Search Results (23,162)

Background/Objectives: Serum neuron-specific enolase (NSE) is a biomarker of neuronal injury, but its prognostic role in pediatric convulsive status epilepticus (CSE) remains uncertain. We evaluated the association between serum NSE levels and short-term neurological outcome, assessed model calibration with internal bootstrap validation, and examined whether NSE provides incremental discrimination beyond established clinical severity scores. Methods: This was a single-center retrospective cohort study of children aged 1 month to 18 years admitted to a tertiary pediatric intensive care unit (PICU) with CSE as the primary admission diagnosis between January 2024 and November 2025. The primary outcome was poor neurological outcome at hospital discharge, defined as a worsening of ≥1 point in the Pediatric Cerebral Performance Category (PCPC) score from baseline (ΔPCPC ≥ 1) or in-hospital death. A multivariable logistic regression model adjusting for NSE, PRISM III, acute symptomatic etiology, and mechanical ventilation was developed, with bootstrap optimism-corrected internal validation (2000 resamples) and formal calibration assessment. Separate models for in-hospital mortality and for neurological deterioration among survivors were conducted as secondary analyses. Diagnostic operating characteristics were reported with 95% Wilson confidence intervals. The study followed the STROBE and TRIPOD reporting guidelines. Results: Of 132 children included (median age 26 months, 56.1% male), 60 (45.5%) had a poor neurological outcome including 18 deaths (13.6%). Serum NSE was significantly higher in the poor-outcome group (median 22.0 vs. 14.4 μg/L; p < 0.001). In the primary multivariable model, NSE (adjusted OR 1.11 per μg/L; 95% CI 1.06–1.19; p = 0.001) and PRISM III (adjusted OR 1.15; 95% CI 1.03–1.37; p = 0.013) were independently associated with poor outcome. The model showed acceptable calibration (Hosmer–Lemeshow p = 0.130) and a bootstrap optimism-corrected AUC of 0.759. NSE remained independently associated with both in-hospital mortality (aOR 1.13) and with ΔPCPC ≥ 1 in survivors (aOR 1.09). The AUC for NSE alone was 0.741 (95% CI 0.65–0.82) for poor outcome and 0.885 (0.79–0.96) for mortality. The combined PRISM III + NSE model showed a numerically higher but not statistically significant AUC compared with PRISM III alone (0.784 vs. 0.726; DeLong p = 0.103). Conclusions: Higher serum NSE is independently associated with adverse short-term neurological outcome and mortality in pediatric CSE, including in survivor-only analysis. However, the present data do not demonstrate clinically meaningful incremental prognostic value beyond PRISM III, and the proposed cutoff was derived and tested in the same cohort and is therefore optimistic. These findings are hypothesis-generating and require external validation in prospective multicenter cohorts with serial sampling and long-term neurodevelopmental follow-up before routine clinical use can be advocated. Full article

Background/Objectives: The aim of this study was to systematically synthesize and quantitatively estimate the mean serum 25-hydroxyvitamin D concentrations across populations in Kazakhstan and to examine variations according to age group, health status, and geographic region. In addition, we specifically evaluated healthy subgroups to establish reference estimates that may be useful for future epidemiological surveillance and public health planning. Methods: A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. PubMed, Scopus, ScienceDirect, and Google Scholar were searched through March 2026 without date restrictions. Studies reporting the mean serum vitamin D concentrations among Kazakhstani populations were included. Random-effects meta-analysis was performed in R. Subgroup analyses were conducted by age group, health status, and geographic region. Meta-regression, influence diagnostics, publication bias assessment, JBI risk-of-bias evaluation, and GRADE certainty-of-evidence assessment were performed. Results: Sixteen studies comprising 28 groups and 5771 participants were included. The pooled mean serum 25(OH)D concentration in the overall cohort was 22.3 ng/mL (95% CI: 19.3–25.3), while the healthy cohort demonstrated a slightly higher pooled mean of 24.4 ng/mL (95% CI: 20.3–28.4). Adolescents had the lowest vitamin D levels among all age groups. Significant regional variability was observed, and meta-regression identified male participant proportion as a significant moderator (p = 0.03). Heterogeneity was extremely high across analyses (I² ≈ 99.9%). Conclusions: Mean serum 25(OH)D concentrations were generally within the insufficient range across the included study groups in Kazakhstan, including healthy subgroups. However, because the certainty of evidence was very low and between-study heterogeneity was extreme, the findings should be interpreted cautiously. These results support the need for standardized national surveillance and locally evaluated public health policy considerations, including targeted supplementation for high-risk groups, screening strategies where clinically indicated, and assessment of food fortification options. Full article

As the first generation in their families to pursue higher education, the mental health of first-generation college students has attracted significant attention from the academic community. Self-esteem and academic performance are significant factors influencing anxiety and mental health among first-generation college students. However, longitudinal research evidence specific to this group in China remains scarce. This study utilized two waves data, selecting a sample of 1024 first-generation college students (mean age 21.73; 55.18% male). Through follow-up surveys conducted at one-year intervals, a cross-lagged model was employed to systematically examine the longitudinal predictive relationships among self-esteem, academic performance, and anxiety. The results indicate significant negative correlations among self-esteem, academic performance, and anxiety. Cross-lagged analysis further indicated that self-esteem at T1 (β = −0.098, p < 0.05) and academic performance at T1 (β = −0.067, p < 0.05) were prospectively associated with lower anxiety at T2. This study reveals the longitudinal predictive associations among self-esteem, academic performance, and anxiety among China’s first-generation college students, providing empirical evidence for universities to improve their mental health support systems by focusing on the self-esteem development of this group and offering targeted academic support. Full article

Background/Objectives: Respiratory syncytial virus (RSV) is a major cause of respiratory illness across the lifespan, yet its health-economic burden in adults remains under-recognized. Building on a previously published nationwide analysis of RSV-associated hospitalizations in Switzerland (2017–2023), this study aimed to estimate age-specific direct inpatient hospitalization costs and assess their implications for healthcare systems. Methods: We conducted a nationwide health-economic analysis using Swiss Federal Statistical Office (FSO) hospitalization data (2017–2023) combined with SwissDRG-based cost statistics (2024). Age-specific costs per hospitalization were applied to RSV-associated hospitalization counts. To account for disease severity, additional estimates were derived by applying RSV-specific length-of-stay (LOS) ratios between RSV-associated and all-cause hospitalizations, reflecting the longer duration of RSV-associated admissions. Results: Total RSV-associated hospitalization costs were estimated at CHF 55.1–76.0 million annually. Children aged 0–9 years accounted for the highest number of hospitalizations and the largest share of total costs (CHF 27.8–34.3 million). Despite fewer hospitalizations, adults aged ≥ 60 years generated comparable total costs (CHF 23.6–36.7 million), driven by substantially higher costs per case. Costs increased markedly with age, reflecting longer hospital stays and higher clinical severity. Additional analyses demonstrated a substantial increase in costs in the post-pandemic period, particularly in older adults, suggesting improved detection of RSV-associated hospitalizations. Conclusions: RSV-associated hospitalizations impose a substantial economic burden on the Swiss healthcare system. The disproportionate contribution of older adults highlights the importance of targeted prevention strategies and provides a foundation for future health-economic evaluations and policy decision-making. Full article

Background/Objectives: Leukocyte telomere length (TL) is a marker of biological aging associated with cardiovascular disease, chronic kidney disease, and malignancy in the general population. Its long-term prognostic significance in systemic lupus erythematosus (SLE) remains unclear. We aimed to evaluate the association between baseline TL and long-term clinical outcomes in patients with SLE. Methods: Prospective cohort study including 97 Caucasian women with SLE. Relative TL was measured in whole blood using quantitative polymerase chain reaction (qPCR) at baseline. A control group of 50 healthy Caucasian women from the same geographical region was included for comparison. Patients were followed for a mean of 9.7 ± 2.8 years. Outcomes included thrombotic cardiovascular events, damage accrual, incident malignancy, and chronic kidney disease. Associations were assessed using multivariable regression models adjusted for potential confounders. Results: Mean age was 51.6 ± 13.8 years and mean relative TL was 4.3 ± 1.0. Relative TL was inversely associated with age (β = −0.20, p = 0.048) and was shorter in patients with hematological manifestations (p = 0.038). No differences in relative TL were observed between SLE patients and controls. Relative TL was not associated with disease activity, cumulative damage, cardiovascular risk factors, vitamin D levels, or subclinical atherosclerosis. During follow-up, 13.4% of patients experienced cardiovascular events, 10.3% developed malignancy, and 11.3% developed chronic kidney disease. Relative TL was initially associated with long-term damage accrual, glomerular filtration rate and cardiovascular events; however, after adjustment for age, only the association with glomerular filtration rate remained at the limit of statistical significance (p = 0.05). Conclusions: In this prospective cohort, relative TL was primarily associated with aging, hematological manifestations, and glomerular filtration rate, but not with disease activity or most long-term clinical outcomes. These findings suggest that TL reflects biological aging rather than disease-specific processes and has limited utility as a prognostic biomarker in SLE. Full article

Contemporary health cultures increasingly promote disciplined eating and bodily optimisation, contributing to growing interest in orthorexia nervosa (ON), a pattern of restrictive eating characterised by an obsessive focus on food purity and health. While ON has been widely studied in relation to dietary restriction and health anxiety, less attention has been given to how individuals themselves construct meaning around these practices. The present qualitative study aimed to explore how individuals displaying orthorexic tendencies construct moral identity and self-worth through their dietary practices. Eighteen participants (13 women, 5 men; aged 19–58) living in the United Kingdom who self-identified as “healthy eaters” took part in semi-structured interviews. Data were analysed using reflexive thematic analysis within a social constructionist framework. Four themes were generated: (1) The Disciplined Self, describing how strict dietary practices were framed as evidence of personal control and self-regulation; (2) The Body as Evidence of Purity and Health, where physical appearance and bodily feelings were interpreted as confirmation of moral and dietary correctness; (3) Ethical Eating and Moral Positioning, illustrating how participants positioned their food choices as ethically superior; and (4) Guilt and Moral Repositioning, highlighting the moral emotions that followed perceived dietary transgressions. These findings suggest that orthorexic eating practices function not only as health behaviours but also as moral performances through which individuals construct disciplined, responsible, and virtuous identities. Understanding these moral and identity dimensions may help situate orthorexic tendencies within broader sociocultural narratives surrounding health, morality, and self-discipline. Full article

The classic tripartite life-course model (education, work, and retirement) is under increasing pressure from rising longevity and structural labour-market change. This study examines how Millennials and Generation Z in Portugal conceptualise retirement and the life course, asking whether these cohorts adhere to a standardised, sequential logic or aspire to more fluid, multi-stage trajectories, and whether observed differences reflect generation or socioeconomic position. A cross-sectional survey of 234 participants aged 18–43 assessed perceptions of retirement, openness to non-linear life cycles, future concerns, preparation strategies, and orientations towards lifelong learning. Responses were analysed using non-parametric tests (Mann–Whitney U, Kruskal–Wallis) and multivariate linear regression, with outcomes stratified by income, education, and occupational status. Participants showed a widespread preference for greater flexibility around the tripartite sequence rather than its abandonment, the statutory retirement age persisting as a reference point. Trust in the public pension system was low and cross-cutting, with over 70% doubting its capacity to ensure an adequate retirement, while Generation Z reported significantly greater concern about losing professional purpose. Socioeconomic position was a more consistent stratifier than generation for financial preparation, which rose with income and education; distrust, by contrast, was predicted by neither socioeconomic position nor generation in multivariate models. These findings indicate that biographical deinstitutionalisation may already be underway among younger Portuguese cohorts, with structural risks increasingly individualised, carrying implications for the redesign of life-course policies and social protection systems in an era of longevity. Full article

Objectives: For patients with multiple myeloma (MM), an increasing proportion of treatment is now delivered at home. While this shift offers convenience and supports continuity of care, it also demands new ways to ensure patient safety outside the hospital. Although patients receiving home-based treatment are generally clinically stable, each administration still requires a pre-treatment safety assessment, traditionally performed by telephone. We aimed to evaluate whether digital patient-reported outcomes (PROs) could replace these calls to determine treatment readiness. Methods: This feasibility study included 30 patients (median age 76 years, 60% male). Prior to each scheduled treatment, patients completed a digital symptom questionnaire. An algorithm stratified patients according to treatment readiness. In total, 233 questionnaires were distributed and 179 completed (completion rate 77%). Healthcare professionals were blinded to PRO data during the study, and PRO-based assessments were compared with standard nurse-led telephone evaluations after study completion. Results: Digital PRO data reliably identified patients ready for treatment. The algorithm achieved a positive predictive value of 100%, indicating concordance between PRO-based readiness classification and clinical decisions. The negative predictive value was 19%, reflecting that most patients reporting symptoms were ultimately eligible for treatment. Overall, nearly 80% of routine pre-treatment telephone calls could safely be omitted without compromising patient safety. Conclusions: This study suggests that digital PRO-based symptom reporting may support a reduction in routine pre-treatment telephone assessments for selected patients with MM receiving daratumumab. The approach showed potential for streamlining clinical workflows while maintaining patient safety, although confirmatory studies are needed before implementation. Full article

Background/Objectives: Despite the availability of free national mammography services, participation in breast cancer screening remains suboptimal in Kuwait. This study aimed to assess breast cancer screening beliefs and barriers among women in Kuwait using the Breast Cancer Screening Beliefs Questionnaire (BCSBQ) and to examine their associations with sociodemographic characteristics. Methods: This study is a secondary analysis of a cross-sectional dataset collected among 458 women aged ≥20 years across all six governorates of Kuwait. Data were collected using a structured questionnaire including the BCSBQ, breast cancer knowledge measures, and a general help-seeking barrier scale. Internal consistency was assessed using Cronbach’s alpha, and exploratory factor analysis was performed to evaluate construct validity. Group differences were examined using t-tests and one-way analysis of variance with post hoc correction, while adjusted associations were assessed using general linear models and linear regression. Results: The BCSBQ demonstrated good internal consistency (Cronbach’s α = 0.808) and a clear three-factor structure (Kaiser–Meyer–Olkin = 0.790; Bartlett’s test p < 0.001), explaining 50.26% of the total variance. Nearly half of participants (48.7%) reported positive attitudes toward screening, while 16.4% exhibited firmer fatalistic beliefs and 18.8% reported elevated mammography-related barriers. A substantial proportion believed that screening is only necessary when symptoms are present (57.2%). Lower education and younger age were significantly associated with higher barriers and less favorable screening beliefs (p < 0.05). In regression analysis, higher mammography-related barriers were associated with greater general help-seeking barriers, whereas more positive attitudes were associated with lower barriers, explaining 11.5% of the variance (R² = 0.115, p < 0.001). Conclusions: Breast cancer screening beliefs among women in Kuwait are shaped by sociodemographic factors, particularly education level and age, with persistent misconceptions and perceived barriers influencing screening perceptions. Targeted, culturally appropriate interventions are needed to address these gaps and promote participation in Kuwait’s free-access screening program. Full article

Location-based games (LBGs) have increasingly been adopted in education for experiential, situated, and collaborative learning. While used in subjects such as geography and history, their application in mathematics remains underexplored, partly because mathematical concepts are abstract and hard to embed in spatial game environments. This study examines the feasibility and educational potential of LBGs in lower-secondary mathematics. Using a mixed-methods approach, two location-based activities were tested with 28 students aged 12–14. In the first, students used Global Positioning System (GPS)-enabled devices to reach landmarks (e.g., a volleyball court, a church), where they took on-site measurements and applied geometric reasoning to calculate areas, perimeters, and volumes. In the second, they followed a treasure hunt, solving algebraic equations and word problems to form a secret word. Questionnaires, observations, and teacher interviews showed high engagement, participation, and collaboration, with students viewing the activities as meaningful revision. Teachers found them valuable and feasible within curricular limits, despite challenges such as preparation time, technical issues, and regulations. However, given the small sample and exploratory design, findings should be interpreted with caution: no general inferences can be drawn, and no direct learning-outcome measures were used. The study offers empirical insights into designing mathematics-oriented LBGs and future research directions. Full article

Background: Rheumatoid arthritis (RA) is a persistent autoimmune condition defined by widespread synovial tissue inflammation and structural joint deterioration, with an estimated global prevalence between 0.5% and 3%. The disease predominantly targets synovial joints, resulting in progressive functional impairment when therapeutic intervention is delayed or inadequate. Objective: This review aims to comprehensively examine the contributing risk factors, underlying pathophysiological processes, and recently developed immunoengineering-based therapeutic strategies applicable to the clinical management of rheumatoid arthritis. Methods: A structured review of peer-reviewed literature was undertaken through PubMed, utilizing a targeted search strategy incorporating the terms ‘rheumatoid arthritis’ and ‘immunoengineering.’ Filters were applied to restrict results to English-language publications from peer-reviewed sources. The review emphasized studies investigating genetic susceptibility, environmental determinants, immune cell behaviour, and novel therapeutic advances in RA management. Results: Multiple interdependent risk factors underpin RA development, most notably genetic variants including HLA-DRb1 alleles, alongside demographic influences such as biological sex and advancing age, as well as obesity and pathogenic microbial exposure. These factors collectively initiate a self-amplifying inflammatory process characterized by protein citrullination and the subsequent generation of anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF). The ensuing immune dysregulation—driven principally by monocyte and T-lymphocyte infiltration—propagates synovial inflammation and progressively destroys cartilaginous and bony structures. Conclusions: While considerable progress has been achieved in RA pharmacotherapy, existing treatments remain constrained by systemic side effects and incomplete therapeutic responses. Emerging immunoengineering strategies offer a targeted approach to modulating the molecular and immunological milieu of affected joints, providing improved therapeutic precision. Continued investigation in this area is anticipated to yield novel clinical pathways capable of substantially enhancing patient outcomes in rheumatoid arthritis care. Full article

This article examines the medium to long-term enrollment patterns of an AI-based platform designed to support children in learning robotics and participating in a national robotics competition in Romania. Drawing on registration and participation data covering students and teachers across urban and rural schools between 2020 and 2025, the study documents a consistent pattern: an initial period of high enrollment and rapid adoption followed by a steady decline over time. A key feature of the initiative is that hardware, platform access, and learning resources were provided entirely free of charge, allowing cost-related explanations for the decline to be set aside and structural and human factors to be examined directly. The paper makes two primary contributions. First, it proposes a System Dynamics framework grounded in innovation diffusion theory as a first-generation calibration model for understanding AI-enabled educational robotics adoption in a resource-constrained national context. The model is designed to be progressively tested and refined as anonymized aggregate data accumulates, and it relies exclusively on anonymized aggregated public data in accordance with GDPR requirements. Second, it advances the hypothesis that an AI-based educational platform, even one from which all financial barriers have been removed, will experience sustained enrollment decline in the absence of adequate human teacher involvement. The empirical trajectory and model outputs are consistent with this hypothesis and motivate further investigation. This represents a hypothesis-generating and framework-building paper. The framework reveals pronounced urban-rural disparities and differential outcomes by age of entry. All findings are presented as model-generated hypotheses rather than empirically demonstrated conclusions. The paper invites researchers gathering comparable data from similar initiatives in other countries to collaborate in testing and refining the model. The central conclusion is cautiously optimistic: AI may support robotics education adoption, but it is not a substitute for dedicated teachers, and without sustained investment in human capital, even a financially accessible platform is insufficient to maintain long-term enrollments. Full article

Background/Objectives: Hyalinizing clear cell carcinoma (HCCC) and clear cell odontogenic carcinoma (CCOC) are rare clear cell neoplasms with overlapping histopathological features. This study aimed to compare their clinicopathological characteristics, particularly in anatomically challenging sites such as the palate and maxilla. Methods: Three analyses were performed. First, an unpublished series of five HCCC and three CCOC cases was evaluated for diagnostic histopathological features. Second, a PRISMA-ScR-guided literature review of 58 HCCCs and 45 CCOCs restricted to tumours arising in intraoral minor salivary glands, major salivary glands and gnathic bones published between 2000 and 2025 was conducted using PubMed. Third, a sub-analysis compared palatal HCCC and maxillary CCOC (25 vs. 14 cases), integrating literature and unpublished cases. Results: The case series and overall literature review showed that HCCC and CCOC predominantly occurred in adults (mean age, case series: 50.8 years; literature: 56.33 years for HCCC and 61 vs. 54.11 years for CCOC) with a female predilection (case series: 60%; literature: 68%) and generally exhibited clinically indolent behaviour. The site of occurrence, soft tissue (HCCC) versus intraosseous location (CCOC), was the principal distinguishing feature. No marked differences were observed between the two tumours in either the overall literature analysis or the site-specific sub-analysis. However, CCOC at maxillary/palatal sites presented with a higher number of larger lesions and higher number of cases with nodal metastasis compared with HCCC, most probably indicating delayed clinical detection rather than intrinsic aggressiveness of CCOC. Histopathological overlap was considerable; however, diffuse dense hyalinization (4/5), focal glandular differentiation (2/5), mucous-secreting cells (4/5) and salivary gland association (5/5) favoured HCCC, whereas patchy hyalinization (3/3), larger tumour lobules (3/3) and peripheral palisading (2/3) favoured CCOC. Conclusions: HCCC and CCOC demonstrate clinicopathological similarities and shared EWSR1 rearrangement, supporting a close biological relationship. The considerable overlap between these tumours support the hypothesis that CCOC may represent the intraosseous counterpart of HCCC and highlight the importance of integrated clinicopathological assessment and further clarification in future WHO classifications. Full article

Background: Digital health technologies have expanded access to home fetal heart rate (FHR) monitoring devices, enabling fetal surveillance outside clinical settings. However, evidence on women’s awareness, acceptance, and experiences with these devices remains limited. Objective: To assess awareness, adoption, user experience, perceived reassurance, and attitudes toward home FHR monitoring among pregnant and postpartum women. Methods: A cross-sectional online survey was conducted using a structured questionnaire distributed via Google Forms. Eligible participants were women aged ≥18 years who were currently pregnant or had been pregnant within the previous two years. The survey evaluated awareness and use of home FHR monitoring devices, usage patterns, sources of recommendation and instruction, emotional responses, perceived reassurance, mobile application integration, and overall attitudes. Descriptive statistics and exploratory subgroup analyses were performed. Results: A total of 225 women completed the survey; 166 (73.8%) reported using a home FHR monitoring device during pregnancy. Most users reported positive emotional experiences, with calmness as the most common response. Home monitoring was generally perceived as reassuring, and many participants felt calmer on days of device use. Gynecologists were the primary source of device recommendations and usage instructions. Participants highlighted the importance of professional guidance, clear instructions, and mobile application support. Primiparous women had significantly higher adoption rates than multiparous women (p < 0.001). Conclusions: Home FHR monitoring was widely accepted and commonly perceived as reassuring. These devices may support patient-centered prenatal care when accompanied by appropriate professional guidance. Further prospective studies are needed to assess their clinical utility, safety, and integration into prenatal care pathways. Full article

Background: Aneurysm treatment options are rapidly evolving, as evidenced by the recent introduction and widespread adoption of flow diversion and intrasaccular devices. However, there is a need to understand how these newer technologies are used for difficult-to-treat aneurysms. The main aims of this study were to investigate the variation in aneurysm treatment recommendations among neurosurgeons, interventional radiologists, and interventional neurologists and to generally describe trends in endovascular treatment. Methods: In this survey-based study conducted from June to September 2024, participants were presented with clinical vignettes and asked to choose preferred treatment options, with responses analyzed based on demographic variables including specialty, age, and training prior to and after the introduction of flow diversion. Results: A total of 108 respondents completed the study with a representative mix of specialties—(45 (42.5%) radiologists, 22 (20.8%) neurologists, and 39 (36.8%) neurosurgeons. Sixty-six (61.1%) trained after the introduction of flow diversion. Treatment recommendations were significantly different by specialty (p < 0.001). The Kappa statistic to assess variation in responses showed significant variation in treatment preferences across aneurysm subtypes, ranging from poor (κ = 0.07) to fair (0.31). Treatment of ruptured aneurysms varied by specialty with radiologists opting for stent-assisted coiling at a higher rate than neurologists or neurosurgeons (p < 0.001). There was no significant difference in rates of recommending flow diversion or intrasaccular devices between those who had trained before and after their introduction (p = 0.97). Conclusion: The study highlights the dynamic nature of aneurysm management and considerable variability among different specialties. Further exploration into the rationale for each decision is needed to understand how specialty training affects these decisions. Full article