Search Results (1,549)

Background: Diet during pregnancy plays a crucial role in promoting healthy dietary behaviours and positive maternal and child health outcomes. However, evidence regarding the factors associated with healthy dietary behaviours among pregnant women is limited. The SaperePer study aims to assess the dietary behaviours of pregnant women and identify the sociodemographic, lifestyle, and health-related factors that influence their choices. Methods: This cross-sectional analysis included 1254 pregnant women recruited from two Northern Italian centres (Turin and Cuneo). Dietary behaviour was assessed using a questionnaire, which generated a diet-related scores. Associations between these scores and participants’ characteristics were investigated using multivariable regression models. Results: Overall, participants reported relatively favourable dietary habits and a low prevalence of risky behaviours. Higher socioeconomic position was found to be one of the strongest contributing factors to dietary behaviour (medium vs. low β (95% CI) = 1.18 (0.93, 1.42); high vs. low β (95% CI) = 1.57 (1.10, 2.04), both p < 0.001). Higher dietary behaviour scores were positively associated with older maternal age, moderate physical activity, and better perceived physical and psychological health, whereas smoking and alcohol consumption were associated with lower scores. Conclusions: Dietary behaviour during pregnancy appears to be shaped by a complex interplay of socioeconomic, behavioural, and health-related factors rather than by nutritional knowledge alone. These findings highlight the need for tailored interventions that address the social and contextual features of dietary behaviour to encourage healthier habits during pregnancy. Full article

Background/Objectives: Analyses of the 2023 Korea National Health and Nutrition Examination Survey described health-literacy distributions by smoking status but did not model current conventional cigarette smoking across continuous Health Literacy Index for the Community (HLIC) scores or report a standardized absolute difference. Methods: We analyzed 5792 adults aged ≥19 years. Survey-weighted quasi-Poisson models estimated prevalence ratios (PRs) per 5-point-lower HLIC score, adjusting for age, sex, education, and household income. Standardized prevalences were compared for scores below versus at or above 30. Exploratory analyses separated former smokers from adults with fewer than 100 lifetime cigarettes and tested interaction by sex. Results: The adjusted PR per 5-point-lower score was 1.103 (95% confidence interval (CI), 1.020–1.192). Standardized smoking prevalence was 18.08% below 30 and 14.74% at or above 30; the difference was 3.34 percentage points (95% CI, 1.08–5.60). There was no clear evidence of sex-related heterogeneity on the PR scale (interaction p = 0.541), although the estimate among women was imprecise. Conclusions: Lower self-reported HLIC was associated with modestly higher smoking prevalence. The cross-sectional design precludes temporal inference, but the association may be relevant to the design and evaluation of accessible smoking-prevention and cessation services. Longitudinal and intervention studies are needed. Full article

Cigarette smoke exposure is a major preventable risk factor for respiratory disease and drives oxidative and inflammatory lung injury, highlighting the urgent need for safe, multi-target interventions beyond conventional anti-inflammatory therapy. Formononetin (FMN), a naturally occurring isoflavone with antioxidant, anti-inflammatory, and microbiota-modulating potential, may offer a dietary-botanical strategy against smoke-related pulmonary damage. This study evaluated FMN against cigarette smoke extract (CSE)-induced lung injury and explored its associations with intestinal barrier integrity, gut microbiota, taurine metabolism, SLC6A6 expression, and NF-κB activation. In a CSE-challenged mouse model, oral FMN, particularly at 70 mg/kg, improved body weight gain, reduced the lung index, attenuated pulmonary histopathological injury, restored GSH/GSSG and SOD, decreased MDA, and suppressed TNF-α, IL-1β, and IL-6 expression. FMN also ameliorated colonic injury and restored ZO-1 and occludin expression. Exploratory 16S rRNA sequencing and fecal metabolomics indicated FMN-associated alterations in gut microbial composition and metabolic profiles, with taurine and hypotaurine metabolism identified as a candidate pathway for further investigation. FMN further restored lung taurine content and SLC6A6 expression while inhibiting NF-κB activation. These findings suggest that FMN alleviates CSE-induced lung injury and that this improvement is associated with coordinated changes in gut microbiota composition, taurine metabolism, SLC6A6 expression, and NF-κB activation. Full article

Background: Academic pressure during examination periods is frequently reported alongside irregular lifestyle behaviors. The study aimed to explore the interplay between habitual eating behaviors, sleep quality, and self-reported stimulant use and coping adaptations specifically during examination periods among healthcare university students. Methods: This cross-sectional study included 265 university students (Mage = 22.00, SD = 4.46). Dietary behaviors and sleep quality were assessed using the Three-Factor Eating Questionnaire (TFEQ-R21) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Behavioral profiles, substance-use patterns, and attitudes toward academic pressure were examined using bivariate analyses, multivariate logistic regression, and TwoStep cluster analysis. Statistical analyses were performed using IBM SPSS Statistics version 26.0. Results: A high prevalence of poor sleep quality was observed, with 72.8% (n = 193) of participants meeting the clinical criterion for poor sleep (PSQI > 5.0; M = 7.79 ± 3.53), and high sleep disturbances were significantly associated with smoking, energy drink use, coffee escalation, general dietary supplement utilization, and smart-drug use. Multivariate analysis revealed that poor sleep quality (OR = 1.118, 95% CI [1.022, 1.222]) and younger age (OR = 0.843, 95% CI [0.735, 0.967]) were independently associated with higher odds of energy drink use. A distinct cognitive disconnect was observed in tobacco usage: conventional smoking was negatively associated with self-perceived health (OR = 0.401, 95% CI [0.182, 0.884]), whereas electronic cigarette use showed no significant association. TwoStep cluster analysis identified three distinct student typologies during exams: non-users (32.6%), poly-substance users (34.5%), and OTC supplement/caffeine users (33.0%), with active substance-utilizing profiles displaying significantly worse sleep quality and higher emotional eating. Conclusions: These findings highlight distinct cross-sectional lifestyle and coping patterns among healthcare students, emphasizing the need for targeted institutional interventions that support healthy behavioral adaptations and stress management during academic challenges. Full article

Background/Objectives: In the operating room, surgical staff are exposed to inhalation of smoke from the combustion of tissues when using electrocautery. By introducing HIPEC/peritonectomy in the treatment of malignant neoplasms of the peritoneum, exposure to smoke is significantly increased. To adequately perform this procedure, high-power monopolar cautery is used. The aim of this study was to assess carbon monoxide exposure associated with surgical smoke generated during peritonectomy procedures and to compare it with exposure during standard colorectal resections. Methods: In this prospective observational study, a total of 360 blood samples were collected and analyzed from surgeons participating in surgical procedures. The study cohort was divided into two groups: the HIPEC/peritonectomy group and the standard resection group. Blood samples were obtained from three surgeons who participated in a total of 30 procedures, comprising 15 HIPEC/peritonectomy procedures and 15 standard resection procedures. Samples were collected at the start of the intervention, at the 20th and 40th minutes, and at the end of procedures. Results: COHb values increased over time, and levels were higher in the peritonectomy group. An increase in MetHb levels was seen in HIPEC/peritonectomy, but not in the standard colorectal resection group. The observed values did not lead to symptoms of acute CO poisoning. Conclusions: The results suggest that the use of electrocautery increases carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels in surgical staff; however, these increases did not reach clinical significance. The long-term health consequences of repeated exposure to surgical smoke, as well as the effectiveness of personal protective equipment and smoke evacuation systems in reducing this exposure, should be investigated in future studies. Full article

Background/Objectives: The Winograd procedure is a widely utilized surgical option for treating ingrown toenails. However, there is a lack of comparative data regarding its outcomes in the presence of active infection. The objective of this study was to compare the clinical outcomes and complication rates of the Winograd procedure for great toe ingrown toenails between patients with and without chronic severe preoperative local infection. Methods: This retrospective study included 388 great toes that underwent the Winograd procedure for ingrown toenails between 2015 and 2025 with minimum 6 months’ follow-up. Cases were categorized into two groups based on the presence (Group 1, n = 76) or absence (Group 2, n = 312) of preoperative signs of severe local infection (abscess, granulation tissue formation, and/or foul odor). Demographic factors, and clinical outcomes, including postoperative infection rates, antibiotic duration, and recurrence rates, were evaluated and compared between the two groups. Results: Patients in Group 1 were significantly younger (29.7 vs. 39.5 years; p = 0.001) and had a higher smoking prevalence (11.8% vs. 5.1%; p = 0.033) than those in Group 2. Postoperatively, the mean duration of antibiotic administration (13.9 vs. 10.6 days; p = 0.114) and the incidence of superficial operative site infection (31.6% vs. 28.2%; p = 0.561) showed no significant differences between the two groups. Persistent infection lasting more than three weeks was comparable (15.8% vs. 11.5%; p = 0.313), with similar antibiotic durations in these cases (33.0 vs. 36.6 days; p = 0.094). Most importantly, the postoperative recurrence rate did not differ significantly between the two groups, with 13.2% in Group 1 compared to 15.3% in Group 2 (p = 0.625). Conclusions: Immediate Winograd procedure with radical excision of infected granulation tissue showed no statistically significant differences in postoperative complication or recurrence rates, even in patients with chronic severe preoperative local infection. These findings suggest that immediate surgical intervention can be considered a feasible treatment option for direct source removal. Full article

Background/Objectives: Tobacco use among young adults remains a public health concern. Understanding trends in tobacco and e-cigarette use may help inform future education and intervention strategies. This survey aims to assess tobacco and e-cigarette use and related perceptions over a 5-year period. Methods: A validated 33-item questionnaire was sent to students at a Midwestern university in Fall 2018, 2020, and 2023. The survey assessed tobacco use, e-cigarette use, and perceptions. Results: A total of 8143 student responses were collected over the 5-year period. A total of 3850 students participated in 2018, 1743 in 2020, and 2550 in 2023. Current traditional cigarette use declined over time (6.1%, 3.2%, 4.2%, respectively), while e-cigarette use decreased but remained the most common product (22.9%, 23.1%, 18.8%, respectively). Disagreement with the statements that imply e-cigarettes are a safe or effective option to quit smoking, and agreement with the stance that e-cigarettes are addictive, all increased during the 5-year period. Conclusions: These survey findings suggest a decrease in self-reported tobacco and e-cigarette consumption over the 5-year study period. Continued surveillance of local alongside national and global systems remains essential to determine whether specific sub-populations mirror the broader use patterns. Full article

Background/Objectives: Acute lower respiratory infections (ALRIs) are an important cause of morbidity among children under five years of age. This study aimed to identify factors associated with ALRI among children under five treated at a Peruvian emergency hospital. Methods: We conducted an observational, analytical, retrospective cross-sectional study using medical records of children treated in the pediatric emergency department of Hospital de Emergencias José Casimiro Ulloa, Lima, Peru, between January and December 2024. ALRI was defined as a physician-recorded diagnosis of pneumonia or bronchiolitis; the comparison group comprised children with acute bronchitis or upper respiratory tract infection. Crude and adjusted prevalence ratios (PRs) with 95% confidence intervals (CIs) were estimated using Poisson regression with robust variance. Results: The final sample included 322 children, of whom 154 (47.8%) had ALRI. In the adjusted model, age 0 to <2 years (aPR = 1.27; 95% CI: 1.03–1.56), absence of exclusive breastfeeding (aPR = 1.24; 95% CI: 1.02–1.51), birth weight < 1000 g (aPR = 1.43; 95% CI: 1.09–1.87), incomplete immunizations (aPR = 1.28; 95% CI: 1.07–1.53), and passive smoking exposure (aPR = 1.38; 95% CI: 1.15–1.65) were independently associated with higher ALRI prevalence. Conclusions: ALRI accounted for nearly half of the ARI diagnoses in this pediatric emergency analytical sample. Younger age, absence of exclusive breastfeeding, extremely low birth weight, incomplete immunizations, and passive smoking exposure were independently associated with ALRI and may help identify children requiring closer clinical assessment and preventive interventions. Full article

Background: Alcohol and tobacco use remain important public health concerns among people living with HIV (PLWH), even after achieving viral load suppression. This study examined the socio-demographic factors associated with alcohol and tobacco use among virally suppressed PLWH in the Eastern Cape Province, South Africa. Methods: A cross-sectional study was conducted among 244 adults receiving antiretroviral therapy with suppressed viral loads at public healthcare facilities in the Eastern Cape Province. Data were collected using the Alcohol Use Disorders Identification Test (AUDIT) and the WHO STEPwise questionnaire. Alcohol use was classified according to the AUDIT, and participants were further categorised into low-risk (AUDIT score < 8) and risky drinking (AUDIT score ≥ 8) for regression analyses. Associations between socio-demographic characteristics and alcohol use were initially examined using cross-tabulations and exact tests where appropriate. Univariable and multivariable binary logistic regression analyses were subsequently performed to identify factors independently associated with risky alcohol use and smoking. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results: Of the 244 participants, 57.0% were female, and 61.5% were employed. Based on the total AUDIT score, 60.2% of participants were classified as risky drinkers, while 44.3% were current smokers. In the multivariable analysis, employment was independently associated with risky alcohol use (AOR = 2.03, 95% CI: 1.11–3.73) and current smoking (AOR = 3.75, 95% CI: 1.98–7.08). Compared with single participants, married (AOR = 2.61, 95% CI: 1.25–5.45), separated (AOR = 5.19, 95% CI: 1.98–13.60), and divorced participants (AOR = 3.32, 95% CI: 1.05–10.49) had higher odds of risky alcohol use. Conclusion: Alcohol use and tobacco smoking remain common among virally suppressed PLWH in the Eastern Cape Province. Although viral load suppression is an important treatment outcome, it does not fully reflect broader health behaviours that may compromise long-term health. Integrating routine screening for alcohol and tobacco use, together with targeted behavioural interventions and harm reduction strategies, into comprehensive HIV care may improve long-term health outcomes. Full article

Tobacco use remains one of the leading preventable causes of morbidity and mortality worldwide, contributing to more than 7 million deaths annually and imposing a substantial economic burden on healthcare systems and global productivity. The addictive properties of tobacco are primarily mediated by nicotine, which exerts its effects through neuronal nicotinic acetylcholine receptors (nAChRs) within brain reward circuits. Among these receptor subtypes, α4β2-containing nAChRs play a central role in nicotine dependence by regulating dopaminergic signaling associated with reinforcement, craving, withdrawal, and relapse. Repeated nicotine exposure induces neuroadaptive changes in receptor expression and neural circuitry, contributing to the chronic and relapsing nature of addiction. Advances in addiction neuroscience and receptor pharmacology have enhanced the understanding of nicotine-mediated signaling and facilitated the development of evidence-based smoking cessation therapies. Current treatment approaches include nicotine replacement therapies, antidepressant-based interventions, and partial nAChR agonists such as varenicline and cytisine. Emerging strategies encompass subtype-selective ligands, allosteric modulators, immunotherapeutics, neuromodulation techniques, and digital health technologies aimed at improving cessation outcomes. This review summarizes the neuropharmacological mechanisms underlying nicotine addiction and critically examines current and emerging therapeutic strategies, highlighting their mechanisms of action, clinical efficacy, limitations, and future potential for tobacco cessation. Full article

Background: Patients with coronary artery disease (CAD) receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remain at risk of early adverse outcomes, including in-hospital mortality. Simple risk stratification based on routinely available variables may help identify higher-risk patients, but a limited number of outcome events constrains robust prediction-model development and validation. Aim: This exploratory study aimed to derive a preliminary, interpretable clinical score based on routinely available variables for risk stratification of all-cause in-hospital mortality in CAD patients receiving DAPT after PCI. In the clopidogrel-dominant practice setting of the participating centers, the score was conceived as a hypothesis-generating risk-enrichment framework rather than a validated treatment-selection tool or a surrogate measure of platelet reactivity. Methods: We analyzed a retrospective cohort of 1600 adults with CAD admitted between 2022 and 2024; 36 in-hospital deaths occurred. Twenty demographic, clinical, laboratory, and instrumental variables were evaluated. The primary outcome was all-cause in-hospital mortality during the index hospitalization. For exploratory score derivation, the dataset was randomly divided into a derivation subset (75%; n = 1200) and a hold-out assessment subset (25%; n = 400). Predictors were explored using univariable and multivariable logistic regression with stepwise selection. Continuous variables were categorized using Weight of Evidence binning, and an integer point score was derived. Performance was summarized using ROC analysis, AUC, sensitivity, specificity, and accuracy. Given the small number of deaths and the data-driven modelling workflow, all performance estimates were considered preliminary rather than definitive internal validation. Results: The exploratory six-variable score included age ≥ 57 years, estimated glomerular filtration rate < 45 mL/min/1.73 m², body mass index ≥ 25 kg/m², troponin I ≥ 100, prior myocardial infarction, and current smoking. In the derivation subset, each additional point was associated with higher odds of mortality (OR 1.39; 95% CI 1.29–1.51; p < 0.001), and the AUC was 0.654. A Youden-index threshold of approximately 6 points yielded sensitivity of 0.41, specificity of 0.80, and accuracy of 0.72. In the hold-out assessment subset, sensitivity was 0.53, specificity was 0.70, accuracy was 0.70, and AUC was 0.61. These estimates indicate modest discrimination and should be interpreted cautiously because only 36 outcome events were available. Conclusions: This exploratory clinical score showed modest discrimination for all-cause in-hospital mortality and should be regarded as a preliminary, hypothesis-generating risk-stratification approach. It is not sufficiently validated for routine prognostic classification, platelet-reactivity triage, or antiplatelet treatment selection. Model redevelopment using event-efficient methods, resampling-based internal validation, and subsequent external validation are required before clinical implementation. Full article

Type 2 diabetes mellitus (T2DM) is increasingly managed through lifestyle measures, yet the value of pairing structured exercise with a well-characterised phytotherapeutic adjunct remains poorly defined. We examined whether adding Nigella sativa (NS) to combined aerobic and resistance exercise (EX) yields greater improvements in metabolic, inflammatory, and oxidative-stress markers than exercise alone in men with T2DM. In this three-arm randomised controlled trial, 90 sedentary, non-smoking men (aged 40–60 years; T2DM duration > 2 years; glycated haemoglobin (HbA1c) 6.5–9.0%; body mass index (BMI) < 30 kg/m²) were allocated 1:1:1 to control, EX, or EX + NS (2 g/day; n = 30 per group) for four weeks. Fasting blood samples obtained before and after the intervention were used to measure glycaemic indices (fasting blood glucose (FBG) and fructosamine), a lipid panel (total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c)), inflammatory markers (tumour necrosis factor-α (TNF-α), interleukin-4 (IL-4), and adiponectin), and oxidative-stress markers (thiobarbituric acid–reactive substances (TBARS) and catalase activity). Outcomes were analysed by two-way repeated-measures analysis of variance (time × group), with partial eta-squared (η_p²) and 95% confidence intervals (CIs) reported for all principal effects. Relative to control, both exercise arms significantly improved body composition and glycaemic, lipid, inflammatory, and oxidative-stress profiles (all p < 0.05). The time × group interaction was significant for every outcome except systolic and diastolic blood pressure and triglycerides. Compared with EX alone, EX + NS produced significantly greater improvements in FBG, HDL-C, TBARS, and catalase activity; changes in fructosamine, total cholesterol, TNF-α, IL-4, and adiponectin favoured EX + NS directionally but did not reach significance after correction for multiple comparisons. Triglycerides, LDL-C, and blood pressure did not differ between the two exercise arms. These hypothesis-generating findings support NS as a candidate adjunct to structured exercise for selected metabolic and redox outcomes, and warrant larger, longer, sex-balanced confirmation. Full article

Dry eye disease (DED) is a complex ocular surface disorder characterized by tear film instability, discomfort, hyperosmolarity, inflammation, and neurosensory dysfunction. Since individuals spend a significant amount of time inside buildings, exposure to indoor environments has emerged as a noteworthy and adjustable factor influencing ocular surface disorders. This analysis consolidates recent findings connecting indoor air contaminants, such as particulate pollutants, volatile organic substances, formaldehyde, and other gaseous irritants, as well as tobacco and cooking fumes, heavy metals, organophosphate flame retardants, and liquid crystal compounds, with the mechanisms and symptoms associated with DED. Research suggests that indoor environmental factors can exacerbate DED by triggering interconnected mechanisms such as oxidative damage, inflammation, lipid degradation, meibomian gland issues, decreased tear production, impairment of goblet cells and the mucin layer, disruption of tight junctions, and damage to the corneal or conjunctival epithelium. The most robust clinical evidence currently pertains to tobacco smoke, particulate matter, indoor air pollution, low humidity, and poor ventilation. In contrast, although biological plausibility exists for heavy metals, flame retardants, and liquid crystal monomers, the supporting data remain relatively sparse, indirect, and less comprehensive. Harmonized exposure assessments, prospective cohort studies, analyses of pollutant mixtures, and experimental intervention trials are needed to better characterize dose–response relationships and to establish effective preventive measures. Assessment of environmental history and improvement of indoor air quality should be regarded as integral and interrelated components in the prevention and management of DED. Full article

Objective: To evaluate current and emerging perioperative optimization strategies in genitourinary surgery and assess their potential to improve surgical outcomes, particularly in patients with modifiable risk factors. Methods: A literature review was conducted using PubMed databases examining perioperative interventions relevant to patients undergoing surgery for genitourinary cancers. Areas of focus included enhanced recovery after surgery protocols, nutritional optimization, exercise prehabilitation, smoking cessation, glucagon-like peptide-1 receptor agonists, and gut microbiome modulation. Evidence from clinical trials, observational studies, systematic reviews, and current clinical guidelines was reviewed and synthesized. Results: Current evidence supports the use of enhanced recovery after surgery protocols to reduce acute complications, shorten length of stay and decrease recovery time. Nutritional optimization and exercise prehabilitation demonstrated improved functional and metabolic capacity. Smoking cessation improved wound healing and decreased pulmonary and infectious complications. Emerging evidence suggests GLP-1 RAs offer metabolic benefits, and microbiome-targeted interventions may improve postoperative recovery through gut microbiome diversity preservation, although clinical data remains limited. Conclusions: Perioperative strategies demonstrate promising potential to improve outcomes in patients undergoing genitourinary surgeries by addressing modifiable risk factors. Further prospective studies are needed to guide clinical implementation. Full article

Background: Former and current smokers in lung cancer screening remain at elevated risk for lung cancer despite smoking cessation. We and others have shown that curcumin (CUR) exhibits anti-inflammatory and antiproliferative effects but is limited by poor bioavailability. However, since CUR is lipophilic, co-administration with ω-3 FAs represents a mechanistically rational strategy to enhance delivery and target complementary pathways, including signal transducer and activator of transcription 3 (STAT3) and the transcription factor NF-κB (NF-κB) signaling for lung cancer chemoprevention. Methods: We conducted a randomized, single-blind, placebo-controlled Phase II pilot study evaluating CUR combined with ω-3 FAs in high-risk former and current smokers with CT-detected pulmonary nodules. Participants received intervention agents with active-dose groups (low dose = 3; high dose = 9) or a placebo (n = 7) for 6 months. Primary endpoints included radiologic changes in nodule size, number, and density. Secondary endpoints included safety, adherence to the study agent and exploratory biomarker analyses. Correlation analyses of imaging-derived metrics were performed to assess relationships among LDCT parameters. Results: Nineteen participants were enrolled (intervention, n = 12; placebo, n = 7). Eighteen (11 intervention, 7 placebo) subjects completed post-intervention imaging. One subject was unable to complete follow-up and study-related procedures. Data from the treatment arms were pooled for analysis and comparison with the placebo arm. No statistically significant between-group differences were observed in primary imaging endpoints. The intervention was well tolerated, with predominantly grade 1 adverse events. Exploratory analyses demonstrated consistent positive correlations among established imaging biomarkers, with clustering of size-based metrics (mean diameter, volume, sum of longest diameters) and density-based parameters. Multidimensional scaling supported this structure, indicating internal coherence among imaging-derived endpoints. Conclusions: Although no statistically significant treatment effect on the image biomarkers was observed, this pilot study demonstrates feasibility challenges and identifies coherent imaging biomarkers that may serve as intermediate endpoints in early-phase chemoprevention trials. These results support further investigation of strategies utilizing agent combinations with enhanced bioavailability and safety and refinement of trial design in high-risk lung cancer patient populations. Full article