Search Results (37,731)

Prescription drug misuse among youth is a significant public health problem that can lead to negative consequences, including addiction and overdose deaths. This study examined the effectiveness of an evidence-based hybrid approach in preventing prescription drug misuse outcomes in high school students. The prevention program used a combination of e-learning modules and classroom activities to enhance social and personal competence skills and refusal skills to deter prescription drug misuse and other types of substance misuse. Findings indicated that prescription sedative misuse was lower among students who received the hybrid prevention program compared to students in the control group. Perceived risk of using prescription sedatives, painkillers, and stimulants prescribed for someone else was higher in the intervention group relative to the control group students. These findings indicate that a comprehensive, universal school-based hybrid prevention program can produce positive impacts on sedative use and perceived risks of prescription drug misuse. Full article

Background/Objectives: In recent decades, new technologies have been progressively integrated into various areas of mental health care. Mobile applications are potentially effective tools that allow psychiatric patients themselves to access self-management resources and tools within the community setting. Mental health nursing plays a key role in enabling patients to take an active role in their care and in promoting activities that foster their involvement and empowerment. The primary aim of this pilot study was to develop the PsyAPP mobile application to support both nurses and individuals with mental illness in managing care and improving health outcomes, and to assess its feasibility within a real-world clinical setting. Methods: A mobile application (PSYAPP) and a complementary web-based nursing management platform were designed and implemented. A total of 20 psychiatric patients enrolled in a partial hospitalization program in Soria (Spain) participated. Participants were assigned to experimental (app users) and control groups. Psychological empowerment, global functioning, and suicide risk were assessed before and after the intervention. Results: Patients who used the application showed significantly greater psychological empowerment (W = 2.04, p ≤ 0.04) compared with the control group. Statistically significant improvements were observed in psychological, social, and occupational functioning. Regarding suicide risk, no statistically significant changes were detected between pre- and post-intervention measurements in either group. Overall, PSYAPP demonstrated feasibility and potential utility as an innovative tool to support mental health care follow-up. Conclusions: This study developed and implemented a mobile application designed to enhance mental health care by supporting both patients and psychiatric nurses. Results showed significant improvements in global functioning in both the app and control groups, suggesting that rehabilitative treatment contributed to overall progress. Suicide risk did not significantly change within groups, although improvements were seen in the full sample, likely due to clinical care rather than app use. Only the experimental group demonstrated increased psychological empowerment, indicating that the app may effectively enhance patient engagement and involvement in their own care. Full article

Research suggests that the impact of childhood sexual trauma (CST) on adult well-being varies in relation to characteristics of CST experiences (e.g., age of onset and duration/frequency) that influence the degree of trauma severity. Yet there remains a need for a CST severity measure that consistently delineates survivors with an elevated risk of adverse adult outcomes (AAOs) and accounts for correlations between severity characteristics. We compared two theory-based, categorical proxy measures of CST severity (duration and developmental timing) in their relationship with three AAOs, among a national probability sample of U.S. adult CST survivors (N = 568). We found a strong relationship between CST duration and developmental timing (p < 0.001), and redundancy in their impact on AAOs (i.e., no meaningful difference in how well they predicted AAOs). Participants with more chronic CST (≥4 years duration or occurring across childhood and adolescence) were twice as likely to report AAOs as other participants. Findings support the importance of assessing trauma chronicity in research and practice, to focus prevention and intervention strategies on CST survivors with the greatest long-term health risk. A categorical CST duration measure offers a theory-based assessment strategy that accounts for both the temporal and developmental effects of trauma severity on health outcomes. Full article

Background: Childhood obesity represents the most common nutritional and metabolic disorder in industrialized countries and constitutes a major public health concern. In Italy, 20–25% of school-aged children are overweight and 10–14% are obese, with marked regional variability. Excess adiposity in childhood is frequently associated with hypertension, dyslipidemia, insulin resistance, and non-alcoholic fatty liver disease (NAFLD), predisposing to future cardiovascular disease (CVD). Objective: To investigate anthropometric indicators of cardiometabolic risk in 810 children and adolescents aged 7–17 years who underwent assessment for competitive sports eligibility at the Sports Medicine Unit of Modena, evaluate baseline knowledge of cardiovascular health aligned with ESC, AAP (2023), and EASO guidelines. Methods: 810 children and adolescents aged 7–17 years undergoing competitive sports eligibility assessment at the Sports Medicine Unit of Modena underwent evaluation of BMI percentile, waist circumference (WC), waist-to-height ratio (WHtR), and blood pressure. Cardiovascular knowledge and lifestyle habits were assessed via a previously used questionnaire. Anthropometric parameters, blood pressure (BP), and lifestyle-related knowledge and behaviors were assessed using standardized procedures. Overweight and obesity were defined according to WHO BMI-for-age percentiles. Elevated BP was classified based on the 2017 American Academy of Pediatrics age-, sex-, and height-specific percentiles. Statistical analyses included descriptive statistics, group comparisons, chi-square tests with effect size estimation, correlation analyses, and multivariable logistic regression models. Results: Overall, 22% of participants were overweight and 14% obese. WHtR > 0.5 was observed in 28% of the sample and was more frequent among overweight/obese children (p < 0.001). Elevated BP was detected in 12% of participants with available measurements (n = 769) and was significantly associated with excess adiposity (χ² = 7.21, p < 0.01; Cramér’s V = 0.27). In multivariable logistic regression analyses adjusted for age and sex, WHtR > 0.5 (OR 2.14, 95% CI 1.32–3.47, p = 0.002) and higher sedentary time (OR 1.41 per additional daily hour, 95% CI 1.10–1.82, p = 0.006) were independently associated with elevated BP, whereas BMI percentile lost significance when WHtR was included in the model. Lifestyle knowledge scores were significantly lower among overweight and obese participants compared with normal-weight peers (p < 0.01). Conclusions: WHtR is a sensitive early marker of cardiometabolic risk, often identifying at-risk children missed by BMI alone. Baseline cardiovascular knowledge was suboptimal. The observed gaps in cardiovascular knowledge underscore the importance of integrating anthropometric screening with structured educational interventions to promote healthy lifestyles and long-term cardiovascular prevention. Full article

Probiotics, whether consisting of a single strain or multiple strains, are attracting growing interest in the management of type 2 diabetes mellitus (T2DM). However, their efficacy remains a matter of controversy and requires careful consideration. Accordingly, this meta-analysis aimed to compare the efficacy of single-strain to that of multi-strain probiotics supplementation on glycated haemoglobin (HbA1c) and fasting blood glucose (FBG) levels in adults with T2DM. Nineteen articles published between 2017 and 2024 obtained from 4 databases (Cochrane, Web of Science, Scopus, and PubMed) were included. These interventions, conducted in a total of 1159 participants, lasted from 6 to 24 weeks and were based on clearly identified probiotic formulations, with assessments of HbA1c and FBG. The results showed that, overall, probiotic supplementation had no significant effect on HbA1c (−0.24%; 95% CI [−0.76; 0.27]; p = 0.36), although a trend towards reduction was observed for single-strain formulations (−0.57%; p = 0.05). Regarding FBG, only the multi-strain group showed a significant reduction (−0.76; 95% CI [−1.18; −0.34]; p < 0.001), while the effect of the single-strain formulation was not significant. The comparison between the two formulations (Wald test) showed that there was no significant difference (p ≤ 0.05). However, high heterogeneity (I² > 75%) and variable strains/doses limit confidence in these findings. Full article

Background/Objectives: Branched-chain fatty acids (BCFAs) exhibit a range of biological activities; however, their limited natural abundance and high cost have constrained in vivo research. Lanolin represents a promising source for enriching BCFAs. Nevertheless, the in vivo application, safety, and dose-effect relationship of BCFAs derived from lanolin (BCFAs-DFL) remain unassessed. Methods: In this study, the acute toxicity in C57BL/6J mice was first evaluated for 7 days by a single oral administration of 5000 mg/kg BW of BCFAs-DFL. Subsequently, 40 mice were divided into four groups (control group, low dose of 100 mg/kg BW, medium dose of 300 mg/kg BW, and high dose of 600 mg/kg BW) and were continuously administered by gavage for 28 days to study the effects of BCFAs-DFL on the growth, blood biochemistry, intestinal morphology, and intestinal flora of the mice. Results: In the acute toxicity test, BCFAs-DFL exhibited no lethality or abnormalities in mice, indicating its non-toxic nature. Throughout the 28-day trial, mice in the medium- and high-dose groups experienced a notable decrease in average daily feed intake (p < 0.05), yet their weight gain remained unaffected (p > 0.05). Hemoglobin and hematocrit levels declined in the high-dose group (p < 0.05). Conversely, serum aspartate aminotransferase and total bilirubin levels escalated in the medium- and high-dose groups, while triglycerides and urea nitrogen levels decreased (p < 0.05). The serum’s total antioxidant capacity and immunoglobulin levels (IgA, IgG) rose in proportion to the dosage (p < 0.05). BCFAs-DFL notably enhanced the villus height of the jejunum and ileum in mice (p < 0.05). Gut microbiota analysis indicated no significant impact on overall α and β diversity. Conclusions: The 28-day intervention revealed that BCFAs-DFL can modulate feeding behavior, TG, T-AOC, and immunoglobulin levels in mice. Additionally, it promotes the development of intestinal villi. Based on various indicators, a dosage of 100 mg/kg BW effectively induces beneficial metabolic regulation, such as the reduction of triglycerides, without causing a burden on liver metabolism. This dosage may represent a more suitable application for potential use. Full article

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical patients with chronic conditions is a priority for healthcare. Methods: This meta-analysis summarized data from 39,493 medical patients across 14 non-randomized trials that had been identified by a prior review of the survival benefits of social support interventions. Results: Across four studies reporting hazard ratio data, the results failed to reach statistical significance (HR = 2.10, 95% CI = 0.99 to 4.48, p = 0.0546), and the results of ten studies reporting odds ratio data were of smaller magnitude (OR = 1.27, 95% CI [0.72, 2.23], p > 0.05). Heterogeneity characterized both the odds ratio data (I² = 53%; Q = 18.1, p = 0.03) and hazard ratio data (I² = 89%, Q = 23, p < 0.001). A notable finding was that studies with longer periods of data collection showed longer survival among medical patients receiving social support. Conclusions: Long-term observations may be necessary for the survival benefits of social support interventions to become apparent. Further research with a larger pool of data from long-term follow-up studies will be needed to establish firm conclusions. Full article

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, with comparatively limited attention given to how individual reminiscence is implemented and sustained within care home practice. Methods: This study was an implementation-focused qualitative exploration of staff experiences of introducing and embedding individualised reminiscence in care home practice. Care home staff participated in four monthly workshops that introduced principles of individualised reminiscence and supported them to plan and implement reminiscence with at least one resident. Participants used either the InspireD digital reminiscence app (n = 19) or non-digital approaches such as life story books (n = 2), depending on local preferences and perceived suitability. Three focus groups were conducted with 21 care home staff to explore experiences of implementing individualised reminiscence and perceptions of its impact on residents, staff, and families. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were identified: (1) reminiscence within pressured systems; (2) resident experience and identity; (3) adapting and sustaining practice; and (4) families as partners in reminiscence. Participants described challenges associated with workload pressures, role expectations, and variability in family involvement, which influenced how reminiscence was adopted in practice. Despite these constraints, participants described perceived benefits for residents, including perceived improvements in mood, engagement, and expressions of identity. Participants also discussed perceived increased staff confidence, strengthened staff–resident relationships, and enhanced awareness of person-centred care practices. Conclusions: Findings highlight the perceived potential of individualised reminiscence to support person-centred and relational care in care homes, while identifying key contextual influences on implementation. Further research is needed to examine sustainability and effectiveness using comparative and mixed-method designs. Full article

Background: High-intensity interval training (HIT) is a time-efficient strategy to improve metabolic health in children, but its impact on inflammatory markers is still unclear. Therefore, we conducted a meta-analysis to examine the role of HIT on pro-inflammatory cytokines including C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-α) in children with overweight/obesity. Methods: A meta-analysis was conducted following PRISMA guidelines. PubMed, Web of Science, Scopus, and Embase were searched up to 31 July 2025, for studies involving children with overweight/obesity aged 6 to 18 years. Randomized controlled trials and non-randomized controlled trials with outcome measurements that included CRP, IL-6, and TNF-α were included. Random-effects models were used to aggregate a mean effect size (ES) with 95% confidence intervals (CI), and potential moderators were explored. Results: In total, 768 participants from 15 studies were included. HIT significantly improved CRP (574 participants, 13 studies, SMD = −0.63, 95% CI: −1.02 to −0.24, p < 0.01) when compared to control group/pre-intervention. There were no significant effects on IL-6 and TNF-α, and no differences when compared to moderate-intensity training. Subgroup analyses indicated greater effectiveness in intervention duration, work-and-rest ratio, and work time were the significant moderators (p < 0.05). Conclusions: High-intensity interval training is effective for reducing CRP levels in children with obesity. Intervention duration, work-and-rest ratio, and work time can affect the intervention effects of HIT. Full article

The increasing need to regenerate public housing stock highlights the importance of adopting integrated evaluation tools capable of supporting transparent, sustainable, and public value-oriented investment decisions. This study compares two alternative intervention strategies—renovation with extension and demolition followed by reconstruction—by applying a Cost–Benefit Analysis (CBA) model developed in two phases. In the first phase, the analysis focuses on social benefits, with the aim of assessing their contribution to collective well-being. The second phase incorporates potential energy-related benefits, estimated on the basis of performance improvements associated with the two design scenarios. The results demonstrate that the integrated consideration of economic, social, and energy–environmental dimensions affects the relative performance differences between the examined strategies, offering a more comprehensive evaluation framework than conventional approaches based solely on monetary costs. The proposed model, which is replicable in Mediterranean contexts, contributes to the ongoing international debate on ex ante evaluation tools and provides operational insights to support urban regeneration policies oriented towards more effective, equitable, and policy-consistent solutions, in line with the objectives of the European Green Deal and the 2030 Agenda. The two-phase structure allows decision-makers to distinguish between short-term social effects and long-term energy-related benefits, offering a transparent support tool for public investment choices under fiscal constraints. Full article

This study investigates the structural evolution and projected trajectory of greenhouse gas (GHG) emissions across the EU27 from 1990 to 2030, with a particular focus on their implications for the effectiveness of European climate policy. Drawing on official sectoral data and employing a multi-method framework combining time series modelling (ARIMA), machine learning (Random Forest), regime-switching analysis, and segmented linear regression, we assess past dynamics, detect structural shifts, and forecast future trends. Empirical findings, based on Markov-switching models and segmented regression analysis, indicate a statistically significant regime change around 2014, marking a transition to a new emissions pattern characterised by a deceleration in reduction rates. While the energy sector experienced the most significant decline, agriculture and industry have gained relative prominence, underscoring their growing strategic importance as targets for policy interventions. Hybrid ARIMA–ML forecasts indicate that, under current trajectories, the EU is unlikely to meet its 2030 Fit for 55 targets without adaptive and sector-specific interventions, with a projected shortfall of 12–15 percentage points relative to 1990 levels, excluding LULUCF. The results underscore critical weaknesses in the EU’s climate policy architecture and reveal a clear need for transformative recalibration. Without accelerated action and strengthened governance mechanisms, the post-2014 regime risks entrenching a plateau in emissions reductions, jeopardising long-term climate objectives. Full article

Visceral leishmaniasis (VL) is a serious vector-borne disease affecting humans and dogs, posing major public health challenges in endemic regions. Control efforts often target sandfly vectors, whose larvae and pupae develop in soil. Environmental management, such as removing organic matter, reducing moisture, and pruning vegetation, aims to limit breeding sites and reduce sandfly populations. This study evaluated the impact of integrated interventions on sandfly behavior in priority areas for VL control in Araçatuba, São Paulo, Brazil. The control strategy combined environmental management, canine surveys, and educational actions across seven local work areas (LWAs). Between 2019 and 2021, CDC-type light traps were installed in intra- and peridomiciliary settings at twelve properties in LWA 5. Spatial risk analysis for canine transmission was conducted in LWAs 3 and 5 using a Generalized Additive Model, with results presented as spatial odds ratios. Vector prevalence was analyzed using negative binomial regression compared to historical municipal data. Intervention coverage averaged 52.91% of visited properties (n = 15,905), ranging from 48% to 76.8% across LWAs. Adherence to environmental management exceeded 85%. Of the 150 sandflies collected, 98.67% were Lutzomyia longipalpis and 1.33% Nyssomyia neivai. A 6% reduction in vector density was observed compared with historical data, although this difference was not statistically significant. Spatial risk varied among LWAs, indicating heterogeneous transmission levels. These findings suggest that integrated environmental and educational interventions may contribute to reducing vector density and that identifying priority areas tends to support surveillance and the effectiveness of disease control actions. Full article

Background: Dietary transitions toward Westernized patterns (WDPs) (high in processed foods, sugars, and fats) pose a global public health challenge. The Westernized Diet Index (WDI) measures adherence to these patterns. However, its validity with respect to metabolic biomarkers warrants thorough evaluation for use in epidemiological and clinical research. Objectives: This study validates the WDI using metabolic biomarkers (including anthropometrics, blood pressure, fasting blood glucose (FBG), triglycerides, HDL-c, LDL-c, and total cholesterol), examines its association with metabolic syndrome (MetS), and compares scoring methods to identify the most effective measure of WDPs adherence. Methods: Data from 10,146 participants in the Fasa Adult Cohort Study (FACS) were used. We calculated the WDI using global (WDI-G) and population (WDI-P) Z scores and food group (WDI-FG)-based algorithms. Validation employed logistic and linear regression, ROC (receiver operating characteristic) curves, Youden’s index, and k-means clustering. Results: All WDI scoring methods (across all methods, higher scores indicated lower adherence to WDPs) demonstrated a strong, significant association with all three MetS definitions (WHO, NCEP: ATPIII, and IDF) and nearly all investigated metabolic biomarkers. In fully adjusted logistic models, WDI Global (WDI-G) (OR: 0.23) and WDI Food Groups (WDI-FG) (OR: 0.26) were significantly associated with MetS (based on the WHO definition). Also, in fully adjusted linear regression models, a 10% increase (reflecting lower adherence to WDPs) in the WDI-G score (range: −2.03 to 1.11) was significantly associated with a 3.96 mg/dL reduction in FBG and a 2.61 cm reduction in waist circumference. Additionally, ROC curves (AUC: 0.57–0.61) demonstrated that WDI predicts MetS with moderate accuracy. The strongest associations were observed with population-based scoring. In addition, based on comparative performance, WDI-G, WDI-P, and WDI-FG appear most suitable for cross-population, within-cohort, and mechanistic or intervention-focused research, respectively. Conclusions: The WDI shows promise as a nutritional tool for assessing adherence to WDPs and exploring associations with metabolic health outcomes, including MetS. These findings suggest that the WDI may be useful in future dietary, public health, and clinical research, although further validation in diverse populations is warranted. Full article

Background/Objectives: Targeted muscle reinnervation and regenerative peripheral nerve interface procedures have emerged as effective techniques for reducing post-amputation pain and preventing symptomatic neuroma formation. However, the optimal timing of these procedures remains debated. This study aims to compare complication and reoperation rates between acute and delayed advanced nerve interface procedures in lower-extremity amputees. Methods: A retrospective cohort study was conducted including 74 patients who underwent acute or delayed targeted muscle reinnervation and/or regenerative peripheral nerve interface procedures between 2019 and 2025 at a tertiary academic medical center. Procedures performed concurrently with amputation or during early-stage reconstruction were classified as acute, whereas procedures performed more than one month after amputation were classified as delayed interventions. The primary outcome was postoperative surgical complications occurring within one year. Mann–Whitney U and chi-square tests were used for group comparisons. Univariable and multivariable logistic regression analyses were performed to identify factors associated with surgical complications, adjusting for potential confounders. A p-value < 0.05 was considered statistically significant. Results: Of 80 limbs, 47 (58.8%) underwent acute and 33 (41.3%) underwent delayed procedures. One-year complication rates were 23.4% in the acute group, and 12.1% in the delayed group, with wound-related complications predominantly occurring in patients undergoing amputation for infection or vascular disease. Unexpected reoperation rates were 19.1% for acute and 12.1% for delayed interventions. On univariable and multivariable analyses, early procedures demonstrated higher odds of surgical complications. However, these associations did not reach statistical significance and were limited by baseline differences in patient comorbidity and etiology. Conclusions: Early advanced nerve interface procedures were performed in more medically complex patients and were associated with higher observed rates of surgical complications, whereas delayed procedures were associated with a higher incidence of recurrent symptomatic neuromas. These findings underscore the importance of patient selection, etiology of amputation, and surgical context, rather than timing alone, when determining the optimal approach to nerve interface reconstruction following lower-extremity amputation. Full article

With the rapid development of Massive Open Online Courses (MOOCs), high dropout rates have become a major challenge, limiting the quality of online education and the effectiveness of targeted interventions. Although existing MOOC dropout prediction methods have incorporated deep learning and attention mechanisms to improve predictive performance to some extent, they still face limitations in modeling differences in course difficulty and learning engagement, capturing multi-scale temporal learning behaviors, and controlling model complexity. To address these issues, this paper proposes a MOOC dropout prediction model that integrates multi-scale convolution with a symmetric dual-attention mechanism, termed SDA-Net. In the feature modeling stage, the model constructs a time allocation ratio matrix (MRatio), a resource utilization ratio matrix (SRatio), and a relative group-level ranking matrix (Rank) to characterize learners’ behavioral differences in terms of time investment, resource usage structure, and relative performance, thereby mitigating the impact of course difficulty and individual effort disparities on prediction outcomes. Structurally, SDA-Net extracts learning behavior features at different temporal scales through multi-scale convolution and incorporates a symmetric dual-attention mechanism composed of spatial and channel attention to adaptively focus on information highly correlated with dropout risk, enhancing feature representation while maintaining a relatively lightweight architecture. Experimental results on the KDD Cup 2015 and XuetangX public datasets demonstrate that SDA-Net achieves more competitive performance than traditional machine learning methods, mainstream deep learning models, and attention-based approaches on major evaluation metrics; in particular, it attains an accuracy of 93.7% on the KDD Cup 2015 dataset and achieves an absolute improvement of 0.2 percentage points in Accuracy and 0.4 percentage points in F1-Score on the XuetangX dataset, confirming that the proposed model effectively balances predictive performance and model complexity. Full article