Search Results (1,869)

Repair programs are pervasive in idiopathic pulmonary fibrosis (IPF), yet they fail to reach completion. While single-cell and spatial omics have identified cellular states associated with injury-repair programs, a central paradox remains: why do these programs persist without reconstituting functional lung architecture? This review integrates evidence from multiscale omics, spatial analyses, and translational studies to propose a lesion-centered “non-resolving repair” framework that explains IPF progression. We argue that disease progression is driven by the persistence of cellular repair programs after the pathways required for maturation, state exit, and microenvironmental reset have become compromised. These compartment-specific failures converge within spatially organized lesion units, where aberrant cellular activity and matrix distortion reinforce one another, embedding failed repair within tissue architecture. This perspective shifts the focus from cataloging disease-associated cell states toward evaluating failed biological transitions and regional resolution capacity. Clinically, it reframes antifibrotic therapy around overcoming spatial barriers to repair and highlights the need for translational endpoints that distinguish marker suppression from structural stabilization and functional tissue reconstruction. Delineating which lesional niches retain resolution capacity will be essential for identifying where repair-oriented interventions may still re-engage organized tissue repair in IPF. Full article

General practitioners (GPs) are at the forefront of stunting interventions, but only a few studies have examined their understanding of growth monitoring. Therefore, this study aims to assess the effectiveness of massive open online course (MOOC)-based Continuing Medical Education (CME) programs to increase GPs’ knowledge of nutrition and early detection of growth abnormalities. The study procedures were carried out using a pre- and post-cohort approach involving 121 GPs, mostly working in primary care in Indonesia. The pre- and post-test scores were observed before and after the 12-week MOOC intervention, and the participants were asked for feedback. There were 190 verified participants; the attrition rate was 27.4% (n = 52), and there were six participants with incomplete data, leaving 121 participants as the final sample. The results showed that post-test scores significantly increased after intervention in all domains. These domains included early-life nutrition (7.00 to 9.00), breastfeeding and lactation management (5.56 to 7.78), and feeding problems (7.33 to 8.00) (p < 0.001). Participants reported high satisfaction and preferred a combination of synchronous and asynchronous learning. The feedback suggested improving parental education techniques, specifically in low-socioeconomic settings, and strengthening collaboration between GPs and nutritionists in managing feeding problems. Full article

Interlimb asymmetry is relevant for monitoring neuromuscular function in athletes, but evidence on futsal-specific preventive strategies in youth players remains limited. This study examined the effects of a 20-week Futsal Preventive Program (FPP) on functional interlimb asymmetry and explored injury risk during a 9-month surveillance period. Sixty-seven youth male outfield players completed pre- and post-intervention assessments (control group, n = 36; experimental group, n = 31), while 79 players were included in the injury-risk analysis (control group, n = 41; experimental group, n = 38). The experimental group performed a 15 min neuromuscular warm-up weekly, while the control group continued its usual warm-up. Asymmetry was assessed using countermovement jump (CMJ), horizontal jump (HJ), and 505 change-of-direction (COD 505) tests. The program produced a task-specific reduction in COD 505 asymmetry compared with the control group (cluster-adjusted difference = −1.27 percentage points; 95% CI: −2.00 to −0.53; Bonferroni-adjusted p = 0.03), whereas no significant intervention effects were observed for CMJ or HJ asymmetry. Across the full 9-month surveillance period, the crude cumulative injury-risk estimate was RR = 0.92 (95% CI: 0.59–1.45), with the confidence interval including the null value. These findings support a task-specific effect of the FPP on COD 505 asymmetry, without evidence of corresponding effects on CMJ or HJ asymmetry. Injury findings were descriptive and hypothesis-generating and do not establish preventive efficacy. Further studies with a larger number of randomized teams, greater weekly intervention exposure, and individual training and match exposure monitoring are warranted to clarify potential effects on injury incidence. Full article

The mental health of young people has increasingly emerged as a public health priority due to the growing prevalence of mental health problems during adolescence and early adulthood. The literature has identified community-based programs as effective strategies for promoting well-being and preventing psychological symptomatology. In this context, the present study aimed to evaluate the impact of the interventions provided by junior psychologists working in the Youth Health Offices of the Cuida-te Program of the Portuguese Institute of Sports and Youth (IPDJ) on the quality of life, well-being, and mental health of Portuguese youth through a pre- and post-intervention analysis. A total of 1164 young people, aged between 12 and 29 years old, participated across three editions of the program. Self-report instruments were used to assess the quality of life, the well-being, and the psychological symptoms (stress, depression, and anxiety) of the participants. The results revealed statistically significant improvements between pre- and post-intervention assessments, including increased quality of life and well-being, as well as reduced levels of stress, depression, and anxiety. These findings were observed among both female and male participants and across different age groups. Non-binary participants showed less pronounced results, although with no statistically significant differences identified, suggesting the need for more research with larger samples and for inclusive interventions tailored to the specific needs of sexual and gender minorities. Overall, the work carried out appears to constitute an effective and cost-effective community-based response for the prevention of mental health symptoms and the promotion of mental health in adolescents and young adults, reinforcing the importance of permanent, accessible, and inclusive public policies. Full article

This paper is presented by a collective of Black women who have devoted years to sexual health as educators, programmers and facilitators. It offers an insider perspective on their experiences facilitating the pilot of the Sista2Sista project, a sexual health intervention adapted to the Canadian context for young Black women ages 15–29. The post-pilot focus groups were conducted with stakeholders and facilitators to gather feedback on the intervention. This approach centers the perspectives of facilitators and stakeholders in implementing sexual health programs for Black youth. Findings show that the Sista2Sista pilot benefited from Black women facilitators, whose positionality fostered a culturally affirming space for young Black women. Additionally, the findings highlight gaps in race-based data and sexual health programming for Black youth in Ontario specifically, and Canada more broadly. Participants highlighted the need for holistic, relevant and sustainably funded interventions that address sexual health alongside pleasure, body image and systemic barriers, such as anti-Black racism. Overall, this paper contributes to a deeper understanding of sexual health for young Black women by centring the lived experiences of Black women facilitators who informed the pilot intervention while advocating for contextually relevant approaches that reflect the realities of Black communities. Full article

Background: School violence is a major public health concern, with bullying alone affecting up to 50% of adolescents worldwide. Life skills-based programs have been proposed as a promising preventive approach, yet evidence for their effectiveness in secondary education remains limited. This systematic review and meta-analysis aims to synthesize the existing evidence on the effectiveness of life skills-based violence prevention programs among adolescents aged 12–18. Methods: A systematic literature search was conducted across five databases (PubMed, Scopus, ERIC, CINAHL, and PsycInfo) in accordance with PRISMA 2020 guidelines (INPLASY202650168). Interventional studies published between 2005 and 2025 that targeted secondary school students were eligible. Risk of bias was assessed using the Cochrane RoB2 (for RCTs/cRCTs) and ROBINS-I tools. A three-level random-effects meta-analytic model with Robust Variance Estimation was employed to pool Hedges’ g effect sizes. Results: Nineteen studies met the eligibility criteria, with 18 contributing 56 effect sizes to the meta-analysis. The pooled effect size was statistically significant (g = −0.2652, 95% CI [−0.4879, −0.0425], p = 0.0196), indicating an overall small reduction in violent behaviors. However, a high degree of variation in effects was observed across studies (Q(55) = 2263.58, p < 0.001; I² = 99.23%). None of the examined moderators—including outcome type, study design, and risk-of-bias tier—significantly explained this heterogeneity. The sensitivity analysis, excluding one highly influential study, yielded a smaller pooled effect (g = −0.1422, 95% CI [−0.2246, −0.00598]) while maintaining high heterogeneity (I² = 92.82%). Conclusions: Although life skills-based programs demonstrate a statistically significant overall average effect in reducing school violence among adolescents, this finding must be interpreted with extreme caution given the high degree of variation in effect sizes across contexts and the fact that prediction intervals span across zero. Because moderator analyses revealed no significant differences across intervention types, study designs, or outcome categories, no specific program type can be identified as consistently more effective. Future primary research must prioritize prospectively registered trials with multi-informant assessments to establish true intervention effectiveness. Full article

Background and Objectives: The optimal timing of orthodontic intervention in children remains debated, particularly during the mixed dentition phase. Despite potential benefits, variability in clinical decision-making persists. This study explored orthodontists’ perceptions, clinical practices, and clinical decision-making regarding the timing of early orthodontic intervention in Saudi Arabia. Materials and Methods: An interpretive qualitative study was conducted using semi-structured interviews with nineteen licensed orthodontists practicing in Saudi Arabia. Participants were purposively sampled to ensure diversity in clinical experiences and practice settings. Interviews were conducted in English and Arabic, using detailed contemporaneous field notes that were subsequently expanded for analysis. Data were analyzed using thematic analysis following Braun and Clarke’s framework, with iterative coding supported by investigator triangulation, reflexive memoing, and participant validation. Data collection continued until thematic saturation was achieved. Results: Four major themes were identified. Early intervention was widely perceived as beneficial, particularly for functional problems, Class III malocclusions, and crossbites. However, decision-making was highly individualized, with many clinicians adopting a selective approach and deferring treatment in mild cases. Variation in clinical reasoning was observed across individual participant accounts, reflecting clinical judgment and contextual influences. Key barriers included limited parental awareness, financial constraints, and delayed referrals. System-level factors, such as variability in insurance coverage, referral pathways, and the lack of structured early screening programs, were identified as important influences on access to timely care. Conclusions: Early orthodontic intervention should be applied selectively, based on clinical indications and patient-specific factors. The context-specific findings highlight the need for appropriately tailored guidance, improved referral systems, structured early screening, and consideration of clinical, practitioner-related, and healthcare system factors to support consistent, patient-centered orthodontic care. Full article

Purpose: Accurate assessment of skeletal maturation is important for timing pediatric dental and orthodontic interventions. This study compared bone age estimates generated by two AI-based programs, CRESCOM MediAI-BA and VUNO Med-BoneAge^®, in Korean children and adolescents undergoing orthodontic diagnostic evaluation. Methods: This retrospective study compared bone-age estimates generated by CRESCOM MediAI-BA and VUNO Med-BoneAge^® using left hand–wrist radiographs from 200 Korean children and adolescents (100 boys and 100 girls; 6–17 years) undergoing orthodontic diagnostic evaluation. Chronological age and program-derived bone age were compared by sex and age group using the Wilcoxon signed-rank test. Standardized differences were summarized using Cohen’s d, and Spearman correlations were calculated among chronological age, program-derived bone age, and the CRESCOM skeletal maturity indicator (SMI). Results: The standardized differences between chronological age and CRESCOM-predicted bone age were very small in boys (d = 0.143) and small in girls (d = 0.258). Corresponding differences for VUNO Med-BoneAge^® were small in boys (d = 0.254) and girls (d = 0.216). CRESCOM SMI correlated strongly with chronological age (ρ = 0.852), VUNO-predicted bone age (ρ = 0.910), and CRESCOM-predicted bone age (ρ = 0.932; all p < 0.001). However, statistically significant age- and sex-specific differences were observed between chronological age and AI-predicted bone age and between the two programs. Conclusions: CRESCOM MediAI-BA may provide clinically useful adjunctive information for skeletal-maturity assessment; nevertheless, AI-derived bone-age estimates from different programs should not be considered interchangeable and should be interpreted in conjunction with clinical findings and established skeletal-maturity indicators. Full article

Background: Combat sports require athletes to repeatedly perform explosive actions under conditions of fatigue, demanding high levels of neuromuscular coordination, reactive agility, and intermittent effort capacity. This study examined changes in biomechanical and neuromuscular performance over a 15-week period during which competitive Sambo athletes completed a CrossFit-based functional training program alongside their regular sport-specific training. Methods: Forty male Sambo athletes (22.4 ± 2.6 years) completed a longitudinal repeated-measures intervention consisting of three weekly CrossFit-based sessions integrated into regular sport-specific training. The program was periodized across four progressive mesocycles emphasizing functional strength, explosive power, reactive agility, and fatigue resistance. Pre- and post-intervention assessments included upper- and lower-limb reaction speed, vertical jump height, repeated jump endurance, reactive agility, grip endurance, body-weight squat performance, Romanian deadlift repetitions, and the Special Judo Fitness Test (SJFT). Statistical analyses included paired-samples t-tests or Wilcoxon signed-rank tests with Benjamini–Hochberg false discovery rate correction (α = 0.05). Results: Significant post-intervention improvements were observed in most performance variables. Upper- and lower-limb reaction performance improved by 22.9% and 9.7%, respectively (p < 0.001), while vertical jump height increased by 11.4% and repeated jump endurance by 16.6% (p < 0.001). Reactive agility time decreased by 6.6% (p < 0.001), indicating faster cognitive-motor responsiveness. Functional strength improved substantially, with increases of 43.7% in body-weight squat performance and 71.9% in Romanian deadlift repetitions (p ≤ 0.001). Grip endurance improved by 6.3% (p = 0.007), whereas maximal handgrip strength showed no significant changes. The SJFT index decreased by 5.0% (p < 0.001), reflecting enhanced intermittent effort efficiency and fatigue tolerance. Large effect sizes were identified for upper-limb reaction speed (d = 1.42), explosive endurance (d = 1.46), and reactive agility (d = 0.96). Conclusions: Over the 15-week study period, participation in a CrossFit-based functional training program integrated into regular Sambo practice was associated with improvements in several biomechanical and neuromuscular performance outcomes, including reaction performance, explosive power, agility, muscular endurance, and sport-specific work capacity. However, because the study did not include a control group, these changes cannot be attributed exclusively to the CrossFit-based intervention. Controlled studies are required to distinguish intervention-specific effects from seasonal training adaptations, continued sport-specific practice, and test familiarization. Full article

Background: Pakistan is one of only two countries where wild poliovirus type 1 (WPV1) continues to persist. Vaccine refusals challenge efforts to end the virus, especially in high-risk communities. Methods: A qualitative exploratory study took place from September to November 2025 in three High-Risk Union Councils (HRUCs) of Karachi, Pakistan. The study examined reasons for refusing the polio vaccine and identified specific communication and operational strategies to improve vaccine acceptance. A total of 23 in-depth interviews and 10 focus group discussions were conducted with 71 participants, including parents who refuse the vaccine, polio program staff, physicians, and government stakeholders. Data were analyzed using a sequential inductive and deductive thematic approach, mapping findings onto the Socio-Ecological Model (SEM) with NVivo 15 (Lumivero, Denver, CO, USA). Results: Factors influencing polio vaccine refusals were interconnected and spanned multiple levels. At the intrapersonal level, campaign fatigue, a lack of knowledge about poliomyelitis, concerns about side effects, and rumors about infertility were common. Community-level factors included household gatekeepers, local influencers, and digital misinformation. Institutional barriers included weak communication from the frontline, inadequate supervision, workforce shortages, poor tracking of refusals, and limited involvement of physicians. At the policy level, refusals were linked to distrust in governance, poor municipal services, and dissatisfaction with vertical campaign methods. Recommended strategies included integrating polio services with routine immunization and primary healthcare, strengthening counseling by physicians, engaging trusted local influencers and community leaders, expanding targeted social media campaigns to counter misinformation, implementing quick responses to rumors, enhancing workforce capacity, and using data-driven microplanning, including targeted SNIDs and focused interventions in areas with chronic refusals. Conclusions: Polio vaccine refusals are shaped by social, communication, operational, and structural factors. Improving communication and operational guidelines by reducing the number of campaigns, increasing active engagement at the frontline, integrating polio activities into routine health services, and addressing misinformation with a dynamic communication strategy may enhance vaccine acceptance and support polio eradication efforts. Full article

Background: U.S. mortality trends involving pancreatic cancer and pulmonary embolism (PE) and whether PE is becoming increasingly represented among pancreatic cancer deaths remain incompletely characterized. Methods: We analyzed CDC WONDER Multiple Cause of Death data for adults aged ≥ 25 years from 1999 through 2024. Deaths were included in the primary analysis when pancreatic cancer and PE were both recorded as underlying or contributing causes. Age-adjusted mortality rates (AAMRs) were evaluated using Joinpoint Regression Program version 6.0.1. Forecasting and additional weighted log-linear and segmented regression analyses were performed in R version 4.5. Additional analyses evaluated race/ethnicity, the proportion of pancreatic cancer underlying-cause deaths with PE recorded, and sensitivity to the COVID-19 years. Results: Overall, 18,243 deaths involved both pancreatic cancer and PE. The AAMR increased from 0.19 per 100,000 in 1999 to 0.55 in 2024. Mortality increased by 2.65% annually during 1999–2016 and by 8.54% annually during 2016–2024, with a significantly steeper post-2016 slope (p < 0.001). Rates were consistently higher among males and non-Hispanic Black individuals. Hispanic or Latino mortality increased significantly during 2011–2024, whereas estimates for Asian or Pacific Islander individuals were too sparse or frequently suppressed to support reliable longitudinal trend analysis. Among deaths with pancreatic cancer as the underlying cause, the proportion with PE recorded increased from 1.00% in 1999 to 2.85% in 2024, with significantly faster growth after 2016 (p < 0.001). Excluding 2020–2021 did not materially alter the post-2016 increase. Conclusions: Mortality involving pancreatic cancer and PE increased substantially in the United States, and PE was recorded in a growing proportion of pancreatic cancer deaths. These death-certificate data identify an increasing population-level burden but cannot establish causality or demonstrate the effectiveness of specific clinical interventions. Full article

Background/Objectives: Lifestyle interventions may alleviate treatment-related toxicity and improve patient-centered outcomes during radiotherapy (RT). This scoping review mapped randomized evidence on lifestyle interventions delivered during RT, summarized reported outcomes, and identified evidence gaps. Methods: PubMed and Web of Science were searched for randomized controlled trials (RCTs) published from April 2016 to April 2026. Eligible studies included adults who received exercise, nutritional, psychological, combined, or multimodal lifestyle interventions during their RT treatment. Study characteristics, intervention details, and outcomes were charted and narratively synthesized. Results: Twenty-three RCTs were included. Exercise interventions were evaluated in 12 studies, nutrition in five, psychological in one, combined exercise-and-nutrition in two, combined nutrition-and-psychological in two, and multimodal interventions comprising all three components in one study. Breast, head and neck, and prostate cancers were most frequently represented. QoL, fatigue, and functional capacity were the most commonly assessed outcomes. Exercise interventions were most consistently associated with improvements in fatigue and functional capacity, whereas effects on QoL were less consistent. Nutritional interventions showed favorable findings for nutritional status and treatment-related toxicity. Psychological, combined, and multimodal interventions showed favorable findings for selected QoL, fatigue, nutritional, and psychological outcomes. Key evidence gaps included heterogeneous intervention protocols and outcomes assessment, limited evidence for non-exercise interventions and underrepresentation of several cancer populations. Conclusions: Lifestyle interventions delivered during RT may improve selected patient-centered and treatment-related toxicity outcomes. Exercise comprised the largest body of evidence, whereas other intervention types were less frequently evaluated. Heterogeneity across studies limits conclusions regarding optimal approaches. Further RT-specific studies using standardized intervention programs and comparable outcome measures are required to inform supportive-care delivery. Full article

Background: Physical exercise induces coordinated endocrine and metabolic adaptations that contribute to the regulation of glucose homeostasis, lipid metabolism, stress responses, and anabolic processes. However, the integrated effects of combined aerobic and resistance exercise on multiple endocrine and metabolic outcomes require further investigation. This study aimed to evaluate the effects of a 12-week combined aerobic and resistance exercise program on endocrine and metabolic parameters in normal-weight and mildly overweight adults. Methods: A total of 60 adults were randomly allocated to an exercise group (EX, n = 30) or a control group (CON, n = 30). The EX-group completed a supervised 12-week combined exercise program consisting of three 60 min sessions per week, including aerobic exercise and multi-joint resistance training, whereas the CON-group maintained their habitual physical activity levels. Endocrine parameters, including insulin, glucagon, cortisol, growth hormone (GH), thyroid hormones, and sex-specific hormones, as well as fasting glucose, lipid profile, and homeostasis model assessment of insulin resistance (HOMA-IR), were assessed at baseline and after 12 weeks. Results: Compared with the control condition, the exercise program was associated with favorable changes in endocrine and metabolic profiles. The EX-group showed reductions in fasting insulin, cortisol, fasting glucose, and HOMA-IR, together with increased GH levels. Favorable changes were also observed in the lipid profile, including reductions in total cholesterol, low-density lipoprotein cholesterol (LDL), and triglycerides and an increase in high-density lipoproteins cholesterol (HDL). In the male subgroup, total testosterone increased following the intervention, whereas estradiol changes in the female subgroup were more limited. Changes in insulin were associated with changes in glucose regulation and lipid parameters, while GH and cortisol changes showed additional associations with metabolic outcomes. Conclusions: These findings support the role of structured combined exercise as a non-pharmacological strategy for promoting endocrine and metabolic health and preventing metabolic dysfunction. Full article

Background/Objectives: Positive psychological constructs such as psychological well-being, resilience, subjective vitality, and mental toughness are fundamental to students’ emotional adjustment and overall development. Physical activity (PA) is a modifiable factor known to enhance these variables; however, the influence of its timing throughout the day remains underexplored. This systematic review aimed to examine the effects of PA on psychological well-being, resilience, subjective vitality, and mental toughness in children and adolescents, considering the timing of implementation—before, during, or after school hours—and the specific characteristics of the activities performed. Methods: Following the PRISMA guidelines, a comprehensive search was conducted in Scopus, PubMed, ERIC, and Web of Science, identifying 29 studies published between 2014 and 2026, comprising 12 cross-sectional and 17 longitudinal studies. Results: Overall, PA was positively associated with all four psychological variables across different times of the day. PA before school, such as active commuting and active starts, was primarily associated with higher in well-being and vitality. During-school interventions, particularly structured programs such as active breaks and cooperative games, were associated with better resilience, emotional self-regulation, and prosocial behavior. After-school PA, especially organized and voluntary activities, was associated with higher resilience and mental toughness. The effects varied according to the intensity, structure, social context, and student role, with moderate-to-vigorous intensities and cooperative formats producing the most consistent benefits. Conclusions: In conclusion, PA appears to exert a beneficial influence on positive psychological development, with variations depending on the time and mode of practice. Schools, particularly through Physical Education programs, constitute a key context for promoting students’ emotional, motivational, and behavioral health. Full article

Background/Objectives: Internet Gaming Disorder (IGD) is included in ICD-11 and poses a substantial risk to Saudi university students, yet no structured nursing intervention framework exists within Saudi higher education health services. This paper presents the Resilience-Based Nursing Intervention Framework (RBNIF), a three-tiered, theory-driven nursing architecture translating evidence on impulsivity, resilience, and IGD into practice specifications for this setting. Methods: Using secondary analysis of a dataset of 207 gaming students from four King Saud University colleges, framework development followed a four-phase Medical Research Council (MRC) process: theoretical identification (I-PACE, Dual Process Theory, COM-B), evidence synthesis, Behavior Change Wheel/Intervention Mapping, and cultural adaptation via Bernal et al.’s Ecological Validity Framework. Results: The sample (58.9% male; 20–25 years, 61.4%; bachelor’s level, 73.9%) yielded three tiers differentiated by a dual-domain screening rule (elevated impulsivity and/or low resilience, rather than a single combined score): Tier 1 (universal psychoeducation); Tier 2 (six-session group program, S-UPPS-P ≥ 52 and/or CD-RISC-10 ≤ 20; 63 of 207 participants [30.4%]); and Tier 3 (10-session RIRDH clinical program, IGDS9-SF ≥ 36, met by 38 of 207 participants [18.4%]). Fifty-two participants (25.1%) met the elevated-impulsivity criterion, and 51 (24.6%) met the low-resilience criterion. Each tier specifies nursing competencies and behavior change techniques, with cultural adaptation integrating Islamic values concepts (sabr, mizan, tawakkul), family protocols, and single-sex delivery. Conclusions: To our knowledge, the RBNIF is the first theory-driven, culturally adapted nursing intervention architecture for IGD in Saudi university health services; a focused, non-systematic search of PubMed, Scopus, and CINAHL identified no directly comparable published framework. It is pre-implementation and requires feasibility testing, pilot evaluation, and a cluster-randomized controlled trial (c-RCT). Full article