Search Results (3,037)

Objective: Our aim was to investigate the oral health-related quality of life (OHRQoL) and dental care experiences of adults with Cerebral Palsy (CP). Methods: In 2023, adults with CP and their caregivers from four Australian states completed questionnaires, including the Oral Health Impact Profile-14 (OHIP-14). Non-parametric tests were conducted to analyze associations between demographic and CP-related variables and OHRQoL. Results: A total of 69 respondents participated, including n = 22 adults with CP and n = 47 caregivers of adults with CP. Most adults with CP were diagnosed with a spastic motor type (46/69, 66%), with bilateral spasticity being the most common (30/46, 65%). The mean OHIP-14 score was 10.3 ± 9.3 (mean ± SD). Nearly 70% reported challenges cleaning their teeth, over 25% lacked a dentist, more than 60% found dental exams challenging, and nearly 50% required specialized dental care. In bivariate analysis, OHIP-14 was associated with daily oral care routines (p = 0.012) and “simple dental check-up” (p = 0.017). There was a statistically significant relationship between socio-economic status and scores for the handicap dimension (p = 0.040). Higher OHIP-14 scores were associated with greater levels of impairment regarding gross motor (p = 0.199), manual functioning limitations (p = 0.001), speech (p = 0.123), and communication function scales (p = 0.319). Conclusion: Adults with CP reported challenges participating in and maintaining oral health and accessing dental care, influenced by physical, functional, and socio-economic factors. These findings indicate the need for inclusive care and strategies to support access to services. Full article

Background/Objectives: Chronic ulcers represent a major public health concern, being associated with substantial morbidity, impaired quality of life, and significant costs to healthcare systems. Against the backdrop of an aging population and increasing prevalence of chronic comorbid conditions, this study aimed to profile hospitalized patients with chronic ulcers in Romania and to examine their differential patterns of healthcare resource utilization. Methods: We conducted a retrospective analysis of the national administrative hospitalization database between 2017 and 2022, including adult patients with at least two admissions coded with a primary diagnosis of chronic ulcer. Sociodemographic, clinical, and healthcare utilization indicators were extracted, standardized, and analyzed using the K-means clustering algorithm to derive utilization-based phenotypes. Results: Two distinct patient clusters were identified: the first comprised predominantly elderly patients with multiple comorbidities, prolonged hospitalizations, and frequent readmissions, representing a high-burden profile; the second included relatively younger patients with fewer comorbidities, shorter hospital stays, and lower readmission rates, reflecting a more stable clinical profile. The high-burden cluster accounted for a disproportionate share of inpatient resource consumption, underscoring its impact on the healthcare system. Conclusions: These findings highlight the importance of early identification of potential high-burden patients, enabling the implementation of personalized care strategies and more efficient allocation of hospital resources, with the potential to improve health outcomes and support healthcare system sustainability. Full article

This study investigates the factors that influence household trip generation across the United States using the National Household Travel Survey (NHTS) dataset. Recognizing the limits of a one-size-fits-all modeling approach, we conduct a two-stage analysis to investigate spatial heterogeneity within travel behavior. Stage one creates a benchmark analysis, comparing advanced machine learning models (CatBoost and random forest) to a traditional linear regression model. Contrary to prevailing trends in predictive modeling, the results reveal that linear regression not only delivers competitive overall performance but also emerges as the best performing model in the majority of states. Providing optimal balance between predictive accuracy and interpretability. Building on these findings, the second stage applies state specific linear models to uncover geographic differences in trip generation drivers. The findings highlight extensive spatial heterogeneity: while core demographic variables like household size and the presence of young children show consistent effects across the US, the influence of socio-economic factors such as income and vehicle ownership are highly context-dependent and spatially volatile. These findings highlight the importance of moving beyond black box modeling and instead implementing place based, context sensitive techniques in the promotion of more effective and equitable transportation plans. Full article

This research examines the relationship between socio-demographic characteristics of the survivors and their changing social situations after the earthquake and post-traumatic stress disorder (PTSD) and survivor’s guilt. It also examines the mediating role of survivor guilt between early maladaptive schemas and PTSD severity. The study involved 127 people exposed to the 6 February 2023, southern and central Türkiye and northern and western Syria earthquake. Participants’ sociodemographic characteristics, changing living conditions due to the earthquake, and feelings and thoughts of survivor guilt were evaluated with online data forms. Young Schema-Short Form, Post-Traumatic Stress Disorder Symptom Control Checklist, Beck Depression Inventory, and Beck Anxiety Inventory were employed. There was a notable connection between survivor guilt, the pessimism schema, and the PTSD severity. Additionally, changes in the participants’ living conditions especially occurring during posttraumatic periods were associated with survivor guilt and PTSD levels. The mediation analysis indicated that survivor guilt partially mediates the relationship between the pessimism schema and PTSD severity. Focusing on the social conditions of survivors, pessimism schema, and survivor guilt will be beneficial in preventive interventions and treatment approaches for PTSD. Full article

Background/Objectives: Discrimination has wide-ranging implications, affecting patients’ trust in healthcare professionals and their intentions to seek care. It can cause barriers that can affect access to care, especially among racial and ethnic minority groups in mental healthcare settings. Hence, we aim to examine the relationship between racial discrimination and reasons for using telehealth services. Method: Using the 2022 Health Information National Trends Survey (HINTS-6), we isolated 6017 participants who reported on discrimination inquiry. The primary dependent variable in this study is self-reported discrimination in healthcare, while the main independent variable is the reason for the most recent telehealth visit, and several socio-demographic variables were included as covariates, including age, sex, education, income, and marital status. Descriptive statistics were generated, and multivariable regression analysis was estimated as well, with a p-value < 0.05. Results: Non-Hispanic Black individuals had significantly higher odds of reporting discrimination compared to non-Hispanic White individuals (crude OR: 11.85, 95% CI: 7.67–18.309). Similarly, Hispanic individuals (crude OR: 4.626, 95% CI: 2.899–7.384) and individuals of other racial backgrounds (crude OR: 6.883, 95% CI: 4.04–11.729) had significantly increased odds of experiencing discrimination. Conclusions: The findings of this study offer critical insights into the determinants of perceived discrimination within telehealth services. Given the sustained integration of telehealth into healthcare delivery, it is imperative to develop and implement targeted strategies that provide education and resources to promote health equity among Non-Hispanic Black patients. Full article

Background and Objectives: Vitiligo is a chronic autoimmune skin disorder characterized by the loss of pigmentation, resulting in depigmented patches due to the destruction of melanocytes. This condition can lead to considerable psychological distress, and research indicates a possible connection with major depressive disorder (MDD). Nonetheless, the depth and nature of this association, particularly within the Saudi population, have not been thoroughly investigated. This case–control study seeks to explore the relationship between vitiligo and depressive symptomatology, evaluate the severity of depressive symptoms in vitiligo patients compared to control subjects, and examine the association between the clinical severity of vitiligo (assessed using the Vitiligo Area Scoring Index, VASI) and depressive symptoms (measured using the PHQ-9, a validated screening instrument based on DSM criteria). Materials and Methods: A total of 700 participants were included, comprising 340 individuals with vitiligo and 360 controls with other skin conditions. Participants completed a web-based questionnaire that collected sociodemographic data and included the PHQ-9 assessment. The severity of vitiligo was determined using the VASI. Statistical analysis involved using the computer program IBM Statistical Program for Social Sciences (SPSS) (version 26.0). Results: The average PHQ-9 score was significantly higher for patients with vitiligo (8.28 ± 7.36) compared to controls (6.30 ± 4.70, p = 0.028). While the overall rates of mild to severe depression were comparable (41.5% in vitiligo patients versus 40.3% in controls, p = 0.748), vitiligo patients exhibited higher occurrences of moderately severe depression (11.8%) and severe depression (10.9%) compared to controls (5.8% and 0.8%, respectively; p < 0.001). A weak, yet significant, positive correlation was found between VASI and PHQ-9 scores (ρ = 0.184, p < 0.001). The vulgaris and segmental types of vitiligo exhibited the highest median depression scores (PHQ-9: 11 and 9, respectively; p < 0.001). Logistic regression analysis indicated that those with genital vitiligo had greater odds of experiencing depression (OR = 12.10, p = 0.039), while those with universalis vitiligo faced even higher odds (OR ≈ 26,837.84, p = 0.001). Interestingly, higher VASI scores were linked to lower odds of depression (OR = 0.927, p = 0.029). Additionally, the risk of depression significantly increased with higher income levels and among individuals aged 50 years and older. Conclusions: Although the overall prevalence of depression was not significantly different between vitiligo patients and controls, the degree of depressive symptoms was notably more severe in those with vitiligo. Specific clinical subtypes, particularly genital and universalis vitiligo, were found to be more closely associated with an increased risk of depression. These results highlight the importance of regular mental health screenings and customized psychosocial support in dermatological care, especially for high-risk groups. Full article

Background: Adherence to the Mediterranean diet (MD) is associated with improved health outcomes, however limited evidence exists on the socio-demographic and behavioral determinants of MD adherence among university students, a population at risk of developing unhealthy habits during a critical life stage. Methods: A cross-sectional study was conducted among 2697 students (70.6% female) enrolled at a university in Northern Italy. MD adherence was measured using the validated Medi-Lite score. Multivariable logistic and linear regression models were used to identify socio-demographic and behavioral associations with high adherence to the MD (score ≥12). Principal component analysis was performed to explore multivariate patterns across dietary components and participant characteristics. Results: Overall, 25.6% of participants were classified as having high adherence to the MD. Higher adherence was more frequent among women, non-smokers, older students, and those living with their families. Students in health sciences showed greater adherence compared to those in other fields of study. Conversely, frequent users of mobile food ordering applications and smokers were less likely to adhere to the MD. These associations remained consistent after adjusting for age and sex. Conclusions: Adherence to the MD is suboptimal among university students and influenced by socio-demographic and behavioral factors. Targeted interventions should prioritize younger males, smokers, and convenience food users, while promoting sustainability and social support as facilitators of healthier dietary patterns. Full article

Fibrotic diseases contribute to nearly half of all deaths in industrialized countries, yet effective early detection strategies remain lacking, particularly in low-resource settings. This study aimed to quantify the global burden of fibrosis-related diseases using updated global burden of disease (GBD) 2021 data across 204 countries and territories and establish a cost-effective diagnostic approach targeting vestigial-like family member 3 (VGLL3), a fibrosis-associated transcriptional co-regulator. Our analysis revealed that from 1990 to 2021, fibrosis-related disability-adjusted life years (DALYs) and mortality increased by 16.71% and 4.83%, respectively, with neoplasms and chronic obstructive pulmonary disease (COPD) being the main contributors. We also found a growing burden disproportionately concentrated in low socio-demographic index (SDI) regions. To address the diagnostic gap, we developed a novel immunoassay targeting VGLL3, an intrinsically disordered transcriptional co-regulator implicated in early fibrotic remodeling. The assay demonstrated a detection range of 27.01–2512.36 nM and a limit of detection of 12.55 nM. Immunohistochemical validation in a mouse myocardial infarction model confirmed the antibody’s specificity in fibrotic tissues. This work highlights widening global health disparities in fibrosis burden and introduces a cost-effective, scalable diagnostic strategy for early fibrosis detection, particularly suitable for resource-limited settings. Full article

This study investigates the impact of railway transfer penalties on the demographic structure of the Tokyo Metropolitan Area. While previous research has emphasized travel time to the city center as a key determinant of socio-demographic structure, this paper highlights the additional influence of transfer penalties—specifically walking and waiting times—on urban demographic patterns. Using 1 km grids as the unit of analysis, travel time to Tokyo Station is calculated as a measure of accessibility, and the difference in travel time with and without accounting for transfers is defined as the transfer penalty for each grid. The spatial distribution of these penalties is mapped, and their effects on the population are estimated while considering heterogeneity based on distance to the city center. The results indicate that beyond accessibility, higher transfer penalties are associated with lower population densities. Moreover, the negative impact of transfer penalties is observed only in areas located at an intermediate distance from the city center (approximately 26–46 km). Finally, incorporating this spatial heterogeneity, the paper visualizes the projected contribution of transfer penalties to future population distribution. Full article

Background: Weekend presentation to the emergency department (ED) has been associated with increased morbidity and mortality in various clinical settings. However, the literature is scant whether such an effect exists for patients presenting with COVID-19 infection. Additionally, comparative analyses of mortality predictors in COVID-19 patients evaluated at the emergency department need further exploration. Methods: This retrospective cohort study examined factors associated with mortality among adult patients (aged ≥ 18 years) who presented with COVID-19 to the emergency departments of five hospitals within the Johns Hopkins Health System (combined capacity: 2513 beds) between March 1 and 4 May 2020. Data were extracted from electronic health records. Multivariable logistic regression was utilized to assess the relationship between mortality and a range of variables, including sociodemographic characteristics, clinical presentation, laboratory parameters, pre-existing comorbidities, and weekend versus weekday presentation. Results: Of the 2767 patients, 685 (25%) presented to the emergency department on weekends. Compared to weekday presenters, weekend patients were more likely to be hospitalized (64%), and these patients had a mean symptom duration of 5 days (SD ± 6). Weekend presenters also exhibited higher rates of clinical frailty, dehydration, hypoxia, and respiratory distress upon arrival. In multivariable logistic regression analysis adjusting for sociodemographic characteristics, clinical risk factors, and laboratory findings, independent predictors of increased mortality included absence of a primary care provider (OR 3.47; 95% CI: 2.37–5.07), peripheral oxygen saturation (SpO₂) < 95% at presentation (OR 1.46; 95% CI: 1.001–2.12), and hyperglycemia (OR 2.13; 95% CI: 1.25–3.65). Notably, the presence of crackles on physical examination demonstrated a trend toward reduced mortality (OR 0.47; 95% CI: 0.24–0.92). Conclusions: While weekend presentation was associated with higher hospitalization rates among patients with COVID-19, it did not independently predict increased mortality. Absence of a primary care provider, hypoxia, and hyperglycemia at presentation emerged as strong, independent predictors of mortality in the ED setting. Race, gender, and obesity were not significantly associated with mortality in this cohort, warranting further investigation. These findings may support more effective triage and risk stratification strategies in current and future public health emergencies. Full article

Background/Objectives: Anorexia–Cachexia Syndrome (ACS) is a multifactorial condition common in advanced chronic illnesses, leading to significant impacts on prognosis and quality of life. This retrospective cohort study aimed to evaluate the prevalence, management strategies, and clinical and patient-centered outcomes of ACS in a home-based palliative care team. Methods: Clinical records of 128 adult patients followed between 2021 and 2024 were analyzed. Data collected included sociodemographic variables, clinical diagnosis, nutritional parameters (Palliative Performance Scale (PPS), Mini Nutritional Assessment (MNA)), symptoms (anorexia, fatigue), interventions (enteral nutrition, psychological and rehabilitative support), and relevant medications. Statistical analysis included descriptive, inferential, and multivariable proportional hazard regression analysis to identify independent predictors of weight loss and anorexia. Results: Manifestations of ACS were observed across both oncologic and non-oncologic conditions. The prevalence of weight loss and anorexia were interrelated and were not different between diagnostic groups. Using multivariable analysis, higher baseline MNA scores (HR = 3.797, p = 0.006) and the use of enteral nutrition (HR = 7.418, p = 0.014) were independently associated with an increased risk of significant weight loss. Lower baseline PPS scores (HR = 0.069), use of enteral nutrition (HR = −0.890), and the presence of psychological support were protective for subsequent anorexia. Dexamethasone use was associated with greater nutritional decline in univariate models. Conclusions: The management of ACS in home palliative care requires the early identification of symptoms, multidisciplinary intervention, and personalized strategies beyond disease etiology. Risk of weight loss is associated with higher MNA scores, and these are best managed in the first week. In anorexia cases, psychological support is protective. Full article

In Italy, the debate on migrants often focuses on issues such as social integration, economic conditions, and access to services. However, a little-investigated aspect concerns the double stigmatization of LGBTQ+ migrants, a reality made invisible by both the lack of research and the strict anti-LGBTQ+ laws present in many countries of origin. This study aimed to compare homonegativity levels between first- and second-generation migrants. A quantitative approach was used, with 127 participants (age 18–55, M = 30.63, SD = 11.58) completing an anonymous online questionnaire in three different languages. The instrument included a sociodemographic form and the Italian Scale for Measuring Homonegativity. A multivariate General Linear Model (GLM) analysis revealed significant effects of generation (p < 0.001, η² = 0.688) and gender (p < 0.01, η² = 0.144), with second-generation youth and women reporting lower levels of homonegativity. Religious affiliation had a minimal impact, influencing only the perception of deviance towards gay men (p < 0.05). Interactions between factors were generally non-significant, except for gender and religion. These findings underline the importance of generational and gender differences in the formation of homonegativity and highlight the need for further research to explore the cultural and social dynamics influencing these attitudes. In addition, there is a need to further explore how experiences of discrimination influence the well-being of LGBTQ+ migrants and what resilience strategies are adopted to address the challenges of homonegativity and marginalization. Full article

This study examines journalists’ perceptions of the impact of artificial intelligence (AI) on disinformation, a growing concern in journalism due to the rapid expansion of generative AI and its influence on news production and media organizations. Using a quantitative approach, a structured survey was administered to 504 journalists in the Basque Country, identified through official media directories and with the support of the Basque Association of Journalists. This survey, conducted online and via telephone between May and June 2024, included questions on sociodemographic and professional variables, as well as attitudes toward AI’s impact on journalism. The results indicate that a large majority of journalists (89.88%) believe AI will considerably or significantly increase the risks of disinformation, and this perception is consistent across genders and media types, but more pronounced among those with greater professional experience. Statistical analyses reveal a significant association between years of experience and perceived risk, and between AI use and risk perception. The main risks identified are the difficulty in detecting false content and deepfakes, and the risk of obtaining inaccurate or erroneous data. Co-occurrence analysis shows that these risks are often perceived as interconnected. These findings highlight the complex and multifaceted concerns of journalists regarding AI’s role in the information ecosystem. Full article

This study examines the evolution of willingness to accept the monkeypox (Mpox) vaccine in Romania between 2022 and 2025. It explores key sociodemographic and behavioral predictors of vaccine acceptance and investigates how public perceptions—particularly concerning disease severity and conspiracy beliefs—have shifted across two independent cross-sectional samples. Two nationally distributed surveys were conducted in July 2022 (n = 820) and January–February 2025 (n = 1029), targeting Romanian residents aged 18 and above. Data were analyzed using descriptive statistics, Chi-square tests, Kolmogorov–Smirnov tests, and a Random Forest classification model to assess the relative importance of predictors of vaccine acceptance. Between 2022 and 2025, vaccine acceptance increased modestly, particularly among individuals aged 36–65 and those with prior experience of voluntary or COVID-19 vaccination. Random Forest analysis identified behavioral factors as the strongest predictors of acceptance in both years, while the influence of education and gender varied over time. Belief in conspiracy theories slightly declined and lost predictive relevance by 2025. Perceptions of pandemic potential and fear of infection also decreased, suggesting reduced risk salience and possible pandemic fatigue. Despite a slight upward trend, overall Mpox vaccine acceptance in Romania remains among the lowest in Europe. These findings highlight the need for targeted public health communication, particularly toward skeptical or demographically vulnerable groups. Prior vaccination behavior emerged as a key driver of acceptance, indicating that trust-building strategies should capitalize on existing pro-vaccination habits. Future research should adopt qualitative and longitudinal approaches to better capture the evolving psychosocial dynamics of vaccine hesitancy. Full article

Discrimination and harassment (DH) against women are topics of broad concern to gender equality advocates. This study aimed to investigate the prevalence of DH against women in Nigeria, based on seven specific forms of DH captured in the 2021 Nigeria Multiple Indicator Cluster Survey (MICS), and to identify key socio-demographic factors associated with an aggregated DH outcome variable. Drawing upon data from 38,806 women aged 15–49, we used descriptive statistics to summarize the prevalence of DH across seven reasons and the socio-demographic characteristics of respondents, followed by chi-square analysis to test bivariate associations and binary logistic regression to identify predictors. Results showed that the prevalence of DH against Nigerian women (18.9%) was significantly associated with socio-demographic factors such as age, education level, wealth index, marital status, and ethnicity. At the individual level, women who felt very unhappy had higher odds of experiencing DH (OR = 3.101, 95% CI: 2.393–4.018, p < 0.001) compared to those who felt very happy. In contrast, women with higher/tertiary education (OR = 0.686, 95% CI: 0.560–0.842, p < 0.001) were 31.4% less likely to face DH than those with no education. Regionally, respondents living in Zamfara (OR = 5.045, 95% CI: 3.072–8.288, p < 0.001) were over five times more likely to experience DH than those in Kano state. The findings underscore the need for policy interventions and support systems to address DH against women in Nigeria. Full article