Search Results (36,595)

Heat stress is a growing concern in cattle production systems due to the increasing frequency and intensity of extreme weather events driven by climate change. This review synthesizes current knowledge on the multifaceted impacts of heat stress and focuses on nutritional strategies to mitigate its effects on ruminating cattle. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Heat stress adversely affects cattle physiology, behavior, rumen function, and overall productivity, particularly in dairy animals with high metabolic activity. During heat stress episodes, changes in the microbial population have been reported; however, there is no clear consensus, as findings vary widely among studies depending on diet, feed intake, animal type and experimental design. This variability limits the ability to draw general conclusions regarding changes in the rumen microbiome driven by heat stress. In this context, dietary nutritional intervention strategies offer a practical and scalable approach to enhance thermotolerance and maintain performance under heat stress conditions. Key nutritional strategies include modifications in diet composition to reduce metabolic heat production, with some approaches carrying potential risks to animal health, e.g., increasing dietary energy density through concentrates while minimizing forage content. Supplementation with rumen-protected nutrients like amino acids, vitamins, and minerals can be used to support immune function, antioxidant capacity, and metabolic stability. Polyphenols and betaine contribute to oxidative stress reduction and gut integrity, while probiotics may be used to improve rumen fermentation and nutrient utilization. Sensor technologies, including rumen boluses and wearable devices, offer the potential to monitor physiological responses to heat stress in real time and offer opportunities for precision feeding and early intervention. Most published studies only cover short periods of heat stress, and there is a lack of in vitro models simulating rumen hyperthermia. In parallel, future research should therefore prioritize longitudinal, in vivo trials that integrate physiological, metabolic, and microbial responses to understand the long term and systemic effect of heat stress. In addition, controlled trials in commercial settings are necessary to prove the transferability of results to commercial herds. A multidisciplinary approach combining nutritional, environmental, and technological strategies is likely to play an important role in safeguarding cattle welfare and productivity in a warming climate. Full article

Background/Objectives: Due to its rapidly aging population, lung cancer is expected to become the second most common and deadliest cancer in Japan. Although surgery is the primary treatment for early-stage non-small cell lung cancer (NSCLC), advances in radiation therapy technology mean that stereotactic body radiation therapy (SBRT) is also a viable option for elderly patients with various underlying health conditions. Methods: We conducted a retrospective analysis to evaluate the outcomes of SBRT in 50 consecutive elderly patients (37 of whom were aged 80 and older) with early-stage peripheral NSCLC (Tis~T2aN0M0), who were treated with SBRT at our hospital and received a total dose of 55 Gy in four fractions. Results: The three-year overall, disease-free and cause-specific survival rates for all patients were 73.2%, 88.5% and 91.4%, respectively. For patients aged 80 years and older, these rates were 77.5%, 90.6% and 91.4%, respectively. There was no local recurrence. Hematogenous metastases were observed in four patients. However, hilar and subcarinal lymph node metastases developed in only one patient. Grade 2 pneumonitis and chest wall injuries (CWIs) were observed in two and five patients, respectively. Patients with larger tumors had a significantly higher incidence of chest wall injuries. Conclusions: SBRT at a total dose of 55 Gy in four fractions can achieve safe and satisfactory outcomes for early-stage peripheral NSCLC, even in patients aged 80 years and older. While CWIs were limited to Grade 2, attention to the chest wall dose is advisable when treating tumors adjacent to the chest wall. Full article

Background/Objectives: Despite existing guidelines on limiting screen time, children and adolescents are spending an increasing number of hours in front of digital devices. This increase raises concerns about long-term health consequences, particularly in the context of the growing prevalence in childhood overweight and obesity. The aim of this review is to present the current state of knowledge regarding the relationship between increased screen time and weight-related health outcomes in the pediatric population. It also highlights the need for health education targeting both children and parents, based primarily on developing skills to manage time spent in front of electronic screens. Methods: A narrative review of the literature was conducted in the MEDLINE (PubMed), Web of Science and Scopus databases, including studies published between 2015 and 2025. Results: Available evidence suggests that prolonged screen exposure may be associated with reduced physical activity, circadian rhythm disturbances, including sleep problems, increased stress levels, and adverse mental health outcomes. These factors may interact and reinforce one another, potentially contributing to a positive energy balance and an increased risk of overweight and obesity among young people. Conclusions: The evidence reviewed highlights the ongoing digitalisation of younger generations and the potential consequences of excessive screen use. The underlying mechanisms appear complex and multidirectional. However, methodological heterogeneity across studies underscores the need for well-designed longitudinal and intervention research. Full article

Background: Immune fitness (IF) reflects the body’s ability to mount appropriate immune responses. Monitoring IF could improve tailored treatment in oncological rehabilitation. The Immune Status Questionnaire (ISQ) and the Single-Item Scale (SIS) were developed to assess IF, but their clinimetric properties in cancer rehabilitation remain unknown. Aims: To evaluate the construct validity, responsiveness, and correlation between the ISQ and the SIS in oncological rehabilitation. Methods: The study population included people participating in oncological rehabilitation during or within one year after medical treatment. Data were collected prospectively via questionnaires. Construct validity and responsiveness were assessed through predefined hypotheses, including correlations with fatigue, sleep problems, malnutrition risk, activity impairment, and physical functioning. Results: In total, 97 individuals were included in the analyses. Median ISQ and SIS scores were 8/10 and 7/10, respectively. Correlations ranged from r = −0.21 to r = −0.50. Only the SIS correlations with fatigue and physical functioning, and the ISQ correlation with fatigue, met the predefined thresholds. Responsiveness hypotheses were not confirmed. Conclusions: The ISQ and the SIS demonstrated low construct validity and responsiveness in this population. IF scores were higher than expected. Correlations showed links between fatigue, physical functioning, and IF. Future research should develop tools tailored to the complex immune disturbances experienced by cancer survivors. Full article

Background/Objectives: Within pediatric healthcare systems, integrated strategies combining dietary and oral hygiene interventions have been proposed to improve oral health outcomes. In order to evaluate the effects of combined dietary and oral hygiene approaches on behavioral, knowledge-based, and clinical outcomes in pediatric populations, this systematic review synthesized evidence from intervention studies. Methods: A comprehensive literature search was conducted on 5 September 2025 using PubMed, Scopus, Web of Science, Google Scholar, and arXiv. Children and adolescents (0–18 years old) exposed to dietary and oral hygiene interventions with documented behavioral, clinical, or knowledge-related outcomes were included in eligible studies. Studies were stratified by age groups (0–5, 6–12, and 13–18 years) in order to address developmental heterogeneity. The Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies with a comparator were used to evaluate the risk of bias. For single-arm pre–post studies, a narrative risk-of-bias assessment was conducted, as ROBINS-I is not designed for uncontrolled studies. Due to methodological and clinical heterogeneity, a narrative synthesis approach was applied. Results: Out of 1231 records, eight outcome-reporting intervention studies satisfied the inclusion criteria. Improvements in self-reported oral hygiene behaviors, dietary habits, and oral health knowledge were consistently linked to integrated interventions across developmental subgroups. There was little and inconsistent evidence for clinical outcomes, such as caries and periodontal indicators. Conclusions: In pediatric populations, integrated dietary and oral hygiene interventions seem to enhance behavioral and educational oral health outcomes. These findings highlight the need for developmentally tailored preventive strategies integrated within pediatric healthcare frameworks. Full article

We explored the epidemiological evidence on the prevalence of mental health symptoms among current and former elite athletes as well as among their entourage members. Methods: A systematic review and meta-analysis were conducted in PubMed, PsycINFO, SportDiscus and Scopus to retrieve original quantitative studies that (i) were written in English, (ii) were conducted exclusively among current or former elite athletes and/or their entourage members, and (iii) presented prevalence rates of mental health symptoms. Results: In total, 72 studies were included, focusing on self-reported mental health symptoms (not on clinically diagnosed mental health disorders). Meta-analyses comprising 2596 to 10,927 current elite athletes showed that the prevalence of mental health symptoms ranged from 4% for drug misuse to 33% for distress. Meta-analyses comprising 2070 to 3405 former elite athletes showed that the prevalence of mental health symptoms ranged from 12% for depression to 28% for alcohol misuse. Because of the considerable heterogeneity among the included studies, the pooled prevalence estimates from these meta-analyses should be interpreted cautiously, as they summarize highly heterogeneous populations. Mental health symptoms were found to also be common among entourage members, with prevalence rates ranging from 5% for depression or anxiety to 53% for alcohol misuse in high-performance staff (including coaches) and reaching up to 36–58% for burnout in healthcare professionals working during the Paralympic games. Conclusions: Showing considerable heterogeneity across included studies, our systematic review and meta-analysis established that mental health symptoms are commonly reported by current and former elite athletes, as well as by their high-performance staff (including coaches) and medical staff. This warrants the implementation of various tailored resources, such as mental health literacy, screening programs and the availability of interdisciplinary medical and psychological support. Full article

Background: The increasing utilization of diagnostic imaging has raised concerns regarding imaging overuse, unnecessary radiation exposure, and downstream diagnostic cascades. Because primary care physicians serve as the first point of contact for most patients, diagnostic decisions made in primary care may substantially influence healthcare resource utilization at the system level. This study aimed to develop and evaluate a conceptual diagnostic stewardship framework for primary care using a simulation-based modeling approach. Methods: A synthetic dataset consisting of 100 common primary care conditions was developed across ten clinical domains. Model parameters, imaging utilization probabilities, and diagnostic pathway assumptions were derived from literature-informed estimates and multidisciplinary expert judgment. Each condition was assigned diagnostic attributes including World Health Organization age group classification, commonly requested laboratory tests, preferred imaging modality, and imaging necessity classification (Class A: imaging usually unnecessary; Class B: conditional imaging; Class C: imaging usually required). Using this dataset, a simulation model representing one million hypothetical primary care visits was constructed. Imaging utilization, modality distribution, radiation burden index, incidental diagnostic cascades, and a relative diagnostic resource utilization index were estimated under a baseline diagnostic scenario and a framework-guided diagnostic stewardship scenario. Results: In the baseline scenario, the model generated 412,000 imaging examinations across one million simulated visits (41.2% imaging rate). Within the simulation model, application of the framework was associated with an estimated reduction in imaging examinations to 258,000, corresponding to a 37% reduction in imaging utilization. The estimated population-level radiation burden index decreased from 285,000 to 179,000 units, representing a 37% reduction in radiation exposure. The number of incidental diagnostic cascades decreased from 48,200 to 29,700 events, while the relative diagnostic resource utilization index decreased from 2,480,000 to 1,690,000 units. Sensitivity analyses confirmed the robustness of these findings across alternative model assumptions. Conclusions: Within the assumptions of this simulation model, the proposed diagnostic stewardship framework generated modeled reductions in imaging utilization, radiation burden, and downstream diagnostic consequences. These findings illustrate the potential impact of structured diagnostic stewardship strategies and provide a hypothesis-generating basis for future validation using real-world clinical data. Full article

Encephalitozoon cuniculi is a globally distributed microsporidian of veterinary and public health relevance, particularly due to its zoonotic potential and high prevalence in domestic rabbits (Oryctolagus cuniculus). This study aimed to estimate the presence of anti-E. cuniculi antibodies in pet rabbits from the Porto district, Portugal, using an indirect enzyme-linked immunosorbent assay (ELISA). Blood samples were collected from 54 domestic rabbits during routine veterinary appointments and hospitalisation between September 2024 and January 2025. Plasma samples were analysed for anti-E. cuniculi antibodies. Thirty-four rabbits (63%) were seropositive, indicating substantial exposure within the sampled population. This prevalence is consistent with reports from other European countries and may indicate E. cuniculi is endemic among pet rabbits in Portugal. Given the zoonotic nature of this pathogen, these findings reinforce the need for surveillance strategies integrating animal and public health perspectives. Full article

Background: Food insecurity and water insecurity are increasingly recognized as interconnected social determinants of health; however, their co-occurrence remains underexplored in U.S. populations. SNAP households with children experience a high prevalence of both food and water insecurity. This study estimated the prevalence of food insecurity and water insecurity and examined their co-occurrence among SNAP households with children in the Southern U.S. Methods: A cross-sectional, web-based survey was conducted among 683 SNAP participants residing in households with children. Food insecurity was assessed using the 10-item USDA Adult Food Security Survey Module, and water insecurity was measured using the Household Water Insecurity Experiences (HWISE) scale. Descriptive statistics estimated prevalence, and regression analyses assessed associations. Results: Food insecurity (75.1%) and water insecurity (53.9%) were highly prevalent among surveyed SNAP households with children. Nearly half of households (48.6%) experienced both conditions, while 19.6% were secure in both. Food insecurity alone was reported by 26.5% of households, and water insecurity alone by 5.3%. Higher food insecurity scores were associated with increased odds of water insecurity (AOR = 1.33, 95% CI: 1.26–1.40, p < 0.001). Conclusions: Food insecurity and water insecurity frequently co-occur among SNAP households with children. Integrated public health strategies addressing both food and water access are needed to reduce disparities and improve household well-being. Full article

Background: West Virginia is of particular concern regarding HPV vaccine hesitancy, currently ranking 45th among U.S. states in HPV vaccine uptake. General vaccine hesitancy and HPV- and HPV vaccine-specific misinformation, both associated with lower vaccination, have increased in recent years, complicating efforts to identify key drivers of HPV vaccine acceptance and effective intervention targets. Methods: This study used a Qualtrics survey of n = 330 parents of children aged 0–14 in West Virginia. Measures included parental HPV vaccine acceptance for their youngest child (reflecting either completed vaccination or intention to vaccinate), general vaccine hesitancy measured using the Vaccine Hesitancy Scale (VHS), and endorsement of nine common HPV- and HPV vaccine-specific misinformation statements. Misinformation items were summed and demonstrated good internal reliability (Cronbach’s α = 0.868). Results: Hierarchical logistic regression analyses indicated significant racial/ethnic differences across all model steps, with non-White parents less likely to report HPV vaccine acceptance for their child (p < 0.001). In Step 2, lower levels of general vaccine hesitancy predicted higher HPV vaccine acceptance (p < 0.001). In the final model, higher endorsement of HPV- and HPV vaccine-specific misinformation was associated with lower HPV vaccine acceptance (p = 0.035). Conclusions: These findings underscore the independent and additive influence of general vaccine hesitancy and HPV- and HPV vaccine-specific misinformation on parental HPV vaccine acceptance in West Virginia. Community-engaged public health strategies should prioritize strengthening vaccine confidence and directly addressing HPV- and HPV vaccine-specific misinformation, particularly among underserved populations. Full article

Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine (Phe) metabolism caused by pathogenic variants in the phenylalanine hydroxylase (PAH) gene, resulting in toxic phenylalanine accumulation that, if untreated, causes profound intellectual disability and neurodevelopmental impairment. PKU is especially significant in the Kingdom of Saudi Arabia (KSA), where high consanguinity rates substantially elevate disease prevalence relative to Western populations, and the country’s expanding newborn screening programs have highlighted PKU as a persistent public health concern. This review provides a translational synthesis of the Saudi PKU literature, covering epidemiology, molecular pathophysiology, genetics, clinical presentation, diagnosis, treatment, prognosis, and future directions. We summarize global and regional incidence data and show that Saudi Arabia, driven by consanguinity, is among the countries with the highest reported PKU burden worldwide. We review the metabolic basis of phenylalanine neurotoxicity and the allelic heterogeneity of the PAH gene, with attention to variants enriched in Saudi and Arab cohorts, including the founder allele p.R252W. Diagnostic pathways anchored in newborn screening and tandem mass spectrometry are discussed alongside neurodevelopmental outcomes and gaps in Saudi PKU surveillance. We outline established and emerging therapies, including dietary management, sapropterin (BH4), pegvaliase, large neutral amino acids, and investigational gene and mRNA therapies. Throughout, we identify where genuine Saudi-specific evidence exists and where general PKU knowledge is extrapolated to the Saudi context because of limited local data, most notably the absence of a national PKU registry. This review is intended to serve as a translational reference for clinicians, metabolic dietitians, geneticists, and policymakers engaged in PKU care in Saudi Arabia and the wider Arab region. Full article

Genomic testing is a key component of precision oncology; however, Black patients receive genomic testing at lower rates. The purpose of this qualitative study was to identify individual and health system drivers of genomic testing disparities at a National Cancer Institute-designated comprehensive cancer center. We conducted interviews with 15 oncology providers and 11 Black cancer patients between September 2023 and October 2024. These patients were eligible for genomic testing based on National Comprehensive Cancer Network (NCCN) guidelines, being diagnosed within last 10 years (2014–2023), at least 18 years old, and English-speaking. Providers included oncologists and oncology patient navigators. Topics included motivators, barriers, and knowledge of genomic testing and factors influencing decision-making. The Penchansky and Thomas theoretical framework of healthcare access (e.g., availability, accessibility, accommodation, affordability, and acceptability) guided thematic analysis. Among patients eligible for genomic testing, most participants (n = 7) received genomic testing as part of their cancer treatment based on EMRs, however many patients (n = 7) could not recall discussing genomic testing with their oncologist. Most patients and all providers highlighted affordability as a challenge: patients were concerned about unexpected costs associated with testing, while providers were concerned about costs of matched molecular targeted therapy. Both patients and providers highlighted patient-centered communication to mitigate mistrust and promote patient engagement in care. Despite limited awareness, Black patients view genomic testing positively. Addressing multiple dimensions of access is key to improving system-level processes and ensuring that more patients benefit from lifesaving targeted therapy. Full article

Background: Sarcopenia, characterized by age-related loss of muscle mass and strength, is a growing public health concern requiring early detection; this exploratory study evaluated a range of anthropometric measurements and indices to identify those most suitable for screening low muscle strength in hospitalized geriatric patients and to determine preliminary cut-off values that may support screening in settings with limited access to specialized equipment or trained personnel. Materials and Methods: In this cross-sectional study, 390 hospitalized geriatric-ward patients aged ≥ 60 years were included. The median age was 77.00 years (72.00, 82.00), and 258 participants (66.2%) were women. Anthropometric and body composition measurements were performed, and handgrip strength was assessed. Low muscle strength was defined according to The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Logistic regression analyses were used to assess associations between anthropometric measurements and low muscle strength, and receiver operating characteristic (ROC) curve analysis was used to evaluate their screening performance. Results: Among 390 participants, 67 (17.2%) had low muscle strength. Low muscle strength was associated with older age, lower body weight, BMI (Body Mass Index), fat-free mass, and smaller arm and calf circumferences. Higher arm and calf circumferences were significantly associated with a lower risk of low muscle strength in both women (OR = 0.913 and 0.884) and men (OR = 0.793 and 0.769; all p < 0.05). ROC analysis identified optimal screening cut-offs: arm 26.5 cm and calf 31.5 cm in women, and arm 29.5 cm and calf 33 cm in men, showing moderate screening performance, with an area under the ROC curve (AUC) of 0.63–0.78. Conclusions: Calf and arm circumferences are simple, quick, and non-invasive measurements that may be useful for screening low muscle strength in hospitalized geriatric patients, particularly in settings with limited access to specialized equipment. These measurements may help identify individuals who require further assessment for sarcopenia according to current clinical guidelines, with age being an important factor to consider. The proposed cut-off values should be considered hypothesis-generating rather than diagnostic thresholds for sarcopenia and require external validation in independent populations before they can be recommended for routine clinical use. Full article

Background/Objectives: Possible sarcopenia has been proposed as an early clinical category for identifying individuals at risk of adverse muscle-related outcomes before full diagnostic evaluation. This study examined whether comorbidity burden is associated with possible sarcopenia more strongly than routinely available clinical and laboratory variables. Methods: We conducted a retrospective propensity score-matched case–control study using the Korean National Health Insurance Service database (2002–2019). Possible sarcopenia was not defined according to guideline-based muscle strength, muscle mass, or physical performance criteria. Instead, we used KCD code M62.5 as a claims-based proxy for clinically suspected muscle wasting or atrophy suggestive of possible sarcopenia. After exclusion of individuals with missing data, 1793 cases were matched 1:1 with 1793 controls according to age, sex, residential area, and insurance type. Anthropometric measures, biochemical parameters, lifestyle factors, and Charlson Comorbidity Index (CCI) scores were compared. Logistic regression and receiver operating characteristic analyses were performed to evaluate associations and discriminatory performance. Results: In the matched population, most anthropometric, biochemical, and lifestyle variables were not significantly different between groups. Fasting blood glucose and gamma-glutamyl transferase were higher in the claims-based possible sarcopenia group, but these associations were not retained in the multivariable model. The CCI score was independently associated with possible sarcopenia (odds ratio: 1.25, 95% confidence interval: 1.20–1.30; p < 0.001). In receiver operating characteristic analysis, the CCI showed the highest discriminatory ability among individual predictors (area under the curve, 0.603). The multivariable model yielded an area under the curve of 0.610. Conclusions: In administrative health data, claims-recorded muscle wasting or atrophy suggestive of possible sarcopenia was more consistently associated with multimorbidity burden than with individual routine clinical or laboratory markers. These findings support cautious, comorbidity-aware interpretation of muscle wasting/atrophy codes, but do not establish diagnostic validity for possible sarcopenia. Full article

Pesticide use remains important in modern agriculture, vector control, and household pest management. However, exposure to pesticide active ingredients and residues remains a persistent public health concern. In addition to active ingredients, people may also be exposed to other constituents of commercial pesticide formulations, such as adjuvants and solvents, which can influence overall toxicity and health outcomes. These exposures may occur among direct applicators and may also affect other populations through contaminated air, water, soil, food, clothing, and household surfaces. This narrative review examines pesticide exposure from a community health perspective, emphasizing occupational, para-occupational, residential, dietary, drinking-water, airborne, and cumulative exposure pathways. It highlights vulnerable groups, including agricultural workers, children, pregnant women, women in agricultural communities, older adults, people with chronic illness, and marginalized rural populations. Evidence reviewed in this article links pesticide exposure with acute poisoning, respiratory effects, neurobehavioral and neurodevelopmental outcomes, cancer-related risks, reproductive and developmental effects, endocrine and metabolic disruption, cardiovascular outcomes, dermatological reactions, immune dysregulation, and biomarker-based subclinical changes. Beyond disease endpoints, pesticide exposure may also affect household income, education, mental well-being, food security, livelihoods, and intergenerational health. Major challenges include weak exposure assessment, underreporting, limited biomonitoring in low- and middle-income settings, and inconsistent community-level indicators. Strengthening surveillance, risk communication, integrated pest management, safer storage and disposal, protective regulation, and community-centered biomonitoring is essential to reduce pesticide-related health burdens. Full article