Search Results (265)

Zinc is an essential micronutrient involved in many physiological processes in the human body, including immune system regulation, cellular survival, neurologic function, and erythropoiesis. Zinc deficiency can result in a wide range of clinical manifestations, including impaired immune function, dermatologic findings, and decreased growth. Anemia has been reported as a hematologic manifestation of zinc deficiency and may be underrecognized in clinical practice. This narrative review examines the pathophysiology of zinc deficiency-associated anemia, highlighting zinc’s role in erythropoiesis, heme biosynthesis, and red blood cell stability. It also outlines populations at increased risk for zinc deficiency, including patients with chronic kidney disease, sickle cell disease, malabsorptive disorders, chronic proton pump inhibitor use, and older adults. Emerging evidence suggests that zinc deficiency-associated anemia may represent a potentially modifiable contributor to anemia in selected at-risk populations, although the strength of evidence varies across clinical settings and study designs. Assessment of zinc status may be considered in patients with unexplained or refractory anemia and additional risk factors for deficiency. Further prospective studies are needed to clarify the role of zinc deficiency in anemia and define appropriate screening, supplementation, and monitoring strategies. Full article

Efforts to liberate patients from invasive mechanical ventilation (MV) begin when the underlying cause of acute hypoxemic respiratory failure (AHRF) or adult respiratory distress syndrome (ARDS) that led to use of invasive ventilation has resolved or improved and patients can initiate spontaneous breaths. In preparation for liberation, clinicians transition patients to spontaneous modes of ventilation as soon as possible while ensuring that patients’ respiratory effort is not insufficient or excessive during weaning attempts. Concurrently, clinicians aim to minimize the effects of sedative and analgesic agents, screen daily to identify patients who are ready to undergo a spontaneous breathing trial (SBT), and conduct SBTs to help assess patients’ readiness for extubation. Extubation failure is rarely the consequence of a single physiological abnormality. Rather, it reflects the interaction of multiple mechanisms that often coexist, including an imbalance between respiratory system load and capacity, ineffective cough, and secretion burden among others. For these reasons, single weaning parameters and SBTs may fail to identify some patients who are at risk for extubation failure. Conversely, indices and scores that combine two or more parameters and newer techniques may provide mechanistic insights into the pathways that lead to extubation failure, help to characterize ‘at-risk’ phenotypes, and identify patients who may benefit from closer monitoring, targeted therapeutic strategies, and/or early application of noninvasive respiratory support strategies such as high-flow nasal cannula (HFNC) and bilevel noninvasive positive pressure ventilation (NIV). Full article

Background: In Italy, seasonal flu vaccination was recommended for all children aged 6 months to 6 years, all adults aged ≥60 years and specific at-risk groups. Influenza vac-cine effectiveness (IVE) varies from season to season. It can be related to several factors: possible mismatches between circulating virus strains and vaccine composition, the host immune response and the interval between the vaccine administration and the epidemic peak. The present study aimed to estimate IVE against acute respiratory infections (ARIs) caused by influenza during the 2024/25 season in the Province of Pescara, Abruzzo Region, Southern Italy. Methods: A retrospective test-negative case–control study was conducted in the tertiary hospital of the province of Pescara, Abruzzo region, Southern Italy. The study considered all naso/oropharyngeal swabs performed between 15 October 2024 and 1 April 2025. Results: During the study period, 5452 tests were performed and met the inclusion criteria. Among them, 637 tested positive for influenza (11.68%) and 4815 (88.32%) were considered controls. The IVE estimated using the fully adjusted model showed an overall effectiveness of 41.36% (from 1.08 to 57.29%). Considering influenza type, IVE against influenza A was 37.23%, whereas IVE against influenza B was 77.28%. Conclusions: The 2024/2025 season was characterized in our Italian region by a delayed start in flu circulation, with a concomitant and prominent co-circulation of all virus types. Available vaccines provided a moderate protection against laboratory-confirmed influenza, with an estimated VE of 41%. Full article

Background/Objectives: Substance use disorders remain a significant public health concern, particularly when vulnerability emerges during adolescence and young adulthood. Although much of the literature has focused on treatment and recovery, prevention-oriented scholarship increasingly points to the value of strengths-based approaches that reduce risk by cultivating protective processes. This narrative review examines resilience as a protective factor in substance use prevention across adolescence and young adulthood, with particular attention to health promotion, developmental context, and multilevel prevention systems. Methods: A narrative review approach was used to synthesize interdisciplinary literature from psychology, public health, education, addiction studies, and prevention science. The review focused on peer-reviewed scholarship addressing resilience, protective factors, and prevention-related processes relevant to adolescent and young adult substance use. Literature was analyzed thematically across major domains including conceptualizations of resilience, developmental relevance, protective factors, prevention strategies, diverse and at-risk populations, and conceptual and methodological challenges. Results: The literature suggests that resilience is most useful for substance use prevention when conceptualized as a dynamic and ecological process rather than a fixed individual trait. Protective processes associated with lower substance use risk include emotional regulation, adaptive coping, family support, peer connectedness, school engagement, community cohesion, and culturally meaningful sources of identity and belonging. Prevention strategies appear most promising when they are multilevel, relational, developmentally responsive, and integrated with broader mental health and health promotion efforts. At the same time, the literature remains limited by definitional inconsistency, measurement variability, heterogeneous outcome indicators, a predominance of cross-sectional evidence, inconsistent or null protective effects for some factors and outcomes, and insufficiently contextualized uses of resilience. Conclusions: Resilience offers a valuable framework for substance use prevention across adolescence and young adulthood when it is grounded in developmental, ecological, and equity-aware perspectives. Prevention may be strengthened by moving beyond deficit-focused models and intentionally cultivating the supportive conditions under which young people can adapt, connect, and thrive without turning to substances as a means of coping. Full article

Single studies are often cited to support claims of nutritional soundness or unsoundness regarding vegan or meat-based pet foods when compared to nutritional guidelines from authorities such as the Association of American Feed Control Officials (AAFCO), the European Pet Food Industry Federation (FEDIAF), and the National Research Council (NRC). However, there is little overarching evidence concerning the nutritional soundness of these different pet food types. Such overarching evidence is increasingly important as alternative vegan or meat-based pet food types become more available, such as insect-based, raw meat, and microbial protein-based pet foods. In this systematic review, 54 relevant studies examining the nutritional soundness of vegan, vegetarian, or meat-based dog or cat foods were descriptively analyzed. Only 10 (18.5%) studies found no nutritional deficiencies or excesses across their sampled pet foods relative to AAFCO, FEDIAF, or NRC guidelines. Numerous nutrient deficiencies and excesses were found across all pet food types. Most commonly, these included deficiencies in calcium, phosphorus, and zinc for both dog and cat food, as well as the amino acid taurine exclusively in cat food. The nutrients found to be most commonly in excess were also calcium and phosphorus, and copper—with the latter breaching not only FEDIAF requirements, but also EU legislative limits. Meat-based, insect-based, veterinary prescription, and vegan pet food types each had particularly at-risk nutrients that pet food companies should be aware of. For instance, vegan pet foods often performed well in terms of their fatty acid profile and selenium levels, but some had deficiencies in certain B vitamins. In contrast, some meat-based pet foods were prone to selenium deficiencies. Generally speaking, aside from such specific nutritional flaws, problems were observed across all pet food types. In fact, dog and cat foods (including wet and dry, growth and adult maintenance) of various types commonly failed to fulfil multiple nutritional requirements. To safeguard dog and cat health and welfare, urgent interventions are warranted to improve the nutritional soundness of many pet foods. Full article

Background/Objectives: There is wide variability in the available estimates on the burden of Long-COVID (LC), both among adults and children. Preliminary evidence suggests that this inconsistency may be due, at least in part, to the adoption of uneven diagnostic criteria, proposed by several international entities during the course of the pandemic, but no comprehensive evaluation has been performed so far to quantify the extent of variation among children. This systematic review and meta-analysis aims to update the available epidemiological estimates of LC among pediatric subjects, and to systematically appraise the degree of variability that can be attributed to the diagnostic criteria adopted. Methods: A systematic literature search identified cohort studies providing data on LC among children and adolescents with a previous SARS-CoV-2 infection. We computed (a) proportion and (b) head-to-head meta-analyses (a) to quantify the pooled rates of LC and LC-related symptoms, and (b) to assess the likelihood of developing LC based upon selected demographic and/or clinical characteristics, respectively. Results: In total, 52 cohort studies and 960,089 subjects were included. The pooled rate of LC was 18.1% (95% CI: 13.1–23.6), ranging from 16.2% to 21.6%, according to NIH or WHO diagnostic criteria, respectively. Fatigue, respiratory and neurological symptoms were most commonly reported by LC patients. Stratified analyses showed that females, adolescents (vs. children), subjects with comorbidities, and those with a previous severe COVID-19 (as compared to asymptomatic primary infections) were more likely to develop LC (all p < 0.05). In contrast, the likelihood of LC onset did not significantly vary between individuals with ≥1 anti-SARS-CoV-2 vaccine dose, versus the unvaccinated (pooled OR: 0.92; 95% CI: 0.61–1.41). Conclusions: Although the available estimates may largely vary depending on the adopted definition, LC affects a meaningful proportion of the pediatric population; as such, common clinical criteria and diagnostic approaches are urgently needed. Moreover, given the relevant methodological heterogeneity and the generally poor-to-fair quality of a large part of the available literature, high-quality studies adopting standardized methodologies are warranted to identify at-risk populations and guide the implementation of targeted follow-up strategies. Full article

Acute myeloid leukaemia (AML) remains a highly lethal malignancy with poor prognosis in adults above 60 years old and often occurs after radiation exposure. Emerging evidence suggests that circadian rhythm disruption, prevalent in shift workers, may contribute to cancer development. Clock genes (CGs) regulate fundamental cellular processes, including the DNA damage response (DDR), cell cycle progression, and haematopoiesis. In the absence of substantial experimental data, this review examines the potential pathways linking circadian clock dysregulation to radiation-induced AML (rAML) and evaluates how temporal disruption may modulate leukaemogenesis and radiation-induced effects. The evidence was synthesised on core clock components (BMAL1, CLOCK, PER, CRY, REV-ERB, ROR), their dysregulation in AML, and their roles in radiation response. Epigenetic and post-transcriptional regulatory mechanisms, including m⁶A RNA modification and sirtuin-mediated chromatin remodelling, were evaluated for their contribution to circadian-regulated DNA repair capacity. Multiple CGs demonstrated aberrant expression in AML, with BMAL1 showing tissue-specific dysregulation, and PER1/2/3 was consistently downregulated in peripheral blood. Clock proteins directly regulate DNA damage checkpoints through interactions with ATM/CHK2 and p53 pathways. Circadian disruption enhances inflammatory signalling, promotes accumulation of myeloid-derived suppressor cells, and accelerates immune senescence. Moreover, radiation exposure modulates CG expression, which may alter repair fidelity and increase leukaemogenic risk. Understanding these connections in the context of disrupted circadian rhythms could help identify at-risk populations and improve shift workplace health policies. Full article

Emerging adulthood may be particularly challenging for young people who have graduated from educational frameworks for adolescents at risk, many of whom have faced complex social, emotional, or familial hardships, alongside academic challenges such as school dropout, yet the mechanisms linking such adversity to well-being remain insufficiently understood. Drawing on Self-Determination Theory, this study examined whether satisfaction of three basic psychological needs (autonomy, competence, and relatedness) mediates the association between negative life events and mental well-being among emerging adults from at-risk educational backgrounds. Participants were 256 Israeli emerging adults (aged 18–25; 48.8% female) who had completed their secondary education in frameworks for youth at risk. Mental well-being was assessed across emotional, social, and psychological dimensions, alongside measures of negative life events and need satisfaction. Parallel mediation analyses indicated that exposure to a greater number of negative life events was associated with lower psychological need satisfaction. Direct effects of negative life events on well-being became nonsignificant once need satisfaction was included, whereas total indirect effects remained significant across outcomes. Competence emerged as the most consistent mediator, while autonomy was specific to emotional well-being and relatedness to social and psychological well-being. These findings identify need satisfaction as a key mechanism linking adversity to well-being and highlight the importance of maintaining supportive relational and developmental structures for young adults transitioning out of at-risk educational frameworks. Full article

Background: Chronic kidney disease (CKD) is a major public health problem, primarily affecting patients with diabetes mellitus and/or hypertension. Early detection is critical to delay progression to renal replacement therapy. Therefore, this study aims to evaluate the implementation of a digital module for CKD detection in at-risk patients within the Peruvian Social Health Insurance system (EsSalud) during 2024. Materials and Methods: Data were collected through the Renal Health Module (MOSARE), a digital tool integrated into EsSalud’s electronic health record for monitoring patients at risk of CKD. Key indicators were assessed using the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. Quantitative analyses evaluated patient identification, screening, and diagnosis, while qualitative analyses of technical documents identified barriers, facilitators, and stakeholder perceptions. Results: In 2024, MOSARE was implemented in a population of 1,667,856 insured individuals with CKD-related risk conditions, predominantly women (55.7%) and adults aged >55 years (88.3%). Nationwide, 93,266 patients were screened (5.59% reach), with 34.3% diagnosed with CKD. Screening coverage showed substantial geographic variability (0.35–29.59%). A total of 32,004 CKD cases were identified, with 84.2% in early stages (1–3A). Adoption reached 66.8% of level I and II healthcare facilities, with variability across networks. Regarding maintenance, 65% of trained facilities sustained active use. Implementation gaps were associated with interoperability issues, resource limitations, and training variability. Conclusions: MOSARE proved to be a feasible and operationally sensitive tool for CKD screening and risk identification, improving integration of renal care. However, addressing technical, training, and resource barriers is essential to ensure sustainability and scalability. Full article

Purpose: To investigate the short-term impact of scleral lens wear on intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness. We hypothesized that scleral lens wear would produce a measurable elevation in IOP accompanied by detectable RNFL thinning compared with soft contact lens wear. Methods: This prospective, randomized, contralateral-eye crossover study included 31 healthy participants (mean age: 26 ± 3 years). Each participant wore a 16.5 mm scleral lens over one eye and a soft contact lens over the fellow eye for 8 h, with assignments reversed between visits. IOP was measured using two tonometers: a transpalpebral Diaton tonometer and a non-contact tonometer (NCT), and RNFL thickness was measured by optical coherence tomography at four time points: pre- and post-lens application, and pre- and post-lens removal. Results: Eyes fitted with scleral lenses exhibited a significant IOP increase immediately after lens application (pre-application: 11 ± 3 mmHg vs. post-application: 16 ± 4 mmHg, p < 0.001), sustained throughout 8 h of wear (pre-removal: 16 ± 4 mmHg), and returned to baseline after removal (11 ± 3 mmHg). No significant IOP changes were observed in soft contact lens-wearing eyes (p > 0.05). Scleral lens wear was also associated with small but statistically significant peripapillary RNFL thinning (pre-application: 110 ± 11 µm vs. post-application: 107 ± 11 µm, p < 0.001), which returned to baseline after lens removal. No significant RNFL changes were observed with soft contact lens wear (p > 0.05). Bland–Altman analysis revealed poor agreement between Diaton and NCT measurements, consistent with the published literature on transpalpebral tonometry. Conclusions: Short-term scleral lens wear was associated with transient IOP elevation and peripapillary RNFL thinning, both reversible upon lens removal, in healthy young adults. These findings highlight the need for further longitudinal investigation in at-risk populations such as those with ocular hypertension, keratoconus, or early glaucoma before clinical monitoring recommendations can be established. Full article

The COVID-19 pandemic accelerated telehealth adoption, but disparities in digital access hinder its potential, especially for older adults in nonmetropolitan areas. This study examined associations between sociodemographic factors and access to select digital resources among nonmetropolitan Medicare beneficiaries. This cross-sectional study used the 2022 Medicare Current Beneficiary Survey Public Use File, including 1732 Medicare beneficiaries aged ≥65 in nonmetropolitan areas. The dependent variable of digital access was categorized as (1) access to both a computer/tablet and the internet, (2) access to either, and (3) access to neither. A survey-weighted multinomial logit model was conducted to examine associations between sociodemographic factors and digital access, with no access to either a computer/tablet or the internet as the reference category. Approximately 71.7% of nonmetropolitan beneficiaries had both computer/tablet and internet access, 14.4% had one or the other, and 13.9% had neither. About one-third of study beneficiaries lacked full digital access. Older age, male, minority race/ethnicity, lower education, and lower income were associated with reduced digital access among nonmetropolitan beneficiaries. Targeted interventions to expand digital access for these at-risk populations are needed. Full article

Background and Objectives: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awareness, the published literature exhibits substantial heterogeneity in reported prevalence estimates and recovery outcomes across different injury mechanisms. This narrative review aims to synthesize available evidence on the prevalence, clinical characteristics, recovery patterns, and prognostic factors of tinnitus and hearing loss following traumatic injury, with a particular focus on comparing outcomes across distinct trauma mechanisms and evaluating the impact of early intervention. Materials and Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science for studies published between January 2010 and December 2025. The search strategy combined terms related to traumatic injury (e.g., “acoustic trauma,” “blast injury,” “traumatic brain injury,” “head trauma”) with terms related to auditory dysfunction (e.g., “tinnitus,” “hearing loss,” “auditory dysfunction”). Eligible studies included observational studies (cohort, cross-sectional, case–control) reporting original data on tinnitus and/or hearing loss prevalence, recovery outcomes, or prognostic factors in adult or mixed populations exposed to traumatic injury. A narrative synthesis was organized thematically around the key research questions. Results: The available evidence consistently indicates that tinnitus and hearing loss are frequent consequences of blast injury, acute acoustic trauma, and traumatic brain injury, although reported prevalence estimates vary considerably across studies due to differences in populations, injury mechanisms, and diagnostic criteria. Blast injury is associated with mixed hearing loss (conductive and sensorineural components), while acute acoustic trauma typically causes sensorineural hearing loss, often with a characteristic high-frequency notch. Traumatic brain injury can lead to central auditory processing deficits even when pure-tone thresholds are normal. Recovery is variable and often incomplete; tympanic membrane perforations frequently heal spontaneously, but sensorineural components often persist. Early treatment (within days to two weeks) is associated with better recovery outcomes. Conclusions: Trauma-associated tinnitus and hearing loss are highly prevalent and frequently result in persistent disability. The strong association between early treatment and improved recovery outcomes supports the implementation of prompt audiological evaluation and intervention following traumatic injury. These findings underscore the need for routine audiological screening in at-risk populations and for continued research into preventive strategies, standardised assessment protocols, and optimised treatment regimens. Full article

Background/Objective: Persistent dry mouth, associated with poor oral health and lower quality of life (QoL), affects approximately 20% of adults in the global population. Indicating a potential role in nutrition, Camellia sinensis tea leaves contain bioactive compounds that may help prevent and manage dry mouth. This review aimed to evaluate the effects of different tea types on salivary flow rate (SFR), salivary pH, and QoL in healthy and at-risk patients and patients with hyposalivation or xerostomia. Methods: A systematic review without meta-analysis (SWiM) was conducted. Pre-defined inclusion and exclusion criteria were applied to databases: PubMed, Scopus, Web of Science, and the Cochrane Library. Results: Eighteen studies met the eligibility criteria for inclusion in the review. Over 50% of studies investigated either black or green tea, with most conducted in healthy young adults (67%) and predominantly among females. Fifteen of the studies reported that tea intervention improved at least one outcome of interest. In general, green tea improved SFR and salivary pH more consistently than black, oolong, or matcha tea, particularly in at-risk populations and patients diagnosed with xerostomia. Conclusions: Tea consumption, particularly of green and black tea, showed a transient enhancement of salivary flow, pH, and QoL, offering a low-cost non-pharmacological approach to supporting oral health. Definitive recommendations were limited by heterogeneity in study interventions and outcome measurements, small sample sizes, and incomplete reporting of study details. However, tea’s potential as an adjunct for the prevention and management of dry mouth warrants further study in larger, well-designed studies that employ standardized protocols. Full article

In modern society, adolescents experiencing mental health problems are increasing. This study aims to identify barriers to mental health care at the individual, family, school, and staff levels among at-risk adolescents, employing a mixed-methods approach. Given the ethical and practical constraints of engaging at-risk adolescents directly, the study quantitatively analyzed responses to the AMPQ-III-I survey from 47 runaway adolescents, while conducting interviews with eight school nurses serving as proxy informants. The at-risk adolescents were found to be in a state of mental health crisis characterized by somatization, self-harm, excessive digital media use, and peer imitation. Within the family environment, they experienced communication gaps with adults, concerns about mental health stigma, and the risk of disengagement from home and school. Despite experiencing physical and emotional difficulties that hindered their ability to focus on academic work, schools tended to deprioritize mental health, and these adolescents reported notably low utilization of professional counseling. School nurses, although well-positioned to identify at-risk adolescents, expressed barriers such as excessive workload and a lack of communication among teachers. These findings suggest that, to support the growing and intensifying population of at-risk adolescents, an urgent shift in awareness and the alleviation of barriers within the family–school–staff ecosystem is required. Full article

Background/Objectives: Traumatic brain injury (TBI) is increasingly understood as a chronic condition, but the role of early post-injury lifestyle behaviors in later cardiometabolic risk remains unclear. We examined whether lifestyle behaviors reported 1 year after injury were associated with the accumulation of common cardiometabolic risk factors by 5 years in the Traumatic Brain Injury Model Systems (TBIMS) National Database. Methods: This retrospective cohort secondary analysis included adults with followed 1-year and 5-year interviews, complete 1-year data on four behaviors, and the complete ascertainment of hypertension, diabetes or high blood sugar, and high cholesterol at both waves. The exposure was a favorable lifestyle count based on not smoking, non-heavy alcohol use, non-obese body mass index, and sports or exercise at least 10 times per month. The primary endpoint was the incident accumulation of at least two new common cardiometabolic conditions between years 1 and 5. The analytic cohort was an observed-data subset defined by follow-up retention, complete behavior data, paired outcome ascertainment, and baseline at-risk status rather than a random sample of all TBIMS participants. Results: Among 10,057 linked participants with followed interviews at both waves, 9593 were adults, 3182 had complete four-behavior exposure data, 689 had complete cardiometabolic ascertainment, and 581 formed the primary at-risk observed-data cohort. The primary endpoint occurred in 39 participants (6.7%). Each additional favorable behavior was associated with lower odds of the primary endpoint in the adjusted model (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.41–0.98; p = 0.040). The results were similar after adjustment for the 1-year Functional Independence Measure cognitive score and in Firth logistic regression. Because the final cohort was selected and the number of primary events was small, the estimates should be interpreted as exploratory and may not generalize to the broader TBI population. Conclusions: More favorable 1-year lifestyle profiles were associated with lower 5-year cardiometabolic risk factor accumulation after TBI. These findings support prevention-oriented follow-up but do not establish causality or validate a prognostic score. Full article