Search Results (605)

Objectives: Celiac disease (CD) is an immune-mediated disorder triggered by gluten ingestion. Although a gluten-free diet (GFD) is the only effective treatment, patients may still experience inflammation, nutritional imbalances, and reduced quality of life. Physical activity (PA) has demonstrated anti-inflammatory benefits; however, its role in CD management remains unclear. This systematic review aimed to synthesize evidence on the associations of PA and the outcomes of exercise interventions in individuals with CD, focusing on metabolic, nutritional, clinical, and functional outcomes. Methods: Following PRISMA guidelines, we included peer-reviewed observational and experimental studies assessing PA in individuals with CD across all age groups, without language or date restrictions. Searches were conducted in PubMed, Scopus, Web of Science, EMBASE, and SPORTDiscus. The risk of bias was evaluated using JBI and Cochrane RoB 2 tools. Results: Fourteen studies (17 publications) were included, the vast majority of which were cross-sectional, along with one quasi-experimental study and two randomized controlled trial cohorts reported across five publications. Data from these predominantly observational studies suggested possible, yet inconsistent, links between higher PA levels and better profiles in body composition, inflammatory and oxidative markers, quality of life, and psychological outcomes. Positive associations were also observed in some studies regarding gastrointestinal symptoms and adherence to the GFD. However, findings on metabolic markers and bone mineral density were inconsistent and linked to dietary factors. Conclusions: While PA represents a potential adjunct in the comprehensive management of CD, particularly in relation to functional and inflammatory outcomes. However, the current evidence remains highly preliminary, limited, and inconsistent, which restricts the strength of any definitive conclusions. Therefore, high-quality, longitudinal studies and well-designed clinical trials are needed to confirm its long-term benefits, especially in the pediatric population, and to establish specific recommendations. Full article

Glutamate excitotoxicity is a key contributor to the pathogenesis of glaucoma, a leading cause of irreversible blindness worldwide; however, the molecular events driving progressive retinal ganglion cell (RGC) loss and axonal degeneration remain incompletely understood, and effective neuroprotective therapies are lacking. Here, we evaluated the preventive potential of K9-C-peptide, a biopolymer-conjugated human C-peptide, in a mouse model of N-methyl-D-aspartate (NMDA)-induced retinal neurodegeneration and optic nerve axonal transport impairment, and examined potential mechanisms underlying its protective effects. In NMDA-induced excitotoxic mouse retinas, intracellular Ca²⁺ elevation mediated NMDA-induced oxidative stress, including both intracellular and mitochondrial reactive oxygen species (ROS) generation and lipid peroxidation. NMDA exposure induced activation of Müller glia and microglia and upregulation of inflammatory cytokines, ultimately leading to RGC death; these effects were attenuated by prolonged intraocular delivery of ROS scavengers. K9-C-peptide significantly reduced NMDA-induced retinal degeneration, including RGC loss and retinal thinning, and preserved optic nerve axonal transport function in both whole-mount retinas and optic nerve longitudinal sections. These protective effects were associated with suppression of NMDA-induced oxidative stress, mitochondrial dysfunction, and inflammation and reactive gliosis, without altering intracellular Ca²⁺ levels. Notably, sustained intraocular delivery of human C-peptide conferred robust neuroprotection for at least 3 weeks against NMDA-induced retinal degeneration and optic nerve axonal transport impairment. These findings suggest that K9-C-peptide acts as a long-acting neuroprotective agent that mitigates oxidative stress-driven retinal damage and axonal dysfunction, highlighting its translational potential as a C-peptide-based neuroprotective strategy for retinal glutamate excitotoxicity. Full article

Background/Objectives: Resting energy expenditure (REE) rises during critical illness, but its determinants and prognostic relevance remain incompletely characterized. Identifying a circulating signal that tracks REE could provide a bedside surrogate for metabolic demand where indirect calorimetry is unavailable. This prospective pilot study described longitudinal trajectories of indirect calorimetry-measured REE, Sequential Organ Failure Assessment (SOFA) score, serum cortisol and insulin-like growth factor-1 (IGF-1) over two weeks in the intensive care unit (ICU), examined whether the REE trajectory was attenuated by adjustment for these variables, and generated preliminary effect-size and variance estimates for mortality. Methods: This single-center pilot study enrolled 39 critically ill adults at Evangelismos General Hospital (Athens, Greece); sample size was pragmatic, not based on an a priori power calculation. REE (Q-NRG metabolic monitor), cortisol and IGF-1 were measured at admission and days 5–7, 10–11 and 13–14, alongside SOFA. Trajectories were modeled with linear mixed-effects models using all available repeated measures. Confounding was assessed by adding SOFA, cortisol and IGF-1 as covariates and evaluating attenuation of the time effect; no formal mediation analysis was performed. Causes of missing data were quantified and a completers-only sensitivity analysis was undertaken. Mortality was analyzed by Cox regression with ICU length of stay as the time variable. Estimation was emphasized throughout; point estimates and 95% confidence intervals (CIs) are reported in preference to significance testing. Results: Mean age was 54.6 ± 18.1 years; 69.2% were male; median admission SOFA was 6 (IQR 3–9). ICU and 28-day mortality were 20.5% (8/39) and 10.3% (4/39). REE/kg rose from 25.3 ± 3.7 to a peak of 27.2 ± 4.2 kcal/kg/day by days 10–11 (likelihood-ratio χ² = 17.2, p = 0.0006). Attrition was driven predominantly by discharge alive (18 of 23 patients missing at days 13–14) rather than death (n = 2), and the trajectory was preserved in a completers-only sensitivity analysis (χ² = 9.13, p = 0.028). Cortisol declined (21.1 to 13.4 μg/dL) and IGF-1 rose (80.0 to 105.4 ng/mL); SOFA was essentially unchanged. REE did not correlate with SOFA, cortisol or IGF-1 at any time-point, and the time effect was not attenuated by adjustment for them. Admission REE was not associated with ICU mortality (HR 1.00, 95% CI 1.00–1.00). Higher admission REE was associated with a longer ICU stay, and this persisted after adjustment for body mass index (p = 0.026) and fat-free mass (p = 0.001). Age (HR 1.04, 95% CI 1.00–1.09) and admission SOFA (HR 1.18, 95% CI 0.98–1.44) were the covariates most associated with ICU mortality. Conclusions: REE rose progressively over the first 10–11 days of critical illness. Its trajectory was not attenuated by adjustment for SOFA, cortisol or IGF-1, which is compatible with—but does not establish—independence from the adrenal and somatotropic markers measured here. Neither REE nor these hormones were associated with mortality; age and disease severity remained the dominant prognostic factors, supporting a larger confirmatory study. Full article

Empirical evidence for AI formative assessment combined with gamification remains scarce in subjective aesthetic disciplines. This study examined whether such integration enhances metacognitive regulation in undergraduate color education and whether the effect is conditional on learners’ prior AI credibility belief. A four-arm, four-wave cluster-randomized controlled trial (N = 540, 24 classes, eight cross-allocated teachers) compared gamification with AI feedback, gamification with dose-matched human feedback, gamification only, and traditional instruction; the primary outcome was metacognitive regulation measured 4 weeks post-intervention. Gamification produced a small-to-medium effect over traditional instruction (d = 0.34, p_Holm = 0.015). AI and human feedback did not differ on average (d = 0.07; underpowered). Autoregressive mediation confirmed metacognitive regulation as a longitudinal mediator of intervention effects on motivation and achievement. On an exploratory basis, prior AI credibility belief moderated the AI-versus-human indirect effect on motivation (p_Holm = 0.034) but not achievement (p_Holm = 0.054), with higher-belief learners benefiting; given the limited power of the AI-versus-human comparison, this conditional pattern is reported as a tentative finding rather than as confirmatory evidence. These findings extend self-determination theory and the self-regulated learning framework to aesthetic education and provide preliminary support for the deployment of prior-trust-aware AI feedback, pending replication. Full article

Background/Objective: Non-IgE-mediated food allergies (non-IgE-FAs) are increasingly recognized in infancy as causes of delayed gastrointestinal symptoms, nutritional compromise, and impaired growth. This retrospective study aimed to evaluate longitudinal growth outcomes in children with non-IgE-FAs managed with different dietary interventions and to explore phenotype-specific differences and clinical correlations. Methods: Children diagnosed with non-IgE-FAs at the Pediatric Clinic Unit of Salesi Hospital (Ancona, Italy) between July 2022 and June 2025 were included. Anthropometric, clinical, and laboratory data were collected at baseline (T0) and follow-up visits at 6, 12, and 18 months. Weight-, length-, and BMI-for-age z-scores were calculated using Growth Calculator 4.0. Longitudinal growth trends were assessed through individual linear regression slopes, and dietary intervention effects were evaluated with ANOVA models. Results: Thirty-seven children were included (57% male), 95% of whom were diagnosed with CMA. Slope analyses demonstrated significant positive trends for BMI z-scores (median 0.340, IQR −0.171 to 1.130; p = 0.013). BMI slope differed according to phenotype when comparing children with FPE and those with FPIAP (mean slope = 0.068 ± 0.795 vs. 0.782 ± 0.873, respectively; p = 0.048). No significant differences in BMI improvement were observed between children on an elimination diet, breastfed children whose mothers followed an elimination diet, and those on a free diet. Conclusion: Dietary management in children with non-IgE-FAs was associated with improved growth trajectories, particularly in BMI-for-age z-scores. Children with FPE showed a less favorable BMI trajectory than those with FPIAP. Although the choice of dietary strategy did not significantly affect growth outcomes in this cohort, individualized nutritional assessment and judicious use of elimination diets remain essential. Larger prospective studies are needed to refine phenotype-specific nutritional strategies and optimize long-term outcomes. Full article

Problematic smartphone use in adolescence has been linked cross-sectionally to poorer academic and emotional functioning, but the longitudinal mechanisms remain unclear. Using three waves of the Panel Study on Korean Children (W14–W16; ages 14–16), this study tested whether problematic smartphone use at age 14 predicts four developmental outcomes at age 16—school adjustment, self-regulated learning, ego resilience, and subjective happiness—through four age-15 mediators: gaming, video-watching, self-study hours, and academic stress. Hierarchical regressions with autoregressive controls, bootstrap a-paths, and 16 indirect effects tested with 20,000-draw Monte Carlo confidence intervals were estimated. Problematic smartphone use predicted three outcomes but not subjective happiness, for which the association was indirect only. Seven indirect effects were significant, and six survived Benjamini–Hochberg false discovery rate correction. The findings indicated two pathways: a time-displacement pathway (gaming and reduced self-study) specific to self-regulated learning and an academic-stress pathway linked to school adjustment, ego resilience, and happiness. Crucially, in baseline-controlled sensitivity analyses, the time-use pathways remained significant, whereas the stress pathway was fully attenuated, indicating a concurrent rather than a prospective association. Results were robust across path-model SEM, full-information maximum likelihood, and inverse-probability weighting, supporting a dual-pathway account of adolescent digital development. Full article

Against the backdrop of population aging, the well-being of older adults with disabilities in daily life and its underlying mechanisms has increasingly become an important research topic. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), this study focuses on 509 individuals aged 60 and above with disabilities. It incorporates informal social support, depression risk, and life satisfaction into a unified analytical framework, and employs ordered Logit models, binary Logit models, and the KHB decomposition method to examine their interrelationships and underlying mechanisms. The results show that: (1) informal social support is positively associated with the life satisfaction of older adults with disabilities; (2) informal social support is negatively associated with depression risk; and (3) depression risk is negatively associated with life satisfaction and plays a significant mediating role in the relationship between informal social support and life satisfaction, accounting for 23.25% of the total effect. From a daily life perspective, this study reveals that the well-being of older adults with disabilities is not solely derived from institutional resource provision, but is generated and sustained through ongoing social interactions and relational networks. The study therefore deepens our understanding of the everyday and relational dimensions of subjective well-being in later life. Full article

Background: With accelerated population aging, depressive symptoms in later life have become a major public health issue. The Chinese version of the MIND (cMIND) diet is a neuroprotective dietary pattern adapted to Chinese dietary habits. Previous studies have found that adherence to the cMIND diet is associated with lower levels of depressive symptoms, but the underlying statistical association patterns remain unclear. This study adopted a statistical moderated mediation framework to characterize cross-sectional associations, to examine the direct association between cMIND diet adherence and depressive symptoms, the statistical associational mediating pattern of social participation, and the exploratory moderating effect of exercise on the first segment of the statistical mediation chain. Methods: Data were drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 8578 adults aged 65 years and older. Cross-sectional mediation and moderated mediation analyses were conducted using Model 4 and Model 7 of the PROCESS macro, with 5000 bootstrap resamples to test the significance of cross-sectional statistical indirect effects. Results: cMIND diet adherence was negatively associated with depressive symptoms (B = −0.414, p < 0.01). Social participation showed a statistical partial mediation pattern in this association, with the statistical indirect effect accounting for 14.02% of the total effect. Exploratory moderated mediation analysis showed that exercise moderated the first segment of the statistical mediation chain (B = 0.283, p < 0.01). The positive association between cMIND diet adherence and social participation was stronger among exercisers (simple slope = 0.635, p < 0.01) than among non-exercisers (simple slope = 0.352, p < 0.01). Correspondingly, the indirect association between cMIND diet adherence and depressive symptoms through social participation was stronger in the exercise group (indirect effect = −0.064, 95% CI [−0.079, −0.050]) than in the non-exercise group (indirect effect = −0.036, 95% CI [−0.045, −0.026]). Conclusions: Among Chinese older adults, higher adherence to the cMIND diet is significantly associated with lower levels of depressive symptoms, and this association shows a partial statistical mediation pattern linked to higher social participation. The positive association between cMIND diet adherence and social participation is more pronounced among adults who engage in regular exercise, which corresponds to a more pronounced statistical indirect association with depressive symptoms through social participation. As these findings are based on cross-sectional data and reflect only associational patterns, and given the limited effect magnitude, they provide only preliminary theoretical reference for the development of intervention strategies integrating dietary improvement and social participation promotion for late-life depressive symptoms. Full article

Background: Allergic respiratory diseases, primarily asthma and allergic rhinitis, affect hundreds of millions worldwide. Their rising prevalence reflects complex gene–environment interactions that the exposome framework organizes into external, internal, and social domains shaping the development and progression of respiratory allergic diseases. Methods: Narrative review based on structured searches in PubMed/MEDLINE and Scopus (2015–2025), supplemented with 11 key references; 42 publications were selected from 1015 records. Results: Air pollution showed consistent but modest associations with asthma (HR 1.04–1.12); household dampness and mold showed larger effect sizes on symptom severity (OR 1.48–1.52); and occupational exposures showed the largest effect sizes across studies (RR 3.2–4.3). Systemic inflammation, oxidative stress, and nasal microbiome alterations were identified as internal mediators linking exposures to allergic phenotypes, though mechanistic pathways remain incompletely defined. Social exposome studies suggested context-dependent patterns: socioeconomic advantage correlated with greater sensitization in some settings, while deprivation could amplify disease progression and mortality risk (HR 1.18–1.32). Conclusions: The exposome offers a valuable integrative framework, but clinical translation is limited by scarce longitudinal multi-exposure studies and underrepresentation of low- and middle-income regions. Priorities include life-course cohorts integrating all three domains and targeted interventions in housing and occupational settings. Full article

The gut microbiome is a dynamic ecosystem that plays essential roles in host metabolism, immune regulation, colonization resistance, and maintenance of intestinal homeostasis. Antibiotic exposure profoundly disrupts this ecosystem by reducing microbial diversity, depleting beneficial commensals, reshaping microbial metabolic functions, and remodeling the gut resistome through the selection and dissemination of antibiotic resistance genes (ARGs). Increasing evidence from longitudinal metagenomic, multi-omics, and experimental studies indicates that these perturbations may persist long after antibiotic withdrawal due to incomplete ecological recovery, sustained mobile genetic element-mediated ARG dissemination, and altered microbiome resilience. Beyond antimicrobial resistance, antibiotic-induced dysbiosis has been associated with reduced short-chain fatty acid production, altered bile acid metabolism, impaired epithelial barrier function, and broader disturbances in host metabolic homeostasis, although many of these relationships remain associative rather than causal. This review provides an integrated overview of antibiotic-driven gut microbiome dysbiosis, emphasizing the ecological, functional, metabolic, and resistome-level consequences of antibiotic exposure together with the mechanisms governing microbiome recovery. Current microbiome-targeted restoration strategies, including probiotics, phage therapy, fecal microbiota transplantation, and next-generation microbiome therapeutics, are critically evaluated with particular attention to their evidence maturity, limitations, and translational potential. Finally, key knowledge gaps and future research priorities are discussed to support the development of more effective microbiome-preserving antimicrobial strategies and to limit the long-term dissemination of antimicrobial resistance. Full article

High-involvement work systems (HIWSs) have been an important organisational aspect in increasing employee job performance. However, the high-involvement work system is often looked at collectively using one dimension instead of through the individual dimensions of the work system. Using the power, information sharing, rewards, and knowledge (PIRK) model, the present cross-lagged study aims to examine the influence of the individual dimensions of the PIRK model on employees’ opportunities for skill development and emotional job demands, subsequent quality of work (QoW) and the processes involved. This quantitative cross-lagged study involved 120 New Zealand (NZ) employees (80.8% female; mean age = 32.4 years) from various industries. The results showed a significant positive effect of opportunities for skill development on employees’ QoW. In addition, the four dimensions of the PIRK model had significant positive effects on opportunities for skill development. However, only the information-sharing and knowledge dimensions produced a significant negative effect on emotional job demands. Opportunities for skill development mediated the relationship between the four dimensions of the PIRK model and employees’ QoW, whereas emotional job demands only mediated the relationship between the information-sharing and knowledge dimensions of the PIRK model and employees’ QoW. This study contributes to the limited cross-lagged and longitudinal research on human resource work systems and provides empirical evidence on the role of the organisational work system in supporting employee QoW through opportunities for skill development and emotional job demands. Full article

Parental psychological control is theoretically posited as a vital antecedent of perfectionism, yet empirical research connecting them remains limited, with the underlying mechanisms being particularly underexplored. Specifically, it remains unclear whether parental psychological control is associated with the maladaptive (evaluative concerns) and adaptive (personal striving) facets of perfectionism through convergent or divergent pathways. Three-wave longitudinal design (T1–T3) with six-month intervals was conducted with 1432 adolescents (M_age = 14.60, SD = 1.66, 54% girls) to investigate the direct and indirect effects. Data were analyzed using structural equation modeling, complemented by a random-intercept mediation model to disentangle trait versus state-level effects. Results revealed a distinct pathway linking parental psychological control to perfectionism dimensions via need frustration that is linked to both higher maladaptive and lower adaptive perfectionism. While T1 parental psychological control predicted frustration of all three basic needs in T2, the downstream pathways diverged. Relatedness and competence frustration mediated the link to increased T3 evaluative concerns, whereas autonomy frustration mediated the link to decreased T3 personal striving. Supplementary analysis using a random-intercept mediation model indicated that the overall mediation process was primarily influenced by stable trait-level differences rather than within-person deviations. Findings highlight that parental psychological control differentially predicted perfectionism facets through specific need frustration, with the overall indirect process reflecting primarily a stable, trait-level mechanism. Full article

Background: Clinical reasoning is a core midwifery competency, yet adopting standardized NANDA–NIC–NOC frameworks remains challenging due to perceived abstraction. Objective: To explore the effectiveness of a pedagogical intervention combining collaborative learning, artistic mediation, and AI to enhance midwives’ clinical reasoning. Methods: A convergent parallel mixed-methods study with 40 practicing midwives at Hassan I Hospital, Morocco, involving a structured workshop with a learning game, symbolic tree creation, and AI-facilitated reflection. Inductive thematic analysis was applied to qualitative data, complemented by descriptive pre/post rubric scores assessed by two independent raters. Results: Four themes emerged: (1) improved structuring of clinical reasoning; (2) deeper conceptual appropriation of the NANDA–NIC–NOC framework; (3) enhanced reflexivity and metacognition via AI; (4) high engagement and pedagogical acceptability. Conclusions: Integrating collaborative gaming, artistic mediation, and AI showed high pedagogical acceptability and supported immediate structuring of clinical reasoning in midwifery, offering a promising and feasible model for initial and continuing training in resource-limited settings. Longitudinal studies are needed to confirm long-term clinical impact. Clinical reasoning; NANDA–NIC–NOC; artificial intelligence; simulation-based learning; collaborative learning; educational innovation. Full article

Objective: This study examined the prospective association between self-reported physical exercise and depressive symptoms among older adults, and further tested whether loneliness statistically accounted for this association and whether baseline cognitive emotion regulation strategies moderated the exercise–loneliness pathway. Methods: A two-wave prospective survey with a six-month interval was conducted among 980 community-dwelling older adults in Zhengzhou, China. Baseline data were collected in September 2024, and follow-up data were collected in March 2025. Physical exercise was assessed using the Physical Activity Rating Scale-3, depressive symptoms using the 10-item Center for Epidemiologic Studies Depression Scale, loneliness using the 8-item UCLA Loneliness Scale, and cognitive emotion regulation strategies using the short version of the Cognitive Emotion Regulation Questionnaire. Cross-lagged models were used to examine the residual prospective association between physical exercise and depressive symptoms. A two-wave prospective explanatory model was then tested to examine the role of follow-up loneliness, and moderated explanatory (half-longitudinal) analyses were conducted using baseline adaptive and maladaptive cognitive emotion regulation strategies as moderators. Results: Baseline physical exercise was significantly associated with lower depressive symptoms at follow-up after controlling for baseline depressive symptoms and covariates (β = −0.182, p < 0.001). In contrast, baseline depressive symptoms were not significantly associated with follow-up physical exercise (β = −0.016, p = 0.633). Baseline physical exercise was negatively associated with follow-up loneliness (β = −0.267, p < 0.001), and follow-up loneliness was positively associated with follow-up depressive symptoms (β = 0.324, p < 0.001). The indirect association through follow-up loneliness was significant (indirect effect = −0.087, 95% CI [−0.112, −0.065]). Baseline adaptive cognitive emotion regulation strategies strengthened the association between physical exercise and lower loneliness (interaction β = −0.076, p < 0.001), whereas baseline maladaptive strategies weakened this association (interaction β = 0.059, p = 0.004). Conclusions: Self-reported physical exercise was prospectively associated with fewer depressive symptoms among older adults six months later. This association was statistically accounted for, in part, by lower follow-up loneliness, and baseline cognitive emotion regulation strategies were associated with the strength of the exercise–loneliness association. Because this study used a two-wave observational design with the explanatory variable and outcome measured at the same follow-up wave, the findings should be interpreted as prospective associations rather than evidence of causal or temporal mediation. Full article

Governance–Sustainability has increasingly emerged as an important framework for understanding how institutional capacity influences long-term development outcomes. This study empirically examines the relationships among Institutional Quality, Energy Transition, and Population Health and Development Outcomes within the ASEAN-10 states. Drawing upon the theoretical perspectives of New Institutionalism and Ecological Modernization Theory, the study employs Structural Equation Modeling (SEM) to analyze balanced longitudinal panel dataset (2000–2020) (N = 210 observations). The empirical results indicate that Institutional Quality is significantly associated with Energy Transition outcomes (β = −0.981, p < 0.001), while Energy Transition is significantly associated with Population Health and Development Outcomes (β = −0.982, p < 0.001). Furthermore, the findings provide evidence of a significant mediation effect, indicating that the relationship between Institutional Quality and Population Health and Development Outcomes operates indirectly through Energy Transition processes. The study contributes to the governance and sustainability literature by integrating institutional quality, sustainability transitions, and development outcomes within a unified Governance–Sustainability framework and supporting a Multi-Level Governance perspective. From a policy standpoint, the findings highlight the importance of strengthening institutional capacity and sustainability governance to support long-term development objectives. Overall, the results demonstrate that Institutional Quality functions as a foundational condition for sustainability transitions, while Energy Transition serves as a key mechanism linking governance capacity with Population Health and Development Outcomes in the ASEAN context. Full article