Search Results (3,662)

Background and Objectives: Cardiovascular disease is the leading cause of mortality in patients with ANCA-associated vasculitis (AAV) after the first year post-diagnosis. This study investigated relationships between traditional risk factors, echocardiographic findings, disease activity, and major adverse cardiovascular events (MACE) in AAV patients. Aim: This retrospective single-center study aimed to evaluate the impact of traditional cardiovascular risk factors and echocardiographic parameters on the occurrence of MACE in patients with AAV. Materials and Methods: This study included adult patients with AAV who were evaluated between 2020 and 2025. Data collected included demographics, cardiovascular risk factors, Birmingham Vasculitis Activity Score version 3 (BVASv3), laboratory parameters, immunosuppressive therapy, and transthoracic echocardiography (TTE) findings. MACE was defined as myocardial infarction, stroke, revascularization, cardiovascular hospitalization, or cardiovascular death. Results: The cohort comprised 32 females (61.5%) and 20 males (38.5%), with a mean age of 62.4 ± 12.4 years. MACE occurred in 38.5% of patients. Male gender (p = 0.002), overweight (p = 0.016), hyperlipidemia (p = 0.003), and prior cardiovascular disease (p = 0.002) were significantly associated with MACE in univariate analyses. Patients with MACE had larger left atrial anteroposterior dimensions on the parasternal long-axis view (median 3.9 vs. 3.3 cm, p = 0.002) and lower left ventricular ejection fraction assessed by the modified biplane Simpson’s method (median 53% vs. 60%, p = 0.002). Valvular dysfunction was not associated with MACE in a statistically significant manner. Disease activity markers (BVASv3 and CRP) showed no significant correlation with cardiovascular events or echocardiographic parameters. Conclusions: Our results demonstrate that traditional cardiovascular risk factors are stronger determinants of MACE in AAV patients than disease-specific parameters. Cardiac structural changes, including left atrial dilation and decreased left ventricular ejection fraction, were significantly associated with cardiovascular outcomes. These findings underscore the importance of integrating systematic cardiovascular risk assessment and aggressive risk factor modification into standard AAV management protocols. Full article

Species distribution models (SDMs) are widely used to define climatic constraints on species ranges, yet their ability to reflect demographic processes remains poorly understood. We integrated annually calibrated SDMs (1981–2005) with tree-ring width data from 15 European forest species in the Iberian Peninsula to evaluate if climatic suitability mirrors tree growth, particularly for populations at their climatic tolerance limits. Our results show that higher suitability consistently relates to reduced growth decline, acting as a reliable proxy for forest vigor. Notably, interannual variability in climatic suitability was positively associated with growth, suggesting that climatic fluctuations may enhance physiological resilience. We also found that Mediterranean species exhibit higher growth sensitivity to climatic suitability changes than Eurosiberian species. These findings demonstrate that SDMs can capture functional constraints beyond mere presence, positioning annual climatic suitability as a key predictor of radial growth and offering valuable insights for forest management under climate change. Full article

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have proven beneficial in chronic heart failure (HF) across a wide range of left ventricular ejection fractions (LVEFs). Emerging data suggests that these benefits may extend to acute HF decompensation through enhanced decongestion. Purpose: To investigate changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels according to SGLT2i use among patients hospitalized for acute HF decompensation. Methods: In this prospective cohort study, consecutive patients hospitalized for HF decompensation were enrolled. Demographics, comorbidities, and cardiovascular risk factors were recorded. Participants were classified into three groups: Group 1—No SGLT2i use or discontinuation; Group 2—Prior SGLT2i use and continuation; Group 3—SGLT2i-naïve with initiation during hospitalization. NT-proBNP was measured on admission and discharge. Results: A total of 159 patients (median age 79 years, 64.8% male) were included. Group 1 patients exhibited negligible changes in NT-proBNP, whereas those continuing or newly initiating SGLT2i demonstrated significant reductions (absolute change: 506 [8792] pg/mL vs. −5610 [9461] pg/mL vs. −3602 [4409] pg/mL, p = 0.001, percentage change: −2.1 [63.4]% vs. −30.3 [39.0]% vs. −38.3 [41.5]%, p = 0.001). Multivariable regression confirmed that SGLT2i continuation or initiation independently predicted greater NT-proBNP reduction. Conclusions: NT-proBNP levels were significantly reduced among patients with decompensated HF treated with SGLT2i, with the greatest reduction in treatment-naïve patients. These findings highlight the potential role of SGLT2i even during acute HF hospitalization. Full article

Background: Vitamin D status is influenced by season, age, and public health messaging. The COVID-19 pandemic was accompanied by heightened interest in vitamin D, but long-term national data from Central/Eastern Europe remain limited. We aimed to characterize 10-year trends, seasonal variation, and demographic determinants of serum 25-hydroxyvitamin D [25(OH)D] in Slovenia, with particular focus on changes during the COVID-19 period. Methods: We performed a retrospective cross-sectional analysis of all serum 25(OH)D measurements performed at the Slovenian national reference laboratory between January 2014 and December 2023. The core analytic cohort included 106,875 patients with valid 25(OH)D results, aged 0–100 years. Vitamin D status was classified as deficient (<30 nmol/L), insufficient (30–50 nmol/L), adequate (50–75 nmol/L), and optimal (>75 nmol/L). Temporal trends, seasonal patterns, and age- and sex-specific differences were assessed using non-parametric tests and Kendall’s τ. Results: Mean 25(OH)D concentration over the study period was 61.9 ± 34.2 nmol/L; 16.0% of patients were deficient and 22.8% insufficient. Annual mean 25(OH)D increased from 57.0 nmol/L in 2014 to 67.2 nmol/L in 2023, with a significant upward temporal trend and a 14.6% higher mean level during 2020–2023 compared with 2014–2019. Seasonal variation was pronounced (≈20% higher summer–autumn vs. winter–spring), and vitamin D status declined progressively with age, with the highest deficiency prevalence in patients ≥ 70 years. Females had slightly higher 25(OH)D than males, although absolute differences were small. Conclusions: This laboratory-based analysis of tested patients showed higher 25(OH)D concentrations during and after the COVID-19 period, superimposed on persistent seasonal and age-related gradients. These observations identify older adults and winter testing periods as important contexts for vitamin D optimization, but they should be interpreted as descriptive trends among tested individuals rather than as evidence of causal pandemic effects or population-wide prevalence changes. Full article

In the late 1990s, there was much speculation on what music and music education would look like at the beginning of the 21st century. Few predicted the level of change that we have witnessed since then. In fact, developments in technologies, demographics, societies and global relations that have taken place in the world over the past 100 years would have been neigh unimaginable decade by decade, and keep coming with ever-increasing intensity. Travel, trade and technology have connected people and cultures in myriad and often wonderful ways. But inequities, divisions, and conflicts also reached new heights, with the first half of the 2020s subject to a seemingly endless stream of natural and manmade disasters and conflicts. Inevitably, all of these developments impacted on the world of music in general, and also on music education. In this essay, I try to summarise some key experiences and observations of my own first fifty years of living musical diversity (a world that started to open before me when I began learning Indian sitar in Amsterdam in 1975), and efforts across five continents that I have been involved in or researched. Juxtaposing this with key literature on the topic this provides a broad basis for presenting ideas and views on progress towards giving musical practices from across the globe an appropriate place in music education at all levels: in community settings, schools, and institutions for professional training of performers and educators. In that process, I identify three critical junctures which can simultaneously present obstacles and opportunities for positive change: (1) terminologies, social inclusion, and the politics of diversity; (2) musical dynamics, technology, and institutional change; and (3) evolutions and revolutions in music learning and teaching. These inform a challenging but clear agenda for scholars, policy makers, institutional leaders, practising musicians and music educators worldwide who strive for more inclusive, diverse, equitable and relevant practices. Full article

Background: Firearm injuries are the leading cause of mortality among youth in the United States and legislation is a key strategy in reducing youth firearm injuries and deaths. Maryland recently enacted a stronger child access prevention (CAP) law known as Jaelynn’s Law, which mandates secure firearm storage and imposes stricter penalties for violations. Objectives: The aim of this study was to examine firearm storage practices and beliefs in a pediatric and adult emergency department in Baltimore before and after the implementation of Jaelynn’s Law. Method: This descriptive study recruited 396 adult participants from pediatric and adult EDs at Johns Hopkins Hospital before and after the implementation of Jaelynn’s Law. Participants completed a survey on demographics, firearm ownership, and storage practices. Those with unsafe storage practices were provided educational pamphlets and safe storage devices. Data were analyzed using SPSS Statistics 28, with descriptive statistics, t-tests, and Chi-square analyses used to assess differences pre- and post-law implementation. Results: Of the participants, 29% owned firearms, with 86% of firearm owners having children in the home. Firearms were primarily stored locked and unloaded. No significant differences in storage practices were observed after implementation of Jaelynn’s Law. Participants cited quick access for personal protection as a key barrier to safe storage. Conclusions: We found no significant change in safe storage practices post-implementation of Jaelynn’s Law. Concerns about personal safety continue to be of primary concern and public health campaigns, legislative measures, and community investment are necessary to enhance safety and safe storage compliance. Full article

Background: Low back pain is a common musculoskeletal complaint among postpartum women due to physical changes that occur during pregnancy and delivery, which can lead to different disability levels. Therefore, the aim of this study was to evaluate the disability levels and associated factors of postpartum women within the first year after childbirth. Methods: A descriptive cross-sectional study design was used to gather data from post-partum women between 6 weeks and 12 months after childbirth using an online self-administered questionnaire. This questionnaire included demographic variables, the Nordic Musculoskeletal Symptoms Questionnaire, the Pain Intensity Numeric Rating Scale, and a back disability questionnaire. Results: Among 400 postpartum mothers, 71% reported low back pain, with 51.1% experiencing mild disability. Logistic regression showed significant predictors of disability, including cesarean delivery (6.49 times higher likelihood), having 4–5 children (1.98 times), and more than six children (3.45 times). Breastfeeding increased disability risk (2.44 times), while mixed feeding reduced it (0.52 times). The model explained 49.8% of disability variance (p < 0.001). Conclusions: Disability is a common problem among postpartum women, highlighting the importance of healthcare providers addressing these challenges. Full article

Objectives: Colistin is frequently used as a last-line treatment option for periprosthetic joint infections (PJIs) caused by multidrug-resistant (MDR) Gram-negative pathogens, and mortality rates are high in this patient group. This study aimed to evaluate 90-day mortality and its associated clinical factors in MDR Gram-negative PJI cases treated with colistin, with particular attention to the American Society of Anesthesiologists (ASA) score and changes in renal function during therapy. Methods: Patients diagnosed with MDR Gram-negative PJI and treated with intravenous colistin at a single center between 2010 and 2024 were retrospectively reviewed. Demographic data, infection localization, comorbidities, American Society of Anesthesiologists (ASA) score, causative pathogens, presence of sepsis, intensive care unit (ICU) admission, duration of colistin therapy, pre- and post-treatment renal function parameters, and mortality were all recorded. Survivors and non-survivors were compared using univariate analysis. Results: The cohort included 44 patients with a mean age of 72 years (23 women and 21 men). Infections involved the hip in 33 patients (75.0%) and the knee in 11 (25.0%). Twenty-two patients (50.0%) were in the high-ASA group (ASA ≥ III group). Within 90 days of initiating colistin therapy, 25 patients died and 19 survived. A high ASA score was significantly more common among non-survivors than among survivors (18/25 (72.0%) vs. 4/19 (21.1%); p < 0.001), and dialysis requirement was also more common among non-survivors [20/25 (80.0%) vs. 8/19 (42.1%); p = 0.013]. End-of-treatment renal parameters were significantly worse among non-survivors, including urea [71.2 (50.9–78.8) vs. 38.5 (34.8–42.5) mg/dL; p = 0.003], creatinine [2.29 (1.75–2.64) vs. 0.93 (0.72–1.60) mg/dL; p = 0.003], urea delta [42.8 (38.0–48.6) vs. −5.4 (−7.9 to −2.0) mg/dL; p = 0.006], and creatinine delta [0.78 (0.33–1.57) vs. 0.16 (0.10–0.57) mg/dL; p = 0.008] levels. In contrast, age, sepsis, ICU admission, and colistin treatment duration were not significantly associated with 90-day survival. Conclusions: In this high-risk cohort of patients with MDR Gram-negative PJI treated with colistin, the 90-day mortality rate was high and was associated with higher American Society of Anesthesiologists scores, dialysis requirements, and worsening renal function during treatment. No significant association was observed between treatment duration and response in this cohort. These findings should be interpreted cautiously, given the retrospective design and the limited sample size. Full article

Background/Objectives: Given the growing prevalence of myopia worldwide, prevention and proactive management of at-risk children becomes increasingly important. This study sought to evaluate trends in myopia development in pediatric pre-myopic patients and determine how optometrists in Canada manage pre-myopia. Methods: In this retrospective chart review, records for children aged 6–10 years who had an eye exam between 2017 and 2021 were reviewed. Pre-myopic children were included if the presenting refraction at the first visit was between +0.75D and −0.25D (inclusive). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) at each clinical site. Demographic information, refractive status and recommended interventions were recorded. Results: A total of 1740 pre-myopic patients were included across 15 practices in Ontario, of which 184 patients developed myopia (10.6%) during the years studied. Cohort year groups did not differ in baseline age (mean ± SD 8.39 ± 1.43 years) or baseline refractive error (+0.13 ± 0.27 DS). At initial encounters, most clinicians monitored without intervention (mean across cohort years 91.9%), with some recommending lifestyle changes (3.5%) and SV spectacles/CL (3.0%). This pattern remained stable over the years studied. Pre-myopic children developed myopia at a similar age over the study period (mean ± SE: 9.66 ± 0.16 years) and experienced a faster rate of loss of hyperopic reserve (loss of −0.26 ± 0.07 D/year in the 2017 cohort vs. −0.73 ± 0.18 D/year in the 2020 cohort and −0.71 ± 0.10 D/year in the 2021 cohort) regardless of patient age. Conclusions: Pre-myopic children in the 2020 and 2021 cohort years experienced an accelerated loss of hyperopic reserve compared to those in the 2017 cohort. Despite this, very few pre-myopic children were recommended lifestyle changes, which were known to be effective for delaying myopia onset. Since delaying myopia onset may be more impactful than subsequent myopia treatment, additional research should focus on effective interventions for the pre-myopic population. Full article

Introduction: Optimization of guideline-directed medical therapy in chronic heart failure remains challenging in real-world practice, particularly outside settings with routine cardiopulmonary exercise testing. In this context, cardiovascular rehabilitation can improve functional capacity, symptoms, and quality of life, while structured follow-up may also facilitate treatment adjustment. We therefore evaluated whether exposure to a structured multimodal functional assessment pathway, embedded within a more intensive follow-up model, was associated with pharmacological optimization and functional change in chronic heart failure. Methods: We conducted a retrospective, single-center cohort study including adults with chronic heart failure with reduced or mildly reduced ejection fraction managed in a tertiary university clinic. Patients were classified according to documented exposure to an integrated pathway that combined standardized 6 min walk testing, heart rate dynamics, oxygen saturation response, perceived exertion, validated quality-of-life assessment, and prespecified interim reassessment, versus usual care. The integrated pathway involved more frequent clinical contact than usual care. The primary outcome was change in 6 min walk distance over 6 months. Secondary outcomes included changes in heart rate recovery, oxygen saturation nadir, Borg perceived exertion score, quality-of-life score, intensity of guideline-directed medical therapy, treatment intensification rates, and heart failure hospitalization. Results: The study included 250 patients with comparable baseline demographic and clinical characteristics. Patients managed within the structured pathway showed greater improvement in 6 min walk distance at 6 months than those receiving usual care, together with more pronounced improvement in secondary functional parameters and quality-of-life scores. Pharmacological optimization, reflected by higher uptake and intensification of guideline-directed medical therapy, also occurred more frequently in the structured pathway group. The integrated group, however, also had higher follow-up intensity, which limits causal interpretation of the observed between-group differences. Conclusions: In this real-world heart failure cohort, exposure to a structured care pathway combining repeated multimodal functional profiling with closer follow-up was associated with greater functional improvement and more intensive pharmacological optimization. These findings should be interpreted as pathway-level associations rather than proof that functional assessment alone drove benefit, and they require prospective validation. Full article

Objective: This study aimed to estimate the trends, projections, and determinants of standalone and coexisting forms of malnutrition (CFM) at the global, regional, national, and individual level among children under five in low- and middle-income countries (LMICs). It also assessed the projection trajectory towards the 2030 global nutrition targets (GNTs) for child growth including stunting, wasting, obesity, and CFM. Methods: Data from 48 LMICs were analyzed using the Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS). Children with complete anthropometry were included for national- and individual-level descriptive analyses. Projected prevalence of each form of malnutrition, including CFM, was calculated using the Annual Rate of Change. Inferential analyses employed generalized linear regression models with two-way interaction terms to identify determinants of each malnutrition type. Findings: By 2030, 22 of 48 LMICs are projected to achieve the GNT of stunting, wasting, and obesity, that is up from 10 countries currently, while Yemen and Zimbabwe are expected to remain off-track. Stunting is the most prevalent form, affecting 42 countries, with nine nations projected to have over 50% of children affected by a form of malnutrition. Wasting, obesity, and CFM are rising in several countries. Maternal education and household wealth were the strongest determinants, with children of uneducated mothers and from poorest households at the highest risk. Inequalities are narrowing slowly by 1–2% per year, and marked regional disparities persist. Conclusions: Many LMICs are off-track to meet child-growth targets when CFM is considered alongside standalone indicators. The government and global health partners must strengthen nutrition surveillance systems and equity-focused policies and programs to routinely capture CFM and prevent as well as manage all forms of malnutrition at the national and individual levels. Full article

Urban demographic dynamics—including migration, aging, fertility change, and population redistribution—are central to sustainable urban development, urban resilience, and long-term well-being. In many small and transition economies, rapid urbanization combined with sustained emigration and population aging poses significant challenges for urban planning, labor markets, housing systems, and public services. The purpose of the paper is to evaluate urban sustainability-related demographic risks by a composite index and assess long-term demographic dynamics with different trajectories of migration flows and fertility. Since migration flows are more intense among urban population, depopulation is very high in peripheral rural areas, and urbanization is about 64% in Armenia, the results of the research will inform national and urban policy makers to reshape policy frameworks to enhance long-term urban resilience. This study develops a demographic threat index (DTI) to assess demographic risks relevant to urban sustainability in Armenia over the period 2000–2023. The index integrates 20 indicators grouped into three pillars—population change, population health, and socio-economic vulnerability—with indicator weights derived using principal component analysis (PCA). The results reveal a persistent increase in demographic risks, marked by accelerated population aging, declining youth cohorts, and rising socio-economic vulnerability, particularly in urban contexts. A decomposition of population change demonstrates that net migration has been the dominant driver of demographic dynamics, outweighing the combined effects of fertility and mortality. Scenario-based population projections further indicate that even optimistic increases in fertility are insufficient to stabilize population trajectories without sustained positive migration. By linking demographic security to urbanization, migration, and socio-economic vulnerability, the study highlights the importance of integrated urban and demographic policy frameworks. The proposed index offers a replicable tool for evaluating demographic risks in countries facing similar urban and demographic transitions and provides evidence-based insights for urban planning, migration management, and sustainable city strategies. Full article

Winter tourism is increasingly influenced by changing socio-demographic dynamics, climate change, and evolving leisure preferences. While prior research has examined winter tourist motivations, sustainability strategies and climate change adoption, less attention has been paid to differences between urban and rural residents in their attitudes toward domestic winter leisure tourism. This study addresses this gap by exploring variations in participation patterns, service evaluations, and overall tourism experiences among urban and rural Bulgarian residents. Drawing on a quantitative survey of urban and rural residents (n = 1003), the research systematizes the general characteristics of domestic winter leisure tourism practices and evaluates key tourism service dimensions, including accessibility, accommodation, pricing, infrastructure, and environmental quality. Descriptive statistics and inferential analyses were applied to identify statistically significant differences between groups. The findings reveal distinct behavioural and perceptual patterns: urban residents demonstrate higher participation frequency and place greater emphasis on service quality and diversified amenities, whereas rural residents show stronger sensitivity to pricing and accessibility factors. Differences are also observed in the overall evaluation of the tourism experience, reflecting structural and socio-economic disparities. The study contributes to winter tourism literature by integrating spatial residence into the analysis of domestic tourism demand and experience assessment. The results provide practical implications for destination managers and policymakers seeking to design differentiated marketing strategies and improve service provision in line with the needs of diverse domestic segments. Full article

Habits are important factors that help guide the performance of health behaviours, yet little is known about how habits form following a major context change. To observe the habit trajectory of physical activity engagement and assess the relationship between habit trajectory and theoretical determinants of habit formation, a longitudinal design was used to track physical activity habit trajectory over 12 weeks during COVID-19 lockdowns. Participants (N = 41) selected a cue related to physical activity, to assist in increasing their engagement. At baseline, and every two days, participants reported their behaviour, habit, and cue exposure. Trait self-control, history of physical activity behaviour, and demographic information were also collected at baseline. Physical activity habit strength significantly increased from baseline to the final assessment 12 weeks later; however substantial variability was observed in growth over time and neither the linear nor the logarithmic growth model provided a good fit at the overall level. Nonetheless, higher levels of self-control were significantly related to faster habit strength formation. Individual differences in habit formation require further investigation to better understand why some individuals form habits while others do not. Full article

Background/Objectives: Left ventricular ejection fraction (LVEF) typically improves after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (SAS). However, the clinical significance and prognosis of patients presenting with supranormal LVEF (≥65%) remain poorly defined. This study aims to describe LVEF behavior, its relationship with mortality, and its effect on cardiac structure in this specific subgroup. Methods: A retrospective observational study was conducted at Hospital Clínico San Carlos (2008–2019), including SAS patients with pre-procedural supranormal LVEF. Patients were classified into two groups: those whose LVEF normalized (55–65%) and those whose LVEF remained supranormal. Demographic, clinical, and echocardiographic variables were collected at baseline and one-year follow-up. The primary endpoint was all-cause mortality at two years. Results: Out of 101 analyzed patients (mean age 82.8 years, 71.2% women), 71 (70.3%) experienced LVEF normalization at one year. Two-year mortality was 10% in the normalized group and 9.8% in the non-variable group, showing no significant difference. Regarding geometric characteristics, a trend toward left ventricular mass regression was observed only in the LVEF-normalized group (Delta −10; p = 0.062 vs. −8.4; p = 0.197). History of bleeding was the only variable showing a trend toward worse prognosis (p = 0.064). Conclusions: LVEF behavior one year after TAVI in patients with baseline supranormal function tends toward normalization. This change is not associated with differences in two-year mortality but is linked to a trend toward beneficial reverse cardiac remodeling. Full article