Search Results (879)

Background/Objectives: Migraine is a common, disabling neurological disorder disproportionately affecting women during hormonally sensitive phases like menarche, pregnancy, and menopause. Despite awareness of sex-specific risk factors, management remains fragmented and predominantly neurologist-led, with limited coordination. To address these gaps, this project aimed to develop a national expert consensus, endorsed by scientific societies, on multidisciplinary migraine management in women across the lifespan, integrating perspectives from neurology, gynecology, endocrinology, cardiology, and general medicine. Methods: A two-round Delphi survey was conducted among 145 Italian clinicians representing the five specialties. The Scientific Board formulated 50 questions, each consisting of a variable number of statements, covering diagnostic approaches, hormonal therapies, comorbidities, and organizational care pathways. Statements were rated on a nine-point Likert scale, and consensus was defined using pre-specified criteria based on median scores and agreement. Results: Overall, 79 of 145 statements (54%) achieved consensus. High-level agreement emerged on sex-informed diagnostic strategies, including systematic gynecological and endocrinological evaluation and hormonal profiling in women with migraine. Round 2 facilitated consensus on contentious issues, such as avoiding estrogen-containing contraceptives in migraine with aura, individualized thrombotic risk assessment during menopause, and structured interdisciplinary coordination—particularly among neurologists, gynecologists, and general practitioners—during fertility planning and assisted reproduction. Qualitative feedback emphasized the need to update clinical pathways, implement standardized referral models, and strengthen interprofessional communication. However, persistent divergence remained on selected topics, particularly the role of hormonal contraceptives as a first-line approach to migraine management in women of reproductive age, reflecting different priorities between gynecologists and neurologists. Conclusions: This Delphi initiative provides the first national multidisciplinary consensus on migraine management in women in Italy. The findings support the development of sex- and life-stage-specific clinical guidance and integrated care models tailored to the complex needs of women with migraine. Full article

Background: Accumulating evidence suggests that environmental light cues influence brain function and neurodegenerative processes; however, the underlying cellular mechanisms remain incompletely understood. Methods: Here, using a Tau-overexpressing Drosophila model, we investigated how light exposure modulates neurodegeneration-associated phenotypes, with a particular focus on adenosine signaling and mitochondrial homeostasis. We performed behavioral assays, biochemical measurements, genetic interference targeting the adenosine receptor, and mito-QC reporter analysis to assess mitochondrial quality control. Results: We show that light exposure ameliorates Tau-induced behavioral impairments and neuropathological features, reducing climbing time by approximately 29% in males and 45% in females, and extending median lifespan by ~29% in males and ~26% in females. Notably, biochemical analyses revealed that light exposure significantly increases brain adenosine levels at ZT12 by approximately 5 to 6 nmol/L in both sexes (p < 0.01), suggesting a light-dependent modulation of adenosine availability. To further examine the role of adenosine signaling, we performed genetic interference experiments targeting the adenosine receptor. These results indicate that adenosine receptor-associated signaling is functionally involved in the beneficial effects of light, as disruption of this pathway attenuates the light-induced improvements in behavioral and mitochondrial phenotypes. Using a mito-QC reporter system, we further show that light exposure enhances mitochondrial quality control, as reflected by a ~2.3-fold increase in mitolysosome density (p < 0.001). Importantly, this effect is modulated by the functional state of adenosine signaling, suggesting a potential interaction between these processes. Conclusions: Together, our findings indicate that light exposure is associated with coordinated changes in adenosine signaling and mitochondrial quality control, which may contribute to the attenuation of Tau-induced deficits in Drosophila. This work provides insight into how environmental light cues may influence neurodegeneration-related cellular processes and highlights the potential relevance of light-based interventions for future mechanistic and translational studies. Full article

Objective: Restrained eating has been recognized as a maladaptive behavior linked to various adverse health outcomes, such as eating disorders and anxiety, which can significantly impact both physical and mental well-being. However, little is known about how perceived sociocultural pressures correlate with restrained eating. Therefore, based on the Tripartite Influence Model and Objectification Theory, we investigated the association between perceived sociocultural pressure and restrained eating as well as the potential mediating role of self-objectification and body-esteem in this association. Method: Participants were 1774 students aged 16–33 years (M_age = 19.28 years, 65.80% female) who completed assessments of perceived sociocultural pressure, self-objectification, body-esteem, and restrained eating. Results: The results indicated that after controlling for body mass index and sex, perceived sociocultural pressure was positively correlated with restrained eating. Self-objectification and body-esteem were serial mediators of the association between perceived sociocultural pressure and restrained eating. Discussion: These correlational results suggest that body-esteem may serve as a promising intervention target for programs designed to prevent and reduce restrained eating. In addition, these correlational findings shed light on the prevention and intervention of restrained eating and provide a new theoretical perspective on mental health. In addition, implications and directions for future research were also discussed. Full article

Fertility and hatchability are key reproductive traits affecting the efficiency and sustainability of poultry production; however, their genetic improvement remains challenging because of low heritability and complex biological control. In this study, we estimated the genetic parameters and compared the pedigree- and genomic-based prediction models for fertility rate (FER), hatchability of fertile eggs (HOF), and hatchability of eggs set (HOS) in Thai native chickens. In total, 7075 egg records from 1558 animals were analyzed, including pedigree data for 2646 individuals and genotypes for 400 animals. Prediction performance was evaluated using pedigree-based best linear unbiased prediction (PBLUP), single-step genomic BLUP (ssGBLUP), and weighted ssGBLUP (WssGBLUP). Additive heritability estimates for all traits ranged from low to moderate (0.051–0.068), indicating that environmental factors play an important role in the expression of these traits. Across all traits, WssGBLUP achieved the highest accuracy (0.647–0.648) and showed improved dispersion close to unity, indicating better model stability. Compared with PBLUP, WssGBLUP increased the prediction accuracy by 30–39%, respectively, whereas ssGBLUP outperformed PBLUP by approximately 14–22%. Genome-wide association analysis identified 65 candidate genes across multiple chromosomes, with a strong enrichment of significant signals on the Z chromosome, thus highlighting the role of sex-linked genetic variation. Individual loci explained small proportions of variance, confirming the polygenic nature of these traits. These findings demonstrate that weighted genomic approaches can substantially improve the accuracy and reliability of genetic evaluations for reproductive traits. Overall, this study provides practical support for implementing genomic selection in Thai native chickens, potentially contributing to enhanced reproductive performance, genetic progress, and sustainable poultry production. Full article

Background/Objectives: School-aged children in Japan receive food and nutrition education (shokuiku) to promote well-balanced dietary habits. However, among high school students, the association between current well-balanced diets and shokuiku during elementary school years has not been analysed. Herein, we examined the associations between recollections of shokuiku during childhood, current well-balanced dietary habits, and eating and lifestyle behaviours among Japanese high school students, with a particular focus on sex differences. Methods: Overall, 254 second-year high school students (56.3% female) at a public high school in the Hyogo Prefecture, Japan, were included. A hypothetical model was constructed using factors potentially associated with well-balanced dietary habits (i.e., consumption of balanced meals at least twice daily), including recollections of shokuiku during elementary school (education on nutritional balance based on the ‘three food groups’, major nutrients’ role, and breakfast importance) and current eating and lifestyle behaviours. Simultaneous sex-based multi-population analysis was performed. Results: The model demonstrated good fit (GFI = 0.944, AGFI = 0.903, CFI = 0.982, RMSEA = 0.036, and AIC = 145.174). Among female students, current well-balanced dietary habits showed significant positive associations with shokuiku (standardised estimate, female: 0.22, p = 0.005 vs. male: −0.07, p = 0.46), frequency of rice consumption (0.22, p = 0.016 vs. 0.13, p = 0.15), and eating meals with family (0.22, p = 0.003 vs. 0.36, p < 0.001). Conversely, bedtime (−0.28, p < 0.001 vs. −0.03, p = 0.72) showed a significant negative association. Among male students, only eating meals with family showed a significant positive association with current well-balanced dietary habits. Conclusions: Current well-balanced dietary habits among female high school students may be positively associated with shokuiku. Eating rice and meals with family was conducive to well-balanced dietary habits, unlike late bedtime. Full article

Background/Objectives: Epilepsy is a long-term condition marked by recurring seizures that greatly affect daily life. The thalamus, with its extensive connections to the cortex, plays a vital role in epileptic processes. Changes in the volume of the thalamic nuclei are believed to occur in epilepsy. Our study aimed to examine the volumetric characteristics of thalamic nuclei in individuals diagnosed with generalized epilepsy and to explore the potential role of changes in these nuclei in the process of epileptogenesis. Methods: In this retrospective study, a total of 232 participants were included in the study. 1.5T MRI images of epilepsy patients and age- and sex-matched healthy individuals were analyzed. Thalamus nucleus volumes were measured using the VolBrain automatic segmentation system. Right–left volumetric comparisons of homologous thalamic nuclei were performed within each study group to evaluate hemispheric lateralization patterns. Groups were compared based on sex. FDR correction and ANCOVA adjustment for ICV and age were applied; significance threshold was p < 0.05 after correction. Results: After applying false discovery rate (FDR) correction, significant differences were observed in multiple thalamic nuclei in the epilepsy group compared to controls. In women, volume increases were confirmed in the right VAN, bilateral VPLN, and left MGN, while bilateral MTN volumes were significantly reduced and right ISN volume was lower in the epilepsy group. In men, only bilateral MTN volumes remained significant after FDR correction; no nucleus survived after additional ANCOVA adjustment for intracranial volume and age. Right–left comparisons revealed consistent lateralization patterns, with AVN showing right-sided predominance and VAN showing left-sided predominance across both sexes after FDR correction. Conclusions: After correction for multiple comparisons and adjustment for intracranial volume and age, only a limited number of thalamic nuclei remained significantly altered, predominantly in female patients. These findings suggest that thalamic involvement in generalized epilepsy may be selective rather than widespread and may vary according to sex. Full article

Background: Uric acid (UA) exhibits a dual role, with anti-oxidant or pro-oxidant effects determined by its concentration. However, its association with lipid metabolism across different uric acid states remains unclear. This study explored lipid abnormalities across the full uric acid spectrum in a large adult population. Methods: A total of 13,223 adults included in this analysis were classified as hypouricemic, normouricemic, or hyperuricemic based on serum uric acid levels. Lipid profiles, prevalence, associations, risk estimates, and diagnostic accuracy were evaluated using descriptive and multivariate statistical analyses. Results: The prevalence of hyperuricemia was 17.26%, while hypouricemia accounted for 2% of the population. Compared with normouricemia, hyperuricemic subjects exhibited substantially greater levels of LDL, TC, and TG and lower HDL concentrations (all p < 0.0001). Conversely, hypouricemia exhibited elevated HDL and lower LDL, TC, and TG levels, a pattern consistent across sex and age groups. Lipid abnormalities were most frequent among hyperuricemic participants, notably low HDL (45.9%), high LDL (52.8%), high TC (48.2%), and high TG (36.8%). In contrast, hypouricemia was associated with the lowest prevalence and reduced odds of each abnormality. Serum UA correlated significantly with all lipid measures. In multiple regression analysis, UA remained an independent positive predictor of LDL-C (β = 3.45), TC (β = 3.09), and TG (β = 11.33), and a negative predictor of HDL (β = −2.66) after adjusting for age, sex, glycemia status, and renal function. Conclusions: Both UA extremes reflect distinct metabolic states: hyperuricemia showed an adverse lipid profile, whereas hypouricemia was associated with a comparatively more favorable lipid profile, highlighting the association between UA levels and lipid metabolism. Full article

Background: Health literacy plays an important role in medication understanding, self-management, and engagement with healthcare services among older adults. Limited health literacy may contribute to medication-related problems and reduced utilization of pharmacist-led services in geriatric populations. Methods: A cross-sectional, questionnaire-based survey was conducted among geriatric outpatients (≥60 years) attending a tertiary-care teaching hospital in Saudi Arabia. Health literacy was assessed using a four-domain functional tool—covering prescription label comprehension, understanding of healthcare instructions, confidence in completing medical forms, and comprehension of written health information—developed in alignment with established health literacy frameworks, including the Health Literacy Survey—European Union (HLS-EU) model and Baker’s conceptual framework. Participants were classified as having higher health literacy (0–2 domains impaired) or lower health literacy (3–4 domains impaired). Sociodemographic characteristics, clinical burden, medication self-management behaviors, and awareness of clinical pharmacist services were recorded. Multivariable logistic regression was used to identify factors independently associated with lower health literacy. Results: A total of 200 participants were included. Impairment in three or more domains was observed in 55.5% of participants. Lower health literacy was independently associated with older age, lower educational attainment, lower income, female sex, multimorbidity, and polypharmacy. Participants with lower health literacy reported higher rates of missed or incorrect medication dosing and unreported adverse drug reactions and lower use of medication management aids. Awareness of clinical pharmacist services and prior exposure to pharmacist counseling were significantly lower among participants with lower health literacy. Willingness to receive pharmacist counseling was higher among participants with higher health literacy and greater awareness of pharmacist roles. Conclusions: Health-literacy impairment is common among geriatric outpatients and is associated with medication self-management behaviors and engagement with pharmacist-led services. These findings highlight the relevance of functional health literacy in geriatric medication use and support further research on literacy-sensitive pharmacist-led interventions. Full article

Background/Objectives: Heart failure (HF) classification based on left ventricular ejection fraction (LVEF) provides an incomplete representation of disease complexity, as it does not fully integrate functional impairment, structural remodeling, and clinical severity within a unified framework. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used for diagnosis and risk stratification, prior studies have primarily evaluated its role in isolation or within individual HF phenotypes, leaving its phenotype-specific distribution and integrative capacity across the HF spectrum insufficiently defined. This study aimed to address this gap by systematically evaluating NT-proBNP across HF phenotypes and assessing its potential as an integrative biomarker linking ventricular dysfunction, structural remodeling, and clinical severity. Methods: A cross-sectional study was conducted including 125 participants, comprising 65 clinically stable HF patients and 60 age- and sex-matched controls. HF patients were stratified according to LVEF into HF with reduced EF (HFrEF) (n = 28), (HFmrEF) (n = 20), and HF with preserved EF (HFpEF) (n = 17). Serum NT-proBNP concentrations were measured using a standardized electrochemiluminescence immunoassay. Clinical and echocardiographic parameters, including LVEF, left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAD), and New York Heart Association (NYHA) functional class, were recorded and analyzed. Results: NT-proBNP levels were significantly higher in HF patients compared with controls (1845 ± 620 vs. 95.7 ± 40.5 pg/mL; p < 0.001) and demonstrated a clear stepwise increase across phenotypes (HFrEF: 2850.6 ± 710.4; HFmrEF: 1620.8 ± 480.2; HFpEF: 920.9 ± 310.3 pg/mL; p < 0.001). NT-proBNP showed a strong inverse correlation with LVEF (r = −0.68, p < 0.001) and significant positive correlations with LVEDD (r = 0.61, p < 0.001) and LAD (r = 0.57, p < 0.001). Higher levels were associated with more advanced NYHA functional class (III–IV vs. II: 2510 ± 680 vs. 980 ± 340 pg/mL; p < 0.001). ROC analysis demonstrated robust discriminatory performance across HF phenotypes, with the highest accuracy observed in HFrEF. Conclusions: NT-proBNP exhibits a phenotype-dependent gradient and consistently reflects ventricular dysfunction, adverse structural remodeling, and clinical severity across the HF spectrum. These findings support its role as an integrative biomarker that captures the multidimensional nature of HF, with potential implications for phenotype-based risk stratification and more precise clinical decision making. Full article

The gut microbiota influences host health, development, nutrition, and behavior, positioning it as a frontier research area in life sciences. Bactrocera dorsalis is a major agricultural pest, with a short life cycle, ease of laboratory rearing, and the availability of germ-free larvae. The gut microbiota of B. dorsalis is complex and relatively insensitive to environmental influences. Due to these advantages, B. dorsalis has emerged as a promising model organism for gut microbiota research. This review synthesizes the advantages of B. dorsalis as a model organism, detailing its gut structure and the composition of its microbiota across developmental stages, sexes, diets, and geographical populations—highlighting the dominance of Enterobacteriaceae as a core component. Key functional roles of gut microbiota in B. dorsalis are elucidated, including nutrient provisioning, regulation of development and reproduction, enhancement of environmental adaptability, behavioral modulation, pesticide resistance, and immune interactions. The mechanisms underpinning gut microbiota homeostasis, involving the host Duox/ROS system, NOX enzymes, and the Imd pathway, are also discussed. Limitations are addressed, alongside future directions for leveraging genetic tools to dissect host–microbe interplay. Furthermore, the potential applications of gut microbiota research—including probiotics for Sterile Insect Technique optimization, microbial-based attractants, and paratransgenesis for pest control—are emphasized. Collectively, B. dorsalis offers a platform for understanding intricate host–microbe interplay and inspires novel pest management strategies. Full article

Background/Objectives: Air pollution is associated with many adverse health consequences, including deteriorated kidney function. The aim of the research was to determine the association of medium-term exposure to air pollutants and hospitalizations due to acute kidney injury (AKI). Methods: The retrospective population-based study was conducted on the EP-PARTICLES cohort between 2011 and 2020 (80,000,000 person-years). We estimated municipality-specific associations between air pollution and AKI admissions using generalized additive models with Poisson regression. Results are reported as risk ratio in AKI admissions (RR) with corresponding 95% confidence intervals (95% CI). Results: During the 10-year study period, 47,467 AKI cases were reported (median age 77 years, IQR 68–84; 51.2% women). Mean concentrations of pollutants were 21.4 µg/m³ (SD 5.2) for particulate matter with a diameter of 2.5 μm or less (PM_2.5), 7.5 µg/m³ (1.8) for nitrogen dioxide (NO₂), and 1.8 ng/m³ (0.8) for benzo[a]pyrene (BaP). In mid-term exposure analyses (lag 0–30), each 10 µg/m³ increase in PM_2.5, PM₁₀, NO₂ and CO, and each 1 µg/m³ increase in BaP, was associated with higher AKI risk, with the strongest effect observed for NO₂ (RR 1.066, 95% CI 1.033–1.099). No association was found for SO₂. Subgroup analyses showed consistent directions of association across sex and age groups, with NO₂ remaining the most detrimental pollutant. Although statistical significance varied between pollutants, no significant effect modification by sex or age was observed (p > 0.05). Conclusions: Mid-term exposure to ambient air pollution is associated with an increased risk of AKI-related hospitalizations, with NO₂ showing the strongest effects. These findings identify mid-term exposure as a relevant temporal window and support the role of air pollution as a modifiable risk factor for AKI. Full article

Background: Pulmonary arterial hypertension (PAH) is a rare and progressive disorder characterized by increased pulmonary vascular resistance and vascular remodeling. Genetic polymorphisms, epigenetic modifications, and ion channel dysregulation are increasingly recognized as key contributors to disease pathogenesis. Anoctamin-1 (ANO1/TMEM16A), a calcium-activated chloride channel, plays a critical role in vascular tone regulation. Objective: This study aimed to investigate the association between ANO1 gene polymorphisms (rs7127129 and rs2509153), promoter methylation status, and serum chloride levels in patients with idiopathic pulmonary arterial hypertension (IPAH), congenital heart disease (CHD), and chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A total of 106 IPAH patients, 40 CHD patients, and 30 CTEPH patients, together with 125 healthy controls, were included. The control group had a comparable age distribution, with a balanced sex ratio, whereas females predominated in all three PH groups. Genotyping was performed using TaqMan-based real-time PCR. Promoter methylation was analyzed using bisulfite conversion followed by quantitative real-time PCR. Serum chloride levels were measured using an ion-selective electrode method. Results: No significant association was observed between rs7127129 and rs2509153 polymorphisms and IPAH or CTEPH (p > 0.05). However, rs7127129 showed a significant association with CHD (p < 0.05). After excluding hypertensive patients, both polymorphisms remained significantly associated with CHD. Serum chloride levels differed significantly among groups (p < 0.001), with higher levels observed particularly in the CTEPH and CHD groups compared to controls, while IPAH patients exhibited intermediate but still elevated levels relative to controls. In contrast, promoter methylation levels were significantly lower in all patient groups compared to controls. An inverse relationship between chloride levels and methylation status was observed. Conclusions: ANO1 polymorphisms are not major determinants of IPAH or CTEPH but may contribute to CHD susceptibility. Increased serum chloride levels, together with decreased promoter methylation, suggest a potential mechanistic link between ion channel dysregulation and epigenetic alterations in pulmonary hypertension. Further large-scale and functional studies are warranted. Full article

Children in residential care constitute a particularly vulnerable group at high risk of developing emotional and behavioral difficulties as a consequence of adverse experiences and dysfunctional family environments. Identifying risk and protective factors is essential for designing interventions tailored to their needs; however, the available research remains limited and does not always provide the evidence required to guide effective programs within the child protection system. The aim of this study was to examine the prevalence of emotional and behavioral problems among children in residential care and to analyze the role of family factors, sex, and age in these difficulties. The sample consisted of 210 children aged 6 to 18 years institutionalized in residential care centers and supervised apartments. A cross-sectional design was employed, administering the Strengths and Difficulties Questionnaire (SDQ) along with an ad hoc questionnaire to collect socio-family variables. The results reveal a high prevalence of emotional and behavioral difficulties. The multivariable models explained between 8.1% and 29.4% of the variance in emotional and behavioral functioning and showed that age, sex, exposure to gender-based violence, parental substance use, and parental intellectual disability were associated with specific emotional and behavioral dimensions. The study highlights the need to develop and implement educational and therapeutic programs aimed at strengthening children’s emotional regulation, addressing behavioral difficulties, and considering family-related adversity in intervention planning. Full article

Immune thrombocytopenia (ITP) is a heterogeneous autoimmune disorder characterized by immune-mediated platelet destruction and impaired platelet production. Increasing evidence suggests that systemic inflammation plays a significant role in disease pathogenesis and clinical outcomes. This study aimed to evaluate the prognostic significance of inflammatory indices and their association with complications, mortality, treatment response, and relapse in patients with ITP. In this single-center retrospective study, 166 adult patients diagnosed with primary ITP between January 2015 and December 2024 were analyzed. Demographic, clinical, and laboratory data at diagnosis were collected. Inflammatory indices derived from complete blood count parameters, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were evaluated. Their associations with clinical outcomes were assessed using appropriate statistical methods. During the observation period based on retrospective medical records, complications occurred in 12% of patients, and mortality was observed in 6.6%. Patients with complications had significantly higher D-dimer levels and reduced bone marrow megakaryocyte production. In group comparisons, mortality was significantly associated with advanced age, male sex, and comorbidities. Laboratory findings revealed that lower hemoglobin, lymphocyte count, mean platelet volume, and albumin levels, along with higher PLR, erythrocyte sedimentation rate, bilirubin, and D-dimer levels, were significantly associated with mortality. Inflammatory indices such as NLR and PLR were not associated with complication development, but PLR was significantly associated with mortality. Response to intravenous immunoglobulin (IVIG) therapy was significantly associated with higher total protein, albumin, and fibrinogen levels, and lower erythrocyte sedimentation rate. Relapse was significantly associated in group comparisons with increased inflammatory activity, higher reticulocyte count, and positivity for antinuclear antibodies and Helicobacter pylori antigen. Systemic inflammation and impaired megakaryopoiesis play critical roles in the prognosis of ITP. While conventional inflammatory indices showed limited predictive value for complications, markers such as PLR, D-dimer, and albumin were associated with mortality and clinical outcomes. These findings suggest that readily available laboratory parameters may provide valuable insights for risk stratification and personalized management in patients with ITP. Full article

Sex differences and lifestyle factors such as physical activity play an important role in cardiovascular autonomic regulation. Heart rate variability (HRV) is a widely used marker of cardiac autonomic modulation and cardiovascular health. However, the combined influence of sex and physical activity levels on HRV in young, healthy adults has not been sufficiently explored. Therefore, this study investigated the effects of sex and a physically active lifestyle on HRV in men and women. A cross-sectional study was conducted on a cohort of young, healthy adults aged 18–30 and categorized into four groups based on: physically active men (AM; n = 37), sedentary men (SM; n = 44), and physically active women (AW; n = 31) and sedentary women (SW; n = 40). Regarding the impact of lifestyle, the AM group exhibited 41% higher total variance (VAR-RR) and 34% higher RMSSD (a parasympathetic index) than the SM group. The AW exhibited 74% and 78% higher VAR-RR and RMSSD, respectively, compared to the SW. Furthermore, the physically active groups (AM and AW) displayed a 75% and 50% lower LF/HF ratio, respectively, compared to their sedentary counterparts. Interestingly, the LF/HF ratio was 66% higher, and the RMSSD was 20% lower in the AM group than in the AW group. HRV indices demonstrated large to very large effect sizes. In conclusion, these findings demonstrate significantly advantage in cardiac autonomic modulation among physically active individuals and women. Together, these results reinforce the roles of female sex and an active lifestyle as important protective factors for cardiovascular health. Full article