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This study aimed to investigate 1) the longitudinal associations between food patterns and body weight in young adulthood, and 2) how food patterns of young adults relate to food consumption in early, middle and late childhood. The study sample includes 700 participants of the Québec Longitudinal Study of Child Development. During childhood, frequency of consumption of various foods was reported on ten occasions between 1.5 and 13 years. At age 22 years, food frequency questions (with quantities) were used to derive four food patterns (labeled healthy, beverage-rich, protein-rich, and high-energy-density) through exploratory factor analysis. Self-reported height and weight were collected at 22 and 23 years. Regression analyses were performed to assess associations between 1) food patterns and weight outcomes a year later (BMI, BMI change, and overweight status); 2) frequency of consumption of eight food groups in childhood and food patterns in adulthood. Dietary habits characterised by the consumption of vegetables, fruit, plant-based sources of protein and whole-grain cereal products were related to a lower risk of obesity a year later. Conversely, dietary habits characterised by a high consumption of energy-dense foods, of animal sources of proteins and, among women, of high quantities of liquids were associated with higher risk of excess weight a year later. Healthier food choices in childhood were associated with healthier food patterns in young adulthood. These findings reinforce the value of preventive dietary interventions in the early years to foster eating environments that favour healthy eating and healthy weights in adulthood.
Radiotherapy (RT) is a highly effective breast cancer treatment. However, RT can deliver radiation dose to the healthy tissues of the shoulder, increasing the potential for long-term shoulder morbidity. This study compared the dose delivered to key shoulder muscles between common RT techniques and patient positioning.
Methods:
The treatment plans of 54 patients were analysed, including those treated in the prone and supine positions. Eight shoulder muscles were contoured on each patient’s computer tomography scan. The following breast treatment techniques were analysed: hybrid-intensity-modulated RT (hybrid IMRT), wedged field, two partial arcs volumetric-modulated arc therapy (VMAT), hybrid VMAT, and 3-field supraclavicular technique. Moreover, the effect of patient positioning was also evaluated (supine versus prone). Muscle radiation exposure was compared for the mean dose and the percent muscle volume exposed to V15 Gy and V30 Gy.
Results:
The mean dose and exposed volume for the pectoralis major and pectoralis minor were similar between hybrid IMRT, wedged field, VMAT, and hybrid VMAT. VMAT and hybrid VMAT delivered a greater mean dose to most posterior shoulder muscles compared to hybrid IMRT, though overall exposure remained generally low for these muscles. The 3-field supraclavicular technique increased radiation exposure to all shoulder muscles, particularly to the pectoralis major, the pectoralis minor and the supraspinatus. Prone positioning significantly reduced V15 Gy and V30 Gy exposure for both anterior and posterior shoulder muscles.
Conclusion:
Shoulder muscle exposure was similar between hybrid IMRT, wedged field, VMAT and hybrid VMAT. The anterior shoulder muscles were consistently exposed to radiation with all RT techniques investigated in this study. In comparison, the 3-field supraclavicular technique substantially increased the radiation exposure to the posterior shoulder muscles. Lastly, delivering radiation in the prone position spared the anterior and posterior shoulder muscles. These findings inform treatment planning decisions aimed at mitigating the risk of long-term shoulder dysfunction.
The current study examined perceptions of and experiences with Flint Families Cook, a virtual cooking and nutrition program for youth and families.
Design:
Families were invited to participate in virtual focus groups after completing the five-week Flint Families Cook program. The research study was guided by Social Cognitive Theory. Researchers used thematic analysis to examine the transcribed focus groups, identify patterns across transcripts, and develop emerging themes.
Setting:
Families living in Flint and surrounding Genesee County, Michigan, USA engaged in virtual focus groups via Zoom.
Participants:
Youth (n=32; 59% female, 53% African American) and adult caregivers (n=31; 90% female, 39% African American) participated in focus groups between October 2020 and February 2022.
Results:
Five themes were generated from the focus group discussions: (i) general cooking challenges; (ii) class format; (iii) family support; (iv) provision of food; and (v) instruction and learning.
Conclusions:
In addition to perceived positive impacts on cooking skills and nutrition education, many participants shared that Flint Families Cook encouraged family cohesion and support. Most caregivers felt the program, which included instruction by a chef and dietitian as well as ingredient box delivery, had important impacts on emotional health of youth and family resilience. Flint Families Cook, and similar virtual scalable programs, could broadly reach children and families to support physical and psychosocial health, especially in low-resource communities where such interventions may be most beneficial.
End-of-life dreams and visions (ELDVs) and delirium frequently occur near death but differ in core features. Clinical differentiation becomes challenging when they co-occur. This case report illustrates the interplay between ELDVs and delirium, examines the limits of current diagnostic criteria in mixed cases, and outlines a nuanced approach to distinction.
Methods
We report the case of an elderly Brazilian woman with metastatic cancer who exhibited both ELDVs and delirium. Mental status was serially assessed using the Confusion Assessment Method (CAM). ELDV accounts were prospectively triangulated across patient, family, and clinician reports to enhance reliability and contextual understanding.
Results
The patient’s experiences showed ELDV hallmarks – vivid, realistic encounters with deceased relatives, biographical relevance, and preparatory themes – yet many were affectively distressing and occurred alongside fluctuating attention and consciousness consistent with delirium. CAM effectively identified delirium but could not, on its own, distinguish ELDVs within delirious states. When co-occurring, ELDVs often emerged during “windows of lucidity” marked by preserved autobiographical context, intact recall with subsequent coherent narration, and insight, despite intense emotional valence. Distress alone was not discriminatory, probably being shaped by psychosocial and cultural factors. These observations indicate the need to supplement CAM with qualitative and phenomenological criteria, including content, vividness, biographical meaning, insight, cultural fit, and acuity/recall.
Significance
To our knowledge, this is the first case to map evolving end-of-life mental status using serial CAM while prospectively documenting ELDVs via triangulated reports. The findings highlight the complexity of differentiating co-occurring ELDVs and delirium and challenge the sufficiency of CAM alone. An integrated approach – combining CAM screening with structured ELDV assessment – may prevent misclassification and support holistic, dignified palliative care. As a single case in an underexplored domain, these insights require confirmation in larger, prospective studies to assess generalizability.
This study aimed to evaluate the characteristics, difficulties, and outcomes of patients who underwent transcatheter ablation treatment due to arrhythmia with a diagnosis of CHD.
Methods:
A total of 166 patients (189 substrates) with CHD who underwent catheter ablation between November 2013 and 2023 were evaluated retrospectively. EnSite™ (St Jude Medical Inc., St Paul, MN, USA) was used in all patients.
Results:
The mean age was 14.8 ± 7.9 years (2.9–43 years). The most common CHD’s were Ebstein anomaly (n: 40), tetralogy of Fallot (n: 31), atrial septal defect (n: 25), ventricular septal defect (n: 22), great artery transposition (D/L TGA, n: 12), and complex CHD in single ventricle physiology (n: 9). The most common arrhythmia mechanisms were Wolf-Parkinson-White syndrome (WPW, n: 50), intraatrial reentrant tachycardia (IART, n: 39), typical atrioventricular nodal reentrant tachycardia (AVNRT, n: 37), and ventricular tachycardia-ventricular extrasystoles (VT/VES, n: 23). There was more than one arrhythmia in 23 patients and multiple manifest accessory pathways in 10 patients. The average procedure time was 174 ± 69.3 minutes, and the average fluoro time was 8.3 minutes. While successful ablation was performed in 176/189 (acute success 93.1%) substrates, the procedure was unsuccessful in five patients and suboptimal in eight patients. Recurrence was observed in 11 patients (6.4%) during a mean follow-up period of 49.2 ± 30.1 months. A second ablation was performed on 13 patients. Acute success was achieved in all except one patient. A total of 11 patients are being followed up with medical treatment.
Conclusion:
Despite the complex anatomy, age, operations, and limited vascular access possibilities in patients diagnosed with CHD, transcatheter ablation treatment with advances in electrophysiology, the introduction of different energy types, special ablation catheters, multipolar mapping catheters, and 3D nonfluoroscopic mapping systems seems to be a safe and effective option.
This study has investigated the relationship between the gut microbiota compotision and the growth performance in pigs from birth to the finishing stage, focusing on nutrient metabolism. Of 59 crossbred pigs [(Landrace × Large Yorkshire) × Duroc] from seven sows, individuals with high and low daily gain (DG) were assigned to high DG (HDG, n = 11) and low DG (LDG, n = 8) groups. Fecal samples collected at weaning (21 days), growing (95–106 days) and finishing (136–152 days) stages were analyzed for amino acids, short-chain fatty acids, and microbial composition using 16S rRNA sequencing. Although birth and weaning weights were similar in both groups, the HDG group had significantly higher weights in the growing and finishing stages (P < 0.01). The microbial composition of the LDG group revealed a higher abundance of f_Lachnospiraceae;__ at weaning (P < 0.05), whereas the HDG group contained higher abundance of g_Streptococcus and g_Prevotella 7 at the finishing stage (P < 0.05). Functional analysis revealed increased amino acid metabolism in the HDG group at the finishing stage (P < 0.05). During the growing stage, total free fecal amino acid content was low in the HDG group (P < 0.05); at weaning, levels of isobutyric and isovaleric acids, key amino acid fermentation products (P < 0.05, P < 0.01), were higher. These findings indicate growth stage-specific differences in the gut microbiota and metabolic profiles between groups with different growth performance, suggesting microbial and metabolic characteristics may influence growth performance.
This study systematically evaluates the effects of probiotic interventions on gut microbiota and clinical outcomes in diabetic patients to determine the optimal target population and conditions for effective use, with an emphasis on precision treatment. A comprehensive search was performed across PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Internet (CNKI), and Wanfang databases until April 2024. Randomized controlled trials (RCTs) assessing probiotics as adjunctive therapy for diabetes were included. The control group received standard care, and the intervention group received probiotics alongside standard care. Data were managed with Endnote and Excel, and analyses were conducted using Revman 5.3 and Stata 16. Twelve RCTs involving 1,113 participants were included. Probiotics significantly increased fecal Lactobacillus (standardized mean difference (SMD) 1.42, P < 0.0001, I2 = 95%) and Bifidobacterium levels (SMD 1.27, P < 0.0001, I² = 90%) and reduced fasting plasma glucose (SMD -0.35, P = 0.004). Subgroup analysis showed that shorter intervention durations (≤3 months) improved FPG, HbA1c, and Bifidobacterium levels, while younger patients (≤60 years) experienced the most significant improvements in Bifidobacterium levels. In conclusion, probiotics improve gut microbiota and clinical outcomes in diabetic patients, with intervention duration and patient age as key factors influencing treatment effectiveness.
Overweight and obesity have become a global public health concern, with prevalence rising sharply in low- and middle-income countries. This study analyzed temporal trends in overweight and obesity among schoolchildren in the largest capital city of Brazil, from 2006 to 2024.
Design:
Repeated cross-sectional.
Setting:
Schoolchildren aged 6 to 19 from Porto Velho, Rondônia, Brazil.
Participants:
A total of 12,646 participants were evaluated. To assess the body mass index z-score, standardized body mass and height measurements were used, stratified by sex (male and female) and age group (6-10 and 11-19 years). Temporal trends were assessed using joinpoint regression analysis.
Results:
Overall, 17.8% of participants were classified with overweight, and 8.6% were classified with obesity. The study also found that obesity prevalence was consistently higher among younger age groups compared to adolescents. The results revealed a significant increase in obesity prevalence among girls (annual percentage change [APC] = 5.81%; 95% confidence interval [95%CI] = 1.03-10.81; p-value = 0.021) and children aged 6 to 10 years (APC = 5.20%; 95%CI = 1.17-9.39; p-value = 0.017), while no significant trends were observed for overweight or for male adolescents or adolescents aged 11 to 19 years.
Conclusions:
Our findings indicate rising obesity among girls and children aged 6–10 and support the need for urgency. We recommend targeted action, including implementing mandatory quality physical education and school nutrition standards, enforcing restrictions on marketing to children, and prioritizing municipal policies that increase access to healthy foods.
The effect of the Japanese diet on cancer incidence remains unclear. The purpose of this study was to examine the association between the Japanese diet and the risk of all-cause and site-specific cancer. We analysed 14-year follow-up data from the Osaki Cohort study of 25,570 Japanese men and women aged 40–79 years. The Japanese diet was evaluated using a 39-item food frequency questionnaire at baseline. Based on a previous study, we used eight food items to calculate the Japanese Diet Index (JDI) score: rice, miso soup, seaweed, pickles, green and yellow vegetables, seafood, green tea, and beef and pork. The participants were divided into quartiles based on their JDI scores. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of cancer incidence. During the mean 10.4 years of follow-up, we identified 3,161 incident cases of all-cause cancer. Multivariable analysis showed that the JDI score was not associated with cancer incidence. In comparison to Q1 (the lowest), the multivariable HRs and 95%CIs were 1.01 (0.92–1.12) for Q2, 0.94 (0.85–1.04) for Q3, and 1.06 (0.95-1.18) for Q4 (the highest). Furthermore, separate analyses of nine common cancer sites demonstrated no association with the JDI score. The results were consistent even after a sensitivity analysis using multiple imputation. This prospective study showed that the Japanese diet was not associated with cancer incidence. The results suggests that the Japanese diet could contribute to a person’s overall health and well-being without increasing cancer risk.
Beliefs in evil spirits and the practice of deliverance from supernatural forces have been widespread throughout history. Many psychological and physical afflictions have been attributed to involuntary demonic possession. Traditional remedies, for those reporting inhabitation by evil spirits, can involve exorcism believed to expel such forces. Similar beliefs may be symptomatic of major mental illness and treatments namely medication and psychotherapy, are frequently recommended. An increasingly secular western world is also seeing growth in non-denominational Christian churches and other faiths, who accept spirit possession and exorcism. Culturally competent mental health professionals, seeking to understand their patients’ world view, may struggle with exorcism, seeing it as an interference to conventional treatment. They may be being unwilling thus to attempt differentiation between possession and mental illness. This paper explores the diversity of views on this topic and points of contention and overlap. The risks and cautions necessary in approaching this issue are stressed.
Substance use disorders and addictions are mental disorders deeply interconnected with other psychiatric conditions – and this connection is of fundamental importance. Although addictions are formally recognized as mental health disorders, they are often not addressed as such in research or clinical practice. Psychiatric research, clinical care, and treatment development remain largely organized along traditional diagnostic boundaries. While diagnostic classifications provide structure and clinical utility, it is increasingly evident that psychiatric diagnoses are neither fully separable nor independent entities. Despite extensive discussion on comorbidity, addictions are frequently excluded from broader conceptualizations of the intertwined nature of mental disorders. Yet, they share substantial commonalities with other psychiatric conditions across clinical presentation, psychopathology, genetic vulnerability, neurobiological mechanisms, socioenvironmental risk factors, and treatment strategies. Maintaining a conceptual divide between addictions and other psychiatric disorders reinforces diagnostic “tunnel vision,” constraining our understanding of neuropsychopathology and contributing to persistent gaps in care and treatment accessibility. This narrative review examines the overlapping risk factors, clinical features, and therapeutic approaches that link addictions with other mental disorders. We argue that advancing psychiatric research and nosology requires a deliberate acknowledgement of these transdiagnostic overlaps and shared mechanisms. The challenge is particularly evident in the understanding and treatment of dual disorders. Progress will depend on integrative, collaborative frameworks that bridge scientific and clinical perspectives and foster dynamic feedback between empirical research and clinical practice. Recognizing mental disorders as interdependent systems may offer a more coherent and effective foundation for understanding and treatment.
Due to the high prevalence of depression among young adults, identifying prevention strategies during young adulthood are crucial. Dietary polyphenols have been associated with depression in older cohorts; however, the association remains unclear, particularly in young adults. This study aimed to assess the prospective association between the intake of total polyphenols, polyphenol classes, and polyphenol subclasses with depressive symptoms in young adults. Data from 1,484 Raine Study Generation 2 participants [52.7% female; baseline mean age (SD): 20 (0.5)] at the -20, -22, and -27 year follow-ups (N = 964, 979, and 1,094, respectively), with overlap across follow-ups, were used. Energy-adjusted polyphenol intake was estimated from food frequency questionnaire data using our expansion of the AUSNUT 2011-13 and Phenol-Explorer to include polyphenol content data and categorised into quartiles. The primary outcome was self-reported depressive symptoms assessed via the 21-item Depression, Anxiety, and Stress Scale averaged across the three timepoints. Linear mixed-effects models were used to assess the association between the polyphenol intake exposures and depressive symptoms. Sociodemographic characteristics and lifestyle- and health-related behaviours were adjusted for. Participants in the highest quartiles for flavonol and hydroxybenzoic acid intake had lower depressive symptoms across time than participants in the lowest quartiles [flavonols (Q4 v Q1 mean difference: -1.41, 95%CIs: -2.51, -0.31); hydroxybenzoic acids (Q4 v Q1: -1.42, 95%CIs: -2.54, -0.29)]. We found no evidence of a highest versus lowest association for all other polyphenol categories. Future studies are required to investigate whether increasing polyphenol intake could protect against depression in young adults.
Total energy expenditure (TEE) is estimated as the product of basal metabolic rate (BMR) and an SCI-specific factor. The agreement between TEE and total energy intake (TEI) was just established. The findings suggested the existence of positive and negative energy balance distributions. Forty-two males with chronic SCI underwent BMR followed by detailed metabolic profile after overnight fast. TEI and macronutrients of 3-day dietary logs were analyzed using the Nutrition Data System for Research software. Energy surplus was calculated as TEE minus TEI. Body composition assessment was conducted using dual energy x-ray absorptiometry. 57% of SCI participants were classified as negative energy surplus with an average TEI of 1284±422 compared to 2197±553 kcal/day in the positive energy group (P = 0.0002). Negative energy group had a higher BMR (9%; P =0.02), greater body weight (P =0.03), greater total body lean mass (P= 0.03) and consume greater percentage of protein compared to the positive energy group. Percentage macronutrients of protein explained 27% of the variance of energy surplus in a multivariate regression model (r2 =0.27; P = 0.008). TEI adjusted to fat-free mass explained 87% of the variance in energy surplus and 34.7 kcal/kg/day was recommended to balance TEI with TEE. Persons with SCI are either classified into negative or positive energy surplus groups. Larger body weight and greater protein intakes are among the major characteristics of the negative energy group. Clinicians may need to consider the spectrum of energy balance before starting dietary regimen after SCI.