Search Results (33,434)

(1) Background: The COVID-19 pandemic presented unprecedented challenges for people with multiple sclerosis (PwMS) in Oman, necessitating targeted healthcare planning and patient support. This study aimed to investigate the impact of COVID-19 on MS management and disease course, incidence, and outcomes of COVID-19, psychosocial and mental health effects of the pandemic, and demographic and clinical predictors of the effects related to COVID-19 among Omani PwMS. (2) Methods: This cross-sectional study was conducted from January to April 2021. Adult (18–60 years) Omani PwMS completed a structured interview along with the Expanded Disability Status Scale (EDSS) and World Health Organization Well-being Index (WHO-5). Clinical data on relapses and disease-modifying therapies and adherence were analyzed. The data was statistically analyzed. (3) Results: Of 104 PwMS (73.1% female), 22.1% contracted COVID-19, with fatigue being the most reported symptom (87%). Female sex (p = 0.042), younger age (18–34 vs. 35–45 years; p = 0.014), diagnosis of COVID-19 (p = 0.037), and low current mental well-being scores (p = 0.021) predicted greater COVID-19-related effects. (4) Conclusion: These findings highlight the need to study the mental resilience of this subgroup of PwMS and provide them with targeted support during crises. Full article

Background: Varicella remains a prevalent vaccine-preventable disease, but breakthrough infections are increasingly reported. However, long-term, population-based studies investigating the temporal and demographic characteristics of breakthrough varicella remain limited. Methods: This retrospective study analyzed surveillance data from Jinhua City, China, from 2016 to 2024. Varicella case records were obtained from the China Information System for Disease Control and Prevention (CISDCP), while vaccination data were retrieved from the Zhejiang Provincial Immunization Program Information System (ISIS). Breakthrough cases were defined as infections occurring more than 42 days after administration of the varicella vaccine. Differences in breakthrough interval were analyzed across subgroups defined by dose, sex, age, population category, and vaccination type. A bivariate cubic regression model was used to assess the combined effect of initial vaccination age and dose interval on the breakthrough interval. Results: Among 28,778 reported varicella cases, 7373 (25.62%) were classified as breakthrough infections, with a significant upward trend over the 9-year period (p < 0.001). Most cases occurred in school-aged children, especially those aged 6–15 years. One-dose recipients consistently showed shorter breakthrough intervals than two-dose recipients (M = 62.10 vs. 120.10 months, p < 0.001). Breakthrough intervals also differed significantly by sex, age group, population category, and vaccination type (p < 0.05). Regression analysis revealed a negative correlation between the initial vaccination age, the dose interval, and the breakthrough interval (R² = 0.964, p < 0.001), with earlier and closely spaced vaccinations associated with longer protection. Conclusions: The present study demonstrates that a two-dose varicella vaccination schedule, when initiated at an earlier age and administered with a shorter interval between doses, provides more robust and longer-lasting protection. These results offer strong support for incorporating varicella vaccination into China’s National Immunization Program to enhance vaccine coverage and reduce the public health burden associated with breakthrough infections. Full article

Introduction: Extrinsic skin damage is often a result of oxidative stress caused by exposure to environmental factors such as ultraviolet (UV) radiation, ozone (O₃), and various pollutants. As a result, topical antioxidants have been evaluated for their effectiveness in mitigating or reversing skin damage caused by environmental factors. Topical antioxidants containing a combination of l-ascorbic acid, tocopherol, and ferulic acid have significantly improved markers of skin health after exposure to environment-induced skin damage. However, research suggests that l-ascorbic acid and tocopherol tend to be relatively unstable, possibly affecting their efficacy against outdoor stressor damage. It has been shown that ferulic acid significantly improves the stability of both l-ascorbic acid and tocopherol, but its long-term stabilization effects on these antioxidants are relatively unknown. Material and Methods: This study evaluated the time-dependent effectiveness of a topical antioxidant mix containing 15% l-ascorbic acid, 1% tocopherol, and 0.5% ferulic acid (AOX) on UV-induced skin damage. Skin biopsies (12 mm, n = 60) were placed in a 6-well plate with medium and incubated at 37 °C and 5% CO₂ overnight. The day after, skin samples were pretreated with 10 µL of differently aged AOX (0-, 6-, 12-, and 36-month-old) and then exposed to different doses of UV light (100, 200, 400 mJ/cm²) daily over four days. AOX formulations were stored in a cool, dry, and dark place at approximately 20–22 °C during the whole study. This study evaluated 4-hydroxynonenal (4-HNE) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) as oxidative damage and skin DNA damage markers, Collagen1 and Filaggrin as skin structure, and IL-8 and Nrf2 as inflammatory and defensive response. Results: UV exposure significantly increased oxidative and inflammatory markers in human skin explants affecting also filaggrin and collagen levels. However, pre-treatment with the antioxidant formulation, particularly in its younger formulations (0-, 6-, and 12-month-old), significantly reduced the damaging effect of UV. Additionally, all antioxidant formulations effectively mitigated UV-induced damage across all doses. Conclusions: Our results indicate that pre-treatment with this formulation consistently reduces UV-induced oxidative damage and DNA damage in human skin explants, regardless of the formulation age and the discoloration state. Although effective, the protective capacity of aged formulations may be reduced only when extreme UV exposure is tested, a condition that is unlikely to occur under typical environmental conditions. These results support ferulic acid as a stabilization agent for topical antioxidant mixtures. Full article

Stunting is a chronic growth disorder that not only affects height but may also impair craniofacial development. Facial proportions, especially in the vertical dimension, may provide additional anthropometric insight into growth status among children. Objectives: To assess and compare the vertical and horizontal facial proportions of stunted and non-stunted children, and to explore the potential of facial dimensions as supportive indicators for early-stunting detection in community-based settings. Methods: This cross-sectional analytical study involved 266 children aged 7–72 months (mean age 42.63 ± 13.82 months) from several community health centers in Bandung, Indonesia. Children were categorized as stunted or non-stunted based on WHO height-for-age Z-scores. Facial dimensions were measured directly by calibrated pediatric dentistry residents using manual instruments. The vertical dimensions included Nasion–Subnasale (N–SN) and Subnasale–Menton (SN–M), while horizontal dimensions included zygomatic width and intergonion width. Data were analyzed using the Mann–Whitney U test and Spearman correlation. Results: Significant differences were found in vertical facial dimensions between stunted and non-stunted children: median N–SN (32.4 mm vs. 33.6 mm; p = 0.003) and SN–M (42.5 mm vs. 45.1 mm; p < 0.001). No significant differences were observed in horizontal dimensions. All facial parameters showed a positive correlation with age (p < 0.001). No significant differences were found based on sex. Conclusions: Stunted children exhibited shorter vertical facial dimensions compared to their non-stunted peers, while horizontal dimensions remained stable across groups. Vertical facial proportions may serve as supportive indicators in the screening and monitoring of childhood stunting. This method has potential for integration into community-based growth monitoring using simple or digital anthropometric tools. Full article

Heme, an essential prosthetic group involved in mitochondrial respiration and transcriptional regulation, is synthesized via the rate-limiting enzyme 5-aminolevulinic acid synthase (ALAS). Utilizing heterozygous mouse models for ALAS1 and ALAS2, our studies have revealed diverse systemic consequences of chronic heme deficiency. ALAS1-heterozygous (ALAS1+/−) mice develop metabolic dysfunction characterized by insulin resistance, glucose intolerance, and abnormal glycogen accumulation, linked mechanistically to reduced AMP-activated protein kinase (AMPK) signaling. These mice also exhibit pronounced mitochondrial dysfunction, impaired autophagy, and accelerated aging phenotypes, including sarcopenia and metabolic decline, highlighting heme’s role as a critical metabolic regulator. Additionally, ALAS2 heterozygosity (ALAS2+/−) leads to impaired erythropoiesis, resulting in anemia and ineffective iron utilization. Importantly, supplementation with the heme precursor 5-aminolevulinic acid (5-ALA) significantly mitigates ALAS1+/− phenotypes, restoring metabolic function, mitochondrial health, autophagy, and immune competence. This review encapsulates key findings from our group’s research together with advances made by multiple research groups over the past decade, collectively establishing heme homeostasis as a central regulator of systemic physiology and highlighting the therapeutic potential of 5-ALA in treating heme-deficient pathologies. Full article

The COVID-19 pandemic exacerbated mental illness, accelerated cognitive decline, and deepened social inequalities. In low and middle-income countries (LMIC) such as Panama, it is unclear as to whether, and to what extent, the pandemic lockdowns affected cognitive, mental, and physical health of older adults. This study investigated changes in cognitive function, mental health, and physical health in a sample of Panamanian older adults assessed before and during the pandemic, and examined whether sociodemographic variables were associated with cognition and mental health. Participants completed in-person interviews between 2018 and early 2020 and a follow-up telephone interview between February and May 2021. Repeated measures analyses showed no significant changes in cognitive function or depression; however, participants reported fewer chronic illnesses. Linear regression analysis indicated that higher cognitive function during the pandemic was associated with younger age, higher education, and having sufficient income. An attrition analysis compared participants who completed both interviews to those who were lost to follow-up, revealing that participants who dropped out of the study had lower socioeconomic status and greater impairment at baseline. These findings highlight the need for targeted support for vulnerable older adults during public health crises. Full article

The increasing prevalence of chronic metabolic diseases poses a significant challenge in the modern world, impacting healthcare systems and individual life expectancy. The World Health Organization (WHO) recommends that older adults (65+ years) engage in 150–300 min of moderate-intensity or 75–150 min of vigorous-intensity physical activity, alongside muscle-strengthening and balance-training exercises at least twice a week. However, nearly one-third of the adult population (31%) is physically inactive, which increases the risk of developing obesity, type 2 diabetes, cardiovascular diseases, hypertension, and psychological issues. Physical activity in the form of aerobic exercise, resistance training, or a combination of both is effective in preventing and managing these metabolic diseases. In this review, we explored the effects of exercise training, especially on respiratory and pulmonary factors, including oxygen consumption, pulmonary ventilation, and blood gas analyses among adults. During exercise, oxygen consumption can increase up to 15-fold (from a resting rate of ~250 mL/min) to meet heightened metabolic demands, enhancing tidal volume and pulmonary efficiency. During exercise, the increased energy demand of skeletal muscle leads to increases in tidal volume and pulmonary function, while blood gases play a key role in maintaining the pH of the blood. In this review, we explored the influence of age, body composition (BMI and obesity), lifestyle factors (smoking and alcohol use), and comorbidities (diabetes, hypertension, neurodegenerative disorders) in the modulation of these physiological responses. We underscored exercise as a potent non-pharmacological intervention for improving cardiopulmonary health and mitigating the progression of metabolic diseases in aging populations. Full article

Background/Objectives: Older adults (65+) are the fastest growing age group in Canada, comprising 18.8% of the country’s population. During the COVID-19 pandemic, use of virtual care, including telehealth and tele-medicine, increased dramatically among older adults in Canada who often face higher health risks, mobility limitations, and many barriers to accessing healthcare. Despite the rapid expansion in virtual care, no systematic review has focused specifically on virtual care among older adults in Canada. This review aims to explore the factors influencing virtual care adoption and the experiences of older Canadians during the pandemic through a systematic review. Methods: Conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the review involved a comprehensive search of PubMed, Scopus, ESCBOHost, and Web of Science on 2 May 2025, yielding 281 unique citations. After screening and applying eligibility criteria, 15 studies employing quantitative, qualitative, or mixed-methods designs, with sample sizes ranging from 15 to 2,282,798, were included and appraised using the Mixed Methods Appraisal Tool (MMAT). Results: The review identified three domains of factors and the ways in which each factor shapes older adults’ virtual care experiences: (1) personal factors influencing virtual care use and demand (e.g., age, education, language, income, immigration status, community sizes), (2) resource factors impacting virtual care adoption (e.g., technology access, support), and (3) varying virtual care experiences among older adults (e.g., in assessment and communication efficacy, privacy, care quality, convenience, safety, and costs). Conclusions: This review highlights the complexities of virtual care engagement among older adults and underscores the need for inclusive, tailored strategies to improve the accessibility and effectiveness of virtual care delivery in both pandemic and post-pandemic contexts. Full article

Background: Exposure-based cognitive behavioral therapy (Ex-CBT) is widely seen as the gold-standard treatment for anxiety and obsessive-compulsive disorder (OCD). Yet, minoritized youth are underrepresented in efficacy studies, raising questions about the applicability of Ex-CBT to minoritized youth. Effectiveness data suggest systematic adaptation of Ex-CBT to address youth culture and context is likely needed, and many clinicians make adaptations and augmentations in practice. However, research on the specific strategies clinicians use to address their youth clients’ culture and context within anxiety and OCD treatment is lacking. In the current study, we assess practice-based adaptations, augmentations, and process-based approaches utilized when delivering treatment to youth for OCD and anxiety in public mental health clinics. Methods: We conducted qualitative interviews with 16 clinicians from both specialty anxiety and general mental health clinics serving youth with anxiety or OCD in the public mental health system. Participating clinicians had a mean age of 32.19 (SD = 5.87) and 69% of therapists identified as female; 69% identified as White, 25% identified as Asian, and 6% as Black or African American. In qualitative interviews, clinicians shared how they addressed clients’ culture and context (e.g., social identities, stressors and strengths related to social identities and lived environment). Thematic analysis identified the strategies clinicians employed to address culture and context. Results: Clinicians reported incorporating culture and context through process-based approaches (e.g., building trust gradually, considering clients’ social identity stressors, engaging in self-awareness to facilitate cultural responsiveness) and through culturally adapting and augmenting treatment to promote person-centered care. Core strategies included proactive and ongoing assessment of clients’ cultural and contextual factors, adapting exposures and augmenting Ex-CBT with strategies such as case management and discussion of cultural context, and taking a systems-informed approach to care. Conclusions: Examining practice-based adaptations, augmentations, and process-based approaches to treatment for minoritized youth with OCD or anxiety can inform efforts to understand what comprises person-centered culturally responsive Ex-CBT. Empirical testing of identified strategies is a needed area of future research. Full article

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the effects of mild exercise during chemotherapy on patient anxiety. Methods: This prospective paired cohort study was conducted in the General Oncology Hospital of Kifisia “Agioi Anargyroi” in Athens, Greece. Adult cancer patients undergoing chemotherapy participated, excluding those with cognitive, hearing, or motor impairments, those who experienced side effects, or those who declined consent. Anxiety was measured before and after a 20-minute exercise routine performed during chemotherapy, using the Greek-translated State–Trait Anxiety Inventory (STAI). The exercise regimen included warm-up, full-body stretching, and cool-down exercises. Pre- and post-exercise scores were analyzed using the Wilcoxon signed-rank test. Results: Forty-five patients (20 women, 25 men; mean age 69.02 ± 10.62 years) with various cancer backgrounds participated. Pre-intervention anxiety levels were in the borderline “moderate” range, dropping post-exercise to the “low” range. Mean STAI scores decreased from 37.73 ± 13.33 to 32.00 ± 14.22 (p < 0.0001), with a medium-large effect size (Cohen’s d for paired samples = −0.646). No significant correlation was found between age and anxiety scores. Discussion: This study found a significant short-term reduction in anxiety, suggesting that incorporating mild exercise during chemotherapy may help in alleviating patient stress. The medium-to-large effect size supports the potential for meaningful short-term benefits. Conclusions: Incorporating mild exercise during chemotherapy may help reduce anxiety and psychological burden. These findings underscore the need for more comprehensive research in larger, more diverse populations to better understand the benefits of incorporating mild exercise during chemotherapy. Full article

Objective: This study explored HIV testing prevalence and its associated factors among reproductive-aged women in Liberia. Study Design: A secondary and descriptive cross-sectional study was performed among Liberian women aged 15–49 years using the 2019 Liberia Demographic and Health Survey (LDHS) data set. Methods: Descriptive statistics were used to describe the characteristics of these women. Bivariate and multivariable logistic regression models were applied to determine factors associated with HIV testing. All analyses were adjusted for unequal probabilities of selection and non-response by use of survey weights. Results: Among the 8065 participants in this survey, 490 women had never had sex and were excluded, leading to the final sample size being 7575 women. The prevalence of HIV testing among Liberian women aged 15 to 49 years in 2020 was 57.17% (95% CI: 56.2 to 60.4). HIV testing among these women is associated with pregnancy history (aOR 6.40, 95% CI:4.99 to 8.22, p < 0.001), STI history (aOR 1.21, 95% CI:1.02 to 3.19, p < 0.001), knowledge of vertical transmission (aOR 1.65, 95% CI:1.23 to 2.21, p = 0.001), and highest educational level (primary (aOR 1.39, 95% CI:1.16 to 1.68, p < 0.001), secondary (aOR 2.10, 95% CI:1.73 to 2.53, p < 0.001), and higher education (aOR 6.80, 95% CI:3.75 to 12.32, p < 0.001)). Conclusions and Contribution: HIV testing prevalence of 57.17% demonstrates an unmet need for HIV testing among Liberian women aged 15 to 49 years and, thus, it is recommended that HIV testing and counseling services should mostly target these women in rural areas, with limited health services and less educated women. Full article

Background: Maxillary sinus puncture (MSP), once a cornerstone for diagnosing and treating acute rhinosinusitis (ARS), has declined with the rise in less invasive techniques. This study explores MSP trends, its association with age, and long-term effects on quality of life using data from the Study of Health in Pomerania (SHIP). Methods: Data from SHIP-START-2 (n = 2332), SHIP-START-3 (n = 1717), and SHIP-TREND-0 (n = 4420) cohorts were analyzed to assess MSP prevalence, demographic correlations, and quality- of-life impacts using SNOT-20-D, EQ-5D-3L, and SF-12. Results: MSP prevalence was higher in older SHIP-START cohorts (11.2% in START-2) compared to SHIP-TREND-0 (9.5%), reflecting its historical decline. The procedure was more frequently reported by participants aged > 60 years (e.g., 14.0% in START-2) than by younger groups (<40 years: 3.5% in START-2). MSP was associated with increased SNOT-20-D scores across cohorts (e.g., +0.28 in START-2, p < 0.001) and minor reductions in EQ-5D-3L and SF-12 mental health scores, indicating greater symptom burden but limited general health impact. The age- and time-related decline in MSP highlights its diminishing role in modern practice. Conclusions: While MSP offers diagnostic insights and serves as an indicator for ARS, its modest impact on long-term quality-of-life underscores the need for alternative, minimally invasive techniques for sinonasal conditions. Full article

Background and Objectives: Exclusive breastfeeding offers optimal nutrition and health benefits for infants, yet many mothers face challenges that impact their ability to breastfeed. This study aimed to explore breastfeeding practices among Romanian mothers and identify factors associated with successful exclusive breastfeeding. Materials and Methods: A cross-sectional online survey was conducted from February to March 2025, targeting Romanian mothers via social media platforms. The questionnaire, developed specifically for this study, collected data on sociodemographics, birth and neonatal variables, hospital practices, feeding intentions, community influences, and breastfeeding outcomes. A total of 874 valid responses were analyzed using Fisher’s exact tests and multivariable logistic regression. Results: While 87.2% of mothers intended to breastfeed, only 56.1% reported exclusive breastfeeding. Factors significantly associated with reduced likelihood of exclusive breastfeeding included maternal age ≥ 30 years (OR = 1.40, p = 0.042), Cesarean delivery (OR = 1.78, p < 0.001), absence of rooming-in (OR = 2.32, p < 0.001), and pacifier use (OR > 4.7, p < 0.001). Protective factors included non-smoking status (OR = 0.52, p < 0.001) and encouragement to breastfeed by medical staff (OR = 1.60, p = 0.004). Despite external advice to use formula, many mothers continued breastfeeding. Conclusions: Although breastfeeding intention was high, exclusive breastfeeding remains suboptimal in Romania. Targeted support—particularly in maternity hospitals and for mothers recovering from Cesarean sections—alongside prenatal education and consistent postnatal guidance are essential to bridge the gap between intention and practice. Full article

Background: China is confronted with the dual challenges of deeply interwoven population aging and the digitalization process. The digital integration and mental health issues of the elderly group are becoming increasingly prominent. Objectives: The present study aimed to analyze the pathways through which individual, family, and social factors influence Internet use in the elderly through a multi-level analysis framework, to examine the association between Internet use and mental health with a view to providing empirical evidence for digital technology-based mental health intervention programs for the elderly, and to promote the scientific practice of the goal of healthy aging. Methods: Based on the data of the 2021 China General Social Survey (CGSS) and provincial Internet development indicators, a mixed cross-sectional dataset was constructed. Logistic hierarchical regression and OLS regression methods were adopted to systematically investigate the multi-level factors associated with Internet use among the elderly group and its association with mental health. Results: The results indicate that individual resources (younger age, higher education level, and good health status) and family technical support (family members’ Internet access) are strongly associated with Internet usage among the elderly, while regional Internet penetration rate appears to operate indirectly through micro-mechanisms. Analysis of the association with mental health showed that Internet use was related to a lower score of depressive tendency (p < 0.05), and this association remained robust after controlling for variables at the individual, family, and social levels. Conclusions: The research results provide empirical evidence for the health promotion policies for the elderly, advocating the construction of a collaborative intervention framework of “individual ability improvement–intergenerational family support–social adaptation for the elderly” to bridge the digital divide and promote the digital integration of the elderly population in China. Full article

Managed freshwater replenishment is a significant restoration method in the Yellow River Delta. However, their impacts on plankton communities, which are key bioindicators of aquatic ecosystem health and sensitive to the changes in the environment, remain poorly quantified. In this study, we conducted plankton surveys across wetlands subjected to freshwater restoration durations ranging from 5 to 22 years. We assessed shifts in phytoplankton and zooplankton community structure, biomass, diversity, and their relationships with environmental drivers. Results revealed distinct temporal dynamics: phytoplankton biomass and diversity followed a “U-shaped” trajectory (initial decline followed by recovery), while zooplankton biomass decreased but diversity increased with restoration duration. Canonical Correspondence Analysis (CCA) and Partial Least Squares Path Modeling (PLS-PM) identified salinity (Cl⁻, SO₄²⁻) and dissolved nitrate (NO₃⁻) as primary environmental controls for both groups. Cyanobacteria dominated phytoplankton biomass initially but declined with restoration age, while rotifers replaced copepods as the dominant zooplankton taxon over time. These findings demonstrate that freshwater restoration restructures plankton communities through salinity-mediated physiological constraints and altered nutrient availability, with implications for ecosystem function and adaptive management in anthropogenically influenced deltas. Full article