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The coach-athlete relationship is central for the development and well-being of adolescent athletes, but the mechanisms underlying this relation are underexplored. Learning life skills may explain these underlying mechanisms; therefore, understanding this line of inquiry can help optimize the coaching process and life skill development. Given this context, this study aims to analyze how the interactions between coaches and adolescent athletes are associated with well-being, as well as understand the statistical mediating role of life skills. A total of 312 Brazilian adolescent athletes participated, completing measures assessing the coach-athlete relationship, life skills and well-being. The paths (coach-athlete relationship → life skills → well-being) were tested using structural equation modeling. As a result, life skills showed a statistical indirect association accounting for 45.7% of the variance explained in the association between the coach-athlete relationship with well-being. Among the dimensions associated with the coach-athlete relationship, commitment emerged as a significant correlate of all life skills. Moreover, complementarity showed a direct association with all three well-being domains. Additionally, closeness showed a specific direct association only with psychological well-being. With regards to life skills, goal setting was positively associated with all three well-being domains, whereas emotional skills showed a negative association, suggesting that they may function as a marker of prior adversity. Taken together, the coach-athlete relationship is not a monolithic construct; its dimensions show functional specificity in their associations. From an applied standpoint, sport-based programs should prioritize building a relationship of commitment as a foundational element to support the intentional teaching of skills.

Aging and increased life expectancy generate growing challenges for end-of-life care in old age, particularly in rural contexts marked by territorial and health inequalities. From the perspective of gerontological geography and the notions of autonomy and agency of older adults, this study aims to generate an understanding of end-of-life as a lived experience from the subjective worlds of and with the people involved. To this end, a qualitative study, with an ethnographic approach and case study strategy, was conducted in the Los Lagos Region of Chile between 2022 and 2023. This included semi-structured interviews and ethnographic observation of rural older adults in the end-of-life stages, their caregivers, and rural health teams. The results show that remaining at home is a central desire and organizes care, sustained primarily by feminized family networks and rural primary care. The home becomes a space of care, and health teams play a key role in providing clinical and relational support at the end-of-life. It is concluded that end-of-life care in rural areas requires territorial approaches that recognize autonomy in old age and the structural inequalities of these processes. El envejecimiento y aumento de la esperanza de vida generan desafíos crecientes para los cuidados de fin de vida en la vejez, particularmente en contextos rurales marcados por desigualdades territoriales y sanitarias. Desde la geografía gerontológica, y las nociones de autonomía y agencia de las personas mayores, este estudio se propone generar una comprensión del fin de vida como experiencia vital desde los mundos subjetivos de y con las personas implicadas. Para ello, se realizó un estudio cualitativo, de enfoque etnográfico y estrategia de estudio de caso, en la Región de Los Lagos, Chile, entre 2022 y 2023, que incluyó entrevistas semiestructuradas y observación etnográfica a personas mayores rurales en etapas de fin de vida, las personas cuidadoras y los equipos de salud rural. Los resultados muestran que la permanencia en el hogar constituye un deseo central y organiza los cuidados, sostenidos principalmente por redes familiares feminizadas y por la atención primaria rural. El hogar se transforma en un espacio de cuidado y los equipos de salud cumplen un rol clave en acompañamiento clínico y relacional del fin de vida. Se concluye que los cuidados de fin de vida en la ruralidad requieren enfoques territoriales que reconozcan autonomía en la vejez y las desigualdades estructurales de estos procesos.

Caring for a family member with Alzheimer’s disease can be physically, emotionally, and mentally challenging, affecting a caregiver’s overall well-being and daily life. We looked at two tools—the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) and the EQ-5D-5L—to see how well they measure the impact of caregiving on a caregiver’s quality of life and to expand the available tools for properly evaluating caregiver quality of life in health economic evaluations in Japan. We also examined how these tools related to caregivers’ feelings of stress and burden using the eight-item short Japanese version of the Zarit Burden Interview. We surveyed 705 family caregivers of people with Alzheimer’s disease through an online questionnaire. Our results showed that both tools provide helpful information but focus on different areas of a caregiver’s quality of life. The EQ-5D-5L mainly looks at general health issues like mobility, self-care, and anxiety, but it doesn’t fully capture the social and emotional challenges of caregiving. Alternatively, the ASCOT-Carer offers a clearer picture of a caregiver’s well-being, especially regarding social connections and emotional health. Moreover, the ASCOT-Carer was better than the EQ-5D-5L at showing the stress and burden that caregivers experience. This highlights that the ASCOT-Carer is more sensitive to the specific challenges that caregivers face. While both tools are helpful, the ASCOT-Carer may be a more suitable tool for evaluating the impact of caregivers’ real-life struggles on their quality of life, making it a valuable resource for health economic evaluations.

Metformin, a first-line antidiabetic drug, has demonstrated anticancer potential in various malignancies, yet its precise mechanisms in hepatocellular carcinoma (HCC) remain incompletely defined. Here, we show that metformin inhibits lipid accumulation and proliferation in HCC cells through modulation of N6-methyladenosine (m6A) RNA methylation. Treatment of HepG2 and Huh7 cells with metformin significantly reduced intracellular triglyceride and cholesterol levels, concomitant with decreased lipid droplet accumulation and impaired cell proliferation. Mechanistically, metformin lowered global m6A methylation by downregulating the m6A methyltransferase Methyltransferase-like 3 (METTL3), while upregulating the demethylase Fat mass and obesity-associated protein (FTO). Functional assays revealed that METTL3 overexpression restored lipid accumulation and proliferation in metformin-treated cells, whereas METTL3 knockdown phenocopied the lipid-lowering and anti-proliferative effects of metformin. Further analyses identified the METTL3/ACC1/FASN axis as a critical downstream pathway, with metformin suppressing m6A modification and expression of Fatty acid synthase (FASN) and Acetyl-CoA carboxylase 1 (ACC1) transcripts - effects reversed by METTL3 overexpression. These findings establish METTL3 as a central mediator of metformin's metabolic and antiproliferative activities in HCC, uncovering a previously unappreciated epitranscriptomic mechanism by which metformin impedes tumor progression.

The aerosol foam formulation of calcipotriol/betamethasone dipropionate (Cal/BD) is an efficacious topical treatment for psoriasis. This study evaluated the efficacy of Cal/BD foam versus ointment in Chinese patients, on the basis of investigator-assessed and patient-reported outcomes (PROs) from a 4-week clinical trial, including post hoc analyses after 2 weeks of treatment. A randomized, investigator-blind, active-controlled, parallel-group phase 3 trial was conducted in China. Native Chinese adults (≥ 18 years) with plaque psoriasis involving 2-30% of the body surface area (BSA), with at least mild disease severity according to the Physician's Global Assessment (PGA), and modified Psoriasis Area and Severity Index (mPASI) ≥ 2 were randomized 1:1 to receive either Cal/BD foam or ointment once daily for a 4-week treatment period. Efficacy was assessed at weeks 0, 2, and 4 using mPASI, PGA, BSA, Dermatology Life Quality Index (DLQI), Psoriasis Symptom Inventory (PSI), and Subject's Global Assessment of disease severity (SGA). A total of 302 patients were randomized to each treatment. Both groups had clinically meaningful improvements across all outcome measures from baseline to week 2, with sustained or further improvements at week 4. For Cal/BD foam-treated patients, mean change from baseline in mPASI was -59.87% at week 2 (versus ointment: -54.59%; P = 0.010) and -74.69% at week 4 (versus ointment: -70.22%; P = 0.043). Other investigator-assessed outcomes based on mPASI and PGA showed statistically significant treatment differences favoring Cal/BD foam at week 4. Improvements in PROs (DLQI, PSI, and SGA) were numerically slightly greater with Cal/BD foam than ointment, though not statistically significant. For Cal/BD foam-treated patients, mean change from baseline in DLQI was -3.9 at week 2 (versus ointment: -3.7; P = 0.5012) and -5.5 at week 4 (versus ointment: -5.3; P = 0.5119). Cal/BD foam showed rapid onset of action with clinically meaningful improvements in signs, symptoms, and quality of life in Chinese patients with plaque psoriasis. ClinicalTrials.gov: NCT05919082. Plaque psoriasis is the most common type of psoriasis, a chronic disease affecting the skin and other body systems. Plaques are thick, scaly patches of skin that can be itchy and painful, limiting patients' everyday activities. Plaque psoriasis has a major impact on quality of life, comparable with the impact of other chronic diseases such as cancer and heart disease. Many treatments, such as creams, tablets, and injections, can improve plaque psoriasis, but they do not always work well for everyone. In a clinical trial in China, we tested two treatments-a foam and an ointment-that have the same amount of two active ingredients: calcipotriol (Cal) and betamethasone dipropionate (BD). The goal was to find out if Cal/BD foam, which is the newer treatment, worked as well as Cal/BD ointment in Chinese men and women with plaque psoriasis. The trial participants were randomly distributed into two groups, each with 302 participants. One group applied Cal/BD foam on their plaques and the other group applied Cal/BD ointment, both once daily for 4 weeks. Both groups had meaningful improvements in psoriasis signs and symptoms as well as quality of life already after 2 weeks, with sustained or further improvements after 4 weeks. Overall, the improvements were slightly greater with Cal/BD foam than with Cal/BD ointment.

1. Why is this study needed?Little is known about the quality-of-life of caregivers of disabled-older-adult in China. The Care-related Quality of Life instrument (CarerQol) is designed to measure informal caregivers’ quality of life. This instrument requires validation in these populations to determine its suitability and identification of potentially modifiable predictors that may improve informal caregivers’ quality-of-life (CRQoL).2. What is the key problem/issue/question this manuscript addresses?This study examined whether the CarerQol was a reliable and valid instrument in informal caregivers of disabled older adults in China. We also examined which factors were associated with CarerQol scores.3. What is the main point of your study?The Chinese CarerQol can be used to capture CRQoL among informal caregivers of disabled older adults in China, providing information that complements generic health measures and inform caregiver support.4. What are your main results and what do they mean?The CarerQol instrument performed well with no clear ceiling or floor effects. Known-group analyses supported the expected direction, with larger effect-sizes for factors closely related to CarerQol domains (such as depressive symptoms, caregiving burnout, and care willingness). Most correlations met our a priori expectation of at least moderate strength, supporting convergent validity. A worse financial situation, heavier caregiving burden, and lower care willingness were associated with lower CarerQol scores. These findings suggest that the CarerQol is a suitable instrument for measuring quality-of-life across Chinese informal caregivers of disabled older adults. We also highlight modifiable predictors of CRQoL, including strengthening financial support, service support, and caregiver guidance programs.

The socio-economic situation in Lebanon has been dramatically deteriorating over the years affecting food insecurity (FI), psychological distress, and health-related quality of life (HRQoL). Therefore, the objectives of the study are to estimate the prevalence and severity of FI among Lebanese residents; evaluate the association between FI and psychological distress; and examine the association between FI and HRQoL. A cross-sectional study was conducted among residents of Lebanon aged 18 years or older in 2024. The final sample included 519 participants. The Food Insecurity Experience Scale, Beirut Distress Scale (BDS), and EQ-5D-5&#xa0;L were used to assess FI, distress, and HRQoL levels, respectively. The questionnaire also included sociodemographic and general health-related questions. Regression analysis was applied to explore the association of FI with psychological distress and HRQoL after adjustment for relevant covariates. 14.3% of the participants exhibited moderate to severe FI. A moderate level of HRQoL was shown with a mean of 74.18 (SD&#x2009;=&#x2009;19.0) for the EQ-VAS. Moreover, FI was significantly associated with HRQoL and psychological distress. FI (B&#x2009;=&#x2009;5.183), age (B&#x2009;=&#x2009;0.092), gender (B&#x2009;=&#x2009;3.998), employment status (B&#x2009;=&#x2009;0.558), and job loss (B&#x2009;=&#x2009;6.021), were significant predictors of the BDS (p&#x2009;<&#x2009;0.05). Whereas FI (B&#x2009;=&#x2009;-&#x2009;8.490), age (B&#x2009;=&#x2009;-&#x2009;0.461), job loss (B&#x2009;=&#x2009;-&#x2009;4.659), and household income (B&#x2009;=&#x2009;1.466) were significant predictors of EQ-VAS (p&#x2009;<&#x2009;0.05). FI was associated with poorer mental health and lower HRQoL among Lebanese residents. This highlights the impact of the socio-economic crisis and provides data that could guide efforts to improve population health, especially for NGOs that are providing support to local communities. Lebanon has been facing severe socio-economic crises over the past years that have negatively affected food security, people&#x2019;s mental health, and overall wellbeing, yet no population-based studies have been conducted to date to explore these issues. This study investigates the association of food insecurity with mental health, specifically psychological distress, and health-related quality of life. It aims to identify vulnerable groups that are most affected by the crises in order to develop targeted interventions. The study measures the prevalence of food insecurity among Lebanese residents and examines whether it is associated with higher psychological distress and lower health-related quality of life. Results revealed that about 14% of the participants were food insecure (moderate to severe FI) and it was linked to higher distress levels, and poorer health-related quality of life. Female, older individuals, unemployed, those who lost their jobs because of the crisis, those with lower educational attainment, and lower monthly income, showed worsened outcomes. The study revealed key dimensions of health that have been affected and provided data that could guide efforts to improve health of the population, especially for various NGOs that are providing support to local communities.

Incarcerated populations face greater health challenges, including higher rates of communicable and mental diseases. However, traditional health measures like disease prevalence and life expectancy do not capture their physical, mental, emotional, and social well-being. This scoping review will summarize the health-related quality of life (HRQoL) outcomes in incarcerated populations using preference-based HRQoL instruments (and measures that can be used to derive utility scores), providing insights for health policies and economic evaluations. A scoping review was conducted following PRISMA-ScR guidelines. Six electronic databases and three health technology assessment agencies were searched for peer-reviewed studies reporting preference-based HRQoL or HRQoL scores that can be used to generate health state utility values in incarcerated populations. Eligibility and data extraction were performed by two independent researchers.Findings were synthesized to identify knowledge gaps. Twenty-two articles met the inclusion criteria, primarily focusing on male and white populations. Ten studies targeted disease-specific populations, with mental health disorders (n&#x2009;=&#x2009;7) being the most prevalent. Across studies, inmates generally reported lower HRQoL scores than the general population, especially those with mental health issues. Female and Indigenous inmates had lower HRQoL scores than male and non-Indigenous inmates. The variety in HRQoL instruments used, with each assessing different domains, hinders direct comparisons between studies. Validating instruments specific to incarcerated populations may be needed for future research. Overall, incarcerated populations, especially women and Indigenous inmates, demonstrate poorer HRQoL than the general population. There is a need for more diverse, inclusive studies to address these gaps. Incarcerated populations face greater health issues that are not fully captured by traditional health measures. Health-related quality of life (HRQoL) provides a more comprehensive view of their physical, mental, emotional and social well-being. This study summarizes HRQoL research in incarcerated populations using standardized tools. The purpose of this study is to provide a scoping review of the HRQoL outcomes of incarcerated populations, summarizing existing research and identifying gaps in the literature. Our findings reveal that inmates generally have lower HRQoL scores compared to the general population, and those with mental health issues reporting the lowest scores. Additionally, female and Indigenous inmates tend to have poorer HRQoL than male and non-Indigenous inmates. The findings highlight the need for HRQoL tools specifically tailored to incarcerated populations and call for more diverse studies, particularly for underrepresented groups.

This study aimed to identify subgroups of health-related quality of life (HRQoL) and examine predictors of latent class membership among low- and high-income cancer survivors using latent class analysis (LCA). We analyzed data from the Korea National Health and Nutrition Examination Survey (2013-2020), including 1075 cancer survivors. HRQoL patterns were identified using LCA based on the EuroQol five-dimension questionnaire. Analyses were conducted separately for low- and high-income groups to examine income-stratified HRQoL patterns. Sociodemographic characteristics and chronic disease status were included as covariates in the latent class models to examine predictors of class membership within each income group. Income-stratified LCAs suggested differential HRQoL patterns. Three latent HRQoL classes were identified in the low-income group: Good HRQoL, Pain and Mobility Impairment, and Poor HRQoL. In the high-income group, two classes were identified: Good HRQoL and Pain and Mobility Impairment. While education was a common predictor in both groups, other predictors varied by income level. In the low-income group, older age, unemployment, and multimorbidity were significantly associated with impaired HRQoL classes, whereas female sex predicted membership in the Pain and Mobility Impairment class in the high-income group. These findings highlight differences in HRQoL patterns and associated factors across income-stratified groups of cancer survivors, underscoring the limitations of relying solely on average HRQoL scores in survivorship care. Survivorship strategies should be tailored to the differential HRQoL patterns and associated predictors identified within each income group, thereby promoting more targeted and equitable care for cancer survivors. Health-related quality of life (HRQoL) is a key measure for understanding cancer survivors&#x2019; well-being after cancer. However, most studies use a single total score of HRQoL, which can mask important differences across physical, psychological, and social aspects. Considering its multidimensional nature, examining patterns across HRQoL domains can provide a more comprehensive understanding of survivors&#x2019; well-being. Moreover, since socioeconomic status&#x2014;especially income&#x2014;strongly influences HRQoL, it is important to explore how these patterns differ by income level. Therefore, this study examined HRQoL patterns among low- and high-income Korean cancer survivors and identified factors related to each pattern. Three patterns were found among low-income survivors&#x2014;Good HRQoL, Pain and Mobility Impairment, and Poor HRQoL&#x2014;and two among high-income survivors&#x2014;Good HRQoL and Pain and Mobility Impairment. Education was associated with better HRQoL patterns in both groups, but other predictors differed. Among low-income survivors, older age, unemployment, and multiple chronic diseases were linked to poorer HRQoL patterns. Among high-income survivors, women were more likely to belong to the Pain and Mobility pattern. These findings highlight the need for survivorship strategies that address heterogeneity across income-stratified groups, promoting equitable and comprehensive care for cancer survivors, even when overall HRQoL scores appear satisfactory.

The ULTRA trial evaluated the impact of ultra-early and short-term tranexamic acid (TXA) treatment in patients with subarachnoid hemorrhage (SAH) and found no clinical benefit at six months. This post-hoc analysis examines whether TXA improves quality of life (QoL) at three and six months. The ULTRA trial was a randomized, controlled, multicenter study conducted from July 2013 to July 2019. Patients received either TXA or standard care. This analysis included patients who completed at least one QoL questionnaire. The primary endpoint was QoL, assessed using the EQ-5D-3L questionnaire at three and six months. Linear mixed models adjusted for confounders were used to analyze the association between TXA and QoL. Of the 955 ULTRA patients, approximately 25% died, and 63% completed at least one QoL questionnaire. At three months, the TXA group had a mean EQ-5D index score of 0.75 versus 0.71 in the control group (p&#x2009;=&#x2009;0.11) and a mean EQ-5D Visual Analogue Scale (VAS) score of 89 versus 86 (p&#x2009;=&#x2009;0.10). At six months, the mean EQ-5D index score was 0.84 in the TXA group compared to 0.82 in the control group (p&#x2009;=&#x2009;0.23), and the mean VAS was 92 in the TXA group compared to 89 in the control group (p&#x2009;=&#x2009;0.13). Ultra-early and short-term TXA did not result in a significant improvement in QoL at three or six months in patients with SAH. Given the lack of benefit on both clinical outcome and QoL, routine use of TXA is not recommended. Netherlands Trial Register: NTR3272. gov: NCT02684812.

Health-related quality of life (HRQoL) is a vital indicator of evaluating care outcomes and prognosis, yet little is understood about its developmental trajectories in older patients with chronic pain. This study aimed to identify latent HRQoL trajectories and their predictors, and to develop explainable machine learning models for predicting HRQoL deterioration. This prospective cohort study assessed 608 older patients with chronic pain at admission and at 1, 3, and 6&#x2009;months post-admission, collecting data on HRQoL, general characteristics, pain level, activities of daily living (ADL), depression, and perceived social support. Growth mixture modeling was applied to identify trajectories of physical and mental HRQoL. Predictors were selected using LASSO regression and SVM-RFE. Nine explainable machine learning models were developed for both components, and SHAP interpreted the outputs. An HRQoL decision-support dashboard was developed to facilitate potential clinical application. Three physical HRQoL trajectories were identified: Stable High, Decline and Low Stability, alongside two mental HRQoL trajectories: Improvement and Decline. Key predictors included education level, pain duration, pain level, ADL, depression, and perceived social support, with ADL and pain level being the most influential for physical and mental HRQoL, respectively. This dual-trajectory study identified five distinct HRQoL patterns in older patients with chronic pain, elucidating key predictors via explainable machine learning. The proposed HRQoL decision-support dashboard may provide an interpretable tool to support understanding of predictive relationships and assist healthcare professionals in HRQoL assessment. Not applicable.

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