Search Results (408)

Background/Objectives: Sleep duration and physical activity are key behavioral components in the development of healthy lifestyles during adolescence. In Peru, a considerable proportion of school students do not meet recommended levels of physical activity and may also experience insufficient sleep, which could negatively affect their eating habits. This study aimed to analyze the association between sleep duration, physical activity level, and healthy eating habits among Peruvian secondary school students. Methods: An observational, analytical, cross-sectional study was conducted among 275 secondary school students aged 12 to 17 years. Sleep duration, physical activity, and eating habits were assessed using validated questionnaires. Associations were analyzed using Pearson’s chi-square test and multivariable binary logistic regression. Results: Students who slept 7 h had higher odds of having healthy eating habits compared with those who slept 6 h or less (aOR = 2.525; 95% CI: 1.181–5.536; p = 0.018). In addition, students with low levels of physical activity showed lower odds of having healthy eating habits compared with those with high levels of physical activity (aOR = 0.097; 95% CI: 0.005–0.564; p = 0.032). Conclusions: Sleep duration and physical activity were associated with healthy eating habits among Peruvian secondary school students. These findings support the importance of promoting integrated school-based strategies that jointly address sleep, physical activity, and nutrition during adolescence. Full article

High-altitude hypoxia is associated with sleep disruption, affective fluctuation, and changes in cognitive performance, yet prior findings remain markedly heterogeneous in both direction and magnitude. To clarify this variability, this structured narrative review synthesizes evidence from systematic reviews, meta-analyses, and key empirical studies on psychological and cognitive adaptation to high-altitude hypoxia, with a particular focus on personality and related traits. The review is organized along three axes: exposure context and characterization (real-altitude field/residential exposure, hypobaric chambers, normobaric hypoxia, expedition settings, and dose alignment), exposure duration and time course, and outcome domains spanning sleep/fatigue, affective adaptation, and cognitive performance. Across the literature, cognitive effects appear domain-specific and strongly conditioned by exposure dose, temporal stage, and task characteristics, whereas sleep disturbance during the early acclimatization period emerges as one of the more consistent findings and appears closely intertwined with anxiety-related responses. Although direct personality-related evidence remains limited and uneven, the available findings can be organized into a testable trait–process–outcome framework that distinguishes candidate associations with relatively more direct evidence from mechanism-informed hypotheses. Neuroticism/emotional stability and anxiety-related traits have received comparatively more direct empirical investigation than other personality domains, but the available evidence is insufficient to regard them as established predictors of high-altitude adaptation. The roles of conscientiousness, resilience/hardiness, extraversion, agreeableness, and openness remain more tentative and are better treated as targets for prospective testing. We therefore propose that personality-related dispositions may influence adaptation-relevant outcomes through candidate processes involving threat appraisal, coping, resource regulation, and social interaction. We conclude that future research should strengthen exposure dose characterization, specify the boundary conditions for generalizing across real-altitude, hypobaric-chamber, normobaric hypoxia, and expedition settings, and adopt longitudinal, multilevel, and ecologically valid designs to test personality-related pathways more rigorously. Full article

Fibromyalgia (FM) causes widespread pain, poor sleep, fatigue, and reduced quality of life. Exercise is the best supported non-pharmacological treatment, yet many patients report that it is insufficient on its own. Somatic tracking is a component of pain reprocessing therapy. It is promising in chronic back pain but untested as a stand-alone intervention in FM. The Fibromyalgia Somatic Tracking and Exercise Program Study (FIBROSTEPS) is a single-center 2 × 2 factorial randomized controlled superiority trial estimating the separate and combined effects of group exercise and somatic tracking on the impact of FM. Two hundred adults aged 18–65 years, of either sex, with FM diagnosed by the 2016 criteria, are randomized 1:1:1:1 after an 8-week baseline period to general activity recommendations plus usual care (control), supervised group exercise, somatic tracking, or both. Both interventions run for 16 weeks with one session per week (45 min physiotherapist-led group exercise; 40 min guided somatic tracking with a certified therapist). The primary outcome is change in total original Fibromyalgia Impact Questionnaire score (0–100) from week 8 to week 24, analyzed by intention-to-treat. Secondary outcomes include insomnia severity, daily pain intensity, and Fitbit-measured activity and sleep. The trial has 80% power for the two main effects; the exercise × somatic-tracking interaction is prespecified as exploratory. No results are reported; the trial will provide randomized evidence on somatic tracking in FM, alone and combined with exercise, informing multi-component FM rehabilitation. Trial Registration: ClinicalTrials.gov (NCT06922747). Ethics Approval: Regional Committee for Medical and Health Research Ethics (REK), reference 2025/853403. Full article

Background: Obesity is a chronic, multifactorial disease that demands personalized and sustainable management approaches. Digital health technologies, such as artificial intelligence, wearable devices, mobile health apps, and virtual reality (VR), may support obesity care by providing enhanced behavioral monitoring, personalized feedback, and patient engagement. Objective: This critical narrative review discusses the current evidence on artificial intelligence, wearable technologies, and VR in the context of precision nutrition and obesity management and their possible clinical applications and limitations. Method: A critical narrative review was conducted using peer-reviewed literature published between 2019 and 2026 and identified through PubMed and Google Scholar. Search terms included combinations of “precision nutrition,” “personalized nutrition,” “obesity,” “weight management,” “metabolic health,” “digital health,” “artificial intelligence,” “machine learning,” “mobile health,” “wearable devices,” and “omics” using Boolean operators. Evidence from randomized controlled trials, systematic reviews, meta-analyses, and key conceptual studies was critically synthesized due to substantial heterogeneity in interventions and outcomes. Result: Wearables and mobile applications can enable continuous self-monitoring of physical activity, dietary intake, sleep, and physiological measures. Artificial intelligence may improve dietary personalization, risk prediction, glycemic control, and adaptive feedback. VR offers an immersive way to tackle behavioral and cognitive mechanisms related to overeating such as cravings, food cue reactivity, and inhibitory control. However, the evidence is heterogeneous, with many studies limited by short follow-up periods, small samples, variable adherence, and insufficient clinical validation. Conclusions: Artificial intelligence, wearable technologies, and VR are promising tools for precision obesity management, but their long-term clinical effectiveness remains uncertain. Future research should prioritize adequately powered trials, longer follow-up, standardized outcomes, transparent algorithms, ethical data governance, and integration with multidisciplinary nutrition and obesity care. Full article

Background/Objectives: Occupational burnout is a major challenge among healthcare workers. Night-shift work, insufficient sleep, and lifestyle factors may contribute to higher burnout levels. This study examined associations of night-shift work, sleep duration, and physical activity with burnout using the Burnout Assessment Tool (BAT). Methods: This cross-sectional study included 213 healthcare workers undergoing routine occupational health assessments in Bucharest, Romania, between January and April 2026. Burnout was assessed using the BAT-23 core questionnaire and BAT Secondary Symptoms module. Data on night-shift work, sleep duration, physical activity, age, sex, and professional experience were analyzed using group comparisons, correlations, and multivariable linear regression. Results: Night-shift workers had higher burnout scores than non-night-shift workers (3.36 ± 0.43 vs. 2.44 ± 0.41, p < 0.001), while physically active participants had lower scores than sedentary workers (2.46 ± 0.44 vs. 3.23 ± 0.52, p < 0.001). Burnout correlated negatively with sleep duration (r = −0.336, p < 0.001) and physical activity (r = −0.655, p < 0.001), and positively with night-shift work (r = 0.798, p < 0.001). In adjusted analysis, night-shift work (B = 0.831, 95% CI 0.637–1.024, p < 0.001), shorter sleep duration (B = −0.079, 95% CI −0.127 to −0.031, p = 0.001), and female sex (B = 0.162, 95% CI 0.029–0.295, p = 0.017; male = 0, female = 1) were associated with higher burnout; the model explained 58.6% of the variance. Conclusions: Night-shift work and shorter self-reported sleep duration were independently associated with higher burnout. Physical activity was associated with lower burnout only in unadjusted analyses. Owing to the cross-sectional design and self-reported exposures, findings should be interpreted as associations and confirmed longitudinally. Full article

Circadian rhythms determine biological clocks that manage daily biological functions, including the sleep–wake rhythm, hormone release, and immune function. This can affect immune-mediated chronic inflammation in rheumatoid arthritis (RA), which leads to joint damage, pain, swelling, and morning stiffness. These clinical manifestations follow a distinct circadian rhythm because of the cyclic pattern of leukocyte movement, secretion of pro-inflammatory cytokines such as IL-6, IL-1β, and TNF-α at night, and fluctuations in cortisol and melatonin levels. Despite the increasing amount of evidence showing that insufficient sleep and disruption of the biological clock may play a role in RA development through suppression of the immune response in macrophages and resorption processes in osteoclasts, the cause of this phenomenon is still under investigation. The present-day guidelines continue to endorse DMARDs as the basis of treatment, while studies are exploring the role of chronotherapy as an adjunctive method for alleviating symptoms and enhancing disease outcomes. In this review, we explore current knowledge regarding the links between the molecular basis of circadian biology and the pathogenesis of RA, highlight recent trends in immune and bone remodeling mechanisms, and discuss modern possibilities for using chronotherapy, precision medicine, and advanced drug-delivery methods based on circadian rhythms to create optimal treatment strategies for RA. Full article

Background: Mental health is the main factor of the overall quality of life of both individuals and the community. In contemporary society, mental health is gaining more and more significance, although there is still an insufficient level of awareness among people about what factors can affect our mental health and why it is of such importance for daily functioning. Material: The research used an anonymous questionnaire created by a team of doctors from the Clinic for Psychiatry in Novi Sad with the aim of assessing how the ongoing social situation in Serbia affects the mental health of the population. Results: It was shown that there is a statistically significant link between levels of feeling tense and following the news about the ongoing protests. The research has shown that there are statistically significant differences in emotional response in relation to gender and age resulting from the current situation. A statistically significant association between sleep problems and the use of anxiolytic therapy has been proven. Most of the respondents declared that the current situation in which we live has a negative impact on mental health. Conclusions: The results of the research indicate that social circumstances in Serbia significantly affect the psychological functioning of the population. Full article

Excessive mind wandering is increasingly recognized as a clinically relevant cognitive feature of adult attention-deficit/hyperactivity disorder (ADHD), yet its relationship with sleep-related characteristics remains insufficiently understood. This cross-sectional study with a control group examined associations between sleep-related characteristics and excessive mind wandering in 316 adults with clinically confirmed ADHD and 121 screened controls. Participants completed measures of ADHD symptoms, mind wandering, anxiety–depressive symptoms, and self-reported sleep-related characteristics adapted from Pittsburgh Sleep Quality Index items; mid-sleep time was calculated from reported sleep onset and final awakening. Group comparisons, correlation analyses, and multiple regression analyses were conducted. Adults with ADHD showed higher mind wandering, greater ADHD symptom severity, anxiety–depressive symptom burden, poorer subjective sleep quality, and later mid-sleep time than controls, whereas sleep duration did not differ between groups. Mind wandering was associated with ADHD symptom severity, anxiety–depressive symptoms, later mid-sleep time, and poorer subjective sleep quality. In regression analysis, ADHD diagnosis was the strongest independent correlate of mind wandering. Anxiety–depressive symptom burden, poorer subjective sleep quality, and later mid-sleep time, but not sleep duration, also remained independently associated with higher mind wandering. Findings suggest that sleep timing and subjective sleep quality may be clinically relevant to excessive mind wandering in adults with ADHD. Full article

Obstructive sleep apnea (OSA) affects nearly one billion adults worldwide and involves mechanical upper-airway obstruction alongside metabolic dysfunction, systemic inflammation, and gut–brain axis disruption. Despite the efficacy of continuous positive airway pressure (CPAP), suboptimal long-term adherence highlights the need for complementary pharmacological strategies. This narrative review synthesizes preclinical and clinical evidence on GLP-1-based therapies, encompassing selective GLP-1 receptor agonists and tirzepatide, a dual GIP/GLP-1 receptor agonist, in obesity-associated OSA. Preclinical studies show that GLP-1 receptor activation can reduce visceral adiposity, attenuate pro-inflammatory signaling, improve glucose and lipid metabolism, and modulate hypothalamic appetite circuits. However, the only identified murine study evaluating liraglutide during intermittent hypoxia—an experimental model of one component of OSA rather than the complete disorder—did not reverse hypoxia-induced insulin resistance, indicating that persistent intermittent hypoxia may limit metabolic improvement in that model. Clinically, liraglutide and tirzepatide have reduced the apnea–hypopnea index (AHI) and improved several cardiometabolic outcomes. Numerically larger AHI reductions were reported in the tirzepatide trials, although no head-to-head comparison with selective GLP-1 receptor agonists is available. Tirzepatide is approved by the U.S. Food and Drug Administration for moderate-to-severe OSA in adults with obesity, together with a reduced-calorie diet and increased physical activity, and may be used without concomitant positive airway pressure in eligible patients or as an adjunct to ongoing therapy. The observed respiratory benefits appear to be mediated predominantly by weight loss and related reductions in mechanical and metabolic burden. Evidence supporting additional weight-independent mechanisms remains insufficient, and longer-term mechanistic studies in broader populations are required. Full article

Background/Objectives: Exercise-induced muscle damage, inflammation, oxidative stress, and accumulated fatigue affect post-exercise recovery and long-term training adaptations in athletes. Consequently, nutritional strategies supporting recovery have gained attention in sports nutrition. Among emerging compounds, adaptogens have attracted particular interest due to their potential anti-fatigue, antioxidant, and sleep-enhancing properties. However, evidence in trained athletes remains limited. Therefore, the aim of this narrative review is to summarize the current scientific evidence regarding the use of selected adaptogens in sport and to evaluate their potential roles in exercise recovery, training adaptation and exercise performance. Particular attention is given to Withania somnifera (ashwagandha), Panax species, Rhodiola rosea and Cordyceps species. Furthermore, this review discusses the practical implications and current limitations of the available evidence for athletes and sports practitioners. Conclusions: Current evidence from a limited number of heterogeneous studies suggests that selected standardized adaptogen preparations may provide beneficial effects on specific exercise-recovery-related outcomes and selected aspects of exercise performance in trained athletes. Among the adaptogens discussed, most consistent evidence concerns Withania somnifera, whereas the evidence for Panax species, Rhodiola rosea and Cordyceps species remains limited and should be considered preliminary. Furthermore, the available literature is characterized by a limited number of studies conducted in trained athletes, the underrepresentation of female athletes, and considerable heterogeneity in extract composition and supplementation protocols. Consequently, the current evidence is insufficient to formulate definitive recommendations regarding the efficacy, optimal dosage, or long-term safety of adaptogen supplementation. Further well-designed randomized controlled trials are required to establish evidence-based recommendations. Full article

Background: Celiac disease (CD) is an immune-mediated enteropathy associated with extra-intestinal manifestations. Sleep disorders may be frequent in CD patients. We aimed to investigate the quality of sleep in CD patients and to assess its relationship with clinical and biochemical parameters. Methods: We included patients with a proven diagnosis of CD under a gluten free diet at least twelve months prior to enrolment. All the participants completed the Sleep Scale from the Medical Outcomes Study (MOS sleep scale) and the Sleep Problems Index II was calculated. A high SLP9 score indicated a bad quality of sleep and values >20 revealed sleep disturbance. Moreover, blood samples were collected and demographic and clinical data were recorded from each subject. Linear logistic regression was used for uni- and multivariate analyses; the b coefficient and 95% confidence intervals (CI) were calculated. Results: We enrolled 53 patients, with the mean age being 42.75 ± 11.19 and 84.9% being females. The average hours of sleep per night were 6.47 ± 1.11. The mean SLP9 was 37.44 ± 20.65. Forty patients (75.5%) showed sleep disturbance, and 81.1% of patients had vitamin D insufficiency. According to univariate analysis, high SLP9 values (worse sleep) were inversely related to the number of sleep hours (b = −0.38, 95%CI: −11.8 to −2.2, p = 0.005) and to vitamin D levels (b = −0.57, 95%CI: −2.7 to −0.46, p = 0.009). In multivariate analysis only serum levels of vitamin D were inversely related to SLP9 (b = −0.47, 95%CI −12.8 to −0.43, p = 0.05). Conclusions: Low serum levels of vitamin D are independently associated with poor sleep quality in celiac patients. These findings need to be confirmed in future experimental and clinical studies. Full article

Short stature is a common pediatric endocrine–metabolic disorder characterized by impaired linear growth and increased risks of adverse health outcomes. Although previous reviews have summarized associations between gut microbiota and childhood health, few have focused on the mechanistic links among microbial composition, microbial-derived metabolites, endocrine regulation, and skeletal growth in short stature. This review provides an integrated framework exploring the potential interactions among gut microbiota composition, microbial-derived metabolites, endocrine regulation, and skeletal development in short stature. We summarize the clinical characteristics and epidemiological features of major short stature subtypes and discuss emerging evidence demonstrating the involvement of gut microbiota alterations and metabolite dysregulation in growth regulation. Particular attention is given to the bidirectional interactions between the gut microbiota and the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis, as well as the potential role of the gut–liver–bone axis in skeletal growth. Furthermore, this review integrates evidence from metabolomics studies, experimental animal models, and microbiota-targeted interventions to provide mechanistic insights into microbiota-mediated growth regulation. Dietary factors, physical activity, sleep, antibiotic exposure, probiotic interventions, and current clinical treatments are also discussed from the perspective of microbiota modulation. Despite increasing interest in microbiota-based strategies, clinical translation remains limited by insufficient functional validation, unclear causal relationships, and a lack of well-designed intervention trials. Future integration of functional microbiology, multi-omics approaches, and human-based validation platforms may facilitate the development of microbiome-based precision interventions for improving growth outcomes in children with short stature, particularly those with ISS. Full article

Background/Objectives: Vitamin D deficiency is commonly observed in patients with breast cancer and may affect disease course and treatment outcomes. The determinants of vitamin D status in this population remain incompletely understood, particularly with respect to lifestyle, psychosocial, and tumour-related factors. The aim of this study was to identify environmental and clinical factors associated with serum 25-hydroxyvitamin D [25(OH)D] concentrations in women with breast cancer, with particular emphasis on dietary patterns, psychological distress, sleep quality, and tumour molecular subtype. Methods: A cross-sectional observational study was conducted among 101 women with histopathologically confirmed invasive breast cancer, recruited at the St. John of Dukla Oncology Centre of the Lublin Region (COZL) in Lublin, Poland, between 2018 and 2019. Serum 25(OH)D concentrations were measured by electrochemiluminescence immunoassay (ECLIA; Roche Diagnostics) within 2–8 weeks after surgical treatment. Clinical and lifestyle data were collected using standardised questionnaires and medical records. Dietary patterns were assessed with the KomPAN questionnaire (pro-healthy diet index pHDI-10 and non-healthy diet index nHDI-14). Psychological distress was measured with the Distress Thermometer. Multiple linear regression with backward stepwise elimination was applied to identify factors independently associated with of 25(OH)D concentration. Results: Insufficient vitamin D status (25(OH)D < 30 ng/mL) was found in 56.4% of participants. The multivariable regression model was statistically significant (F(6,92) = 15.298; p < 0.001), explaining 49.9% of the variance in 25(OH)D concentrations. Factors independently associated with lower 25(OH)D included higher BMI (b = −0.715; p = 0.005), sleep disturbances (b = −6.257; p = 0.020), higher psychological distress score (b = −2.263; p < 0.001), and luminal B versus luminal A subtype (b = −5.909; p = 0.025). A higher pro healthy diet index (pHDI-10) was independently associated with higher 25(OH)D (b = 0.245; p = 0.040). Conclusions: Vitamin D status in patients with breast cancer is shaped by complex interactions among modifiable lifestyle factors and tumour characteristics. Targeted interventions addressing diet quality, psychological well-being, sleep health, and weight management may improve vitamin D status in this population. The association between molecular subtype and 25(OH)D concentrations warrants further prospective investigation. These findings should be interpreted with caution, as vitamin D supplementation and direct measures of sun exposure—both established determinants of 25(OH)D—could not be included as covariates and may account, at least in part, for the associations reported. Full article

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder associated with increased cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is the standard treatment for OSA; however, its effects on cardiovascular outcomes remain incompletely established. This umbrella review synthesized and critically appraised the evidence regarding the effects of CPAP on surrogate, intermediate, and functional cardiovascular outcomes in adults with OSA. Materials and Methods: An umbrella review of systematic reviews and meta-analyses evaluating CPAP therapy in adults with OSA was conducted. A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library from database inception to 28 February 2026. Eligible reviews assessed cardiovascular outcomes, including blood pressure, cardiac function, autonomic function, cardiovascular biomarkers, and functional cardiovascular measures. Methodological quality was evaluated using AMSTAR 2, and the certainty of evidence for the main outcomes was assessed using the GRADE framework. Results: Thirty-eight systematic reviews and meta-analyses were included. CPAP therapy was consistently associated with reductions in systolic blood pressure (mean difference [MD] −4.8 mmHg) and diastolic blood pressure (MD −3.0 mmHg), with additional improvements in 24 h ambulatory blood pressure. Favorable effects were also observed for left ventricular ejection fraction (MD 3.27), left ventricular diastolic function (weighted mean difference [WMD] 0.22), and sympathetic nervous system activity, reflected by lower circulating noradrenaline levels (standardized mean difference [SMD] −1.10) in randomized controlled trials. Improvements in BNP/NT-proBNP concentrations and New York Heart Association functional class were reported among patients with heart failure, whereas no significant effect was observed on body mass index. The certainty of evidence ranged from low to moderate, and methodological confidence of the included reviews was predominantly moderate, low, or critically low. Conclusions: CPAP therapy was associated with improvements in several surrogate, intermediate, and functional cardiovascular outcomes in adults with OSA, particularly blood pressure, left ventricular function, and sympathetic activity. However, the certainty of evidence ranged from low to moderate, and substantial heterogeneity and methodological limitations warrant cautious interpretation. Current evidence remains insufficient to demonstrate a consistent reduction in major adverse cardiovascular events or cardiovascular mortality. Further high-quality randomized controlled trials with longer follow-up are needed to clarify the long-term cardiovascular impact of CPAP therapy. Full article

Historically framed as a behavioral addiction, gambling disorder (GD) has had its somatic dimension neglected by standard clinical evaluation. This is a narrative, hypothesis-generating review focusing on the somatic aspects of GD. Cross-sectional and prospective evidence increasingly shows a somatic phenotype distributed across four axes: cardiovascular (hypertension, angina, stroke, acute stress-induced cardiac events), metabolic (obesity, type 2 diabetes, chronic liver disease), sleep-related (insomnia, poor sleep quality, daytime sleepiness), and—as an emerging and insufficiently characterized dimension—neurological (clustering with seizures and frontal lobe epilepsy). Three candidate biological systems may translate this exposure into multi-system physiology: (i) a hyperreactive mesostriatal reward circuit hypothesized to sustain a behavioral cluster of smoking, hazardous alcohol use, low physical activity, and unhealthy diet; (ii) an integrated stress response postulated to shift from acute hyperreactivity to chronic basal cortisol blunting and reduced vagal tone; and (iii) putative alterations in peripheral neurotrophic signaling and frontal-callosal structure, marked by elevated peripheral brain-derived neurotrophic factor and by frontal-callosal white-matter alterations—with cumulative allostatic load serving as a conceptual integrating frame. We propose that GD can be a behaviorally driven systemic medical condition, warranting internal medicine involvement alongside addiction psychiatry. Within this framework, glucagon-like peptide-1 receptor agonists emerge as an exploratory therapeutic hypothesis warranting dedicated evaluation in GD, given their action on the mesolimbic reward substrate and phase 3 evidence in adjacent cardiometabolic, hepatic, and sleep conditions. Full article