Search Results (40,303)

Background: This study examined the association between specific unhealthy eating behaviors and sleep quality among university students. Understanding how dietary habits affect sleep during significant lifestyle transitions associated with university experience can inform health promotion strategies. Methods: A cross-sectional design was employed using a self-reported questionnaire to assess eating behaviors, timing of meals, and sleep-related behavior among a sample of international university students. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) tool. Statistical analyses were used to assess the relationship between eating patterns, overall sleep quality, and its components. Results: More than half of the students had poor sleep quality (51.7%). Daytime dysfunction was significantly more common in females than in males (27.9% vs. 8.3%, respectively; p < 0.001). Conversely, poor sleep efficiency was more prevalent among males than females (27.5% vs. 15.8%; p = 0.008). Multivariate logistic regression revealed that, compared to students who did not frequently consume heavy evening meals, those who did were more likely to experience poor sleep quality (OR = 2.73, 95% CI: 1.575–4.731). Similarly, those who frequently substitute snacks for main meals were more likely to experience poor sleep quality than those who did not (OR = 2.68, 95% CI: 1.465–4.895). Finally, students who ate within three hours of bedtime had higher odds of poor sleep quality compared to those who had their last meal more than three hours before bedtime (OR = 2.06, 95% CI: 1.173–3.629). Conclusions: Unhealthy dietary habits, such as consuming heavy evening meals, substituting snacks for main meals, and having a short meal-to-bedtime interval, were significantly associated with poor sleep quality. Interventions promoting healthier dietary patterns and appropriate meal timing could help improve sleep in this population. Full article

This study examined stakeholders’ satisfaction with current student classification and progress monitoring systems and explored their perceptions of the potential role of artificial intelligence (AI) in enhancing these processes. A cross-sectional survey was administered to 313 stakeholders, including teachers, administrators, decision-makers, and educational service providers. Descriptive statistics, multiple regression analysis, and group comparisons were employed to examine satisfaction levels, predictors of satisfaction, and expectations regarding AI integration. Despite high satisfaction with the current systems (85%), nearly 80% of stakeholders rated AI integration as essential. The most frequently expected functions of an AI-enabled system were predicting student challenges (33.2%), generating detailed analyses and reports (32.9%), customizing individual learning plans (22.7%), and providing immediate feedback (11.2%). Anticipated challenges focused on acceptance and adaptation by teachers and students (40.9%) and concerns about privacy and system integration. Regression analysis revealed that perceptions of classification practices (β = 0.473, p < 0.001) were a stronger predictor of satisfaction than perceptions of progress monitoring practices (β = 0.315, p < 0.001). Demographic analyses revealed greater dissatisfaction among non-teaching staff, females, and mid-career professionals. The findings show that stakeholders are broadly satisfied with existing systems while simultaneously demanding AI-driven innovation, suggesting satisfaction reflects acceptance rather than alignment with stakeholders’ needs and expectations. Full article

Bacteremia is a life-threatening condition contributing significantly to sepsis-related mortality worldwide. With delayed appropriate antibiotic therapy, mortality increases by 20% regardless of antimicrobial resistance. This study evaluated the perceived clinical utility of Artificial Intelligence (AI)-powered Clinical Decision Support Systems (CDSSs) (OneChoice and OneChoice Fusion) among specialist physicians managing bacteremia cases. A cross-sectional survey was conducted with 65 unique specialist physicians from multiple medical specialties who were presented with clinical vignettes describing patients with bacteremia and 90 corresponding AI-CDSS recommendations. Participants assessed the perceived helpfulness of AI decision-making, the impact of AI recommendations on their own clinical judgment, and the concordance between AI recommendations and their own clinical judgment, as well as the validity of changing therapy based on CDSS recommendations. The study encompassed a diverse range of bacterial pathogens, with Escherichia coli representing 38.7% of the isolates and 30% being extended-spectrum β-lactamase (ESBL) producers. Findings show that 97.8% [(95% CI: 92.2–99.7%)] of physicians reported that AI facilitated decision-making and substantial concordance (87.8% [95% CI: 79.2–93.7%; Cohen’s κ = 0.76]) between AI recommendations and physicians’ therapeutic recommendations. Stratification by pathogen revealed the highest concordance for Escherichia coli bacteremia (96.6%, 28/29 cases). Implementation analysis revealed a meaningful clinical impact, with 68.9% [(95% CI: 58.3–78.2%)] of cases resulting in AI-guided treatment modifications. These findings indicate that AI-powered CDSSs effectively bridge critical gaps in infectious disease expertise and antimicrobial stewardship, providing clinicians with evidence-based therapeutic recommendations that can be integrated into routine practice to optimize antibiotic selection, particularly in settings with limited access to infectious disease specialists. For optimal clinical integration, we recommend that clinicians utilize AI-CDSS recommendations as an adjunct to clinical judgment rather than a replacement, particularly in complex cases involving immunocompromised hosts or polymicrobial infections. Future research should prioritize prospective clinical trials that evaluate direct patient outcomes to establish evidence of broader clinical effectiveness and applicability across diverse healthcare settings. Full article

Background: Celiac disease (CD) is a chronic immune-mediated enteropathy that is treated exclusively with a lifelong gluten-free diet (GFD). Hepatic involvement, including hepatic steatosis (HS), is common in both newly diagnosed and long-term GFD-treated CD patients. Limited data exist regarding HS prevalence and risk factors in CD, and the effects of dietary patterns, including GFD and the Mediterranean diet (MD), remain unclear. Objective: This study investigated the prevalence and severity of HS in newly diagnosed, pre-GFD and GFD-treated CD patients compared to non-celiac control subjects, while assessing the influence of dietary adherence. Methods: In a nested cross-sectional study within the ARCTIC trial (NCT05530070), 290 Hungarian adults were enrolled (60 pre-GFD CD, 156 CD on GFD, and 74 control subjects). HS was assessed by ultrasonography, and dietary adherence was evaluated using the Standardized Dietitian Evaluation and Mediterranean Diet Score (MDS). Binary regression models were applied to identify predictors of HS. Results: HS was diagnosed in 34% of participants, most frequently in pre-GFD CD patients. BMI was the strongest predictor of HS both overall and within the CD cohort (OR = 1.27; 95% CI: 1.16, 1.42; p < 0.001). Neither adherence to GFD nor overall MD adherence significantly influenced the prevalence of HS. Severity of HS correlated with higher BMI, older age, and diabetes prevalence, while individual MD components, including olive oil consumption, were associated with milder HS. Conclusions: HS is more prevalent in CD patients, particularly pre-GFD patients, and is strongly associated with BMI. While overall dietary patterns did not significantly impact HS, certain diet components may modulate severity. Full article

The COVID-19 pandemic was responsible for an unprecedented increase in psychological problems among post-secondary students worldwide. Drawing on data from a repeated cross-sectional (RCS) project, this study investigated changes in psychological symptoms, emotional regulation (cognitive reappraisal and emotional suppression), and academic, social, and personal–emotional college adjustment, and associations between these variables among students in two countries during the phases of lockdown (2021), lifting of restrictions (2022), and the endemic phase (2023). University students in Canada (n = 1014) and Spain (n = 447) completed online surveys during these periods. Students in both countries reported significant declines in perceived COVID-19 stress across the pandemic phases. In comparison with pre-pandemic rates, elevated psychological symptoms remained constant. There were some country differences, but sex differences were consistent. Psychological symptoms mediated the association between cognitive reappraisal and the adjustment measures among Canadian students during each pandemic period. Alternatively, they mediated the linkages of maladaptive emotional suppression with academic, social, and personal–emotional functioning of Spanish students at every phase, but only during the lifting of restrictions and the endemic phase for Canadian students. The results indicate the complexity of country and context in the role of emotional regulation during uncontrollable conditions and provide directions for intervention in stressful situations, including adjustment to university and future disastrous environmental events. Full article

Taking into account both the health and environmental aspects of food, the EAT-Lancet Commission proposed a healthy reference diet (Planetary Health Diet—PHD). The aim of this narrative review is to summarize the results obtained in epidemiological studies on the association between the PHD and risk factors, non-communicable diseases, and cause-specific mortality. The literature search was conducted in February 2025 and was based on the PubMed electronic database. The results of this review are divided into four parts, which include the results of cohort studies, cross-sectional studies, case–control studies, and meta-analyses. This review, showing what types of studies have been conducted so far, allows for a summary of the current knowledge of the relationship between the PHD and risk factors, non-communicable diseases, and cause-specific mortality. Cohort studies provided most of the results, which confirmed that higher adherence to the PHD has a beneficial effect on human health, especially taking into account the lower risk of diabetes, cardiovascular disease (CVD) and CVD mortality, cancer and cancer mortality, as well as all-cause mortality. However, it is concluded that the association between the PHD and stroke, different types of stroke, hypertension, dyslipidemia, and some specific types of cancer must be confirmed. Specifically, randomized controlled trials should be conducted, as, to our knowledge, there is a lack of these types of studies to date. Such studies should be conducted in different regions using the Planetary Health Diet adapted to the local, cultural, geographical, and demographical aspects of a particular region. Full article

Background/Objectives: Precise evaluation of mandibular morphology is essential for orthodontic diagnosis, growth assessment, and treatment planning. While lateral cephalograms are traditionally used for angular measurements, orthopantomograms (OPGs) allow side-specific assessment of mandibular structures. This study aimed to analyze bilateral gonial angles, bigonial width, and ramus heights on OPGs using artificial intelligence (AI)–assisted tracing, with a focus on symmetry, sex-related differences, and clinical applicability. Methods: A cross-sectional study was conducted on 78 Romanian patients (46 females, 32 males; mean age 22.8 ± 8.7 years) seeking orthodontic treatment. Standardized OPGs were obtained and analyzed using WebCeph AI-driven software. Bilateral gonial angles, bigonial width, and ramus heights were measured. Symmetry between sides and differences between sexes were evaluated, and correlation analyses were performed. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Results: The mean right and left gonial angles were 126.3° and 127.1°, respectively, with no significant sex- or side-related differences (p > 0.05). Bigonial width averaged 134.9 mm, being slightly larger in males, although not statistically significant (p = 0.240). Ramus heights were comparable bilaterally (right: 48.4 mm; left: 48.3 mm), with males showing slightly greater values. Correlation analysis demonstrated strong bilateral symmetry for gonial angles (r = 0.795) and ramus heights (r = 0.895). Negative correlations were observed between gonial angles and both bigonial width and ramus height, whereas bigonial width correlated strongly with ramus height. Measurement reproducibility was high (ICC > 0.75). Conclusions: OPGs, when combined with AI-assisted analysis, provide reliable and reproducible measurements of gonial angles and ramus heights, comparable to cephalometric values. Their ability to assess right and left sides separately enhances clinical utility in detecting asymmetries and monitoring mandibular growth. However, caution is advised when interpreting transverse parameters such as bigonial width, where CBCT remains the gold standard. AI-driven OPG analysis represents a cost-effective, accessible, and low-radiation diagnostic tool with significant potential for precision orthodontics. Full article

Background/Objectives: Increasing awareness of factors that put the population at high risk of frailty is essential to prevent frailty and minimize its adverse consequences. Methods: In this cross-sectional study, participants were over the age of 65 and living in nursing homes. The Edmonton Frailty Scale was used to determine frailty, the Sarcopenia Rapid Screening Test (SARC-F) was used to assess sarcopenia, and the Mini Nutritional Assessment (MNA) questionnaire and 7-day 24-h dietary recall were used to determine the nutritional status of the older adult population. Data were analyzed by SPSS 25.0 for Windows (Statistical Package for Social Sciences). Results: The frailty scale score of gender was statistically significant (p < 0.05). There was a statistically significant difference in sarcopenia status and malnutrition based on the distribution of the frailty status among the participants (p < 0.05). There was a statistically significant difference in vitamin C intake adequacy according to the distribution of frailty status among older adults (p < 0.05). There was a positive correlation between frailty status and sarcopenia (r = 0.773; p < 0.05). Frailty and nutritional status were significantly negatively correlated (r = −0.496; p < 0.05). There was a significant positive correlation between the sarcopenia status and malnutrition status of the participants (r = 0.489; p < 0.005). Conclusions: Older adults living in nursing homes are at risk for frailty syndrome, malnutrition, and sarcopenia. Evaluating older adults in terms of all these factors and implementing daily nutrition plans and support according to these results is of great importance for promoting a healthy life. Full article

This study presents comprehensive experimental, analytical, and numerical analyses of heat transfer during countercurrent flow of Fluorinert FC-72 and distilled water within a multi-mini-channel (MMCH) module under steady-state conditions. The experimental investigation was conducted in a test section inclined at an angle of 165 degrees relative to the horizontal plane, utilizing an infrared camera to measure the external temperature of the heated mini-channel (MCH) wall. The test module comprised twelve MCHs: six hot (HMCH) and six cold mini-channels (CMCH), each with a rectangular cross-section. The dimensions of each MCH are 140 mm in length, 18.3 mm in width, and 1.5 mm in depth, with a hydraulic diameter of d_h = 2.77 mm. The heating system on the top wall of the external heated copper comprises a halogen heating lamp. Results include infrared thermographs, temperature distributions, and heat transfer coefficients (HTCs) along the channels. Local HTCs were calculated using a one-dimensional (1D) approach, a simple analytical method, at interfaces such as the heated plate—HMCHs, HMCHs—separating plate, separating plate—CMCHs, and CMCHs—closing plate. CFD simulations conducted with Simcenter STAR-CCM+ incorporated empirical data from experiments, using parameters like temperature, pressure, velocity profiles, and heat flux density to determine HTCs. The maximum difference between the 1D method and CFD results was 29% at the HMCHs/separating plate interface. In comparison, the minimum was 13.5% at the separating plate/CMCHs interface, with an average across all channels and heat flux densities. Full article

This paper presents the first theoretical investigation of the effect of a variable equilibrium coefficient on the steady-state transport of a binary electrolyte in a desalination channel cross-section of the electrodialyzer. To address this problem, we developed a new mathematical model in the form of a boundary value problem for an extended system of stationary Nernst–Planck–Poisson equations. We obtained a numerical solution to this problem using the finite element method. Analysis of this solution revealed that the channel cross-section has a complex structure: it is divided into seven regions dominated by different processes, and, consequently, the solution to the boundary value problem behaves differently in each of them. Existing models of the diffusion layer or channel cross-section typically assume a constant equilibrium coefficient. In this paper, we demonstrated that in the channel cross-section, the velocity change corresponding to the equilibrium constant is related not only to the field strength but also to the magnitude of the space charge. In the space-charge region, in the boundary layers near the ion-exchange membranes, intense dissociation of water molecules occurs, and the higher the equilibrium coefficient, the more intense this dissociation is. We have shown that an internal boundary layer (recombination region) arises deep within the solution, associated with the recombination reaction of H+ and OH− ions. In this study, we found that with increasing equilibrium coefficient, fluxes increase, while with increasing fluxes, the electric field strength decreases proportionally, and equilibrium is reached. We demonstrate that by calibrating a single fitting parameter in the model, the simulation results can be matched to experimental data with high accuracy. Thus, our proposed model and its numerical solution provide a completely new understanding of the ion transport process in electromembrane systems, taking into account the influence of the dissociation/recombination reaction of water molecules. Full article

Background: Varicella zoster virus (VZV) remains a significant cause of pediatric morbidity in populations in Lebanon, yet comprehensive data on population immunity and vaccination uptake are limited. This study aimed to estimate VZV seroprevalence and identify factors associated with immunity and vaccine uptake among children and adolescents in Northern Lebanon. Methods: A cross-sectional study was conducted among 180 participants aged 1–18 years recruited from urban and rural settings in North Lebanon. After receiving informed parental consent, sociodemographic and clinical information were collected via structured questionnaires. Anti-VZV IgG and IgM antibodies were measured using validated Enzyme-Linked Immunosorbent Assays (ELISA). Associations with seropositivity and vaccination uptake were analyzed using multivariable logistic regression. Results: IgG seroprevalence was 79.4% (95% CI: 72.7–85.1), indicating prior exposure or immunization, while IgM antibodies, reflecting recent infection, were detected in 5.0% (95% CI: 2.3–9.4) of participants. Among vaccinated participants, IgG seropositivity was 63.6% (95% CI: 43.5–83.7) in the one-dose group and 89.5% (95% CI: 83.0–96.0) in the two-dose group. Completing the two-dose regimen was significantly associated with a higher IgG seropositivity (OR = 0.110, 95% CI: 3.2–52.4, p = 0.002). Parental reporting of history of varicella showed high sensitivity (99.0%) and overall accuracy (90.8%) in predicting seropositivity. Primary vaccination barriers included preference for natural infection (67%), perceived non-necessity (19%), and cost (10%). Regular pediatric follow-up strongly predicted vaccination (OR = 15.239, p < 0.001), whereas low parental awareness was associated with decreased vaccine uptake (OR = 0.027, p = 0.015). Conclusions: Suboptimal VZV vaccination coverage and persistent susceptibility underscore the need to integrate varicella vaccination into Lebanon’s national immunization schedule. Targeted educational efforts and enhanced pediatric healthcare engagement are critical to increasing vaccine uptake and reducing disease burden. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a major metabolic disorder associated with progressive microvascular complications such as nephropathy, retinopathy, and neuropathy. Early detection of diabetic nephropathy (DN) remains challenging, as conventional markers such as urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) are influenced by non-renal factors and lack sensitivity for subclinical injury. Sirtuin 2 (SIRT2), a cytoplasmic NAD⁺-dependent deacetylase involved in oxidative stress and inflammatory regulation, has recently been implicated in renal pathophysiology. This study aimed to assess the relationship between serum SIRT2 levels and the presence of diabetic nephropathy and to evaluate its potential utility as a complementary biomarker reflecting early renal injury. Methods: In this single-center, cross-sectional study, 180 participants aged 18–80 years were enrolled: 60 healthy controls, 60 T2DM patients without nephropathy (T2DM − DN), and 60 T2DM patients with nephropathy (T2DM + DN). Serum SIRT2 concentrations were quantified using a validated ELISA. Group comparisons, multinomial logistic regression, and receiver operating characteristic (ROC) curve analyses were performed to assess associations between SIRT2 and renal indices (UACR and eGFR). Statistical significance was set at p < 0.05. Results: Serum SIRT2 concentrations showed a progressive elevation across study groups (p < 0.001), with median levels of 6.13 ng/mL in healthy controls, 8.53 ng/mL in T2DM − DN, and 33.19 ng/mL in T2DM + DN. ROC analysis revealed good diagnostic performance for differentiating DN from healthy controls (AUC = 0.813, sensitivity 75%, and specificity 78.3%). Multivariable regression analysis identified SIRT2 as an independent correlate of DN after adjusting for metabolic and renal covariates (adjusted OR = 1.22, 95% CI 1.11–1.35, p < 0.001). Conclusions: Serum SIRT2 levels were observed to increase in parallel with the presence and severity of diabetic nephropathy and remained independently associated with the condition after adjustment for conventional risk factors. These findings suggest that SIRT2 may serve as a feasible complementary biomarker reflecting renal injury processes not captured by traditional measures. Further longitudinal studies are warranted to clarify its prognostic significance and potential for clinical integration. Full article

Background: Mental health conditions are a growing public health concern among U.S. adolescents, particularly high school students. Emerging data show a strong link between exposure to neighborhood violence and increased risk of poor mental health outcomes, such as depression, anxiety, and persistent sadness. Objective: This study examined the relationship between neighborhood violence exposure and mental health outcomes among high school students. Method: This is a cross-sectional study using the 2023 Youth Risk Behavior Survey. The sample included 19,910 students in grades 9–12 across gender and race. Mental health status and exposure to neighborhood violence were analyzed using chi-square tests and logistic regression models. Results: Students exposed to neighborhood violence had significantly higher odds of reporting poor mental health outcomes (AOR = 1.789, 95% CI: 1.573–2.035, p < 0.001) than the unexposed. Additionally, female, Hispanic/Latino, and multiracial students reported higher rates of mental health disorders than the male students. Conclusions: Neighborhood violence exposure was significantly associated with poor mental health outcomes among high school students. These findings signify the need for targeted interventions to support affected students and reduce neighborhood violence exposure, particularly in marginalized communities. The findings will inform public health professionals, educators, and policymakers to make targeted school-based mental health interventions and community-centered policies addressing neighborhood safety and adolescent mental health. Full article

Background and Objectives: Hyperuricemia is frequent in patients with uncontrolled type 2 diabetes (T2D) and may reflect intertwined renal and metabolic dysfunction. Simple tools to identify those at highest risk are lacking. Materials and Methods: We retrospectively analyzed 253 adults with uncontrolled T2D (HbA1c ≥ 7%) hospitalized at a tertiary center (2022–2023). Patients were stratified by hyperuricemia status (serum uric acid >7.0 mg/dL in men and >6.0 mg/dL in women). Demographic, clinical, biochemical, and pharmacological data were compared. Independent predictors were explored with multivariable modeling. A two-parameter Renal–Metabolic Risk Score (serum urea and triglyceride-to-LDL cholesterol ratio [TG/LDL]) was derived and evaluated by ROC analysis. Results: Compared with non-hyperuricemic patients (n = 20), those with hyperuricemia (n = 233) had higher serum urea (32.15 ± 21.21 vs. 19.76 ± 10.02 mg/dL; p < 0.001) and numerically higher TG/LDL (2.94 ± 6.73 vs. 1.95 ± 1.28; p = 0.062). Serum uric acid was lower in the hyperuricemia group due to categorical definition thresholds and treatment effects (5.69 ± 1.87 vs. 6.77 ± 2.12 mg/dL; p = 0.038). The derived Renal–Metabolic Risk Score showed an AUC = 0.67 and differed significantly between groups (p ≈ 1.2 × 10⁻⁵). Conclusions: The derived RMRS, based on simple and inexpensive laboratory parameters, offers a preliminary tool for assessing hyperuricemia risk in uncontrolled T2D. From a clinical and assistive practice perspective, this score may help nephrology nurses and multidisciplinary teams identify high-risk patients who require closer monitoring of renal and metabolic complications. It could further guide early dietary counseling, pharmacological optimization, and frailty assessment in chronic kidney disease care. Future studies are needed to validate the score in larger and more diverse populations before its integration into routine practice. Full article

Background: The COVID-19 pandemic has been associated with increased sedentary behavior in children, raising concerns about posture and spinal health. This study compared standardized measures of sitting spinal alignment in two independent cohorts assessed before (2017) and after (2024) the pandemic and examined correlations among alignment parameters across different sitting postures. Methods: This cross-sectional study included healthy children aged 9–13 years. The sternal angle, sacral angle, lumbar lordosis, thoracic kyphosis, trunk tilt, and lateral deviation were measured using a Saunders digital inclinometer and a DIERS Formetric 4D rasterstereographic system in passive, forced, and corrected sitting postures. Results: No statistically significant differences were observed between the 2017 and 2024 cohorts (p > 0.05). Within each cohort, significant posture-related differences were found for the sternal and sacral angles, lumbar lordosis, and lateral deviation (p < 0.05), while thoracic kyphosis and trunk inclination differed between passive and corrected sitting (p < 0.05). The sternal angle correlated moderately to strongly with thoracic kyphosis (r = 0.657–0.695, p < 0.001), and the sacral angle correlated with lumbar lordosis (r = 0.679–0.743, p < 0.001). Conclusions: Similar alignment parameters across time-separated cohorts suggest no major cohort-level shifts in standardized sitting posture; however, behavioral factors were not directly assessed. Strong correlations among sagittal angles emphasize the consistent geometric relationship between the sternum, sacrum, and spinal curvatures. A sternal angle of approximately 65° was consistently associated with physiologically favorable spinal alignment and may serve as a practical reference value for posture assessment and education. Full article