Search Results (42,615)

Background/Objectives: The impact of non-fluoride trace metals (NFTMs) in drinking water on oral health remains an under-explored area of environmental health. This scoping review maps global evidence on the associations between non-fluoride trace metals (NFTMs) in drinking water and oral health outcomes, such as dental caries, enamel hypoplasia, and periodontal diseases. Methods: A systematic search of electronic databases including PubMed, Scopus, Web of Science, and Embase was executed to identify peer-reviewed observational and experimental studies published within a 10-year window between January 2015 and December 2025. Data extraction captured geographic settings, target populations, specific metal exposures, oral health assessment indices, and observed health parameters. Results: A total of 20 studies met the inclusion criteria, consisting of 16 cross-sectional studies, 2 case–control studies, 1 prospective cohort study, and 1 experimental laboratory evaluation. Heavy metals such as lead (Pb), cadmium (Cd), and arsenic (As) were frequently associated with elevated risks of dental caries and structural enamel defects, such as demarcated opacities. Conversely, elements like molybdenum (Mo) demonstrated potential inverse, protective associations with caries prevalence. Most of the evidence relies on cross-sectional designs, which limits the ability to infer temporal pathways or direct biological causation. Conclusions: The mapped literature indicates that non-fluoride trace metals in drinking water are associated with shifts in oral health outcomes. However, substantial heterogeneity in exposure pathways, geographic variability, and the lack of standardized mixture-risk assessments limit definitive conclusions. Future prospective epidemiological tracking and standardized multi-metal exposure models are required to clarify these environmental pathways. Full article

Background/Objective: Melanoma is an aggressive skin malignancy characterized by significant molecular heterogeneity. Among the molecular alterations identified in melanoma, BRAF mutations represent one of the most common genetic abnormalities and play an important role in activating the MAPK signaling pathway. BRAF mutation status has become clinically important because of its prognostic significance and implications for targeted therapy. This study aimed to evaluate the frequency of BRAF mutations and their associations with demographic, histopathological, and clinicopathological characteristics in melanoma patients at the only referral center for BRAF testing in Kosova, the Institute of Pathology, University Clinical Center of Kosova (UCCK). Methods: This retrospective study included 127 melanoma patients. Descriptive statistics, frequency analysis, Spearman’s correlation and multivariable binary logistic regression analyses were performed to evaluate associations between BRAF mutation status and clinicopathological variables, including age, gender, Breslow thickness, histological type, ulceration, and anatomical localization. Results: BRAF mutation was identified in 76 of 127 melanoma patients (59.8%). The BRAF V600E/V600E2/V600D variants represented the predominant molecular subtype (75%). BRAF-positive melanoma was more frequently observed in younger patients and was significantly associated with increased Breslow thickness, nodular melanoma, ulceration, and trunk localization. Conclusions: BRAF mutations were highly prevalent in melanoma patients from Kosova and were associated with clinicopathological features of a more aggressive disease. The findings establish an important baseline for molecular epidemiology in the country and support the integration of routine BRAF testing into personalized melanoma management and future regional research. Full article

Most instruments used to assess depression have been developed in sociocultural contexts that differ substantially from those of Spanish-speaking Latin American populations. To address this limitation, the present study developed and evaluated a new brief measure of depressive symptomatology for use in northeastern Mexico. The study included 414 participants (Mage = 27.37 years, SD = 13.72). An initial pool of 23 items, grounded in interbehavioral psychology, was developed and subsequently evaluated by a panel of 58 expert judges. Based on content-validity analyses, the instrument was reduced to 15 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) supported a final four-item, one-factor solution. The final model demonstrated adequate fit to the data (χ²/df = 0.281, AGFI = 0.993, NNFI = 1.015, CFI = 1.000, RMSEA = 0.000, 90% CI [0.000, 0.094], and SRMR = 0.008). Evidence of discriminant and convergent validity was supported by a negative correlation with the Subjective Happiness Scale (r = −0.294, p < 0.01) and a positive correlation with the seven-item version of the Center for Epidemiologic Studies Depression Scale (CESD-7; r = 0.273, p < 0.01). Construct reliability was satisfactory (H = 0.841). Overall, the findings provide preliminary evidence supporting the reliability and validity of the proposed instrument as a brief screening measure of depressive symptomatology in a Mexican sample, mostly from Nuevo León. Full article

Background: Toxoplasmosis is a globally prevalent zoonotic infection caused by Toxoplasma gondii, with potentially severe consequences for pregnant women, foetuses, and immunocompromised individuals. Despite its public health importance, epidemiological data on T. gondii infection in Kuwait remain limited and restricted to selected population groups. This study assessed the seroprevalence of T. gondii among community-based adult participants in Kuwait and examined potentially associated risk factors. Methods: A cross-sectional study was conducted in September 2024 in Kuwait City and Jahra governorates. Serum samples from a convenience sample of 200 adults attending governmental polyclinics were screened for T. gondii IgM and IgG antibodies using VIDAS ELISAassays, with IgG-positive samples further analysed for IgG avidity. Demographic and exposure data were collected using structured questionnaires. Univariable and multivariable associations between demographic and exposure-related factors and IgG seropositivity were statistically evaluated. Results: The overall IgG seroprevalence was 11.5% (23/200), with no significant difference between governorates. All samples were IgM-negative, and all IgG-positive and equivocal samples showed high avidity. Age >40 years was associated with seropositivity in univariable analysis, but this association was not significant after adjustment (aOR = 2.21, 95% CI: 0.88–5.89; p = 0.092). No significant associations were observed with sex, nationality, educational level, travel history, cat ownership, or contact with stray cats. Conclusions: Among the participating community-based adults in Kuwait, T. gondii seroprevalence was lower than that reported in several regional studies, with serological findings consistent with past rather than recent infection. No demographic or exposure-related factor was independently associated with seropositivity. Larger population-based studies specifically powered to investigate risk factors and incorporating dietary, occupational, environmental, and migration-related exposures are needed to better characterise transmission pathways and inform targeted One Health surveillance and prevention strategies. Full article

Background/Objectives: Food insecurity (FI) is a major public health challenge and is monitored globally using the Food Insecurity Experience Scale (FIES). In Peru, the recent incorporation of the FIES into the National Household Survey (ENAHO) enables the generation of nationally representative estimates. This study evaluated the statistical validity of the FIES and estimated the prevalence of food insecurity among Peruvian households. Methods: A cross-sectional study was conducted using ENAHO 2025 data. FI was assessed using the eight-item FIES. Rasch analysis evaluated item fit, severity ordering, reliability, residual correlations, and differential item functioning. National prevalence estimates of moderate-or-severe and severe FI were calculated using the Food and Agriculture Organization of the United Nations (FAO) FIES methodology and household sampling weights. Results: The study included 32,041 households, representing approximately 9.9 million households nationwide. The FIES demonstrated satisfactory statistical validity, with a Rasch reliability of 0.796. Item severities followed the expected progression of FI, residual correlations remained below the recommended threshold, and no substantial differential item functioning was observed. The prevalence of moderate-or-severe FI was 30.9%, while severe FI affected 4.0% of households. Higher prevalence was observed among households living in extreme poverty, with unmet basic needs, lower educational attainment, permanent functional limitations, and in rural and Amazonian areas. Conclusions: The FIES demonstrated adequate validity for household-level monitoring of FI in Peru. Nearly one-third of households experienced moderate-or-severe FI, and prevalence varied across socioeconomic and geographic groups. The integration of the FIES into ENAHO provides a valuable platform for routine monitoring and food security policymaking. Full article

Food additives are consumed as mixtures in ultra-processed foods, but their independent contribution to glucose dysregulation is difficult to separate from diet quality and food matrix. PubMed/MEDLINE, Embase, Web of Science Core Collection, Scopus, and CENTRAL were searched from inception to 30 April 2026, followed by a supplementary PubMed update on 26 July 2026. This critical narrative review integrates epidemiological, human-intervention, animal, ex vivo, and mechanistic evidence. Successive NutriNet-Santé analyses associate several additive co-exposure profiles, emulsifiers, preservatives, food colouring additives, and non-nutritive sweeteners with incident type 2 diabetes mellitus. However, these analyses use substantially overlapping participants, lack independent additive-specific cohort replication, and remain vulnerable to residual confounding. Experimental evidence is strongest for selected emulsifiers and sweeteners, which may alter gut microbiota, intestinal barrier function, inflammatory signalling, or short-term glycaemic responses. No human trial has demonstrated the complete pathway from additive exposure to clinically meaningful insulin resistance or diabetes, and null or compound-specific findings argue against a uniform class effect. Current evidence therefore supports biological plausibility, not causality or additive-specific clinical recommendations. Longer controlled feeding trials should test realistic mixtures while holding the food matrix constant and should incorporate exposure validation, repeated microbiome and metabolomic sampling, intestinal permeability measures, and validated insulin-sensitivity endpoints. Full article

Background/Objectives: Non-communicable diseases (NCDs) are a leading cause of death globally, particularly in low- and middle-income countries undergoing rapid epidemiological transition. Apolipoprotein E (APOE) polymorphisms have been implicated in modulating risk for cardiovascular and neurodegenerative diseases. This study characterizes the distribution of APOE alleles and genotypes in an Angolan population sample and explores associations with demographic variables. Methods: A cross-sectional study was conducted in Huambo Province, Angola, with 200 unrelated adults aged 40–70 years. Genotyping for ε2, ε3, and ε4 was performed via real-time PCR. Allelic and genotypic frequencies were calculated and tested for Hardy–Weinberg equilibrium. Associations with sex, age (≤54 vs. >54 years), and urban vs. rural residence were analyzed. Results: ε3 was the most frequent allele (63%), followed by ε4 (24.8%) and ε2 (12.2%). The ε3 homozygous genotype was prevalent (44%), with ε3/ε4 (19%) and ε2/ε3 (18%) also common. Significant Hardy–Weinberg disequilibrium was observed due to excess ε4 homozygotes and deficit of certain heterozygotes; possible contributing factors, including population structuring, convenience sampling, and technical aspects of genotyping, are discussed. ε4 prevalence was higher in urban residents and older individuals, while ε3 and ε2 were more common in rural areas and younger participants. Conclusions: Our results reveal notable genetic heterogeneity and highlight the epidemiological and evolutionary importance of ε4 in Angola. The findings underscore the need for integrating population genomics into public health strategies targeting NCD prevention, especially in rapidly urbanizing African contexts. Full article

Introduction: Multimorbidity, defined as the coexistence of two or more chronic conditions in the same person, represents a major challenge for modern health systems due to its association with adverse health outcomes, increased mortality, and high healthcare utilization. We aimed to assess the prevalence of multimorbidity in the adult population of Serbia and examine its association with demographic and socioeconomic factors and healthcare utilization. Methodology: Data were drawn from the 2019 Serbian National Health Survey. Descriptive statistics, chi-square and independent-samples t-tests, as well as univariate and multivariate logistic regression analyses, were performed to examine the associations. Results: The study included 12,439 adults—48.5% men and 51.5% women (mean age: 52.83 ± 17.69). Multimorbidity was present in 35.2% of participants. It was significantly more frequent among women than men (39.65% vs. 30.53%, p < 0.001) and increased markedly with age, reaching 68.63% among individuals aged ≥80 years. Participants with multimorbidity were significantly older than those without it (p < 0.001). Higher prevalence was observed among widowed individuals, participants with lower education, economically inactive persons, those with poorer material status, and residents of Southern and Eastern Serbia (all p < 0.001). Multivariable regression analysis confirmed independent associations between multimorbidity and female sex, older age, lower education, poorer socioeconomic status, and regional disparities. Multimorbidity was a strong predictor of healthcare utilization. Individuals with multimorbidity were significantly more likely to use inpatient and day hospital services, visit specialist physicians, use prescribed medications, and receive home care (all p < 0.05). Conclusion: Multimorbidity affects more than one-third of adults in Serbia and is strongly associated with demographic and socioeconomic disadvantage. It substantially increases healthcare utilization, underscoring the need for integrated, patient-centered care and targeted public health interventions. Full article

Co-infection between influenza and Streptococcus pneumoniae is an important public health concern, since influenza can increase susceptibility to secondary bacterial invasion and enhance bacterial transmission. We develop and analyze a compartmental model of influenza–pneumococcal co-infection with eleven epidemiological compartments, incorporating imperfect vaccination, quarantine, and a three-stage pneumococcal progression from colonization to invasive disease. We establish the positivity and boundedness of solutions, determine the equilibria, and derive, via the next-generation matrix method, the sub-model reproduction numbers $R_0^I$ and $R_0^P$ together with the composite threshold $R_0=max\{R_0^I,R_0^P\}$. Each single infection undergoes a forward bifurcation: the disease-free equilibrium is locally asymptotically stable when the corresponding reproduction number is below unity, and a unique endemic equilibrium—globally asymptotically stable in the pneumococcal sub-model, established by a Goh–Volterra Lyapunov function—emerges above it. When both thresholds exceed unity, the two infections compete for the shared susceptible pool and undergo competitive exclusion: one infection persists while the other, together with the co-infected class, is eliminated. We show that the outcome is governed not by the disease-free reproduction numbers but by the invasion reproduction numbers evaluated at the single-infection boundary equilibria, so that even equal disease-free thresholds do not yield coexistence. Numerical simulations confirm the analytical results and quantify the effect of quarantine and vaccination, providing a framework for assessing control of interacting respiratory infections. Full article

Background and Objectives: Advances in medical, surgical, and acute burn care have shifted burn care from survival alone to survivorship; such improvement can be accompanied by extensive morbidity and disability in chronicity not previously encountered. The epidemiological characteristics of patients treated at a burn rehabilitation center, in the context of evolving social and occupational environments, may provide insights into current trends and their clinical implications. Notably, updated epidemiological data reflecting these changes in burn injury patterns remain scarce worldwide. To date, no epidemiological data from a burn rehabilitation center have been reported in Taiwan. Therefore, this study aimed to bridge this gap by providing a recent epidemiological review from the perspective of a burn rehabilitation center. Materials and Methods: This is a single-center, retrospective cross-sectional study enrolling patients who sustained burn injuries between January 2016 and December 2023. Data were collected from medical records and analyzed using SPSS version 20.0. Results: A total of 143 patients were recruited, of whom 101 were male (70.6%). The mean age was 38.51 years (SD = 20.28), and the mean total body surface area (TBSA) burned was 20.83% (SD = 18.77). Flame burns were the most common etiology, accounting for 67 cases (46.9%). Among the 143 patients, 73 (51.0%) sustained work-related burns, which were associated with a higher incidence of eye involvement compared with non-work-related burns (28.8% vs. 14.3%, p = 0.036). The upper extremity was the most frequently involved anatomical site, affecting 98 patients (68.5%). Conclusions: The present findings highlight an underrecognized need for stronger safety measures that address both personal and environmental risk factors. Risk-reduction strategies should particularly account for the aging workforce and vulnerable anatomical sites to mitigate preventable human and economic losses. Full article

The aim of the study was to analyse the epidemiological characteristics of confirmed COVID-19 cases in the Tumbes region between March 2020 and December 2022. Method: An ecological design with a descriptive approach was used for the study population, which consisted of 51,421 confirmed cases of COVID-19 residing in the provinces of Contralmirante Villar, Tumbes, and Zarumilla in the department of Tumbes. Confirmed cases of COVID-19 reported in SISOVID by the Ministry of Health and the registry of confirmed cases of COVID-19 in all age groups were recorded. The sociodemographic data collected was supplemented with information available on the web platform of the National Institute of Statistics and Informatics (INEI). The data were organized into databases and analyzed using software such RStudio (versión 2024.12.1), applying epidemiological indicators (incidence, prevalence, mortality, and lethality). The epidemiological data were organized and analyzed in a database prepared in Microsoft Excel to consolidate the information through data filtering and organization. Results: Among the main findings, a decrease in incidence was observed between 2021 (7840/100,000 inhabitants) and 2022 (5721/100,000 inhabitants), although the cumulative case rate increased from 15% to 20%. The mortality rate fell significantly from 2.57 per 1000 inhabitants in 2021 to 0.33 in 2022. The highest fatality rates were concentrated among people over 60 years of age with comorbidities, especially men. Conclusion: The pandemic was unevenly distributed, affecting adults between 30 and 59 years of age, populations with pre- existing conditions, and densely populated urban areas the most. The geographic distribution of cases helped identify areas warranting priority for improving the health response. It is recommended to strengthen epidemiological surveillance, improve access to health services in densely populated areas, and prioritise care for vulnerable groups such as older adults and indigenous peoples. Full article

Non-communicable diseases (NCDs), including type 2 diabetes mellitus (DM), hypertension (HTA), obesity (OB), and cardiovascular disease (CVD), represent a major global health burden and disproportionately affect socially vulnerable populations. Small extracellular vesicles (EVs) are stable carriers of proteins and regulatory RNAs that may reflect endothelial dysfunction and cardiometabolic stress. This study explored plasma-derived EV-associated biomarkers in adults from La Guajira, Colombia, with emphasis on miR-126-3p, miR-21-5p, miR-92a-3p, and SNAIL. Anthropometric, clinical, and biochemical data were obtained from a cross-sectional cohort. Representative plasma samples were selected for EVs isolation by size-exclusion chromatography. Vesicles were characterized by nanoparticle tracking analysis, scanning transmission electron microscopy, protein quantification, Western blotting, and bead-based flow cytometry. Candidate miRNAs were identified by small RNA sequencing and validated by stem-loop RT-qPCR. Bioinformatic enrichment analyses were performed using miRNet 2.0 and KEGG pathway analysis. The epidemiological cohort showed a high cardiometabolic burden, with waist-to-height ratio (WHtR) and triglyceride-glucose (TyG) index emerging as key markers of central adiposity and metabolic dysfunction. Plasma-derived EVs displayed the expected nanoscale morphology and expressed canonical vesicle markers. Protein cargo analyses revealed EMT- and remodeling-associated proteins, including SNAIL and GAL-3. EV-associated miR-126-3p, miR-21-5p, and miR-92a-3p were enriched predominantly in hypertensive and hypertensive-diabetic groups. In an exploratory sub-cohort, CD31-positive EVs showed a trend toward increased expression in individuals with previous myocardial infarction or stroke (p = 0.057). KEGG enrichment analysis linked the identified miRNA signature to pathways involved in endothelial dysfunction, inflammation, vascular remodeling, apoptosis, and extracellular matrix organization. Plasma-derived EVs from individuals with cardiometabolic disorders carry molecular signatures consistent with endothelial stress and vascular remodeling. These findings identify miR-126-3p, miR-21-5p, miR-92a-3p, SNAIL, and CD31-positive EVs as exploratory candidate biomarkers that require validation in larger prospective cohorts. Full article

Electric scooters (e-scooters) and electric bicycles (e-bikes) are established urban micromobility modes, and children and adolescents form a growing share of riders. This narrative review synthesises peer-reviewed evidence on e-scooter and e-bike injuries in patients aged 18 years or younger, covering epidemiology, mechanisms, injury patterns, clinical outcomes, comparisons with conventional devices, and prevention. Each source was classified as dedicated paediatric evidence, mixed-age evidence with extractable paediatric results, adult or mixed-age evidence used only for context, or an adult-dominated systematic review, so that the basis of every claim is explicit. The reported burden has risen across national surveillance data and single-centre series, and one population-adjusted analysis found injury rates increasing by 293% for e-bikes and by 88% for powered scooters between 2019 and 2022. Most studies lack exposure denominators, so exposure-adjusted paediatric risk remains poorly quantified and rising counts cannot be equated with rising risk. Injuries affect adolescent boys disproportionately and peak at ages 11 to 14 years. Extremity and soft-tissue injuries predominate, while a clinically important minority sustain traumatic brain injury, craniofacial and dental trauma, or severe multisystem injury. Low helmet use and higher device speeds are consistently associated with more severe outcomes, although observational designs cannot establish causal effects and device type is confounded with rider age and road exposure in every available paediatric comparison. Powered devices are associated with greater severity than non-powered counterparts. Speed limitation and helmet promotion appear promising, but paediatric-specific effectiveness evidence remains limited. Prospective paediatric research incorporating exposure denominators is the priority. Full article

Species of the genus Streptococcus constitute important pathogens in human and veterinary medicine, being responsible for a wide spectrum of infections ranging from mild illnesses to severe invasive pathologies. Although β-lactams continue to be effective against most species, the global increase in resistance to macrolides, lincosamides, tetracyclines, and, in some cases, reduced susceptibility to penicillin represents a growing challenge for antimicrobial therapy. This review synthesizes the clinical and epidemiological landscape of antimicrobial resistance in the main Streptococcus species, including Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus dysgalactiae, and other species of clinical and veterinary relevance, addressing their epidemiological profiles, molecular mechanisms of resistance, and virulence factors. The main genetic determinants involved in resistance are discussed, namely the erm, mef, and tet genes, as well as the impact of alterations in penicillin-binding proteins, horizontal gene transfer, and biofilm formation on the persistence of infections and decreased therapeutic efficacy. Simultaneously, the main virulence factors are analyzed, including polysaccharide capsules, adhesins, toxins, extracellular enzymes, and immune response evasion mechanisms that contribute to the colonization, dissemination, and severity of infections. The importance of epidemiological and genomic surveillance, particularly through whole-genome sequencing, in monitoring the spread of resistant clones and identifying determinants of resistance and virulence is also highlighted. Taken together, the data highlight the need to strengthen programs for the rational use of antimicrobials, to promote integrated surveillance strategies from a One Health perspective, and to deepen knowledge about the interaction between antimicrobial resistance and virulence, in order to improve strategies for the prevention, diagnosis, and treatment of infections caused by Streptococcus spp. Full article

Stroke is a leading cause of death and disability worldwide. Exposure to ambient air pollutants and the risk of stroke have been reported in many studies, but the results vary greatly among different regions. This study aims to investigate the association between short-term exposure to air pollution and the admission of total stroke and its subtypes in the Luohu District, Shenzhen. A time-stratified case-crossover study was conducted among 21,973 newly diagnosed stroke cases in Luohu, Shenzhen from 2014 to 2022. Residential exposure to air pollution was assessed using validated grid datasets. A distributed lag model (DLM) and conditional logistic regression model were implemented to evaluate the relationship between ambient air pollution and the admission of stroke and its subtypes. We found that a 10 µg/m³ increase in exposure to NO₂ and SO₂ was positively associated with a 2.73% increase (95% confidence interval [CI]: 2.21%, 3.25%) and a 24.89% increase (20.87%, 29.06%) in the odds of total stroke admission, respectively. Statistical significance has also been found in subtypes. Stronger associations were observed in females (SO₂), the elderly (NO₂ and SO₂), and the cold season (NO₂ and SO₂). Our findings indicate that exposure to NO₂ and SO₂ exacerbates the risk of stroke admission, especially in the elderly, females, and the cold season. Full article