Search Results (85)

Background/Objectives: Y chromosome microdeletions in the azoospermia factor (AZF) regions are a major genetic cause of severe male infertility, yet their relationship with hormonal profiles in azoospermic men remains unclear. This study aimed to investigate AZF microdeletions and associated hormonal parameters in azoospermic patients. Methods: Azoospermic patients were screened for AZFa, AZFb, and AZFc microdeletions using multiplex real-time PCR targeting sequence-tagged site (STS) markers (sY84, sY127, and sY254). Patients were categorized into AZF-negative and AZF-positive groups, with the latter further stratified according to their deletion subtype. Serum follicle-stimulating hormone (FSH), testosterone, and inhibin B levels were measured. Hormonal parameters were compared between groups using the Mann–Whitney U test, and a logistic regression analysis was performed to evaluate associations between hormonal variables and AZF deletion status. Results: AZF microdeletions were detected in 18.7% (17/91) of patients. Patients without AZF deletions showed a median FSH level of 17.40 (7.12–31.27) IU/L. In contrast, AZFc deletion carriers exhibited an intermediate median FSH level of 21.10 (16.11–26.10) IU/L and lower median inhibin B concentrations (25.50 [25.25–26.00] pg/mL) compared with AZF-negative patients (56.00 [33.50–106.50] pg/mL). Median testosterone levels in AZFc patients (3.61 [2.87–4.35] ng/mL) remained within the expected physiological range. However, no statistically significant differences were observed between the AZF subgroups for age (p = 0.262), FSH (p = 0.506), testosterone (p = 0.615), or inhibin B (p = 0.524). The logistic regression analysis also showed no significant association between hormonal parameters and AZF deletion status. Conclusions: Hormonal parameters alone are insufficient to predict the presence of AZF microdeletions in azoospermic men. These findings highlight the importance of routine genetic screening for accurate diagnosis, clinical management, and reproductive counseling in male infertility. Full article

Background/Objective: Rapid, validated dietary screening tools are lacking for individuals with spinal cord injury (SCI), where routine clinical check-ups do not allow sufficient time for extensive dietary assessments typically required to evaluate adherence to dietary recommendations. We developed a 15-item dietary screener (SCI NutriTool) and evaluated its accuracy in classifying non-adherence to a healthy food pyramid compared with a validated food frequency questionnaire (FFQ). Methods: The SCI NutriTool was developed through literature review and expert consensus. In a validation study, 51 adults with SCI (mean age 57.0 years; 76.5% men; 68.8% traumatic injury) completed the SCI NutriTool twice and a validated 97-item FFQ, which served as the reference method. Results: The SCI NutriTool demonstrated substantial variability in performance across food groups, reflecting its domain-specific screening properties. Sensitivity was high for fruits and vegetables (91.7%), protein-rich foods (90.5%), and sweetened/alcoholic beverages and snacks (82.4%), with relatively high positive predictive values (PPV: 73.7–90.5%), supporting the tool’s ability to identify individuals who are likely non-adherent and may benefit from further nutritional assessment or counselling. In contrast, for starchy foods and nuts, oils, and fatty spreads/sauces, sensitivity was low (20.0% and 50.0%), while specificity was modest. This indicates that the tool performs better in correctly identifying adherent individuals in these domains, which is reflected in higher negative predictive values (NPV: up to 94.1%). However, the low sensitivity suggests that individuals with non-adherence may be missed, limiting the tool’s usefulness as an early screening trigger for these food groups. Conclusions: The SCI NutriTool’s performance varies across food groups, demonstrating a stronger ability to identify non-adherence in protein-rich foods, fruit and vegetables, sweetened and alcoholic beverages, and snacks, but limited discriminatory capacity for others. In particular, it is not suitable for screening non-adherence to starchy foods and fats. Accordingly, it is best used as a triage tool to guide further dietary assessment and targeted nutritional interventions rather than as a standalone diagnostic instrument. Full article

Introduction: Congenital myasthenic syndrome (CMS) is a rare hereditary disorder of the neuromuscular junction caused by pathogenic variants that affect acetylcholine transmission. We report three pediatric cases with CMS, including a rare homozygous CHRNE mutation previously described only once, a novel CHRNE compound heterozygous variant, and two novel DPAGT1 variants associated with limb-girdle CMS (LG-CMS), thereby expanding the known genetic and phenotypic spectrum of the disorder. Case presentation: The first patient, a 4-year-old girl born to consanguineous parents, presented with bilateral ptosis and fatigable weakness since infancy. Whole-genome sequencing revealed a homozygous CHRNE variant, c.991C>T. The second patient, a 4-year-old boy born to non-consanguineous parents, presented with congenital bilateral ptosis and ophthalmoplegia without generalized weakness. Genetic analysis identified compound heterozygous CHRNE variants, c.905C>G and c.1040T>C. Both patients demonstrated marked improvement with pyridostigmine therapy. The third patient, a 3-year-old girl born to non-consanguineous parents, presented with severe limb weakness requiring assistance in walking and performing daily activities with minimal ocular involvement, suggesting a diagnosis of LG-CMS. Genetic testing identified two novel variants in the DPAGT1 gene in the compound heterozygous form, c.710G>T and c.858C>A. The initial response to pyridostigmine diminished over time. Conclusions: These cases underscore the phenotypic heterogeneity of CMS, even within the same genetic subtype, and expand the existing mutational spectrum of CHRNE and DPAGT1 genes. This study also highlights the essential role of molecular diagnosis in distinguishing CMS from other neuromuscular disorders. Early genetic confirmation facilitates genotype-targeted therapy, prevents inappropriate immunosuppression, and enables informed reproductive counseling. Full article

Background: The ageing of world population is simultaneously a great triumph and a great challenge. It is essential to adjust healthcare systems to older populations and community pharmacies are not an exception. Objectives: The goal was to identify barriers and facilitators, perceived by older patients, that may influence counselling in community pharmacy and, consequently, therapeutic adherence. Methods: A qualitative study was performed. Six focus groups were conducted with 51 participants. The target population was people aged at least 65 years who are autonomous and frequently go to community pharmacies. Results: Three main themes emerged: barriers centered in physical space, centered in older adults and centered in pharmacy professionals. Eight categories emerged from the data analysis. Aisles and access, general impairments and time management were most mentioned categories of each theme, respectively. Furthermore, several facilitators were identified, which were organized according to the same three themes, with an additional one, facilitators centered in society. There were nine categories identified. Human skills, ambiance, appointment and medication management were the most cited ones of each theme, respectively. Conclusions: It is urgent to implement real measures to update community pharmacies settings. A checklist with the main facilitators and the barriers that should be avoided would help public authorities and community pharmacies directors to adapt and to change community pharmacies’ environments. Full article

Background/Objectives: This study aimed to evaluate the relationship between cumulative occupational exposure and ocular surface alterations in Colombian tomato farm workers, using data collected through a cross-sectional survey. In addition, the study sought to explore how occupational exposure duration may support risk stratification and targeted preventive strategies in this vulnerable population. Methods: A cross-sectional observational study was conducted involving 72 tomato farm workers in Colombia. Participants were grouped according to duration of agricultural work experience (<15 years vs. ≥15 years). Clinical assessments included slit lamp examination, tear film break-up time (BUT), Schirmer test, and fluorescein staining. Subjective symptoms were evaluated using the McMonnies Dry Eye Questionnaire. Ocular surface alterations, including conjunctival changes and Meibomian gland dysfunction, were documented and statistically analyzed between groups. Results: Workers with ≥15 years of experience reported significantly higher dry eye symptom scores (McMonnies mean = 8.19 ± 2.54) than those with <15 years (mean = 6.59 ± 2.61; p = 0.006). Schirmer test scores were lower in the experienced group (16.30 ± 11.48 mm vs. 22.71 ± 11.20 mm; p = 0.018), indicating reduced tear production. Bulbar conjunctival alterations and Meibomian gland obstruction were significantly more frequent in the experienced group (p = 0.002 and p = 0.013, respectively). No significant differences were found in BUT or eyelid findings. Conclusions: Long-term agricultural work was associated with increased dry eye-related symptoms and clinical signs of ocular surface compromise among Colombian tomato farm workers. From a personalized medicine perspective, occupational exposure duration may represent a useful risk-stratification factor to identify workers who could benefit from targeted screening, preventive counseling, protective interventions, and individualized follow-up. These findings support the implementation of tailored occupational eye health strategies to reduce cumulative ocular surface damage in vulnerable rural populations. Full article

Background: Recovery following total joint arthroplasty varies substantially among patients, and psychological factors may partly account for this variability. Although anxiety and depression have been widely investigated, the specific contribution of preoperative surgical fear to postoperative pain and quality of recovery remains unclear. This study aimed to examine the association between preoperative surgical fear and postoperative pain intensity and quality of recovery. Methods: This prospective, hospital-based observational study enrolled 89 patients undergoing primary total knee or hip arthroplasty. Preoperative surgical fear was measured using the Surgical Fear Questionnaire (SFQ). Pain intensity was assessed with the Numeric Rating Scale (NRS) preoperatively and at three postoperative time points. Recovery quality at 24 h was evaluated using the Quality of Recovery-40 (QoR-40). Pearson correlation and multiple linear regression analyses were performed to evaluate associations and identify variables independently associated with recovery outcomes, controlling for potential confounders, including age, sex, ASA physical status, and type of surgery. Results: The mean SFQ score was 26.62 ± 15.19, and the mean QoR-40 score was 157.63 ± 16.66. Surgical fear was moderately and negatively correlated with overall recovery quality (r = −0.546, p < 0.001). In multiple linear regression analysis, surgical fear was most strongly associated with poorer overall recovery quality (β = −0.563, p < 0.001), within a model explaining 30.3% of the variance (adjusted R² = 0.303). At the subscale level, surgical fear was significantly associated with emotional state, pain, physical comfort, and perceived support. Pain intensity at 12 h postoperatively was significantly associated with reduced physical independence (β = −0.218, p = 0.038). Pain intensity peaked at 12 h postoperatively (p < 0.001). Conclusions: Higher levels of preoperative surgical fear are associated with poorer quality of recovery following total joint arthroplasty. These findings highlight surgical fear as a potentially relevant perioperative factor and support the integration of routine psychological assessment into perioperative care pathways in relation to early postoperative recovery outcomes. From a clinical perspective, early identification of patients with high surgical fear may facilitate targeted perioperative counseling and supportive interventions by healthcare professionals, potentially improving recovery outcomes. Full article

Background/Objectives: Patient satisfaction and supportive care are key quality indicators in certified Head and Neck Cancer Centers (HNCC). We assessed patient-reported experiences across diagnostic staging and surgical treatment pathways, focusing on discharge management and supportive service integration. Materials and Methods: In this prospective cross-sectional study, 84 inpatients were surveyed at the time of hospital discharge after diagnostic tumor staging (n = 45) or surgical treatment (n = 39) at a German tertiary HNCC. Phase-specific standardized questionnaires with five-point Likert scales were analyzed using Pearson’s chi-square and Fisher’s exact tests. Associations of sex and treatment intensity with satisfaction and supportive care utilization were explored descriptively and in an exploratory manner. Results: Overall ratings were high across both cohorts for admission processes, inpatient organization and medical and nursing care, with no statistically significant between-group differences (p > 0.05). Information regarding diagnostic and perioperative procedures was rated very positively in both groups. Discharge-related items were generally favorable. However, patients who underwent surgery reported greater uncertainty and lower reported utilization of formal discharge management. This difference did not reach statistical significance (p = 0.0559) and should therefore be interpreted as a non-significant trend toward less positive evaluation compared with diagnostic patients. Supportive services were rated predominantly good to very good by users (>95% positive ratings). Utilization differed by treatment intensity: Speech therapy was more frequent in operative patients (p < 0.001) and social work counseling was offered and utilized more often in patients undergoing extensive surgery (p = 0.042 and p = 0.027, respectively). Overall dissatisfaction was strongly associated with perceived deficiencies in information on diagnostic procedures and tumor-related counseling (both p < 0.001), whereas waiting time for surgery was not associated with negative overall ratings. Conclusions: Patient satisfaction was consistently high across diagnostic and surgical pathways. Adequate, transparent and repeated information, particularly on diagnostics and tumor counseling, was strongly associated with higher overall satisfaction, whereas objective timing metrics were not associated with negative ratings. Discharge management may represent a sensitive transition point, particularly after extensive surgery and may therefore be a relevant target for further optimization and proactive integration of supportive care services. Sex-specific findings were limited and should be interpreted cautiously due to small subgroup sizes. Full article

Background and Clinical Significance: Alpha-1 antitrypsin deficiency (AATD) is an autosomal codominant disorder caused by pathogenic variants in the SERPINA1 gene, resulting in reduced circulating alpha-1 antitrypsin (AAT) or production of dysfunctional protein. AAT is the principal inhibitor of neutrophil elastase, and its deficiency leads to unchecked proteolytic activity, progressive destruction of lung parenchyma, and increased susceptibility to infections. Severe deficiency, particularly in individuals homozygous for the Z allele (PI*ZZ), predisposes to early-onset panacinar emphysema, chronic airflow obstruction, and liver disease. Despite its clinical relevance, AATD remains markedly underdiagnosed and is frequently misclassified as smoking-related chronic obstructive pulmonary disease (COPD), delaying access to disease-modifying therapy, genetic counselling, and preventive strategies. Early recognition is therefore essential to improve outcomes. Case Presentation: We report the case of a 68-year-old ex-smoker with a long-standing diagnosis of “COPD” who presented with acute-on-chronic type 2 respiratory failure and community-acquired pneumonia. Spirometry revealed severe airflow obstruction, and high-resolution computed tomography demonstrated extensive basilar panlobular emphysema, raising suspicion for AATD. Serum AAT concentration was critically low at 26.8 mg·dL⁻¹, and isoelectric focusing confirmed a PI*ZZ phenotype. Next-generation sequencing identified homozygosity for the SERPINA1 c.1096G>A (Z) variant, with no additional pathogenic alleles. Cascade family screening revealed multiple heterozygous PI*MZ relatives. Before augmentation therapy could be initiated, the patient developed severe Legionella pneumophila pneumonia with secondary bacterial superinfection, progressing to refractory septic shock and death. Conclusions: This case illustrates how AATD can masquerade as smoking-related COPD for years, leading to missed opportunities for timely intervention. It underscores the importance of testing all adults with COPD or refractory asthma at least once, regardless of age or smoking history. Early diagnosis enables initiation of augmentation therapy, targeted vaccination, lifestyle modification, and genetic counselling, ultimately improving prognosis and reducing preventable morbidity and mortality. Full article

Reproductive genetic carrier screening (RGCS) is recommended preconceptionally or early pregnancy to identify the risk of autosomal recessive (AR) disorders in healthy couples. Data on shared carrier status at the couple’s level remains limited in Eastern Europe. This study presents the first couple-based RGCS analysis in Western Romania. We retrospectively analyzed RGCS results from 247 couples with no known consanguinity at the time of evaluation (494 apparently unrelated individuals, aged 22–52 years), assessed at a single genetic center between 2020–2024. Next-generation sequencing was performed using an expanded panel targeting 302 genes, including 300 genes associated with AR onset disorders. This analysis was accompanied by both pre- and post-test genetic counseling. The prevalence of individual and shared carrier status and reproductive risk was assessed. Pathogenic or likely pathogenic (PLP) variants were identified in the study cohort, with an overall couple carrier frequency of 64.37%. Shared carrier status for PLP variants in the same gene was identified in 17.4%, including three couples carrying pathogenic variants in two shared genes. Additionally, 46.96% of couples carried pathogenic variants in different genes without overlapping. The most frequently shared genes with PLP variants were HFE, CFTR, SMN1, BTD, and COL7A1; 14 additional shared genes with PLP variants were associated with severe, early-onset disorders. Forty-three couples were deemed high risk for AR conditions. Their reproductive choices varied, including in vitro fertilization or proceeding with pregnancy with or without prenatal testing. Couple-based RGCS revealed a substantial burden of shared AR carrier status in Western Romania, supporting the implementation of population-level screening programs to improve reproductive risk assessment and informed decision-making. Full article

Background: Cervical cancer remains a leading cause of cancer-related deaths among women in Nigeria. In 2023, the Government of Nigeria, with support from Gavi and partners, introduced the single-dose human papillomavirus (HPV) vaccine through a phased, school-based campaign. The first phase was launched in October 2023 across 16 states, followed by a second phase in May 2024 that expanded coverage to the remaining states and the Federal Capital Territory. This study evaluates the additional impact of a behavioral insights–informed digital intervention, comprising a social media campaign amplified by trained pharmacists serving as local influencers, implemented in 2025 to increase acceptance and uptake of HPV vaccination during routine immunization. Methods: A pre-test/post-test quasi-experimental design with a control group was implemented in three Nigerian states in 2025 to assess the additional impact of a behavioral insights–informed social media campaign designed to strengthen social approval for HPV vaccination, increase awareness of vaccination locations, and reinforce caregivers’ recognition of their adolescent daughters’ desire to be vaccinated. Messages were amplified by trained pharmacists who served as local influencers. Caregivers of adolescent girls aged 9–17 years were recruited online through targeted Facebook and Instagram advertisements during Nigeria’s transition from school-based HPV vaccination campaigns to routine immunization. Caregivers in treatment areas were exposed to geofenced social media advertisements on Facebook and Instagram and pharmacist counseling, while those in control areas were not. Logistic regression models using a difference-in-difference approach estimated the campaign’s effect on HPV vaccination, controlling for caregiver and adolescent characteristics. Additional statistical models assessed the campaign’s impact on caregivers’ motivation and ability—key drivers of behavior according to the Fogg Behavior Model. Results: HPV vaccination increased at a significantly higher rate in the treatment compared to the control area. The adjusted odds of an adolescent girl being vaccinated were 1.48 times higher in the treatment area at follow-up (95% CI: 1.14–1.92). Adjusted marginal effects indicated that exposure to the campaign increased the probability of vaccination by 8.9 percentage points relative to the control group. The rate at which caregivers’ motivation (aOR = 1.31, 95% CI: 1.00–1.70) and ability (knowing where to get vaccinated: aOR = 1.38, 95% CI: 1.07–1.79; ease of vaccination: aOR = 1.59, 95% CI: 1.22–2.06) increased was also higher in the treatment area. There was no relative increase in intervention versus control groups in factual knowledge regarding HPV vaccination. Conclusions: A behavioral insights–informed social media campaign in which pharmacists served as influencers was associated with higher HPV vaccine uptake during routine immunization. The higher rate of vaccination observed in intervention areas was associated with higher rates of caregiver motivation and ability but not with higher rates of caregiver knowledge. These findings are consistent with the potential of behavioral insights–informed digital campaigns to complement routine immunization efforts and improve vaccine uptake in low- and middle-income countries. Full article

Background/Objectives: Approximately half of US children who meet traditional cochlear implant (CI) candidacy criteria receive an implant. As candidacy expands to include a broader range of hearing configurations, identifying factors that influence referral completion and CI uptake is increasingly important. This study examined the predictors of CI evaluation completion and surgery among children referred for CI assessment, including both traditional and non-traditional candidates. Methods: The medical records of pediatric patients referred for an initial CI evaluation from 2018 through 2024 were reviewed. Referral outcomes were categorized as evaluation not completed, candidate who declined surgery, or candidate who proceeded with surgery. Two binomial logistic regression models assessed the demographic, audiologic, and contextual predictors of CI evaluation completion and CI uptake, including age at referral, candidate type, insurance, referral year, communication mode, race/ethnicity, unaided thresholds, rurality, and county-level social health determinants. Results: The completion of the CI evaluation was significantly influenced by race/ethnicity, candidate type, referral year, and age. Mixed-race children demonstrated higher completion rates than White children. Completion was lower among children with single-sided deafness (SSD), children referred in 2022, and older children. Among children determined to be candidates, 69% proceeded with surgery. CI uptake showed similar patterns, with lower rates among Hispanic children, children with residual hearing or SSD, children referred in 2022, and older children. Conclusions: CI uptake at this center exceeded national averages but was associated with race/ethnicity, candidate type, age, and year of referral. Targeted counseling and outreach may improve timely referral and informed decision-making. Full article

Background: The effectiveness of prostate-specific antigen (PSA)-based early detection of prostate cancer remains controversial and implementation-dependent. Screening policy changes have substantially altered PSA testing behavior in the United States, yet longitudinal evidence from non-organized European settings is limited. We assessed 12-year changes in awareness and utilization of PSA-based early detection and identified subgroups requiring targeted counseling. Methods: Two cross-sectional survey waves were conducted in 2009 (Study Phase 1) and 2021 (Study Phase 2) among men recruited via general practitioner practices in urban and rural regions of Germany. The survey was developed and reported according to the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Identical questionnaires were used across phases. Endpoints were awareness of PSA-based early detection and prior PSA testing. Univariable and multivariable logistic regression evaluated independent associations with sociodemographic and behavioral factors. To assess sensitivity to compositional differences between survey waves, post-stratified weighted analyses re-aligning Study Phase 2 to the Study Phase 1 distribution of age category, educational attainment, and smoking status were conducted. Results: The analytic cohort comprised 890 men (Study Phase 1, n = 755; Study Phase 2, n = 135). Compared with Study Phase 1, Study Phase 2 participants more frequently were non-smokers (63.0% vs. 48.5%, p < 0.001) and had a university degree (38.5% vs. 30.5%, p = 0.002). In primary multivariable analyses, higher educational attainment (OR 1.71, 95% CI 1.24–2.36) and paternity (OR 1.94, 95% CI 1.25–3.01) were independently associated with greater awareness, whereas increasing age (OR 1.39, 95% CI 1.29–1.50) and higher educational attainment (OR 1.63, 95% CI 1.19–2.24) were independently associated with utilization. Study phase was not independently associated with either endpoint in primary models. In post-stratified sensitivity analyses, study phase was positively associated with utilization, indicating sensitivity of temporal contrasts to population composition. Conclusions: In primary multivariable analyses, we did not detect statistically significant temporal differences in awareness or utilization of PSA-based early detection within this German non-organized setting. The emergence of a study phase effect in weighted sensitivity analyses suggests that apparent time trends may be influenced by compositional differences between survey waves. Persistent social gradients, particularly related to educational attainment, underscore the importance of targeted, evidence-based counseling in opportunistic early detection systems. Larger, prospectively designed studies are needed to distinguish true temporal change from sampling-related effects. Full article

Background: Food allergy (FA) is an increasing public health concern with significant implications for child health and quality of life. Early introduction of allergenic foods has been shown to reduce the risk of food allergy development; however, maternal awareness and adherence to these recommendations remain inconsistent. This study aimed to assess maternal awareness and practices regarding the timing of allergenic food introduction among mothers residing in Makkah, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted between November 2023 and March 2024 involving parents of children aged younger than 48 monthsin the Makkah region. Data were collected via a self-administered electronic questionnaire distributed through social media platforms. Results: A total of 391 parents participated. Parent-reported food allergy was identified in 11.3% of children, while 14.6% had eczema. Early introduction (<12 months) was more common for egg (43.3%) and wheat (71.1%) compared to peanut (28.9%), tree nuts (30.9%), sesame (30.9%), and seafood (28.9%). A considerable proportion of children had not been introduced to key allergenic foods even after 36 months, particularly peanuts (45.3%) and sesame (42.2%). Children with eczema were significantly more likely to have early introduction of egg (p = 0.035), tree nuts (p = 0.046), and seafood (p = 0.031). Similarly, children with a family history of food allergy had higher early introduction rates of tree nuts (55.3% vs. 44.0%, p = 0.043) and seafood (62.3% vs. 49.1%, p = 0.019). Only 25.8% of mothers were aware that early introduction might prevent food allergies, and just 22% reported receiving professional advice to introduce allergenic foods early. Conclusions: Maternal awareness regarding the timely introduction of allergenic foods in Makkah remains limited, with delayed introduction persisting beyond 36 months for several high-risk allergens. These findings underscore the need for targeted educational interventions and improved counseling by healthcare providers. Full article

Gestational diabetes mellitus (GDM), one of the most common metabolic complications of gestation, affects approximately 10–15% of all pregnancies and represents a significant challenge for obstetricians and diabetologists aiming to reduce adverse feto-maternal outcomes. Medical nutrition therapy remains the cornerstone of GDM management, alongside lifestyle modification and pharmacological treatment in the presence of unmet glycemic targets. However, current dietary recommendations primarily emphasize nutrient composition and caloric intake, often without fully considering the temporal aspects of food intake. Chrono-nutrition is an emerging field that investigates the interaction between meal timing, circadian rhythms, and metabolic regulation. Increasing evidence indicates that glucose metabolism and insulin sensitivity exhibit marked diurnal variations, which may be further amplified in women with GDM, resulting in time-dependent differences in postprandial glycemic responses. This narrative review summarizes the current evidence on the role of chrono-nutrition in GDM by integrating mechanistic insights with findings from observational and interventional human studies. Although the available literature is limited by heterogeneity and a paucity of well-designed randomized controlled trials, the convergence of biological plausibility and emerging clinical data suggests that chrono-nutrition may represent a potential low-risk refinement of standard medical nutrition therapy. Incorporating temporal aspects of eating into dietary counseling may help frame glycemic management within a more physiologically aligned and personalized nutritional approach for pregnancies complicated by GDM. Full article

Background: Brace adherence is a key determinant of treatment success in adolescents with idiopathic scoliosis. However, adherence is influenced by multiple clinical, psychological, and social factors, and reported wear times vary widely across studies. This systematic review and meta-analysis aimed to identify determinants of brace adherence and assess their quantitative impact on real wear. Methods: A comprehensive search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar from database inception to November 2025. A total of 1040 records were identified, 620 were screened, and 45 full-text articles were assessed for eligibility. In total, 17 studies met the inclusion criteria and were included in the qualitative synthesis, and 10 provided extractable quantitative data and were included in the meta-analysis. A random-effects model was used to calculate pooled mean differences for identified determinants, including sex, age, early adherence, and sensor-based monitoring. Results: In total, 17 studies involving 1716 adolescents were included, and 10 provided extractable quantitative data for meta-analysis. Objective sensor-based monitoring was consistently associated with higher adherence, with a pooled mean difference of 25.6 percent compared with non-sensor methods. Early adherence significantly predicted long-term compliance, with a mean difference of 9.6 percent. Younger adolescents demonstrated greater adherence than older patients, with a mean difference of 19.1 percent, while sex differences favored females but did not reach statistical significance. Psychosocial determinants such as body image perception, stress, family dynamics, and religious environment played an important role in modulating adherence. Higher body mass index (BMI) and reduced quality of life were associated with poorer compliance. Overall, studies evaluating positive determinants reported a pooled mean adherence of 89.6 percent compared with 67.7 percent in studies characterized by negative determinants. Conclusions: Brace adherence is determined by a combination of clinical and psychosocial factors. Sensor-based monitoring, strong early adherence, and supportive environments consistently enhance compliance, whereas stress, poor body image, and higher BMI hinder wear. Targeted interventions, early counseling, and standardized adherence metrics are needed to improve outcomes in brace-treated scoliosis. Full article