Search Results (2,071)

Cardiovascular diseases, malignancy, and diabetes mellitus are the most common chronic non-communicable diseases affecting the population in Serbia. According to The Cancer Registry of the Republic of Serbia, breast cancer is the most common cancer affecting women in Serbia. Every year, 4600 women get diagnosed with BC, and 1600 women die from this disease. Every eighth woman in Serbia is diagnosed with BC. This review aims to summarize clinical and theoretical information about breast cancer, metabolic syndrome and cardiovascular risk connection. The literature search was conducted through PubMed, Google Scholar and cross-references in January 2024. We concluded that although there is a well-established connection between cardiovascular risk, metabolic syndrome, inflammation, dyslipidemia, obesity, diabetes mellitus and breast cancer, more multicenter prospective clinical studies are needed to establish the precise association and pathophysiological mechanisms. Full article

Non-communicable diseases (NCDs) such as Diabetes Mellitus (DM) and Sickle Cell Disease (SCD) pose an escalating health challenge in Africa, underscored by diagnostic deficiencies, inadequate surveillance, and limited health system capacity that contribute to late diagnoses and consequent preventable complications. This review adopts a comparative framework that considers DM and SCD as complementary indicator diseases, both metabolic and genetic, and highlights intersecting diagnostic, infrastructural, and governance hurdles relevant to AI-enabled screening in resource-constrained environments. The study synthesizes epidemiological data across both African and high-income regions and methodically catalogs machine learning (ML) and deep learning (DL) research by clinical application, including risk prediction, image-based diagnostics, remote patient monitoring, privacy-preserving learning, and governance frameworks. Our key observations reveal significant disparities in disease detection and health outcomes, driven by underdiagnosis, a lack of comprehensive newborn screening for SCD, and fragmented diabetes surveillance systems in Africa, despite the availability of effective diagnostic technologies in other regions. The reviewed literature on ML/DL shows high algorithmic accuracy, particularly in diabetic retinopathy screening and emerging applications in SCD microscopy. However, most studies are constrained by small, single-site datasets that lack robust external validation and do not align well with real-world clinical workflows. The review identifies persistent implementation challenges, including data scarcity, device variability, limited connectivity, and inadequate calibration and subgroup analysis. By integrating epidemiological insights into AI diagnostic capabilities and health system realities, this work extends beyond earlier surveys to offer a comprehensive, Africa-centric, implementation-focused synthesis. It proposes actionable operational and policy recommendations, including offline-first deployment strategies, federated learning approaches for low-bandwidth scenarios, integration with primary care and newborn screening initiatives, and enhanced governance structures, to promote equitable and scalable AI-enhanced diagnostics for NCDs. Full article

Background: Ultra-processed foods (UPFs) have emerged as a critical component of diet quality, yet data on the associations between UPF and nutrient intakes remain limited. This study aimed to evaluate nutrient consumption in relation to UPF intake and adherence to international dietary guidelines for non-communicable disease (NCD) prevention. Methods: Data from 469 individuals aged 2–18 years enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were analyzed. Intakes were assessed using two 24 h recalls, and foods were classified according to the NOVA system. Participants were categorized by UPF energy intake tertiles. Nutrient adequacy was assessed using Nordic Nutrition Recommendations, European Society of Cardiology guidelines for macronutrients, and the Institute of Medicine’s Estimated Average Requirements and Adequate Intake values for micronutrients. Results: Children in the highest UPF tertile had significantly higher intakes of energy, carbohydrates, added sugars, saturated fats, polyunsaturated fats, and cholesterol, but lower intakes of protein compared to those in the lowest tertile. Fiber intake remained inadequate across all tertiles, with no significant differences. Regarding adherence to NCD prevention guidelines, children in the 3rd UPF tertile had a 2.3 times higher prevalence ratio for exceeding added sugar recommendations, while their protein intake prevalence ratio was 0.8 times lower. For micronutrients, the highest UPF tertile showed significantly elevated intakes of vitamins E, B₁, folate, calcium, iron, copper, and sodium, but lower potassium intake compared to the lowest tertile. Conclusions: Our results underscore the need for effective public health strategies to improve diet quality in children and adolescents and prevent diet-related NCDs. Full article

Background/Objectives: Poor dietary habits are a major contributor to non-communicable diseases (NCDs), the leading cause of mortality worldwide. To promote healthier eating, governments and stakeholders have implemented various nutrition policies, including front-of-pack nutrition labeling (FOPNL). The Choices International Foundation (Choices), through its criteria, supports these efforts through its standardized nutrient profiling system (NPS). Originally developed to underpin a positive FOPNL logo, in 2021, the criteria were expanded into a globally oriented five-level profiling system covering 23 basic and 10 discretionary food groups, addressing key nutrients such as trans-fatty acids, saturated fat, sodium, sugar, fiber, and energy. To ensure continued scientific relevance, the Choices criteria are periodically reviewed by an independent International Scientific Committee (ISC). Methods: This paper presents the 2025 revision of the Choices criteria, focusing on priority areas identified through stakeholder consultation and recent scientific developments. Results: Key updates include the introduction of nutrient-based equivalence criteria for plant-based alternatives to meat and dairy, based on protein and selected micronutrient thresholds. Non-sugar sweeteners (NSSs) were newly included as a factor that lowers a product’s health classification and makes it ineligible for a positive FOPNL. Additionally, the industrially produced trans-fatty acid (iTFA) criteria were revised and aligned with the latest World Health Organization (WHO) recommendations, improving both technical feasibility and policy coherence. While options for incorporating whole-grain and micronutrient criteria were explored, these were not included in the current revision. Conclusions: The 2025 update system enhances the scientific rigor, policy alignment, and global applicability of the Choices system. By providing a harmonized and evidence-based tool, it aims to support national policies that foster healthier food environments and, ultimately, improve public health outcomes worldwide. Full article

Multimodal methods provide valuable opportunities within Participatory Action Research (PAR), to foster meaningful participation, and amplify marginalized voices. However, conventional research approaches have not always adequately captured the complex realities of the lived experiences of families, and multimodal techniques have remained underutilized for the exploration of such experiences. This study aimed to explore the use of creative multimodal methods, within a PAR framework, grounded in care among vulnerable South African families. A qualitative design was adopted, incorporating Human-centered Design principles, within a PAR approach. The participants were recruited from the Saldanha Bay Municipality area (n = 70), as well as Mitchells Plain (n = 59). The multimodal methodology included Draw-and-Tell, painting, object and photo elicitation, I-Poems, and LEGO^®-based activities. Data were annotated and transcribed verbatim, followed by thematic analysis. A total of 42 participants contributed towards the validation of the methods. The participants described experiences of deep emotional insight, self-reflection, and self-recognition, through engagement with the multimodal activities. The findings revealed that these approaches were: (1) credible, producing internally valid and contextually rich data; (2) contributory, generating original and applicable insights into family life; (3) communicable, offering accessible and structured ways for diverse participants to express their experiences; and (4) conforming, ensuring ethical engagement through inclusive participation. These findings demonstrate the potential of creative, arts-based, and participatory approaches, to advance methodological innovation in qualitative family research. Full article

Background/Objectives: Given the high prevalence of obesity and abdominal obesity in Indigenous adults from Sonora (IAS) and its strong association with diet, this study evaluates the association of dietary inflammatory index (DII) with obesity and abdominal obesity and its indicators, such as body mass index (BMI) and waist circumference (WC), respectively. Methods: This cross-sectional study included data from 559 adults across two Indigenous populations (Seris and Yaquis) collected in two separate studies. Obesity and abdominal obesity were classified according to the definitions established by the World Health Organization and the International Diabetes Federation. The DII was calculated with data from population-specific food frequency questionnaires. Multiple linear regression was used to assess the association between the DII variable (expressed as both numeric and categorical) and BMI and WC, separately; multiple logistic regression was used to evaluate the association between obesity and abdominal obesity. Results: The prevalence of obesity and abdominal obesity was 34.1% and 78.2%, respectively. There was a positive association between the DII and BMI (DII as numeric: β = 0.53, p = 0.001; tertile3 of DII vs. tertile1: β = 1.86, p = 0.001) and WC (DII as numeric: β = 1.15, p = 0.002; tertile3 of DII vs. tertile1: β = 3.81, p = 0.005). Similar results were found for both types of obesity. Conclusions: Higher DII scores were associated with increased obesity indicators (BMI and WC) and a higher risk of obesity and abdominal obesity in IAS. Promoting anti-inflammatory diets represents a feasible approach for preventing non-communicable diseases. Full article

Aging induces sarcopenia and reduces bone mineral density, altering body composition. These modifications contribute to physical decline, increase non-communicable disease risk and increase the likelihood of hospitalization, thereby representing a substantial public health burden. In this study, we assessed the effects of isometric training with neuromuscular electrical stimulation conditioning contractions (ISO-NMES) and dynamic resistance training (DRT) on physical and functional capacities. Moreover, we investigated the impact of ISO-NMES training on the force and power of the trained and untrained leg. Eighteen sessions of ISO-NMES training for knee extensors were performed by 10 older adults (age: 70.1 ± 4.9 years; ISO-NMES group). The DRT group (n = 12; age: 70.5 ± 2.8 years) performed 18 sessions of dynamic resistance training at a local fitness center. Maximum voluntary contraction (MVC) and peak power (P) of lower limbs as well as functional capacities assessed with the 5 Sit to Stand, Timed Up and Go and 6 Minutes Walking Tests were examined in both groups before and after the related training protocols. At the end of the training period, only the ISO-NMES group had improved MVC (+30.4%, p < 0.001) and bilateral force (ISO-NMES: +6.3%, p = 0.032). Moreover, both groups had significantly improved functional capacities. Finally, in the ISO-NMES group, MVC, force and power significantly increased in both legs with a greater effect for MVC in the trained than untrained leg (+30.4 vs. +13.5%, p < 0.001). These findings suggest that ISO-NMES training was an effective strategy to improve physical and functional capacities in older adults. Thus, it could be considered as a potential intervention, particularly when the mobility to perform physical training is limited. Full article

Obesity is among the top contributing factors for non-communicable chronic disease development and has attained menacing global proportions, affecting approximately one of eight adults. Phytochemicals that support energy metabolism and prevent obesity development have been the subject of intense research endeavors over the past several decades. Cycloastragenol is a natural triterpenoid compound and aglycon of astragaloside IV, known for activating telomerase and mitigating cellular aging. Here, we aim to characterize the effect of cycloastragenol on lipid metabolism in a glucose-induced obesity model in Caenorhabditis elegans. We assessed the changes in the body length, width, and area in C. elegans maintained under elevated glucose through automated WormLab system. Lipid accumulation in the presence of either cycloastragenol (100 μM) or orlistat (12 μM), used as a positive anti-obesity control drug, was quantified through Nile Red fluorescent staining. Furthermore, we evaluated the changes in key energy metabolism molecular players in GFP-reporter transgenic strains. Our results revealed that cycloastragenol treatment decreased mean body area and reduced lipid accumulation in the C. elegans glucose-induced model. The mechanistic data indicated that cycloastragenol suppresses the nuclear hormone receptor family member NHR-49 and the delta(9)-fatty-acid desaturase 7 (FAT-7) enzyme, and activates the 5′-AMP-activated protein kinase catalytic subunit alpha-2 (AAK-2) and the protein skinhead 1 (SKN-1) signaling. Collectively, our findings highlight that cycloastragenol reprograms lipid metabolism by down-regulating the insulin-like receptor (daf-2)/phosphatidylinositol 3-kinase (age-1)/NHR-49 signaling while simultaneously enhancing the activity of the AAK-2/NAD-dependent protein deacetylase (SIR-2.1) pathway. The anti-obesogenic potential of cycloastragenol rationalizes further validation in the context of metabolic diseases and obesity management. Full article

Background/Objectives: This study examined the clinical utility of diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression (DWIBS) for differentiating infectious from non-infectious aortitis. Methods: The study included 32 patients with suspected inflammatory aortitis who underwent non-contrast computed tomography (NCCT) and magnetic resonance imaging. We evaluated the diagnostic performance of DWIBS using the spinal cord as a reference, NCCT, and their combination. The diagnosis of infectious aortitis was adjudicated based on imaging, clinical, and laboratory findings. We conducted a sensitivity analysis using a stricter definition of infectious aortitis that required both surgical and microbiological confirmation. Results: Fifteen patients were diagnosed with infectious aortitis. The sensitivity, specificity, and areas under the receiver operating characteristic curves were 93.3%, 70.6%, and 0.82, respectively, for NCCT; 93.3%, 76.5%, and 0.85, respectively, for DWIBS; and 86.7%, 94.1%, and 0.90, respectively, for the combination of both modalities. In the sensitivity analysis, the combined DWIBS and NCCT approach demonstrated a specificity of 87.5% and a sensitivity of 70.8%. Conclusions: DWIBS using the spinal cord as a reference appears to be a promising diagnostic tool for differentiating infectious from non-infectious aortitis, especially when combined with NCCT. Full article

Refugee-serving primary health centres/clinics (PHCs) provide culturally safe, integrated care for refugee children, yet little is known about how their health conditions and outcomes are assessed. This scoping review examines the current literature on the health conditions and outcomes of refugee children aged 0–5 years and how they are measured in refugee-serving PHCs in Canada. In partnership with the New Canadians Health Centre and guided by Joanna Briggs Institute methodological guidelines, we systematically searched Medline, CINAHL, Scopus, and Embase. Included studies focused on refugee children in Canada and reported health conditions, outcomes, and their measurements within PHCs. Twenty-five studies (2008–2024) met the inclusion criteria, most from Ontario (n = 11), followed by Alberta and Saskatchewan (n = 4 each). Reported health conditions or outcomes (n = 24) spanned the physical (n = 19), developmental, and mental health domains (n = 5). Communicable (e.g., gastrointestinal infections, hepatitis) and non-communicable conditions (e.g., malnutrition, vitamin D deficiency) were mostly reported. Although some standardized approaches were used, substantial variability exists across provinces and conditions or outcomes measured. Findings reveal a disproportionate focus on physical health and notable variability and gaps in child health measures, limited cultural adaptation, and lack of longitudinal data. Standardized, culturally responsive, and age-appropriate measurement approaches are needed to enhance health equity and inform evidence-based policy for refugee children in Canada. Full article

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

Background/Objectives: Healthcare workers (HCW) in primary care settings play a significant role in recommending vaccines to patients. We aimed to describe COVID-19 vaccination knowledge, attitudes, perception, and practices (KAPP) of HCWs in Tunisia and identify associated factors. Methods: We conducted a national cross-sectional survey (29 January to 3 February 2024) among HCWs in primary public healthcare centers using purposive sampling. Factors associated with good knowledge, positive attitude, and good practice, measured through Likert scales using face-to-face questionnaires, were identified using binary logistic regression. Results: We included 906 HCWs (mean age = 41.87 ± 8.89 years). In total, 37.75% (342/906) of HCWs had good knowledge and perception, 4.30% (39/906) had a positive attitude, and 24.9% (226/906) had good practices related to COVID-19 vaccination. Working in urban compared to rural areas was associated with good knowledge (aOR = 1.57, 95%CI = 1.12–2.21) and positive attitude (aOR = 4.94, 95%CI = 1.19–20.44) to COVID-19 vaccination. Physicians had better KAPP scores than other medical professionals. HCWs working in departments with high-risk patients were more likely to have good knowledge (aOR = 1.28, 95%CI = 1.00–1.72). Positive attitude was also associated with being male (aOR = 2.97, 95%CI = 1.75–5.07) and having at least one non-communicable disease (aOR = 1.92, 95%CI = 1.14–3.23). Being male (aOR = 1.97, 95%CI = 1.35–2.88) and having more years of professional experience (aOR = 1.81, 95%CI = 1.29–2.52) were associated with good practice. Conclusions: Just over a third of HCWs in primary healthcare clinics had good knowledge of COVID-19 vaccination, while positive attitudes and good practices were low. Targeted interventions, particularly for HCWs with less professional experience working in rural settings, are needed to increase good practices and improve COVID-19 vaccination coverage in Tunisia. Full article

Background/Objectives: The first 1000 days of life represent a critical window for growth and neurodevelopment, during which nutrition strongly influences brain development and metabolic programming. In phenylketonuria (PKU), dietary management is essential to prevent neurological impairment and later-life risk of non-communicable diseases (NCDs). This review examines current evidence on PKU from pregnancy through complementary feeding, highlighting the impact of nutritional strategies on neurodevelopmental and metabolic outcomes. Methods: This narrative review, following PRISMA guidelines, used a systematic search of PubMed and Scopus with defined PICO questions. Original research, reviews, and guidelines on PKU nutrition during the first 1000 days were included, emphasizing neurological and metabolic outcomes. Results: Articles addressed prenatal and postnatal factors in PKU. Optimised metabolic control in women with PKU is critical to prevent maternal PKU syndrome, reducing risks of miscarriage, congenital heart defects, microcephaly, and neurocognitive impairment. Pre-conception dietary management, frequent blood Phe monitoring, supplementation with Phe-free protein substitutes (PSs), micronutrients, and emerging pharmacological therapies support maternal and foetal health. Following newborn screening, early dietary treatment in infants with PKU maintains plasma Phe within safe ranges, promoting growth and neurodevelopment. Breastfeeding, combined with Phe-free infant PSs, is feasible, and complementary feeding should be introduced carefully. Frequent monitoring and tailored dietary adjustments, including second-stage PSs, support metabolic control, while data on gut microbiota remain limited. Conclusions: Early multidisciplinary interventions are crucial to optimise metabolic and neurodevelopmental outcomes during this window of opportunity. Further research is needed to address remaining gaps and optimise PKU management across the first 1000 days. Full article

Periodontitis is a chronic non-communicable inflammatory disease in which oxidative stress plays an important role in tissue destruction and alveolar bone loss. Excessive production of reactive oxygen species disrupts redox homeostasis, activates inflammatory signaling pathways, and promotes regulated cell death processes such as pyroptosis and ferroptosis. The Nrf2/Keap1 pathway is a key regulator of antioxidant defense and cellular adaptation to redox imbalance. Impaired Nrf2 signaling has been associated with enhanced oxidative injury, NF-κB and NLRP3 inflammasome activation, osteoclast-driven bone resorption, and reduced regenerative capacity in periodontal tissues. Experimental studies suggest that Nrf2 activation can restore the redox balance and attenuate inflammation and bone destructive responses in a periodontal model. Moreover, therapeutic approaches involving phytochemicals, microbial-derived metabolites, and redox-responsive biomaterials have been reported to influence Nrf2-related signaling in experimental settings. However, the majority of the available evidence is derived from in vitro or animal studies, and the relevance of these findings to clinical periodontitis remains to be established. This review summarizes the current advances linking oxidative stress, redox signaling, cell death pathways, and bone remodeling with Nrf2 dysfunction in periodontitis and outlines the key mechanistic insights while highlighting the existing knowledge gaps. Full article