Principles and Practice of Clinical Research
Welcome Welcome to the Principles and Practice of Clinical Research Journal. This is an Official journal of the Principles and Practice of Clinical Research program affiliated to the ECPE Harvard TH Chan School of Public Health and an Official Journal of the Scala Institute Association. The Principles and Practice of Clinical Research is journal dedicated to disseminating cutting-edge clinical research evidence. As a peer-reviewed scientific journal, we aim to foster the exchange of knowledge among researchers, academicians, and professionals. Globalization has contributed significantly to the dissemination of information in different areas of knowledge. Scientific papers are therefore the way to contribute to this global debate and advance in science. PPCR journal will therefore contribute to disseminate the latest research and updates on clinical research. PPCR journal aims to provide a medium for the publication of scientific articles of high quality, thus promoting the work and training of clinical researchers globally. This is a Free Open Access Journal, it is initially expected to be quarterly and open for new submissions. Send your scientific article! Check out the rules for submission. As the journal aims to be an international publication, all information and article submission should be formatted in English. Regards, Editor-in-Chief: Professor Felipe Fregni, MD, PhD, MMSc, MPH Managing Editors: Mustafa Reha Dodurgali, MD Online ISSN: 2378-1890 Metrics: H-index - 3 Indexed in: Google Scholar Science Gate - https://www.sciencegate.app/source/1713572797 License: CC BY 4.0
Modernizing the Pathway for Non-Opioid Analgesics
Copyright (c) 2025 Bassel Almarie, Mustafa Reha Dodurgali, Felipe Fregni
Restoring Guidelines: EBM-X to Bring Critical Thinking and Humility Back to Evidence-Based Medicine
Copyright (c) 2025 Lisbeth Martinez, Lucas Mena, Beatriz Cubilhas, Danilo Monteiro, Andre Canteri, Felipe Fregni
The Transformative Power of NIH Funding: Advancing Careers, Science, and Public Health
Copyright (c) 2025 Bassel Almarie, Felipe Fregni
Association between Zinc and Vitamin D Intake and Obesity among Women: A Cross-Sectional Analysis of NHANES 2017-2018
Background: Micronutrient intake, particularly zinc and vitamin D, has been hypothesized to influence obesity risk through metabolic and inflammatory pathways. However, evidence on these associations in women remains limited and mixed. The current study aimed to examine the relationship between zinc and vitamin D intake and obesity among adult women using nationally representative data. Methods: We conducted a cross-sectional analysis of 1,043 adult women from the NHANES 2017–2018 dataset. Obesity was defined as body mass index (BMI)≥30 kg/m2. Zinc and vitamin D intake was categorized as adequate or inadequate based on dietary guidelines (zinc>8 mg/day; vitamin D>15 mcg/day). Logistic regression models estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between micronutrient intake and obesity. The models were adjusted for diabetes, exercise status, age, Hispanic origin, smoking, and other comorbidities. Results: Vitamin D intake>15 mcg/day was associated with higher odds of obesity in the unadjusted analysis (OR =1.37; 95% CI: 1.05–1.78;p=0.02), but it was not statistically significant after adjustment (adjusted OR = 1.28; 95% CI:0.95–1.71;p=0.09). Zinc intake of>8 mg/day was not significantly associated with obesity (adjusted OR = 1.38; 95%CI: 0.33–5.86;p=0.66). Key predictors of higher obesity risk included the presence of diabetes (adjusted OR = 2.13; 95%CI: 1.48–3.07;p<0.01) and comorbidities>1 (adjusted OR = 2.33–2.37 across models; p <0.01). Protective factors included physical activity (adjusted OR = 0.62; 95% CI: 0.47–0.81;p<0.01), Hispanic ethnicity (adjusted OR = 0.82;95% CI: 0.74–0.92;p<0.01), and increasing age (adjusted OR = 0.99 per year; 95% CI: 0.98–0.99;p<0.01). Smoking and total fat intake were not significantly associated with obesity. Conclusions: In this cross-sectional analysis of U.S. women, neither zinc nor vitamin D intake was significantly associated with obesity after adjustment for confounders. Diabetes, comorbidities, exercise, and Hispanic ethnicity emerged as important predictors of obesity. These findings highlight the multifactorial nature of obesity and underscore the need for longitudinal research using biomarker-based assessments of nutrient status to better understand these relationships.
Copyright (c) 2025 Andres Soto Rodríguez, Andrei Shanchev, Pamela Yanet Gil Galleguillos, Beatriz Cubilhas, Raissa Carvalho, Taciana Baez, Giulia Cenci, Carlos Alberto Vergara Ascenzo, Cristy Tavarez, Felipe Martinez, Leo Peña, Diego Saa, Martina Donoso, Saheed Oyedele, Katherine Amaro, Marcos Barros, Simone Barbosa, Ana Diaz, Sharif Folorunso, Tatiana Gatilova, Patricia Leite, Niurkiss Mallen, Cinthia Minatel, Carol Moreno, Gabriel Sakaya, Mery Terreno, Carolina Uribe, Adela Yip, Jinhui Peng, Veronica Posse
III Symposium on Innovation and Translational Neuroscience & XVI International Symposium on Neuromodulation
Abstract from the III Symposium on Innovation and Translational Neuroscience & XVI International Symposium on Neuromodulation presented in São Paulo, Brazil in 2024.
Copyright (c) 2024 Sara Pinto Barbosa, Alma Alma Sanchez Jimenez, ICCR Scientific Team, Felipe Fregni
Adequate Zinc Intake Is Associated with a Lower Risk of Childhood Obesity: Findings From NHANES 2017-2018
Background: Childhood obesity is an escalating global health concern, with nutrient intake emerging as an important modifiable factor. Zinc plays a key role in the metabolic and inflammatory pathways; however, its relationship with childhood obesity remains underexplored. This study investigated the association between zinc intake and obesity in U.S. children aged 2–18 years. Methods: A secondary analysis was conducted using data from the National Health and Nutrition Examination Survey(NHANES) 2017–2018. The variables were analyzed using logistic regression to estimate odds ratios and 95% confidence intervals for the association between childhood obesity and dietary zinc intake. Children were categorized as “obese” or“ non-obese” based on age- and sex-adjusted BMI percentiles. Zinc intake was categorized as “adequate” or “inadequate” based on the recommended daily intake according to age and sex. Confounding variables, including race/ethnicity, dietary fiber, fat, and protein intake, comorbidities, and the poverty-to-income ratio, were controlled for in the adjusted model. Results: Among 2,704 children (mean age 9.63±4.84 years), 16.8% were classified as obese. In the unadjusted analyses, adequate zinc intake was not significantly associated with obesity (OR = 0.73; 95% CI: 0.41–1.29;p=0.285). However, after adjustment for confounders, adequate zinc intake was significantly associated with reduced odds of obesity (OR = 0.50;95% CI: 0.26–0.97;p=0.042). Higher income and certain racial/ethnic groups were also protective, whereas higher fat and protein intake and comorbidities were associated with increased obesity risk. Conclusion: Adequate dietary zinc intake is independently associated with lower odds of obesity in U.S. children. Thesefindings support further exploration of zinc’s role in obesity prevention strategies and underscore the importance ofaddressing micronutrient deficiencies in pediatric populations.
Marília Aparecida Silva Oliveira Machado
Copyright (c) 2025 María Alejandra Rodríguez Brilla, Camila María Martínez Marte, Natasha Carvalho Pandolfi, Kaliana Nascimento, Gilberto Perez Rodriguez Garcia, Belen Rivera, Anna Carolyna Gianlorenco, Nicole Nakousi-Capurro, Ewerton Alves Portela dos Santos, Kasiemobi Eberechukwu Uchime, Tatiane Aparecida de Miranda, Gabriella Moreira Requião, Luciana Valentina Olivera González, Eneidy Pina, Qudus Olajide Lawal, Tamara Zompa, Gabriel Sant'Ana Carrijo, Iyanuoluwa O. Ojo, Mutwakil Elbidiari, Bruno Francisco Buzetti Spinelli, Luiz Fernando Mantovani, Marília Aparecida Silva Oliveira Machado, Ana Beatriz Ferreira Rolim, Danilo Hantschick Fernandes Monteiro, Arthur Andrade Braga, Wilson Fandino, Karla Loureiro Loss
Exploring the Link Between Hepatitis A and B Vaccination and Social Support in the US Population: Insights from the NHANES 2005-2006 Cohort
Background: High social support is easily assessed and associated with a healthier lifestyle, including vaccination adherence. Similarly, immunization is a widely available public health statistic associated with healthier behaviors. However, the link between the hepatitis immunization status and social support needs to be explored. Methods: We assessed the association between levels of social support and hepatitis immunization status using the National Health and Nutrition Examination Survey (NHANES), a cross-sectional multidisciplinary database publicly available for researchers. With 2005–2006 data, 2997 participants were included. Statistical analyses were conducted using STATA18.5v software, including the odds ratio of both univariable logistic regression and multivariable logistic regression. After adjusting for clinically relevant confounders, two distinct models were designed: 1) full immunization, and 2) incomplete immunization. Results: Multivariable analysis revealed significantly greater odds of high social support for participants fully or partially immunized against both hepatitis A and B: 3.15 (95% CI 1.03–9.66,p=0.04) and 3.35 (95% CI 1.15–9.75,p=0.03), respectively. Conclusion: Our findings show an association between vaccination and social support in both adjusted models. Individuals not vaccinated at all may behave differently from those willing to be, at least partially, immunized. It seems that a similar behavior that may lead to vaccination may also lead to increased social support. Therefore, our study suggests that hepatitis vaccination could perhaps be a surrogate marker for public-health-related outcomes.
Copyright (c) 2025 Daniel Bancovsky, Manjushree Shastry, Martina Caccamo, Omar E. Vasquez-Perez, Merce Avellanet, Kumud Chapagain, Rebecca Soares, Magali Coyoy, Hoang Nguyen, Juliana Calit, Asma Qudayr, Rintu Sharma, Cynthia L. P. de Borborema, Sebastine Oiwoh, Jorge Alave, Beatrice Dalbianco, Maria Antonieta Lopes, Ricardo E. Nunez-Rocha, Maria Magalhaes, Faiez Alsatou, Felipe Duarte, Jessica Rodriguez, Ilgin Genc, Walter Ramos, Fabricio Kleber, Patricia Rioja, Ignacio Montealegre, Isabel Cabral, Luiz Viola, Barbara Grohmann, Yoldyz Huynh, Lucas Vidoto, Arantxa Ramirez, Anny Christina Chin, Alessandra Carvalho
Dietary Zinc and Vitamin D Intake and Diabetes Risk in Older U.S. Adults: NHANES 2017–2018
Background: Diabetes Mellitus (DM) is a leading chronic condition worldwide, affecting an estimated 537 million individuals between the ages of 20 and 79 years, equivalent to 10.5% of the world’s population. Micronutrients such as vitamin D and zinc have been suggested as potential modifiers of disease development; however, the literature often excludes older adults, resulting in limited data on their impact in this population. Methods: We conducted a secondary cross-sectional analysis of the NHANES 2017–2018 dataset. Participants older than50 years were included based on self-reported diabetes status. Logistic regression models (univariate and multivariate) were used to assess associations between micronutrient intake and diabetes, adjusting for age, BMI, gender, race, educational level, physical activity, thyroid comorbidities, smoking, and fat and sugar intake. Results: Of the 9,254 survey respondents, 1,172 met inclusion criteria. In univariate analysis, zinc intake (OR 0.98,95% CI 0.93–1.04,p=0.534) and vitamin D intake (OR 1.00, 95% CI 0.99–1.00,p=0.831) were not significantlyassociated with diabetes. In multivariate models, zinc (OR 1.02, 95% CI 0.91–1.14,p=0.666) and vitamin D (OR 0.99,95% CI 0.99–1.00,p=0.360) remained nonsignificant. Significant predictors included older age (OR 1.06 per year, 95%CI 1.04–1.08,p<0.001), female gender (OR 0.47 vs. males, 95% CI 0.35–0.64,p<0.001), race (Mexican-American OR1.79, 95% CI 1.06–3.02, p=0.029; Non-Hispanic Black OR 1.60, 95% CI 1.10–2.34, p=0.014), higher BMI (OR 1.10per kg/m2, 95% CI 1.08–1.13,p<0.001), and lower educational attainment (college graduate OR 0.53, 95% CI 0.33–0.84,p=0.007). The model demonstrated good discriminatory power (AUC = 0.73). Conclusion: No significant association was found between dietary zinc or vitamin D intake and diabetes in adults aged50 years and older. Demographic and anthropometric factors such as age, gender, race, BMI, and education were stronglylinked to diabetes risk, with elevated risk observed among Mexican Americans and Non-Hispanic Blacks.
Copyright (c) 2025 Ana Derzi, Andressa Masson, Carla Chavarria, Caterina Paiva, Cristiane Paganoti, Daniel Abad, Daniella Audi, Dermeval Neto, Dominique Schakel, Elianet Castillo, Felipe Cordova, Fernanda Malta, Helio Grullon, Jose Fermin, Karen Bedirian, Kendya Reyes, Mobolaji Jaiyesimi, Nicol Ortega, Paula Sotelo, Santiago Pastrana-Brandes, Tomas Marques, Vanessa Lessa, Stefania Zapata, Tomas Mansur
Vitamin D and Zinc Supplementation Effect in Cancer Incidence - An Analysis of NHANES 2017-2018
Background: Cancer remains a leading cause of mortality globally, emphasizing the need for prevention strategies. Nutritional supplements like zinc and vitamin D have been studied for their potential cancer-preventing effects, given their roles in immune response and essential cellular functions, including cell differentiation, repair, and gene regulation. However, evidence linking these supplements to reduce cancer incidence is still inconclusive. This study evaluates whether zinc and vitamin D supplementation are associated with a lower risk of cancer, considering lifestyle factors modifications. Methods: This analysis utilized data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). The final sample included 5,569 participants after exclusions for missing data. Descriptive analysis assessed demographic characteristics, and logistic regression models evaluated associations between zinc and vitamin D supplements intake and cancer incidence, adjusting for covariates. Analyses were conducted using StataNow/BE 18.5. Results: No significant associations were found between zinc or vitamin D intake and cancer risk after adjustments. Significant predictors of cancer incidence included age, gender, and race, with higher risk. Conclusions: These findings suggest that zinc and vitamin D supplementation may not significantly reduce cancer risk in the general population. Cancer risk was more strongly associated with demographic factors like age, gender, and race. Future research should explore the long-term effects of these nutrients in more specific subgroups or through randomized controlled trials.
Copyright (c) 2025 Cindy Martinez, Alexandra Roman, Lennart Merkle, Khalid Al-Naamani, Isabela Schettini, Gabriel Beilfuss Rieth, Daniela Morales, Maria Gonzalez, Lisbeth Martinez, Emmanuel Bonilla, Mario Najera, Larine Cenci, Sophia Negrao, Pedro Kaufmann, Luiz Araujo, Natalia Moros, Maria Silvana Pellice, Azucena Armas, Katilenia Caraballo, Carolina Cardoso, Ayatullah Aly, Sintip Pattanakuhar, Ahmed Sweilim, Siyu Dai, Amin Saied, Klaithem Mohamed, Kazukiko Takemura, Adamu Dalhatu, Adela Lazar
Association Between Regular Exercise and Cancer Risk: Insights from NHANES 2017-2018
Introduction: Physical activity is associated with reduced risk for several chronic diseases; however, its association with cancer remains unclear, with mixed findings across literature. This study investigates the relationship between exercise status and cancer diagnosis in a representative sample of U.S. adults, hypothesizing that regular physical activity is inversely associated with cancer diagnosis, independent of demographic and lifestyle factors. Methods: Data from the 2017–2018 cycle of the National Health and Nutrition Examination Survey (NHANES) were analyzed, including 5,246 participants after exclusion of cases with missing data. Exercise status, based on self-reported moderate or vigorous recreational activity, was the primary exposure variable, and history of cancer diagnosis was the outcome. Logistic regression models were used, adjusting for age, gender, race/ethnicity, annual family income, education level, obesity, and alcohol consumption. Results: Exercise was associated with a significantly lower likelihood of cancer diagnosis (OR = 0.80, 95% CI: 0.65–0.99, p = 0.039). Increasing age and non-Hispanic White race were positively associated with cancer diagnosis. When alcohol consumption was included as a covariate, the association between exercise and cancer diagnosis became non-significant, suggesting alcohol may confound the observed relationship. Discussion: These findings suggest a potential protective role of physical activity in reducing cancer risk; however, the effect of other lifestyle factors, such as alcohol consumption, complicates this association. Future longitudinal and interventional studies with objective measures of physical activity are necessary to further elucidate these relationships and inform preventive strategies for cancer.
Copyright (c) 2025 Carla Pastora-Sesin, Ivanhoe Leite, Fabiana Souza, Zeidan A Zeidan, Dolly Ruiz, Ana Lucia Izaguirre, Davi Ratto, Alois Osorio, Sofia Rios, Pedro Lorencetti, Nicole Peña, Maria Melo, Isabella Gagliardi, Frederick Gerritzmann, Valeria Villabona, Sara Rodriguez, Karina Solano, Fernando Mellado, Jose Rivera, Fabiano Fabris, Sara Khalid, Juan Rangel, Marco Junior, Pedro Luiz Danielian
Food Insecurity is Associated with Obstructive Respiratory Disorders Among U.S. Adults: A Cross-Sectional Study
Introduction Food insecurity leads to significant challenges in public health, warranting investigation into its potential effects on various health outcomes. This study aims to examine the association between food insecurity and respiratory diseases, specifically asthma, chronic bronchitis, and emphysema, among U.S. adults aged 20 and older. Methods Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006, we employed logistic regression analysis to assess these relationships, controlling for confounding factors such as race/ethnicity, gender, smoking history, age, and educational level. Results Our analysis revealed that individuals classified with "Very Low" food security exhibited significantly higher odds of experiencing respiratory problems, with an odds ratio (OR) of 2.02 (95% CI: 1.48-2.77, p < 0.001) compared to the reference group. Additionally, even after adjusting for confounders, those with "Low" food security also showed increased odds (adjusted OR = 1.59, 95% CI: 1.21-2.09, p = 0.001) alongside "Very Low" food security (adjusted OR = 2.18, 95% CI: 1.54-3.07, p < 0.001). Conclusion These findings highlight that food insecurity significantly contributes to the prevalence of respiratory diseases, underscoring the necessity of addressing food access issues as part of public health interventions aimed at improving respiratory health outcomes. Future research should further elucidate these relationships and explore targeted interventions that address the root causes of food insecurity.
Copyright (c) 2025 Ruan Pablo Duarte Freitas, Victoria Gomes Andreata, Alaa Ali, Alfredo Gabriele Nanni, Ana Luíza Soares Pinto, Bruno Meireles De Moraes, Carol Arce Sanjur, Caroline Borginho, Claudia Gonzalez, Cristal N. Pride, Einer C.E. Arevalo-Rios, Erwin Erwin, Glauco Marinho Plens, Hiroshi Hayashi, Jose Max Narvaez Paliza, Karina Gisell Duerksen Crespo, Keila Miranda-Limachi, Kelvin Henrique Vilalva, Linda Angie Paucar, Luiza Lara Gadotti, Mitha Al Balushi, Mariana Pilon Capella, Patricio A. Alfaro, Roksana Hasib, Pedro Slindvain Freitas, Staling Guillermo Pallares Escorcia, Supattana Chatromyen
Association Between Fiber Intake and Depression in US Adults: Data from National Health and Nutrition Examination Survey (NHANES) 2017–2018.
Depression is a multifaceted mental health disorder affecting 280 million people globally. The pursuit of effective interventions has triggered investigations into the role of fiber intake in modulating depression, which remains a controversial issue. At least part of the discrepancies may result from the large number of covariates not accounted for in studies linking depression and fiber intake. We aimed to fill this gap using data from a large recent American population-based cross-sectional study from the National Health and Nutrition Examination Survey (NHANES 2017-2018) and a detailed assessment of known covariates. Data from 9,254 adult subjects were analyzed and 3,979 fulfilled the inclusion/exclusion criteria. The variables were categorized to undergo evaluation by a logistic regression model adjusted for covariates by StataNow v18.5. The model was proven statistically acceptable. Supplementary fiber intake, vigorous recreational activities, living with a partner, and old age's odds ratios indicated that these variables showed 24.91%, 46.79%, 52.66%, and 65.48% decreased odds of presenting moderate to severe depression, respectively, constituting protective factors against depression. However, poverty, thyroid issues, comorbidities, obesity, and being a female odds ratios revealed that these factors accounted for 55.23%, 37.56%, 65.41%, 38.37%, and 25.94% increase odds of aggravating moderate to severe depression. In conclusion, supplementary fiber consumption may be a protective tool against moderate to severe depression.
Copyright (c) 2025 Hadia Safarat Kirmani, Maiara Cássia Pigatto, Kendra Aira Cabrera, Débora Renz Barreto Vianna, Carolina Parra Mardones, Ila Marques Porto Linares, Claudia Lopez Muñoz, Paul Pereyra, Marie Andree Cosenza Barnéond, Florentina Diaconescu, José Elías León Donis, Vinicius Costa de Assis, Basira Hanafi Lawal, Elizabeth Leon-Cuevas, Giliana Melany Collado, Giovanna Brandão Saliba, Nagheli Fernanda Borjas-Calderón, Ibelema Alaere Ijeoma Datubo-Brown, Sofia Gnecco, Silvia Di-Bonaventura, Orleancio Gomes Ripardo de Azevedo, Adriana Romina Menendez-Mite, Areerat Suputtitada, Tarek Khalaf Saleh Rabiei, José Omar Santellán Hernández, Carolina Schibuola Crespo, Motaz Almahmood, Walter Araujo Zin, Sara Barbosa Franco, Rui Nakamura
Impact of Migration status on Obesity : An Adjusted Logistic Regression Analysis
Introduction: Obesity impacts about 42% of adults in the United States, affecting both U.S.-born and non-U.S.-born individuals, who comprise 14% of the population. This study investigates how migration status and residency duration influence obesity risk, adjusting for clinical, socioeconomic, and behavioral factors. Methods: Data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed, including 5,591 adults aged 20 and older. Logistic regression assessed obesity, defined as a Body Mass Index (BMI) ≥30 kg/m², relative to migration status, with adjustments for age, gender, race, income, education, comorbidities, and behaviors. Results: Among 2,540 participants, 45.4% were classified as obese. Of U.S.-born individuals, 77.1% had a BMI ≥30 kg/m², compared to 40.9% of non-U.S.-born individuals. Non-U.S.-born individuals showed 46.2% lower odds of obesity (OR 0.54; p < 0.0001). In the adjusted model, foreign-born status was associated with 40% lower obesity odds (adjusted OR 0.6; p < 0.0001), though longer residency increased risk. Risk factors included female gender, Hispanic or Black race, higher income, and depression. Specifically, those residing in the U.S. for 15-20 years had 60% greater obesity odds (OR 1.62; p = 0.04), while over 20 years of residence saw an 88% increase (OR 1.88; p = 0.002). Conclusion: Migration status significantly influences obesity risk, with lower prevalence in non-U.S.-born individuals. However, longer U.S. residency heightens obesity risk, emphasizing the need for targeted public health strategies addressing cultural, socioeconomic, and dietary challenges faced by immigrants.
Copyright (c) 2025 Marianna Leite, Gabriel Cojuc, Juliana Paulucci, Raunaq Khanna, Clara Noble, Maria Fernandez, Lisa Schutze, Christiane Soyer, Camila Carvalho, Emilia Almanzar, Gabriela Lima, Ian Maia, Julianne DeCastro, Andre Molina, Andressa Scarpitta, Caio Araujo, Paula Hayakawa, Thaise Sestelo Uzeda, Virginia Neta, Yelidad Llaverias, Adriana Villamizar, Andrea Noronha, Elena Su, Joyeta Razzaque, Marco Luque, Ricardo Cayolla, Salomon Huancahuire, Savci Telek, Victoria Alvarado, Andre Canteri
Association Between Physical Activity and Depression among Women: An Analysis of NHANES 2017–2018 Data
Background: Depression is a prevalent mental disorder that affects approximately 5% of adults globally as of 2023. Women are 50% more likely to experience depression than men, making it one of the leading causes of disability among women. Despite the effectiveness of antidepressants, their side effects underscore the need to explore other interventions, such as physical activity (PA). This study aimed to investigate the relationship between PA and depression among women using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018, addressing gaps in understanding the impact of PA intensity and specific lifestyle factors on women with depression. Methods: This exploratory, observational, cross-sectional study included female participants aged 20 years and older from the NHANES 2017-2018 survey. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9), and PA was categorized into moderate- and vigorous activity. Logistic regression models were used to evaluate the association between PA and depression, controlling for potential confounders, including age, ethnicity, marital status, education, poverty ratio, lifestyle factors, and comorbidities. Results: Overall, 10.45% of participants reported depressive symptoms. Moderate PA was associated with 35% lower odds of depression (OR=0.65, 95% CI: 0.47–0.91, p=0.009). Vigorous PA showed a non-significant trend toward reduced odds of depression (OR=0.76, 95% CI: 0.49–1.19, p=0.243), which became significant in sensitivity analyses. High sugar intake was linked to a higher risk of depression (OR=1.97, 95% CI: 1.24–3.13), while fiber intake was protective. Women with arthritis had 63% higher odds of depression (OR=1.63, 95% CI: 1.17–2.27, p=0.003), and those with chronic bronchitis had more than twice the odds (OR=2.08, 95% CI: 1.38–3.12, p<0.001). Conclusion: This study addresses critical gaps in the literature by focusing on the specific effects of different PA intensities on depression among women. The findings support the inclusion of moderate exercise and a balanced diet in mental health interventions for women, offering valuable insights into non-pharmacological treatment options.
Association Between Household Dust Exposure andSleep Duration: Findings from NHANES 2005–2006
Objective: Indoor pollutants such as household dust have been suggested as potential contributors to health problems, including sleep disturbances. This study investigates the association between household dust exposure and sleep quality among American adults using data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2006. Methods: Data from the NHANES were used in a cross-sectional design. The total dust weight (mg) was the primary exposure variable, and sleep outcomes included self-reported sleep duration, sleep latency, and physician-diagnosed sleep disorders. Data analysis was conducted using univariate and multivariate regression models in STATA with adjustments for confounders. Results: Data on 5,582 adults aged ≥18 years regarding sleep duration and 4,893 regarding sleep latency were available. In an adjusted model controlling for age and emotional support, dust weight was significantly associated with a slight decrease in sleep duration (adjusted β = -0.104, 95%CI: -0.206 to -0.002, p = 0.047). In multivariate logistic regression, dust weight showed a significant negative association with sleep duration (adjusted OR = 0.854, 95% CI: 0.740–0.985, p = 0.030), while age and emotional support demonstrated positive associations. Sleep latency showed no significant relationship with dust weight in linear regression analysis, even when controlling for emphysema and PHQ-9 scores (adjusted β = -0.221, 95% CI: -1.394 to 0.952, p = 0.712). Multivariate logistic regression analysis confirmed that there was no significant association between dust weight and sleep latency Conclusions: This study suggests that household dust exposure modestly affects sleep duration, highlighting the value of improving indoor air quality to enhance sleep health.
Elmustafa Mohamed Saifeldin Fadul Abdalla
Maria Carolina Fontana Antunes de Oliveira
Copyright (c) 2025 Rogerio Takahashi, Tatiana Soares, Ramiro Sienra , Jose Gabriel Lara Amador, Pilar Loreto Buendía Montenegro, Maria Daniela Sarquis, Elmustafa Mohamed Saifeldin Fadul Abdalla, Enry Jacob Melgar , Ewerton Borges de Souza Lima, Mariana Alcantara Roldi de Azeredo, Yahaira Tatiana Carpio Colmenares, Carlos Betancourt-Mendez, Christel Teresa Trifone , Eva Borges, Jessica Vasconcellos, Julia Bertuzzo Tavares , Vitória Kanjo De Ávila , Laura Cecilia Ibanez-Pintor, Mateus Cendon de Paula , Natalia Rojas Amaris, Roger Hiroshi Albornoz Toyohama, Tobias Lerchner, Maria Ximena Rivera Escobar, Jose Alberto Genao, Guido Felizzia, Safa Almarzoky Abuhussein, Inia Andrea Perez Villa, Yusuf Adelabu, Arthur Gomez da Silva Netto, Maria Carolina Fontana Antunes de Oliveira, Khalid Mahmoud Fadlelmoula Ahmed, Christianne Fernades Valente Takeda, Gabriel Vallejos Peñaloza, Tatiana Gomez Gomez, Mohamed H. Mahmoud, Sundus Sardar, Ygor Junqueira, Augusto Mendes, Nantawan Koonalinthip
Impact of Recreational Exercise on Nonsteroidal Anti-inflammatory Drug (NSAID) Use: A Comprehensive Analysis of the NHANES Database
Introduction: This study examines whether recreational physical activity can reduce NSAID use among adults. While NSAIDs effectively manage pain, they carry risks like gastrointestinal and cardiovascular side effects. Exercise, known for its anti-inflammatory effects, offers a non-pharmacological alternative. Physical activity reduces inflammation through anti-inflammatory cytokines, and lower visceral fat, and immune support, suggesting it may reduce NSAID need. Methods: A cross-sectional analysis used 2017-2018 NHANES data, representing the U.S. population, including 5,145 adults with complete NSAID use and recreational physical activity data. Statistical analysis with STATA 18.5 applied univariate and logistic regression modeling to assess associations between recreational exercise (moderate, vigorous, or both) and NSAID use. Confounders, including age, gender, BMI, arthritis, and trouble sleeping, were adjusted in the final model. Key Findings: Participants engaging in both moderate and vigorous exercise had significantly lower odds of NSAID use (OR 0.50, 95% CI: 0.32, 0.78). Conversely, arthritis (OR 3.89, 95% CI: 2.83, 5.34) and at least one comorbidity (OR 1.75, 95% CI: 1.15, 2.65) were linked to higher NSAID use Implications and Conclusion: This study highlights regular moderate and vigorous exercise as a viable non-pharmacological strategy to reduce NSAID use and associated health risks. Recognizing factors like arthritis and sleep quality that influence NSAID use helps improve pain management strategies, with exercise as a beneficial addition. Further research should explore exercise types and lasting effects on NSAID reduction.
Copyright (c) 2025 Maham Safarat Kirmani, Carlos Alberto Narvaez Gaitán, Maria-Antonia Pelaez Lopez , Ana Gabriela Claros Ospina , Danielle Magalhães, Tejasvi Dwivedi, Jonathan Isai Cazares Gonzalez, Julia Cristhina Monteiro Klock, Maria Victoria Wolf, Belissa Zaiek, Fátima Lucia Nuñez Sanz, Radja Messai Badji, Renata Drummond, Sumia Ahmed , Raphael Gracindo, Arthur Lopes, Maria Camila Ayala Peña, Julia Collete de Souza, Lionete Filha, Monserrat Guraieb-Trueba, Arthur Segurado, Elisa Gabrielli, Joao Ribeiro, Marco A. López Cáceres, Bruno Henrique Schuta Bodanese, Miguel Urina-Triana
Depressive Symptoms and Subjective Daytime Sleepiness in a Population-Based Study
Introduction: Sleep disorders can contribute to the development and worsening of depression symptoms. To understand how depression impacts sleep regulation, models are necessary. This study aims to analyze how depression influences sleep patterns. Methods: A cross-sectional study was conducted using the NHANES 2017-2018 dataset, which included 5.088 adults. The primary outcome was the presence of daytime sleepiness among participants with depressive symptoms (PHQ-9 > 4) compared to participants without depressive symptoms (PHQ-9 ≤ 4). The regression analysis considered the following covariates: age, gender, BMI, and the presence of at least one comorbidity. A secondary analysis examined the severity of depression, BMI > 25, and a history of diabetes or cancer. Statistical analyses were performed using StataNow/BE 18.5. Results: Participants exhibiting depressive symptoms had a significantly higher likelihood of feeling sleepy during the day (OR 4.39; 95% CI 3.83–5.04; p < 0.001). Univariate analysis revealed statistically significant associations (p < 0.05) for all included variables: Age (OR = 0.99, log-likelihood = -2911.28); Gender (OR = 1.27, log-likelihood = -2907.12); BMI (OR = 1.03, log-likelihood = -2853.69); At least one comorbidity (OR = 1.69, log-likelihood = -2882.59). The final model confirmed a significant association between depressive symptoms and daytime sleepiness (OR 4.00; 95% CI 3.48–4.61; p < 0.001) after adjusting for confounding factors. Conclusion: There is a significant association between depressive symptoms and daytime sleepiness, underscoring the need for a multifaceted approach to enhance sleep quality, alleviate depression symptoms, and manage comorbidities.
Copyright (c) 2025 Clarissa Bueno, Eline Rozaria Ferreira Barbosa, Desiree Rodrigues da Veiga, Hilario de Sousa Francelino, Andrea Suarez Gomez, Ivan Dunshee de A.O. Santos Filho, Lyna Kyria Rodrigues de Almeida, Pedro Henrique Martins da Cunha, Erika Bushatsky Andrade de Alencar, Abrahan Salcedo Perez, Chukwuma Eze Okereke, Daniel Gomez-Carrillo, Danny Chris Vinas, Rinna Segatto Siquieroli, Agustin N. Posso, Victor Barrientos Labra, Sara Lanaia, Isabella Meneghetti Inacio Silva, Elmira Mustafayevna Lomashvil, Laura Soledad Samudio Sanchez, Sebastian Castañon Muñoz, Priscila Fuentes, Angelica Sam, Andrea De Góes Trindade Mello, Nicolas Emiliozzi, Mayra Gabriela Ayala
Impact of Physical Activity Level on Memory in the Older Adult Population in the United States: A Cross-Sectional Study
Background: Physical activity (PA) is widely associated with improved cognitive function, including memory, in older adults. However, the extent to which this relationship varies across age groups and is influenced by other health and lifestyle factors remains unclear. This study examined the association between physical activity levels and self-reported memory problems in adults aged 50 to 85 years, using a nationally representative dataset to assess the relationship between physical activity levels and self-reported memory problems in adults aged 50 to 85 years, stratified by age groups. Methods: This exploratory cross-sectional study used the NHANES 2005-2006 dataset. The relationship between memory problems and activity levels was assessed across middle-aged (50–64 years) and elderly (65–85 years) groups. Multivariate analysis was adjusted for potential confounders, and age was tested as an effect modifier. Results: Among 3,277 participants, 22% were classified as less active. In unadjusted analyses, less active individuals had significantly higher odds of memory problems in both the middle-aged (OR = 2.15; 95% CI: 1.27–3.63; p = 0.004) and elderly groups (OR = 1.67; 95% CI: 1.01–2.75; p = 0.042). These associations were attenuated and no longer statistically significant after adjusting for confounders. Sleep disorders were significantly associated with memory problems in both age groups, while depression and lower education were significant only in the elderly. Conclusion: While physical activity shows a potential protective association with memory problems—particularly in middle-aged adults—this relationship appears to be influenced by other health and lifestyle factors. Age-specific interventions that address sleep quality, mental health, and education may be more effective in supporting cognitive health in older populations.
Copyright (c) 2025 Alice Liriano, Ana Isabella Bencosme, Angélica Furzán, Bruno Cateb Resende de Oliveira, Carla Arias, Carolina Matté Dagostini, Claudia Meireles, Daniel Musse Gomes, Daniela Jorquera, David Moros, Erlando Mendez, Giovanna Oliveira dos Santos, Hanan Alshareef, Jazmin Insfran, Jorge Pastrana, Komwudh Konchalard, Lucas Koji Uchiyama, Marcos Brioschi, Mario Diego Teles Correia, Marcos Rafael Ramirez Marquez, Matheus Machado Rech, Mayra Muñoz, Natalia Rodriguez, Nelia Sanchez-Crespo, Nicole Beatriz Gonçalez Mannis, Olumide Adeniyi, Pascal Gaechter, Rodrigo Mariano, Silvia Castro Piedra, Tatiana Dus
Association Between Physical Activity Intensity and Allergies in Children: Insights from NHANES 2005-2006
Background Allergies are among the most prevalent global health conditions, affecting a growing proportion of children each year and imposing a burden to healthcare systems and families. The etiology of allergies involves complex interactions between genetic, socioeconomic, and environmental factors, with potential contributions from modifiable factors like physical activity (PA). This study examined whether higher frequency and intensity of PA are associated with reduced allergy diagnoses in children. Methods This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 dataset. The sample included 2,196 children aged 2–11 years. Univariate and multivariate logistic regression models assessed the association between PA frequency and allergy diagnosis. All analyses were conducted using StataNow/BE version 18.5 software. Results Among the 2,196 children analyzed, 19.85% had been diagnosed with allergies. The median frequency of vigorous PA was 7 times per week. Logistic regression analyses showed no significant association between physical activity frequency and allergy diagnosis (adjusted OR: 0.998, 95% CI: 0.971–1.026, p = 0.915). However, older age, race, and family income were significantly associated with an increased likelihood of allergies, while room humidity showed a small protective effect. Conclusion These findings support that while physical activity does not significantly impact allergy diagnoses in children, other demographic and environmental factors have significant influence. Further research is needed to explore additional modifiable factors, such as dietary influences and specific environmental exposures, to better inform prevention strategies.
Copyright (c) 2025 Luiza F. F. Sandes, María A. Barón Esparza, Patricia Langenegger, Samuel Ristovski List, Rafael Pinto-Colmenarez, Abril Perez Rivas, Artur Tenorio, Camila Roberta Caseli, Daniela Estrada, Déborah David Pires, Edgar Acon, Faruk Hernández Sampayo, Geronimo Pacheco, Guilherme Gradim Fabbron, Heberti Silva, Hellen Rose Maia Salazar, Ivan Morales, Lucas Gremaschi, Maíra Fabiana Rodrigues Neves, Muhannad Abu Abthan, Orlando Antonio Loyola Ávila, Paula Andrea Figueroa Saint-Jour, Phu Pham, Ruben Riera Pazmino, Tassia Bastos, Timo Schenker, Wilson Roberto Catapani, Saskia Kamphuis
Potential Benefits of Green Tea on Cancer-Related Outcomes: The Impact of Dosage and BMI as Effect Modifiers
ABSTRACT Introduction: Green tea, GT, catechins, epigallocatechin-3-gallate (EGCG) and its polyphenol extract called Polyphenon E have been studied as potential anticancer agents. This systematic review evaluates the effect of GT exposure on cancer outcomes while focusing on the influence of green tea dosage and body mass index (BMI) as effect modifiers. METHODS: A systematic review of studies among PubMed, Scopus, and Embase until June 2024, evaluating green tea or Polyphenon E among cancer patients was performed. Of 150 publications, five studies were included, comprising four RCTs and one single-center prospective cohort study. We evaluated the effects of green tea interventions on cancer biomarkers and survival outcomes, as well as the possible modifying role of BMI on such endpoints. RESULTS: The included studies have different types of cancers, dosages of green tea, and durations of intervention. High-dose green tea (≥800 mg EGCG) reduced certain biomarkers; for example, insulin-like growth factor-1 (IGF-1) and proliferating cell nuclear antigen (PCNA); there is not consistency across biomarkers or cancer types. Among the observational studies identified, only one reported a statistically significant dose-response association between green tea consumption and improved survival among ovarian cancer patients. BMI data varied little between the intervention and placebo arms across the studies; this certainly limits the ability to assess BMI as an effect modifier. CONCLUSION: While there was a trend towards a reduction of certain cancer biomarkers associated with green tea consumption, due to limitations in the data it is not possible to conclusively determine effect modification by dosage or BMI. Variability in study designs, dosages, and cancers limits generalizability. Future studies are warranted that are well-designed regarding dosage standardization, long-term effects, and identification of an interaction between green tea and standard cancer therapies. Keywords: Green tea, Catechins, Epigallocatechin-3-gallate (EGCG), Body Mass Index (BMI), Cancer
Copyright (c) 2025 Lisbeth Martinez, Maria Gonzalez, Gabriel Bielfuss Rieth, Khalid Al-Naamani, Alexandra Roman, Cindy Martinez, Daniela Morales, Isabella Shetiini, Lennart Merkle, Katilenia Caraballo, Emmanuel Bonilla, Mario Najera, Larine Cenci, Sophia Negrao, Pedro Kaufmann, Luiz Araujo, Natalia Moros, Maria Pellice, Azucena Armas, Carolina Cardoso, Ayatullah Aly, Sintip Pattanakuhar, Ahmed Sweilim, Siyu Dai, Amin Saied, Klaithem Mohamed, Kazukiko Takemura, Adamu Dalhatu, Adela Lazar, Karen Mori, Thamiris Fallani, Erich Katsuyama, Felix Ehret, Blanca Bazan, Carolina Alcoforado, Ligia Facin, William Sosa, Keiko Ueda
The Effect of Probiotics on Prevention of Respiratory Tract Infections in Children and Adolescents: A Systematic Review
Background: Respiratory tract infections (RTIs) are a common cause of illness and health care visits in children. Probiotics have shown promising results in reducing the incidence and duration of RTIs. However, significant gaps remain to be cleared, such as the variability in study results due to differences in probiotic strains, doses and populations studied. The present systematic review collected evidence on the effect of various probiotic strains and administration schedules on RTIs in children and adolescents. Methods: A comprehensive search strategy for randomized controlled trials (RCTs) was employed using both Medical Subject Headings (MeSH) and non-MeSH terms across Medline, EMBASE, and Web of Science databases. Screened RCTs assessed the effect of any probiotic strain, form of administration, and dosing schedule on the incidence of RTIs in healthy pediatric and adolescent populations aged 28 days to 17 years across different settings. Results: According to predefined eligibility criteria, we identified 32 RCTs, with a total of 8415subjects. Of these, 25 (78.1%) studies reported a positive effect of probiotics in reducing the incidence of RTIs. However, the results were notably heterogeneous, with 22 different probiotic strains and a variety of administration schedules and study designs. The most frequent strain genus was Lactobacillus, used in 46.8% of trials and the doses ranged from thousands (105) to over tens of billions (1010) of colony forming units (CFU). Conclusion: The findings of the present review confirm the potential of probiotics to reduce the occurrence of RTIs in children, especially LGG strains in day care centers. However, the wide range of probiotic strains and administration schedules emphasizes the need for further research to find the most effective strains and establish standardized guidelines for using them to prevent RTIs in children. Keywords: Probiotics; Pediatrics; Respiratory Tract Infections; Preventive Medicine.
Copyright (c) 2025 Patricia Langenegger, Samuel Ristovski List, Abril Perez Rivas, Artur Tenorio, Camila Roberta Caseli, Daniela Estrada, Deborah Pires, Edgar Acon, Faruk Hernandez, Geronimo Pacheco, Guilherme Gradim Fabbron, Heberti Silva, Hellen Rose Salazar, Ivan Morales, Lucas Gremaschi, Luiza Sandes, Maira Fabiana Rodrigues Neves, Maria Baron, Muhannad Abu Abthan, Orlando Loyola, Paula Figueroa, Phu Pham, Ruben Riera, Saskia J.M. Kamphuis, Tassia Bastos, Timo Schenker, Wilson Catapani, Rafael Pinto-Colmenarez
Effectiveness of Remote Mindfulness Interventions in Reducing Depressive Symptoms During Pregnancy and the Postpartum Period: A Systematic Review and Meta-analysis
Aim: This systematic review examines the effectiveness of mobile and remote mindfulness interventions in reducing depression symptoms during pregnancy and the postpartum period. Background: Postpartum depression is highly prevalent in women and can contribute to up to 20% of maternal mortality, affecting the health of both mother and child. Effective treatment is a challenge, and a growing number of studies show that mobile and remote mindfulness interventions are potential new interventions. Design: A systematic review and meta-analysis. Methods: A comprehensive search was conducted in PubMed and Cochrane Library on May 4th, 2024, investigating randomized controlled trials in pregnant women. A meta-analysis was performed on seven studies assessing the impact of remote mindfulness interventions on depression symptoms measured with the Edinburgh Postnatal Depression Scale (EPDS). Results: A total of 997 studies were screened, with 7 studies included in the final analysis. A meta-analysis of four studies on the reduction of EPDS scores immediately post-intervention was conducted. Significantly lower EPDS scores were observed in the intervention group compared to the control group (mean difference -1.93; 95% CI -3.78 to -0.08; P = 0.04, I² = 81%, P < 0.01; high heterogeneity). A second meta-analysis on the persistence of effects through the postpartum period showed no significant differences between the groups (mean difference -2.63; 95% CI -6.13 to 0.86; P = 0.14, I² = 91%, P < 0.01; high heterogeneity). Conclusion: Mindfulness interventions delivered through mobile health applications have the potential to prevent depressive symptoms during pregnancy and the postpartum period.
Copyright (c) 2025 Maria Yemane, Tadeus Luis Lopez Ulloa, Alvaro Lopes de Oliveira, Amanda Querino Andrade Viana, Andrea Siles De La Portilla, Bruno César Rodrigues do Amaral, Daniela Lorena Alvarado Rodriguez, David Abalovich, Débora Pinheiro Xavier, Fabiane Barbero Klem, Federico Antillon-Klussmann, Gabriela Coelho Itaya, Gabriella Bezerra dos Santos, Harsh Vardhan Chawla, Isabela Castaneda, Issbah Rma, Johan Antonio De La Rosa Laureano, Luca Ferrari, Lucas Fernando Uratani, Marcia Beatriz Oliveira de Sousa, María Alejandra Garza Ledezma, Matías Deck Labra, Miguel Miranda, Nadine Alejandra Aranis Seguic, Rodas Annose, Rodrigo Pegado, Salvatore Minnella, Seunghyun Kim, Sofia Teixeira Prates de Oliveira, Yasmin Azevedo Elias, Yazmin Alejandra Heredia Allegretti
Impact of Rising Global Temperatures on Dengue Infection and Serotype Distribution: A Mini Review
Background: Dengue virus (DENV) infection is currently one of the most significant vector-borne viral diseases in terms of global morbidity and mortality. Climate change studies have demonstrated the association between dengue virus transmission and variations in ambient temperature. We performed a mini-review to evaluate whether there are differences in the association between the increase in ambient temperature and the incidence of dengue among the different dengue serotypes. Methods: For this systematic review we searched MEDLINE and PubMed databases for studies published within the last 15 years, from database inception to the execution of this review, focusing on the association between dengue incidence of serotypes and temperature variations globally. We excluded studies that involved reviews, modeling with only prospective data, prediction, or predictive models. The quality of the evidence was assessed using the Newcastle-Ottawa Scale (NOS). Findings: There is a significant association between temperature and DENV infection due to global warming. No specific dengue serotypes were identified as predominant in the reviewed studies. Aedes aegypti and Aedes Albopictus, the primary dengue vectors of DENV, have different behaviors in response to temperature changes. Discussion: The findings of this review emphasize the strong relationship between temperature and dengue incidence. Expanding the geographical scope and including more prospective studies would enhance the understanding and generalizability of these findings. Conclusion: This review showed a significant relationship between temperature increases (in the context of global warming) and dengue infection, leading to potential outbreaks. A more thorough analysis of serotypes is recommended for future studies.
Copyright (c) 2025 Staling Guillermo Pallares Escorcia , Claudia Gonzalez, Alaa Ali, Alfredo Gabriele Nanni, Ana Luíza Soares Pinto, Bruno Meireles de Moraes, Carol Arce Sanjur, Caroline Borginho, Cristal N. Pride, Einer C.E. Arevalo-Rios, Erwin León, Glauco Marinho Plens, Hiroshi Hayashi, Jose Max Narvaez Paliza, Justyna Garnier, Karina Gisell Duerksen Crespo, Keila Miranda-Limachi, Kelvin Henrique Vilalva, L. Angie Paucar Cisneros, Luiza Lara Gadotti, Mariana Pilon Capella, Mitha Al Balushi, Patricio A. Alfaro, Pedro Slindvain Freitas, Roksana Hasib, Ruan Pablo Duarte Freitas, Sibin Marian, Victoria Gomes Andreata, Supattana Chatromyen
Exploring the Inflammatory Basis of Fibromyalgia and Long-COVID: Insights from Human and Animal Studies
Background Fibromyalgia is a chronic disorder characterized by widespread pain and fatigue. Recent evidence suggests that inflammation may play a role in fibromyalgia's pathophysiology. The COVID-19 pandemic has introduced long-COVID, a condition with overlapping symptoms to fibromyalgia, prompting further investigation into shared inflammatory pathways. Objective To evaluate the association between inflammatory markers and fibromyalgia in humans, assess the relevance of animal models in studying these markers, and explore the similarities and differences in inflammatory markers between fibromyalgia and long-COVID patients. Methods A systematic review was conducted using PubMed, Medline, Embase, and Scopus databases. Studies involving human participants with fibromyalgia, animal models of fibromyalgia, and long-COVID patients with fibromyalgia-like symptoms were included. Data on inflammatory markers were extracted, and the quality of studies was assessed. A meta-analysis was performed where possible. Results Elevated levels of IL-6, TNF-α, and CRP were consistently reported in fibromyalgia patients compared to controls. Animal models corroborated these findings, demonstrating similar inflammatory profiles. In long-COVID patients, IL-6 and TNF-α levels were also elevated, suggesting shared inflammatory pathways with fibromyalgia. Conclusion Inflammatory markers such as IL-6 and TNF-α are elevated in both fibromyalgia and long-COVID patients, indicating potential commonalities in their pathophysiological mechanisms. This highlights the need for targeted anti-inflammatory therapies and further research into the inflammatory basis of these conditions. Keywords Fibromyalgia, Long-COVID, Inflammatory Markers, Cytokines, Systematic Review, Meta-Analysis
Copyright (c) 2025 Sofia Leonardo, Felipe Fregni
Digital Health Interventions to Improve Vaccination Rates and Awareness Among Immigrant Populations: Barriers, Facilitators, and Outcomes - A Scoping Review
Background: Digital health interventions are suggested to improve vaccine coverage and awareness in the general population. However, given the scarcity of information within migrant populations, this scoping review aims to identify existing evidence on digital health interventions designed to improve vaccination and health outcomes among this social group. Methods: In this scoping review, we searched CENTRAL, PubMed, and Scopus for observational studies and randomized controlled trials (RCT). Two independent reviewers screened articles, performed data extraction and synthesis, and assessed bias risk using CovidenceⓇ. Bias was evaluated with the Cochrane RoB 2, Newcastle-Ottawa Scale (NOS), or JBI tool. We analyzed digital health interventions aiming to boost vaccination rates and awareness among immigrant populations, evaluating barriers and facilitators. The focus was on vaccines such as COVID 19, HPV, Hepatitis B, Influenza, childhood vaccines. Targeting immigrants, primarily from South and East Asia, the Middle East, and Hispanic/Latinx populations. The interventions of interest included digital appointment reminders, mobile applications, messaging platforms, and digital storytelling. Findings: Out of the 673 studies initially identified, 19 met the criteria for data extraction and synthesis. Published between 2012 and 2024, these included six quasi experimental studies, five cross-sectional studies, four randomized control trials, three qualitative studies and one survey. Research spanned several continents and countries such as North America, Germany, China, Jordan,Turkey and Uganda. The role of digital tools in increasing the vaccination rate must be reinforced, with particular emphasis on the personalized content of the message for recipients. The measurement tools influencing vaccination rates are not only diverse but also complex. They encompass a wide range of factors, from knowledge about immunization to emotions and vaccine intention, highlighting the multifaceted nature of the issue. Several factors interfere with vaccination rates (e.g., language barriers, costs, long wait times, scheduling difficulties, lack of transportation, and child support). Some confounders may impact the effectiveness and uptake of vaccination programs in undocumented immigrants from seeking vaccination services, such as socioeconomic status, education level, language barriers, cultural beliefs and practices, distrust in the healthcare system, legal status and fear of deportation. Interpretation: Digital health interventions show promise in enhancing vaccination awareness among migrant populations. Findings from this scoping review suggest that these interventions should be customized for specific populations, taking into account barriers, facilitators, and cultural beliefs.
Copyright (c) 2025 Clara Noble, Andrea Noronha, Marianna Leite, Adriana Villamizar, Andre Canteri, Andre Molina, Andressa Scarpitta, Caio Araujo, Camila Carvalho, Christiane Soyer, Elena Su, Emilia Almanzar, Gabriel Cojuc, Gabriela Lima, Ian Maia, Joyeta Razzaque, Juliana Paulucci, Julianne DeCastro, Katia De Oliveira, Lisa Schutze, Marco Luque, Maria Fernandez, Paula Hayakawa, Raunaq Khanna, Ricardo Coyolla, Salomon Huancahuire, Savci Telek, Thaise Pereira, Victoria Alvarado, Virginia Neta, Yelidad Llaverias
The Effect of Vitamin C Supplementation in Wound Healing: A Systematic Review of Randomized Controlled Trials
Background: Vitamin C increases the proliferation of dermal fibroblasts, this favors the collagen synthesis and wound healing. However, there is no solid evidence to support this practice. Main objective: This review aims to evaluate the effects of vitamin C supplementation in soft tissue wound healing. Methods: We searched 3 databases (PubMed, Embase and Cochrane) and included randomized controlled studies until July 10th, 2024, that evaluated the effect of vitamin C administered by any route in wound healing of skin and soft tissues. We excluded traumatic injuries and burns. Risk of bias was assessed using the Cochrane risk-of-bias (RoB-1) tool. Results: We identified 10 relevant studies, including 599 participants. Findings were summarized qualitatively and a meta-analysis was not feasible because of significant heterogeneity of settings and outcomes between the studies. Studies that evaluated the effect of vitamin C on healing in the dental setting and on ulcers had mostly positive results, while studies on corneal tissue and hysterectomy did not show a significant effect. All articles were unicentric and small, with unclear or high risk of bias except for one low risk study. Conclusions: The available literature studying vitamin C in wound healing is inconsistent. Relatively, few studies exist and have a small number of participants in different clinical scenarios, mainly with high or unclear risk of bias. Larger and higher quality studies are warranted. Also, this intervention is simple and has low cost. Further investigation on this topic may impact patient’s quality of life and healthcare economic burden.
Copyright (c) 2025 Ana Derzi, Andressa Masson, Carla Chavarria, Caterina Paiva, Cristiane Paganoti, Daniel Abad, Daniella Audi, Dermevel Neto, Dominique Schakel, Elianet Castillo, Felipe Cordova, Fernanda Malta, Hans-Udo Richarz, Helio Grullon, Iloba Njokanma, Ivan Duarte, Jose Fermin, Karen Bedirian, Kendya Reyes, Krista Cano, Lucia Salgueiro, Mobalaji Jaiyesimi, Monaly Ribeiro, Nicol Ortega, Onyekachi Aniume, Paula Sotelo, Santiago Pastrana, Stefania Zapata, Tomas Marquez, Vanessa Lessa
Air Pollution and Pediatric Central Nervous Tumors: A Systematic Review of Evidence and Public Health Implications
Background: Exposure to environmental pollution, particularly air pollutants, and its relationship with childhood central nervous system (CNS) tumors is a growing public health concern. Understanding these associations is crucial for the implementation of protective measures for children and the development of strategic public policies. Objective: This systematic review examines the association between air pollution exposure and the risk of CNS tumors in the pediatric population aged 0-19 years. Methods: Following PRISMA guidelines, we used PubMed, SCOPUS, EMBASE, Google Scholar, and CENTRAL baselines up to May 2024. We included only observational studies focusing on children exposed to air pollutants, excluding tobacco-related exposures. Data on study design, population characteristics, exposure assessment, and types of CNS tumors were extracted and analyzed. Results: We included 25 studies (case-control and cohort) conducted across North America, Europe, Australia, and Asia. The studies assessed pollutants such as benzene, nitrogen dioxide (NO2), particulate matter (PM2.5), and polycyclic aromatic hydrocarbons (PAHs). Some studies reported positive associations between specific pollutants and increased CNS tumor risk, while others found no significant links. Variability in exposure assessment methods contributed to inconsistent findings. Conclusion: The evidence linking air pollution to childhood CNS tumors remains inconclusive. Further research, with standardized exposure assessments and consideration of critical exposure windows, is needed to clarify these associations and inform public health policies to reduce environmental risks to children. Key words: Air pollutants, Environmental exposure, Central Nervous System Neoplasms, Pediatrics.
Copyright (c) 2025 Tatiana Soares, Nantawan Koonalinthip, Rogerio Diniz Takahashi, Jose Gabriel Lara-Amador, Ramiro Sienra, Pilar Buendía Montenegro, Maria Daniela Sarquis, Elmustafa Abdalla, Enry Jacob Melgar-Garcia, Ewerton Borges de Souza Lima, Mariana Alcantara Roldi de Azeredo, Yahaira Carpio Colmenares, Carlos Betancourt-Mendez, Christel Trifone, Eva Borges, Jessica Monteiro Vasconcellos, Julia Bertuzzo Tavares, Vitória De Ávila, Laura C. Ibanez-Pintor, Mateus Cendon de Paula, Natalia Rojas Amaris, Roger Albornoz, Tobias Lerchner, Maria Ximena Escobar, Jose Genao Ega, Safa Almarzoky Abuhussain, Inia Andrea Perez Villa, Yusuf Adelabu, Arthur Gomez da Silva Netto, Maria Carolina Fontana Antunes de Oliveira, Khalid Mahmoud Fadlelmoula Ahmed, Christianne Fernades Valente Takeda, Gabriel Vallejos Peñaloza, Tatiana Gomez Gomez, Mohamed H. Mahmoud, Sundus Sardar, Thalita Bento Talizin, Guido Felizzia
The Influence of Maternal Diet on Gut Microbiota Diversity During Pregnancy: A Mini-Review
Background: The gut microbiota plays a critical role in maintaining health, influencing nutrient metabolism, immune function, and disease susceptibility. During pregnancy, maternal diet can significantly alter gut microbiota composition and diversity, potentially impacting maternal and fetal health. Methods: This mini-review aims to answer whether maternal diet during pregnancy is associated with the composition and diversity of maternal gut microbiota. A comprehensive literature search was conducted in Embase, Scopus, PubMed, Web of Science, and Cochrane databases in May 2024. A risk of bias assessment was done. Results: Twenty articles were selected, including randomized controlled trials, cohort, cross-sectional, and case-control studies. Which revealed that increased dietary fiber intake was consistently associated with higher gut microbiota richness and diversity. Conversely, high-fat diets were linked to reduced microbial diversity and pro-inflammatory profiles. Dietary interventions such as vegetarian and Mediterranean diets promoted a more diverse and beneficial gut microbiota composition. Conclusion: Maternal diet during pregnancy is closely associated with changes in gut microbiota composition and diversity. These findings underscore the importance of dietary interventions in managing gut microbiota and improving pregnancy outcomes. Future research should focus on personalized nutrition strategies to optimize maternal and fetal health.
Copyright (c) 2025 Veronica Posse, Pamela Yanet Gil Galleguillos, Beatriz Cubilhas, Raissa Carvalho, Taciana Baez, Giulia Cenci, Carlos Alberto Vergara Ascenzo, Cristy Tavarez, Felipe Martinez, Leo Peña, Diego Saa, Martina Donoso, Andrei Shanchev, Saheed Oyedele, Katherine Amaro, Marcos Barros, Simone Barbosa, Ana Diaz, Sharif Folorunso, Tatiana Gatilova, Patricia Leite, Niurkiss Mallen, Cinthia Minatel, Jinhui Peng, Gabriel Sakaya, Mery Terreno, Carolina Uribe, Adela Yip, Andrés Soto-Rodríguez
Impact of Music Therapy on Cognitive Function in Elderly Patients with Mild Cognitive Impairment and Early Dementia: A Systematic Review
Introduction: Cognitive decline in the elderly significantly impacts the quality of life of patients and caregivers. Safer non-pharmacological interventions that stimulate natural healing have gained popularity recently. This systematic review evaluates the impact of music therapy (MT) in improving cognition and neuropsychiatric symptoms in elderly with mild cognitive impairment (MCI) and early dementia. Methods: Studies included randomized controlled trials (RCTs) and quasi-experimental studies focusing on MT for elderly patients (age ≥65 years) with MCI or early dementia due to Alzheimer's disease (AD) or vascular dementia (VD). Studies without control groups, non-peer-reviewed and not in English were excluded. Searches were run in PubMed, CENTRAL, Scopus, and Web of Science using key concepts dementia, music therapy and cognition. The Cochrane Risk of Bias Tool was used to evaluate the risk of bias in the RCTs. Interventions included any modality of MT. Outcomes evaluated cognition, using valid and reliable scales. Results: Fourteen studies (1,169 participants) were included. Significant post-intervention improvements were noted in cognitive measures such as the mini-mental state exam, Montreal cognitive assessment, and Digit Span scores. Active MT reduced neuropsychiatric symptoms in AD as measured by neuropsychiatric inventory scores. However, the effects varied across cognitive domains and MT modalities. The limitations of the studies included small sample sizes, short intervention and follow-up durations, and heterogeneous study designs limiting generalizability. Conclusions: Music therapy showed potential as a non-pharmacological intervention to improve cognitive function and reduce neuropsychiatric symptoms in elderly patients with MCI and early dementia. Further large-scale, well-designed studies are needed.
Copyright (c) 2025 Alice Liriano, Ana Isabella Bencosme, Angélica Furzán, Bruno Cateb Resende de Oliveira, Carla Arias, Carolina Matté Dagostini, Claudia Meireles, Daniela Jorquera, Daniel Musse Gomes, David Moros, Erlando Mendez, Giovanna Oliveira dos Santos, Jazmin Insfran, Jorge Pastrana, Komwudh Konchalard, Lucas Koji Uchiyama, Matheus Machado Rech, Mayra Muñoz, Marcos Brioschi, Marcos Rafael Ramirez Marquez, Mario Correia, Natalia Rodriguez, Nelia Sanchez-Crespo, Nicole Beatriz Gonçalez Mannis, Olumide Adeniyi, Pascal Gaechter, Rodrigo Mariano, Silvia Costa Piedra, Tatiana Dus
Associations Between Food Insecurity and Depression, Anxiety, and Psychological Distress in Adulthood Across High-Income and Low- to Middle-Income Countries: A Systematic Review of Observational Studies
Background: Food insecurity is the lack of consistent access to enough food for an active, healthy life, affects millions globally, including high-income countries. It is linked to adverse mental health outcomes like depression, anxiety, and stress. Objectives: To synthesize literature on the impact of food insecurity on depression, anxiety, and stress across various populations and regions. Methods: This mini systematic review follows PRISMA guidelines. Observational studies published from 2014 onwards, involving participants aged 18 and older exposed to food insecurity were included. Studies involving COVID-19, pregnant individuals, and cancer patients were excluded. A search was conducted in PubMed, Cochrane, and Google Scholar between April and June 2024. Covidence was used for screening, data extraction, and quality assessment. Risk of bias was evaluated using the Newcastle–Ottawa Scale. Results: 871 papers identified, 11 met the inclusion criteria. Six studies were conducted in the USA, while others included Canada, India, Panama, China, Mexico, and Russia. Food insecurity was assessed using validated scales like the USDA 10-Item Adult Food Security Module. The review found that individuals with food insecurity had significantly higher odds of experiencing depression (adjusted ORs 2.5-3.4), anxiety (adjusted ORs 2.3-3.1), and stress (adjusted ORs 2.0-2.8). These associations were consistent across different demographic groups and regions. Discussion: Food insecurity significantly increases risks of depression, anxiety, and stress, persisting after adjustments for sociodemographic and health factors. Conclusions: Food insecurity profoundly impacts mental health, highlighting the need for targeted interventions and policies to improve food security and mental health, especially for vulnerable populations.
Copyright (c) 2025 Hadia Safarat Kirmani, Silvia Di-Bonaventura, Adriana Romina Menendez-Mite, Areerat Suputtitada, Basira Hanafi Lawal, Carolina Parra Mardones, Carolina Schibuola Crespo, Claudia Andrea Lopez, Débora Renz Barreto Vianna, Elizabeth Leon-Cuevas, Florentina Diaconescu, Giliana Melany Collado, Giovanna Brandão Saliba, Ibelema Alaere Ijeoma Datubo-Brown, Ila Marques Porto Linares, Javier Bernardo Chambi, José Elías León Donis, Jose Omar Santellán Hernández, Kendra Aira Cabrera, Maiara Cássia Pigatto, Marie Andree Cosenza Ba, Motaz Almahmood, Nagheli Fernanda Borjas-Calderón, Orleancio Gomes Ripardo, Paul Pereyra, Sofia Gnecco, Tarek Khalaf Saleh Rabiei, Vinicius Costa Assis, Walter Araujo Zin, Sara Pinto Barbosa