Search Results (27,455)

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by pruritic eczematous lesions that significantly alter quality of life of patients. Dupilumab, a new biologic agent, has demonstrated efficacy and safety in the general adult population with AD. However, evidence on its use in elderly patients is limited. Objectives: The objective of this work was to systematically assess the effectiveness and safety of dupilumab in patients aged ≥60 years with AD, based on published data. Methods: A systematic review and meta-analysis were conducted following the PICO(S) framework. Articles written in English and published before 31 December 2024 that investigated patients ≥ 60 years with AD treated with dupilumab were included. Meta-analysis of the observational studies was performed using a random-effects model with subgroup and meta-regression analyses. Results: Twenty-one articles met the inclusion criteria. After 16 weeks of treatment, dupilumab significantly reduced disease severity (EASI: 21.8; 95% CI: 18.3–25.2), intensity of pruritus (P-NRS: 5.8; 95% CI: 4.2–7.3), and quality of life impairment (DLQI: 11.3; 95% CI: 6.1–16.5); all p < 0.001. Meta-regression revealed previous treatment with cyclosporin A as a predictor of a poorer response to treatment. The generalized-prurigo phenotype was associated with worse control of pruritus. The most common adverse events were conjunctivitis, injection site reactions, and facial flushing. Conclusions: Dupilumab appears to be an effective and well-tolerated treatment for AD in elderly patients. More research is warranted to evaluate its long-term effectiveness and safety in this age group. Full article

Background/Objectives: Digestive problems are common in the general population and may be influenced by lifestyle, emotional status and diet. This study aimed to estimate the prevalence of digestive problems in Spanish adults and examined associated factors. Methods: Descriptive cross-sectional analysis of anonymized adult microdata from the 2023 Spanish Health Survey was performed. Data were collected using a mixed-mode design (self-administered web questionnaire with interviewer-administered follow-up). Digestive problems were recoded by combining gastric ulcer, constipation, and prescribed use of laxatives, astringent drugs, and stomach medication. Therefore, digestive problems are primarily defined as the presence of gastric ulcers, diarrhea, and/or constipation. Variables included sociodemographic, Body Mass Index (BMI), smoking, alcohol intake, physical activity, Personal Health Questionnaire Depression Scale (PHQ-8), World Health Organization Well Being Index (WHO-5), and macronutrient intake estimated from a Food-Frequency Questionnaire using the Spanish Food Composition Database (BEDCA). Group comparisons and multivariable logistic regression were conducted (95% CI; significance level set at p < 0.05). Results: Of 34,148 participants, 13,518 provided information on digestive problems; among these respondents, 3860 (28.6%) reported having digestive issues. Prevalence ranged from 5.2% to 36.5% among national territories. Higher odds (OR) of digestive problems were associated with age (OR 1.026, 95% CI 1.023–1.029), female sex (OR 1.168, 1.070–1.276), non-smoking (OR 1.240, 1.005–1.531) and ex-smoking (OR 1.447, 1.272–1.647) compared to current smokers, higher PHQ-8 scores (OR 1.040, 1.029–1.051), greater protein intake (OR 1.016, 1.009–1.023), consumption of sweet pastries (OR 1.058, 1.039–1.077), and dairy products (OR 1.027, 1.002–1.053); in contrast, lower odds were associated with higher WHO-5 scores (OR 0.985, 0.982–0.987), total fiber intake (OR 0.968, 0.949–0.987), and legume consumption (OR 0.894, 0.856–0.933). Conclusions: Digestive problems show considerable variability in prevalence among survey-based Spanish sample. Digestive problems were associated with older age, female sex, depressive symptoms, high-protein intake, and higher consumption of sweet pastries and dairy products, whereas higher well-being scores, higher fiber intake and legume consumption were associated with lower odds of digestive problems. Full article

As population aging accelerates, the mounting burden on informal family caregivers in areas lacking formal care systems threatens the sustainability of elder care. This study aims at evaluating how the rural living environment and external connectivity jointly alleviate caregiver burden and exploring whether regional accessibility serves as a substitute for local infrastructure deficits. Guided by Ecological Systems Theory, we analyzed a cross-sectional dataset of 327 matched caregiver-recipient dyads from rural China using multivariate regression and mediation models. Results indicate that a favorable local environment reduces burden both directly and indirectly through improved recipient health. Crucially, county-level accessibility moderates this relationship via a substitution effect, where the marginal relief from local environmental improvements is most potent in isolated areas but diminishes where external access is convenient. Dimension-specific analyses show that developmental and physical strains are particularly sensitive to these factors. We conclude that sustaining informal care requires a dual-pathway strategy: prioritizing local “soft” assets like community safety and cultural activities while enhancing regional connectivity to service hubs. Ultimately, this research provides empirical evidence and a theoretical framework for enhancing rural informal care sustainability through environmental optimization, thereby advancing Sustainable Development Goals regarding health, reduced inequalities, and sustainable communities. Full article

Behavior-related factors represent a major cause of cat relinquishment to shelters, highlighting the need for reliable tools to support appropriate matching between cats and adopters. The present study applied the ASPCA^® Meet Your Match^® Feline-ality™ assessment to evaluate personality profiles of shelter cats and to examine factors associated with variation in personality expression across shelters. A total of 113 cats housed in six shelters in the south of France were assessed using a standardized behavioral protocol. Differences between shelters were evaluated using one-way ANOVA for behavioral scale scores, while associations between personality type and shelter affiliation, sex, coat color, and age were analyzed using χ² tests of independence. Significant differences between shelters were observed for the majority of behavioral assessment items, as well as for composite valiance and independent–gregarious scale scores. Shelter affiliation was significantly associated with the distribution of Feline-ality™ personality types, indicating that personality profiles were not uniformly distributed across shelters. No statistically detectable association was found between personality type and sex. In contrast, significant associations were observed between personality type and both coat color category and age category, suggesting non-random variation in personality distribution across these factors. These findings indicate that shelter-related and individual factors are associated with variation in feline personality expression. While causal relationships cannot be inferred, the results underscore the importance of considering environmental context and population characteristics when interpreting shelter-based behavioral assessments. The Feline-ality™ framework appears to be a useful tool for characterizing personality variation in shelter cats and may support improved adoption matching when applied with appropriate caution. Full article

Background/Purpose: Primary urethral cancer is a rare malignancy, accounting for less than 1% of all urogenital cancers. Current epidemiological data from Europe are scarce and outdated. Therefore, the analyzes and comparison of the incidence and mortality of PUC in selected European countries, with particular focus on Poland, based on the most recent available registry data, were performed. Methods: Our study is based on country-level data and is descriptive in nature. Incidence data for PUC were obtained from the national cancer registries of Poland, Latvia, Slovenia, and Hungary. Mortality data were sourced from the WHO Mortality Database. Age-standardized incidence rates were calculated for two time intervals (2000–2009 and 2010–2019). Age-standardized mortality rates for individuals aged ≥45 years were calculated using the European Standard Population (ESP2013). Trends in incidence and mortality in Poland were analyzed using a five-year moving average. Results: The highest incidence of PUC was observed in Hungary, while Poland showed the lowest incidence. Latvia had the highest ASMRs for both sexes, whereas Poland and Greece reported the lowest mortality rates. Despite slight annual fluctuations, the overall PUC mortality rate in Poland has remained stable. Our study is limited by the relatively short analyzed period (2000–2021), restricted availability of C68.0 incidence data from national cancer registries, and incomplete mortality data in the WHO mortality database. Conclusions: This first contemporary comparative analysis of PUC epidemiology in Europe highlights the rarity of this malignancy and the limited data availability. Based on the knowledge drawn from the literature presented in the article on the impact of centralization on the increase in overall survival and the decrease in mortality in rare cancers, the authors believe that centralization of care can improve PUC patient outcomes. Full article

Objective: To better define potential executive function difficulties in individuals living with HIV but not clinically identified as having HAND, with and without mild to moderate cocaine dependence (CD), our cross-sectional study examined executive function performance on the Stroop Color-Word Test (Stroop) and the Trail Making Test (TMT) in four groups stratified by HIV and CD status. Method: We recruited 101 participants (26 HIV+/CD+; 18 HIV+/CD−; 30 HIV−/CD+; 27 HIV−/CD−). We utilized a 2 (HIV: yes/no) × 2 (Cocaine: yes/no) MANCOVA while controlling for age and premorbid intelligence on the Stroop trials (i.e., color-naming, word-reading, interference), and TMT-A and TMT-B z-scores, number of errors, and the B/A ratio. Results: HIV was associated with significantly slower performance on the Stroop Interference (p = 0.012, η² = 0.064). CD showed a trend towards slower performance on interference trials (p = 0.061, η² = 0.037) and was associated with significantly more errors on the Stroop Word-Reading (p = 0.028, η² = 0.050) and Interference trials (p = 0.046, η² = 0.041), suggestive of difficulties with inhibitory control and written language processing. There were no significant HIV × Cocaine interactions. Conclusions: Our results suggest HIV without clinically identified cognitive impairment and CD are associated with distinct and potentially overlapping executive functioning deficits, particularly for measures of inhibitory control. Notably, CD showed trend-level slowing on Stroop Interference performance, suggesting partial overlap with HIV effects. Clarifying the specific cognitive processes impacted by HIV and CD can help guide tailored interventions to improve functional outcomes in these populations. Full article

Background and Objectives: Cognitive disorders are a significant health problem in patients undergoing peritoneal dialysis and can profoundly impair both quality of life and treatment outcomes. Early identification of risk factors for the development of cognitive disorders in this population is therefore essential. This study aimed to (1) determine the prevalence of cognitive dysfunction in patients on peritoneal dialysis, (2) examine its association with sociodemographic characteristics, and (3) assess whether anaemia is associated with cognitive dysfunction in these patients. Materials and Methods: A cross-sectional study was conducted in November 2024 at the University Clinical Centre of Vojvodina, Clinic for Nephrology and Clinical Immunology, and included 36 patients on peritoneal dialysis. The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function, while a structured questionnaire was used to collect sociodemographic data. Anaemia was determined based on haemoglobin levels. Results: Cognitive dysfunction was present in 69.4% of patients on peritoneal dialysis, while anaemia, as indicated by haemoglobin values, was present in 58.3% of the sample. Older age, rural residence, and lower haemoglobin levels were significantly associated with cognitive dysfunction in patients on peritoneal dialysis. Conclusions: Preserved cognitive function is a key prerequisite for the adequate implementation of peritoneal dialysis and for maintaining patients’ quality of life. The findings indicate the need for further research to identify effective strategies for preventing and treating anaemia, a factor associated with cognitive dysfunction in this patient population. Full article

A correlation between the near-surface ozone concentration in the urban atmosphere and hospitalizations of community-acquired pneumonia patients has been analyzed based on a long-term (five years) series of observations in the warm season in Moscow, Russia. The study included hospitalization records for patients over 15 years old. One of the main goals was to reveal vulnerable groups of the urban population that react most strongly to increased ozone concentrations. It has been shown that increased near-surface ozone concentrations lead to increased hospitalizations. Older people (over 60 years old) are most sensitive to the negative impact of air pollution. Women in this age group are more sensitive to the effects of ozone air pollution than men. In the middle-aged group (31–60 years), the highest correlation between the number of community-acquired pneumonia cases and the ozone level in the atmospheric surface layer, conversely, was in men, but it was still lower than the rate in older people. The young people (15–30 years old) group turned out to be insensitive to the near-surface air pollution. Full article

Recent studies in the Romanian Western Carpathians have revealed increasing socio-demographic fragility in rural areas and small towns, driven by depopulation, population aging, and declining living standards. These trends stem from the legacy of forced collectivization and industrialization (1950–1990) and the post-1990 transition, which triggered extensive out-migration and the erosion of local socio-economic structures. This study examines the fragility of human communities in the Trascău Mountains in order to evaluate spatial, demographic, and economic recovery dynamics and to assess settlement vulnerability as a major obstacle to sustainable regional development. Fragility was measured using indicators of population density and change, age structure, accessibility, and socio-demographic dynamics, based on comparative data for the interval of 1977–2021. These variables were integrated into a composite development index (Id), derived from twelve indicators covering demography, economy, infrastructure, and living standards, enabling the hierarchical classification of settlements by degree of vulnerability. The methodological framework combines empirical and analytical methods, statistical, cartographic, bibliographic, and field-based analyses within evolutionary, structural–functional, and typological perspectives. The results identify the main drivers of decline, quantify their impacts, and outline development prospects and policy directions for reducing territorial disparities. Overall, fragile settlements emerge as critical pressure points that undermine sustainability, intensify regional instability, and increase risks related to migration and social cohesion. Full article

Background/Objectives: RELiZORB immobilized lipase cartridge (ILC) is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. It is cleared by the FDA for pediatric and adult use. Limited data have been published regarding the effect of ILC use on growth in children younger than 5 years of age. Methods: We performed a retrospective evaluation of real-world data extracted from a third-party reimbursement program database. All patients in the program database who initiated ILC use with enteral formula when 1 to 4 years of age between 2019 and 2023 were included. Baseline and follow-up weight, height/length, and body mass index (BMI) data were collected for up to 12 months. Results: A total of 186 patients from 90 clinics in the United States were included. A subset (143 patients) with baseline and follow-up growth measurements was included in the efficacy analysis population; 76% were diagnosed with cystic fibrosis. Mean weight and BMI z-scores improved significantly (0.63 [p < 0.001] and 0.53 [p = 0.006], respectively) from baseline to 12 months after initiation of ILC use. Significant improvement in the mean weight z-score was observed after 3 months. Among people with cystic fibrosis (pwCF) who initiated ILC use when 2 to 4 years of age, those with a BMI ≥ 50th percentile increased from 22% at baseline to 43% after 12 months (p = 0.021). Improvement in weight-for-length was also observed in 1-year-old pwCF. Conclusions: Real-world evidence showed that initiation of ILC use was associated with significant improvements in mean weight and BMI z-scores among young children. Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background/Objectives: Low back pain (LBP) is increasingly prevalent among children and adolescents and represents a growing public health concern due to its potential persistence into adulthood. Screen-based sedentary behavior has substantially increased in pediatric populations. However, evidence regarding its association with LBP remains inconsistent, and the existence of a dose–response relationship is not well established. Methods: A systematic review and meta-analysis of observational studies was conducted in accordance with PRISMA guidelines. Studies examining the association between screen-based sedentary behavior and LBP in children and adolescents aged 6–18 years were included. Random-effects meta-analyses were used to pool continuous exposure estimates, and a multivariate random-effects dose–response meta-analysis was performed to assess changes in LBP risk across increasing levels of daily screen time. Results: A total of 30 studies were included. The pairwise meta-analysis of continuous exposure showed no statistically significant association between screen time and LBP, with OR = 1.02 (95% CI 0.65 to 1.59). In contrast, the dose–response meta-analysis demonstrated a significant positive association, with a 26% (95% CI 8% to 48%) increase in the odds of LBP for each additional hour of daily screen time. High between-study heterogeneity was observed, and most studies relied on self-reported measures of screen exposure and LBP, which may have introduced recall and misclassification bias and warrants cautious interpretation of the findings. Conclusions: Higher levels of screen-based sedentary behavior were associated with an increased risk of LBP in children and adolescents when examined using a dose–response approach, whereas pairwise meta-analyses did not identify a significant association. Nevertheless, substantial between-study heterogeneity and high risk of bias limit causal inference and require cautious interpretation. Full article

Objectives: Non-ST-segment elevation myocardial infarction (NSTEMI) in the elderly is frequently complicated by multiple comorbidities, which influence clinical outcomes. However, the prognostic significance of atrial fibrillation (AF) in this context remains uncertain. This study aimed to evaluate the impact of AF on short- and long-term mortality in elderly patients (≥65 years) with NSTEMI. Methods: This cross-sectional observational study included 474 NSTEMI patients aged 65 years and older. Participants were stratified into four groups based on age (65–74 vs. ≥75 years) and the presence or absence of AF. One-month and one-year all-cause mortality were assessed as the primary and secondary endpoints, respectively. Results: AF was detected in 23 (11.6%) of 199 patients aged 65–74 and in 80 (29.1%) of 275 patients aged ≥75. While one-month mortality did not differ significantly among the four groups (p = 0.514), one-year mortality showed a statistically significant difference (p < 0.001). Univariate analysis revealed that AF was not predictive of one-month mortality. In multivariate Cox regression analysis, AF, reduced creatinine clearance, and left ventricular ejection fraction <50% were identified as independent predictors of one-year mortality. Conclusion: AF is not associated with short-term mortality in elderly NSTEMI patients; however, it serves as an independent predictor of one-year mortality. These findings highlight the importance of long-term rhythm monitoring and management in this high-risk population. Full article

Background/Objectives: Specific pharmacological osteoporosis therapy (SPOT) is regarded as a key intervention to reduce fracture risk and improve musculoskeletal function. Real-life data, particularly regarding functional muscular outcomes and pain trajectories, remain limited. This study aimed to longitudinally analyze bone mineral density, laboratory parameters, handgrip strength, functional performance, and pain symptoms under guideline-based SPOT. Methods: In this monocentric prospective real-life observational study, 178 patients (80.9% women; median age 82 years) with confirmed osteoporosis were followed for a median of four years. All patients received guideline-recommended antiresorptive or osteoanabolic therapy. Analyses included T-scores, 25(OH)D, calcium, handgrip strength, Chair Rise Test (CRT), tandem stance (TS), pain parameters, alkaline phosphatase (AP), HbA1c, fractures, comorbidities, and body mass index (BMI). Time-dependent changes were evaluated using linear mixed-effects models. Results: Bone mineral density improved highly significantly (ΔT-score ≈ +0.45 SD; p < 0.001), with no differences between therapy groups (antiresorptive vs. osteoanabolic) or BMI categories. Serum 25(OH)D levels increased markedly (Δ ≈ +20 nmol/L; p < 0.001), while calcium levels showed a small but highly significant decrease (Δ ≈ −0.047 mmol/L; p < 0.001), particularly under antiresorptive treatment. Dominant (Δ ≈ −1.95 kg; p < 0.001) and non-dominant handgrip strength (Δ ≈ −0.83 kg; p = 0.046) decreased significantly. In contrast, functional performance improved significantly: CRT time decreased by ~1 s (p = 0.004), and TS time increased by ~1 s (p = 0.007). Back pain decreased highly significantly (Δ ≈ −1.5 NRS; p < 0.001), while pain-free walking time (Δ ≈ +38 min; p = 0.031) and pain-free standing time (Δ ≈ +31 min; p = 0.038) both increased significantly. AP levels decreased significantly (p = 0.003), particularly among normal-weight patients. HbA1c changes were not significant. Overall, 73% of patients had at least one major osteoporotic fracture. Conclusions: In this real-life cohort, guideline-based specific pharmacological osteoporosis therapy was associated with significant improvements in bone mineral density, vitamin D status, functional performance, and pain-related outcomes. Despite a moderate decline in handgrip strength, balance- and mobility-related functional parameters improved, suggesting preserved or even enhanced functional capacity in daily life. These findings provide real-world evidence on the associations between SPOT, laboratory parameters, functional performance, and pain outcomes in a very elderly and multimorbid population. Full article

Background: Studies outside Japan have linked sugar-sweetened beverage (SSB) intake with weight gain; however, evidence in Japanese adults is scarce, and no study has examined beverage-derived energy in relation to anthropometric indices and handgrip strength. Methods: The participants were employees of Fujita Health University aged 20–39 years (n = 76; male n = 35, average age: 29.97 ± 4.67 years; female n = 41, average age: 27.29 ± 4.53 years). Energy from beverage intake was assessed via the Brief Beverage Intake Questionnaire-15, and energy from alcoholic drinks, milk, SSBs, and total beverages was calculated. The associations of energy from different beverages with nutrient intake, BMI, skeletal muscle mass index (SMI), and handgrip strength were analyzed via ordinary least squares (OLS) regression; quantile regression (QR) and the generalized additive model (GAM) were used for sensitivity analyses. Results: Increased SSB intake was associated with increased BMI (standardized β = 0.35, 95% CI 0.12–0.58, p(OLS) < 0.001; p(QR) = 0.23; p(GAM) < 0.001) and was nonlinearly associated with increased SMI (standardized β = 0.21, 95% CI 0.043–0.37, p(OLS) = 0.02; p(QR) = 0.11; p(GAM) = 0.02), even after adjustment for total energy intake. Modest milk intake was linked to higher protein intake and a higher SMI without a higher BMI (standardized β = 0.18, 95% CI 0.020–0.35, p(OLS) = 0.03; p(QR) = 0.39; p(GAM) = 0.03). Conclusions: A positive association was found between SSB intake and both BMI and SMI and between MILK intake and SMI. Clarification in larger, diverse Japanese populations will be necessary. Full article