Search Results (3,258)

Purpose: Decentralized hearing care models facilitated by community health workers (CHWs) can improve access to care in low-income settings. Preset hearing aids, which offer user-selectable pre-developed amplification programs, may support such models, but little is known about their real-world use and alignment with clinical recommendations. Method: This longitudinal study formed part of a feasibility project implementing the World Health Organization’s (WHO’s) hearing aid service delivery approach in three low-income South African communities. Adults (≥18 years) with confirmed moderate-to-severe bilateral hearing loss were fitted with preset hearing aids by trained CHWs. Devices offered four preset amplification programs. Participant-driven selections were recorded at four distinct time points: fitting and follow-ups at 2 weeks, 2 months, and 6 months post-fitting. Results: In total, 36 participants (mean age = 76 years, SD = 8.9, range 50–96) were fitted with devices. Although over half (right: 52.8%, left: 58.3%) presented with high-frequency loss, only 34% initially selected the corresponding program. Most participants (80.6%, n = 29) changed their selections at least once over the six months. Significant associations between hearing loss configuration and selection occurred at some time points only in the left ear, but agreement with clinically recommended programs declined from 42% at baseline to 28% at six months. Conclusions: CHW-facilitated hearing aid delivery supports user autonomy in low-resource settings. However, frequent changes and divergence from clinically recommended programs suggest reliance on user-driven trial-and-error adjustments rather than audiometric fit, which may limit long-term benefit. Ongoing, person-centred guidance is needed for the effective use of preset hearing aids. Full article

Background: Anthracycline-based chemotherapy is associated with a risk of cancer therapy-related cardiac dysfunction (CTRCD), particularly in patients with moderate to high cardiovascular risk. Left ventricular global longitudinal strain (GLS) is a sensitive marker for early myocardial dysfunction, but the prognostic value of baseline GLS in this population remains unclear. Objective: We aimed to evaluate whether baseline GLS can predict CTRCD in moderate- to high-risk cancer patients undergoing anthracycline chemotherapy. Methods: In this prospective, single-center observational study, 80 anthracycline-naive cancer patients classified as moderate or high risk were enrolled. Baseline GLS was assessed via speckle-tracking echocardiography, with a threshold of ≥−18% considered decreased. Patients were followed for 12 months, and the primary endpoint was the development of CTRCD per ESC 2022 Cardio-oncology guidelines. Results: Of the 77 patients completing follow-up, 27.3% had decreased baseline GLS. CTRCD occurred in 62.4% of patients, with higher incidence among those with decreased GLS (76.7%) compared to those with normal GLS. In multivariable analysis, GLS ≥−18% was the only significant independent predictor of CTRCD (RR 12.0, 95% CI 2.0–71.9; p = 0.0065). All-cause mortality was also significantly higher in patients with decreased baseline GLS (19.1% vs. 1.8%, p = 0.018). Conclusions: Decreased baseline global longitudinal strain is an independent predictor of cancer therapy-related cardiac dysfunction and all-cause mortality in moderate- to high-risk patients receiving anthracycline therapy. These findings support the inclusion of baseline GLS in pre-treatment cardiovascular risk assessment, particularly in patients with an LVEF above 54%, to more effectively identify those who may benefit from early cardioprotective interventions. Full article

Caries is the most prevalent chronic disease affecting oral health in preschool children. In this 12-month prospective cohort study of 3–4-year-olds, we investigated the community-level bacterial–fungal interkingdom interactome and its role in cariogenic microenvironments, using 16S rRNA gene (bacterial) sequencing and ITS2 gene (fungal) sequencing of unstimulated saliva. Longitudinal analysis identified 19 key bacterial and fungal species that were associated with both caries progression and clinical features. Salivary bacteria Desulfovibrio, Bacteroides heparinolyticus, Alloprevotella, Anaerobiospirillum, and fungus Candida tropicalis not only showed altered abundances during caries development but also correlated with severity of caries, establishing diagnostic microbial signatures for caries prediction. The salivary mycobiome exhibited highly active and complex intra-network interactions in the caries-active state, suggesting that fungal networks may drive the broader community-wide microbiota interaction network in the caries state. Metabolic profiling further revealed distinct pathway shifts before and after caries onset. The findings demonstrate that caries progression follows ecological succession governed by cross-domain interactions. This study highlighted the fungal network’s important role in driving dysbiosis, advancing the current understanding of early childhood caries beyond bacterial-centric models, and also highlighted fungi not only as modulators but as active contributors to cariogenesis, which could guide future antimicrobial strategies. Full article

Background/Objectives: Bitter Taste Receptors (encoded by TAS2R genes) are expressed in mucosal and bronchial epithelia, as well as in immune cells, contributing to defense against airborne pathogens such as SARS-CoV-2. Data on single-nucleotide polymorphisms (SNPs) in TAS2R genes or pseudogenes in COVID-19 are limited. This study examined the association between TAS2R SNPs and COVID-19 infection and seroconversion in European individuals participating in the Canadian Longitudinal Study on Aging. Methods: Data from the Genome-wide Genetic Data, Comprehensive Baseline (version 7.0), Follow-up 2 (version 1.1), COVID-19 Questionnaire Study (4-2020 to 12-2020), and COVID-19 Seroprevalence (Antibody) Study (11-2020 to 7-2021) datasets were accessed. Associations of TAS2R SNPS with COVID-19 infection or seroconversion were determined using logistic regression adjusted for sociodemographics, genetic principal components, smoking, vaccine doses, and chronic medical conditions (diabetes, immune-mediated inflammatory diseases (IMIDs), respiratory disease, and cardiovascular disease). Results: In the COVID-19 Questionnaire Study (N = 14,073), the rs117458236 (C) variant in TAS2R20 showed a trend toward an association with COVID-19 infection (OR = 1.95; 95% Confidence Interval (CI): 0.98, 3.51). In the COVID-19 Antibody Study (N = 8313), the rs2234235(G) variant in TAS2R1 was associated with anti-nucleocapsid (OR = 1.55; CI: 1.06, 2.20) and anti-spike response (OR = 0.74; CI: 0.57, 0.98); the rs2234010(A) variant in TAS2R5 was associated with anti-nucleocapsid (OR = 1.56; CI: 1.08, 2.19); and the rs34039200(A) variant in TAS2R62P was associated with anti-spike (OR = 0.86; CI: 0.77, 0.97). In a subgroup analysis, the rs2234235(G) variant in TAS2R1 was associated with a decreased anti-spike response to infection or vaccination in individuals with IMIDs or respiratory disease and an increased risk of SARS-CoV-2 infection. Conclusions: TAS2R variants are associated with COVID-19 infection and vaccine response. These data may inform personalized management and vaccination strategies. Full article

Objective: False lumen (FL) thrombosis plays a key role in aortic remodeling after Frozen Elephant Trunk (FET) surgery, yet current imaging assessments are limited to categorical classifications. This study aimed to evaluate an unsupervised artificial intelligence (AI) algorithm based on a variational autoencoder (VAE) for automated, continuous quantification of FL thrombosis using serial computed tomography angiography (CTA). Methods: In this retrospective study, a VAE model was applied to axial CTA slices from 30 patients with aortic dissection who underwent FET surgery. The model encoded each image into a structured latent space, from which a continuous “thrombus score” was developed and derived to quantify the extent of FL thrombosis. Thrombus scores were compared between postoperative and follow-up scans to assess individual remodeling trajectories. Results: The VAE successfully encoded anatomical features of the false lumen into a structured latent space, enabling unsupervised classification of thrombus states. A continuous thrombus score was derived from this space, allowing slice-by-slice quantification of thrombus burden across the aorta. The algorithm demonstrated robust reconstruction accuracy and consistent separation of fully patent, partially thrombosed, and completely thrombosed lumen states without the need for manual annotation. Across the cohort, 50% of patients demonstrated an increase in thrombus score over time, 40% a decrease, and 10% remained unchanged. Despite these individual differences, no statistically significant change in overall thrombus burden was observed at the group level (p = 0.82), emphasizing the importance of individualized longitudinal assessment. Conclusions: The VAE-based method enables reproducible, annotation-free quantification of FL thrombosis and captures patient-specific remodeling patterns. This approach may enhance post-FET surveillance and supports the integration of AI-driven tools into personalized aortic imaging workflows. Full article

Background: Parental cognitive characteristics may represent environmental risk factors in obsessive–compulsive disorder (OCD). This study compared obsessive beliefs, metacognitions, and ruminative thinking in parents of adolescents with OCD and healthy controls (HCs), and examined links with clinical features in patients. Methods: Participants were 45 adolescents with OCD, 45 HCs, and both their mothers and fathers. The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) assessed symptom severity in adolescents. Parents completed the Obsessive Beliefs Questionnaire (OBQ), Ruminative Thought Style Questionnaire (RTSQ), 30-item Metacognitions Questionnaire (MCQ-30), and Patient Health Questionnaire-9 (PHQ-9). Data were analyzed using linear mixed-effects models, followed by correlation and regression analyses. Results: Parents of patients had higher scores on the importance/control of thoughts, the need to control thoughts, and cognitive self-consciousness (MCQ-CSC). Mothers of adolescents with OCD had the highest scores on inflated responsibility/threat estimation (OBQ-RTE), perfectionism/intolerance of uncertainty (OBQ-PIU), rumination, and cognitive confidence (MCQ-CC). Regression analyses showed that lower maternal MCQ-CC predicted earlier OCD onset, while higher rumination predicted later onset. Obsession severity in adolescents was linked to higher maternal MCQ-CSC, obsessive slowness to maternal OBQ-PIU, and pathological doubt to greater maternal rumination. Children’s indecisiveness correlated with paternal OBQ-RTE and OBQ-PIU. Conclusions: Our findings revealed elevated cognitive vulnerabilities for OCD in mothers of affected adolescents and identified specific associations between parental cognitive characteristics and their children’s symptom profiles. Future longitudinal studies using dyadic parental design with larger samples may further elucidate the role of parental cognitive patterns in the development and course of OCD. Full article

Objective: This study aimed to validate the clinical utility of a salivary molecular platform (Oral Predict^®) for periodontal pathogen detection across preventive, therapeutic, and maintenance settings. Methods: A longitudinal randomized study was conducted involving 78 adults who provided saliva samples at baseline, one month, and three months after professional dental hygiene. Participants were randomized into two groups: control group (n = 39) and probiotic group with Oral Predict^® probiotic supplementation (n = 39). Crude saliva was processed directly without nucleic acid extraction and analyzed by multiplex real-time PCR using either the compact Real-time PCR system or standard thermocyclers. Results: At baseline, Fusobacterium nucleatum was the most prevalent pathogen (84.6%), followed by Tannerella forsythia (53.8%) and Porphyromonas gingivalis (46.2%). The Total Pathogen Burden Score (TPBS) showed progressive increases with age, smoking, and poor oral hygiene, and was significantly higher in participants with gingival bleeding. Among individual pathogens, no significant associations were observed with periodontitis staging or grading. Professional hygiene induced mean reductions of 1–2 logs across all pathogens, with TPBS decreasing from 8.7 ± 3.2 to 4.1 ± 2.8 (p < 0.001). At three months, 69.2% of the control group experienced bacterial rebound, whereas 85% of probiotic users sustained or improved bacterial reductions. Conclusions: Salivary molecular testing provides a robust, non-invasive approach for periodontal pathogen detection, treatment monitoring, and long-term maintenance assessment. The flexibility of the Oral Predict^® platform across point-of-care and laboratory settings, combined with automated interpretation, supports integration into preventive protocols and personalized periodontal care. These findings demonstrate the potential of saliva-based molecular diagnostics to shift periodontal management from reactive to predictive and precision-based strategies. Full article

Background/Objectives: The longitudinal associations between different modalities of sedentary behaviors (SBs) and sedentary patterns (SPs) with metabolic syndrome (MetS) in children and adolescents are unclear. We aimed to analyze the cross-sectional and longitudinal (2-year follow-up) association between SB and SP with the MetS score in Spanish children and adolescents. Methods: 76 children (34 females) and 186 adolescents (94 females) were included for SB analyses, and 175 children (82 females) and 188 adolescents (95 females) for SP. Children and adolescents were aged 6–11.9 years and 12–17.9 years, respectively. SB were assessed by a self-reported questionnaire and SP were determined by accelerometry. The MetS score was computed from the waist circumference, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose levels. Different linear regression models were implemented to examine cross-sectional, longitudinal, and change associations of SB and SP with MetS. Results: Total daily SB, educative daily SB, and mean SB were longitudinal and inversely associated with MetS (β = −0.001, all p < 0.05) in male adolescents, while other daily SB was longitudinal and inversely associated with MetS (β = −0.002, all p < 0.05) in female adolescents. Changes in screen and other daily SB were directly associated with MetS in female adolescents (β = 0.001 to 0.002, all p < 0.05). In contrast, changes in educative daily SB were inversely associated with MetS in female adolescents (β = −0.001, all p < 0.05). Conclusions: Few associations between SB modalities and the MetS score were found, mainly in adolescents and often in unexpected directions. In male adolescents, total and educative daily SB were negatively associated with MetS. In female adolescents, other daily SB and changes in educative daily SB showed negative associations, while changes in screen-based and other daily SB were positively associated with MetS. No associations were found between SP and MetS. Given the low evidence available to date, more longitudinal studies analyzing SB and SP simultaneously are needed to reach solid conclusions. Full article

Purpose: This study aimed to evaluate retrospectively self-reported changes in tinnitus severity and distress associated with the COVID-19 pandemic and vaccination using validated self-report instruments. It further explored patient-reported onset of tinnitus following vaccination, gender differences in symptom severity, and associations with psychological distress. Method: A cross-sectional online survey was completed by 189 adults between December 2023 and April 2024. Participants retrospectively self-reported tinnitus onset and severity before, during, and after the COVID-19 pandemic using the Tinnitus Handicap Inventory (THI) and the Tinnitus Reaction Questionnaire (TRQ). Additional items assessed COVID-19 vaccination history, infection status, and adverse vaccine reactions. Repeated measures ANOVAs and chi-square tests were used to examine retrospectively reported longitudinal changes and group differences. Results: Mean THI scores increased significantly over time—before (M = 9.57, SD = 16.00), during (M = 29.97, SD = 32.30), and currently (M = 36.92, SD = 28.04)—with large effect sizes across functional, emotional, and catastrophic subscales (p < 0.001). TRQ scores also were reported to rise from before (M = 7.86, SD = 15.29) to during (M = 26.38, SD = 29.58) and remained elevated at the current time (M = 29.79, SD = 24.00), p < 0.001. Approximately 25.9% and 27.0% of respondents reported new or worsened tinnitus after the first and second vaccine doses, respectively. No significant gender differences in symptom severity were observed. TRQ severity classification revealed a marked shift, with moderate or greater distress increasing from 5.8% (before) to 35.6% (current). Conclusions: Retrospective self-reports indicated that tinnitus burden significantly increased during the COVID-19 pandemic and remained elevated at the time of survey completion. A notable proportion of individuals reported new-onset tinnitus following vaccination, though causality cannot be inferred. These findings highlight the need for continued monitoring and comprehensive care addressing both audiological and psychological components of tinnitus. Full article

Background: Evolutionary game theory (EGT), originating from Darwinian competition studies, offers a powerful framework for understanding complex healthcare interactions where multiple stakeholders with conflicting interests evolve strategies over time. Unlike traditional game theory, EGT accounts for bounded rationality and strategic evolution through imitation and selection. Aims and objectives: In our study, we use Synthetic Knowledge Synthesis (SKS) that integrates descriptive bibliometrics and bibliometric mapping to systematically analyze the application of EGT in healthcare. The SKS aimed to identify prolific research topics, suitable publishing venues, and productive institutions/countries for collaboration and funding. Data was harvested from the Scopus bibliographic database, encompassing 539 publications from 2000 to June 2025, Results: Production dynamics is revealing an exponential growth in scholarly output since 2019, with peak productivity in 2024. Descriptive bibliometrics showed China as the most prolific country (376 publications), followed by the United States and the United Kingdom. Key institutions are predominantly Chinese, and top journals include PLoS One and Frontiers in Public Health. Funding is primarily from Chinese entities like the National Natural Science Foundation of China. Bibliometric mapping identified five key research themes: game theory in cancer research, evolution game-based simulation of supply management, evolutionary game theory in epidemics, evolutionary games in trustworthy connected public health, and evolutionary games in collaborative governance. Conclusions: Despite EGT’s utility, significant research gaps exist in methodological robustness, data availability, contextual modelling, and interdisciplinary translation. Future research should focus on integrating machine learning, longitudinal data, and explicit ethical frameworks to enhance EGT’s practical application in adaptive, patient-centred healthcare systems. Full article

Background: Following childbirth, up to 20% of women may have postpartum depression (PPD), which can adversely affect the mother’s health, the infant’s development, and familial connections. Numerous causes exist, although recent research indicates that micronutrient shortages are modifiable biological factors. This systematic review aims to consolidate existing knowledge regarding the relationship between micronutrient levels and the risk of PPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO. We reviewed every study published up to April 1, 2025, on PubMed, Scopus, and Web of Science. Nineteen studies met the inclusion criteria. We employed the Newcastle–Ottawa Scale to assess bias. Results: Nineteen studies were included in the analysis. Vitamin D was the most extensively researched vitamin. The majority of the studies (9 out of 13) identified a significant correlation between low serum 25(OH)D levels and PPD symptoms. Individuals with diminished levels of vitamin B12 and zinc had an elevated risk of PPD. There was insufficient evidence for folate, magnesium, iron, and selenium. This was frequently due to methodological discrepancies, insufficient control of confounding variables, and variations in biomarker timing. The majority of the studies exhibit a low to moderate likelihood of bias. Conclusions: Increasing evidence suggests that deficiencies in specific micronutrients, particularly vitamin D, vitamin B12, and zinc, may contribute to the onset of postpartum depression. The results indicate that targeted nutritional screening and management may be beneficial in perinatal mental health care, notwithstanding the inability to ascertain the exact causative factors. There is a necessity for more rigorous longitudinal investigations and randomised trials to enhance our understanding of processes and assist physicians in making informed judgements. Full article

Background and Objectives: Albuminuria is a key clinical marker for early detection of diabetic kidney disease (DKD) in individuals with type 2 diabetes mellitus (T2DM). The triglyceride-glucose (TyG) index, a simple surrogate of insulin resistance, has been increasingly investigated for its potential association with renal complications. This study aimed to evaluate the relationship between the TyG index and albuminuria in patients with T2DM and assess its clinical utility as an accessible metabolic marker reflecting early renal involvement. Materials and Methods: This retrospective cross-sectional study included 570 adult patients with confirmed T2DM who were followed at a tertiary internal medicine outpatient clinic between January and December 2024. Participants were classified as albuminuric or non-albuminuric based on spot urine albumin-to-creatinine ratio (ACR) values. Clinical and biochemical parameters were collected from medical records, and the TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Logistic regression models were used to identify independent factors associated with albuminuria. ROC analysis was performed to evaluate the discriminatory accuracy of the TyG index. Results: The median TyG index was significantly higher in the albuminuric group compared to the non-albuminuric group (10.0 vs. 9.1; p < 0.001) and increased progressively with albuminuria severity (p < 0.001). In multivariate logistic regression analysis, elevated TyG index, hyperlipidemia, and reduced estimated glomerular filtration rate were independently associated with albuminuria. When evaluated as a continuous variable, the TyG index showed strong discriminatory ability (area under curve (AUC) = 0.949; 95% confidence interval (CI): 0.933–0.964). Using the optimal cut-off threshold of 9.6, the TyG index maintained high diagnostic performance (AUC = 0.870; 95% CI: 0.839–0.902; sensitivity 87.7%, specificity 86.3%). Subgroup analyses confirmed the robustness of this association across clinical and demographic variables. Conclusions: In this study, higher TyG index values were significantly associated with the presence and severity of albuminuria in individuals with T2DM. While causality cannot be inferred, the findings suggest that the TyG index may serve as a practical, cost-effective tool for identifying patients at increased risk for early diabetic kidney involvement. Prospective longitudinal studies are needed to confirm its predictive value and clinical applicability. Full article

Objectives: Multidisciplinary management of chronic pain benefits many patients, although some continue to experience refractory pain. Administration of lidocaine infusions (LI) to manage certain chronic pain conditions has been reported in adults, but evidence is limited for its utility in managing pediatric chronic pain. We reviewed LIs for refractory pain in children to (1) describe the patient population that received LI and (2) evaluate the response to LI. Methods: With IRB approval, a retrospective review of patients receiving LI for refractory pain between 2016 and 2021 was conducted at Boston Children’s Hospital. Demographic, medical, pain, sleep, and school function information was collected through self-report and from the electronic medical record. Longitudinal outcomes for a subset of these patients were analyzed using the Chronic Pain Repository database. Results: During the study period, 3959 patients presented for management of chronic pain. Among this population, 184 (5%) patients aged 22 years or younger ultimately received LI as part of their pain management. A total of 350 LIs were administered and were well tolerated. During approximately 42% of the infusions, patients experienced an immediate statistically significant decrease in pain scores. Among the patients with follow-up data, pain improvement was not sustained. Discussion: LI for the treatment of chronic pain appears safe and may be useful for managing refractory pain in pediatrics. Although approximately half of the patients who received LI reported an immediate positive response, the small follow-up sample did not show a continued response. Study limitations preclude demonstrating long-term efficacy of LI; therefore, a prospective study is critical. Full article

Background/Objectives: The triglyceride–glucose index (TyG) and conicity index (CI) are markers of insulin resistance and abdominal obesity, respectively. However, their joint impact on stroke remains unclear. This study aimed to assess the association between the novel composite TyG–conicity index (TyG-CI = TyG × CI) and stroke risk. Methods: This prospective cohort study enrolled 8011 participants aged 45 years or older with no history of stroke at baseline, from the China Health and Retirement Longitudinal Study. Cox proportional hazards regression models were used to estimate the impact of TyG-CI on the risk of incident stroke. Restricted cubic spline regressions were applied to estimate possible nonlinear associations. The predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) and time-dependent Harrell ‘s C-index. Results: Over a mean follow-up of 8.36 years, 753 participants (9.4%) experienced stroke. After adjusting for potential confounders, compared with the lowest quartile, the adjusted HRs of incident stroke for participants with the highest quartile of TyG, CI, and TyG-CI were 1.36 (95%CI 1.05–1.76), 1.43 (95%CI 1.15–1.78), and 1.69 (95%CI 1.31–2.17), respectively. Restricted cubic spline analysis confirmed a linear relationship between TyG-CI and stroke risk (p for nonlinearity = 0.90). The AUC was highest for TyG-CI (0.594), exceeding TyG (0.575) and CI (0.575) with statistically significant differences (all p < 0.05). Conclusions: Elevated TyG-CI indicates a higher stroke risk, with superior predictive value compared to its components alone, providing a promising indicator that is simple, reliable, and inexpensive for identifying stroke risk in clinical practice. Full article

Background: Patients who undergo coronary artery bypass graft (CABG) surgery often experience both physical and psychological challenges in the post-acute phase and thus follow an integrated rehabilitation program. Objective: This study aimed to examine changes in anxiety, depression, physical health, and mental health from admission to discharge and during a follow-up period up to 6 months after discharge. Methods: This study investigated longitudinal trends in the psychological and physical health of 608 patients (aged 65.75 ± 9.03 years, 80% male) undergoing a multidisciplinary rehabilitation program following CABG surgery. Repeated measures linear mixed models were used. Results: Significant reductions in depression (b = −7.30, p < 0.001) and anxiety (b = −2.22, p < 0.001) from admission to discharge were predicted by factors such as age (dep: b = 0.08, p < 0.001), male sex (dep: b = −1.15, p < 0.001), psychological symptoms (depression predicted by anxiety: b = 0.24, p < 0.001; anxiety predicted by depression: b = 1.25, p < 0.001), and the absence of preexisting stress (dep: b = 0.68, p < 0.001; anx: b = 1.68, p < 0.018). During the follow-up period from 45 days to 6 months postdischarge, physical health significantly improved (b = 3.77, p < 0.001), as predicted by age (b = −0.14, p < 0.001), male sex (b = 3.22, p < 0.001), mental health (b = 0.14, p < 0.001), and ejection fraction >35% (b = 3.56, p < 0.05). Discussion: These findings highlight the importance of considering both physical and psychological factors when designing rehabilitation programs for postacute CABG patients. Full article