Search Results (128)

Background/Objectives: The obesity epidemic coexists with the phenomenon of “hidden hunger” (Type B malnutrition)—a micronutrient deficiency amidst a caloric excess. Traditional dietary assessment methods often distort the actual picture by ignoring technological losses during cooking, which necessitates the use of digital tools. Methods: A cross-sectional study (N = 3267) was conducted using the digital platform “NIAP”. The analysis was based on valid 3–7-day dietary records with algorithmic accounting for nutrient retention factors during thermal processing. The nutrient profiles of individuals with a normal body mass index (BMI) and obesity (BMI ≥ 30 kg/m²) were compared. Results: The epidemiology of intake shortfalls was highly prevalent and pronounced: 99.9% of the cohort had ≥1 inadequacy (with a mean negative deviation of −77.3% for vitamin D and −59.2% for Omega-3), and 61.5% exhibited ≥10 simultaneous multiple intake shortfalls. These inadequacy rates remained robust in a sensitivity analysis excluding under-reporters. The obesity group consumed significantly more energy, saturated fatty acids, added sugars, cholesterol, and sodium, but demonstrated a lower relative macronutrient intake (g/kg of body weight). Absolute fiber intake did not differ between the groups, indicating a decrease in its density per 1000 kcal in the diet of individuals with obesity; the intake of Omega-3 polyunsaturated fatty acids (PUFAs) showed a downward trend. The Na:K ratio was significantly higher in the obesity group (1.19 vs. 1.04, p < 0.001). Correlation analysis confirmed an inverse relationship between BMI and the overall nutrient density of the diet. Conclusions: A high-energy diet does not compensate for systemic micronutrient inadequacy among the evaluated cohort. Obesity is associated with a dietary imbalance favoring “empty calories” and pro-inflammatory components against a background of severe multiple dietary inadequacies. The integration of algorithmic dietary assessment that accounts for cooking losses is critical for objective diagnosis and personalized nutritional intervention. Full article

Background/Objectives: Placenta accreta spectrum (PAS) is an increasingly prevalent and potentially life-threatening complication in women with placenta previa. Despite widespread clinical use, the inter-modality agreement between prenatal ultrasound and MRI and their comparative value for predicting perioperative hemorrhage remain poorly characterized, particularly in low-to-moderate risk populations where placenta accreta predominates. We aimed to compare inter-modality agreement between standardized ultrasound and MRI impressions and to evaluate each modality’s predictive value for perioperative hemorrhage. Methods: This prospective cohort study enrolled 47 women with placenta previa who underwent both standardized ultrasound and MRI prospectively between 28 + 0 and 32 + 6 weeks of gestation, with perioperative outcomes collected at the time of cesarean delivery. Both modalities were classified using a three-tier impression system (None/Suspected/Likely) based on standardized structural, vascular, and invasive marker composites. The primary outcome was inter-modality agreement (linearly weighted Cohen’s κ); secondary outcomes were the association of each modality’s impression with postpartum hemorrhage (PPH; estimated blood loss ≥ 1000 mL) and estimated blood loss (EBL). Results: PAS was confirmed in 18 of 47 women (38.3%), predominantly placenta accreta (83.3%). Inter-modality agreement was fair (weighted κ = 0.263), structural concordance was moderate (κ = 0.539), while vascular agreement was near-absent (κ = 0.085). Ultrasound impression demonstrated a dose-dependent association with PPH rates (38.5%, 52.9%, and 82.4% across None, Suspected, and Likely tiers; p = 0.048) and EBL (800, 1000, and 1800 mL; p = 0.003), with logistic regression confirming a 2.70-fold increase in PPH odds per tier (p = 0.018; AUC 0.657). MRI impression was not associated with PPH (p = 1.000), EBL (p = 0.743), or PAS status (p = 0.741; AUC 0.543). Serum AFP was significantly elevated in women with PPH (p = 0.005). Conclusions: In this accreta-predominant, low-to-moderate risk cohort, ultrasound—but not MRI—demonstrated a significant dose-dependent association with perioperative hemorrhage. These findings should not be interpreted as evidence of general MRI inadequacy but rather as reflecting the specific imaging context in which MRI’s strengths in deep invasion characterization are less clinically determinative. These results support ultrasound as the primary tool for hemorrhage risk stratification in this population. Full article

(1) Background: The global expansion of teleworking has increased concern regarding musculoskeletal pain associated with home-based working conditions. This study quantified the prevalence of musculoskeletal pain among Brazilian teleworkers and explored ergonomic and environmental factors associated with the distribution of physical symptoms and the multisite pain burden. (2) Methods: A cross-sectional survey was conducted between June and August 2024, analyzing 184 valid responses from teleworkers across various professional sectors. Data were collected via an online questionnaire assessing sociodemographic characteristics, workstation ergonomics, and musculoskeletal symptoms using the Nordic Musculoskeletal Questionnaire (NMQ). Statistical analyses included Pearson’s chi-square tests, logistic regression, and exploratory Random Forest modeling to prioritize predictors. (3) Results: Musculoskeletal pain was reported by 74% of participants, with the lower back (40.8%), neck (36.4%), and upper back (30.4%) being the most frequently affected anatomical regions. The primary ergonomic and environmental factors associated with pain reports included discomfort with the desk and mouse, suboptimal thermal comfort, and prolonged sitting. Odds ratios demonstrated strong statistical co-occurrence between recent and 12-month pain reports, particularly for the shoulders, reflecting overlapping recall indicators rather than temporal symptom progression. (4) Conclusions: Musculoskeletal pain is highly prevalent among Brazilian teleworkers, showing clear links to localized workstation inadequacies and overlapping short- and long-term symptom reporting. These findings highlight the need for targeted institutional occupational health policies, such as ergonomics training and adjustable furniture provision, while future longitudinal research remains essential to confirm causal pathways. Full article

Background: Hashimoto’s thyroiditis (HT) is a chronic autoimmune disorder characterized not only by thyroid dysfunction but also by metabolic disturbances, micronutrient inadequacies, and low-grade inflammation. Composite indices derived from routine laboratory parameters may therefore help capture the broader systemic profile of the disease. This study explored within-cohort associations of immunonutritional indices including the Prognostic Nutritional Index (PNI), Nutritional Risk Index (NRI), and Controlling Nutritional Status (CONUT), and hemogram-derived inflammatory markers including the Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII), with thyroid function, thyroid autoimmunity, metabolic characteristics, disease duration, and vitamin D status in adults with Hashimoto’s thyroiditis. Methods: This cross-sectional study included 229 adults diagnosed with HT. PNI, NRI, CONUT, and complete blood count-derived inflammatory markers were evaluated in relation to thyroid function, thyroid autoimmunity, disease duration, metabolic characteristics, and vitamin D status. Because most variables were not normally distributed, the main analyses were conducted using non-parametric tests. Correlations were evaluated using Spearman’s rank correlation coefficients. Exploratory regression models were estimated using HC3 heteroscedasticity-consistent robust standard errors, and CRP-based sensitivity analyses were performed by excluding participants with CRP > 10 mg/L. Results: Vitamin D deficiency was highly prevalent and affected 70.3% of the participants. Among the immunonutritional indices, NRI differed significantly according to BMI category and HOMA-defined insulin resistance (both p < 0.001), indicating a closer relationship with metabolic burden. PNI was associated with disease duration (p = 0.009), whereas the inflammatory indices were largely similar across the clinical groupings examined. In exploratory robust regression models, the explanatory power remained modest (R² = 0.066–0.171). PLR showed the most consistent index-related association with TSH, whereas the CONUT–FT3 association observed in the full-sample robust model was not retained after CRP-based sensitivity analysis. Conclusions: Adults with HT in this study showed frequent vitamin D deficiency together with a substantial burden of excess weight and insulin resistance. Routine immunonutritional and inflammatory indices may provide supportive information on within-cohort biochemical and metabolic heterogeneity, but they should not be interpreted as stand-alone diagnostic or prognostic markers. In particular, NRI appeared to reflect metabolic and adiposity-related burden more than nutritional risk alone, while PLR showed the most internally consistent index-related association with TSH. Full article

The persistently high prevalence of gender-based violence and harassment (GBVH) in higher education institutions is a well established phenomenon, as is the inadequacy of institutional responses and the silencing of those who aim or attempt to report it. Drawing on Ahmed’s concept of ‘non-performativity’, ‘institutional speech acts that do not bring into effect what they name’, this paper argues that the non-performativity of anti-bullying and harassment policy is an exercise of power, consistent with Agócs concept of institutionalised resistance. Reporting misconduct is intentionally transformational, but seen as a threat to powerful organisational actors, who exercise institutional power to enact procedures in such a way that victim-survivors are unvoiced and tricked into ‘reluctant acquiescence’ with adverse consequences on their personal and occupational health. We employ documentary analysis to critique policies and procedures for GBVH in Irish universities, and specifically how institutional power is exercised through policy documents. The analysis is based on ten pseudonymised universities, rendering a sample size of 23 documents, pertaining to GBVH for staff. We find that the tone and language employed in policies, and the way in which the informal and formal approaches in anti-bullying and harassment policies frame the problem, serve the interests of the institution. Confidentiality clauses, the framing of the problem as an individualistic, incident-based problem, to be resolved case-by-case, and quasi-legal processes facilitate non-performativity, preserving institutional power and the status quo. From a public health perspective such inertia undermines efforts to prevent harm and promote workplace wellbeing. Meaningful reform will require that HEIs employ alternative tools capable of unsettling these entrenched institutional arrangements and to adopt alternative, proactive tools that prioritise accountability, transparency, prevention and health gain. We suggest new tools in the form of victim-centred, trauma-informed, remediation- and restorative-based approaches. Full article

Background: Violence in healthcare settings affects nursing students during clinical training and may compromise their mental well-being, learning experiences, and professional development. Despite evidence from high-income countries, limited data exist on how contextual and organizational factors in Latin American settings shape these experiences. This study aimed to assess the frequency and types of violence experienced by nursing students during clinical practice and the academic and emotional consequences. Methods: Cross-sectional study conducted among undergraduate and graduate nursing students in Mexico City who had completed at least one hospital-based clinical placement in the previous 12 months. Data were collected between January 2024 and September 2025 using a validated questionnaire assessing types of violence, perpetrators, academic and emotional consequences. Violence was defined as experiencing events “occasionally,” “sometimes,” or “frequently.” Descriptive statistics were calculated. Associations were examined using Pearson’s chi-square test, and logistic regression models adjusted for age, sex, and year of study. Results: Seventy-three students participated (86.3% female). Non-physical violence was the most frequent type (90.4%), followed by sexual harassment (49.3%), mainly perpetrated by nurses (62%) and physicians (46.5%). Considering leaving the profession (41.4%) and feelings of inadequacy (66.2%) were the most common academic and emotional consequences. Although some associations were observed in bivariate analyses, these were not significant after adjustment. Conclusions: Violence during clinical training is highly prevalent and may represent a significant threat to nursing students’ mental well-being and professional development. Strengthening institutional policies, reporting mechanisms, and supportive learning environments is essential to mitigate its impact and promote safer clinical training. Full article

Background/Objectives: Multiple sclerosis (MS) is a chronic, demyelinating and neurodegenerative disease frequently associated with dysphagia, nutritional imbalances, and alterations in body composition. This study aims to describe the anthropometric profile and body composition in people with MS, estimate the risk and type of dysphagia, analyse dietary intake and habits, and evaluate the evolution of these parameters over six months. Methods: This descriptive analytical longitudinal study included 30 patients with MS (20 women, 10 men), with a median age of 53.3 years at baseline and 54.0 years at final assessment. The prevalence of dysphagia risk was determined, dietary patterns and body composition were characterised, and their interactions were explored through two assessments conducted six months apart. Results: Overall, 90% of the sample had relapsing–remitting MS (RRMS). At both the initial and final assessments, the median BMI was above 25 kg/m² and a high prevalence of dysphagia risk (63.3% and 76.7%), particularly for liquids. Frequent inadequacies were observed in the intake of certain macronutrients and micronutrients, including energy, fibre, potassium and magnesium. Likewise, the analysis by food groups revealed low adherence to recommendations, particularly for fruits, cereals, legumes, fish and lean meats. No significant differences were detected between the two time points. Conclusions: Dysphagia, dietary intake, habits, and body composition are interconnected dimensions in MS; systematically integrating nutritional assessment and dysphagia screening into clinical practice would contribute to a more comprehensive management and to improvements in swallowing disorders and nutritional status in people with MS. Full article

Disputes over delay assessments are costly, persistent, prevalent worldwide, often funded by taxpayers, and negatively impact productivity in the construction sector. The identified academic literature argues that the main causes of the escalation of disagreements over delay assessments from contract claims into disputes (or factors) are objective factors, particularly unavailability and/or inadequacy of relevant project data. However, those findings are not based on comprehensive investigations of all factors involved, employing research methodologies that rely upon real-life project data. This article contributes to the fulfilment of the aforementioned knowledge gap. Published literature and twenty-one case studies were evaluated to identify the factors. The research findings revealed that although data-related issues were often important factors, they were not the main and/or most frequently identified ones. Subjective factors, including manipulation of programme activity completion dates, reliance on biased assumptions when data is unavailable, misinterpretation of material records, and self-serving delay analysis, were the main factors. The findings suggest that the root cause of this issue is the exploitation of systemic flaws, including the unavailability of good/best practice guidance on assessing the impact of delays, deficient contract provisions, inadequate impartiality, divergent priority of interests, unexploited technologies, and the confidential nature of dispute resolution methods. Full article

Background: Venous catheters are standard devices in clinical practice. However, their use is not exempt from possible errors and complications. In addition, using them effectively is key to avoiding complications such as infection or phlebitis. Objectives: To determine the frequency of appropriate venous catheters chosen based on the drug and treatment duration in hospitalized patients in a region with 154,000 inhabitants. Methods: A cross-sectional design was carried out between 14 and 28 February 2020, in patients with a peripheral or central intravenous catheter admitted to the acute care unit. Variables collected were related to the catheters, patients, and nurses. Results: One hundred and eighty-eight patients were included, with 319 catheters inserted by 68 nurses. Seventeen patients (8.8%) were ruled out due to the lack of data on the medication administered. Finally, data from 171 patients were included in the final analysis, with 297 catheters inserted. Of them, 246 catheters (82.8%) were inadequate. Discussion: In this point-prevalence study, catheter inadequacy affected more than four out of five catheters and was mainly linked to the use of peripheral catheters for high-risk IV medications and/or for treatments extending 7 days or more. Conclusion: The selection of venous catheters in acute care units is not usually adequate since many peripheral catheters are placed in patients who require intravenous medication during a prolonged period or who are receiving risk medication. Full article

Second-generation incretin-based therapies have transformed the pharmacological management of obesity by inducing substantial and sustained weight loss. The weight-reducing effects are primarily mediated through appetite suppression, reduced energy intake, and modulation of eating behavior. While therapeutically beneficial, these mechanisms may also influence dietary quality, micronutrient exposure, and overall nutritional status, particularly in individuals with obesity, a population already characterized by a high prevalence of baseline nutritional inadequacy. This narrative review is intended to inform clinicians, clinical nutrition specialists and researchers involved in obesity management by summarizing baseline micronutrient vulnerability in obesity, synthesizing available evidence on dietary intake, biochemical micronutrient status, and nutrition-related clinical outcomes during incretin-based therapy, discussing plausible mechanisms linking these therapies to micronutrient risk, and outlining approaches to risk-stratified nutritional monitoring in clinical practice. Full article

Background/Objectives: The increasing trend of foodborne zoonotic pathogens exhibiting antimicrobial resistance (AMR) represents a growing threat to food safety and public health in sub-Saharan Africa (SSA). Resistant strains of foodborne zoonotic pathogens compromise treatment efficacy, raise illness, and threaten sustainable food systems in human and animal health. However, regional understanding and policy response are limited due to the fragmentation of data and the inadequacy of surveillance. This systematic review and meta-analysis aimed to achieve the following: (1) estimate the pooled prevalence of AMR, including multidrug resistance (MDR) in selected foodborne pathogens; (2) compare subgroup variations across countries, pathogen species, and antibiotic classes; and (3) evaluate temporal trends. Methods: Following PRISMA 2020 guidelines, studies published between 2010 and June 2025 reporting AMR and MDR in Salmonella, Campylobacter, or E. coli from food or animal sources in SSA were systematically reviewed. Data on pathogen prevalence, AMR profile, and MDR were extracted. Random-effects meta-analysis using R software was implemented to estimate the pooled prevalence and the 95% confidence intervals (95% CI). Subgroup analyses were performed to explore heterogeneity across countries, antibiotic class, and bacterial species. Results: Ninety studies from 16 sub-Saharan African countries were included, encompassing 104,086 positive isolates. The pooled foodborne pathogen prevalence was 53.1% (95% CI: 51.5–54.7), AMR prevalence was 61.6% (95% CI: 59.4–63.9), and MDR prevalence was 9.1% (95% CI: 8.3–10.0). The highest resistance was reported in Campylobacter spp. (43.6%), followed by Salmonella spp. (29.1%) and E. coli (22.8%). High heterogeneity was observed across studies (I² = 95–99%, p < 0.001). Conclusions: It is concluded that substantial AMR burden exists in food systems, highlighting an urgent need for integrated One Health surveillance, antimicrobial stewardship, and policy harmonization in SSA. Strengthening laboratory capacity, enforcing prudent antimicrobial use, and promoting regional data sharing are critical for the management of antimicrobial resistance in sub-Saharan Africa. Full article

Background/Objectives: The Fourth Italian National Food Consumption Survey (IV SCAI 2017–2020) provides updated and comprehensive data on the dietary habits of the Italian population. The study aimed to assess nutrient intakes and their main food sources among individuals aged 3 months to 74 years and to evaluate the adequacy of intakes against the Italian dietary reference values (DRVs). Methods: A nationally representative sample of 1969 participants were surveyed using two non-consecutive food diaries (ages 3 months–9 years) and 24 h recalls (ages 10–74 years) in accordance with the European Food Safety Authority’s EU Menu guideline. The multiple source method was used to estimate the usual intakes accounted for intra-individual variability. Nutrient adequacy was assessed against age- and sex-specific DRVs, and the main food sources of macro- and micronutrients were identified. Results: Energy intake was below DRVs for adults, particularly women, while protein intake exceeded recommendations across all ages, mainly from animal sources (67% of total). Total fat (38%En) and saturated fat (12%En) exceeded the recommendations, whereas carbohydrates (45%En) and dietary fibre were suboptimal. Vitamin D and calcium intake were markedly below DRVs for all age groups; iron inadequacy was prevalent among females. The main energy sources were cereals (39%), milk and dairy (15%), oils and fats (13%), and meat (10%). Vegetables and fruits were leading contributors to vitamins A and C, while meat, fish, and dairy provided vitamin B12 and D. Conclusions: The Italian diet remains cereal-based but shows nutritional imbalances: notably, excessive protein and fat intake and widespread deficiencies in vitamin D, calcium, iron, and fibre. These findings underline the need for targeted nutrition policies to realign dietary patterns with the national recommendations. Full article

Background: Pediatric patients often receive medicines manipulated from adult formulations due to a lack of age-appropriate products. While such practices are clinically routine, they may reflect deeper systemic deficiencies in pediatric pharmacotherapy. Objective: This scoping review aimed to map the prevalence, definitions, and types of pediatric drug manipulation and to conceptualize manipulation as an indicator of structural gaps in formulation science, regulation, and access. Methods: A systematic search of PubMed (January 2014–July 2024) included 10 studies reporting the frequency of drug manipulation in children aged ≤18 years. Eligible studies were synthesized narratively according to PRISMA-ScR guidelines. Results: Ten studies from nine countries were included, reporting manipulation frequencies ranging from 6.4% to 62% of all drug administrations and up to 60% at the patient level. Manipulated formulations most commonly included oral solid doses, altered through dispersing, splitting, or crushing. Definitions and methodologies varied considerably. The findings revealed five recurring structural gaps: limited pediatric formulations, inconsistent regulatory implementation, lack of standardized definitions and guidance, insufficient evidence on manipulation safety, and inequitable access across regions. Conclusion: Manipulation of finished dosage forms for use in children is a widespread, measurable phenomenon reflecting systemic inadequacies in formulation development, regulation, and access. Recognizing manipulation as a structural indicator may guide policy, innovation, and equitable pediatric pharmacotherapy worldwide. Full article

This study compared executive functions, anthropometric profile, and dietary habits in adolescent girls with and without eating disorder (ED) symptoms. The main objective was to determine the relationship between the presence of ED symptoms and the degree of executive function impairment. A case–control design was used with 209 Mexican adolescents who completed ED screening questionnaires. Of the total sample, 54 participants scored above the clinical cutoff, and 39 of them completed both the BANFE-2 assessment and the anthropometric measurements. These 39 adolescents with ED symptoms were matched with an equal number of adolescents without symptoms to form the control group. Additionally, 21 adolescents in the ED symptoms group and 25 in the control group completed the 24 h dietary recall and food frequency questionnaires. The main findings were as follows: the prevalence of ED symptoms was 25.8%. Adolescents with ED symptoms showed higher body mass index, waist circumference, body fat percentage, and neck circumference compared with those without symptoms. They also exhibited poorer inhibitory control, reflected in a greater number of errors, along with non-significant trends toward lower performance on the maze test, Card Sorting, and Card Game. Dietary inadequacy was also more pronounced in the ED symptoms group. Furthermore, the presence of ED symptoms significantly increased the likelihood of severe executive function impairment. In conclusion, adolescents with ED symptoms demonstrated an altered anthropometric profile, dietary deficiencies, and reduced inhibitory control. Full article

Background: Gestational weight gain (GWG) is commonly used as an indicator of nutritional adequacy during pregnancy and a marker for pregnancy outcomes. This study aims to report the prevalence and extent of GWG inadequacy among Saudi women and to examine the effects of GWG inadequacy on pregnancy outcomes. Methods: This study was conducted as part of the Riyadh Mother and Baby Multicenter Cohort Study; it included 6984 women with singleton pregnancies. Adverse pregnancy outcomes—including hypertension, gestational diabetes (GDM), cesarean section (CS), low birth weight (LBW), Neonatal Intensive Care Unit admission (NICU), and macrosomia—were compared between women with adequate and inadequate GWG, based on the Institute of Medicine (IOM) guidelines. Results: Of the participants, 2221 women (31.8%) had adequate GWG for prepregnancy BMI, 2959 (42.4%) had inadequate GWG, and 1804 (25.8%) had excessive GWG. Women with normal prepregnancy BMI and inadequate GWG had significantly increased odds of delivering LBW infants (adjusted odds ratio (AOR) = 1.61, 95% CI: 1.17–2.20). Inadequate GWG also decreased the odds of emergency cesarean delivery among women with obesity (AOR = 0.75, 95% CI: 0.56–0.97) and lowered the likelihood of NICU admission for infants of obese women (AOR = 0.59, 95% CI: 0.36–0.97). Women with prepregnancy obesity experienced the highest rate of adverse outcomes; however, the prevalence of all adverse outcomes decreased as the degree of weight gain inadequacy increased. Conversely, underweight women had the highest percentage of LBW, with this percentage increasing as weight gain inadequacy increased. Conclusions: The effects of inadequate GWG vary depending on maternal prepregnancy BMI and the specific outcome assessed. For women with obesity, reduced weight gain during pregnancy may be beneficial. In contrast, inadequate GWG is associated with a higher incidence of LBW in women with normal prepregnancy BMI and underweight women. Full article