Search Results (6,932)

Background: Gaming is a common leisure activity among university students, a life stage marked by late adolescence and emerging adulthood, when digital habits and psychosocial outcomes are still developing. However, gaming behaviors and motivations differ by gender, making it important to understand these variations to identify trends and potential risks linked to excessive use. This study examines whether gender is associated with differences in gaming habits, motivations, and perceived toxicity within a sample of Italian university gamers. Methods: A total of 394 participants (M = 22.8 years, SD = 3.6; 58% male) who actively played video games completed an online questionnaire on sociodemographic and gaming variables. Data were analyzed using t-tests and linear discriminant analysis. Results: Results showed gender differences in age of gaming onset, weekly gaming time, perceived toxicity, and motivations such as violent gratification, cognitive challenge, coping, and social interaction. However, discriminant analysis identified weekly gaming hours, violent gratification, and age as key differentiating factors, but the model accounted for a limited proportion of between-group variability. Conclusions: These findings suggest that gender accounts for a limited proportion of variability, indicating a trend toward gender parity in the analyzed gaming variables. Full article

Introduction: Verbal fluency (VF) is a neuropsychological measure sensitive to lexical–semantic organization and prefrontal circuits. Its link with social cognition—specifically with the recognition of mental states from the eyes—remains scarcely explored in Latin American contexts. Objective: To examine the association between performance on the Verbal Fluency Test (phonological and semantic) and mental-state recognition, as measured by the Reading the Mind in the Eyes Test (RMET) in Ecuadorian adults, controlling for sociodemographic variables. Method: A cross-sectional correlational study with 397 healthy adults (Mage = 36.8 years, SD = 11.5; range: 18–83; 219 women, 178 men) assessed in Quito, Ecuador, using the multidomain ECUACOG neuropsychological battery. Pearson’s correlations with 95% CIs, Spearman’s correlations, the Kolmogorov–Smirnov test, one-way ANOVA with η², Tukey’s HSD post hoc comparisons, and simple linear regressions were computed. Results: Total VF was significantly associated with RMET score (r = 0.227, 95% CI [0.131, 0.319], p < 0.001, N = 390). Semantic VF showed a higher correlation than phonological VF (r = 0.239, 95% CI [0.144, 0.331] vs. r = 0.163, 95% CI [0.065, 0.258]; Steiger’s Z = 1.86, p = 0.063, non-significant trend). Educational level was associated with both VF (semantic VF: η² = 0.093, p < 0.001) and RMET (η² = 0.045, p < 0.001) scores. The semantic VF–RMET association remained significant after statistically controlling for TMT-B and for educational level (partial r = 0.202, p < 0.001). Conclusions: Lexical–semantic richness is significantly associated with mental-state recognition in Ecuadorian adults. These findings contribute to the generation of neuropsychological normative data in Ecuador. Full article

Background/Objectives: Vitrectomy with gas tamponade is the standard treatment for idiopathic macular hole (MH); however, prolonged facedown positioning (FD) and delayed postoperative assessment of MH closure may increase patient burden. This study aimed to evaluate the anatomical and functional outcomes of vitrectomy with 50% fluid–air exchange for idiopathic MH, with particular emphasis on the feasibility of early postoperative OCT assessment and individualized postoperative management. Methods: This retrospective study included 22 eyes from 19 patients who underwent 27-gauge pars plana vitrectomy with internal limiting membrane peeling and 50% fluid–air exchange for idiopathic MH between April 2019 and January 2025. MH closure was evaluated postoperatively using spectral-domain optical coherence tomography (OCT), and FD was discontinued once closure was confirmed. The primary outcome was the MH closure rate. Secondary outcomes included time to closure, changes in best-corrected visual acuity (BCVA), and complications. Results: Primary MH closure was achieved in 20 of 22 eyes (90.9%). The mean time to closure was 1.7 days, and closure was confirmed on postoperative day 1 in 14 eyes (64%). MH status was successfully evaluated using conventional SD-OCT in all 22 eyes (100%), and no eye required swept-source OCT imaging. Two eyes required reoperation with complete fluid–air exchange, after which both achieved closure. Mean BCVA improved significantly from 0.45 ± 0.30 logMAR preoperatively to 0.15 ± 0.31 logMAR postoperatively (p < 0.001). No severe intraoperative or postoperative complications, including retinal detachment or endophthalmitis, were observed. Conclusions: Vitrectomy with 50% fluid–air exchange enabled early postoperative assessment of MH status using conventional SD-OCT and facilitated individualized management of facedown positioning. Further prospective comparative studies are warranted to define its role in contemporary MH surgery. Full article

Background/Objectives: The apolipoprotein B to apolipoprotein A1 (ApoB/A1) ratio has been proposed as a marker of cardiovascular risk, but its value for assessing extracranial and intracranial atherosclerosis beyond conventional lipid markers remains uncertain. We evaluated whether the ApoB/A1 ratio improves discrimination of severe atherosclerosis in high-risk statin-naive patients. Methods: We retrospectively included 3416 statin-naive patients who underwent lipid profiling and carotid duplex ultrasonography and/or cerebrovascular imaging between 2014 and 2023. The primary outcome was stenosis severity, categorized as normal, mild (<50% stenosis), or severe (≥50% stenosis, including occlusion), based on clinical imaging reports. Secondary outcomes were carotid plaque score and the number of stenotic intracranial vessels. Associations were assessed using multivariable ordinal logistic regression with 1-SD–standardized lipid markers. Results: The ApoB/A1 ratio was independently associated with greater stenosis severity (adjusted odds ratio 1.24 per 1-SD increase, 95% CI 1.15–1.35; p < 0.0001). Adding ApoB/A1 to a model including clinical covariates, LDL-C, and HDL-C significantly improved discrimination of severe stenosis on every metric examined (continuous NRI +0.142, 95% CI 0.053–0.227; IDI +0.0058, 0.0026–0.0088; likelihood ratio p = 0.0004), although the absolute increase in AUC was modest (0.660 to 0.668; ΔAUC +0.008; DeLong p = 0.026). Associations were consistent for carotid plaque score and intracranial vessel-count outcomes. Conclusions: In high-risk statin-naive patients undergoing carotid or cerebrovascular evaluation, the ApoB/A1 ratio was independently associated with atherosclerosis severity and provided modest incremental discrimination beyond conventional lipid markers. Apolipoprotein assessment may help refine risk stratification in this population. Full article

Aim: To evaluate the real-world effectiveness, durability, and safety of faricimab 6 mg in eyes with treatment-refractory retinal vein occlusion (RVO)-associated macular oedema (MO) in the United Kingdom (UK). Methods: This was a retrospective, single-centre observational study of eyes with RVO that were switched to faricimab after prior treatment with previous anti-vascular endothelial growth factor (anti-VEGF) agents. Baseline demographics, treatment history, pinhole visual acuity (VA), optical coherence tomography (OCT) biomarkers, and injection intervals were recorded. Eyes were treated using a treat-and-extend regimen without a loading phase. Functional, anatomical, durability, and safety outcomes were assessed over follow-up. Results: A total of 22 eyes from 22 patients were included, with a mean (SD) age of 67.9 (11.9) years and a mean (SD) RVO duration of 201.4 (153.1) weeks. Eyes had received a mean (SD) of 20.8 (16.9) prior anti-VEGF injections. The mean (SD) follow-up was 45.7 (15.8) weeks, with a mean (SD) of 5.9 (2.3) faricimab injections. There was no significant change in pinhole VA (53.5 (18.5) vs. 55.0 (18.8) letters, p = 0.08). The central subfield thickness (CST) reduced from 407.6 (102.1) to 377.0 (186.5) µm, and the maximum central retinal thickness from 483.6 (103.1) to 442.2 (187.2) µm, although these changes were not statistically significant (p > 0.05). The proportion of eyes with subretinal fluid (SRF) decreased from 18.2% to 4.5%, and intraretinal fluid (IRF) from 100% to 81.8%. Injection intervals between the first and second faricimab injections increased significantly from 4.9 (1.4) to 7.7 (3.4) weeks (final injection interval, p = 0.004). Six eyes (27.3%) discontinued faricimab, with three (13.6%) requiring an intravitreal dexamethasone implant following a suboptimal response. One eye (4.5%) developed transient intraocular pressure elevation; no cases of intraocular inflammation or endophthalmitis were observed. Conclusions: In this heavily pre-treated, chronic RVO cohort, switching to faricimab without a loading phase resulted in stable visual acuity, modest but non-significant anatomical improvements, and a significant extension in treatment intervals. These findings suggest that faricimab may provide durability benefits and disease stabilisation in treatment-refractory RVO, although functional gains may be limited in chronic disease. Further prospective studies are required to define optimal switching strategies. Full article

Background: Atrial functional mitral regurgitation (AFMR) results from left atrial (LA) remodeling and mitral annular dilation in patients with atrial fibrillation and preserved left ventricular function. While annular dilation is considered the primary mechanism, the role of leaflet morphology in determining regurgitation severity remains incompletely characterized. We hypothesized that leaflet morphology, rather than annular dilation alone, is more strongly correlated with AFMR severity. Methods: We prospectively studied 113 consecutive patients with persistent atrial fibrillation and AFMR who underwent comprehensive three-dimensional transesophageal echocardiography (3D TEE). Mitral valve geometry was analyzed using dedicated software (EchoPAC v.206, 3D MVQ Analysis). Patients were classified according to MR severity: non-significant (grade 0–1) versus moderate or severe (grade 2–3). Logistic regression identified predictors of moderate or severe AFMR. Results: Moderate or severe MR was present in 57 patients (50.4%). Compared with patients with non-significant MR, those with moderate or severe regurgitation exhibited larger annular dimensions (3D annular area 12.7 vs. 11.4 cm², p = 0.005), reduced non-planar angle (145° vs. 149°, p = 0.027), greater leaflet areas, and increased tethering parameters. Anterior leaflet length was markedly greater in the moderate/severe group (2.7 vs. 2.4 cm, p = 0.001). In different multivariable analyses models adjusting for age, sex, LA diameter, and 3D annular area, anterior leaflet length (OR 3.16 per SD, 95% CI 1.65–6.61, p = 0.001), anterior leaflet area (OR 3.42 per SD, 95% CI 1.48–8.74, p = 0.006), and posterior leaflet length (OR 0.39 per SD, 95% CI 0.15–0.86, p = 0.043) remained independently associated with moderate or severe AFMR. ROC analysis demonstrated good discriminative ability for anterior leaflet length (AUC 0.746, with an optimal threshold of 2.55 cm, sensitivity 75%, specificity 68%), and anterior leaflet area (AUC 0.680, and an optimal cut-off value of 5.75 cm², sensitivity 70.2%, specificity of 64.3%). Conclusions: In patients with AFMR, anterior leaflet dimensions assessed by 3D TEE are the strongest independent predictors of moderate or severe regurgitation, outperforming annular parameters. These measurements may represent practical tools for risk stratification and patient selection for intervention. Full article

Information security and anti-counterfeiting are crucial across various industries. To address the limitations of traditional anti-counterfeiting materials, including low responsiveness, easy replication, and poor environmental stability, a fluorescein (Flu) loaded zeolitic imidazolate framework (ZIF-8) photothermal-responsive anti-counterfeiting hydrogel was designed. Flu was first confined within ZIF-8 via a one-pot method and then embedded into a polyacrylamide/lauryl methacrylate (PAM/LMA) network. This hydrogel emits intense green luminescence under 365 nm UV illumination. Its fluorescence can be quenched by Fe³⁺ and recovered upon exposure to PO₄³⁻, which endows the material with rewritable data storage capacity. Sodium dodecyl sulfate (SDS) and sodium chloride (NaCl) in the hydrogel provide a temperature-dependent reversible transparency transition, allowing multi-level information encryption through the synergistic action of temperature, ions, and UV light. In addition, the hydrogel also features low toxicity, degradability, and an environmentally friendly solvent-free synthesis. This work demonstrates a multi-stimuli responsive strategy that overcomes the limitation of traditional single-responsive anti-counterfeiting materials, offering a promising approach for the design of rewritable and eco-friendly intelligent anti-counterfeiting systems and serving as a reference for the development of multifunctional responsive materials. Full article

Background: Abdominal aortic aneurysm (AAA) is typically asymptomatic until rupture, and established risk factors do not fully explain its occurrence. Whether social isolation, loneliness, polygenic susceptibility, and systemic inflammation jointly influence AAA risk remains unclear. Methods: We included 356,181 White British participants from the UK Biobank free of AAA at baseline. Social isolation and loneliness indices were derived from questionnaires. A genome-wide polygenic risk score (PRS) for AAA was constructed using PRS-CS and grouped into tertiles. The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were calculated from baseline blood counts. Incident AAA was identified through linked hospital, primary care, mortality, and self-report records. Cox models estimated hazard ratios (HRs), and mediation analyses quantified the proportion of the social isolation–AAA association explained by inflammatory indices. Results: Over 15.6 years of follow-up, 1727 AAA events occurred. A social isolation index ≥2 was associated with higher AAA risk (HR 1.23; 95% CI 1.05–1.46), and each 1-SD increase corresponded to ~11% higher risk; loneliness was not associated with AAA. Although statistical interactions were non-significant, individuals with both high PRS and high social isolation had fourfold higher risk than those with low PRS and no isolation. SIRI, but not SII, was independently associated with AAA (HR 1.24; 95% CI 1.06–1.46) and mediated ~5% of the association. Conclusions: Social isolation, particularly in genetically susceptible individuals, identifies a population at substantially elevated AAA risk, partly via systemic immune–inflammatory activation, and may represent a modifiable target for prevention. Full article

Objectives: To analyze evolutionary predictors of post-COVID syndrome (PCS). Methods: This Cohort study was conducted from April 2021 to December 2023. PCS persistence was defined as a score of ≥2 points on the post-COVID-19 Functional Status (PCFS) scale (range 0–4, where higher scores indicate more limitations). Symptom clusters were identified using correspondence analysis. The association between PCS persistence and symptoms and symptom clusters were assessed using multivariable analysis, considering both the acute infection period and the baseline PCS visit variables. Results: The 112 included patients showed a mean of 6.1 symptoms (standard deviation [SD] 3.2), most commonly dyspnea (67.9%), asthenia (67.0%), fatigue (57.1%), and myalgia (49.1%). Regarding baseline functional status, 59.8% scored 2 points on the PCFS; 40.2%, 3 points; and 2.6%, 4 points. Moreover, 68.7% had depression and 83.0%, anxiety. Two symptom clusters emerged: anxiety + depression + severe PCFS, and palpitations + hyporexia + dyspnea. At a mean of 12.1 months (SD 9.2), the persistence rate was 33.9% (cumulative persistence time 20 months [SD 11.9]). Persistence was significantly associated with the absence of rhinitis (odds ratio [OR] 3.67, 95% confidence interval [CI] 1.28–10.52) during acute infection, and the presence of fatigue (OR 4.88, 95% CI 1.77–13.44) and depression (moderate: OR 4.28, 95% CI 1.05–17.44; severe: OR 10.31, 95% CI 2.60–40.90) at the baseline visit. The model multivariable demonstrated a good fit (likelihood ratio test 30.1, p < 0.001) and predictive capacity (area under the receiver operating curve 0.804). The anxiety + depression + severe PCFS cluster was significantly associated with persistence (OR 3.26, 95% CI 1.21–8.76; p = 0.012). Conclusions: A third of patients with PCS still experience significant functional impairment 20 months after onset. Persistence is associated with the absence of rhinitis during acute infection and with severe anxiety, depression, and functional impairment measured by the PCFS on detection of PCS. Full article

Background/Objectives: This study aimed to compare the visualization rates of fetal anatomical structures with standard 2D ultrasound examination versus a single 3D volume acquired during the first trimester. Methods: This multicenter prospective study was performed in nine tertiary referral centers, by experienced sonographers. A standard protocol was adopted in both 2D and 3D modalities to assess the 17 anatomical structures listed in the national and international guidelines. The included cases were non-anomalous fetuses from women booked for combined screening test between 11 + 0 and 13 + 6 weeks. Results: Two hundred and thirty-nine women were included in the study. The mean gestational age at ultrasound examination was 12 weeks ± 5 days (±5.4 SD). All the 17 structures were seen in 155/239 fetuses (64.85%) at 2D evaluation and in 84/239 (35.15%) at 3D evaluation (p = 0.001). Comparing 2D and 3D visualization, the following anatomical structures showed a statistical difference: posterior fossa (92% vs. 74%, p < 0.005); neck (94.2% vs. 87.2%, p < 0.001); orbits (93% vs. 85.6%, p < 0.001); nasal bone (93% vs. 88.8%, p = 0.016); lung fields (99.5% vs 96.7%, p = 0.046); cardiac axis (99.5% vs. 83.9%; p < 0.001); bladder (97.5% vs. 91.7%, p < 0.001); abdominal wall (98.7% vs. 94.2%, p < 0.001). For the other anatomical portion, no statistically significant differences were found. Conclusions: Our study demonstrates that a full assessment of fetal anatomy is best performed using 2D ultrasound, while 3D ultrasound showed lower overall visualization rates, with comparable performance for selected structures, suggesting a potential supplementary use in specific clinical contexts. Full article

Background: The global prevalence of anxiety and internalizing disorders in adolescence has increased epidemiologically over the past decade, compounded by the impact of the COVID-19 pandemic and the expansion of digital social networks. Despite the availability of empirically based interventions, their systematic implementation in Spanish educational settings—especially in socioeconomically vulnerable environments—remains insufficient. This study aimed to assess the emotional symptomatology profile in a sample of adolescents enrolled in the 2nd year of Compulsory Secondary Education (CSE) and to describe the changes in symptomatology observed after implementation of a multicomponent intervention program in an ordinary school setting. Methods: a quasi-experimental single-group repeated-measures design was used, with pretest–posttest measurements (T1–T2). The sample included 79 participants (age in completed years: M = 13.28 years, SD = 0.64; range: 12–15; 49.4% female, 44.3% male, 6.3% undisclosed), selected by convenience at IES Estuaria (Huelva). The assessment instrument was the Revised Child Anxiety and Depression Scale (RCADS-47), which measures total anxiety, total internalization, and six clinical subdimensions aligned with DSM-5: generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), separation anxiety (SA), social phobia (SP), and obsessive–compulsive disorder (OCD). The intervention consisted of five multicomponent group workshops (45 min/session; three class groups) integrating emotional psychoeducation, receptive music therapy, cognitive–behavioral emotional regulation, assertive communication, and body expression/mindfulness. Results: At pretest, Social Phobia (SP) showed the highest clinical impairment, significantly affecting more females (66.67%) than males (20.00%). Generalized Anxiety Disorder (GAD) also presented high impairment in females. Significant correlations between pairs of subdimensions revealed a high comorbidity pattern. Following the intervention, reductions in clinically significant levels were observed across all dimensions. Matched-pairs Wilcoxon signed-rank tests confirmed statistically significant score reductions from T1 to T2 in Total Anxiety, Total Internalization, Social Phobia, and Generalized Anxiety Disorder (all p < 0.05), with the largest effect for Social Phobia (r = 0.46); no significant change was detected for Panic Disorder, Separation Anxiety, Major Depressive Disorder, or Obsessive–Compulsive Disorder, although the direction of change favored improvement in all cases. Conclusions: The multicomponent intervention program produced improvements in emotional symptomatology over the short-term follow-up period, although without achieving complete clinical remission in any subdimension. The persistent sex differences—with greater residual impairment in the female group after intervention—underscore the need to incorporate a gender perspective in the design of school emotional health programs. High comorbidity rates between subdimensions support the utility of transdiagnostic approaches. Implications for school nursing practice and future research are discussed. Full article

The healthy development of executive function (EF) skills in childhood and adolescence provides a crucial foundation for later outcomes, from mental and physical health to academic achievement and socio-emotional functioning. Although meta-analyses have identified associations between children’s EF skills and early experiential factors, these are often examined in terms of broad categories (e.g., socioeconomic status) or cumulative risk factors (e.g., adverse childhood experiences; ACEs). The current study leverages longitudinal data (N = 1295) from six cohorts from the Environmental influences on Child Health Outcomes (ECHO) program to identify unique associations among specific prenatal, perinatal, and early life conditions and three specific EF skills (inhibitory control, working memory, and cognitive flexibility) measured later in childhood. Indicators of socioeconomic status, birth outcomes, parental characteristics, and pre- and post-natal exposures to alcohol and tobacco were measured before age 6 years. EF skills and language were measured from ages 6–15 years (M = 9.95, SD = 1.92), using measures from the NIH Toolbox. Two complementary statistical methods, a psychological network approach and regression trees, were employed to disaggregate early predictors of EF development. Results from both methods converged to suggest that specific early conditions showed associations with specific EF skills, and that higher birth weight (independent of pre-term status) was a stronger predictor of better EF skills than other early conditions. Neither approach showed meaningful associations between EF skills and maternal ACEs. Birth weight appears to serve as a particularly sensitive summary index of prenatal influences on EF development. Full article

Pain is highly prevalent during hospitalization, and inadequate assessment contributes to avoidable suffering, prolonged length of stay, and increased resource use. Nurses play a central role in pain assessment, timely analgesic administration, patient education, and escalation of care. Background/Objectives: This study assessed nurses’ knowledge and attitudes regarding pain assessment and management and examined perceived causes of delayed pain treatment and perceived barriers to timely pain control at a tertiary hospital in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted in inpatient and outpatient departments at King Abdulaziz Medical City, Jeddah, Saudi Arabia (August–December 2023). Registered nurses providing direct patient care were recruited via convenience sampling. Data were collected using a demographic and clinical practice questionnaire, the Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP), and an adopted instrument assessing perceived causes of delayed pain treatment and perceived barriers. Data were analyzed using descriptive statistics, two-tailed t-tests, one-way ANOVA with assumption checks and post hoc testing, Pearson correlations, and multiple linear regression. Results: A total of 125 nurses participated; 95.2% were female and 80.8% held a bachelor’s degree. The mean NKASRP composite score was 46.69% (SD = 9.90), indicating a suboptimal knowledge-and-attitudes profile. Age group was significantly associated with NKASRP scores (F = 5.136, p = 0.007), and age remained the only significant independent predictor in the multivariable model (b = 0.055, p = 0.006). The most frequently perceived delay was contacting a physician for opioid prescription (58.4%), followed by obtaining opioids from the pharmacy (46.4%). Major perceived barriers included insufficient staff–patient communication (60.0%), insufficient patient knowledge of pain control (52.8%), and inadequate staffing (49.6%). Conclusions: Nurses demonstrated a low composite knowledge-and-attitudes score and reported communication, workflow, and system-related barriers relevant to timely analgesia. These findings support further prospective evaluation of targeted educational and system-level strategies in similar settings. Full article

Background/Objectives: The quality and safety of care provision have consistently remained central concerns for the management of healthcare organizations worldwide. Nurses’ work environment and occupational behaviors may significantly affect these outcomes. The present study aimed to evaluate the nursing work environment, assess the extent of quiet quitting among nurses, and investigate their impact on the quality and safety of care delivery. Methods: A cross-sectional study was conducted in Greece, and data were collected via an online survey between October and December 2025. Quiet quitting and work environment were measured using the nine-item Quiet Quitting Scale (QQS) and the five-item short form of the Practice Environment Scale of the Nursing Work Index (PES-5), respectively. Multivariable logistic regression analyses were performed using IBM SPSS Statistics 28.0. The level of statistical significance was set at 0.05. Results: The sample included 492 nurses. The overall quiet quitting rating was low to moderate (mean = 2.18, SD = 0.65), and the mean score for the PES-5 was 2.44 (SD = 0.53) indicating a moderate realization of a supportive work environment. More than half of the participants (52.0%, n = 256) rated the quality of care at their unit as good, and 23.6% (n = 116) as fair. Additionally, 33.1% (n = 163) of the nurses described patient safety as good and 28.5% (n = 140) very good. In the multivariable model, lower scores for quiet quitting were significantly associated with higher likelihood of reporting perceived quality of care as good or excellent (adjusted OR = 0.429; 95% CI: 0.310–0.593; p < 0.001) and increased odds of reporting perceived patient safety as good or excellent (adjusted OR = 0.394; 95% CI: 0.281–0.553; p < 0.001). Higher PES-5 scores were linked to more than nine-fold increased odds of reporting good or excellent perceived quality of care (adjusted OR = 9.155; 95% CI: 5.374–15.596; p < 0.001) and an over twenty-fold increase in the odds of reporting good or excellent perceived patient safety (adjusted OR = 22.190; 95% CI: 11.533–42.693; p < 0.001). Conclusions: This study highlighted that low levels of quiet quitting and a more favorable nursing practice environment are important and independent predictors of better perceived quality and safety of care. Full article

Background: Vitamin D has been implicated in several biological pathways involved in atrial remodeling, yet its association with incident atrial fibrillation (AF) remains uncertain across epidemiological studies. Objectives: The objective was to evaluate the association between circulating vitamin D levels and the risk of incident AF through a systematic review and meta-analysis of prospective studies using a harmonized continuous analytical framework. Methods: A systematic review and meta-analysis of prospective cohort studies was performed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using the generic inverse variance method. To improve comparability across studies, effect estimates were harmonized to a common continuous contrast corresponding to a 1-standard-deviation (1-SD) difference in circulating vitamin D levels. Estimates were then oriented such that higher values reflected lower vitamin D status and higher AF risk. Random-effects models were used as the primary analytical approach. Sensitivity analyses included leave-one-out testing and an additional pooled analysis incorporating a threshold-based study after approximate rescaling to the continuous 1-SD framework. Results: Five prospective studies were eligible for quantitative assessment. In the primary continuous harmonized analysis, including the four studies with directly reported or more reliably rescaled continuous estimates, lower vitamin D status was associated with a higher risk of incident AF (HR 1.08, 95% CI 1.05–1.11), with no statistical heterogeneity (I² = 0%). In a sensitivity analysis including the HUNT study after approximation of its threshold-based estimate to the continuous 1-SD framework, the pooled association remained statistically significant (HR 1.08, 95% CI 1.05–1.11), with low heterogeneity (I² = 7%). The direction of effect remained stable across sensitivity analyses. Conclusions: Lower circulating vitamin D levels were associated with a modestly higher risk of incident AF in prospective studies. The most internally consistent quantitative signal emerged from analyses conducted within a common continuous 1-SD framework. Inclusion of a threshold-based study through approximate rescaling did not materially alter the pooled estimate, although this step relied on additional assumptions. These findings support an observational association but do not establish causality or justify vitamin D supplementation specifically for AF prevention. Full article