Search Results (531)

This study investigates the link between changes in physical activity (PA) measured by wearable accelerometers and the worsening of knee osteoarthritis (KOA) symptoms over two years. Using data from 782 participants in the Osteoarthritis Initiative accelerometer sub-study, PA was tracked with hip-worn ActiGraphs. Participants were classified as “worsening” if their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score increased by >10 points and as “stable” otherwise. PA was categorized into daily counts and minutes spent in various intensity levels, and analyzed in 3 h intervals across the day. Of the participants, 123 (15.7%) experienced worsening symptoms. At baseline, both groups had similar characteristics aside from slower sit-to-stand times in the worsening group. Over two years, the worsening group had a greater decline in total daily activity counts (−18% vs. −10%) and more significant reductions during late afternoon and evening (15:00–21:00; −21% vs. −6%). This group also showed a notable decrease in gait speed, longer sit-to-stand times, and a trend towards greater medial joint space narrowing. These findings suggest that larger declines in PA, especially in activities in the late afternoon and evening, are associated with worsening KOA symptoms, although causality cannot be established. Full article

Background: Diabetes mellitus is known to affect the prognosis of critically ill patients; however, its impact on independence in activities of daily living (ADL) at hospital dis-charge remains unclear. This study aimed to investigate whether preexisting diabetes is associated with reduced ADL independence at hospital discharge among critically ill patients. Methods: In this prospective cohort study, 423 adult intensive care unit (ICU) patients who were admit-ted for ≥48 h were enrolled and categorized by the presence or absence of diabetes. Primary outcomes included time to achieve walking independence (unassisted walking over 50 m) and the Barthel Index at discharge. Secondary outcomes were handgrip strength, ICU length of stay, and highest ICU Mobility Scale (IMS) scores. Multivariable analyses adjusted for age, illness severity, and other confounders. Results: Among the 101 patients with diabetes, time to achieve walking independence at discharge was significantly longer compared to those without diabetes (p = 0.013). The diabetes group also had a lower Barthel Index (p = 0.020), longer ICU stays (p = 0.003), weaker handgrip strength (p = 0.041), and lower maximum IMS scores (p = 0.002). Multivariable analysis confirmed that diabetes was independently associated with reduced ADL independence and poorer physical function at discharge. Conclusions: Preexisting diabetes is an independent predictor of impaired ADL independence in critically ill patients. These findings highlight the importance of early and individualized rehabilitation strategies for patients with diabetes in the ICU. Full article

Classical earth pressure theories often struggle to account for the complex coupling effects of wall displacement and spatial non-uniformity under non-limit states. This study presents an interpretable machine learning framework designed to extract universal mechanical laws from heterogeneous experimental datasets. Using a multi-source database of rigid retaining walls with sandy backfill, a three-stage feature refinement strategy is proposed that incorporates Recursive Feature Elimination, Collinearity Analysis, and Interpretability Comparison to identify a parsimonious set of five fundamental physical parameters. A SHapley Additive exPlanations-Categorical Boosting (CatBoost-SHAP) framework is established to predict the active earth pressure coefficient (K) and interpret the underlying mechanisms across various movement modes (RB, RT, and T). Results demonstrate that the model effectively captures the progressive evolution of shear bands and the soil arching effect. Specifically, a critical displacement threshold of Δ/H ≈ 0.006 is identified, marking the transition from mode-dominated stress non-uniformity to magnitude-driven limit states. Leave-One-Dataset-Out Cross-Validation (LODOCV) confirms the model’s ability to maintain physical consistency over purely statistical fitting despite significant inter-literature heterogeneity. Finally, a Graphical User Interface (GUI) is developed to facilitate rapid, displacement-based design in engineering practice. This research bridges the gap between empirical laboratory observations and generalized mechanical logic, providing a data-driven foundation for refined geotechnical design. Full article

Background/Objectives: Adolescence represents a critical period for the formation of lifestyle habits that often persist into adulthood, significantly shaping long-term health outcomes and contributing to the development of non-communicable diseases. This study aims to assess the impact of Food Game, a secondary school-based programme, delivered throughout the academic year, to promote healthy eating, physical activity, and sustainability awareness among students. Methods: As part of the Food Game programme, 184 adolescents aged 14–16 years from the Milan area (Italy) completed two questionnaires, administered before and after the intervention (November 2024, April 2025), evaluating dietary habits, lifestyle behaviours, and attitudes toward sustainability. This uncontrolled intervention study assessed dietary changes using a composite score [0–14], with higher scores indicating healthier eating patterns. Pre–post intervention differences were analysed using paired t-tests for continuous variables and McNemar’s test for categorical variables. Results: After participation in Food Game, a significant improvement in mean dietary score from 7.6 to 8.2 (p < 0.001) occurred. Overall, 28.3% of the students worsened their score and 53.2% improved (≥1-point increase), including a significant improvement (≥2-point increase) in 29.4%. Fruit, vegetable, and fish intake increased, while consumption of meat, processed meat, and snacks decreased (p < 0.05). Waste recycling did not change (94.6%), and tap water non-significantly increased. No significant changes were observed in water intake, physical activity, screen time, or addictive behaviours. Conclusions: These findings support the potential of peer-led gamified interventions to promote healthier eating in youth. Future controlled studies are required to rigorously evaluate the Food Game programme’s effectiveness in relation to adolescents’ diet, lifestyle, and sustainability habits. Full article

Background/Objectives: Lower limb amputation (LLA) negatively affects the physical and psychological health of individuals, leading to a lower quality of life and sedentary lifestyle. The objective of this scoping review is to search for evidence regarding physical activity interventions in individuals with LLA, investigating improvements in specific outcomes related to quality of life and performance. Methods: PRISMA guidelines—extension for scoping reviews—were used to structure the study. The research was conducted between 26 July 2023 and 30 September 2023; it was structured by defining two PICO questions (P = amputation, I = physical exercise, O1 = quality of life, and O2 = performance) through Pubmed, Cochrane, and Pedro databases. The study included subjects with LLA of any etiology, in prosthetic or pre-prosthetic phase, practicing non-competitive physical activity. The results were then subjected to both qualitative and quantitative analysis. Results: Of the 615 studies identified, 18 were included in the review. They consisted of 6 systematic reviews (SR), 5 RCTs, 4 case–control studies, 1 case report (CR), and 2 cross-sectional (CS). Physical activity (PA) interventions were extremely heterogeneous and were, therefore, categorized into 6 modalities: surveys were the most reported strategies (57%), followed by personalized training (23%), strength training (13%), endurance training (13%), combined training (2%), and gait training (5%). Due to the heterogeneity of the studies, the variety of interventions proposed and the different outcomes registered, there is no evidence that one approach is more effective than another, while each group showed benefits on different specific outcomes. In total, five outcome categories were identified: quality of life was the most frequently analysed (42%), followed by cardiovascular fitness (20%), muscular fitness (14%), gait parameters (13%), functionality and disability (11%). Conclusions: PA represents a valuable strategy for improving performance and quality of life in individuals with LLA, offering a variety of interventions. Although there is no evidence that one strategy is better than the others, each activity has proven to be effective on specific outcomes, therefore, the choice must depend on the patient’s necessities. The preferred option should be the personalization of the training according to individual needs, coupled with long-term planning and remote monitoring. Creating meeting places and supporting occasions for sports activities could be a valid option. Further research could help to clarify the benefits of such interventions and enhance the understanding of how to optimize the management of LLA patients. Full article

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome involves interconnected cardiovascular, renal, and metabolic conditions. The dose–response relationship between physical activity and bidirectional CKM stage transitions remains unclear. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), cross-sectional analysis pooled 14,310 observations from 10,868 participants. Logistic regression with clustered robust standard errors accounted for intra-individual correlation. Longitudinal analysis (n = 3442) employed continuous-time multi-state Markov models with a 5-state structure (Stages 0–4). To evaluate physical activity effects, stages were regrouped into low-risk (Stages 0–2) and high-risk states (Stages 3–4) using a 2 × 2 transition intensity matrix. Physical activity was measured in MET-min/week and categorized into quartiles (Q1–Q4). Results: Compared with Q1, Q2, Q3, and Q4 were associated with 43.1%, 52.5%, and 53.1% lower risk of high-risk CKM stages, respectively. RCS analysis demonstrated nonlinear dose–response relationships between physical activity and CKM stage progression. Subgroup analyses showed more pronounced protective effects in older adults and single individuals. During 4-year follow-up, 31.6% experienced progression and 6.8% showed improvement. Stage 4 acted as a complete absorbing state without any reversal. Transition intensity analysis revealed that transitions between adjacent stages were notably higher than cross-stage transitions. The Q4 physical activity level significantly reduced transitions from low-risk to high-risk states (HR = 0.598, 95% CI: 0.459–0.777) and promoted transitions from high-risk to low-risk states (HR = 2.995, 95% CI: 1.257–7.134). Conclusions: Moderate-to-high physical activity effectively reduces CKM progression risk and promotes improvement, providing evidence for CKM prevention and management. Full article

Background/Objectives: Comprehensive knowledge of body composition and bone status across the lifespan is critical for clinical evaluation and public health initiatives. This study aimed to develop age- and sex-specific reference curves for body composition and bone status in a physically active Greek population aged 18–80 using dual-energy X-ray absorptiometry (DXA). A secondary objective was to examine age- and sex-related trends in fat distribution, lean mass (LM), and bone status. Methods: A cross-sectional analysis was conducted on 637 participants (275 men and 362 women). Physical activity was assessed through structured interviews evaluating type, frequency, and intensity, categorized using established guidelines from organizations such as the American Heart Association and World Health Organization. Anthropometric data and DXA scans were utilized to measure parameters including fat mass (FM), LM, and BMD. Participants were stratified into age categories, and percentile curves were generated using generalized additive models for location, scale, and shape (GAMLSS). Results: Among women, body mass increased by 20.9% and body fat percentage rose by 38.3% from the youngest to the oldest age group, accompanied by a 5.7% reduction in bone mineral density (BMD) and an 11.5% decline in bone mineral content (BMC). Men exhibited a 49.1% increase in body fat percentage, with LM remaining stable across age groups. In men, BMD decreased by 1.7%, while BMC showed minimal variation. Notable sex differences were observed in fat redistribution, with android fat (AF) increasing significantly in older individuals, particularly among women, highlighting distinct age-related patterns. Conclusions: This study provides essential reference data on body composition and bone status, emphasizing the need for tailored interventions to address sex- and age-related changes, particularly in fat distribution and bone density, to support improved health outcomes in aging populations. Full article

Background/Objectives: The Lancet Commission proposes a new obesity definition that combines body mass index (BMI) with anthropometric measurements to distinguish adipose tissue excess more effectively. This study aims to determine the prevalence of obesity based on the new definition and to examine cardiometabolic risk factors and lifestyle habits across different obesity phenotypes in the urban population of Lithuania. Methods: This study was conducted among residents of Kaunas city from 2020 to 2024. A total of 3426 adults aged 25–69 years (57.1% of the random sample) were participated. Three individuals were excluded due to missing anthropometric data. Participants were categorized into three phenotypes: (1) no obesity (BMI < 30 kg/m² and no or one elevated anthropometric measure, (2) anthropometric-only obesity (BMI < 30 kg/m² and at least 2 elevated anthropometric measures), and (3) BMI-plus-anthropometric obesity (BMI ≥ 30 kg/m² plus at least one elevated anthropometric measure or BMI ≥ 40 kg/m²). Standardized anthropometric, biochemical, and clinical measurements were collected, along with self-reported dietary habits and leisure-time physical activity. Results: Anthropometric-only obesity was highly prevalent, affecting 36.1% of males and 22.7% of females (p < 0.05). The prevalence of BMI-plus-anthropometric obesity was 24.1% among males and 21.4% among females. Individuals with anthropometric-only obesity had significantly higher odds of metabolic syndrome (OR 8.64; 95% CI 6.97–10.71), diabetes (OR 3.01; 95% CI 1.72–5.25), coronary heart disease (OR 1.48; 95% CI 1.12–1.97), and several lipid abnormalities compared with those without obesity. The highest cardiometabolic risk was observed in the BMI-plus-anthropometric obesity group. Greater adiposity was associated with higher intake of red meat, junk foods, and sugary drinks, while physical activity levels declined across obesity categories. Conclusions: Anthropometric-only obesity is a common and metabolically adverse phenotype that cannot be detected using BMI alone. A new obesity definition enhances identification of high-risk individuals and supports targeted prevention strategies. Full article

Insufficient physical activity (PA) is a significant health challenge among working-age populations. This study aimed to develop context-specific processes to promote PA among adults aged 35–60 years. A participatory action research approach was conducted across seven provinces in upper southern Thailand. The study consisted of three phases: (1) preparation and situation analysis, (2) development and implementation of PA promotion programs, and (3) program evaluation and lessons learned. In Phase 1, the working-age population was categorized into four groups: Group 1: PA occupation and exercise; Group 2: PA occupation but non-exercise; Group 3: non-PA occupation but exercise; Group 4: non-PA occupation and non-exercise. In Phase 2, an exercise program and PA tracking guide were developed and implemented over a 6-month period. In Phase 3, based on the complete-case analysis, 175 participants enrolled, with 101 (57.7%) and 100 (57.1%) remaining at 3 and 6 months, respectively. Based on the last observation carried forward analysis (n = 175 across the 6 months), the proportion achieving global recommended PA levels and time spent in weekly moderate- to vigorous-intensity PA increased significantly in the non-exercise groups (Groups 2 and 4). All participants in the exercise groups (Groups 1 and 3) met the recommended PA level at baseline; however, this level was not maintained at the endpoint. The context-based PA promotion programs improved PA participation among non-exercise working-age adults. Future research should identify strategies to enhance program uptake and sustain engagement. Full article

Background: Insulin resistance (IR) is a key metabolic abnormality underlying type 2 diabetes and cardiometabolic diseases. Although lifestyle and sociodemographic determinants are well described, the role of psychosocial constructs—such as purpose in life—remains insufficiently characterized. No prior study in large occupational samples has examined the associations between purpose in life and IR when evaluated through three complementary indices: the triglyceride–glucose index (TyG), the Single-Point Insulin Sensitivity Estimator for Insulin Resistance (SPISE-IR), and the metabolic score for insulin resistance (METS-IR). Objectives: To analyze the cross-sectional associations between purpose in life and IR indicators in a large working population and determine whether these associations persist after accounting for sociodemographic and lifestyle factors. Methods: A cross-sectional study was conducted among 93,077 Spanish workers aged 20–69 years undergoing routine occupational health examinations. IR was estimated using TyG, SPISE-IR, and METS-IR indices. Purpose in life was assessed using the 10-item Purpose in Life Test and categorized into three groups based on the empirical distribution of scores. Multinomial logistic regression models adjusted for age, sex, social class, smoking, Mediterranean diet adherence, physical activity, and BMI were used to examine associations. Results: Lower purpose in life was consistently associated with higher IR categories across all indices. Compared with individuals reporting high purpose, those with low purpose had higher odds of belonging to the high IR category (TyG ORa 1.59; 95% CI 1.45–1.74; SPISE-IR ORa 1.94; 95% CI 1.76–2.13; METS-IR ORa 2.21; 95% CI 1.98–2.47). Adding purpose in life to sociodemographic and lifestyle models modestly improved discrimination for identifying high IR categories. Conclusions: In this large occupational cohort, purpose in life was independently associated with insulin resistance as measured by three metabolic indices. These findings highlight the relevance of psychosocial factors in metabolic health. Longitudinal studies are needed to clarify temporal pathways and assess whether purpose-oriented approaches may contribute to improved metabolic profiles. Full article

Background: Depression represents a major public health burden in Hungary, where prevalence remains higher than the global average. Although diet is an increasingly studied factor associated with mental health, evidence from Central and Eastern Europe is scarce. Methods: This cross-sectional study analyzed data from the Hungarian wave of the European Health Interview Survey (EHIS) 2019, a nationally representative sample of 5603 adults aged ≥15 years. Depressive symptom severity was assessed using the Patient Health Questionnaire-8 (PHQ-8) and categorized as none (0–4), mild (5–9), and moderate-to-severe (≥10). Self-reported frequency of consumption of fruits, vegetables, fruit juice, dairy products, fish, processed meat, sweetened beverages, coffee, and sweeteners was examined. Multivariable ordinal logistic regression models, adjusted for gender, age, education, income, physical activity, smoking, and alcohol consumption, were used to estimate associations with depressive symptom severity. Results: Overall, 77.9% of participants had no depression, 17.0% mild, and 5.1% moderate-to-severe symptoms. After full adjustment, lower consumption of fruits and vegetables, less frequent fruit juice intake, and lower processed meat consumption were associated with higher odds of more severe depressive symptoms. Moderate coffee intake (1–2 cups/day) was associated with lower odds than heavier consumption. Conclusions: In the Hungarian adult population, poorer dietary patterns, particularly low intake of fruits, vegetables, and paradoxically lower processed meat consumption, are significantly associated with greater depressive symptom severity, independent of major sociodemographic and lifestyle factors. These findings underscore the potential role of diet quality in mental health and support public health efforts to promote nutrient-rich dietary patterns in Hungary. Full article

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy, and its prevalence continues to rise worldwide. Dietary management is the cornerstone of therapy, yet adherence may impose a substantial everyday burden. This study aimed to assess perceived burden and practical challenges related to following a diabetic diet in women with GDM. Methods: A cross-sectional anonymous online questionnaire study was conducted among 109 women with a current or past diagnosis of GDM within the previous five years. The survey addressed self-reported difficulties in maintaining normal blood glucose levels, adherence to a diabetic diet, perceived increases in grocery expenses, time required for meal preparation, dietary preferences, and family attitudes toward the diet. Associations between categorical variables were analyzed using contingency tables and the contingency coefficient. Results: Women with insulin-treated GDM (GDM2) reported more difficulties maintaining normal blood glucose levels than women treated with diet and physical activity alone (GDM1) (p = 0.014). Educational level was associated with perceived financial burden (p = 0.013) and meal preparation time (p = 0.003). These patterns likely reflect both differences in economic resources and the extent of dietary changes undertaken, rather than uniform differences in nutritional awareness. Pregnancy status was associated with dietary preferences, as non-pregnant respondents more often reported liking diabetic-diet meals than pregnant respondents (p = 0.037). Overall, 53.2% of respondents reported that a diabetic diet made daily functioning more difficult, mainly due to increased time and financial demands. Conclusions: Dietary management of GDM is associated with a meaningful perceived burden, especially among women requiring insulin therapy and those facing financial and time constraints. Understanding these subjective challenges may support more individualized dietary counseling and patient-centered care. Full article

Forest ecological compensation policies (FECPs) are a key institutional arrangement for balancing ecological conservation and farmers’ development needs in national parks. Existing research has often treated such policies as a homogeneous whole, failing to clearly reveal the mechanisms through which different policy types affect farmers’ livelihoods, while also paying insufficient attention to complex property-rights settings. This study takes Wuyi Mountain National Park—a typical representative of collective forest regions in southern China—as a case study. Based on 239 micro-survey datasets from farming households and employing the mprobit model and moderating effect models, it investigates the influence, mechanisms, and heterogeneity of farmers’ livelihood capital in terms of their livelihood strategy choices under the moderating roles of “blood-transfusion” and “blood-making” FECPs. The results show the following: (1) Among the sample farmers, livelihood strategies are distributed as follows: pure agricultural type (31.8%), out-migration for work type (20.5%), and commercial operation type (47.7%). (2) Farmers’ livelihood capital has a significant impact on their livelihood strategy choice, with different dimensions of capital playing distinct roles. (3) FECPs follow differentiated moderating pathways. “Blood-transfusion” policies emphasize compensation and buffering functions, reducing farmers’ livelihood transition pressure through direct cash transfers; “blood-making” policies reflect empowerment and restructuring characteristics, activating physical assets and reshaping the role of social capital through productive investment. Together, they constitute a complementary system of protective security and transformative empowerment. Accordingly, this study proposes policy insights such as building a targeted ecological compensation system that is categorized, dynamically linked, and precise; innovating compensation fund allocation mechanisms that integrate collective coordination with household-level benefits; optimizing policy design oriented toward enhancing productive capital; and establishing robust monitoring, evaluation, and adaptive management mechanisms for dynamic FECPs. Full article

Nutrition risk is prevalent in community-dwelling older adults, and leads to increased morbidity and mortality. Understanding the factors associated with the development of high nutrition risk is crucial for the development of appropriate programs and policies to address this problem. Therefore, our objective was to identify the psychosocial factors correlated with the development of high nutrition risk, as assessed by SCREEN-8, among Canadian adults categorized by ten-year age groups (45–54, 55–64, 65–74, and 75+). We used data from 17,051 participants in the tracking cohort of the Canadian Longitudinal Study on Aging and employed multivariable binomial logistic regression to identify the social and demographic factors associated with the emergence of high nutrition risk at follow-up, three years after the baseline. Baseline data were gathered between 2011 and 2015. At baseline, 34.4% of participants across all age groups were at high nutrition risk, while 40.0% were at high risk at follow-up. Factors consistently associated with the development of high nutrition risk across all age groups included lower levels of social support, lower self-rated social standing, infrequent participation in sports or physical activities, infrequent participation in cultural or educational activities, and lower household incomes. Programs and policies addressing these factors may reduce the prevalence of high nutrition risk and the development of high nutrition risk. Full article

Bacteriophage contamination remains a persistent and costly challenge in industrial bio-manufacturing. Traditional control strategies rely heavily on physical exclusion and chemical disinfection, yet these passive measures often fail to address the rapid evolutionary adaptation of phages and their persistence in complex fermentation environments. Recent genomic and biochemical discoveries have revealed a diverse arsenal of bacterial antiviral immune systems beyond the classical Restriction-Modification and CRISPR-Cas pathways, including cyclic oligonucleotide-based signaling systems and various abortive infection mechanisms. This review systematically summarizes the latest advances in bacterial anti-phage defense mechanisms, categorizing them into adsorption inhibition, replication interference, nucleic acid degradation, and population-level suicide defense. Furthermore, we discuss the application of synthetic biology in integrating these defense modules to construct broad-spectrum “pan-immune” microbial chassis. This active defense strategy offers a fundamental solution to phage predation and provides a theoretical basis for developing robust next-generation cell factories. Full article