Search Results (3,034)

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

Background/Objectives: Hidradenitis suppurativa (HS), a chronic, inflammatory skin condition, severely affects quality of life. Despite advances in understanding its pathophysiology, major gaps persist in diagnosis and management. This study examined the journeys and unmet needs of Italian participants via an online survey, focusing on diagnostic delays, treatments, and quality of life for HS. Methods: Data were collected through a survey shared by the HS patient association in a dedicated Facebook group, using 45 closed-ended questions through Computer-Assisted Web Interviews. A total of 320 participants completed the survey in January 2023. Results: Participants reported consultations with approximately five clinicians before receiving a formal diagnosis, with a 10-year delay. Dissatisfaction with primary care was high (73%). Dermatologists played a central role in disease management. Only 24% of participants were on biologic therapy, despite the higher satisfaction levels compared to other treatments. HS was associated with quality-of-life impairments, particularly in psychological wellbeing (58%), daily functioning, and economic productivity. Unmet needs included better psychological support, improved access to biologics, nutritional guidance, and increased awareness of the disease among healthcare professionals. Conclusions: HS imposes considerable physical, psychological, and economic burdens. Earlier diagnosis, improved treatment strategies, and enhanced patient-centered care are essential to reducing this burden. Full article

Food allergy (FA) is a chronic condition that can affect adolescents’ emotional well-being, daily functioning, and psychosocial adjustment. Digital interventions based on serious games may support the development of socioemotional competencies in this population, although evidence remains limited. This study explored the psychological outcomes derived from emoTIChealth, a serious game designed to promote psychological adjustment and emotional competencies in adolescents with FA. A quasi-experimental longitudinal design with repeated measures and no parallel control group was conducted in 23 adolescents aged 11–17 years diagnosed with FA. Participants completed assessments at two pre-intervention time points and one post-intervention assessment. Outcomes included health-related quality of life, emotional competencies, socioemotional skills, self-concept, healthy habits, psychopathological symptoms, and perceived disease threat. A significant decrease in emotional awareness-related dimensions was observed, particularly in attention to others’ emotions and global emotional awareness. A significant decrease in Global Difficulties and the presence of psychopathology post-intervention was also observed. The participants’ emotional state and perceived difficulties during the intervention were associated with changes in some psychological outcomes. These findings provide preliminary evidence that emoTIChealth may influence specific emotional processes in adolescents with FA, although its impact on broader psychosocial and health-related outcomes appears limited. Further controlled studies with larger samples are warranted. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents the hepatic manifestation of systemic metabolic dysfunction and has become one of the leading causes of chronic liver disease worldwide. Although obesity is a major determinant of MASLD, the metabolic and lifestyle context in which the disease develops may vary across different geographical and dietary environments. The present study aimed to evaluate the prevalence of MASLD among adults with metabolic dysfunction from two European cohorts, to compare the clinical, metabolic, lifestyle, and psychological characteristics of participants with MASLD from Romania and Italy, and to explore differences according to MASLD status within each cohort. In addition, intestinal permeability was exploratorily assessed in a subgroup of the Italian cohort. Methods: This prospective multicentre observational study included 132 adults undergoing metabolic and hepatic evaluation in Romania (n = 52) and Italy (n = 80). Hepatic steatosis was assessed using SteatoTest in the Romanian cohort and ultrasonography in the Italian cohort. Anthropometric and metabolic parameters were recorded in all participants. Dietary quality was evaluated using the MEDI-LITE questionnaire, physical activity using the International Physical Activity Questionnaire (IPAQ), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and health-related quality of life using the 36-Item Short Form Health Survey (SF-36). Intestinal permeability was evaluated in the Italian cohort using the lactulose/mannitol absorption test. Results: MASLD was identified in 80.8% of participants from the Romanian cohort and in 66.3% of participants from the Italian cohort. Among patients with MASLD, Italian participants exhibited significantly higher body mass index, waist circumference, fasting insulin, total cholesterol, LDL cholesterol, and diastolic blood pressure compared with Romanian participants, whereas HDL cholesterol levels were significantly higher in the Romanian cohort. Sex-stratified analyses revealed significant sex-related differences in anthropometric and metabolic parameters within both cohorts. In both geographical populations, participants with MASLD demonstrated lower adherence to the Mediterranean diet, lower physical activity levels, higher depressive symptom burden, and less favorable quality-of-life indicators compared with participants without MASLD. Exploratory analyses of intestinal permeability in the Italian cohort did not reveal significant differences according to MASLD or obesity status. Conclusions: MASLD was highly prevalent in both Romanian and Italian adults with metabolic dysfunction. Patients with MASLD exhibited distinct metabolic and lifestyle profiles across the two geographical cohorts, supporting the potential contribution of environmental and lifestyle-related factors to MASLD heterogeneity. Lower adherence to the Mediterranean diet, reduced physical activity, and increased psychological burden were consistently associated with MASLD in both populations. Exploratory intestinal permeability analyses did not demonstrate significant differences according to MASLD or obesity status in the Italian cohort. Full article

Background: Familial Mediterranean Fever (FMF) is a chronic autoinflammatory disease that may adversely affect sleep quality, emotional well-being, and other patient-reported outcomes during childhood and adolescence. However, previous pediatric studies have frequently included heterogeneous patient populations with varying disease activity, limiting understanding of the relationship between disease severity and psychosocial functioning. Objective: To evaluate sleep quality and depressive symptoms in clinically stable children and adolescents with FMF during attack-free periods and to investigate their relationships with disease severity assessed using the International Severity Scoring System for Familial Mediterranean Fever (ISSF) and developmental factors. Methods: This cross-sectional case–control study included 72 children and adolescents with FMF and 88 age- and sex-comparable healthy controls. All patients with FMF were evaluated during clinically stable attack-free periods while receiving maintenance colchicine therapy. Depressive symptoms and sleep quality were assessed using the Children’s Depression Inventory (CDI) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Disease severity was evaluated using the ISSF. Multivariable logistic regression analysis was performed to identify factors independently associated with poor sleep quality. Results: Healthy controls demonstrated significantly higher mean CDI and PSQI scores than patients with FMF (CDI: 10.3 ± 6.8 vs. 8.2 ± 5.3, p = 0.048; PSQI: 4.7 ± 2.7 vs. 3.0 ± 2.3, p < 0.001). Poor sleep quality (PSQI ≥ 5) was more frequent among controls (46.6% vs. 25.0%, p = 0.006). Within the FMF cohort, adolescents (13–18 years) had significantly poorer sleep quality than younger children (p = 0.005). Increasing age was independently associated with poor sleep quality (OR 1.24, 95% CI 1.07–1.43; p = 0.003), whereas FMF diagnosis was not independently associated with poor sleep quality after adjustment for age and sex. No significant association was identified between ISSF-defined disease severity and psychosocial outcomes. Sleep quality showed a modest positive correlation with depressive symptom severity (Spearman’s ρ = 0.313, p = 0.007). Conclusions: Children and adolescents with FMF receiving maintenance colchicine therapy during clinically stable attack-free periods did not demonstrate poorer sleep quality or greater depressive symptom severity than age- and sex-comparable healthy controls. Increasing age appeared to be more closely associated with poor sleep quality than clinically assessed disease severity, whereas sleep quality showed a modest association with depressive symptom severity. These findings suggest that incorporating routine assessment of sleep quality and psychological well-being into multidisciplinary follow-up may facilitate a more comprehensive evaluation of children and adolescents with FMF. Full article

Background/Objectives: This exploratory comparative cross-sectional observational study investigated brain fog symptoms, cognitive function, sleep quality, quality of life, and selected serum biomarkers related to inflammation and neurocognitive function in newly diagnosed patients with celiac disease (ND-CeD), patients with CeD on a gluten-free diet (GFD-CeD), and controls. Methods: A total of 62 participants were included: ND-CeD patients (n = 18), GFD-CeD patients (n = 17), and healthy controls (n = 27) with no statistically significant differences in age or sex distribution across groups. Brain fog symptoms and severity, cognitive function, sleep quality, and quality of life were assessed using the Brain Fog Scale (BFS), Brain Fog Severity Score (BFSS), Montreal Cognitive Assessment (MoCA), Single-Item Sleep Quality Scale (SQS), and World Health Organization Quality of Life Questionnaire-Brief Form-TR (WHOQOL-BREF-TR), respectively. Serum BDNF, S100B, TLR4, IL-6, and nitric oxide (NO) levels were measured by ELISA. Results: ND-CeD patients had higher BFSs and BFSSs and lower MoCA, SQS, and WHOQOL-BREF-TR scores than healthy controls (p < 0.05). GFD-CeD patients showed numerically intermediate or more favorable scores than ND-CeD patients in several outcomes; however, most differences from controls were not statistically significant. Compared with ND-CeD patients, GFD-CeD patients had higher WHOQOL-BREF-TR General Health, Psychological Health, and Social Relationships scores (p < 0.05). In exploratory within-group analyses, after correction for multiple comparisons, higher BFS scores were associated with poorer psychological health and lower MoCA scores, and higher MoCA scores were associated with better psychological and physical health domains, particularly in the ND-CeD group. In the adjusted regression model, older age, income status, and newly diagnosed disease status were independently associated with MoCA scores. No statistically detectable between-group differences were observed in serum IL-6, NO, BDNF, S100B, or TLR4 levels. Conclusions: These preliminary findings suggest that brain fog symptoms, cognitive performance, sleep quality, and quality of life may deserve greater attention at diagnosis and during follow-up in celiac disease. Although GFD-CeD patients showed more favorable scores in some outcomes, these cross-sectional differences should not be interpreted as treatment-related improvement. Larger longitudinal studies with objective assessment of gluten-free diet adherence, disease activity, micronutrient status, sleep quality, and gut–brain axis-related biomarkers are needed to confirm these findings. Full article

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, and lowering low-density lipoprotein cholesterol (LDL-C) remains a cornerstone of cardiovascular prevention. Statins are among the most extensively studied and widely prescribed medications and have demonstrated substantial benefits in reducing major adverse cardiovascular events in both primary and secondary prevention settings. Nevertheless, the effectiveness of statin therapy in routine clinical practice is frequently compromised by poor adherence, treatment discontinuation, concerns regarding adverse effects, and persistent residual cardiovascular risk. This narrative review synthesises contemporary evidence relating to the mechanisms of action of statins, their role in primary and secondary prevention, determinants of medication adherence, statin-associated muscle symptoms (SAMSs), and emerging developments in precision cardiovascular medicine. Current evidence indicates that although statins remain highly effective in reducing cardiovascular risk, long-term treatment success is strongly influenced by behavioural, psychological, social, and healthcare system factors. Increasing attention has also been directed towards the multifactorial nature of SAMSs and the contribution of nocebo effects to perceived statin intolerance. Emerging approaches involving pharmacogenomics, artificial intelligence, digital health technologies, and multidimensional risk assessment offer opportunities for more individualised prevention strategies, although important limitations relating to cost, accessibility, and external validity remain. Overall, contemporary cardiovascular prevention requires a patient-centred approach that integrates biological, behavioural, and social determinants of health to optimise treatment adherence and improve long-term cardiovascular outcomes. Full article

Background/Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with substantial physical and psychosocial burden. Illness acceptance is an important component of adaptation to chronic disease, yet it remains underexplored in HS. Therefore, this study aimed to assess illness acceptance in HS patients. Methods: This cross-sectional study included 123 consecutive adult HS patients. Illness acceptance was assessed using the Acceptance of Illness Scale (AIS). Disease severity was evaluated using Hurley staging and the International Hidradenitis Suppurativa Severity Score System (IHS4). Pain and itch were measured using the Numeric Rating Scale. Quality of life (QoL) was assessed with the Dermatology Life Quality Index (DLQI) and Hidradenitis Suppurativa Quality of Life (HiSQoL). Depression and anxiety were evaluated using PHQ-9, GAD-7, and HADS. Results: The mean AIS score was 31 ± 8.7 points, with 14% of patients showing low and 24% moderate illness acceptance. Lower acceptance was associated with higher Hurley stage (p = 0.031). A significant negative correlation between AIS scores and IHS4 values was found (r = −0.26; p = 0.013). Additionally, AIS scores correlated negatively with pain (r = −0.22; p = 0.019) and itch (r = −0.23; p = 0.021). Strong negative correlations were found with QoL impairment (DLQI: r = −0.63; HiSQoL: r = −0.65; p < 0.001) and psychological distress, including depression (PHQ-9: r = −0.55; HADS-D: r = −0.60) and anxiety (GAD-7: r = −0.50; HADS-A: r = −0.56; p < 0.001 for all). Conclusions: Targeting illness acceptance may improve overall patient outcomes. Full article

Pruritus is a common and burdensome symptom in inflammatory, autoimmune, and connective tissue skin diseases, significantly impairing quality of life, sleep, and psychological well-being. Pruritus arises from a complex interplay between skin barrier dysfunction, immune activation, and neuronal sensitization involving cytokines, alarmins, neuropeptides, and sensory pathways. Increasing evidence indicates that both biological sex and gender-related factors influence itch perception, severity, and clinical expression, although these differences remain insufficiently explored. This review provides a comprehensive analysis of current evidence on sex- and gender-related differences in pruritus across dermatological diseases, with particular attention to the neuroimmune mechanisms underlying chronic itch. Available studies suggest that women more frequently report greater itch intensity, enhanced psychological burden, and higher impairment in daily activities and sleep, whereas men may exhibit different clinical and sensory profiles. However, findings remain heterogeneous because of methodological limitations, small cohorts, and the lack of standardized itch assessment tools. In addition to biological determinants, psychosocial and behavioral factors likely contribute to sex- and gender-specific differences in chronic pruritus. Overall, the available evidence highlights the need for more standardized and sex-informed research approaches to improve the understanding and management of pruritus in dermatological diseases. Full article

Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by fluctuating symptoms, long-term medication use, bodily uncertainty, and complex self-management demands. These features can make patients’ experiences difficult to narrate, recognize, and integrate into everyday life. This study aimed to explore how Chinese women living with SLE use visual narratives to make sense of illness disruption, treatment burden, identity changes, and relational experience. Methods: This qualitative study used Virtual Photovoice, an online visual method in which participants generate and discuss photographs about lived experience, with eight Chinese women living with SLE. Data included participant-generated photographs, brief captions, SHOWeD-based written reflections structured around prompts that move from image description to broader reflection, and transcripts from three online Photovoice workshops. The data were analyzed using reflexive thematic analysis within a participatory-informed Virtual Photovoice design, informed by illness narrative theory. Results: Four themes were developed: Invisible Battlefield, Masks and Boundaries, Anchors of Order, and Longing to Be Seen. Participants used photographs and accompanying accounts to give form to fatigue, pain, and bodily uncertainty; negotiate the boundaries between concealment and disclosure; transform medication routines, dietary practices, and illness-related objects into anchors of order and agency; and contrast embodied relational support with clinical encounters experienced as distant or indicator-centered. Conclusions: The findings show how visual illness narratives can support meaning-making, self-recognition, and reflection on patient-centered communication among women living with SLE. Virtual Photovoice offers a narrative and participatory-informed approach for understanding psychological, embodied, and relational dimensions of chronic illness that are often difficult to express through routine clinical or everyday language. Full article

Background/Objectives: Illness uncertainty is a pervasive psychosocial experience in chronic conditions that is particularly prominent in pediatric oncology. While existing research has explored its psychological impact, a gap remains in understanding how this uncertainty evolves throughout the disease trajectory and how families collectively negotiate and manage this experience over the long term. Methods: This qualitative study was conducted in the hematology ward at a pediatric hospital in Shanghai, China. Using purposive sampling, semi-structured interviews were performed with 32 participants from 12 families of children currently undergoing cancer treatment. Data were collected through in-depth interviews and analyzed using reflexive thematic analysis. The sample was dominated by leukemia cases, with a small number of lymphoma cases; therefore, the findings are most directly transferable to families of children with hematological malignancies. Results: Illness uncertainty is a dynamic and persistent experience permeating the entire pediatric cancer trajectory. Key sources of uncertainty include diagnostic ambiguity and delays, barriers in physician–patient communication, and profound disruptions to family daily life. In response, families proactively develop multidimensional coping strategies: reframing meaning to accept uncertainty, reorganizing family roles and responsibilities, strengthening internal communication, and mobilizing external support networks. These strategies demonstrate both family resilience and inherent vulnerability under sustained pressure. Conclusions: Illness uncertainty in pediatric cancer transcends medical boundaries and is deeply embedded in family life. Healthcare systems should recognize uncertainty as a core experience throughout the disease process and provide family-centered psychosocial and structural support. Strengthening hospital social work services and fostering synergy between peer networks and community resources are essential to enhancing families’ capacity to manage uncertainty and alleviating their long-term psychosocial burden. Full article

Background/Objectives: In this study, we aimed to investigate age-specific prevalence and patterns of oral frailty among Korean adults and examine its multidimensional associations with physical and mental health and health-related quality of life, from a life-course perspective. Methods: This cross-sectional study included 4459 adults aged ≥25 years from the 2023 Korea National Health and Nutrition Examination Survey. Oral frailty was defined as the presence of ≥4 deficits across 9 clinical and behavioral indicators. Associations of oral frailty with chronic diseases, appendicular skeletal muscle mass (ASM), psychological symptoms, and health-related quality of life were examined across age-stratified cohorts (25–44, 45–59, 60–74, and ≥75 years). Results: The prevalence of oral frailty was significantly higher in older age groups (8.2% at 25–44 years to 48.5% at ≥75 years, p < 0.001). Frail participants showed significantly higher prevalence of hypertension and diabetes and lower ASM, compared with non-frail participants. Difficulty pronouncing words and toothache experience showed the strongest contributions to the overall oral frailty score (p < 0.001). Oral frailty was also significantly associated with higher perceived stress and generalized anxiety, particularly among younger adults aged 25–44 years. Health-related quality of life was consistently lower in frail participants than in non-frail participants across all age groups (p < 0.001). Conclusions: Oral frailty is a multidimensional indicator associated with systemic aging, metabolic health, psychological distress, and reduced quality of life across the life course. These findings support the need for integrated, life-course-oriented oral health interventions beginning in early adulthood to prevent functional decline and promote healthy aging. Full article

Environmental noise has emerged as a pervasive yet frequently underestimated environmental stressor with consequences for biodiversity, public health, and societal well-being. Although a substantial body of epidemiological research has linked chronic transportation-related noise exposure with cardiovascular disease, sleep disturbance, psychological distress, impaired cognitive performance, and premature mortality, comparatively few studies have estimated its broader economic burden within a planetary health framework. This study presents an exploratory order-of-magnitude economic valuation based on a large-cohort epidemiological risk-transfer scenario. A hazard-ratio-based framework was applied to estimate noise-attributable mortality among populations subjected to road traffic environmental noise levels above 60 dB. Both tangible costs, representing forgone economic productivity, and intangible costs, representing societal welfare losses using the Value of a Statistical Life framework, were estimated. Under baseline assumptions, chronic transportation-related environmental noise was associated with approximately 27,692 annual attributable deaths—when applying a hazard-based ratio—estimated annual productivity losses of approximately US$7.28 billion and welfare losses valued at approximately US$353.91 billion under the Value of a Statistical Life framework. These findings suggest that chronic transportation-related environmental noise represents a potentially important, though often overlooked, environmental externality with substantial health and economic implications. The proposed framework provides an initial basis for future research evaluating the wellbeing, societal, and economic magnitude of environmental noise within a planetary health context. Full article

Cancer patient–informal caregiver dyads function as core collaborative units across the cancer trajectory from diagnosis to recovery. A central challenge for these dyads lies in managing illness uncertainty alongside the demands of dyadic coping, two interrelated factors that jointly shape long-term quality of life, psychological well-being, and disease adaptation. These two factors interact to shape their long-term quality of life, psychological well-being, and disease adaptation. Past studies have mostly examined dyadic coping and illness uncertainty separately. Employing a narrative review design, this study searched the PubMed database for literature published from 2021 to 2025, and synthesizes evidence on association pathways and moderating factors between dyadic coping and illness uncertainty among adult cancer patient–informal caregiver dyads. Existing research on dyadic coping has predominantly focused on the effects of interventions (e.g., enhanced spousal communication, joint exercise) on emotional health and relationship quality. Studies on illness uncertainty have largely examined its association with anxiety and depression, but have failed to provide a comprehensive understanding of the interactive pathways between the two constructs. This review addresses this gap by synthesizing evidence from three perspectives: interactive mechanisms, heterogeneous characteristics, and integrated intervention directions. Evidence from the reviewed literature suggests that illness uncertainty represents a critical antecedent of dyadic coping among cancer dyads. Illness uncertainty and dyadic coping share a bidirectional association, and this relationship is moderated by factors including cancer type, patient age, and cultural background. Most uncertainty management interventions effectively reduce illness uncertainty in specific populations. Synthesized evidence indicates that dyadic coping is a significant predictor of relationship satisfaction among couples coping with chronic illness. Interventions that are made for these couples need to include things like psychoeducation and skill-building parts that are about dyadic coping, so that they can improve the couples’ relationship satisfaction. Based on predominantly observational evidence with heterogeneous study designs, the authors propose that combining uncertainty management interventions with dyadic coping skills training represents a key direction for future clinical care optimization. This review provides evidence-based implications for developing targeted dyadic care strategies and advancing family-centered, full-course cancer care models. Full article

Over the last few decades, survival among patients with lung cancer (LC) has progressively improved due to major advances in treatment strategies, particularly the introduction of immunotherapy and targeted therapies, as well as the increased detection of early-stage disease resulting from the widespread use of chest computed tomography (CT). Although the reduction in mortality, frequently achieved through effective control of the primary disease, represents a major therapeutic success, it also raises new clinical challenges, including the long-term management of cancer remission or disease stability and the competing risk of adverse outcomes related to comorbidities and treatment-related toxicities. Among these, cardiovascular (CV) complications have emerged as particularly relevant because of their frequency and prognostic impact. Within the framework of a holistic long-term management approach, increasing attention should be directed toward non-pharmacological interventions targeting lifestyle factors, particularly nutrition and physical exercise, whose role remains underestimated. These interventions may modulate chronic inflammation and immune responses, which are key drivers influencing both the effectiveness of novel anticancer therapies and the progression of cardiovascular complications. Patients with LC frequently present malnutrition and unfavorable lifestyle patterns associated with substantial physical and psychological stress, factors that may negatively affect treatment outcomes and overall prognosis. This narrative review examines the emerging role of targeted nutritional strategies and structured physical exercise as integral components of supportive care in LC, with a specific focus on their impact on cardiac metabolism, CV risk, and response to anticancer therapies, including immunotherapy. Full article