Search Results (1,154)

Background: Despite decades of high childhood vaccination coverage, pertussis has re-emerged in the Autonomous Province of Vojvodina (AP Vojvodina), Serbia. We aimed to describe the temporal, seasonal, and age-specific patterns of pertussis in AP Vojvodina and to analyze trends by vaccination status in order to highlight changes in epidemiology and potential gaps in vaccine-induced protection. Methods: We retrospectively analyzed 2796 pertussis cases reported between January 1997 and December 2024, examining temporal, seasonal, and age-specific trends, stratifying by vaccination status across four consecutive periods (1997–2003, 2004–2010, 2011–2017, and 2018–2024). Results: Throughout the 28-year period, after low and sporadic cases in the pre-2012 period, a dramatic rise was observed in 2014, 2017, and 2018, culminating in the highest annual number of reported cases in 2024 (1011 cases). Throughout this period, primary vaccination coverage with the DTwP/DTaP three-dose series ranged between 91% and 98%, while first booster coverage gradually declined from 98% in the early 2000s to 83% in 2024. Regarding seasonality, a sharp increase in cases began in 2012, peaking in November 2023 (>350 cases) and early 2024 (312 in January, 268 in February), with a seasonal shift from summer peaks in the 2011–2017 period to higher incidence rates during colder months more recently. Adolescents aged 10–14 years had the highest cumulative incidence (1149.4/100,000), followed by infants under 12 months (978.5/100,000), despite the latter representing fewer absolute cases. The proportion of pertussis in fully vaccinated individuals rose from 6.3% (1997–2003) to 49.7% (2018–2024). Conclusions: These findings suggest that booster immunization in adolescence and routine maternal vaccination during pregnancy could reduce transmission, particularly to infants. Enhanced surveillance and updated immunization policies are critical to mitigating future pertussis outbreaks. Full article

Background and Objectives: Emerging evidence indicates that individuals exposed to adverse childhood experiences (ACEs) face elevated risks for various chronic illnesses. However, the association between ACEs and osteoporosis risk remains underexplored, particularly regarding potential modifications by genetic susceptibility. This prospective cohort study aims to examine the relationship of ACEs with incident osteoporosis and investigate interactions with polygenic risk score (PRS). Materials and Methods: This study analyzed 124,789 UK Biobank participants initially free of osteoporosis. Cumulative ACE burden (emotional neglect, emotional abuse, physical neglect, physical abuse, sexual abuse) was ascertained through validated questionnaires. Multivariable-adjusted Cox proportional hazards models assessed osteoporosis risk during a median follow-up of 12.8 years. Moderation analysis examined genetic susceptibility interactions using a standardized PRS incorporating osteoporosis-related SNPs. Results: Among 2474 incident osteoporosis cases, cumulative ACEs showed dose–response associations with osteoporosis risk (adjusted hazard ratio [HR]_{per one-unit increase} = 1.07, 95% confidence interval [CI] 1.04–1.11; high ACEs [≥3 types] vs. none: HR = 1.26, 1.10–1.43). Specifically, emotional neglect (HR = 1.14, 1.04–1.25), emotional abuse (HR = 1.14, 1.03–1.27), physical abuse (HR = 1.17, 1.05–1.30), and sexual abuse (HR = 1.15, 1.01–1.31) demonstrated comparable effect sizes. Sex-stratified analysis revealed stronger associations in women. Joint exposure to high ACEs/high PRS tripled osteoporosis risk (HR = 3.04, 2.46–3.76 vs. low ACEs/low PRS) although G × E interaction was nonsignificant (P-interaction = 0.10). Conclusions: These results suggest that ACEs conferred incremental osteoporosis risk independent of genetic predisposition. These findings support the inclusion of ACE screening in osteoporosis prevention strategies and highlight the need for targeted bone health interventions for youth exposed to ACEs. Full article

Background/Objectives: We studied the possible protective effect of dietary curcumin in curry meals against cognitive decline and mild cognitive impairment (MCI) and dementia in a population-based Singapore Longitudinal Ageing cohort study. Methods: Baseline curry consumption frequency was categorized as five categories ranging from ‘never or rarely’ to ‘daily’. Among 2920 participants (mean age 65.5 ± SD 7.1 years) free of stroke, Parkinson’s disease, or traumatic brain injury at baseline, cognitive decline (MMSE drop ≥2) was assessed at 3–5 years (mean 4.5) follow-up. Occurrence of incident MCI-dementia was assessed at follow-up among 2446 participants without neurocognitive disorder at baseline. Results: A decreasing linear trend was observed between higher levels of curry consumption and cognitive decline (p = 0.037). The cumulative incidence of MCI-dementia decreased from 13.1% in those who never or rarely consumed curry to 3.6% in those who consumed curry daily (linear p < 0.001). The adjusted OR across levels of curry consumption exhibited a linear trend (p = 0.021) from OR = 0.61 (p < 0.05) for occasional consumption to OR = 0.21 (p < 0.001) for daily consumption. Conclusions: The intake of dietary curcumin through curry shows a dose-dependent reduction in incidence of cognitive decline and MCI-dementia in this Asian population of community-based elders. Full article

Background/Objectives: Falls are recognized as a leading cause of injury, with approximately one in ten incidents resulting in physical injury. Although virtual reality (VR)-based interventions have been explored for fall prevention, systematic reviews and meta-analyses remain limited. This study aimed to assess research trends and evaluate the effectiveness of VR-based fall prevention through a systematic review and meta-analysis. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out in PubMed, EBMASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Korean databases from their inception through 31 December 2024. A total of 49 studies met the inclusion criteria, and a meta-analysis was conducted on 37 studies with available data using “R” 4.4.1 software. Effect sizes (ESs) and 95% confidence intervals (CIs) were calculated for key outcomes. Results: The VR-based interventions showed a statistically significant positive effect on falls self-efficacy, as measured by the Falls Efficacy Scale (FES) (ES = 0.28, 95% CI: 0.17–0.39, p < 0.001). However, no significant reduction was observed in the number of falls (ES = −0.31, 95% CI: −0.80–0.17, p = 0.20). Subgroup analysis by participant medical condition for the FES revealed the largest effects in the Parkinson’s disease (PD) group (ES = 0.61), followed by the multiple sclerosis (MS) (ES = 0.34), the “other” group (ES = 0.25), and “healthy” participants (ES = 0.24). A statistically significant reduction in the number of falls was observed only in the MS group (ES = −0.56). Conclusions: VR-based interventions are effective in improving falls self-efficacy, particularly among individuals with neurological conditions, such as Parkinson’s disease and multiple sclerosis. However, evidence for a reduction in actual fall incidence remains limited. Further large-scale, long-term studies are needed to evaluate the sustained impact of VR interventions on fall prevention outcomes. Full article

Background: Staphylococcus spp. represent the most prevalent Gram-positive organisms in children with malignancies or undergoing haematopoietic cell transplantation (HCT), contributing to significant morbidity and mortality. This study aimed to assess the epidemiology, risk factors, treatment strategies, and outcomes of staphylococcal infections (SIs) in paediatric haemato-oncology (PHO) and HCT patients in Poland over a 12-year period. Methods: A retrospective, multicentre study was conducted across 17 paediatric oncology centres in Poland. The clinical and microbiological data of patients under the age of 18, diagnosed with malignancies or post-HCT, were analysed for confirmed SI between 2012 and 2023. The variables assessed included demographics, underlying conditions, infection type and source, antimicrobial susceptibility, treatment, and 30-day infection-free survival. Results: Among 1725 patients with SI, 1433 were PHO and 292 were HCT patients. The cumulative incidence of SI was 12.7% in PHO and 14.3% in HCT patients (p = 0.008). The 30-day survival rate was significantly higher in PHO compared to HCT patients (98.4% vs. 93.2%, p < 0.001). Most deaths were caused by S. epidermidis, S. haemolyticus, and S. hominis, predominantly involving methicillin-resistant coagulase-negative Staphylococci (MRCNS). Multivariate Cox regression identified undergoing HCT (HR = 3.0, 95% CI: 1.6–5.6, p < 0.001) and treatment of infection > 10 days (HR = 2.0, 95% CI: 1.1–3.6, p = 0.019) as independent risk factors for mortality. Conclusions: Staphylococcal infections pose a significant challenge in paediatric oncology and transplant populations. Optimising prevention, diagnostics, and antimicrobial therapy is crucial for improving outcomes in these high-risk groups. Full article

Background/Objectives: To investigate the incidence of new-onset diabetic retinopathy (DR) in individuals with pre-existing type 2 diabetes (T2D) up to 3 years post SARS-CoV-2 infection. Methods: This retrospective study consisted of 5151 COVID-19 and 5151 propensity-matched non-COVID-19 patients with T2D in the Montefiore Health System between 1 March 2020 and 17 January 2023. The primary outcome was new-onset DR at least 2 months after the index date up to 17 January 2023. Matching for index date between groups was also used to ensure the same follow-up duration. Hazard ratios (HRs) were computed, adjusted for competing risks. Results: T2D patients with COVID-19 had a higher cumulative incidence of DR than T2D patients. The unadjusted HR for COVID-19 status for developing new DR was 2.44 [1.60, 3.73], p < 0.001. The adjusted HR was 1.70 [1.08, 2.70], p < 0.05, and the adjusted HR for prior insulin use was 3.28 [2.10, 5.12], p < 0.001. Sex, ethnicity, and major comorbidities had no significant association with outcome. Conclusions: T2D patients who contracted COVID-19 exhibited a significantly higher risk of developing DR within three years post infection compared to propensity-matched controls. The increased incidence was primarily driven by greater pre-existing insulin usage and SARS-CoV-2 infection in the COVID-19 positive cohort. Full article

Background/Objectives: Radical cystectomy performed via midline laparotomy is associated with substantial postoperative pain, frequently necessitating a high opioid consumption, which may impair immune function and delay recovery. The rectus sheath block (RSB) is widely used as part of multimodal analgesia to enhance postoperative pain control; however, the duration of analgesia is limited when using single-injection techniques. Dexamethasone has increasingly been used as a perineural adjuvant to prolong the effects of peripheral nerve blocks and enhance analgesia. This randomized controlled trial evaluated whether adding perineural dexamethasone to an RSB improves analgesic efficacy in patients undergoing a radical cystectomy. Methods: Fifty-two adult patients scheduled for radical cystectomy were randomly assigned to receive an ultrasound-guided bilateral RSB with either 0.25% ropivacaine alone or 0.25% ropivacaine combined with 4 mg dexamethasone per side after skin closure. Postoperative pain was assessed using a numeric rating scale (NRS) at 3, 6, 12, 18, 24, and 48 h following surgery. Cumulative intravenous patient-controlled analgesia (IV-PCA) in terms of fentanyl consumption and the incidence of rebound pain—defined as an increase in the NRS from ≤3 to ≥7 within 24 h after the block administration—were also recorded. Results: The dexamethasone group exhibited significantly reduced cumulative fentanyl consumption. Pain scores were consistently lower in the dexamethasone group compared with the ropivacaine-only group at all time points except 3 h postoperatively. The incidence of rebound pain was also substantially lower in the dexamethasone group. Conclusions: Perineural dexamethasone as an adjuvant to an RSB provides effective and prolonged analgesia, reduces opioid requirements, and lowers rebound pain incidence in patients undergoing a radical cystectomy. Full article

Background/Objectives: This study examines the academic discourse surrounding Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM) for first responders using Latent Dirichlet Allocation (LDA) topic modeling. It aims to uncover latent topical structures in the literature and critically evaluate assumptions to identify gaps and limitations. Methods: A corpus of 214 research article abstracts related to CISD/M was gathered from the Web of Science Core Collection. After preprocessing, we used Orange Data Mining software’s LDA tool to analyze the corpus. We tested models ranging from 2 to 10 topics. To guide interpretation and labeling, we evaluated them using log perplexity, topic coherence, and LDAvis visualizations. A four-topic model offered the best balance of detail and interpretability. Results: Four topics emerged: (1) Critical Incident Stress Management in medical and emergency settings, (2) psychological and group-based interventions for PTSD and trauma, (3) peer support and experiences of emergency and military personnel, and (4) mental health interventions for first responders. Key gaps included limited focus on cumulative trauma, insufficient longitudinal research, and variability in procedural adherence affecting outcomes. Conclusions: The findings highlight the need for CISD/M protocols to move beyond event-specific interventions and address cumulative stressors. Recommendations include incorporating holistic, proactive mental health strategies and conducting longitudinal studies to evaluate long-term effectiveness. These insights can help refine CISD/M approaches and enhance their impact on first responders working in high-stress environments. Full article

Background/Objectives: Pressure injuries (PIs), a recognized indicator of care quality, have a higher incidence in intensive care units (ICUs). Our objective was to assess whether critically ill patients identified as “unprotected” (COMHON ≥ 11) developed pressure injuries despite additional preventive measures. Methods: A historical cohort study of an adult ICU was carried out. Of the 811 patients admitted in 2022, 400 were selected. All of them were subjected to the ICU’s PI Prevention Protocol, and those with a moving average of the COMHON Index ≥ 11 were given two additional measures: a multilayer dressing on the sacrum, and anti-equinus and heel-pressure-relieving boots. Results: A total of 36 patients presented with PIs (cumulative incidence of 9%). Significant differences were observed in their mean length of stay and in their disease severity score (APACHE-II). Most of the PIs were located on the sacrum, followed by the heel. Prior to the appearance of the PIs, a sacral dressing was applied to 100% of the patients, while anti-equinus and heel-pressure-relieving boots were only applied to 58.3%. Of the 36 patients with PIs, 52.8% had a PI on the sacrum and 22.2% on the heel. Conclusions: Focusing only on those who presented with PIs, we observed that the considered measures were not effective for preventing PIs in all the patients. Not all PIs are preventable, and individual risk factors should be considered. In the future, we will analyze the individual characteristics of these patients and verify whether the Prevention Protocol was followed, in order to determine how they could have been prevented or whether they were so-called unavoidable PIs. Full article

Objective: Tumor progression is regulated by systemic immune status, nutritional metabolism, and the inflammatory microenvironment. This study aims to investigate inflammatory–nutritional biomarkers associated with metachronous liver metastasis (MLM) in colorectal cancer (CRC) and develop a machine learning model for accurate prediction. Methods: This study enrolled 680 patients with CRC who underwent curative resection, randomly allocated into a training set (n = 477) and a validation set (n = 203) in a 7:3 ratio. Feature selection was performed using Boruta and Lasso algorithms, identifying nine core prognostic factors through variable intersection. Seven machine learning (ML) models were constructed using the training set, with the optimal predictive model selected based on comprehensive evaluation metrics. An interactive visualization tool was developed to interpret the dynamic impact of key features on individual predictions. The partial dependence plots (PDPs) revealed a potential dose–response relationship between inflammatory–nutritional markers and MLM risk. Results: Among 680 patients with CRC, the cumulative incidence of MLM at 6 months postoperatively was 39.1%. Multimodal feature selection identified nine key predictors, including the N stage, vascular invasion, carcinoembryonic antigen (CEA), systemic immune–inflammation index (SII), albumin–bilirubin index (ALBI), differentiation grade, prognostic nutritional index (PNI), fatty liver, and T stage. The gradient boosting machine (GBM) demonstrated the best overall performance (AUROC: 0.916, sensitivity: 0.772, specificity: 0.871). The generalized additive model (GAM)-fitted SHAP analysis established, for the first time, risk thresholds for four continuous variables (CEA > 8.14 μg/L, PNI < 44.46, SII > 856.36, ALBI > −2.67), confirming their significant association with MLM development. Conclusions: This study developed a GBM model incorporating inflammatory-nutritional biomarkers and clinical features to accurately predict MLM in colorectal cancer. Integrated with dynamic visualization tools, the model enables real-time risk stratification via a freely accessible web calculator, guiding individualized surveillance planning and optimizing clinical decision-making for precision postoperative care. Full article

Background/Objectives: Worldwide, men experience a higher incidence of pancreatic cancer (PC) than women. Methods: To increase understanding of the underlying reasons for this sex-related difference, we analysed general and sex-related risk factors for PC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (women/men No. = 293,682/136,728; 717/577 PC-cases). Results: Cox proportional hazards models showed a 1.31-fold higher risk of developing PC for men compared to women (HR, 95% CI 1.15–1.49) after adjustment for age, smoking history, BMI, diabetes, and alcohol consumption. Associations of PC with established risk factors did not differ between men and women, with the exception of a greater risk of PC among women with greater attained body height, meat consumption and cigarettes smoked (1.12 (1.05–1.19) per 5 cm, 1.18 (1.02–1.36) per 100 g/d, 1.42 (1.27–1.59) per 10/d; respectively). Among child-bearing women, long cumulative duration of breastfeeding was inversely associated with risk of PC (HR 0.74, 95% CI 0.61–0.89) for >5.7 months of breastfeeding (median) relative to ≤5.7 months and among HRT users, cumulative duration of HRT use was inversely associated with PC risk (HR 0.71, 95% CI 0.53–0.95, >2.4 versus ≤2.4 years). Further reproductive and hormonal factors, such as age at menarche, number of full-term pregnancies, age at menopause, or use of oral contraceptives, were not significantly associated with PC risk. Conclusions: Pooled analyses of large cohort studies are needed to confirm these results, and detailed data on the type and intensity of HRT are required to better evaluate its effect. Full article

Reliable short-term forecasts of hepatitis B incidence are indispensable for sizing national vaccine and antiviral procurement. However, predictive modelling is complicated when surveillance streams experience reporting delays and episodic under-reporting, as has occurred in Ukraine since 2022. We address this challenge by training a deliberately compact two-layer long short-term memory (LSTM) network on 72 monthly observations (January 2018–December 2023) drawn from the Public Health Center electronic registry and evaluating performance on a strictly held-out 12-month horizon (January–December 2024). Grid-search optimisation selected a 12-month sliding input window, 64 hidden units per layer, 0.20 dropout, the Adam optimiser, and early stopping. Walk-forward validation showed that the network attained mean squared errors of 411 for acute infection and 76 for chronic infection on the monthly series. When forecasts were aggregated to the cumulative scale, the mean absolute percentage error remained below 1%. This study presents the first peer-reviewed hepatitis B forecasts calibrated on Ukraine’s registry during a period of pronounced reporting instability, demonstrating that robust accuracy is attainable without missing-value imputation. Full article

Background/Objectives: The role of KDM6A gene mutations in acute myeloid leukemia (AML) remains poorly understood. This study aimed to evaluate the impact of KDM6A mutations on relapse risk, cumulative incidence of relapse (CIR), relapse-free survival (RFS), and overall survival (OS) in adult AML patients, with a particular focus on those with RUNX1::RUNX1T1 fusion. Methods: the retrospective analysis was conducted on 1970 adult AML patients treated at Peking University People’s Hospital. Of these, 1676 patients who achieved complete remission (CR) were included. Among them, 27 harbored KDM6A mutations. Propensity score matching (PSM) was used (1:10 ratio) to compare outcomes between patients with and without KDM6A mutations. Further analysis focused on 207 patients with RUNX1::RUNX1T1 fusion, among whom 13 had KDM6A mutations (PSM 1:5). Results: In the overall cohort, KDM6A variants (n = 27) had a higher 2-year CIR (45.7% vs. 28.6%, p = 0.04). Fine–Gray analysis showed KDM6A variants independently increased relapse risk (HR = 1.98 [1.08–3.63], p = 0.03). KDM6A mutations were associated with inferior 2-year RFS (36.3% vs. 60.9%, p = 0.044). Multivariable analysis confirmed KDM6A mutations as independent predictors of poor RFS (HR = 3.08 [1.56–6.08], p = 0.001). Among RUNX1::RUNX1T1 patients, KDM6A mutations significantly increased relapse risk (75.0% vs. 21.7%, p < 0.001), raised 2-year CIR (46.9% vs. 24.0%, p = 0.05), worsened 2-year RFS (31.3% vs. 71.9%, p < 0.001), and lowered 2-year OS (63.3% vs. 86.4%, p = 0.002). They were also independent predictors of CIR (HR = 2.46 [1.11–5.47], p = 0.03), RFS (HR = 5.1, [2.5–10.5], p < 0.001) and OS (HR = 12.9, [4.3–38.7], p < 0.001). Conclusions: KDM6A mutations are significantly associated with increased relapse risk and poor prognosis in AML, especially in patients with RUNX1::RUNX1T1 fusion, and may serve as a valuable prognostic biomarker. Full article

Background/Objectives: The triglyceride–glucose (TyG) index is a recognized marker for cardiovascular disease (CVD) risk linked to insulin resistance. Combining TyG with anthropometric indicators (AIs) may improve risk prediction, but the comparative value of different AIs, including novel ones like Relative Fat Mass (RFM), is unclear. This study aimed to identify which combination of TyG and AIs has the strongest association with incident CVD in a middle-aged and elderly Chinese cohort. Methods: In this prospective study, we evaluated the association between the cumulative average of TyG combined with eight AIs (TyG-AIs) and incident CVD, heart disease, and stroke. Using data from 5192 participants in the China Health and Retirement Longitudinal Study (CHARLS), we used multivariable logistic regression to compare the predictive value of these composite indices. Results: During follow-up, 1382 (26.6%) participants developed CVD. After full adjustment, the TyG index alone was only significantly associated with stroke. In contrast, most TyG-AIs showed stronger associations with all outcomes. Notably, the index combining TyG with Relative Fat Mass (TyG-RFM) exhibited the most robust associations with total CVD (OR = 2.236), heart disease (OR = 1.679), and stroke (OR = 3.288) when comparing the highest to lowest quartiles. Conclusions: Cumulative average TyG-AIs, particularly TyG-RFM, demonstrated more robust associations with incident CVD than the TyG index alone. The TyG-RFM index shows promise as a valuable tool to improve cardiovascular risk stratification, especially for identifying at-risk non-obese individuals. Full article

Immune checkpoint inhibitor diabetes mellitus (ICI-DM) is an emerging phenomenon in the adult oncology population, with an increased incidence reflecting the increased use of immunotherapy; however, risk factors for ICI-DM have not been fully identified. The aim of this integrated literature review was to synthesize the published literature on ICI-DM and the factors associated with an increased risk for its development. The review was guided by Sanieszko’s Epidemiology Triad theoretical framework. We conducted a literature search using the Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed databases. The analysis included 2030 studies that met the search criteria, 23 of which were peer-reviewed articles that met the inclusion criteria. The results demonstrated a positive relationship between older age, medical history of diabetes, the presence of susceptible alleles, and exposure to immunotherapy, with an increased risk for ICI-DM. Future studies should include larger samples, more diverse populations, and a broad range of institutions to confirm the risk factors associated with ICI-DM. Full article