Search Results (10,515)

The paradigm shift toward precision oncology in advanced breast cancer has increased therapeutic complexity, prolonging survival for many patients while simultaneously expanding the temporal burden associated with cancer care. Time toxicity, defined as the cumulative time spent receiving, accessing, coordinating, and recovering from medical interventions, is increasingly recognized as a clinically meaningful but still under-assessed dimension of patient-centered value. Beyond its organizational and economic implications, time toxicity may exert profound psychological and psychiatric effects, particularly in patients with advanced disease, for whom time represents not only a practical resource but also an existential, relational, and emotional domain. This narrative review examines how objective and subjective dimensions of time toxicity may inform patient-centered decision-making in advanced breast cancer. We summarize current evidence on the temporal demands of cancer care in advanced breast cancer and their psychological and relational consequences, focusing on how these factors can be discussed in patient-centered treatment decisions. From a value-based oncology perspective, the review examines how treatment optimization, subcutaneous formulations, oral therapies, telemedicine-based surveillance, decentralized care models, and early psycho-oncological assessment may reduce non-value-added time in clinical settings while preserving quality of care. Methodological challenges in measuring time toxicity and correlating it with overall survival, health-related quality of life, anxiety, depression, demoralization, and illness-related distress are also discussed. Incorporating time toxicity into shared decision-making may help clinicians move beyond traditional efficacy endpoints. It may support a more comprehensive approach in which survival benefit, psychological well-being, personal priorities, and the subjective value of time are considered together. Full article

Background: The prevalence of overweight and obesity in Chinese school-aged children has continued to rise, posing significant health risks. Rational nutrition knowledge and dietary behaviors are important for obesity prevention and control. The ‘Know Your Food’ campaign aimed to promote nutritious diets and empower informed food choices among Chinese children and young people. This study aims to assess both the implementation and effectiveness of the campaign in primary school settings. Methods: The monitoring framework was designed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and consisted of a series of social media advocacy and school-based nutrition sessions. A monitoring system based on the RE-AIM model was developed to assess the impact of the campaign. Observational data on reach, effectiveness, adoption, implementation, and maintenance were collected through media tracking, self-reported questionnaires, and focus group discussions. Results: Between 13 May and 15 June 2022, the campaign gained 77.13 million views and 291,029 interactions from social media. The campaign garnered positive feedback as it reached a wide audience through traditional media, social media and school sessions. 94.7% of the respondents were willing to share campaign information. After the session, more than two thirds of the students reported behavior change, with 70.0% reporting eating five vegetables a day, 67.7% reporting drinking fewer sugary drinks, 74.0% reporting replacing snacks with fruits/nuts, 76.9% reporting doing exercises, and 78.0% reporting getting sufficient sleep. Conclusions: The ‘Know Your Food’ campaign was able to reach and engage the target audience, increasing nutrition knowledge, and influencing behavior change within the short observation window. The findings exemplify the implementation and effectiveness of this campaign and highlight the importance of using a comprehensive assessment framework to assess such nutrition campaigns. Full article

(1) Background: Lead exposure is an important preventable environmental health concern among children, especially in low- and middle-income countries. In Indonesia, evidence from routine health service settings remains limited. (2) Methods: This cross-sectional study assessed blood lead levels (BLLs) and associated factors among children aged 1–5 years attending 12 primary health care facilities in Bogor City and Bogor Regency between December 2025 and January 2026. A total of 420 children were recruited consecutively during routine services. Environmental and household risk factors were collected using structured questionnaires, and venous blood samples were analyzed using inductively coupled plasma mass spectrometry. Elevated BLL was defined as ≥5 µg/dL. (3) Results: The mean BLL was 2.24 µg/dL, and 21.9% of children had elevated BLLs. Prevalence was higher in Bogor Regency than in Bogor City (41.2% vs. 2.4%; p < 0.001) and among children residing near lead-processing activities (44.2% vs. 16.2%; p < 0.001). One child had a BLL of 66.82 µg/dL. Results were returned to caregivers and facilities; children with BLL ≥ 5 µg/dL received counselling, exposure-reduction advice, nutritional support, and follow-up planning, while the child with BLL > 45 µg/dL was urgently referred for confirmatory assessment and specialist management. (4) Conclusions: Primary healthcare–based screening can identify vulnerable children and trigger clinical, nutritional, environmental, and referral responses, although longitudinal follow-up and environmental source testing are needed. Full article

The metabolic mechanisms linking prenatal particulate matter (PM) to fetal growth remain unclear. A prospective cohort of 616 mother–fetus pairs in Guangzhou had ultrasound-based fetal growth parameters repeatedly measured from mid to late pregnancy. Fetal head circumference (HC), abdominal circumference (AC), femur length (FL), and biparietal diameter (BPD) were standardized as z-scores. Estimated fetal weight (EFW) trajectories were classified as average, slow, and rapid growth. Residential PM₁, PM_2.5, and PM₁₀ were assessed with 1 km spatiotemporal models. Multinomial logistic regression analyzed PM-EFW trajectory associations. Generalized estimating equations evaluated PM–fetal growth z-score relationships. Maternal plasma glucose and insulin levels at mid-pregnancy were examined as intermediate factors. Each 5 μg/m³ increase in PM was associated with higher odds of rapid EFW growth versus average growth (OR _PM1 = 1.56, 95% CI: 1.03, 2.37; OR _PM2.5 = 1.44, 95% CI: 1.10, 1.88; OR _PM10 = 1.28, 95% CI: 1.05, 1.56). Positive associations were also observed for BPD, HC, and AC z-scores, with PM₁ showing the numerically larger effect estimates. Maternal fasting plasma glucose and insulin resistance may partly explain the observed associations of PM exposure with rapid EFW growth and fetal growth parameters, with estimated proportions of 5.0–29.4%. This study highlights the potential risk of accelerated fetal growth associated with maternal PM exposures, and maternal glucose metabolism may represent a plausible pathway. Full article

Companion animals have increasingly become central to human emotional life, yet the literature linking living with companion animals, human–animal interaction, and mental health remains fragmented. This study mapped global research trends on companion animals and mental health from 2000 to 2024 using bibliographic records retrieved from the Web of Science Core Collection (WoSCC). A final dataset of 930 peer-reviewed articles was analyzed with Bibliometrix (RStudio), CiteSpace, and VOSviewer to characterize publication growth, national and institutional collaboration, influential authors and journals, co-cited references, keyword clusters, and citation bursts. Results show a strong nonlinear increase in output after 2015, with the United States as the dominant contributor and Australia and the WoSCC country node labelled England (distinct from Scotland) as important international bridges. Core knowledge clusters center on human–animal interaction, animal-assisted intervention, older adults, child/adolescent development, loneliness, attachment, and post-traumatic stress. Recent burst terms and references indicate a shift from general companion-animal caregiving and physiological stress buffering toward intervention design, vulnerable populations, and pandemic-era mental health. Overall, the field has matured into an interdisciplinary research area with growing methodological sophistication, but future work should strengthen cross-cultural evidence, longitudinal designs, standardized outcome measures, and explicit assessment of animal welfare. Full article

Maternal wellbeing during pregnancy is an important component of maternal mental health and has implications for both maternal and child outcomes. Although psychological resources such as self-control and social support are generally assumed to promote wellbeing, maternal wellbeing may also be influenced by psychological vulnerabilities, including perceived stress and ADHD (Attention Deficit Hyperactivity Disorder) symptoms. Recent theoretical perspectives further suggest that some beneficial characteristics may exhibit diminishing returns at higher levels. This study examined linear and nonlinear associations among perceived stress, ADHD symptoms, self-control, perceived social support, and maternal wellbeing during the second trimester of pregnancy. A sample of 149 first-time pregnant women from Romania completed measures of maternal wellbeing, perceived stress, ADHD symptoms, self-control, and perceived support from partners, family members, and friends. Hierarchical regression analyses were conducted, including quadratic terms derived from the Too-Much-of-a-Good-Thing framework. Perceived stress emerged as the strongest predictor of lower maternal wellbeing, whereas family support was positively associated with wellbeing. ADHD symptoms were negatively associated with wellbeing at the bivariate level but did not uniquely predict wellbeing after controlling for the remaining study variables. Most importantly, self-control demonstrated a significant nonlinear association characterized by diminishing returns, such that increases in self-control were associated with progressively smaller improvements in wellbeing at higher levels. No comparable nonlinear effects were observed for perceived stress or social support. Overall, the findings suggest that maternal wellbeing is shaped by both psychological vulnerabilities and psychological resources, and that the benefits of some psychological strengths may not increase uniformly across their entire range. Full article

National health surveys generate reusable population-based evidence, but repeated use may produce thematic concentration, heterogeneous methodological reporting, and analytical overlap. This revised bibliometric and meta-research study audited 328 Scopus records retrieved for Peru’s Demographic and Family Health Survey (ENDES), excluded 14 records without eligible analytical ENDES use, and analyzed 314 publications. Matched full texts were available for 284 articles. Publications spanned 2001–2026 and increased mainly from 2019 onward. The most frequent thematic domains were Cardiometabolic health/adiposity (n = 93), Maternal/reproductive health (n = 77), and Child nutrition and growth (n = 39). The most reused ENDES years after validation were 2019 (n = 110), 2018 (n = 81), 2017 (n = 76), 2021 (n = 68), and 2022 (n = 66). Initial ENDES-year extraction showed a 25.4% false-positive rate, a 45.8% false-negative rate, and 28.3% complete article-level agreement. At a pairwise similarity threshold of 0.80, 32 analytical-overlap clusters were identified. The findings characterize the Scopus-indexed and Scopus-retrieved ENDES corpus and emphasize the need for explicit corpus auditing, transparent coding rules, validated survey-year extraction, and reproducible scripts. Full article

Background/Objectives: Ultra-processed foods (UPFs) are linked to cardiometabolic disease, but cross-sectional surveys often underestimate or invert these associations due to age structure, diagnosis-related dietary changes, and reporting bias. This study explores the potential influence of these biases and examines cross-sectional associations between dietary proxies and prevalent cardiometabolic conditions using the most recent national data from Spain. Methods: We analyzed the 2023 Spanish Health Survey (n = 21,032). Body Mass Index (BMI) was derived from self-reported weight and height. Hypertension and diabetes were defined as self-reported medical diagnoses. Dietary items were mapped as UPF-rich proxies, processed-meat exposure, protective dietary markers, and beverage comparators. Weighted logistic models were adjusted for sociodemographic and lifestyle factors. Bias-probing analyses included stratification by self-rated health, exclusion of severe chronic comorbidities (n = 4107), and model-based beverage contrasts. Results: Prevalence reached 53.6% for excess weight, 23.9% for prevalent hypertension, and 7.4% for prevalent diabetes. Weekly fast-food consumption was consistently associated with excess weight (OR 1.20, 95% CI 1.07–1.35), obesity (OR 1.28, 95% CI 1.09–1.50), prevalent hypertension (OR 1.18, 95% CI 1.02–1.37), and prevalent diabetes (OR 1.33, 95% CI 1.10–1.61). Excluding participants with severe chronic comorbidities strengthened the fast-food association with prevalent diabetes (OR 1.46, 95% CI 1.17–1.81). Conclusions: Fast food emerged as the most consistent adverse dietary marker co-occurring across all prevalent outcomes, whereas processed meat was specifically associated with prevalent excess weight and obesity rather than prevalent cardiometabolic diagnoses. Stratified and sensitivity analyses provided empirical patterns consistent with age confounding and possible post-diagnosis dietary changes influencing cross-sectional associations, highlighting the need for cautious interpretation in public health surveillance. Full article

Informed consent is fundamental to Australian newborn bloodspot screening (NBS), but emerging genomic screening technologies pose new challenges to clinical care and research. Optimizing consent processes is necessary to support ethical practice and maintain public trust as NBS evolves. This study aimed to identify gaps and opportunities to improve NBS consent processes in Queensland, Australia, while also exploring preliminary insights into the evolving complexity of consent in the context of genomic NBS (gNBS) and NBS-related research. A qualitative study design was used, with two facilitated interest-holder workshops (a total of 12 h) involving 86 participants (healthcare professionals, policy-makers, researchers, genomics experts, and consumer representatives). Workshop 1 (n = 25) was held virtually, and Workshop 2 (n = 61) was held in person. Thematic analysis was used to identify practical recommendations and ethical considerations. Participants identified three priority domains for improving consent in Queensland’s NBS program: (1) revision of the Guthrie Card and consent statement, (2) development of consistent, antenatal information resources across healthcare providers, and (3) standardized consent delivery training for healthcare staff. Discussions also highlighted tensions around information requirements for informed consent, revealing growing complexities regarding layered consent models. While recommendations on research consent were not fully developed at the workshop, insights highlighted the growing complexity and divergence of views on layered consent models. Findings suggest that improving NBS consent requires both operational reform and reassessment of ethical standards, alongside broader interest-holder engagement and feasible, scalable models also suited to genomic technologies. A nationally consistent framework is needed. Full article

Background/Objectives: Long-term recovery following adolescent anorexia nervosa (AN) remains incompletely understood because restoration of nutritional status does not necessarily coincide with psychological remission. Comprehensive evaluation of recovery requires consideration of psychological, behavioural, and patient-reported outcomes in addition to anthropometric measures. To evaluate long-term recovery following adolescent anorexia nervosa by integrating clinical outcomes, patient- and caregiver-reported experiences, orthorexic tendencies, and eating-disorder psychopathology, and to identify factors associated with persistent psychological impairment. Methods: This retrospective follow-up study employed a cross-sectional survey design. Families of 100 former patients previously hospitalized for adolescent anorexia nervosa in a child and adolescent psychiatric inpatient unit were invited to participate 5–10 years after discharge. Follow-up questionnaires were returned by 23 former patients and 17 caregivers. Former patients completed the SCOFF questionnaire and questions assessing orthorexic tendencies, whereas caregivers and the patients as well provided information regarding their child’s long-term recovery, treatment experiences, current functioning, and selected demographic characteristics. Responses from former patients and caregivers were analysed according to respondent group and the variables available for each group, while information from both groups was used to obtain a comprehensive assessment of long-term recovery. Descriptive and inferential statistical analyses were performed. Results: Mean BMI increased from 13.4 kg/m² during the acute phase of illness to 18.8 kg/m² at follow-up, indicating substantial nutritional improvement. Nevertheless, approximately 60% of former patients screened positive on the SCOFF questionnaire, suggesting persistent eating-disorder symptoms despite nutritional rehabilitation. Orthorexic tendencies were strongly associated with positive SCOFF screening results (Cramér’s V = 0.828; p < 0.001). Psychiatric comorbidity and poorer subjective health perception were also associated with less favourable long-term outcomes. Qualitative findings further demonstrated that recovery was perceived as extending beyond symptom reduction to include psychological wellbeing, restoration of autonomy, interpersonal functioning, and social reintegration. Full article

Background/Objectives: Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem autoimmune disease that is associated with more severe organ involvement, more intensive drug therapy, and increased long-term organ damage compared with adult-onset disease. The objectives of this study were to evaluate the performance of widely used small area-level multidimensional indicators of neighborhood disadvantage in a mixed urban–rural cSLE cohort against disease outcomes. Methods: This retrospective cohort study utilized electronic health records to identify and evaluate pediatric patients with cSLE across a single center in South Carolina between 1 January 2020 and 31 December 2024. Primary outcomes included disease activity at diagnosis, measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K); the achievement of a low lupus disease activity state (LLDAS) by the last visit; the development of major organ involvement; and the rates of unplanned hospitalizations and emergency department visits. The associations of the census tract-level Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Childhood Opportunity Index (COI) with clinical presentation and outcomes were estimated using generalized linear models and logistic regression. Results: A total of 85 patients with cSLE were included, of which 76% reported being of Black race, and 28% lived in rural areas. Lupus disease severity was inconsistent across the metrics of area-level social vulnerability, neighborhood deprivation, child opportunity, and rurality. Patients who lived in more socially vulnerable communities were more likely to attain LLDAS during follow-up, while those who lived in lower-opportunity areas were more likely to develop CNS lupus. Baseline disease activity, renal involvement, and healthcare use were not significantly associated with area-level social disadvantages or rurality. Conclusions: In this single-center, mixed urban–rural cohort of children with cSLE, indicators of neighborhood-level disadvantage and rurality alone explained little variation in disease severity and disease control overall. The utility of available small area-level metrics is likely context-dependent and influenced by regional features, population characteristics, and the outcomes being studied. Future work should integrate individual- and area-level factors across diverse settings to better understand the drivers of health disparities. Full article

Kindergarten environments combine high microbial exposure with increased immunological vulnerability, yet antibiotic resistance genes (ARGs) in kindergarten dust remain poorly characterized. This systematic review synthesized evidence on the occurrence and potential health relevance of ARGs in kindergarten dust. Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched. Four studies from China, Hong Kong, and Norway (2018–2024) met the inclusion criteria. ARGs were detected in all kindergarten dust samples, indicating that dust is a consistent reservoir of antibiotic resistance determinants. A consensus resistome (classes detected in ≥2 studies) encompassed sulfonamide, macrolide–lincosamide–streptogramin B (MLSB), tetracycline, beta-lactam, aminoglycoside, and multidrug resistance genes; beta-lactam resistance genes were the only class reported in all four studies. Clinically important ARGs associated with last-resort antibiotics, including mecA, vanA, bla_NDM, and mcr-5, were reported in three studies. Class 1 integron-integrase genes (intI1) frequently co-occurred with ARGs, suggesting potential horizontal gene transfer. Limited evidence indicated higher ARG abundance in urban and winter samples. One study reported antibiotic-resistant bacteria carrying resistance markers concordant with those in kindergarten dust in the urine of children attending the same facilities; however, this cross-sectional, single-site evidence is consistent with, but not sufficient to establish, a dust-to-child exposure pathway. The available evidence supports the plausibility that kindergarten dust may contribute to children’s exposure to ARGs and ARG-carrying bacteria, but current studies do not establish causal transmission from dust to child colonization or infection. Standardized monitoring and longitudinal studies are needed to assess health risks and guide mitigation strategies in early childhood educational settings. Full article

Background: Expanded Newborn Screening (NBS) allows screening for more than 50 inborn errors of metabolism (IEMs), thanks to the use of tandem mass spectrometry (MS/MS). Beyond its primary diagnostic function, NBS offers a valuable opportunity to obtain comprehensive information regarding the nutritional status of each newborn. This aspect is particularly significant in very-low-birth-weight (VLBW) preterm infants, who are at increased risk of multiple perinatal complications. The objective of the present study was to leverage the extensive dataset generated from NBS samples of VLBW infants to explore potential correlations with longitudinal extrauterine growth restriction (EUGR). Methods: We retrospectively analyzed 155 VLBW newborns hospitalized in the neonatal intensive care unit (NICU) and screened at IRCCS Giannina Gaslini Children’s Hospital between May 2021 and December 2023. Forty-six NBS metabolites were evaluated at 48–72 h of life (T0), 30 days of life (T1), and at a body weight of 1800 g (T2). Results: Several metabolites showed significant differences between infants with and without longitudinal EUGR in the univariate analyses across the three sampling time points. However, after adjustment for multiple comparisons using the Benjamini–Hochberg procedure, no metabolite remained significantly associated with longitudinal EUGR. Conclusions: Although several metabolites initially appeared to be promising candidates, no independent metabolic signature of longitudinal EUGR was identified after adjustment for multiple testing. Nevertheless, the biological plausibility of several metabolic pathways potentially implicated in postnatal growth provides a rationale for future prospective studies with larger cohorts and more targeted metabolic panels to better elucidate the biological mechanisms underlying longitudinal EUGR. Full article

Background: Timely hepatitis B vaccine birth-dose (HepBV-BD) vaccination is a cornerstone strategy for preventing mother-to-child transmission of hepatitis B virus (HBV). Although hepatitis B vaccination coverage in China has improved substantially, evidence regarding long-term district-level spatiotemporal inequalities in timely birth-dose vaccination remains limited, particularly in western China. This study assessed spatiotemporal disparities in hepatitis B vaccination coverage across Chongqing, China, from 2016 to 2025. Methods: This ecological descriptive study used district- and county-level vaccination surveillance data from the Chongqing Immunization Information Management System. Temporal trends in HepBV-BD, timely birth-dose (TBD), HepBV2, and HepBV3 coverage were analyzed. Regional disparities, interregional inequalities, and spatial clustering were assessed using Global Moran’s I and Local Indicators of Spatial Association (LISA). Results: All vaccination indicators improved substantially during the study period. TBD coverage increased from 81.9% to 95.4%, whereas HepBV3 coverage increased from 83.7% to 98.7%. TBD coverage was strongly positively associated with HepBV3 coverage(r = 0.95, p < 0.001). Mountainous ethnic minority regions consistently exhibited the lowest TBD coverage despite marked improvement over time. Absolute interregional inequality decreased from 30.8 to 8.4 percentage points. Although Global Moran’s I was not statistically significant, LISA analysis identified persistent localized low-coverage clusters in southeastern mountainous regions and emerging high–high clusters in northern Chongqing. Conclusions: Hepatitis B vaccination coverage in Chongqing improved markedly between 2016 and 2025, accompanied by declining geographic inequality. Nevertheless, persistent spatial inequities in timely birth-dose vaccination remained in mountainous ethnic minority areas. Continued monitoring of spatial inequalities, together with strengthened primary healthcare capacity, culturally tailored health education, and equitable resource allocation, may help support geographically targeted immunization strategies and accelerate progress toward the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Full article

Background/Objectives: Maternal vitamin D deficiency has been associated with preeclampsia, but evidence regarding preconception partner-specific vitamin D biomarkers is limited. We evaluated associations between preconception maternal and paternal vitamin D biomarkers and the odds of preeclampsia. Methods: This secondary prospective cohort analysis used data from the Folic Acid and Zinc Supplementation Trial (FAZST), a multicenter study conducted in the United States between 2013 and 2017. Of the 2370 enrolled couples who were seeking infertility treatment, 1054 couples achieved a documented pregnancy. Because preeclampsia can only be ascertained among pregnancies progressing beyond 20 weeks of gestation, the primary analytic population was restricted to 826 pregnancies that reached ≥20 weeks, including 98 with preeclampsia and 728 without preeclampsia. Preconception serum total 25-hydroxyvitamin D (25(OH)D), vitamin D-binding globulin (VDBG), albumin, free 25(OH)D, and bioavailable 25(OH)D were assessed in both partners. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: In categorical analyses, maternal total 25(OH)D findings were consistent with a possible U-shaped pattern. Compared with concentrations of 30–< 50 ng/mL, concentrations ≤20 ng/mL were associated with higher odds of preeclampsia (aOR = 2.58, 95% CI: 1.13–5.88), as were concentrations ≥50 ng/mL (aOR = 5.45, 95% CI: 1.71–17.41). Similar categorical patterns were observed for maternal free 25(OH)D, with higher odds at concentrations ≤8.25 pg/mL (aOR = 2.23, 95% CI: 1.13–4.43) and ≥12.5 pg/mL (aOR = 4.71, 95% CI: 1.97–11.29), and for maternal bioavailable 25(OH)D concentrations ≤3.5 ng/mL (aOR = 2.61, 95% CI: 1.19–5.72) and ≥5.0 ng/mL (aOR = 5.38, 95% CI: 2.15–13.46). Lower paternal bioavailable 25(OH)D was associated with lower odds of preeclampsia in the fully adjusted model (aOR = 0.50, 95% CI: 0.28–0.89); however, this finding should be considered exploratory. Conclusions: Among pregnancies progressing to ≥20 weeks, lower and higher categories of maternal total, free, and bioavailable 25(OH)D were associated with the odds of preeclampsia relative to intermediate categories. These categorical findings are consistent with a possible U-shaped pattern but do not establish a nonlinear dose–response relationship. Paternal findings were limited and should be considered exploratory. Full article