Search Results (2,970)

Background: Obesity is a multisystemic health problem causing chronic diseases like diabetes or cardiovascular diseases, but also reproductive dysfunctions like infertility in adults or altered puberty onset in children. Exercise is a recognized intervention to control or prevent energy imbalance, thus deeply contributing to metabolic health in physiological and pathological conditions. The kisspeptin system (KS), the main gatekeeper of reproduction and puberty onset in mammals, is also an upcoming “metabolic sensor”, linking energy homeostasis to reproductive ability both centrally and peripherally. Objectives: This narrative review aims at summarizing recent evidence from animal models and human studies on the role of the KS in energy homeostasis, with a focus on the upcoming role of the KS as a metabolic sensor able to modulate the functionality of the hypothalamus–pituitary–gonad axis in males as an adaptive response to exercise. Methods: PubMed and Scopus search (date: 2015–2025; keywords: kisspeptin and metabolism, male reproduction or exercise; kisspeptin and doping). Results and Conclusions: This review article illustrates the crucial role of the KS in linking energy homeostasis and male reproduction at the central and peripheral levels, and modulation of the KS by exercise in physiological and pathological conditions. Due to the large amount of data from animal models, knowledge gaps occur in the analysis of the relationship among KS, energy homeostasis, male reproduction and exercise in humans, particularly in the case of overtraining. Lastly, kisspeptin inclusion in the doping list is also discussed. Full article

Atherosclerosis is now recognized as a chronic inflammatory disease of the arterial wall, in which perivascular adipose tissue (PVAT) has evolved from a passive structural component to a key player in regulating vascular homeostasis and the pathophysiology of atherosclerosis, playing an active, not just structural, role. PVAT surrounds blood vessels and influences them metabolically, immunologically, and vascularly by secreting adipokines, cytokines, and other bioactive mediators. Under physiological conditions, PVAT has protective roles, as it produces adiponectin, nitric oxide (NO), and other vasodilatory factors that help maintain vascular tone and reduce inflammation. In particular, brown-like PVAT (rich in Uncoupling Protein-1 (UCP1) and mitochondria) offers significant vasoprotective effects. Under pathological conditions (obesity, dyslipidemia, insulin resistance), PVAT undergoes a phenotypic transition towards a pro-inflammatory profile by increasing leptin, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) secretion and decreasing adiponectin, contributing to endothelial dysfunction, vascular smooth muscle cell (VSMC) proliferation, local immune cell recruitment, extracellular matrix (ECM) remodeling, and fibrosis. PVAT plays a complex role in vascular health and disease, interacting with systemic metabolism through the secretion of bioactive molecules. Metabolic imbalances can promote PVAT inflammation. Epigenetic alterations and micro ribonucleic acid (miRNAs) can influence PVAT inflammation, and modern imaging methods for PVAT assessment, such as the fat attenuation index (FAI) and artificial intelligence-assisted radiomic profiling, may become predictive biomarkers of cardiac risk. Future directions aim to identify biomarkers and develop targeted therapies that modulate PVAT inflammation and dysfunction in the context of cardiovascular diseases. Full article

Periodontal disease is a widespread chronic condition linked to systemic illnesses such as cardiovascular disease, diabetes, and adverse pregnancy outcomes. Despite its global burden, population-specific studies on its risk factors remain limited, particularly in Central and Eastern Europe. The SANA-biome Project is a cross-sectional, community-based study designed to investigate the biological and social determinants of periodontal disease in Romania, a country with disproportionately high oral disease rates and minimal microbiome data. This protocol will integrate metagenomic, proteomic, and metabolomic data of the oral microbiome from saliva and dental calculus samples with detailed sociodemographic and lifestyle data collected through a structured 44-question survey. This study is grounded in two complementary frameworks: the IMPEDE model, which conceptualizes inflammation as both a driver and a consequence of microbial dysbiosis, and Ecosocial Theory, which situates disease within social and structural contexts. Our aims are as follows: (1) to identify lifestyle and behavioral predictors of periodontal disease; (2) to characterize the oral microbiome in individuals with and without periodontal disease; and (3) to evaluate the predictive value of combined microbial and sociodemographic features using statistical and machine learning approaches. Power calculations based on pilot data indicate a target enrollment of 120 participants. This integrative approach will help disentangle the complex interplay between microbiological and structural determinants of periodontal disease and inform culturally relevant prevention strategies. By focusing on an underrepresented population, this work contributes to a more equitable and interdisciplinary model of oral health research and supports the development of future precision public health interventions. Full article

Multimorbidity, or the presence of two or more co-occurring chronic medical conditions, is extremely prevalent within the United States (US), with disproportionately high incidence rates in individuals with minoritized identities. Sleep disturbances are an empirically supported risk factor contributing to disease status and maintenance throughout the lifespan. Given this, this study examines the relationship between disturbed sleep and multiple chronic conditions (MCCs) in adults using cross-sectional data from (n = 1013) participants enrolled in the Survey of Midlife Development in the US Study (MIDUS-2). Participants within this study were predominantly female (54.9%), white (93.2%), middle-aged (M_AGE = 58 years old), and experienced multimorbidity (56.6%) by having two or more (M_CHRON = 2.25) chronic health conditions in the past year. A negative binomial regression indicated that sleep disturbances significantly predict the number of chronic health conditions, with sleep-disturbed individuals reporting a 41% increase in reported health conditions (IRR = 1.407, p < 0.001). Findings suggest that disturbed sleep is significantly related to disease presence in aging populations and should be addressed through early intervention to mitigate negative health consequences. Full article

Obesity has become a major public health crisis and serves as an underlying condition for other chronic metabolic diseases. The dysregulation of the inhibitory and regulatory mechanisms of the mesolimbic dopamine system, particularly dopamine D2 receptors (D2Rs), plays a critical role in driving excessive food consumption and compulsive eating habits. Based on the current literature, chronic consumption of high-fat foods elicits hedonic sensations and has the potential to downregulate and desensitize D2Rs, impairing their signaling and inhibitory action. This impairment thereby alters the downstream signaling of the D2Rs, involving the inhibition of adenylyl cyclase and the associated cascade. Although individual components of this proposed pathway have been studied, a comprehensive synthesis has not been established. This review aims to explore the relationship between D2R downregulation and desensitization and their effects on the downstream signaling cascade. We hypothesize that alterations in this pathway may lead to the dysregulation of the expression of orexigenic and anorexigenic neuropeptides, contributing to binge-eating behaviors. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition with high morbidity and mortality, often accompanied by comorbidities such as alcohol use disorder (AUD). A thorough understanding of the interaction between COPD and AUD is crucial for improving patient outcomes and addressing management challenges. Objectives: This study analyzed temporal trends, clinical characteristics, and hospital outcomes associated with AUD among adults hospitalized with COPD in Spain between 2016 and 2023. Methods: A population-based cohort study was conducted using the Spanish Hospital Discharge Registry. We included adults aged ≥40 years with a diagnosis of COPD. AUD was identified through ICD-10 codes. Temporal trends in AUD prevalence were evaluated using Joinpoint regression, stratified by sex. We also assessed clinical characteristics including pneumonia, obesity, asthma, obstructive sleep apnea (OSA), supplemental oxygen use, long-term steroid use, and mechanical ventilation. Outcomes analyzed included ICU admission and in-hospital mortality (IHM). Results: Among 2,545,151 COPD hospitalizations, 263,568 (10.35%) had an AUD diagnosis. AUD prevalence rose from 8.66% in 2016 to 12.57% in 2023, with a sharper increase in women. Patients with AUD were younger and had higher rates of tobacco use (84.11% vs. 49.33%; p < 0.001) and psychiatric disorders. Multivariable analysis showed male sex, substance use, psychiatric illness, and external cause admissions were independently associated with AUD. Although overall IHM was lower in AUD patients (7.46% vs. 8.2%; p < 0.001), it increased with age, pneumonia, COVID-19, and higher comorbidity. IHM rose progressively, peaking in 2023 (15.6%). Conclusions: AUD prevalence in COPD hospitalizations increased significantly, especially in women. IHM also rose over time. These results highlight the need for integrated approaches targeting mental health and substance use in COPD management. Full article

Background: Migraine and chronic periodontitis are prevalent conditions that may share common inflammatory and neurovascular pathways. Growing evidence suggests an association between periodontal inflammation and migraine, yet large-scale population-based studies are limited. Objective: To investigate the association between chronic periodontitis and the occurrence of migraine using a nested case-control design in a nationally representative Korean adult cohort. Methods: This study utilized data from the Korean National Health Insurance Service-Health Screening Cohort (2002–2019). A total of 43,359 individuals diagnosed with migraine (ICD-10: G43) were matched 1:4 by age, sex, income, and residence with 173,436 controls. Chronic periodontitis was identified using ICD-10 code K053. Conditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, behavioral, and clinical covariates. Results: A significant association was observed between chronic periodontitis and migraine. Individuals with at least one diagnosis of periodontitis within one year prior to migraine onset had increased odds of migraine (adjusted OR = 1.10, 95% CI: 1.08–1.13). Similar associations were observed for two diagnoses within one year (OR = 1.05; 95% CI: 1.01–1.09) and one diagnosis within two years (OR = 1.10; 95% CI: 1.08–1.13). No association was found with three or more diagnoses in one year. Subgroup analyses confirmed consistent associations across migraine subtypes and demographic strata. Conclusions: This study demonstrated a statistically significant association between chronic periodontitis and migraine, suggesting a potential shared inflammatory or neurovascular mechanism. Recognizing periodontal disease as a modifiable factor may offer new insights into migraine prevention and management. Further longitudinal and interventional studies are warranted to establish causality. Full article

Adherence to medications is a significant challenge in chronic disease management. Poor adherence can lead to adverse patient outcomes including disease progression, increased morbidity, reduced quality of life, higher hospitalization rates, increased medical costs, and mortality. Medical adherence is a complex issue, influenced by multiple factors, including patient-related, medication-related, and healthcare system-related barriers. This review explores reasons for both intentional non-adherence, such as patients underestimating the consequences of the disease, inadequate education or poor healthcare provider–patient communication, and unintentional non-adherence, including forgetfulness, pathophysiological barriers, socioeconomic barriers (including lifestyle and patient factors), or healthcare resource limitations. Multifaceted, patient-tailored interventions that could improve adherence are discussed, including promoting health education, enhancing healthcare provider–patient engagement, and exploring alternative medical solutions and emerging technological advances. No single approach fits all; this review aims to deepen the understanding of intentional and unintentional non-adherence and to inform targeted interventions to empower patients, foster trust, and improve adherence for those with chronic conditions. Full article

High blood pressure, or hypertension, remains a leading risk factor for cardiovascular disease, contributing significantly to global morbidity and mortality, particularly in Caribbean island nations like Curaçao. This pilot study assessed the impact of a health fair led by Community Health Workers (CHWs) or Promotornan di Salú and organized in collaboration with local faith-based organizations to increase hypertension awareness and promote preventive behaviors. The study utilized a cross-sectional design, and data were gathered from attendees at a health fair held on 29 June 2024, at the Iglesia House of Worship in Willemstad, Curaçao. A structured questionnaire was used to collect demographics, event satisfaction, health behavior intentions, and qualitative feedback data from participants aged 12 years and older. Of the 145 participants, 78.6% rated the event as excellent, 83.4% expressed plans to change their health behaviors, 80.6% intended to share information with family and friends, and 59.7% intended to follow up with a general practitioner (GP)/doctor. These findings highlight the effectiveness of culturally tailored, community-based initiatives to raise hypertension awareness, improve health literacy, and promote preventive health behaviors. The success of this intervention emphasizes the potential of CHW-led health fairs as valuable public health strategies and practical training opportunities for reducing the burden of chronic conditions like hypertension. Full article

Background: Adhesive small bowel obstruction (ASBO) is a common and challenging surgical condition. In the absence of peritonitis, bowel ischemia, or clear surgical indicators on CT imaging, the initial management is typically non-operative. While clinical and radiological factors influencing non-operative management (NOM) are well described, the role of age and chronic health conditions remains less well defined. The primary aim of this study was to evaluate the incidence of NOM failure in patients with various comorbidities. Methods: This study utilized data from the National Inpatient Sample to analyze cases of ASBO between 2016 and 2019. Collected data included demographics, diagnosis, presence of chronic health conditions (diabetes mellitus, congestive heart failure, chronic kidney disease, chronic pulmonary diseases, peripheral vascular disease), length of hospital stay, and mortality. Patients were divided into two groups: Group A (18–65 years) and Group B (>65 years). We compared demographics comorbidities, NOM failure rates, and mortality between the groups. Univariate analysis was performed to assess age and comorbidities and risk factors for NOM failure in each group, followed by multivariable analysis within each group. Results: A total of 1,611,099 admissions with ASBO were identified in the NIS database; 63.03% were females. The failure rate of NOM in patients without comorbidities was 21%, compared to 26.5% in patients with one or more comorbidities. In Group A, 20% of patients required surgery, compared to 26.2% of patients in Group B (p = 0.001). Conclusions: Being aged over 65 and the presence of chronic health disease, excluding diabetes mellitus, are independent predictors of NOM failure in patients with ASBO. The presence of multiple comorbidities further increases the risk of NOM failure. Full article

Diabetes mellitus (DM) poses an increasingly high global health burden nowadays, while in adults, chronic kidney disease (CKD) associated with DM impacts 20–40% of those with the condition. Effective management of CKD in patients with diabetes necessitates a comprehensive, multidisciplinary approach. Numerous factors, including glomerular hyperfiltration, oxidative stress, inflammation, and hypoxia are linked to the advancement of diabetic kidney disease (DKD). Currently, no specific treatment for DKD has been established, prompting extensive exploration of new approaches. Renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter 2 inhibitors have demonstrated renoprotective effects in various human clinical trials. Additionally, glucagon-like peptide 1 receptor agonists and mineralocorticoid receptor antagonists have been reported as effective in managing DKD, while new therapeutic candidates are also under investigation, such as soluble guanylate cyclase activators and aldosterone synthase inhibitors. Recent evidence has shown that treating diabetic nephropathy by reducing albuminuria levels and retarding its progression is a complex skill. The purpose of this review is to support the impressive results that appear in reducing albuminuria and the progression of diabetic nephropathy with early and intensive combination treatment compared to the recently emerged conventional monotherapy, with agents that act on different pathophysiological mechanisms. Full article

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 day/week), medium (2–4 days/week), or high (≥5 days/week). All-cause mortality was tracked through verified records. Cox proportional hazards models were used to estimate hazard ratios (HRs), with adjustments for demographics, lifestyle factors, and baseline health conditions. Results: A total of 2092 participants (mean age = 63.7 ± 10.4 years) were included in the final analytic sample. Higher physical activity frequency was significantly associated with lower mortality in unadjusted models. Participants engaging in activity ≥5 days/week had a 67% reduced mortality risk compared to the low-frequency group (HR = 0.33, p < 0.001). However, after adjusting for health-related covariates, the protective effect was attenuated and no longer statistically significant. In the fully adjusted model, advanced age, current smoking, and ADL limitations emerged as the strongest independent risk factors for mortality, while being married and residing in a rural area were significantly protective effects. Conclusions: The association between frequent physical activity and reduced mortality risk among Chinese older adults is profoundly mediated by baseline health status and functional capacity. These findings highlight the importance of integrated, multifactorial public health interventions that address chronic disease management and functional rehabilitation alongside physical activity promotion. Full article

Chronic pain is a significant and complex health condition characterized by persistent or recurrent pain lasting more than three months. Exercise-based rehabilitation is an effective non-pharmacological intervention, yet its underlying mechanisms have not been fully elucidated. This review systematically maps the molecular pathways of exercise-induced analgesia onto the pathophysiological cascades of chronic pain, aiming to fill a key gap in the current literature. It explores the molecular and cellular mechanisms underpinning the pathophysiology of chronic pain, indicating that the persistence of chronic pain stems from peripheral sensitization driven by inflammatory mediators and central sensitization involving glial cell activation and N-methyl-D-aspartate (NMDA) receptor-mediated neuroplasticity. Exercise can interrupt these pathological cascades through multi-system adaptations, including activation of the endogenous opioid and serotonergic systems activation and anti-inflammation. However, a significant gap remains in translating this mechanistic understanding of chronic pain into optimized, personalized exercise prescriptions, requiring future research into different exercise modalities, sex-specific responses, and the impact of comorbidities. Full article

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities in adoption have emerged, particularly in rural and underserved populations. This study aims to evaluate the impact of telemedicine on patient satisfaction before and during the pandemic, with a focus on chronic disease management—notably hypertension—and to identify factors influencing the equitable adoption of telehealth. Methods and Procedures: This study used a mixed method approach, combining quantitative survey data and causal loop modeling to analyze patient satisfaction levels and the interplay between telehealth adoption, healthcare access, and demographic disparities. Patient-reported satisfaction data were collected in two time periods—before and during the pandemic. Causal modeling was used to explore systemic relationships between provider support, technology access, patient engagement, and health equity. Results: The findings revealed that telemedicine significantly enhanced healthcare access during the pandemic, with a notable increase in patient satisfaction scores. Patients with chronic conditions, especially those diagnosed with hypertension, reported the improved continuity of care and reduced geographic barriers. However, disparities in telehealth access were more pronounced in non-metropolitan areas and among older adults and minority populations. Causal analysis highlighted key enablers of telehealth success, i.e., provider support, digital literacy, and access to reliable internet and devices. Conclusions: Telemedicine presents a transformative solution for equitable healthcare delivery, especially in chronic disease management. Strategic efforts are needed to address adoption disparities and ensure the sustained and inclusive integration of telehealth after the pandemic. Full article

Objective: We aimed to quantify multiple sclerosis (MS)-related work productivity and to illustrate the longitudinal trends for relapses, disease progression, and utilization of health care resources in a nationally representative cohort of working North Americans living with MS. Background: The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) is a multicentered physician-reported registry which prospectively collects clinical information including imaging data over a long period of time from people with MS from sites across the U.S. and Canada. The Health Economics Outcomes Research (HEOR) Advisory Group has also incorporated Health-Related Productivity and Health Resource Utilization questionnaires, which collect information about health care economics of people with MS and its effects on daily life. Design/Methods: This is a prospective observational study utilizing data from NARCRMS. Socio-demographic, clinical, and health economic outcome data were collected through previously validated and structured questionnaires. Logistic regression was used to calculate the relative odds of symptom impact, with a generalized logit link for number of relapses. Cox proportional hazards regression was used to calculate hazard ratios for time to first relapse. Results: Six hundred and eighty-two (682) people with MS were enrolled in NARCRMS and had completed the HEOR questionnaires at the time of the analysis. Among the participants, 61% were employed full-time and 11% were employed part time. Fatigue was the leading symptom reported to impact both work and household chores. Among the employed participants, 13% reported having missed work with a median of 6.8 (IQR: 3.0–9.0) missed hours due to MS symptoms (absenteeism), while 35% reported MS having impacted their work output (presenteeism). The odds of higher disease severity (EDSS 2.0–6.5 vs. 0.0–1.5) were 2.29 (95% CI = 1.08, 4.88; p = 0.011) times higher for participants who identified reduction of work output. Fatigue was the most identified symptom attributed to work output reduction. Among all participants, 33% reported having missed planned household work with a median of 3.0 (IQR: 2.0–5.0) hours. The odds of higher disease severity were 2.49 (95% CI = 1.37, 4.53; p = 0.006) times higher for participants who identified reduction in household work output, and 1.70 (CI = 1.27, 2.49; p = 0.006) times higher for those whose fatigue affected housework output as compared to other symptoms. Conclusions: A preliminary review of the first 682 patients showed that people with MS had reduced work and housework productivity even at an early disease state. Multiple sclerosis (MS) can significantly impair individuals’ ability to function fully at work and at home, with fatigue overwhelmingly identified as the primary contributing factor. The economic value of finding an effective treatment for MS-related fatigue is substantial, underscoring the importance of these findings for policy development, priority setting, and the strategic allocation of healthcare resources for this chronic and disabling condition. Full article