Search Results (13,378)

Background: Irritable bowel syndrome (IBS) is a chronic disorder of brain–gut interaction closely linked to psychological stress and highly prevalent among university student populations, yet data from Bahrain remain scarce. This study estimated the frequency of self-reported IBS-like symptoms among university students in Bahrain and examined their associations with sex, age, qualification level, body mass index (BMI), psychological stress, and lifestyle behaviors. Methods: A cross-sectional, online questionnaire-based survey was conducted among 310 students at the University of Bahrain in October 2021. A self-administered 16-item instrument, based on the Rome III symptom domains and used as a symptom-screening rather than a diagnostic tool (face validity only; no formal psychometric validation was performed), assessed sociodemographic characteristics, self-reported IBS-like symptoms, stress and anxiety, and lifestyle behaviors. Data were analyzed using chi-square tests and one-way ANOVA; effect sizes were quantified using Cramér’s V (chi-square) and partial eta-squared (η², ANOVA); the significance threshold was α = 0.05 (two-tailed). Results: Self-reported IBS-like symptoms were common: 52.9% (95% CI 47.3–58.4) reported recurrent abdominal pain, 58.1% (95% CI 52.5–63.4) abdominal bloating, and 80.3% (95% CI 75.5–84.4) reported interference with academic activities. Most participants perceived their mental state (84.8%) and examinations (73.2%) to worsen symptoms, yet only 48.7% correctly identified IBS. Exploratory subgroup analyses suggested differences by qualification level, with diploma-level students reporting higher rates of abdominal pain (p < 0.001; Cramér’s V = 0.22), bloating (p < 0.05; Cramér’s V = 0.13), and perceived psychological impact on symptom severity (p < 0.001; Cramér’s V = 0.19) compared with bachelor- and master-level counterparts. The substantial female over-representation (79%) precluded formal sex-based inference; all findings should be interpreted in this context. Conclusions: Self-reported IBS-like symptoms were commonly endorsed, and participants frequently perceived psychological stress to worsen symptoms. Diploma-level students may represent a previously unrecognized potentially at-risk subgroup warranting further investigation and, if confirmed, targeted stress-focused health-promotion strategies, particularly through brief psychoeducation modules integrated within diploma-program curricula, and dedicated prospective research. Future studies should incorporate validated Rome IV diagnostic criteria, multivariable regression modeling, and biomarker assessment to elucidate underlying brain–gut mechanisms. Full article

Background: Inequitable access to clinical trials persists in blood cancers despite ongoing equity, diversity, and inclusion (EDI) efforts. Despite the critical role of clinical trials in improving survival and outcomes, recruitment remains suboptimal, limiting patient access to potentially life-saving therapies. Practical and scalable approaches are therefore needed to address the non-medical barriers that hinder patient readiness upstream of enrolment. Methods: Myeloma Canada led a national, multi-phase initiative using human-centred design (HCD) to operationalize EDI in clinical trials. Following an initial systems level workshop, the two-day Phase 0 workshop used a HCD approach that convened a purposively selected multidisciplinary group of stakeholders to co-design operational solutions for non-medical barriers affecting trial participation for patients. Given the use of purposive sampling, the results should be interpreted as reflecting a balanced range of diverse, informed perspectives across the Canadian clinical trial ecosystem. Results: Participants identified persistent cultural, logistical, financial, and linguistic barriers, along with fragmented awareness of available supports. Across diverse personas and care settings, all groups independently converged on a human-centred, equity-focused pre-trial navigation model supported by simple digital tools, including AI-enabled infrastructure drawing on curated resources from validated sources with appropriate governance, privacy, and oversight. Digital tools were proposed to support, rather than replace, human support and to align with existing health system realities. Conclusions: This hypothesis-generating work proposes a feasible, sustainable, and scalable equity-embedded, protocol-agnostic navigation framework. Its external hub-and-spoke structure can reduce non-medical barriers, strengthen trial access and accrual, and enhance representativeness. Pilot implementation that assesses feasibility, uptake, workflow impact, equity effects, and implementation burden is warranted. Full article

Background/Objectives:BCR::ABL1-negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF), are clonal hematopoietic stem cell disorders characterized by chronic systemic inflammation and elevated thrombotic risk. Osteoarthritis (OA), the most prevalent joint disease globally, is common in MPNs and shares a common proinflammatory cytokine milieu with MPNs. However, whether symptomatic OA may independently impact MPN-related symptom burden and thrombotic outcomes remains unexplored. Methods: In this prospective two-center study conducted in Croatia (2021–2023), 107 consecutive MPN patients diagnosed by 2016 World Health Organization criteria underwent orthopedic evaluation and completed the MPN Symptom Assessment Form (MPN-SAF) at enrolment. Symptomatic OA was defined as radiographic grade ≥1 (Kellgren–Lawrence) with concordant symptoms. Patients were subsequently followed for thrombotic events. Multiple linear regression and Cox proportional hazards regression were used for multivariable analyses. Results: Symptomatic OA was identified in 64 patients (59.8%). The total symptom score (TSS) was significantly higher in OA patients (p < 0.001), and in multivariable analysis, OA independently predicted higher TSS (β 10.12, 95% confidence interval-CI 5.38–14.86, p < 0.001), alongside female sex and arterial hypertension. Over a median follow-up of 44 months, 10 thrombotic events occurred. Patients with symptomatic OA had significantly worse time to thrombosis (hazard ratio-HR 3.61, 95% CI 1.02–12.8, p = 0.046). In multivariable Cox regression, OA remained associated with thrombosis (HR 15.55, p = 0.002), while female sex (HR 0.17, p = 0.042) and aspirin use (HR 0.15, p = 0.019) were protective. Conclusions: Symptomatic OA may be associated with higher symptom burden and, in this preliminary analysis, with higher thrombotic risk in MPNs. These findings support systematic OA evaluation in MPNs and multidisciplinary management strategies targeting this frequent and burdensome comorbidity. Full article

Background/Objectives: The increasing prevalence of electronic nicotine delivery systems (ENDS) has prompted questions regarding their effects on periodontal health. While the detrimental impacts of cigarette smoking are well-established, the periodontal implications of ENDS use remain poorly understood. This narrative review aimed to evaluate current evidence comparing periodontal parameters, inflammatory markers, and oral microbiome composition among ENDS users, cigarette smokers, and non-smokers. Methods: A structured literature search was conducted in PubMed (January 2009–May 2026) following a PICO question: “What is the impact of ENDS, compared to cigarette smoking and non-smoking, on periodontal health?” Clinical studies reporting on periodontal health parameters (plaque index, bleeding on probing, probing depth, and clinical attachment loss), inflammatory markers (e.g., IL-1β, IL-6, TNF-α), and microbial composition were included. Due to methodological heterogeneity across studies, meta-analysis was not feasible, necessitating narrative synthesis. Results: Across studies, clinical periodontal findings in ENDS users were heterogeneous and did not consistently resemble those of either cigarette smokers or non-smokers. In contrast, ENDS use was consistently associated with alterations in inflammatory profiles and oral microbiome composition, characterized by selective changes in specific inflammatory cytokines rather than uniform inflammatory upregulation, as well as shifts towards microbial communities linked to periodontal inflammation. Notably, these biological alterations were not uniformly reflected in traditional clinical periodontal indices. Conclusions: ENDS use is associated with heterogeneous clinical findings and inflammatory and microbial alterations that suggest ENDS is a distinct exposure rather than a predictable intermediate between smoking and non-use. This review, to our knowledge, is the first to integrate clinical, inflammatory, and microbiome outcomes and highlights the limitations of relying solely on clinical parameters to assess the impact of ENDS on periodontal health. It also underscores the need for well-designed longitudinal studies to clarify the periodontal implications of ENDS use. Full article

Background/Objectives: Patients with adolescent idiopathic scoliosis (AIS) are at increased risk of emotional distress, yet little is known about the immediate psychological impact of receiving the diagnosis itself. This study aimed to evaluate short-term changes in self-esteem, anxiety, depression, and stress before and after AIS diagnosis, and in the early post-diagnostic period. Methods: In this cohort study, 179 adolescents (10–18 years) referred for suspected AIS completed the Rosenberg self-esteem scale (RSES) and Depression, Anxiety and Stress Scale (DASS 21) before clinical and radiographic assessment (T1). Based on clinical findings and Cobb angle measurements, participants were classified as having mild scoliosis (Cobb angle >10°, <20°) managed with observation alone (Group A, n = 30), moderate/severe scoliosis (Cobb angle >20°), candidates for bracing treatment (Group B, n = 30), or no scoliosis (Group C, n = 119). Adolescents with scoliosis (Groups A and B) repeated the questionnaires immediately after diagnosis and treatment recommendations (T2). Group B completed a third assessment 1–2 months after initial examination (T3). Results: At baseline, RSES and DASS 21 scores did not differ significantly between groups. Following diagnostic disclosure, Group A showed a significant decline in self-esteem, while both groups showed increases in stress, anxiety, and depression. In Group B, reassessed at T3, stress and anxiety decreased, whereas depression remained elevated relative to baseline. Conclusions: AIS diagnosis was associated with a self-esteem decline that followed a pattern dependent on curve severity, with an immediate drop in mild AIS (Group A) versus a delayed decline emerging one to two months later in moderate/severe cases (Group B). Anxiety and depressive symptoms increased significantly in both groups, while stress increased significantly only in those with moderate/severe scoliosis (Group B). Routine screening of mental health after AIS diagnosis, alongside interdisciplinary care involving mental health professionals, may help identify vulnerable patients and enable timely psychosocial support. Full article

Background and Objectives: Children with cerebral palsy (CP) are at increased risk for oral health problems, yet prospective evidence on the impact of dental rehabilitation on oral health-related quality of life (OHRQoL) in this population remains limited. This study aimed to prospectively evaluate the effects of comprehensive chairside dental rehabilitation on OHRQoL in children with spastic-type CP across two age groups, and to compare outcomes with healthy controls over a 12-month follow-up period. Materials and Methods:This prospective controlled pilot study included 22 children (11 with spastic-type CP, 11 healthy controls), individually matched by age, sex, and caries index (dmft/DMFT). Participants were divided into two subgroups based on dentition stage: the primary dentition group (n = 12; 6 CP, 6 controls; ages 4–6, assessed with the parent-reported ECOHIS) and the mixed dentition group (n = 10; 5 CP, 5 controls; ages 7–10, assessed with the POQL, which incorporates both child-reported and parent-reported forms). OHRQoL was measured at baseline, 3, 6, and 12 months. Comprehensive chairside dental rehabilitation was performed in accordance with AAPD guidelines. The Friedman test and Mann–Whitney U test were used for within-group and between-group comparisons, respectively. Effect sizes (Kendall’s W and r) and 95% confidence intervals were calculated for statistically significant findings. Results: Parent-reported POQL scores demonstrated statistically significant improvement over 12 months in both the CP (p = 0.004) and control (p = 0.007) groups, with the most pronounced change occurring between baseline and the 12th month. ECOHIS scores and child-reported POQL scores decreased across time points without reaching statistical significance. No significant between-group differences were detected at any time point. Conclusions: Comprehensive chairside dental rehabilitation was associated with significant improvements in parent-reported OHRQoL in both children with CP and healthy controls, whereas ECOHIS and child-reported POQL scores showed numerical improvements that did not reach significance. These findings indicate that high-functioning children with spastic-type CP can benefit from dental rehabilitation comparably to their healthy peers, though larger and more heterogeneous samples are needed to confirm and generalize these preliminary results. Full article

Introduction: Ultra-processed foods (UPFs) are characterized by high levels of additives such as sugars, fats, and preservatives and, due to their composition, represent a major public health concern, being associated with several adverse effects, including impacts on the immune system. People living with HIV (PLHIV) present immune dysfunctions resulting from viral infection and may therefore be particularly vulnerable to the effects of UPF consumption. In this context, investigating this association is necessary to support healthcare strategies and improve assistance for PLHIV. Objective: To investigate the relationship between UPF consumption and the lymphocyte profile of PLHIV. Methods: This was a cross-sectional study. PLHIV receiving outpatient follow-up care for at least six months participated in the study and were categorized according to UPF consumption (≤2 times/week; >2 times/week). Sociodemographic data, UPF consumption assessed through a food frequency questionnaire, anthropometric measurements, and blood samples were collected. Association, comparison, and correlation tests were performed, with statistical significance set at p < 0.05. After adjustment, lymphocyte percentage remained independently associated with UPF consumption. Results: A total of 92 PLHIV participated in the study, with a mean age of 43.0 ± 12.0 years. PLHIV with higher UPF consumption presented lower counts of CD3+ lymphocytes (p = 0.03), CD45+ lymphocytes (p = 0.01), and total lymphocytes (p = 0.03) compared to those with lower UPF consumption. UPF consumption was negatively correlated with CD3+ (r = −0.21; p = 0.04), CD4+ (r = −0.20; p = 0.05), CD45+ (r = −0.23; p = 0.02), and total lymphocyte counts (r = −0.25; p = 0.01). No associations were found between sociodemographic or clinical variables and UPF consumption among PLHIV (p > 0.05). Conclusions: High UPF consumption was associated with lower lymphocyte counts in PLHIV, suggesting a potential association between dietary patterns and immune status. Therefore, the implementation of public health policies and nutritional follow-up is necessary to reduce UPF consumption and promote healthy eating among PLHIV. Full article

Waste tires as an alternative fuel in the cement industry offer multiple advantages, including reduced CO₂ emissions and decreased reliance on fossil fuels. In this study, a comparative life cycle assessment (LCA) was conducted for cement clinker production with coal (CPC) as fuel and with waste tires as an alternative fuel (CPCT). The study adopted a “gate-to-gate” scope, with a functional unit of 1 ton of clinker. Environmental impacts were evaluated using the IMPACT 2002 + method. Global warming and non-renewable energy were the dominant impacts in cement clinker production. Compared to the CPC scenario, the CPCT scenario reduced the endpoint damage to resources, climate change, and human health by 19.91%, 2.30%, and 0.70%, respectively. However, the damage to ecosystem quality increased by 11.53%. When the waste tires substitution ratio increased from 5% to 20% according to scenario simulation results, the impacts on non-renewable energy and global warming dropped by 16.23% and 8.59%, respectively. Conversely, this higher substitution ratio exacerbated terrestrial acid/nutri (+10.75%), aquatic acidification (+9.70%), and respiratory inorganics (+5.76%). The results indicated a trend toward reduced reliance on coal and lower CO₂ emissions in the cement clinker production process through the substitution of waste tires. Nevertheless, the trade-off involved higher emissions of certain pollutants, most notably NO_x, leading to increased ecosystem-related impacts. Full article

Parthenium hysterophorus L. is highly invasive across many countries, impacting agriculture, human and animal health and the environment. Despite a widespread invasive range, the persistence of P. hysterophorus seeds (achenes) in the soil profile has been identified as a gap in current knowledge. A long-term seed persistence field trial was under-taken, where packets of P. hysterophorus seeds were buried, retrieved periodically over 10 years and the viability assessed. Time, burial depth and soil type (clay or loam) significantly influenced seed viability. Overall viability was <5% after 5 years, and <0.2% of viable seed was recovered after 7 to 10 years. The decline was faster in seeds at 0 cm (on the soil surface) and buried at 20 cm and slower in seeds buried at 2.5 cm and 10 cm. At most retrieval times viability was higher in seeds retrieved from clay soil plots than from loam soil plots. Pasture cover (present or excluded) did not significantly influence the viability of seeds. Data from controlled ageing laboratory experiments indicated persistent seeds and complemented the field trial data. Based on the weight of 1000 seeds, less than 20 mm of rainfall could incorporate 50% of seeds into three soil types. Parthenium hysterophorus develops a persistent seed bank when incorporated into the soil and infestations will require longer-term control even if seed input is prevented. Full article

Background: Ultrafine particles (UFPs) represent a significant occupational health concern in commercial cooking environments, yet comprehensive exposure assessment in pizzerias remains limited despite their global prevalence and unique cooking processes. Understanding UFP exposure patterns and associated health effects in this widespread food service sector is crucial for protecting worker health. Objective: To quantify occupational exposure to airborne UFPs among pizzeria workers across different oven technologies. Methods: A cross-sectional observational study was conducted in 10 pizzerias in the Cagliari metropolitan area (April 2022–March 2024), encompassing wood-fired ovens (WFO, n = 6), electric ovens (EO, n = 3), and mixed systems (BO, n = 1). Ventilation characteristics were documented at each site to evaluate their influence under real-world operating conditions. Personal UFP exposure was measured using DISCmini diffusion size classifiers (10–700 nm range), while qualitative particle characterization employed ELPI+ impaction with SEM-EDS analysis. Results: UFP concentrations varied dramatically by oven type, with median values of 3.18 × 10⁴ particles/cm³ (WFO), 1.29 × 10⁵ particles/cm³ (EO), and 2.55 × 10⁵ particles/cm³ (BO). Seven of ten pizzerias exceeded WHO precautionary limits (20,000 particles/cm³), with electric oven facilities showing concentrations comparable to high-emission industrial operations. Elemental analysis revealed predominantly carbon-based particles with significant iron, aluminum, and silicon content, indicating combined combustion and mechanical abrasion sources. Conclusions: Pizzeria workers experience substantial UFP exposure levels that frequently surpass those in other food service environments and approach levels typically observed in high-exposure industrial workplaces. Electric ovens generate significantly higher UFP levels than wood-fired systems, likely due to ventilation efficiency differences. Full article

The prebiotic concept now extends past inulin and fructo-oligosaccharides to diverse dietary compounds for selective gut microbial utilization and health promotion. This review explores Pleurotus eryngii as a source of prebiotic substrates, with a focus on how preparation methods and molecular traits affect its digestive stability, fermentability and food applicability. The tested materials include various mushroom-derived fractions: polysaccharides (native and modified), β-glucan extracts, powders, hydrolysates, protein co-extracts, exopolysaccharides and composite matrices. Many fractions survive upper gastrointestinal digestion and produce short-chain fatty acids whose profiles vary with the substrate during fecal fermentation. Animal studies have demonstrated their positive impacts on intestinal barriers, immunity and metabolism, and these ingredients fit well into multiple food formulations. Rather than treating Pleurotus eryngii as a uniform polysaccharide product, evaluations should be performed for each individual preparation. Existing data supports Pleurotus eryngii as a promising source of structurally diverse candidate prebiotic substrates, with a consistent biological rationale linking digestive persistence, microbial fermentation, short-chain fatty acid production, microbiota modulation and gut-related host responses. Further research is required to verify the microbiota-related causal mechanisms, assess finished food products and implement human microbiota intervention trials. Full article

Background and Objectives: Periodontal diseases are highly prevalent worldwide and have been associated with impaired oral health-related quality of life (OHRQoL). However, the strength and direction of this association remain inconsistent, particularly when sociodemographic and behavioural factors are considered. The aim of this study was to evaluate the independent association between periodontal status and OHRQoL in Bulgarian adults attending a university dental clinic, while accounting for sociodemographic factors and sleep quality, which was included as a clinically relevant behavioural determinant of oral health-related quality of life. Materials and Methods: This cross-sectional study included 504 adult participants (≥18 years) who underwent comprehensive periodontal examination and completed validated questionnaires. OHRQoL was assessed using the culturally adapted Bulgarian version of the Oral Health Impact Profile (OHIP-14), and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Due to the skewed distribution of OHIP-14 scores, the outcome was dichotomized at the sample median. Multivariable logistic regression analysis was performed to assess independent associations, adjusting for age, sex, education, financial status, place of residence, and sleep quality. Results: Periodontal status, sex, and sleep quality were independently associated with impaired OHRQoL. Females demonstrated lower odds of impaired OHRQoL compared to males (OR = 0.636; 95% CI: 0.428–0.924; p = 0.025). Poor sleep quality was associated with increased odds of impaired OHRQoL (OR = 1.554; 95% CI: 1.041–2.321; p = 0.031). Periodontitis was significantly associated with impaired OHRQoL (OR = 3.526; 95% CI: 2.073–5.998; p < 0.001), reflecting a complex relationship between clinical periodontal status and subjective health perception. Conclusions: OHRQoL is influenced by a multifactorial framework integrating periodontal status, behavioural factors, and sociodemographic characteristics. These findings highlight the importance of incorporating patient-reported outcomes into periodontal assessment and support a biopsychosocial approach to oral health research. Full article

Background/Objectives: Accurate assessment of dietary behaviors is essential for understanding their impact on health and guiding nutritional policies. Given the escalating prevalence of noncommunicable diseases in the MENA region, the availability of culturally adapted and psychometrically validated Arabic-language instruments is essential for accurate health assessment. This systematic review aims to identify and evaluate studies that have translated, adapted, or validated dietary behavior measurement instruments into Arabic. Methods: Following the PRISMA guidelines and registered in PROSPERO (CRD420251157552), a search was conducted in PubMed, Scopus, and Web of Science. Studies including the validation, translation, or adaptation of instruments into Arabic among Arabic-speaking populations were included. Methodological quality was assessed using the COSMIN checklist. Results: Thirty-two studies were included, published between 2006 and 2025, primarily in Lebanon (n = 14) and Saudi Arabia (n = 6). The instruments measured various concepts: dietary intake, diet quality, eating disorders, etc. While internal consistency and structural validity were frequently assessed with adequate methodological quality, content validity, measurement error, and responsiveness were either under-reported or failed to meet COSMIN standards. Conclusions: Despite an increasing volume of publications, the methodological quality of Arabic instrument validation remains heterogeneous, with significant gaps in the assessment of longitudinal properties. Efforts are needed to improve the rigor of adaptation processes and to evaluate key properties such as responsiveness in order to ensure reliable tools for research and clinical practice in the MENA region. Full article

Background/Objectives: Federated electronic health record networks are increasingly used for real-world evidence generation, but publication-use patterns for TriNetX remain incompletely characterized. This study mapped Web of Science-indexed articles that explicitly mentioned TriNetX and examined their distribution across clinical domains and study purposes. Methods: We searched the Web of Science Core Collection for articles published during 2018–2025 with “TriNetX” in the title, abstract, or author keywords. Bibliometric indicators, journal sources, citation impact, author-keyword co-occurrence, and trend topics were analyzed using R, bibliometrix, Biblioshiny, and VOSviewer. A reproducible rule-based dictionary classified clinical domains and study purposes, and a supplementary Scopus analysis assessed pattern-level reproducibility. Results: The corpus included 1573 articles. Annual output increased from 1 article in 2018 to 871 in 2025. Corresponding-author output was concentrated in the United States and Taiwan. Highly cited studies were dominated by COVID-19 research. Keyword analyses suggested a shift from pandemic-related topics toward mortality, cardiometabolic disease, and medication-related outcomes. Domain–purpose mapping showed that risk/prognosis studies were most common, whereas effectiveness, health services, and method/validation studies were less frequent. Scopus validation reproduced the main annual, source-level, and domain–purpose patterns. Conclusions: TriNetX-based publications expanded rapidly and diversified across clinical fields. Domain–purpose mapping shows where research has concentrated and where it remains sparse; lower frequency, however, should not be read as a definitive clinical evidence gap, since some areas may be less suited to the platform. Where the network is well suited, future work could give greater attention to comparative effectiveness, long-term safety, care pathways, and phenotype validation. Full article