Search Results (5,283)

Background/Objectives: The goal of the study is to examine associations of baseline residential elevation with blood biomarkers and newly reported multisystem chronic diseases among middle-aged and older adults, and to explore whether routine blood indicators may lie on these pathways. Methods: We analyzed 2011, 2015, and 2018 data from the China Health and Retirement Longitudinal Study (CHARLS). Wave 1 provided residential elevation, covariates, and 14 biomarkers; Wave 3 provided intermediate biomarkers; and Wave 4 identified 13 chronic disease outcomes based on participants’ reports of having received a physician diagnosis. High elevation was defined as ≥1500 m. Baseline and longitudinal samples included 11,371 and 9270 participants. Analyses used multivariable linear regression, attrition-weighted Cox models, logistic sensitivity models, restricted cubic splines, and exploratory mediation analysis. Results: High-elevation residence was associated with 9 of 14 biomarkers. Among 182 biomarker–disease Cox models, 35 associations had false-discovery-rate-adjusted q < 0.05, including 32 involving outcomes with at least 50 newly reported cases in the high-elevation group. Direct multiple-imputation inverse-probability-weighted (MI-IPW) Cox models showed that high-elevation residence was associated with higher estimated hazards over the interview interval for newly reported lung disease, kidney disease, arthritis, and hypertension; the first three associations remained significant in weighted logistic models. MI-IPW sensitivity analyses retained 31 of the 32 event-reliable biomarker–disease findings. No indirect effect survived multiple-comparison correction, including after excluding participants who had reported the relevant disease by Wave 3. Among the eight outcomes examined using restricted cubic splines, only kidney disease showed nominal evidence of nonlinearity (p = 0.017). Conclusions: Baseline residential elevation was associated with distinct biomarker patterns and heterogeneous disease risks. Routine blood biomarkers were prospectively associated with later disease reporting but did not provide stable evidence of mediation. These observational findings support cautious, disease-specific interpretation and further prospective and mechanistic research. Full article

Background/Objectives: Quiet quitting, workplace gaslighting, and moral resilience are increasingly recognized as important to employee wellbeing, yet they have rarely been studied together, and evidence from white-collar workforces outside healthcare is scarce. This study examined these three constructs, as well as the associations between them, among white-collar employees of a governmental organization in Greece. Methods: A cross-sectional study was conducted with a self-report questionnaire completed by 433 employees, about 90% of the target population. Quiet quitting, workplace gaslighting, and moral resilience were measured with the Quiet Quitting Scale, the Gaslighting at Work Scale, and the revised Rushton Moral Resilience Scale (RMRS-16). Results: The mean quiet quitting score was 2.26 (SD 0.69), the mean gaslighting score was 1.84 (SD 0.76), and the mean moral resilience score was 3.08 (SD 0.43). In multivariable analysis, higher moral resilience was independently associated with lower quiet quitting (b = −0.52, 95% CI: −0.65 to −0.39) and lower gaslighting (b = −0.49, 95% CI: −0.65 to −0.34). Higher gaslighting was associated with higher quiet quitting (b = 0.27, 95% CI: 0.19 to 0.35). Men and younger employees reported higher levels of both. Conclusions: Moral resilience was independently associated with both lower supervisory gaslighting and lower quiet quitting. These cross-sectional findings cannot establish causality. If confirmed in longitudinal research, interventions that strengthen moral resilience and improve supervisory practices may support employee engagement and wellbeing in white-collar workforces. Full article

Background/Objectives: Individuals with attention-deficit/hyperactivity disorder (ADHD) often experience communication difficulties (CDs), including challenges with language development, pragmatic communication, and speech processing. While these difficulties are typically associated with cognitive and behavioral symptoms; emerging research suggests that biological and nutritional factors may also contribute. This narrative review aims to explore how diet patterns, gut microbiome changes and oxidative stress might be associated with communication difficulties in ADHD. Methods: This review was performed using the SANRA (Scale for the Assessment of Narrative Review Articles) framework. A structured/comprehensive literature search was performed across major databases including PubMed, Scopus and Web of Science. Google Scholar has been utilized as a complementary database to support emerging studies that have not yet been registered in these databases. The search focused on studies that investigated the connections between nutrition, microbiome dysregulation, oxidative stress, ADHD and communication-related outcomes. Results: Current research indicates that unbalanced diets, micronutrient deficiencies, and changes in the gut microbiome can lead to neuroinflammation and oxidative stress. All these biological processes may disrupt neurotransmission and neural connectivity, which can potentially affect brain regions and networks that are highly important for attention and language processing, including both cortical and subcortical structures. Therefore, communication difficulties in ADHD may, in part, stem from these interconnected neurobiological mechanisms. However, direct clinical evidence linking nutritional factors, gut microbiome alterations, or oxidative stress with communication-specific outcomes in ADHD remains very limited, as most available studies have focused on core ADHD symptoms, attention, executive functioning, or biological markers. Conclusions: Dietary factors, alterations in the gut microbiome, and oxidative stress may collectively contribute to the complex underlying causes of communication disorders in ADHD. This review proposes an integrative framework that links nutrition-related mechanisms to communication outcomes, emphasizing the potential impact of modifiable lifestyle factors. Further longitudinal studies are needed to establish causal relationships and determine the clinical effectiveness of targeted nutritional interventions for communication difficulties in ADHD. Full article

Background: Although advances in critical care have improved short-term outcomes, sepsis survivors continue to face substantial chronic morbidity and impaired long-term survival. Conventional threshold-based tools such as the Sequential Organ Failure Assessment (SOFA) and Modified Early Warning Score (MEWS) show moderate and variable discrimination across cohorts. Reported areas under the receiver operating characteristic curve (AUROCs) must therefore be interpreted in relation to the population, prediction horizon, and outcome used in each study rather than as direct head-to-head comparisons. Objectives: This review evaluates how artificial intelligence (AI) could be linked with dynamic plasma metabolites, particularly citrulline and β-hydroxybutyrate (3-HB), to support biologically informed sepsis phenotyping, while critically examining mechanistic evidence, clinical limitations, and translational readiness. Data Synthesis: Machine-learning and natural language processing architectures have shown promising discrimination in many early-detection studies, with pooled AUROCs near 0.87 and reported prediction windows extending to 48 h. However, performance estimates vary with cohort composition, outcome definition, and validation design, and they should not be ranked against unrelated biomarker studies. Human sepsis studies generally associate low or persistently low citrulline with impaired intestinal function and organ injury, but no sepsis-specific decision cutoff has been externally validated. For 3-HB, an AUROC of 0.8429 for septic liver injury was derived from a cohort of 57 patients and has not been shown to add value beyond routine liver tests or illness-severity measures. Murine experiments provide mechanistic hypotheses for ketone-mediated organ protection, but model-specific and sometimes opposing nutritional effects limit direct translation. These metabolites are therefore best considered candidate longitudinal features for multimodal phenotyping rather than stand-alone clinical triggers. Conclusions: Biologically informed algorithmic surveillance is a promising direction, but clinical implementation requires prospective serial sampling, explicit adjustment for renal, hepatic and nutritional confounders, head-to-head comparison with routine markers, and external validation of calibration and clinical utility. Until these requirements are met, citrulline and 3-HB should support research phenotyping rather than direct treatment selection. Full article

Background: This scoping review maps and synthesizes the scientific evidence on the epidemiological profile and determinants of sick leave and work-related accidents in Brazil, with an emphasis on studies using data from the Brazilian Federal Medical Expert Service of the Ministry of Social Security. Methods: Following the PRISMA-ScR guidelines and the JBI Manual for Evidence Synthesis, eight databases (SciELO, PubMed/MEDLINE, Scopus, Web of Science, LILACS, CINAHL, PsycINFO, Embase) were searched for quantitative observational studies published between 2000 and 2025. Out of the 218 studies identified, 18 met the eligibility criteria. Results: Cross-sectional designs (66.7%) and ecological/time-series designs (22.2%) predominated. The findings identified musculoskeletal disorders as the leading cause of work absence; mental disorders were the third leading cause, exhibiting an upward trend; and a significant influence of institutional factors, especially the Social Security Technical Epidemiological Nexus, on the observed patterns. Determinants operate at the individual, occupational/organizational, and institutional levels. Conclusions: Empirical research on work disability in Brazil remains fragmented, providing limited capacity for causal inference. The findings support five priority areas: sectoral risk management, workplace mental health, territorial strategies for musculoskeletal disorders, sick leave trajectory policies, and data governance, all of which necessitate longitudinal and quasi-experimental studies to evaluate interventions and the impact of institutional changes. Full article

The rapid advancement of artificial intelligence (AI) and growing global fragmentation are reshaping how multinational enterprises manage cross-border strategic alliances. Prior research has focused on alliance formation and resource access, yet less attention has been paid to how AI transforms the managerial capabilities required for effective alliance orchestration. This study addresses this gap by examining how AI augmentation may alter the microfoundations of dynamic managerial capabilities (DMC) in cross-border alliances. Building on DMC theory, the paper proposes an AI-augmented framework with four interrelated microfoundations: AI-enhanced managerial cognition, algorithmic social capital, hybrid human–AI capital, and AI-enabled political capital. Using an abductive research design and longitudinal case analyses of Carrefour–Google, Walmart–IBM, and Tesco–Carrefour, the study illustrates how AI may support the reshaping of sensing, seizing, and reconfiguring processes. It uses a Gioia-informed coding procedure to enhance transparency in the elaboration of theory. The findings suggest that AI may improve data-driven sensing, enable scalable coordination through algorithmic trust, enhance ambidexterity through human–AI collaboration, and support proactive regulatory positioning. However, these benefits are expected to be contingent on institutional conditions, including data governance constraints and power asymmetries. The study contributes by extending DMC theory and highlighting how AI-enabled capabilities could drive alliance performance in complex global environments. Full article

This mixed-methods study examines the associations among fintech advancement, green finance, and financial inclusion in Jordan, an emerging economy. It draws on a distinctive three-part dataset: survey data from 21 commercial banks (N = 21), a national household survey, and semi-structured interviews with stakeholders. The quantitative results indicate that the positive association between fintech adoption and the provision of green finance is statistically consistent with full mediation by banks’ absorptive capacity, particularly their digital maturity and data analytics capabilities. Proactive regulatory support significantly moderates this mediated relationship. Market demand, by contrast, has no statistically significant moderating effect. At the household level, the combined use of digital and green financial products is associated with higher formal account ownership and with the use of a greater number of financial products. The interviews support these results, pointing to institutional capacity and regulatory clarity as essential enabling factors. Given the cross-sectional bank-level data (N = 21) and the exploratory scope of the mediation analysis, causal interpretations should be avoided. Future longitudinal research is needed to examine temporal dynamics. Even so, these findings offer policymakers an initial empirical framework: channeling fintech toward sustainable development will likely require targeted interventions to build institutional digital capacity and establish clear regulatory frameworks, rather than depending solely on market forces. Full article

Educational inequality and early school leaving remain persistent challenges in stratified education systems, particularly for disadvantaged students in rural areas. Although mentoring programmes are widely promoted as compensatory interventions, relatively little is known about how institutionally embedded mentoring influences educational aspirations and trajectories within highly stratified school systems. This study examines the nationwide Hungarian Teach for Hungary mentoring programme, in which university students provide formally organised peer mentoring to disadvantaged lower secondary school students. The study adopts a triangulated mixed-methods design, integrating longitudinal administrative education data (2018–2024), pre–post survey data, and qualitative interviews. The dataset includes 25 higher education institutions, 108 partner schools, and more than 3300 mentored students, enabling an analysis of mentoring processes across diverse institutional and regional contexts. The findings suggest that mentoring is associated with more structured educational aspirations, smoother transitions to upper secondary education, and more stable patterns of school participation, particularly in disadvantaged rural settings. Rather than producing direct academic effects, mentoring appears to operate through institutional mechanisms that shape students’ access to educational information, expectations, and opportunity structures. Formal mentor preparation, ongoing supervision, and institutional coordination emerge as key conditions for sustaining high-quality mentoring relationships and supporting students’ educational orientation. The study contributes to international research on mentoring and educational inequality by conceptualizing mentoring as an institutionally mediated mechanism embedded within stratified education systems. Beyond the Hungarian context, the findings provide analytically transferable insights for education systems seeking to address persistent inequalities in educational access and transition opportunities. Full article

Background and Objectives: Regular physical activity is important for students’ health and well-being, but participation may be influenced by motivation and perceived barriers. This study assessed physical activity levels, motivational regulation, perceived barriers, and their associations among students enrolled in Lithuanian higher education institutions. Materials and Methods: A cross-sectional survey was conducted among 370 students. The questionnaire assessed weekly physical activity, motivational regulation, perceived barriers, and sociodemographic characteristics. Group comparisons and exploratory hierarchical multivariable logistic regression were performed. Results: Overall, 74.6% of the participants met the World Health Organization physical activity recommendations. In separate analyses, male participants and those from major cities were more likely to meet the World Health Organization physical activity recommendations. Intrinsic and identified regulation were the most prominent motivational factors, whereas lack of energy, lack of willpower, and lack of time were the most frequently reported barriers. In the final model, higher intrinsic regulation was associated with greater odds of meeting the recommendations (odds ratio 1.64, 95% confidence interval 1.10–2.44), while lack of willpower (odds ratio 0.34, 95% confidence interval 0.19–0.60) and lack of time (odds ratio 0.35, 95% confidence interval 0.18–0.68) were associated with lower odds. Sociodemographic characteristics were not statistically significant in the final model. Conclusions: Most participants in this sample met the World Health Organization physical activity recommendations. The findings highlight the relevance of intrinsic regulation and selected perceived barriers to physical activity participation. These exploratory associations may help guide future longitudinal and intervention research on context-specific physical activity promotion in higher education. Full article

Research on endocrine patterns associated with reproduction and lactation in felids has focused mainly on rare or endangered species and remains limited in the domestic cat (Felis catus). Using a non-invasive longitudinal approach, we measured faecal glucocorticoid, progesterone, and testosterone metabolites (fGCm, fPm, and fTm) in nine females before mating and during three months of lactation, examining associations with litter characteristics and kitten survival. Lactational concentrations were expressed relative to each female’s median baseline, while baseline concentrations were analysed separately. Relative fGCm concentrations were negatively associated with the number of surviving kittens but not with litter losses. Relative fPm concentrations were positively associated with both fGCm and fTm, whereas the fGCm–fTm relationship did not reach statistical significance. Relative fPm concentrations were lower in the third than in the first month of lactation, while fTm showed a similar decreasing tendency. Baseline fGCm and fPm were not associated with reproductive parameters. Median baseline fTm showed a negative, non-significant relationship with first-month kitten survival. These findings indicate distinct temporal patterns and associations among steroid metabolites, while the relationship between baseline fTm and kitten survival requires validation in larger datasets. Full article

Background and Objectives: The outcomes for patients with localised prostate cancer are variable, even within defined tumour grades or clinical risk groups. Identifying features associated with disease aggression is imperative in contemporary PCa research. ISUP 2 PCa is particularly important in this regard as it exhibits a wide range of oncologic behaviour. The aim of this study was to evaluate the relationship between the tumour volume at radical prostatectomy (RP) and metastasis-free survival (MFS) in patients with ISUP 2 PCa. Methods: In this longitudinal multicentre cohort study, we reviewed the data of 809 consecutive patients with ISUP 2 PCa who underwent RP between 1996 and 2021. The tumour volume was estimated by summing the visual percentage involvement and multiplying it by specimen weight. Kaplan–Meier and Cox regression models were used to assess MFS. Linear regression was used to identify the preoperative predictors of the tumour volume (TV), with the appropriate assumption checks. Key Findings: The median TV was 2.9 cc (IQR: 1.4–7.0 cc). The TV categories were <2 cc (37%), 2–20 cc (53%), and >20 cc (11%). The median PSA follow-up was 42 months; 11% experienced biochemical recurrence (BCR). The BCR rates differed significantly across volume categories (p < 0.01). At 120 months, MFS was highest in the <2 cc group (97%) and lowest in the >20 cc group (87%) (p < 0.01). Conclusions and Clinical Implications: Prostate-TV in ISUP-grade group 2 disease is independently associated with MFS. Tumours > 20 cc warrant closer monitoring and may benefit from adjuvant therapy. The improved pre-operative prediction of TV could support more tailored treatment strategies, including suitability for surveillance. What does the study add? We demonstrate for first time that tumour volume at prostatectomy is correlated with metastasis-free survival in ISUP 2 PCa. At 120 months, MFS was highest in the <2 cc group (97%) and lowest in the >20 cc group (87%) (p < 0.01). This has implications for post-operative surveillance. Full article

Background/Objectives: This systematic review examines psychological interventions for children with neurodevelopmental disabilities within a neurodiversity framework, emphasizing that variations in cognition, behavior, and neurological functioning represent natural forms of human diversity rather than deficits. Methods: A systematic literature search was conducted across the PubMed, PsycINFO, and Google Scholar databases for studies published between 2010 and 2025. Studies were included if they focused on children with autism spectrum disorder (ASD), learning or intellectual disabilities (LD/ID), or specific learning disabilities (SpLD), and evaluated psychological or behavioral interventions. Results: A total of 34 studies met the inclusion criteria after screening and full-text review. The findings indicate that traditional interventions, such as Applied Behavior Analysis (ABA) and Cognitive Behavioral Therapy (CBT), demonstrate effectiveness in improving adaptive behavior, emotional regulation, and cognitive functioning. However, more recent approaches, including Naturalistic Developmental Behavioral Interventions (NDBI), person-centered therapies, and gamified interventions, show greater alignment with neurodiversity principles by emphasizing individual strengths, autonomy, and environmental adaptation. Conclusions: Despite promising outcomes, the evidence base remains uneven, with a predominant focus on autism and limited high-quality studies addressing other neurodevelopmental conditions. The review highlights the need for more rigorous, inclusive, and longitudinal research, as well as the integration of neurodivergent perspectives in intervention design. Overall, the findings suggest that interventions incorporating individualized, strengths-based, and context-sensitive adaptations are associated with more consistent improvements in both functional outcomes and quality of life. Full article

The current study examined whether individual differences in attachment orientation, mate-retention tactics (benefit-provisioning and cost-inflicting strategies), and COVID-19-related stressors (impact, uncertainty, and perceived risk) were associated with IPV victimisation across two time points, one month apart, in Brazil and the UK (N = 1416 at Wave 1; N = 353 at Wave 2). Linear mixed-effects models controlled for age, sex, ethnicity, and relationship length. IPV victimisation did not significantly change over time, and COVID-19-related variables were not associated with any form of IPV. Brazilian participants reported higher psychological IPV than UK participants, although no country differences emerged for physical or sexual IPV. Cost-inflicting mate-retention strategies were positively associated with all forms of IPV in both countries, with consistently stronger associations in the UK. Attachment avoidance was positively associated with all forms of IPV in Brazil but was negatively associated with psychological and sexual IPV in the UK. Attachment anxiety and benefit-provisioning strategies were associated with psychological IPV in Brazil only. These findings suggest that associations between attachment, mate-retention strategies, and IPV victimisation may vary across cultural contexts, underscoring the value of culturally sensitive approaches to IPV research and intervention. Full article

Background/Objectives: Takotsubo cardiomyopathy (TTC), also known as “broken heart syndrome”, is an acute and reversible cardiac condition often triggered by emotional or physical stress. Increasing evidence suggests a strong comorbidity between TTC and psychiatric disorders, particularly anxiety and depression. However, the nature, prevalence, and implications of these associations remain incompletely understood. This scoping review aimed to systematically map the available evidence on the association between Takotsubo cardiomyopathy and anxiety and depressive disorders, characterize the prevalence and nature of these psychiatric comorbidities, evaluate the methods used for their assessment, and identify knowledge gaps to guide future research and clinical practice. Methods: A systematic search of MEDLINE (via PubMed), Embase, Web of Science, and Google Scholar was conducted for peer-reviewed human studies published up to December 2025 in English or French. Eligible studies reported on psychiatric comorbidities in TTC populations, including pre-existing disorders, psychiatric triggers, or psychological sequelae. A standardized extraction grid and the Joanna Briggs Institute appraisal tools were used for data collection and quality assessment. Results: Eighteen studies were included. Depression and anxiety were prevalent among TTC patients, frequently preceding or accompanying cardiac events. Emotional stressors such as bereavement or panic attacks were commonly cited as triggers. Despite this, only a minority of studies used validated psychometric tools, and longitudinal psychiatric follow-up was rare. Most studies were limited by small sample sizes, retrospective designs, and heterogeneity in diagnostic approaches. Conclusions: The findings reveal a consistent association between TTC and affective disorders, underscoring the role of the brain–heart axis. Integrating psychiatric screening and follow-up into TTC management may enhance outcomes. Future interdisciplinary research is needed to clarify causal pathways and inform prevention and treatment strategies. Full article

Livestock production in Africa occurs across highly heterogeneous agroecological and management environments, ranging from extensive pastoral and mixed crop–livestock systems to intensive enterprises. These systems are characterized by seasonal and spatial variation in feed resources, reliance on locally available forage and agricultural by-products, climatic stress, endemic diseases, and the use of indigenous and locally adapted breeds. Such conditions create distinctive microbiome–host interactions that remain poorly represented in global livestock omics research. Although the gut microbiome is central to nutrient utilization, immune function, metabolic homeostasis, and resilience, the functional mechanisms linking microbial communities, diet, host physiology, and productivity in African livestock remain insufficiently characterized. African systems are particularly underrepresented in integrated microbiome–metabolomics datasets, longitudinal studies, and artificial intelligence (AI)-enabled predictive models, limiting the development of context-specific precision nutrition strategies. This review examines the integration of metabolomics and AI with microbiome and host data to advance precision livestock nutrition within an African and One Health context. It identifies both substantial constraints and strategic opportunities. Limited research infrastructure, high-quality regional datasets, computational capacity, and specialized expertise remain major barriers. Conversely, Africa’s diversity of livestock breeds, feed resources, agroecological conditions, and naturally occurring resilience phenotypes provides an important opportunity to identify microbiome–metabolite signatures associated with feed efficiency, disease resilience, climate adaptation, and product quality. Emerging metabolomics and computational capacity, particularly in South Africa, could support regional research networks and continental data infrastructures. Furthermore, the review proposes an Africa-specific approach that develops locally grounded, scalable, and resource-sensitive precision nutrition strategies, strengthening antimicrobial stewardship, animal health, food safety, climate resilience, sustainable livestock production, and broader One Health objectives. Full article