agricultural workers and may represent an underrecognized cause of mucocutaneous disease. We conducted a descriptive cross-sectional survey in agricultural communities in southern Thailand (August–November 2025) to estimate the prevalence, clinical characteristics, and dermatology-specific quality-of-life impact of pesticide-attributed symptoms. Agricultural workers with pesticide use or exposure within the preceding 12 months were recruited via convenience sampling; participants provided consent and completed standardized interviewer-administered questionnaires assessing demographics, pesticide exposure history and application practices, personal protective equipment (PPE) use, self-reported cutaneous and mucosal symptoms (ocular and oral/nasal), and the Dermatology Life Quality Index (DLQI). Of the 354 eligible individuals, 228 participated in the study, and 226 were included in the analyses. The median age was 54 years (interquartile range [IQR], 15), and 82.7% were male. Overall, 14.6% reported pesticide-attributed cutaneous symptoms, 5.3% reported ocular mucosal symptoms, and 0.4% reported oral/nasal mucosal symptoms. Cutaneous manifestations were predominantly symptoms occurring after exposure, with pruritic, erythematous eruptions affecting the arms and hands that typically resolved within 1–7 days after cessation of exposure. Among symptomatic participants, the median DLQI was 0.5 (IQR 3.0); however, DLQI scores were significantly higher among participants who reported pesticide-attributed cutaneous symptoms (p < 0.001) and ocular symptoms (p < 0.001). These findings suggest that pesticide-associated mucocutaneous effects are generally mild yet clinically meaningful, underscoring the need to strengthen PPE training, risk communication, and occupational health surveillance in agricultural settings. Full article

Academic achievement serves as a crucial indicator of quality within higher education. In this context, internet addiction and procrastination emerge as significant factors influencing student performance. However, existing literature has predominantly focused on objective and comparative metrics, such as grades, thereby limiting the exploration of the subjective dimension from the student’s perspective. This research aims to investigate the mediating role of internet addiction (IA) in the relationship between academic procrastination (AP) and self-perceived academic achievement (AA) among Peruvian university students. Employing an explanatory and cross-sectional design, data were collected from 525 university students aged 18 to 40 years, utilizing validated instruments such as the Internet Addiction Questionnaire, the University Academic Performance Scale, and the Academic Procrastination Scale. The findings revealed a negative influence of AP on AA (b = −0.385, p < 0.001, 95% CI [−1.457, −0.991]), a positive influence of AP on IA (b = 0.205, p < 0.001, 95% CI [0.341, 0.886]), and a positive influence of IA on AA (b = 0.326, p < 0.001, 95% CI [0.239, 0.441]). IA partially and competitively mediates 12.5% of the relationship between AP and AA. Full article

Hydrogen is widely regarded as a promising clean energy carrier, and blending hydrogen into existing natural gas pipelines is considered a cost-effective and practical pathway for large-scale deployment. Supplying hydrogen-enriched natural gas to buildings requires careful consideration of the safe operation of pipelines and appliances without introducing new risks. In this study, on-site demonstrations and experimental tests were conducted in two high-rise buildings in Weifang to evaluate the impact of hydrogen addition on high-rise building natural gas distribution systems. The results indicate that hydrogen blending up to 20% by volume does not cause stratification in building risers and leads only to a relatively minor increase in additional pressure, approximately 0.56 Pa/m for every 10% increase in hydrogen addition. While hydrogen addition may increase leakage primarily in aging indoor gas systems, gas meter leakage rates under a 10% hydrogen blend remain below 3 mL/h, satisfying safety requirements. In addition, in-service domestic gas alarms remain effective under hydrogen ratios of 0–20%, with average response times of approximately 19–20 s. These findings help clarify the safety performance of hydrogen-blended natural gas in high-rise building distribution systems and provide practical adjustment measures to support future hydrogen injection projects. Full article