Search Results (37,480)

Background: Prostate cancer substantially affects patients’ quality of life (QoL). However, whether distinct QoL profiles exist among patients remains unclear. Objective: This study aimed to identify latent QoL profiles among patients with prostate cancer and explore factors associated with profile membership. Methods: A cross-sectional study included 200 patients with prostate cancer recruited from a tertiary hospital in China between May and December 2024. QoL was assessed using the Functional Assessment of Cancer Therapy–Prostate (FACT-P). Latent profile analysis was performed using Mplus 8.3, and the optimal model was selected according to information criteria, entropy, and likelihood ratio tests. Multivariable logistic regression was used to examine factors associated with profile membership. Results: LPA identified two distinct subgroups: low QoL (32.5%) and high QoL (67.5%). Medium and heavy economic burden significantly increased odds of low QoL (OR = 4.13, 95% CI: 1.13–15.02, p = 0.032; OR = 11.12, 95% CI:1.55–79.86, p = 0.017). Urinary continence markedly reduced odds of low QoL (OR = 0.08, 95% CI: 0.02–0.25, p < 0.001). Longer diagnosis-to-treatment intervals were associated with membership in the low-QoL profile (1–3 months: OR = 2.99, 95% CI: 1.26–7.08, p = 0.013; >3 months: OR = 3.36, 95% CI: 1.02–11.07, p = 0.046). Conclusions: This study identified two QoL profiles among patients with prostate cancer. The findings suggest that person-centered QoL assessment may facilitate early identification of patients with greater supportive care needs and contribute to more individualized survivorship care. Full article

Traditional frameworks evaluating the university academic experience often give limited attention to students’ reported use of Artificial Intelligence. This study psychometrically validates a novel measurement model, testing whether AI-related academic practices emerge as a distinct component of students’ perceived academic experience. Using a cross-validation design, 2403 undergraduate students from a private university in Bolivia were surveyed. The dataset was randomly split for Exploratory Factor Analysis (EFA, n = 1200) to uncover latent variables and Confirmatory Factor Analysis (CFA, n = 1203) to validate the structural stability of a refined 31-item scale. The EFA revealed a cohesive five-factor structure: (1) Academic Engagement and Student Life, (2) Student-Reported AI Use in Academic Learning, (3) Communication and Critical Thinking Skills, (4) Teaching Quality, and (5) Academic Dedication. The CFA confirmed an excellent model fit (CFI = 0.954, RMSEA = 0.046), supporting strong construct validity. Furthermore, inter-factor correlations showed that student-reported AI use was positively associated with academic engagement and with the broader Communication, Ethical, and Critical Thinking Skills domain. These empirical results suggest that, within this institutional context, students perceive AI as a relevant element of their academic routines. By validating the University Academic Experience and AI Integration Survey, this study provides a context-specific framework for assessing students’ self-reported use and perceived integration of AI in academic learning as a distinct dimension of their academic experience. The validated instrument is not intended for directly measuring learning outcomes, educational effectiveness, teaching effectiveness, or institutional quality. Full article

The development of depression frequently impacts epileptic patients due to unmanaged central nervous system changes. This may severely reduce their quality of life. These mental conditions can lead to the administration of illicit drugs for self-medication. However, these substances may increase seizure frequency. The combination of this condition may both interacting brain disorders deeply aggravate each other, requiring simultaneous, comprehensive treatment. The aim will be to systematically evaluate the role of phytomedicine in managing comorbid depression and recreational substance use in people with epilepsy. The methods followed the PRISMA guidelines. This systematic review protocol outlines an evaluation of phytomedicine’s role in managing comorbid depression and recreational substance use in epilepsy patients. Data were searched using nine online databases for 2000–2026 primary studies, extracted data, assessed risk of bias, and performed a narrative or meta-analysis synthesis. It is well documented that depression and recreational substance use frequently coexist, with severity influenced by youth, homelessness, unemployment, childhood trauma, and prolonged substance dependence. Several evidence globally consistently demonstrates strong associations between depressive symptoms and heroin, cocaine, benzodiazepine, and alcohol use. The statistical analyses obtained indicate that substance use and depression reinforce each other, highlighting the need for integrated mental health, addiction, and psychosocial interventions to improve clinical outcomes. This highlighted a complex interaction among depression, epilepsy, and substance use. It emphasised an integrated management approach while cautiously evaluating phytomedicine’s efficacy, safety, and drug interactions. Therefore, the use of phytomedicine may complement integrated epilepsy care by addressing depression and substance use, although robust clinical evidence remains essential for validation. Full article

Dementia is one of the leading causes of disability and dependence among older adults and is increasingly encountered in patients undergoing surgery. As populations age and surgical interventions become more common, understanding the perioperative care of patients with pre-existing dementia has become an important clinical priority. Dementia is associated with reduced cognitive reserve, chronic neuroinflammation, synaptic dysfunction, blood–brain barrier impairment, neurotransmitter abnormalities, and cerebrovascular dysregulation, all of which may increase vulnerability to perioperative neurological injury. Surgical trauma and anaesthesia trigger systemic inflammatory, metabolic, and haemodynamic responses that may disrupt cerebral homeostasis and contribute to perioperative neurocognitive disorders, including postoperative delirium and delayed neurocognitive recovery. Postoperative delirium is consistently associated with accelerated cognitive and functional decline and may represent an important link between perioperative stress and adverse long-term outcomes. However, despite strong biological plausibility, current clinical evidence does not establish a direct causal relationship between anaesthesia, surgery, and accelerated dementia progression. Interpretation of the available literature is limited by methodological heterogeneity, residual confounding, and the frequent exclusion of patients with established cognitive impairment. This narrative review summarizes the neurobiological mechanisms underlying increased perioperative vulnerability in dementia, critically examines current evidence regarding the effects of anaesthesia and surgery on long-term cognitive and functional outcomes, and discusses practical strategies to reduce perioperative risk. A better understanding of these complex interactions is essential to optimize perioperative care and preserve cognitive function, functional independence, and quality of life in this highly vulnerable patient population. Full article

Background/Objectives: Multiple sclerosis (MS) affects motor, cognitive, psychological, and social functioning that impairment-based scales do not fully capture. This systematic review evaluated the measurement properties and applications of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in adults with MS across research and clinical contexts. Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to 25 May 2026. Eligible peer-reviewed studies reported extractable WHODAS data in adults with MS. Evidence was organized into measurement, clinical-association, participation/employment, intervention, digital-monitoring, and longitudinal streams. Design-appropriate critical-appraisal tools and outcome-specific certainty assessments were applied; quantitative pooling was assessed but was not justified. Results: Of the 677 records identified, 28 reports were included. Five reports evaluated measurement properties; moderate-certainty evidence supported reliability and construct validity, although precision differed among 12-, 32-, and 36-item forms. Associations with quality of life and clinical severity were supported by low-certainty evidence. Evidence concerning fatigue, mood, cognition, participation, and employment was of low or very low certainty because most studies were cross-sectional, used heterogeneous metrics, or involved overlapping cohorts. Intervention evidence was of very low to low certainty: WHODAS was secondary, and interventions, time points, and scoring methods were not comparable. Eight reports arose from one overlapping research program. Conclusions: WHODAS 2.0 provides a multidimensional patient-reported account of functioning in MS and may complement, but not replace, the Expanded Disability Status Scale. Evidence supports measurement use more strongly than prognostic, treatment-response, or benefit-determination claims. Standardized version selection, scoring, domain reporting, and prespecified longitudinal endpoints are required. Full article

Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy characterized by chronic anemia, recurrent pain episodes, and multi-organ complications, which collectively impact patients’ quality of life and functional capacity. Exercise and physical activity are recognized as essential components of general health and well-being; however, their role in individuals with SCD remains underexplored due to concerns regarding safety, tolerance, and the potential to precipitate vaso-occlusive crises. This study aimed to assess the patterns and frequency of exercise and physical activity among patients with sickle cell disease using a validated questionnaire. Methods: We conducted a cross-sectional study on patients diagnosed with sickle cell disease at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. After obtaining ethical approval, we contacted the patients by phone or met them in person and administered the Global Physical Activity Questionnaire (GPAQ). Data on age, gender, comorbid conditions, disease-related variables, and weekly physical activity were collected. Total physical activity was expressed in metabolic equivalent of task (MET)-minutes per week, and participants achieving ≥600 MET-minutes per week were classified as meeting the World Health Organization (WHO) recommendation. Results: Of the 97 patients, males represented 52.6% of the participants, with a median age of 33 years. Overall, 70.1% of the patients were on hydroxyurea, and 14.4% had undergone splenectomy. More than half of the patients (56.7%) reported difficulties with exercise. According to the findings, 39% of the patients were getting enough physical activity each week, as recommended by the WHO. Male patients were significantly more likely to meet the WHO physical activity recommendation (p = 0.003), whereas no statistically significant associations were observed for age, nationality, body mass index, hemoglobin level, hydroxyurea use, splenectomy, hospital admissions, transfusion history, comorbidities, or exercise-related symptoms (all p > 0.05). Conclusions: Our data suggest that a significant proportion of patients with SCD did not achieve the WHO-recommended physical activity level, with adherence observed in only about forty percent of participants, and that adherence was more common in male patients (adjusted odds ratio 3.30, 95% CI 1.36–8.52, after multivariable adjustment for age, body mass index, hemoglobin, and transfusion status). This association was concentrated in occupational rather than recreational activity and was not explained by the clinical variables measured. Because no comparison group was studied, the extent to which this shortfall is attributable to SCD itself, rather than to the population-level inactivity already documented in Saudi Arabia, cannot be determined from these data. These findings identify a potential area for targeted intervention, particularly among women, and underscore the need for further research into disease-specific and sociocultural barriers before tailored programs can be developed. Further larger, controlled, multi-center studies are necessary to clarify the specific contribution of SCD to inactivity and to guide individualized physical activity promotion in this population. Full article

Demolition is recognised as a strategic construction process enabling the transition between an asset and a building cycle. Rather than removing a structure, it requires a design and management approach that preserves safety, material quality, traceability, and environmental performance. This paper develops a demolition-management framework linking pre-demolition assessment, method selection, hazardous-material control, waste classification, logistics, safety measures, environmental mitigation, and documentation-based traceability. The framework is applied to the partial demolition of a precast reinforced-concrete storage building within an industrial compound in Treviso, Italy. The project involved time constraints, limited working space, adjacent structures, and asbestos–cement components. The case study illustrates a phased process including asbestos abatement, perimeter slab cutting, crane-assisted dismantling, controlled top-down mechanical demolition, dust suppression, and coordinated temporary storage and waste transport documentation. Results show that safety and circular-economy objectives are mutually reinforcing when demolition is planned as an integrated and auditable end-of-life construction-management process, focused on removing, separating, classifying, and routing materials through pathways. In constrained industrial settings, sequencing, staging areas, specialised subcontracting, and documentation readiness are decisive for reducing interference, maintaining operational continuity, and supporting material recovery. The study proposes a workflow, while acknowledging the limitations of a single-case design and the absence of multi-project quantitative data. Full article

The construction industry is increasingly pressured to reduce its environmental footprint through the adoption of sustainable materials and digital innovation. This literature review examines the convergence of Building Information Modeling (BIM) and related digital technologies with bio-based and sustainable construction materials, aiming to enhance environmental, economic, and social sustainability performance. A descriptive search of Scopus, Web of Science, and IEEE Xplore databases yielded 94 peer-reviewed articles published between 2015 and April 2026. The analysis identifies three principal integration pathways: (i) material quantification and environmental accounting through BIM−LCA integration, (ii) parametric design exploration and multi-objective optimization, and (iii) life cycle coordination via digital twins and automated fabrication. BIM was identified in 62 of 94 publications (66%), making it the dominant technology, followed by LCA (35 publications, 37%) and digital twins (25 publications, 27%). Findings indicate that BIM functions as a central enabling platform, improving material traceability, design accuracy, and decision-making quality particularly by managing the inherent variability of bio-based materials through moisture-dependent parameters, sourcing data, and performance monitoring. While environmental sustainability—particularly embodied carbon reduction—dominates the literature, economic and social dimensions remain underexplored, appearing in less than 1.1% of reviewed studies. The review also highlights persistent barriers, including data interoperability issues, high upfront costs, limited material databases, and skill gaps. Drawing on socio-technical systems theory, a conceptual framework is proposed to illustrate the interdependencies between digital capabilities, bio-based material strategies, and sustainability outcomes. A three-stage implementation roadmap is outlined to support practitioners in adopting BIM-enabled bio-based workflows. The review concludes that the synergy between digital technologies and renewable materials offers a promising trajectory toward circular, low-carbon construction, but calls for more longitudinal empirical research, standardized sustainability metrics, and integrated assessment frameworks that encompass social and economic considerations alongside environmental performance. Full article

Prostate cancer is the most commonly diagnosed non-cutaneous malignancy among men in the United States and remains a leading cause of cancer-related mortality. Its marked biological, molecular, and histopathological heterogeneity creates a central diagnostic challenge: identifying clinically significant disease while limiting unnecessary biopsy and overdiagnosis of tumors unlikely to affect survival or quality of life. Although prostate-specific antigen (PSA) remains the foundation of early detection, its limited cancer specificity has driven the development of increasingly risk-adapted diagnostic pathways. Contemporary evaluation integrates clinical risk assessment and PSA-derived measures with selectively used blood- and urine-based biomarkers, multiparametric magnetic resonance imaging (mpMRI), image-guided biopsy, histopathological classification, genomic risk assessment, and molecular imaging. Biomarkers such as the Prostate Health Index, 4Kscore, IsoPSA, MiCheck, SelectMDx, and ExoDx may refine biopsy decisions in appropriately selected patients but should be interpreted according to the clinical setting, decision threshold, and surrounding diagnostic pathway. Prostate MRI and PI-RADS-based assessment have become central to pre-biopsy evaluation, while MRI-targeted biopsy improves detection of Grade Group ≥ 2 disease. Increasing use of the transperineal biopsy route offers comparable cancer detection with a lower infectious risk. Following diagnosis, Grade Group, adverse histological features, clinical risk models, and selected tissue-based genomic classifiers provide complementary prognostic information. PSMA PET/CT has further improved staging of selected patients with higher-risk disease and localization of biochemical recurrence. Precision diagnostics must also account for disease phenotypes that may not be adequately represented by conventional PSA- and imaging-based pathways, including intraductal carcinoma, cribriform architecture, ductal adenocarcinoma, and neuroendocrine prostate cancer. Emerging approaches, including artificial intelligence-assisted MRI interpretation, digital pathology, high-frequency micro-ultrasound, liquid biopsy, alternative molecular radiotracers, and multi-omic integration, show increasing potential but remain at different stages of validation and clinical adoption. This review critically examines contemporary prostate cancer diagnostics within United States clinical practice, distinguishing established guideline-supported approaches from selectively used adjuncts and emerging technologies. Particular emphasis is placed on diagnostic performance in context, clinical utility, external validation, healthcare equity, regulatory considerations, and the need to demonstrate that increasing diagnostic complexity translates into meaningful improvements in patient care. Full article

Chronic pain, sleep disturbances, and mental health disorders such as anxiety and depression disorders frequently co-occur, forming a self-reinforcing cycle that impairs daily functioning and quality of life. Chronic pain is driven by peripheral and central sensitization, the latter sustained by reciprocal microglial–astrocytic crosstalk and maladaptive neuroplasticity. Poor sleep amplifies pain through inflammation and circadian disruption. Imbalances in serotonin, dopamine, and norepinephrine, together with limbic alterations and HPA axis dysregulation, contribute to comorbid anxiety and depression. Elevated pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α), NF-κB-driven neuroinflammation, and mitochondrial oxidative stress serve as key molecular links. Building on previous evidence, this review presents an updated triadic, mechanism-based framework describing the reciprocal reinforcement among chronic pain, sleep disturbances, and anxiety and depressive disorders. Consequently, therapeutic strategies targeting inflammatory cytokines, microglial and astrocytic activation, neurotransmitter imbalance, and psychological dysfunction may help address these shared neuroimmune and neuroplastic mechanisms underlying these interconnected disorders. Full article

Nursery habitats sustain fish populations by supporting early life stages and buffering environmental variability, yet their functioning under climate oscillations remains poorly understood in the Eastern Tropical Pacific. We analyzed ichthyoplankton assemblages in the Gulf of Tortugas, Colombia (2010–2020), to assess taxonomic composition, spatiotemporal variability, and environmental drivers. ENSO cycles and local oceanographic conditions were evaluated as determinants of nursery function and resilience using richness estimators, diversity indices, Caswell’s neutral model, and multivariate approaches (PERMANOVA, PERMDISP, CAP, BIOENV). Assemblages were dominated by Cetengraulis mysticetus, with recurrent contributions from Sciaenidae, Haemulidae, Gerreidae, and Carangidae—families of artisanal fisheries importance. ENSO phases explained interannual variability: El Niño years reduced diversity and weakened retention, whereas La Niña years supported more balanced assemblages. Spatial heterogeneity revealed central retention zones and peripheral diversity hotspots. Environmental gradients, particularly chlorophyll-a, zooplankton biomass, transparency, and pH, consistently structured larval distribution, reflecting the coupling of productivity, water quality, and circulation. These findings demonstrate that the Gulf of Tortugas functions as a dual nursery system and ecological node of resilience, underscoring the importance of protecting such habitats for ecosystem-based fisheries management and biodiversity conservation in a changing ocean. Full article

Mood disorder symptoms represent an important but understudied mental health concern among physicians in Romania, with potential implications for quality of life and suicide risk. This cross-sectional study included 104 medical doctors. Validated self-report instruments were used to assess depressive symptoms, manic and cyclothymic symptoms, bipolar risk, suicidal behaviour, and quality of life. Pearson correlation analyses and multiple linear regression models were conducted to examine associations and identify predictors of quality of life and suicide risk. Overall, 33% of participants screened positive for depressive symptoms, 21% for manic symptoms, 71% for cyclothymic symptoms, 12% for suicide risk, and 2% for bipolar risk. Depression, cyclothymia, and suicide risk were negatively correlated with quality of life, whereas manic symptoms showed a positive association. In multivariate analyses, cyclothymia predicted poorer quality of life (β = −0.43, p < 0.001) and manic symptoms seemed to predict better quality of life (β = 0.26, p = 0.008), while depressive symptoms uniquely predicted greater suicide risk (β = 0.24, p = 0.048). These findings indicate a high prevalence of mood disorders among Romanian physicians and suggest distinct patterns linking mood symptoms to quality of life and suicide risk. The results highlight the importance of early identification, stigma reduction, and targeted mental health interventions to support physician well-being and healthcare system sustainability. Full article

Background: Spiritual wellbeing is increasingly recognised as a key area of complex oncology and palliative care, but evidence from Eastern Europe is still limited. Understanding how spiritual well-being and religiosity are related to psychological distress and quality of life can inform holistic support interventions in cancer patients. Objective: To describe spiritual well-being, religiosity, anxiety, depression, and quality of life in a Romanian cancer cohort, and to examine associations between spiritual well-being and psychological distress. Methods: A cross-sectional study was carried out in 124 cancer-stricken adults at a regional cancer centre in Romania. Participants completed FACIT-Sp-12 (spiritual well-being), RCI-10 (religious belief), HADS (depression), and EQT QLQ-C30 (QoL). Multivariable linear regression was used to determine independent predictors of outcomes in patients. Results: Participants had a median age of 65 years (53–71) and 70 (56%) patients had metastatic disease. Religious involvement was high and spirituality related to disease was commonly reinforced, with 66 (53%). There were twice as many cases of clinical depression symptoms (28%) as anxiety symptoms (14%). A median QoL score of 51 (IQR: 37–64 points) was revealed by descriptive analysis of the EORTC QLQ-C30. In adjusted multivariable models, spiritual well-being was significantly and independently associated with lower anxiety (β = −0.25, p = 0.030) and depression (β = −0.29, p = 0.013), with models accounting for 11.5% and 10.8% of variance, respectively. Global quality of life was best explained by the model (R² = 26.4%), with independent contributions from impaired ECOG performance status (β = −0.27, p = 0.006) and depressive symptoms (β = −0.22, p = 0.014), whereas religious commitment showed no independent association with any primary outcome. Conclusions: In this Romanian cohort, spiritual well-being, not religious adherence, remained independently associated with lower anxiety and depression, suggesting that spiritual well-being is associated with better psychological health among cancer patients. Religious affiliation has not been shown to be independent of any outcome, a difference with direct implications for the screening of spiritual care. Global quality of life, on the other hand, was independently associated with both physical functional status (ECOG) and depressive symptom burden, rather than with spiritual or religious factors, underlining that both functional decline and psychological distress remain central to cancer-related quality of life. Full article

Unusually frequent and soft stools may negatively impact the quality of life. A postbiotic containing heat inactivated Limosilactobacillus fermentum CNCM I-2998 and Lactobacillus delbrueckii subsp. lactis CNCM I-4831 has previously been shown to alleviate gastrointestinal symptoms and diarrhea in patients with clinically diagnosed gastrointestinal disorders. This study evaluated whether this postbiotic can support bowel movement frequency in Japanese healthy adults with self-reported frequent and soft stools. In a randomized, double-blind, placebo-controlled clinical trial, participants (n = 100) received the postbiotic (20 billion heat-inactivated cells per day) or placebo for four weeks. The primary endpoint was weekly bowel movement frequency. Secondary endpoints included days with bowel movements per week, sense of relief, stool characteristics (shape, color, odor, water content), gastrointestinal symptoms, and fecal microbiome composition. After four weeks, the postbiotic group showed significantly lower bowel movement frequency and fewer days with bowel movements when compared with the placebo group. Importantly, these reductions were not accompanied by decreased stool volume or increased hard stools or constipation symptoms. Mild changes in microbiome composition were detected across groups, and no adverse events were reported. These findings suggest that the postbiotic is safe and can help reduce bowel movement frequency in healthy individuals experiencing unusually frequent and soft stools. Full article

Allergic rhinitis (AR) is a chronic inflammatory disease that substantially affects quality of life. Despite available therapies, symptom control remains suboptimal owing to treatment burden. Cultivated sclerotium of Lignosus rhinocerus (TM02^®), known for its allergy-dampening bioactivities, is a promising adjunctive AR treatment. A randomized, double-blinded clinical trial was conducted in 108 AR patients, who received either TM02^® or placebo for 30 days. Primary outcomes consisted of Total Nasal Symptom Score (TNSS), reflective of past 12 h and 2 weeks (TNSS12hrs and TNSS2wks), and the Allergic Rhinitis Control Test (ARCT). The secondary endpoints were the peripheral immune biomarkers: IgE, IFNγ, IL-4, IL-5 and IL-13. Safety was assessed with adverse events (AEs) and full blood-counting analyses. Statistical analysis was performed using generalized estimating equation (GEE) in the modified per-protocol (mPP). mPP analysis (N_TM02^® = 25; N_placebo = 31) demonstrated significant treatment effectiveness of TM02^® in total TNSS12hrs, total TNSS2wks, and ARCT (β = −3.70, p-value < 0.001; β = −4.44, p-value < 0.001; and β = 3.89, p-value = 0.017, respectively). Secondary endpoint analysis did not reveal significant changes. However, a positive associative pattern (β = 14.94; p-value = 0.003) was observed between TNSS2wks and IL-5 level changes. There were no significant differences in AE incidences and laboratory safety biomarkers between treatment arms. The present study revealed that TM02^® reduced AR symptom severity with minimal adverse effects. The underlying mechanism may involve the modulation of IL-5 levels and allergic inflammation. Overall, TM02^® is a potential adjunctive or complementary treatment option for AR with persistent symptoms. Full article