Search Results (189)

This study examined social and physical environmental exposures, health, and healthcare utilization among children aged 0–12 in urban areas. A population-based cross-sectional design was used, incorporating general practitioners’ data (2018–2019, n = 14,547), and societal and environmental data. Latent class analysis identified three distinct classes based on child and family demographics: ‘Dutch-origin two-parent household’ (n = 7267), ‘households with diverse countries of origin’ (n = 4313), and ‘single-parent household’ (n = 2967). Binary and multinomial logistic regression examined associations with environmental factors and child health outcomes. Children from the Dutch-origin class most often had favorable family demographics, neighborhood conditions, and health outcomes. Children from the diverse countries of origin class most often faced adverse neighborhood conditions, had higher rates of physical or somatic health conditions, and higher healthcare costs. Children from the single-parent class more often had less favorable family demographics, a higher likelihood of mental health problems, more frequent general practitioner visits, and were often in contact with youth care. This study highlights how child and family demographics and social and neighborhood conditions impact child health and healthcare utilization. Future approaches should focus on strategies to build and strengthen family and community resilience and adopt family-centered, context-sensitive interventions. Full article

Even in highly developed countries such as Japan, urban–rural disparities in inclusion and digitalization persist, offering lessons for other nations confronting similar divides. Diversity and inclusion in school environments appear to be associated with children’s well-being. However, few studies have examined how children perceive inclusion in the classroom or how such perceptions—along with digital device use and interpersonal factors—relate to their subjective well-being (SWB). This study broadens the scope of research by incorporating inquisitiveness and generativity, examining these associations among children in rural Japan. A cross-sectional survey was conducted with 2158 elementary and junior high school students in Kochi Prefecture. Students were classified into five diversity-related categories, and multinomial logistic and median regression models were applied to analyze associations with the core outcomes. Notably, two-thirds of the students were classified into the inclusion category. SWB was positively associated with inclusion and negatively with exclusion, while inquisitiveness and generativity were higher among students in the inclusion and differentiation categories. Both traits were positively associated with adult responsiveness, as well as adherence to digital use rules. The findings suggest that inclusive classroom climates and supportive digital practices foster children’s inquisitiveness, generativity, and SWB, although associations are correlational, not causal. Full article

Background: Cardiovascular-kidney-metabolic syndrome (CKM) represents a multisystem condition involving obesity, diabetes, chronic kidney disease, and cardiovascular diseases. Frailty, as measured by the Frailty Index (FI), is linked to adverse outcomes, but its association with CKM severity and mortality remains unclear. This study aimed to evaluate the relationship between frailty status, CKM staging, and mortality risk. Methods: We analysed data from 19,407 adults aged ≥ 45 years from NHANES 1999–2018. Frailty status was assessed using a 49-item Frailty Index (FI) and categorised as robust (FI ≤ 0.08), pre-frail (0.08 < FI < 0.25), or frail (FI ≥ 0.25). CKM was staged from 1 to 4 based on established clinical criteria. Multinomial logistic regression assessed the association between frailty status and CKM staging. Cox proportional hazards models evaluated the associations between frailty status and all-cause, cardiovascular, and non-cardiovascular mortality among CKM patients. Results: A total of 19,407 participants (median [IQR] age: 63.00 [54.00–72.00] years, 50.77% male), with 19,089 CKM patients. Frail individuals exhibited significantly higher odds of being assigned to advanced CKM stages. Over a median follow-up of 8.4 years, 4794 participants died. Kaplan–Meier curves and restricted cubic spline analyses demonstrated a clear gradient in mortality risk across frailty categories. Compared with the robust group, pre-frail and frail individuals had significantly higher risks of all-cause (HR = 1.47 and 2.83, respectively), cardiovascular (HR = 1.71 and 3.78), and non-cardiovascular mortality (HR = 1.40 and 2.57). Conclusions: Frailty status demonstrated a significant association with CKM staging and mortality outcomes. Early identification of frailty may help guide risk stratification and inform tailored interventions for individuals with CKM. Full article

Background/Objectives: Suboptimal gestational weight gain (GWG) has been linked to increased risks of adverse maternal outcomes. Evidence linking diet in pregnancy to GWG remains limited. We assessed relationships between adherence to five dietary patterns (Planetary Health Diet [PHD], Dietary Approaches to Stop Hypertension [DASH], Alternate Mediterranean Diet [AMED], Healthy Eating Index [HEI], and Alternate Healthy Eating Index [AHEI]) and 2009 Institute of Medicine GWG categories. Methods: Women expecting singleton pregnancies participated in the NICHD Fetal Growth Studies and completed a food-frequency questionnaire (FFQ) at 8 to 13 weeks of gestation that captured their baseline diet. Adherence to each dietary pattern was calculated, with higher scores indicating greater adherence. Women were categorized into low, moderate or high adherence to each dietary pattern. Using multinomial logistic regression, we estimated adjusted odds ratios and 95% confidence intervals [OR (95% CIs)] of inadequate or excessive GWG (reference category: adequate), for high vs. low adherence to each dietary pattern. Results: In the full cohort, women with high vs. low adherence to DASH, AMED, HEI, or AHEI (but not PHD) had a 13% to 31% lowered odds of inadequate total GWG [ranging from 0.87 (0.58, 1.31) for AMED to 0.69 (0.48, 0.99) for DASH]. High adherence to DASH or HEI was associated with lower odds of inadequate first-trimester GWG, after correcting for multiple testing [DASH: 0.36 (0.22, 0.61), HEI: 0.49 (0.30, 0.79)]. No significant association was observed between any of the dietary patterns and excessive total and trimester-specific GWG. Conclusions: Greater adherence to several dietary patterns was associated with lowered odds of inadequate GWG. Future studies could characterize these diets objectively by identifying metabolite signatures and examining their associations with GWG. Full article

Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Patient disposition following TBI has been shown to interact with factors such as age, sex, and injury severity to impact clinical outcomes. Discharge home is associated with better functional outcomes and lower mortality, while discharge to rehabilitation or long-term care facilities is linked to greater injury severity, older age, and higher comorbidity burden. The aim of this study was to further correlate clinical outcomes with discharge dispositions in patients with severe TBI. Methods: This is a retrospective study (2020–2023) of dispositions in patients with severe TBI with AIS (head) ≥ 3. We investigated the relationship between patient disposition and a range of clinical variables, using both parametric (ANOVA) and non-parametric (Kruskal–Wallis, Wilcoxon, Van der Waerden, Savage, Kolmogorov–Smirnov, and Cramer–von Mises) statistical tests. Variables significant in univariate analysis were entered into a multinomial logistic regression model, with discharge home as the reference group. Results: In a cohort of 824 patients, 25.1% were female (n = 207) and 74.9% were male (n = 617). The mean age was 64.1 years for females and 48.9 years for males. Those admitted for severe TBI were included in our analysis. Most patients were discharged home (52.8%), followed by death (12.4%), inpatient rehab (5.1%), and home with services (5.6%). Significant associations were found between disposition and sex, with both males and females most likely to be discharged home (p = 0.0174), as well as between disposition and injury type (p = 0.0186). Disposition was significantly associated with most major clinical variables: hospital length of stay (HLOS), vent days, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS), with p-values < 0.0001 for ANOVA and non-parametric tests. Longer HLOS and ICULOS were associated with discharge to skilled nursing facilities (SNF) most frequently. Days on mechanical ventilation correlated most strongly with discharge to SNF. Lower GCS scores and higher AIS and ISS scores were linked to death or brain death. Prolonged EDLOS was predominantly associated with psychiatric admissions. Higher levels of ETOH were associated with discharge to police custody, followed by homelessness. Conclusions: Our study supports existing evidence that discharge disposition following severe TBI is influenced by several factors, such as injury severity, age, sex, and clinical variables, such as length of stay and ventilator days. Full article

Background/Objectives: Physical activity (PA) is widely recognized as a beneficial approach to improving the health-related quality of life (HRQoL) of breast cancer survivors. This study explored key research topics and emerging trends in studies related to PA and HRQoL among breast cancer survivors. Methods: Titles and abstracts of 3847 English-language research articles (2000–2024) were retrieved from PubMed, EMBASE, Web of Science, and Scopus using keywords related to ‘breast cancer’, ‘PA/exercise’, and ‘HRQoL’. A text-mining algorithm based on the Dirichlet-multinomial regression approach in Python was applied to identify the top 10 research topics and their trends over time. Results: In total, 10 key topics emerged: (1) Quality of Life and Well-being, (2) Cancer Treatment and Health-Related Fitness, (3) Supportive Care and Psychosocial Factors, (4) Survivorship, Palliative Care, and Integrative Medicine, (5) Physical Activity and Sedentary Behaviors, (6) Upper Limb-Related Side Effects, (7) Cancer-Related Fatigue and Symptoms, (8) Epidemiological and Clinical Factors, (9) Side Effects of Cancer Treatment, and (10) Weight Management. Among these, Topics 1, 2, 3, 8, and 9 followed upward trajectories, while others showed relatively stable trends. Conclusions: Findings highlight that PA research on breast cancer survivors’ HRQoL spans all stages of survivorship and considers both clinical outcomes and psychosocial and emotional well-being. Understanding how PA and HRQoL have been represented in research helps clarify which survivor needs have received attention and which remain underexplored. These thematic patterns underscore growing acknowledgement of survivors’ lived experiences and offer a roadmap for addressing future research and care gaps. Full article

Background/Objectives: Adherence to oral endocrine therapy (OET) is essential to reduce recurrence but is predominantly lower among underserved patients, leading to worse health outcomes. We aimed to depict longitudinal patterns of OET adherence using group-based trajectory modeling (GBTM) and identify predictors associated with each adherence trajectory. Methods: A single-center, retrospective study was conducted to analyze data from women 18 years or older with metastatic breast cancer who initiated with an OET and were treated from January to December 2022. Adherence was measured using a proportion of days covered (PDC > 80%) for 12 months. Binary monthly indicator of PDC was incorporated into GBTM. Four models were generated by changing the number of groups from 2 to 5, using a 2nd-order polynomial function of time. A multinomial logistic regression model was run to evaluate the predictors of non-adherence trajectories, and “adherence” was considered the reference group. Results: A total of 346 women had a (mean age of 60) years; 93% were Hispanic or of Mexican origin; 90% were taking aromatase inhibitors (AIs), with an endocrine therapy of 1.05 years. Three trajectories of adherence to GBTM were identified: a gradual decline in adherence (n = 88, 25.5%), improving suboptimal adherence (n = 106, 30.6%), and adherent (n = 152, 43.9%). Multinomial logistic regression analysis showed that significant predictors are diabetes (odds ratio (OR), 2.96; 95% confidence interval (CI), 1.57–5.57) and fewer years of therapy (OR, 2.96; 95% CI, 1.57–5.57). Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Conclusions: Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Significant predictors should be considered when designing targeted interventions. Full article

Approaches to writing play an important role in both the writing processes and outcomes. However, little is known about whether L2 writers adopt different combinations of approaches in academic writing contexts and what factors predict such combinations. Hence, this study aimed to identify different profiles of approaches to writing in an L2 academic context and examine how they are predicted by writing self-efficacy and large language model (LLM) acceptance. To this end, a total of 578 Chinese graduate students were recruited to participate in the study. Latent profile analysis revealed three distinct writing profiles: unorganized (Profile 1), dissonant (Profile 2), and deep and organized (Profile 3), with the majority of students categorized under the dissonant profile. Additionally, multinomial logistic regression analysis revealed that writing self-efficacy positively predicted profile membership, with the strongest effect observed for Profile 3, followed by Profile 2 and then Profile 1. LLM acceptance also positively predicted profile membership, with the strongest effect for Profile 2, followed by Profile 3 and then Profile 1. Full article

Approximately 10% of the US Black diaspora were born either in Latin America and the Caribbean (LAC) or Sub-Saharan Africa (SSA), projected to account for a third of the Black US diaspora by 2060. Yet, details on foreign-born Black women’s labor and delivery (L&D) characteristics, such as the type of birth attendant, remain scarce. We used the National Center for Health Statistics 2016 to 2020 Natality data (n = 2,041,880). The associations between detailed maternal nativity (DMN) and the type of attendant at birth (i.e., physician, certified nurse-midwife (CNM), certified professional midwife (CPM)) among US-born, LAC-born, and SSA-born Black women were examined using multivariate multinomial regression. The study revealed that LAC-born women were more likely to have a CNM during birth than US-born Black women, but Haitian-born and Jamaican-born women had lower odds of having a certified professional midwife (CPM) at birth. When compared to US-born Black women, Cameroonian-born women had decreased odds of having either a CNM or CPM during birth. Findings suggest that DMN could be an indicator of cultural preferences in maternity care. There is a need for further investigation beyond DMN and comprehensive data collection methods for future research to understand the specific needs and preferences of different ethnocultural groups to improve maternity care and prevent adverse maternal health outcomes. Full article

Background: Patients with obesity seeking bariatric surgery often display high rates of depressive symptoms, which are linked to worse clinical and surgical outcomes. A comprehensive evaluation of depression-related features in this population is lacking. Therefore, this study investigated clinical and psychopathological factors associated with depressive symptoms’ severity in 946 outpatients with obesity undergoing pre-surgical evaluation. Methods: The sample (45.1 ± 12 years) was subdivided according to Patient Health Questionnaire-9 (PHQ-9) into ‘absent’, ‘mild’, and ‘moderate-to-severe depression’ groups, which were compared for sociodemographic characteristics, childhood trauma, and emotional dysregulation. Assessments included the Childhood Trauma Questionnaire-Short-Form (CTQ-SF) and Difficulties in Emotion Regulation Scales (DERS). Inflammatory levels were evaluated through the Systemic Immune-inflammatory Index (SII). Multinomial logistic regression and correlations were performed to evaluate predictors of depression severity and their interrelationship. Results: Beyond sociodemographic and clinical differences, patients with moderate-to-severe depression displayed higher childhood trauma, emotional dysregulation, and inflammatory levels. Logistic regression with 95% confidence intervals showed that higher CTQ-SF scores were significantly associated with moderate-to-severe vs. absent depression (p = 0.005, 95% CI: 1.02–1.09), while elevated DERS scores were a risk factor for both moderate-to-severe vs. mild (p < 0.001, 95% CI: 1.04–1.11) and vs. absent depression (p < 0.001, 95% CI: 1.11–1.18). Additionally, PHQ-9 was significantly correlated with CTQ-SF, DERS, and SII. Conclusions: A worse clinical picture was observed in patients with moderate-to-severe depression, and significant interactions were found between psychopathology and inflammatory indexes. Emotional dysregulation was primarily associated with depression severity. These preliminary results support the implementation of rigorous pre-operative screening to identify and deliver targeted psychotherapeutic/pharmacological interventions aimed at improving clinical and post-surgical outcomes. Full article

Background/Objectives: Hepatic clearance is important in determining clinical drug administration strategies. Achieving accurate hepatic clearance predictions through in vitro-to-in vivo extrapolation (IVIVE) relies on appropriate model selection, which is a critical step. Although numerous models have been developed to estimate drug dosage, some may fail to predict liver drug clearance owing to inappropriate hepatic clearance models during IVIVE. To address this limitation, an in silico-based model selection approach for optimizing hepatic clearance predictions was introduced in a previous study. The current study extends this strategy by verifying the accuracy of the selected models using ex situ experimental data, particularly for drugs whose model choices are influenced by protein binding. Methods: Commonly prescribed drugs were classified according to their hepatic extraction ratios and protein-binding properties. Building on previous studies that employed multinomial logistic regression analysis for model selection, a three-phase classification method was implemented to identify five representative drugs: diazepam, diclofenac, rosuvastatin, fluoxetine, and tolbutamide. Subsequently, an isolated perfused rat liver (IPRL) system was used to evaluate the accuracy of the in silico method. Results: As the unbound fraction increased for diazepam and diclofenac, the most suitable predictive model shifted from the initially preferred well-stirred model (WSM) to the modified well-stirred model (MWSM). For rosuvastatin, the MWSM provided a more accurate prediction. These three capacity-limited, binding-sensitive drugs conformed to the outcomes predicted by the multinomial logistic regression analysis. Fluoxetine was best described by the WSM, which is consistent with its flow-limited classification. For tolbutamide, a representative capacity-limited, binding-insensitive drug, no significant differences were observed among the various models. Conclusions: These findings demonstrate the accuracy of an in silico-based model selection approach for predicting liver metabolism and highlight its potential for guiding dosage adjustments. Furthermore, the IPRL system serves as a practical tool for validating the accuracy of the results derived from this approach. Full article

Background/Objectives: To determine if the results of cytogenetic analyses of choroidal melanoma biopsies after ruthenium-106 plaque brachytherapy (RPB) are affected by this procedure. Methods: A retrospective study was conducted on 368 patients with choroidal melanoma treated with RPB who underwent cytogenetic testing at the Liverpool Ocular Oncology Centre (LOOC) between May 2012 and November 2024. Data on demographics, tumor characteristics, treatment date, biopsy timing (pre- or post-RPB), and cytogenetic results were extracted from the LOOC database. Statistical analysis included descriptive statistics, binary, and multinomial logistic regression to assess associations between biopsy timing and biopsy success rates. Results: Biopsies were performed before RPB in 58.7% (216/368) cases, and post-PBR in 41.3%. Cytomorphological identification and molecular genetic testing were successful in 96.4% and 85.1% cases, respectively. Timing of biopsy, patient demographics, and tumor characteristics did not significantly influence cytogenetic test outcomes. Molecular testing could not be performed on 6.8% (25/368) cases as the DNA was insufficient in these samples. Genetic testing success slightly declined beyond three months post-RPB, though a few cases had delayed biopsy (n = 8). Pre-RPB biopsies more frequently demonstrated monosomy 3, whereas post-RPB biopsies had higher rates of disomy 3 (χ², p < 0.05). Conclusions: Prognostic biopsies post-RPB provide reliable cytomorphological and molecular genetic results using MLPA or MSA. Test failure is not significantly influenced by biopsy timing, patient or tumor characteristics, biopsy modality, or genetic technique. Insufficient DNA yield remains a key limitation, emphasizing the importance of obtaining adequate tissue samples. Biopsies within three months are preferable to optimize success in molecular testing. Full article

China has effectively safeguarded biodiversity by building the world’s largest system of nature reserves, but the livelihoods of farmers near the reserves are often not guaranteed. This paper aimed to deeply explore the intrinsic relationship between the geographical location of households and their livelihood outcomes within seven nature reserves across three provinces in China. Innovatively, this study subdivided households’ livelihood outcomes into four patterns: high well-being with high dependency (H-H), high well-being with low dependency (H-L), low well-being with high dependency (L-H), and low well-being with low dependency (L-L), in order to comprehensively analyze the diversity of households’ livelihoods and further reveal the spatial logic and mechanisms underlying regional development imbalances. Methodologically, a combination of quantitative analysis and qualitative research was adopted. Representative villages in the protected area and outside the protected area were selected for semi-structured interviews with the village heads. Meanwhile, farmers were randomly selected in the villages for structured interviews and 1106 questionnaires were collected. Through variance analysis, the study first identified the unique advantages of H-H-pattern households in natural resource utilization. Subsequently, a multinomial logistic model was used to deeply analyze how geographical location (including whether a household was located within a protected area and the distance to markets) affected the transition mechanisms of the other three livelihood outcomes towards the H-H pattern. Based on this, marginal effect analysis was employed to further delineate the specific influence pathways of geographical factor changes on households’ livelihood outcome selection probabilities. The results showed that the geographical location of households’ residences had a significant impact on their livelihood outcomes. For households in the L-L and H-L patterns, proximity to markets could significantly increase the probability of their livelihood transitioning to the H-H pattern. Meanwhile, residing within protected areas significantly promoted the transition of L-L and H-L households to the H-H pattern but showed a certain inhibitory effect on L-H households. Marginal effects analysis further shows that both living in protected areas and reducing distance to markets increase the tendency of households to be highly dependent on natural resources for livelihood outcomes. Compensation policies should be designed according to local conditions, and subsidies for the development of ecotourism and other service industries should be increased for rural households in protected areas to ensure sustainable development rather than transfer payments. Full article

Background/Objectives: Breastfeeding has been positively associated with development of various developmental and cognitive outcomes. Although not fully understood, psychosocial, environmental, nutrients (docosahexaenoic acid) etc., have been proposed as reasons. There is a paucity of studies that have looked at individual language milestones and language milestones associated with school readiness in the age group of 3–5 years old in a nationally representative sample. This study aimed to analyze the language milestones association with breastfeeding in this group of children. Methods: The dataset was obtained from the National Survey of Child Health (NSCH) 2022–2023 combined sample. Overall, 22,866 children met the inclusion criteria. Secondary analysis of the NCSCH data was done using multinomial regression models amongst four breastfeeding categories (never breastfed, breastfed less than 6 months, breastfed until 6 months but not exclusively, exclusive breastfeeding) with 16 language variables. Results: The results of the study show that children in the breastfeeding categories (breastfed until 6 months but not exclusively and exclusive breastfeeding until 6 months) had a positive association across many language variables including variables used to analyze school readiness. Individual language variables’ adjusted odds ratio and significance has been analyzed. The reference category was never breastfed. Conclusions: The study results support positive association of breastfeeding with language variables. Per our review, limited research has been reported where so many individual language variables have been analyzed in a nationally representative sample across four different breastfeeding categories. Full article

We investigate what drives small and medium-sized enterprises (SMEs) in the Alps–Adriatic macro-region to offer green products and services. A sample of 2305 SMEs from Flash Eurobarometer 498 is analyzed with a multinomial logit model that distinguishes firms that already offer green products/services, those planning to do so within two years, and those with no such intention. SMEs implementing ≥ 5 resource-efficiency actions are 75% more likely to offer green products/services (RRR = 1.75, p < 0.05). An increase in the share of green jobs to >30% of staff triples that likelihood (RRR = 3.65, p < 0.01). Selling only services reduces the probability by 17%. Country dummies show Austria and Slovenia as early movers, while Croatia lags. This is the first study to apply a three-outcome model to green market activity in this macroregion, thus revealing nonlinear and country-specific patterns that a binary approach would mask. This study has multiple implications for entrepreneurial practice: (i) entrepreneurs should focus on high-leverage resource-efficiency bundles (energy, waste, circular design) rather than single actions; (ii) policymakers should combine financial incentives with green-skills vouchers to accelerate adoption in service-oriented SMEs. Full article