Search Results (21,827)

Background: Physical exercise is a vital component of cancer rehabilitation, with demonstrated improvements in cancer health-related outcomes, relapse rates, mortality and overall survival, yet global participation remains low. In Singapore, uptake of community cancer rehabilitation is limited despite high prevalence of treatment-related impairments. Methods: A cross-sectional study was conducted among adults (≥21 years) enrolled in the Singapore Cancer Society Rehabilitation Center between December 2021 and March 2023. Clinical data was collected from medical records and assessments included the Distress Thermometer (DT), Brief Illness Perception Questionnaire (Brief IPQ), and modified Bandura’s Exercise Self-Efficacy (ESE) scale. Adequate exercise was defined as ≥150 min/week of moderate intensity aerobic exercise and ≥2 days/week of resistance training. Regression analyses were performed to identify factors associated with meeting recommended moderate-intensity aerobic exercise levels. Results: The median age of our study cohort was 60.0 (IQR: 51.0–66.3) years. Of 132 analyzed participants, only 29.5% met recommended aerobic exercise levels and 9.1% met resistance training level recommendations. The median duration of moderate intensity aerobic exercise per week was 85.0 (30.0–180.0) minutes. The three most common cancer diagnoses amongst the participants were breast (53.8%), gastrointestinal (11.4%) and gynecological (7.6%) cancers. Clinically significant distress (DT ≥ 5) was present in 40.9% of patients. Multivariate regression analyses revealed that having lower ESE was the only significant psychosocial factor associated with a lower likelihood of meeting recommended aerobic exercise activity levels (OR = 0.856; 95% CI = 0.787–0.931; p < 0.001). Conclusions: Our study found a low prevalence of meeting recommended physical activity levels amongst our cohort of Asian cancer survivors enrolled in a community rehabilitation program in Singapore. Reinforcing the need for future longitudinal studies involving Asian cancer survivors to explore additional factors associated with physical inactivity and whether behavioral interventions targeting ESE will improve physical activity participation. Full article

Coffee fermentation is a critical yet under-optimized stage of the coffee value chain, with significant implications for beverage quality, process consistency, and smallholder livelihoods. Pichia species, together with several non-Saccharomyces yeasts historically associated with the genus, are frequently detected in natural and semi-dry coffee fermentation; however, their functional roles remain insufficiently characterized, constraining evidence-based starter-culture design. Direct coffee evidence implicates P. kudriavzevii, P. kluyveri, and Meyerozyma guilliermondii (formerly Pichia guilliermondii) in substrate transformation, fermentation dynamics, and sensory quality development. However, these findings are derived exclusively from studies conducted on single farms during single harvest seasons, without independent validation across multiple farms, harvest seasons, origins, or production environments, limiting their broader applicability. In contrast, ecologically prevalent species, including P. fermentans, Wickerhamomyces anomalus (formerly Pichia anomala), and Debaryomyces hansenii (formerly Pichia hansenii), remain largely unexplored in the context of coffee fermentation. To contextualize the current knowledge and identify promising avenues for future research, this review synthesizes evidence from cocoa, Baijiu, bakery, vinegar, dairy, and other solid-state fermentation systems. Across these diverse matrices, Pichia and related non-Saccharomyces yeasts frequently exert a disproportionate influence on flavor development, microbial succession, and process stability relative to their population abundance. The reported mechanisms include ester and higher-alcohol production, modulation of bacterial community dynamics, extracellular enzymatic activity, and bioprotective effects. Notably, functional impact often occurs without numerical dominance; ester production can increase alongside declining ethanol yield, and ecological persistence may increase despite declining absolute abundance, implicating community-level interactions in addition to direct metabolic activity. However, both the mechanisms and the magnitudes of these effects vary across fermentation systems, underscoring that functions demonstrated in one matrix cannot be assumed to translate directly to coffee without experimental validation. Future progress will require strain-level characterization, mechanistic studies, deliberate multi-species consortium design, process optimization, and field-scale validation in diverse coffee-producing environments. Such efforts will provide a scientific foundation for evidence-based starter-culture development capable of improving coffee quality, consistency, and producer value. Full article

Background/Objectives: Dietary supplements (DSs) and over-the-counter (OTC) medications for mood improvement and stress relief are widely used, but little is known about how their use relates to coping preferences, trust in physicians, and communication with doctors. This exploratory cross-sectional study compared users and non-users of such products in Poland. Methods: Data were collected between October 2024 and May 2025 and included 798 adults recruited through a mixed-mode convenience sampling strategy (636 online and 162 in person). Participants were classified as current users (CUs; n = 184), past users (PUs; n = 297), or never-users (NUs; n = 317). The outcomes included hypothetical future coping strategies (under an assumption of unlimited resources), trust in physicians using an author-translated adaptation of the Trust in Doctors in General (T-DiG) scale and three-category communication-related attitudes. Multivariable models were adjusted for age, gender, education, medical or health science background, and recruitment mode. Results: Overall, 60.3% of respondents reported current or past use. Compared with NUs, both CUs and PUs had higher adjusted odds of selecting future DS/OTC use (CUs: aOR = 5.60, 95% CI 3.44–9.14, p < 0.001; PUs: aOR = 2.44, 95% CI 1.52–3.93, p < 0.001). PUs also had higher adjusted odds of selecting psychotherapy (aOR = 1.50, 95% CI 1.04–2.17, p = 0.031; overall p = 0.018). Product-use status was associated with selected items of T-DiG: communication competency (overall p = 0.031) and global trust (overall p < 0.001). Compared with NUs, CUs had lower adjusted scores on both subscales (aMD = −0.19, 95% CI −0.33 to −0.04, p = 0.010 and aMD = −0.40, 95% CI −0.59 to −0.21, p < 0.001, respectively). Overall product-group effects were also observed for the first two communication items: CUs had lower relative risk ratios than NUs for discussing product-related doubts first with their physician (RRR = 0.52, 95% CI 0.35–0.78, p = 0.001) and for feeling free to raise such doubts (RRR = 0.57, 95% CI 0.36–0.92, p = 0.022). Conclusions: Product-use status showed selective associations with hypothetical coping preferences, physician trust, and communication-related attitudes rather than a uniform pattern of reluctance to seek professional support. Current use was most strongly associated with lower trust and less favorable product-related communication attitudes. Given the cross-sectional design and hypothetical nature of the coping outcomes, these findings do not establish causality, temporal ordering, or actual healthcare-seeking behavior. Full article

Walking plays an important role in improving public health and creating more livable cities. Participatory planning incorporates the local knowledge and preferences of residents, community organizations, and other stakeholders into the identification of walking routes. However, whether these routes are actually used after implementation remains insufficiently understood. Using Fukuoka, Japan, where community walking maps and routes have been developed through local participation for over two decades, this study combines these participatory walking routes with crowdsourced walking data, built environment indicators, and spatial analysis to substantiate their actual use and inform route improvement. The results show that these routes generally have higher walking usage than the citywide average, although substantial spatial differences remain. Hotspot routes were concentrated around waterfront areas, commercial districts, and public transport hubs, whereas coldspot routes were more common in suburban, mountainous, and island areas. Route usage was positively associated with street visibility, land-use diversity, population density, and public transport accessibility. Significant spatial dependence and heterogeneity further indicate that these associations vary across urban contexts. These findings highlight the value of local knowledge in identifying walking routes and the value of crowdsourced walking data in evaluating their actual use. Communities can build on this approach by involving local people in identifying walking routes and then using crowdsourced behavioral data to evaluate and refine them, supporting better walking environments. Full article

Balcony gardening has become increasingly relevant in dense urban environments, providing residents with a way to address limited access to green spaces and reduced everyday contact with nature. Despite the growing importance of urban green infrastructure (GI), there is a significant lack of understanding of balcony gardening as a decentralized, distributed, and resident-driven component of urban greening, as it is often viewed as an isolated hobby. This study conceptualises balcony gardening as a micro-scale, resident-driven component of urban GI. Data were collected in Sweden via a semi-structured online survey. The results show that among the surveyed group, balcony gardening is mainly motivated by food self-provision (77%) and aesthetic enjoyment (67%), while also providing intangible benefits such as improved mood (65%) and reduced stress (36%). Knowledge is primarily acquired through self-learning (90%) and digital communities, compensating for the lack of formal support. Respondents perceived balcony gardening as falling outside formal governance structures, with limited interaction with local authorities. Respondents face structural barriers, including limited space (51%) and insufficient lighting (41%). The findings highlight the governance gaps of a practice that respondents associate with multiple urban sustainability functions, pointing to the need for more inclusive planning approaches. Full article

Background: Food insecurity continues to pose a significant public health challenge in urban low-income communities, where limited resources and unstable food systems may negatively relate to children’s nutrition. Although prior studies have linked food insecurity with inadequate dietary intake, the role of coping strategies in this relationship remains insufficiently understood. This study investigated the associations between household food insecurity, coping strategies, and children’s dietary intake in densely populated urban areas of Surabaya, Indonesia. Methods: A cross-sectional study was conducted among 55 mother–child pairs in Simolawang and Bulak Banteng from September 2025 to February 2026. We used the Household Food Insecurity Access Scale (HFIAS) and the Short Food Literacy Questionnaire (SFLQ), and coping behaviors were assessed using the Reduced Coping Strategy Index (r-CSI). Children’s dietary intake was obtained through a Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Pearson correlation and multivariate regression analyses were applied to examine relationships among variables. Results: Most households were classified as food secure (61.82%), although varying degrees of food insecurity were observed. Household food insecurity was not significantly associated with children’s energy or macronutrient intake. In contrast, coping strategy scores were positively associated with household food insecurity (β = 0.26–0.27), indicating greater use of coping strategies among households experiencing greater food insecurity. Conclusions: Food insecurity was linked to increased coping behaviors but not directly to children’s macronutrient intake. Coping mechanisms may help sustain short-term intake but do not guarantee adequate nutrition. Interventions should address both food access and dietary quality in urban poor settings. Full article

Objective: It is commonly believed in the public health community that the mRNA vaccines from Pfizer and Moderna were broadly similar in preventing COVID-19 mortality, with perhaps a small advantage for Moderna. We revisit this question, using a research design that controls for healthy-vaccinee bias. Methods: We studied deaths among persons aged 15 years or greater from January 2021 through December 2022 in Indiana, linked to vaccination records, using an outcome measure, namely COVID-19 Excess Mortality Percentage (CEMP), which uses non-COVID natural mortality to control for HVB. Results: We find both large healthy-vaccinee bias for both vaccines, and larger bias for Pfizervaccinees: Pfizer recipients were healthier and thus would have faced lower COVID-19 mortality without vaccination. For ages 60+, we find almost 50% higher COVID-19 remaining mortality risk (RMR) for Pfizer vaccinees receiving primary vaccination over a “core period” from 2Q2021 through 1Q2022: the average Pfizer/Moderna RMR ratio was 1.49. For ages 15–59, this ratio was 1.25, but was not statistically significant. For booster dose for ages 60+, the average Pfizer/Moderna RMR ratio was 1.34. For 2Q2022 through 4Q2022, after the major Omicron wave, we find much lower vaccine effectiveness and no significant Pfizer–Moderna difference. Conclusions: During the period with both good vaccine availability and high COVID-19 mortality (2Q-2021–1Q2022), the Moderna vaccine was associated with lower COVID-19 mortality, relative to the Pfizer vaccine. A possible explanation is the higher Moderna dose (100 μg vs. 30 for Pfizer). After that period, a high percentage of the population had natural immunity from prior COVID-19 infection; we find only small mortality gains from vaccination, with no significant Pfizer–Moderna difference. Policy Implications: Controlling for healthy-vaccinee bias, Moderna was associated with lower COVID-19 mortality, relative to Pfizer. This difference was not known in real-time due to the failure of the available studies to address healthy-vaccinee bias. Controlling for such bias is vital when making vaccination policy. Full article

G protein-coupled receptors (GPCRs) are dynamic allosteric proteins whose signaling properties are governed by reciprocal communication between extracellular ligand-binding sites and intracellular transducer interfaces. Although classical pharmacological models established the concept that ligand binding and G protein coupling are thermodynamically linked, recent structural, biophysical, and computational studies have revealed a far more complex picture in which GPCRs exist as ensembles of interconverting conformational states. Accumulating evidence indicates that G proteins function not only as downstream signaling effectors but also as endogenous allosteric modulators. By reshaping receptor conformational landscapes, G protein coupling can influence the structure and dynamics of orthosteric ligand-binding pockets, thereby regulating ligand affinity, binding kinetics, and receptor selectivity. These findings support a bidirectional model of GPCR signaling in which information is transmitted not only from ligand-binding sites to intracellular signaling partners but also in the reverse direction through receptor-wide allosteric networks. Disease-associated mutations of endothelin A receptor (ETAR) provide in vivo evidence that structural perturbations located far from orthosteric ligand-binding sites can alter ligand recognition through long-range allosteric communication. In addition, emerging studies of positive allosteric modulators demonstrate the therapeutic potential of selectively stabilizing ligand–receptor–G protein complexes. These observations suggest that ligand recognition, receptor activation, and transducer coupling should be viewed as integrated properties of a dynamic receptor–ligand–transducer ensemble. This perspective provides a conceptual framework that links classical GPCR pharmacology, structural biology, disease mechanisms, and next-generation drug discovery. Full article

In this article, a dual-band frequency-selective surface (FSS) is proposed for wireless communication systems operating in the sub-6 GHz 5G band and emerging upper-mid-band frequencies considered for future wireless applications. The proposed FSS exhibits two passbands centered at 4.8 GHz and 6.9 GHz, with corresponding reflection coefficients of $-33$ dB and $-25$ dB, respectively. The associated $-10$ dB impedance bandwidths extend from 4.6–5.0 GHz and 6.6–7.2 GHz, providing efficient transmission within the desired operating bands. Between these passbands, the proposed structure exhibits a band-stop response centered at 5.5 GHz, where the transmission coefficient ($S_{21}$) reaches a minimum value of $-40$ dB over the frequency range of 5.2–5.8 GHz. This intermediate stopband suppresses unwanted signal transmission, particularly within the Wi-Fi band, thereby improving spectral selectivity and reducing potential interference in multi-band wireless communication environments. Furthermore, the proposed single-layer FSS maintains stable transmission and reflection characteristics under different polarization states and oblique incidence angles up to 60°. The measured results show good agreement with the simulated responses, demonstrating the suitability of the proposed design for applications requiring dual-band transmission and intermediate band-stop filtering in next-generation wireless communication systems. Full article

Background: Poor adherence to home exercise programs is a persistent challenge in physical rehabilitation and beyond. Data suggest that follow-up telehealth visits featuring behavior change techniques can improve adherence. However, the optimal frequency of behavioral support for effective self-management of technology-enabled home exercise programs remains unclear. This paper investigates how adherence to home exercise varies with the number of follow-up visits holding the type of exercise constant and measuring adherence objectively. Methods: A secondary analysis of adherence was conducted on participants from the VIGOROUS five-site, single-blind, and randomized controlled trial. Chronic (>6 months) community-resident stroke survivors with mild-to-moderate upper extremity hemiparesis (n = 111) were assigned 15 h of asynchronous video game-based home exercise over 3 weeks. Participants received behavioral support during (a) one single in-person session, (b) four in-person sessions, or (c) four in-person sessions plus six remote teleconsultations. Each consultation incorporated standardized behavior change techniques—contracting, feedback, self-monitoring, action planning, and guided problem solving—to promote increased paretic arm use during daily activities. The primary outcome was adherence (minutes exercising), objectively captured by the gaming system for 87 participants. Results: Six telehealth visits with remote therapeutic monitoring (RTM) increased home exercise completion by 3.3 h [95% CI: 0.008, 6.60]; each remote or in-person consultation was associated with an estimated 34 min of additional asynchronous home exercise. Conclusions: RTM, which does not require travel to a healthcare facility, is a time-efficient modality to enhance therapeutic engagement. Behaviorally focused telehealth visits boost stroke survivors’ adherence to a structured home exercise program. Full article

Background: Healthy lifestyle guidance is an important component of outpatient preventive care, yet evidence is limited on whether outpatients receive satisfactory guidance across multiple lifestyle domains. This study examined receipt of satisfactory healthy lifestyle guidance and its associated factors among outpatients in China. Methods: This national multicenter cross-sectional study used data from the outpatient component of the fifth National Third-Party Evaluation of the Action Plan for Further Improving Healthcare Services. A total of 31,599 outpatients from 143 tertiary public hospitals across all 31 provincial-level administrative regions of mainland China were included. The primary outcome was receipt of satisfactory healthy lifestyle guidance, defined as receiving at least one type of guidance and reporting satisfaction or high satisfaction. Mixed-effects logistic regression models with hospital-level random intercepts were used to identify associated factors. Results: Dietary guidance was the most frequently reported domain, followed by physical activity, weight management, and smoking cessation and alcohol reduction guidance. Overall, most outpatients were classified as having received satisfactory healthy lifestyle guidance. In the fully adjusted model, male sex and hypertension were associated with higher odds of satisfactory guidance, whereas a greater number of chronic conditions and unclear physician type were associated with lower odds. Satisfaction with history taking and disease communication and perceived respect and comfort from healthcare professionals were strongly associated with satisfactory healthy lifestyle guidance. However, these contemporaneously measured patient-reported indicators may reflect overlapping dimensions of patients’ overall outpatient care experience. Sensitivity analyses yielded broadly consistent findings. Conclusions: Satisfactory healthy lifestyle guidance was common among outpatients in China’s tertiary public hospitals, but guidance was unevenly distributed across lifestyle domains. Patients’ evaluations of satisfactory healthy lifestyle guidance were closely associated with their broader communication and interpersonal care experiences. However, because these measures were self-reported and assessed contemporaneously, the observed associations should not be interpreted causally. Full article

Early childhood education and care (ECEC) systems in equitable welfare states are designed to provide comparatively standardised institutional inputs, yet substantial developmental gaps among children persist. This study examined this configuration—descriptively labelled the “Flemish Paradox”—using data from the OECD’s International Early Learning and Child Well-being Study (IELS 2025) for the Flemish Community of Belgium (2363 five year olds in 200 ECEC centres; parent-questionnaire data were available for a subset of the sample, and missing parent-report data were addressed through multiple imputation). Children’s cognitive and executive skills were measured with standardised direct tablet-based assessments, while home environments were reported by parents, separating measurement sources. Two-level hierarchical linear models with design-based weighting (child weight and 92 BRR replicate weights), pooled across five plausible values and 20 multiply imputed datasets, showed comparatively limited between-centre outcome variation (ICC ≈ 23% for foundational learning, ≈11% for executive function). Within centres, family socioeconomic status (B = 25.11, p < 0.001) and a print-focused home literacy index (PHLI; B = 16.60, p < 0.001) were positively associated with foundational learning, and centre-mean PHLI showed an independent contextual association (B = 24.11, p < 0.001). A positive within-centre indirect association through children’s executive function skills was estimated (3.60, 95% Monte Carlo CI [1.83, 5.40]); a secondary exploratory analysis indicated a parallel between-centre pattern (8.40, 95% CI [1.16, 15.65]). Centre socioeconomic composition was strongly associated with outcomes (B = 36.38, p < 0.001); the analysis did not provide evidence that it modified the within-centre PHLI–learning association (p = 0.219). The findings are consistent with cultural-capital perspectives and indicate that family resources, print-focused home literacy, and EFs are jointly associated with early learning within a multilevel ECEC context. However, the cross-sectional design does not establish temporal or causal mediation, and the results should not be interpreted as evidence regarding the effectiveness of particular family- or centre-based interventions. Full article

Background: Transitional age youth aged 18–25 years are more likely to engage in risky behaviors, displaying significantly higher alcohol and illicit drug use levels than adolescents and older adults. College students are particularly vulnerable at this critical life juncture as transitioning to adulthood may impact emotional health and well-being, contributing to anxiety, depression, and feelings of hopelessness, all of which are linked to increased risk of substance use and disorders. Objective: This study characterizes the design and status of the MAPme Project, a prospective project centered on substance use and emotional wellness during and beyond college. Herein, we describe the 2018–2024 pilot cohort that was followed during the first two years of college, remotely during the COVID-19 pandemic, and upon the return to campus. We also describe our latest 2025+ cohort with ongoing data collection. Participants: The 2018–2024 cohort comprised 301 college freshmen who completed online assessments at baseline (Wave 1). The 2025+ cohort has currently enrolled 618 students and counting. Methods: We provide descriptive information on both cohorts, along with preliminary associations of pre- and early collegiate substance use outcomes, psychopathology, sleep patterns, and personality traits. Results: Approximately 64% of first-year students reported use of a substance in the 90 days leading up to college in 2018. Alcohol and cannabis were the most prevalent substances used in both cohorts with males consuming more alcohol than females. Females reported greater levels of daily stressors and mood symptoms. Other health and personality characteristics and observed associations between psychosocial risk and protective factors are described. Prior studies demonstrate the ability to test research hypotheses in the social, health, and clinical areas of psychology with robust statistical power. Conclusions: Substance use and emotional well-being vary considerably upon entry into college/university and at any particular moment in time. The MAPme Project encourages the engagement of students to address challenges associated with lack of awareness, inclusivity, and acceptance of scientific research. Overcoming barriers of inclusivity and empowering the community is key to the successful adoption and implementation of campus health and community-oriented research programs and systematically enhancing research training. Full article

Obesity-related complications have long been significant risk factors threatening human health. Sanhua tea is an instant tea composed of Rosa rugosa Thunb., Jasminum sambac (L.) Ait., Citrus aurantium L. var. amara Engl., Nelumbo nucifera Gaertn., and Ligusticum chuanxiong Hort. This study aimed to investigate the protective effects and underlying mechanisms of Sanhua tea in obese mice. An obesity model was established by feeding C57BL/6J mice a high-fat diet. Mice received intragastric Sanhua tea at doses (500, 1500, and 2500 mg/kg/day) for three weeks. Biochemical analyses indicated that Sanhua tea significantly reduced total cholesterol, triglyceride, low-density lipoprotein cholesterol, and pro-inflammatory cytokine levels in serum. Sanhua tea also alleviated liver oxidative stress by reducing malondialdehyde levels and regulating the activities of related enzymes. Additionally, Sanhua tea maintained gut microbiota diversity and reshaped microbial composition, reducing the Firmicutes/Bacteroidota ratio, increasing beneficial bacterial communities, and significantly decreasing harmful bacterial communities. Metabolomics analysis revealed that Sanhua tea altered liver metabolites, which were significantly associated with specific gut microbes. These metabolites influenced pathways such as ABC transporters, general metabolic pathways, and central carbon metabolism in cancer, contributing to obesity alleviation. In conclusion, Sanhua tea alleviated obesity symptoms in mice by modulating blood lipid levels, liver metabolism, and gut microbiota. Full article

As key drivers of soil biogeochemical cycles, soil microbial communities play essential roles in maintaining soil fertility, nutrient cycling, and plant growth. In this study, high-throughput sequencing of 16S rRNA and ITS genes was used to investigate the diversity, the composition, and the driving factors of bacterial and fungal communities in bulk soils across four soil groups collected from different vegetation covers (forest soil (FS), soybean field (PGS), and two Atractylodes japonica cultivation soils (ALO and ALR)) under identical climatic conditions. The results showed that the bacterial α-diversity remained stable across all the vegetation types, whereas the fungal α-diversity and richness were more sensitive to the vegetation type, with the PGS generally exhibiting lower Shannon and Chao1 indices. The β-diversity analysis revealed significant differences in the microbial community structure among the vegetation types, with a stronger effect on fungi (R² = 0.737, p = 0.001) than on bacteria (R² = 0.493, p = 0.001). At the phylum and genus levels, the fungal communities displayed more pronounced shifts than the bacterial communities, which remained relatively stable. A redundancy analysis indicated that the soil chemical properties significantly shaped the microbial community structure (p = 0.002). The microbial communities in the A. japonica soils (ALO and ALR) were primarily driven by pH, available phosphorus, and available potassium, while the FS and PGS communities were more strongly influenced by soil organic carbon, total nitrogen, and nitrogen forms (NH₄⁺-N and NO₃⁻-N). The Spearman correlation and functional prediction analyses further confirmed that the key soil factors differentially regulated the abundance and ecological functions of the dominant microbial taxa. These findings demonstrate the vegetation-specific assembly of soil microbial communities and highlight the distinct edaphic drivers associated with A. japonica cultivation, providing a scientific basis for soil health management and the sustainable cultivation of this medicinal plant. Full article