Search Results (227)

Background: Basal cell carcinoma (BCC) is the most common skin cancer worldwide, with a multifactorial aetiology involving environmental and intrinsic factors. A small subset of patients develops high-frequency BCC (HF-BCC), defined as ≥9 BCCs within 3 years. Objective: To analyse demographic, clinical, and histopathological features of non-syndromic HF-BCC in a Belgian cohort, compared with low-burden BCC patients and healthy controls. Methods: A retrospective cohort study was conducted at Erasme Hospital (Brussels) using data from the EUSCAP platform. Clinical, behavioural, and histopathological data were collected and statistically analysed. Results: Of 783 patients, 16 with HF-BCC were identified. For comparison, 32 patients with 1–2 BCCs and 117 patients without BCC were selected. HF-BCC patients showed distinct characteristics, including a higher proportion of superficial BCCs (68.3% vs. 50%, p = 0.01) and fewer nodular subtypes (43.2% vs. 63.5%, p = 0.01). Their tumours were less frequently located on the nose and ears compared with patients having 1–2 BCCs. HF-BCC was associated with a personal history of squamous cell carcinoma (SCC) and actinic keratosis (AK). Conclusions: HF-BCC patients display distinct anatomical, histopathological and clinical characteristics, with a predominance of superficial BCC and an association with a personal history of SCC and AK. They show a lower frequency of tumours on the nose and ears, with a stronger tendency for localisation on the trunk and extremities. Identifying risk factors and genetic markers may contribute to improved early detection strategies, preventive measures, and the development of targeted therapies. Full article

Cannabinoid receptor 1 (CB₁) signalling is critical for weight gain and for milk intake in newborn pups. This is important as in humans, low birth weight increases the risk for attention-deficit hyperactivity disorder (ADHD). Moreover, some children with ADHD also have Tourette syndrome (TS). However, it remains unclear if insufficient CB₁ receptor signalling may promote ADHD/TS-like behaviours. Here, ADHD/TS-like behaviours were studied from postnatal to adulthood by exposing postnatal wild-type CB₁ and Cannabinoid receptor 2 (CB₂) knockout mouse pups to SR141716A (rimonabant), a CB₁ receptor antagonist/inverse agonist. Postnatal disruption of the cannabinoid system by SR141716A induced vocal-like tics and learning deficits in male mice, accompanied by excessive vocalisation, hyperactivity, motor-like tics and/or high-risk behaviour in adults. In CB₁ knockouts, rearing and risky behaviours increased in females. In CB₂ knockouts, vocal-like tics did not develop, and males were hyperactive with learning deficits. Importantly, females were hyperactive but showed no vocal-like tics. The appearance of vocal-like tics depends on disrupted CB₁ receptor signalling and on functional CB₂ receptors after birth. Inhibition of CB₁ receptor signalling together with CB₂ receptor stimulation underlie ADHD/TS-like behaviours in males. This study suggests that the ADHD/TS phenotype may be a single clinical entity resulting from incorrect cannabinoid signalling after birth. Full article

Background/Objectives: Metabolic syndrome (Mets) risk is influenced by both parents’ preconception lifestyle, yet most interventions target individuals rather than couples. True couples-based interventions that engage both partners equally remain rare. This study aimed to assess the feasibility and adherence of a 10-week lifestyle intervention delivered to heterosexual couples in the preconception period. Methods: This was a pre-post mixed-methods study involving eight nulliparous, cohabiting couples (N = 16 participants) planning a pregnancy within three years. Couples received tailored dietary and physical activity advice via remote sessions. Qualitative data were collected through post-intervention dyadic interviews and thematically analysed to explore participants’ experiences and perspectives on feasibility and adherence. Quantitative data on anthropometry, dietary intake (serves from five food groups), and sedentary behaviour were descriptively analysed. Wilcoxon signed-rank tests were used to assess changes in paired outcomes. Results: qualitative findings highlighted shared motivation, mutual accountability, cultural barriers, and the practicality of the intervention structure. All couples completed the intervention (100% retention). Among participants who required change, improvements were observed in all eight individuals for body mass index and in five out of seven individuals for waist-to-hip ratio. Statistically significant improvements were found in BMI (p = 0.027) and grain intake (p = 0.002), while other dietary and anthropometric changes were not significant. Dietary improvements were noted in 43 out of 80 observations across vegetables, fruits, grains, protein, and dairy intake. Sedentary hours were reduced in 12 of 16 participants, though increases in physical activity intensity were limited. Conclusions: A true-couples-based lifestyle intervention is feasible and acceptable in the preconception period. The approach shows potential for improving diet and reducing sedentary behaviour. Future research with a larger sample and longer duration is recommended to assess long-term effectiveness and broader applicability. Full article

Background: Dementia is a syndrome with a high global prevalence that includes a number of progressive diseases of the brain affecting various cognitive domains such as memory and thinking and the performance of daily activities. It manifests as symptoms which often include significant mood and behaviour changes that are highly varied. Changed moods and behaviours due to dementia may reflect distress and may be stressful for both the person living with dementia and their informal and formal carers. To provide dementia care support specific to mood and behaviour changes, the Behaviours in Dementia Toolkit website (BiDT) was developed using human-centred design principles. The BiDT houses a user-friendly, digital library of over 300 free, practical, and evidence-informed resources to help all care partners better understand and compassionately respond to behaviours in dementia so they can support people with dementia to live well. Objective: (1) To characterize the users that visited the BiDT; and (2) to understand the platform’s early impact on these users. Methods: A multi-method, descriptive study was conducted in the early post-website launch period. Outcomes and measures examined included the following: (1) reach: unique visitors, region, unique visits, return visits, bounce rate; (2) engagement: engaged users, engaged sessions, session duration, pages viewed, engagement rate per webpage, search terms, resources accessed; (3) knowledge change; (4) behaviour change; and (5) website impact: relevance, feasibility, intention to use, improving access and use of dementia guidance, recommend to others. Data was collected using Google Analytics and an electronic survey of website users. Results: From 4 February to 31 March 2024, there were 76,890 unique visitors to the BiDT from 109 countries. Of 76,890 unique visitors to the BiDT during this period, 16,626 were engaged users as defined by Google Analytics (22%) from 80 countries. The highest number of unique engaged users were from Canada (n = 8124) with an engagement rate of 38%. From 5 March 2024 to 31 March 2024, 100 electronic surveys were completed by website users and included in the analysis. Website users indicated that the BiDT validated or increased their dementia care knowledge, beliefs, and activities (82%) and they reported that the website validated their current care approaches or increased their ability to provide care (78%). Further, 77% of respondents indicated that they intend to continue using the BiDT and 81.6% said that they would recommend it to others to review and adopt. Conclusions: The BiDT is a promising tool for sharing practical and evidence-informed information resources to support people experiencing dementia-related mood and behaviour changes. Early evaluation of the website has demonstrated significant reach and engagement with users in Canada and internationally. Survey data also demonstrated high ratings of website relevance, feasibility, intention to use, knowledge change, practice support, and its contribution to dementia guidance. Full article

Background: Postmenopausal women face increased risk of developing metabolic syndrome (MetS) and cardiovascular disease (CVD) due to hormone changes during menopause. Life’s Essential 8 (LE8), a relatively new cardiovascular health assessment index by the American Heart Association, may impact MetS diagnostics and potential treatment strategies. This study investigated the association between LE8 and MetS among postmenopausal women. Methods: National Health and Nutrition Examination Survey (NHANES) data were extracted (2011–2020). LE8 comprised eight health behaviours and factors (score of 0–100) classified into low (0–49), moderate (50–79), and high (80–100) cardiovascular health status. MetS was defined as metabolic dysfunctions comprising insulin resistance, central obesity, dyslipidaemia, impaired glucose metabolism, and hypertension. Complex survey-adjusted regression models were used. Effect modification by race and female hormone use were investigated. Results: 5402 postmenopausal women were included (mean age: 63.0 y), and 3152 (58.3%) met MetS criteria. LE8 scores for those with and without MetS were 58 ± 13.8 and 70 ± 14.1 (p < 0.001), respectively (mean ± SD). Higher LE8 scores were associated with lower odds of having MetS (Odds ratio (OR) for a 10-score increase: 0.53, 95% CI: [0.48, 0.57], p < 0.001). Nicotine exposure score was inversely associated with the likelihood of having MetS (0.52 [0.34, 0.80], p = 0.022). The association between LE8 status and odds of MetS differed by race (p-interaction = 0.01); ‘moderate’ or ‘high’ cardiovascular health status lowered odds of MetS in all races except other/multi-racial. Conclusions: The inverse relationship between LE8 scores and MetS suggests that integrating LE8 components into management strategies may help prevent CVD in postmenopausal women. Full article

Systemic arterial hypertension (SAH), characterised by a persistent increase in BP beyond the reference values for the species, is a concerning and detrimental clinical condition. The aim of this manuscript is to present the state of the art on SAH in companion animals, including the different types of hypertension, diagnostic and therapeutic approaches, and the factors associated with its occurrence, such as the role of stress. It also discusses the benefits and challenges related to the measurement process. SAH is categorised into types based on the underlying cause: situational, secondary, and idiopathic (the least frequently observed). The situational type occurs when stress is the primary factor, such as during veterinary visits, contact with other animals, or in cases of ‘white coat syndrome’. If the stressor is removed, BP values tend to normalise. The most common type of SAH is the secondary form, which is associated with an underlying condition, such as renal, cardiac, endocrine, or neurological diseases, or a combination of these. Diagnosing SAH is a challenging task for many veterinarians due to factors related to handling the animal, managing the equipment, and interpreting the results. Consequently, many professionals either take inaccurate measurements or misinterpret the results, often prescribing antihypertensive medications prematurely or unnecessarily. Despite being a well-standardised and well-documented process, challenges persist. Treatment often involves antihypertensive drugs, either alone or in combination, alongside management of the underlying causes, when present. Therefore, BP values should be obtained correctly, with clinical-therapeutic decisions carefully aligned with the factors that may influence them. Full article

Background: “Chemsex” involves the intake of a range of drugs (e.g., synthetic cathinones, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), ketamine, methamphetamine, “poppers”, type V phosphodiesterase (PDE) inhibitors, MDMA/ecstasy, cocaine, cannabis, and occasionally a few other molecules as well, to enhance and prolong sexual experiences. This paper aims to provide an overview of the clinical pharmacology of the vast range of drugs that are being used for chemsex with a focus on both the medical and psychopathological disturbances that they can produce. Methods: A narrative literature review was conducted using Pubmed, Scopus, and Web of Science databases. A total of 273 papers published up to January 2025 were screened; articles were selected based on relevance to chemsex/sexualized used behaviour and related substances. Both human and preclinical studies were considered. Results: The use of stimulants is likely related to the need to increase as much as possible both sexual arousal and performance but also to increase social interactions. Furthermore, the empathogenic/entactogenic activities of some MDMA-like “love drugs” facilitate the occurrence of “feeling closer/more intimate” emotional sensations, and GHB/GBL may provide the user with a subjective sensation of disinhibition, hence facilitating condomless meetings with a higher number of random partners. Conversely, ketamine may be used to both enjoy its psychotropic dissociative characteristics and facilitate the potentially painful receptive anal intercourse and/or fisting experiences. Most typically, these drugs are consumed in combination, with polydrug exposure possibly facilitating the occurrence of serotonergic syndrome, seizures, drug–drug pharmacokinetics’ interaction, and sympathomimetic overstimulation. Following these polydrug exposures, a range of psychopathological conditions have at times been reported. These issues may lead to misuse of opiates/opioids, gabapentinoids, and/or antipsychotics. Conclusions: Further actions should aim at reducing the stigma that prevents individuals from accessing necessary healthcare and support services. A multidisciplinary approach that combines medical, psychological, and social support remains key to managing the complex challenges posed by chemsex-related drug use. Full article

The British National Institute for Health and Care Excellence (NICE) published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in October 2021. NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. An article by White et al., which is written by 51 researchers, claims that there are eight anomalies in the review process and the interpretation of the evidence by NICE. In this article, we reviewed the evidence they used to support their claims. Their three most important claims are that NICE redefined the disease, that CBT and GET are effective, and that fixed incremental increases are not part of GET. However, our analysis shows that the disease was not redefined by NICE. Instead, it was redefined in the 1990s by a group of doctors, including a number of authors of White et al., when they erased the main characteristic of the disease (an abnormally delayed muscle recovery after trivial exertion, which, over the years, has evolved into post-exertional malaise) and replaced it with chronic disabling severe fatigue. Their own studies show that CBT and GET do not lead to a substantial improvement of the quality-of-life scores or a reduction in CFS symptom count, nor do they lead to objective improvement. Also, both treatments have a negative instead of a positive effect on work and disability status. Moreover, a recent systematic review, which included one of the authors of White et al., showed that ME/CFS patients remain severely disabled after treatment with CBT. Our analysis of, for example, the PACE trial’s GET manual for therapists exposes the fixed incremental nature of GET. Why the authors are not aware of that is unclear because eight of them were involved in the PACE trial. Three of them were centre leaders and its principal investigators, four others were also centre leaders, and another one was one of the three independent safety assessors of the trial. Moreover, many of these eight authors wrote, or were involved in writing, this manual. In conclusion, our analysis shows that the arguments that are used to claim that there are eight anomalies in the review process and the interpretation of the evidence by NICE are anomalous and highlight the absence of evidence for the claims that are made. Furthermore, our analysis not only exposes the fixed incremental nature of GET, but also of CBT for ME/CFS. Full article

Background: A conceptual shift in healthcare emphasises multimorbidity and multibehaviours as interconnected phenomena, highlighting dose–response associations and sex-specific differences. Data-driven approaches have been suggested for overcoming methodological challenges, of multimorbidity research. By using exploratory factor analysis, this study aimed to identify sex specific lifestyle associative multimorbidity patterns, providing valuable evidence to primary care providers and informing future multimorbidity guidelines. Methods: A retrospective observational study examined the electronic health records of three general practices in the UK between 2015 and 2018. The participants were aged 18+ with lifestyle multimorbidity, having engaged with multiple health risk behaviours. Stratified exploratory factor analysis with oblique rotation was used to identify sex specific lifestyle associative multimorbidity patterns. Results: The study included N = 7560 patients, with females comprising 53.9%. Eight independent lifestyle associative multimorbidity patterns were identified and distributed as follows. For females, three patterns emerged: cardiometabolic–neurovascular spectrum disorders (42.97% variance), respiratory conditions (8.08%), and sensory impairment (5.63%), with 25.4% assigned to these patterns. For males, five patterns were revealed: cardiometabolic–vascular spectrum disorders (34.10%), genitourinary (9.19%), respiratory–vision (8.20%), ocular (5.70%), and neurovascular–gastro–renal syndrome (4.54%), with 43%. Conclusions: We revealed eight different sex-specific lifestyle-associated patterns, implying the need for tailored clinical approaches. The application of exploratory factor analysis yielded clinically valuable and scientifically rigorous multimorbidity patterns. Clinically, the findings advocate for a paradigm shift towards person-centred care, integrating multimorbidity and SNAP multibehaviours to enhance the complexity of inquiry and treatment of high-risk populations. Full article

Background/Objectives: A healthy diet is essential for managing Polycystic Ovary Syndrome (PCOS), yet optimal recommendations remain unclear, highlighting the need to explore alternative lifestyle interventions. The Mediterranean diet (MedDiet) supports cardiometabolic health; however, challenges with adherence within this population are unknown. This study examines the acceptability and experiences of an ad libitum MedDiet in women with PCOS, offering recommendations for implementation. Methods: A 12-week MedDiet intervention was conducted with women aged 18–45 years, diagnosed with PCOS and a BMI ≥ 25 kg/m² (n = 12). Adherence was assessed using the Mediterranean Diet Adherence Screener. Surveys and semi-structured interviews, guided by the Capability, Opportunity, Motivation–Behaviour (COM-B) model, explored participants’ experiences. Thematic analysis identified barriers and facilitators, which were mapped to the COM-B and Theoretical Domains Framework (TDF), with all findings subsequently aligned with the Behaviour Change Wheel to inform implementation strategies. Results: MedDiet adherence significantly improved from baseline to week 12 (Baseline: 4.1 ± 1.8; week 12: 8.3 ± 2.3; p = 0.001), alongside increases in knowledge (p = 0.004), cooking confidence (p = 0.01), and time management (p = 0.01). Adherence factors were mapped to 12 of the 14 TDF domains. Key facilitators included health benefits, reduced weight pressure, educational resources, and simple guidelines. Barriers involved organisation, food availability, and external influences. Effective implementation should integrate MedDiet education, behaviour change support, practical resources, and professional training for nutrition professionals and healthcare providers to support referrals and weight-neutral dietary management. Conclusions: A short-term ad libitum MedDiet is acceptable for women with PCOS. Strategies for patients and healthcare providers, aligned with the intervention functions of education, training, and enablement, are key to supporting adherence. Full article

The early lactation phase in dairy cows is characterised by significant metabolic and inflammatory changes. This study aimed to evaluate the relationship between serum nonesterified fatty acids (NEFAs), a marker of negative energy balance (NEB), and serum amyloid A (SAA), an indicator of systemic inflammation. Blood samples were collected from 71 Holstein cows during the transition period 17 (±3) DIM, and serum concentrations of NEFAs and SAA were measured. The results revealed a significant negative correlation between NEFAs and SAA (r = −0.441, p < 0.001), suggesting that increased fat mobilisation may suppress the inflammatory response, thereby increasing the susceptibility to metabolic and infectious diseases. The emerging research indicates a negative association between SAA levels and milk fat-to-protein ratio in dairy cows, particularly under inflammatory conditions. The research indicates that elevated levels of SAA, which is an inflammatory biomarker, are frequently associated with alterations in milk composition, including a reduced fat-to-protein ratio. This study examined the correlations among serum NEFAs, SAA, milk composition, and dairy cattle health. A strong positive correlation was identified between serum NEFAs and milk fat content (r = 0.459, p < 0.001), as well as between serum NEFAs and the milk fat-to-protein ratio (r = 0.516, p < 0.001). Cows with elevated serum NEFA levels (classified as II-NEFA) exhibited significantly higher milk fat content (4.20%) and milk fat-to-protein ratios (1.33) compared to cows with lower serum NEFA levels (I-NEFA class; 3.81% and 1.17, respectively). The data indicate that elevated serum NEFA levels are associated with an increased milk fat synthesis, likely driven by enhanced fat mobilisation during NEB. A significant negative correlation was observed between SAA and both milk fat content (r = −0.426, p < 0.001) and the milk fat-to-protein ratio (r = −0.535, p < 0.001), indicating that inflammation may impair milk fat production. Elevated SAA levels were also associated with increased cow activity (r = 0.382, p < 0.001), suggesting that inflammation may lead to behavioural changes driven by discomfort. Our findings suggest that milk composition reflects the metabolic and inflammatory status of dairy cows and could serve as a non-invasive alternative to blood sampling for assessing energy balance and health. NEB, which typifies early lactation, promotes fat mobilisation, resulting in elevated serum NEFA levels and an increased risk of metabolic disorders such as fatty liver syndrome and ketosis. Moreover, high serum NEFA levels adversely affect immune function, increasing vulnerability to infections such as mastitis. Monitoring milk composition may enable the early detection of NEB and inflammatory conditions, thereby supporting proactive health management. However, further research is necessary to elucidate the role of NEFAs and inflammation in the development of metabolic diseases in cattle. Full article

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders diagnosed in children. It has a complex pathophysiology with several potential risk factors, including psychological disorders like anxiety and depression. This paper aimed to find genetic, pathophysiological, and clinical links between psychological factors (mainly anxiety and depression) and IBS in children. Impairment of the gut–brain communication and signalling of serotonin is responsible for both gastrointestinal and psychological disorders. Childhood psychological events seem to be linked to gastrointestinal symptoms not only in childhood but also in adulthood. Evidence of the efficacy of therapies targeting psychological disorders (antidepressant, hypnotherapy, and cognitive behavioural therapy) in children with IBS was evaluated. Further studies that use updated criteria for IBS and uniform questionnaires and outcome measures are needed to draw reliable conclusions regarding the connection between psychological factors and IBS. Full article

Background/Objectives: Excess adiposity, affecting 43% of the global adult population, is a major contributor to cardiometabolic diseases. Lifestyle behaviours, specifically dietary habits, play a key role in weight management. Real-time assessment methods such as Ecological Momentary Assessment (EMA) provide context-rich data that reduce recall bias and offer insights into dietary triggers and lapses. This study examines dietary triggers among adults with excess adiposity in Singapore using EMA, focusing on factors influencing dietary adherence and lapses. Methods: A total of 250 participants with a BMI ≥ 23 kg/m² were recruited to track dietary habits for one week, at least three times a day, using the Eating Behaviour Lapse Inventory Survey Singapore (eBLISS) embedded within the Eating Trigger Response Inhibition Program (eTRIP© V.1) smartphone app. Logistic regression analysis was used to identify predictors of dietary adherence. Results: Of the 4708 responses, 76.4% of the responses were indicative of adherence to dietary plans. Non-adherence was primarily associated with food accessibility and negative emotions (stress, nervousness, and sadness). Factors such as meals prepared by domestic helpers and self-preparation were significantly associated with adherence. Negative emotions and premenstrual syndrome were identified as significant predictors of dietary lapses. Conclusions: EMA offers valuable insights into dietary behaviours by identifying real-time triggers for dietary lapses. Future interventions can utilise technology-driven approaches to predict and prevent lapses, potentially improving adherence and weight management outcomes. Full article

Background/Objectives: Malan syndrome (MALNS) is an ultra-rare genetic disorder caused by aberrations in the NFIX gene, located at chromosome 19p13.2. Key features of MALNS include general overgrowth, a typical facial gestalt, muscle–skeletal abnormalities, speech difficulties and intellectual disability. Additionally, MALNS frequently presents with autism-like behaviour and social challenges. However, characterisation of the cognitive profile of MALNS, including social perception skills, is limited. Methods: Six children and adolescents with MALNS, whose clinical and emotional–behavioural features had been described in previous studies, were assessed by means of a single, co-normed neuropsychological battery covering multiple cognitive domains. Results: Consistent with their intellectual disability, performance was generally weak across all neuropsychological subtests. Nonetheless, memory for faces, visual attention and contextual (non-verbal) theory of mind emerged as relative strengths of the profile, both at group and individual levels. Conversely, tasks requiring verbal reasoning and language comprehension, such as comprehension of instructions and verbal theory of mind, represented weaknesses for all participants. Conclusions: These findings provide a further characterisation of cognitive and social functioning in MALNS, which can inform future research as well as clinical practice and rehabilitation Full article

Background: Cardiometabolic risk factors such as hypertension, overweight, and obesity have become increasingly common among African students who tend to become more sedentary in urban environments. This systematic review aimed to determine and identify major risk factors of cardiometabolic disease prevalence reported among African university students. Methods: The protocol was registered with PROSPERO (registration no.CRD42024553280). A comprehensive literature search was performed using scientific databases from Google Scholar, PubMed, Web of Science, Scopus, ProQuest, and African Journals Online (AJOL). The search was limited to articles published between 2000 and 2024, which reported cardiometabolic diseases/risk factors among African university students. Data were extracted using a standardised form, capturing details on study characteristics (author, year, location, study design), participant demographics (age, sex), prevalence of cardiometabolic diseases, and associated risk factors. Results: A total of thirty-seven studies that met the inclusion criteria, thirty-six cross-sectional and one longitudinal, were included in the study. The prevalence range of the various risk factors identified was 0.6–21.7% (obesity) and 0.28–26.4% (hypertension), 1.7–18.8% (diabetes), 0.5–18.2% (pre-diabetes), 1.9–48.6% (metabolic syndrome), and 1.1% to 57.3% (dyslipidemia). Some common sedentary lifestyles and unhealthy behaviours identified among the students were fast foods (21.3–85.73%), alcohol (3.7–63%), and smoking (1.02–13%). Conclusions: The review’s findings suggest that rapid urbanisation and changes in lifestyle and behaviours are responsible for an increased prevalence of cardiometabolic risk factors in African university students. Targeted health promotion programmes, regular screening, and policy interventions might all go a long way in preventing the predicted increase in the prevalence of cardiovascular and metabolic diseases among this group of young adults in Africa. Full article