Search Results (2,176)

Use of anticholinergic and sedative medications is potentially inappropriate in older adults due to associated adverse effects, including impaired cognitive and physical function. This study evaluated anticholinergic and sedative burden in Croatian community-dwelling older adults using the Drug Burden Index (DBI) and examined its association with self-reported health and healthcare utilization over 12 months. This observational, cross-sectional study, part of the EuroAgeism H2020 ESR 7 project, included conveniently sampled adults ≥ 65 years from community pharmacies in three Croatian regions. Data were collected using a standardized research questionnaire. DBI was used to quantify exposure to anticholinergic and sedative medications. Multivariate regression analyses examined associations between DBI and health outcomes, using logistic regression for binary outcomes and linear regression for self-reported health. Among 388 participants (63.7% female, median age 73), most had multimorbidity (median five diagnoses) and polypharmacy (63.9%), while 57% used at least one DBI medication—most commonly diazepam (15.5%) and tramadol (14.7%). High DBI (≥1) independently predicted more emergency department (ED) visits (OR = 2.45) and worse self-rated health (B = −0.26), but not hospitalization. High DBI in older adults was associated with more ED visits and poorer self-rated health, highlighting the need for targeted interventions to reduce anticholinergic and sedative use in this vulnerable population. Full article

This study investigates the influence of driver-related factors on on-street parking choice by integrating stated preference (SP) and revealed preference (RP) survey methods. A hybrid SP–RP survey was designed to simulate realistic parking scenarios, and 423 valid questionnaires were collected online and offline. Key factors affecting parking choice were identified through descriptive analysis, including user acceptance of differentiated pricing and satisfaction with existing policies. The Kaiser–Meyer–Olkin (KMO = 0.904) and Bartlett’s test (p < 0.001) confirmed data suitability for factor analysis. A binary logistic regression model was developed to quantify variable effects under different travel purposes. Key findings include the following: monthly parking fee had the strongest effect (OR = 6.691, p = 0.010) on parking choice for shopping/entertainment trips; model prediction accuracy ranged from 80.87% to 83.56% across travel purposes; and goodness-of-fit metrics were strong (McFadden R² = 0.630, Nagelkerke R² = 0.772). The results provide empirical evidence on parking choice determinants and support the design of demand-responsive parking policies through dynamic and differentiated pricing strategies. Full article

Background: Hip fractures are common in the elderly and often require ICU admission post-surgery due to high ASA scores and comorbidities. Length of hospital stay after ICU is a crucial indicator affecting patient recovery, complication rates, and healthcare costs. This study aimed to develop and validate a machine learning-based model to predict the factors associated with extended hospital stay (>7 days from surgery to discharge) in hip fracture patients requiring postoperative ICU care. The findings could help clinicians optimize ICU bed utilization and improve patient management strategies. Methods: In this retrospective single-centre cohort study conducted in a tertiary ICU in Turkey (2017–2024), 366 ICU-admitted hip fracture patients were analysed. Conventional statistical analyses were performed using SPSS 29, including Mann–Whitney U and chi-squared tests. To identify independent predictors associated with extended hospital stay, Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied for variable selection, followed by multivariate binary logistic regression analysis. In addition, machine learning models (binary logistic regression, random forest (RF), extreme gradient boosting (XGBoost) and decision tree (DT)) were trained to predict the likelihood of extended hospital stay, defined as the total number of days from the date of surgery until hospital discharge, including both ICU and subsequent ward stay. Model performance was evaluated using AUROC, F1 score, accuracy, precision, recall, and Brier score. SHAP (SHapley Additive exPlanations) values were used to interpret feature contributions in the XGBoost model. Results: The XGBoost model showed the best performance, except for precision. The XGBoost model gave an AUROC of 0.80, precision of 0.67, recall of 0.92, F1 score of 0.78, accuracy of 0.71 and Brier score of 0.18. According to SHAP analysis, time from fracture to surgery, hypoalbuminaemia and ASA score were the variables that most affected the length of stay of hospitalisation. Conclusions: The developed machine learning model successfully classified hip fracture patients into short and extended hospital stay groups following postoperative intensive care. This classification model has the potential to aid in patient flow management, resource allocation, and clinical decision support. External validation will further strengthen its applicability across different settings. Full article

Background: Sarcoidosis is a systemic granulomatous disease with a highly variable clinical course, and distinguishing it from other diseases and predicting its prognosis can be challenging. In recent years, hematological and biochemical parameters have been investigated as potential biomarkers for assessing inflammation and predicting disease prognosis. This study aimed to evaluate the prognostic value of the lactate dehydrogenase-to-albumin ratio (LAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). Methods: This retrospective, single-center study included 369 newly diagnosed patients with sarcoidosis who were admitted between January 2020 and October 2024. Sarcoidosis was diagnosed based on current ERS, ATS, and WASOG guidelines. At the 6-month follow-up, patients’ clinical courses were classified as regression, stable, or progression based on clinical, radiological, and pulmonary function tests. The predictive values of various hematological and biochemical parameters were analyzed using statistical methods, including binary logistic regression analysis and ROC analysis. Results: A total of 369 patients were included in the study. At the 6-month follow-up, 63.4% of patients showed regression, 21.4% had a stable course, and 15.2% showed progression. The progression group had a significantly higher LAR (5.26 [4.21–7.76]) compared to the stable/regression group (4.59 [3.82–5.86]) (p = 0.033). Additionally, baseline FVC% (OR, 0.97; p = 0.036) and the presence of dyspnea (OR, 3.08; p = 0.03) were identified as independent risk factors for disease progression. No significant associations were found between NLR, PLR, LMR, and serum ACE levels and the clinical course. The cutoff value of LAR for predicting disease progression was 4.87 (AUC: 0.605), with a sensitivity of 58.8% and specificity of 59.7%. Conclusions: Our study, which is the first to evaluate the prognostic value of LAR in sarcoidosis, identified this parameter as a significant indicator for the clinical course. The finding of significantly higher LAR levels in patients with disease progression suggests its potential as a prognostic biomarker. These results may help guide treatment and follow-up strategies, although further large-scale prospective studies are needed for validation. Full article

Background: Coronary collateral circulation (CCC) plays a crucial protective role in patients with chronic total occlusion (CTO), mitigating ischemia and improving long-term outcomes. However, the degree of collateral vessel development varies substantially among individuals. Systemic inflammatory and nutritional status may influence this variability. The Naples Prognostic Score (NPS) is a composite index reflecting these parameters, yet its relationship with CCC remains incompletely defined. Methods: We retrospectively analyzed 324 patients with angiographically confirmed CTO at Selçuk University Faculty of Medicine between 2014 and 2025. Coronary collaterals were graded using the Rentrop classification, and patients were categorized as having poor (grades 0–1) or good (grades 2–3) collaterals. The NPS was calculated using serum albumin, cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Baseline clinical and laboratory data were compared between groups. Univariate and multiple binary logistic regression analyses were performed to identify independent predictors of collateral development. Results: Of the 324 patients, 208 (64.2%) had poor and 116 (35.8%) had good collateral circulation. Patients with good collaterals had higher body mass index, HDL Cholesterol (HDL-C), and triglyceride levels, and significantly lower NPS values compared with those with poor collaterals (p < 0.05 for all). In multiple binary logistic regression analysis, HDL-C (OR 1.035; 95% CI 1.008–1.063; p = 0.011) and NPS (OR 0.226; 95% CI 0.130–0.393; p < 0.001) emerged as independent predictors of well-developed collaterals. Conclusions: Both NPS and HDL-C are independently associated with the degree of coronary collateral circulation in CTO patients. These findings highlight the interplay between systemic inflammation, nutritional status, lipid metabolism, and vascular adaptation. As simple and routinely available measures, NPS and HDL-C may serve as practical tools for risk stratification and identifying patients at risk of inadequate collateral formation. Prospective studies with functional assessments of collateral flow are warranted to confirm these associations and explore potential therapeutic interventions. Full article

Background: Child sexual abuse (CSA) is a serious public health concern that violates the rights of children. In Mexico, little is known about the actual figures for this type of violence. Objective: This study aimed to determine trends in the prevalence and case characteristics of CSA in a representative sample of children in Mexico. Materials and Methods: Data from the National Health and Nutrition Survey (ENSANUT) for 2018, 2020, 2021, 2022 and 2023 were used (n = 24,179). Proportions of CSA were estimated using the weighted mean of a binary variable, and the variance of the estimated proportion was calculated using the Taylor linearization method. Logistic regression models were estimated, and Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (95% CIs) were obtained. Results: The prevalence of CSA ranged from 2.22% (2018) to 5.66% (2023). There was an increasing trend in CSA between 2018 and 2021, which was even more pronounced (154.95%) between 2018 and 2023 (p < 0.001). The main perpetrator in CSA cases was a family member (78.51%), and most victims did not report the abuse to the authorities. Girls were more likely to experience CSA (AOR = 2.83, 95% CI: 1.72–4.68), and as years passed (from 2018 to 2023), the likelihood of becoming a victim of CSA increased. Conclusions: CSA is a problem that has increased in recent years in Mexico. It is noteworthy that the main perpetrator is within the family, which may influence the lack of reporting of these cases. In view of this situation, it is necessary to implement strategies to prevent CSA in children, involving mothers, fathers, and caregivers. Full article

The massive volumes of data and the intensification of digital transformation are reshaping recruitment practices within organizations, particularly for specialized information technology (IT) profiles. However, existing studies have often remained conceptual, focused on developed economies, or limited to a narrow set of factors, thereby leaving important gaps in emerging contexts. Moreover, there are few studies that critically assess how Data Mining is impacting the IT recruitment process, and none that assess this in the context of Morocco. This study employs an extensive literature review to explore the role of Data Mining in facilitating the recruitment of top IT candidates, focusing on its ability to improve selection quality, reduce costs, and optimize decision-making procedures. The study provides empirical evidence from the Moroccan aeronautical and digital services sectors, an underexplored context where IT talent scarcity and rapid technological change pose critical challenges. Primary data comes from a survey of 200 IT recruitment professionals operating in these sectors in Morocco, allowing an assessment of the impact of Data Mining on IT talent acquisition initiatives. The findings reveal that a range of capabilities resulting from the application of Data Mining significantly and positively influences the success of IT recruitment processes. The novelty of the article lies in integrating six key determinants of algorithmic recruitment into a unified framework and demonstrating their empirical significance through binary logistic regression. The focus on the Moroccan context adds value to the international discussion and extends the literature on HR analytics beyond its conventional geographical and theoretical boundaries. The article thus contributes to the emerging literature on the role of digital technologies in IT recruitment that will be of interest to industry practitioners and other researchers in this field. Full article

Background/Objectives: Alcohol consumption can increase the risk of dyslipidemia, thereby elevating the risk of cardiovascular diseases. However, the relationship between alcohol consumption patterns and dyslipidemia remains controversial. Based on large-scale cross-sectional data from the Chinese population, this study aims to investigate the correlations between various alcohol consumption behaviors and dyslipidemia among adult residents in China. Methods: Our analysis utilized data from the 2015–2017 China Nutrition and Health Surveillance project, which provides a large, nationally representative sample (N = 52,471). We employed a binary logistic regression model specifically designed for complex sampling frameworks. This model was utilized to assess the relationship between various alcohol consumption behaviors (including daily alcohol intake levels and drinking frequency) and the incidence of hypercholesterolemia, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol (low HDL-C), and elevated levels of low-density lipoprotein cholesterol (high LDL-C). Drinking behaviors were classified into three distinct categories for analysis: China classification (never, moderate, excessive), WHO classification (never, low-risk, medium-risk, high-risk), and drinking frequency (never, <1, 1–3, 4–6, ≥7 times/week). Results: Compared with never drinkers, the risk of hypercholesterolemia was significantly higher in men who were excessive drinkers (aOR = 1.39, 95%CI: 1.24–1.57), medium-risk drinkers (aOR = 1.24, 95%CI 1.01–1.53), high-risk drinkers (aOR = 1.67, 95%CI: 1.4–1.95), and those who drank more than once a week (aOR range: 1.27–1.65), and there was no such association in women (p > 0.05). Compared with never drinkers, the risk of hypertriglyceridemia was higher in male drinkers with excessive drinking (aOR = 1.35, 95%CI: 1.24–1.47), medium-risk drinking (aOR = 1.29, 95%: 1.11–1.50), high-risk drinking (aOR = 1.52, 95%CI: 1.3–1.71), and a drinking frequency more than 1 time/week (aOR range: 1.22–1.38), while in women, it was moderate drinking (aOR = 0.85, 95%CI 0.77–0.94), low-risk drinking (aOR = 0.86, 95%CI 0.78–0.94), and a drinking frequency of more than once a week (aOR = 0.74, 95%CI 0.63–0.87) that reduced the occurrence of hypertriglyceridemia. Compared with non-drinkers, men with any drinking status had a lower risk of low HDL-C (aOR range: 0.38–0.90) and a similar association was also observed in women (aOR range: 0.26–0.84). Compared with never drinkers, male excessive drinkers (aOR = 0.86, 95%CI: 0.77–0.97), medium-risk drinkers (aOR = 0.80, 95%CI:0.65–0.99), high-risk drinkers (aOR = 0.83, 95%CI: 0.70–0.97), and those with a drinking frequency of 1–3 times/week (aOR = 0.89, 95%: 0.79–0.99) had a lower risk of high LDL-C, and there was no such association in women (p > 0.05). Conclusions: Significant gender differences were observed in the effects of alcohol consumption on lipid profiles. Men who were excessive drinkers, medium-risk drinkers, high-risk drinkers, and those who drank more than once a week had a higher risk of hypercholesterolemia and hypertriglyceridemia, but a lower risk of low HDL-C and high LDL-C. In women, moderate drinking was associated with a reduced risk of hypertriglyceridemia. Any alcohol consumption and drinking frequency more than 1 time/week were associated with a lower risk of low HDL-C in women. No significant association was found between alcohol consumption and hypercholesterolemia or high LDL-C in women. Full article

A substantial body of literature has examined the factors predicting happiness among various groups; however, few studies have systematically focused on happiness and related factors among Muslim Americans. Within the framework of the stress-process paradigm, this current study addresses fundamental arguments regarding job insecurity as a key predictor of happiness and the role of religious involvement as a buffering factor against the deleterious effects of job insecurity as a structural stressor. Thus, our work contributes to the literature by examining the potential relationships between religious covariates and job insecurity with happiness. Using data from the 2007 Pew Survey of Muslim Americans, we test the study hypotheses accordingly. Findings from the binary logistic regression models demonstrate that (a) job insecurity is a negative predictor of happiness for both males and females; (b) religious involvement is positively associated with happiness for both males and females; and remarkably (c) religious involvement buffers the adverse effects of job insecurity on happiness for females, not males. We discuss the study findings and address implications, limitations, and future research avenues. Full article

Background/Objectives: Timely initiation of antenatal care (ANC) services is crucial for ensuring maternal and fetal well-being. Despite the importance of ANC, research regarding its initiation remains limited in the Jazan region of Saudi Arabia, an area with notable adverse birth outcomes. Therefore, this study aimed to assess pregnant women’s initiation of ANC and identify associated factors and significant barriers for timely initiation. Methods: A cross-sectional study was conducted among 369 Saudi pregnant women in their third trimester attending ANC clinics in the Jazan region in 2024. A structured questionnaire was used to collect data. Andersen’s behavioral model of healthcare utilization provided the framework for the study. Descriptive statistics, chi-square tests, and binary logistic regression were used to analyze the data. Results: The majority of women (78.9%) initiated ANC in the first trimester. Higher maternal education was positively associated with early ANC initiation (aOR = 2.369, 95% CI: 1.154–4.901), whereas higher paternal education was negatively associated with early ANC initiation (aOR = 0.350, 95% CI: 0.175–0.699). When modeled independently, the positive association of higher maternal education was attenuated but was not significant, while the negative association of higher husband’s education remained the same. Those living more than three km from health facilities (aOR = 0.510, 95% CI: 0.276–0.941) and seeking care for reasons other than routine follow-up were less likely to initiate ANC early. Most women received essential services, but only 37.1% had ultrasound tests. Conclusions: While ANC initiation in Jazan showed promising trends, factors like geographical accessibility remain a significant barrier. Targeted interventions should address these identified barriers, which fall within predisposing, enabling, need, and external environmental factors. Further investigations of pregnant women’s familial decision-making and low ultrasound test utilization in relation to ANC are recommended. Full article

Protein kinases are important molecules of Alzheimer’s Disease (AD), driving neuronal demise and the emergence of the disease’s destructive hallmarks. Cdk5 has recently been highlighted as a key therapeutic target for AD. This study evaluated the expression levels of Cdk5 and Mcl1 (Cdk5’s substrate) in blood samples of 61 AD, 55 Mild Cognitive Impairment (MCI), and 57 Geriatric Controls (GC), and explored the in vitro inhibition of Cdk5. The serum levels of Cdk5 and Mcl1 were measured by Surface Plasmon Resonance (SPR) and verified by Western blot and RT-PCR. Molecular modeling and simulation studies were used to identify a potent hit targeting Cdk5 and validated by binding studies using SPR. The peptide rescue effect was analyzed by MTT assay in the AD cellular model. SPR analysis revealed a significant change in Cdk5 and Mcl1 levels in the serum samples of AD and MCI compared to GC. Results were validated by Western blot and RT-PCR. Binary logistic regression analysis revealed that the concentration of both Cdk5 and Mcl1 was independently associated with disease after adjusting for certain parameters. ROC analysis established an optimum diagnostic cutoff value for Cdk5 [24.97 ng/µL (AUC-0.90)] and Mcl1 [23.08 ng/µL (AUC-0.94)] with high sensitivity and specificity. The peptide YCWS strongly binds to Cdk5′s ATP binding site, confirmed by molecular modeling and SPR. In the AD cellular model, peptide YCWS rescued neurotoxicity, increased Mcl1 levels, and reduced destructive hallmarks by inhibiting Cdk5. It can be concluded that Cdk5 is a promising molecule as a circulatory biomarker for the diagnosis of the early stages of AD, and its peptide inhibitor YCWS is a potential therapeutic agent. Full article

Background: Shock index (SI) is calculated by dividing heart rate (HR) by systolic blood pressure (sBP) and is a useful tool for predicting the prognosis of trauma patients. This study aimed to determine whether SI is useful in predicting mortality in patients undergoing emergency surgery for trauma. Methods: We analyzed 1657 patients who underwent emergency surgery for trauma. Patients were divided into SI < 1 and SI ≥ 1 groups and the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), revised trauma score (RTS), Korean Triage and Acuity Scale (KTAS), transfusion amount, and mortality were compared. Binary logistic regression analysis was performed to identify factors associated with mortality. Results: There were significant differences in GCS, ISS, RTS, and KTAS in the SI ≥ 1 group compared to the SI < 1 group (all p-values < 0.001). In the SI < 1 cohort, the mortality rate was 11% (144/1283), and in the SI ≥ 1 group the mortality rate was 33% (125/374) (p < 0.001). Age, GCS, ISS, SI ≥ 1, and KTAS were determined to be predictors of mortality by logistic regression analysis. In particular, SI ≥ 1 group members exhibited a high association with elevated mortality (OR, 2.498; 95% CI, 1.708–3.652; p < 0.01). Conclusions: Although SI alone has limitations in predicting the patient’s prognosis, patients with SI ≥ 1 upon arrival at the emergency room are associated with mortality of patients undergoing emergency surgery for trauma, along with already known trauma assessment systems such as GCS, ISS, and KTAS. Full article

Benzene, toluene, ethylbenzene, and xylene (BTEX) are a common class of volatile organic compounds linked to adverse health outcomes. Although BTEX have been shown to have endocrine disrupting properties, their potential impacts on pubertal development in children remain unclear. In this study, for the first time, we investigated the possible association of BTEX exposure with precocious puberty (PP) and early puberty (EP) in children. We conducted a case–control study that included 246 children diagnosed with PP or EP and a controls category matched for sex and age. Urinary concentrations of seven BTEX metabolites and the oxidative DNA damage biomarker 8-hydroxy-2′-deoxyguanosine (8-OHdG) were measured by high-performance liquid chromatography-tandem mass spectrometry. Compared with the control groups, urinary catechol (1,2-DB) levels were significantly higher in both PP (median: 85.3 vs. 42.4 μg/g creatinine) and EP children (median: 62.0 vs. 48.1 μg/g creatinine). Binary logistic regression models showed that 1,2-DB was positively associated with EP (OR = 1.36, 95% CI: 1.10, 1.69), while trans,trans-muconic acid (MU) was negatively correlated with PP (OR = 0.47, 95% CI: 0.24, 0.92), and PGA was negatively correlated with EP (OR = 0.73, 95% CI: 0.56, 0.93) adjusted for confounders. Stratified analyses showed that the relationship between BTEX metabolites and EP varied by parental education level. Our findings revealed that exposure to BTEX, especially benzene, may influence pubertal timing in children, but there was no relationship between oxidative DNA damage and PP or EP. The biological mechanism of BTEX exposure affecting pubertal development requires further investigation. Full article

Background: Non-islet cell tumor hypoglycemia is increasingly reported with gastrointestinal stromal tumors (GIST), but population-level estimates of its clinical impact are limited. We evaluated associations between hypoglycemia and inpatient outcomes among GIST hospitalizations. Methods: We conducted a retrospective cross-sectional study of the National Inpatient Sample (NIS) 2018–2020. Adult GIST discharges were identified by ICD-10-CM codes and stratified by hypoglycemia. Primary outcomes were in-hospital mortality and resource utilization—length of stay (LOS) and total hospital charge. Secondary outcomes included malnutrition, sepsis, ascites, peritonitis, bowel perforation, intestinal obstruction, gastrointestinal bleeding, and iron deficiency anemia. Analyses used survey-weighted logistic regression for binary outcomes and generalized linear models for continuous outcomes. A propensity score-matched sensitivity analysis balanced sepsis and malnutrition. Results: Among 61,725 GIST hospitalizations, 0.72% had hypoglycemia. Mortality was 12.6% with hypoglycemia vs. 3.1% without; adjusted odds of death were higher (aOR 4.16, 95% CI 2.06–8.37; p < 0.001). Hypoglycemia was also associated with malnutrition (aOR 5.63, 3.37–9.40), sepsis (aOR 4.00, 2.24–7.14), ascites (aOR 3.43, 1.63–7.19), and peritonitis (aOR 2.91, 1.17–7.22). LOS was 4.61 days longer on average (not significant; p = 0.185), and total hospital charge was $5218 higher (β = 19,116.8; p = 0.95). In the matched cohort, the mortality association attenuated but persisted (aOR 1.38, 1.27–1.49; p < 0.001); peritonitis remained significant (aOR 1.10, 1.04–1.17), intestinal obstruction (aOR 4.91, 3.44–7.05) and iron deficiency anemia (aOR 3.54, 1.62–7.74) became significant, while ascites and gastrointestinal bleeding were not significant. Conclusions: Hypoglycemia in GIST, although uncommon, marks a higher-risk inpatient trajectory with increased mortality and several complications; these signals largely persist after balancing severity proxies. Resource-use differences were directionally higher but not statistically significant. Recognition of hypoglycemia may aid risk stratification and inpatient management in GIST. Full article

This study examined social and physical environmental exposures, health, and healthcare utilization among children aged 0–12 in urban areas. A population-based cross-sectional design was used, incorporating general practitioners’ data (2018–2019, n = 14,547), and societal and environmental data. Latent class analysis identified three distinct classes based on child and family demographics: ‘Dutch-origin two-parent household’ (n = 7267), ‘households with diverse countries of origin’ (n = 4313), and ‘single-parent household’ (n = 2967). Binary and multinomial logistic regression examined associations with environmental factors and child health outcomes. Children from the Dutch-origin class most often had favorable family demographics, neighborhood conditions, and health outcomes. Children from the diverse countries of origin class most often faced adverse neighborhood conditions, had higher rates of physical or somatic health conditions, and higher healthcare costs. Children from the single-parent class more often had less favorable family demographics, a higher likelihood of mental health problems, more frequent general practitioner visits, and were often in contact with youth care. This study highlights how child and family demographics and social and neighborhood conditions impact child health and healthcare utilization. Future approaches should focus on strategies to build and strengthen family and community resilience and adopt family-centered, context-sensitive interventions. Full article