Epidemiologia

Background/Objectives: This study explored the association between daily step count (DSC) and health outcomes in older adults in Spain. A total of 668 individuals aged 60–100 years (mean = 71.33 ± 8.11 years) participated. Methods: Participants wore a Xiaomi Mi Band 4 accelerometer continuously for seven days. Physical and cognitive tests were conducted, along with questionnaires on depression, quality of life, and physical activity. Results: On average, men walked 8919.08 ± 4455.65 steps/day, significantly more than women (7855.46 ± 7855.46 steps/day, p = 0.002). A moderate negative correlation was found between age and DSC (r = −0.460, p < 0.001). The coefficient of variation in DSC increased across age groups, indicating growing heterogeneity with advancing age. Individuals in the high International Physical Activity Questionnaire (IPAQ) category walked 1517 more steps/day than those in the low activity group (p < 0.001), confirming IPAQ level as a strong determinant of physical activity. Participation in organized physical activity was associated with an additional 909 steps/day (p = 0.004). Meeting age-specific step recommendations is associated with better anthropometric, psychosocial, and cardiometabolic markers, but many of these differences disappear after adjusting for age and sex. Conclusions: DSC in older adults is strongly influenced by age, sex, and physical activity level. DSC may not adequately assess health in older adults. Walking intensity should be considered for accurate evaluation. Full article

Timely identification of infectious disease threats is essential for public health readiness. Conventional indicator-based surveillance systems, while dependable for tracking established pathogens, frequently lack the agility and sensitivity to detect new infections promptly. Syndromic surveillance, which examines pre-diagnostic and non-specific health indicators from many data sources in near real time, serves as a significant complementary method that improves early warning and situational awareness. This narrative study analysed selected experiences with syndromic surveillance, utilising peer-reviewed literature and institutional records. Four primary data streams were examined: emergency department and hospital records, pharmacy and over the counter (OTC) sales, participative citizen-generated data, and hybrid multi-source systems. Syndromic indicators were reported to identify outbreaks two to fourteen days before standard laboratory reporting across many trials. Data from the emergency department exhibited the highest sensitivity and specificity (47.34% and 91.95%, respectively), whereas pharmacy and participative data offered early indicators at the community level. Integrated systems like ESSENCE (Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA) and SurSaUD^® (Saint-Maurice cedex, Paris, France) attained enhanced accuracy yet necessitated significant data integration and governance capabilities. Syndromic surveillance enhances epidemic preparation by detecting atypical health-seeking behaviours and variations from baseline patterns prior to formal diagnosis. Nonetheless, its efficacy is contingent upon data quality, interoperability, and contextual adaptation. Countries like Bulgaria could improve national early-warning capabilities and overall health security through the gradual adoption of pilot projects and integration with existing surveillance networks. Full article

Purpose: Breast cancer (BC) incidence has been increasing rapidly in North Africa, including Morocco, yet evidence regarding modifiable lifestyle factors remains limited. This study aimed to assess the associations between physical activity, sedentary behavior, daily work habits, and BC risk among Moroccan women, addressing an important gap in regional data. Methods: We conducted a case–control study between 2019 and 2023, including 1400 histologically confirmed incident BC cases and 1400 matched controls. Physical activity was assessed across the lifespan, considering type, intensity, and duration. Associations with BC risk were estimated using adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Moderate physical activity was inversely associated with BC risk, showing a clear dose–response relationship. Compared with the lowest physical activity level, the highest quartile showed significantly lower odds of BC (aOR = 0.37 (95% CI: 0.29–0.47). Vigorous physical activity during young adulthood and mid-adulthood was similarly linked to reduced risk. Active daily habits, such as walking and regular stair climbing, were associated with lower odds, whereas frequent occupational fatigue and sweating were linked to increased risk. Conclusions: Our findings highlight a significant inverse association between physical activity and BC risk among Moroccan women. Notably, moderate PA and active daily habits like brisk walking are linked to lower odds of the disease. While these findings support the role of physical activity as an important factor associated with breast cancer prevention, the retrospective design of the study limits causal inference. Full article

Background/Objectives: Health Promotion Centres (HPCs) in Slovenia represent a European best practice for integrated prevention and health promotion. This study explores the feasibility of adapting the Slovenian HPC model to Bergamo Province, Lombardy, considering local population needs and health system characteristics. Methods: We conducted a qualitative feasibility and policy analysis based primarily on documentary review, complemented by a webinar, a study visit to Slovenia, and expert consultations (conducted in two group discussions) with professionals from ATS (Agenzia Tutela della Salute) Bergamo and local ASST (Azienda Socio-Sanitaria Territoriale) providers. Data were analysed using the PIET-T framework (Population–Intervention–Environment–Transfer). Results: Eight key elements define the Slovenian model: (1) governance and stewardship; (2) structural financing; (3) standardized service portfolio; (4) systematic preventive referrals; (5) integration with primary care and screening; (6) multidisciplinary teams with codified training; (7) community outreach and equity orientation; and (8) information systems and reporting. While Bergamo shares similar demographic and epidemiological profiles, differences in behavioral risk factors, project-based financing, fragmented initiatives, and limited digital integration necessitate adaptation. The comparative assessment highlighted key areas requiring contextual adaptation, including financing mechanisms, organisational coordination, workforce capacity, digital interoperability, and approaches to equity. Conclusions: The Slovenian HPC experience demonstrates the potential of integrated, community-based health promotion. Its adaptation to Lombardy appears feasible if core components are preserved and tailored to local governance, population, and health system conditions. These organisational features may be particularly relevant for time-dependent conditions, such as acute cardiovascular and cerebrovascular events, by potentially supporting more timely risk-factor management and coordination across diagnostic and emergency pathways. Rather than a blueprint for reform, this experience offers useful insights to reinforce prevention and health promotion within the ongoing territorial care reform in Lombardy. Full article

Background: Sepsis constitutes a major healthcare burden worldwide, with an estimated 48.9 million incident cases and 11.0 million deaths in 2017, accounting for nearly one-fifth of all global deaths. Even with advances in definitions and guidelines, significant inequalities persist in awareness, early treatment, and health system readiness. Methods: We performed a structured narrative review of epidemiology studies, clinical case definitions, diagnostic approaches, stewardship interventions, and health system reports. Both electronic sources (PubMed, Web of Science, Embase, Scopus) and grey literature (World Health Organization [WHO], National Institute for Health and Care Excellence [NICE], Society Critical Care [SSC]) were explored. Evidence incorporated themes were organized across recognition, diagnostics, antimicrobial therapy, organ support, guidelines, and health system determinants. Results: Measurement tools, including quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA), exhibited suboptimal sensitivity and utility in varied clinical environments. Biomarkers (procalcitonin, presepsin, CD64) and rapid molecular diagnostics, including metagenomic next-generation sequencing (mNGS) and AI-based devices, enhance detection but are limited by cost and infrastructure constraints. Each hour of delay in antibiotic therapy is associated with a 6–10% increased risk of mortality, underscoring the importance of stewardship, including the incorporation of empiric regimens with rapid de-escalation. Health system bottlenecks—human resources, funding, infrastructure—continue to be a significant determinant of outcomes, especially in low- and middle-income countries. Conclusions: Attaining the 2030 WHO targets for sepsis involves precision diagnostics, adaptable guidelines, stewardship frameworks, and resilient health systems. Fair application and resource allocation are crucial to lower the incidence and mortality worldwide. Full article

Global health faces unprecedented challenges driven by communicable diseases, which are increasingly amplified by persistent health inequities, the impact of climate change, and the speed of emerging crises. Prevention is not merely a component but the foundational strategy for an effective, sustainable, and fiscally responsible public health response. This paper delves into the pivotal role of core prevention levers: robust vaccination programs, stringent hygiene standards, advanced epidemiological surveillance, and targeted health education. We detail how contemporary technological advancements, including Artificial Intelligence (AI), big data analytics, and genomics, are fundamentally reshaping infectious disease management, enabling superior predictive capabilities, faster early warning systems, and personalized prevention models. Furthermore, we thoroughly examine the imperative of integrating the One Health approach, which formally recognizes the close, interdependent links between human, animal, and environmental health as critical for combating complex threats like zoonoses and Antimicrobial Resistance (AMR). Despite significant scientific progress, persistent socio-economic disparities, the pervasive influence of health-related misinformation (infodemics), and structural weaknesses in global preparedness underscore the urgent need for decisive international cooperation and equitable financing models. We conclude that only through integrated, multidisciplinary, and resource-equitable strategies can the global community ensure effective prevention, mitigate severe socio-economic disruption, and successfully build resilient healthcare systems capable of withstanding future global health threats. Full article

Background/Objectives: The aging process is typically marked by a reduction in functional fitness, which heightens the likelihood of falling. Although obesity is established as a determinant of poor mobility, the interplay between excess weight and advanced age is still a topic of research interest. Therefore, this research investigated how age, sex, and Body Mass Index (BMI) interact to influence fall risk among older adults living in the community. Methods: This cross-sectional investigation involved 815 participants (M_age = 70.45 ± 6.10 years), stratified by age (sexagenarians, septuagenarians, octogenarians) and BMI (normal weight, overweight, obesity). Fall risk was assessed using the Timed Up and Go test. A Three-Way ANOVA examined the main and interaction effects. Results: No significant three-way interaction (p = 0.334) or main effect of sex (p = 0.079) was found. However, a significant age x BMI interaction was observed (p = 0.007). In sexagenarians and septuagenarians, obesity was associated with significantly slower fall risk performance compared to normal weight (p < 0.001). Conversely, in octogenarians, this difference was not significant (p = 1.000) with normal-weight individuals. Conclusions: Obesity may be a significant risk factor for falls, especially in adults aged 60 to 79 years. In octogenarians, the protective benefit of normal weight disappears, revealing a “weight paradox” likely driven by sarcopenia. Fall risk assessments and weight management strategies should be tailored to age, focusing on preserving muscle mass in octogenarians. Full article

Background/Objectives: Prostate cancer (PC) is one of the most commonly diagnosed malignancies globally; depending on the treatment strategy used, erectile dysfunction (ED) is a frequently reported adverse outcome among PC patients. The current study evaluated ED prevalence among Pakistani PC patients and its effects on physical, psychological, and social well-being, aiming to address critical gaps in survivorship care for this population. Methods: A cross-sectional, multicenter, observational, questionnaire-based study was conducted in Rawalpindi and Islamabad, Pakistan, from February to April 2025. Health-related quality of life (HRQoL) among PC patients was measured using the Short Form Health Survey 36 (SF-36), while ED prevalence and severity were assessed by the International Index of Erectile Function (IIEF) instrument. Results: Among N = 400 PC patients, surgical treatments predominated (radical prostatectomy: 61.0%; n = 244), while hormonal (androgen-deprivation therapy: 31.5%; n = 126) and chemotherapy (23.3%; n = 93) were also commonly utilized. ED experience was high among PC patients in the erectile function (40.8%; n = 163) and in the intercourse satisfaction (45.0%; n = 180) domains; these showed moderately strong and significant positive correlations across all SF-36 domains, particularly physical functioning (r = 0.52; p < 0.001) and social functioning (r = 0.49; p < 0.001). Regression analysis confirmed sexual function domains explained 60% of HRQoL variance (adjusted R² = 0.60). Conclusions: This study reveals high rates of treatment-related ED—and its biopsychosocial impact–among Pakistani PC patients, with significant negative impacts on HRQoL. The findings underscore the urgent need to integrate sexual health management into standard oncological care practices to improve holistic patient outcomes. Full article

Background/Objectives: Prostate cancer is the second most common cause of cancer-related mortality among the male population worldwide. It is among the leading reasons for the increasing number of years of life lost, working years of life lost, and gross domestic product (GDP) loss in Bulgaria. The primary objective of this study is to evaluate the burden of prostate cancer in Bulgaria, including calculating years of life lost (YLL), years of working life lost (YWLL), and the associated indirect costs. Methods: An observational time-series study was conducted using official national data from the National Statistical Institute (NSI), the INFOSTAT database, and the National Social Security Institute. The study covered the period 2008–2023 and included all registered male deaths attributed to malignant neoplasm of the prostate (ICD-10: C61). YLL, YWLL, and indirect costs were calculated using the human capital approach. Due to restricted access to age-specific mortality files, additional mortality records were obtained through formal data requests to NSI. Results: Prostate cancer led to 127,457 YLL and 6345 YWLL, with productivity losses reaching €88.2 million. Mortality showed an overall increasing trend up to 2020, while YWLL declined due to deaths shifting to older age groups. Conclusions: Despite the advancements in prostate cancer diagnosis and treatment, our findings demonstrate a negative trend regarding YLL, YWLL, and indirect costs associated with the disease, in contrast to other European countries. Strengthening early screening, reducing diagnostic delays, and improving national cancer registry capacity are critical to mitigating future health and economic losses. Full article

Background/Objectives: This ecological study aimed to investigate changes in the time-varying reproduction number (Rt) of SARS-CoV-2 across six regions of Massachusetts from 2020 to 2022 and to evaluate the impact of various nonpharmaceutical interventions (NPIs) implemented in 2020 by examining associated changes in the Rt. Methods: COVID-19 incident case data from the Johns Hopkins University database were adjusted for reporting delays using deconvolution and for underreporting via a Poisson-distributed multiplier of 4. Negative and zero counts were corrected using imputation. Rt was estimated using R package EpiEstim (Version 2.2-4) with a 7-day sliding window from 2020 to 2022 and with non-overlapping time windows between policy changes in 2020. Results: From 2020 to 2022, Massachusetts experienced five COVID-19 surges, linked to the wild-type strain and emerging variants, with Rt exceeding 1 during each wave and stabilizing at or dropping below 1 during low-incidence phases. School closure and gathering restrictions, the first major intervention, were associated with a 14.7% statewide reduction in Rt (95% credible interval (CrI): −23.6%, −5.6%), with greater reductions in high-density areas such as Boston (−16.9%; 95% CrI: −26.9%, −7.5%). No statistically significant changes in Rt were found to be associated with other NPIs in 2020, including the mask mandate, reopening phases, travel restrictions and quarantine requirements, and curfews. Conclusions: Our findings highlight the different NPIs’ varying impacts on COVID-19 transmission dynamics across regions in Massachusetts in 2020 and underscore the importance of early interventions for future pandemic preparedness. Full article

Background: Dementia is an increasing public health challenge in Mexico, yet recent national data on mortality patterns remain limited. This study examines temporal trends in dementia-related mortality and its sociodemographic and ecological characteristics among adults aged ≥65 years from 2017 to 2023. Methods: National mortality records from the General Directorate of Health Information were analyzed. Annual dementia-related mortality rates were calculated based on mid-year population estimates from CONAPO. Trends were assessed with regression analysis, including population offsets, and individual- and state-level characteristics were evaluated. Results: Between 2017 and 2023, dementia-related deaths increased from 761 to 1425, corresponding to an observed rise from 7.9 to 14.6 deaths per 100,000 inhabitants aged ≥65 years. Period trend indicated an average annual expected increase of 18.6% in dementia related mortality. A transient decline occurred in 2020–2021, coinciding with the COVID-19 pandemic. At the individual level, higher education was associated with greater odds of dementia certification, whereas Indigenous ethnicity appeared protective, which may reflect patterns consistent with diagnostic and reporting disparities. Higher state-level life expectancy correlated with higher dementia mortality, while greater population aging was inversely associated. Conclusions: Dementia-related mortality in Mexico shows a sustained upward trend with regional heterogeneity and apparent inequities in diagnosis and reporting. Strengthening mortality surveillance, improving certification quality, and integrating dementia indicators into national non-communicable disease registries are essential to guide equitable policy responses. Full article

Background/Objectives: Birth preparedness and complication readiness (BPCR) is a cornerstone of maternal health strategies designed to minimize the “three delays” in seeking, reaching, and receiving skilled care. In Ethiopia, uptake of BPCR remains insufficient, and little evidence exists on how individual- and community-level factors interact to shape preparedness. This study assessed the determinants of BPCR among women of reproductive age in Hawela Lida district, Sidama Region. Methods: A community-based cross-sectional study was conducted among 3540 women using a multistage sampling technique. Data were analyzed with multilevel mixed-effect negative binomial regression to account for clustering at the community level. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported to identify determinants of BPCR. Model fitness was assessed using Akaike’s Information Criterion (AIC), the Bayesian Information Criterion (BIC), and log-likelihood statistics. Results: At the individual level, women employed in government positions had over three times higher expected BPCR scores compared with farmers (AIRR = 3.11; 95% CI: 1.89–5.77). Women with planned pregnancies demonstrated higher BPCR preparedness (AIRR = 1.66; 95% CI: 1.15–3.22), as did those who participated in model family training (AIRR = 2.53; 95% CI: 1.76–4.99) and women exercising decision-making autonomy (AIRR = 2.34; 95% CI: 1.97–5.93). At the community level, residing in urban areas (AIRR = 2.78; 95% CI: 1.81–4.77) and in communities with higher women’s literacy (AIRR = 4.92; 95% CI: 2.32–8.48) was associated with higher expected BPCR scores. These findings indicate that both personal empowerment and supportive community contexts play pivotal roles in enhancing maternal birth preparedness and readiness for potential complications. Random-effects analysis showed that 19.4% of the variance in BPCR was attributable to kebele-level clustering (ICC = 0.194). The final multilevel model demonstrated superior fit (AIC = 2915.15, BIC = 3003.33, log-likelihood = −1402.44). Conclusions: Both individual- and community-level factors strongly influence BPCR practice in southern Ethiopia. Interventions should prioritize women’s empowerment and pregnancy planning, scale-up of model family training, and address structural barriers such as rural access and community literacy gaps. Targeted, multilevel strategies are essential to accelerate progress toward improving maternal preparedness and reducing maternal morbidity and mortality. Full article

Background/Objectives: The COVID-19 pandemic caused over seven million deaths globally as of July 2024. In an attempt to bring the pandemic under control, immunization was implemented as the main preventive strategy. This study aimed to investigate the knowledge, attitudes, and practices (KAP) of hospitalized patients and healthcare workers (HCWs) regarding COVID-19 vaccination, as well as the factors contributing to COVID-19 vaccination rates. Methods: This cross-sectional, survey-based KAP study was conducted between November 2024 and February 2025 in five hospitals across five cities of the Republic of Srpska, Bosnia and Herzegovina. Results: There were 571 respondents, 68% of whom were female, with an average age of 39.17 ± 14.74 years; one-third held a university degree. The study sample consisted of patients and healthcare workers (HCWs) (59% vs. 41%). During the pandemic period, 46.6% of respondents were diagnosed with COVID-19, with a higher prevalence among healthcare workers compared to patients (54.2% vs. 41.2%). Among the 55.2% of respondents who were vaccinated, HCWs were more often vaccinated than patients (70.9% vs. 44.2%) and more likely to know that vaccines protect against severe forms of disease and death (80.8% vs. 68.5%). Patients more often believed that vaccination against COVID-19 may lead to sterility in young patients (11.3% vs. 6%) and were more often afraid of vaccination compared to the occurrence of COVID-19 (35.6% vs. 24.8%). Regression analyses showed that independent predictors of COVID-19 vaccination were older age (p < 0.001), higher education level (p = 0.039), knowledge of vaccine production technology, and the belief that vaccinated individuals have milder symptoms of the disease (p = 0.002). Conversely, the belief that the COVID-19 situation was overblown was negatively associated with vaccination (p = 0.004). Conclusions: HCWs had better knowledge, more positive attitudes, and better vaccination practices against COVID-19 in comparison to patients. However, there are still certain dilemmas and hesitations among HCWs toward COVID-19 vaccination. Full article

Background and objectives: During an outbreak, measles cases tend to aggregate into increasingly bigger clusters that show specific characteristics, different from the non-cluster cases. As the measles threat continues throughout Europe in 2025 with a high notification rate in Romania as well, exploring how clustering affects the disease propagation can provide additional insights into how to improve measles surveillance and control. Methods: National measles cases from 2020 to 2024 have been split into cluster (at least three related cases) and non-cluster-related cases and analyzed comparatively based on vaccination status, disease-related data (hospitalization) and patient-related data (age, location). Large outbreaks with at least 150 cases, allowing for more comprehensive R₀ analysis, have been described and the basic reproduction numbers computed for each of them. Results: There are statistically significant differences in vaccination status, age, and hospital stay between outbreak and non-outbreak cases. Large outbreaks (≥150 cases) show a high degree of variability, with R₀ values varying from as low to 1 to as high as 3.92, indicating limited measles transmission control. Conclusions: The findings in this research highlight the critical impact of clustering on measles transmission dynamics during outbreaks. Significant differences in vaccination status, age, and hospitalization rates between cluster and non-cluster cases underscore the importance of targeted surveillance and intervention strategies while the wide range of R₀ values observed in large outbreaks points to inconsistent control measures and emphasizes the need for strengthened vaccination campaigns and improved outbreak response protocols to better contain measles spread. Full article

Background/Objectives: Cardiovascular diseases (CVDs) remain a leading cause of mortality worldwide, with a particularly high burden in Central Asian countries. Despite ongoing urbanization, rural populations constitute a significant demographic in this region, yet epidemiological data stratified by urban and rural residence are limited and fragmented. This systematic review aimed to synthesize current evidence on the incidence, prevalence, mortality, and risk factor profiles of CVDs among urban and rural populations in Central Asia, identify disparities, and inform targeted prevention and control strategies. Methods: A systematic literature search was conducted across the PubMed, Science Direct, Web of Science, and Google Scholar databases for studies published between 2015 and 2025. Included studies reported cardiovascular health indicators with urban–rural stratification in Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, and Turkmenistan. Data extraction and qualitative synthesis were performed, with methodological quality assessed using the Newcastle–Ottawa Scale. Results: Eight original studies met the inclusion criteria, encompassing national and regional datasets with diverse designs, including retrospective analyses, cross-sectional surveys, and registry data. Overall, CVD incidence and prevalence showed increasing trends in both urban and rural areas, with consistently higher mortality rates in urban populations. Key modifiable risk factors—hypertension, obesity, dyslipidemia, and smoking—were prevalent, particularly in rural settings. Variability in healthcare access and preventive program implementation contributed to the observed disparities. Limited data from some countries, particularly Tajikistan and Turkmenistan, highlight gaps in epidemiological surveillance. Conclusions: The cardiovascular disease burden in Central Asia demonstrates significant urban–rural disparities, underscoring the need for tailored public health interventions and enhanced healthcare resource allocation in rural regions. Strengthening epidemiological monitoring and implementing region-specific prevention programs targeting modifiable risk factors are imperative for reducing CVD morbidity and mortality. Further high-quality research is necessary to address existing data gaps and optimize cardiovascular health strategies across the region. Full article

Background/Objectives: Blood donation is essential to health systems and represents a valuable epidemiological model for studying physiological adaptation to controlled blood loss. Regular blood donors constitute a distinct, health-screened population whose biological responses offer unique insight into mechanisms of resilience and key determinants of population health. Hypoxia-inducible factor 1-alpha (HIF-1α) is a key regulator of erythropoiesis and cellular response to hypoxia, and its modulation following blood donation may inform donor safety and the sustainability of blood donation programs. This study aimed to characterize the sociodemographic, lifestyle, and anthropometric profiles of blood donors in relation to hematopoietic biomarkers (vitamin B12 and folic acid) and to evaluate changes in serum HIF-1α concentration after donation, emphasizing the public health relevance of voluntary blood donation. Methods: A cross-sectional study was conducted among 324 voluntary blood donors (159 regular and 165 occasional). Serum HIF-1α was measured before and 30 min after donation, together with vitamin B12 and folic acid levels. Sociodemographic and lifestyle characteristics (physical activity, smoking, dietary habits) were collected through standardized questionnaires (EHIS-3, FFQ), and anthropometric parameters were assessed. Results: Regular donors were older and predominantly male, with comparable socioeconomic indicators between groups. Both regular and occasional donors showed favorable lifestyle profiles, including low smoking prevalence and moderate physical activity. Skinfold thickness was significantly greater in regular donors (p < 0.001). The main biological finding was a robust post-donation increase in HIF-1α concentrations (≈80%, p < 0.001), independent of donation frequency or lifestyle. No significant associations were found between lifestyle factors and vitamin B12 or folate levels. Conclusions: Blood donation induces a rapid elevation in HIF-1α, reflecting activation of hypoxia-responsive pathways and short-term hematopoietic adaptation. Beyond its biomedical relevance, voluntary blood donation represents a meaningful epidemiological and public health model for studying physiological resilience and the health benefits of altruistic behavior. These findings underscore the importance of donor surveillance and motivation as components of broader preventive health and health equity strategies. Full article

Background/Objectives: Discovered in 2019, COVID-19 spread rapidly worldwide, leading from mild forms of the disease to critical forms or death, predominantly among vulnerable patients. Severity scores help clinicians in stratifying the risk of complications and death among patients diagnosed with SARS-CoV-2 infection. Methods: This study aims to identify the severity scores used in this type of infection, while bibliometric analysis carried out provided a comprehensive overview of global research patterns, trends, and cooperation in scientific literature on the chosen topic. Results: We conducted a literature screening to identify severity scores used in SARS-CoV-2 infection. Scores including CURB-54, COVID-GRAM, NEWS, APACHE II, SOFA, qSOFA, CALL, MuLBSTA, ISARIC 4C, and PADUA were identified with different performance indices. Conclusions: There were different results obtained depending on the geographical area of applicability, patient groups analyzed, and individual patient characteristics. Full article

Background/Objectives: To examine trends in tobacco and alcohol consumption among individuals with and without diabetes mellitus (DM) in Spain from 2014 to 2020 and identify sociodemographic, lifestyle, and comorbidity-related predictors of consumption. Methods: Population-based cross-sectional study using data from the 2014 and 2020 European Health Interview Surveys for Spain. Participants’ self-reported tobacco and alcohol consumption were analyzed based on DM status. Results: This study included 7854 participants (3927 participants with DM and 3927 participants without DM). Among participants with DM, tobacco and alcohol consumption remained stable over the study period, with tobacco from 15.2% in 2014 to 14.8% in 2020 (p = 0.761) and alcohol from 37.2% to 39.8% (p = 0.088), respectively. Tobacco consumption did not differ significantly between those with and without DM (15.0% vs. 15.2%, p = 0.777). However, alcohol consumption was significantly lower among those with than without DM (38.6% vs. 48.7%, p < 0.001). In those with DM, predictors of tobacco consumption included male sex, younger age, alcohol consumption, living without a partner, and DM, and predictors of alcohol consumption included male sex, active smoking, higher education, and sedentary lifestyle. Conclusions: Between 2014 and 2020, both tobacco and alcohol consumption remained stable among individuals with DM. The prevalence of alcohol consumption was lower among those with than without DM. Key predictors of tobacco and alcohol consumption included sex, lifestyle behaviors, and socioeconomic factors. These findings highlight the need for targeted public health interventions to reduce harmful substance use in DM populations and mitigate associated health risks. Full article

Aim: This study aimed to assess self-reported oral and orofacial health, hygiene habits, and oral health knowledge among Croatian athletes, and to determine factors influencing that knowledge. Differences between contact and non-contact sports, as well as the occurrence of dental trauma and temporomandibular joint (TMJ) symptoms, were also examined. Methods: A cross-sectional, questionnaire-based study was conducted among 1007 athletes (56% male, 44% female) aged 18–42 years, recruited through national sports federations and university sports clubs. The instrument comprised 85 items divided into five domains: sociodemographic data, oral hygiene habits, self-assessed oral health, TMJ symptoms, and oral health knowledge. Data were analysed using descriptive statistics, Chi-square and Fisher’s exact tests, and generalised linear modelling (p < 0.05). Results: Athletes demonstrated moderate oral health knowledge (mean score 11.3 ± 4.4/18). While 92.2% recognised that poor oral hygiene leads to caries and periodontitis, only 52.4% correctly identified the ideal time to replant an avulsed tooth. Female participants, older age groups, and those with higher education had significantly better knowledge (p ≤ 0.05). Recreational athletes scored higher than amateurs (p = 0.002), and those with prior dental trauma experience also showed greater awareness (p = 0.028). No significant difference was found between contact and non-contact sports (p = 0.287). Despite good brushing habits (86.9% brushed twice daily), only 25.4% regularly used dental floss or interdental brushes. A small proportion of athletes reported symptoms related to temporomandibular joint function, most commonly joint clicking (18.2%), tooth wear (13.4%), and nocturnal bruxism (14.3%). There were no significant differences between contact and non-contact sports, except for muscle stiffness near the temples (p = 0.024) and daytime or stress-related teeth grinding (p = 0.013 and p = 0.018). Conclusions: Croatian athletes demonstrated moderate oral health knowledge and satisfactory hygiene habits, but preventive practices remain inadequate. Education level, gender, and previous dental trauma were key determinants of knowledge. Systematic preventive programmes and targeted education are necessary to improve oral health awareness in sports populations. Full article