Search Results (36,657)

Background: Adolescence is a critical developmental period during which dietary habits are formed and may influence long-term health outcomes. Monitoring changes in adolescents’ eating behaviors and nutrition-related knowledge over time is important for developing effective health promotion strategies. The aim of this study was to compare adolescents’ (Lower Silesia, Poland) dietary habits and nutritional knowledge between two study periods (2011 and 2023) using comparable survey methods. Methods: A repeated cross-sectional comparison of two independent cohorts was conducted using an identical questionnaire in both study periods. The 2023 cohort included 14-year-old primary school students (n = 100; 48 girls and 52 boys), while the comparison group consisted of adolescents aged 13–15 years assessed in 2011 (n = 377; 202 girls and 175 boys). Anthropometric measurements and self-reported data on dietary habits and nutritional knowledge were analyzed using descriptive statistics and group comparison tests. Results: The findings indicate changes in selected dietary behaviors and levels of nutritional knowledge among adolescents over the studied period. A higher percentage of students in 2023 reported eating four meals per day and obtaining information about healthy eating from the Internet rather than from television. Students in 2023 were also more likely to recognize the relationship between diet and attention, identify the harmful effects of energy drinks and excessive fast-food consumption, and provide correct answers regarding proper nutrition. Nutritional knowledge improved over time, with a mean percentage of correct responses of 71.9% in 2023 compared with 63.7% in 2011. Although nutritional awareness improved in several areas, certain unhealthy eating habits remained prevalent, including irregular breakfast consumption and frequent intake of sweets. Changes in the distribution of body weight categories were also observed, with gender-specific differences between cohorts. Conclusions: The results suggest that improvements in nutritional knowledge alone may not be sufficient to ensure positive changes in dietary behavior among adolescents. Continued monitoring of adolescent nutrition and the development of comprehensive health promotion strategies addressing both knowledge and environmental influences remain necessary. Full article

Objectives: Clinical trials are essential for therapeutic innovation in rheumatology. A recent decline in clinical trial activity in Hungary has highlighted the need to better understand patient experiences and motivations. This study assessed patient satisfaction and motivation in clinical trials, compared these with routine specialist care, and evaluated healthcare professionals’ motivations. Methods: In this single-center, cross-sectional study, 129 patients completed self-administered questionnaires (61 trial participants and 68 receiving routine care) primarily using a 6-point Likert scale; additionally, 21 healthcare professionals rated their motivations on a Visual Analog Scale (VAS 0–10). Categorical variables were analyzed using chi-square or Fisher’s exact tests, and continuous variables using paired two-tailed t-tests. Results: The main drivers of trial participation were physician recommendations (100%) and trust in the treating physician (100%). Access to novel therapies (98%), closer monitoring (83%), and additional diagnostic procedures (95%) were also significant motivators. Trial participants reported significantly higher satisfaction compared with routine care in terms of consultation time (97% vs. 36%, p < 0.001), staff availability (95% vs. 41, p < 0.001), assistance (93% vs. 36%, p < 0.001), and visit organization (98% vs. 34%; p < 0.001). Overall satisfaction with routine care remained high in both groups. In the control group, fears of disease worsening and the burden of frequent visits were key deterrents. Among healthcare professionals, access to innovative treatments was the strongest motivator, while administrative workload and documentation demands were the primary barriers. Conclusions: Clinical trial participation is associated with high patient satisfaction, driven by physician–patient trust and structured, personalized care. Reducing administrative burdens may be crucial for sustaining clinical research in academic settings. Full article

Balancing structural safety and economic efficiency in super-tall building design remains a formidable challenge. To address this issue, this study proposes a genetic-algorithm-based multi-variable, multi-objective optimization method. The design variables include the member sizes and vertical layout positions of outrigger and belt trusses, as well as the cross-sectional dimensions of mega-columns. Total structural weight and maximum inter-story drift ratio are adopted as objective functions, while code-specified constraints, such as shear-weight ratio, stiffness-weight ratio, and axial compression ratio, are incorporated to formulate the fitness evaluation for optimization. Taking a 300 m baseline structure designed for 6-degree seismic intensity and equipped with two outrigger trusses and three belt trusses as an example, single-variable sensitivity analyses are first performed. The results show that optimizing any single parameter can yield certain local improvements, yet it cannot overcome the weight–deformation trade-off induced by strong variable coupling. By selecting representative feasible solutions from the multi-variable solution set that match the “optimal” values identified by single-variable optimization as benchmarks, the multi-variable optimum reduces the total structural weight by approximately 6.5–18.4% relative to these representative designs. Moreover, optimal layout strategies of outrigger and belt trusses are investigated for two typical building heights (200 m and 300 m) and two seismic intensity levels associated with design ground motions having a 10% exceedance probability in 50 years, namely 6-degree (0.05 g) and 8-degree (0.20 g). Finally, the proposed method is validated through a case study of a super-tall financial center in Chongqing, where the total structural weight is reduced by 12.3% after optimization while the inter-story drift ratio still satisfies relevant code requirements. The results demonstrate that the proposed framework can generate competitive feasible solutions and provide a systematic means to achieve a balanced trade-off between structural safety and economic efficiency for outrigger–belt-truss super-tall buildings. Full article

Background: Body mass index (BMI) is commonly used to assess nutritional status; however, it cannot distinguish between fat and lean tissue. In young adults, this limitation may mask excess adiposity and distort diet–adiposity associations. Bioelectrical impedance analysis (BIA) provides more detailed measures, including percent of body fat (PBF), skeletal muscle mass (SMM), and the visceral fat level. Objectives: To examine how combining BMI with BIA-based classifications of adiposity influences the assessment of diet–body composition associations in young adults. Methods: This cross-sectional study of 285 young adults (median age 18 years, IQR: 18–20) used InBody BIA to classify participants by BMI and PBF. Dietary habits were assessed via food frequency questionnaire covering eight food groups. Group comparisons used Mann–Whitney U tests with Cohen’s d effect sizes; correlations used Spearman’s rank correlation. Results: Thirty-five participants (12.3%) were BMI-Normal but PBF-High (normal BMI with elevated body fat), a phenotype missed by BMI screening; overall BMI-PBF agreement was 75.4%. Physical activity (IPAQ) correlated significantly with body composition markers, PBF (rho = −0.177, p = 0.003) and SMM (rho = +0.186, p = 0.002), but not with BMI (rho = +0.060, p = 0.310). BMI showed an inverse association with self-reported sweets consumption (rho = −0.138, p = 0.020), likely reflecting a reporting bias rather than true intake, as this pattern disappeared when examining actual adiposity (PBF: rho = +0.032, p = 0.591). Conclusions: Combining BIA with BMI may improve the detection of elevated body fat (12.3% prevalence of normal BMI with elevated body fat); BMI-based screening may not identify all individuals with elevated body fat. Physical activity associations support the complementary value of BIA alongside BMI. Apparent diet–BMI associations may be confounded by adiposity misclassification and reporting bias. Full article

Background/Objectives: Vitamin D deficiency and malnutrition may lead to poor outcomes in colorectal cancer (CRC) patients. This study aims to perform an integrative analysis of serum vitamin D, nutritional status, anthropometric parameters and biochemical profiles in advanced CRC patients. Methods: The study included 58 advanced CRC patients. Serum vitamin D levels were measured by a chemiluminescence immunoassay. Nutritional status was evaluated with the Mini Nutritional Assessment (MNA). Body composition profiles were assessed using a bioelectrical impedance analyzer, and handgrip strength was measured with a handgrip dynamometer. Biochemical and clinical parameters were retrieved from an electronic database. Correlation, regression and receiver operating characteristic (ROC) analyses were performed. Results: Abnormal nutritional status and vitamin D deficiency were diagnosed in 55.17% and 50.00% of patients, respectively. Sarcopenia was diagnosed in 29.31%. Serum vitamin D concentrations were negatively correlated with absolute neutrophil counts (ANC). MNA scores showed significant negative correlations with ANC, platelet count, alkaline phosphatase and carcinoembryonic antigen. In multivariable regression models, albumin remained statistically associated with both serum vitamin D levels (β 7.049; 95% CI: 1.686–12.413; p = 0.011) and MNA score (β 6.951; 95% CI: 4.623–9.278; p < 0.001). Furthermore, albumin showed exploratory performance in ROC analyses for malnutrition and vitamin D deficiency (AUC^ROC 0.814 and 0.725, respectively), which should be interpreted cautiously given potential overlap with MNA-defined nutritional status and the limited sample size. Conclusions: Vitamin D deficiency, malnutrition and systemic inflammation commonly co-occur and are closely interrelated in patients with advanced CRC. A comprehensive assessment of nutritional status in a CRC supportive care setting is recommended. Full article

Hydropower is a cornerstone of global renewable energy; however, reservoir sedimentation directly undermines its benefits and operational lifespan. A critical, often overlooked, aspect of sedimentation is the compaction of fine-grained deposits, which introduces systematic discrepancies between standard siltation calculation methods. This study addresses this gap by developing a machine learning-based model to quantify sediment compaction and correct siltation estimates using the Xiluodu Hydropower Station on the Jinsha River, China, as a case study from 2014 to 2020. Based on hydrological, sediment, and fixed-section monitoring data, we applied five machine learning algorithms (Linear Regression, Neural Network, Random Forest, Gradient Boosting, and Support Vector Regression) to establish a relationship between the compaction thickness and the following key predictors: Year, Cumulative Sediment Thickness, Annual Sediment Thickness, and Distance to the Dam. The results demonstrate that the Neural Network (NN) model significantly outperforms traditional models, effectively capturing complex, nonlinear compaction dynamics with strong predictive accuracy (test R² = 0.766, RMSE = 0.047 m) and no significant overfitting. SHAP analysis revealed the dominant influences of consolidation time (years) and overburden stress (Cumulative Sediment Thickness), linking the model’s predictions to fundamental geotechnical principles. Applying the NN model to correct for the cross-sectional volume method markedly improved its consistency with the independent sediment transport method, reducing the average relative difference from −33.7% to −6.5% (2016–2020). This study provides the first quantitative, continuous (198 km, 221 sections) assessment of reservoir-scale sediment compaction, confirming its widespread existence and demonstrating its critical role in the long-standing methodological discrepancies. Our study transformed compaction from an acknowledged phenomenon into a quantifiable correction, offering a novel, data-driven framework to enhance the accuracy of reservoir sedimentation assessments globally. Full article

Background: Chronic low-grade inflammation plays a central role in the pathogenesis of type 2 diabetes (T2DM) and its complications. Neopterin, a marker of macrophage activation and Th1-mediated immune response, has been associated with cardiovascular disease and metabolic disorders. However, its relationship with diabetic autonomic neuropathy remains insufficiently investigated. Methods: We conducted a cross-sectional study including 129 participants (93 with T2DM and 36 with obesity without carbohydrate disturbances). Clinical, anthropometric, and biochemical assessments were performed. Cardiovascular autonomic neuropathy was evaluated using Ewing cardiovascular reflex tests and sudomotor dysfunction scoring. Neopterin concentrations were measured in serum. Correlation, ROC, and logistic regression analyses were performed. Results: Neopterin levels were not significantly different between T2DM and obesity groups. No differences were observed in patients with versus without peripheral neuropathy, nephropathy, or retinopathy. However, neopterin levels were significantly higher in individuals with cardiovascular autonomic neuropathy (p = 0.013). Neopterin correlated with cardiovascular autonomic neuropathy score, sudomotor dysfunction, fasting glucose, fasting insulin, and HOMA-IR. It showed a moderate negative monotonic correlation with eGFR (Spearman’s rho = −0.41, p< 0.001). In multivariable logistic regression adjusted for age, HbA1c, BMI, eGFR, and diabetes duration, each 1-SD increase in neopterin was associated with 2.67-fold higher odds of cardiovascular autonomic neuropathy (95% CI 1.21–5.89; p = 0.015). Conclusions: Circulating neopterin is independently associated with cardiovascular autonomic neuropathy in T2DM but not with classical microvascular complications. These findings suggest a potential role of immune-mediated mechanisms in the pathogenesis of diabetic cardiovascular autonomic neuropathy. Full article

Background: Artificial intelligence (AI) is poised to fundamentally reshape healthcare delivery, offering unprecedented advancements in diagnostics, treatment personalization, and operational efficiency. However, a growing body of international research reveals a critical “optimism–knowledge gap”: healthcare professionals are enthusiastic about AI’s potential but possess limited technical knowledge and practical experience. This gap compromises the safe and effective implementation of AI tools. The Italian healthcare context presents a unique and amplifying challenge, as it is defined by the stringent “human-in-the-loop” oversight mandated by the Garante per la protezione dei dati personali (Italy’s Data Protection Authority). This legal framework makes clinician competence not just a goal, but a prerequisite for regulatory compliance. Objective: This study aimed to provide an exploratory quantitative assessment of AI awareness, practical application, and understanding of its limitations among a sample of clinicians in Italy. It specifically sought to compare the preparedness of hospital-based clinicians and general practitioners (GPs) and to identify the workforce’s perceived educational needs within this unique legal environment. Methods: A descriptive, cross-sectional survey was conducted from February to August 2025. Using a non-probability convenience sampling method via professional networks, the survey yielded 362 total responses. Data were analyzed descriptively and inferentially using Chi-square (${\chi }^2$) tests to compare cohort responses on familiarity, practical exposure, knowledge of limitations, and interest in further training. Results: A universal and high demand for education was found, with 89.9% of all respondents being “Moderately” or “Very” interested in learning more about AI. This optimism coexists with dangerously low practical exposure. The gap was most profound among GPs, 44.1% of whom have “Never” used an AI tool—a rate significantly higher than hospital clinicians (34.9%; ${\chi }^2=3.14$, p = 0.045). Furthermore, 32.6% of GPs admitted that they “understand some benefits but not the limitations.” Conclusions: Italian clinicians mirror the global optimism–knowledge gap. These findings underscore the urgent need for structured, continuous education in AI literacy to address ethical and regulatory imperatives within the Italian healthcare system. Full article

Prosocial behavior supports social cohesion and legal order. Drawing on attachment theory and emotional socialization theory, this study examined whether peer attachment promotes prosocial behavior through positive legal emotion, defined as affective identification with and respect for law, and whether social exclusion moderates this pathway. A cross-sectional survey was conducted with 401 Chinese university students. Measures assessed peer attachment, positive legal emotion, social exclusion, and prosocial behavior. Gender and parental education were included as control variables. Correlational and regression analyses were conducted, followed by conditional process modeling using Hayes’ PROCESS Model 60 with 5000 bootstrap resamples to test mediation, moderation, and moderated mediation effects. Peer attachment significantly and positively predicted prosocial behavior. Positive legal emotion partially mediated the relationship between peer attachment and prosocial behavior. Social exclusion significantly moderated the association between peer attachment and positive legal emotion. The indirect effect of peer attachment on prosocial behavior through positive legal emotion became stronger as social exclusion increased. Moderated mediation analyses further confirmed that the indirect effect intensified at higher levels of social exclusion. Positive legal emotion represents an important psychological mechanism linking peer relationships to prosocial outcomes, while social exclusion functions as a key contextual boundary condition. Interventions that strengthen peer support, enhance legal emotional engagement, and reduce social exclusion may promote prosocial and legal socialization among university students and contribute to broader social integration and stability. Full article

Background/Objectives: With growing waves of migration, children speaking a home language different from the language of school literacy have become increasingly common in Western education systems. In this context, understanding and monitoring bilinguals’ reading development is crucial to inform both educational and clinical practices and ensure equitable services. The present study contributes to the literature by investigating learning patterns in single-word reading across primary school grades. Monolingual and bilingual children learning to read in an alphabetic orthography were examined. Methods: The sample consisted of 565 typically developing monolingual and bilingual primary school children from grades 1–5 (bilinguals = 162). Participants completed a computerised Lexical Decision task (LDT) recording accuracy and response times, and standardised tests of reading and cognition. A parental questionnaire was used to gather socio-demographic and linguistic information. Results: Response bias-corrected accuracy rates in the LDT revealed an increase in sensitivity across school years after correcting for potential confounds (SES, vocabulary, nonverbal intelligence). No significant effect of bilingualism was observed. Response times for correct responses also decreased consistently across grades after controlling for the same confounds. Although no significant main effect of bilingualism emerged, an interaction with grade revealed a greater decrease in response times for second-grade bilinguals compared to monolingual peers. Conclusions: Monolingual and bilingual children showed comparable sensitivity rates and reading times, suggesting similar decoding skill acquisition. However, an earlier decrease in response times for bilinguals points to a facilitatory effect in the early stages of reading development, consistent with a bilingual advantage during skill learning. Full article

Academic functioning in university students emerges from the interplay of motivational, self-regulatory, emotional, and contextual processes. The present study examined the network structure linking academic motivation, self-regulated learning, academic engagement, academic burnout, generalized anxiety, self-esteem, and students’ ratings of instruction. Participants were 530 university students from Western Romania (Mage = 28.86, SD = 9.75; 87.5% women). Data were collected through an online cross-sectional survey using validated self-report instruments. A Gaussian Graphical Model was estimated using the EBICglasso procedure to examine the unique associations among the study variables and their relative structural importance within the network. The results indicated a moderately dense psychological network, with academic burnout emerging as the most structurally central node. Intrinsic motivation toward achievement, identified regulation, and performance control were positioned within the adaptive core of the network, whereas burnout, anxiety, amotivation, and low self-esteem clustered within the maladaptive region. Academic engagement occupied an intermediary position linking motivational and self-regulatory processes. Overall, the findings support a systems-oriented interpretation of academic functioning, suggesting that burnout represents a key convergence point in students’ psychological functioning, while self-determined motivation and self-regulated learning may serve as protective processes. These results highlight the value of network analysis for identifying psychologically meaningful intervention targets in higher education. Full article

Background: Mechanistic evidence increasingly implicates fructose exposures as contributors to the development and exacerbation of asthma and other atopic diseases. Proposed mechanisms include gut dysbiosis, impaired epithelial barrier integrity in the gut and airways, metabolic endotoxemia, and amplification of type 2 immune responses. However, epidemiologic findings linking fructose intake with asthma and atopic disorders remain heterogeneous. Objective: To conduct a review of epidemiologic studies evaluating associations between dietary fructose-containing exposures and atopic outcomes in pediatric populations. Methods: A systematic search of PubMed and Embase identified cohort, case-control, cross-sectional, and randomized feeding studies assessing fructose exposure in relation to asthma and atopic outcomes in pediatric populations. Eligibility screening, data extraction, and risk-of-bias assessment were conducted by one reviewer and confirmed by the other. Results: Seventeen epidemiologic studies met criteria. Multiple cohorts (e.g., BRISA, PIAMA) reported modest to moderate associations between higher sugar-sweetened beverage (SSB) intake and pediatric asthma or “asthma traits.” Cross-sectional analyses from NHANES and the National Children’s Study showed stronger associations, with greater fructose exposures linked to two- to five-fold higher odds of asthma. High fructose beverage consumption demonstrated the most consistent positive associations. Large ISAAC-based studies reported largely null findings, reflecting broad dietary exposure categories and limited specificity for fructose-rich beverages. Evidence for rhinitis, eczema, and sensitization was directionally consistent. Conclusions: Despite heterogeneity, the convergence of mechanistic plausibility with epidemiologic signals supports a potential contributory role of high fructose exposure in pediatric atopic disease. More rigorous longitudinal studies with biomarker-based exposure assessment are needed to refine causal inference. Full article

Background/Objectives: Corneal endothelial cells (CEnCs) exist on the inner surface of the cornea and regulate its hydration. The immune system cannot penetrate CEnCs easily because the cornea is avascular and anterior chamber-associated immune deviation suppresses the immune reaction. Nevertheless, inflammatory cells can infiltrate through the corneal stroma and anterior chambers, and corneal endothelial inflammation can occur. In this cross-sectional study, we investigated the association between the neutrophil-to-lymphocyte ratio (NLR) and human corneal endothelial cells (CEnCs). Methods: A total of 307 eyes from 307 subjects who underwent specular microscopy were included. Corneal endothelial cell density (CECD), hexagonality (HEX), central corneal thickness (CCT), coefficient of variation (CV), and cell area were measured preoperatively using specular microscopy. Whole blood samples were obtained to measure the complete blood cell count. The NLR was calculated, and its relationship with CEnCs was evaluated. Results: In all subjects, CV was positively correlated with the percentage (%) of neutrophils (r = 0.120, p = 0.037) and absolute neutrophil count (r = 0.131, p = 0.022) and negatively correlated with the % of lymphocytes (r = −0.131, p = 0.022). HEX was correlated with the % of neutrophils (r = −0.156, p = 0.006), % of lymphocytes (r = 0.141, p = 0.014), % of basophils (r = 0.142, p = 0.013), the NLR (r = −0.129, p = 0.024), and the mean corpuscular volume (r = 0.121, p = 0.035). Conclusions: CV and HEX, which indicate the stability of CEnCs, are associated with NLR in the peripheral blood, suggesting that systemic inflammation and immunity may implicate in the pathology of CEnCs. Full article

Background/Objectives: Sarcopenia (SP) and osteoporosis (OP) are common yet underrecognized complications of liver cirrhosis, contributing to increased morbidity and mortality. Their coexistence, termed osteosarcopenia (OS), represents a compounded musculoskeletal impairment. Insulin-like growth factor 1 (IGF-1), synthesized in the liver, has been implicated in muscle and bone metabolism. This study aimed to assess the prevalence and association of laboratory and clinical parameters with SP, OP, and OS in cirrhotic patients, with a focus on IGF-1 deficiency and their impact on mortality. Methods: This cross-sectional study included 100 cirrhotic patients at a tertiary center. Sarcopenia was diagnosed using CT-derived L3 skeletal muscle index and osteoporosis via the DEXA scan. IGF-1 levels and metabolic parameters were measured. Multivariate logistic regression identified laboratory and clinical factors associated with musculoskeletal complications. However, due to the cross-sectional design, causal relationships could not be inferred. Results: SP, OP, and OS were present in 41%, 22%, and 11% of patients, respectively. IGF-1 levels were significantly lower in patients with SP, OP, and OS (p < 0.05) and were independently associated with increased risk of SP (OR = 1.797, p = 0.006), OP (OR = 1.873, p = 0.045), and OS (OR = 2.326, p = 0.003). Mortality rates were significantly higher among patients with OS (72.7%), OP (77.3%), and SP (56.1%). OS conferred the highest adjusted mortality risk (OR = 2.739, p = 0.009), followed by SP (OR = 2.278, p = 0.015) and OP (OR = 1.958, p = 0.036). Conclusions: Musculoskeletal complications are highly prevalent and predictive of mortality in cirrhosis. IGF-1 deficiency is a strong independent biomarker for SP, OP, and OS. Routine screening and early intervention targeting IGF-1 pathways and nutrition may improve outcomes in this population. Full article

Stay cables are critical load-bearing components in cable-stayed structures, making corrosion distribution vital for damage diagnosis and maintenance. To address the insufficient characterization of circumferential multi-point corrosion distribution in stay cables, a theoretical model of circumferential multi-point defect magnetic charge for the stay cables was established, and a self-magnetic flux leakage experiment was conducted on 37-wire steel specimens with circumferential corrosion. The effects of corroded wire number (N), corrosion time (T), and circumferential angle number (K) on the axial B_x component of the magnetic flux leakage signal were analyzed. The relationship between the θ-B_x-max peak distribution and corrosion patterns was clarified. Quantitative models for corrosion number (c), center (θ_c), and the cross-sectional corrosion rate (α) were established. The results indicate that c improves the determination of the number of concentrated corrosion sites in the ‘peak platform’ corrosion distribution type. Based on the Lorentz fitting, the maximum prediction error of θ_c is 15.1%, and the prediction accuracy of the cross-sectional corrosion rate α exceeds 90%. The study provides a reference for the quantifiable characterization and evaluation methods of the circumferential multi-point defect distribution in stay cables. Full article