Search Results (41)

Background/Objectives: Breastfeeding represents a critical developmental window during which maternal biology, environmental exposures, and nutrition converge to influence infant gastrointestinal health and long-term developmental trajectories. From a One Health perspective, breastfeeding can be conceptualized not as a static nutritional act, but as a dynamic and modifiable biological system in which maternal factors shape early-life microbiota assembly and immune programming. This narrative review explores how microbiota-oriented strategies during breastfeeding may foster a favorable trajectory of infant health, potentially extending to transgenerational outcomes. Methods: This narrative review is structured around a ten-point decalogue addressing interconnected domains relevant to the maternal–milk–infant microbiota axis, including maternal diet, microbial diversity, environmental exposures, psychological stress and probiotic use. Current mechanistic and clinical evidence was examined to evaluate how these domains may modulate microbiota composition and function during breastfeeding. Attention was given to probiotic supplementation, including strain specificity, timing of administration, and clinical context, as well as to the broader implications of a One Health framework. Results: Available evidence suggests that maternal nutritional patterns, environmental and psychosocial exposures, and targeted microbiota-modulation strategies may influence the composition and functional properties of human milk and the developing infant microbiota. Probiotic use during breastfeeding appears to have strain-specific and context-dependent effects, with potential benefits in selected clinical scenarios. However, findings remain heterogeneous, and uncertainties persist regarding optimal strains, timing, and long-term outcomes. Conclusions: Breastfeeding can be understood as a dynamic biological interface shaped by maternal and environmental factors. Integrating microbiota-oriented strategies within a One Health framework may support infant gastrointestinal health and possibly contribute to longer-term developmental trajectories. Nevertheless, careful interpretation of the current evidence is warranted to avoid reductionist, supplement-centered approaches and to prevent maternal overmedicalization or blame. Full article

Background: The growing use of digital health technologies in diabetes care offers new opportunities for self-management and clinical monitoring. However, there remains significant variability in the extent to which individuals engage with these digital tools. Understanding the psychosocial and clinical factors associated with the use of digital health technologies is crucial for developing targeted implementation strategies. Objectives: The aim of this study was to assess the use of digital health technologies among adults with diabetes and to explore their relationship with psychosocial factors—especially technology acceptance and self-efficacy—as well as certain clinical characteristics, including diabetes-related stress, age, and disease duration. Methods: We conducted a cross-sectional study involving 304 adults with diabetes. Digital engagement was measured using the Digital Adherence and Use Questionnaire (DAUQ), a 7-item self-report instrument (Cronbach’s α = 0.89), from which a composite Digital Engagement Score was calculated (range 1–5) to indicate the level of technology-related self-management behaviors. Participants were descriptively categorized into low- and high-engagement groups. Engagement patterns were also analyzed by diabetes type to understand structural differences in technology exposure. Relationships between psychosocial variables and the outcome were examined using correlation analyses. Since engagement among participants with type 1 diabetes (T1D) showed limited variability, multivariable regression analyses were performed on participants with type 2 diabetes (T2D) using beta regression, with linear regression as a sensitivity analysis. An exploratory beta regression was also conducted for T1D. Results: Overall, 35.5% of participants were classified as having high digital engagement. High engagement was observed in more than 90% of participants with T1D, compared to 4.1% of those with T2D. Median engagement scores differed significantly between low- and high-engagement groups (median [Q1–Q3]: 1.71 [1.71–2.39] vs. 3.86 [3.86–4.43]). Highly engaged participants reported much higher levels of openness to technology (median [Q1–Q3]: 5.00 [1.00–5.00] vs. 1.00 [1.00–1.00], p < 0.001) and self-efficacy (median [Q1–Q3]: 3.00 [3.00–3.00] vs. 5.00 [5.00–5.00], p < 0.001). In T1D, multivariable beta regression analyses showed that age was independently associated with digital engagement, with each 10-year increase corresponding to a decrease in engagement (β = −0.147, 95% CI −0.219 to −0.075, p < 0.001). Diabetes duration and psychosocial variables were not independently associated with engagement in the multivariable model. In contrast, among participants with T2D, insulin treatment emerged as the strongest independent predictor of engagement (β = 0.996, 95% CI 0.859–1.134, p < 0.001), and diabetes-related stress emerged as an independent predictor of engagement (β = 0.069, 95% CI 0.006–0.132, p = 0.033). Technology acceptance was positively associated with engagement (β = 0.694, 95% CI 0.350–1.037, p < 0.001), whereas higher self-efficacy was independently associated with lower engagement intensity (β = −0.366, 95% CI −0.608 to −0.124, p = 0.003). Age and diabetes duration were not independently associated with engagement after adjustment. Conclusions: Digital engagement appears to function as a structurally embedded component of self-management in T1D, with limited variability and largely independent of psychosocial modulation. In T2D, engagement is predominantly driven by treatment characteristics (insulin treatment), psychosocial dynamics (stress, technology acceptance), with higher self-efficacy associated with reduced reliance on digital tools. These findings suggest distinct behavioral mechanisms underlying digital health utilization across diabetes types and support the need for tailored implementation strategies. Full article

During the COVID-19 pandemic, women have had to face different psychosocial problems. For this reason, psychoeducational interventions based on web-based resources have been developed to address their mental health. This study aimed to evaluate the pilot of a psycho-emotional support web platform based on elements of cognitive-behavioural therapy in Mexican women during the COVID-19 pandemic. Through a pre-experimental design with pre-test and post-test evaluations, 73 women between 18 and 68 years old (M = 43.42 years, SD = 12.40) had access to this platform for one month, which contained four thematic modules (stress, anxiety, depression and violence). They also received two complementary three-hour synchronous sessions. All participants reported similar levels of emotional symptoms (p > 0.05), as well as perceiving violence exerted by their partners (p > 0.05). The web platform and its psychoeducational content turned out to be quality informative resources; however, no statistically significant changes were observed in the psychological variables in question. Web platforms and emotional support applications should be developed according to the needs and characteristics of the population for which they are designed; this will promote greater satisfaction and reduce therapeutic abandonment. Full article

Hair loss disorders, particularly androgenetic alopecia (AGA), are common conditions that carry significant psychosocial impact. Current standard therapies, including minoxidil, finasteride, and hair transplantation, primarily slow progression or re-distribute existing follicles and do not regenerate lost follicular structures. In recent years, regenerative medicine has been associated with a gradual shift toward approaches that aim to restore follicular function and architecture. Stem cell-derived conditioned media and exosomes have shown the ability to activate Wnt/β-catenin signaling, enhance angiogenesis, modulate inflammation, and promote dermal papilla cell survival, resulting in improved hair density and shaft thickness with favorable safety profiles. Autologous cell-based therapies, including adipose-derived stem cells and dermal sheath cup cells, have demonstrated the potential to rescue miniaturized follicles, although durability and standardization remain challenges. Adjunctive interventions such as microneedling and platelet-rich plasma (PRP) further augment follicular regeneration by inducing controlled micro-injury and releasing growth and neurotrophic factors. In parallel, machine learning-based diagnostic tools and deep hair phenotyping offer improved severity scoring, treatment monitoring, and personalized therapeutic planning, while robotic Follicular Unit Excision (FUE) platforms enhance surgical precision and graft preservation. Advances in tissue engineering and 3D follicle organoid culture suggest progress toward producing transplantable follicle units, though large-scale clinical translation is still in early development. Collectively, these emerging biological and technological strategies indicate movement beyond symptomatic management toward more targeted, multimodal approaches. Future progress will depend on standardized protocols, regulatory clarity, and long-term clinical trials to define which regenerative approaches can reliably achieve sustainable follicle renewal in routine cosmetic dermatology practice. Full article

Pain in children and adolescents remains an underestimated and undertreated condition, with long-term physical and psychosocial consequences. Non-invasive neuromodulation has emerged as a promising, low-risk approach for managing acute and chronic pain by modulating central and peripheral neural pathways. This systematic review followed PRISMA 2020 guidelines to evaluate the efficacy, safety, and clinical applicability of non-invasive neuromodulation techniques in pediatric pain. Searches were conducted in PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and ScienceDirect for randomized controlled trials (RCTs) published between 2015 and 2025. Six RCTs met the inclusion criteria, encompassing percutaneous electrical nerve field stimulation (PENFS), transcutaneous auricular vagus nerve stimulation (taVNS), transcutaneous electrical acupoint stimulation (TEAS), and transcutaneous electrical nerve stimulation (TENS). Four trials reported significant reductions in pain intensity alongside improvements in functional outcomes and quality of life, particularly in functional abdominal pain and postoperative contexts. Most studies showed low or moderate risk across domains, with appropriate randomization and blinded assessment. No serious adverse events were reported, confirming an excellent safety profile. These findings support non-invasive neuromodulation as a feasible and well-tolerated adjunct to conventional pediatric pain management. Further high-quality trials are warranted to standardize protocols and explore mechanisms of neuroplasticity in the developing nervous system. PROSPERO (CRD420251170866). Full article

The use of radiotherapy in oncology patients aged 80 years and older represents a significant clinical challenge due to the limited availability of prospective data and the under-representation of this age group in clinical trials. Most existing evidence originates from retrospective analyses of small patient cohorts. Radiotherapy remains a cornerstone of cancer treatment, providing both curative and palliative benefits. Technological advances, including intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT), have significantly improved treatment precision, reduced toxicity, and enabled the adoption of hypofractionated regimens. These shortened treatment schedules are particularly advantageous for older patients, reducing the burden of prolonged therapy while maintaining therapeutic efficacy. Comprehensive Geriatric Assessment (CGA) plays a crucial role in optimizing treatment decisions for octogenarian patients by addressing their clinical, functional, and psychosocial needs. However, the routine use of CGA remains limited due to logistical and time constraints. Despite these challenges, current evidence suggests that radiotherapy is generally well tolerated in this population, with acceptable toxicity profiles even among frail patients. As the global population of individuals aged 80 years and older continues to increase, the development of specific clinical guidelines tailored to this demographic has become essential. There is an urgent need for prospective studies providing robust evidence regarding the efficacy, safety, and tolerability of radiotherapy in older adults. This review aims to summarize the current state of knowledge on the role of radiotherapy in patients aged 80 years and older and to highlight the need for evidence-based, individualized oncologic care for this growing patient population. Full article

Background: The Sparrow (Modified Lazy-S) incision was developed as an alternative to the level 1 oncoplastic approach in breast-conserving surgery. Unlike the standard Lazy-S incision, both ends are more curved, a central skin islet is preserved, and the incision can be safely applied in all four breast quadrants, either horizontally or vertically. Large anterior skin islets facilitate the safe excision of tumors located near the skin, thereby reducing the risk of positive anterior margins. This technique is straightforward and does not require specialized training. Methods: Patients with invasive carcinoma who underwent breast-conserving surgery using the Sparrow incision at Istanbul University-Cerrahpasa Breast Clinic between January 2017 and January 2020 were retrospectively screened. Results: All 57 patients underwent the Sparrow incision. The overall complication rate was 8.8%, consistent with previously reported rates (9.8–10.97%). Patient-reported outcomes, assessed using Breast-Q™ modules, demonstrated high levels of satisfaction in terms of breast shape, symmetry, and psychosocial well-being. Conclusions: The Sparrow incision is an oncologically safe technique with potential advantages, as it does not prolong operative time or require additional instruments. It permits excision of previous biopsy sites and can be applied in patients undergoing neoadjuvant therapy or presenting with multifocal tumors. Patient-reported outcomes suggest favorable esthetic and psychosocial results. Full article

Background/Objectives: Despite the intent of most mothers to breastfeed their children, breast or nipple pain can be the reason for early cessation of breastfeeding. Current understanding about lactation-related pain revolves around mechanical or pathological causes, discounting the role of psychosocial factors which can influence management of pain. The Breastfeeding Pain Reasoning Model is a clinical reasoning tool developed to support those evaluating women’s lactation-related pain. We aimed to explore perspectives of breastfeeding women on lactation-associated pain and determine how they align with the Breastfeeding Pain Reasoning Model (BPRM). Methods: We conducted a qualitative descriptive study using phenomenological approach in Singapore. Eighteen women with recent breast and/or nipple pain during lactation underwent individual semi-structured interviews in 2022. Thematic analysis was performed. Results: Deductive analysis showed that lactation-associated pain was aligned with BPRM’s domains (i.e., local stimulation, external influences, and central modulation). Psychosocial factors likely influencing central processing of pain were not recognised by most of the participants. Participants described severe breastfeeding pain often accompanied by feelings of vulnerability, injustice, and uncertainty. Inductive analysis identified two additional themes of motivation and expectations. Conclusions: Greater awareness of the interplay between the broad influences on pain is needed. Using an interoceptive lens could help to illustrate how signals from the breast inform the brain, and how social, emotional, and cognitive factors influence the individuals’ perception of painful experiences. Educating breastfeeding women and healthcare personnel about the biopsychosocial nature of pain may empower women to better navigate the challenges of breastfeeding and improve breastfeeding outcomes. Full article

Background/Objectives: Childhood trauma significantly hinders the developmental and academic outcomes of learners, particularly in under-resourced schools such as those in Limpopo province, South Africa. Teachers in these settings often face challenges in supporting trauma-exposed learners due to a lack of knowledge, training, and appropriate resources. Addressing this gap requires the development of structured, trauma-informed educational support systems. Methods: This study forms the final phase of a multi-phase research project aimed at developing a trauma-informed curriculum for primary school teachers. A multi-phase mixed method design was adopted across four phases: (1) a global scoping review to identify effective trauma-informed interventions; (2) empirical interviews with primary school teachers, trauma center managers, clinical psychologists, and social workers to understand local needs and experiences; (3) development of a conceptual framework grounded in theoretical and empirical findings; and (4) curriculum development guided by El Sawi’s curriculum design model. The curriculum was validated using structured questionnaires with a panel of stakeholders including educators, mental health professionals, and curriculum experts. Results: The study identified critical issues, including teachers’ limited understanding of childhood trauma, lack of standardized training, and inadequate classroom strategies. Key curriculum components were developed to address these gaps, including modules on the nature of trauma, early identification of symptoms, trauma-informed teaching practices, and collaboration with mental health professionals. Validation results indicated strong agreement on the curriculum’s clarity, relevance, and potential impact. Conclusions: The developed trauma-informed curriculum provides primary school teachers in Limpopo with the knowledge, tools, and confidence to support trauma-exposed learners. It emphasizes early identification, responsive classroom strategies, and inter-professional collaboration. This curriculum has the potential to enhance learning environments and promote better educational and psychosocial outcomes for trauma-affected learners. Full article

Longevity and healthy aging result from the complex interaction of genetic, epigenetic, microbial, behavioral, and environmental factors. The central nervous system—particularly the cerebral cortex—and the autonomic nervous system (ANS) play key roles in integrating external and internal signals, shaping energy metabolism, immune tone, and emotional regulation. This narrative review examines how the brain–ANS axis interacts with epigenetic regulation, telomere dynamics, the gut microbiome, and the exposome to influence biological aging and resilience. Relevant literature published between 2010 and 2025 was selected through comprehensive database searches (PubMed, Scopus, Google Scholar), with a focus on studies addressing the multisystemic determinants of aging. Emphasis is placed on lifestyle-related exposures, such as diet, physical activity, psychosocial support, and environmental quality, that modulate systemic physiology through neurovisceral pathways. Drawing on empirical findings from classical Blue Zones and recent observational research in the Cilento region of southern Italy, this review highlights how context-specific factors—such as clean air, mineral-rich water, Mediterranean dietary patterns, and strong social cohesion—may foster bioelectric, metabolic, and neuroimmune homeostasis. By integrating data from neuroscience, systems biology, and environmental epidemiology, the review proposes a comprehensive model for understanding healthy longevity and supports the development of personalized, context-sensitive strategies in geroscience and preventive medicine. Full article

Frozen shoulder (FS) is a complex and multifactorial condition characterized by persistent inflammation, fibrosis, and metabolic dysregulation. Despite extensive research, the underlying drivers of FS remain poorly understood. Recent findings indicate the coexistence of pro-inflammatory and fibrosis-resolving macrophages within affected tissues, suggesting a dysregulated immune response influenced by metabolic and neuroendocrine factors. This review proposes that leptin resistance, a hallmark of metabolic syndrome and chronic inflammation, may play a central role in FS pathogenesis by impairing macrophage polarization, perpetuating inflammation, and disrupting fibrosis resolution. The JAK-STAT signaling pathway, critically modulated by leptin resistance, may further contribute to immune dysregulation by sustaining inflammatory macrophage activation and interfering with tissue remodeling. Additionally, FS shares pathogenic features with fibrotic diseases driven by TGF-β signaling, mitochondrial dysfunction, and circadian disruption, further linking systemic metabolic dysfunction to localized fibrotic pathology. Beyond immune and metabolic regulation, alterations in gut microbiota, bacterial translocation, and chronic psychosocial stress may further exacerbate systemic inflammation and neuroendocrine imbalances, intensifying JAK-STAT dysregulation and leptin resistance. By examining the intricate interplay between metabolism, immune function, and fibrotic remodeling, this review highlights targeting leptin sensitivity, JAK-STAT modulation, and mitochondrial restoration as novel therapeutic strategies for FS treatment. Future research should explore these interconnections to develop integrative interventions that address both the metabolic and immune dysregulation underlying FS, ultimately improving clinical outcomes. Full article

Background/Objectives: Non-response to initial treatment options for major depressive disorder (MDD) is a common clinical challenge with profound deleterious impacts for affected patients. Few treatments have received regulatory approval for treatment-resistant depression (TRD). Methods: A systematic search of United States and European Union clinical trials registries was conducted to identify Phase II, III, or IV clinical trials, with a last update posted on or after 1 January 2020, that were evaluating medications for TRD. For both the US and EU registries, the condition term “treatment resistant depression” and associated lower-level terms (per registry search protocol) were used. For the US registry, a secondary search using the condition term “depressive disorders” and the modifying term “inadequate” was also performed to capture registrations not tagged as TRD. Two additional searches were also conducted in the US registry for the terms “suicide” and “anhedonia” as transdiagnostic targets of investigational medications. Trials were categorized based on the primary mechanism of action of the trial’s investigational medication. Results: Fifty clinical trials for TRD, 20 for anhedonia, and 25 for suicide were identified. Glutamate system modulation was the mechanism currently with the most compounds in development, including antagonists and allosteric modulators of NMDA receptors, AMPA receptors, metabotropic type 2/3 glutamate receptors, and intracellular effector molecules downstream of glutamate signaling. Psychedelics have seen the greatest surge among mechanistic targets in the past 5 years, however, with psilocybin in particular garnering significant attention. Other mechanisms included GABA modulators, monoamine modulators, anti-inflammatory/immune-modulating agents, and an orexin type 2 receptor antagonist. Conclusions: These investigations offer substantial promise for more efficacious and potentially personalized medication approaches for TRD. Challenges for detecting efficacy in TRD include the heterogeneity within the TRD population stemming from the presumed variety of biological dysfunctions underlying the disorder, comorbid disorders, chronic psychosocial stressors, and enduring effects of prior serotonergic antidepressant medication treatments. Full article

Background and Objectives: The International Society for Modulation defines persistent spinal pain syndrome type 2 (PSPS-type 2), formerly known as failed back surgery syndrome, as a condition where patients continue to experience pain or develop new pain following spinal surgery intended to alleviate back or lower-limb discomfort. PSPS-type 2 is characterized by pain and significant disability, affecting quality of life. Spinal cord stimulation has proven effective in treating this syndrome, although the role of psychological factors, such as pain catastrophizing and central sensitization, remain unclear. This study seeks to examine the potential connection between psychosocial responses and both functionality and pain perception in patients with persistent spinal pain syndrome type 2 who have undergone spinal cord stimulation treatment. Materials and Methods: A single-site, cross-sectional study was conducted on individuals diagnosed with persistent spinal pain syndrome type 2 who were receiving spinal cord stimulation. Study participants were required to meet specific eligibility criteria and were assessed for disability, pain perception, fear of movement, pain catastrophizing, and central sensitization. The spinal cord stimulation procedure involved the placement of electrodes at vertebral levels T8–T11 for precise pain control, with a particular focus on targeting the dorsal root ganglion to alleviate chronic pain. Results: Thirty-seven patients with persistent spinal pain syndrome type 2 have undergone spinal cord stimulation treatment for 4.68 ± 5.25 years. Clinical assessments indicated a pain perception score of 5.6 ± 1.96, Central Sensitization Inventory score of 42.08 ± 18.39, disability score of 37.62 ± 16.13, fear of movement score of 33.11 ± 8.76, and pain catastrophizing score of 28.43 ± 13.14. Finally, pain catastrophizing was significantly associated with pain perception (β = 0.075 and p = 0.008) and disability (β = 0.90 and p < 0.01). Conclusions: Catastrophizing plays a crucial role in pain perception and disability among patients with persistent spinal pain syndrome type 2 receiving spinal cord stimulation. Integrating psychological interventions may improve clinical outcomes for these patients. Full article

Background/Objectives: Traumatic craniomaxillofacial (CMF) injuries are associated with various symptoms/concerns that affect patients’ quality of life. The assessment of outcomes from the patient perspective has been limited by the absence of patient-reported outcome (PRO) measures tailored to this patient population. To address this need, we employed a mixed methods, multi-step process to first identify the most important symptoms/concerns and then use this information to construct a PRO symptom battery. Methods: CMF clinicians and patients who had sustained traumatic CMF injuries participated in semi-structured interviews to elicit the symptoms/concerns considered the most important. The data were analyzed using an iterative coding procedure and symptom/concern frequency was tabulated. The findings were used to develop a conceptual model of the most important symptoms to include in a PRO battery. Existing items were modified as needed and new items were drafted to ensure adequate coverage of the symptoms. Results: The resulting AO CMF Injury Symptom Battery includes four modules specific to the injury site (oral, ocular, nasopharyngeal, ear) and five universal modules (pain/sensation, cognitive, cosmetic, psychosocial, and injury impact). Conclusions: The AO CMF Injury Symptom Battery offers promise for assessing symptoms only patients can report on in clinical research and practice. Ongoing research will examine the battery’s psychometric properties. Full article

Transitioning from childhood into adolescence is an extraordinary time of life, associated with major physical, emotional, cognitive, and social changes and characterized by dynamic development in which interaction with the environment modulates the individual resources responsible for well-being and health. This sensitive period is the time when, in addition to hormonal, metabolic, and neural changes, certain behavioral strategies begin to take shape that will shortly go on to define the emotional, social, and cultural identity of the individual. This narrative review aimed to uncover the crucial processes underlying the transition by identifying processes that are responsible for cognitive, psychosocial, and emotional development, in the absence of disease. For this aim, we highlight (1) the physical, psychological, and social determinants during the transition from childhood to adolescence; (2) the role of health-related variables in resilience or vulnerability mechanisms; and (3) recent school-based strategies to promote health and well-being. Recognizing that health and well-being are the result of the interaction of many biological, psychological, social, cultural, and physical factors will lead to comprehensive health promotion involving all actors joining the growth process, from health professionals and the educational community to parents and community. Furthermore, it is important that psychosocial dimensions are strengthened already during childhood to prevent the onset of frailty and illness in adolescence. Full article