Search Results (206)

This research investigates higher education admission outcomes at Hungarian universities for ethnic Hungarian minority students residing in countries within the Carpathian Basin. The region is distinguished by a variety of national policies that impact minority education. By analyzing extensive data on the availability of mother tongue education, the status of minority rights, advanced level examination performance, and types of settlement using a wide range of statistical methods, our study reveals significant cross-national differences in the distribution of admission scores and central tendencies. Compared to lower and more varied scores for students from Ukraine and Romania, ethnic Hungarian students from Serbia and Slovakia achieved high average admission scores. Performance was notably more consistent among students from EU member states compared to non-EU regions, strongly linking outcomes to the more robust implementation of minority rights and better access to mother-tongue education within the EU framework. A critical finding is the strong positive correlation (Pearson r = 0.837) between admission scores and advanced level examination results, highlighting the pivotal role of these exams for the academic progression of these minority students. The Jonckheere-Terpstra test (p < 0.05) further confirmed significant performance differences between ranked country groups, with Serbian and Slovak students generally outperforming their Ukrainian and Romanian counterparts. Counterintuitively, settlement type (urban vs. rural) exhibited a negligible relationship with admission scores (r = 0.150), explaining only 2% of score variability. This challenges common assumptions and suggests other factors specific to the Hungarian minority context are more influential. This study provides crucial insights into the complex dynamics influencing Hungarian minority students’ access to higher education, underscoring cross-country educational inequalities, and informing the development of equitable minority rights and mother-tongue education policies in Central Europe for these often-marginalized communities. Full article

Background/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency with a high mortality rate requiring urgent treatment. This study aimed to identify clinical predictors of inpatient mortality and poor postoperative course after aSAH surgical clipping. Methods: We performed a retrospective review of medical records for 210 patients with aSAH treated via surgical clipping at our institution between 2010 and 2019. Baseline demographic data and clinical characteristics related to aSAH were collected. To identify factors associated with inpatient mortality and a poor postoperative course after aSAH microsurgical clipping, we conducted a univariate and bivariate analysis, as well as a multivariate analysis via the Poisson regression model. Results: The overall cumulative mortality over the 10-year study period was 11.43%. A severe WFNS scale score (aRR: 2.86; 95% CI: 1.28–6.39; p = 0.011) and having 1 (aRR: 5.76; 95% CI: 2.02–16.39, p = 0.001) or ≥2 (aRR: 18.86; 95% CI: 5.16–68.90, p < 0.001) postoperative neurosurgical complications were associated with an increased risk of inpatient mortality. A moderate (aRR: 3.71; 95% CI: 1.45–9.50; p = 0.006) or severe (aRR: 4.18; 95% CI: 1.12–15.60; p = 0.034) Glasgow scale score on admission, and presenting 1 (aRR: 2.31; 95% CI: 1.27–4.19; p = 0.006) or ≥2 postoperative clinical complications (aRR: 3.34; 95% CI: 1.83–6.10; p < 0.001) were associated with an increased risk of a poor postoperative course. Conclusions: While promising and widely supported by the published literature, these findings require further validation in a larger prospective and multi-centered study to adequately propose health policies on neurointensive care for the Peruvian population. Ultimately, developing socioeconomic setting-focused intervention algorithms and clinical practice guidelines could enhance the survival and postoperative course of patients presenting with aSAH. Full article

This paper reports findings on the social patterning of dog bite injuries in Scotland and discusses their implications for prevention policies. Previous studies have shown evidence of social inequalities in dog bites in other countries, but this analysis provides new evidence about Scotland. Three sources of health record data are used (NHS 24 (telephone) records, accident and emergency department records, and hospital admissions records). The records span the period of 2007–2019 and combine information on 59,111 health records involving injuries caused by dogs (from 48,599 different individuals). The results are presented, summarising the volume of dog bite injuries across time periods by the age of respondents, the location of the incident, and the Scottish Index of Multiple Deprivation categorisation for their locality. The results suggest consistent patterns of social inequality in injuries caused by dogs. We argue that the most important finding concerns the higher risk for people from more deprived areas, and we discuss mechanisms that might lie behind the patterns and how policies might respond to them. Existing policies focus on the breed of dog and punitive strategies, but we argue that different approaches are more likely to be effective in addressing a socially stratified public health issue. Full article

Background: Cholangiocarcinoma, malignancies arising from the intrahepatic and extrahepatic bile ducts, has increased in incidence in the United States over the past few decades. The reported incidence of cholangiocarcinomas is high, particularly in specific racial groups such as Asian and Pacific Islander patients. Race also significantly impacts disparities in healthcare utilization and clinical outcomes. Our study focused on the impact of race on admission, clinical outcomes, and disposition of cholangiocarcinoma. Methods: We performed a retrospective analysis of cholangiocarcinoma-related hospital admissions, using the National Inpatient Sample for the year 2022. Patients were stratified according to race into the following groups: White, African American, Hispanic, Asian or Pacific Islander, Native American, and Other. The data analysis was performed using STATA/BE version 18.5. Univariable and multivariable logistic regression models were applied to evaluate the relationship between race and clinical and healthcare utilization outcomes. Results: In 2022, 7479 hospitalizations were recorded for cholangiocarcinoma in the United States. Among these, 65.99% were White, 13.27% Hispanic, and 10.13% African American. There was a statistically significant difference in gender distribution across racial groups (p < 0.001), with males comprising the majority in all groups. Males outnumbered females in all racial groups except among the Hispanic group. Significant racial disparities in mortality were observed, with White patients showing a mortality rate of 6.69%, compared to higher rates among African American (9.76%), Native American (8.51%), and Asian or Pacific Islander (8.09%) patients, while Hispanic (5.04%) and Other (5.88%) groups had lower rates (p < 0.001). Conclusions: The study underscores the racial disparities among cholangiocarcinoma hospitalizations, with African American, Native American, and Asian patients facing disproportionately higher mortality and poorer in-hospital outcomes compared to White patients. This analysis highlights the healthcare strategies and policy reforms to promote equitable treatment by mitigating these disparities and to improve cholangiocarcinoma outcomes. Full article

Dengue virus infection (DVI), a mosquito-borne arboviral infection, is prevalent in tropical and subtropical regions, including Bangladesh, where incidence has surged over the past three decades—particularly in urban and peri-urban areas. This study investigates the factors influencing DVI seropositivity among clinically suspected patients admitted to the selected hospitals of Savar, Dhaka, and Chattogram. Data were collected from 850 clinically suspected patients admitted to two hospitals in Savar, Dhaka, and two in Chattogram during 2019. Questionnaire responses and laboratory test results (NS1, IgM, and IgG) were analyzed using descriptive statistics, chi-square tests, and logistic regression. Out of 450 admissions in Savar, 330 tested positive, while Chattogram reported 145 positives from 400 cases. No significant differences were observed between regions in relation to hospital type, season, gender, or household preventive measures. In Savar, DVI status was significantly associated with season, mosquito net use, and patient contact. In Chattogram, household repellent use and patient contact were key factors. Diagnostic tests varied in detection capability. These findings can inform targeted intervention strategies and public health messaging, such as promoting personal protection measures and community awareness campaigns, particularly in high-incidence urban settings. However, further research across diverse geographic and socio-ecological contexts is needed to enhance the generalizability and policy relevance of these results. Full article

Background/Objectives: Pediatric asthma is a leading cause of emergency department visits, and air pollution is a known primary environmental trigger. Although worldwide air pollutants have been associated with asthma exacerbations, limited data have been reported in the Eastern Province of Saudi Arabia. This study aimed to investigate the relationship between air pollution and pediatric asthma admissions among children aged 2 to 14 years old at King Fahd Hospital of the University Hospital (KFHU). Methods: This is a retrospective cohort study, over 366 days, including 1750 pediatric asthma-related ER visits and daily concentrations of air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, CO, and O₃) and meteorological factors (temperature and humidity). Various statistical models, such as Poisson regression and ARIMA, were applied to determine the association between pollutants levels and hospital ER visits. The data were visit-based in nature, and it was not possible to follow up with repeat visits or for admission status for individual patients. Results: Elevated levels of PM_2.5, NO₂, and CO were significantly associated with more pediatric asthma ER visits, mainly on the same day and with short lags. PM_2.5 displayed the strongest association, consistent with its deeper pulmonary penetration and greater toxicity. Also, PM₁₀ levels were inversely associated with ER visits, possibly due to particle size and deposition location differences. Significantly correlated with increased ER visits are lower ambient temperature and higher humidity. Conclusions: This study offers strong evidence on the relationship between air pollution and pediatric asthma events, in turn highlighting the vital importance of air quality regulation, public health policies, and clinical vigilance for environmental exposures. Full article

Background/Objectives: This study investigates the evolution of hospital capacity and utilization in California between 2003 and 2023, focusing on emergency departments (EDs) and trauma centers (TCs). We seek to document structural changes in the healthcare delivery system with respect to hospital-based emergency and trauma services. Methods: This analysis examines changes in population demographics, hospital resources, and patient utilization patterns across facility types. Given the significant increase in the proportion of the population aged 65+ and the documented higher use of emergency and trauma services by this population, we expected to observe an expansion in ED and trauma service capacity and utilization. Results: Utilizing a comprehensive dataset of California general acute care hospitals over this 20+ year period, our descriptive analysis reveals major shifts in the healthcare delivery system, notably the increased prominence of hospitals with EDs, particularly those designated as trauma centers. Findings indicate that, while the overall number of hospitals and licensed beds has slightly decreased, facilities with EDs, especially trauma centers, have increased their capacity and manage a greater proportion of inpatient admissions and ED visits. Conclusions: The increase in ED visits and inpatient admissions at trauma centers, contrasted with decreases in both capacity and utilization at non-trauma hospitals, indicates a significant restructuring of the health delivery system with significant implications for healthcare policy, financing, operations, and affordability. The high and increasing percentage of inpatient admissions originating from hospital EDs and from hospitals with trauma centers suggests a need for policies that foster integration between ED and inpatient care and the broader healthcare delivery system, while at the same time managing the increase in prices and costs associated with growing emergency services utilization. Further research is needed to explore the implications of these trends, particularly concerning their impact on the affordability of healthcare in the US. Full article

While air pollution is known as a risk factor for acute myocardial infarction (AMI) incidence, its impact on AMI subtypes—ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI)—remains incompletely understood. This study analyzed 149,632 AMI hospital admissions (70,730 STEMI and 69,594 NSTEM) in Beijing, China, from 2013 to 2019 using a time-stratified case-crossover design to evaluate the association between daily concentrations of six air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃) and daily hospital admissions for total AMI, STEMI, and NSTEMI. Elevated levels of PM_2.5, PM₁₀, SO₂, NO₂, and CO were significantly associated with increased admission risk for total AMI, STEMI, and NSTEMI, with the strongest lag effects observed at lag0 for STEMI and at lag1 for NSTEMI. Subgroup analyses showed enhanced effects of PM_2.5, SO₂, and NO₂ for total AMI and SO₂ for NSTEMI among individuals with asthma. Additionally, a stronger effect of PM₁₀ on STEMI was observed among individuals with stroke. These findings demonstrate that air pollutants differentially impact AMI subtypes through distinct temporal patterns and population vulnerabilities, underscoring the necessity of incorporating AMI subtype classification and individual susceptibility factors in environmental health risk assessments and related public health policies. Full article

This paper chronicles the evolution of the presbyterate of the Ruthenian Byzantine Metropolitan Catholic Church in the United States of America from the time of the first wave of immigrants to the United States to the present day. It looks at critical junctures in the history of this sui iuris Church regarding (1) the importation of married priests from Europe serving in the Metropolia during the first wave of immigration; (2) the restriction of consideration for priestly formation and ordination to celibate men; (3) the more recent importation of married priests from Europe in response to the critical shortage of clergy; and (4) most recently, the admission of American-born married men to priestly formation and ordination. This paper will examine in more detail the changing face of the presbyterate across the Metropolia, beyond the boundaries of the Passaic Eparchy. This paper also discusses how the Metropolia has adapted to forming married men alongside single men for the presbyterate as well as developed a policy for the formation of married deacons for the married presbyterate. The Byzantine Catholic Seminary adapted from having a student body of celibate men to one that includes celibate men, men who are dating, and others who are married. This paper also discusses the reception of married priests and their families by the lay faithful as well as the reception and acceptance of married priests and their families by celibate clergy. Finally, this paper discusses how the restoration of the married presbyterate to the Metropolia has been a positive development for the Church. Full article

Background: The objective of this review is to demonstrate the efficacy of mifepristone as an inducing agent of labor by analyzing its impact on cervical maturation and maternal and neonatal outcomes. The research results showed that mifepristone facilitates cervical ripening and enhances uterine sensitivity. Methods: A narrative review of the literature was conducted to descriptively summarize and compare available data. No formal meta-analytic model was applied. The analysis was descriptive and based on pooled aggregated data without the use of inferential modeling. Studies published through November 2024 were retrieved using the Medline, Ovid, Scopus, and Web of Science databases. The search was based on a combination of keywords: “mifepristone”, “induction”, and “labor”. Randomized clinical trials and prospective and retrospective studies concerning full-term pregnancies with unfavorable cervices were included, while studies concerning termination of pregnancy or intrauterine death were excluded. The outcomes analyzed included cesarean section rates, neonatal intensive care unit admissions, and oxytocin and prostaglandin use. Results: Ten studies were analyzed, with a total of 1561 patients. The use of mifepristone showed a reduction in the use of oxytocin (RR = 0.84; 95% CI: 0.70–1.01), although this difference did not reach statistical significance (p = 0.065), and a highly significant reduction in prostaglandin use (42.7% vs. 78.9%; RR = 0.54; 95% CI: 0.48–0.60; p < 0.0001), with no significant difference in cesarean section rate (18.9% vs. 23.6%; RR = 0.80; 95% CI: 0.63–1.01; p = 0.068). However, a significantly higher rate of neonatal ICU admissions was observed in the mifepristone group (13.9% vs. 9.3%; RR = 1.48; 95% CI: 1.08–2.02; p = 0.014). Only studies excluding patients with a previous cesarean section were included for the analyses of cesarean sections, oxytocin, and prostaglandin use, while all studies were retained for NICU evaluation. Conclusions: Mifepristone represents a promising option for labor induction due to its ability to improve cervical maturation and reduce the need for additional uterotonic agents. Our pooled analysis confirmed a significant reduction in prostaglandin and oxytocin use, and a non-significant trend toward fewer cesarean deliveries. However, the observed increase in NICU admissions in the mifepristone group raises important concerns regarding neonatal safety. Further studies are needed to investigate whether this association reflects underlying clinical factors, variations in NICU admission policies, or a true pharmacological effect. Future research should focus on optimizing dosing regimens, identifying patient subgroups who benefit most, and clarifying neonatal outcomes through long-term follow-up. Full article

Hospital length of stay (HLOS) is a critical healthcare metric influencing patient outcomes, resource utilization, and healthcare costs. While reducing HLOS can improve hospital efficiency and patient throughput, it also poses risks such as premature discharge, increased readmission rates, and potential compromise of patient safety. This literature review synthesizes current evidence on the determinants of HLOS, including patient-specific factors such as demographics, comorbidities, and socioeconomic status, as well as hospital-related factors like admission route, resource allocation, and institutional policies. We also examine the relationship between HLOS and key clinical outcomes, including mortality, readmission rates, and healthcare-associated infections. Additionally, we evaluate predictive modeling approaches, including artificial intelligence and machine learning, for forecasting HLOS and guiding early intervention strategies. While interventions such as enhanced recovery after surgery (ERAS) protocols, multidisciplinary care teams, and structured discharge planning have demonstrated efficacy in reducing HLOS, their success varies based on healthcare setting, patient complexity, and resource availability. Predictive analytics, incorporating clinical and non-clinical variables, offer promising avenues for improving hospital efficiency, yet may carry risks related to data quality and model bias. Given the impact of HLOS on clinical and economic outcomes, targeted interventions and predictive models should be applied cautiously, with future research focusing on refining personalized discharge strategies and addressing disparities across diverse patient populations. Full article

Clostridioides difficile infection (CDI) appears mainly as nosocomial antibiotic-associated diarrhea, and community-acquired infection is increasingly being recognized. The threshold of asymptomatic colonization and the clinical manifestation of CDI need further elucidation. Community-acquired CDI (CA-CDI) should be considered when the disease commences within 48 h of admission to hospital or more than 12 weeks after discharge. Although CDI is not established as a food-borne or zoonotic disease, some data support that direction. The spores’ ability to survive standard cooking procedures and on abiotic surfaces, the formation of biofilms, and their survival within biofilms of other bacteria render even a low number of spores capable of food contamination and spread. Adequate enumeration methods for detecting a low number of spores in food have not been developed. Primary care physicians should take CA-CDI into consideration in the differential diagnosis of diarrhea, as there is a thin line between colonization and infection. In patients diagnosed with inflammatory bowel disease and other comorbidities, C. difficile can be the cause of recurrent disease and should be included in the estimation of diarrhea and worsening colitis symptoms. In the community setting, it is difficult to distinguish asymptomatic carriage from true infection. For asymptomatic carriage, antibiotic therapy is not suggested but contact isolation and hand-washing practices are required. Primary healthcare providers should be vigilant and implement infection control policies for the prevention of C. difficile spread. Full article

The Piracicaba River basin, in the State of São Paulo, Brazil, covers approximately 12,400 km² and plays a crucial economic role in São Paulo’s agribusiness corridor. However, it faces recurrent episodes of pollution, impacting water quality and public health, especially in urban areas exposed to contamination. Despite this, few studies have investigated the ecological and epidemiological consequences of this environmental degradation. Therefore, this study analyzed the correlation between physicochemical and biological variables of the Piracicaba River and the incidence of diseases in the city of Piracicaba between January 2019 and September 2024. Data on hospital admissions for respiratory, neurological, and liver symptoms were used, as well as environmental and water quality information, such as dissolved oxygen, turbidity, conductivity, and the presence of cyanobacteria, obtained from public databases. The results showed seasonal patterns and long-term trends, highlighting the health risks associated with the river’s pollution. Parameters such as phosphorus, pH, cyanobacteria concentration and climatic factors (temperature and humidity) showed an influence on the occurrence of respiratory, digestive, and neurological diseases. The study reinforces the need for continuous monitoring of water quality and public policies to mitigate impacts on the population’s health. Full article

Background: Heart transplantation (Htx) remains the definitive therapy for patients with end-stage heart failure. Despite advancements in mechanical circulatory support (MCS), immunosuppressive strategies, and organ allocation policies, donor availability remains a major limitation. This study analyzes the trends in Htx in the United States between 2016 and 2022, focusing on demographic shifts, mortality trends, and 30-day readmission patterns. Methods: We utilized the National Inpatient Sample (NIS) from 2016 to 2022 and the National Readmissions Database (NRD) for 2021 to identify Htx admissions using ICD-10 PCS code O2YA0Z0. Patient characteristics, mortality rates, and readmission patterns were analyzed using ANOVA and multivariate logistic regression, with statistical significance defined as p < 0.05. Results: The total number of Htx procedures increased from 641 in 2016 to 773 in 2022. The mean age of transplant recipients remained between 45 and 50 years, with no significant differences across years. Racial and socioeconomic disparities persisted, with approximately 60% of transplants occurring in White patients and 21–26% of recipients belonging to the lowest income quartile. All-cause in-hospital mortality remained stable at 4–7%. The 30-day readmission rate in 2021 was 57.7%, with heart failure, transplant rejection, and infections being the leading causes. Peripheral vascular disease (PVD) was the only comorbidity significantly associated with higher 30-day readmission risk (OR: 1.815, 95% CI: 1.477–2.230). Conclusions: Htx utilization has increased over time, driven by improvements in donor allocation and perioperative management. However, racial and socioeconomic disparities remain, and readmission rates continue to be high. Future efforts should focus on optimizing post-transplant care and addressing disparities to improve long-term outcomes. Full article

Ensuring the profitability of retailers utilizing in-store inventory for online fulfillment is a pivotal issue in omnichannel retailing. This study examines the inventory allocation challenges faced by retailers when managing interactions between online and offline channels to identify strategies that maximize revenue. The findings enable retailers to address key operational conflicts while implementing omnichannel strategies. We develop an omnichannel newsvendor model, deriving an optimal strategy for retailer inventory level and online acceptance thresholds, demonstrating the economic superiority of this approach over traditional policy. Furthermore, this paper further explores how carry-over inventory influences strategic decisions, particularly in quantifying the trade-off between the cancellation cost and the inventory holding cost. The results reveal that cancellation costs incentivize retailers to increase safety stock and reduce online acceptance thresholds, with strategy sensitivity intensifying as offline demand dispersion grows. Compared to the traditional policy, our policy demonstrates superior performance when the cancellation cost remains below a critical value, though its effectiveness decreases under high offline demand dispersion. Moreover, dynamic strategy adjustments must balance the cancellation cost against the holding cost in the carry-over scenario. The proposed framework systematically integrates inventory allocation with demand admission control, addressing a critical gap in existing literature that has failed to comprehensively link these two operational levers. This dual-focused perspective significantly advances omnichannel inventory management theory. Full article