Search Results (5,383)

Background: Adjuvant endocrine therapy (AET) enhances survival outcomes in hormone receptor–positive (HR+) breast cancer. However, this treatment is associated with toxicities that may adversely affect the quality of life (QoL) and impact patient–physician communication. A thorough understanding of symptom-reporting behaviors is essential for optimizing survivorship care. Methods: This cross-sectional study surveyed 191 female patients with HR+ breast cancer undergoing adjuvant AET (tamoxifen or aromatase inhibitors ± ovarian function suppression [OFS]) at Antalya Training and Research Hospital between July and August 2025. QoL, symptom burden, and adverse event (AE) reporting behaviors were assessed using validated instruments (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 [EORTC QLQ-C30], adapted Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events [PRO-CTCAE]). Categorical variables were compared using chi-square tests, and multivariate analyses were performed using logistic regression. Results: The median age was 54 years (interquartile range [IQR]: 46–61 years). The following independent variables were identified as predictors of a higher symptom burden: prior chemotherapy (odds ratio [OR]: 3.75; 95% confidence interval [CI]: 1.46–9.69; p = 0.006), OFS use (OR: 3.29; 95% CI: 1.51–7.15; p = 0.003), AE reporting to physicians (OR: 3.52; 95% CI: 1.80–6.88; p < 0.001), and complementary and alternative medicine (CAM) use (OR: 7.27; 95% CI: 1.57–33.63; p = 0.011). Independent predictors of poor QoL included receiving psychological support (OR: 0.36; 95% CI: 0.19–0.67; p = 0.002) and AE reporting (OR: 0.28; 95% CI: 0.13–0.64; p = 0.001). Conclusions: Symptom burden and QoL in patients with HR+ breast cancer receiving AET are influenced by clinical history, including chemotherapy and OFS; behavioral factors, such as reporting behaviors; and supportive care, including CAM and psychological support. The routine integration of patient-reported outcomes and proactive symptom monitoring is crucial for delivering personalized and effective survivorship care. Full article

Background/Objectives: Understanding the seroepidemiology of P. falciparum antibody responses is essential for assessing the acquisition of natural immunity and may guide interventions that impact the acquisition of immunity against malaria in endemic areas. This study assessed the association between antigen-specific IgG responses and protection against P. falciparum infection in children from Burkina Faso. Methods: Children aged 1.5 to 12 years were followed using cross-sectional and longitudinal approaches. IgG responses to 16 P. falciparum antigens were measured using a multiplex assay and analyzed by age group and malaria infection status. Associations between antibody levels and clinical malaria risk were assessed using incidence rate ratios (IRRs), and predictive performance of antibody combinations was evaluated using ROC analysis. Results: IgG responses to AMA1, CSP, and MSP2 CH150 showed weak but significant positive correlation with age. Children aged 5–12 years had higher antibody levels than younger children aged 1.5–5 years. Uninfected children had higher levels of antibodies to EBA181 RIII-V, Rh5.1, and SEA1, while infected children had elevated AMA1 and MSP2 CH150. Anti-GLURP R2 and anti-Rh5.1 antibodies were associated with reduced malaria risk (adjusted IRR = 0.52 and 0.40, respectively). The antibody combination of AMA1, GLURP R2, and Etramp5 Ag1 showed the best predictive performance (AUC = 0.70). Conclusions: This study underlines the value of less-studied antibodies (Etramp5 Ag1, Rh5.1, HSP40 Ag1) for diagnosing and protecting against malaria, opening up prospects for the development of more effective tests and targeted vaccine approaches. The variability of responses according to age and infection status calls for further studies to optimize prevention strategies. Full article

Heartworm disease, caused by Dirofilaria immitis and transmitted by mosquitoes, represents a major veterinary and zoonotic concern. Beyond its recognized cardiopulmonary effects in dogs, increasing evidence suggests that parasite-derived antigens may contribute to allergic disease in humans. Gran Canaria (Canary Islands, Spain) is a hyperendemic region for heartworm disease, offering a unique setting to explore this potential relationship. Therefore, the aim was to analyze the association between canine infection with D. immitis and the occurrence of allergic conditions in their owners on Gran Canaria. This cross-sectional study included 644 dogs and their respective owners. Dogs were tested for circulating D. immitis antigens using a commercial rapid test. Owners provided information on allergy through medical anamnesis. Associations between canine infection status, animal-related variables (age, sex, breed, habitat), and owner-reported allergies (age, sex) were analyzed using chi-square and Fisher’s exact tests with Bonferroni correction. The results showed that 46.4% of dogs tested positive for D. immitis and 43.8% of owners reported allergic diseases. However, 24.64% of dog owners who tested negative for heartworm disease and 65.89% of owners with positive pets reported allergic diseases. In fact, owners of infected dogs exhibited a significantly higher prevalence of allergies compared to those of uninfected dogs. Canine age, sex, breed, and owner demographics were not associated with infection or allergies. However, dog habitat was significantly associated with both outcomes: dogs living indoors had lower infection rates, while owners of infected dogs in mixed indoor–outdoor environments reported the highest rates of allergy. This study provides the first epidemiological evidence of an association between canine heartworm infection and allergies in owners within a hyperendemic European region. The findings suggest that cohabitation with infected dogs may represent a novel risk factor for atopy, reinforcing the importance of integrated preventive measures and highlighting the relevance of a One Health approach. Full article

Food and nutrition services are critical to the health of long-term care home (LTCH) residents, yet little is known about how regulatory inspections detect non-compliance with Food, Nutrition, and Hydration (FNH) standards. We conducted a cross-sectional study of administrative inspection data from all licensed LTCHs in Ontario, Canada. One inspection report was randomly selected per LTCH, yielding a sample of 623 LTCHs. The data were collected for the period spanning 1 January 2024 to 31 December 2024. The primary exposure was use of the FNH inspection protocol, and the outcome was FNH non-compliance, defined as at least one Written Notification or Compliance Order. Statistical analyses included chi-square tests for categorical variables and independent samples t-tests (including Welch’s t-tests where appropriate) for continuous variables, with effect sizes (Φ, Cramer’s V, Cohen’s d) reported to complement p-values. This study did not require research ethics review under Western University policy, consistent with Canada’s Tri-Council Policy Statement (TCPS 2, Article 2.2) regarding use of publicly available data. FNH non-compliance was identified in 12.2% (n = 76) of all LTCHs, and in 43.7% of those using the FNH protocol. Use of the FNH protocol was associated with a higher likelihood of detecting FNH non-compliance compared with other inspection protocols (p < 0.001, Φ = 0.55). LTCH ownership and inspection type were also associated with detection patterns. This exploratory study provides the first province-wide analysis of FNH non-compliance in Ontario LTCHs. Findings suggest that inspection protocols influence detection of FNH issues, underscoring the need for further comparative and qualitative research to understand the organizational factors underlying non-compliance. Full article

There are no studies that have investigated factors influencing the outcome of dressage horses with suspensory ligament (SL) branch injuries. The aim was to determine if age, breed, work level, injury severity, anatomical localisation of injury, number of injured branches, periligamentous fibrosis, persistence of power Doppler signal or coexistent osteoarthritis of a metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joint influenced the prognosis of 70 dressage horses. Outcome was defined as good (return to pre-injury level of work or higher), poor (return to a lower level of work) or retirement. Chi-squared or Fisher’s exact test and the Kruskal–Wallis test were used to identify relationships between variables of interest and follow-up outcome. Follow-up outcome was good in 44/70 horses (62.9%), poor in 13/70 (18.6.%) and 13/70 horses (19.1%) were retired due to no response to treatment. Ultrasonographic lesion grade (p = 0.07), cross-sectional area (CSA) of the SL (p = 0.96), CSA of the lesion (p = 0.28) and the lesion CSA as a percentage of the SL CSA (p = 0.40) were not associated with outcome. Power Doppler signal was present in 75.8% of injured branches at the initial examination. The severity of power Doppler signal was not associated with outcome (p = 0.20); however, persistence of power Doppler signal was negatively associated with outcome (p < 0.001). Other variables did not influence the follow-up outcome. Early recognition of SL branch injury is likely to result in a more favourable outcome with appropriate treatment and management. Full article

Electromagnetic (EM) metamaterials have a wide range of applications due to their unique properties, but their design is often based on specific topological structures, which come with certain limitations. Designing with stochastic topologies can provide more diverse EM properties. However, this requires experienced designers to search and optimise in a vast design space, which is time-consuming and requires substantial computational resources. In this paper, we employ a deep learning network agent model to replace time-consuming full-wave simulations and quickly establish the mapping relationship between the metamaterial structure and its electromagnetic response. The proposed framework integrates a Convolutional Block Attention Module-enhanced Variational Autoencoder (CBAM-VAE) with a Transformer-based predictor. Incorporating CBAM into the VAE architecture significantly enhances the model’s capacity to extract and reconstruct critical structural features of metamaterials. The Transformer predictor utilises an encoder-only configuration that leverages the sequential data characteristics, enabling accurate prediction of electromagnetic responses from latent variables while significantly enhancing computational efficiency. The dataset is randomly generated based on the filling rate of unit cells, requiring only a small fraction of samples compared to the full design space for training. We employ the trained model for the inverse design of metamaterials, enabling the rapid generation of two cells for 1-bit coding metamaterials. Compared to a similarly sized metallic plate, the designed coding metamaterial radar cross-section (RCS) reduces by over 10 dB from 6 to 18 GHz. Simulation and experimental measurement results validate the reliability of this design approach, providing a novel perspective for the design of EM metamaterials. Full article

This study aimed to analyze the attitudes of Toledo University students toward gender and violence, as well as their sexist beliefs, considering different sociodemographic variables, and to examine the associations between these attitudes and the expression of sexism. A descriptive cross-sectional design was employed, which was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The study population consisted of 1176 students who completed an online survey that collected sociodemographic information and incorporated the Questionnaire of Attitudes toward Gender and Violence (CAGV), along with measures of hostile and benevolent sexism derived from the Ambivalent Sexism Inventory (ASI). A descriptive analysis, an inferential analysis and a Pearson correlation were performed for the scores of the two scales used, controlling for the influence of sex and age. Among the participants, 67.1% were women and 32.0% were men. The average age was 20.1 years, with a deviation of 2.2 years, and the age was between 18 and 26 years. This work was carried out in several Faculties of the Campus. The results highlight the significant differences between the groups of men and women in both questionnaires. In general, men have higher scores than women do, so they have higher sexist attitudes and beliefs. The correlations between both questionnaires are significant among all categories. We believe that the data analyzed call for the implementation of action plans to reduce sexist behavior in university students. Universities must establish action plans against gender violence. Full article

Background/Objectives: Cerebral blood flow (CBF) and cerebral blood volume (CBV) are critical perfusion metrics in diagnosing ischemic stroke. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables the evaluation of these cerebral perfusion metrics; however, accurately assessing them remains challenging. This study aimed to: (1) assess CBF asymmetry by quantifying and comparing it between contralateral hemispheres (right vs. left) within the MCA, ACA, and PCA territories using paired t-tests, and describe pattern of CBV; (2) evaluate overall inter-territorial regional variations in CBF across the different cerebral arterial territories (MCA, ACA, PCA), irrespective of the hemisphere, using ANOVA; (3) determine the correlation between CBF and CBV using both Pearson’s and Spearman’s correlation analyses; and (4) assess the influence of age and gender on CBF using multiple regression analysis. Methods: A cross-sectional study of 55 ischemic stroke patients was conducted. DCE-MRI was used to measure CBF and CBV. Paired t-tests compared contralateral hemispheric CBF in MCA, PCA, and ACA, one-way ANOVA assessed overall inter-territorial CBF variations, correlation analyses (Pearson/Spearman) evaluated the CBF-CBV relationship, and linear regression modeled demographic effects. Results: Significant contralateral asymmetries in CBF were observed for each cerebral pair of cerebral arteries using a paired t-test, with descriptive asymmetries noted in CBV. Separately, ANOVA revealed significant overall variability in CBF between the different cerebral arteries, irrespective of hemisphere. A strong positive correlation was found between CBF and CBV (Pearson r = 0.976; Spearman r = 0.928), with multiple regression analysis identifying age and gender as significant predictors of CBF. Conclusions: This study highlights hemispheric asymmetry and inter-territorial variation, the impact of age, and gender on CBF. DCE-MRI provides perfusion metrics that can guide individualized stroke treatment, offering valuable insights for therapeutic planning, particularly in resource-limited settings. Full article

Background/Objectives: Sleep disorders, particularly insomnia, are increasingly recognized as key determinants of mental health. Disturbances in sleep architecture may exacerbate hormonal dysregulation, contributing to menstrual cycle irregularities and premenstrual syndrome (PMS). The study investigate the relationship between insomnia symptoms, menstrual problems, and PMS among nursing students. Methods: The cross-sectional study was conducted using a web-based survey (CAWI) among 72 female graduate nursing students. The questionnaire included questions about menstrual history, the presence of menstrual disorders, PMS symptoms, and lifestyle and body mass index (BMI). Insomnia was assessed using the Polish version of the Athens Insomnia Scale (AIS), taking ≥8 as the cutoff point. Logistic regression analysis with confounding variables was performed. Results: 70% of participants had PMS symptoms, 19.5% had irregular menstrual cycles, and 86.5% reported problems with menstrual bleeding. The mean AIS score was 10.1 (SD = 4.05). Women with insomnia were almost 4 times more likely to experience PMS symptoms (OR = 3.93; 95% CI 1.14–13.59), more than 7 times more likely to experience bleeding problems (OR = 7.56; 95% CI: 1.51–37.97), and each additional AIS score increased the risk of cycle irregularity by 24% (OR = 1.24, 95% CI 1.01–1.50). Conclusions: The findings indicate a significant association between insomnia symptoms, menstrual disturbances, and PMS, underscoring the complex links between sleep, reproductive, and mental health. Preventive interventions, particularly sleep hygiene education, may serve as an effective strategy to support women’s overall health and well-being. Full article

Compassion fatigue is a widely recognized phenomenon in human care settings, but it has been little explored in the veterinary field, despite sharing many of the same determinants. This study aimed to (1) identify distinct emotional risk profiles in veterinarians based on their levels of compassion fatigue and satisfaction; (2) estimate the relative prevalence of compassion fatigue in each of these profiles; and (3) analyze the predictive value of sociodemographic variables (gender, age, cohabitation) on belonging to these profiles. A cross-sectional study was conducted with 135 practising veterinarians. An abbreviated version of the ProQOL scale, adapted to the animal context, was used. Its two-dimensional structure (compassion fatigue and satisfaction) was validated using confirmatory factor analysis. Hierarchical cluster and k-means analyses were performed on the factor scores, which identified four emotional profiles: (1) intense emotional involvement, (2) emotional detachment, (3) functional distancing, and (4) high emotional risk. The latter grouped 23% of the sample, while 50.4% presented significant levels of emotional exhaustion. Finally, an ordinal regression was applied, which showed that being over 44 years of age (OR = 2.11) and living with a partner (OR = 1.94) increase perceived emotional risk, with no significant effects of gender. The findings highlight the need for training initiatives that enhance emotional regulation and communication with animal guardians or owners, while promoting sustainable, ethically responsible, and emotionally healthy professional practice. Full article

Background and Objectives: Speech sound disorders, particularly dislalia (DIS), often stem from multifactorial anatomical, functional, and emotional causes during child development. Early identification of risk factors can improve therapy outcomes and prevent long-term communicative and social impairments. This study aimed to assess the relationship between structural (orofacial anomalies, dental arch morphology, and gonial angle (GA)), emotional, and therapeutic variables as predictors of DIS and its subtypes in children aged 5–12 years. Materials and Methods: A cross-sectional observational study was conducted on 121 pediatric subjects (58 boys; 63 girls; median age 7.5 years) using clinical examination, standardized speech assessments, emotional-behavioral questionnaires, and radiological imaging(GA measurement). Associations between DIS types, TMJ function, anatomical variation, and therapy outcomes were analyzed using chi-square tests (χ²), odds ratios (ORs), and 95% confidence intervals (CIs). Results: Cleft-type (OR = 21.43; p = 0.003), asymmetrical (OR = 14.66; p = 0.004), and crossbite arches (OR = 6.43; p = 0.013) significantly predicted DIS. A GA > 130° and <120° trended toward increased speech and motor dysfunction (OR = 4.67; p = 0.086). Emotional dysregulation (ED) moderately increased the functional temporomandibular joint dysfunction (FTMJD) risk (OR = 2.26; p = 0.060). Early therapy initiation (<7 years) and FTMDJ normalization were consistently associated with superior speech improvement outcomes (OR = 3.10 and 2.40; p < 0.01). Conclusions: DIS is strongly impacted by structural craniofacial anomalies, particularly cleft-type arches and severe jaw angle deviations. Our findings provide evidence that preliminary personalized approaches and emotional regulation may be beneficial for improving treatment outcomes. These exploratory associations support the rationale for interdisciplinary screening in pediatric populations, but confirmation in multicentric and longitudinal studies is needed. Full article

Background: Adolescent mental health is a growing public health concern, with increasing prevalence of anxiety, depression, and emotional dysregulation. While nutrition is a recognized factor in physical health, its role in mental well-being, especially through holistic models, remains underexplored. Objectives: This study examines a moderated mediation model in which perceived healthy eating (self-rated diet quality) was associated with positive mental health (PMH) in adolescents, mediated by stress management and moderated by peer social support. Methods: A cross-sectional study was conducted with a sample of 505 adolescents aged 13 to 15 years (mean age 13.62). Using PROCESS Model 14, we tested a moderated mediation model where perceived nutrition served as the predictor, stress management as the mediator, and PMH as the outcome. Peer support was included as a moderator of the mediation pathway. Gender, age, nationality and educational variables were controlled for in the analysis. Results: The model explained 36% of the variance in PMH. Perceived healthy eating was significantly associated with better stress management (B = 0.20, p < 0.001), which in turn was related to higher levels of PMH (B = 6.38, p < 0.001). Peer support played a moderating role between stress management and PMH. Conclusions: These findings underscore the importance of promoting nutritional awareness and adolescents’ self-perception of healthy eating to support both physical and emotional well-being. Interventions should adopt a holistic approach that integrates emotional regulation strategies and leverages peer influence to enhance mental health outcomes. Given the alarming rates of mental health issues in youth, nutrition-based programs that incorporate psychosocial components may offer a promising avenue for prevention and promotion. Full article

Post-traumatic stress disorder (PTSD) is frequently comorbid with persistent depressive disorder (dysthymia), indicating shared neurobiological pathways that influence stress modulation, emotional regulation, and neurohormonal adaptation. This study examines the roles of serum biomarkers—small ubiquitin-like modifier 1 (SUMO1), malondialdehyde (MDA), fractalkine (CX3CL1), and ubiquitin C-terminal hydrolase L1 (UCHL1)—involved in oxidative stress management, neuroimmune regulation, and neuronal proteostasis. In this cross-sectional analysis, biomarker expression was assessed in 92 male trauma-exposed participants aged 19–50 years, divided into three groups: PTSD duration ≤ 5 years (n = 33, median age 34.0 years [IQR 31.0–41.0]), PTSD duration > 5 years (n = 31, median age 36.0 years [IQR 29.5–41.0]), and controls without current or past PTSD (n = 28, median age 33.5 years [IQR 24.3–41.5]). Participants were stratified into younger (19–34 years) and older (35–50 years) cohorts to account for age-related neurobiological variability. Dysthymic symptomatology was evaluated using the Cornell Dysthymia Rating Scale (CDRS), focusing on chronic subthreshold depressive features. Results indicated a significant association between PTSD and elevated dysthymic symptom burden (p < 0.001), with both PTSD subgroups demonstrating mild to moderate CDRS severity compared to euthymic controls. Biomarker analysis revealed phase-dependent alterations: SUMO1 levels were significantly elevated in the ≤5 years PTSD group compared to controls (p = 0.002), suggesting early compensatory neuroprotection, whereas UCHL1 was markedly increased in the >5 years PTSD group (p = 0.015), which is indicative of chronic neuronal damage and proteostatic disruption. No significant differences were observed in MDA or CX3CL1 across groups (p > 0.05). These findings highlight PTSD’s contribution to sustained affective dysregulation, potentially mediated by temporal shifts in oxidative stress and protein homeostasis markers. Clinically, this supports the utility of biomarker profiling for risk stratification, early intervention, and personalized therapeutic strategies, such as targeted modulation of SUMOylation or UCHL1 activity, to enhance neuroresilience and mitigate progression to severe mood disorders. Full article

Physical activity practice and excessive screen time affect adolescent girls’ body satisfaction and body image. This study aimed to estimate the association between screen time and physical activity in relation to body dissatisfaction and body image among girls from different Brazilian regions, considering both the direct effect and the influence of sociodemographic characteristics and school affiliation. This is a cross-sectional study based on secondary data analysis. The outcomes were body dissatisfaction and body image dissatisfaction due to excessive thinness and excessive fat. Physical activity and screen time were independent variables. The moderating variables included sociodemographic characteristics and school affiliation. Direct effects were observed in active girls with a lower odds ratio (OR) of dissatisfaction due to excessive thinness (Southeast region, OR: 0.56, 95% CI: 0.34–0.90; South region, OR: 0.43, 95% CI: 0.19–0.43), whereas those with high screen times were more likely to report dissatisfaction due to excessive fat (Southeast region, OR: 1.80, 95% CI: 1.35–2.40; Northeast region, OR: 1.97, 95% CI: 1.28–3.03). Effect modification was observed based on sociodemographic characteristics and school affiliation. These behaviors were directly associated with body dissatisfaction, and age, school affiliation, skin color, and maternal education were important moderators of the relationship between physical activity and screen time. Full article

Background/Objectives: Problematic smartphone use is common among nursing students and has been linked to academic and psychosocial difficulties. This PROSPERO-registered systematic review (CRD42024559668) identified the instruments used to assess smartphone addiction in nursing students and, secondarily, pooled typical addiction levels using the Smartphone Addiction Scale–Short Version (SAS-SV; 10–60) and examined psychosocial correlates. Methods: Following PRISMA 2020, we searched PubMed, Scopus, Web of Science, CINAHL and ScienceDirect from 1 January 2014 to 9 May 2024. Eligible studies assessed problematic smartphone use in undergraduate nursing students with validated instruments, while development-only studies and pandemic-specific contexts were excluded. Methodological quality was appraised using the JBI checklist, and a random-effects meta-analysis was performed to estimate pooled scores and explore cross-study variability. Results: Fifty-three studies met inclusion; eleven contributed to the SAS-SV meta-analysis (N = 5586). The pooled mean score was 29.5 (95% CI 27.7–31.3), with very high heterogeneity (I² = 98%). Sensitivity analyses yielded similar results, and no publication bias was detected. Across studies, higher smartphone addiction was correlated with elevated stress and anxiety, sleep disturbance, and poorer academic and clinical performance. Conclusions: Nursing students’ SAS-SV scores cluster around ~29/60, with substantial between-study variability. Higher addiction scores were consistently associated with stress, anxiety, poor sleep, and reduced academic and clinical performance. However, interpretation is limited by the cross-sectional nature of the included studies and the very high heterogeneity observed. Standardising measurement is essential, but equally important is developing targeted educational interventions to foster healthier smartphone habits in nursing education. These results may guide nursing educators and institutions to design programs that foster healthier digital habits and support students’ academic and clinical performance. Full article