Search Results (13,530)

Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a heterogeneous endocrine and metabolic disorder associated with reproductive dysfunction, hyperandrogenism, insulin resistance, chronic low-grade inflammation and an increased risk of long-term cardiometabolic disease. Lifestyle intervention remains the cornerstone of management; however, the optimal nutritional strategy continues to be debated. This narrative review summarizes current evidence on nutritional management of PMOS, including dietary approaches, the role of the gut microbiota, dietary supplementation and complementary lifestyle interventions. Current evidence indicates that no single dietary model is universally superior for all women with PMOS. Instead, different dietary approaches may improve selected anthropometric, metabolic, endocrine, and reproductive outcomes, although the consistency of these effects varies across interventions and outcomes. The most consistent benefits are observed for body weight, insulin resistance, glycolipid metabolism and cardiometabolic risk, whereas improvements in reproductive and hyperandrogenic outcomes are generally more variable. Gut microbiota modulation represents a biologically plausible mechanism linking diet with metabolic and reproductive function, although its role as a mediator of dietary effects remains insufficiently established. Adjunctive supplementation, particularly with inositols, vitamin D, omega-3 fatty acids, and selected probiotics or synbiotics, may improve selected metabolic and reproductive outcomes, although the certainty and consistency of these effects vary across supplements. Such approaches should be considered complementary to, rather than a replacement for, lifestyle management. Physical activity, behavioural support, adequate sleep and stress management further contribute to comprehensive care, although evidence is strongest for structured exercise interventions. Lifestyle approaches may also have a role in early risk modification, particularly through the prevention of excess weight gain and promotion of physical activity, although direct evidence for primary prevention of PMOS remains limited. Overall the findings support individualized and sustainable nutritional and lifestyle strategies rather than a universal therapeutic approach. Future research should focus on well-designed long-term randomized trials and the development of personalized approaches that account for clinical and metabolic heterogeneity in PMOS. Full article

Background: Chronic pain is a complex condition affecting approximately 20–30% of adults worldwide. Increasing evidence demonstrates that chronic pain is a heterogeneous condition influenced by biological mechanisms, psychological factors, social circumstances and individual patient characteristics. These differences contribute to variable treatment responses and highlight the need for individualized clinical care. Objective: This narrative review provides a practical, clinical framework for individualized chronic pain management in primary care, emphasizing mechanism-informed clinical phenotyping, non-pharmacological and pharmacological interventions, shared decision-making, continuous reassessment and practical implementation within time-constrained practice settings. Methods: A non-systematic literature search of MEDLINE/PubMed, the Cochrane Database of Systematic Reviews and current international clinical guidelines (e.g., IASP, ICD-11, NICE, and CDC) was conducted for contemporary literature published from 2015 to 2026. Evidence was qualitatively selected and synthesized regarding pain mechanisms, primary care assessment, non-pharmacological therapies, modern pharmacotherapy, and health implementation frameworks. Results: Individualized chronic pain care requires the identification of contributing clinical pain mechanisms—nociceptive, neuropathic, nociplastic or mixed—while recognizing that these exist on a continuum rather than as mutually exclusive entities. Effective primary care management prioritizes active non-pharmacological interventions (exercise, pain neuroscience education as part of multidisciplinary rehabilitation, psychological therapies and sleep optimization) followed by selective, mechanism-informed pharmacotherapy. Regular reassessment using multidimensional functional criteria is essential for the optimization of benefit while minimizing treatment-related harms. Conclusion: Primary care clinicians are well positioned to deliver individualized chronic pain management through longitudinal relationships, clinical phenotyping, physical examination and coordinated multimodal care. An individualized approach focused on patient-defined functional goals provides a practical model for improving outcomes in primary care. Full article

Fibromyalgia is a chronic disorder characterized by widespread pain, fatigue, sleep disturbances, cognitive dysfunction, and psychological symptoms. This randomized controlled trial evaluated whether exercise delivered through immersive virtual reality (IVR) provides additional benefits beyond supervised conventional exercise in women with fibromyalgia. Thirty-six participants were randomized to IVR or conventional exercise, with both interventions comprising 12 supervised sessions over six weeks. Sixteen IVR and twelve control participants completed post-intervention assessment. Linear mixed-effects models using all available observations showed greater improvement in fibromyalgia-related impact, assessed using the Fibromyalgia Impact Questionnaire-Revised (FIQR), with IVR (group × time interaction, p = 0.002). Global cognitive screening performance, assessed using the Montreal Cognitive Assessment (MoCA), also improved more with IVR (unadjusted p = 0.005; Holm-adjusted p = 0.025). Sleep quality improved within the IVR group, but the between-group difference did not remain significant after multiplicity adjustment (Holm-adjusted p = 0.080). No significant between-group differences were observed for depression, anxiety, or stress. Retention was 88.9% with IVR and 66.7% with conventional exercise. Both interventions were well tolerated, with only mild transient adverse events and no intervention-related discontinuations. IVR was feasible and well tolerated and may provide additional benefits for fibromyalgia-related impact and global cognitive screening performance. Larger, adequately powered randomized controlled trials are needed to confirm these findings. Full article

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by recurrent upper airway collapse. Continuous positive airway pressure (CPAP) is the gold standard treatment but is burdened by low adherence rates. Nighttime hypoxia may alter sleep structure and OSA symptoms, potentially affecting PAP treatment adherence. This study aims to evaluate whether nocturnal hypoxia measures could predict long-term PAP adherence. We conducted a real-life, retrospective study including 207 OSA patients. Clinical data were collected on symptoms, comorbidities, home sleep apnea test (HSAT) metrics, prescribed therapy and objective adherence data via in-built device software. Nocturnal respiratory failure (NRF) was defined as a total sleep time with SpO₂ < 90% (TST90) ≥ 30%. Among the cohort, 119 patients met the criteria for NRF. These patients exhibited higher BMI, more severe OSA and a higher prevalence of COPD compared to those without NRF. At follow-up, patients with NRF demonstrated significantly better treatment adherence and more frequently reported improvement in several daytime and nighttime symptoms. Time-to-event analysis and adjusted multivariable regressions showed a higher probability of good long-term PAP adherence in patients with TST90 ≥ 30%. These findings suggest that prolonged nocturnal hypoxemia may identify a subgroup of patients more likely to maintain long-term PAP treatment. Full article

Introduction: Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by reduced platelet counts. Dupilumab, an IL-4 receptor antagonist, is effective in allergic and auto-inflammatory diseases; however, use in ITP remains unexplored. Case Presentation: A 78-year-old male with chronic ITP, maintained on a thrombopoietin receptor agonist (TPO-RA) with an average platelet count of around 78,000/μL, demonstrated a sustained rise in platelet counts (> 100,000/μL) shortly following initiation of dupilumab for an unrelated chronic obstructive pulmonary disease. This improvement enabled a stepwise reduction in TPO-RA to < 20% of his base dosage while maintaining adequate platelet levels for three years since. Despite detailed patient interviews and chart review, we were unable to identify any clinical factors besides commencement of dupilumab as a potential explanation. If indeed causative, we speculate that a TPO-RA-sparing effect of dupilumab might occur via disruption of IL-4 signaling, leading to inhibited Th9 cell activation and subsequent IL-21 production to restore Treg/Th17 balance, thus contributing to decreased platelet destruction. Conclusions: This case supports a potential role for dupilumab in the treatment of chronic ITP. To our knowledge, it is the first report suggesting a therapeutic benefit of IL-4 blockade in this disease. Identification of predictive immunologic biomarkers, such as cytokine profiles or T-cell subset signatures, might help identify patients most likely to benefit from IL-4 pathway modulation. Further controlled studies are warranted to clarify the immunologic mechanisms underlying this response and to assess the therapeutic potential of targeting the IL-4 axis in ITP. Full article

Sleep disturbances are common across affective disorders and may coexist with traumatic stress and persistent hyperarousal. This narrative review examines how trauma-related hyperarousal and sleep dysfunction are associated with major depressive disorder (MDD) and bipolar disorder (BD), while distinguishing observed associations from proposed mechanisms. A targeted search of PubMed, Scopus, and Google Scholar identified clinical, neurobiological, and translational literature on trauma, hyperarousal, insomnia, nightmares, circadian disruption, MDD, and BD. The evidence supports a multidimensional view of hyperarousal involving partly overlapping autonomic, cognitive–attentional, affective, and behavioral domains; however, it does not establish hyperarousal as a unitary mechanism or justify equating trauma-related vigilance with manic activation. Sleep disturbance may function as a symptom, vulnerability factor, or prodromal change, but no single sleep measure is currently a validated individual-level prognostic marker. Clinically, trauma history, sleep phenotype, affective state, comorbidity, medication effects, and current safety should be assessed jointly. Cognitive behavioral therapy for insomnia and established trauma-focused treatments have the strongest clinical basis within their indicated populations, whereas imagery rehearsal therapy, prazosin, chronobiological strategies, and candidate biomarkers require diagnosis-specific and evidence-graded interpretation. Longitudinal studies integrating objective sleep measures and explicit temporal modeling are needed before proposed pathways or precision approaches can be considered clinically validated. Full article

Background/Objectives: Psychological distress, poor sleep quality, and reduced quality of life commonly co-occur among medical students, yet their mutually adjusted relationships remain less well characterised within curriculum-based mind–body exercise settings. We examined whether these relationships were replicated across two unlinked survey waves and whether psychological distress and sleep quality remained associated with overall quality of life after mutual adjustment. Methods: An unlinked repeated cross-sectional study was embedded within a 12-week university Wuqinxi mind–body exercise course. Anonymous surveys were administered at course initiation (T0) and completion (T1), with 184 valid responses at each wave. Psychological distress, sleep quality, and overall quality of life were assessed using the DASS-21, PSQI, and the PROMIS Global Health Global02 item, respectively. Spearman correlations and proportional-odds ordinal logistic regression were performed with adjustment for sex, age, and previous mind–body exercise experience. Holm correction was applied. Results: Associations among the three health domains were directionally consistent at both waves (|ρ| = 0.359–0.494; all Holm-adjusted p < 0.001). In mutually adjusted models, poorer sleep quality was associated with lower odds of higher overall quality of life at T0 (OR per SD = 0.375, 95% CI 0.269–0.522) and T1 (OR per SD = 0.400, 95% CI 0.287–0.558; both Holm-adjusted p < 0.001). Associations for psychological distress were weaker and did not remain statistically significant after multiplicity correction. Conclusions: Across two unlinked survey waves embedded in a 12-week Wuqinxi course, poorer sleep quality remained associated with lower overall quality of life after adjustment for psychological distress and measured covariates, whereas the corresponding association for psychological distress was weaker. These findings characterise concurrent health relationships within the intervention context but do not establish within-person change or causal effects of Wuqinxi. Full article

Seafarer fatigue is multifactorial and a leading contributor to maritime accidents, yet we identified no study establishing which fatigue factors matter most for the Indonesian fleet, and maritime prioritisation studies rarely report indices that allow their consensus to be audited. A two-round modified Delphi study was conducted with ten Indonesian maritime experts drawn from maritime safety research, maritime academia, and senior seafaring. The panel rated 14 candidate fatigue factors, derived from the authors’ systematic review of 34 articles, on a 0–10 importance scale, and separately ranked the five factors most important for governance. Consensus was assessed through agreement on relevance, dispersion, inter-rater concordance, and per-rater stability, and was reported in line with the Accurate Consensus Reporting Document (ACCORD) reporting guideline. Agreement strengthened between rounds (Kendall’s W 0.557 to 0.648; both p < 0.001), and eight of ten raters showed moderate-to-strong rank stability. Nine factors reached full content validity and were retained, dominated by sleep and operational constructs; five environmental and organisational factors were classified as contextual. The exploratory governance ranking diverged from the importance ratings. The study delivers an ordered factor set endorsed by this expert panel rather than representative of the sector, separating what instrumented monitoring should measure from what policy should act on. Full article

Background: Sleep disturbances among healthcare students can negatively affect academic performance and future clinical decision-making. However, limited evidence exists on insomnia among Emergency Medical Services (EMS) students, a group exposed to unique academic and operational stressors. This study assessed insomnia severity and its demographic and health-related correlates among paramedic students in Saudi Arabia. Methods: A cross-sectional study was conducted among 238 EMS students in Saudi Arabia. Insomnia severity was assessed using the Insomnia Severity Index (ISI). Descriptive statistics summarized insomnia levels, and bivariate tests and multiple linear regression were used to examine group differences and predictors in SPSS. Results: The mean ISI score was 11.8 ± 5.3, indicating subthreshold insomnia among paramedic students. Higher insomnia severity was observed among single students than among married students (12.1 vs. 7.4, p = 0.005), among students at private universities (19.3 vs. 11.6, p = 0.001), and among those with chronic medical or diagnosed mental illness (p < 0.05). No significant differences were found by gender, region, academic level, or dormitory residence (p > 0.05). Regression analysis showed that marital status and university type were significant predictors of insomnia symptom severity. Conclusions: Insomnia is common among EMS students and may have implications for both student well-being and future clinical performance. Addressing sleep health within EMS education may support better academic outcomes and safer healthcare delivery. Full article

Public safety telecommunicators sustain 24/7 operations through nonstandard, rotating schedules that may affect health and performance, yet scheduling research specific to emergency communications centers remains limited. We aimed to examine how shift-work structure or scheduling characteristics may contribute to occupational performance, physical health, psychological health, and social and family functioning outcomes in emergency dispatchers and comparable 24/7 safety-critical occupations, identifying risks, practical considerations, and priority research gaps. We searched PubMed, PsycINFO, CINAHL, Web of Science, and Scopus for primary studies published January 2000–May 2026. We included studies examining associations among five scheduling exposure domains (shift timing and duration; rotation and circadian disruption; recovery and schedule spacing; predictability and control; and overtime and interventions) and outcomes spanning occupational performance, physical and psychological health, health behaviors, and social functioning. The search yielded 5259 studies; 66 met the inclusion criteria and were largely observational. Three studies examined dispatcher populations, with no dispatcher-specific evidence for three exposure domains. The most consistent cross-occupational signal linked night work and extended shifts to impaired sleep and cognitive performance. Comparator evidence indicated that schedule architecture and schedule control or mandatory overtime were associated with outcomes independent of shift length. This persistent evidence gap concerns a workforce facing continuous coverage demands, high cognitive load, and trauma exposure. Available evidence supports reframing center schedules as occupational health exposures and prioritizing high-quality (e.g., longitudinal, intervention-based) dispatcher research. Full article

The fixed rubber tapping machine (FRTM) is a key piece of equipment for mechanized rubber tapping and is characterized by high-density, large-group deployment under the forest canopy. With the application of artificial intelligence technology, group communication control for FRTMs has become an important and novel research direction. In this paper, based on a LoRa communication network, a novel relay-node deployment method guided by an installation heat mode (a deployment-priority index for FRTM installation) is proposed for FRTM groups in rubber forests and is applied for testing. By integrating installation dimensions, latex yield, and trunk quasi-cylindricity across rubber trees, a novel installation heat mode for FRTMs is constructed based on diameter at breast height (DBH). A logarithmic path loss model is established for a specific rubber plantation in Danzhou and D724W1-LoRa relay nodes; the effective range of the relay nodes is determined, and their forest communication performance and group sleep strategy are evaluated experimentally. The deployment positions of the relay nodes are determined using a finite-depth enumeration search algorithm. A hybrid mesh-star network comprising FRTMs and relay nodes is deployed in Baodao Xincun, Danzhou, achieving an average communication failure rate of 0.6% under normal and rainy weather conditions and demonstrating high reliability. The proposed method provides a practical solution for large-scale FRTM cluster management in tropical plantations. Full article

Introduction: Suicidal ideation during pregnancy is an important public health concern. Psychological inflexibility may be associated with emotional and sleep-related symptoms linked to suicidal ideation; however, these patterns of association remain insufficiently understood in pregnant women. Objective: The objective was to examine the relationship between psychological inflexibility and suicidal ideation in pregnant women by evaluating the multiple mediating roles of depressive symptoms, insomnia, and generalized anxiety. Method: A quantitative, cross-sectional associative study using latent variables was conducted with 962 pregnant women receiving care at the National Maternal and Perinatal Institute (INMP), located in Cercado de Lima, Lima, Peru, between October and December 2025. Participants completed the Acceptance and Action Questionnaire-II (AAQ-II), Frequency of Suicidal Ideation Inventory (FSII), Athens Insomnia Scale (AIS), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2). Structural equation modeling (SEM) was performed using R version 4.5.1 within the RStudio Version 4.5.1 environment. Results: The proposed model showed a good fit, scaled χ²(179) = 506.334, p < 0.001, robust CFI = 0.968, robust TLI = 0.963, robust RMSEA = 0.052, 90% CI [0.046, 0.057], and SRMR = 0.030. Psychological inflexibility showed a significant direct association with suicidal ideation (β = 0.246, p < 0.001) and significant indirect associations through depressive symptoms (β = 0.245, p < 0.001) and insomnia (β = 0.030, p = 0.007), whereas the indirect association through generalized anxiety was not significant (β = 0.007, p = 0.749). The total indirect association was significant (β = 0.282, p < 0.001), while the direct association remained statistically significant after inclusion of the mediators. Conclusions: Psychological inflexibility was associated with suicidal ideation among pregnant women, with depressive symptoms and insomnia showing significant indirect associations. These cross-sectional findings identify relevant correlates of suicidal ideation that warrant further longitudinal investigation. Full article

Background: Problematic digital-media use and gaming disorder have emerged as important public health concerns, particularly among adolescents. Along with psychosocial factors, genetic susceptibility and neuroendocrine pathways may contribute to individual vulnerability to problematic digital-media use and gaming-related problems. Objectives: This review aims to summarize current evidence on the genetic polymorphisms and endocrine pathways associated with problematic digital-media use and gaming disorder, with emphasis on dopaminergic reward mechanisms and hypothalamic–pituitary–adrenal (HPA) axis regulation. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar for studies published up to 30 June 2026. Relevant human studies addressing genetic, epigenetic, endocrine, or related neurobiological mechanisms of problematic digital-media use and gaming-related behaviors were identified and narratively synthesized according to the principal biological pathways examined. Results: The available evidence suggests that genetic variants affecting dopaminergic neurotransmission (DRD2, COMT, DAT1, and DRD4), stress regulation (CRHR1, FKBP5), serotonergic signaling (SLC6A4), sleep-circadian regulation and other pathways (CHRNA4, NTRK3) may increase susceptibility to problematic Internet and gaming use. Excessive digital media exposure has been associated with alterations in dopaminergic signaling, stress and sleep–circadian regulation, including changes in hypothalamic–pituitary–adrenal axis activity, cortisol secretion and melatonin secretion. These alterations may be related to differences in reward processing, sleep, and emotional regulation, as well as to compulsive digital behaviors. Bidirectional associations have also been reported between problematic digital-media use and depression, anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD). Conclusions: Genetic and endocrine factors may contribute to a broader biopsychosocial vulnerability to problematic digital-media use and gaming-related problems. However, current evidence is insufficient to establish individual genetic variants or endocrine measures as clinically actionable biomarkers. Future research should prioritize large, adequately powered longitudinal studies with harmonized phenotypes, objective behavioral measures, genome-wide approaches, and independent replication to clarify the clinical relevance of biological markers and their potential role in risk prediction and personalized intervention. Full article

Background: Subjective cognitive complaints (SCCs) in middle-aged and older adults are recognized as early warning signs of future cognitive decline. While biological risk factors have been studied extensively, less is known about how modifiable lifestyle factors, stress, mood and sleep relate to actual performance on cognitive tests. Objective: To examine associations between lifestyle (physical activity, alcohol consumption), psychosocial factors (perceived stress, mood, sleep) and standardized cognitive performance in adults with SCCs. Methods: We conducted a cross-sectional analysis using baseline data from 276 adults aged 50–75 years enrolled in the N-HANCE study. Participants completed the Test of Attentional Performance (TAP) and Digit Span (Forward and Backward). Lifestyle and psychosocial variables were assessed using structured questions and validated self-report scales. Associations were examined using Spearman correlations and Mann–Whitney U tests, with Benjamini–Hochberg correction applied across the full family of 132 predictor–outcome comparisons, followed by linear regression models adjusted for age, sex and educational attainment. Results: Educational attainment showed the strongest and most consistent associations, relating to better performance across attention and memory measures assessed (ρ = 0.21 to 0.44, all q < 0.01). Older age was associated with poorer memory span and less consistent alertness. A history of depression was associated with reduced alertness and this association was essentially unchanged after adjustment (β = −0.19, p < 0.001). Higher BMI was associated with poorer memory span (ρ = −0.18; adjusted β = −0.16, p = 0.005) and higher perceived stress with poorer working memory (Digit Span Backward ρ = −0.21; adjusted β = −0.11, p = 0.046; p = 0.062 under robust standard errors). Associations involving mood and sleep quality attenuated to non-significance after adjustment, while physical activity retained only a marginal association with divided attention. Nineteen of 132 associations survived correction for multiple comparisons. Conclusions: In adults with SCCs, educational attainment and age, a proxy of cognitive reserve and an index of aging respectively, rather than modifiable targets, accounted for the strongest associations with objective cognitive performance. Among potentially modifiable factors, a history of depression and higher BMI showed the most robust independent associations, while associations with mood and sleep did not persist after adjustment and physical activity retained only a marginal association. These cross-sectional findings identify candidate risk and resilience markers that require confirmation in longitudinal follow-up. Full article

Background/Objectives: Adenotonsillar hypertrophy (ATH) is the primary driver of pediatric obstructive sleep-disordered breathing (OSDB), potentially leading to cardiac remodeling. This study evaluated the impact of adenotonsillectomy (AT) on electrocardiographic (ECG) parameters and correlated these changes with sleep metrics. Methods: This prospective study evaluated ECG parameters (P-wave and QRS morphology) in children (>3 years) with symptomatic ATH before and three months after AT. A subset underwent sleep analysis via Cardiopulmonary Coupling (CPC) at both time points. Pre- and postoperative data were compared using paired t-tests and Linear Mixed Models (LMMs). The link between ECG and sleep modifications was also analyzed using Pearson and Spearman correlations of their respective variations (Δ). Results: Significant reductions were observed in the maximum RR interval (p = 0.027). Mean P-wave duration significantly shortened (84.40 ± 6.51 ms to 81.20 ± 3.32 ms; p = 0.043) and mean amplitude increased (0.076 ± 0.008 mV to 0.080 ± 0.004 mV; p < 0.001). Mean, minimum, and maximum QRS amplitudes increased significantly (p ≤ 0.018). Exploratory LMM confirmed that these modifications remained significant after adjusting for age and sex. Furthermore, post hoc analyses revealed that Δ QRS maximum amplitude exhibited negative correlations that survived false discovery rate (FDR) adjustment with Δ AHI 4% max (r = −0.727, p = 0.045), Δ ODI 3% max (r = −0.765, p = 0.045), Δ ODI 4% mean (r = −0.819; p = 0.033), and Δ maximal hypoxic burden (r = −0.730; p = 0.045). Conclusions: AT may alter ECG parameters. QRS amplitude increments correlated well with a decrease in nocturnal respiratory events. These findings may represent preliminary ECG changes associated with postoperative respiratory improvement. Larger controlled studies are needed to determine whether these ECG parameters can serve as markers of post-operative cardiopulmonary recovery. Full article