Obesity is a global public health issue and a major contributor to non-communicable diseases. In recent decades, the prevalence of obesity in adolescents has risen at an alarming rate. Although several systematic reviews have evaluated the effects of physical activity for the management of obesity in adolescents, key limitations remain in the literature, particularly in reporting completeness and the lack of standardised assessments of the certainty of evidence.

To synthesise evidence on the benefits and harms of physical activity interventions for the management of obesity in adolescents aged between 10 and 19 years.

We searched various databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), and two trial registries, from 2012 to 4 December 2025. We applied no restrictions on language or publication status. We also searched grey literature sources.

We included randomised controlled trials (RCTs) that evaluated physical activity interventions lasting at least 12 weeks, of any frequency, type, or intensity, in adolescents aged 10 to 19 years with obesity (as defined by study investigators) at baseline. Eligible comparators included standard care, waiting list, no physical activity, or any other active interventions, such as a comparison of different physical activity parameters (duration, frequency, intensity).

Critical outcomes: body weight, body mass index (BMI), BMI z-score, waist circumference, body fat percentage, glucose, and insulin resistance. Important outcomes: physical well-being, mental well-being, physical activity levels, overall quality of life, blood pressure, adiposity, lipid biomarkers, insulin, fasting glucose, mortality, adverse events, presence of obesity-related comorbidities or any non-communicable disease, disability, prevalence of obesity in adulthood, alterations in hunger, and access to health services.

Pairs of review authors independently assessed the risk of bias in each included study using the original version of the Cochrane tool (RoB 1).

We synthesised results using meta-analysis when appropriate. Given the clinical and statistical heterogeneity, we predominantly used a random-effects model alongside sensitivity analyses. When meta-analysis was not feasible, we employed synthesis without meta-analysis (SWiM) methods. We assessed the certainty of the evidence using the GRADE approach. We grouped eligible comparisons into two broad categories: (1) physical activity intervention versus no-intervention control; and (2) one physical activity intervention versus another physical activity intervention or an active control. The first category is our main comparison.

We included 30 studies (1508 participants) conducted across 15 countries, published between 2012 and 2023 (median year: 2017), with participants' ages ranging from 10 to 17 years. We assessed all included studies to be at high risk of bias.

Physical activity intervention versus no-intervention control In adolescents with obesity aged 10 to 19 years, low-certainty evidence suggests that any form of physical activity may slightly improve the following outcomes compared to no intervention: body weight (mean difference (MD) -1.88 kg, 95% confidence interval (CI) -3.34 to -0.42; I² = 47%; 17 studies, 749 participants); waist circumference (MD -2.88 cm, 95% CI -3.70 to -2.06; I² = 0%; 10 studies, 476 participants); and body fat percentage (MD -2.96%, 95% CI -3.52 to -2.39; I² = 10%; 9 studies, 313 participants). This review identified very low-certainty evidence regarding the effects of any form of physical activity on BMI (MD -1.38 kg/m², 95% CI -1.94 to -0.83; I² = 43%; 16 studies, 537 participants), BMI z-score (MD 0.01 z-score units, 95% CI -0.34 to 0.37; I² = 84%; 6 studies, 250 participants), glucose (MD -0.29 mmol/L, 95% CI -0.45 to -0.12; I² = 76%; 7 studies, 299 participants), and insulin resistance (MD -0.99, 95% CI -1.25 to -0.73; I² = 66%; 6 studies, 256 participants). Compared to no intervention, any form of physical activity may improve mental well-being, based on evidence from one study with 56 participants (self-perception: MD 0.22, 95% CI -0.10 to 0.54; self-efficacy: MD 0.58, 95% CI 0.21 to 0.95; self-esteem: MD 0.47, 95% CI 0.18 to 0.76). We identified low- or very low-certainty evidence for other important outcomes, including physical activity levels, blood pressure, other measures of adiposity and fat distribution, insulin and fasting glucose, and lipid biomarkers. The studies included in the main comparison did not report on the following important outcomes: physical well-being, overall quality of life, mortality, adverse events, comorbidities, disability, presence of obesity in adulthood, alterations in hunger or satiety, or access to health services. One physical activity intervention versus another physical activity intervention or active control All comparisons involving one type of physical activity versus another type (for example, high-intensity interval training versus moderate-intensity continuous training) or versus an active control group (such as participation in regular school physical activity programmes) were supported by very low-certainty evidence. Thus, the effects of the various types and levels of physical activity on the reported outcomes are uncertain.

Physical activity may improve health outcomes in adolescents with obesity, but the certainty of the evidence is low to very low. Serious methodological limitations, clinical and statistical heterogeneity, as well as small-study effects and imprecise results limited the certainty and interpretability of the current evidence base. Important knowledge gaps remain as none of the included studies enrolled adolescents with disabilities, the studies provided little information on contextual factors, and the amount of evidence hindered the analysis of relevant subgroups. Future high-quality, well-reported studies will likely change the review's conclusions.

The Department of Nutrition and Food Safety at the World Health Organization (WHO) commissioned and provided financial support for this work. WHO acknowledges financial support from the Norwegian Agency for Development Cooperation, the Swedish International Development Cooperation Agency, the Government of the Grand Duchy of Luxembourg, and the Government of Germany to the Department of Nutrition and Food Safety.

The full protocol was registered, and it is publicly available (https://osf.io/2wksa).

Breast cancer has become more common in developing countries like India and is the most common cancer among women globally. Even though screening greatly increases survival, poor participation rates are still seen in rural areas. The purpose of this cross-sectional study, which was carried out in Lalton Kalan village, Punjab, was to provide insight into how sociodemographic traits affected the health consciousness and attitudes of 203 women who were 30 years of age and older regarding breast cancer screening. Data were collected using a pre-tested questionnaire that utilized the Health Consciousness Scale (HCS) and the Attitude Scale for Cancer Screening (ASCS). Both HCS and ASCS scores were found to be significantly impacted by age, education, marital status, occupation, and socioeconomic status. A positive correlation was established between screening attitudes and health consciousness (r = 0.441, t(201) = 6.96, p < 0.001). These results demonstrate the potential value of enhancing health education and incorporating breast cancer awareness into national health programs for disadvantaged rural populations.

Although antidepressant use during pregnancy has been linked to adverse birth outcomes such as stillbirth and preterm delivery, existing evidence is conflicting and rarely presents absolute risk estimates. We aimed to assess the association between antidepressant use during pregnancy and birth outcomes, alongside estimates of absolute risk to aid clinical interpretation.

We conducted a multi-country cohort study using data from the UK Clinical Practice Research Datalink (1996-2018), Norwegian Medical Birth Registry (2009-2020), and Swedish Medical Birth Register (2006-2020). Discordant sibling analyses and paternal negative controls were used to investigate associations with stillbirth, neonatal death, gestational age, size for gestational age, and Apgar score < 7 at 5-min among pregnancies delivered at ≥ 22 weeks' gestation.

Among 120 209 (4.8%) pregnancies exposed to antidepressants, maternal use was associated with stillbirth (adjusted pooled odds ratio [aOR] 1.16, 95% CI 1.05-1.28), preterm delivery (aOR 1.26, 95% CI 1.23-1.30), and low Apgar score (aOR 1.83, 95% CI 1.75-1.91). Associations persisted in sibling analyses with greater uncertainty. The predicted absolute risk of stillbirth was 0.34% among unexposed pregnancies and 0.40% among exposed. When restricting to mothers with depression or anxiety, the association with stillbirth attenuated (aOR 1.07, 95% CI 0.94-1.21). Paternal antidepressant use was modestly associated with preterm delivery and low Apgar score.

Maternal antidepressant use during pregnancy may be associated with increased risks of preterm delivery and low Apgar score, though absolute risks remain low. Residual confounding related to parental mental health is likely to explain part of these associations.

Non-communicable diseases (NCDs), including type 2 diabetes mellitus (DM), hypertension (HTA), obesity (OB), and cardiovascular disease (CVD), represent a major global health burden and disproportionately affect socially vulnerable populations. Small extracellular vesicles (EVs) are stable carriers of proteins and regulatory RNAs that may reflect endothelial dysfunction and cardiometabolic stress. This study explored plasma-derived EV-associated biomarkers in adults from La Guajira, Colombia, with emphasis on miR-126-3p, miR-21-5p, miR-92a-3p, and SNAIL. Anthropometric, clinical, and biochemical data were obtained from a cross-sectional cohort. Representative plasma samples were selected for EVs isolation by size-exclusion chromatography. Vesicles were characterized by nanoparticle tracking analysis, scanning transmission electron microscopy, protein quantification, Western blotting, and bead-based flow cytometry. Candidate miRNAs were identified by small RNA sequencing and validated by stem-loop RT-qPCR. Bioinformatic enrichment analyses were performed using miRNet 2.0 and KEGG pathway analysis. The epidemiological cohort showed a high cardiometabolic burden, with waist-to-height ratio (WHtR) and triglyceride-glucose (TyG) index emerging as key markers of central adiposity and metabolic dysfunction. Plasma-derived EVs displayed the expected nanoscale morphology and expressed canonical vesicle markers. Protein cargo analyses revealed EMT- and remodeling-associated proteins, including SNAIL and GAL-3. EV-associated miR-126-3p, miR-21-5p, and miR-92a-3p were enriched predominantly in hypertensive and hypertensive-diabetic groups. In an exploratory sub-cohort, CD31-positive EVs showed a trend toward increased expression in individuals with previous myocardial infarction or stroke (p = 0.057). KEGG enrichment analysis linked the identified miRNA signature to pathways involved in endothelial dysfunction, inflammation, vascular remodeling, apoptosis, and extracellular matrix organization. Plasma-derived EVs from individuals with cardiometabolic disorders carry molecular signatures consistent with endothelial stress and vascular remodeling. These findings identify miR-126-3p, miR-21-5p, miR-92a-3p, SNAIL, and CD31-positive EVs as exploratory candidate biomarkers that require validation in larger prospective cohorts.

Non-communicable diseases (NCDs), including cardiovascular disease and diabetes, present an increasing challenge in humanitarian settings. While healthcare services in refugee camps have traditionally prioritised acute and communicable diseases, the long-term management of chronic conditions remains difficult, particularly among older adults. This study explored healthcare providers' perspectives on barriers to cardiovascular disease and diabetes care among elderly Rohingya refugees living in Cox's Bazar, Bangladesh.

A qualitative study was conducted using semi-structured interviews with six physicians working in Rohingya refugee camps in Cox's Bazar, Bangladesh. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis.

Three overarching categories of barriers were identified: service delivery barriers, physical and environmental barriers, and socio-cultural barriers. Healthcare providers described limited diagnostic capacity, restricted medication availability, fragmented continuity of care, transport difficulties, challenging camp terrain, language barriers, low health literacy, and reliance on informal healthcare providers as key challenges affecting long-term management of cardiovascular disease and diabetes. These interconnected barriers were perceived to reduce healthcare access and continuity of care for elderly Rohingya refugees.

The findings suggest that humanitarian healthcare systems should strengthen long-term management of non-communicable diseases among ageing refugee populations. Improving diagnostic capacity, ensuring reliable access to essential medicines, enhancing continuity of care, and supporting culturally appropriate health education and outreach services may improve chronic disease management in humanitarian settings. Further research exploring the perspectives of elderly Rohingya refugees is needed to complement healthcare provider perspectives.

Chronic noncommunicable diseases, including cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer, constitute leading causes of global mortality, with suboptimal diet identified as a primary modifiable risk factor. Plant-based dietary patterns (PBDPs) can be conceptualized along a continuum of quality, with whole-food PBDPs consistently linked to lower risks of CVD, T2D, and all-cause mortality, though much of this evidence derives from studies of vegan or healthy plant-based dietary index patterns rather than whole-plant-food diets directly. Evidence further indicates that minimizing or eliminating added salt, oil, and sugar (SOS) within whole-food PBDPs may provide additional cardiometabolic benefits, primarily by favorably modifying three graded intermediate biomarkers: low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and adiposity. Dietary sodium increases BP in a linear, dose-dependent manner and enhances food palatability, potentially promoting passive overconsumption and increased adiposity. Although added oil is preferable to saturated fat for LDL-C reduction, preliminary evidence suggests that adding olive oil to an already oil-restricted whole-food PBDP may reduce its LDL-C and body-weight benefits; these findings are hypothesis-generating and require confirmation in larger, longer-term trials. Whole-food fat sources such as nuts and seeds may offer cardiovascular benefits at least equivalent to those of oils, without this attenuating effect. Added sugar promotes excess caloric intake, contributing to increased adiposity, and may impair insulin sensitivity; these effects are most clearly and consistently established for sugar-sweetened beverages (SSBs), whereas the evidence for solid added sugars is weaker and may depend more on excess energy intake and broader dietary context. This narrative review synthesizes evidence from systematic reviews, meta-analyses, Mendelian randomization studies, and key clinical trials to evaluate whether whole-food PBDPs minimizing or eliminating SOS may provide incremental benefit for chronic disease risk reduction and management compared to whole-food PBDPs that include these additives. Direct long-term randomized evidence comparing SOS-restricted to SOS-inclusive whole-food PBDPs remains limited, and the possible incremental benefit of SOS restriction within an already health-promoting dietary pattern warrants further investigation. Complete SOS elimination has not yet been shown to provide incremental benefit beyond a high-quality PBDP, and any benefit is likely greatest in individuals with hypertension, obesity, elevated cardiometabolic risk, or high baseline SOS intake.

Background/Objectives: Anaemia is a critical public health challenge in Sub-Saharan Africa (SSA), particularly among adolescents. The objective was to estimate the pooled prevalence of anaemia among adolescents in SSA and synthesise evidence on its nutritional and contextual determinants. Methods: A systematic search of databases including PubMed, CINAHL and Web of Science was conducted for studies published from January 2000 to October 2025. The methodological approach was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled prevalence estimates were computed using random-effects models, and heterogeneity was assessed using the I² statistic and Cochran's Q test. Subgroup and meta-regression analyses were performed to explore sources of variation. Determinants were synthesised as pooled odds ratios with 95% confidence intervals. Publication bias was evaluated through funnel plot asymmetry and Egger's regression test. Results: Forty-eight (n = 48) studies involving 76,596 adolescents met the inclusion criteria. The pooled prevalence of anaemia was 33% (95% CI: 0.28-0.39), with substantial heterogeneity across studies. Factors associated with higher odds of anaemia included low dietary diversity (OR 1.74, 95% CI: 1.10-2.74) and poor iron or micronutrient supplementation adherence or lack of supplementation (OR 1.94, 95% CI: 1.25-3.01). Infection-related exposures (OR 3.03, 95% CI: 1.99-4.61) and environmental determinants (OR 2.23, 95% CI: 1.41-3.55) were also significantly associated with anaemia. Socio-demographic factors associated with anaemia included menstrual factors among girls (OR 2.51, 95% CI: 1.58-3.99), household size (OR 3.32, 95% CI: 1.61-6.85), awareness (OR 1.71, 95% CI: 1.08-2.70), and age group (OR 2.37, 95% CI: 1.47-3.83). Conclusions: Anaemia among adolescents in SSA remains an important public health concern, although the pooled estimates should be interpreted cautiously because of substantial heterogeneity and methodological differences across studies. The findings suggest that adolescent anaemia is associated with multiple nutritional and contextual factors, but more consistent and context-specific research is needed to refine regional estimates and guide interventions.

Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that is associated to adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) as two major diseases of the virus. Due to limited data on its prevalence in general populations in Tehran and as this virus is endemic in Iran, this study aimed to assess HTLV-1 prevalence among patients attending the triage unit of Imam Khomeini Hospital during 2024-2025.

In this cross-sectional study conducted between 2024 and 2025, patients presenting to the triage unit were randomly selected. Exclusion criteria included active infection with HBV, HCV, or HIV, and receiving antiretroviral therapy (ART). After obtaining informed consent, 5 mL of whole blood was collected from each participant. The DNJIA kit (ROJE Technologies, Iran) was used to extract DNA. We used primers that targeted the HBZ and Tax regions of the viral genome to do PCR amplification to find HTLV-1.

Out of 197 individuals enrolled in this cross-sectional study, 1 participant (0.51%) was positive for HTLV-1. The HTLV-1-positive case was a 40-year-old single male with a history of both blood transfusion and prior surgery, but no history of organ transplantation, substance addiction, or travel. Most of the people who took part were men (54.3%) and married (58.9%), and their average age was 39.7 ± 12.1 years. Fisher's exact test showed a statistically significant association between HTLV-1 positivity and a history of blood transfusion (p = 0.015) and a significant link with a history of surgery (p = 0.020). History of blood transfusion, organ transplantation, surgery, and addiction were reported by 3 (1.5%), 1 (0.5%), 4 (2.0%), and 1 (0.5%) participants, respectively. Foreign travel was reported by 77 (39.1%) participants, whereas 100 (50.8%) had a history of domestic travel. The most frequently visited foreign destinations were Turkey (n = 25) and the United Arab Emirates (n = 20). Among domestic destinations, the most commonly visited cities were Isfahan (n = 22) and Mazandaran (n = 19).

The only positive case (0.51%) had known risk factors associated to HTLV-1 infection including prior surgery and blood transfusion. Given the higher reported prevalence of HTLV-1 in endemic regions including Iran, and the increased risk among certain populations-such as individuals with a history of intravenous drug use, multiple sexual partners, or co-infection with other viruses-future studies should focus on these high-risk groups and the virus prevalence over time. Targeted screening in such populations may provide a more accurate picture of the virus's distribution during different time frames for more effective control and prevention measures.

Noncommunicable diseases (NCDs) account for about 73.7% of deaths across the Gulf Cooperation Council (GCC). GCC states have adopted long-term national development visions to provide a coherent framework for economic diversification. A synthesis of how these visions shape NCD policy priorities is needed to understand their role as action-guiding frameworks and identify opportunities for continued system strengthening.

We conducted a qualitative policy analysis using an interpretive approach, covering six vision documents, the Gulf Center for Disease Prevention and Control (Gulf CDC) NCD policy mapping report, and 18 key-informant interviews from health and non-health sectors across GCC countries. We coded documents and transcripts and synthesized findings across themes.

Vision documents positioned health as a development priority and referenced prevention, healthy lifestyles, or health-system reform. Measurable targets varied, with some frameworks specifying indicators such as life expectancy or premature NCD mortality. Stakeholders reported that visions elevated NCDs on political agendas and facilitated multisector measures including food-reformulation, Healthy Cities initiatives, and expanded NCD screening. They also highlighted areas where continued system strengthening could support more consistent translation into sectoral programs.

GCC development visions can function as high-level levers for NCD prevention and health-system reform when supported by cross-sector coordination, clear indicators, and routine monitoring and evaluation.

Objective: Reducing the length of hospital stay (LOS) is a core objective in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to develop an interpretable and clinically applicable machine learning tool for predicting prolonged LOS in this population. Methods: This retrospective three-center study enrolled 1342 patients, who were randomly allocated to a training set (70%) and a test set (30%). Candidate predictors were screened using least absolute shrinkage and selection operator (LASSO) regression, and six machine learning models were developed and compared: logistic regression, random forest, gradient boosting machine, CatBoost, support vector machine, and neural network. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. Model interpretability was achieved through SHapley Additive exPlanations (SHAP) and subgroup analyses. Results: Prolonged LOS, defined as >10 days (the median LOS in the training set), occurred in 42.0% of patients. Nine predictors were identified, including daily inhaled medication use, sputum microbiological examination, antibiotic administration, corticosteroid therapy, diuretic use, ICU admission, oxygenation index, platelet count, and neutrophil count. The random forest model demonstrated superior and consistent discriminative performance, achieving an AUC of 0.778 (95% CI: 0.748-0.807) in the training set and 0.721 (95% CI: 0.672-0.771) in the test set. SHAP analysis ranked diuretic use, daily inhaled medication use, corticosteroid therapy, sputum microbiological examination, and antibiotic administration as the five most influential features, revealing treatment-related variables associated with prolonged LOS. Subgroup analyses indicated better predictive performance in lower-risk patients (age ≤ 65 years with eGFR 1-2 stage). Conclusions: Random Forest may enable to promptly identify prolonged LOS high-risk patients, enhancing clinical vigilance and optimizing healthcare resource allocation in AECOPD patients.