Search Results (4,646)

American Indian communities may be at increased risk of water-related PFAS exposure. However, communicating the health risks of PFAS exposure requires attention to concepts of health literacy and aligning educational messages with the community’s understanding of health. The purpose of this study was to determine the health literacy demand of PFAS educational materials, with specific attention to their appropriateness for American Indian communities. Publicly available PFAS educational materials were evaluated using the Simple Measure of Gobbledygook (SMOG), the Patient Education Material Assessment Tool (PEMAT), and a cultural appropriateness tool. The mean reading level of the materials was above 12th grade. The PEMAT scores for the 33 print materials were 62% (understandability), 34% (actionability), and 61% (cultural appropriateness). For the videos, the scores were 62% (understandability), 53% (actionability), and 68% (cultural appropriateness). Neither the print nor the video materials met acceptable health literacy standards, meaning the materials are not well-designed for a variety of health literacy levels. There was a lack of actionable directives that should be addressed in future PFAS educational materials. This study highlights the importance of working closely with community partners to develop education materials that match the skills and preferences of the intended audience. Full article

To quantify preferences and trade-offs for non-overall survival (OS) endpoints among Canadian adults treated for early-stage cancers, participants completed ten choice sets in a discrete choice experiment. Standard-of-care (SoC) was compared to new treatment profiles defined by five attributes: five-year OS, two-year disease advancement, pathological complete response (pCR), and short- and long-term side effects. SoC attribute levels remained constant across respondents, except OS, which varied. For the new treatment, all attributes except OS (fixed as unknown) varied. Data were analyzed using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Among 103 adults treated for early-stage gastrointestinal (n = 40), breast (n = 32), or lung (n = 31) cancer, median age was 59 (Q1, Q3: 43, 75) years; 46.6% were female. Each 25% decrease in SoC OS was associated with higher odds of choosing the new treatment (OR 3.49; 95% CI 2.82–4.31; p < 0.01). Reductions in disease advancement (OR 1.55; 1.26–1.91; p < 0.01) and mild or no short-term side effects versus severe (OR 6.67; 4.35–10.00) significantly increased selection odds; long-term side effects and pCR showed modest, non-significant influence. When OS data were available for SoC, OS strongly influenced decisions; without OS data for new treatments, participants prioritized disease control and short-term tolerability. Full article

This field study examined extant aquatic food production and marketing in the three coastal states of Lagos, Ogun, and Ondo before IMTA across 15 Local Government Areas (LGAs)/Local Council Development Areas (LCDAs). Marketing mix practices in coastal aquatic food systems were explored through a structured, qualitative assessment using a multi-value chain perspective. Monthly sales volumes most frequently fell within the range of 1–5 tonnes. The local market was dominant, with some sales in the international markets. Respondents asserted that post-harvest processing was diverse, and some were satisfied with the technology available to preserve their products. Cold storage practices across coastal states were hindered by unreliable power supply. Zero-level channel distribution dominated among traders, with over 90% relying on word-of-mouth (WOM) to promote their products. Consumers showed a strong preference for the quality of local products and expressed openness to incorporating seaweed into their purchases. Health benefits, taste, and other reasons for purchase decisions varied significantly across the state χ² (df = 8, n = 300) = 92.39, p < 0.001. These findings provide a baseline for IMTA in Nigeria, highlighting existing strengths, market dynamics, and infrastructure gaps that must be addressed to support sustainable integration. Full article

Background/Objectives: Inflammatory bowel disease (IBD) is associated with reduced areal bone mineral density (aBMD) and an increased risk of osteoporosis and fragility fractures. Although exercise improves bone health in the general population, its effects on aBMD in adults with IBD are unclear. This systematic review aimed to evaluate the effects of structured exercise interventions on aBMD in adults with IBD and to assess the certainty of the evidence. Methods: We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook. Searches were performed in CENTRAL, MEDLINE, Scopus, and Web of Science from inception to November 2025. We included randomized controlled trials comparing structured exercise interventions with usual care, no structured exercise or no intervention in participants aged 16 years and older with IBD. The primary outcome was aBMD; physical activity was a secondary outcome. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0), and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The review protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) CRD42024617200. Results: Two randomized controlled trials (n = 164), both conducted exclusively in adults with Crohn’s disease, met the inclusion criteria. Combined impact and resistance training for 6 months was associated with greater lumbar spine aBMD compared with usual care, while hip outcomes were not consistently improved. A 12-month low-impact exercise program compared with no intervention suggested greater trochanter aBMD gain among fully compliant participants, but intention-to-treat between-group differences were not statistically significant across skeletal sites. Due to heterogeneity in interventions and reporting, meta-analysis was not performed. Overall certainty of the evidence was very low because of methodological limitations and imprecision. Conclusions: We are very uncertain about the effect of exercise interventions on aBMD in adults with IBD. Current randomized evidence is limited to adults with Crohn’s disease and is insufficient to determine the optimal exercise modality, frequency, intensity, progression, or loading characteristics for improving bone health. Well-designed trials across IBD phenotypes are needed to clarify the role of exercise in bone health management in IBD. Full article

Background: Vitamin D deficiency is a common global health problem and remains highly prevalent in Türkiye, where limited food fortification and heterogeneous clinical practices contribute to variability in testing and supplementation strategies. Aims: To provide Türkiye-specific best practice recommendations for defining clinically relevant serum 25-hydroxyvitamin D [25(OH)D] thresholds, identifying adult risk groups for targeted testing, and recommending evidence-based prevention, treatment, and monitoring approaches while minimizing under-treatment and inappropriate high-dose use. Methods: This national expert consensus document was developed by endocrinologists from across Türkiye using a structured, modified Delphi methodology. Draft statements informed by systematic literature reviews were rated via online surveys using a 9-point Likert scale, followed by two Delphi rounds and a face-to-face consensus meeting in İstanbul in October 2025. Results: Recommendations addressed sun exposure, laboratory assessment, screening, supplementation, treatment, and follow-up. Serum 25(OH)D <20 ng/mL was defined as deficiency and <12 ng/mL as severe deficiency, with a target range of 20–50 ng/mL. Routine population-wide screening was not recommended; instead, targeted testing in high-risk adults and symptom-driven biochemical evaluation were endorsed. Empiric supplementation was recommended for selected high-risk groups, with cholecalciferol as the preferred agent. Higher individualized doses were suggested in obesity or malabsorption, while loading regimens were reserved for specific clinical indications, such as severe deficiency or certain medical conditions that impair vitamin D metabolism. Reassessment of 25(OH)D at 8–12 weeks was recommended. Conclusion: These consensus-based recommendations provide a practical, context-specific framework for assessing, preventing, treating, and monitoring vitamin D deficiency in adults in Türkiye. Full article

Non-nutritive sweeteners (NNSs) are consumed to reduce intake by providing a sweet taste with little to no energy. Despite regulatory approval and extensive use, uncertainty remains about their long-term role in weight management and health, and about whether exposure to sweet taste itself, independent of energy, influences these outcomes. This narrative review synthesizes evidence from three recent European consortia: SWEET, SWITCH and Sweet Tooth, which together provide complementary data from acute, short- and long-term randomized controlled trials. The studies examined the effects of NNSs and dietary sweet taste exposure on body weight, health-related biomarkers, sweet taste preference, and eating behavior. Across studies, replacing sugars with NNSs appeared to support weight loss maintenance, while NNS consumption and dietary sweet taste exposure showed no adverse changes in body weight, glucoregulatory and endocrine biomarkers, cardiometabolic risk factors, gut microbiota, or liver enzymes. Likewise, neither NNS use nor different dietary sweet taste exposure altered sweet taste liking, appetite sensation, energy intake, or food choice. However, interpretation should consider the characteristics of the included studies, including selected populations, intervention context, outcome heterogeneity, and the fact that several behavioral and biomarker outcomes were secondary or exploratory. Overall, the reviewed evidence suggests that replacing sugar intake with NNSs may support weight management strategies, while differences in habitual dietary sweet taste exposure per se appear largely neutral with respect to health-related biomarkers and sweet taste preferences. Full article

The inner beauty functional food sector has grown rapidly in South Korea. These products are orally consumed bioactive formulations designed to improve skin health, hair vitality, and overall wellness. However, empirical evidence on consumption patterns and product format preferences across different demographic groups remains limited. This cross-sectional study examined consumption patterns, purchase channels, and product format preferences among 502 Korean adults who had experience with inner beauty functional foods. Chi-square analysis was used to examine differences in consumption reasons, duration of use, purchase channels, and product format preferences according to socio-demographic characteristics. Results showed that skin health was the dominant consumption motivation (47.6%), particularly among younger and female consumers, while weight management and hair and nail health were more prevalent among older adults. Online purchasing dominated (57.8%), with significant age- and education-based variation; consumers in their 20s purchased online at 67.5%, declining to 44.4% among those aged 40 and above. Capsule and tablet formats were most prevalent overall (41.6%), with males, married consumers, and graduate-degree holders showing significantly stronger preference for this format, whereas gummy and chewable formats were more frequently preferred by female consumers. These findings provide practical implications for inner beauty producers, food distributors, and nutrition educators seeking to align product development and communication strategies with the heterogeneous preferences of Korean inner beauty consumers. Full article

Background: Rural and remote health systems are diverse; while many of these settings face persistent workforce shortages and access gaps, not all are underserved. Nurses play a critical role in improving access, continuity, and quality of care in these contexts. However, evidence on their roles, the challenges they face, and the outcomes associated with their contributions remains fragmented. Objective: To map the roles, challenges, and reported outcomes of nurses working in rural and remote healthcare settings, and to examine the quality and scope of the available evidence. Design: This study employed JBI scoping review methodology and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Methods: Eligible studies involved registered nurses (RNs) and nurse practitioners (NPs) providing care in rural or remote settings and reporting at least one outcome related to patients, services, or health systems. Six bibliographic databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, Cochrane Library) plus Google Scholar for supplementary grey literature retrieval and targeted grey literature were searched (from 1 January 2000 to 30 September 2025). The lead author conducted screening and data extraction, supported by a 10% calibration pilot and structured peer debriefing. Design-specific critical appraisal was undertaken descriptively to inform interpretation but did not determine inclusion. Results: From 22 primary empirical studies (plus 2 contextual-only entries; 24 total, nurses’ roles clustered into direct clinical care, care coordination/navigation, telehealth facilitation, and health promotion. Reported outcomes were predominantly in access/utilization (e.g., time-to-care), quality and safety indicators, and patient-reported outcomes/experiences; clinical endpoints were less common. Conclusions: Nurses in rural and remote settings enact broad, adaptive roles that appear to support healthcare access and service continuity. The evidence base is predominantly descriptive, and causal claims about effectiveness cannot be drawn from the available studies. Standardized outcome frameworks, multi-reviewer methodologies, and effectiveness-focused primary research are needed to advance this field. Full article

Soil nematodes are integral to soil micro-food webs and serve as sensitive bioindicators of soil ecological condition. However, how forest vegetation and soil properties interact to shape nematode community assembly, network structure, and functional stability remains inadequately understood. Using 18S rRNA gene amplicon sequencing coupled with phylogenetic null modeling, we examined soil nematode communities across four forest types along a succession gradient. Although taxonomic diversity (e.g., Shannon and Pielou indices) differed significantly among forest types, network topology and stochastic assembly processes were more closely associated with community restructuring and co-occurrence patterns. This suggests that, while diversity is not irrelevant, network- and assembly-based metrics provide complementary and often more sensitive indicators of nematode community responses to forest type. Co-occurrence network analysis revealed that mixed forests fostered more complex and potentially stable networks, whereas plantations formed dense but potentially vulnerable networks. Assembly processes were not dominated by strong deterministic selection (|βNTI| ≤ 2 for most comparisons), a pattern consistent with undominated processes (e.g., ecological drift, weak environmental filtering). Dispersal limitation played a negligible role in this system. Partial Least Square Path Modeling identified spatial factors and key soil properties (e.g., pH, electrical conductivity, soil water content, and organic carbon) as primary drivers of community structure. Our findings indicate that assessing soil food web health should integrate network analysis and stochasticity metrics rather than rely solely on taxonomic diversity. For sustainable forest management, mixed-species stands are preferable to monoculture plantations, and maintaining soil physicochemical heterogeneity is critical for community stability. Full article

Diabetic cardiomyopathy (DC) is a serious health issue. MicroRNA-155b expression dysregulation might be involved in the fibrotic cycle in DC. L-Arginine (l-arg) is reported to have a preferable impact on the cardiovascular system. We aimed to understand the pathogenesis of DC and to detect the potential protective effect of l-arg through modulation of apoptosis, inflammation, fibrosis, and miR-155b expression. This study comprised four groups of forty adult male rats (10 rats in each group): diabetics, l-arg diabetics, l-arg, and controls. Blood glucose, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), body weight, and cardiac hypertrophy index (HW/BW ratio) were assessed. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) was done. Expressions of toll-like receptor-4 (TLR4), pro-inflammatory interleukin 1 beta (IL-1β), interleukin 6 (IL-6), anti-inflammatory interleukins (IL-4, IL-13), apoptotic markers (bcl-2, bax) and microRNA-155b were measured by real-time PCR. Myocardial light, electron microscopic and morphometric studies were performed. Results showed a significant decrease in cardiac hypertrophy (HW/BW = 0.0030 ± 0.0002 mg/g), echocardiographic parameters (LVEF = 54.12 ± 1.628% and LVFS = 20.40 ± 0.541%), hemodynamic parameters (HR = 411.0 ± 9.684 bpm, SBP/DBP = 84 ± 4.998/60 ± 3.062 mmHg) and downregulation of the expression of IL-4, IL-13, IL- 1β, IL-6 and TLR4 in the l-arg diabetic group compared to diabetic rats. Additionally, restoration of normal appearance of most cardiac myofibrils, intact blood vessels, decreased cardiac fibrosis and upregulation of bax expression were observed. Expression of microRNA-155b increased by 0.007 for each gram increase in blood glucose (>1.45, it showed 100% specificity and 96.7% sensitivity). In conclusion, microRNA-155b upregulation is associated with enhancement of the transcription of inflammatory cytokines and apoptotic genes. L-arginine may be a useful protective strategy for DC through modulation of apoptosis, inflammation, and fibrosis, in addition to regulating the expression of miR-155b. Full article

Social robots hold promise for enhancing later-life support, but user needs and preferences for multimodal interaction modalities remain underexplored. This study explores awareness, willingness, perceived barriers, and modality–function associations across multiple interaction modalities among middle-aged and older adults, and proposes a conceptual five-layer architecture for design guidance. A questionnaire survey with 199 Chinese respondents (aged 45–64: 89.4%, 65+: 10.6%) examined perceptions of voice, visual, gestural, affective, sEMG, and brain–computer interface interactions. Voice and visual modalities were the most preferred; gesture and affective interactions were moderately accepted; awareness of sEMG was high but may reflect confusion with other sensor technologies; and BCI awareness and willingness were low. Based on survey findings and the literature, a conceptual five-layer architecture is presented to inform future social-robot design. The sample predominantly comprised middle-aged participants, so findings reflect prospective later-life users rather than the broader older-adult population. This study offers user-centered insights into multimodal social-robot interaction and provides design implications for future development rather than evaluating emotional-health interventions. Full article

Depression is a critical global public health challenge, and the demand for accurate automated detection methods has generated considerable research interest in Transformer-based models. Despite their substantial promise, a comprehensive investigation into their architectural efficacy, intrinsic mechanisms, and barriers to practical implementation remains lacking. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, this systematic review was conducted across six databases (IEEE Xplore, Elsevier, Springer, MDPI, PubMed, and arXiv). The final search was performed in October 2025, covering English-language empirical studies published between 2020 and 2025 that employed Transformer-based architectures for depression detection. Risk of bias and methodological quality were independently appraised by two authors using a six-dimension structured rubric, with disagreements resolved by a third author. Findings were narratively synthesized given substantial cross-study heterogeneity. This systematic review analyzed 46 studies and provided the first comprehensive, mechanism-level, architecturally stratified comparison of encoder-only, decoder-only, hybrid, and multimodal fusion paradigms, examining self-attention dynamics and transfer learning strategies. Since 2019, these frameworks have evolved from text-centric approaches to advanced multimodal systems. Encoder-only models show consistently strong results in high-throughput text-based screening, decoder-only models demonstrate stronger few-shot learning capabilities, hybrid architectures show the highest observed median performance in clinical interview settings across the reviewed studies, and multimodal fusion systems offer complementary advantages when heterogeneous signal integration is critical. These trends are task-contextualized and should not be interpreted as unconditional rankings, given heterogeneity in evaluation metrics and tasks across studies. Nonetheless, four principal challenges hinder clinical translation: overreliance on self-reported data, cross-linguistic bias, absence of uncertainty quantification, and substantial computational overhead. Future efforts should shift from incremental benchmark improvements toward clinical utility through standardized psychiatric validation, uncertainty-aware architectures, fairness-enforced training across diverse populations, and the integration of Transformer-based models with wearable and mobile health data to improve detection stability and reduce translational risk. This systematic review was registered on the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/SYF9N). This research was funded by the Faculty of Information Science and Technology and by Universiti Kebangsaan Malaysia under Grant TAP-K014364. Full article

Heat waves have intensified since the 1960s, leaving older adults uniquely susceptible to heat-related illnesses, including hyperthermia and fluid-electrolyte imbalances. While clinicians recognize that certain medications increase heat vulnerability, the specific interplay between drug use and patient characteristics remains unclear. This scoping review, following the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, investigated the risk of heat-related illness associated with medication use in older adults to identify research gaps. Investigators queried four databases for English-language primary literature (2000–2025) based on predefined Population, Concept, and Context criteria. Additionally, a grey literature search mapped existing United States (U.S.) mitigation strategies. Two reviewers independently screened studies via Covidence, and one extracted data. Results included 61 primary studies and 41 grey literature sources. While epidemiological data confirm higher heat-related morbidity and mortality in older populations, few experimental studies evaluate medication’s specific role. Despite many public health efforts, specific, evidence-based guidance on managing drug-heat interactions is limited. Diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), anticholinergics, and antipsychotics were the medication classes most frequently associated with heat-related illness. This review underscores a critical need for research into the confluence of age, multimorbidity, and polypharmacy to inform future clinical mitigation and protect vulnerable populations. Full article

Purpose: This study explores how older adults with chronic back pain (CBP) evaluate different user interface (UI) designs and gamification elements for an ultrasound-based wearable providing real-time biofeedback during segmental stabilization exercises (SSE). The aim is to identify design preferences and motivational factors to enhance usability, engagement, and adherence in this specific population. Methods: We conducted a mixed-methods study with 15 older adults (aged ≥ 65) experiencing CBP. Participants interacted with three UI mockups (simple, anatomical, and playful) via a Wizard-of-Oz simulation and evaluated additional motivational elements (e.g., points, badges, progress charts). Semi-structured interviews and the Technology Usage Inventory (TUI) subscales were used to assess usability, acceptance, and intention to use. Results: Participants preferred the simple and anatomical UI designs, citing clarity, professionalism, and ease of interpretation. The playful design was viewed as less appropriate due to perceived infantilization. Game elements such as progress tracking, points, and levels were positively received, while competitive features like leaderboards were viewed critically. Most participants expressed interest in integrating pain education, favoring multimedia formats. Conclusions: Digital health tools for older adults must prioritize intuitive, medically reliable interfaces and allow personalization of motivational and educational components. The findings highlight the need for age-appropriate UI design and suggest that well-balanced gamification and educational features may enhance perceived acceptance and have the potential to support long-term use, which should be evaluated in longitudinal studies. Full article

Forests in Poland play a key recreational role, and the growing interest in sylvaturism requires optimized management. Despite the growing body of research on forest recreation, existing studies rarely address the role of small-scale infrastructure in shaping user preferences and its integration into spatial planning frameworks, which constitutes a research gap in this study. This study aimed to identify user preferences for small infrastructure and to develop an application-oriented, socially sensitive model for forest trail design that supports sustainable management. The research was conducted in 2021–2024 using the CAWI method on a group of 402 adult Poles. Data analysis included descriptive statistics, Pearson’s chi-square tests to assess demographic differences, and correspondence analysis to identify user preference profiles. The results not only confirmed a clear hierarchy of needs but also demonstrated that differences between user groups relate primarily to the intensity rather than the structure of preferences. A clear hierarchy of needs was confirmed, with route map boards (86.32%), educational boards (72.64%), and benches (71.14%) dominating. Based on the results, a modular design model was developed (modules: basic, comfort, accessibility, and activity), which constitutes a conceptual advancement over existing planning approaches by introducing a flexible, user-oriented framework that links social preferences with spatial decision-making. By integrating empirical social data into the planning process, the proposed framework extends current knowledge on recreation planning and provides a structured basis for adaptive forest trail design. This tool could help managers efficiently channel tourist traffic, protect ecosystems, and promote public health. Full article