Search Results (13,348)

Background: Visceral obesity is increasingly recognised not as a simple excess of adipose tissue, but as a systemic pathological condition characterised by profound metabolic, endocrine, and immune dysregulation. Visceral adipose tissue (VAT) operates as an autonomous neuro-immune-endocrine organ whose dysfunctional expansion drives insulin resistance, atherogenesis, and accelerated cellular ageing through mechanisms converging on chronic low-grade sterile inflammation, referred to as inflammaging. Objectives: This narrative review integrates evidence across four domains: (1) the multi-system clinical complications of visceral obesity and the methodological controversies surrounding its measurement; (2) the cellular heterogeneity, immunometabolic reprogramming, and molecular mechanisms through which excess VAT accelerates biological ageing, with a focus on genomic instability, mitochondrial dysfunction, the NAD⁺/sirtuin regulatory axis, cellular senescence, and inter-organ communication; (3) the role of bioelectrical impedance analysis (BIA)—particularly phase angle—as a non-invasive functional biomarker of biological age and longevity, positioned critically against alternative assessment methods; and (4) current knowledge gaps and priorities for future research. Methods: A narrative review of PubMed/MEDLINE, Google Scholar, and the Cochrane Library was conducted using MeSH terms and free-text keywords including visceral obesity, bioelectrical impedance analysis, phase angle, sarcopenia, inflammaging, mitochondrial dysfunction, cellular senescence, epigenetic clocks, NAD⁺, sirtuin, and longevity, supplemented by citation-tracking of retrieved reviews. English-language articles published up to April 2025 were considered, prioritising systematic reviews, meta-analyses, and prospective cohort studies; formal risk-of-bias tools and quantitative synthesis were not applied, consistent with a narrative review design. Results and Discussion: BIA-derived phase angle constitutes a macroscopic electrobiological correlate of inflammaging: low phase angle values in visceral obese subjects overlap with those of frail elderly individuals, reflecting impaired membrane integrity, loss of active cell mass, and altered ICW/ECW balance. However, this evidence base remains largely cross-sectional and correlative; the directionality and population-specific calibration of BIA-derived indices constitute the principal unresolved methodological questions. Integration with epigenetic clocks, circulating NAD⁺ levels, and gut microbiome indices offers a framework for dynamic biological age assessment, though prospective interventional validation is still lacking. Sarcopenic obesity, evaluated through EWGSOP2 combined with BIA-derived skeletal muscle mass index and handgrip dynamometry, represents a critical comorbidity demanding integrated therapeutic targeting. Conclusions: BIA provides a quantitative, accessible correlate for translating cellular metabolic health into clinically actionable parameters, complementary to rather than a replacement for anthropometric and imaging-based methods. Optimising phase angle and reducing VAT through anti-inflammatory nutrition, exercise, and nutraceutical strategies targeting the NAD⁺/sirtuin and mTOR/AMPK axes constitutes a measurable objective for the promotion of healthy longevity, contingent on the longitudinal, mechanistic studies identified as priorities in this review. Full article

Per- and polyfluoroalkyl substances (PFAS) are persistent “forever chemicals” associated with environmental and public health risks. Despite increasing concern, policies and mitigation strategies often lag behind PFAS contamination, and many communities lack accessible solutions for reducing exposure. Effective risk communication is needed to develop public awareness of, engagement with, and adoption of PFAS mitigation practices. This study examined how risk message framing may influence behavioral intentions to reduce PFAS contamination in everyday living environments. A between-subjects experiment (N = 296) exposed participants to one of four PFAS messages varying in threat (high vs. low) and efficacy (high vs. low) levels. Participants reported very limited prior exposure to PFAS risk messaging. High-threat messages generated greater fear than low-threat messages, but high-efficacy messages did not produce significantly greater perceived efficacy than low-efficacy messages. The interaction between threat and efficacy significantly predicted emotional flow, with the high-threat/high-efficacy condition generating greater emotional flow than the low-threat/low-efficacy condition. Fear, perceived efficacy, and emotional flow were significant positive predictors of PFAS mitigation behavioral intentions. Findings suggest that PFAS risk communication should pair credible threat information with actionable efficacy cues that help audiences move from fear toward agency, hope, and protective intentions. Full article

Cutaneous graft-versus-host disease (GVHD) is a common complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT). Despite established guidelines, discrepancies persist between clinical trial evidence and real-world practice, particularly for newer agents such as ruxolitinib. To characterize the phenotypic spectrum of cutaneous GVHD, evaluate real-world treatment strategies—with a specific focus on systemic and topical ruxolitinib—and assess adherence to national and international guidelines, we conducted a retrospective observational study of patients undergoing allo-HSCT between 2015 and 2025 who were referred to a dedicated dermato-haematology clinic. Clinical, histological, and therapeutic data were collected. Cutaneous manifestations were classified according to National Institutes of Health (NIH) and Italian Group for Blood and Marrow Transplantation (GITMO) criteria. Of 62 transplanted patients, 44 (71%) developed GVHD, with the skin as the most frequently involved organ. Acute GVHD predominantly presented with maculopapular eruptions, whereas chronic GVHD showed heterogeneous phenotypes, including sclerotic variants. First-line management was largely guideline-concordant. Systemic ruxolitinib was administered to 3% of patients in the aGVHD group and 3% in the cGVHD group. Steroid-refractory and steroid-dependent status was not systematically recorded; therefore, treatment eligibility could not be reliably determined, and the observed frequencies should not be interpreted as evidence of underuse. Topical ruxolitinib was not used and remains investigational for cutaneous GVHD. Interpretation should also consider that the study period encompassed changes in regulatory approval, reimbursement, and access to targeted therapies. Structured multidisciplinary assessment may support the management of complex cutaneous GVHD, although its effects on treatment decisions and patient outcomes require prospective evaluation. Full article

Drowning is a largely preventable global public health problem. Many unintended drownings are linked to the initial responses to cold-water immersion (cold shock), which includes a rapid involuntary cardio-respiratory response that increases the risk of aspirating water within the first two minutes of immersion. Floating rather than struggling to swim can help survival in this circumstance. In light of early research and subsequent changes in anthropometry, we are re-examining whether bone mineral density (BMD) in people from African, Caribbean, and Asian communities influences their float. This study examined predictors of float outcome. A total of 101 participants of African, Caribbean, Asian, or mixed heritage were recruited; 96 attempted a two-minute supine float following instruction and practice, of whom 89 were successful. Body fat percentage strongly correlated with buoyancy and floating outcome, while other predictors, including BMD, showed weak or no association. Passive floaters (no movement required) demonstrated greater buoyancy and less exertion than active floaters (purposeful movement required). These findings suggest that body fat percentage is the primary factor influencing float outcome, and that with appropriate instruction and practice, individuals of African, Caribbean and Asian heritage can “find their float”. The results indicate that floating is a learnable competence and highlight the need for integrated drowning prevention strategies combining existing campaigns with accessible, community-based practices and co-produced approaches to improve engagement and equity. Full article

HIV-tuberculosis (HIV-TB) co-infection remains a leading cause of morbidity and mortality among people living with HIV and disproportionately affects immigrant and refugee communities in the United States. While antiretroviral therapy has improved HIV outcomes, cultural, social, and psychological barriers hinder timely diagnosis and sustained HIV-TB co-infection care in these populations. This integrative review aims to synthesize evidence on cultural, social, and psychological factors influencing access to diagnosis, treatment, and management of HIV, TB, and HIV-TB co-infection among immigrant and refugee populations in the United States. This study is an integrative review guided by Whittemore and Knafl’s framework. We conducted a systematic search of PubMed, Scopus, and CINAHL for peer-reviewed, mixed-methods, quantitative, qualitative, and review articles published in English between 2015 and 2025. After duplications were removed and dual screening of 107 retrieved records, 16 articles met inclusion criteria for this study. Findings were thematically categorized and synthesized. The themes generated were placed into three main categories: cultural factors including stigma and misperceptions about disease transmission; social factors such as limited healthcare access, lack of insurance, and socioeconomic marginalization; and psychological factors including fear of deportation, trauma, and mistrust of healthcare systems. Addressing HIV-TB co-infection in immigrant and refugee populations requires holistic, trauma-informed, and community-engaged strategies that integrate mental health support, culturally and linguistically tailored education, and policy reforms to remove structural obstacles. Future research should employ culturally validated measures to co-create sustainable interventions and advance health equity. Full article

Tuberculosis (TB) remains a leading cause of infectious disease-related mortality worldwide despite major advances in diagnostics, treatment, and programmatic control. Achieving the goals of the World Health Organization End TB Strategy requires a greater emphasis on prevention alongside improvements in diagnosis and treatment. This viewpoint examines evolving priorities in TB prevention and highlights key insights from studies included in the Special Issue ‘New Perspectives in Tuberculosis Prevention and Control’. The articles published in the Special Issue highlight the importance of identifying populations at increased risk of infection, disease transmission, and disease progression; strengthening the implementation of tuberculosis preventive treatment among household contacts and people living with HIV; and addressing the behavioral, social, and structural determinants that influence access to TB prevention and care. They also demonstrate persistent challenges related to medicine availability, healthcare worker capacity, patient initiation and follow-up, program monitoring, and the implementation of preventive interventions in resource-constrained settings. Emerging developments in diagnostics, biomarkers, vaccines, and digital health may contribute to the longer-term TB prevention agenda but require further evaluation of their feasibility, affordability, and programmatic relevance. Collectively, the evidence indicates that effective TB prevention extends beyond individual biomedical interventions and requires coordinated approaches involving healthcare systems, communities, surveillance systems, and social support mechanisms. Continued investment in implementation research, health-system strengthening, program management, economic evaluation, and multisectoral action will be critical to translate existing evidence into sustainable, equitable, and context-specific strategies for reducing the global burden of TB. Full article

Latin America and Africa face complex public health challenges shaped by social, environmental, and epidemiological factors. This study conducts a comparative analysis of publicly available national health strategies and national policy documents from 52 countries in Africa and 12 countries from Latin America, supplemented with data from the World Health Organization (WHO) and Pan American Health Organization (PAHO). The analysis focuses on five domains: social determinants of health, environmental health, infectious diseases, non-communicable diseases (NCDs), and immunization. This study examines how these health priorities are represented in national policy frameworks. Across the reviewed country sample, national policy documents tend to emphasize challenges related to health care access, the growing burden of NCDs, and environmental risks. In selected Latin American countries, migration-related pressures, health system fragmentation, and uneven vaccination coverage are primarily highlighted. In selected African countries, policy priorities tend to focus on communicable diseases, infrastructure limitations, and large zero-dose populations. The study underscores policy priorities and highlights opportunities for cross-regional learning. Strengthening primary health care, improving domestic health financing, and enhancing environmental health governance emerge as key areas for policy development. These findings support the value of comparative policy analysis in informing context-sensitive and equity-oriented health strategies. Full article

Background/Objectives: While there is an existing body of quantitative data on the psychological and mental burden of suicide-bereaved parents, further qualitative research is needed to explore suicide-bereaved mothers’ living experiences in specific sociocultural contexts, especially in Southern Europe and the Eastern Mediterranean. Given the persistent stigma surrounding suicide in these societies, and the fact that previous research has often overlooked mothers’ perspectives in favor of broader samples of bereaved parents, we explored the psychosocial needs of Greek-speaking suicide-bereaved mothers in the Republic of Cyprus, and their experiences in accessing formal mental healthcare support. Methods: An inductive, secondary content analysis of qualitative data collected through personal semi-structured interviews with ten suicide-bereaved mothers was employed. Results: Participants’ psychosocial needs centered around a “persistent orientation towards protection,” encompassing three interconnected domains: (1) self-protection and the need for acceptance by shielding themselves from stigma, social judgment, and emotional disintegration, (2) ensuring a safe and protective environment for the surviving family by safeguarding the psychological well-being and cohesion of surviving family members, and (3) protecting the posthumous dignity and memory of the deceased child. Rather than seeking formal support, participants overwhelmingly avoided mental health services, citing a lack of empathy, cultural misunderstanding, and fear of further stigmatization. Mental health professionals were often perceived as inadequate or even harmful, undermining participants’ need for protective attitudes, self-reliance and self-respect during bereavement. These responses reflected how stigma and gendered social expectations surrounding suicide shaped participating bereaved mothers’ disengagement from the healthcare system, despite their intense psychological needs. Conclusions: These findings underscored how gendered social expectations, combined with the stigma surrounding suicide, created significant psychosocial barriers to mental health care for women navigating traumatic grief, particularly in sociocultural contexts where suicide remains highly stigmatized. Full article

Excessive fluoride in groundwater and industrial wastewater poses serious risks to human health. Although commercial γ-alumina is a low-cost adsorbent recommended for defluoridation, its limited adsorption capacity and poor regeneration stability hinder its practical application. In this work, three template-free γ-alumina materials with distinct morphologies (nanosheets, rhombic flakes, and nanofibers) were synthesized by a mild hydrothermal method and systematically compared with commercial granular γ-alumina. To isolate the effect of morphology, all four γ-alumina adsorbents were prepared with comparable BET surface areas (180–230 m²·g⁻¹). Their structural, morphological, and surface properties were comprehensively characterized, and their fluoride adsorption performance, adsorption mechanism, and regeneration behavior were systematically evaluated. Despite their similar BET surface areas, the four samples exhibited markedly different adsorption performances. At an initial fluoride concentration of 600 mg·L⁻¹, the adsorption capacity followed the order: nanosheets (87.2 mg·g⁻¹) > nanofibers (49.0 mg·g⁻¹) > rhombic flakes (46.1 mg·g⁻¹) > commercial alumina (35.0 mg·g⁻¹). The superior adsorption performance of the nanosheet morphology suggests that the accessibility and local chemical environment of surface hydroxyl species, rather than their total abundance alone, play an important role in fluoride adsorption. In contrast, nanofibrous XW-600 exhibited superior resistance to repeated acid–alkali regeneration, preserving its crystal structure and fibrous morphology while maintaining the highest residual adsorption capacity among the synthesized alumina samples after five regeneration cycles. Overall, the results suggest that alumina morphology strongly influences fluoride adsorption performance and regeneration stability. This work provides a simple, template-free strategy for preparing morphology-controlled γ-alumina and offers new insights into the relationship between alumina morphology and fluoride adsorption, providing guidance for the rational design of high-performance, regenerable alumina adsorbents. Full article

Access to safe, nutritious, and sustainable food remains a major challenge in many Low- and Middle-Income Countries (LMICs), where food insecurity, malnutrition, and foodborne diseases frequently coexist. Despite growing recognition of the interconnections between food safety, nutrition security, and sustainability, monitoring systems often assess these dimensions separately, limiting the effectiveness of policy interventions. This study conducted a structured methodological review and framework development study of indicators used to monitor food safety, nutrition security, and sustainability within food systems, with particular emphasis on LMIC contexts. Peer-reviewed literature and internationally recognized monitoring frameworks, drawn from Scopus, Web of Science, PubMed, Google Scholar, and institutional repositories including FAO, WHO, World Bank, and GAIN, were systematically reviewed, yielding 75 sources encompassing 54 peer-reviewed articles and 21 institutional reports, from which 47 indicators were identified and assessed. Indicators were evaluated according to relevance, data availability, methodological robustness, and policy actionability. The review identified a core set of ten operationally relevant indicators, including the Global Diet Quality Score (GDQS), Minimum Dietary Diversity for Women (MDD-W), Food Insecurity Experience Scale (FIES), foodborne disease burden indicators, cost of a healthy diet, and post-harvest loss rates. Building on these findings, an integrated indicator selection framework is proposed to support context-specific monitoring and decision-making in LMICs. The results suggest the value of a One Health approach that links human, animal, and environmental health, and three One Health interface indicators, antimicrobial resistance prevalence in food chain isolates, zoonotic disease incidence attributable to food, and pesticide residue exceedance rate in fresh produce, are explicitly integrated into the proposed framework with LMIC-specific implementation pathways. A key limitation of this review is that it did not employ formal systematic methods and may not have exhaustively identified all relevant indicators across the full breadth of the published literature. Full article

Background/Objective: The Behavioral and Mental Wellness in Indigenous Communities (BMWIC) education program was created to address mental health (MH) resource gaps in the Fort Belknap Community (FBC). Designed to enhance MH literacy, task-shifting capacity, and MH care coordination skills, the FBC partnered with Johns Hopkins School of Nursing (JHSON) to co-develop a culturally aligned MH training program. This protocol outlines the development of the BMWIC curriculum. Methods: Steps 1–5 of the 6-step Collaborative Participatory Adaptation Model (CPAM) guided the development of the BMWIC, including collaboration, review of evidence-based models, cultural adaptation of materials, and the creation of a robust evaluation plan to be conducted. Four courses were ultimately developed on: historical trauma, culturally informed MH screening and care, risk and protective factors and health-related Tribal, state and federal legal jurisdiction in American Indian and Alaska Native (AI/AN) communities. Discussion: The BMWIC development process serves as a prime example of translating community priorities into an educational intervention through a combination of best practices in health science education with Indigenous ways of knowing (IWK). Targeted training and task shifting, such as through the BMWIC, may have the potential to expand MH-related knowledge and strengthen the capacity of community health systems to identify psychological and behavioral concerns early, coordinate care more effectively, and improve access to MH care and resources at the community level. Conclusions: This protocol may be useful for academic-community partnerships creating culturally informed educational programs across disciplines and specialties in service to Indigenous communities. The next steps will involve piloting and evaluating the curriculum and collaborating with healthcare organizations to determine sustainable pathways for scaling the BMWIC where it is most needed. Full article

Background: Emergency medical services (EMS) personnel experience high rates of psychological distress yet demonstrate low utilization of mental health services. Factors associated with actual service use—rather than intentions or attitudes—are not well understood. Methods: Using secondary data from 36,697 licensed Florida EMTs and paramedics collected during the 2022 licensure renewal process, logistic regression models evaluated the relative contributions of workplace factors, attitudinal variables, trauma exposure, and mental health symptoms in their association with service utilization. Results: Psychological symptoms, particularly anxiety and depression, were the strongest factors associated with help-seeking. Peer support emerged as one of the few system-level factors associated with increased service use, even after accounting for symptom presence. Stigma-related variables showed weaker and, in some cases, counterintuitive associations. Suicidality and substance use were modestly associated with help-seeking beyond core symptom variables. Findings were consistent among trauma-exposed personnel. Discussion: Results are consistent with the potential value of early identification, routine symptom screening, and integrated, system-level supports such as peer support and access to confidential, occupationally competent care. Full article

The consumption of plant-based milk alternatives (PBM) has increased rapidly in recent years due to growing concerns about sustainability, health, and animal welfare. This study summarizes international research on consumer behavior related to PBM products based on large-sample questionnaire surveys and openly accessible sources. A scoping review was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and the methodological framework of Arksey and O’Malley. Relevant articles were identified through the Web of Science, ScienceDirect, and Dimensions databases. After a two-stage screening process, only Open Access journal articles published between 2018 and 2024 were included, covering studies conducted across Europe, North America, the Middle East, the Far East, and Australia. Eligible studies used questionnaire-based methods, involved at least 200 respondents, and focused on consumer behavior toward plant-based milk alternatives. The selected studies were analyzed using the “when–where–what” framework, considering research periods, geographical locations, and investigated topics. Findings were synthesized in a summary table and supported by a graphical model illustrating key consumer behavior dimensions. Results show that taste, health consciousness, environmental sustainability, and animal welfare are the main drivers of PBM consumption across different countries and cultures. However, price sensitivity, nutritional concerns, and strong attachment to conventional dairy products remain significant barriers to wider adoption. These findings can support the identification of target consumer groups and the market positioning of PBM products, while also providing a foundation for future consumer behavior research. By establishing the scope, volume and comparability of the existing quantitative evidence base, this scoping review also assesses whether the literature is sufficiently mature to support a subsequent systematic review. Full article

Background/Objectives: Methylphenidate is widely used for attention-deficit/hyperactivity disorder and is available in immediate-release (IR) and extended-release (XR) formulations. Long-term reported private-sector dispensing data from Costa Rica remain limited. Because methylphenidate is a controlled medication, longitudinal dispensing trends are relevant for monitoring access, formulation use, and dose-standardized exposure at the health-system level. This study described reported private-sector methylphenidate dispensing trends from 2017 to 2024 by dispensed boxes and Defined Daily Doses (DDDs). Methods: This retrospective ecological drug-utilization study analyzed reported private-sector administrative controlled-substance dispensing records from 1 January 2017 to 31 December 2024. Products were standardized by brand or generic designation, strength, dosage form, and formulation class. Outcomes included annual and cumulative dispensed boxes, formulation-specific share, XR-to-IR ratio, year-over-year change, presentation-level distribution, population-standardized rates, and DDDs calculated using the WHO reference value of 30 mg/day. Results: Total dispensing increased from 988,739 boxes in 2017 to 2,774,698 boxes in 2024 (+180.63%; CAGR 15.88%). Overall, 13,807,824 boxes were dispensed; IR accounted for 9,344,944 boxes (67.68%) and XR for 4,462,880 boxes (32.32%). In DDDs, XR exceeded IR in every study year and represented 61.0% of cumulative dose-standardized exposure. Conclusions: Reported private-sector methylphenidate dispensing in Costa Rica increased substantially between 2017 and 2024. IR predominated by dispensed boxes, whereas XR predominated by DDDs, highlighting the importance of reporting both administrative volume and dose-standardized metrics. These findings provide a private-sector baseline for controlled-medication surveillance and may inform monitoring of access, formulation mix, and dose-standardized exposure to methylphenidate in Costa Rica. Full article

This article examines how sexual violence against Indigenous women and girls is compounded by intersectional discrimination and secondary victimisation within state institutions. It conducts a structured, focused cross-regime comparative jurisprudential analysis of Inter-American Commission on Human Rights (IACHR) Case 11.565 (González Pérez et al. v. Mexico) and the UN Committee on the Rights of the Child (CRC) Views in Camila v. Peru. The cases are purposively paired because they share a common legal phenomenon—sexual violence against Indigenous survivors followed by rights-relevant institutional responses—while differing in age, immediate perpetrator, institutional pathway and international regime. The study combines doctrinal analysis with a normatively traceable benchmark framework derived from the American Convention on Human Rights, the Convention of Belém do Pará, CEDAW, the Convention on the Rights of the Child, ILO Convention No. 169, UNDRIP and international investigation standards. Six domains are assessed categorically: language and cultural accessibility; secondary victimisation and survivor-centred treatment; investigation and evidentiary practice; health and informed consent; protection from reprisals and displacement-related harms; and reparations and guarantees of non-repetition. The comparison identifies recurring failures in linguistic access, institutional treatment, protection and implementation of structural remedies. It argues that intersectionality is constitutive of the legal harm, not merely contextual, and that it modifies the content of due diligence by requiring enhanced, intercultural and child-sensitive institutional safeguards. The framework does not quantify harm or rank violations; it makes the legal and institutional basis of the comparison transparent and offers actionable benchmarks for institutional design, litigation and monitoring. Full article