Search Results (221)

Background/Objectives: Obesity is a chronic, progressive, and relapsing disease that requires long-term, multidisciplinary management rather than episodic weight-loss treatment. Although novel incretin-based anti-obesity pharmacotherapies, including GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, have markedly improved the clinical management of obesity, weight reduction alone does not fully capture treatment success. Body composition, lean mass preservation, physical function, nutritional adequacy, psychological well-being, adherence, and long-term weight-loss maintenance are increasingly recognized as essential therapeutic outcomes. This narrative review critically examines the role of lifestyle medicine as a co-therapeutic strategy during modern anti-obesity pharmacotherapy, with particular attention to physical activity, nutrition, behavioral support, and individualized monitoring. Methods: A narrative literature search was conducted in PubMed up to June 2026. The review included studies addressing adults with overweight or obesity and evidence related to anti-obesity pharmacotherapy, physical activity, nutrition, body composition, functional outcomes, eating behavior, quality of life, treatment tolerability, adherence, weight regain, and long-term maintenance. Results: Current evidence indicates that incretin-based therapies produce substantial and clinically meaningful weight loss, but pharmacological efficacy may be limited by reductions in lean mass, gastrointestinal adverse events, inadequate nutritional intake, treatment discontinuation, and weight regain after drug withdrawal. Physical activity should be considered a therapeutic component rather than only a tool for increasing energy expenditure, as aerobic exercise supports cardiometabolic health and cardiorespiratory fitness, while resistance training helps preserve muscle strength, bone health, and functional capacity. Nutritional strategies are equally important, particularly during appetite suppression, to maintain adequate protein, fiber, fluids, micronutrients, and diet quality. Behavioral factors, including sleep, stress, mood, stigma, self-regulation, and the food environment, may influence adherence and long-term outcomes. Conclusions: Novel anti-obesity drugs should not be viewed as replacements for lifestyle medicine but as powerful tools within an integrated chronic-care model. The goal of treatment should move beyond maximal body-weight reduction to durable improvements in body composition, metabolic health, physical function, nutritional status, quality of life, and weight-loss maintenance. Full article

Background/Objectives: Obesity is associated with alterations in cognitive control processes that support performance monitoring and dietary self-regulation, but the neurocognitive markers most closely tied to body weight status in young adulthood remain unclear. Methods: Sixty-two young adults completed a modified Simon task while continuous electroencephalography (EEG) was recorded. Response-locked event-related potentials (ERPs) were quantified for error-related negativity (ERN) and error positivity (Pe). The association between body mass index (BMI) and ERP amplitudes was examined under three parameterizations: BMI as a continuous variable, BMI split into three categories (normal weight, overweight, obese), and BMI split into two median-matched categories. Results: Higher BMI was associated with reduced (less negative) ERN amplitude under continuous (r = 0.30, p = 0.016, and median-split, Cohen’s d = −0.69, p = 0.009) specifications, and at the level of a trend under the three-group classification F(2, 59) = 2.80, p = 0.069, η²p = 0.09. The association was most consistent for neutral trials, where it reached significance under the continuous (r = 0.32, p = 0.010) and three-group (F = 3.31, p = 0.043) specifications and approached significance under the median-split (d = −0.51, p = 0.051). The BMI-ERN association remained significant after adjustment for age, sex, cardiorespiratory fitness, physical activity, and trait impulsivity. In contrast, Pe amplitude did not differ as a function of BMI under any specification. In exploratory analyses that did not survive correction for multiple comparisons, Pe amplitude was positively associated with mindful eating disinhibition and negatively associated with UPPS-P Positive Urgency, independent of BMI. Conclusions: These cross-sectional findings indicate that elevated adiposity in young adulthood is associated with attenuated pre-conscious conflict and error monitoring (i.e., ERN), whereas conscious error awareness (i.e., Pe) is unrelated to body weight status. The exploratory Pe–trait associations are offered as hypotheses for future confirmatory work rather than as established effects. Full article

Negative emotion and perceived food deliciousness are important factors contributing to unhealthy food choices, but their interaction during food decision-making remains unclear. This study examined how negative emotion and deliciousness congruency influence high-calorie food choices and related event-related potential (ERP) responses in overweight individuals (OWs) and normal-weight individuals (NWs). Fifty female college students, including 24 OWs and 26 NWs, completed a binary food choice task before and after negative and neutral emotion induction. Participants chose high-calorie foods more frequently and responded faster in the deliciousness-incongruent condition than in the deliciousness-congruent condition. Negative emotion increased high-calorie food choices among OWs but not among NWs. The deliciousness-incongruent condition elicited less negative N1 amplitudes and marginally less negative N2 amplitudes. P3 amplitudes were modulated by emotion, group, and deliciousness congruency, with negative emotion reducing P3 amplitudes in NWs but not in OWs. High-calorie food choices are jointly shaped by negative emotion, deliciousness congruency, and weight status. Deliciousness advantage facilitates high-calorie food choices, whereas negative emotion selectively increases such choices among OWs. ERP results suggest that these effects involve both early attentional processing and later evaluative processing. Full article

Objectives: Takotsubo syndrome (TTS) is an acute, often reversible disorder of left ventricular systolic function, the pathophysiology of which is complex and still being studied. A growing body of clinical research indicates that patients’ nutritional status may substantially influence the development and trajectory of Takotsubo syndrome. This review aims to systematically identify, map, and synthesize the existing scientific evidence on how malnutrition, nutrient deficiencies, and eating disorders contribute to Takotsubo syndrome (TTS), with particular attention being paid to the underlying pathophysiological mechanisms, predisposing factors, clinical manifestations, and prognostic implications. Methods: The scoping review was carried out following the methodological framework of the Joanna Briggs Institute (JBI) and in alignment with the PRISMA-ScR reporting standards. A comprehensive search for descriptors and keywords was performed across six electronic databases: PubMed, Scopus, Web of Science, EBSCO (MEDLINE Complete), Cochrane Library, and Google Scholar on 23–30 April 2026. Systematic reviews and meta-analyses were screened only to map the existing evidence landscape and identify research gaps, but they were not used as primary sources of data nor included in the final evidence synthesis. In line with scoping review methodology, no formal appraisal of the methodological quality of the included studies was undertaken. Results: Of the 19 articles initially identified, 8 met the inclusion criteria following a rigorous selection process. Key findings indicate that malnutrition on hospital admission is associated with significantly higher rates of 30-day adverse events and in-hospital mortality in patients with TTS. Eating disorders such as anorexia nervosa, by inducing electrolyte disorders and autonomic dysfunction, increase susceptibility to TTS and its complications. The impact of specific deficiencies (e.g., vitamin D) on the deterioration of hemodynamic parameters and the risk associated with renutrition syndrome that may trigger rare variants of TTS has also been documented. Conclusions: Malnutrition, nutritional deficiencies, and eating disorders are significant risk factors and prognosis modifiers in patients with Takotsubo syndrome, leading to an increased incidence of complications and mortality. Early and comprehensive management of nutritional status, including identification and correction of deficiencies and interdisciplinary treatment of eating disorders, is critical to improving clinical outcomes in this vulnerable patient population. Full article

Published microbiological data for Albanian artisanal dairy and meat supply chains remain limited, particularly for origin-specific cheeses, raw farm milk, and selected meat products. This targeted exploratory study examined 145 physical samples representing independent product lots or, for raw milk, independent bulk-milk lots obtained in separate collection events. The samples were organised into 29 organism-by-matrix analytical categories, with five independent experimental units in each category. ISO-based methods were used to enumerate hygiene indicators and screen for selected pathogens. Beta-glucuronidase-positive Escherichia coli counts were below 10 CFU/g in cow milk feta-type brined cheese and sausage, while Enterobacteriaceae counts were below 10 CFU/g in goat yoghurt and pistachio cake. In three raw-milk cheese-origin groups with quantified Escherichia coli data, mean counts ranged from 3.08 to 3.25 log CFU/g. For Liqenasi and Bardhoke, all five results in each category were >300 CFU/g and were treated as right-censored; the exact counts above this value were not quantified, so these observations were excluded from numerical summaries. Raw milk aerobic colony counts ranged from 4.52 to 6.52 log CFU/mL. Unconfirmed presumptive Salmonella spp. culture screening findings were obtained for 5/5 frozen chicken portions tested at 10 g and 5/5 pork portions tested at 25 g. Listeria monocytogenes was not detected in 5/5 ready-to-eat grilled chicken portions, each 25 g. Findings apply only to the sampled lots and support confirmatory sampling, complete lot documentation, and quantitative follow-up of right-censored results. Full article

Background/Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with psychiatric burden, but longitudinal data on incident psychiatric outcomes remain limited. This study aimed to evaluate incident psychiatric disorders in adults with HS compared with matched non-HS controls and to assess sex-specific risk. Methods: We conducted a retrospective propensity score–matched cohort study using the TriNetX Global Collaborative Network. Adults with at least two HS diagnoses and no prior psychiatric diagnosis were compared with non-HS controls with repeated general health examination encounters and no psychiatric history. Time-to-event analyses estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Sensitivity analyses used a 30-day lag and restriction to the most recent 5-year period. Results: After matching, 37,964 pairs were retained for the primary individual-outcome analysis. Median follow-up was shorter in the HS cohort than in matched controls (844 vs. 1505 days). HS was associated with increased risk of any psychiatric disorder (12.3% vs. 5.8%; HR 3.17, 95% CI 3.01–3.34) and severe psychiatric illness (0.6% vs. 0.1%; HR 6.70, 95% CI 4.77–9.41). Elevated risks were observed for bipolar/manic disorders, personality disorders, substance use disorders, psychotic disorders, suicidal ideation, depression, eating disorders, anxiety, and insomnia/parasomnia. Women had higher hazards of depression and anxiety, whereas men had higher hazards of substance use disorders; insomnia/parasomnia showed a nominal association with higher hazard in men. Conclusions: In this observational EHR-based study, HS was associated with broad incident psychiatric morbidity. These findings support consideration of proactive mental health assessment and integrated dermatologic–psychiatric care in patients with HS. Full article

Background/Objectives: Insomnia is a prevalent sleep disorder with substantial public health implications, yet epidemiological data from Serbia remain limited. This study aimed to assess the prevalence of clinically significant insomnia symptoms in the adult population of Serbia and to examine associated sociodemographic, comorbidity, psychosocial, and lifestyle factors. Materials and methods: A cross-sectional study was conducted from September 2023 to September 2025, including 2577 adults aged 18–89 years across Serbia. Insomnia symptom severity was measured using the Insomnia Severity Index (ISI), with scores ≥ 15 indicating clinically significant insomnia symptoms. Sociodemographic, comorbidity, psychosocial, and lifestyle factors were assessed via self-reported questionnaires. Multivariable logistic regression with LASSO variable selection was used to identify factors independently associated with clinically significant insomnia symptoms. Results: The prevalence of clinically significant insomnia symptoms (ISI ≥ 15) was 10.9%. Independent factors associated with clinically significant insomnia symptoms included being single (OR = 1.54) or divorced (OR = 1.75), lower educational attainment (OR = 0.71 per level increase), being retired (OR = 1.83) or a student (OR = 1.66), dermatological comorbidities (OR = 2.99), use of anxiolytic medications (OR = 2.44), exposure to stressful life events (OR = 1.88), engagement in late-night activities (OR = 1.37), consumption of coffee/tea (OR = 2.22), energy drink consumption (OR = 1.52), and late-night eating habits (OR = 1.27). Conclusions: Clinically significant insomnia symptoms among adults in Serbia are influenced by a complex interplay of sociodemographic, comorbidity, psychosocial, and lifestyle factors. These findings underscore the need for integrated approaches that address both medical and modifiable behavioral determinants in the prevention and management of insomnia symptoms. Full article

Accurate measurement of chewing events in natural eating conditions is important for unobtrusive monitoring of feeding behavior and masticatory function. Yet, existing methods often rely on contact sensors, dedicated wearables, or manual annotation. This work presents a non-contact, video-based framework for chewing-event detection using frontal facial video, normalized 3D facial landmark dynamics, and recurrent temporal modeling. To obtain physiologically grounded reference labels, synchronized bilateral anterior temporalis surface electromyography was acquired during real-meal sessions and used to derive chewing-event annotations during dataset construction, whereas inference relied exclusively on video. Facial motion was represented from frame-wise 3D landmarks and processed by recurrent neural networks, with model selection performed through Bayesian hyperparameter optimization. On an independent hold-out test set comprising five sessions and 18,836 frames, the proposed method detected 577 chewing events versus 589 ground truth events, corresponding to a mean absolute error of 4.4 chews/session and a mean absolute percentage error of 4.32%. A comparison with a related rule-based video method from the literature showed substantially larger counting errors (MAE = 39.4, MAPE = 30.39%), particularly in sessions that included concurrent activities such as speaking, suggesting that the proposed approach can reduce counting errors relative to the considered rule-based baseline under the specific meal conditions tested in this feasibility study. The effect of landmark-localization uncertainty on the predicted chewing probability was assessed through Monte Carlo propagation, showing limited impact for most prediction instants and greater sensitivity for intermediate probability values. Finally, the ONNX implementation achieved a mean latency of 8.96 ± 5.74 ms on CPU and 6.89 ± 3.58 ms with CUDA execution on the test workstation, supporting real-time applicability. To support practical deployment, the pipeline was also implemented as a native Kotlin Android application and tested on a commercial tablet, achieving real-time operation at 20 fps. Full article

Whether learned cognition can affect evolutionary outcomes remains a long-standing question. This study addresses a narrower mechanism: whether a model-based planner benefits from learned rules that explicitly condition on the action just taken. The testbed is a spatial artificial ecology with plants, shelters, a predator, reproduction, and a day/night cycle. Five rule-use arms are evaluated on matched simulation seeds. At age 200, agents switch to a weaker learned-lite planner that relies more strongly on learned rule predictions. The pre-specified hypothesis is that access to filtered action-conditioned rules improves outcomes relative to an otherwise identical no-rule-policy baseline, in which rules are still induced and stored but are not used for action selection. In thirty paired replicates under the default reproductive gates, the action-conditioned arm outperforms the no-rule baseline on all four pre-specified primary endpoints. The strongest effect is behavioural: the action arm produces 91.4 additional successful post-switch eating events per run ($d_z=1.56$, 93.3% paired win rate, $p<{10}^{-4}$). It also produces 10 additional crystallized clean-causal rules per replicate ($d_z=0.58$, $p_t=0.0034$). All four primary paired-t p-values remain significant after Bonferroni correction across the four-endpoint family. A diagnostic check shows that omitting reproductive cooldown from the planner’s rollout reverses the arm ordering on the same paired seeds; reinstating cooldown recovers the reported result. Two exploratory checks delimit the claim: broad unfiltered rule access can impair foraging, and a means–ends extension shifts behaviour toward reproduction without producing a robust whole-life fitness gain. Within this simulation, access to action-conditioned rules has a measurable effect on post-switch behaviour that is distinct from passive environmental prediction and from clean-crystallized rules alone. Full article

Binge-eating disorder (BED), defined as recurrent episodes of consuming large amounts of food in a short period of time while experiencing a loss of control, remains difficult to manage. Although several pharmacological options are available, they often provide limited long-term benefit and may cause adverse effects. Emerging evidence suggests that gut microbiota dysbiosis contributes to BED pathophysiology. Cytokine infiltration of the gut barrier ultimately causes neuroinflammation, highlighting the gut–brain axis as a potential therapeutic target. This systematic review and meta-analysis evaluated the effectiveness and safety of central nervous system-targeting pharmacotherapies and psychobiotics for BED. Cochrane Library, PubMed, and the Virtual Health Library were searched for randomized controlled trials published from January 2000 to January 2026. Eligible studies evaluated monotherapy with a central nervous system-acting drug or psychobiotics in clinically diagnosed BED populations. Twenty pharmacological trials (n = 2154) and five psychobiotic trials (n = 304) met the inclusion criteria. Risk of bias was assessed using the Cochrane RoB 2 tool, and pooled estimates were calculated using random-effects models. Pharmacological interventions showed a significant pooled effect versus placebo (Standard Mean Difference (SMD) = 0.307, 95% Confidence Interval (CI): 0.103–0.511, p = 0.003), although heterogeneity warrants cautious interpretation. Psychobiotics showed a moderate and significant effect (SMD = 0.680, 95% CI: 0.448–0.913; I² (heterogeneity index) = 0%) and no reported adverse events. Overall, our study implies that psychobiotics may be a safe and potentially effective adjunctive approach for BED, but larger, well-designed trials are needed. Full article

Background: Equine-assisted therapy (EAT) is a supportive intervention for children with autism spectrum disorder (ASD). Aim: This pilot study evaluated the feasibility of a cognitive–motor EAT intervention to explore its preliminary effects on motor coordination in children with ASD. Methods: A single-group pre-test–post-test design was adopted. Twelve children (mean age: 10.08 ± 1.51 years; ASD level 1–2) participated in a 16-week EAT program. The intervention integrated EAT with cognitive dual-task activities targeting attention and perceptual processing. Motor performance was assessed before and after the intervention using the Movement Assessment Battery for Children (MABC-2). Results: The RM-ANOVA examined pre–post changes. A significant improvement in the MABC-2 Total Test Score was observed (p = 0.036; ηp² = 0.34; 95% CI [0.541, 13.792]), indicating a trend of improvement of global motor coordination. No significant improvements were observed in Manual Dexterity, Aiming and Catching, and Balance subscale scores. Conclusions: A cognitively enriched EAT program promoted improvements in overall motor competence in ASD children, even without measurable changes in specific motor skills. The intervention was feasible and well-tolerated, with high adherence and no adverse events. These preliminary findings support the feasibility and potential value of integrating cognitive–motor demands into EAT and provide a rationale for larger randomized controlled studies. Full article

Background/Objectives: Time-restricted eating (TRE) has shown promise for improving glycemic control and supporting weight management in individuals with Type 2 Diabetes Mellitus (T2DM). However, limited evidence exists regarding factors that influence adherence to TRE in this population. This study aimed to explore the experiences of adults with T2DM who completed a 6-month TRE intervention to identify key barriers and enablers in adherence. Methods: A qualitative design was used involving semi-structured interviews with twenty-two adults (12 male, 10 female) with T2DM who completed a 6-month TRE intervention involving a 9 h eating window ending at 7:00 pm. Interviews were transcribed verbatim and analyzed inductively using thematic analysis. Results: Facilitators included (1) social and professional support; (2) simplicity; (3) perceived physical benefits such as weight loss, improved glycemic control, and sleep; and (4) improved routine. Barriers included (1) social events occurring outside the eating window; (2) misalignment of eating times with daily routines; and (3) hunger outside permitted eating hours. Although hunger was common, it did not consistently undermine adherence. Conclusions: TRE was viewed as acceptable and feasible for adults with T2DM when supported through structured implementation. Future interventions should incorporate social support and tailor strategies to individual routines to enhance sustainability. Full article

Explosive ordnance (EO), including AXO (abandoned explosive ordnance), IEDs (improvised explosives devices), and UXO (unexploded ordnance), are widely recognised for their blast and fragmentation hazards, but they also represent a persistent and under-addressed source of occupational chemical exposure for explosive ordnance disposal (EOD) personnel. EOD core activities liberate mixed metals and energetic chemicals, resulting in exposures that are multi-route (inhalation of dusts and fumes, dermal loading amplified by sweat and glove occlusion, and ingestion via hand-to-mouth transfer during eating, drinking, or smoking) and multi-temporal (repeated low-dose background plus task-driven spikes), as well as chemically complex. Clinically, this can present as syndromic overlap across acute and chronic domains, with symptoms that are easily misattributed to heat stress, dehydration, infection, or fatigue. Acute effects of concern include neurotoxic presentations (headache, dizziness, confusion, tremor, and seizure), respiratory and mucosal irritation following dust or fume events, gastrointestinal symptoms, and patterns suggestive of acute hepatic or renal stress, particularly when high-intensity tasks occur in hot environments that compound physiologic strain. Chronic outcomes relevant to repeatedly exposed EOD personnel include renal function decline, neurocognitive effects that can degrade operational decision making and safety, persistent haematologic abnormalities, and endocrine disruption signals, with long-latency risks requiring cautious interpretation given sparse longitudinal data and confounding co-exposures. This review synthesises the current evidence base through an EOD lens and translates it into pragmatic clinical and programmatic actions: task-based exposure characterisation; tiered biomonitoring and medical surveillance aligned to operational tempo; incident-triggered assessment pathways after high-residue events; and prevention strategies that work under field constraints, including contamination control zones, hygiene enforcement, glove and respiratory protection optimisation, tool and vehicle decontamination, and measures to prevent secondary transfer and take-home exposure. The central takeaway is practical: EOD programs can reduce morbidity and improve readiness by treating explosive ordnance as a chemical mixture exposure problem, adopting mixture-aware clinical triage, and embedding surveillance and controls that match how EOD work is actually performed. Full article

With the increasing demand for enhanced security and surveillance, the integration of multimodal AI has shown significant promise. We developed and fine-tuned a transformer-based model, the Large Language and Vision Assistant–OneVision, tailored for human event and action recognition. By utilizing a multimodal approach, we identified specific human actions, including eating, running, fighting, sitting, and sleeping, within diverse real-world settings. Through knowledge distillation and Low-Rank Adaptation, the model’s performance was optimized in demonstrating substantial improvements in context-aware recognition and response generation. Evaluation results showed recall-oriented understudy for obtaining evaluation (ROUGE)-1 score of 0.6844, ROUGE-2 score of 0.5751, ROUGE-L score of 0.6520, and the bilingual evaluation understudy score of 68.20, demonstrating significant gains in accuracy and interpretability. The model’s success highlights its potential for real-time applications in surveillance, healthcare, and interactive AI systems, providing reliable, efficient, and context-sensitive human action detection. Full article

Ischemic stroke and its chronic cerebrovascular complications represent significant public health challenges with considerable societal impact. Consequently, healthcare initiatives worldwide are placing greater emphasis on preventing and lowering cerebrovascular risk. Alongside medical therapies, it is now widely recognized that modifying risk factors—many of which are controllable—can substantially reduce the probability of acute cerebrovascular events, up to 33% according to data from trials such as PREDIMED. This modification is often achievable through dietary interventions such as the Mediterranean diet (MedDiet), which positively influences vascular health. The MedDiet, long established as the traditional eating pattern in Mediterranean regions, is an effective means of counteracting factors that jeopardize vascular health and elevate the risk of acute events. To date, there are no narrative reviews that have addressed the impact of the Mediterranean diet on cerebrovascular risk and the consequences of acute cerebrovascular events in terms of disability and neurological functional recovery, focusing on how individual components of the MedDiet, at the molecular level, contribute to the prevention of acute vascular episodes, paving the way for new approaches in the treatment of cerebrovascular patients. Full article