Search Results (34,788)

Background and Objectives: Current evidence remains insufficient to determine whether the impact of autism spectrum disorder (ASD) on dental health is primarily mediated through oral hygiene and dietary habits or through direct effects of the disorder itself. This study examined the theoretical pathways through which ASD severity and toothbrushing-related and dietary-choice-related factors influence dental health in autistic children and adolescents. Materials and Methods: A cross-sectional study was conducted with 399 mothers reporting on their autistic children (aged 2–18 years, mean = 7.8). The exclusion criterion was being older than 18 years. Data included parent-reported data about ASD severity, dental health status, willingness to brush teeth, and dietary quality (assessed using the Diet Quality Inventory). Structural Equation Modeling (SEM) was used to analyze the direct and indirect effects of ASD severity on dental health, with probit regression coefficients estimated using the WLSMV method. Results: Parent-reported variables of ASD severity, diet quality, and toothbrushing willingness together explained 37% of the variance in dental health. The direct effect of ASD severity on dental health was 0.199 (p = 0.039). The indirect effect via toothbrushing was 0.137 (p = 0.006), and via diet quality, it was 0.070 (p = 0.020). The total indirect effect of ASD on dental health was 0.207 (p = 0.026), which was approximately as strong as the direct effect. The associations among the studied variables were statistically equivalent across sex and age groups. Conclusions: Parent-reported ASD severity shows significant association with dental health outcomes, both directly and indirectly, with toothbrushing behavior emerging as the primary mediator. Interventions that promote regular brushing (and, to a lesser extent, healthier eating) may help to reduce the dental health disparities associated with autism. Full article

Caregiving for visually impaired individuals imposes substantial psychological, social, and financial burdens. This study examined depressive symptoms among family caregivers in rural Limpopo, South Africa, and their associations with sociodemographic and socioeconomic factors. A cross-sectional survey was conducted among 253 informal caregivers (response rate: 85.5%). Data on age, gender, marital status, education, employment, income, and socioeconomic status were collected. Depressive symptoms were assessed using the full 20-item Centre for Epidemiologic Studies Depression Scale (CES-D), and associations were analysed using chi-square tests, Cramer’s V, and logistic regression. Moderate-to-severe depressive symptoms were reported by 29.2% of caregivers, with 28.1% experiencing mild-to-moderate symptoms. Male caregivers were less likely to report minimal symptoms (OR = 0.3; 95% CI: 0.12–0.65). Caregivers aged 50–59 years were more likely to report lower depressive symptoms (OR = 1.3). Unmarried caregivers had higher odds of depressive symptoms compared with married caregivers (OR = 2.3). Education was protective: secondary education was associated with lower odds of severe symptoms, while primary education significantly increased risk (OR = 18.1). Lower-income caregivers tended to report higher depressive symptoms. Depressive symptoms among caregivers are influenced by gender, age, marital status, education, and income. Interventions such as psychosocial support, financial assistance, and community-based respite services are essential to reduce caregiver burden. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are prevalent neurodevelopmental conditions in childhood. Beyond biological factors, social and environmental conditions influence developmental experiences and pathways to diagnosis. Nationally representative studies examining multiple social determinants in relation to ADHD, ASD, and comorbidity across recent years remain limited. Methods: We analyzed pooled cross-sectional data from six cycles (2018–2023) of the U.S. National Survey of Children’s Health, including 205,480 children aged 3–17 years. Parent-reported, clinician-diagnosed current ADHD and ASD were the primary outcomes; comorbid ADHD and ASD were examined secondarily. Social determinants included household income relative to the federal poverty level, parental education, health insurance type, food insecurity, and caregiver-reported neighborhood safety. Survey-weighted prevalence estimates and logistic regression models accounted for the complex sampling design and adjusted for demographic, family, regional, and temporal factors. Results: The weighted prevalence of ADHD was 9.7% and ASD was 2.9%; 1.1% of children had comorbid ADHD and ASD. Lower household income, food insecurity, unsafe neighborhood conditions, and lower parental education were associated with higher adjusted odds of both conditions. Boys had substantially higher odds of ADHD and ASD. After adjustment, non-Hispanic Black and Hispanic children had lower odds of ASD than non-Hispanic White children, consistent with differential identification rather than lower underlying prevalence. Comorbidity was concentrated among socially disadvantaged children. Conclusions: ADHD and ASD are socially patterned across U.S. children. Integrating developmental screening with assessment of social risks may support more equitable identification and intervention. Full article

Background: Vietnam is undergoing a rapid nutrition transition, yet evidence on nutrient intake and inadequacy among adolescents and young adults remains limited. This study aimed to assess nutrient intakes and patterns of inadequacy among Vietnamese youth aged 16–25 years across population groups and regions. Methods: A cross-sectional study was conducted among 1005 participants from five provinces in northern, central, and southern Vietnam. Dietary intake was assessed using a two-stage 24 h recall, and nutrient inadequacy was evaluated using Estimated Average Requirement (EAR), Acceptable Macronutrient Distribution Range (AMDR), and Estimated Energy Requirement (EER) reference standards. Results: Energy and macronutrient intakes differed across groups. University students had the lowest energy intake, while young workers consumed the highest proportion of carbohydrates. Calcium inadequacy exceeded 95% in all subgroups. Regional disparities were observed, with lower intakes of several micronutrients in the South. Compared with high school students, university students showed higher risks of inadequate protein and vitamin A intake, whereas young workers exhibited lower risks of inadequate carbohydrate and folate intake but a higher risk of vitamin A inadequacy. Conclusions: Vietnamese youth exhibited substantial micronutrient inadequacies with marked variation across groups and regions. These findings underscore the need for targeted nutrition interventions tailored to specific youth contexts. Full article

Background/Objectives: Work-related musculoskeletal disorders (WMSDs) experienced by employees are the cause of significant issues and costs for companies. At PNU, understanding of the risk factors contributing to this pain is limited, impeding the development of effective solutions. To address this, it is important to examine various factors such as sociodemographics, ergonomics, psychology, and job satisfaction. By investigating these factors, PNU can create targeted interventions to improve worker health and reduce musculoskeletal pain. Methods: A cross-sectional study was conducted among 150 female staff members at the health colleges of Princess Nourah bint Abdulrahman University in Saudi Arabia, employing a multistage sampling technique. Data were collected from 20 December to 4 April 2024 using a standardized Google Forms questionnaire. Data analysis was performed using JMP software (version 14). Results: The results show a high prevalence of musculoskeletal pain among participants, with the analysis identifying several individual, ergonomic, and psychosocial risk factors that significantly correlated with reported pain, including prolonged sitting, poor posture, job stress, and low job satisfaction. Conclusions: Musculoskeletal disorders are prevalent among staff members, with ergonomic and psychosocial factors playing a significant role. Interventions targeting these risk factors are essential to improving occupational health and staff productivity. Full article

Background: Potential drug–drug interactions (pDDIs) present substantial challenges to medication safety during care transitions. Warfarin, with its narrow therapeutic index and extensive interaction profile, provides a strategic model for examining pDDIs at discharge. This study aimed to characterize the burden and determinants of major warfarin pDDIs among patients discharged from a tertiary-care hospital. Methods: This retrospective cross-sectional study analyzed electronic health records of 1667 patients discharged home on warfarin. Major pDDIs were identified using the Micromedex^® Drug Interaction database. Log-binomial regression was used to assess predictors of ≥1 major pDDIs, and generalized Poisson regression was used to model the number of pDDIs per patient. Results: Major warfarin pDDIs were identified in 81.6% (95% CI: 79.6–83.4%) of patients at hospital discharge. The burden was considerable: 35.1% (95% CI: 32.8–37.4%) of patients had one major pDDI, while 46.5% (95% CI: 44.1–48.9%) had two or more. Polypharmacy (≥5 concurrent medications) was the strongest predictor, associated with a higher risk of any major pDDI (adjusted risk ratio 1.72, 95% CI: 1.46–2.02) and nearly three times the burden of interactions per patient (adjusted incidence rate ratio (IRR) 2.87, 95% CI: 2.36–3.49). When modeled as a continuous variable, each additional discharge medication was associated with a 9% increase in predicted pDDI burden (IRR 1.09, 95% CI: 1.08–1.10). Conclusions: Using warfarin as a model for high-risk medication safety, major pDDIs were highly prevalent at hospital discharge, with polypharmacy as a significant predictor of both the presence and burden of interactions. These findings emphasize the importance of identifying polypharmacy-related pDDIs to reduce potential drug interaction risk during care transitions. Full article

Background and Objectives: Nationwide registries that provide comprehensive insights into the atopic dermatitis (AD) population and management in routine practice are lacking in Baltic countries. Real-world studies to explore the clinical and economic burden of AD are highly needed. We present findings from the Baltic cohort of the larger observational study ESSENTIAL AD, conducted in Europe, the Middle East, and Africa. Materials and Methods: This cross-sectional, retrospective chart review study enrolled adult AD patients routinely managed with systemic and/or non-systemic therapy in Estonia, Latvia, and Lithuania. Data was collected during one office visit. AD severity was assessed using the Eczema Area and Severity Index (EASI) and SCORing Atopic Dermatitis (SCORAD) and impact on quality of life was assessed using the Dermatology Life Quality Index (DLQI) (primary endpoints). Results: Fifty patients were enrolled, with a mean (standard deviation [SD]) age of 33.6 (11.67) years, and 60% were women. Mean (SD) time since AD diagnosis was 21.8 (14.8) years. An equal proportion of patients received systemic therapy (including combination therapy) or non-systemic therapy (50% each). Mean (SD) EASI, SCORAD, and DLQI total scores were 9.8 (9.76), 38.0 (16.5), and 10.5 (7.1), respectively. No significant difference was observed between patients receiving systemic and non-systemic therapy in terms of EASI (mean [SD] 11.5 [12.2] versus 8.2 [6.3]; p = 0.7636), SCORAD (35.4 [20.8] versus 40.6 [11.5]; p = 0.2563), and DLQI (9.5 [7.6] versus 11.5 [6.5]; p = 0.1962). Hospitalization rate (95% confidence interval) was significantly higher in patients on systemic versus non-systemic therapy (0.4 [0.2–0.8] versus 0.1 [0.0–0.4]; p = 0.0424). Monthly out-of-pocket expenses (USD) were higher in Latvia (mean [SD]: 103.7 [2.64]) versus Estonia (55.6 [1.82]) and Lithuania (53.8 [1.90]). Conclusions: Adult AD patients from the Baltic region still face a considerable disease and economic burden, regardless of treatment received. Improved disease management and better access to guideline-recommended advanced systemic therapies are necessary. Full article

Introduction: The Mediterranean Diet is known for its protective effects against cardiovascular and metabolic diseases. Metabolic syndrome, characterized by multiple health risk factors, is increasingly concerning in older populations. Understanding dietary impacts on metabolic health is key for promoting healthy ageing. Objectives: This feasibility study aimed to explore the relationship between adherence to the Mediterranean Diet and metabolic risk factors in older adults participating in a community exercise program and to evaluate the feasibility of applying validated tools in this setting. Methods: A cross-sectional design was used. Adherence to the Mediterranean Diet was evaluated using the PREDIMED questionnaire, while Metabolic Syndrome was evaluated according to National Cholesterol Education Program criteria. Blood samples were taken following WHO guidelines. Results: Ten participants (mean age 73.1 years; 90% women) were included. 50% showed high adherence to the Mediterranean Diet, while 40% had moderate or low adherence. No participants met the full criteria for Metabolic Syndrome. Significant associations were found between Mediterranean Diet adherence and chronic disease (r = 0.869, p < 0.01), and an inverse correlation with the number of Metabolic Syndrome criteria (r = –0.707, p < 0.05). The Mediterranean Diet score was also inversely related to cholesterol (r = –0.740, p < 0.05). Conclusions: Higher adherence to the Mediterranean Diet was associated with better metabolic profiles, highlighting its potential protective role. The study demonstrates the feasibility of incorporating nutritional screening in community exercise programs for older adults. Future research should include larger and longitudinal samples and integrate inflammatory biomarkers. Full article

Background/Objectives: Feeding difficulties in childhood can persist over time, affecting health and family dynamics. Timely identification is crucial to prevent atypical eating behaviors and nutrition-related consequences. However, data on childhood feeding difficulties remain limited. This study provides the first pilot characterization of eating behaviors among Italian children aged 5–11 years in order to characterize feeding difficulties, identify protective or detrimental factors, and assess relationships with anthropometric indices or blood pressure. Methods: In 2023, a 1-year cross-sectional pilot study was launched by the Società Italiana delle Cure Primarie Pediatriche involving child–parent dyads. Family pediatricians collected anthropometric data and blood pressure, after which parents completed an online questionnaire purposely developed for this study. The questionnaire generated a feeding difficulty score (0–10) where higher values reflected greater risk of atypical eating behaviors. Scores were categorized as follows: low risk (0–1), intermediate risk (2–6), and high risk (7–10). Results: A total of 742 questionnaires were collected. Overall, 19.8% of the children were categorized as high risk (7–10) for atypical behavior, 43.8% as intermediate risk (2–6), and 36.4% as low risk (0–1). Children with two omnivorous parents showed significantly lower odds of feeding difficulty scores at or above any threshold (OR 0.46, 95% CI 0.30–0.71; p < 0.0001). Borderline associations were observed for a breastfeeding duration of at least 9 months (OR 0.79, 95% CI 0.61–1.02; p = 0.075) and baby-led weaning (OR 0.72, 95% CI 0.52–1.00; p = 0.053). High-risk children had a significantly lower BMI percentile with respect to the other groups. Conclusions: A significant proportion of Italian children aged 5–11 years exhibited moderate to severe risk of atypical behaviors. Parental eating appears to play a key role in shaping children’s eating behaviors in middle childhood, underscoring the pivotal role of pediatricians in guiding families. Further research and targeted strategies are needed to prevent childhood feeding difficulties. Full article

Government managers should understand the determinants of work commitment, a people analytics metric. This study focuses on training, involvement, clarity of organisational goals, and performance feedback. According to Social Exchange Theory (SET), these predictors are salient, and the literature review suggests that there is little or no existing literature related to the South African government department. This study was conducted to expand the body of knowledge of SET, using a quantitative approach and a cross-sectional case study design within the South African government department. Subsequently, 260 respondents were selected, who completed a validated closed-ended questionnaire. The data were analysed in SMART PLS 4, using structural equation modelling for analysis. The key findings determined that training predicted involvement most strongly (β = 0.377, t = 6.171, p < 0.05), and involvement mediated the relationship between training and clarity on organisational goals (β = 0.096, t = 2.716, p < 0.05). Moreover, it found that clarity on organisational goals was a significant predictor of work commitment (β = 0.257, t = 3.638, p < 0.05). The priority–performance map analysis (IPMA) ranked priority highest but performance lowest, revealing insights into the organisation’s aims. The managerial implication is that the government department must strengthen the clarity of organisational goals across all levels. Full article

Background/Objectives: Veterinarians often experience poor mental health, including higher than typical rates of depression and anxiety. Self-dehumanization, which refers to the feeling of being less than human, may reflect an important yet neglected factor in poor veterinarian mental health. Methods: 201 veterinarians completed an online survey consisting of demographic questions, questions regarding their practice settings, and measures of self-dehumanization, depression, anxiety, burnout, and secondary traumatic stress. Results: About 10% of veterinarians reported self-dehumanization. Most veterinarians had clinically significant symptoms of depression and anxiety, as well as moderate levels of burnout and secondary traumatic stress. Burnout and secondary traumatic stress positively predicted anxiety, while burnout, secondary traumatic stress, and self-dehumanization positively predicted depression. Cross-sectional mediation analyses indicated that burnout and secondary traumatic stress both significantly mediated the links between self-dehumanization and anxiety, and self-dehumanization and depression. Conclusions: This study provides new insight into the role of self-dehumanization in the poor mental health of veterinarians, which has implications for the development of preventative measures. Full article

Physical activity (PA) is a cornerstone of non-pharmacological hypertension management, yet evidence on its determinants remains limited in African populations. We conducted a cross-sectional study among 383 hypertensive patients in two referral hospitals in Cameroon to assess PA levels and associated factors. PA was classified as insufficiently active (<600 MET-min/week) or active (≥600 MET-min/week). Overall, 54% of participants were insufficiently active, 37.9% had moderate activity, and 8.1% reported vigorous activity. Older age was strongly associated with inactivity, particularly for ages 60–74 (aOR = 2.84, p < 0.001) and for ≥75 years (aOR = 18.67, p < 0.001). Comorbidities also predicted inactivity, including renal failure (aOR = 2.41, p < 0.001) and diabetes/other complaints (aOR = 4.92, p < 0.001). Female sex increased the odds of inactivity (aOR = 1.42, p = 0.038). Whereas higher education was protective, particularly secondary (aOR = 0.12, p < 0.001) and high-school level (aOR = 0.05, p < 0.001). Among inactive participants, the most frequent barriers were lack of motivation (38.6%), physical impairment (37.2%), lack of prescription (23.2%), and space constraints (21.7%), whereas perceived benefits (39.1%), motivation (26.1%), and available space (32.4%) were the most cited facilitators; however, none of these factors showed a significant association with PA in chi square analysis. The high prevalence of inactivity and the strong influence of sociodemographic and clinical characteristics underscore the need for tailored interventions that target older adults, women, and patients with comorbidities, while strengthening education and structured support for PA within hypertension care pathways. Full article

Background: Tibial pilon fractures are, in most cases, complex injuries caused by high-energy trauma. This type of fracture requires surgical stabilization and immobilization that impairs ankle function by reducing range of motion, muscle strength, and affecting the mechanical properties of the muscles. Methods: We evaluated 22 patients who required surgery for tibial pilon fractures and 22 age-matched healthy controls. Dynamometry assessed the isometric strength of the dorsiflexors and plantar flexors. Myotonometry of the tibialis anterior, peroneus longus, and medial and lateral gastrocnemius muscles analyzed the muscle tone, biomechanical (stiffness and decrement), and viscoelastic properties (mechanical stress relaxation and ratio of relaxation time to deformation time (creep). Results: Compared to the control group, the patients had significantly decreased isometric strength in both the dorsal flexors and plantar flexors on the affected side. Myotonometric measurements did not reveal significant differences in the tibialis anterior and peroneus longus muscles. Both medial and lateral gastrocnemius muscles exhibited significantly increased frequency and stiffness, and significantly decreased relaxation and creep in patients when compared to the control group. Conclusions: When compared to healthy controls, patients with surgically treated unilateral pilon fracture had a decreased isometric muscle force of ankle dorsiflexors and plantar flexors of both affected and non-affected lower limbs. Myotonometry indicated increased frequency and stiffness, along with decreased values of viscoelastic parameters (stress relaxation time and creep) in the medial and lateral gastrocnemius muscles on both sides. Full article

Background: An increasing number of university students report feeling lonely, a negative experience arising from a mismatch between perceived and actual social relationships. Loneliness has been linked to poorer mental health. However, the relationship between qualitative (sources of loneliness) and quantitative (high or low) differences in loneliness and mental health is under researched. The aims of this research were to (a) identify profiles of loneliness among university students across three indicators of loneliness, namely, social, family, and romantic indicators, using latent profile analysis (LPA); (b) examine the differences among identified profiles based on dimensions of mental health indicators (depression, anxiety, and stress), social support, and life satisfaction; and (c) assess profile membership based on demographic variables (gender, social isolation, relationship status, and education characteristics) and the Big Five personality traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism). Method: A cross-sectional survey was conducted on 912 university students from five cities in Uttar Pradesh, India. Participants completed questionnaires covering demographic details and validated measures assessing loneliness, depression, stress, anxiety, social support, life satisfaction, and the Big Five personality traits. Data were analyzed using the latent profile module in Jamovi and fit indices, namely, BIC, AIC, and BLRT, and entropy was used to select the best profile. Results: The latent profile analysis identified four profiles for university student loneliness, including Social and emotional lonely (31.4%), Moderate romantic lonely (23.8%), Moderate social lonely (8.2%), and Severe romantic lonely (36.6%). Moreover, the Social and emotional lonely profile scored the highest on depression, anxiety, and stress. The Moderate romantic lonely profile scored the highest on life satisfaction and social support. Being in a relationship decreased the likelihood of being categorized as Severe romantic lonely. In terms of personality, neuroticism was the strongest predictor of profile membership. This study is a step towards identifying at-risk lonely individuals with varying sources of loneliness. Identifying different profiles of lonely individuals will have direct implications for designing interventions that cater to a particular group rather than a one-size-fits-all approach. Full article

Solid rocket motors (SRMs) play a pivotal role in space exploration owing to their reliability and high thrust-to-weight ratios. SRM propellant health monitoring is in critical demand owing to the complex operational scenarios throughout the entire life cycle of SRMs. To achieve in situ detection of three-dimensional stress, this study introduces a novel flexible three-dimensional stress sensor (FSS). First, a liquid metal pressure-sensing element with a variable cross-section was designed and numerically modeled. The performance of the FSS under different loading conditions was analyzed using finite element modeling. The sensing element prototype was fabricated using mold casting and liquid metal injection methods. The fabricated sensing-element prototype with an area ratio of 1:5 exhibited a sensitivity coefficient of 1.5%/kPa at a pressure of 300 kPa, a maximum hysteresis error of 3.98%, and a stability error of 0.17%. Finally, the FSS was developed by integrating multiple pressure-sensing elements and encapsulating the force-concentrating layers. The fabricated FSS prototype was characterized using simulated propellant experiments. Via comparison with the simulation results, the FSS was found to detect multiaxial stress differences when embedded within a propellant. Full article