Search Results (25,288)

Background: Diabesity, the coexistence of obesity and type 2 diabetes, is a major public health concern. Shift work and unhealthy lifestyle behaviors may exacerbate its prevalence, particularly in working populations. Objective: This study aims to evaluate the association between sociodemographic characteristics, health behaviors, and shift work and the prevalence of diabesity, using both BMI and the CUN-BAE estimator, in a large cohort of Spanish workers. Methods: This cross-sectional study included 53,053 workers (59.8% men) aged 18–69 years who underwent occupational health examinations. Diabesity was defined as obesity (BMI ≥ 30 kg/m² or high CUN-BAE) plus fasting glucose ≥ 100 mg/dL or prior diagnosis of diabetes. Adherence to the Mediterranean diet was assessed by the MEDAS questionnaire, physical activity by the IPAQ, alcohol intake by standard drink units (UBEs), and socioeconomic class by the CNAE-11 classification. Shift work was defined according to ILO criteria. Logistic regression was used to assess associations, adjusting for potential confounders. Results: Shift work was independently associated with increased odds of diabesity both in men and women. Diabesity prevalence was higher when assessed by CUN-BAE compared with BMI. Age, male sex, lower socioeconomic class, physical inactivity, smoking, poor diet adherence, and alcohol intake were all significantly associated with higher risk. The CUN-BAE index showed superior sensitivity in identifying individuals at risk. Conclusions: Shift work and unhealthy behaviors are key determinants of diabesity among Spanish workers. The use of adiposity estimators beyond BMI, such as CUN-BAE, should be encouraged in occupational health surveillance. Workplace-targeted interventions are urgently needed to address this growing metabolic burden. Full article

Cryptorchidism is a common congenital disorder in male horses characterized by the failure of one or both testes to descend into the scrotum. This developmental anomaly has important clinical, surgical, and economic implications, particularly in breeding animals. This retrospective study investigates the prevalence and laterality of cryptorchidism in a large equine population presented to two veterinary referral hospitals—Colorado State University Veterinary Teaching Hospital (CSU VTH, 1984–2014) and Oakridge Equine Hospital (OEH, 2008–2023). Medical records were reviewed to identify affected horses, and data on breed, age, and laterality of retained testes were collected. Anatomical location of retention (inguinal vs. abdominal) was excluded due to inconsistent documentation across the study period. A total of 777 horses met the inclusion criteria, with Quarter Horses comprising the majority of clinical cases. Quarter Horses exhibited a strong predisposition for left-sided testicular retention, whereas Thoroughbreds and Arabians more commonly presented with right-sided retention. These breed-specific trends in laterality suggest possible developmental factors influencing testicular descent. Understanding these patterns can aid in clinical diagnosis, improve surgical planning, and contribute to evidence-based breeding recommendations aimed at reducing the incidence of cryptorchidism in equine populations. Full article

(1) Background: Upper limb (UL) function plays a central role in daily life, enabling essential tasks such as reaching, grasping, and eating. While numerous tools exist to evaluate UL kinematics, their application in pediatric populations is often limited by a lack of age-specific validation. This study presents a novel motion analysis protocol featuring a customized marker set, aimed at assessing UL movements in the three anatomical planes across different age groups, with a focus on pediatric applicability. (2) Materials and Methods: A SmartDX motion capture system was used, with 30 markers positioned on the upper body, referencing the trunk as the root of the kinematic chain. Ten healthy participants (mean age: 18.69 ± 12.45 years; range: 8.0–41.4) without UL impairments were recruited. The broad age range was intentionally selected to assess the protocol’s transversal applicability. (3) Results: Results showed excellent intra-operator reliability for shoulder and wrist kinematics (ICC > 0.906) and good reliability for elbow movements (ICC > 0.755). Inter-operator reliability was good to excellent (shoulder ICC > 0.958; elbow ICC > 0.762; wrist ICC > 0.826) Usability, measured via the System Usability Scale, was rated as good (83.25). (4) Conclusions: The proposed protocol demonstrated strong reliability and practical usability, supporting its adoption in clinical and research settings. Its design allows for adaptability across motion capture platforms, promoting wider implementation in pediatric UL functional assessment. Full article

Background/Objectives: Metabolic syndrome (MetS) comprises a cluster of cardiometabolic risk factors that vary dynamically under environmental and behavioral influences. Although there are data suggesting seasonal variability in individual metabolic components, few studies have comprehensively assessed MetS as a composite condition across seasons using a large, nationally representative population. In this study, we aimed to evaluate the seasonal and monthly patterns of MetS prevalence and component burden, with a focus on sex-specific differences. Methods: We analyzed 5,507,251 health screening records from 2,057,897 Korean adults aged ≥40 years between 2013 and 2022, obtained from the National Health Insurance Service database. Seasons were categorized as: spring (March–May), summer (June–August), fall (September–November), and winter (December–February). Trends in MetS prevalence and its components were evaluated monthly and seasonally, stratified by sex. Results: MetS prevalence significantly varied by season in both sexes (p < 0.001), ranging from 30.2% to 34.5% in men and from 21.5% to 25.5% in women. Among men, a U-shaped pattern was observed, with the lowest prevalence during summer and a progressive increase through winter. Women showed a steady decline in prevalence from January to September, followed by a slight rebound. Winter was associated with increased odds of MetS in both sexes. A significant interaction between sex and season (p for interaction <0.001) indicated the presence of sex-specific temporal patterns. Conclusions: This nationwide study revealed clear seasonal variation in MetS prevalence and component burden, with sex-specific patterns. These findings highlight the importance of incorporating seasonality and sex in cardiometabolic risk assessments and public health interventions. Full article

Background/Objectives: We report on the association of clinical, demographic, and peri- and intraoperative factors with patient outcomes in large- and, separately, medium-vessel acute ischemic stroke (AIS) occlusions treated with mechanical thrombectomy or medical thrombolysis. Increasingly, neuroimaging, particularly novel markers of collateral status, has become useful in predicting response to endovascular treatment (EVT) among AIS patients. However, the relationship between these neuroimaging markers, documented predictors of stroke outcomes, and post-EVT functional status in anterior circulation large-vessel occlusions (LVOs) as compared to medium-vessel occlusions (MeVOs) remains unclear. We evaluated whether shared predictors of 90-day post-EVT functional outcomes in LVO compared to MeVO AIS patients within our institution exist. Methods: We retrospectively evaluated AIS patients treated at our institution between 9 January 2017 and 10 January 2023. The following were the inclusion criteria were applied: (i) CTA confirmed anterior circulation large or medium vessel occlusion; (ii) diagnostic CT perfusion was performed; (iii) mechanical thrombectomy was performed. A low modified Rankin score (mRS) indicating good functional outcomes (i.e., functional independence) was defined as less than or equal to 2, in accordance with prior studies. Univariate and multivariate logistic regression analyses were conducted to determine associations between demographic, clinical, and radiologic factors and mRS ≤ 2. Results: A total of 249 LVO (mean age 65.3 ± 16.2, 53.8% female) and 91 MeVO (mean age 68.9 ± 13.3, 46.2% female) patients met the inclusion criteria. Upon multivariate regression adjusted for race, age, hypertension, diabetes mellitus, radiologic features, IV alteplase, admission NIHSS, and reperfusion status, young age (p = 0.004), low admission NIHSS (p = 0.0001), and good reperfusion status (p = 0.007) were associated with good functional outcomes in LVO stroke. By contrast, no factors were significantly associated with good functional outcomes in MeVO stroke. Conclusions: Known factors, including young age, low admission stroke severity, and successful reperfusion predict EVT outcomes in LVO stroke but not necessarily in MeVO stroke. Further studies regarding predictors of MeVO outcomes in nonsurgical cases, including collateral status, may guide optimal medical management for this population. Full article

Background/objectives: Multiple systemic treatments are available for metastatic castration-resistant prostate cancer (mCRPC), with unclear safety profiles. This study seeks to describe the safety determined in randomized clinical trials of a systemic treatment for mCRPC and whether safety differs by age. Methods: We utilized individual patient data from industry-funded phase 2/3 trials in mCRPC on abiraterone acetate (AA). Vivli, a clinical trial repository site, was used. One investigator independently performed screening. Relative effects of treatment were assessed with frequencies and odds of serious adverse events (SAEs). The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Subgroup analysis measured odds of SAEs as modified by age. Results: We identified 14 trials with 4296 patients. The median age of participants was 69 years. Nearly all participants experienced at least one adverse event (98.4% abiraterone, 97.3% standard of care [SOC]). More serious adverse events (grade 3 or 4) and deaths (grade 5) occurred in those receiving SOC (71.8%) compared to abiraterone (64.1%). The most frequent adverse event category was “Musculoskeletal and Connective Tissue Disorders”. The most frequent event types included anemia, back pain, hypertension, fatigue, hypokalemia, and bone pain. The odds of all events were lower in those receiving abiraterone compared to SOC. Odds of a serious musculoskeletal event were lower in older subjects by 22% (OR 0.78; 95% CI 0.63, 0.96). Conclusions: In this IPD meta-analysis, abiraterone acetate provides no greater risk of SAE in those receiving abiraterone than those receiving SOCs. Patients in the RCTs are younger and healthier than those in the general population; consequently, the results of RCTS might not be applied to the general population, especially those under-represented in the RCTs. There is a need to further evaluate abiraterone-related fractures and neuromuscular toxicities (NMTs) as key outcomes to gain insight into risk factors related to these adverse events. A real-world prospective study is warranted to examine the overall risks and benefits associated with treatment. Full article

Background: Loneliness and social isolation among older people are currently widespread and recognized as the foremost public health problems globally and locally. Hong Kong, which exhibits a rapid aging trend and an expanding elderly population, is inevitably facing these issues. This study explored the lived experiences of loneliness among older adults in Hong Kong. Methods: Qualitative interviews were conducted among older adults in the community aged 60 or above who were cared for by migrant domestic workers and presented varying levels of loneliness. Purposive sampling was used to select subjects for face-to-face, semi-structured individual interviews, with consent for audio recording, which led to the inclusion of 19 older adults, among whom five were male, nine lived with a spouse, and three lived with their children. Interpretative phenomenological analysis was adopted. Results: We identified a core theme, “Should I stay at home alone?”, and the following four interrelated themes: (1) experience of inadequate social support and networks, (2) altered family dynamics and support, (3) deterioration in physical functions and mobility limitations, and (4) experience of negative and complex emotions. Conclusions: Based on our investigation into the lived experience of loneliness among older adults locally, we recommend that the government, non-governmental organizations, and healthcare institutions establish appropriate strategies and integrated services to address the social, physical, familial, and emotional issues in this population to foster healthy aging, improve their quality of life, and encourage support from families and communities. Full article

Background/Objectives: Proteinuria, a marker of renal dysfunction, has been implicated in cancer risk, yet its role in gastric carcinogenesis remains underexplored in high-incidence populations. This study evaluated the association between urine dipstick proteinuria severity and gastric cancer incidence in a nationwide Korean cohort. Methods: We analyzed data from the Korean National Health Insurance Service–National Sample Cohort, including 220,941 adults aged > 40 years, without a diagnosis of cancer, who received health examinations in 2009. Proteinuria was classified by single dipstick testing as negative, 1+, or ≥2+. Participants were followed for a mean of 4.37 ± 0.49 years (965,601.2 person-years). Multivariable Cox proportional hazards models adjusted for age, sex, body mass index, systolic blood pressure, fasting glucose, LDL cholesterol, estimated glomerular filtration rate, smoking status, alcohol intake, and physical activity were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During follow-up, 1934 participants (0.88%) developed gastric cancer. A significant dose–response relationship emerged (p for trend = 0.037). In fully adjusted models, 1+ proteinuria conferred no significant risk increase (HR 1.10; 95% CI, 0.80–1.51), whereas ≥2+ proteinuria was associated with a 42% higher gastric cancer risk (HR 1.42; 95% CI, 1.00–2.02). Conclusions: Severe dipstick proteinuria independently predicts elevated gastric cancer risk in Korean adults. Integration of urine dipstick testing into gastric cancer screening protocols may offer a simple, cost-effective strategy for risk stratification, particularly in high-incidence settings. Full article

Rapid population aging in developing countries has intensified demand for accessible nursing home services, yet spatial disparities in service distribution remain insufficiently examined in secondary cities. This study investigates spatial distribution and multi-dimensional accessibility of nursing homes in Kunming, China, using comprehensive spatial analytical methods to inform sustainable urban development. We analyzed 205 nursing homes with 47,600 beds, evaluating spatial distribution patterns, economic accessibility, and spatial accessibility across different transportation modes. Our analysis reveals a pronounced monocentric pattern with nursing resources concentrated within central urban districts, creating a “primary core-multiple satellite” structure and spatial mismatch between service supply and older adult population needs. A distinct institutional dichotomy exists between publicly and privately operated facilities, establishing a dual-track system with different accessibility implications for social equity. Economic accessibility analysis demonstrates significant barriers in central urban and tourism-oriented districts dominated by higher-priced private facilities, where minimum prices frequently exceed average monthly pension. Spatial accessibility remains inadequate across all transportation modes, with only 24.3% of communities achieving normal or higher accessibility via private car, 21.5% via public bus, and merely 13.9% via walking. These limitations primarily stem from insufficient service capacity (34 beds per 1000 older adults) relative to demographic needs rather than transportation constraints. We recommend three sustainable interventions: implementing demand-based planning mechanisms, establishing progressive pricing policies, and developing older adult-friendly transportation networks. This framework supports sustainable urbanization by promoting spatial equity and efficient resource allocation, providing valuable insights for secondary cities pursuing sustainable development goals. Full article

Lifetime reproductive output (LRO), also called lifetime reproductive success (LRS) is often described by its mean (total fertility rate or net reproductive rate), but it is in fact highly variable among individuals and often positively skewed. Several approaches exist to calculating the variance and skewness of LRO. These studies have noted that a major factor contributing to skewness is the fraction of the population that dies before reaching a reproductive age or stage. The existence of that fraction means that LRO has a zero-inflated distribution. This paper shows how to calculate that fraction and to fit a zero-inflated Poisson or zero-inflated negative binomial distribution to the LRO. We present a series of applications to populations before and after demographic transitions, to populations with particularly high probabilities of death before reproduction, and a couple of large mammal populations for good measure. The zero-inflated distribution also provides extinction probabilities from a Galton-Watson branching process. We compare the zero-inflated analysis with a recently developed analysis using convolution methods that provides exact distributions of LRO. The agreement is strikingly good. Full article

The human virome—comprising viruses that can persist in a host, those that benefit the host, and those that remain latent—has gained increasing acceptance as a modulator of immune response toward vaccination. The factors known to influence vaccine efficacy include host genetics, age, and bacterial microbiota, while the virome is a much less considered fourth dimension. This article reviews how components of the virome such as Torque Teno Virus (TTV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), and bacteriophages impact both innate and adaptive immune responses, including mechanisms of immune pre-activation, trained immunity, and molecular mimicry from both beneficial and detrimental perspectives for vaccine-induced immunization. Emphasis is given to immunocompromised populations such as transplant recipients and those with HIV, where virome composition has been shown to correlate with vaccine responsiveness. Experimental models support clinical observations on how chronic viral exposures can either enhance or inhibit vaccine efficacy. Finally, we discuss virome-aware precision vaccinology and call for the integration of the virome in the development of immunization strategies, thus improving outcomes through customization. Full article

Emotion regulation strategies, specifically expressive suppression (ES) and cognitive reappraisal (CR), are known to influence mental health outcomes in the general population and adult elite athletes. Young elite athletes, who face unique academic and athletic pressures, remain understudied in this regard. The main aim of this study was to examine the relationship between ES and CR and mental health in young elite athletes. This longitudinal study included 93 young elite athletes (aged 15–17) attending upper secondary education in Sweden. Participants completed the Emotion Regulation Questionnaire and the General Health Questionnaire at three time points over 12 months. Linear mixed models were used to examine associations between ES, CR, and mental health. Higher use of ES was significantly associated with poorer mental health (β = 0.34, p < 0.001), while greater use of CR predicted better mental health (β = −0.33, p < 0.001) across the study period. Expressive suppression and CR are both important for the mental health of young elite athletes, with CR being protective and ES conferring risk. Given the observed associations, future research could examine whether interventions aiming to enhance CR and reduce ES are linked to better mental health in young elite athletes. Full article

Identification of temporal relations among suicide mortality and economic/political implementations provides important information for not only planning suicide prevention but also socioeconomic/psychosocial measures. This cross-sectional observation study analyzed temporal fluctuations and causalities of suicide mortalities of working-age individuals, disaggregated by age/gender/social standing (employed/unemployed), in Japan from 2009 to 2024, using government databases, by joinpoint and vector-autoregressive analyses. Suicide mortality among total and employed females decreased until the COVID-19 pandemic outbreak but sharply increased, synchronized with the pandemic outbreak, before resuming a downward trend. Among males, the decreasing trends attenuated from 2016, followed by a transient increase in 2022. Unemployed males aged 40–69 exhibited four joinpoints: 2016 (decreasing–increasing), 2018 (increasing–decreasing), 2022 (decreasing–increasing), and 2023 (increasing–stable). In contrast, suicide mortality among unemployed females aged 40–69 sharply increased in 2022 and maintained the high level. Among individuals aged 30–39, suicide mortality reversed from decreasing to increasing in 2016 (males) and 2018 (unemployed females). Economic expansion was protective for employed individuals but had no significant effect on unemployed populations. The government management instability (AENROP) index was positively associated with suicide mortality among employed and unemployed males and employed females. Unemployed females aged 30–39 were sensitive to AENROP but not economic conditions, while those aged 40–69 were largely unaffected by either. Increasing employment of individuals with psychiatric disabilities was positively associated with suicide mortality among unemployed males (30–69) and females under 40. Positive impacts of the employment rates of individuals with psychiatric disabilities and unemployment enhanced from 2016 and 2022, respectively, whereas the impacts were inconstantly affected by political rather than economic factors. Suicide mortality among unemployed individuals has emerged as a critical public health concern in Japan, with rates more than doubling among males and tripling among females in the 2020s. These findings underscore the need for integrated suicide prevention policies that address both labor market vulnerabilities and psychosocial determinants. Full article

(1) Background: Prematurity remains a leading contributor to neonatal morbidity and mortality, with long-term consequences that extend well beyond the neonatal period. This cross-sectional study aimed to identify key maternal, perinatal, and neonatal factors that influence the short- and long-term evolution of preterm infants. It also seeks to evaluate the level of post-discharge follow-up care, parental involvement during NICU hospitalization, access to supportive therapies such as physiotherapy and RSV prophylaxis, and the impact of breastfeeding practices. Additionally, the study explores parental awareness and use of recent national initiatives in Romania, such as the “Premature and Vulnerable Newborn’s Notebook”. (2) Methods: A total of 360 mothers of preterm infants born between 2001 and 2025 responded to a structured questionnaire assessing clinical characteristics, NICU care, parental involvement, and post-discharge support. (3) Results: The findings indicate that assisted reproduction and pregnancy plurality were associated with higher maternal age, while vaginal delivery was associated with lower gestational age at birth. Notably, only 25% of infants were enrolled in structured follow-up programs, and a large proportion of families relied on private services for physical therapy. Kangaroo mother care was reported by just 16.4% of mothers. While breastfeeding rates improved after discharge, access to multidisciplinary follow-up and public physiotherapy remains limited. Encouragingly, most mothers endorsed the proposed national initiative for a “Premature and Vulnerable Newborn’s Notebook.” (4) Conclusions: This study underscores the urgent need for a comprehensive national follow-up strategy to ensure equitable and continuous care for Romania’s vulnerable preterm population. Full article

Introduction: Tuberculosis (TB) predominantly affects older adults in Japan, and prolonged hospitalization remains a challenge. This study evaluated both clinical and social factors influencing hospitalization duration. Methods: We retrospectively analyzed 203 patients with smear-positive pulmonary TB admitted to NHO Wakayama Hospital (2017–2022). Stepwise multiple regression was used to identify factors associated with hospitalization duration. Results: Key factors included time to smear negativity, duration from isolation release to discharge, independence in daily life, and discharge destination. Prolonged stays were often due to social issues, such as difficulties in arranging transfers to long-term care homes or family acceptance. Conclusions: While Japan is developing new discharge criteria based on clinical indicators, our findings highlight the significant impact of non-clinical, social factors on hospitalization duration. Addressing these factors is essential for effective discharge planning. Full article