Search Results (2,203)

Background: Diabetic retinopathy (DR) is a leading cause of vision-related disability worldwide. Evidence on how clinical and sociodemographic factors jointly shape vision-related quality of life (VRQoL) in Eastern European settings remains limited. Methods: We conducted a cross-sectional study of 151 adults with ophthalmologically confirmed DR attending a tertiary ophthalmology clinic in Northeastern Bulgaria (June 2023–February 2025). Best-corrected visual acuity (BCVA; decimal, better-seeing eye), glycated hemoglobin (HbA1c; ordinal categories), duration of diabetes, age, sex, DR subtype, and education were recorded. VRQoL was assessed using the NEI VFQ-25 questionnaire. Non-parametric tests were applied as appropriate; multiple linear regression identified independent predictors of NEI VFQ-25 composite scores. Results: Median age was 62 years (IQR 12.5); 53.0% were female. NEI VFQ-25 median was 77.2 (IQR 37.8). BCVA correlated positively with VRQoL (Spearman’s ρ = 0.455, p < 0.001). VRQoL differed by educational level (Kruskal–Wallis χ² = 37.3, p < 0.001, ε² = 0.249), but not by sex (Mann–Whitney U = 2740, p = 0.711); a trend was observed across DR subtypes (H = 5.386, p = 0.067). The multivariable model was significant (F(7, 132) = 10.64, p < 0.001; adjusted R² = 0.336). Higher VRQoL was independently associated with better BCVA (B = 35.38, 95% CI 25.81–44.95, p < 0.001), higher educational attainment (B = −10.15, 95% CI from −13.92 to −6.38, p < 0.001; coded such that lower education predicts lower scores), and DR subtype (B = 6.63, 95% CI 1.91–11.36, p = 0.007). Age, sex, HbA1c, and diabetes duration were not significant. Conclusions: In this Bulgarian cohort, functional vision (BCVA), education, and DR subtype are the principal determinants of VRQoL, highlighting the need for patient-centered strategies that integrate clinical and social factors. Full article

In Peru, large-scale migration from the provinces to Lima in the second half of the twentieth century has created a context of intense language and dialect contact. This study examines /s/ variation among migrants from the Andean region, where Quechua, Aymara, and varieties of Andean Spanish—shaped through long-standing contact with these indigenous languages—are spoken. We analyze the speech of 59 participants representing “classic Limeños,” whose families have lived in Lima for several generations, and three generations of Andean migrants, using corpora collected in 1999–2002 and 2012–2013 to trace linguistic change in apparent time. Univariable analyses show significant generational differences: as distance from migration increases, aspiration becomes more frequent and elision declines, while [s] remains relatively stable after the first generation. Multivariable models incorporating migrant generation, family origin, neighborhood, education, and sex reveal that while a combined variable of migrant generation and family origin is significant, neighborhood, education, and sex are stronger predictors. Speakers from established neighborhoods, those with university education, and female speakers favor aspiration and [s], aligning with prestige norms. Mixed-effects logistic regression of linguistic variables confirms structured sociolinguistic change: the following segment is the strongest linguistic predictor, and there is a clear intergenerational shift from elision toward aspiration. However, constraint hierarchies—especially following segment and stress—remain stable, indicating change in rates rather than in linguistic conditioning. Full article

Background/Objectives: Brain metastases (BM) are common in small cell lung cancer (SCLC) and portend poor outcomes. Contemporary determinants of survival in the modern treatment era remain incompletely defined. We evaluated factors associated with overall survival (OS) among patients with SCLC and BM using a recent, nationally representative dataset. Methods: We identified adults diagnosed with SCLC and brain metastases between 2018 and 2020 in the National Cancer Database (NCDB). Demographic, clinical, treatment, and survival data were extracted for analysis. Unadjusted OS was estimated using Kaplan–Meier methods. Multivariable Cox proportional hazards models identified factors associated with mortality, with proportional hazards (PH) assessed using scaled Schoenfeld residuals. Complementary Accelerated Failure Time (AFT) modeling was performed to confirm robustness. Results: Of 62,671 SCLC cases, 11,074 (17.7%) had BM, including 32.6% with brain-only disease. Median overall survival (mOS) was 6.6 months (95% CI, 6.47–6.87); patients with brain-only disease had an mOS of 8.8 months (8.38–9.26), compared with 5.95 months (5.75–6.18) for those with concurrent extracranial metastases. In multivariable analysis, age ≥ 65 years (HR 1.13, p < 0.001) was associated with higher mortality, whereas female sex (HR 0.87, p < 0.001), Black (HR 0.88, p = 0.001), Asian (HR 0.80, p = 0.022), and Hispanic (HR 0.87, p = 0.008) patients had lower hazards. Worse outcomes were associated with public or no insurance, lower income, non-academic facilities, and extracranial metastases; educational attainment was not significant. Proportional hazards assumptions were largely met with minor deviations, and AFT modeling confirmed consistent results. Treatment modality remained independently associated with survival in both models. Conclusions: In this contemporary national cohort, survival among patients with SCLC and brain metastases was influenced by multiple clinical, sociodemographic, and treatment factors, including age, sex, insurance status, facility type, and extent of metastatic disease. Treatment modality remained an independent predictor of survival. These results provide updated real-world benchmarks and highlight the need for prospective studies to define optimal management strategies in this high-risk population. Full article

Background: Vaccine hesitancy and refusal are growing public health challenges, reflecting individual decisions and social inequalities. The COVID-19 pandemic reshaped vaccine perceptions and may have amplified pre-existing differences. This study analyzed the evolution of vaccine hesitancy and refusal among adults in the Community of Madrid (Spain) between 2019 and 2024. We also explored the associated sociodemographic profiles. Methods: A retrospective observational study was conducted using data from the Non-communicable Disease Risk-Factor Surveillance System through a computer-assisted telephone interview (CATI) survey, targeting adults aged 18–64 years. Four waves (2019, 2020, 2021, 2024) were analyzed. Prevalence rates with 95% confidence intervals (95%CI) were calculated. The associations with sociodemographic variables (sex, age, country of birth, education, and employment status) were assessed using Poisson regression models to obtain crude and adjusted prevalence ratios (aPR). Results: A total of 7978 participants were included (49.1% men; mean age 41.97 years). Vaccine hesitancy increased from 3.8% (95% CI: 3.0–4.7) in 2019 to 18.5% (95% CI: 16.8–20.2) in 2024; vaccine refusal increased from 2.1% (95% CI: 1.6–2.8) to 8.0% (95% CI: 6.9–9.3). Vaccine hesitancy and refusal adjusted for socioeconomic variables increased in 2024 compared to 2019 (PRa: 5.04; 95% CI: 3.96–6.41 and aPR: 4.00; 95% CI: 2.86–5.59, respectively). Hesitancy was associated with female sex and middle age in 2019, to middle age in 2020, to intermediate education and migrant origin in 2021, and to education and migrant status in 2024. Vaccine refusal showed a similar pattern to that of vaccine hesitancy, highlighting the association with socioeconomic vulnerability. Conclusion: Between 2019 and 2024, vaccine hesitancy and refusal increased, and the association with socioeconomic vulnerability has also increased. Equity-based vaccination strategies are needed in order to strengthen institutional trust and reduce structural barriers to vaccine acceptance. Full article

Background: We examined the prevalence and correlates of energy drink (ED) consumption in Polish adults using an archival, nationally sourced dataset. Methods: Cross-sectional analysis of 120,000 adults from the archival 2024 National Health Test of Poles (computer-assisted web interview). ED consumption was assessed by frequency and dichotomized for regression (ever vs. never). Multivariable logistic regression estimated adjusted odds ratios (aOR) with 95% confidence intervals; an age cut-off was derived using ROC/Youden. Owing to the cross-sectional design, all estimates are interpreted as associations rather than causal effects. Results: In this national sample, 16.9% of adults reported ever consuming energy drinks, while regular (weekly or more frequent) consumption was rare (2.8%). After multivariable adjustment, the strongest independent correlates of ever consuming an energy drink were an age ≤53 years (aOR 3.80, 95% CI 3.61–4.01), male sex (aOR 3.17, 95% CI 3.03–3.32), frequent fast-food consumption (aOR 2.63, 95% CI 2.51–2.76), and being a current smoker (aOR 2.49, 95% CI 2.23–2.77). In contrast to the initial hypothesis, consumption was not found to be independently associated with education level. A strong, dose-dependent relationship was observed between consumption frequency and an increased prevalence of sleep disturbances, depression, and somatic complaints like headaches and chest pain. Conclusions: Energy drink consumption in Poland is concentrated within a high-risk demographic of young to middle-aged men and is deeply embedded within a cluster of adverse health behaviors. These findings underscore the need for comprehensive public health interventions that address the entire lifestyle pattern, rather than focusing solely on energy drink use. Full article

Background/Objectives: Nowadays, the importance of educating and ensuring communication with patients is also emphasized in groups of patients undergoing anesthesia. The safety and quality of services provided to this group of patients may be related to the information received by them. Therefore, the aim of this review is to explore the patients’ knowledge observed globally and discuss the potential influencing factors. Methods: This review was based on a search of PubMed using MeSH terms and keywords. Additionally, citation searching for relevant articles was performed. Results: The related literature illustrates high heterogeneity among studies with varying results. The knowledge concerning appropriate recognition of anesthesiologists as doctors ranged from 32,8% to 90.5%. However, most studies concluded that patients’ knowledge regarding anesthesia is poor. There was no homogenous pattern regarding the possible impact of age, sex, education, profession or previous anesthesia on patients’ knowledge. Patients’ most common concern was not waking up after anesthesia. The response to patients’ varying knowledge may be the use of educational aids including online alternatives. This approach limits the use of medical resources and may help to alleviate patients’ anxiety. Conclusions: Future studies may focus on a thorough analysis of knowledge in a representable population followed by an observation of aspects shaping the level of education. The precise influence of patients’ education on anesthesia outcomes is yet to be determined. However, further investigation may bring appropriate clinical guidance and help to ensure the best quality of anesthesia services is provided. Full article

Background and Objectives: Unplanned return to the operating room (URTOR) is a sensitive indicator of surgical quality; however, data in neurosurgery are limited. This retrospective study analyzed patients who underwent URTOR following neurosurgical procedures over an eight-year period to define early and late patterns, identify underlying causes, and evaluate the distribution of cases according to surgeon experience. Materials and Methods: Records of 18,258 consecutive surgeries including both elective and emergency procedures in adult and pediatric patients, performed at a single center between 2010 and 2018 were retrospectively reviewed. Unplanned reoperations within 30 days of the index surgery were defined as URTOR; those occurring within ≤7 days were classified as “early,” and those occurring between 8 and 30 days were classified as “late.” Demographic data, surgical characteristics, causes of URTOR, and surgeons’ seniority were examined. Results: Among 18,258 neurosurgical procedures, 324 URTORs (1.8%) were identified. The median patient age was 38 years; 37% were children. Early URTOR comprised 59% and was primarily associated with hemorrhagic–vascular complications, whereas late URTOR accounted for 41% and was dominated by cerebrospinal fluid-related and infectious complications. Late events prevailed in significantly younger cases and were disproportionately followed by ventriculo–peritoneal shunt or endoscopic third ventriculostomy index operations. Junior surgeons performed 74% of later operations requiring URTOR versus 30% of early failures. Sex, weekday/weekend timing, and surgeons’ experience did not affect the overall URTOR classification categories. The median interval was six days. Conclusions: Centers worldwide have begun to examine URTOR rates, which are directly associated with hospital quality measurements. These results may inform targeted education and prevention by identifying patient groups at higher reoperation risk within a specific timeframe. Full article

Comprehensive sex education (CSE) is recognized globally as a key strategy for promoting adolescent well-being and preventing gender-based violence (GBV). Yet, in the United States, the absence of a federal mandate and deep political division results in inconsistent and often inadequate CSE within and across the 50 states. Our review critically examined U.S. sex education policy and programming research literature in relation to GBV prevention. We also conducted a 50-state policy content analysis of sex education requirements, alongside related political trends and overlapping conservative policies. Discussed as, the “politics of sex education,” our findings reveal that states lacking medically accurate CSE also are more likely to support abstinence-only education, restrict discussions of race and gender in secondary educational settings, and adopt laws limiting reproductive and LGBTQ+ rights. We also found that CSE, when culturally responsive, trauma-informed, and medically accurate, can reduce GBV and equip youth with essential skills necessary to understand consent in intimate relationships. Overall, our literature review and policy clustering underscores how educational content is shaped by broader ideological agendas. Findings point to a dearth of research, particularly concerning educational practice in more conservative political contexts. We conclude with recommendations around the need for coordinated policy reform, educator training, and community collaboration to address GBV through evidenced-based CSE. Full article

Background/Objectives: The Test of Gross Motor Development (TGMD-2) totals assume equal weighting of the 12 locomotor (LOC) and object control (OC) skills, yet validation studies indicate differential contributions. The study compared equal- and differential-weighted scores for LOC and OC skills, with three fitness and two physical activity (PA) outputs during guided active play (GAP). Methods: Children’s (n = 82; 7.6 ± 1.5 years) TGMD-2 LOC and OC differential factor weights were estimated with Exploratory Factor Analysis (EFA) and compared to equal weights with multiple linear regression (two, five, and eight predictors) and Chi-square analyses. Predictor variables included fitness, BMI, sex, age stages, and PA assessed by energy expenditure (PAEE) and intensity (MVPA) estimated using accelerometry during 1 h GAP. Results: EFA supported a two-factor structure (variance explained = 51.1%) with ≥0.500 loadings for 9/12 skills. Differential- and equal-weighted LOC and OC scores showed varied contributions from individual skills. Multiple linear regression analysis showed similar explained variances (R²) of 53% (PAEE), 40% (MVPA), 31% (OC), and 14% (LOC) for equal or differential scores with eight predictors. Although β coefficients varied, going from two, five, and eight predictors, the impact of equal and differential weights was comparable. Chi-square analysis indicated high OC associated with MVPA (X² (4) = 9.42, p ≤ 0.05), LP, and STR with PAEE. Conclusions: TGMD-2 outputs with equal- and differential-weighted scores are adequate for clinical/educational use, which show similar relationships with PA and HRF variables. Differential-weighted TGMD-2 scores comprise different contributions of movement skills and may hold promise for intervention studies focused on varied or target tasks and movement abilities. Full article

Background/Objectives: This study aims to investigate the association between health literacy (HL) and stress among family caregivers of older adults with dementia. Methods: Older adults and their caregivers were recruited from the geriatric outpatient memory clinic of an Italian hospital. Caregiver stress was assessed using the General Health Questionnaire-12 items (GHQ-12). HL was measured using the Newest Vital Sign (NVS) and the Short Form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Results: A total of 170 (71% females) caregivers, including spouses and offspring, were included in the analysis. According to the NVS, 53% demonstrated adequate HL, while 83% achieved adequate scores on the S-TOFHLA. The median GHQ-12 score was 15, with 48% presenting a score above 14, indicating higher stress levels; women reported significantly higher GHQ-12 scores than men. In a multivariate linear regression analysis adjusted for sex, education, and number of care tasks provided, the S-TOFHLA score showed a borderline association with the GHQ-12 score (B = −1.45; p = 0.064). When characteristics of the care-recipient were added to the model, the S-TOFHLA score emerged as an independent predictor of the GHQ-12 score (B = −1.41; p = 0.048), along with female caregiver sex and behavioral and psychological symptoms in the care-recipients. Exploratory analysis suggested that the association between HL and stress was present among male but not female caregivers. Conclusions: HL was associated with psychological stress in caregivers of older adults with dementia, with the relationship appearing more pronounced among male caregivers. Full article

Background/Objectives: Relative age differences within the same school year may influence adolescents’ physiological adaptations to physical activity programs. While biological maturity (maturity offset, MO) is often considered a more relevant indicator than chronological age (CA), empirical evidence from school-based interventions remains limited. This study aimed to compare the predictive value of CA and MO in explaining health-related adaptations to an eight-week high-intensity interval training (HIIT) program delivered during physical education classes. Methods: A total of 256 adolescents (112 boys and 144 girls) participated in HIIT protocols integrated into regular lessons. Health-related outcomes included maximal oxygen uptake (VO₂max), body fat percentage (BFP), systolic blood pressure (SBP), and diastolic blood pressure (DBP), assessed at baseline, post-intervention, and follow-up. Maturity offset (MO) was estimated using Moore’s method. Statistical analyses included MANOVA/ANOVA, linear regression, and dominance analysis, all stratified by sex. Results: Chronological age explained more variance in the studied outcomes than MO, particularly for BFP and VO₂max among girls. In boys, a significant CA × MO interaction predicted SBP, indicating interdependence between both age indicators. Dominance analysis confirmed the overall predominance of CA as a predictor across most outcomes. Conclusions: Chronological age proved to be a stronger predictor of adaptation to school-based HIIT than biological maturity, suggesting that calendar age better reflects cumulative behavioral and environmental influences. These findings highlight the need for age-sensitive and personalized approaches when designing physical education interventions to optimize health-related outcomes in adolescents. Full article

Nature-based activities have been linked to psychophysical restoration, but the role of individual baseline conditions in predicting recovery remains unclear. This study examined whether baseline stress levels and mental wellbeing influence psychophysical recovery after an immersive barefooting experience, and whether sociodemographic factors (sex and education) and access to green spaces moderate these effects. A convenience sample of 249 adults (58% female, mean age 45 years) voluntarily participated in a structured barefooting trail in two Italian parks and, after the activity, completed post-experience self-report questionnaires using validated scales (Perceived Stress Scale, Restorative Outcome Scale, and Warwick–Edinburgh Mental Wellbeing Scale). Multivariate logistic regression analyses showed that higher baseline mental wellbeing significantly predicted greater psychophysical recovery, while short-term perceived stress did not. None of the tested interactions with sex, education level, or access to green space were significant. These results suggest that mental wellbeing, rather than recent stress, may be a key factor in maximizing restorative experiences in immersive nature-based activities, and that this effect appears consistent across sociodemographic and environmental contexts. While preliminary, these findings highlight the potential of barefoot walking and similar multisensory activities as low-cost strategies to maintain and enhance psychological wellbeing. Full article

Background/Objectives: Protein-energy wasting (PEW) affects up to 75% of hemodialysis (HD) patients, yet adherence to oral nutritional supplements (ONSs) remains poorly understood. This study evaluated ONS adherence patterns, associated socio-demographic and psychological factors, and clinical outcomes over 24 months in chronic HD patients. Methods: A 24-month prospective study was conducted in 101 HD patients. Adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), and depressive symptoms with the Beck Depression Inventory (BDI). Nutritional status was evaluated using the Malnutrition–Inflammation Score (MIS) and anthropometric measurements. Laboratory markers were obtained. Individualized nutritional education was provided at each visit. Results: Regular ONS use was reported in 50.5% of patients. High adherence (MMAS-4 = 0) was observed in 36.6% of the cohort. Forgetfulness (45.3%) and adverse effects (34.4%) were the most common obstacles. Adherence was significantly associated with sex (p = 0.007), with men more frequently demonstrating low adherence. Education level showed a weak, but significant positive correlation with MMAS-4 score (Spearman’s ρ = 0.25, p = 0.018), indicating slightly lower adherence among more educated patients. MMAS-4 and BDI scores were positively correlated (Spearman’s ρ = 0.25, p = 0.04), indicating that greater depressive symptom burden was associated with lower adherence. Regular ONS users demonstrated improved nutritional status (lower MIS; 9 vs. 7, p < 0.001), higher hemoglobin (106 vs. 114 g/L, p = 0.03), and increased mid-upper arm circumference (MUAC; 26 vs. 28 cm, p = 0.02). Lean tissue mass was preserved over time (p = 0.009). However, individualized education had limited effect on patients with initially low adherence. Individualized nutritional education was associated with improved acceptance and implementation of recommendations. Over two years of follow-up, nutritional education was associated with preserved lean and fat tissue index (LTI, p = 0.009; FTI, p = 0.08), reductions in interdialytic weight gain, and significant improvements in MUAC, waist circumference, and scapular skinfold thickness (p = 0.03; p < 0.001; p = 0.02). Prealbumin and hemoglobin levels also increased significantly (p = 0.02; p = 0.04). However, education alone was insufficient for certain subgroups, particularly older patients and those initially classified as non-adherent. During follow-up, 17 patients died. Lower MUAC (OR = 2.97, 95% CI: 1.45–6.08) and triceps skinfold thickness (OR = 1.37, 95% CI: 1.12–1.68) were the strongest independent predictors of mortality. Conclusions: Adherence to ONSs remains suboptimal in HD patients. Individualized nutritional education was associated with improved adherence and nutritional status in some subgroups but may be insufficient in older or initially non-adherent patients. Simple anthropometric markers are strong mortality predictors and may offer practical value for routine monitoring. Full article

Background: Non-Hodgkin lymphoma (NHL) is a significant public health concern in Ethiopia. However, data on non-infectious risk factors are scarce. Methods: We conducted an age- and sex-matched hospital-based case–control study at two referral hospitals in Ethiopia, enrolling 207 NHL cases and 405 controls. Self-reported occupational, medical, and lifestyle-related exposures were collected via structured interviews. Conditional logistic regression was used to estimate adjusted odds ratios (AOR) and 95% Confidence Intervals (CIs), adjusting for education and residence. Results: NHL cases were predominantly male (64.3%) with the majority diagnosed between ages 36–65. Low-grade NHL was the most common subtype (56.4%). Rural residence (AOR = 2.62, 95% CI: 1.71–4.0) and lower educational level (OR = 2.08, 95%CI: 1.33–3.15) were significantly associated with NHL. Occupational exposures, including gardening (AOR = 1.68, 95% CI: 1.04–2.2), pesticide use (AOR = 2.14, 95% CI: 1.34–3.40), agricultural work (AOR = 1.76, 95% CI: 1.12–2.83), and keeping farm animals within the household (AOR = 2.41, 95% CI: 1.51–3.84) were linked to higher NHL odds. In contrast, smoking (AOR = 0.31, 95% CI: 0.17–0.55) and alcohol consumption (AOR = 0.55, 95% CI: 0.35–0.87) were inversely associated with NHL. A history of infection requiring hospitalization (AOR = 2.12, 95% CI: 1.15–3.96) and tonsillectomy/uvulectomy (AOR = 2.61, 95% CI: 1.19–5.71) were associated with increased NHL odds. Subgroup analysis revealed stronger associations between occupational exposures and high-grade NHL, while low-grade NHL was linked to tonsillectomy/uvulectomy. Conclusions: Occupational, medical, and lifestyle-related factors are associated with NHL risk in Ethiopia. Full article

Background/Objectives: Despite the availability of highly effective medications, hypertension is among the most important risk factors for mortality. Because medication adherence is challenging worldwide, enhancing it to improve the prognosis of hypertension is useful. The aim of this study was to describe the prevalence of antihypertensive medication nonadherence among individuals aged 18–64 years in a deprived Hungarian population and its determinant factors, and to quantify the impact of antihypertensive medication nonadherence on premature mortality. Methods: We used data from a cohort of hypertensive individuals aged 18–64 years linked to the Health Insurance Fund’s medication purchasing data. The antihypertensive treatment adherence appropriateness (ATAP) was computed as the ratio of the observed time when a patient was properly treated to their observed survival time. ATAP was dichotomized by an observed mean of 0.872. Using adjusted odds ratios (AORs) from multivariate logistic regression models with 95% confidence intervals (CIs), we analyzed the factors influencing the mortality risk in 4962 participants over seven years of follow-up. Results: A total of 493 deaths occurred. An extremely high mortality risk was observed among patients with inappropriate adherence (AOR = 56.2, 95%CI: 41.9–75.4), which could be attributed partly to residual confounding. Significant protective factors were female sex and high education attainment. However, older age and all investigated comorbidities (diabetes mellitus, ischemic heart disease, chronic obstructive pulmonary disease, and cancer) were significantly associated with an increased risk of a lethal outcome. Similarly, smoking was also a risk factor. Conclusions: Our investigation revealed the following: (1) in the studied group of patients aged 18–64 years from an extremely disadvantaged Hungarian population, 87.2% of the person-time was covered by the appropriate redemption of medications; (2) nonadherence to medication was more common among younger adults, men, Roma people, current smokers, and COPD patients, whereas the likelihood of appropriate adherence was higher among patients with diabetes mellitus; (3) medication nonadherence was an extremely strong risk factor for a lethal outcome of HTN during the 7-year follow-up period; and (4) methods by which nonadherent patient behavior can be detected should be applied rigorously, and the detected nonadherence should be considered a signal for intervention to improve the prognosis of HTN. Full article