Search Results (2,555)

Background: Premenstrual disorders (PMDs), including premenstrual syndrome and premenstrual dysphoric disorder, are common conditions that may substantially affect adolescents’ physical and psychological well-being. However, their presentation and management during adolescence are complicated by reproductive-axis maturation, overlap with other medical conditions, and limited adolescent-specific evidence. This review aimed to provide an interdisciplinary perspective on PMDs in adolescents, integrating biological, psychological, developmental, clinical, and sociocultural aspects. Methods: A structured narrative review was conducted. Publications addressing the neuroendocrine and developmental mechanisms, clinical manifestations, psychosocial consequences, diagnosis, and treatment of PMDs were considered, with adolescent-specific evidence prioritized where available. Results: Current evidence suggests that PMDs are associated with altered sensitivity to physiological ovarian steroid fluctuations and their neuroactive effects rather than abnormal circulating hormone concentrations alone. In adolescents, PMDs may present with diverse somatic, affective, cognitive, and behavioral symptoms and are associated with impaired quality of life, school functioning, interpersonal relationships, and psychological well-being. Diagnostic assessment remains challenging because symptoms may overlap with normal pubertal changes and psychiatric disorders. Prospective monitoring of symptom cyclicity and functional impairment is therefore essential. Pharmacological treatments, particularly selective serotonin reuptake inhibitors and selected combined oral contraceptives, represent important therapeutic options, while psychological, lifestyle, physical activity, and physiotherapeutic interventions may provide additional benefits. However, most treatment evidence is derived from adult populations. Conclusions: PMDs in adolescents should be conceptualized as multidimensional conditions requiring an interdisciplinary approach integrating gynecological, psychiatric, psychological, endocrinological, primary care, and lifestyle perspectives. Greater recognition and developmentally appropriate assessment may facilitate earlier diagnosis and individualized management. Further prospective, adolescent-specific research is needed to clarify the biological and psychosocial determinants of PMDs and establish evidence-based strategies for their multidisciplinary management. Full article

Background: Despite the rapid proliferation of mobile health applications in oncology, real-world uptake, determinants of use, and patient needs among breast cancer patients remain insufficiently described, particularly in the German healthcare context. This study aimed to assess health app use in breast cancer patients and to identify sociodemographic, lifestyle, and psychosocial correlates. Methods: We conducted a non-interventional, cross-sectional, anonymous paper-based survey among adult breast cancer patients receiving outpatient, day-care, or inpatient treatment, or follow-up at a tertiary university hospital (July 2022–January 2023). Descriptive statistics and group comparisons with false discovery rate correction and multivariable logistic regression were used to examine associations between app use and sociodemographic, lifestyle, and psychosocial variables. Results: A total of 202 patients were included (mean age 56.4 ± 13.8 years). Health app users were significantly younger than non-users (51.7 ± 11.0 vs. 64.7 ± 13.8 years, p < 0.001, Cohen’s d = 1.08). Age was the only variable that was independently associated with the use of health apps in the multivariable analysis (adjusted OR 0.43 per 10 years, 95% CI 0.29–0.64). Health app use showed no significant associations with indicators of physical fitness or lifestyle, perceived social support, or emotional burden. Health and fitness apps were the most frequently used app category (77.4%). Physicians were the most frequently consulted source of medical information (77.6%), and only one participant reported having received a digital health application on prescription. Conclusions: In this breast cancer cohort, health app use was common and age-associated. Given patients’ reliance on physicians and the near-absent DiGA prescription rate, age-sensitive implementation strategies and structured clinician guidance are needed to support equitable digital engagement in breast cancer care. Full article

Background: Obesity is a heterogeneous chronic disease, yet it is still commonly defined and managed using body mass index alone. Identifying clinically meaningful subgroups may support more efficient, precise and practical care. Objective: To identify and characterize population-level heterogeneity among adults with obesity in a large Israeli healthcare cohort. Methods: In this cross-sectional study, we analyzed deidentified electronic health record data from the Leumit Obesity Registry. Adults with obesity who had at least one documented weight measurement and height or BMI record during 2024 were included. Demographic, socioeconomic, lifestyle, clinical, and treatment variables were analyzed using K-prototypes cluster analysis to identify subgroups within a mixed-data population. Results: The study included 68,203 adults with obesity. Five distinct patient clusters were identified: metabolically healthy young adults, 19% of the cohort; adults with low comorbidity, 18%; middle-aged adults with moderate comorbidity, 23%; multimorbid seniors with socioeconomic disadvantage, 24%; and higher socioeconomic status advanced age with high clinical burden, 16%. The clusters differed substantially in age, comorbidity burden, socioeconomic status, and obesity-treatment utilization. GLP-1 use was most common in the older multimorbid clusters, particularly among low SES. Dietitian use was lower in the oldest and sickest cluster, despite high disease burden. Bariatric surgery was overall relatively rare and was concentrated mainly in the younger clusters. Conclusions: Adults with obesity in this large population-based registry did not represent a single clinical group, but rather several distinct phenotypes with different clinical and treatment patterns. These findings support a shift toward more phenotype-informed obesity care and resource planning. Full article

A Healthcare Recommender System (HRS) is a personalized decision-support system designed to recommend healthcare-related services, providers, information, advice, diagnoses, treatments, or lifestyle tips to users based on users’ preferences, characteristics, or individualized health data. Healthcare recommendation systems rely on multiple data sources. Among these sources, user reviews and comments on online healthcare platforms and social media serve as a valuable source to provide direct and often experience-based information about users’ satisfaction and opinions regarding healthcare services. Therefore, this study focuses on exploiting sentiment information extracted from user-generated reviews to enhance healthcare service recommendations. We propose a novel framework that integrates sentiment analysis on the Yelp dataset using DistilBERT, a lightweight transformer-based language model. The proposed framework incorporates Neural Collaborative Filtering (NCF) for the recommendation process. It utilizes Singular Value Decomposition (SVD) to address sparsity issues in user–item interaction data, thereby maintaining reliable performance even with limited data availability. The proposed approach achieved a Mean Absolute Error (MAE) of 0.34, a Root Mean Square Error (RMSE) of 0.66, and an Area Under the Curve (AUC) of 0.92. It also demonstrated strong ranking performance, achieving a Recall@10 of 0.74, demonstrating its effectiveness and accuracy in recommendation tasks. Compared with the rating-based, without-SVD, and without-NCF variants, which achieved RMSE values of 0.97, 1.80, and 1.14, respectively, the proposed model consistently achieved better performance. These results highlight the contribution of sentiment analysis, SVD-based interaction augmentation, and NCF to the recommendation performance. These results are promising and confirm the potential of the proposed approach for improving the reliability and performance of recommender systems. Full article

This is a consensus-based Canadian review with the primary purpose of expanding knowledge regarding supportive and topical therapies for chronic graft vs. host disease (cGvHD). There is often a lack of confidence in treating certain organ specific manifestations, and access to specialists with organ specific expertise varies across the country. This paper covers information gained from a literature review and Canadian transplanter expertise and will serve as a guide for hematopoietic cell transplant healthcare providers to topical cGvHD therapies accessible in Canada. We will review common symptoms and signs focused specifically on skin, mouth, eye and genital tract cGvHD and on lifestyle modifications and topical treatments as an adjunct to our recent publication on systemic treatment for cGvHD. Full article

Introduction: Black men experience persistent disparities across the prostate cancer continuum, including inequities in access to survivorship support. This study examined the perceived value, acceptability, and experiences of accessing a multicomponent digital survivorship program among Black men with prostate cancer. Methods: This exploratory mixed-methods study was embedded within the ongoing international Phase 4 implementation trial of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month digital intervention integrating exercise, pelvic floor muscle training, nutrition, stress management, psychosocial support, and peer connection. Fourteen self-identified Black participants contributed six-month program evaluation and qualitative data collected through open-ended responses and conference-based focus group discussions. Nine participants (64%) had undergone surgery with or without radiation and/or hormone therapy, four (29%) had received radiation with or without hormone therapy, and one (7%) was on active surveillance or had received no treatment. Quantitative data were summarized descriptively, and qualitative data were analyzed using inductive thematic analysis. Results: PC-PEP was highly valued, with median ratings of 10 (IQR 8–10) for likelihood of recommending the program and 9 (IQR 8–10) for overall usefulness. Among participants with available item-level data, 11/13 (85%) reported lifestyle improvement and 12/13 (92%) endorsed offering PC-PEP as standard care. Qualitative findings identified the value of holistic survivorship support, peer connection, normalization of vulnerability, and support for physical and psychological self-management. Participants also described limited awareness of PC-PEP at diagnosis and reliance on individual clinicians or incidental opportunities to learn about the program. Participants emphasized the need for earlier referral, greater representation, and culturally relevant community outreach. Conclusions: Black men who accessed PC-PEP reported high perceived value and identified benefits across multiple dimensions of survivorship. Their experiences, however, highlighted an important distinction between program availability and meaningful access: participants’ experiences suggest that availability alone may not ensure timely connection to survivorship support. Earlier referral, culturally responsive outreach, and integration of survivorship support into routine prostate cancer care may help close this gap. Full article

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has become the most common chronic liver disease in childhood, paralleling the global increase in pediatric obesity and metabolic dysfunction. Once considered a benign condition, pediatric MASLD is now recognized as a heterogeneous and potentially progressive disease that may advance from simple steatosis to steatohepatitis, fibrosis, and, rarely, cirrhosis, with lifelong hepatic and cardiometabolic consequences. Its pathogenesis is multifactorial, involving insulin resistance, adipose tissue dysfunction, chronic low-grade inflammation, genetic and epigenetic susceptibility, environmental factors, and alterations in the gut microbiome. Most affected children are asymptomatic, and diagnosis is often prompted by elevated liver enzymes or incidental imaging findings. Noninvasive tools, including ultrasonography, elastography, serum biomarkers, and emerging multi-omics approaches, are improving disease detection and risk stratification, although liver biopsy remains the reference standard in selected cases. Lifestyle modification, including dietary optimization, increased physical activity, and gradual weight reduction, remains the cornerstone of management, while pharmacological therapies are still under investigation in pediatric populations. The marked variability in disease susceptibility; progression; and treatment response underscores the need for a personalized medicine approach. Integrating clinical characteristics with genomic, epigenomic, metabolomic, and microbiome data may enable early identification of high-risk children, more accurate prognostic assessment, and individualized preventive and therapeutic strategies. Early detection and multidisciplinary care involving pediatricians, hepatologists, endocrinologists, dietitians, and families may help reduce disease progression and the risk of long-term hepatic and cardiometabolic complications. This review summarizes current evidence on the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of pediatric MASLD, with a particular emphasis on precision diagnostics, biomarker discovery, and personalized therapeutic approaches. It also discusses current challenges and future directions for implementing personalized medicine to improve outcomes and reduce the lifelong burden of pediatric MASLD. Full article

Background: Hypertension is a major contributor to cardiovascular morbidity and mortality globally, with particularly poor control in disadvantaged communities. Although awareness is generally high, sustaining lifestyle changes and treatment adherence remains difficult. This study examined socioeconomic, behavioural, and health system factors associated with hypertension management and explored the role of community-engaged health education in strengthening primary health care. Methods: A cross-sectional descriptive study was conducted among 107 adults with hypertension attending public primary health care facilities. Data were collected using structured questionnaires covering socioeconomic status, health system access, medication adherence, lifestyle practices, and knowledge and attitudes. Descriptive statistics summarized participant characteristics, while chi-square tests and multivariable logistic regression identified factors associated with clinic attendance, dietary adherence, lifestyle practices, and self-management. Results: Awareness of hypertension (86.9%) and trust in clinic care (91.6%) were high; however, a clear knowledge practice gap was evident. Although 79.4% acknowledged the importance of lifestyle changes, only 45.8% followed a hypertension-specific diet. Structural barriers included low income (39.3% earning <R3 000/month) and long distances to clinics (46.7% living ≥5 km away). Health worker advice strongly predicted dietary adherence (OR = 6.36, p = 0.001), lifestyle adherence (OR = 4.24, p = 0.006), and overall self-management (OR = 12.46, p = 0.024), whereas knowledge alone did not. Conclusions: Hypertension management is constrained more by structural and health system factors than by lack of awareness. Strengthening primary health care counselling and community-based health education may improve sustained lifestyle change and outcomes. Full article

Background/Objectives: Excess adipose tissue is associated with adverse changes in muscle metabolism and body composition. GLP-1 receptor agonists (GLP-1 RA) have transformed the treatment of obesity; however, concerns remain regarding the potential impact of treatment-associated weight loss on lean mass. This study aimed to evaluate the effects of GLP-1 RA on body composition in adults with obesity without type II diabetes mellitus (T2DM), with a particular focus on changes in lean mass. Methods: A database search of Medline Ultimate, Scopus, Web of Science, PubMed, and Embase was conducted to identify studies published up to December 30, 2024. Randomized controlled trials involving adults with obesity and without T2DM who received GLP-1 RA and reported changes in body composition were included. The protocol was registered with PROSPERO (CRD42025645378). Random-effects meta-analysis was performed using inverse-variance weighting. Results: A total of 2776 articles were identified, of which three trials comprising 171 participants met the inclusion criteria. Compared with controls, participants receiving GLP-1 RA treatment experienced greater reductions in lean mass (MD = −0.78 kg, 95% CI: [−1.37 to −0.16], I² = 63.2%). GLP-1 RA treatment was also associated with a significant reduction in fat mass (MD = −3.43 kg, 95% CI: [−5.94 to −0.93], I² = 78.2%). Conclusions: The loss of lean mass was greater in patients treated with GLP-1 RA than in the control group. These results highlight the importance for clinicians to incorporate lifestyle interventions, including physical activity and nutritional support, alongside therapy with GLP-1 RA. Full article

Liver fibrosis is the common pathway through which chronic liver injury progresses to cirrhosis, portal hypertension, liver failure, hepatocellular carcinoma, and systemic complications. Its burden is increasing worldwide, driven mainly by metabolic dysfunction-associated steatotic liver disease, alcohol-related liver disease, viral hepatitis, and cardiometabolic comorbidity. Current evidence supports a clinically practical approach centered on early risk recognition, non-invasive fibrosis assessment, etiologic treatment, lifestyle and metabolic risk reduction, and timely referral of patients with suspected advanced fibrosis. Although advanced cirrhosis may remain only partly reversible, fibrosis can regress when the injurious stimulus is controlled, making prevention of progression a realistic therapeutic goal. This review provides a clinically actionable framework for the assessment, management, and prevention of liver fibrosis, integrating current insights into epidemiological trends, etiopathogenesis, non-invasive and portal-hypertension assessment, sex-specific effects, hepatic and extrahepatic outcomes, and treatment strategies. It highlights the potential for fibrosis regression when the underlying etiologic factor is controlled and emphasizes the stages (F0–F2) at which reversibility is most achievable. Additionally, the paper outlines key research priorities to address current knowledge gaps in biomarker discovery, precision medicine, and artificial intelligence-assisted risk stratification, while defining priorities for personalized screening, multidisciplinary care, and combination antifibrotic research. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has become one of the most common chronic liver diseases worldwide, representing a major global health challenge closely linked to metabolic syndrome, obesity, and type 2 diabetes mellitus (TD2M). The condition is characterized by a multisystem nature driven by complex multifactorial mechanisms, including insulin resistance, lipotoxicity, mitochondrial dysfunction, genetic predispositions, and gut-liver axis alterations. Although liver biopsy remains the gold standard, non-invasive markers and advanced imaging methods are of key importance for early risk stratification. Furthermore, while liver-related complications such as fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) are significant, cardiovascular disease remains the leading cause of mortality in patients with MASLD. Current management relies primarily on lifestyle modifications, targeted pharmacotherapy (such as pioglitazone, GLP-1 receptor agonists, SGLT-2 inhibitors), and novel experimental therapies. Consequently, MASLD requires a multidisciplinary approach emphasizing early diagnosis, risk stratification, and comprehensive treatment of both hepatic and extrahepatic manifestations. Full article

Background: The gluten-free diet (GFD) remains the cornerstone of treatment for celiac disease (CeD), yet it is associated with a substantial psychosocial and practical burden. As novel therapies are being developed, understanding patient priorities, and their alignment with physician perceptions, is essential to guide future therapeutic strategies. Methods: We conducted a multicenter, cross-sectional online survey of adults with confirmed CeD followed at tertiary referral centers in Italy (Salerno), the UK (Sheffield) and Malta (La Valletta). The questionnaire collected demographic data, a 0–10 visual analogue scale (VAS) assessing self-reported adherence to the GFD, and responses to a single-choice question exploring what participants missed most since starting the GFD. A parallel survey was administered to healthcare providers to assess their perception of patients’ unmet needs. Descriptive statistics and between-groups comparisons were performed. Results: A total of 486 patients (74.7% female; mean age 43.2 years; 215 from Italy, 196 from the UK and 75 from Malta) and 134 physicians were included. GFD adherence was high, with a median score of 10. The most frequently reported unmet need among patients was the desire for an unrestricted diet (25.9%), followed by a preference for a medication allowing occasional gluten exposure (16.9%), greater availability of gluten-free options during travel (15.0%), and improved safety when eating out (13.6%). Interest in a lifelong pharmacological alternative to the GFD was limited (9.5%). Despite minor differences in the distribution of responses across centers, the overall pattern of patient priorities was remarkably consistent. Among 134 physicians (76 (56.7% from the United Kingdom, 20 (14.9%) from Malta, and 38 (28.4%) from Italy)), the most frequently perceived patient need was also an unrestricted diet (17.9%), but a higher proportion attributed importance to lifelong pharmacological therapy (16.4%). The distribution of responses differed significantly between patients and physicians (χ² test, p < 0.001). Conclusions: Patients with CeD across different European healthcare systems report consistent unmet needs driven primarily by lifestyle constraints and the burden of maintaining a strict GFD. Importantly, most patients do not seek complete replacement of the GFD, but rather strategies that provide greater flexibility and protection against occasional gluten exposure. A significant mismatch exists between patient priorities and physician perceptions, with clinicians overestimating the demand for a definitive cure and underestimating the importance of day-to-day disease burden. Future efforts should improve GFD practicality and prevent accidental gluten exposure, while an unrestricted diet remains the ultimate therapeutic goal. Full article

Background/Objectives: Obesity is a well-established risk factor for several cancers, yet few studies have explored survivorship outcomes among obesity-related cancer (ORC) survivors—a growing public health concern. Beyond cancer risk, obesity is associated with poorer health-related quality of life (HRQoL), greater comorbidity burden, and adverse lifestyle behaviors during survivorship. This study examined differences in these outcomes between ORC and non-ORC survivors living in Puerto Rico. Methods: We analyzed 569 cancer survivors aged ≥21 years actively undergoing treatment from the Impact of Social Determinants of Health on the Cancer Care Continuum in Cancer Survivors in Puerto Rico Study, with survey data collected between 2023 and 2025. ORC status was classified based on the presence of a primary ORC (n = 262); all others were classified as non-ORC (n = 307). Outcomes included: (1) HRQoL, assessed using the Functional Assessment of Cancer Therapy-General overall score and domains; (2) comorbidities; and (3) lifestyle behaviors (i.e., physical activity, alcohol use, and smoking status). Poisson regression models with robust standard errors estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for all outcomes except smoking status and comorbidity burden, which were analyzed using multinomial logistic regression models to estimate adjusted relative risk ratios (aRRRs). Results: ORC survivors had a higher relative risk of former smoking (vs. never smoking) than non-ORC survivors (aRRR: 1.74, 95% CI: 1.02–2.96). No other differences were observed between groups. Older ORC survivors reported better emotional (aPR = 0.59, 95% CI: 0.41–0.85) and physical (aPR = 0.74, 95% CI: 0.58–0.95) well-being than older non-ORC survivors. Among male participants, ORC survivors reported a lower prevalence of moderate/exceeded drinking than non-ORC survivors. Conclusions: Findings highlight a higher relative risk of former smoking (vs. never smoking) among ORC survivors compared with non-ORC survivors, with additional sex- and age-specific patterns in alcohol use and emotional/physical well-being. Full article

The rising incidence of chronic autoimmune and autoinflammatory diseases has been increasingly associated with environmental and lifestyle factors, including Western dietary patterns, intestinal dysbiosis, and reduced production of short-chain fatty acids (SCFAs). Reduced production of acetate, propionate, and butyrate has been associated with impaired epithelial barrier function, altered peripheral immune tolerance, and low-grade systemic inflammation. This article integrates and systematizes current knowledge in the field of immunometabolism, focusing on the role of the microbiota–metabolism–immunity axis. The molecular mechanisms by which these bacterial metabolites modulate immune function—both through the activation of specific surface receptors and direct epigenetic regulation—are analyzed in detail. SCFAs have been shown to actively reprogram the metabolic and transcriptional profiles of effector cells, stimulating anti-inflammatory macrophage polarization, suppressing cellular inflammatory cascades, and inducing the differentiation of protective regulatory T cells. To address the pharmacokinetic limitations of natural fatty acids, this study critically evaluates modern translational strategies. The clinical potential of synthetic receptor agonists, selective epigenetic modulators, and advanced next-generation bacterial consortia is analyzed. The presented data synthesis not only organizes the pathophysiological foundations but, above all, points to promising new directions for personalized non-pharmacological immunomodulation in the treatment of inflammatory diseases. Full article

Background: Sleep disorders, particularly chronic insomnia (Nidranasha), represent an escalating global public health challenge associated with extensive neuropsychological and metabolic morbidities. While conventional pharmacotherapy provides immediate symptomatic relief, concerns regarding dependency, tolerance, and altered sleep architecture necessitate the evaluation of evidence-based complementary interventions. Ayurveda offers a comprehensive multi-modality framework for sleep health through internal adaptogenic herbs (Abhyantar Chikitsa), external oil-based therapies (Bahir Parimarjana), and structured lifestyle regimens (Dinacharya/Ratricharya). This narrative literature review evaluates the current clinical and mechanistic evidence supporting Ayurvedic interventions for sleep disorders. Methods: A focused narrative review was conducted across PubMed; Scopus; Cochrane Central Register of Controlled Trials (CENTRAL); Google Scholar; and Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) Research Portal for literature published between 05/01/2016 and 05/01/2026. Randomized trials, open-label and single-arm clinical studies, mechanistic and phytochemical work, and toxicological and herb–drug interaction studies were eligible. Results: Standardized Withania somnifera root extract is supported by the most rigorous data, including double-blind placebo-controlled trials with polysomnographic or actigraphic corroboration reporting reductions in sleep-onset latency and improvements in sleep efficiency. Evidence for Bacopa monnieri and Valeriana wallichii is more limited and derives largely from studies in which sleep was a secondary outcome. External therapies, notably Shirodhara and Abhyanga, are associated with favorable autonomic and electroencephalographic changes, but the available trials are small, short, and difficult to blind, and non-specific effects of warmth, touch, and therapist attention cannot be separated from any specific treatment effect. Mechanistic work implicates modulation of gamma-aminobutyric acid (GABA) signaling, hypothalamic–pituitary–adrenal signaling, and parasympathetic activation, but these findings are hypothesis-generating and derive largely from in vitro and animal models at concentrations of uncertain human relevance. Conclusions: Ayurvedic interventions show preliminary signals of benefit in insomnia, most consistently for standardized Withania somnifera, but overall certainty remains low because of risk of bias, indirect evidence, poor standardization, and an absence of long-term safety data. Current evidence supports further rigorous investigation and carefully monitored adjunctive use in selected patients rather than general integration into routine care or substitution for established treatment. Full article