Search Results (49,626)

Background: The relationships of different physical activity domains [e.g., Occupation-related Physical Activity (OPA), Transportation-related Physical Activity (TPA), and Leisure-time Physical Activity (LTPA)] with sleep disorders (SD) remain poorly elucidated. This study investigated the associations of OPA, TPA, and LTPA with SD in American adults. Methods: Data were derived from 25,732 adults with a mean (standard deviation) age of 49.72 (17.53) years (12,692 male and 13,040 female) participating in the 2007–2018 cycles of the National Health and Nutrition Examination Survey (NHANES). The PA domains were assessed using the Global Physical Activity Questionnaire (GPAQ), and adherence to PA recommendations was determined according to the 2018 PA guidelines. SD were identified by self-reported or doctor-diagnosed questionnaire items. Survey-weighted logistic regression models were applied to evaluate the associations between PA domains and SD, and restricted cubic spline (RCS) analyses were conducted to examine potential nonlinear associations. Results: In the fully adjusted model, total PA was not significantly associated with SD (OR 1.01, 95% CI 0.89–1.13, p = 0.912). Regarding specific PA domains, TPA was associated with lower odds of SD (OR 0.79, 95% CI 0.67–0.93, p = 0.006), whereas OPA was associated with higher odds of SD (OR 1.15, 95% CI 1.02–1.30, p = 0.023). No significant association was observed between LTPA and SD (OR 0.96, 95% CI 0.85–1.09, p = 0.511). The multivariable-adjusted RCS analysis further indicated significant nonlinear associations between PA domains and SD (all p for non-linear <0.001). Conclusion: Our findings underscore a prominent “PA paradox” in sleep health among US adults, suggesting that active commuting (TPA) exerts a protective role against SD, whereas OPA serves as a potential behavioral risk factor. Future longitudinal studies and objective PA measurements are needed to validate these cross-sectional associations. Full article

Background/Objectives: Individual responses to weight-loss diets vary widely due to genetic, metabolic, and lifestyle factors, motivating individualized approaches over “one-size-fits-all” advice. We aimed to evaluate long-term (12-month) weight loss, weight maintenance, and cardiometabolic outcomes of a cohort following a nutrigenetically tailored Mediterranean-style dietary program in a real-world, community setting. Methods: The retrospective data cohort included 426 Israeli adults (mean BMI 32.11 ± 4.58 kg/m²; 66.9% women) who participated in a nutrigenetic weight-loss program. Following nutrigenetic direct-to-consumer screening of 425 genetic variants, the participants received a 3-month personalized adjusted diet with remote dietitian-led follow-up by telephone, after which they transitioned to a 9-month self-monitoring and maintenance period. Blood biochemical parameters were reported from routine Health Maintenance Organization (HMO) laboratory testing. Weight/BMI trajectories (0–3, 3–6, 6–9, 9–12 months) were evaluated using linear mixed-effects models; biomarker changes were analyzed with repeated-measures MANOVA and follow-up univariate ANOVAs. Results: Model-estimated cumulative weight loss at 12 months was 10.12 kg (11.4% of baseline) with a mean BMI reduction of 3.68 kg/m² (p < 0.001). The steepest decline occurred during months 3–6 (−1.13 kg/month). Triglycerides (−14.06 mg/dL), total cholesterol (−4.68 mg/dL), LDL cholesterol (−2.49 mg/dL), fasting glucose (−5.14 mg/dL), and HbA1c (−0.14%) improved significantly (p < 0.05), while HDL cholesterol levels remained stable (+0.86 mg/dL; p > 0.05) at 12 months. Among participants with elevated baseline biochemical values, levels transitioned to normal range by 12-month follow-up for triglycerides (46.4%), total cholesterol (29.4%), LDL cholesterol (34.5%), glucose (39.6%), and HbA1c (35.5%). Conclusions: In a real-world cohort, inclusion of genetic information to personalize dietary guidance was implemented through a flexible, individually tailored program supported by an initial 3-month phase of remote dietitian-led counseling. This approach was associated with durable, clinically meaningful reductions in weight and cardiometabolic risk markers over 12 months. Randomized trials are warranted to confirm causality and evaluate cost-effectiveness. Full article

Sexual and reproductive health research has often centered women’s contraceptive and pregnancy-related experiences, while young men’s perspectives on sexual behavior, STI prevention, and reproductive responsibility remain less visible. This qualitative study explored how young Black heterosexual college men understood sexual health knowledge, masculinity, STI risk, condom use, pregnancy prevention, and readiness for fatherhood. Thirteen self-identified Black college men aged 19–22 years participated in individual semi-structured interviews at a Historically Black College/University (HBCU) in the southern United States. Interviews were conducted online, transcribed, de-identified, and analyzed using reflexive thematic analysis. Four themes were identified: fragmented sexual health knowledge and informal learning; learning masculinity through sexual socialization and developing sexual autonomy; experiential learning, STI stigma, and the negotiation of sexual risk; and reproductive responsibility and pregnancy prevention. Participants described limited formal sexual health education, peer and media influences on masculinity, risk judgments shaped by trust and familiarity, and stronger concern for pregnancy prevention than for STI prevention. Findings suggest that sexual health education and campus-based prevention should engage young Black men as reproductive actors with distinct needs, responsibilities, and relational contexts. Programs should integrate STI prevention, condom counseling, partner communication, alcohol-related risk reduction, and reproductive-intention counseling into male-centered, stigma-sensitive approaches. Full article

Background/Objectives: The potential of vaccines to trigger autoimmune diseases (ADs) has been extensively investigated and remains a routine focus of vaccine-safety research. This post-marketing, real-world study compared the risk of ADs between females who received bivalent human papillomavirus (HPV) vaccine (Cecolin) and unvaccinated females. Methods: Eligible females aged 9–45 years registered in the Xiamen Health and Medical Big Data Center from September 2020 to December 2023 (post-Cecolin period) were enrolled. Cecolin recipients constituted the exposed cohort, and a matched unexposed cohort was generated in a 1:4 ratio based on age and calendar year. Case validation was conducted to determine optimal identification algorithms. Incidence rates (IRs) were calculated and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were derived from zero-inflated Poisson regression. Results: Overall incidence of ADs was 70.63 per 100,000 person-years (95% CI: 67.59–73.77) in the post-Cecolin period. Compared with matched unexposed cohorts, vaccinated females showed a significantly lower AD risk in both contemporaneously matched (IRR = 0.23, 95% CI: 0.08–0.65; p = 0.006) and historically matched (IRR = 0.21, 95% CI: 0.07–0.66; p = 0.008) analyses. Conclusions: Consistent with prior evidence, this study provides real-world evidence further confirming that Cecolin vaccination does not increase the risk of ADs. It adds the first large-scale post-marketing safety evidence for this Chinese domestic bivalent HPV vaccine, filling a critical evidence gap. These results may inform vaccination policy and guide post-licensure safety monitoring in China and other countries that have introduced this vaccine. Full article

Background: The Victorian Cerebral Palsy Register (VCPR) project collects information on all individuals born or living in Victoria since 1970. It is one of the largest cerebral palsy (CP) registers internationally, with over 6800 participants. Methods: This paper will explain how the VCPR was established, how data are collected and the main outcomes from its use over an extended period of time. Results: The knowledge generated through the VCPR has contributed to information about epidemiology including trends in prevalence over time, and rates and causes of death; the VCPR has been used to investigate causal pathways and potential avenues for prevention or amelioration. It has been valuable in identifying cohorts for multidisciplinary studies resulting in improved understanding of the management of associated problems. The VCPR has also been used in the development of measurement tools and has enabled data linkage studies contributing to knowledge about CP. Conclusion: The Register not only provides an efficient means of identifying eligible cohorts, but the population basis of the VCPR provides the ability to assess the generalisability of research cohorts and a means of adjusting for selection bias and potential misinterpretation of study results. The project has gained international recognition for the knowledge generated on prevalence, risk factors, mortality, clinical profiles, neuroimaging patterns, health service use, assessment tools, participation, epidemiology in paediatric orthopaedics, and quality of life. It has underpinned significant improvements in clinical care for children with CP by enabling researchers from diverse disciplines to complete 157 studies. Full article

Home enteral nutrition (HEN) is essential for patients with a functioning gastrointestinal tract who cannot meet nutritional needs orally, yet outpatient management remains complex, resource-intensive, and supported by a limited evidence base. Artificial intelligence (AI) may augment HEN care by extending monitoring, education, risk assessment, documentation support, and operational coordination into the home environment. Consistent with the narrative review format, this article uses a pragmatic, transparent synthesis of influential HEN-specific literature, relevant clinical nutrition evidence, and background knowledge from adjacent fields, including home healthcare, chronic disease management, oncology nutrition, telehealth, and software regulation. Direct evidence in established HEN populations remains scarce; therefore, most AI applications should be considered hypotheses or early implementation opportunities rather than proven standards of care. The strongest near-term opportunities are clinician-supervised patient education, symptom triage, adherence support, remote monitoring, and workflow automation. Predictive analytics, smart pumps, and precision enteral prescription tools are promising but require prospective HEN-specific validation, interoperability with electronic health records and home-infusion systems, reimbursement pathways, and governance safeguards. Key barriers include dataset bias, limited external validation, alert fatigue, privacy and regulatory concerns, unclear accountability, digital equity, cost uncertainty, and the risk of dehumanizing care. AI should be viewed as a complement to multidisciplinary HEN expertise. Priorities for the near future include HEN registries, standardized outcomes, prospective validation, pragmatic implementation trials, health-economic evaluation, and transparent oversight that preserves clinician accountability and patient-centered care. Full article

Occupational Health and Safety (OHS) risk management is an ongoing challenge in resource-scarce chemical industries, especially in developing nations like Tunisia. The current research recommends a hybrid socio-techno-environmental model based on Fuzzy Logic and the Analytic Hierarchy Process (AHP) for occupational health and safety risk assessment and prioritization of occupational health and safety (OHS) risks. The model, based on a backup of expert judgment from pre-specified questionnaires and real data of Tunisian chemical industries, quantifies the risk factors based on criticality and probability of occurrence. Fuzzy–AHP not only evaluates qualitative estimates but also provides a systematic framework for evaluating and prioritizing occupational health and safety risks. Findings are consistent with the fact that socio-organizational factors such as occupational safety culture and compliance among workers play a pivotal role in determining total levels of risk, and in certain cases dominate over technical considerations alone. In offering a scalable and context-sensitive solution, this research has an additional contribution with a decision-support framework that assists organizations in evaluating and prioritizing occupational health and safety risks under uncertain conditions. Its use for policy makers and business interests that seek to maximise OHS performance in given constraints, and its use in actual implementation and compatibility with sustainability and worker health goals, speaks to its utility. Full article

Background: Physical inactivity and functional decline are common among institutionalized older adults, increasing the risk of cardiovascular disease and loss of independence. Innovative strategies such as virtual reality-assisted exercise may enhance adherence and improve health outcomes in this population. Methods: A pilot intervention study with a pre-post design was conducted in five institutionalized older adults who participated in a virtual reality-assisted multicomponent exercise program. The intervention included sessions combining strength, aerobics, balance, and flexibility exercises. Anthropometric, cardiovascular, and functional variables were assessed before and after the intervention. Physiological responses were assessed at the beginning of the sessions, midway through the intervention, and at the end of the program, along with participant satisfaction. Results: Preliminary descriptive changes were identified following the intervention, including lower values for body mass, body fat percentage, and systolic blood pressure, together with higher scores in several functional capacity measures, such as lower and upper body strength, aerobic endurance, and mobility. Physiological responses during exercise remained within expected ranges across sessions. All participants reported high satisfaction with the intervention, and no adverse events were documented. Conclusions: A multicomponent exercise program integrating virtual reality appears to be a feasible and well-tolerated intervention for institutionalized older adults. The preliminary descriptive findings suggest potential favorable changes in cardiovascular health and functional capacity; however, because no control group was included, the specific contribution of the virtual reality component cannot be determined. Full article

Digital health observatories require predictive frameworks that transform administrative health data into reliable territorial risk indicators. We developed a biomedical informatics framework for machine-learning-based epidemiological risk stratification in the Colombian Orinoquía, with explicit attention to data-leakage prevention, validated population denominators, and unit-of-analysis discipline. From 354,088 morbidity records (2018–2023; Arauca, Casanare, Meta, Vichada) we derived 20,212 independent strata (municipality × year × diagnostic group × sex × age category × health component) and computed morbidity rates using official population projections from the Colombian National Administrative Department of Statistics (DANE), correcting a denominator instability present in the original extract. After excluding leakage-generating variables, Gradient Boosting, Random Forest, and a one-hot Logistic Regression baseline were evaluated through temporal validation, group-aware cross-validation, leave-one-department-out validation, and a geographic ablation experiment. Under leakage-controlled, stratum-level conditions, Gradient Boosting achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.913 [95% confidence interval (CI): 0.903–0.923] (Brier: 0.106). SHapley Additive exPlanations (SHAP) analysis identified diagnostic group and age category as the dominant predictors, supported by broadly stable performance without geographic identifiers (AUC 0.871) and consistent cross-department transferability (0.807–0.889); a residual municipality-level clustering effect is reported transparently. Validated denominators reversed the apparent territorial gradient, with the most remote department exhibiting the lowest documented morbidity, consistent with under-registration. Full article

Engineered nanomaterials have been increasingly proposed for the treatment of contaminated soils. Nevertheless, most available evidence has been obtained in water, artificial substrates or short-term laboratory experiments, and performance in real soil is substantially more variable. This review examines nanoscale zero-valent iron, photocatalytic metal oxides, carbon-based nanomaterials, and supported or hybrid formulations, with particular attention to the soil properties and contaminant characteristics that control their mobility, transformation, reactivity, and persistence. Nano-enabled treatments can decrease the mobility of arsenic, chromium, lead, and other potentially toxic elements and can promote the degradation of selected pesticides and hydrocarbons. However, opposite responses have also been reported, including mobilisation of non-target elements, nanoparticle aggregation and passivation, effects on microbial communities and plants, contaminant rebound, and potential transport beyond the treated zone. Environmental assessment should therefore consider both the target contaminant and the applied or transformed nanomaterial, together with ecological and occupational exposure pathways. Current evidence does not support nanoremediation as a general replacement for conventional technologies. Its main value lies in its use as a site-specific component of integrated remediation strategies selected according to soil properties, contaminant behaviour, treatment scale, cost, life-cycle impacts, and future land use. European field experience remains limited, particularly in unsaturated soils, and no harmonised EU-wide authorisation procedure specifically for soil nanoremediation currently exists. Wider implementation will require realistic field trials, long-term monitoring, safer and recoverable formulations, transparent regulatory assessment, and evaluation of soil functions and ecosystem-service recovery. A site-specific decision framework is proposed to support material selection, risk–benefit evaluation, and responsible implementation. Full article

Substituted p-phenylenediamine-derived quinones (PPD-Qs) have become ubiquitous contaminants in various environmental matrices. However, the understanding of the potential health risks posed by human exposure to these emerging compounds remains limited. In this case–control study, we investigated the association between urinary concentrations of six PPD-Q congeners and colorectal cancer (CRC) risk. Detection frequencies of all target PPD-Qs in human urine ranged from 73.7% to 88.2% in the control group and from 70.2% to 89.6% in the case group. 6PPD-Q (2-((4-methylpentan-2-yl)amino)-5-(phenylamino)cyclohexa-2,5-diene-1,4-dione; mean 1.37 μg/g creatinine), 77PD-Q (2,5-bis((5-methylhexan-2-yl)amino)cyclohexa-2,5-diene-1,4-dione; 0.68 μg/g creatinine), and IPPD-Q (2-(isopropylamino)-5-(phenylamino)cyclohexa-2,5-diene-1,4-dione; 0.70 μg/g creatinine) were the predominant PPD-Qs in urine from healthy controls. In CRC cases, 6PPD-Q had the highest mean urinary level (mean 1.75 μg/g creatinine), followed by DPPD-Q (2,5-bis(phenylamino)cyclohexa-2,5-diene-1,4-dione; 0.83 μg/g creatinine) and IPPD-Q (0.73 μg/g creatinine). After multivariable adjustment, higher urinary levels of 6PPD-Q (OR for Q4 vs. Q1 = 1.79, 95% CI: 1.26–2.32), CPPD-Q (2-(cyclohexylamino)-5-(phenylamino)cyclohexa-2,5-diene-1,4-dione; OR = 1.60, 95% CI: 1.26–1.94), and DPPD-Q (OR = 1.47, 95% CI: 1.25–1.68) were significantly associated with increased CRC odds, with nonlinear exposure–response patterns observed. Mixture analysis suggested a positive joint association between urinary PPD-Q concentrations and the odds of CRC, with 6PPD-Q and DPPD-Q contributing most strongly to the estimated statistical association. These findings highlight the need for further prospective studies and potential regulatory considerations to mitigate public health impacts from these contaminants. Full article

Background/Objectives: Zero-calorie beverages (ZCB) are increasingly consumed by adolescents, yet their relationship with mental health remains unclear, and whether any association differs by sex has not been established. We examined the association between ZCB consumption and depressive symptoms in a nationally representative sample of Korean adolescents, with sex as a prespecified effect modifier. Methods: This cross-sectional study analyzed 50,972 adolescents aged 12–18 years (50.9% male; mean age, 15.0 years) from the 2025 Korea Youth Risk Behavior Web-based Survey. Self-reported ZCB consumption during the previous 7 days and depressive symptoms during the previous 12 months were assessed. ZCB consumption was categorized as none, ≤2/week, 3–6/week, or ≥1/day. Survey-weighted logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with non-consumers as the reference. Effect modification by sex was assessed using interaction terms. Results: Depressive symptoms were reported by 12,954 adolescents (25.4%). ZCB consumption was associated with higher odds of depressive symptoms across consumption categories (aOR for ≥1/day 1.76, 95% CI 1.45–2.13; p for trend < 0.001), after adjustment for sociodemographic and lifestyle covariates. The association appeared stronger among females than among males (aOR 1.14 [95% CI 1.11–1.18] vs. 1.05 [1.02–1.08]; p for interaction < 0.001), though significant in both sexes, and persisted after additional adjustment for co-consumed sugar-sweetened and high-caffeine beverages. Conclusions: In this nationally representative sample, daily ZCB consumption was associated with depressive symptoms, with a stronger association observed among females. Prospective studies are warranted to clarify temporality and underlying mechanisms. Full article

Ambient exposure to fine particulate matter (PM_2.5) remains a critical global public health concern; however, the speciation and bioaccessibility mechanisms of particle-bound heavy metals within the lung environment are still insufficiently understood. In particular, the role of soluble and insoluble metal species in simulated lung fluids requires further clarification. Road dust, a major contributor to PM_2.5, contains heavy metals that pose significant inhalation risks, leading to oxidative stress, DNA damage, and systemic toxicity. This study investigated the contamination characteristics, bioaccessibility, pollution level, and speciation of heavy metals in PM_2.5-fractionated road dust (PM_2.5RD) collected from Karachi (a megacity with >27 million inhabitants) and Shikarpur (a medium-sized city of ~0.3 million) in Pakistan. A grid-based sampling approach was applied across four functional zones (residential, school, hospital, and office), yielding 48 samples. Inhalation bioaccessibility was evaluated using artificial lysosomal fluid (ALF; pH 4.5, 37 °C, 24 h), revealing moderate bioaccessibility of Cr, As, and Pb. Pollution status was assessed using contamination factor (CF), integrated pollution index (IPI), pollution load index (PLI), and potential ecological risk index. Geochemical modeling with PHREEQC 3.0 and Visual MINTEQ 3.1 was employed to simulate metal speciation, release behavior, and mineral saturation states. Overall, this study provides mechanistic insights into speciation-driven toxicity of As, Pb, and Cr in simulated lung environments, offering a scientific basis for improved risk assessment and regulatory strategies for PM_2.5-associated metal exposure. Full article

Point-of-care and near-patient diagnostics can shorten the time between testing and clinical or public-health action, but a technically effective test does not by itself create a sustainable diagnostic service. Evidence from diagnostic-access research, digitally connected point-of-care testing, human-centered design, and implementation science indicates that diagnostic technologies must be developed as components of wider service systems encompassing workflows, quality assurance, data governance, maintenance, supply chains, user trust, and linkage to care. Drawing on these bodies of literature, this Perspective introduces the I2Med digital infrastructure framework for point-of-care diagnostics in low-resource and infrastructure-constrained settings. These settings are defined functionally as clinical or public-health environments in which resource or infrastructure constraints can disrupt one or more stages between testing and appropriate action. The I2Med framework integrates six domains: (1) access and context of use; (2) the result-to-action diagnostic workflow; (3) digital interfaces and data governance; (4) quality, risk, usability, and design-control alignment; (5) sustainability, maintenance, and supply continuity; and (6) equity, trust, and community accountability. Operational tools—including a setting typology, a domain-to-artifact matrix, an evidence-to-scale maturity ladder, and a hypothetical application vignette—illustrate how the framework can guide development and implementation planning. The I2Med framework’s central contribution is to reposition the diagnostic device as one component of an interconnected service system and to provide academic, translational, and early-stage development teams with a common structure for identifying implementation dependencies, evidence gaps, and responsibilities. As a conceptual framework, it requires prospective application and evaluation across diverse settings before its utility and transferability can be established. Full article

Patients undergoing cardiac surgery are particularly vulnerable to infectious diseases, which may adversely affect perioperative outcomes and long-term prognosis both before and after the procedure. Moreover, those requiring heart transplantation must take immunosuppressive medications, further compromising their immunity. This narrative review aims to look for the sources of increased risk for infections as well as synthesize vaccination recommendations for these patient groups based on the available literature and guidelines. We considered the influence of age, comorbidities, length of hospitalization, procedure-related risks, and blood product transfusions on the increased risk of vaccine-preventable diseases. By comprehensively addressing these factors, healthcare providers can develop tailored vaccination strategies that maximize protection for cardiac surgical patients while minimizing potential complications and optimizing overall health outcomes. Full article