Search Results (2,178)

In recent years, plastic litter in marine ecosystems has emerged as a global concern. Consequently, efforts to control, mitigate, and remove micro- and macroplastics from marine systems have intensified. In order to thoroughly analyze this topic, the present work provides a comprehensive overview of various strategies aimed at reducing plastic waste pollution spread in marine areas. Based on this, worldwide regulations limiting single-use plastic (SUP) products and microplastics in health care products were discussed. Further attention was also paid to bioplastic production as a potential alternative to non-degradable ones, with particular attention to their different degradability rates in various environmental compartments. Finally, strategies for the reduction in plastic pollution were specifically analyzed through a review of plastic litter collection/removal systems from beaches and the marine environment as well as different waterways. According to the above-mentioned aspects, this work highlights the significance of marine plastic litter pollution and provides support for the identification and selection of effective strategies for the mitigation of the impact of such litter on the environment. Full article

Obesity is currently recognized as a global epidemic and contributes to numerous health complications. It is strongly associated with poor dietary habits, including the widespread availability and consumption of high-calorie foods. We conducted a narrative review of publications from major biomedical databases addressing obesity treatment and public-health interventions. One of the strategies for managing obesity is lifestyle modification—balanced diet and regular physical activity—supported by pharmacological and psychological treatment, and, in selected patients, metabolic and bariatric surgery. Beyond patient-level care, public-health-oriented measures should be considered, including taxation of sugar-sweetened beverages, restriction on advertising of unhealthy foods, regulation of the school food environment, front-of-pack nutrition labelling, mandatory food reformulation, subsidies and incentives for healthy foods, urban-planning policies that promote physical activity, and policies that expand access to bariatric surgery. A comprehensive approach integrating clinical care with public-health policy is likely to yield more effective outcomes than either alone. Full article

Background/Objectives: The rising prevalence of severe adolescent obesity has increased the number of young patients referred for bariatric surgery. The psychiatric and psychosocial profiles of adolescents and of adult women undergoing this treatment remain insufficiently characterized. This study compared preoperative and postoperative psychiatric, psychosocial, and metabolic profiles of adolescents and adult women undergoing bariatric surgery. Methods: This prospective cohort study recruited 77 consecutive female patients (32 adolescents aged <18 years; 45 adult women aged 18–25 years) at a single bariatric center in Poland between December 2022 and December 2023. All participants underwent comprehensive preoperative and one-year postoperative assessments including laboratory testing, standardized psychiatric interviews, and psychometric screening with the Beck Depression Inventory (BDI) and the Patient Health Questionnaire-9 (PHQ-9). Results: Preoperatively, adolescents were more severely affected for their age (median BMI-for-age z-score 3.53) and waited longer between the first obesity clinic visit and surgery. Adolescents more frequently reported self-harm behaviors and moderate-to-severe depression on the BDI, whereas adult women more often reported psychoactive substance use. Both groups achieved comparable improvements in laboratory and comorbidity outcomes at one year, although relative weight loss was greater in adult women (median total weight loss 37.6% vs. 28.4%, p < 0.0001). Postoperatively, a greater proportion of adolescents than adult women improved with respect to social anxiety (50.0% vs. 13.3%, p = 0.0007) and BDI depression severity (53.1% vs. 24.4%, p = 0.02), whereas a greater proportion of adult women improved with respect to psychoactive substance use (46.7% vs. 12.5%, p = 0.003). Generalized anxiety and suicidal ideation declined within both groups, but the extent of improvement did not differ significantly between them. These differences persisted, and for several outcomes became larger, after adjustment for the reduction in BMI, which was smaller in adolescents. Conclusions: In this observational cohort, bariatric surgery was associated with distinct psychiatric and psychosocial outcome profiles in adolescents compared with adult women. Because the study was uncontrolled and included no non-surgical comparison group, these findings are hypothesis-generating and cannot establish a causal effect of surgery or of its timing; confirmation in larger, multicenter studies with appropriate comparison groups is required. Comprehensive multidisciplinary perioperative care and tailored postoperative psychological support appear important for both age groups. Full article

Background/Objectives: Diabetes mellitus is associated with complex behavioral, psychosocial, and functional challenges that may influence disease burden and complication profiles. This study aimed to identify latent dimensions of diabetes self-management and health-related functioning and to evaluate their association with the type of diabetes-related complications. Methods: A cross-sectional study was conducted in 300 patients with type 2 diabetes, classified into microvascular and macrovascular complication groups. A questionnaire comprising DSMQ (diabetes self-management questionnaire) derived items, SF-36-derived items, and other questions was administered to all participants. Exploratory factor analysis was performed to identify latent dimensions related to self-management, emotional burden, dietary behavior, glycemic control challenges, glucose monitoring, and functional status. Composite scores were calculated for factors with acceptable internal consistency. Between-group comparisons, Spearman correlation analysis, and binary logistic regression models adjusted for age, sex, residence area, marital status, education, diabetes duration, and treatment type were applied. Results: Six latent factors were identified: Emotional Burden, Dietary Self-Management, Functional Limitations, Glycemic Control Challenges, Glucose Monitoring, and General Health Perception. However, only the factors demonstrating acceptable internal consistency were retained for subsequent analyses: Emotional Burden, Functional Limitations, and Glycemic Control Challenges. Functional Limitations showed the strongest association with complication type, with patients with macrovascular complications reporting greater functional impairment. After adjustment for potential confounders and correction for multiple comparisons, higher adherence to the recommended meal plan (DSMQ2) and greater functional limitations remained the principal differences between the complication groups. Functional Limitations Score remained independently associated with complication type in both unadjusted and adjusted logistic regression models. Conclusions: These cross-sectional findings support the integration of functional, psychosocial, and behavioral assessment into comprehensive diabetes care and highlight differences in patient-reported outcomes across complication groups. Full article

Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking. Objectives: This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities. Methods: A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient–GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status. Conclusions: Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously. Full article

Dengue virus (DENV) remains a major global public health challenge, driven by the expanding distribution of Aedes vectors, rapid urbanization, and increasing climate variability. This review aimed to synthesize current evidence on dengue transmission dynamics, immunopathogenesis, molecular epidemiology, diagnostic and therapeutic advances, vaccine development, and the influence of climatic factors on disease patterns. A comprehensive search of major electronic databases was conducted to identify relevant literature, followed by a qualitative synthesis of the evidence. The evidence highlights complex transmission cycles involving Aedes aegypti and Aedes albopictus, with transmission strongly influenced by temperature, humidity, rainfall, and extreme climate events. Advances in immunopathogenesis research have improved understanding of mechanisms associated with severe disease, including antibody-dependent enhancement and dysregulated inflammatory responses. Diagnostic innovations, such as reverse transcription polymerase chain reaction (RT-PCR), NS1 antigen detection, and point-of-care technologies, have enhanced case identification, while prevention strategies increasingly incorporate integrated vector management, digital surveillance systems, and emerging vaccines. Integrating epidemiological, molecular, and climatic information may strengthen early warning systems, improve outbreak prediction, and support more effective dengue prevention and control strategies. Full article

Clinical biochemical reports should reflect the clinical perspective, be well organized and biologically oriented, and present accurate reference values based on clinically relevant distributions. To illustrate possible quality issues, we selected Clinical Cases from The New England Journal of Medicine as it publishes comprehensive reports to teach internationally relevant high-level workups. We evaluated their organization with a system organ grouping and the consistency of reference values between comparable cases. We found that the ordering of tests varied across issues, and associated interpretative tests were not organized in a scholarly manner. In several cases, the reference values for hemoglobin did not align with WHO recommendations, the upper reference value for glycohemoglobin did not correspond to established guidelines, and the upper reference value for creatinine did not reflect internationally standardized methods. The ferritin reference values in young women were not adjusted for the postmenopausal age group. When searching for incident blood loss using a common reference in young women and those of postmenopausal age in a large primary health care cohort, the frequency of flagged low ferritin results was so low that the ratio of flagged results to the incidence rate of colorectal cancer was only 1.1 (0.95 confidence interval 1.0 to 1.3). In men, low ferritin flagging was far more prevalent, resulting in a ratio of 11.7 (0.95 confidence interval 11.2 to 12.1). Thus, men had an 11-fold higher theoretical relative sensitivity when detecting occult iron loss compared with women. System organ assessment is a basic clinical competence, and system organ classification for clinical biochemical tests could be used to organize clinical laboratory reports. The reference values provided should be biologically based, harmonized, and readily recognizable by the clinician to accurately guide decisions, in contrast to local procedural determinations. Examination of local laboratory data may reveal biased laboratory support. Full article

Comprehensive orientation is essential for ensuring client and patient safety, strengthening safety culture, and supporting workforce competence in social and health care. Although orientation is recognized as an important patient safety intervention, little is known about how comprehensively client and patient safety topics are incorporated into orientation programs. This study evaluated the extent to which client and patient safety topics were incorporated into orientation programs across Finnish wellbeing services counties. Data: A cross-sectional electronic survey was conducted in 2024. The questionnaire was based on the Finnish national client and patient safety orientation framework and included thirty-nine orientation topics covering safety management, occupational safety, safety culture, risk management, medication safety, infection prevention, information security, and emergency preparedness. Responses were requested from ten predefined social and health care service areas in each of Finland’s 23 wellbeing services counties. Fourteen counties participated, yielding 107 responses. Results: Traditional client and patient safety topics were widely incorporated into orientation programs. The highest affirmative responses concerned individual job responsibilities, confidentiality, processing of client and patient information, occupational safety, medication competence, and incident reporting (all 96–99%). In contrast, psychological safety (58%), second victim practices (14%), self-monitoring programs and plans (42% and 54%), safety culture assessment (41%), and client and patient safety in digital and remote services (62%) were incorporated less frequently. Conclusions: This study provides a national overview of client and patient safety orientation practices based on responses from participating Finnish wellbeing services counties. Traditional client and patient safety topics were widely incorporated into orientation programs, whereas psychological safety, second victim support, self-monitoring, and digital safety were less consistently represented. The findings suggest that implementation of patient safety priorities is uneven across safety domains, with newer organizational and systems-oriented topics appearing less embedded in orientation than traditional clinical safety topics. Orientation may therefore be viewed not merely as an onboarding activity but also as a strategic mechanism for implementing patient safety priorities within healthcare organizations. Full article

There remains a widespread lack of knowledge regarding hidradenitis suppurativa (HS) among physicians in the United States, impeding timely diagnosis and implementation of comprehensive treatment interventions. Despite the presence of supporting communities for affected adolescents and their caretakers, the overall awareness of HS remains low, and a greater consensus on the treatment of HS is needed. Current research highlights the lack of standardized pediatric guidelines for treatment of HS largely due to the varied nature of the disease and limited efficacy of current therapies. Our study aims to explore the relationship between the chronic skin condition HS and social–emotional concerns, mental health, and physical health issues in US children and adolescents. Using the Arksey and O’Malley framework and PRISMA-ScR reporting, we searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase for U.S. studies (2015–2025) on pediatric HS (<18 years) and social–emotional, mental health, or quality-of-life outcomes. Recommendations were synthesized, and study quality was appraised with CASP checklist methods and rigor. Ten studies (2020–2025) met inclusion criteria. Pediatric HS was associated with depression, anxiety, social withdrawal, shame, low self-esteem, and reduced quality of life. Physical comorbidities increased psychosocial burden. Socioeconomic and racial disparities worsened outcomes and access to care. Studies emphasized early diagnosis, routine screening, multidisciplinary management, and disparity-focused interventions. Findings may inform clinical practice and guide research initiatives aimed at improving outcomes for children and adolescents with HS. Full article

Background: Enhancing self-management and coping strategies in cancer patients is critical to improving their quality of life and treatment outcomes. eHealth interventions, such as mobile apps, telehealth platforms, and online support tools, offer accessible, personalized, and cost-effective solutions that empower patients to actively manage their symptoms, adhere to treatment plans, and reduce psychological distress. These digital tools play a pivotal role in bridging care gaps, especially for individuals facing barriers to in-person support, underscoring their growing importance in modern oncology care. Aim: The aim of this study was to evaluate the efficacy of an eHealth intervention in enhancing self-management and coping strategies in cancer patients. Methods: This study was designed as a randomized controlled trial (RCT) and is reported in accordance with the CONSORT guidelines to ensure transparent and comprehensive reporting. A study and control group pre-test/post-test design was employed to investigate the impact of the intervention in the cities of Shaqra and Sajir, Riyadh, Saudi Arabia. A total of 212 participants were recruited using the Symptom-Management Self-Efficacy Scale (SMSE) and the Jaloweic Coping Scale. Result: Before the intervention, the correlation between coping behaviors and self-management practices was weak and statistically insignificant for both groups (study: r = 0.091, p = 0.351; control: r = 0.048, p = 0.622). After the intervention, a significant positive correlation emerged in the study group (r = 0.267, p = 0.006), suggesting that improvements in coping behaviors were associated with enhanced self-management practices. However, no significant change was observed in the control group (r = 0.081, p = 0.412). Conclusions: The intervention significantly improved self-management practices and coping behaviors in the study group, while the control group showed minimal or no improvement. The findings indicate that self-management and coping strategies are interrelated, and demographic factors such as age, education, and income influence the extent of improvement. Trial Registration: ClinicalTrials.gov identifier NCT07457112, registered on 5 March 2026, retrospectively registered. Full article

Power transformers are an integral part of electrical power system infrastructure and play a vital role in the efficient and reliable transmission of bulk electrical power to distribution networks. The careful use of these assets enables the optimization of transmission voltages in power networks, a crucial step for reducing electrical energy losses, enhancing grid reliability, and ensuring uninterrupted electricity supply to end-users in interconnected power networks. Operational reliability of power transformers is a critical aspect in ensuring a continuous power supply. The health index (HI) is a crucial diagnostic tool to determine their real condition. Historically, HI assessments were based on scoring and weighting. Lately, however, there has been a significant change in the attitude towards the use of artificial intelligence (AI) and machine learning (ML) to predict the health of high-voltage power transformers. Although developments are taking place, the existing studies on ML-based HI prediction models for power transformers largely rely on an incomplete dataset containing improper parameters. Moreover, dependency on traditional ML models is a significant limitation when it comes to achieving a higher degree of predictive accuracy. This article presents a sophisticated method for determining the overall health condition of power transformers. A total of twenty of the most appropriate and highly relevant input parameters were selected to effectively evaluate the transformer condition. The dataset for these parameters was collected from real-time testing in accordance with international industry standards (i.e., IEC, IEEE, and ASTM), conducted at 220 kV and 500 kV grid stations in the Multan and Lahore regions, operated by the National Grid Company (NGC) in Pakistan. This comprehensive dataset was fed to five state-of-the-art ML models. The Categorical Boosting Regression (CatBoost Regressor) model demonstrated superior performance, achieving the highest accuracy (R² Score) of 97.2% and the lowest mean absolute error (MAE) of 1.73. The best-performing model was then employed to predict the health index of the power transformers at the 500 kV grid station, Rahim Yar Khan, and the 500 kV grid station, Multan, as a practical case study. To demonstrate the economic importance of the proposed framework, an economic analysis was conducted via an iterative, parameter-skipping imputation strategy for maintenance cost optimization of the electrical power grid. The results verify that the omission of four diagnostic tests (i.e., Dissipation Factor, Capacitance, Insulation Resistance, and Transformer Turn Ratio) can reduce the economic burden by 46.99%, yielding a cost saving of 259,000 PKR per transformer unit. The implementation of this data-driven framework in the national grid can significantly reduce maintenance costs and facilitate an operational shift from traditional preventive maintenance to advanced predictive maintenance. Full article

COVID-19, caused by the SARS-CoV-2 coronavirus, emerged as a global pandemic in 2020, with profound impacts on public health and a substantial burden on intensive care units (ICUs). Because critically ill patients are at increased risk of rapid clinical deterioration and death, there is a need for reliable early prognostic biomarkers to support risk stratification and optimize clinical management. Therefore, this study investigated whether clinical and laboratory parameters obtained at hospital admission could serve as prognostic biomarkers for endotracheal intubation and mortality in critically ill patients with COVID-19 admitted to ICUs. A retrospective analytical study was conducted using the medical records of 107 critically ill patients with confirmed COVID-19 admitted to ICUs. Patients were classified according to clinical outcome as survivors (n = 22) or non-survivors (n = 85). Clinical characteristics and laboratory biomarkers obtained at hospital admission were analyzed. D-dimer, lactate dehydrogenase (LDH), red cell distribution width (RDW), the AST/ALT ratio, and age were independently associated with mortality. In addition, D-dimer and LDH demonstrated moderate discriminatory performance for predicting the need for endotracheal intubation. These findings suggest that routinely available clinical and laboratory parameters obtained at hospital admission may serve as complementary prognostic biomarkers to support early risk stratification and clinical decision-making in critically ill patients with COVID-19. Nevertheless, prospective multicenter studies are warranted to externally validate these findings and further establish their clinical applicability. Full article

Background: Work-related musculoskeletal disorders (WMSDs) have been reported to be very common among hospital workers and particularly nurses. They are assumed or found to be a result of physical workload or poor posture at work and only secondarily a consequence of (general) stress. Due to the increasing workload, more and more digestive endoscopy nurses have WMSDs, but there is still a lack of comprehensive research on the specific factors and patterns of WMSDs in China. Methods: A cross-sectional study was conducted among 400 digestive endoscopy nurses from 35 cities across 10 provinces in China. Data were collected using the Nordic Musculoskeletal Questionnaire (NMQ) and analyzed using multivariable logistic regression and latent class analysis (LCA) to identify associated factors and WMSD occurrence patterns. Results: The overall 12-month prevalence of WMSDs was high (82.5%), particularly in the neck, shoulder, and lower back. Frequent participation in complex endoscopic procedures (adjusted OR range 1.6–1.7) and 6–10 years of work experience (adjusted OR range 1.7–2.5)—rather than daily procedure volume alone—were independently associated with an increased likelihood of WMSDs (p < 0.05). BMI, analyzed using three categories (<24, 24–27.9, ≥28 kg/m²), was not significantly associated with WMSDs in any body region. The LCA revealed three distinct WMSD patterns characterized by multisite pain: a Full-body Pain group (19.0%), a Neck–Shoulder–Lower Back–Upper Back Pain group (42.25%), and a Mild Pain group (38.75%). Conclusions: This study found that digestive endoscopy nurses were at high risk for WMSDs, mainly due to repetitive physical strain and ergonomic challenges. As this was a cross-sectional study, the reported associations should not be interpreted as causal. Ergonomic training, improved workstation design, and workload optimization are important measures to ensure nurses’ health and improve the quality of care. Full article

Background: Bedside prognostication after acute ischemic stroke remains challenging despite the availability of several composite scores, which often demand variables not routinely obtained at admission. Whether the combination of baseline neurological severity and early non-contrast computed tomography findings can support parsimonious, contemporaneous prediction of 3-month functional outcome is an open question, particularly given the well-documented overlap between clinical and imaging measures of stroke extent. Methods: We retrospectively analyzed 432 consecutive adults admitted with confirmed anterior-circulation acute ischemic stroke to a Turkish tertiary care university hospital between January 2022 and December 2025. The primary outcome was a poor functional outcome, defined as modified Rankin Scale (mRS) score 3–6 at 3 months. A prespecified multivariable logistic regression model incorporated three admission variables: baseline National Institutes of Health Stroke Scale (NIHSS) per five-point increment, Alberta Stroke Program Early CT Score (ASPECTS) per one-point increment, and age dichotomized at 65 years. Model performance was assessed with the area under the receiver operating characteristic curve (AUC), five-fold stratified cross-validation, and calibration testing. We additionally performed DeLong tests, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analyses to evaluate the incremental contribution of ASPECTS, and compared the parsimonious model against a comprehensive multivariable model containing ten predictors. Results: At 3 months, 252 patients (58.3%) had poor functional outcome, with 177 deaths (41.0%). Baseline NIHSS emerged as the dominant predictor (adjusted odds ratio [aOR] 4.16 per five-point increase, 95% confidence interval [CI] 2.79–6.22, p < 0.001), whereas ASPECTS retained no independent prognostic value after adjustment (aOR 0.99 per point, 95% CI 0.73–1.34, p = 0.952). Age ≥ 65 years was likewise non-significant (aOR 0.79, 95% CI 0.46–1.37, p = 0.405). The parsimonious model achieved excellent discrimination (AUC 0.904, 95% CI 0.876–0.932; cross-validated AUC 0.899, 95% CI 0.873–0.926) and good overall calibration on internal validation (calibration slope 0.958; calibration-in-the-large 0.009), although the Hosmer–Lemeshow test was significant (p = 0.001), reflecting localized miscalibration in the intermediate-risk range. Adding ASPECTS to a reduced model containing only NIHSS and age produced no meaningful discrimination gain (ΔAUC + 0.0003, DeLong p = 0.50; IDI ≈ 0), consistent with substantial variance sharing between NIHSS and ASPECTS (Spearman ρ = −0.89). A comprehensive model including infarct volume, Glasgow Coma Scale, reperfusion therapy, and comorbidities did not improve discrimination (AUC 0.905) and yielded a worse Akaike information criterion, supporting the sufficiency of the parsimonious model. Conclusions: In this Turkish tertiary center cohort, baseline NIHSS captured most of the prognostic information available at admission, and early ASPECTS added minimal independent value once neurological severity was accounted for. Findings should be interpreted in the context of the high case-mix severity of this referral population; external validation in independent, multicenter cohorts is required before clinical implementation is considered. Full article

Background and objectives: Cancer survivors continue to face significant psychological and quality-of-life challenges following the COVID-19 pandemic. This study aimed to investigate levels of depression, anxiety, stress, quality of life, and perceived social support among patients with cancer during the post-COVID-19 period and to examine their interrelationships. Materials and Methods: A cross-sectional study was conducted among 162 Greek adults with cancer. Participants completed questionnaires assessing psychological distress (Depression Anxiety Stress Scale-21), health-related quality of life (EORTC QLQ-C30), and perceived social support. Descriptive statistics, factor analysis, group comparisons, and correlation analyses were performed. Results: High levels of psychological distress were observed, with 32.1% of participants reporting severe or extremely severe depression, 40.1% severe or extremely severe anxiety, and 29.0% severe or extremely severe stress. Quality of life was moderate, with emotional and social functioning being the most impaired domains, while fatigue, insomnia, and financial difficulties were the most prominent symptoms. Depression, anxiety, and stress were strongly associated with poorer quality of life and greater symptom burden. Higher perceived social support, particularly from family and friends, was associated with better quality of life and lower psychological distress. Conclusions: These findings highlight the need for comprehensive oncology care that incorporates routine psychological assessment and psychosocial support to improve cancer survivorship outcomes. Full article