Search Results (8,429)

Background: Effective management of postprandial glycemic control is critical for diabetic patients, as elevated postprandial glucose levels can lead to complications such as cardiovascular disease and neuropathy. This study evaluates isomaltulose, a low-glycemic-index carbohydrate, as an alternative to sucrose in mitigating postprandial glucose spikes. Objectives: To synthesize evidence from existing studies and assess the efficacy of isomaltulose in reducing postprandial glycemic levels compared to sucrose in diabetic populations. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches were performed across PubMed, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials or crossover studies comparing isomaltulose and sucrose. Data were extracted, and the Cochrane Risk of Bias tool was used to assess study quality. Results: Ten studies were included, involving 367 participants. The meta-analysis showed that isomaltulose significantly reduced plasma glucose level at 60 min post-meal, though the actual effect could be modest in terms of clinical relevance compared to sucrose (MD: −7.99, 95% CI: −8.58, −7.39, p < 0.00001). Notable variability in the study results was observed, which may be attributed to multiple factors such as participant demographics and meal composition. Conclusions: The findings from the analysis are supportive for the use of isomaltulose as a beneficial dietary alternative to sucrose for managing postprandial glycemic levels in diabetic patients. Future research effort is suggested to focus on larger, diverse populations to enhance generalizability and explore the impact of dietary context on glycemic response. Full article

Background/Objectives: This study examines the longitudinal dynamics of anti-nucleocapsid (anti-N) and anti-spike (anti-S) antibody responses to SARS-CoV-2 infection and mRNA vaccination based on 81,878 serum samples from 23,616 healthcare workers (HCWs) across five European countries. It includes data across four scheduled vaccine doses—predominantly BNT162b2—with 25% of samples originating from individuals with confirmed prior infection, as evidenced by elevated anti-S levels, positive Anti-N antibodies, or PCR results. Methods: The study employed a shifted transformation method for data normalization and utilized the Bass diffusion model to predict antibody titer dynamics influenced by both internal factors—such as immune activation contextualized through sociodemographic issues—and external factors, including infection and vaccination. Despite the absence of direct measurements for some internal variables, the model effectively inferred their impact, enabling a rigorous and nuanced delineation of immune response profiles. Results: The Bass diffusion model rigorously captured variations in antibody titers, analyzed through demographic factors such as gender, age, and job role, while thoroughly accounting for pre-infection status. The results indicate that Anti-N antibodies, exclusively produced post-infection, exhibited a rapid decline, while anti-S antibodies, generated from both infection and vaccination, demonstrated prolonged persistence. A significant decline in anti-S levels was observed 3–5 months post-vaccination, with adaptive immunity—characterized by the dominance of internal factors effects relative to external ones—achieved in most groups after the fourth dose. However, adaptive immunity post second dose was limited to specific demographics. Conclusion: These findings emphasize the significance of the Bass Method in predicting vaccine-induced, hybrid immune responses and detecting adaptive immunity by overcoming limitations in internal factor data, thereby advancing effective vaccination and infection control strategies during public health crises. These findings highlight the Bass Method’s value in predicting vaccine-induced and hybrid immunity, effectively addressing internal factor data gaps to enhance vaccination and infection control strategies. Full article

Background: Oral ulceration with bone sequestration (OUBS) is an uncommon clinical lesion characterized by painful mucosal ulceration associated with exposed and necrotic bone in the oral cavity, often without known factors inducing osteonecrosis. Despite its potential for diagnostic confusion with more serious lesions, such as medication-related osteonecrosis, OUBS remains poorly understood and underreported. Objectives: To systematically review the literature on OUBS and identify its main clinical and radiographic characteristics to assist in early diagnosis and appropriate management. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in the PubMed, Scopus, and Web of Science databases on 27 January 2024, to identify case reports, case series, and observational studies that described OUBS. Data extraction focused on demographic information, lesion location, clinical features, radiographic findings, possible etiological factors, management, and outcomes. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized to assess the quality of the case reports and series. Data were synthesized narratively due to heterogeneity among studies. Results: Fifty-seven patients from 22 studies were included. The male-to-female ratio was 2.5:1, with most cases (71.9%) occurring in males. The mean age was 50.22 ± 11.49 years, with the highest incidence in patients aged 50–59 years (64.9%). Most cases were localized to the mandible (94.7%). Clinically, lesions were shallow ulcers (mean size: 0.75 ± 0.85 cm). Pain was the most common symptom (88.9%). Radiographs revealed no significant maxillary abnormalities, but some cases showed radiopaque areas in the mandible. Surgical interventions were most common (40.4%), with complete healing in 67.7% of cases within 4 weeks. Limitations include the predominance of case reports and series, which limits the strength of evidence. Conclusions: Recognizing OUBS can prevent misdiagnosis and unnecessary interventions. Further studies are needed to clarify its etiology and natural history. Registration: This review was registered on the PROSPERO database (registration number CRD42024541416). Full article

Background: Inflammatory and angiogenic mediators play a key role in post-COVID-19 syndrome pathophysiology. These mediators might be of prognostic value for pulmonary function in this syndrome. Objectives: To determine interleukin-6, -12, and -17, macrophage inflammatory protein-1A (MIP-1A), the vascular endothelial growth factor-A (VEGF-A) gene expression levels, the matrix metalloproteinase-9 (MMP-9) plasma levels, and the association of clinical data with pulmonary function in patients with post-COVID-19 syndrome with normal and abnormal spirometry results. Methods: Demographic/clinical data and blood samples were collected (45 patients). Pulmonary function was evaluated (spirometry), and the gene expression levels of inflammatory and angiogenic mediators (IL-6, IL-12, IL-17, MIP-1A, and VEGF-A) were determined in PBMCs (qPCR). MMP-9 plasma levels were determined (ELISA). Results: Seventeen out of forty-five patients with post-COVID-19 syndrome had abnormal spirometry values, which were associated with arterial hypertension, pneumonia, previous hospitalization, and disease severity (p < 0.05). IL-6, IL-12, and VEGF-A gene expression was upregulated in patients with post-COVID-19 syndrome compared with healthy controls. In patients with normal spirometry values, IL-17 and VEGF-A gene expression was upregulated (p < 0.05), but MIP-1A was downregulated (p < 0.05) (vs. the abnormal spirometry group). MMP-9 serum levels were increased in the normal spirometry group compared with the abnormal one (p < 0.05). Conclusions: Post-COVID-19 syndrome has a complex immune pathophysiology, but potential inflammatory and angiogenic biomarkers, such as IL-6, IL-12, IL-17, MIP-1A, and VEGF-A, are differentially expressed in this syndrome and might be prognostic predictors of post-COVID-19 syndrome associated with pulmonary function alterations. Full article

Background: Anemia represents a significant complication in patients with advanced chronic kidney disease (CKD) on hemodialysis, primarily caused by reduced renal erythropoietin production. Despite erythropoiesis-stimulating agents (ESAs) being the cornerstone of treatment, hyporesponsiveness to these agents remains a clinical challenge with implications for patient outcomes. Objective: To identify and quantify risk factors associated with hyporesponsiveness to erythropoietin in patients with CKD on hemodialysis who present with anemia. Methods: This multicenter case–control study analyzed data from 784 hemodialysis patients receiving erythropoietin therapy across six dialysis centers in Ecuador between January and December 2019. Hyporesponsiveness was defined as requiring ≥ 200 IU/kg/week of erythropoietin alfa for ≥3 consecutive months to maintain target hemoglobin levels (10–12 g/dL). Demographic, clinical, and laboratory parameters were compared between hyporesponsive cases (n = 123) and responsive controls (n = 661). Bivariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: The prevalence of erythropoietin hyporesponsiveness was 15.69%. A multivariate analysis identified female sex (adjusted OR = 1.96; 95% CI: 1.20–3.20; p < 0.001), age < 50 years (adjusted OR = 4.25; 95% CI: 2.42–7.47; p < 0.001), serum albumin < 4.0 g/dL (adjusted OR = 10.53; 95% CI: 6.53–16.98; p < 0.001), ferritin ≥ 800 ng/mL (adjusted OR = 7.28; 95% CI: 4.22–12.57; p < 0.001), transferrin saturation < 20% (adjusted OR = 9.27; 95% CI: 5.47–15.69; p < 0.001), parathyroid hormone ≥ 500 pg/mL (adjusted OR = 1.89; 95% CI: 1.16–3.09; p = 0.011), and use of renin–angiotensin system blockers (adjusted OR = 2.25; 95% CI: 1.36–3.71; p = 0.002) as independent risk factors for erythropoietin hyporesponsiveness. Conclusions: Multiple demographic, clinical, and laboratory factors independently contribute to erythropoietin hyporesponsiveness in hemodialysis patients. Identification of these risk factors may guide clinicians in developing individualized treatment approaches, optimizing erythropoietin dosing, and implementing targeted interventions to improve anemia management in this vulnerable population. Full article

Objective: Positive airway pressure (PAP) therapy effectively treats obstructive sleep apnea (OSA), yet adherence to the therapy presents significant challenges. This study identifies demographic and sleep study factors that influence short-term adherence to PAP therapy among patients with OSA by comparing data from adherent and non-adherent groups. Methods: Patients diagnosed with OSA via polysomnography who commenced PAP therapy after titration were divided into adherent and non-adherent groups. We employed propensity score matching in a 1:1 ratio based on age, gender, and body mass index (BMI), including a total of 150 patients in the analysis. Logistic regression analyses were conducted on all pertinent variables, excluding those with high multicollinearity. Non-significant variables were omitted from the final model, whose performance was evaluated using a receiver operating characteristic (ROC) curve, calculating the area under the curve (AUC). Results: Data from 150 participants (mean age 49.56 ± 14.31 years, 79% males, mean BMI 28.96 ± 5.11) were analyzed. Significant predictors of adherence included smoking status (odds ratio [OR] 0.267; 95% confidence interval [CI], 0.116–0.580; p = 0.001), Epworth sleepiness scale (OR 1.080; 95% CI, 1.004–1.166; p = 0.042), oxygen desaturation index (ODI) during titration (OR 0.906; 95% CI, 0.829–0.975, p = 0.015), and optimal PAP levels (OR 1.240; 95% CI, 1.007–1.119; p = 0.029). The ROC curve analysis indicated an AUC of 0.765, confirming the model’s effectiveness in distinguishing between adherent and non-adherent patients. Conclusions: Adherence is negatively affected by smoking, whereas higher daytime sleepiness, optimal PAP levels, and a lower ODI during titration are associated with better adherence, underscoring the importance of personalized treatment approaches. Full article

Background/Objectives: Research suggests that attitudes toward aging significantly impact health and well-being outcomes in older adults and are influenced by various factors. Our study aims to identify gender differences in attitudes toward aging among aging individuals with disabilities while also examining the influence of demographic and psychological factors on these attitudes. Methods: For this cross-sectional study, we collected data from 393 middle-aged and older adults with disabilities via an online Qualtrics survey administered through the Prolific platform in the United States. Participants completed the Attitudes Towards Aging Questionnaire Short Form, Purpose in Life Test Short Form, Mindfulness Attention Awareness Scale, Acceptance of Chronic Health Conditions Scale, and Three-Item Loneliness Scale. Descriptive and correlation analyses, t-tests, and multiple regression analyses were performed. Results: The independent t-test findings reveal significant differences in physical change and psychological growth between men and women, with men scoring higher in physical change and women in psychological growth. In multiple regression analyses, purpose in life significantly predicted all three domains of attitudes toward aging in men, while both purpose in life and acceptance were predictors across all domains in women. Additionally, age, employment, and financial stability contributed to aging attitudes only among women. Conclusions: Attitudes toward aging, specifically physical change and psychological growth, were found to vary by gender, with purpose in life, acceptance, and loneliness influencing these attitudes among both groups, while certain demographic factors influenced aging attitudes only among women. These findings underscore the need for gender-specific interventions addressing these substantial factors. Full article

Background: This study investigates the survival outcomes of individuals with HIV receiving different treatment regimens compared to a control group. Utilizing a cohort dataset with demographic and clinical information, this research aims to assess the impact of various factors, including age, education, and travel time, on survival while controlling for confounding effects using propensity score adjustment. Methods: A total of 380 patients with HIV were included in this study, categorized into an intervention group receiving a specific treatment regimen and a control group. The primary outcome measured was the time to death or censoring. Survival analysis was performed using the Cox proportional hazards model, adjusted for potential confounders, including treatment (intervention and control), age, education, travel time, and gestational age at enrollment. Propensity scores were also incorporated to adjust for treatment selection bias. Results: The Cox model revealed a significant protective effect of the intervention on survival (hazard ratio (HR) = 0.583, p = 0.045), indicating that the treatment improved survival outcomes compared to the control group. After adjusting for propensity scores, the relationship between the intervention and survival remained significant (HR = 0.631, p = 0.106), suggesting the robustness of the treatment’s effect even after accounting for confounding variables. Other covariates, such as age, education, and travel time, did not show significant independent effects on survival, likely due to their correlation with the treatment variable. Conclusions: This study highlights the crucial role of the intervention in enhancing survival among individuals with HIV. The use of propensity score adjustment improves the validity of these findings by mitigating confounding bias in observational data. These results highlight the importance of ART (antiretroviral therapy) in HIV management and demonstrate the utility of statistical methods like propensity scores in clinical research. Further studies with diverse populations and advanced methodologies are recommended to validate these findings across different settings. Full article

Considering the rapid integration of digital services into daily life, it is crucial to analyze the impacts of the substitutability of physical services with digital alternatives. Limited studies have been conducted to investigate the relationship between service substitution and social networks and assess their impact on urban structure. Therefore, this study fills the gap by investigating how digital service substitution and social networks influence residential location choices and urban structure, aiming to support future sustainable urban modeling and planning tools. The study, through a comprehensive analysis incorporating cluster analysis, factor analysis, and binomial logistic regression on a web-based questionnaire survey (n = 6210), finds that socio-demographic factors significantly influence digital alternatives, and that digital service substitution and social networks impact sustainable urban structure. Younger individuals showed significantly higher adoption of digital alternatives, with age negatively associated with relocation likelihood. In urban areas, each additional year of age reduces the likelihood of relocation by approximately 4.4%, and individuals with high shopping substitution are 3.12 times more likely to consider relocation. These findings suggest that urban planners and policymakers to balancing physical and digital service provision to maintain a higher quality of life aligned with the SDGs and ensure sustainable urban development. Full article

As global concerns about climate change and air quality intensify, nations are increasingly adopting sustainable transportation solutions, with electromobility emerging as a key alternative. This study investigates the factors influencing powertrain technology choice and the barriers to electric vehicle (EV) adoption in Poland, focusing on insights from technically educated youth, early-career researchers, and academic professionals. Drawing on a mixed-methods approach, the study investigates public perceptions, motivations, and challenges associated with EV uptake in a country historically reliant on fossil fuels. Key drivers such as environmental considerations, government policies, and infrastructure development are evaluated alongside persistent obstacles, including high initial purchase costs, inadequate charging networks, range anxiety, and scepticism about battery performance. While the sample is not representative of the broader Polish population, it provides insights from a technically literate cohort likely to shape future technological and policy advancements. Our findings reveal that the adoption of EVs among this group is influenced by factors such as technological innovation and government policies, while barriers include high initial costs, limited charging infrastructure, and scepticism about perceived sustainability, battery life, and performance. The research also highlights the critical role of education and awareness in shaping attitudes toward EVs. This study, though limited by sample size and demographic focus, offers valuable contributions to understanding the early-stage adoption of EVs in Poland and serves as a foundation for future research targeting a more diverse population. The applied research model is scalable, providing a framework for broader studies that could include different age groups, geographical regions, and professional sectors. Full article

Exploring the spatiotemporal evolution of urban and rural settlements in African countries could provide critical insights into the patterns of urbanization, regional disparities, and sustainable development in the context of rapid socio-economic and demographic changes. Using global human settlement data alongside multi-source socio-economic and environmental datasets, this study investigates the spatiotemporal dynamics of human settlements in Tanzania from 1975 to 2020. A combination of methods, including hotspot analysis, standard deviation ellipse analysis, and geographic detectors, is employed to examine the characteristics of settlement evolution and the underlying factors contributing to regional differentiation. The findings reveal that over the past 45 years, the expansion of urban centers and urban clusters in Tanzania has significantly accelerated, while rural areas have experienced a corresponding decline, reflecting a shift from low-density to high-density settlements and a transformation from rural to urban landscapes. Dar es Salaam, Mwanza, and Arusha have consistently been hotspots for urban center growth, while Kagera has emerged as a primary hotspot for urban clusters. The distribution of rural hotspots and coldspots generally mirrors that of urban clusters. The spatial distribution of urban centers, urban clusters, and rural areas follows a northwest–southeast orientation, with the spatial distribution of urban centers gradually stabilizing. However, the development gap between urban clusters in the northwest and rural areas in the southeast is widening and narrowing, respectively. Socio-economic factors exert a stronger influence on the development of settlements than natural environmental factors. Population density, GDP density, and road network density are significant drivers of settlement patterns, with their influence intensifying over time. Full article

Facing severe depopulation and aging, rural Japanese communities—particularly marginal settlements (genkai shūraku)—increasingly require revitalization strategies that integrate local culture and elder well-being. This study examines the Ōsawa Engawa Café, a community-led initiative in a mountainous tea-growing village, as a site of ikigai-zukuri—the active creation of life purpose among elderly residents. With the use of a mixed-methods approach, including spatial analysis, household surveys, and interviews, Chi-square Automatic Interaction Detection (CHAID) decision tree analysis was applied to identify factors shaping distinct household café operational states: Operating, Discontinued, and Never Operated. Qualitative findings reveal that support from local leaders, experts, and the government enabled the Ōsawa Engawa café’s launch. Broad household participation, often guided by elderly women, sustained the initiative by sharing local culture—such as engawa (verandas), Zairai tea (native variety), and omotenashi (hospitality)—thereby nurturing residents’ ikigai through daily engagement. Complementing these insights, the CHAID analysis revealed a hierarchy of influential factors: high-frequency support from out-migrated family members was the strongest predictor of continued operation; in the absence of such support, co-resident family cooperation proved essential; where both were lacking, agricultural engagement distinguished households that discontinued from those that never operated. Practically, the Ōsawa model offers a replicable, bottom-up strategy that activates the Rural Cultural Landscape (landscapes shaped by traditional rural life and culture, RCL) through community engagement grounded in cultural practices and elderly ikigai-zukuri, contributing to sustainable rural livelihoods. Theoretically, this study reframes ikigai-zukuri as a key socio-cultural pillar of community resilience in aging rural areas. Fostering such culturally embedded, purpose-driven initiatives is essential for building vibrant, adaptive rural communities in the face of demographic decline. However, the study acknowledges that the Ōsawa model’s success is rooted in its specific socio-cultural context, and its replication in other cultural settings may be limited without contextual adaptation. Full article

Hepatitis B and C (HBV and HCV) infections persist as significant public health concerns. Specific occupational groups, such as waste collectors, continue to face elevated risk due to exposure to contaminated materials. Research studies have underscored heightened infection rates, notably from needle prick injuries. The present study aspires to re-evaluate the prevalence of HBV and HCV among waste collectors and to scrutinize associated risk factors, thereby contributing to the development of effective public health and occupational safety strategies. The study analyzed data from 116 Italian waste collectors who were undergoing regular occupational visits, examining demographics, health conditions, HBV immunization, and annual blood tests for the HBsAg, HBsAb, and HCVAb. The HBsAb was detected in 66 individuals (56.9%), while the HCVAb was found in 4 (3.4%). Logistic regression showed HBV immunization and longer job experience to be significant factors associated with HBsAb presence. Waste collection may increase HBV infection risk due to occupational exposure, unlike HCV, which requires blood-to-blood contact. Preventive strategies, including education, protective equipment, and HBV vaccination, are essential. Ensuring vaccination coverage among waste collectors could reduce infection risk. Further research should assess the occupational risks and the effectiveness of preventive measures. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, with transarterial chemoembolization (TACE) commonly used as a palliative approach for patients who are not candidates for surgical resection. Understanding the factors that influence health-related quality of life (HRQoL) after TACE is essential for improving patient-centered care. This systematic review seeks to consolidate current evidence on the variables that impact HRQoL in HCC patients post-TACE. Methods: In adherence to PRISMA guidelines, a comprehensive search was conducted across five English and Chinese databases—PubMed, Scopus, Web of Science, CNKI, and Wanfang—covering studies from database inception to May 2025. Eligible studies were observational and examined factors affecting HRQoL in post-TACE HCC patients. Two independent reviewers performed screening, data extraction, and quality assessment using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Nine studies met the inclusion criteria, including six cohort studies and three cross-sectional studies. The quality assessment rated seven studies as high quality and two as moderate. A range of validated HRQoL assessment tools was used, with the EORTC QLQ-C30 and FACT-G being the most commonly employed. The factors influencing HRQoL were grouped into five categories: (1) demographic factors (e.g., age, gender, education level); (2) clinical indicators (e.g., liver function, tumor burden); (3) psychological factors (e.g., depression, anxiety, spiritual well-being); (4) social support (e.g., financial status, coping mechanisms); and (5) physical symptoms (e.g., fatigue, pain, appetite loss). Across studies, both symptom severity and psychological distress were consistently associated with lower HRQoL. Conclusions: The HRQoL of HCC patients following TACE is influenced by a complex interplay of demographic, clinical, psychological, social, and symptomatic factors. Tailored, multidimensional interventions addressing these diverse aspects are crucial to optimizing recovery and improving overall well-being. Full article

Objectives: Survival from lung cancer is worse in the UK than in some other countries, with late stage at diagnosis implicated in poor prognosis. The route and referral urgency by which patients obtain a diagnosis influence outcomes. This study investigated whether socio-demographic factors are associated with lung cancer routes to diagnosis in England. Materials and Methods: A total of 181,763 primary invasive lung cancers (ICD-10 C34.0-C34.9) diagnosed from 1 January 2012 to 31 December 2016 were abstracted from the English National Cancer Registration Database. Multivariable logistic regression was used to examine associations between patients’ socio-demographic characteristics and likelihood (adjusted odds ratios) of (i) emergency presentation versus all primary care-initiated routes and (ii) urgent (“two-week wait”/2WW) versus standard primary care-initiated referral. Models included the following factors: deprivation quintile of area of residence at diagnosis (IMD income domain); sex; age; ethnic group; rural/urban residence; and (in the emergency model) region. Results: Socio-demographic variations in diagnosis routes were observed. Patients presenting as emergencies (35.2%) were more likely to be 80 years of age or older, female, of non-White ethnicity, and resident in areas of greater deprivation or the London region. In contrast, 2WW patients (28.3%) were more likely to be aged between 50 and 69 years old, of White ethnicity, and resident in an area of greater deprivation or resident outside of an urban centre; diagnosis through 2WW did not vary by sex. Conclusions: Routes to diagnosis are subject to distinct socio-demographic patterning. Action is needed to ensure that new referral guidelines and lung cancer screening roll-out do not widen socio-demographic inequalities in diagnosis. Full article