Search Results (1,403)

Against the backdrop of the growing alignment between green agricultural transformation and rural land system reform, how stable land tenure promotes farmers’ adoption of green production technologies has become an important issue in achieving high-quality agricultural development. Using 2024 survey data from 1117 farm households in Inner Mongolia under China’s second-round land contract extension policy, this study applies Poisson regression and mediation models to examine how land tenure stability affects farmers’ adoption of green production technologies. The results show that legal, factual, and perceived tenure stability, measured by second-round contract extension signing, no land disputes since the second round, and expectations of no future land adjustment, all significantly promote adoption. Tenure stability promotes adoption through higher income, better credit access, stronger benefit expectations, and greater risk-coping capacity, reflecting both economic and psychological effects. Its positive effect is stronger among small-scale farmers and those with lower-quality cultivated land. Policy efforts should not only prudently advance the second-round land contract extension, but also strengthen tenure security in practice and coordinate support for green production, rural finance, and risk protection. From a multidimensional land tenure stability perspective, this study provides new empirical evidence on how rural land reform translates into green behavioral responses. Full article

Background and Objectives: Falls represent a major public health concern among older adults, contributing substantially to morbidity, mortality, and healthcare burden. This study aimed to analyze trends, demographic characteristics, hospitalization rates, injury patterns, and outcomes of fall-related hospitalizations among individuals aged ≥65 years in Split-Dalmatia County, Croatia, from 2020 to 2024. Materials and Methods: A retrospective epidemiological study was conducted using fall-related hospitalization data from the National Health Information System. Discharges for injury (S00-T98) caused by a fall (W00-W19) were selected using ICD-10. Analyses included individuals aged ≥65 years and were stratified by age group (65–74, 75–84, ≥85 years), sex, and year. Hospitalization rates per 100,000 population were calculated using official population data. Differences were assessed using chi-square and Kruskal–Wallis tests, while Poisson regression was used to estimate rate ratios (RRs) with 95% confidence intervals (CIs) and assess temporal trends. Results: A total of 4737 fall-related hospitalizations were recorded among individuals aged ≥65 years (58.32% of all cases). Hospitalization rates increased markedly with age, with individuals aged ≥85 years having more than a fivefold higher rate compared to those aged 65–74 years (RR = 5.16, 95% CI 4.80–5.56). Women accounted for 69.83% of cases and had higher hospitalization rates than men (RR = 1.74, 95% CI 1.64–1.85). Hip and femur injuries were the most common (50.39%). In-hospital mortality was 3.02% and higher among men. No significant temporal trend was observed (AAPC = −2.18%, p = 0.392). Conclusions: Fall-related hospitalizations are strongly associated with advanced age and female sex, with hip fractures predominating. Although rates remained stable over time, ongoing population ageing is likely to increase the future burden. Targeted, age- and sex-specific prevention strategies should be prioritized. Full article

Diabetes mellitus (DM) may influence susceptibility to ocular infection and inflammatory phenotypes; however, disease-specific DM prevalence across uveitis etiologies has not been well characterized. We evaluated DM prevalence across major uveitis entities in a large single-center cohort and compared observed prevalence estimates with age-specific national estimates from Japan. A total of 3163 adult patients out of 4751 patients newly diagnosed with uveitis at the Tokyo Medical University Hospital between 2004 and 2023 were included in the final analysis after excluding patients without DM-related laboratory parameters, those who declined to participate through the institutional opt-out procedure, pediatric patients, and patients with diabetic iritis. DM was defined as an HbA1c level of 6.5% or higher, current treatment for DM, or a random blood glucose level of 200 mg/dL or higher. For reference comparisons with national data, we analyzed seven adult entities with sufficient sample size. For each entity, expected DM prevalence was based on the corresponding national age-stratum estimate according to the mean age category of that entity. Observed and expected DM prevalence estimates were compared using Fisher’s exact test. Multivariable modified Poisson regression with robust variance estimation was used to estimate adjusted prevalence ratios (aPRs) for DM prevalence, including age, sex, and individual uveitis entities as covariates. Overall, 166 of 3163 patients (5.3%) had DM. DM prevalence differed substantially by etiology, ranging from 18.0% in endophthalmitis to 1.8% in Behçet disease. Selected infectious uveitis showed a higher crude prevalence of DM than selected noninfectious uveitis (10.4% vs. 3.8%; p < 0.01). In comparisons with corresponding national age-stratum estimates, the observed prevalence estimates of DM in endophthalmitis and herpetic iritis did not differ significantly from the expected national prevalence estimates, whereas acute retinal necrosis, intraocular lymphoma, sarcoidosis, and Behçet disease showed a significantly lower prevalence than expected. In the multivariable analysis, older age (aPR per 10-year increase, 1.49; 95% CI, 1.33–1.67; p < 0.001) and male sex (aPR, 2.11; 95% CI, 1.40–3.19; p < 0.001) were independently associated with DM prevalence, whereas individual uveitis entities were not significantly associated after adjustment for covariates. DM prevalence in uveitis is heterogeneous and disease-specific. Although selected infectious uveitis showed a higher crude prevalence of DM, comparisons with corresponding national age-stratum estimates suggested that some of the differences reflected the underlying age structure. Older age and male sex were the strongest independent correlates of DM prevalence. Full article

Background: Congenital tooth agenesis is a common dental anomaly in individuals with orofacial clefts and may be related not only to cleft type but also to skeletal growth characteristics. This study aimed to investigate whether the number of congenitally missing permanent teeth is associated with cleft type, sex, and sagittal and vertical skeletal patterns in non-syndromic cleft patients. Materials and Methods: A retrospective cross-sectional analysis was conducted on 60 patients aged ≥17 years (36 males, 24 females; mean age 19.5 ± 1.8 years) with surgically repaired cleft lip and/or palate, based on clinical records collected over a long-term follow-up period. Sagittal (Class I, II, III) and vertical (normal, deep bite, open bite) skeletal patterns were extracted from available orthodontic records based on routine cephalometric assessment. The number of congenitally missing permanent teeth, excluding third molars, was recorded. Statistical analysis included non-parametric tests and Poisson regression. Results: The distribution of missing teeth deviated significantly from normality according to the Shapiro–Wilk test (p < 0.001). In the Poisson regression model, sex (p = 0.011) and cleft type (p < 0.001) were significantly associated with the number of congenitally missing teeth, whereas sagittal skeletal pattern (p = 0.338) and vertical skeletal pattern (p = 0.281) were not significant predictors. Conclusions: In this retrospective record-based analysis, the number of congenitally missing teeth appeared most consistently associated with cleft type, while sex showed a model-dependent association in the adjusted regression analysis. Full article

Background/Objectives: Postoperative pain after robot-assisted gynecologic surgery delays recovery and prolongs hospitalization, yet evidence on the role of ultrasound-guided rectus sheath block (RSB) in this setting is limited. We investigated whether preoperative ultrasound-guided RSB was associated with a shorter length of hospital stay (LOS) after robot-assisted gynecologic surgery. Methods: This single-center retrospective cohort study included 266 consecutive female patients who underwent robot-assisted gynecologic surgery between November 2023 and April 2024. RSB was introduced in January 2024; 113 patients from the RSB-eligible era who received the block and 153 patients before RSB introduction served as the RSB and comparator groups, respectively. The primary outcome was LOS. Secondary outcomes included rescue intravenous fentanyl and rescue antiemetic use in the post-anesthesia care unit (PACU) and rescue analgesic administration on the general ward through postoperative day (POD) 2. Multivariable quasi-Poisson regression was used to adjust for potential confounders. Results: LOS was significantly shorter in the RSB group (median 3 [IQR 3–3] vs. 4 [³,⁴,⁵] days; p < 0.001; adjusted IRR 0.78, 95% CI 0.72–0.85). The RSB group also required less PACU rescue fentanyl (0.86 [0.68–1.38] vs. 1.17 [0.85–1.69] μg/kg; p < 0.001), fewer rescue antiemetics (3.5% vs. 11.8%; p = 0.029), and fewer ward rescue analgesics on POD 0 (52.2% vs. 68.6%; p = 0.009) and POD 1 (13.3% vs. 34.2%; p < 0.001). Conclusions: Preoperative ultrasound-guided RSB was associated with shorter LOS, reduced PACU opioid and antiemetic requirements, and fewer early ward rescue analgesics. Randomized trials are warranted to confirm these benefits. Full article

Background: COVID-19 during pregnancy has been associated with various obstetric complications; however, epidemiological evidence regarding its relationship with hypertensive disorders of pregnancy (HDP) and preterm birth remains inconclusive. Therefore, we aimed to evaluate the association between COVID-19 during pregnancy and the risk of HDP and preterm birth among Mexican pregnant women. Methods: We conducted a retrospective cohort study based on a review of 3710 medical records of women treated at a tertiary hospital between 2020 and 2023. COVID-19 was diagnosed by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. We estimated adjusted risk ratios (aRRs) using robust Poisson regression models, controlling for potential confounders. Results: The COVID-19 rate was 2.5%. We observed that women with COVID-19 had a higher risk of HDP (aRR = 1.59; 95% CI = 1.07–2.36). When HDP subgroups were analyzed separately, COVID-19 was associated with an increased risk of preeclampsia (aRR = 2.04; 95% CI = 1.34–4.20) and preterm birth (aRR = 1.50; 95% CI = 1.02–2.19). The association with gestational hypertension lost statistical significance after adjustment. Conclusions: Our findings suggest that COVID-19 during pregnancy may be associated with hypertensive disorders of pregnancy and preterm birth. However, the observed association with preeclampsia should be interpreted cautiously because diagnostic overlap between severe COVID-19 and preeclampsia cannot be excluded. Full article

Background/Objectives: Adolescent mental health problems have increased in recent years, with growing concern about the impact of digital behaviors such as problematic video game use and gambling. Internet Gaming Disorder (IGD) and Problem Gambling Symptoms may share psychological risk markers, but evidence in Spanish adolescents is limited. This study aimed to examine the relationship between IGD, problem gambling symptoms, and mental health, and to identify sociodemographic, psychological, and behavioral factors associated, including microtransactions and loot boxes. Methods: A cross-sectional study was conducted with secondary education students from Extremadura (Spain). The final sample included 343 participants. Measures included an ad hoc questionnaire on video game use, the IGDS9-SF, SOGS-RA, and the Strengths and Difficulties Questionnaire (SDQ). Descriptive analyses, Spearman correlations, and multivariable regression (Poisson and negative binomial) were performed. Results: IGD and gambling were positively correlated (Spearman’s ρ = 0.386, p < 0.001) and associated with higher mental health difficulty scores (IGD: ρ = 0.299, p < 0.001; gambling: ρ = 0.214, p < 0.001). Male gender was associated with both outcomes (IGD: incidence rate ratio [IRR] = 1.21 [95% Confidence Interval: 1.13–1.30]; gambling: IRR = 2.90 [1.85–4.60]). Microtransactions were associated with both behaviors (IGD: IRR = 1.17 [1.09–1.25]; gambling: IRR = 1.74 [1.19–2.54]), while loot box use was related only to IGD (IRR = 1.13 [1.05–1.21]). Total SDQ score was positively associated with both IGD (IRR = 1.02 [1.02–1.03]) and gambling (IRR = 1.10 [1.06–1.13]). Younger age was associated with higher IGD scores (IRR = 0.97 [0.96–0.99]). Conclusions: There are similarities in the associations among the examined factors and increased scores of IGD and gambling in adolescents, particularly male gender, higher mental health difficulties scores, and involvement in monetized gaming systems. School-based, family, and public health prevention strategies may benefit from addressing the importance of psychological well-being and increase awareness of the potential risks associated with digital gaming practices. Full article

Background/Objectives: Air pollution is associated with many adverse health consequences, including deteriorated kidney function. The aim of the research was to determine the association of medium-term exposure to air pollutants and hospitalizations due to acute kidney injury (AKI). Methods: The retrospective population-based study was conducted on the EP-PARTICLES cohort between 2011 and 2020 (80,000,000 person-years). We estimated municipality-specific associations between air pollution and AKI admissions using generalized additive models with Poisson regression. Results are reported as risk ratio in AKI admissions (RR) with corresponding 95% confidence intervals (95% CI). Results: During the 10-year study period, 47,467 AKI cases were reported (median age 77 years, IQR 68–84; 51.2% women). Mean concentrations of pollutants were 21.4 µg/m³ (SD 5.2) for particulate matter with a diameter of 2.5 μm or less (PM_2.5), 7.5 µg/m³ (1.8) for nitrogen dioxide (NO₂), and 1.8 ng/m³ (0.8) for benzo[a]pyrene (BaP). In mid-term exposure analyses (lag 0–30), each 10 µg/m³ increase in PM_2.5, PM₁₀, NO₂ and CO, and each 1 µg/m³ increase in BaP, was associated with higher AKI risk, with the strongest effect observed for NO₂ (RR 1.066, 95% CI 1.033–1.099). No association was found for SO₂. Subgroup analyses showed consistent directions of association across sex and age groups, with NO₂ remaining the most detrimental pollutant. Although statistical significance varied between pollutants, no significant effect modification by sex or age was observed (p > 0.05). Conclusions: Mid-term exposure to ambient air pollution is associated with an increased risk of AKI-related hospitalizations, with NO₂ showing the strongest effects. These findings identify mid-term exposure as a relevant temporal window and support the role of air pollution as a modifiable risk factor for AKI. Full article

Background: Measles, mumps, rubella (MMR) and varicella vaccines are often co-administered to optimize coverage, yet safety concerns regarding febrile convulsions persist. In South Korea, MMR and varicella vaccines are administered as separate injections during a single visit (MMR + V). This study evaluated the real-world safety of concurrent MMR + V vaccination, focusing on the domestically implemented MAV/06 and Oka-derived strains. Methods: We conducted a multicenter self-controlled case series (SCCS) study of children aged 12–23 months who received MMR + V and hepatitis A vaccine (HAV) between 2015 and 2024. Using electronic health records, we identified predefined adverse events (AEs), including fever and healthcare visits. Adjusted relative risks (aRRs) were estimated using conditional Poisson regression. Results: Among 3035 children (52.3% male; median age, 12 months), 71.7% received the MAV/06 varicella strain. A distinct peak in AEs occurred 7–13 days after MMR + V administration, with fever showing the greatest increase (aRR, 4.27; 95% CI, 2.76–6.60). The risks of total sick visits (aRR, 2.15; 95% CI, 1.70–2.71) and acute care visits (aRR, 2.13; 95% CI, 1.46–3.10) were similarly confined to this interval and returned to baseline thereafter. Febrile convulsions were uncommon (aRR, 5.37; 95% CI, 1.20–24.01). No excess risks were observed during the HAV or overlap periods, and no synergistic effects of intensive multi-vaccine administration were detected. Conclusions: Concurrent administration of MMR and varicella vaccines in Korean infants—predominantly using the MAV/06 strain—was associated only with expected, transient increases in fever during days 7–13 postvaccination. No serious or sustained safety signals were identified, supporting the continued use of Korea’s separate-injection MMR + V strategy. Full article

Background: The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted cancer screening, diagnosis, and care. This phase of the Hungarian Cancer Epidemiology (HUN-CANCER-EPI) study evaluated trends in cancer incidence and mortality in Hungary during the pre-COVID (2011–2019), COVID (2020–2021), and post-COVID (2022–2023) periods. Methods: Nationwide data from the Hungarian National Health Insurance Fund database were analysed. Age- and sex-adjusted incidence and mortality trends from 2011 to 2019 were modeled using Poisson regression. Changes from trends in 2020–2023 were compared to pre-COVID projections with 95% confidence intervals. Results: From 2011 to 2019, age-standardised cancer incidence declined by 1.9% (95% CI: 1.3% to 2.4%) annually in males and by 1.0% (95% CI: 0.6% to 1.4%) in females. During 2020–2021, incidence dropped sharply below the expected: in 2020 (−12.8% in males and −11.8% in females) and in 2021 (−11.7% and −7.9%, respectively). The largest declines affected prostate, melanoma, and kidney cancer. Rapidly progressing tumors like pancreatic and esophageal showed smaller decreases. By 2023, partial incidence rebounds were observed for prostate cancer, kidney cancer, and melanoma, likely reflecting the recovery of pandemic-delayed diagnoses. Lung and liver cancers showed no rebound. The steepest drops were in males aged 70+, with incomplete recovery. Mortality stayed near expected levels overall, with some exceptions, like melanoma, where the rebound in incidence coincided with increased mortality rates in 2023, which may reflect delayed diagnosis, although this cannot be directly confirmed. Conclusions: The pandemic had lasting, cancer-type-specific impacts on incidence patterns, particularly affecting screening-dependent, slow-growing tumors. Mortality remained largely stable overall during the available follow-up, highlighting the need for targeted recovery strategies and strengthened healthcare system resilience. Full article

One of the most widely used regression models for count data is the Conway–Maxwell–Poisson regression model (CMPRM), which often provides a better fit for over- and underdispersed count data than traditional models, such as Poisson regression and negative binomial regression. Parameter estimation in the CMPRM is typically performed using the maximum likelihood estimation (MLE) method. However, when explanatory variables are highly correlated, a phenomenon known as multicollinearity arises, posing a significant challenge to the analysis. Multicollinearity makes it difficult to identify the individual effects of explanatory variables, leading to inflated variances and larger standard errors of the MLEs. To address the issue of multicollinearity, this paper introduces a new class of Liu-type estimators within the CMPRM. The proposed estimators aim to improve the estimation accuracy and reliability of the CMPRM compared with existing biased estimation methods. The efficiency of the proposed estimator is evaluated through theoretical comparisons and Monte Carlo simulation experiments conducted under various conditions. Furthermore, two real-data applications are presented to demonstrate the practical usefulness of the proposed estimation method. The results from the theoretical analysis, simulation study, and empirical applications indicate that the proposed estimators outperform existing methods in terms of achieving more accurate and reliable estimates. Full article

Background: Antimicrobial resistance (AMR) poses an escalating threat to global health, agriculture, and the environment, demanding urgent multisectoral action under the One Health framework. Despite global awareness efforts, understanding of AMR among the general population remains insufficient, particularly in low- and middle-income countries such as Brazil. This study aimed to evaluate the knowledge, attitudes, and perceptions (KAP) of the Brazilian population regarding AMR. Methods: An online questionnaire was distributed through social media platforms between April and August 2025, resulting in 945 valid responses after data cleaning. Quasi-Poisson models were applied to identify demographic predictors of KAP scores while logistic regression models were used to assess the association between KAP scores and antibiotic use-related practices. Results: Education level was the strongest predictor of higher KAP scores, whereas age and gender showed inconsistent influence. Only 40.3% of respondents correctly identified antibiotics among commonly used medicines, and 25.9% reported proper disposal of antibiotic packaging. More than half (54.2%) were willing to pay more for antibiotic-free products, although only 26.7% had ever noticed such labeling. Network analysis of open-ended responses indicated that concerns about potential health risks and AMR awareness were the primary motivators for purchasing antibiotic-free products. Conclusions: These findings reveal significant gaps in public understanding of antibiotic use and resistance in Brazil, emphasizing the urgent need for targeted educational initiatives, improved public communication, and behavioral interventions to support antimicrobial stewardship and sustainable antibiotic use. Full article

Chimeric antigen receptor (CAR) T-cell therapy is a new standard of care for patients with diffuse large B-cell lymphoma (DLBCL); however, studies including healthcare resource utilization (HRU) during routine care are lacking. Accordingly, a population-based study was conducted using linked administrative databases from Ontario, Canada. Patients with DLBCL that failed ≥2 lines of systemic therapy were included. Cox proportional hazard models estimated associations between covariates and overall survival (OS). Logistic, binomial and Poisson regression explored associations between covariates with toxicity and HRU. We identified 308 patients enrolled to receive CAR T-cell therapy of which 255 patients received CAR T-cells (mean age 59 years; 39% female). From the date of CAR T-cell infusion, the median OS was 25.0 months (95% CI, 21.6–28.1 months). Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome data were available for 155 patients and were reported in 135 (87.1%) and 42 (27.1%) patients, respectively. Of those that received CAR-T cells, 172 patients (67%) were hospitalized with a median length of stay of 5 days (IQR, 0–20) and 243 (95%) had an emergency department visit without hospitalization. Our prospective population-based study demonstrates comparable efficacy and safety of CAR T-cell therapy in the real-world to the pivotal trials and highlights this as an efficacious and relatively safe treatment option for patients with DLBCL in routine clinical care. Full article

Background: Type II workplace violence by patients, relatives, or visitors is an occupational health and patient-safety concern in primary care. Cranston Ridge Medical Clinic (CRMC), a single urban family medicine and walk-in primary care clinic in Calgary, Alberta, plans to implement a universal, risk-informed workplace-safety bundle that is based on observable behaviour, situational risk, and documented safety concerns rather than demographic profiling. Methods: This article describes a single-site internal quality improvement and workplace-safety evaluation protocol. The comparison is CRMC usual practice during the pre-implementation baseline period; there is no concurrent external control group. The planned evaluation will use aggregate, de-identified operational data from a 12-month pre-implementation baseline, a four-week implementation period, and 12 months of post-implementation monitoring. All clinic staff will receive workplace-safety training as part of routine implementation. No staff, patients, or visitors will be recruited as research participants, and the evaluation will not use individual-level staff survey, interview, or focus-group data. Patient/visitor information will be used only as aggregate operational monitoring data when needed to assess safety, access, patient flow, and complaints. Intervention and analysis: The bundle includes worksite analysis, staff training, a brief arrival safety screen, a response algorithm, standardized reporting, monthly safety huddles, and post-incident support. The primary metric will be the Type II workplace-violence incident rate per 1000 clinic visits. Planned analyses include run charts, pre–post rate ratios, and Poisson or negative binomial segmented regression if monthly counts are sufficient. Implementation learning will be summarized from routine training records, safety-huddle summaries, post-incident debrief themes, and other aggregate de-identified operational indicators. Expected contribution: The protocol contributes a transparent, equity-sensitive, and operationally feasible model for balancing staff safety with patient access in primary care. Full article

Background: Multiple Myeloma (MM) remains the most common indication for Autologous Stem Cell Transplant (ASCT). ASCT use is disproportionately lower in older adults, Black patients with MM, as well as those living in rural areas and of low socioeconomic status (SES). Low utilization of ASCT is linked to poor outcomes. There are numerous barriers to ASCT access and limited interventions to address disparate outcomes in patients with MM. Methods: This is an ambispective study conducted at a single institution to identify and mitigate barriers to ASCT utilization. In aim one, we retrospectively evaluated ASCT utilization and overall survival (OS) for MM patients accounting for clinical, geographic (Rural Urban Commuting Area—RUCA), and socioeconomic factors (Yost). In aim two, based on the observations of the retrospective study, we conducted a prospective feasibility study to improve access for vulnerable patients with MM (older adults, Black patients, rural and/or Appalachian residence) using a virtual ASCT consultative model with patient navigation, coordinated with local oncology centers. Poisson regression estimated the relative risk of receiving ASCT. OS was calculated from MM diagnosis to the date of death censoring survivors at last contact and analyzed using Kaplan-Meir. Cox proportional hazard models estimated the hazard ratio for risk of death. The multivariable model was built including significant risk factors from the univariable models to estimate the independent effect of each risk factor. Results: Among 1799 patients, median age of diagnosis was 61 (range 17–87), race was self-identified as White (85.6%), Black (13.1%), or other (1.3%) and it was primarily metropolitan (n = 1205, 71.2%) and 1169 (65%) received a transplant. The hazard of death was lower for those who received a transplant (vs. no transplant, HR = 0.63, 95%CI 0.53–0.74, p < 0.001), patients identified as Black (vs. White, HR = 0.66, 95%CI 0.51–0.85, p = 0.001) and higher SES areas (quartile 2–4 vs. quartile 1, HR = 0.69, 95%CI 0.58–0.83, p < 0.001). Prospectively with patient navigation and virtual consultation (n = 35), half of the patients sought virtual consultation, 68% of patients were eligible for transplant, 43% went on to receive ASCT, of which 42% of patients were non-metropolitan and 15% of patients were from an Appalachian county. Using this strategy, no difference was observed in ASCT utilization by age (31% in age > 70 vs. 45% in age 65–70 vs. 78% in age < 65, p = 0.10), geographical area (47% in metro vs. 50% in non-metro, p = 0.99), or race (46% in White vs. 60% in Black, p = 0.66). Conclusions: Implementing patient navigation and virtual transplant consultation can effectively enhance access to ASCT among underserved MM populations while reducing the influence of racial and geographic differences. Full article