Search Results (5,149)

Objectives: To investigate the association between adherence to national nutritional guidelines (Dutch Healthy Diet Index [DHD-index]) and glaucoma prevalence and to explore whether this association changed after accounting for measured intraocular pressure (IOP). Methods: This cross-sectional study used baseline data 2010–2013 from The Maastricht Study, a population-based cohort in The Netherlands. Adults aged 40–75 years with implausible dietary intake were excluded. Dietary intake was evaluated using a validated food frequency questionnaire, and adherence was quantified by the DHD-index. All participants underwent ophthalmic examination including perimetry and IOP measurement. Logistic and linear regression models examined associations of DHD adherence with glaucoma prevalence and IOP. Additional exploratory analyses assessed whether the association with glaucoma was attenuated after accounting for measured IOP. Results: Among 5729 participants (mean age: 59.5 ± 8.7 years; 50.1% female), glaucoma prevalence was 9.7% (n = 558). Each 10-point increase in DHD-index score was associated with 12.5% lower odds of glaucoma prevalence (odds ratio [OR]: 0.88; 95% confidence interval [CI], 0.83 to 0.93) and lower IOP (β: −0.17; 95% CI, −0.25 to −0.09 mmHg). Individuals in the highest DHD adherence tertile had 38% lower odds of glaucoma than those in the lowest tertile (OR 0.62; 95% CI, 0.50 to 0.76). Additional adjustment for measured IOP yielded similar estimates. Conclusions: Higher adherence to the Dutch Healthy Diet was associated with a lower glaucoma prevalence. The association was only minimally attenuated after accounting for measured IOP. Longitudinal studies should examine whether adherence to national dietary guidelines is associated with glaucoma onset and progression. Full article

Introduction: This systematic review examines the association between ultraprocessed food (UPF) intake and cognitive and executive function in adults. Given the global rise in overweight and obesity and the increasing consumption of UPFs, understanding their potential impact on brain health is of growing importance. Method: A comprehensive literature search was conducted in PubMed, EBSCO, and Scopus databases following PRISMA guidelines. Fourteen studies met inclusion criteria, encompassing cross-sectional, longitudinal, and experimental designs. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool. Results: The majority of studies (78.5%) reported a significant association between higher UPF consumption and poorer cognitive outcomes, including deficits in memory, executive function, and global cognition. Longitudinal studies consistently demonstrated that increased UPF intake is linked to accelerated cognitive decline and a higher risk of mild cognitive impairment and dementia, particularly in middle-aged and older adults. In contrast, cross-sectional findings were more heterogeneous, and evidence in younger populations remains limited and inconclusive. Conclusions: Overall, the findings suggest that high UPF consumption may be a modifiable risk factor for cognitive decline. However, methodological variability and the predominance of observational studies highlight the need for further longitudinal and experimental research to clarify causal mechanisms. Full article

Coastally Trapped disturbances (CTDs) are shifts in wind direction from the pre-dominant direction to equatorward to poleward for a period of time. These CTDs occur during the warm season off the California coast and impact coastal weather conditions and planned offshore wind plants. This study assesses the characteristics of CTD events as observed by lidar and other offshore buoys, then evaluates the ability of modeling systems to capture the correct characteristics, leveraging model output from the High-Resolution Rapid Refresh (HRRR) operational modeling system and the NOW-23 (National Offshore Wind) model dataset. CTDs were analyzed for October 2020 and May through to October of 2021, identifying 18 unique CTD events, confirmed by a nearby National Data Buoy Center (NDBC) buoy. The HRRR model captured most of these events, but the NOW-23 model output contained only 12 events. Composites of the wind, temperature, and pressure perturbations pre-, during, and post-event demonstrated the diminishment in wind speed, particularly for the alongshore component. Although the NOW-23 model captured the alongshore wind component and pressure perturbations well, the cross-shore wind component and temperature perturbations varied substantially. When the turbulent kinetic energy deviation and wind shear was positive across all levels pre-event, the NOW-23 modeling system was less likely to capture the CTD event. In contrast, the events that were captured by the model tended to have negative wind shear aloft pre-event. Full article

This article examines The Mark of Cassandra by Chingiz Aitmatov through the emerging framework of Blue Humanities. While most prior studies have approached Aitmatov’s ecological concerns from a land-based ecocritical perspective, this article shifts the focus to his engagement with oceanic themes and marine environments. By combining literary interpretation with ecological philosophy, the study suggests that The Mark of Cassandra goes beyond the limits of traditional environmental fiction. It presents the ocean not only as a setting but as a source of knowledge and ethical reflection. In this way, Aitmatov’s work seems to anticipate current global discussions on climate change, biodiversity loss, and environmental justice. The novel encourages readers to reconsider the human-centered worldview and adopt a more ecocentric approach. Through its marine symbolism and critical stance on human exploitation of nature, the text offers valuable insights into ecological ethics that cross both national and species boundaries. Overall, this article argues that The Mark of Cassandra is an important literary contribution that challenges the usual borders of ecocriticism and calls for a more integrated and holistic understanding of environmental issues. Full article

Cross-border regions often exhibit complex vegetation-related land-cover patterns due to contrasting natural conditions and divergent development trajectories, causing multi-source land-cover products to suffer from disagreements in class assignment and boundary delineation, especially for cropland, forestland, and grassland. Because border zones are rarely mapping priorities, classification instability near national boundaries undermines transboundary comparisons. To address this, we propose a Conflict-aware Adaptive Distillation Fusion Network (CADF-Net) that fuses multi-source land-cover products to improve the discrimination and spatial consistency of key vegetation classes in cross-border regions. Taking the transnational China–Russia border (Sanjiang Plain and Primorskiy Kray) as a representative case, we integrate geo-environmental factors and introduce a pixel-level Conflict Index (CI) to explicitly steer the model toward discrepancy-prone areas. Building on this, we develop an Adaptive Distillation U-Net (AD-UNet) with uncertainty-adaptive distillation and employ a confidence-guided, dynamically weighted ensemble to generate the final fused land-cover product (CADF-LC). Quantitative assessments demonstrate that CADF-LC achieved an OA of 0.8600, a Kappa of 0.8133, and an mIoU of 0.7589, outperforming all input land-cover products. Compared with the strongest input product, Esri Land Cover, CADF-LC improved OA by 0.0150 and mIoU by 0.0222. Furthermore, it effectively mitigates the trade-off between detail loss and morphological fragmentation. Ultimately, CADF-Net enhances classification stability for key vegetation classes, offering a reliable foundation for transboundary ecological monitoring and land management. Full article

Background: We aimed to study the association between accelerometer-measured physical activity and metabolic markers of diabetes in a nationwide representative sample of U.S. adults. Methods: This cross-sectional analysis included 1259 adults aged ≥18 years from the 2003–2004 National Health and Nutrition Examination Survey (NHANES), the only cycle incorporating objective accelerometry. Physical activity was assessed using hip-worn accelerometers, with moderate-to-vigorous physical activity (MVPA) and sedentary time derived from validated count thresholds. Metabolic outcomes included fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), and insulin resistance estimated by the Homeostatic Model Assessment (HOMA-IR). Survey-weighted linear regression models accounting for the complex sampling design were applied, with sequential adjustment for demographic, socioeconomic, anthropometric, and behavioral covariates. Sensitivity analyses tested alternative MVPA thresholds and wear-time criteria. Results: In unadjusted models, higher MVPA was inversely linked with fasting glucose and insulin concentrations; but, these associations were attenuated after full multivariable adjustment. In contrast, MVPA established a constant inverse association with insulin resistance. Higher MVPA was connected with lower HOMA-IR values, and this relationship remained statistically significant in fully adjusted models and across all sensitivity analyses (all p < 0.001). Associations between sedentary time and metabolic markers were non-sustainable after multivariable adjustment. No significant effect modification by sex was detected. Conclusions: Objectively measured moderate-to-vigorous physical activity is independently linked with lower insulin resistance in U.S. adults. These results emphasize the value of accelerometer-based assessments for identifying early metabolic risk and reinforce physical activity promotion as a key strategy for improving insulin sensitivity. Full article

Background: Suicide prevention strategies in university settings largely rely on detecting explicit suicidal ideation. However, students experiencing severe psychiatric distress may not endorse suicidal thoughts and therefore remain unidentified by ideation-centered screening models. This study aimed to identify and clinically characterize university students with high depressive symptoms, poor sleep quality, and elevated impulsivity who deny suicidal ideation in order to examine whether they represent a vulnerable yet overlooked subgroup. Methods: This cross-sectional secondary analysis included 814 undergraduate students from the National Sleep Research Resource (ANSWERS dataset). Participants were classified into three groups based on median splits of depressive symptoms (CES-D), sleep quality (PSQI), impulsivity (UPPS-P), and the presence or absence of suicidal ideation in the past three months: Invisible (high symptoms without ideation), Visible (high symptoms with ideation), and Healthy (low symptoms without ideation). Group differences were examined using ANOVA and chi-square tests. Multivariate logistic regression was conducted to assess independent predictors of suicidal ideation. Results: The Invisible group comprised 11.8% of the sample. Compared with Healthy participants, these individuals showed poorer sleep quality and higher levels of thwarted belongingness and perceived burdensomeness (all p < 0.001). Cannabis use was most prevalent in the Invisible group (54.2%), exceeding both Visible and Healthy groups (p < 0.001). In adjusted analyses, depressive symptoms (OR = 1.10, 95% CI: 1.08–1.12) and sleep disturbance (OR = 1.06, 95% CI: 1.01–1.12) independently predicted suicidal ideation, whereas impulsivity did not. Conclusions: A clinically meaningful subgroup of students experience severe psychological distress without endorsing suicidal ideation yet show behavioral and interpersonal vulnerability. These findings highlight a limitation of ideation-focused screening and support broader, symptom-informed mental health assessment strategies in university populations. Full article

Diabetes complications may increase frailty rates among the elderly, leading to falls, immobility, dependency, hospitalizations, and death. The study aimed to assess any association between frailty status and glycaemic control among older adults with type 2 diabetes mellitus at Kenyatta National Hospital, Kenya. We conducted a cross-sectional study of 430 older individuals aged 60+ years with type 2 diabetes at a specialized diabetes clinic using a modified FRAIL scale. Mean age was 69.1 years; 65.7% were female and 76.2% completed primary school. Frailty prevalence was 3.8%, pre-frailty constituted 24.3%, and robust/non-frail comprised 71.9%. It was associated with age, social status, health knowledge, duration of DM, blood pressure, body mass index, high-density lipoprotein-C, and renal failure. Mean fasting plasma glucose (FPG) was 8.7 mmol/L, with 60% having FPG > 7 mmol/L; mean glycated haemoglobin (HbA1C) was 8.0%, with 41% having HbA1C > 8%. Glycaemic control was correlated with number of medications, blood pressure, and lipidaemia, but not age, sex, or social status. No correlation was found between frailty and glycaemic control: frailty versus FPG (r = 0.038, p = 0.459; χ² = 0.699, p = 0.705) and HbA1C (r = −0.009, p = 0.877; χ² = 0.046, p = 0.977). Low frailty prevalence was noted, with no association to glycaemic control. Our findings provide evidence for conducting frailty assessments in chronic disease care. Full article

This cross-sectional study explored whether the relationship between adolescents’ physical activity and related factors (such as personal and social factors, and parental safety concern) differed according to adolescents’ levels of access to play spaces. Data from Wave 3 of the Growing Up in Ireland (GUI) national longitudinal study, a nationally representative sample of 5212 adolescents aged 17–18 years, was analyzed. Key study variables included adolescents’ physical activity, personal factors (gender, health status, parents’ education and physical activity levels, and active commuting), social factors (number of friends, family support), and parental safety concerns (perceived safety of walking/playing and neighborhood safety). Two structural equation models (SEMs) were employed to compare relationships among physical activity and related factors for adolescents with high and low access to play spaces. Results showed that adolescents living in areas with high access to play spaces reported significantly higher levels of physical activity. Parents’ levels of education and the number of friends available for play had significant impacts on adolescents’ physical activity, regardless of access to play spaces. However, parental perception of the safety of walking and playing was only significant for adolescents with low access to parks. The associations between related factors and adolescents’ levels of physical activity differed for those with high and low access to play spaces, suggesting that interventions promoting adolescents’ physical activity may not yield equal results across these groups. A key limitation of this study is its cross-sectional design and reliance on self-reported measures, which preclude causal inference. Full article

Background/Objectives: Despite the availability of the National Cancer Screening Program in Korea, participation rates remain suboptimal. The literature demonstrates that cancer screening participation extends beyond individual-level knowledge and attitudes and is largely associated with trust. This study examines the role of trust—across cancer screening tests, health care providers, and health care organizations—as a central determinant of cancer screening participation among Koreans. Methods: A cross-sectional study was conducted with 369 Korean adults aged 40 years and older, recruited through convenience sampling from community centers in a metropolitan city. Data were collected using structured, paper-based questionnaires assessing socio-demographic factors and multilevel trust across specific screening tests, doctors, and health care organizations. Following descriptive statistics, bivariate and multivariate logistic regression analyses were performed to identify significant predictors of cancer screening utilization. Results: Koreans had relatively high trust in doctors and cancer screening tests. On an 11-point numeric rating scale ranging from 0 (not at all) to 10 (completely), the mean scores were 7.47 for the trust in doctors; colonoscopy had the highest trust score (M = 7.71), whereas the fecal occult blood test had the lowest (M = 7.14). Multivariate logistic regression revealed that trust and distrust were associated with the utilization of Pap smear, gastroscopy, upper gastrointestinal series, and colonoscopy in complex and sometimes paradoxical ways, and having a usual source of care was a consistent facilitator of cancer screening. Conclusions: These findings suggest that future research is needed to examine the complex interplay among trust, access to health care, and national policy in shaping cancer screening utilization in the Republic of Korea. Full article

Background/Objectives: Tunisia lacks recent national data on hepatitis B virus (HBV) prevalence, particularly following the introduction of universal HBV vaccination in 1995. A national HBV seroprevalence study is essential to guide prevention strategies. This study aimed to estimate the national seroprevalence of HBV infection and identify its determinants 20 years after vaccine introduction. Methods: We conducted a nationwide, household-based, cross-sectional sero-epidemiological survey among a representative sample of the Tunisian general population using a two-stage cluster sampling method. The study was conducted by the National Observatory of New and Emerging Diseases (ONMNE) between December 2014 and June 2015. Data were collected using standardized questionnaires, and blood samples were tested using electrochemiluminescence (ECLIA) to detect HBV biomarkers (HBsAg, anti-HBc, anti-HBs). HBV infection was defined as the presence of HBsAg and/or anti-HBc with the absence of anti-HBs. Associations between HBV infection and explanatory variables (socio-demographics, vaccination status, intrafamilial transmission, and hospital exposures) were assessed using multivariate logistic regression, reporting adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Among 21,720 participants, 19,155 (88.2%) were tested. The national prevalence of HBsAg was 1.7% (95% CI: 1.55–1.85%), higher among males (2.1%; 95% CI: 1.9–2.4%) than females (1.4%; 95% CI: 1.3–1.6%) (p < 0.001; M/F ratio = 1.48). The mean age of HBsAg-positive participants was 48 ± 15.7 years. Prevalence was highest in the Central (2.3%; 95% CI: 2.0–2.7%) and Southern regions (2.2%; 95% CI: 1.8–2.8%) (p < 0.001). In multivariate analysis, independent risk factors for HBV infection included age >20 years (aOR = 15.10; 95% CI: 4.79–47.64; p < 0.001), having a family member with HBV infection (aOR = 2.82; 95% CI: 2.09–3.79; p < 0.001), residing in the Southern (aOR = 2.51; 95% CI: 1.76–2.71; p < 0.001) or Central region (aOR = 2.18; 95% CI: 1.76–2.71; p < 0.001), male gender (aOR = 1.69; 95% CI: 1.39–2.05; p < 0.001), and hospital follow-up (aOR = 1.23; 95% CI: 1.01–1.51; p = 0.039). HBV vaccination was strongly protective (aOR = 0.36; 95% CI: 0.20–0.62; p < 0.001). Conclusions: The national HBsAg seroprevalence in Tunisia was 1.7%, reflecting a low-endemic status. Vaccination programs should prioritize high-risk groups, including males, adults over 20 years, household contacts of HBV carriers, and residents of the Central and Southern regions. Strengthening infection prevention and control in healthcare settings and adopting intrafamilial precautions among high-risk populations are essential for long-term HBV control. Full article

Gifted education is gaining traction in many non-Western contexts, including the United Arab Emirates (UAE), which has developed many policies to develop giftedness. However, the identification of giftedness relies heavily on instruments developed in Western contexts, which have the potential to derail efforts toward promoting gifted education in the UAE. This study aimed to present data on 999 grade 4 to 12 students who completed the UAE’s national gifted identification test, known as the Hamdan Gifted test. Guided by the Cattell–Horn–Carroll theory, this study reports data on ability tests (verbal ability, nonverbal ability and preknowledge of mathematics and science) completed by students across the UAE between 2018 and 2023. The results revealed that 53% of the participants demonstrated superior ability in science, whereas 19% reported superior ability in mathematics. The percentage of students who demonstrated superior ability in other domains was as follows: verbal ability (52%; word crossing), verbal ability (14; true/false) and nonverbal ability (29%). The study concludes with recommendations for teacher development to enhance the teaching of mathematics to gifted students in schools in the UAE and beyond. Full article

Background: Food bank users experience food insecurity, a social determinant of health linked to poorer physical and mental health. However, evidence on the health-related quality of life (HRQoL) of food bank users in Spain is scarce. Objectives: This study sought to assess HRQoL among users of the Navarra Food Bank and identify associated sociodemographic factors. Methods: We performed a cross-sectional study of heads of household using the Navarra Food Bank. A simple random sample of 350 participants was selected from a population of 2749 families. HRQoL was assessed by telephone using the EQ-5D-5L. We described the prevalence of problems in the five EQ-5D-5L dimensions, calculated the EQ-5D-5L utility index using the Spanish value set, and analyzed EuroQol Visual Analogue Scale (EQ-VAS) scores. Associations with sociodemographic characteristics were examined using multivariable general linear models. Results: Mean EQ-VAS was 73.56 (95% CI: 71.62–75.50), and mean EQ-5D-5L utility index was 0.815 (95% CI: 0.800–0.831). The most frequently reported problems were anxiety/depression (62.9%) and pain/discomfort (55.7%), while mobility (25.5%), usual activities (19.7%), and self-care (8.7%) were less commonly affected. Older age was significantly associated with both EQ-VAS and EQ-5D-5L utility index. Employment status and nationality were significantly associated with EQ-VAS, whereas sex was significantly associated with the EQ-5D-5L utility index. Conclusions: HRQoL was impaired among users of the Navarra Food Bank, with the greatest burden observed in the anxiety/depression and pain/discomfort dimensions. Older age and selected sociodemographic characteristics were associated with poorer HRQoL. Given the cross-sectional design, the findings should be interpreted as associative rather than causal. Full article

Background: School feeding programs aim to improve child nutrition, and they may influence weight outcomes insofar as program modalities and household responses alter children’s total energy intake. This is especially relevant in countries facing the double burden of malnutrition, where undernutrition and micronutrient deficiencies coexist with rising overweight and obesity. This study estimates the effect of Peru’s former National School Feeding Program on obesity and excess weight among children aged 36 to 59 months under a selection-on-observables identification strategy and assesses whether impacts differ across operational modalities, particularly breakfast-only versus breakfast plus lunch and ready-to-eat rations versus foods delivered for preparation. Methods: We use repeated cross-sectional microdata from the Demographic and Health Survey (ENDES) pooled over 2014 to 2018 and link them to administrative information. The sample includes 18,959 children aged 36 to 59 months. To improve comparability, we estimate propensity score weights targeting the average treatment effect on the treated (ATT) using a machine learning generalized boosted model (GBM), and assess covariate balance using standardized mean differences and Kolmogorov–Smirnov statistics. Identification assumes conditional independence given observed covariates and overlap (common support). Main estimates rely on weighted probit models with fixed effects, progressively adding exposure duration, modality indicators, and controls. Distributional effects are examined using quantile regression on the continuous weight-for-height z-score. Results: Without differentiating modalities, beneficiary status is not associated with a statistically significant change in obesity, while pooled baseline estimates indicate a statistically significant higher probability of excess weight. Modality-specific results show that obesity declines only when Qali Warma is delivered as breakfast plus lunch through products to be prepared (approximately −1.0 percentage point in parsimonious models and −0.4 percentage points after controls). Evidence for excess weight is directionally consistent by modality but less conclusive once controls are included. Conclusions: Qali Warma’s effects on early-childhood weight outcomes depend on implementation modality. Evaluations of school feeding programs should incorporate operational heterogeneity, particularly during program redesign. Full article

The Horn of Africa (Kenya, Djibouti, Uganda, Eritrea, Somalia, Ethiopia, South Sudan, and Sudan) faces the highest rates of hunger and malnutrition in the world, exacerbated by conflict and adverse weather conditions. These factors have serious health, educational, social, and economic consequences, especially for children under five and pregnant women. In this context, we analyze each country’s progress toward Sustainable Development Goals (SDGs) 1, 2, 3, and 4, which are closely linked to the eradication of hunger, improved health, and access to quality education. Using comparable data from the United Nations 2030 Agenda up to 2019, the achievement of the SDGs is assessed through a multidimensional approach based on Pena’s P₂ distance method, constructing a composite indicator that allows for robust cross-country comparisons. This method helps identify the key measures needed to prevent future humanitarian crises in the Horn of Africa, including providing urgent assistance to these countries in vital areas such as water, nutrition, education, sanitation, and child and maternal immunization. Factors related to the work of qualified healthcare personnel in treating diseases and improving maternal and neonatal health, as well as facilitating access to basic services such as clean drinking water and sanitation and ensuring girls’ access to primary education, top the rankings in terms of their correlation with greater progress by these countries in achieving these four SDGs, which are crucial for improving the well-being of their populations. Full article