Search Results (3,453)

While individual determinants of students’ well-being are well established, less is known about the association with the institutional context. This study evaluates institutional-level factors associated with students’ mental health while controlling for individual characteristics. The cross-sectional analysis used data from 12 German institutions (n = 13,715) collected in the StudiBiFra survey on study conditions and student mental health. Individual-level variables included gender, age, study subject group, and four mental health variables (general well-being, depressiveness, cognitive stress, and exhaustion). Institution-level variables comprised institution type, excellence status, multi-campus structure, size, and satisfaction with the quality of health promotion services. Multilevel binary logistic regression models were applied to examine associations between institutional characteristics and mental health outcomes, adjusting for individual factors. Students enrolled at universities of applied sciences showed a lower likelihood of reporting depressiveness and exhaustion. Higher levels of depressiveness and cognitive stress were observed among students at medium-sized institutions compared to small ones. Students not enrolled at institutions with excellence status had lower risks of depressiveness, stress, and exhaustion. Additionally, higher satisfaction with institutional health promotion services was associated with reduced odds of depressiveness. Institutional factors are related to students’ mental health beyond individual characteristics, highlighting the need for a holistic, setting-based approach. Full article

Background/Objectives: Prediabetes significantly increases the risk of type 2 diabetes and related complications. Limited data exist for prediabetes among minority groups in Israel, particularly Bedouins. In the Negev region, Jewish and Bedouin populations differ markedly in culture and socioeconomic status. This study aimed to identify gender- and ethnicity-specific predictors of prediabetes. Methods: This retrospective, population-based observational exploratory study used data from 28,754 adults aged 20–65 years insured by Clalit Health Services in Southern Israel (2010–2020). Individuals with prediabetes were matched 1:1 with controls by age, gender, ethnicity, and year of diagnosis. Multivariate logistic regression models stratified by gender and ethnicity identified independent predictors. Results: Prediabetes was identified at significantly younger ages among Bedouins than Jews (6.8 years in men, 11.3 in women). The strongest predictor across all subgroups was metabolic syndrome (OR 2.0–4.0). Gestational diabetes was a major risk factor in women, particularly Jewish (OR 3.6). Cardiovascular disease and the use of statins or thiazide diuretics were independently associated with increased odds of prediabetes. Triglyceride-to-HDL cholesterol ratio was consistently elevated among prediabetes patients. Conclusions: Metabolic and medication-related factors contribute significantly to prediabetes-associated risk, with distinct gender and ethnic patterns. Culturally tailored early interventions and individualized risk profiling may enhance diabetes prevention in Southern Israel. Full article

Background: Medical students are at high risk of psychological distress due to academic and personal pressures. This study assessed stress, depression, and associated factors among medical students, with emphasis on social support. Methods/Material: A cross-sectional survey was conducted among 367 medical students at King Faisal University using the Perceived Stress Scale (PSS) and Patient Health Questionnaire (PHQ). Data were analyzed using IBM SPSS version 29.0. Results: Participants were nearly equally distributed by gender (51.5% females), with a mean age of 22–23 years. The mean corrected PSS-10 score was 20.19 ± 6.21 and the mean PHQ-9 score was 9.45 ± 5.58; 48.2% screened positive for clinically significant depressive symptoms (PHQ-9 ≥ 10). High stress and depressive symptoms were prevalent; 43.1% frequently felt nervous, 44.7% reported hopelessness, and 43.1% endorsed any thoughts of being better off dead or of self-harm on the PHQ-9 screening item. Peer support was associated with significantly lower stress (PSS: 17.77 vs. 21.25, p < 0.001) and depression scores (PHQ: 8.09 vs. 11.0, p < 0.001), and remained an independent predictor of lower odds of a positive depression screen in adjusted analysis (adjusted OR 0.90, 95% CI 0.83–0.96). Female and pre-clinical students showed poorer psychosocial outcomes (p < 0.05). Conclusions: Psychosocial distress is common among medical students, particularly females and pre-clinical students. Higher perceived social support, particularly peer support, was associated with lower stress and depressive symptom scores; given the cross-sectional design these associations cannot establish causation, but they support strengthening peer- and faculty-support systems within medical schools. Findings should be interpreted in light of the cross-sectional, single-centre, self-report design and a response below the pre-specified target, which limit causal inference and generalisability. Full article

Background and Objectives: Cigarette smoking remains a leading modifiable cardiovascular risk factor. This study aimed to analyze decade trends in daily smoking prevalence and its association with education level and physical activity by gender and age groups in Latvia. Materials and Methods: We analyzed data from two distinct waves of a population-based cross-sectional study conducted in Latvia. The study included a stratified random sample of adults aged 25–74 (N = 3807 in 2009; N = 4070 in 2019). Smoking status and education level were self-reported in both years; physical activity data were collected only in 2019. Multivariable logistic regression identified independent factors associated with smoking. Results: From 2009 to 2019, smoking prevalence decreased among men (from 43.6% to 36.0%, p < 0.01) and increased among women (from 15.0% to 18.1%, p < 0.01). Men and women with higher education were significantly less likely to be daily smokers (2019, Men: odds ratio (OR): 0.48, 95% confidence interval (CI) 0.38–0.59; Women: OR: 0.39, 95% CI 0.29–0.50). Among men, the proportion of daily smokers was higher in physically inactive (39.8%) and active (39.0%) groups compared to the moderately active group (31.4%, p < 0.01). However, physical activity level was not a significant predictor of smoking in the multivariable analysis. Conclusions: Over the decade, daily smoking prevalence decreased in men but increased in women in Latvia, with education level being a strong independent predictor. Although the proportion of smokers among men differed across physical activity groups, this factor was not an independent predictor of smoking. These findings underscore the need for targeted public health interventions in Latvia, specifically focusing on individuals with lower education levels to reduce the long-term cardiovascular burden. Full article

Background/Objectives: The Al Haouz earthquake that struck Morocco on 8 September 2023, resulted in substantial material, human, and psychological impacts. Children are at increased risk of psychological disorders, notably post-traumatic stress disorder (PTSD). This study aims to assess probable PTSD and its associated factors among children exposed to the Al Haouz earthquake. Methods: This cross-sectional study, conducted between December 2024 and January 2025, included 536 children from the affected areas. Probable PTSD was assessed using the 20 item Child and Adolescent Trauma Screen (CATS). Sociodemographic and exposure-related data, including post-earthquake conditions, were collected using a structured questionnaire. Data analysis was performed using SPSS software, version 25. Results: Analysis revealed that 47.6% of the children presented with probable PTSD. Multivariable analysis identified several factors independently associated with probable PTSD among children exposed to the earthquake, including age between 11 and 15 years (AOR = 2.02; p < 0.001), female gender (AOR = 1.82; p = 0.001), advanced level of education (AOR = 1.87; p = 0.006), housing damage (AOR = 2.08; p = 0.015), physical injury (AOR = 1.86; p = 0.012), proximity to the epicenter (AOR = 2.22; p = 0.006), temporary shelter in tents (AOR = 1.75; p = 0.02), difficulty of evacuation (OR = 1.97; p = 0.01), and loss of a family member (AOR = 1.98; p = 0.013). Conclusions: This study revealed a high frequency of probable PTSD in children exposed to the Al Haouz earthquake and identifies several associated factors, highlighting the need to targeted, multidimensional interventions. Full article

Background: Gastric cancer is a major global health concern. Although sex- and gender-based differences have been described, they are not yet well established, and the available evidence is often inconsistent. This systematic review aims to explore these differences in the incidence, clinicopathological characteristics, risk factors, treatment, and survival of gastric cancer, thereby contributing to healthcare equity. Methods: A systematic search was conducted in the main medical bibliographic databases (PubMed, Embase and Web of Science) in February 2026 following the PRISMA 2020 guidelines. Studies on gastric cancer were selected based on predefined inclusion and exclusion criteria. The results were synthesized qualitatively according to incidence, clinicopathological characteristics, risk factors, treatment outcomes, and survival. Due to the heterogeneity and predominantly observational design of the included studies, no meta-analysis or formal risk-of-bias assessment was conducted. Results: A total of 38 studies, involving more than 500,000 participants, were included. Most reported a higher incidence of gastric cancer in men, with a predominance of intestinal and well-differentiated tumors, while diffuse and poorly differentiated tumors were more common in women. Men showed higher rates of smoking, alcohol consumption, and postoperative complications. Overall survival tended to be higher in women, especially in early stages, although some studies described worse outcomes among young women. Conclusions: This review highlights relevant sex- and gender-related differences in gastric cancer and underscores the need to systematically incorporate these variables into future research to advance towards more personalized medicine. The available evidence was limited by the predominance of retrospective observational studies and heterogeneity across study designs and reported outcomes. Full article

Children in residential care constitute a particularly vulnerable group at high risk of developing emotional and behavioral difficulties as a consequence of adverse experiences and dysfunctional family environments. Identifying risk and protective factors is essential for designing interventions tailored to their needs; however, the available research remains limited and does not always provide the evidence required to guide effective programs within the child protection system. The aim of this study was to examine the prevalence of emotional and behavioral problems among children in residential care and to analyze the role of family factors, sex, and age in these difficulties. The sample consisted of 210 children aged 6 to 18 years institutionalized in residential care centers and supervised apartments. A cross-sectional design was employed, administering the Strengths and Difficulties Questionnaire (SDQ) along with an ad hoc questionnaire to collect socio-family variables. The results reveal a high prevalence of emotional and behavioral difficulties. The multivariable models explained between 8.1% and 29.4% of the variance in emotional and behavioral functioning and showed that age, sex, exposure to gender-based violence, parental substance use, and parental intellectual disability were associated with specific emotional and behavioral dimensions. The study highlights the need to develop and implement educational and therapeutic programs aimed at strengthening children’s emotional regulation, addressing behavioral difficulties, and considering family-related adversity in intervention planning. Full article

Objective: Based on the Person-Centered Approach, this study targeted parents of very preterm (VPT) infants in Neonatal Intensive Care Units (NICUs) from Italy and Portugal. The primary aim was to classify parents by identifying latent classes of perceived risks (NICU stressors) and resources (sources of social support). Potential specificities in class membership according to Country of Belonging and sociodemographic factors were also investigated. Methods: Overall, 303 parents (92 Italian; 211 Portuguese) completed a survey including sociodemographic factors, Parental-Stressor-Scale-NICU, and Multidimensional-Scale-of-Perceived-Social-Support. Data were analyzed by multigroup latent class analysis and multinomial logistic regression. Results: Three statistically valid and cross-country classes were identified and labelled as Class 1, Adjusted/Beneficial-and-Supported-System, Class 2, Stressed-and-Supported-System, and Class 3, Parental-Role-Alteration-with-Family-Supported-System. Portuguese parents were mainly grouped in Classes 1 and 2, while Italian parents were in Class 3. Men were less likely to belong to Classes 2 and 3, while older parents having another child were more likely to belong to Class 3. Conclusions: The experience of parents of VPT infants in NICUs is inherently challenging, yet identifying specific risk profiles featured by the unique nuances of stressors and sources of support while accounting for further factors (Country of Belonging, Gender, Age, Having another child) can foster the customization of interventions aimed at providing parents with the necessary resources for adjusting to this extremely demanding experience. Full article

Background: Heart failure (HF) is a complex clinical syndrome, and its prognosis depends on many factors, including its etiology and the patient’s sex. We aimed to perform gendered evaluations on ischemic etiology’s impact on HF prognosis. Methods: Hospitalized patients and outpatients were enrolled in the Heart Failure Observational Study (HEROES), which is a prospective, multicenter cohort study, between April 2022 and January 2024. The primary endpoint was all-cause mortality. Results: Among 1410 patients included in the analysis (28.4% females and 71.6% males), 41.1% had ischemic HF etiology, and 58.9% had non-ischemic HF etiology. Ischemic etiology was identified in 28.5% of females and 46.0% of males; p < 0.001. The adjusted hazard ratio (aHR) was 1.16 (95% CI 0.85–1.58; p = 0.363) for all-cause mortality in the non-ischemic group relative to the ischemic reference category. The aHR for all-cause mortality in women relative to men was 1.14 (95% CI: 0.67–1.94; p = 0.633) for ischemic HF and 0.85 (95% CI: 0.56–1.27; p = 0.420) for non-ischemic HF. Conclusions: We found that ischemic and non-ischemic etiologies are associated with comparable all-cause mortality risk in patients with HF. Sex-stratified analyses revealed no significant mortality differentials between women and men within either etiologic category. Full article

Background: Thromboembolism is a serious complication in acute lymphoblastic leukemia (ALL). This systematic review and meta-analysis evaluated thrombosis incidence and risk factors across populations receiving asparaginase-based therapy. Methods: From 214 studies (1994–2026), 58 met inclusion criteria, totaling 23,655 adult, pediatric, and mixed-population patients. Searches included Ovid MEDLINE, Embase, Cochrane CENTRAL, PubMed Central, and Google Scholar. Eligible studies were observational cohorts or clinical trials reporting thrombosis in ALL patients treated with asparaginase. Risk factors assessed included study design, asparaginase formulation, immunophenotype, gender, treatment phase, corticosteroid use, mediastinal mass, ABO blood group, body weight, and age. Random-effects models were used for meta-analysis, and risk of bias was assessed using ROBINS-I and RoB-2. Results: Adults had significantly higher thrombosis rates than children (p < 0.0001). Study design, asparaginase formulation, immunophenotype, and treatment phase differed significantly across age groups (p < 0.0001). T-cell ALL showed higher thrombosis rates than B-cell ALL (p < 0.0001). Significant pediatric risk factors included age ≥ 10 years, mediastinal mass, non-O blood type, and overweight/obesity (all p ≤ 0.0004). Gender and corticosteroid use were not significant predictors. Findings were limited by substantial heterogeneity across included studies. Conclusions: Thrombosis risk was multifactorial. Adults and older children had higher risk, and pediatric patients with overweight/obesity, mediastinal mass, or non-O blood type were particularly vulnerable. Thromboprophylaxis is advised for high-risk groups. This review was not registered and received no external funding. Full article

Background and Objectives: Neurological complications of SARS-CoV-2 infection frequently impair patients’ long-term quality of life. This study aimed to identify clinical and laboratory risk factors—including inflammatory markers and micronutrients—for the occurrence or worsening of neurocognitive disorders in long COVID patients. Materials and Methods: In this prospective observational study, patients presenting with long COVID neurological manifestations were stratified by baseline MoCA score into two groups (≥23 and <23). Clinical, laboratory (inflammatory markers, 25-hydroxy vitamin D, vitamin B12, folic acid), and neuroimaging assessments (global cortical atrophy scale, Fazekas score) were performed over 24 months. Propensity score matching (PSM) for age, gender, and neurological comorbidities yielded 54 patients per group. Results: In the MoCA ≥ 23 group, significant predictors of cognitive decline included severe COVID-19 (OR = 2.211, 95% CI = 1.819–5.973, p = 0.012), autoimmune comorbidities (OR = 1.676, 95% CI = 1.191–2.390, p = 0.043), and elevated neutrophil-to-lymphocyte ratio (NLR; OR = 1.586, 95% CI = 1.431–2.122, p = 0.011). In the MoCA < 23 group, independent predictors were diabetes mellitus (OR = 3.021, 95% CI = 2.65–14.004, p = 0.016), autoimmune comorbidities (OR = 4.987, 95% CI = 1.412–6.033, p = 0.021), and NLR (OR = 5.944, 95% CI = 2.353–19.321, p = 0.015). Serum vitamin D levels were significantly associated with MoCA scores in both groups. Conclusions: COVID-19 severity, autoimmune comorbidities, NLR, and serum vitamin D represent key risk factors for neurocognitive decline in long COVID, highlighting potential targets for early intervention. Full article

Background: Nuclear medicine healthcare professionals (NMHP) sustain chronic occupational exposure to iodine-131 (I-131), conferring an elevated risk of radiation-induced solid thyroid cancer. Established radiobiological prediction tools derive risk coefficients from atomic bomb survivor data but are not configured for rapid individualized risk assessment in occupational exposure settings. This study examined whether machine learning algorithms can serve as high-precision computational surrogates for excess relative risk estimation in NMHP. Aim: The study aimed to (i) develop and validate three machine learning algorithms for predicting the excess relative risk per unit absorbed dose for radiation-induced solid thyroid cancer (ERR/Gy.RST), (ii) characterize relationships between dosimetric and demographic features and predicted risk, and (iii) identify the optimal algorithm for deployment in occupational health surveillance. Methods: A dataset of 4657 observations was constructed from Life Span Study-derived ERR/Gy parameters, adapted to occupational low-dose conditions, using a dose-and-dose-rate effectiveness factor of 2.0, per ICRP Publication 103. Five features (gender, age at exposure, current age, distance from the I-131 source, and cumulative absorbed dose in the thyroid) were used to train a decision tree regressor (dtcr), a random forest regressor (rfr), and a multilayer perceptron (MLP) neural network algorithm. Results: Cumulative absorbed dose in the thyroid correlated positively with ERR/Gy.RST (r = 0.63, p < 0.01), while radiation source distance demonstrated a strong inverse association (r = −0.38, p < 0.01). The MLP algorithm achieved R² score = 0.999, MSE = 0.002, and MAE = 0.010, substantially outperforming the rfr (R² score = 0.700, MSE = 0.410, MAE = 0.295) and the dtcr (R² score = 0.510, MSE = 0.654, MAE = 0.289). Conclusions: The MLP algorithm provides a high-fidelity surrogate for established ERR/Gy.RST projection tools in the NMHP context, enabling computationally efficient, feature-integrated occupational radiation-induced thyroid cancer risk quantification. These findings suggest that machine learning-based surrogate modeling is a practical, scalable complement for occupational health practitioners and radiation protection officers to support individualized surveillance of radiation-induced thyroid cancer risk in nuclear medicine departments. Full article

Fish venom biology reaches far beyond addressing risks of human envenomation. The critical understanding of venom composition and the drivers that modulate it will enable scientists to deliver a span of novel bioresources with multiple potential biotechnological applications. The lesser weever fish (Echiichtys vipera), common in the surf of sandy beaches in Portugal, is a noteworthy case study due to frequent envenomation episodes during summer, albeit the lack of information regarding its venom system and the composition of its venom. We collected about one hundred animals from Costa da Caparica (W Portugal) as beach trawl (arte xávega) by-catch. Histology showed a similar essential microanatomical structure of glands in both venomous spines (dorsal and opercular) and no obvious gender differences. Transversal sections across the spines showed a T-shaped supportive bone structure that harbor masses of large, glandular cells that bear large sacculi. The structure is surrounded by a retractable layer of skin, thicker in the opercular spines comparatively to dorsal. The lack of muscular tissue near the glands and missing venom delivery ducts in the spines suggest that venom secretion in this species is holocrine, i.e., that venom is delivered through rupture of the skin and underlying glandular tissue upon mechanical pressure. Proteomics of the venomous spines (dorsal and opercular) showed a different proteomic signature between males and females, pointing to intersexual variation and suggesting that other biotic and abiotic factors might influence venom composition (maturation stage or geographic distribution). Additionally, protein homology matches performed against known toxins from marine venomous fishes indicated the presence of novel unexplored toxins in this species besides expected cytolysins. Our focus in the future is to identify, isolate and characterize the individual components of this venom. We anticipate new insights on the intraspecific adaptation of fish venom systems to specific ecological needs and advocate for sustainable bioprospecting for novel proteins with high biotechnological potential. Full article

Background: Obesity is an independent and major risk factor for cardiovascular diseases. However, the presence of common comorbidities such as diabetes and hypertension makes it difficult to understand the direct impact of obesity on the myocardium. The aim of this study is to evaluate the isolated effects of weight loss achieved after bariatric surgery on left ventricular (LV) geometry and diastolic functions in individuals with the “Metabolically Healthy Obese” (MHO) phenotype. Materials and Methods: The study included 28 patients (Surgical Group) who underwent Laparoscopic Sleeve Gastrectomy (LSG) between January 2022 and December 2025, had a preoperative Body Mass Index (BMI) > 40 kg/m², and had no known cardiovascular or metabolic diseases. The control group consisted of 25 age- and gender-matched metabolically healthy morbidly obese patients who had not undergone surgery. Demographic and echocardiographic data of all participants were analyzed at baseline and at 6 months. Results: Weight Loss: In the surgical group, BMI decreased from 46.21 kg/m² to 37.11 kg/m² at the 6th month, while no significant change was observed in the control group. Cardiac Structure: In the surgical group, Left Ventricular Mass Index was significantly decreased from 51.11 g/m² to 44.57 g/m². Cardiac Function: The E/A ratio, an indicator of diastolic function, increased significantly from 1.19 to 1.34 in the surgical group, indicating notable improvement. No clinically meaningful change in systolic function was detected. Metabolic Parameters: The surgical group exhibited marked improvements in glucose and lipid profiles (decrease in Total Cholesterol, increase in HDL). Conclusions: The study demonstrates that bariatric surgery, independent of metabolic comorbidities, directly provides “reverse remodeling” of cardiac structure and improves function through reduction of adipose tissue and alleviation of hemodynamic load. These results support the effectiveness of surgery in reducing cardiovascular risk and preserving cardiac structure even in morbidly obese patients without comorbidities. Full article

In Türkiye, working life operates within a hybrid structure in which modern production relations and traditional gender roles intertwine. The automotive sector, in particular, where hegemonic masculinity and conservative values are reproduced, creates a breeding ground for discriminatory practices and safety issues affecting LGB employees. This study aims to analyze the psychosocial and organizational mechanisms underlying LGB individuals’ decisions to disclose or conceal their identities in the context of neoconservative social pressure and industrial masculine culture in Türkiye. Using a qualitative research design grounded in the social constructivist paradigm, semi-structured interviews were conducted with 15 LGB individuals working at different levels of the sector. Data were analyzed using reflective thematic analysis. The findings revealed themes of controlled openness, emotional labor, defense mechanisms, organizational silence, micro-solidarity, and ordinary visibility. It was determined that identity management is experienced as “strategic risk management” rather than an act of liberation, that hierarchical advancement increases the “glass closet” effect, and that employees constantly exhaust their cognitive capacity in a state of “hyper-vigilance”. In conclusion, the study examines the divergence between multinational corporations’ global inclusion policies and local practices and explores the structural factors that sustain organizational silence. Full article