Search Results (3,925)

Background: The benefits of metabolic bariatric surgery (MBS) in people with a body mass index (BMI) ≥ 50 kg/m² are not well-established, with concerns of increased risk and poorer weight loss. The optimal surgical type (gastric bypass [GB] versus sleeve gastrectomy [SG]) is unclear, with studies comparing complication rates, weight loss, and glycaemic outcomes reporting mixed results. Methods: Participants with a BMI ≥ 50 kg/m² undergoing MBS (SG or GB) from 2008 to 2022 were recruited. Demographics, anthropometrics, biochemistry, and diabetes status were analysed at baseline, 12 months, and 24 months post-operatively. Surgical outcomes and complications were analysed. Results: The study included n = 184, with BMI ≥ 50 kg/m² (57.6% female, age 38.6 ± 10.5 years, and BMI 55.3 ± 6.0 kg/m²). Pre-operatively, 21.1% had pre-diabetes, and 33.2% had diabetes (mean HbA1c 8.0 ± 1.7%). Most subjects (89.1%) underwent SG. The overall 30-day adverse event rate was 4.9%, with a higher, but not statistically significant, rate in the GB group (15.0% vs 3.7%, p = 0.061). The GB group had a longer length of stay (GB =4.5 ± 0.6 days, SG = 3.1 ± 0.2, and p = 0.023). The rate of revisional surgery was 2.7%, with no significant difference between groups. The follow-up rate was 67.9% at 12 months and 51.1% at 24 months. The average %total weight loss (%TWL) at 12 months (27.4 ± 9.0%, SG = 27.6 ± 9.0%, GB = 26.0 ± 9.4%, and p = 0.481) and 24 months (27.1 ± 10.9%, SG = 27.4 ± 11.1%, GB = 24.9 ± 8.9%, and p = 0.495) were similar between groups. The GB group had a larger HbA1c reduction (3.2 ± 1.1%) than SG (1.9 ±1.3%, p = 0.030) but no difference in diabetes remission rates (69.2% at 12 months, 76.7% at 24 months). Conclusions: MBS is safe and effective for individuals with a BMI ≥ 50 kg/m², with low complication rates and good weight loss and glycaemic outcomes at 2 years. No statistically significant differences in %TWL, diabetes remission, or complication rates were noted between SG and GB groups, though results are limited by the small number of participants who underwent GB. Full article

Background: Cemented and cementless fixation techniques in total hip arthroplasty (THA) each present distinct biomechanical properties and perioperative risk profiles. While cementless fixation has gained increasing popularity, large-scale nationally representative comparisons of perioperative outcomes between cemented and cementless elective THA remain limited. This study aimed to compare complication rates, healthcare utilization, and temporal trends between cemented and cementless elective THA using the National Inpatient Sample. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2016 to 2021. Adult patients undergoing elective primary total hip arthroplasty were identified using ICD-10-PCS codes and categorized into cemented and cementless fixation groups. Patient demographics, comorbidities, indications, postoperative complications, length of stay, hospital charges, and in-hospital mortality were compared. Multivariate logistic regression analysis was performed to evaluate the independent association between fixation type and postoperative complications while adjusting for demographic, clinical, and hospital-level variables. Results: A total of 81,668 elective THAs were identified, including 40,290 cemented (49.33%) and 41,378 cementless (50.67%) procedures. Cemented THA was associated with a shorter length of stay (2.09 ± 1.88 vs. 2.26 ± 2.47 days, p < 0.001) and lower total hospital charges ($65,584.53 ± 48,797.21 vs. $72,186.84 ± 49,860.20, p < 0.001). Unadjusted analyses demonstrated higher rates of acute kidney injury and sepsis in the cementless group. After multivariate adjustment, cemented fixation was associated with lower odds of acute kidney injury (OR 0.87, 95% CI 0.79–0.96, p = 0.004). However, cemented THA was associated with higher odds of postoperative delirium (OR 1.20, 95% CI 1.02–1.42, p = 0.030), blood transfusion (OR 1.27, 95% CI 1.17–1.37, p < 0.001), and periprosthetic fracture (OR 1.32, 95% CI 1.02–1.71, p = 0.035). Rates of myocardial infarction, pneumonia, venous thromboembolism, urinary tract infection, and in-hospital mortality were similar between groups. Temporal analysis demonstrated comparable utilization trends, with a decline in elective procedures during 2020–2021. Conclusions: In this nationwide analysis, cemented total hip arthroplasty was associated with lower risk of acute kidney injury, shorter length of stay, and lower hospital charges, but higher odds of postoperative delirium, blood transfusion, and periprosthetic fracture compared with cementless fixation. These findings highlight distinct perioperative risk profiles between fixation strategies and may assist surgeons in individualized decision-making for elective total hip arthroplasty. Full article

Background/Objectives: B-cell maturation antigen (BCMA)-directed immunotherapies, including chimeric antigen receptor T-cell (CAR-T) therapies and bispecific antibodies (BsAbs), have improved clinical outcomes in multiple myeloma. However, cytokine release syndrome (CRS) remains a major safety concern, and comparative real-world evidence across BCMA-directed agents remains limited. This study aimed to evaluate and compare CRS reporting patterns associated with BCMA-targeted CAR-T and BsAb therapies using the FDA Adverse Event Reporting System (FAERS) data and to identify predictors of CRS reporting using machine learning-based approaches. Methods: A pharmacovigilance analysis was conducted using FAERS reports from 2021 Q1 to 2025 Q3. Disproportionality analyses were performed using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and information component (IC), and signals were considered present when predefined thresholds were met. Multivariable logistic regression was applied to estimate adjusted odds ratios (aORs) for CRS reporting while adjusting for demographic and reporting characteristics. Machine learning models, including XGBoost, LightGBM, and random forest were developed to predict CRS reporting. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: Among 4046 reports included in the final dataset, CAR-T therapies showed higher CRS reporting odds than BsAbs (aOR: 2.55, 95% CI: 2.16–3.01). Disproportionality analyses identified significant CRS signals for CAR-T therapies across all indices, whereas BsAbs did not meet signal detection thresholds. At the agent level, idecabtagene vicleucel was the only agent meeting all predefined signal detection criteria and exhibited the strongest reporting pattern in multivariable analysis (aOR: 6.96, 95% CI: 5.53–8.75). Among the evaluated models, LightGBM achieved the highest predictive test AUROC (0.762). SHAP analysis identified idecabtagene vicleucel, United States region, and reporting year as the most influential predictors of CRS reporting. Conclusions: CAR-T therapies, particularly idecabtagene vicleucel, exhibited higher CRS reporting odds than BsAbs, with substantial agent-level heterogeneity observed across BCMA-directed immunotherapies. Integrating pharmacovigilance and machine learning approaches may facilitate more individualized safety monitoring by identifying agent-specific differences in CRS risk among BCMA-targeted therapies. Full article

Internet advertising, while enabling unprecedented commercial reach, has become a pervasive vehicle for deceptive practices that inflict measurable harm on consumers. This study empirically investigates the structural relationships between internet advertising falsity and consumer harm by integrating analyses of the mediating role of consumer cognitive processes and the moderating role of consumer vulnerability within a unified structural framework. Survey data were collected from 600 adult consumers with online purchase experience in the Republic of Korea—an advanced digital economy characterized by exceptionally high mobile-commerce penetration, mature e-commerce infrastructure, and evolving digital consumer protection regulation—and analyzed using structural equation modeling (SEM) with AMOS 24.0, supplemented by Hayes’ PROCESS macro Model 59 for conditional process analysis. All 13 hypotheses were supported, although path magnitudes varied substantially across falsity dimensions and mediator pathways—with direct effects ranging from β = 0.156 (false scarcity) to β = 0.224 (performance exaggeration), and indirect effects dominated by the risk assessment distortion pathway. Among the four sub-dimensions of advertising falsity—factual misrepresentation, performance exaggeration, price deception, and false scarcity—performance exaggeration exerted the strongest direct effect on consumer harm. The three cognitive mediators—perceived advertising credibility, risk assessment distortion, and purchase decision pressure—all demonstrated significant partial mediation, with risk assessment distortion emerging as the most powerful indirect pathway. All four consumer vulnerability dimensions—digital literacy level, demographic vulnerability, prior victimization experience, and impulsive buying tendency—significantly moderated the falsity–harm relationship, with low-digital-literacy consumers experiencing approximately 1.7 times the adverse effect of high-literacy counterparts. Moderated mediation analysis revealed that the conditional indirect effect for the high-vulnerability group was approximately 2.3 times that of the low-vulnerability group, confirming that the cognitive harm mechanism intensifies systematically for vulnerable consumers. These findings advance consumer vulnerability theory in the digital context and offer evidence-based implications for consumer protection policy, platform governance, and digital literacy education. Full article

Background/Objectives: Adolescent psychiatric inpatient units play a critical role in the management of severe psychiatric disorders and suicide risk. However, limited evidence exists regarding the clinical and familial factors that simultaneously influence suicidal ideation and treatment outcomes in hospitalized adolescents. This study aimed to identify demographic, diagnostic, and clinical predictors of suicidal ideation and clinical improvement among adolescents hospitalized in a tertiary child and adolescent psychiatry inpatient unit. Methods: This retrospective observational study included 75 adolescents aged 12–18 years who were hospitalized in a tertiary child and adolescent psychiatry inpatient unit between November 2023 and June 2025. Sociodemographic and clinical characteristics were obtained from medical records. Clinical improvement was evaluated using the Clinical Global Impression–Improvement (CGI-I) scale. Group comparisons were conducted using chi-square or Fisher’s exact tests for categorical variables and the Mann–Whitney U test for continuous variables. Multivariate logistic regression analyses were performed to determine independent predictors of suicidal ideation and clinical improvement. Results: Clinical improvement was evaluated in the full sample of adolescents (n = 75), and longer length of stay was independently associated with clinical improvement during hospitalization. Among adolescents admitted with suicidal ideation (n = 45), major depressive disorder, previous suicide attempt, irritability at admission, and fewer siblings were identified as independent predictors of suicidal ideation. In addition, female adolescents had higher rates of suicide attempts and non-suicidal self-injury, whereas psychotic disorders were more common among male adolescents. Conclusions: Suicidal ideation in hospitalized adolescents is strongly associated with affective pathology and prior suicidal behavior. Longer inpatient treatment duration appears to facilitate clinical improvement. These findings highlight the importance of early suicide risk stratification and adequate treatment duration in adolescent psychiatric inpatient care. Full article

Background: Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnoea (OSA). However, CPAP adherence in randomized controlled trials (RCTs) is frequently inadequate, potentially leading to an underestimation of the therapy’s true effect on relevant outcomes. The aim was to identify patient and study characteristics that predict adherence to CPAP therapy in RCTs. Methods: PubMed and the existing meta-analyses were searched (1984 to 31 December 2024). A study-level meta-analysis of RCTs comparing CPAP with inactive control in patients with OSA was conducted. Meta-regressions and subgroup analyses (<4 h vs. ≥5 h usage) were undertaken to identify the predictors of CPAP adherence. Risk-of-bias was assessed using the Cochrane RoB-2 tool. Results: In 136 RCTs reporting on CPAP use, including 8827 patients with OSA (55 [49.5–59.8] years, 77.4 [61.2–89.2]% male, BMI 31 [28.9–33.2] kg/m², Epworth Sleepiness Scale (ESS) 10.0 ± 2.8, apnoea–hypopnoea-index (AHI) 35.7 ± 13.4/h), mean nocturnal CPAP use was 4.5 ± 1 h. CPAP use of ≥4 h, ≥5 h, and ≥6 h per night was observed in 71.3%, 34.1%, and 7.8% of RCTs, respectively. Higher baseline AHI was the strongest predictor of longer CPAP use in meta-regressions (p < 0.001, β = 0.02, 95% CI 0.01–0.04). Baseline AHI was also significantly higher (40.3 ± 12.8 vs. 29.9 ± 12.6) in the ≥5 h vs. <4 h subgroup (p < 0.01, large effect size d = 0.84). A higher nightly CPAP usage was more likely in smaller (p < 0.05, d = 0.45) and single-centre trials (p < 0.05, h = 0.52). Sex distribution, age, BMI, ESS, and follow-up had no significant effect on nightly CPAP use. Conclusions: Higher baseline AHI independently predicted longer CPAP use in RCTs, while sleepiness and demographics did not. This study was registered at PROSPERO (CRD420250653394) and received no external funding. Full article

Small settlements in Serbia are confronted with long-term processes of depopulation, ageing, and migration, characterised by pronounced spatial and structural heterogeneity. This raises questions about the effectiveness of uniform development policies and underscores the need for a differentiated, place-based approach. The aim of this paper is to identify the demographic heterogeneity of small settlements (with fewer than 100 inhabitants) and to analyse its implications for decentralised territorial development. The research is based on the analysis of 1302 settlements in Serbia, using 26 demographic, socio-economic, and geographical indicators. The methodological framework is based on principal component analysis and cluster analysis, complemented by nonparametric tests and logistic regression. The results indicate pronounced population ageing, low labour potential, and a clear spatial polarisation between accessible and peripheral settlements. Four clearly differentiated types of small settlements are identified. It is concluded that demographic heterogeneity represents a key determinant of development capacity, indicating the need for territorially sensitive and differentiated development policies. In this context, decentralisation and tailored development models may contribute to the revitalisation and long-term sustainability of rural areas. Full article

Bullying and victimization are prevalent in school and sport settings, yet they are rarely examined concurrently. This study explored the relationships between school and sport bullying among youth athletes, assessing whether demographic and sport-related factors are associated with these behaviors across contexts. Participants included 189 youth athletes (aged 8–15 years) from Central Macedonia, Northern Greece. They completed a demographic survey and the Bullying and Victimization Questionnaire twice, assessing both school and sport environments. A multivariate analysis of variance (MANOVA) evaluated the effects of gender, educational level, sport type, and contact classification, followed by regression analyses. Results showed that educational level yielded a significant multivariate effect, with secondary school students reporting higher involvement in school bullying, sport bullying, and sport victimization. Crucially, regression analyses revealed that school-context bullying and victimization were the strongest factors associated with corresponding behaviors in sports. Additionally, team sport participation was associated with sport victimization, while demographic factors were related to school bullying perpetration. These findings demonstrate the interconnected nature of bullying between school and sport environments, emphasizing the critical need for coordinated, multi-contextual prevention strategies among educators and coaches. Full article

Postpartum depression (PPD) affects a substantial proportion of women globally and is often underdiagnosed due to barriers in screening, stigma, and limited access to care. This study presents the design and pilot evaluation of an mHealth application (“HeartHabit”) intended to support user awareness, self-monitoring, and potential identification of symptoms of PPD among Greek-speaking mothers. An alpha version of the application was evaluated through an online survey with 30 women within the first postpartum year, using a walkthrough video. The evaluation focused on perceived usability and acceptability rather than clinical outcomes or real-world use. Usability and app quality were assessed via the System Usability Scale (SUS) and a qualitative version of the user Mobile Application Rating Scale (uMARS), respectively, adopting a mixed-methods approach. Demographics, and mood and stress screening data were also captured. Quantitative data were analysed via descriptive statistics and qualitative responses via Framework Analysis. The results indicated high perceived usability (mean SUS = 83.7/100). Qualitative findings highlighted the importance of practical usability, self-regulation tools, personalisation, and connectivity with healthcare professionals. Privacy, data transparency, and user control over personal data were perceived as critical for trust. The application was perceived as a potentially useful adjunct to formal care or as at-home support when access to services is limited. Larger, controlled trials, clinical implementation protocols and clinician training are needed to promote the app’s safe integration into formal care. This mixed-methods evaluation, incorporating usability assessment and patient involvement, may offer a useful paradigm for early-stage digital mental health intervention development. Full article

Background: Therapeutic drug monitoring (TDM) of anti-TNF biologics may help optimise treatment in rheumatoid arthritis (RA), but current therapeutic ranges do not always reflect clinical response in routine practice. Methods: We conducted a retrospective observational study including 224 adults with RA treated with infliximab (IFX), adalimumab (ADL), or etanercept (ETN) during the maintenance phase at Hospital Universitario Puerto Real between May 2016 and May 2023. Drug and anti-drug antibody levels were measured by sandwich ELISA and analysed against clinical response using DAS28. Demographic and clinical variables, associations between drug levels and response, the effect of antibodies, correlations between serum concentrations and DAS28, and the performance of current and proposed therapeutic ranges were evaluated. Results: The cohort was mainly female (62.1%), with a mean age of 57.7 years, BMI of 28.5 kg/m², and mean DAS28 of 3.33. ETN was most frequently used (62.5%), followed by ADL (21.9%) and IFX (15.6%). Drug levels were significantly associated with response (p < 0.001). Anti-drug antibodies were strongly linked to non-response, especially with IFX and ADL. Serum drug levels correlated inversely with disease activity for IFX and ADL, but not for ETN. Current therapeutic ranges showed low sensitivity, while lower proposed ranges improved sensitivity considerably. Conclusions: Current anti-TNF therapeutic ranges have limited ability to identify responders in real-world RA. Lowering the lower bound improves sensitivity and supports more individualised TDM, particularly for IFX and ADL, pending prospective validation. Full article

Eastern deciduous forests are undergoing directional compositional shifts, marked by the progressive replacement of Quercus-dominated canopies with generalists and shade-tolerant taxa. These shifts are increasingly interpreted within a regeneration debt framework, in which canopy composition persists despite recruitment failure and regeneration mismatch in smaller size classes. We evaluated 30 years (1995–2025) of compositional and structural change in adjacent upland and cove forests on the southern Cumberland Plateau, Tennessee, using a permanent nested circular plot design to determine whether previously observed upland resistance reflects durable resilience or delayed demographic transition. Both habitats exhibited continued Quercus decline while remaining compositionally distinct. As documented in prior analyses, reductions in small-diameter stems were more pronounced in the cove forest, but now reveal demographic mismatches between canopy and regeneration layers in both habitats. Upland forests maintained a higher representation of species capable of basal sprouting and clonal growth via root suckering, indicating that vegetative regeneration buffered short-term demographic change. However, recruitment into larger size classes declined in both habitats, demonstrating that buffering facilitated by vegetative regeneration delayed but did not prevent the accumulation of regeneration debt. What appeared as differential resistance through 2014 is more accurately interpreted as temporal offset in regeneration debt accumulation. Full article

This paper presents a dataset collected through a visitor questionnaire survey conducted at the Archaeological Site of Ancient Dodona, Greece, a large-scale, spatially complex open-air archaeological site. The dataset documents visitors’ experiences, perceptions, and information needs, as well as their attitudes toward the use of digital technologies for heritage interpretation and engagement. The questionnaire was administered in printed form to adult visitors at the entrance and exit of the archaeological site. A total of 99 valid responses were collected. The dataset includes information on visitor demographics, visit characteristics, perceptions of existing interpretive material, spatial behavior within the site, and attitudes toward digital applications such as augmented reality, digital storytelling, and interactive tools. All data are fully anonymized and contain no personally identifiable or sensitive information. The dataset supports research in the fields of visitor studies, cultural heritage interpretation, digital heritage, and cultural tourism, and may be reused for comparative studies or for the design and evaluation of digital mediation applications in archaeological contexts. The dataset enables cross-tabulation analyses exploring associations between visitor characteristics and attitudes toward digital mediation, thereby supporting visitor segmentation and the evidence-based development of digital interpretation strategies in archaeological contexts. Full article

Background: We aimed to study the association between accelerometer-measured physical activity and metabolic markers of diabetes in a nationwide representative sample of U.S. adults. Methods: This cross-sectional analysis included 1259 adults aged ≥18 years from the 2003–2004 National Health and Nutrition Examination Survey (NHANES), the only cycle incorporating objective accelerometry. Physical activity was assessed using hip-worn accelerometers, with moderate-to-vigorous physical activity (MVPA) and sedentary time derived from validated count thresholds. Metabolic outcomes included fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), and insulin resistance estimated by the Homeostatic Model Assessment (HOMA-IR). Survey-weighted linear regression models accounting for the complex sampling design were applied, with sequential adjustment for demographic, socioeconomic, anthropometric, and behavioral covariates. Sensitivity analyses tested alternative MVPA thresholds and wear-time criteria. Results: In unadjusted models, higher MVPA was inversely linked with fasting glucose and insulin concentrations; but, these associations were attenuated after full multivariable adjustment. In contrast, MVPA established a constant inverse association with insulin resistance. Higher MVPA was connected with lower HOMA-IR values, and this relationship remained statistically significant in fully adjusted models and across all sensitivity analyses (all p < 0.001). Associations between sedentary time and metabolic markers were non-sustainable after multivariable adjustment. No significant effect modification by sex was detected. Conclusions: Objectively measured moderate-to-vigorous physical activity is independently linked with lower insulin resistance in U.S. adults. These results emphasize the value of accelerometer-based assessments for identifying early metabolic risk and reinforce physical activity promotion as a key strategy for improving insulin sensitivity. Full article

This study examines workplace bullying within the middle-management tier of a large Gauteng-based retail organisation in South Africa, with a focus on structural organisational pressures and perceptual differences among managers. While traditional research often emphasises individual personality traits or victim demographics, this study explores how organisational conditions—particularly the “middle management squeeze” and performance-driven Key Performance Indicators (KPIs)—are reflected in workplace behaviours. Grounded in a positivist paradigm, a quantitative cross-sectional survey was conducted among a probability-based sample of 253 retail managers. Data were collected using the Negative Acts Questionnaire (NAQ-22) and analysed using Exploratory Factor Analysis (EFA) and nonparametric inferential tests. The findings indicate that task-related negative acts, such as micromanagement (M = 2.00) and persistent monitoring (M = 1.87), are frequently experienced. EFA identified two dimensions—General Harassment and Managerial Control—accounting for 62% of the total variance. Inferential results show that perceptions of General Harassment differ significantly across educational groups (p = 0.0268), whereas perceptions of Managerial Control remain consistent (p = 0.3378). These findings indicate that social forms of incivility are interpreted differently across educational cohorts, while task-related managerial practices are widely normalised. The study highlights the importance of understanding workplace bullying as both a structural and perceptual phenomenon and underscores the need for organisational interventions that address systemic pressures rather than relying solely on individual-level approaches. Full article

Exposure to airborne pollen allergens is a major trigger of respiratory allergy, whose prevalence continues to rise throughout Europe. In southern Portugal, the Mediterranean climate and extensive vegetation diversity promote high pollen loads, particularly from the Amaranthaceae family. This retrospective observational study aimed to characterise the sensitisation profiles of patients with positive skin prick tests (SPTs) to Chenopodium album and/or Salsola kali, the dominant Amaranthaceae species in the region. Data from 346 patients were analysed, including demographic and clinical characteristics, SPT results, and specific IgE sensitisation to molecular allergens. Of these, 35% were positive for C. album only, 13% for S. kali only, and 51% for both. In molecular testing, 54% of S. kali-sensitised patients were positive to Sal k 1, whereas only 4% of C. album-sensitised patients were positive to Che a 1. Sensitisation to panallergens such as profilins and Ole e 1-like proteins was frequent, suggesting extensive IgE cross-reactivity between these taxa. A significant correlation in wheal size (r = 0.53, p < 0.0001) further supports shared allergenic determinants. Despite higher SPT positivity to C. album, S. kali is likely the predominant sensitising source in this population. These findings highlight the importance of molecular-based diagnostics to distinguish genuine sensitisation from cross-reactivity in Mediterranean settings. Full article