Search Results (1,016)

We develop a unified likelihood-based framework for limited outcomes built on the two-piece normal family. The framework includes a censored specification that accommodates boundary inflation, a doubly truncated specification on $(0,1)$ for rates and proportions, and a survival formulation with a log-two-piece normal baseline and Gamma frailty to account for unobserved heterogeneity. We derive closed-form building blocks (pdf, cdf, survival, hazard, and cumulative hazard), full log-likelihoods with score functions and observed information, and stable reparameterizations that enable routine optimization. Monte Carlo experiments show a small bias and declining RMSE with increasing sample size; censoring primarily inflates the variability of regression coefficients; the scale parameter remains comparatively stable, and the shape parameter is most sensitive under heavy censoring. Applications to HIV-1 RNA with a detection limit, household food expenditure on $(0,1)$, labor-supply hours with a corner solution, and childhood cancer times to hospitalization demonstrate improved fit over Gaussian, skew-normal, and beta benchmarks according to AIC/BIC/CAIC and goodness-of-fit diagnostics, with model-implied censoring closely matching the observed fraction. The proposed formulations are tractable, flexible, and readily implementable with standard software. Full article

Background/Aim: Fatigue is a common symptom in individuals with chronic obstructive pulmonary disease (COPD) and is associated with reduced quality of life. The aim of this study was to evaluate the relationships between dietary omega-3 (n-3) and omega-6 (n-6) fatty acid intake, obesity, and stress with fatigue in patients with COPD. Materials and Methods: This descriptive cross-sectional study was conducted between 1 February and 31 July 2025, in the pulmonary outpatient clinics of Ağrı Training and Research Hospital in Ağrı and Atatürk University Research Hospital in Erzurum, Türkiye. Study data were collected using a General Information Questionnaire, the COPD and Asthma Fatigue Scale (CAFS), the Perceived Stress Scale (PSS), and an Adult Semi-Quantitative Food Frequency Questionnaire. Higher CAFS scores indicate greater fatigue severity, while higher PSS scores reflect higher perceived stress. Results: CAFS scores correlated strongly with perceived stress (r = 0.718, p < 0.001) and moderately with COPD exacerbation frequency (r = 0.426, p < 0.001). Although higher n-3 intake was inversely associated with fatigue in univariate analyses, this association weakened after adjustment, suggesting that fatty acid composition was not an independent determinant of fatigue. The n-6/n-3 ratio showed a weak positive correlation with fatigue (r = 0.184, p = 0.024). Female reported higher fatigue levels than male (mean [SD], 60.2 [19.3] vs. 51.9 [19.8]; p = 0.042), and patients with comorbid conditions had higher fatigue scores than those without comorbidities (58.1 [18.3] vs. 46.8 [19.4]; p = 0.001). Smoking status was not significantly associated with fatigue (p = 0.788). In backward multiple linear regression analysis, perceived stress emerged as the strongest independent predictor of fatigue (β = 0.519, p < 0.001). Comorbidity presence (β = 0.206, p = 0.030) and smoking status (β = 0.178, p = 0.026) were also significant, while exacerbation frequency (p = 0.062) and female (p = 0.053) showed borderline associations. Conclusions: These findings indicate that fatigue in COPD is primarily influenced by psychosocial stress and multimorbidity, highlighting the importance of integrative management approaches that address mental health burden and comorbid conditions alongside respiratory treatment. Full article

In the digital tourism marketplace, online reviews have become a decisive source of information for travelers who cannot directly assess the quality of hospitality services before purchase. However, it remains unclear how service-related and sustainability-related cues interact to shape guest perceptions in sustainable hotel contexts. This study investigates how intrinsic and extrinsic cues are reflected in online user reviews of sustainable hotels. Drawing on Cue Utilization Theory, a longitudinal content analysis was conducted on a worldwide online travel platform’s (OTP) reviews of hotels certified for their sustainability practices (2004–2024) by user selection. A coding framework was developed deductively based on prior studies on hotel service quality and sustainability practices, and data were analyzed using MAXQDA, Leximancer, and VADER sentiment analysis. Findings indicated that reviews primarily emphasize service quality attributes—particularly staff efficiency, food quality, and accommodation facilities—while sustainability themes appear less frequently, often in nature-related contexts. Sentiment analysis revealed a predominantly positive emotional tone shaped by service quality experiences. Overall, intrinsic cues play a central role in forming guest perceptions, highlighting the need for emotionally engaging sustainability communication strategies. Full article

Background: Food allergy is a leading cause of severe allergic reactions in children and often results in restrictive elimination diets. The oral food challenge (OFC) remains the diagnostic gold standard but is resource-intensive and carries a risk of adverse reactions. This study aimed to identify epidemiological, clinical, and laboratory predictors of OFC outcomes and reaction severity in children with suspected immediate-type food allergies. Methods: We conducted a retrospective review of 148 children who underwent hospital-based, open OFCs due to suspected immediate-type food reactions. Data on demographics, comorbidities, characteristics of the initial reaction, sensitisation profiles (specific IgE [sIgE], skin prick test [SPT]), and OFC outcomes were analysed. Reactions were graded using the Ring and Messmer scale. Results: OFC was positive in 44 of 148 children (29.7%). However, no clinical or laboratory parameters—including prior reaction severity and the magnitude of allergy test results—were associated with the severity of reactions during OFC. Comorbidities—specifically asthma, atopic dermatitis, and allergic rhinitis—were significantly associated with a positive OFC (p < 0.01), as were elevated sIgE levels and larger SPT wheal diameters (p < 0.01 for both). The optimal thresholds for predicting a positive OFC were 0.73 IU/mL for sIgE and 3.5 mm for SPT. Conclusions: Oral food challenge (OFC) remains essential for confirming food allergies in children. Given that the severity of reactions during OFCs cannot be reliably predicted and that low cut-off values of allergy tests were identified for predicting a positive OFC outcome, OFCs should be performed in a controlled and fully equipped medical setting, particularly in children with atopic comorbidities. Full article

Background/Objectives: Vending machines in hospitals offer convenient access to snacks and beverages for employees, visitors, and patients. However, their contents are typically energy-dense and nutritionally poor, which can potentially reinforce unhealthy eating habits. This study aimed to evaluate the impact of introducing healthier vending machine options on purchasing behaviour and consumer perceptions in a hospital setting. Methods: An interventional study was conducted at a university clinical centre in Slovenia. Sales data were collected from a standard vending machine and a pilot machine stocked with healthier products over two 14-day periods. Additionally, a consumer survey assessed factors influencing purchasing decisions and opinions on the healthier offerings. Results: The proportion of healthy items purchased increased from 22% to 39% in the pilot vending machine, indicating a positive shift toward healthier choices. However, total sales declined by 18.81%, suggesting consumer hesitation toward the new product mix. Survey results identified price, ingredients, and visual appeal as the primary factors influencing purchase decisions. Conclusions: The introduction of healthier vending machine options can promote better food choices in hospital environments, though challenges remain regarding consumer acceptance and sales performance. Expanding the variety of healthy items and adopting more competitive pricing strategies may enhance uptake. Further long-term research is needed to assess the sustainability of such interventions and their broader impact on hospital food environments. Full article

Background/Objectives: Obesity is an increasingly concerning public health issue due to its high prevalence and its association with multiple comorbidities. A significant proportion of patients with obesity who undergo bariatric surgery could exhibit suboptimal mid-term outcomes. This study aims to comprehensively assess anthropometric, clinical, biochemical, nutritional, and quality of life parameters in patients with severe obesity undergoing bariatric surgery, with a particular focus on outcomes at 24 months post-surgery to capture mid-term effects that may not be apparent during the first year of follow-up. Methods: A prospective study was conducted in 95 patients with obesity undergoing bariatric surgery (Roux-en Y gastric bypass; RYGB) at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between 2020 and 2023. Participants were followed up at 6, 12, and 24 months after RYGB. The study incorporated anthropometric assessments (BMI, body composition via bioelectrical impedance), full biochemical profiling, dietary analysis (using a validated food frequency questionnaire), and quality of life assessment (SF-36 questionnaire). Results: Our results showed significant weight loss after the intervention, accompanied by improvements in metabolic parameters, and dietary habits. Regarding quality of life, significant improvements were observed in both the physical (baseline: 39.62%; 6 months: 52.40%; 12 months: 53.12%) and mental components (baseline: 42.08; 6 months: 53.40; 12 months: 52.14%) at 6 and 12 months post-surgery. However, our prospective 24-month follow-up revealed that, despite these initial benefits, mental health significantly declined compared with the 12-month follow-up (24 months: 46.85%). In contrast, the physical component remained relatively stable at 24 months (24 months: 50.91%). However, our prospective 24-month follow-up revealed that, despite these initial benefits, there was a decline in mental health compared to the 12-month follow-up. Conclusions: While bariatric surgery is associated with improvements in anthropometric measures and some aspects of quality of life, our findings underscore the need for continued mid-term support to address emerging challenges in mental well-being. Full article

Background/Objectives: Chronic low-grade inflammation and nutritional deficiencies, particularly vitamin D deficiency, have emerged as important contributors to Metabolic syndrome (MetS) pathogenesis but remain underexplored. This study aimed to comprehensively evaluate the associations between dietary intake, vitamin D status, and inflammatory biomarkers (high-sensitivity C-reactive protein -CRP- and ferritin) in patients with MetS. Methods: A cross-sectional observational study was conducted on 141 adult MetS patients at a Mexican hospital. Clinical, anthropometric, dietary (using a validated food frequency questionnaire), and biochemical data including serum 25-hydroxyvitamin D, CRP, ferritin, and neutrophil-to-lymphocyte ratio (NLR) were collected. Vitamin D deficiency was defined as serum 25(OH)D < 20 ng/mL, and high inflammation as CRP ≥ 3 mg/L. Logistic regression models adjusted for confounders were used to analyze associations. Mediation analysis assessed whether vitamin D deficiency mediated the link between dietary intake and high CRP or ferritin. Results: Patients with elevated CRP had significantly lower serum vitamin D levels (14.0 ± 5.1 vs. 22.1 ± 7.0 ng/mL; p < 0.001). Multivariable analysis showed vitamin D deficiency (adjusted OR 7.1; 95% CI 2.5–19.4; p < 0.001) and hyperferritinemia (ferritin ≥ 200 μg/L; aOR 8.0, 95% CI 3.5–18.2, p < 0.001) as predictors of high CRP. Conversely, hyperferritinemia was predicted by vitamin D deficiency (aOR 24.69; 95% CI 3.76–162.16; p = 0.001), elevated CRP (aOR 5.06; p = 0.014), Hb (aOR 63.23; p < 0.001), and inversely by grade 2 obesity (aOR 0.11; 95% CI 0.02–0.60; p = 0.03), confirming bidirectional CRP-ferritin associations and hyperferritinemia as an inflammation marker rather than iron overload indicator. Although Hb > 14.3 g/dL associated with hyperferritinemia, it did not independently predict CRP in multivariate analyses. Frequent consumption of vitamin D-rich foods (milk, fish, Manchego and Oaxaca cheese) was associated with lower inflammation. Mediation analysis confirmed that vitamin D deficiency mediated dietary intake-CRP and dietary intake-ferritin links (Sobel test p < 0.05). Conclusions: Vitamin D deficiency is a key mediator linking inadequate dietary vitamin D intake to systemic inflammation in MetS. Nutritional strategies emphasizing vitamin D repletion and consumption of vitamin D fortified foods may effectively reduce chronic inflammation and improve metabolic outcomes. Full article

Antimicrobial resistance (AMR) poses a global health threat, with urban wastewater systems serving as key reservoirs for resistance dissemination. This study aimed to investigate the relationships among urban environments, bacterial communities, and AMR patterns, and evaluate the specific municipal-scale drivers of resistance gene distribution. Shotgun metagenomic analysis was conducted on 45 wastewater samples collected from 15 municipalities across Latvia to determine the composition of the resistome and its correlation with local factors. The analysis identified 417 distinct antibiotic resistance genes (ARGs) belonging to 108 families, with geographic location serving as the primary driver of ARG distribution, which explained 65.87% of community variation (p = 0.001). Local industrial factors demonstrated significant effects, with food industry wastewater significantly influencing both bacterial taxonomy and ARG profiles (p < 0.05). While the presence of a regional hospital did not shape the overall municipal resistome, hospital-associated wastewater showed 19 overlapping ARGs, including clinically critical carbapenemases. Municipal wastewater systems function as geographically structured reservoirs of AMR that are shaped by localized industrial and healthcare outputs. These findings support wastewater-based AMR surveillance as a valuable tool for tracking specific resistance sources. Full article

Background/Objectives: Inclusive nutrition services and data on children with disabilities living in low- and middle-income countries remain limited. We estimated the prevalence of undernutrition and described feeding practices and difficulties among children with disabilities ages birth to 10 years at a rehabilitation hospital in Uganda and identified barriers and opportunities for inclusive nutrition. Methods: This cross-sectional study enrolled 428 children. Data included demographics, weight, height, mid–upper arm circumference (MUAC), hemoglobin levels, risk for feeding difficulties, caregiver-reported feeding practices, and functional difficulties complemented by 32 caregiver and stakeholder interviews. Undernutrition was defined using WHO z-scores, MUAC, and anemia cutoffs. Associations were examined using Pearson’s chi-squared tests and adjusted odds ratios from logistic regression. Results: Over half of participants were boys (56.1%) and 65.9% were <24 months old. Common conditions included cleft lip/palate (55.4%) and cerebral palsy (38.6%). Undernutrition was prevalent: 45.2% were underweight, 38.3% stunted, 16.1% wasted (by MUAC), and 39.5% anemic. Being at risk for feeding difficulties (67.2% of children) increased the odds of underweight [AOR = 2.28 (1.23–4.24)], stunting [2.46 (1.26–4.79)], and wasting [2.43 (1.10–5.35)] after adjusting for covariates. Bottle-feeding increased the odds of stunting [3.09 (1.24–7.70)] in infants with cleft lip/palate < 12 months old. Poor access to services, food insecurity, and feeding challenges were key barriers to optimal nutrition. Most caregivers reported using practices that support responsive feeding. Conclusions: Reported barriers to services and high levels of undernutrition, strongly linked to feeding difficulties, underscore the need for targeted feeding interventions and better access to inclusive nutrition services in Uganda. Full article

Background: China is currently developing standards for Food for Special Medical Purposes (FSMP) targeting for oncology patients. However, substantial challenges remain in defining optimal fortification levels of omega-3 polyunsaturated fatty acids (ω-3 PUFAs). Accumulating evidence suggests that ω-3 PUFA intake improves postoperative prognosis by modulating oncological parameters in colorectal cancer (CRC) patients. This meta-analysis aimed to evaluate the therapeutic efficacy of ω-3 PUFA supplementation in enhancing postoperative safety and recovery stability following CRC surgery, to address critical gaps in nutritional interventions for optimizing clinical outcomes. These findings are expected to FSMP standard development, clinical nutrition protocols and product innovation. Methods: A systematic literature search was conducted, in accordance with PRISMA guidelines, across major databases until June 16, 2025. Data were analyzed using RevMan v5.4 (Cochrane Collaboration). Results: Thirty-four randomized controlled trials (RCTs) (n = 2889) were included. Compared to controls, the ω-3 PUFAs group showed significantly increased levels of nutritional markers: total protein (p < 0.00001), albumin (p = 0.001); immunological parameters: CD3⁺/CD4⁺/CD8⁺ T-cells, CD4⁺/CD8⁺ ratio (all p < 0.0001); Karnofsky Performance Status (KPS) scores (p = 0.04); and serum ω-3 PUFA concentrations (p = 0.0004). Significant reductions were observed in inflammatory markers, such as procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) (p = 0.004 to < 0.00001); and clinical outcomes, such as hospitalization duration (p < 0.00001), infectious complications (p < 0.00001), anastomotic leakage (p = 0.0005), surgical site infections (p = 0.03). No significant intergroup differences were detected for white blood cells, transcription factor activity, mortality, or crypt cell proliferation indices (p = 0.06–0.55). Conclusions: Overall, ω-3 PUFA supplementation significantly attenuates postoperative inflammation, enhances immune function, shortens hospitalization, and improves the quality of life in CRC patients, though without mortality benefit. Notably, post hoc dose–response analysis identified a supplementation range of 0.16–0.30 g/kg/day as a potentially optimal supplementation range for Chinese CRC populations, providing foundational evidence for clinical practice and FSMP standardization. Full article

Background/Objectives: Listeria monocytogenes (Lm) is an extremely rare cause of brain abscesses, accounting for 1–10% of neurolisteriosis cases reported in the literature, associated with high mortality (approximately 23%). Data on diagnosis, management, and treatment is scarce. We report a case of listerial brain abscesses in an elderly patient in Italy who experienced progressively worsening bilateral ptosis. Methods: Diagnostic evaluation included neuroimaging, blood cultures, and microbiological investigations, followed by antimicrobial treatment according to available evidence. The isolated Lm strain underwent whole genome sequencing. Dietary history was also collected. Results: Positive early blood cultures were pivotal in identifying Lm as the aetiological agent. Neuroimaging revealed brain abscesses consistent with neurolisteriosis. The clinical course was complicated by pneumonia and opportunistic co-infecting pathogens, and despite adequate treatment according to the available literature, the outcome was fatal. Genomic characterisation revealed that the patient was infected with an strain belonged to the sequence type 206 and clonal complex 14, described as hypervirulent. The patient reported consuming several foods known to be associated with an increased risk of listeriosis. Conclusions: This case highlights the challenges involved in diagnosing and managing listerial brain abscesses, particularly in elderly patients. Even when the primary central nervous system infection is under control, the prognosis may be significantly impacted by comorbid conditions and hospital-related complications rather than the infection itself. Our findings underscore the need for improved preventive strategies and targeted risk communication regarding high-risk foods, particularly among elderly populations. Full article

A large and growing empirical literature documents that privatization, deregulation, financialization, and under-regulation of harmful industries are associated with adverse health outcomes in the United States. However, this evidence remains fragmented across sectors and rarely articulates a unifying causal framework. This paper advances the literature by integrating findings across health care, harmful-product industries, and economic and social policy to demonstrate that corporate profit maximization functions as a cross-cutting driver of health disparities and premature mortality in the United States. We synthesize evidence showing that profit-driven incentives shape insurance markets, hospital and physician practice ownership, pharmaceutical marketing, and the aggressive promotion of tobacco, alcohol, ultra-processed foods, opioids, firearms, and fossil fuels—together contributing to more than one million deaths annually. We further document how corporate influence over public policy has increased poverty, economic inequality, and discrimination, all of which are powerful social determinants of health. In contrast to sector-specific analyses, this paper presents a unified, systems-level account of how profit-first governance undermines population health. We conclude by describing how a social movement to achieve a single payer system that provides Medicare for All would not only vastly improve public health, it would be a catalyst for numerous other reforms that enhance the general wellbeing. Full article

Background/Objectives: The impact of choline on congenital heart defects (CHDs) in humans remains unclear. This study aimed to investigate the associations between maternal dietary intakes of choline and choline derivatives during pregnancy and CHD. Methods: This case–control study included 474 cases and 948 controls from hospitals in Northwest China. Pregnant women admitted for delivery were enrolled and completed a validated food frequency questionnaire to assess their dietary intake during pregnancy. A standardized questionnaire was also administered to collect additional pregnancy-related information. Mixed logistic regression models were used to estimate ORs (95%CIs) for CHD in association with choline intake. Results: Higher intakes of total choline, phosphatidylcholine, sphingomyelin, glycerophosphocholine, and phosphocholine in pregnancy were associated with reduced risks of total CHD, ventricular septal defects, and atrial septal defects, with all trend tests showing statistical significance (all p < 0.05). The ORs (95%CIs) of total CHD, comparing the highest with the lowest tertiles of intake, were 0.38 (0.24–0.61) for total choline, 0.51 (0.38–0.70) for phosphatidylcholine, 0.37 (0.26–0.51) for sphingomyelin, 0.34 (0.21–0.53) for glycerophosphocholine, and 0.53 (0.34–0.82) for phosphocholine. The inverse associations remained unchanged according to maternal age, work, education, parity, passive smoking, anemia, medication use, or folate/iron supplements use in pregnancy; however, these associations appeared to be more pronounced among pregnant women in urban areas. Conclusions: Higher maternal intake of dietary choline during pregnancy may be associated with a lower risk of CHD. Promoting choline intake in pregnant women could serve as a potential strategy for the primary prevention of fetal CHD in China. Full article

Metal oxide semiconductor (MOS)-based chemiresistive gas sensors, attributable to their low cost, compact structure, and long operational lifetime, have been widely employed for the detection and monitoring of trace ozone (O₃) in environmental air. Moreover, as ozone is a highly reactive oxidizing species extensively used in medical device sterilization, hospital disinfection, and food processing and preservation, accurate monitoring of ozone concentration is also essential in medical sanitation and food safety inspection. However, their practical applications are often limited by insufficient sensitivity and the requirement for elevated operating temperatures. In this study, Au-modified indium oxide (Au-In₂O₃) nanocomposite sensing materials were synthesized via a hydrothermal route followed by surface modification. Structural and morphological characterizations confirmed the uniform dispersion of Au nanoparticles on the In₂O₃ surface, which is expected to enhance the interaction between the sensor and target gas molecules. The resulting Au-In₂O₃ sensor exhibited excellent O₃ sensing performance under room-temperature conditions. Compared with pristine In₂O₃, the Au-In₂O₃ sensor with 1.0 wt% Au modification demonstrated a remarkably enhanced response of 1398.4 toward 1 ppm O₃ at room temperature. Moreover, the corresponding response/recovery times were shortened to 102/358 s for Au-In₂O₃. The outstanding O₃ sensing performance can be attributed to the synergistic effects of Au nanoparticles, including the spillover effect and the formation of a Schottky junction at the Au-In₂O₃ interface. These results suggest that Au-modified In₂O₃ cauliflower represents a highly promising candidate material for high performance O₃ sensing at low operating temperatures. Full article

Background/Objectives: Under the urban–rural dual structure, rural children’s health security faces multiple challenges. These stem from geographical disadvantages, inadequate resources, and systemic flaws in medical insurance design. The outpatient cost-sharing policy is a key design to address these issues. Methods: Using data from the 2018 China Household Income Project (CHIP), this study employs Propensity Score Matching, Ordered Probit, Logit, and a Two-Part Model to examine the association between the policy and the health and economic outcomes of rural children. Conclusions: The results show that the policy is significantly associated with better child health scores and a higher probability of reimbursement. These positive associations appear to be connected to three potential factors: higher use of outpatient services, better mother’s health, and greater school-related food and accommodation expenses. In contrast to adult populations, no significant substitution between outpatient and inpatient services was observed for children, suggesting the non-discretionary and rigid nature of pediatric hospitalization decisions. This research provides robust empirical evidence for the policy’s potential benefits, offering important implications for optimizing the child medical security system. Full article