Search Results (7,727)

Background: Linear growth during childhood is a key indicator of health status and child development, and liquid cow’s milk has been proposed as a potentially relevant dietary component for this outcome. In this systematic review, we aimed to synthesize the available evidence on the association between liquid cow’s milk consumption and linear growth outcomes in infants and children aged 6 months to 12 years. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Observational and experimental studies published in peer-reviewed journals, with no language restrictions, were included if they assessed habitual liquid cow’s milk consumption as the main exposure and reported linear growth outcomes such as height, growth velocity, or height-for-age z-scores. Searches were performed in PubMed (MEDLINE) and Scopus from database inception to 15 January 2026. Study selection, data extraction, and risk-of-bias assessment were carried out systematically. Due to methodological heterogeneity among the included studies, results were synthesized narratively. Results: Twelve studies conducted across diverse geographic and socioeconomic contexts were included. Most studies reported positive associations between liquid cow’s milk consumption and indicators of linear growth, including greater height, higher growth velocity, or improved height-for-age z-scores. Experimental studies showed significant increases in linear growth among children who received milk regularly, whereas some observational studies reported non-significant associations or results dependent on statistical adjustment. One study assessing complete cow’s milk exclusion observed deceleration in linear growth. Overall, the risk of bias was predominantly moderate. Conclusions: Habitual consumption of liquid cow’s milk during childhood appears to be predominantly associated with favorable linear growth outcomes, although variability exists according to study design, age at exposure, milk type, and exposure assessment. Further research using more robust designs is warranted to clarify the magnitude of the association, potential mechanisms, and implications for weight-related outcomes. Full article

This work examines the machining responses of dry turning in ultrasonic-assisted stir-squeeze cast A356 hybrid nanocomposites reinforced with zirconia (ZrO₂) and graphene oxide (GO). Accordingly, flank wear (VBc) ranged from 0.061 to 0.238 mm, influenced by abrasion, adhesion, built-up edge (BUE) formation, and diffusion mechanisms. Cutting speed had the most significant effect on flank wear (65.65%), followed by depth of cut (18.2%) and feed rate (11.13%), supported by a well-fitted regression model (R² = 0.987; p < 0.05). Surface roughness (Ra) ranged from 1.733 to 7.012 μm, with cutting speed, feed rate, and depth of cut contributing 70.42%, 15.43%, and 9.56%, respectively. The cutting temperature was limited to 127 °C, primarily influenced by cutting speed (60.68%), whereas cutting power varied between 0.353 and 0.644 kW, mainly governed by cutting speed (68.71%) and depth of cut (25.92%). The chip morphology showed a segmented sawtooth pattern due to cyclic fracture initiation during material removal. Multi-criteria optimization using complex proportional assessment (COPRAS) identified v = 90 m/min, f = 0.06 mm/rev, and d = 0.1 mm as the optimal parameters, yielding a tool life of 22.6 min and a machining cost of INR 58.69 per item. This research is further focused on the implementation of different cooling lubrication techniques utilizing environmentally friendly cutting fluids, including Minimum-Quantity Lubrication and nano-MQL, among other types of environments. Full article

Background: Clinical reasoning is a vital competency for safe nursing practice, yet no validated Arabic instrument exists to assess this skill among nursing students in Saudi Arabia. Aim: This study aimed to translate, culturally adapt, and psychometrically evaluate the Arabic version of the Clinical Reasoning Scale (CRS) and to investigate clinical reasoning among Saudi nursing students. Methods: This methodological instrument validation study with a cross-sectional survey component was conducted in Saudi Arabia between January 2024 and May 2025 among nursing students. The Arabic Clinical Reasoning Scale (CRS-A) was translated and culturally adapted in accordance with the WHOQOL Group guidelines for instrument translation. Content validity was assessed by 10 experts, and construct validity was evaluated using exploratory factor analysis (n = 365). The response rate was 98.65%. Internal consistency was evaluated using Cronbach’s alpha (n = 365), and test–retest reliability (n = 30) was measured with the Intraclass Correlation Coefficient (ICC) over a two-week period. Descriptive statistics, one-way analysis of variance (ANOVA), and independent sample t-tests were also performed. Results: The tool’s content validity (S-CVI = 0.98) was confirmed by a panel of experts. The CRS-A demonstrated excellent temporal stability (ICC = 0.95, p < 0.001) and internal consistency (Cronbach’s α = 0.935). The exploratory factor analysis showed that the 16 items’ factor loadings ranged from 0.542 to 0.807, and three factors accounted for 64.33% of the total variance. Students self-reported agreement with clinical reasoning abilities (mean scores: 3.81–4.18). No significant differences in clinical reasoning were found by age (p = 0.102) or gender (p = 0.226), but significant differences were found by Cumulative Grade Point Average (CGPA) (p < 0.001). Conclusions: The Arabic Clinical Reasoning Scale demonstrated preliminary psychometric performance for measuring clinical reasoning among Arabic-speaking student nurses. It provides educators with a valuable tool for identifying learning needs and evaluating educational interventions. Full article

Background: Post-traumatic growth (PTG) refers to positive psychological changes resulting from the struggle with highly challenging or traumatic life events. Psychosocial interventions have demonstrated efficacy in promoting psychological well-being in the aftermath of traumatic experiences. Cognitive Behavioral Therapy (CBT) is among the most extensively studied such interventions, aligning with the PTG model’s prerequisites for growth. Objective: The aim of this systematic review was to assess the efficacy of CBT and CBT-based interventions in promoting PTG. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Scopus, and Google Scholar databases from inception to December 2024. Eligibility criteria included: (a) the inclusion of a CBT or CBT-based intervention, (b) measurement of PTG using the Post-Traumatic Growth Inventory (PTGI), (c) study participants having experienced traumatic life events, and (d) articles written in English. Risk of bias was assessed independently by two reviewers. Due to the heterogeneity of included studies, a qualitative narrative synthesis approach was adopted. Risk of bias was assessed using the RoB-2 tool for RCTs, ROBINS-1 for quasi-experimental studies and Newcastle–Ottawa scale for cohort studies. Certainty of evidence, assessed using the GRADE framework, is considered low. Results: A total of 19 studies were included (13 randomized controlled trials, 3 quasi-experimental, and 3 longitudinal studies). While traditional CBT produced mixed results in fostering PTG, CBT-based therapeutic protocols—particularly those explicitly designed to target PTG or incorporating structured cognitive–emotional techniques—demonstrated more consistent benefits. Limitations of the included studies include measurement of PTG as a secondary outcome, small sample sizes, and the presence of confounding variables. Conclusions: Further high-quality, multicenter randomized controlled trials with standardized protocols are needed to clarify the role of CBT in promoting growth after trauma. Full article

Introduction: Applying the International Classification of Functioning, Disability, and Health (ICF) framework, this study examined longitudinal associations among activities of daily living (ADL) limitations, participation, and well-being among community-dwelling older adults with ADL difficulty. Methods: We used five waves (2015–2019; Waves 5–9) of the National Health and Aging Trends Study (NHATS; baseline n = 5346). Well-being was measured using 11 NHATS items spanning affect, life satisfaction, and perceived control/self-efficacy. Participation was operationalized using five dichotomous indicators of engagement in common social and community activities. Autoregressive cross-lagged structural equation models were estimated using full-information maximum likelihood, and indirect associations were assessed with bootstrap standard errors. Results: We found that ADL limitations were associated with lower subsequent participation, while greater participation was associated with higher subsequent well-being across waves. Indirect associations linking ADL limitations to later well-being through participation were small and time-dependent. Discussion: Overall, the findings are consistent with an ICF-informed perspective in which participation is part of the longitudinal context linking activity limitations and well-being over time, although effect sizes were modest. Full article

Pediatric phlebotomy is a common invasive procedure frequently associated with pain, anxiety, and fear, which may negatively affect children’s cooperation and overall healthcare experiences. Virtual reality (VR) has emerged as a promising non-pharmacological intervention capable of providing immersive distraction and emotional engagement during painful medical procedures. The aim of this systematic review was to evaluate the effectiveness of immersive VR in reducing pain perception and anxiety-related outcomes among pediatric patients undergoing phlebotomy procedures. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question was developed using the PICO framework. Randomized controlled trials and comparative controlled studies published between January 2020 and September 2025 were identified through systematic searches of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies involving children and adolescents aged 4–17 years undergoing phlebotomy or venipuncture procedures were eligible for inclusion. A total of six studies comprising 557 pediatric participants were included in the review. The VR interventions involved immersive and interactive environments, including educational simulations, animated scenarios, and game-based experiences delivered through head-mounted displays. Four studies reported statistically significant reductions in pain and/or anxiety among participants exposed to VR compared with control groups, whereas two studies found no significant differences. Across the included studies, VR interventions were generally well accepted by children, parents, and healthcare professionals, with only mild and transient adverse effects reported. However, substantial heterogeneity was observed regarding clinical settings, VR technologies, intervention protocols, and outcome assessment methods. The current evidence suggests that immersive VR is a promising adjunctive strategy for reducing pain and anxiety during pediatric phlebotomy procedures. Nevertheless, the available evidence remains limited by methodological heterogeneity and relatively small sample sizes. Future research should focus on larger, well-designed randomized controlled trials using standardized intervention protocols and outcome measures to support evidence-based implementation of VR in pediatric clinical practice. Full article

Background/Objectives: Chronic home oxygen therapy—long-term oxygen therapy (LTOT)—improves survival and quality of life in chronic respiratory failure when used ≥15 h/day, but adherence is frequently suboptimal and specific patient-reported outcome measures (PROMs) are scarce. To develop, validate and apply a specific PROM for patients on LTOT. Methods: A prospective observational cohort study was conducted at San Juan de Alicante University Hospital (April 2024–December 2025) following a four-stage process: conceptual framework definition and expert workshop, content validation and item reduction, cognitive interviews with pilot reliability testing (n = 25), and field application to 120 consecutive chronic LTOT users. The LTOT-PROM was designed to capture the patient-perceived impact attributable to LTOT during the previous 4 weeks. Internal consistency was assessed with Cronbach’s α and test–retest reproducibility with the intraclass correlation coefficient (ICC). Results: The final instrument comprises 15 scored items in two dimensions—Daily Activity (9 items) and Adverse Effects (6 items)—plus one ambulatory-only mobility item excluded from the total score. Cronbach’s α was 0.814 (95% CI 0.681–0.906) for Daily Activity, 0.743 (95% CI 0.548–0.872) for Adverse Effects and 0.808 (95% CI 0.677–0.902) for the total scale; total ICC(A,1) was 0.890 (95% CI 0.767–0.950). Among the 120 patients (62 men, 58 women; mean age 78 ± 13 years; mean therapy duration 40 ± 32 months), 68% reported reduced effort for daily activities, 66% reported a reduction in dyspnoea and 67% reported improved self-confidence; 49% reported morning airway dryness and 7% abandoned the equipment due to nasal dryness or rhinitis. Conclusions: The LTOT-PROM is a brief, reliable and reproducible oxygen-specific instrument for assessing the recent patient-perceived impact of LTOT in routine clinical practice. Further studies should evaluate structural validity, external validity and the relationship between LTOT-PROM scores and objective adherence measures. The construct was predefined as the patient-perceived impact attributable to LTOT during a standardised 4-week recall window, and cognitive interviews confirmed that respondents interpreted the items as experienced benefit/burden during that period rather than as week-to-week symptom change. Full article

A total of 3930 blackfin flounder (Glyptocephalus stelleri) individuals were collected continuously on a monthly basis from the East Sea of Korea in 2024 (n = 1800) and 2025 (n = 2130). The total length ranged from 10.6 to 44.0 cm in 2024 and from 11.9 to 49.7 cm in 2025. The major prey items differed between the years. In 2024, polychaetes (75.3%) and amphipods (12.2%) were the dominant prey items, whereas in 2025, euphausiids (33.1%), polychaetes (33.7%), and fish (17.5%) were the most important prey groups, indicating a clear interannual variation in diet composition. PERMANOVA revealed that diet composition varied significantly with year, season, and size class (p < 0.05), with a significant interaction between the year and season. These patterns were consistently supported by the CAP ordination, which showed a clear separation of samples along the seasonal gradient on the CAP1 axis, with additional variations associated with the year and size class observed within the respective seasonal groupings. Ultimately, these results suggest that G. stelleri functions as an opportunistic feeder that is capable of shifting its diet in response to environmental fluctuations. This study aims to provide scientific data for efficient fishery resource management and ecosystem-based assessments in response to future climate change. Full article

Cancer patients receiving systemic therapy experience substantial treatment-related symptoms. Nurse-led digital health interventions, e.g., interactive voice response systems, web platforms, mobile apps, and telehealth, have emerged as strategies to strengthen supportive care. To evaluate its effectiveness, this systematic review summarizes evidence exclusively from randomized controlled trials (RCTs). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, four databases were searched from inception to January 2025 for eligible RCTs involving adults undergoing anticancer therapy; evaluating nurse-led or nurse-co-led interventions using digital or telecommunication technologies; reporting validated symptom or health-related quality of life (HRQoL) outcomes. Risk of bias was assessed. Nine RCTs (N = 3344) met criteria; seven had low risk of bias. Interventions using telephone systems, web portals, mobile apps, or videoconferencing reduced symptom burden and improved HRQoL. The Symptom Care at Home system reduced symptom burden by ~43%, with greatest effects from combined automated monitoring and nurse practitioner follow-up. Additional benefits included improved anxiety, self-efficacy, patient participation, fewer severe toxicities and hospitalization days. In conclusion, nurse-led digital interventions effectively reduce symptom burden and support HRQoL during systemic therapy. Multicomponent models integrating automated monitoring with structured nursing follow-up and decision support appear most beneficial. Full article

Matrix reasoning tasks remain among the most widely used instruments for assessing abstract reasoning and are often assumed to be culturally neutral. However, this assumption has been challenged by studies reporting significant cross-cultural variation in performance on nonverbal matrix reasoning tasks, even when groups show comparable performance on verbal measures of general cognitive ability. One plausible reason is that many matrix reasoning tasks rely primarily on accuracy-based performance metrics while providing limited insight into response timing and task engagement during problem solving. The present study examined the Matrix Reasoning Item Bank (MaRs-IB), a new online matrix reasoning instrument integrating both accuracy and response time, in 458 participants from China and the UK. Results demonstrated strong psychometric properties across both cultural contexts, while also revealing systematic between-group differences in overall task performance. Chinese participants were generally slower but more accurate, whereas UK participants responded more quickly with lower overall accuracy. Rather than reflecting a classical speed–accuracy trade-off, these patterns may indicate cross-cultural variation in persistence, deliberative engagement, and the metacognitive regulation of cognitive effort during reasoning tasks. In particular, Chinese participants allocated more time before responding and persisted longer on challenging task items, whereas UK participants demonstrated relatively faster responding and shorter response times on more challenging items. These findings suggest that cross-cultural differences in matrix reasoning performance may reflect not only differences in observed performance levels, but also variation in how participants allocate time and sustain engagement during cognitively demanding tasks. Full article

Background/Objectives: Against the background of the rapid aging of the population, the symptoms of depression are a major health problem for middle-aged and older adults. This study analyzes the relationship between social participation and the trajectory of depressive symptoms and whether this association varies by gender. Methods: The data comes from five rounds of surveys conducted by the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, including a total of 5796 participants aged 45 or above. The depressive symptoms of each wave are measured using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Social participation was defined as the number of reported activities (0, 1, or ≥2). The development trajectory of depressive symptoms was analyzed through Group-Based Trajectory Modeling (GBTM), and their links with social participation level were subsequently quantified using multinomial logistic regression. Gender differences were assessed via interaction tests and stratified models. Results: GBTM identified four distinct depressive symptom trajectories: low (29.71%), moderate (42.72%), increasing (22.07%), and high (5.50%). Compared with no participation, engaging in one activity was linked to lower odds of falling into the moderate, increasing, and high trajectories; the association was stronger for ≥2 activities. Gender-stratified analyses revealed substantial heterogeneity (all interaction p < 0.01). Among women, single-activity participation was associated with lower odds across all three adverse trajectories. Among men, similar associations required ≥2 activities, with single-activity participation linked only to lower odds of the high trajectory. Conclusions: Higher levels of social participation have significantly reduced the depressive symptoms of middle-aged and older adults, and the gender differences are pronounced. Interventions should improve access to social participation for older women and promote activity diversity for older men. Full article

Background: Given the increasing consumption of ultra-processed foods (UPFs) and the public health importance of cognitive decline in ageing, understanding how UPFs impact cognitive performance is highly relevant. However, evidence in older adults - particularly in Italy—remains scarce, despite the country’s rapidly ageing population, its comparatively low UPF intake, and its distinct Mediterranean dietary context. Methods: We analysed cross-sectional data from 809 community-dwelling adults aged ≥ 65 years (59.4% women) participating in the NutBrain population-based cohort. Dietary intake was assessed using a 102-item semi-quantitative food frequency questionnaire, and daily grams of foods were classified according to the NOVA system into groups, which were analysed using a compositional data analysis approach. Global cognition and domain-specific performance were measured using standardised neuropsychological tests. Associations between NOVA groups and cognitive outcomes were estimated using multiple linear regression models adjusted for potential confounders. Gender-stratified analyses were also performed. Results: UPFs accounted for 21% of total energy intake, with bakery products as the main contributors. A relative increase of unprocessed or minimally processed foods was associated with better cognitive function (B = 0.36, p = 0.014), whereas a greater contribution of UPFs relative to the overall diet was associated with worse global cognitive function (B = −0.26, p = 0.003). The strongest associations were observed for episodic memory, particularly among women. Conclusions: A higher relative consumption of UPF was associated with worse global and memory-related cognitive performance. Longitudinal and experimental studies are warranted to clarify causality and underlying mechanisms. Full article

Background: Rosacea is a chronic inflammatory dermatosis characterized by vascular dysregulation, immune dysfunction, neurovascular alterations, and microbial involvement. Recent advances in understanding its pathophysiology have led to the development of targeted therapeutic strategies addressing multiple disease mechanisms. This systematic review aimed to evaluate contemporary evidence regarding emerging and established treatment approaches for rosacea. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2016 and 2025. Original human studies evaluating therapeutic interventions for rosacea were included. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate for each study design. Results: Fifteen studies involving 537 patients with rosacea and 77 controls (614 participants in total) met the eligibility criteria. Evaluated interventions included vascular-targeted therapies, topical anti-inflammatory agents, systemic and immunomodulatory treatments, and microbiome-oriented approaches. Oxymetazoline, pulsed-dye laser, platelet-rich plasma, ivermectin, azelaic acid, dapsone, sulfur preparations, and metronidazole demonstrated clinical benefits in reducing erythema, inflammatory lesions, or overall disease severity. Emerging therapies, including tofacitinib and oral ivermectin, showed promising results in refractory disease. Microbiome-related interventions, particularly Demodex-targeted therapies and Helicobacter pylori eradication, were also associated with clinical improvement. Risk-of-bias assessment identified two studies with low risk of bias, twelve with moderate risk of bias, and one study with high risk of bias. Conclusions: Current evidence supports a multimodal and mechanism-based approach to rosacea management, integrating vascular, inflammatory, immunological, and microbiological targets. However, the available evidence remains limited by small sample sizes, heterogeneous methodologies, short follow-up periods, and a predominance of non-randomized study designs. Large, well-designed randomized controlled trials are needed to establish optimal evidence-based treatment strategies and define the long-term efficacy and safety of emerging therapies. Full article

Background/Objectives: Medical social work is performed in hospital teams, but evidence remains limited on how medical social workers’ perceived communication and cooperation with physicians and nurses are associated with occupational outcomes. Methods: Using the medical social work module of the China Social Work Longitudinal Survey 2019 (CSWLS2019), this cross-sectional study examined job satisfaction, personal accomplishment, self-rated service quality, and emotional exhaustion. We constructed a four-item communication-and-cooperation index and estimated ordinary least squares (OLS) models with HC3 heteroskedasticity-robust standard errors and city fixed effects. Robustness and exploratory supplementary checks assessed sample definition, alternative specifications, single-item ordered logit models, decomposed components, moderation, and a supplementary seemingly unrelated regression (SUR) system. Results: The index was positively associated with job satisfaction (b = 0.260, p = 0.0010), personal accomplishment (b = 0.416, p = 0.0335), and self-rated service quality (b = 0.151, p = 0.0275). Its association with emotional exhaustion was negative but not statistically significant in the main model (b = −0.186, p = 0.1207), although it became significant in the stricter sample. Decomposed and moderation models provided limited evidence for stable component-specific or moderation patterns. Conclusions: The findings should be interpreted as exploratory associational evidence rather than causal effects. Perceived communication and cooperation with physicians and nurses appear more consistently linked to favorable occupational evaluations than to emotional exhaustion among medical social workers in China. Full article

Background: Parental burnout results from chronic stress related to the parental role and reflects a persistent imbalance between parenting demands and available psychological resources, negatively affecting parental well-being and parent–child relationships. This study examined the associations between parental burnout, parenting attitudes, and psychological resilience within the parental adaptation of the job demands–resources model, with particular attention to the potential mediating role of parenting styles in the relationship between resilience and parental burnout, while controlling for sociodemographic factors. Methods: A cross-sectional design was applied with 447 Hungarian parents who completed an anonymous online questionnaire including the Parental Burnout Assessment, the Parenting Styles and Dimensions Questionnaire, and the 10-item Connor–Davidson Resilience Scale. Data were analyzed using nonparametric correlations, group comparisons, multiple linear regression models with bootstrap estimation, and mediation analyses. Results: Resilience showed negative associations with all dimensions of parental burnout. Authoritarian and permissive parenting styles were positively associated with burnout, whereas authoritative parenting style showed negative associations. In multivariate analyses, authoritative parenting attitudes and fulfillment of the ideal parental role emerged as protective factors, while authoritarian parenting style functioned as a significant risk factor. Mediation analyses further indicated that the association between resilience and parental burnout may partly operate through parenting styles, particularly across the dimensions of emotional exhaustion, contrast, and emotional distancing. Conclusions: Parental burnout appears to be a dynamic psychological process shaped by the interaction of internal resources and parenting functioning, underscoring the importance of resource-oriented approaches in prevention and intervention. Full article