Habits are stimulus-driven responses that are produced independently of the current outcome value. They enable efficient actions in familiar contexts while freeing up cognitive resources. Habits are expected to influence behavior after substantial experience, whereas limited training leaves behavior under goal-directed control. This transition from goal-directed to habitual control has been documented in animal research but remains challenging to replicate in humans. Using a free-operant task, recent studies have suggested that human habits can be fully learned even after short training. This would produce a ceiling effect, explaining null results when the amount of training is manipulated. Here, we propose an alternative explanation: the devaluation protocol was ineffective for a subset of participants who appeared "habitual". To test this hypothesis, we conducted a preregistered conceptual replication of the free-operant task with improved devaluation. As in previous research, we found no difference in habitual responses between short and extended training. In contrast to prior reports, most participants were sensitive to outcome devaluation. Habitual responding was strongly correlated with the effectiveness of the outcome devaluation protocol; habit-like responses were mostly produced by the few participants for whom the devaluation did not work. We further supported our hypothesis by reanalyzing previous datasets, finding that, across all studies, participants who showed more habit-like responses were those for whom the devaluation was less effective. Taken together, our findings suggest that suboptimal outcome devaluation protocols may have biased previous results, leading to habit-like goal-directed responses regardless of the amount of previous instrumental training.
Growing evidence suggests a potential association between apical periodontitis (AP), chronic diseases, and smoking habits. However, findings from individual studies and systematic reviews remain fragmented, and high-level synthesis of available meta-analyses is limited. This umbrella review aimed to comprehensively evaluate and synthesize evidence from published meta-analyses examining the association between AP, chronic diseases, and smoking. A systematic literature search was conducted across major electronic databases from inception to February 12, 2026, to identify relevant meta-analyses. Eligible studies included meta-analyses assessing the association between AP and chronic diseases or smoking, reporting pooled effect estimates. Data extraction was performed independently by two reviewers. Methodological quality was assessed using AMSTAR 2, and certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Pooled effect estimates were synthesized using random-effects models. A total of 15 meta-analyses were included in this umbrella review. Significant associations were identified between AP and several chronic conditions, as well as smoking habits. The pooled estimates indicated that diabetes mellitus (OR = 2.43, 95% CI: 2.03-2.90), cardiovascular disease (OR = 1.98, 95% CI: 1.30-3.00; RR = 1.32, 95% CI: 1.07-1.63), inflammatory bowel disease (IBD) (OR = 1.65, 95% CI: 1.27-2.15), and smoking (OR = 2.45, 95% CI: 1.98-3.02) were significantly associated with AP. The methodological quality of the included reviews varied, with most reviews rated as low quality (60.0%), followed by high quality (20.0%), moderate quality (13.3%), and critically low quality (6.7%); substantial heterogeneity was observed in some analyses. According to the GRADE assessments, the certainty of evidence varied from low to moderate. Evidence synthesized from meta-analyses suggests significant associations between AP and diabetes mellitus, cardiovascular disease, inflammatory bowel disease, and smoking. However, limitations in methodological quality and heterogeneity reduce the strength of the conclusions. High-quality prospective studies and rigorously conducted meta-analyses are needed to further clarify these relationships and strengthen the evidence base for clinical decision-making.
Mandatory isolation and quarantine measures implemented between 2020 and 2021 had important repercussions on labor dynamics. To identify the characteristics of COVID-19 isolation, as well as the habits and working conditions that characterize food insecurity in subsistence workers in Medellin, Colombia, in 2021. Cross-sectional study using primary data sources. An interviewer-administered survey was conducted among 656 workers selected through snowball sampling. Overall, 56.4% were men and 74.7% were aged ≥45 years. Furthermore, 89.9% of women were the primary household income provider, and 74.8% did not have a partner. Alcohol and tobacco use were more frequent among men, and 43.0% of women consumed two meals a day. Furthermore, 95.6% of participants underwent mandatory quarantine; 73.2% remained isolated > 12 weeks; and 77.0% received support during isolation. The prevalence of moderate/severe food insecurity was 44.1%, increasing to 51.4% among women. Conditions characterizing food insecurity included being female, consuming one meal a day, not having a partner, being the primary household income provider, lacking work permit, not receiving government food assistance, making payment arrangements with landlords, and receiving food assistance from a university. Although food insecurity decreased by 10 percentage points, the conditions characterizing it reveal the subsistence circumstances experienced by workers, particularly women, whose social and occupational disadvantage deepened.
Adolescence represents a pivotal stage for the development of lifelong health behaviors. In Saudi Arabia, rising obesity and sedentary lifestyles among youth represent growing public health challenges. While organized sports may positively influence lifestyle behaviors, evidence comparing Saudi adolescent athletes and non-athletes across multiple behavioral domains remains limited. To compare lifestyle habits, including physical activity levels, sedentary behaviors, dietary practices, and sleep duration, between Saudi male adolescent athletes and non-athletes. A cross-sectional study of 124 male high school students aged 16-17 years (70 athletes, 54 non-athletes) from Riyadh used a validated 47-item Arab Teen Lifestyle Study (ATLS) questionnaire. Physical activity was measured in METs-minutes per week. Chi-square tests, independent t-tests, and multiple linear regression were applied. Athletes exhibited significantly higher physical activity levels (98.6% meeting guidelines compared to 55.6% of non-athletes; p < 0.001) and lower BMI (23.64 ± 5.39 versus 29.69 ± 8.34 kg/m2; p < 0.001). Additionally, a greater proportion of athletes reported consuming fruit on five or more days per week (54.3% versus 33.3%; χ2 = 8.10, p = 0.017; V = 0.26). Athletes reported shorter average sleep duration (9.06 ± 3.67 versus 11.28 ± 3.52 h per day; p = 0.001), although both groups exceeded the minimum recommended 8 h. No significant difference was observed between groups in daily screen time (4.04 ± 2.63 versus 4.44 ± 3.08 h; p = 0.44). In an exploratory regression model, frequency of energy drink consumption emerged as the only significant individual predictor of BMI (B = 4.12, 95% CI: 0.32-7.92; p = 0.034), although the overall model was not statistically significant (R 2 = 0.071; F = 1.26; p = 0.278). Participation in organized sports is linked to increased physical activity, lower body mass index, and improved fruit consumption among Saudi male adolescents. However, athletes reported reduced sleep duration, and elevated screen time persisted in both groups. These results support the integration of sports programs into adolescent health strategies and highlight the need for comprehensive interventions that address sleep hygiene, screen time management, and the promotion of physical activity.
Opioid stewardship is a priority in oral and maxillofacial surgery, although most published prescribing data come from academic institutions. The purpose was to evaluate opioid prescribing measured in morphine milligram equivalents (MMEs) following third molar (M3) surgery in private practice (PP) and academic practice (AP) and assess temporal changes. This multicenter retrospective cohort study was conducted at Mayo Clinic (Rochester, MN) and Paradigm Oral Health (Lincoln, NE). Eligible subjects underwent M3 extraction between 2019 and 2024 and received an opioid prescription. Cases with incomplete data were excluded. The predictor variable was practice setting (PP vs AP). The main outcome variable was opioid prescribing amount measured in MMEs. Covariates included subject age, sex, year of surgery, number of M3s extracted, and number of impacted M3s. Independent t-tests assessed MMEs between PP and AP and across years. One-way analysis of variance with Tukey post-hoc testing (P < .01) evaluated extraction and impaction groups and multivariable linear regression evaluated association between practice setting and MMEs. Among 53,549 subjects, 50,585 (94.5%) were treated in PP and 2,964 (5.5%) in AP. The mean age was 27.0 (14.0) years in PP and 22.1 (9.8) years in AP. Males comprised 25,423 (50.3%) of PP subjects and 1,406 (47.5%) of AP subjects. PP subjects received higher unadjusted opioid doses (60.72 ± 27.16 vs 53.69 ± 16.92 MMEs, P < .01). In multivariable regression, PP had higher prescribing, with an adjusted increase of 8.84 MMEs (95% CI: 7.84 to 9.83, P < .01). Opioid prescribing declined significantly from 2019 to 2024 in both settings (P < .001). Repeat prescription rates were less common in PP than AP (1,483 [2.9%] vs 135 [4.6%], P < .01), and procedural complexity was associated with higher MMEs in PP. Opioid prescribing following M3 surgery was higher in PP but declined in both settings from 2019 to 2024, reflecting a specialty-wide trend toward more conservative prescribing.
Urolithiasis prevention depends on sustained fluid intake, timely urination, and appropriate dietary and lifestyle practices. However, occupational routines may make these behaviors difficult to maintain. This study explored participants' perceptions of how occupational routines relate to stone-preventive self-care among individuals with CT-confirmed urolithiasis. An observational qualitative exploratory study was conducted at a tertiary care teaching hospital in South India. Adults with CT-confirmed urolithiasis and at least one calculus measuring 3 mm or more were recruited using maximum-variation purposive sampling across physically demanding or heat-exposed, sedentary or professional, travel-based or mobile, and shift-based or irregular work contexts. Face-to-face semi-structured interviews were conducted in Tamil between February and July 2025. Contemporaneous interview notes were expanded after each interview, translated into English, and analysed using thematic analysis. Clinical and CT-related variables were summarized descriptively to characterize the sample. Twenty-four of 32 approached participants were included. The median maximum stone diameter was 7 mm (interquartile range, 5-10 mm), 15 participants had hydronephrosis and/or obstructive features, and 9 had recurrent stone disease. Six themes were identified: occupationally shaped inadequate hydration; restricted or delayed urination in relation to work setting; disruption of meal timing and food quality; occupational absorption and neglect of self-care; schedule instability, travel, and disruption of daily routines; and stone disease understood as multifactorial, with occupation interacting with other perceived contributors. Across themes, participants described three interconnected pathways through which work routines could make preventive self-care difficult to sustain: infrastructural and access constraints, schedule instability and routine disruption, and cognitive-attentional absorption. Family history, dietary and lifestyle practices, supplements, smoking, alcohol use, and comorbidities were also described as contextual contributors. Occupational routines may influence the feasibility of maintaining stone-preventive self-care among individuals with urolithiasis. The findings support occupation-sensitive counselling and practical workplace strategies that consider water and toilet access, break opportunities, travel demands, shift work, and workload. Longitudinal and implementation studies should assess whether such approaches improve preventive behaviours and stone-related outcomes.
The prevalence of acne vulgaris among rosacea patients is significantly higher than that of the general population, but the risk factors for acne vulgaris among rosacea patients remain unclear. Explore the potential risk factors for the occurrence of acne vulgaris among rosacea patients, focusing on lifestyle, skincare habits, and dietary habits. A total of 300 rosacea patients were included. Lifestyle, skincare habits, and dietary habits were collected using a validated questionnaire survey. A Multivariate logistic regression model was employed to analyze risk factors associated with acne vulgaris. Further subgroup analysis and restricted cubic spline function was used to analyze the related risk factors. The prevalence of acne vulgaris was 30.33% in 300 rosacea patients, which is significantly higher than the 14.83% observed in the general population. Multivariate logistic regression analysis revealed that sufficient sleep duration was a protective factor against acne vulgaris in rosacea patients [OR = 0.738 (0.589-0.926)] (p < 0.05), while the use of sunscreen products was identified as a risk factor [OR = 2.602 (1.083-6.249)], (p < 0.05). Additionally, restricted cubic spline analysis indicated a significant linear dose-response relationship between longer sleep duration and a lower risk of acne vulgaris (Poverall  < 0.05, Pnonlinear  = 0.86). Adequate sleep appears to be a protective factor, while frequent sunscreen use may increase the risk of acne vulgaris among rosacea patients. Tailored lifestyle recommendations may contribute to improved comorbidity management.
Despite advancements in sleep medicine, inadequate sleep habits among young children persist. Establishing appropriate sleep habits in early childhood is essential for supporting physical, emotional, and cognitive development. However, scalable and personalized behavioral interventions for caregivers in community settings remain scarce, particularly AI-enabled systems designed for real-world implementation. This study evaluated adherence, perceived usefulness, and feasibility of Nenne Navi-AI among 50 caregivers recruited in Hirosaki City, Japan, through community health checkups, childcare facilities, and public advertisements. The culturally tailored application integrates supervised machine-learning models with rule-based algorithms to provide personalized guidance and ongoing support for promoting healthier sleep habits. During the 6-month intervention, only 3 of 50 caregivers (6%) experienced continuous 3-month data-entry lapses, with no withdrawals. Significant pre-post improvements were observed in children's number of awakenings after sleep onset and subjective sleep quality ratings. Subgroup analyses suggested improvements among children with poorer baseline sleep habits (≥0.5 SD worse than the sample mean). Post-intervention assessments confirmed high caregiver acceptability, satisfaction, and reduced parenting stress. Nenne Navi-AI demonstrates high feasibility with excellent 6-month adherence and favorable usability feedback. The system shows promise for improving early childhood sleep (night-waking), enhances caregiving experiences, reduces negative parenting emotions, and provides a scalable framework for future AI-enabled pediatric sleep interventions.
The Oberhautchen cells of reptile skin possess micro-ornamentations that are complex structures with a wide diversity. The ongoing debate regarding the origin of these structures oscillates between phylogenetic and ecological drivers. The current study also contributes to this debate by examining micro-ornamentations in seven lizards from three families, one worm lizard, and four snakes from three families that have epigeal, fossorial, saxicolous, or semi-aquatic life habits. They were compared in terms of phylogeny and life habits. Additionally, the variations in different scales of the same individual and different regions of the same scale were studied. The aim of comparing phylogenetically distant species among reptiles was to understand whether micro-ornamentation morphologies evolved convergently in species with the same life habits. The results showed that there are three cell shapes, two cell borders, five cell surfaces, and three ridges as morphological character states within the studied species. These variations might also differ significantly on different scales for an individual and even change gradually on the same scale. The ancestral form possibly has polygonal cells and regular borders with a smooth surface where the ridges are absent. It is essential to consider that convergent evolution facilitates the resolution of "problems" with similar "answers," however, comparisons suggest that phylogenetic limitations are more decisive than habitat restrictions in shaping the diversity of reptile skin micro-ornamentation.
Chronotype and temperament are stable individual traits that influence behaviors such as eating habits. This research examined their impact on an eco-sustainable diet, characterized by a high intake of plant-based foods and reduced consumption of animal products. A total of 738 Italian individuals were surveyed regarding their eating habits using a specific food frequency questionnaire. Individual chronotype was assessed via the revised Morningness-Eveningness Questionnaire (rMEQ), while personality traits were measured according to the HEXACO Adjective Scales. The contribution of these factors to the adoption of an eco-sustainable diet was analyzed using hierarchical binary logistic regression. In our sample, a substantial majority (N = 592; 80.22%) reported a non-eco-sustainable diet, with only 146 participants (19.78%) reporting an eco-sustainable diet. Key predictors of an increased likelihood of adhering to an eco-sustainable diet included being female (OR = 3.05, 95% CI [1.85, 5.03]), a greater preference for morningness (OR = 1.08, 95% CI [1.01, 1.14]), higher levels of Agreeableness (OR = 1.43, 95% CI [1.09, 1.86]), and increased Openness to Experience (OR = 1.60, 95% CI [1.23, 2.07]). Conversely, higher scores in Honesty-Humility (OR = 0.69, 95% CI [0.49, 0.97]), Extraversion (OR = 0.80, 95% CI [0.67, 0.96]), and increasing age (OR = 0.98, 95% CI [0.97, 1.00]) were associated with reduced odds. Both chronobiology and personality traits may significantly influence an individual's inclination toward eco-sustainable dietary choices. The intrinsic characteristics of Agreeableness and Openness to Experience, but not those associated with Honesty-Humility and Extraversion, may facilitate individuals in addressing the contextual challenges of adopting an eco-sustainable diet.
Body image dissatisfaction (BID) is a growing psychosocial concern and is strongly associated with disordered eating behaviors (DEBs), especially among young women. Although global awareness of these issues is increasing, research exploring the prevalence and relationship between BID and DEBs in Palestine remains scarce. This study aimed to assess the prevalence of DEBs and examine their association with BID among female university students. A cross-sectional study was conducted at Birzeit University from February to June 2025 among 295 female students aged 18-25 years recruited through convenience sampling. Data were collected using a structured, self-administered questionnaire that included sociodemographic and anthropometric characteristics, the Eating Attitudes Test-26 (EAT-26), and the Body Shape Questionnaire-16B (BSQ-16B). DEB risk was defined as an EAT-26 score ≥ 20. A total of 12.9% of participants were identified as being at risk of DEBs. BSQ-16B and EAT-26 scores were moderately positively correlated (r = 0.535, p < 0.001). DEBs were significantly associated with higher BMI, smoking, previous DEBs, social media influence, binge eating, weight-loss attempts, and a positive BMI discrepancy between actual and ideal BMI. This study found that a notable proportion of Palestinian university women were at risk of DEBs and that BID was moderately associated with DEBs. These findings support the importance of screening for disordered eating behaviors and body image concerns among female university students in Palestine. This study looked at how young women at Birzeit University feel about their bodies and how these feelings may be linked to unhealthy eating habits. We surveyed 295 female students aged 18 to 25 and asked them about their eating patterns, weight-control behaviors, and how they see their body shape. About 13% of the students showed signs that they may be at risk of disordered eating. Students who felt unhappy with their body shape were more likely to report unhealthy behaviors such as strict dieting, skipping meals, binge eating, or using unsafe methods to lose weight. Those who believed their “ideal” weight was lower than their current weight were also more likely to be at risk. Social media and higher body weight were linked to greater body dissatisfaction. Although not all students were at high risk, many still reported unhealthy weight-control practices. These findings highlight the importance of promoting positive body image, healthy lifestyle habits, and early support services for young women at universities in Palestine.
Alcohol elimination rate is associated with acute alcohol consequences, yet it remains difficult to measure reliably in real-world settings. Wearable transdermal alcohol concentration (TAC) sensors provide a feasible option through passive, continuous monitoring of biological alcohol exposure. This facilitates precise testing of whether alcohol elimination rate predicts alcohol-related consequences in naturalistic environments. Additionally, a faster alcohol elimination rate may buffer or reduce the risk of alcohol-related consequences following high and/or rapid consumption. Two observational studies (Alcohol Habits Study [n = 222] and Project ACE [n = 79]), each using a different alcohol sensor, were used in this study. Participants of both studies were young adults from universities who frequently engaged in heavy episodic drinking. Alcohol-related consequences were collected through daily self-reports the morning after drinking days and included metrics across multiple domains such as physical symptoms, interpersonal conflict, safety risk, sexual risk, and miscellaneous. Alcohol elimination rate and other dynamics were extracted from TAC-positive trajectories for each day. Associations were tested using multilevel modeling. Both studies showed that days with faster elimination rates were associated with more alcohol-related consequences, although statistical significance was observed only in Project ACE. In the Alcohol Habits Study, a significant day-level interaction indicated that the association between peak TAC and alcohol-related consequences was reduced on days with faster alcohol elimination rates. Similar findings emerged in Project ACE but did not reach significance. Both studies demonstrated the same pattern of conditional association: as the daily fall rate increased, the simple association between peak TAC and alcohol-related consequences diminished to the point of non-significance. Our results provide novel evidence that alcohol elimination may have (a) an independent association with alcohol-related consequences in natural settings and (b) a buffering impact on the association between peak TAC and alcohol-related consequences. The results span two studies using two separate wearable sensors, supporting the validity of findings. Future research testing these associations in larger and more diverse samples is warranted.
Growing rates of abstention within higher-income countries and among younger populations (i.e. Generation Z) signals a need to expand our understanding of why drinkers reduce or abstain from alcohol consumption. This paper revisits the Motives for Abstaining from Alcohol Questionnaire (MAAQ) developed by Stritzke and Butt (2001) to validate its use within new populations. MAAQ items, drinking habits, and demographics were collected across two studies. Study 1 recruited Generation Z university students from the UK (N = 207), while Study 2 recruited from the general population (N = 178) and adapted items to reflect social responsibilities outside of education. While the initial factor structure demonstrated good model fit, separating items capturing alcohol-related consequences into distinct subscales improved fit compared to the original 5-factor structure. These new factors capture fear of negative consequences (i.e. "Being intoxicated or drunk may make me vulnerable and put me at risk for harm.") versus social responsibility concerns (i.e. "Drinking may interfere with my school [job] performance.") which uniquely predicted fewer drinking occasions and alcohol units consumed per occasion, respectively. Consistent with alternative measures of abstinence and self-determination theory, findings suggest externally and internally motivated consequences predict unique drinking outcomes.
Millions of people who survive critical illness each year experience new disabilities that prevent them from returning to personally meaningful participation in family and community life ("community reintegration"), which is closely intertwined with resilience. We sought to describe strategies for promoting community reintegration after critical illness as a first step toward health system and care-delivery redesign. We used modified grounded theory to analyze semistructured interviews with patients and families. Interviews took place by phone or videoconference in a large health system in Western Pennsylvania. Patients who had survived critical illness (n = 11) and their family members (n = 11). Four interrelated strategies promoted an upward spiral of community reintegration: 1) develop patient and family skills to manage symptoms of underlying impairments at home; 2) re-establish competence to perform healthy habits and routines; 3) identify and support key roles and relationships so that people stay connected even amidst change; 4) problem-solve the physical and social environments so that people can participate in meaningful activities. Progress upward described a trajectory of resilience, while backsliding downward described a trajectory of demoralization. Four strategies promoted an upward spiral of resilience and community reintegration, and counteracted a downward spiral of demoralization. They yielded novel insights about the spectrum of demoralization versus resilience in the context of disability. Future research should develop and test interventions using these strategies to promote community reintegration as a key step toward population health after critical illness.
Complicated associations between early-life multiplexed environmental exposures and sleep health in preschoolers are poorly understood. This research investigated whether ecological liveability portrayed by multidimensional environmental factors is associated with sleep health in 113,711 preschoolers from 551 Chinese cities. Sleep health was assessed using the Children's Sleep Habits Questionnaire (CSHQ). Nineteen environmental exposures across five domains (points of interest, natural spaces and land cover, built-road environment, air pollution, and meteorology) were evaluated during three susceptibility windows: pregnancy, birth to 36 months, and early life (conception to 36 months). Exposure profiles were identified using the Clustering Large Applications algorithm. Linear mixed-effects and binomial generalised linear mixed models estimated associations between these profiles and sleep health. Sleep disorders (CSHQ total score >41) were identified in 76.4% of preschoolers. Four ecologically distinct and spatially heterogeneous exposure profiles emerged: Profile 1 (Metropolitan-Compact), Profile 2 (Eco-Moderate, liveable reference), Profile 3 (Agro-Industrial-Polluted), and Profile 4 (Heat-Humid-Stressed). Compared with the liveable environment, children exposed to the other three profiles had higher CSHQ scores (Profiles 1, 3, and 4). Postnatal exposure to Profile 3 (OR=1.08, 95% CI 1.03-1.14) and Profile 4 (OR=1.09, 95% CI 1.05-1.14) increased the odds of sleep disorders. The first 36 postnatal months constituted the most sensitive developmental window. Multidimensional exposure profiles shape preschool sleep health beginning in utero and intensifying after birth, with notable spatial heterogeneity across China. These findings highlight the need for time-specific and regionally tailored public health and urban planning strategies to foster ecologically sustainable environments that improve healthy early development.
To evaluate the effects of a combined programme of therapeutic exercise (TE) and pain neurophysiology education (PNE) on health-related quality of life (HRQoL), abdominal wall muscle thickness, menstrual symptoms and sexual function in women with endometriosis. Randomized controlled trial. Outpatient rehabilitation centre specializing in women's health. Forty women diagnosed with endometriosis were assigned at random to either the experimental group (EG) or the standard education group (SEG). The EG participated in 24 combined sessions of TE and PNE over an 8-week period, while the SEG received four online theoretical sessions on healthy lifestyle habits. The primary outcome was HRQoL, assessed using the EQ-5D-5 L (both EQ-VAS and EQ-5D index). The secondary outcomes were abdominal wall muscle thickness, menstruation-related symptoms, and sexual function, assessed using ultrasound, the CVM-22 questionnaire, and the Female Sexual Function Index, respectively. Assessments were conducted at baseline, immediately post-intervention (T1), and at 3-month follow-up (T2). The linear mixed model showed greater improvements in HRQoL (EQ-5D index and EQ-VAS) in the EG compared with the SEG at T1 and T2, with large effect sizes. Exploratory analyses suggested greater increases in abdominal muscle thickness (transverse abdominis and internal oblique) and improvements in menstrual symptoms at T1 and T2, although these findings should be interpreted with caution due to the absence of adjustment for multiplicity. A combined programme of TE and PNE may improve HRQoL in women with endometriosis in the short and medium term. Exploratory analyses reported that abdominal muscle thickness and menstrual symptoms showed favourable changes.
Depression is a common mental health disorder with complex interactions involving systemic inflammation and oral health. Poor oral hygiene has been linked to depressive symptoms, evidence on interdental cleaning, particularly dental floss use, and depression remains limited. The aim of this study is to examine the association between dental floss use and the prevalence of depression in a nationally representative U.S. adult population. Data from 17,250 participants from National Health and Nutrition Examination Survey (NHANES) were analyzed. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores ≥ 10 indicating depression. Dental floss use in was determined by the Oral Health Questionnaire. Logistic and linear regression models were employed to evaluate the association between flossing and depression. Sensitivity analyses included additional adjustment for oral health and oral health as an alternative exposure. Restricted cubic spline (RCS) and subgroup analyses were also conducted. Of the participants, 8% were classified as having depression. Dental floss use was inversely associated with depression risk (OR = 0.954, 95% CI: 0.931-0.978). Flossing ≥ 5 times per week was linked to a lower prevalence of depression (OR = 0.735, 95% CI: 0.619-0.872). RCS analysis revealed a linear relationship between increased flossing frequency and decreased depression risk, and findings were robust across sensitivity analyses. Regular use of dental floss was associated with a reduced risk of depression. These findings highlight the importance of interdental cleaning as a potential preventive strategy in oral hygiene habits and mental health promotion.
Endoscopic full-thickness resection (EFTR) and laparoscopic and endoscopic cooperative surgery (LECS) are minimally invasive treatments for gastric submucosal tumors (SMTs). Because comparative data of both methods are lacking, we aimed to compare the clinical outcomes between EFTR and LECS for gastric SMT. This multicenter study included patients who underwent EFTR or LECS for gastric SMT in four Japanese institutions. A 1:1 propensity score matching (PSM) analysis was performed with a caliper width of 0.2. Covariates included age; sex; body mass index; history of abdominal surgery, cardiovascular disease, or cerebrovascular disease; comorbidities; smoking and drinking habits; antiplatelet and anticoagulant intake; along with tumor location, type, and size. We enrolled 38 patients treated with EFTR and 59, with LECS. After PSM, 21 patients were selected. The histological R0 resection rate was comparable between EFTR and LECS before (95% vs. 100%) and after (91% vs. 100%) PSM. In the EFTR group, median operation time was shorter (93 min vs. 161 min, p < 0.001), median numbers of attending doctors were fewer (5 vs. 3, p < 0.001), with procedure (¥305,330 vs. ¥434,700, p = 0.017) and total hospitalization costs (¥676,400 vs. ¥861,420) lower than those in the LECS group after PSM. Adverse event rates were low (5% vs. 14%, p = 0.606) in both groups. EFTR and LECS provide efficacious oncological outcomes for patients with small (≤ 3 cm) intraluminal type gastric SMT. EFTR demonstrated favorable operative efficiency and economic outcomes, suggesting it may be a potentially cost-effective alternative.
Among various modifiable risk factors, dietary patterns (DPs), as a holistic lifestyle intervention, have become a focus of current research due to their protective effects on cognitive health. Classic Western DPs, such as the Mediterranean diet (MedDiet), have been widely confirmed to effectively improve cognitive function, thereby reducing the risk of Alzheimer's disease (AD). However, existing evidence mainly concentrates on Western populations and their DPs, including the MODERN (Machine learning-assisted Optimizing Dietary intERvention against demeNtia risk) diet optimized using machine learning. Given the significant differences in food types, dietary habits, and cooking methods among Asian populations, research on localized DPs optimized for cognitive health in Asian populations remains insufficient. In this context, the team at the Department of Geriatrics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine has taken the lead in systematically defining the Shanghai Cognitive Diet Pattern (SCDP). This review aims to comprehensively outline the core features and potential biological mechanisms relevant to AD in both classic Western DPs and the emerging East Asian DP. Subsequently, this review will systematically compare Eastern and Western DPs. In conclusion, this review proposes shifting​ dietary strategies from population-level adaptation to individual precision, in conjunction with multimodal lifestyle management, and offers novel strategies for the prevention and management of AD.
Obesity among adolescents has become a global public health concern. Previous studies have shown that multidimensional interventions, such as school-based programs, health education, and guidance on diet and physical activity, effectively improve obesity in adolescents. However, there is a lack of research on bilingual health education interventions in minority language environments in rural and pastoral areas of China. Based on a 2023 field survey of students from three Mongolian middle schools in Ar Horqin Banner, Chifeng City, Inner Mongolia, this study evaluated the effect of a 6-month Mongolian-Chinese bilingual health education intervention on obese adolescents' BMI Z-scores, dietary behaviors, and biochemical indicators (fasting blood glucose, insulin, and blood lipids). Baseline data, including height, weight, and a dietary behavior questionnaire, were collected from 2,210 Mongolian middle school students, of whom 155 obese students were screened out. A 6-month bilingual health-education intervention was implemented for the 155 obese students, with content covering guidance on a rational diet, cultivation of healthy behaviors, and moderate exercise training. Before and after the intervention, the participants underwent height and weight measurements, fasting blood sampling, and completed questionnaires. This study evaluated the intervention effects by examining changes in BMI Z-scores, dietary behaviors, and glucose and lipid-related biomarkers (including fasting blood glucose, insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)) among obese students pre- and post-intervention. Among 2,210 adolescents, the prevalence of overweight and obesity was 13.12 and 7.01%, respectively (combined 20.13%). These rates were significantly higher among males and junior high school students (P < 0.001). The obesity rate is higher in males than in females (OR = 1.883, 95%CI: 1.338 ~ 2.650). Adolescent obesity was significantly associated with parental obesity (OR = 1.847, 95% CI: 1.172 ~ 2.996), specific dietary behaviors (e.g., frequent midnight snacking), reduced physical activity (OR = 2.262, 95% CI: 1.254 ~ 4.081), prolonged sleep duration (OR = 1.622, 95% CI: 1.148 ~ 2.291), and severe body dissatisfaction (P < 0.05). A 6-month health education intervention conducted on 111 adolescents with obesity (44 cases were missing due to various reasons) improved their health awareness, dietary choices, exercise habits, and sleep patterns (P < 0.05). Additionally, compared with baseline and 6 months, changes in BMI Z-scores in males were statistically significant at 3 months (P < 0.05). The intervention significantly improved metabolic profiles: fasting blood glucose, total cholesterol, and LDL-C levels were significantly reduced (all P < 0.05), and the prevalence of abnormal LDL-C and total cholesterol dropped to 0% at the 6-month follow-up. Bilingual health education effectively improved dietary behavior and metabolic indicators in adolescents with obesity. Although the 6-month intervention did not significantly alter overall BMI Z-scores, the short-term decrease observed exclusively in males suggests a potentially beneficial effect on weight management. Ultimately, sustainable obesity prevention and control require collaborative efforts from the government, schools, and families.