Search Results (14,639)

Presbycusis, or age-related hearing loss (ARHL), is a multifactorial disorder characterized by a gradual, bilateral sensorineural decline in hearing sensitivity, predominantly affecting high-frequency sounds. It is one of the most common chronic conditions in the aging population and represents a major public health concern due to its high prevalence and progressive nature. Presbycusis significantly impairs speech perception, especially in noisy environments, leading to communication difficulties, reduced social participation, increased risk of social isolation, and a decline in quality of life. Moreover, growing evidence highlights a strong association between ARHL and cognitive impairment, dementia, depression, and increased frailty in older adults. The etiology of presbycusis is complex and involves the interplay between genetic predisposition and cumulative environmental and lifestyle-related factors. Genetic susceptibility influences cochlear aging, neural degeneration, and vulnerability to external insults. Non-genetic contributors include chronic noise exposure, cardiovascular and metabolic disorders such as diabetes and dyslipidemia, ototoxic medications, smoking, and other lifestyle factors that may accelerate cochlear damage through oxidative stress and microvascular dysfunction. This narrative review aims to provide an updated overview of the genetic and environmental determinants involved in the development and progression of presbycusis. Furthermore, it discusses the clinical implications of these factors for early identification, audiological evaluation, prevention strategies, and personalized management approaches. A better understanding of the multifactorial nature of presbycusis may support the development of targeted interventions to preserve hearing function and improve overall health outcomes in the aging population. Full article

Background: Lifestyle factors such as diet and physical activity significantly impact on the risk of obesity in individuals with Down syndrome (DS). However, in the absence of national nutritional guidelines in individuals with DS, further work is needed to understand their dietary and physical activity patterns. In this work we retrieved caregivers’ responses on those aspects. Methods: We analyzed data from a cross-sectional online survey of caregivers of individuals with DS conducted as part of the GO-DS21 project and reported in the accompanying paper (nutrients-4216283) (n = 764). We explored physical activity patterns, dietary habits, beliefs around weight-loss interventions and caregiver confidence that family members with DS would engage in a healthier lifestyle. Associations were examined using correlation analysis, and cumulative and binary logistic regression models. Results: Caregivers reported that most individuals with DS exercised 1–3 times per week, with frequency declining with age. Males were more likely to exercise daily than females. Caregiver exercise frequency was positively correlated with that of their DS family member (ρ = 0.521, p < 0.001), suggesting clustering of shared health behaviors within households. In adjusted models, caregivers who exercised regularly had up to thirteen-fold higher odds of having a physically active family member with DS (aOR = 13.02, 95% CI: 7.40–24.06, p < 0.001). Fried food consumption and higher snack frequency were independently associated with perceived obesity status, while sugar-sweetened beverage consumption was not. Caregivers favored exercise as a weight-loss strategy, while anti-obesity drugs were endorsed by only 11% of caregivers primarily and were more likely to be endorsed when obesity was perceived (aOR = 4.21, 95% CI: 2.44–7.39, p < 0.001). Finally, caregiver confidence that their family member with DS would engage in healthier behaviors was associated with perceived obesity status and strongly associated with higher physical activity levels (aOR 14.68, 95% CI: 6.59–33.40, p < 0.001). Conclusions: In this large European caregiver survey, reported consumption of selected energy-dense foods was generally low, although fried food intake and higher snack frequency were associated with perceived obesity. Physical activity patterns were closely aligned between caregivers and individuals with DS, suggesting shared household health behaviors. These findings highlight the importance of involving caregivers and family environments in lifestyle interventions aimed at supporting physical activity and weight management in individuals with DS. Full article

Hypertrophic Cardiomyopathy (HCM) is one of the most common inherited cardiomyopathies and remains an important cause of ventricular arrhythmias and sudden cardiac death (SCD), particularly in younger individuals. Although the annual incidence of arrhythmic death is relatively low in contemporary cohorts, identifying those patients who may benefit from primary prevention with an implantable cardioverter-defibrillator (ICD) remains a major clinical challenge. Current risk stratification strategies rely on two principal paradigms. The European approach is centered on the HCM Risk-SCD score, whereas the American approach is mainly based on major clinical risk markers. Both strategies have important strengths and limitations, reflecting the persistent difficulty of accurately predicting arrhythmic events in such a heterogeneous disease. The HCM Risk-SCD score has demonstrated robust external validation and high specificity for identifying patients at higher risk, but it may fail to recognize some vulnerable individuals who remain below conventional treatment thresholds. For this reason, several additional risk modifiers have gained increasing relevance in contemporary practice. Among them, extensive late gadolinium enhancement, left ventricular systolic dysfunction, apical aneurysm, and clinically meaningful genetic findings may provide important incremental prognostic information beyond traditional models. Emerging disease-modifying therapies, in particular Mavacamten, may also influence future risk assessment. However, whether these improvements translate into a true reduction in SCD risk remains uncertain. Importantly, the decision to implant an ICD should not depend on numerical risk alone. It should arise from a process of shared decision-making integrating estimated risk, treatment burden, competing comorbidities, age, lifestyle, and patient values. In this context, the concept of an individualized threshold of “acceptable risk” becomes central. In conclusion, prevention of SCD in HCM is moving beyond conventional scores toward a personalized and dynamic framework in which predictive tools, advanced phenotyping, evolving therapies, clinical expertise, and patient preferences are combined to guide individualized care. Full article

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the availability of effective medications and lifestyle interventions, blood pressure control rates remain poor globally, and the prevalence of hypertension continues to rise. In 2023, the US Food and Drug Administration approved renal denervation—a catheter-based procedure that ablates the renal sympathetic nerves—as an adjunctive treatment for patients with uncontrolled or resistant hypertension, defined as blood pressure above goal despite the use of at least three antihypertensive medications, including a diuretic at maximally tolerated doses. Both radiofrequency and ultrasound-based devices are approved for this procedure. However, individual patient responses vary, and further research is needed to clarify long-term efficacy, safety, and optimal patient selection. The number of trained proceduralists and access to facilities is increasing, but multidisciplinary teams and shared decision-making are recommended to ensure appropriate referrals and patient education. In this review, we discuss the pathophysiology of hypertension and approaches to treatment, review the history of renal denervation and the data on which FDA approval was based, detail the safety profile of commercially available devices, and provide a practical, team-based approach to appropriate patient selection. Full article

Background/Objectives: While the health effects of economic fluctuations are well-documented, the role of policy-related uncertainty remains underexplored. The objective of this study is to examine the association between economic policy uncertainty (EPU) and mortality. Furthermore, we investigate whether changes in lifestyle behaviors are associated with EPU and may help shed light on the relationship between EPU and health outcomes. Methods: We utilize a mixed data sampling (MIDAS) framework to analyze US state-level data from 2009 to 2020. The model controls for unemployment, income, demographic characteristics, as well as state and year fixed effects. This approach enables the incorporation of high-frequency uncertainty measures to capture dynamic mortality responses. Results: The results indicate a statistically significant inverse association between EPU and total mortality. The association is negative across both genders, with a stronger effect observed among males. Across age cohorts, the retirement-age group exhibits the highest sensitivity. In terms of cause-specific mortality, EPU is positively associated with mortality from respiratory diseases and suicide, while it is negatively associated with mortality from homicide, accidents, and pneumonia and influenza. In addition, EPU is significantly associated with a lower prevalence of current drinking and smoking, a higher likelihood of being in a healthy weight range, improved self-reported health, and reduced time spent traveling. Conclusions: The findings suggest heterogeneous associations between EPU and mortality outcomes across demographic groups and causes of death, highlighting the complex and multifaceted nature of the relationship between policy-related uncertainty and population health rather than a uniform response across health outcomes. Full article

Gestational diabetes mellitus (GDM) is increasingly recognized as a complex pathology rooted in systemic and organelle-level dysfunction, specifically involving chronic low-grade inflammation (CLGI), mitochondrial impairment, and endoplasmic reticulum (ER) stress. Central to this pathophysiology is mitochondrial dysfunction, characterized by reduced respiration, impaired metabolic flexibility, and dysregulated fission/fusion machinery, which fuels a self-perpetuating cycle of reactive oxygen species (ROS) production. Concurrently, chronic ER stress triggered by hyperglycemia and lipotoxicity activates the unfolded protein response (UPR), further amplifying redox imbalance through the Endoplasmic Reticulum Oxidoreductin 1/Protein Disulfide Isomerase (ERO1/PDI) axis and bridging metabolic toxicity to inflammation via c-Jun N-terminal kinase (JNK) and nuclear factor kappa-light-chain–enhancer of activated B cells (NF-κB) signaling. The Advanced Glycation Endproducts (AGEs) and the Receptor for Advanced Glycation Endproducts (RAGE) axis act as a molecular catalyst that sequester antioxidants and drive pro-inflammatory feedback loops. These converging mechanisms culminate in profound placental maladaptation, including structural abnormalities like chorangiosis and functional defects in nutrient transport mediated by hyperactive mechanistic target of rapamycin complex 1 (mTORC1) signaling. This review article provides insight into recent evidence to elucidate the meta-inflammatory environment of GDM, where modest but sustained elevations in biomarkers like Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) disrupt redox homeostasis and impair insulin signaling pathways through the activation of stress-sensitive kinases. By integrating these molecular perspectives, the article underscores the necessity of targeting the systemic inflammatory and oxidative continuum spanning pre-conception to the antenatal period through lifestyle interventions and emerging therapeutic strategies to mitigate GDM risk and improve maternal–fetal outcomes. Full article

The lack of continuance use of fitness apps causes persistent concern. This paper endeavors to examine the impact of initial use on the continuance use of fitness apps by incorporating theories on commitment and investment. A fitness app-based online running event and a two-stage field survey were conducted. A total of 162 participants’ app usage data and survey responses were collected and tested using structural equation modeling. The findings revealed that initial use increases users’ affective commitment and continuance commitment to fitness apps, which promotes continuance use in the subsequent period. The continuance use of fitness apps then enhances users’ physical exercise performance. Additionally, this study confirmed the strengthening moderation effect of users’ social network size, indicating that a larger social network amplifies the positive influence of continuance commitment on continuance use. These findings contribute to sustainable health promotion by explaining how sustained engagement with digital exercise tools can support active lifestyles and well-being. Full article

Background: Hypertension is one of the most common noncommunicable diseases. Objectives: This research assessed the magnitude of hypertension among young adults, identified its key determinants, and explored potential strategies adopted for prevention. Methods: A cross-sectional design was employed, including 1606 participants aged 18 years and older, recruited through convenience sampling from universities and community settings. Data were collected using a content-validated questionnaire covering sociodemographic information, personal and family medical history, and lifestyle habits. Results: Of the participants, 993 (61.8%) reported hypertension, nearly double previous national estimates. Male gender, age ≥ 30 years, and family history were significant risk factors, along with smoking, alcohol use, sedentary lifestyle, and unhealthy diet, while physical activity and dietary modification were protective. Despite high prevalence, only 22.1% had controlled blood pressure and 17.8% adhered to medication, with 51.5% relying on herbal remedies. Conclusions: These findings highlight the urgent need for early screening, youth-focused awareness, and culturally tailored interventions to reduce hypertension and prevent long-term cardiovascular complications. Hypertension among young adults in the UAE is a major public health concern, requiring integrated strategies combining education, lifestyle modification, and medical management to improve outcomes. Full article

Freshwater clams (Corbicula spp.), commonly known as shijimi in East Asia, have long been valued for their functional and nutritional properties. In this review, we summarise the physiological effects of hot water extracts derived from Taiwanese freshwater clams (FCE), particularly in relation to metabolic syndrome and other lifestyle-related disorders. Traditionally, shijimi has been used to alleviate hepatic dysfunction and symptoms associated with alcohol consumption. FCE significantly suppresses galactosamine-induced increases in serum aspartate aminotransferase and alanine aminotransferase. In addition, FCE reduces alcohol-induced hepatic lipid accumulation and lowers hepatic cholesterol levels. FCE also influences alcohol metabolism: animals receiving FCE exhibit lower blood alcohol concentrations and a faster rate of alcohol clearance following ethanol administration. These findings suggest that shijimi may protect against alcohol- or drug-induced liver damage, potentially by enhancing alcohol metabolism. Beyond its role in liver protection, shijimi has been associated with the alleviation of jaundice, possibly through increased bile secretion linked to improved cholesterol homeostasis. Supporting this, studies using models of exogenous hypercholesterolemia show that FCE lowers both serum and hepatic cholesterol levels in a dose-dependent manner. Overall, traditional claims regarding the hepatoprotective effects of shijimi are increasingly supported by mechanistic and molecular evidence. This is the first clarified review of the various effects of shijimi. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of global chronic liver disease, with a prevalence of approximately 30%. This review outlines the diagnostic transition from the exclusionary non-alcoholic fatty liver disease (NAFLD) framework to the affirmative MASLD nomenclature, which mandates the presence of at least one of five specific cardiometabolic risk factors (CMRFs) to prioritize active pathophysiology. Beyond hepatic complications, MASLD drives systemic metabolic failure, significantly elevating risks for type 2 diabetes, hepatocellular carcinoma, and cardiovascular disease, the primary cause of mortality in this cohort. Clinical management relies on a standardized, two-tier risk-stratification pathway for advanced fibrosis. Primary care triage utilizes the Fibrosis–4 (FIB–4) index; a score < 1.3 excludes advanced disease via a high negative predictive value, whereas indeterminate or high scores require secondary validation via vibration-controlled transient elastography (VCTE) or the enhanced liver fibrosis (ELF) test to guide specialist referral. Although lifestyle modifications, principally a 7–10% weight reduction and Mediterranean diet adherence, remain foundational, management has transitioned toward disease-modifying pharmacotherapies. A pivotal breakthrough occurred with the 2024 FDA approval of resmetirom, a selective thyroid hormone receptor-beta (THR-β) agonist, for non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced fibrosis. Concurrently, the emergence of GLP-1 receptor agonists and multi-incretin mimetics offers a personalized, multi-target approach simultaneously addressing hepatic inflammation, glycemic control, and adiposity. Full article

Background: Diabetes is a growing public health crisis across the Arab region, where rapid urbanization, dietary transitions, and physical inactivity have contributed to some of the highest diabetes rates globally. Despite a growing recognition of the problem, most diabetes prevention efforts in the region remain small-scale or insufficiently adapted to the sociocultural realities of adults living in the UAE. Evidence-based diabetes prevention strategies, such as the United States’ Centers for Disease Control Diabetes Prevention Program (DPP), reduce the risk of developing diabetes but remain underutilized. Methods: The objectives of this study were to (1) describe the systematic cultural adaptation of the Evidence-based Intervention for Diabetes Prevention (EID) using the Framework for Reporting Adaptations and Modifications–Expanded (FRAME), and (2) assess the preliminary acceptability of the adapted materials through formative focus groups. Results: Materials were culturally tailored to address both deep and surface structures. Deep structure adaptations incorporated Arab cultural values, social norms, and religious practices, including Ramadan-specific content. The original 26-session curriculum was condensed to 12 weekly sessions based on prior research and stakeholder input. Surface-level adaptations included translation into Arabic and development of culturally relevant educational videos. Three formative focus groups (n = 7 total participants) provided preliminary findings of strong acceptability of simplified, culturally relevant, and digitally supported materials. Conclusions: This work will inform the adaptation of an evidence-based lifestyle change program aimed at preventing type 2 diabetes in high-risk individuals to better meet the needs of adults living in the UAE. While some countries have created their own national diabetes prevention efforts, like the United Kingdom, there is notably no similar program in the Arab world. Full article

Background: Residential lifestyle medicine programs have documented immediate and long-term improvements in cardiometabolic risk factors. Despite this, adherence among participants varies in such programs, limiting the positive outcomes that can be achieved. This study aimed to assess how adherence to positive lifestyle behaviors correlates with cardiometabolic risk factors at the end of a residential lifestyle medicine program and at three or more months of follow-up. Methods: Patients enrolled in a NEWSTART^® lifestyle medicine program were invited to participate in this prospective chart review. Outcomes included changes in BMI, blood pressure, medication and supplement use, cardiometabolic disease biomarkers, Mediterranean eating pattern, meat intake, and other lifestyle behaviors. Results: Among 109 adults (78% female; 62% overweight or obese) enrolled in a 6- to 39-day (mean 14.5-day) residential intervention, meat intake reduced by 3.2 servings/week, MEPA III scores increased by 2.3, water intake increased by 2.1 glasses/day, and exercise increased by 193 min/week (all p < 0.01). From baseline to end of program, reductions were noted in blood glucose (−5.3 mg/dL, p = 0.01), total cholesterol (−16.0 mg/dL, p < 0.01), LDL cholesterol (−11.0 mg/dL, p < 0.01), HDL cholesterol (−2.0 mg/dL, p < 0.01), triglycerides (−13 mg/dL, p < 0.01), serum creatinine (−0.03 mg/dL, p = 0.049), systolic blood pressure (−6.0 mmHg, p < 0.01), diastolic blood pressure (−3.0 mmHg, p = 0.01), and weight (−3.2 kg, p < 0.01). At a mean of 8.6 months follow-up, reductions in triglycerides (14.9 mg/dL, p = 0.03) and weight (2.8 kg, p < 0.01) from baseline were sustained, and water intake increased 20% from baseline (1.1 glasses/day, p = 0.01). Improved adherence to a Mediterranean eating pattern score, increase in water intake and reductions in meat intake and BMI predicted favorable health outcomes. Conclusions: Participation in the lifestyle medicine program was associated with improvements in cardiometabolic risk factors during intervention and at follow-up. These outcomes correlated with adherence to positive lifestyle behaviors. Sustained weight reduction as well as dietary and cardiometabolic improvements in our participants suggest the NEWSTART^® intervention may hold promise for maintaining cardiometabolic health. Full article

Diabetes disproportionately affects rural populations in the United States where prevalence and associated complications remain among the highest in the nation. Access to diabetes education and support services is often limited by geography, socioeconomic barriers, and workforce shortages. This study qualitatively explored participant experiences in a telehealth-based Diabetes Self-Management Education and Support (DSMES) program. This study uses interview techniques and takes a phenomenological approach to exploring the lived experiences of 27 program participants. Transcripts were analyzed through three cycles of coding to identify shared themes. Four themes emerged: (1) structural benefits of the program, (2) knowledge gained, (3) lifestyle changes implemented, and (4) improved quality of life. Participants consistently emphasized the value of personalized coaching, emotional encouragement, and practical nutrition education. Findings suggest that individualized telehealth coaching plays an important role in diabetes self-management, particularly in rural and underserved populations. By combining personalization with education and encouragement, programs can improve patient engagement, enhance self-efficacy, and support meaningful behavior change. Full article

Background/Objectives: To describe the progression of axial and segmental ocular biometric lengths and refractive status in adolescents and study independent associations between these changes and baseline ocular biomechanics. Methods: Prospective cohort of 126 eyes from 63 individuals followed for 2.5 years. Data from general health and lifestyle were collected through a validated questionnaire. Data from ocular biometry (IOL MASTER 700^®), objective refraction, and ocular biomechanics (Corvis ST^®) were collected at baseline and the end of follow-up timepoints. Biomechanical parameters were correlated with the variation in axial length (d_AL), vitreous cavity length (d_VCL), and spherical equivalent (d_SE). Multivariable linear regression models (one eye randomly assigned) adjusted for age, SE, and AL were developed to identify independent associations between baseline biomechanics and d_AL, d_VCL, and d_SE. Results: The cohort of the present work had a mean age of 14.1 ± 2.6 years at baseline. Variations of 0.122 ± 0.17 mm, 0.092 ± 0.17 mm, and −0.32 ± 0.9 D were found in AL, VCL, and SE at follow-up, respectively. Within the multivariable regression models, the biomechanical parameters found to be independently associated with d_AL (model 1), d_VCL (model 2), and d_SE (model 3) were as follows: Model 1—Biomechanically corrected IOP (bIOP), Integrated Radius (IR), and A2 Deflection Area (A2DArea); Model 2—bIOP, IR, and A2DArea; and Model 3—IR and WholeEyeMovementMAxTime (MaxWEMT). Conclusions: The study of ocular biomechanical behavior may play a pivotal role in the risk assessment of ocular elongation and myopic progression. This work found independent associations between ocular biomechanical behavior at baseline and axial and segmental ocular elongation and refractive myopization, mainly including bIOP, IR, and MaxWEMT. Full article

During China’s social transformation, the spiritual life of young people exhibits a dual tendency toward secularisation and consumerization. While traditional institutional religion continues to wane, a consumption-based religiosity has surfaced, marking a shift from collective, class-based subcultural expressions to post-subcultural practices centred on individual affect, meaning bricolage, and fluid identities. Through a comparative analysis of historical Real Person Fiction and Yonghe Temple bracelets, this study reveals how contemporary youth transform historical memory and religious symbols into flexible cultural resources. Crucially, this transformation is not a wholesale rupture with tradition but rather a selective appropriation and recontextualization of religious concepts inherited through family upbringing and folk customs. Their practices thus embody a dialectic of discontinuity and continuity: what is discontinued is institutional allegiance to prescribed rituals; what continues is the deep-seated impulse to seek meaning through symbolic practices. The research finds that young people construct temporary scene-based tribes through emotional identification and symbolic consumption, using fluidity and multiplicity to counter anxieties in daily life. Compared to traditional communities, such tribes offer individuals meanings that are more personalised and immediate, reflecting the lifestyles individuals wish to cultivate. Within a context of high uncertainty, they convey fragmented responses to the predicaments of modernity through the reinterpretation and re-narration of historical and sacred symbols. Full article