Search Results (8,580)

Background/Objectives: Hemodynamic and neurohormonal factors, including renal perfusion and venous pressure, may affect diuretic response, which may be modulated by body position. This study aimed to assess whether supine versus upright positioning influences diuretic efficacy and neurohormonal activation during early decongestion in patients with AHF and reduced ejection fraction (HFrEF). Methods: This single-center, prospective, pilot randomized study enrolled 12 hospitalized patients with decompensated HFrEF receiving guideline-directed medical therapy. Participants were randomized (1:1) to remain in either the supine or upright/seated position during intravenous furosemide administration (1 mg/kg: half of the dose administered as a bolus, half as a 2-h infusion). Serial measurements of urine volume, electrolyte excretion, and neurohormonal biomarkers (renin, aldosterone, catecholamines) were performed at baseline, 2, and 6 h after diuretic administration. Results: No significant differences were found between supine and upright groups in total urine output, urine dilution, sodium excretion, or weight change after 6 h. There were no statistically significant differences in renin and aldosterone levels across subsequent timepoints; however, renin concentration tended to be higher in upright than in supine individuals. Interestingly, supine participants demonstrated greater urinary adrenaline concentration after furosemide administration, alone and after adjustment for urinary creatinine. Conclusions: No clinically meaningful differences were found between supine versus upright position patients with AHF, receiving neurohormonal blockade. Full article

The accumulation of heavy metals in fish tissues is widely recognized as an indicator of aquatic environmental pollution, and the analysis of their content provides a basis for assessing ecological risk and the safety of aquatic food. The European eel (Anguilla anguilla) is a species frequently used as a bioindicator in environmental studies due to its wide geographic distribution, long life cycle, and high capacity for bioaccumulation of heavy metals in various tissues. The aim of this study was to assess the variation in the accumulation of heavy metals, i.e., mercury (Hg), lead (Pb), arsenic (As), and cadmium (Cd), in the tissues (muscle, liver, gonads, and gills) of European eels caught in two locations in Polish inland waters. The obtained results showed significant differences both in the concentration levels of individual elements and in their co-occurrence in the examined tissues. The statistical methods used, including correlation analysis, heat maps, and principal component analysis (PCA), allowed for a comprehensive assessment of the relationships between metals and the identification of factors differentiating the studied populations. The obtained results clearly indicate that fish residing in similar environments for long periods exhibit significant differences in heavy metal content in various fish tissues. Fish obtained from environments with potentially higher levels of heavy metal inputs, such as the Oder River EMU compared with the Vistula River EMU, showed higher levels of heavy metal accumulation in tissues. This study also found that the concentration of heavy metals tested did not exceed the safe standards for human fish consumption. Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background/Objectives: Type 2 diabetes (T2D) is a chronic metabolic disorder closely linked to cardiovascular disease and obesity and notably influenced by lifestyle and dietary patterns. The Mediterranean diet has well-established benefits across multiple cardiometabolic risk factors, including those relevant to diabetes. This study aimed to investigate the degree to which adults with T2D adhere to a Mediterranean dietary pattern and to examine how such adherence relates to glycemic and lipidemic regulation. Methods: This cross-sectional study included 100 adults with T2D (54 men and 46 women). Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Score (MDS). Demographic, anthropometric, lifestyle, and clinical data were collected, and glycemic and lipid parameters were analyzed. Associations between Mediterranean diet adherence and metabolic outcomes were examined using correlation analyses and multivariable regression models adjusted for relevant confounders. Results: Most participants showed low adherence to the Mediterranean diet. A significant inverse association was observed between Mediterranean diet adherence and hemoglobin A1c (HbA1c) levels, with individuals scoring ≤35 on the MDS demonstrating higher HbA1c levels. Similar trends were observed in the lowest tertile of adherence. Notably, each one-point increase in MDS predicted a 0.13% reduction in HbA1c. In multivariable regression analyses, Mediterranean diet adherence remained the strongest predictor of glycemic control, independent of age, body mass index (BMI), sex, smoking status, physical activity and the number of antidiabetic treatments. Higher adherence was also significantly associated with lower low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels, as well as higher high-density lipoprotein cholesterol (HDL) concentrations. Conclusions: Greater adherence to the Mediterranean diet is independently associated with improved glycemic regulation and a more favorable lipid profile in adults with T2D. These findings support the Mediterranean diet as a valuable non-pharmacologic strategy for optimizing metabolic outcomes in people with T2D. Full article

Quality of life (QoL) is a multidimensional concept involving physical, psychological, social, and environmental dimensions. Therefore, it reflects not only individual well-being but also the overall well-being and sustainability of societies. Current approaches to QoL have expanded from purely economic or health-based indicators to incorporate a range of multidimensional analyses at urban, regional, and national levels, with more recent emphasis on interlinkages between socio-economic and spatial factors. This research investigates how geoinformation methodologies, including remote sensing, spatial analysis, and machine learning, can be applied to assess QoL across multiple spatial scales. Through a systematic review and comparative evaluation, the study aims to identify which indicators, data sources, and analytical tools are used at each spatial level—from neighborhood and urban scale to regional and national levels. Emphasis was placed on understanding how methodological approaches vary across scales and how spatial resolution, data availability, and urban context influence the design and implementation of QoL assessment frameworks. The main objective was to establish a common analytical framework for evaluating QoL across different spatial scales. The review revealed that combining data, machine learning algorithms, and spatial analysis approaches in a common framework will enhance comparative and predictive capabilities beyond the state of the art, although it will face significant data heterogeneity challenges. Future research aims to develop consistent, multidimensional models supportive of policies fostering sustainability and spatial equity in urban and regional contexts. Full article

Household food waste remains a significant barrier to sustainable consumption goals. This study investigates the impact of sociodemographic characteristics influence self-reported food waste levels in Poland. A cross-sectional CAWI survey (N = 1000), based on the HFSSM, was conducted among adults responsible for purchasing household food. Associations between food waste and structural factors were analysed using χ² tests, Spearman rank correlations, and Mann–Whitney U tests. Age appears as the strongest determinant: younger respondents consistently report higher food waste, while older adults indicate markedly lower levels. Household composition is equally important—the presence and number of children significantly increase waste. Economic status is also relevant: pensioners and disability-benefit recipients report substantially less waste than employed and self-employed individuals. Net household income shows no significant effect. Education does not necessarily reduce food waste; in some comparisons, higher-educated respondents report slightly higher levels, suggesting that formal education does not automatically translate into effective food management routines. The findings highlight that food waste is primarily influenced by life stage, household structure, and daily habits rather than income or education. Interventions should focus on younger adults and families with children, emphasising practical skills such as meal planning, inventory management, appropriate storage, and the use of leftovers. Full article

The study investigates repetitive and time-consuming professional activities performed by occupational health and safety (OHS) specialists in the construction sector in Poland and their attitudes toward the use of modern digital tools, including solutions based on artificial intelligence (AI). The research was conducted using a questionnaire survey, with a purposive sample and a snowball method. A total of 102 individuals participated in the study, of whom 94 valid responses were included in the analysis. The data were examined using descriptive statistics and chi-square tests. The results showed that the most repetitive and time-consuming activities include documentation analysis, report preparation, inspections, and communication. Nearly 46% of respondents indicated that selected elements of their work could be automated or supported by digital tools, while 33% reported using AI-based solutions in everyday practice. Statistically significant relationships were identified between respondents’ age and both their level of concern about new technologies and their perception of technological support potential. No significant relationships were found for enterprise ownership or size. The findings indicate substantial potential for the implementation of digital and AI-supported tools in routine OHS activities. Future research should involve larger and more homogeneous samples, incorporate probabilistic sampling, and explore organisational and competence-related factors influencing technology adoption. Full article

This review synthesizes the literature on the degradation and decomposition of holopelagic Sargassum, with a focus on process dynamics, including microbial contribution, process descriptions, and ecological impacts. Our objective is to consolidate a robust knowledge framework to inform and optimize management strategies in affected areas. Overall, we observed that the current literature relies primarily on isolated field ecological descriptions rather than a coherent, unified research line; mechanistic studies, including bacterial pathways and factors controlling degradation, remain scarce. At the fine scale, microbial community shifts during decomposition are strongly linked to the sequential utilization of distinct organic substrates, thereby favoring the proliferation of microorganisms capable of degrading complex organic molecules and of bacterial groups involved in sulfur respiration, methanogenesis, and nutrient recycling. In the case of sulfur respiration, groups such as Desulfobacterales and Desulfovibrionales may be responsible for the reported H₂S emissions, which pose significant public health concerns. At a broad scale, degradation occurs both on beaches during emersion and in the water column during immersion, particularly during massive accumulations. The initial stages are characterized by the release of organic exudates and leachates. Experimental and observational studies confirm a strong early-stage release of H₂S until the substrate is largely depleted. Depending on environmental conditions, a significant amount of biomass can be lost; however, this loss is highly variable, with notable consequences for contamination studies. Leachates may also contain low but ecologically significant amounts of arsenic, posing a potential contamination risk. Decomposition contributes to water-quality deterioration and oxygen depletion, with impacts at the individual, population, and ecosystem levels, yet many remain imprecisely attributed. Although evidence of nutrient enrichment in the water column is limited, studies indicate biological nutrient uptake. Achieving a comprehensive understanding of degradation and decomposition, including temporal and spatial dynamics, microbiome interactions, by means of directed research, is critical for effective coastal management, improved mitigation strategies, industrial valorization, and accurate modeling of biogeochemical cycles. Full article

Background/Objectives: Neurological diseases are a major cause of long-term disability and dependence. In Poland, as in many countries, informal caregivers provide most long-term care for individuals with chronic and progressive neurological conditions. Although essential, this role is associated with substantial physical, psychological, and social burden. This study aimed to assess the scope and nature of support provided by caregivers to people with neurological diseases and to identify factors associated with differences in support and caregiver burden. Methods: A cross-sectional quantitative study was conducted using a CAWI survey. The sample included 104 informal caregivers of adults with various neurological conditions. An author-designed questionnaire and the “Actually Provided Support” subscale of the Berlin Social Support Scales (BSSS) were used. Nonparametric statistical tests were applied (p < 0.05). Results: Caregivers provided a high level of support, particularly emotional and instrumental support, while informational support was less intensive. Women more frequently reported high emotional and instrumental support. Higher buffering–protective support was more common among caregivers aged over 45 years. The most frequently reported difficulties were psychological fatigue (70.9%) and physical fatigue (60.2%), indicating a substantial caregiving burden. Key barriers included limited access to reimbursed healthcare services and the lack of temporary replacement in caregiving. Caregivers most often indicated the need for respite care and better access to information and education. Conclusions: Informal caregivers play a crucial role in the daily functioning of people with neurological diseases, despite high burden and insufficient systemic support. Expanding respite care, improving access to information, and better coordination of healthcare services are urgently needed. Full article

Background/Objectives: To develop and validate the DMEK Risk and Outcome Prediction (DROP) Score—a benchmarking model integrating patient, donor, surgical, and center-specific parameters for individualized risk assessment following DMEK. Methods: The DROP Score comprises four subscores, namely the Patient Risk Profile (PRP), Donor Tissue Quality (DTQ), Surgical Complexity Index (SCI), and Center Performance Factor (CPF), with literature-derived weights ($\alpha$ = 0.40, $\beta$ = 0.25, $\gamma$ = 0.20, $\delta$ = 0.15) validated by sensitivity analysis (K = 0.82–0.91). Clinical validation included 76 DMEK eyes and 89 controls (2019–2023). Machine learning models utilized EfficientNetV2B3 transfer learning with Random Forest classifiers and patient-level data partitioning. IVCM imaging comprised 6200 images. Results: The mean DROP Score was 39.35 ± 7.61 (Moderate: 92.1%; High: 7.9%). High-risk patients showed worse 12-month BCVA (0.50 vs. 0.31 logMAR) and higher poor prognosis rates (50.0% vs. 34.3%). The DROP Score showed significant correlations with BCVA (r = 0.305, p = 0.007) and ECD (r = −0.352, p = 0.002). Tissue classification accuracy reached 96.2%. Diabetes mellitus emerged as the strongest prognostic factor (OR: 4.34, p = 0.012), followed by hypertension (OR: 2.65, p = 0.078). Conclusions: The DROP Score provides transparent, individualized DMEK risk assessment. Diabetes mellitus and hypertension emerged as dominant systemic prognostic factors, while rebubbling showed no adverse impact on long-term outcomes. Complete four-domain validation requires ongoing prospective data collection. Full article

Colostrum harbors a highly diverse microbial community, predominantly composed of genera such as Staphylococcus, Streptococcus, Lactobacillus, Bifidobacterium, and Enterococcus. The composition and diversity of this microbiota are influenced by maternal factors—including age, body mass index, lactation activity, stress levels, and gestational diabetes—as well as external factors such as mode of delivery, antibiotic exposure, diet, and geographic location. This microbial community plays a critical role in maternal and neonatal health by contributing to early gut colonization, supporting digestion, promoting immune system development, and protecting against pathogenic microorganisms through mechanisms such as antimicrobial peptide production by lactic acid bacteria. The primary aim of this study was to evaluate the impact of mode of delivery on colostrum microbiota by comparing mothers who delivered vaginally with those who underwent cesarean section. Colostrum samples from 15 mothers were subjected to DNA extraction, high-throughput sequencing, and bioinformatic analyses to characterize microbial composition and predicted functional profiles. Although substantial inter-individual variability was observed, no statistically significant differences were detected in overall microbial diversity or community structure between the two delivery groups. However, distinct bacterial taxa and functional characteristics were identified that were specific to each mode of delivery, suggesting subtle delivery-related influences on colostrum microbiota composition. Full article

This study examined the seasonal and size-related variations in the diet composition and feeding strategies of the robust tonguefish Cynoglossus robustus collected in the Yeosu Coast, Korea, from January to December 2024. Stomach content analysis identified amphipods, polychaetes, and brachyurans as the dominant prey items. Ontogenetic dietary shifts were evident, with individuals < 25 cm TL feeding mainly on amphipods, whereas larger individuals consumed more polychaetes and brachyurans, indicating a shift toward larger and more energy-efficient prey with growth. Amphipods, with Ampelisca sp. being predominant, were predominant in spring and summer, whereas crabs and polychaetes increased in autumn and winter, respectively. Seasonal variation was attributed to environmental factors and post-spawning feeding recovery. The estimated trophic level (3.22) suggests that C. robustus functions as a mesopredator consuming benthic invertebrates and plays an essential role in energy transfer within the coastal benthic ecosystem. These findings provide fundamental ecological insights into the trophic structure of the coastal ecosystem in the southern sea of Korea and serve as a scientific basis for sustainable fisheries resource management. Full article

Background/Objectives: Birth preparedness and complication readiness (BPCR) is a cornerstone of maternal health strategies designed to minimize the “three delays” in seeking, reaching, and receiving skilled care. In Ethiopia, uptake of BPCR remains insufficient, and little evidence exists on how individual- and community-level factors interact to shape preparedness. This study assessed the determinants of BPCR among women of reproductive age in Hawela Lida district, Sidama Region. Methods: A community-based cross-sectional study was conducted among 3540 women using a multistage sampling technique. Data were analyzed with multilevel mixed-effect negative binomial regression to account for clustering at the community level. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported to identify determinants of BPCR. Model fitness was assessed using Akaike’s Information Criterion (AIC), the Bayesian Information Criterion (BIC), and log-likelihood statistics. Results: At the individual level, women employed in government positions had over three times higher expected BPCR scores compared with farmers (AIRR = 3.11; 95% CI: 1.89–5.77). Women with planned pregnancies demonstrated higher BPCR preparedness (AIRR = 1.66; 95% CI: 1.15–3.22), as did those who participated in model family training (AIRR = 2.53; 95% CI: 1.76–4.99) and women exercising decision-making autonomy (AIRR = 2.34; 95% CI: 1.97–5.93). At the community level, residing in urban areas (AIRR = 2.78; 95% CI: 1.81–4.77) and in communities with higher women’s literacy (AIRR = 4.92; 95% CI: 2.32–8.48) was associated with higher expected BPCR scores. These findings indicate that both personal empowerment and supportive community contexts play pivotal roles in enhancing maternal birth preparedness and readiness for potential complications. Random-effects analysis showed that 19.4% of the variance in BPCR was attributable to kebele-level clustering (ICC = 0.194). The final multilevel model demonstrated superior fit (AIC = 2915.15, BIC = 3003.33, log-likelihood = −1402.44). Conclusions: Both individual- and community-level factors strongly influence BPCR practice in southern Ethiopia. Interventions should prioritize women’s empowerment and pregnancy planning, scale-up of model family training, and address structural barriers such as rural access and community literacy gaps. Targeted, multilevel strategies are essential to accelerate progress toward improving maternal preparedness and reducing maternal morbidity and mortality. Full article

Low-income individuals are unlikely to save relatively large sums on a regular basis; however, many still fall short of even the modest threshold required for long-term financial security. This study examines the determinants of benchmark-defined undersaving among retail e-payment agents (REAs) operating in the urban slums of Lagos, Nigeria. We use a contingent valuation survey, descriptive analysis, and logistic regression to examine how selected behavioural and demographic factors, alongside a 60-day experimental intervention—the Programmed Microsaving Scheme (PMSS), a hard daily commitment savings device—affect the likelihood of undersaving, defined as saving less than 12% of each REA’s average daily income. While the PMSS appears to have contributed to improvements in post-treatment saving participation and performance among REAs, it did not significantly increase the likelihood of reaching or exceeding the benchmark savings threshold. Consistent with this, average daily income, age, gender, marital status, education, and religion are statistically insignificant predictors of benchmark-defined undersaving. In contrast, self-control, measured using a literature-validated instrument, exhibits a statistically significant negative association with benchmark-defined undersaving, indicating that higher self-control reduces the likelihood of failing to meet the benchmark. Measured risk aversion similarly shows no significant association. Notably, this study introduces a novel 60-day PMSS, co-designed with REAs and neobanks to accommodate daily income savings—a characteristic of the informal sector largely overlooked in the literature on commitment savings devices. From a policy perspective, the findings suggest that while short-horizon commitment devices (such as the 60-day PMSS) and financial literacy are associated with improvements in microsavings among low-income daily earners, achieving benchmark-level saving might require longer-term and more adaptive mechanisms that address income volatility and mitigate other inherent risks. Full article

Background: Managing chronic conditions can overwhelm patients and reduce their confidence in self-management. Patient activation (PA) is a concept that reflects patients’ knowledge, skills, and confidence in managing their health and self-care. In Jordan, PA has not been explicitly studied, particularly among patients with chronic conditions. Therefore, this study explores PA and its determinants in individuals with chronic conditions in Jordan. Methods: A cross-sectional study was conducted using a convenience sample of outpatients recruited from a tertiary hospital in Jordan. Participants completed a questionnaire including sociodemographic and clinical data, the Single Item Literacy Screener, and the 13-item Patient Activation Measure (PAM). Bivariate and regression analyses were conducted to explore the factors associated with PAM scores. Results: Among a total of 666 participants, the mean PAM score was 57.1 ± 9.17, indicating a moderate activation level overall. Regression analysis revealed that being female (p = 0.14), adequate health literacy (p = 0.002), and post-secondary education (p = 0.004) were significantly associated with higher PAM scores, and older age (p = 0.004) and polypharmacy (p = 0.010) with lower scores. An additional regression model showed that the negative association between polypharmacy and PA scores did not differ by health literacy level, with no significant interaction between polypharmacy and health literacy (p = 0.555). Conclusions: This study showed that individuals with chronic illnesses in Jordan had moderate to high patient activation levels. Several sociodemographic and clinical factors were significantly associated with patient activation. Polypharmacy was independently associated with lower patient activation scores, regardless of health literacy levels. However, given the study’s exploratory nature, the results should be interpreted as preliminary evidence warranting further research. Full article