Search Results (26)

Background/Objectives: Alcohol misuse among medical students is commonly attributed to academic stress, yet the specific role of coping mechanisms in this relationship has received limited attention. We investigated whether substance use coping, rather than stress exposure itself, drives alcohol use risk in Romanian medical students, and whether distinct coping-based subgroups can be identified through cluster analysis. Methods: We conducted a cross-sectional survey among 244 medical students (mean age 21.95 ± 3.27 years; 67.2% female) at the University of Medicine and Pharmacy of Craiova, Romania. Alcohol use was measured with the AUDIT and coping strategies with the Brief COPE. Analyses included Mann–Whitney U tests, Spearman correlations, multiple linear and binary logistic regression, and k-means clustering. Results: At-risk drinking (AUDIT ≥ 8) was identified in 19.7% of participants. The tendency to use substances to cope with stress (substance use coping) was the strongest predictor of AUDIT scores in both linear regression (B = 2.090, p < 0.001, R² = 0.513) and logistic regression (OR = 2.026, p < 0.001). Male sex independently predicted at-risk status (OR = 2.572, p = 0.025), while planning was protective in both models (B = −0.657, p = 0.005; OR = 0.691, p = 0.029). Humor also emerged as a significant risk factor (OR = 1.638, p = 0.005). K-means analysis (k = 5) revealed five coping profiles with significantly different AUDIT distributions (Kruskal–Wallis H = 47.26, p < 0.001). The Substance-Oriented cluster (13.1% of students) had a mean AUDIT of 12.66, compared with 3.00–4.13 in other clusters. Conclusions: In a subgroup of medical students, alcohol use appears integrated into the coping repertoire rather than merely being a consequence of stress. The identified coping profiles should be interpreted as prototypical configurations with overlapping boundaries rather than discrete categorical types, given the low silhouette coefficient (0.094) of the cluster solution. The strong predictive effect of substance use coping should be interpreted with the caveat that the Brief COPE Substance Use subscale and the AUDIT share content related to alcohol use behavior, which may inflate the observed association. These findings point to the need for coping-specific interventions. Planning skills training and a more nuanced understanding of humor’s role in drinking contexts may offer avenues for prevention. However, the logistic model’s sensitivity of 50.0% indicates that coping-based identification alone would miss approximately half of at-risk students, underscoring the need for further refinement before clinical application. Full article

Chronic kidney disease (CKD) represents a major global health burden, with growing evidence indicating that its origins extend back to early developmental stages. This narrative review integrates epidemiological, clinical, and mechanistic experimental evidence to position inflammation as a life-course driver of kidney vulnerability rather than a late-stage consequence. Inflammation has emerged as a central mechanistic link connecting adverse prenatal and postnatal exposures to lifelong kidney vulnerability. We highlight the translational potential by identifying pathways amenable to early-life interventions that could modify disease trajectory. During fetal development, maternal nutritional status, metabolic stress, and inflammatory exposures influence nephron endowment, immune maturation, and epigenetic regulation, thereby shaping long-term CKD risk. In childhood, early immune dysregulation and low-grade inflammation contribute to disease initiation, defining critical windows for preventive and renoprotective interventions that can be implemented in at-risk populations. In adulthood and aging, persistent activation of cytokine signaling, inflammasomes, oxidative stress pathways, autophagy–mitophagy imbalance, and cellular senescence drives progressive kidney injury, further amplified by gut microbiota dysbiosis and renin–angiotensin system interactions. Emerging life-course strategies include maternal nutrition optimization, early-life risk stratification, targeted anti-inflammatory and immunomodulatory therapies, and microbiota-directed interventions tailored to developmental stage and individual risk profile. By emphasizing inflammation as a developmentally programmed and preventable process, this review underscores opportunities for early-life and transgenerational CKD prevention, translating mechanistic insights into actionable strategies for preventive medicine and public health. Full article

Traffic violations represent a significant public health concern, with professional drivers substantially impacting road safety. This pilot study compared self-report questionnaires (general personality versus domain-specific), performance-based tests, and driving simulator measures to determine which assessment method best predicts traffic offences among professional truck drivers. Participants (N = 27) completed the Impulsiveness–Venturesomeness–Empathy Questionnaire (IVE), the Road Traffic Behaviours Questionnaire (KZD), and the Vienna Risk-Taking Test Traffic (WRBTV) and performed standardised driving scenarios in a truck simulator. Performance was assessed using speed variations in five validated decision-making situations. Drivers were classified into two groups based on relatively higher and relatively lower numbers of self-reported traffic offences. The KZD demonstrated the strongest group differentiation (p = 0.034, d = 0.76). Simulator performance was significantly different between the groups (p = 0.033, d = −0.68), with offence-reporting drivers showing smaller speed reductions. The WRBTV and the IVE empathy subscale approached significance (p = 0.056 and p = 0.059, respectively). Higher empathy characterised offence-free drivers, suggesting social–emotional factors may contribute to traffic safety. General impulsiveness and venturesomeness showed no group differences. The results indicate that domain-specific questionnaires and behavioural assessments offer superior predictive validity compared to general personality measures for identifying potentially unsafe drivers. ROC analysis revealed moderate predictive validity across significant measures (AUC: 0.64–0.70), with differential patterns of sensitivity and specificity among predictors. The findings suggest implementing tiered screening approaches using domain-specific questionnaires as initial cost-effective tools, followed by simulator assessment for at-risk drivers, enabling transport companies and regulatory bodies to identify high-risk drivers proactively. Full article

The idea that gut microbes or a “bacillus of crime” might promote criminal behavior was popularized in the early 20th century. Today, advances in neuromicrobiology and related omics technologies are lending credibility to the idea. In recent cases of dismissal of driving while intoxicated charges, courts in the United States and Europe have acknowledged that gut microbes can manufacture significant amounts of systemically available ethanol, without a defendant’s awareness. Indeed, emergent research is raising difficult questions for criminal justice systems that depend on prescientific notions of free moral agency. Evidence demonstrates that gut microbes play a role in neurophysiology, influencing cognition and behaviors. This may lead to justice involvement via involuntary intoxication, aggression, anger, irritability, and antisocial behavior. Herein, we discuss these ‘auto-brewery syndrome’ court decisions, arguing that they portend a much larger incorporation of neuromicrobiology and multi-omics science within the criminal justice system. The legalome, which refers to the application of gut microbiome and omics sciences in the context of forensic psychiatry/psychology, will likely play an increasing role in 21st century criminal justice. The legalome concept is bolstered by epidemiology, mechanistic bench science, fecal transplant studies, multi-omics and polygenic research, Mendelian randomization work, microbiome signature research, and human intervention trials. However, a more robust body of microbiota–gut–brain axis research is needed, especially through the lens of prevention, intervention, and rehabilitation. With ethical guardrails in place, greater inclusion of at-risk or justice-involved persons in brain science and microbiome research has the potential to transform justice systems for the better. Full article

About 10% of all forms of melanoma occur in a familial context and may be due to germline predisposing mutations transmitted as autosomal dominant traits within the affected families. CDKN2A is a highly penetrant gene associated to familial melanomas, being responsible of up to 40% of the cases. Other high, moderate, and low penetrance genes are being discovered, even if their own contribution to melanoma risk is still under debate. Indeed, next generation sequencing-based strategies enable large genomic regions to be analyzed, thus identifying novel candidate genes. These strategies, in diagnostic settings, may also improve the identification of the hereditary cases between all melanomas. The identification of the at-risk subjects gives an important opportunity for cancer surveillance in order to reduce the risk of onset and/or make early diagnosis. In addition, the identification of molecular biomarkers may drive the future development of specific targeted therapies, as already done for other inherited cancer syndromes. Here, we summarize the state of the art regarding the molecular basis of the hereditary susceptibility to develop melanoma. Full article

An increasing number of burns are associated with a popular hair braiding trend incorporating synthetic hair extensions. These burns occur predominantly in young African American females and across all age groups. The hair technique involves the ends of the braid being dipped in scalding water to prevent unwinding. This process requires the installer to place the attached hair in hot water behind the client to seal the ends of the braid. This burn injury is most frequently reported on the back, shoulder, arm, forearm, thigh, and leg. The reported cases of this burn injury occurred most frequently in the client. We present a case of a burn injury involving the foot and ankle of the hairstylist installing the braids, a first-ever reported case of this kind. The review focuses on evidence-based management of foot and ankle burns to promote wound healing and prevent limb loss. Standard of care makes education and prevention necessary for lower-extremity burns because these injuries pose a risk to patients with underlying diseases. The review emphasizes the importance of better understanding the mechanism of this burn injury and the necessity to continue treating these injuries as major burns, as well as education about prevention strategies. Lower-extremity thermal injuries challenge physicians due to their unique anatomical and histologic components that affect ambulation. Strategies to prevent these burns in at-risk populations are needed. Hair braiding with scalding water to seal the ends of the braids and other thermal burns can lead to hospitalizations and the need for surgical intervention, driving up health-care costs. Full article

Clinicians who do not specialize in driving have a need for simple assessment tools for both the aging population and new drivers. While many researchers focus on complex driving scenarios presented on simulators or on-road driving, this exploratory study examines the use of interactive exercises presented using a driving simulator to determine if there are differences in the speed at which senior and novice teen drivers respond to the steering wheel and pedal stimuli. This gap is addressed by evaluating performance differences between 34 senior drivers (over 60) and 17 novice teen drivers (ages 16–17) using interactive exercises with a driving simulator: Reaction Timer Steering©, Reaction Timer Stoplight©, and Stoplight and Steering©. Overall, teens had faster reaction times and fewer errors than seniors, yet seniors demonstrated greater improvement over time. Reaction times decreased for both age groups using the Reaction Timer Stoplight exercise. For the Stoplight and Steering exercise, significant differences between the groups were identified for both the number of errors as well as their reaction times. The findings from this exploratory study suggest the potential value of using driving simulators for assessment and potentially training the motor movements associated with driving across different age groups. By providing safe and controlled environments, simulators offer value to clinicians and educators for evaluations, interventions, and skill screenings to potentially improve safety for at-risk driver populations. Full article

College students are a primary population for risky alcohol use behaviors, with one of every eleven students grappling with severe alcohol-related issues. The objective of this scoping review was to synthesize the existing literature to identify factors influencing the prevalence of drinking and driving (DAD) behaviors among college students. A scoping review was conducted using Medline (PubMed), ERIC, The American Journal on Addictions, and the NCHA databases. Criteria for article selection included being published in English and focused on DAD behaviors among college students. Articles excluded from the review were systematic reviews and discussion pieces without empirical findings related to college DAD. Of the included studies (n = 23), most identified a range of factors as being influential in college students’ DAD behavior including a family history of alcohol misuse, the use of other substances such as marijuana, age of initial alcohol consumption, place of residence, propensity for sensation seeking, affiliation with sorority/fraternity groups, and the perception of associated risks. Effective strategies may include education on the risks of combined alcohol and substance use, screening and brief interventions tailored to at-risk students, and the implementation of campus policies that promote responsible alcohol consumption and deter DAD. Full article

Dementia is a major cause of poor quality of life, disability, and mortality in old age. According to the geroscience paradigm, the mechanisms that drive the aging process are also involved in the pathogenesis of chronic degenerative diseases, including dementia. The dissection of such mechanisms is therefore instrumental in providing biological targets for interventions and new sources for biomarkers. Within the geroscience paradigm, several biomarkers have been discovered that can be measured in blood and that allow early identification of individuals at risk of cognitive impairment. Examples of such markers include inflammatory biomolecules, markers of neuroaxonal damage, extracellular vesicles, and DNA methylation. Furthermore, gait speed, measured at a usual and fast pace and as part of a dual task, has been shown to detect individuals at risk of future dementia. Here, we provide an overview of available biomarkers that may be used to gauge the risk of cognitive impairment in apparently healthy older adults. Further research should establish which combination of biomarkers possesses the highest predictive accuracy toward incident dementia. The implementation of currently available markers may allow the identification of a large share of at-risk individuals in whom preventive interventions should be implemented to maintain or increase cognitive reserves, thereby reducing the risk of progression to dementia. Full article

Evidence suggests that patients with long COVID can experience neuropsychiatric, neurologic, and cognitive symptoms. However, these clinical data are mostly associational studies complicated by confounding variables, thus the mechanisms responsible for persistent symptoms are unknown. Here we establish an animal model of long-lasting effects on the brain by eliciting mild disease in K18-hACE2 mice. Male and female K18-hACE2 mice were infected with 4 × 10³ TCID50 of SARS-CoV-2 and, following recovery from acute infection, were tested in the open field, zero maze, and Y maze, starting 30 days post infection. Following recovery from SARS-CoV-2 infection, K18-hACE2 mice showed the characteristic lung fibrosis associated with SARS-CoV-2 infection, which correlates with increased expression of the pro-inflammatory kinin B1 receptor (B1R). These mice also had elevated expression of B1R and inflammatory markers in the brain and exhibited behavioral alterations such as elevated anxiety and attenuated exploratory behavior. Our data demonstrate that K18-hACE2 mice exhibit persistent effects of SARS-CoV-2 infection on brain tissue, revealing the potential for using this model of high sensitivity to SARS-CoV-2 to investigate mechanisms contributing to long COVID symptoms in at-risk populations. These results further suggest that elevated B1R expression may drive the long-lasting inflammatory response associated with SARS-CoV-2 infection. Full article

Influenza vaccination can benefit most populations, including adults ≥ 65 years of age, who are at greater risk of influenza-related complications. In many countries, enhanced vaccines, such as adjuvanted, high-dose, and recombinant trivalent/quadrivalent influenza vaccines (aTIV/aQIV, HD-TIV/HD-QIV, and QIVr, respectively), are recommended in older populations to provide higher immunogenicity and increased relative vaccine efficacy/effectiveness (rVE) than standard-dose vaccines. This review explores how efficacy and effectiveness data from randomized controlled trials and real-world evidence (RWE) are used in economic evaluations. Findings from published cost-effectiveness analyses (CEA) on enhanced influenza vaccines for older adults are summarized, and the assumptions and approaches used in these CEA are assessed alongside discussion of the importance of RWE in CEA. Results from many CEA showed that adjuvanted and high-dose enhanced vaccines were cost-effective compared with standard vaccines, and that differences in rVE estimates and acquisition price may drive differences in cost-effectiveness estimates between enhanced vaccines. Overall, RWE and CEA provide clinical and economic rationale for enhanced vaccine use in people ≥ 65 years of age, an at-risk population with substantial burden of disease. Countries that consider RWE when making vaccine recommendations have preferentially recommended aTIV/aQIV, as well as HD-TIV/HD-QIV and QIVr, to protect older individuals. Full article

Winter in the northern hemisphere is characterized by the circulation of influenza viruses, which cause seasonal epidemics, generally from October to April. Each influenza season has its own pattern, which differs from one year to the next in terms of the first influenza case notification, the period of highest incidence, and the predominant influenza virus subtypes. After the total absence of influenza viruses in the 2020/2021 season, cases of influenza were again recorded in the 2021/2022 season, although they remained below the seasonal average. Moreover, the co-circulation of the influenza virus and the SARS-CoV-2 pandemic virus was also reported. In the context of the DRIVE study, oropharyngeal swabs were collected from 129 Tuscan adults hospitalized for severe acute respiratory infection (SARI) and analyzed by means of real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 and 21 different airborne pathogens, including influenza viruses. In total, 55 subjects tested positive for COVID-19, 9 tested positive for influenza, and 3 tested positive for both SARS-CoV-2 and the A/H3N2 influenza virus. The co-circulation of different viruses in the population requires strengthened surveillance that is no longer restricted to the winter months. Indeed, constant, year-long monitoring of the trends of these viruses is needed, especially in at-risk groups and elderly people. Full article

Research on cognitive tests for older drivers will contribute to accurately identifying unsafe drivers and decreasing the risk that older drivers pose to themselves and other roadway users. This study aims to design and evaluate a comprehensive cognitive test, including memory, reaction and judgment ability tests. A total of 72 drivers from Beijing, China, were recruited in 2020 to participate in these cognitive tests to obtain detailed test information on the recorded response time and accuracy. A one-way ANOVA test was proposed to examine the significance among different age and crash record groups. The comprehensive cognitive test was proved effective in judging the at-risk older drivers, where 96.7% of the safe young group and 100% of the safe older group passed the test, and 89.5% of the at-risk older group failed the test. The study clarified the efficiency and accuracy of each question as well as the whole test. It also confirmed that driving ability decreased with the increase in age. According to the obtained comprehensive cognitive test, it provided a scientific method basis for standardizing the management of the older drivers with a license, so as to guide the older drivers to understand traffic elements and rules. Full article

Occupational noise exposure and hearing loss are prominent in the fire service. Firefighters are routinely exposed to hazardous levels of noise arising from the tools and equipment they use, from sirens and alarm tones to the emergency response vehicles they drive. The present study utilized the Apple Watch to continuously measure environmental noise levels for on-duty firefighters. Participants included 15 firefighters from the metropolitan South Florida area, and 25 adult non-firefighter control subjects. Firefighters were recruited from a variety of roles across two stations to ensure noise exposure profiles were appropriately representative of exposures in the fire service. All participants wore an Apple Watch for up to three separate 24 h shifts and completed a post-shift survey self-reporting on perceived exposures over the 24 h study period. Cumulative exposures were calculated for each shift and noise dose was calculated relative to the NIOSH recommended exposure limit of 85 dBA as an 8 h time-weighted average. The maximum dBA recorded on the Apple Watches was statistically significant between groups, with firefighters experiencing a median of 87.79 dBA and controls a median of 77.27 dBA. Estimated Exposure Time at 85 dBA (EET-85) values were significantly higher for firefighters when compared to controls: 3.97 h (range: 1.20–14.7 h) versus 0.42 h (range: 0.05–8.21 h). Only 2 of 16 firefighters reported the use of hearing protection devices during their shifts. Overall, our results highlight the utility of a commonly used personal device to quantify noise exposure in an occupationally at-risk group. Full article

Background: Decisions around driving retirement are difficult for older persons living with cognitive decline and their caregivers. In many jurisdictions, physicians are responsible for notifying authorities of driving risks. However, there are no standardized guidelines for this assessment. Having access to a driving risk assessment tool could help older adults and their caregivers prepare for discussions around driving retirement. This study compares the clinical profiles of older adult drivers assessed in an academic memory clinic who were referred to the driving authority to older drivers who were not with a focus on instrumental activities of daily living (iADLs). Methods: Data on referred (R) and not-referred (NR) drivers were extracted from medical records. Elements from the medical history, cognitive history, functional abilities, Modified Mini-Mental State (3MS) examination, Trails A/B, and clock drawing were included in the analysis. Four risk factors of interest were examined in separate logistic regression analyses, adjusted for demographic variables. Results: 50 participants were identified in each group. The R group was older on average than the NR. As expected, R were more likely to have Trails B scores over 3 min and have significantly abnormal clock drawing tests. R also showed lower 3MS scores and a higher average number of functional impairments (including managing appointments, medications, bills, or the television). Conclusion: Beyond standard cognitive tests, impairment in iADLs may help general practitioners identify at-risk drivers in the absence of standardized guidelines and tools. This finding can also inform the design of a risk assessment tool for driving and could help with approaches for drivers with otherwise borderline test results. Full article