Search Results (7,713)

Background: Firefighters are at elevated risk of low back pain (LBP), yet predictors, mechanisms, and interventions for LBP in this occupation remain poorly defined. The purpose of this study was to systematically review the literature and synthesize the evidence on functional biomarkers associated with the risk of LBP in firefighters. Methods: PubMed, EMBASE, CINAHL, and PEDro were searched for studies evaluating functional biomarkers in firefighters with or without LBP, including aerobic capacity, anthropometric measures, disability/kinesiophobia, functional work tasks/capacity, imaging/structural/morphological characteristics, kinematics, movement quality/range of motion, muscular fitness, overall physical fitness, physical activity. Empirical evidence statements were generated for each biomarker domain, under Protocol Registration PROSPERO (CRD420251010061). Results: Eighteen studies (n = 32,977) met inclusion criteria and were predominantly cross-sectional (14/18) with fair quality (13/18), which suggests a substantial risk of bias. Higher disability/kinesiophobia and poorer functional work task performance were linked to increased risk of LBP, although causal relationships cannot be determined. Associations for the eight other biomarkers were inconsistent. Two interventional studies demonstrated benefits from trunk-focused exercise. Conclusions: The literature examining functional biomarkers and LBP in firefighters is fragmented, which precludes making robust and broad clinical recommendations for evidence-based implementation. Findings of future research may ultimately lead to approaches to improve the safety and health of firefighters with LBP through patient-centered and tailored programs addressing integrated functional biomarkers across the continuum of prevention, clinical care, and resilience development. Full article

While the future of college student mental health is leaning towards systemic-level integrated behavioral health care models, existing mental health support for science, technology, engineering, and mathematics (STEM) students remains highly individual. The REDFLAGS Model is a mental health resource comprising an acronym of warning signs that suggest a college student might be struggling with mental distress. The aim of this study was to test the utility of The REDFLAGS Model, with a large sample of STEM students (N = 358). Results revealed support for the latent dimensionality of The REDFLAGS Model among a large sample of STEM students. Results also demonstrated that higher recognition of the items on The REDFLAGS Model as warning signs for mental distress was a significant predictor of peer-to-peer referrals to counseling among STEM students. Additionally, STEM students with help-seeking histories and those who identified as female were more likely to recognize the items on The REDFLAGS Model as warning signs of mental distress than those without help-seeking histories and men, respectively. Collectively, results indicated that The REDFLAGS Model has potential to provide college counselors with an empirically supported framework for supporting STEM student mental health. It is available at no cost and can be shared in print or digital formats. Full article

Tropospheric ozone (O₃) pollution is a major concern in urban environments because of its toxicity for both people and vegetation. This paper review provides an overview of atmospheric mechanisms, as well as the potential and best management practices of urban greening for reducing O₃ pollution in cities. Urban greening has often been proposed as a cost-effective solution to reduce O₃ pollution, but its effectiveness depends on careful species selection and integration with broader air quality management strategies. Ozone is a secondary pollutant and the volatile organic compounds emitted by vegetation (BVOCs) can play a prominent role in O₃ formation. A list of recommended and to-avoid species is given here to drive future planting at city scale. Planting low BVOC-emitting species and combining greening with reductions in anthropogenic emissions are key to maximizing benefits and minimizing unintended increases in O₃. Public and non-public institutions should carefully select plant species in consultation with expert scientists from the early stages, e.g., by considering local conditions and pollutant dynamics to design effective greening interventions. Collaborative planning among urban ecologists, atmospheric scientists, and municipalities is thus crucial to ensure that greening interventions contribute to overall air quality improvements rather than inadvertently enhancing O₃ formation. Such improvements will also translate into plant protection from O₃ stress. Therefore, future directions of research and policy integration to achieve healthier, O₃-resilient urban ecosystems are also provided. Full article

Background and Objectives: Stratifying thyroid nodules according to malignancy risk is a crucial step in early diagnosis and patient care. Recently, deep learning techniques have emerged as powerful tools for medical diagnostics, particularly with convolutional neural networks (CNNs) applied to medical image classification. This study aimed to develop a new hybrid CNN model for classifying thyroid nodules using the TN5000 ultrasound image dataset. Materials and Methods: The TN5000 dataset includes 5000 ultrasound images, with 3572 malignant and 1428 benign nodules. To address the issue of class imbalance, the researchers applied an R-based anomaly data augmentation method and a GAN-based technique (G-RAN) to generate synthetic benign images, resulting in a balanced dataset for training. The model architecture was built on a pre-trained EfficientNet-B3 backbone, further enhanced with squeeze-and-excitation (SE) blocks and residual refinement modules to improve feature extraction. The task was to classify malignant nodules (labeled 1) and benign nodules (labeled 0). Results: The proposed hybrid CNN achieved strong performance, with an accuracy of 89.73%, sensitivity of 90.01%, precision of 88.23%, and an F1-score of 88.85%. The total training time was 42 min. Conclusions: The findings demonstrate that the proposed hybrid CNN model is a promising tool for thyroid nodule classification on ultrasound images. Its high diagnostic accuracy suggests that it could serve as a reliable decision-support system for clinicians, improving consistency in diagnosis and reducing human error. Future work will focus on clinical validation, explainability of the model’s decision-making process, and strategies for integration into routine hospital workflows. Full article

Whole-genome sequencing (WGS) is integral to precision oncology, yet most cancer biospecimens used for WGS are formalin-fixed paraffin-embedded (FFPE) due to their widespread availability in clinical practice. However, FFPE processing can degrade DNA quality. This study compares WGS outcomes from matched cryopreserved (CP) and FFPE tumor samples, hypothesizing that CP tissues yield superior sequencing quality and variant detection. Fifty matched pairs of CP and FFPE tumor samples spanning multiple cancer types were obtained from a biobank. DNA was extracted, and WGS was performed. We assessed sequencing quality metrics and variant analysis between the two preservation methods. Presequencing metrics favored CP tissue, with a significantly higher gDNA concentration, DIN, and DNA fragment size. The WGS results showed that the CP samples had a higher mean read depth and larger insert size. Although the mapping percentages were similar, FFPE exhibited higher tumor mutation burden (13.7 vs. 6.4 mutations/Mb) and lower concordance with CP in variant calls (43.5% overlap). CP samples detected more structural variants and enabled the improved identification of oncogenic driver mutations. Cryopreserved tissues consistently outperform FFPE in terms of DNA quality and WGS metrics, enabling the more accurate detection of clinically relevant mutations. These findings support prioritizing CP sample preservation for genomic profiling in cancer care. Full article

Background/Objectives: Pediatric infectious-disease admissions are common but heterogeneous. We characterized clinical, microbiological, and therapeutic patterns and identified high-risk subgroups relevant to antimicrobial stewardship. Methods: In an observational cohort of 136 children stratified by age, we recorded symptoms, diagnoses, culture results, pathogens, antibiotic therapy, and outcomes. A composite risk score integrating age and clinical/microbiological parameters was assessed. Results: Outcomes were generally favorable: intensive care unit (ICU) transfer 8.8% (95% confidence interval [CI]: 4.6–15.1), mortality 0.7% (95% CI: 0.1–3.9), and median length of stay (LOS) 10 days (interquartile range [IQR] 8–12). Pneumonia was the leading diagnosis (44.9%; 95% CI: 36.3–53.6). Among isolates, Escherichia coli (47.1%) and Klebsiella species (spp.) (27.9%) predominated. Pneumonia correlated with prolonged LOS (p = 0.006), and gastroenteritis with ICU transfer (p = 0.038) and longer LOS (p = 0.018). Mixed E. coli + Klebsiella infections were linked to prolonged stay (p = 0.021). The composite score identified a high-risk stratum with higher ICU transfer (p = 0.004) and prolonged stay (p = 0.006). Conclusions: Although overall outcomes were favorable, risk was not uniform. An age-stratified, multifactorial assessment—integrating clinical presentation, microbiology, and a composite score—identified pediatric subgroups with worse prognoses, supporting targeted monitoring and stewardship-aligned, age-aware empiric therapy. External validation is warranted. Full article

Photon-counting computed tomography (PCCT) introduces a new era in thoracic imaging by offering ultra-high spatial resolution, reduced noise, spectral imaging capabilities, and lower radiation dose compared to conventional CT. These features are particularly relevant in thoracic surgery, where precise anatomical and functional assessment is essential throughout the perioperative period. This narrative review outlines the clinical potential of PCCT in surgical planning, intra- and postoperative evaluation, and follow-up of both oncologic and non-oncologic thoracic conditions. PCCT enables accurate bronchovascular mapping and iodine-based perfusion imaging, supporting sublobar resection planning and risk stratification in patients with complex anatomy or reduced lung function. Postoperatively, it enhances detection of subtle complications—such as air leaks or hematomas—and improves image quality near metallic implants through advanced artifact reduction techniques. The ability to combine high-resolution imaging with functional data allows for comprehensive evaluation in a single scan and may aid in differentiating fibrosis from local recurrence. Despite its promises, PCCT adoption is currently limited by high cost, restricted availability, and the need for training and system integration. Furthermore, prospective clinical studies are still needed to determine its impact on surgical outcomes. As technological and infrastructural challenges are addressed, PCCT may become a valuable component of image-guided thoracic surgery, contributing to safer, more personalized care. Full article

Background/Objectives: Patients with incurable cancers enrolled in early phase clinical trials often face uncertainty about prognosis, yet advance care planning (ACP) is frequently delayed. The objective of this study was to assess the documentation of ACP discussions among patients enrolled in early phase oncology trials. Methods: We conducted a retrospective review of electronic medical records for all adults enrolled in early phase clinical trials at a single Australian institution (2012–2021). Data included time from metastatic diagnosis to first ACP discussion, clinical and sociodemographic factors, triggers for discussion, and clinician specialty. Results: Among 170 patients (58% male; median age 65 years), ACP documentation was identified in 109 (64%). ACP was most often initiated within the final year of life (73.8%), with a median interval of 23.5 months from metastatic diagnosis to first documentation. Common triggers were disease progression (39.6%) and hospital admission (37.8%). Discussions were typically led by the treating oncologist or trials specialist (43%) and palliative care physician (37.8%). The most frequently documented topic was the limitations of invasive care such as intubation (60%). Conclusions: ACP documentation was present in two-thirds of patients enrolled in early phase clinical trials, typically late in the disease trajectory. Integrating structured, earlier ACP discussions into oncology pathways would improve alignment of care with patient goals and enhance end-of-life care. Full article

This paper evaluates the Enhancing Mobile Populations’ Access to HIV and AIDS Services, Information and Support (EMPHASIS) programme implemented by CARE International across Bangladesh, India, and Nepal. Using individual-level data, we estimate the programme’s impact on HIV-related knowledge and preventive behaviours among migrant workers. Results show that participation in EMPHASIS significantly increased correct knowledge of HIV transmission, reduced misconceptions, and improved partner communication. These informational gains translated into higher condom use and fewer unsafe sexual practices, with stronger effects among women. The findings provide evidence that peer-led, information-based interventions can improve health behaviours among mobile populations. Integrating such approaches with gender empowerment and mobile health services offers a promising model for addressing HIV vulnerability in cross-border migration settings. Full article

Attention-deficit/hyperactivity disorder (ADHD) in adults has become an increasingly recognized clinical entity, with growing attention in research and healthcare settings. ADHD can significantly affect multiple domains of adult functioning, including education, employment, interpersonal relationships, and both mental and physical health. However, despite the expanding body of literature, gaps in understanding persist. This narrative review synthesizes current evidence on adult ADHD. The literature was systematically searched in databases such as PubMed, Scopus, and PsycINFO using predefined keywords related to ADHD in adults. Inclusion criteria focused on peer-reviewed articles published between 2010 and 2025, addressing epidemiology, etiology, diagnosis, treatment, and functioning. Exclusion criteria included studies with pediatric populations only or lacking methodological rigor. ADHD in adults is prevalent worldwide, with considerable heterogeneity across studies. Its etiology involves complex interactions between genetic, neurobiological, and environmental factors. Clinical presentation in adulthood differs from childhood, with symptoms such as inattention, emotional dysregulation, and executive dysfunction predominating. Diagnostic challenges include retrospective assessment of childhood symptoms and comorbidity with mood and anxiety disorders. Pharmacotherapy and cognitive–behavioral interventions show efficacy, particularly when combined in integrated care models. ADHD negatively affects quality of life and occupational and social functioning and increases the risk of comorbid disorders, including psychoactive substance use. Adult ADHD is a multifaceted condition requiring a comprehensive, multidisciplinary approach to diagnosis and management. Future research should aim to refine diagnostic tools, explore neurobiological markers, and tailor interventions to individual profiles. Expanding knowledge on adult ADHD will improve identification, treatment outcomes, and overall quality of life for affected individuals. Full article

Sepsis poses a significant global health burden, with millions of cases and high mortality rates annually, largely due to challenges in early diagnosis and monitoring. Traditional methods, reliant on nonspecific clinical manifestations and limited biomarkers like C-reactive protein and procalcitonin, often fail to distinguish infection from non-infectious inflammation or capture disease heterogeneity. This review synthesizes recent progress in omics technologies—genomics, transcriptomics, proteomics, and metabolomics—for advancing sepsis management. Genomics, via metagenomic next-generation sequencing, enables rapid pathogen identification and genetic variant analysis for susceptibility and prognosis. Transcriptomics reveals molecular subtypes and immune dynamics through RNA sequencing and single-cell approaches. Proteomics and metabolomics uncover protein and metabolite profiles linked to immune imbalance, organ damage, and metabolic disorders. Multi-omics integration, enhanced by artificial intelligence and machine learning, facilitates biomarker discovery, patient stratification, and predictive modeling, bridging laboratory findings to bedside applications like rapid diagnostic tools and clinical decision support systems. Despite advancements, challenges including data heterogeneity, high costs, and ethical concerns persist. Future directions emphasize single-cell and spatial omics, AI-driven personalization, and ethical frameworks to transform sepsis care from reactive to proactive, ultimately improving outcomes. Full article

Background: Preconception care (PCC) is a key element of preventive reproductive health, aiming to optimise maternal and child outcomes by addressing biomedical, behavioural, psychosocial, and genetic risks before conception. International frameworks provide clear guidance, yet implementation in many low- and middle-income countries remains inconsistent. Methods: A structured narrative review was conducted across PubMed, Web of Science, Cochrane Library, and Google Scholar, focusing on literature published between 2010 and 2025. Eligible sources included empirical studies, clinical guidelines, policy documents, and high-quality grey literature from health authorities. Quality, relevance, and applicability were assessed, with particular emphasis on European and Bulgarian contexts. Results: Evidence from diverse settings demonstrates that PCC interventions—such as chronic disease management, vaccination, lifestyle optimisation, and expanded carrier screening (ECS)—can reduce adverse pregnancy outcomes and prevent severe genetic disorders. Effective international models integrate PCC into primary care, leverage digital health tools, and ensure equitable access through public funding. In Bulgaria, PCC remains underdeveloped: genetic screening is not part of routine care, there are no national guidelines or surveillance systems, and only ~4% of women initiate folic acid supplementation before pregnancy. NGOs and EU-funded digital initiatives provide partial outreach but cannot replace state-supported services. Conclusions: Bulgaria urgently requires a coordinated national PCC strategy, incorporating standardised guidelines, provider training, digital platforms, and phased ECS introduction. Strengthening PCC delivery can reduce preventable maternal and neonatal morbidity, advance reproductive justice, and enhance the long-term sustainability of public health systems. These findings support the development of a publicly funded, guideline-driven national PCC strategy with phased introduction of expanded carrier screening under NHIF to improve equity and long-term system sustainability. Full article

Background/Objectives: Falls are a leading cause of hospitalization, injury, and healthcare spending among older adults. Surveillance data on local falls, especially for those associated with Alzheimer’s disease and related dementias (ADRD), are limited. We conducted a surveillance analysis to describe fall-related hospitalizations and their associations with ADRD in Los Angeles County (LAC). Methods: We analyzed countywide hospital discharge data for LAC residents aged 50+ from 2016–2022 (n = 3,520,927) to assess differences in fall-related hospitalizations by ADRD status and demographic characteristics. We used multivariable logistic regression to identify predictors of fall status and multinomial regression to examine associations between ADRD status and discharge disposition. Results: Of all hospitalizations, 6.8% were fall-related. Individuals hospitalized for falls had longer stays, higher charges, and were more frequently female, older, and White. Fall frequency peaks consistently occurred during winter months, with higher seasonal variation among those without ADRD. After adjustment, ADRD diagnosis was associated with increased odds of fall-related hospitalization (AOR = 1.14) and non-routine discharge, including transfer to a short-term hospital (AOR = 1.35), skilled nursing or other care facilities (AOR = 1.88), and home health care (AOR = 1.23). Conclusions: This study provides one of the most comprehensive local assessments of fall-related hospitalization among older adults in the United States. The findings highlight the increased risk and care complexity among patients with ADRD. As results are descriptive and reflect cross-sectional surveillance, temporality and causality cannot be inferred. Nevertheless, the findings underscore the need for better surveillance and integrated fall prevention, discharge planning, and post-hospital support strategies tailored to individuals with ADRD. Full article

Enterocytozoon bieneusi is the most frequently diagnosed microsporidian parasite in humans and a recognized cause of diarrheal disease, particularly in immunocompromised individuals. Its broad host range, which includes livestock, companion animals, and wildlife, highlights its zoonotic potential and warrants careful epidemiological assessment. This narrative review synthesizes available data on the occurrence and genetic diversity of E. bieneusi in European domestic ungulates (cattle, pigs, sheep, goats, horses, and water buffaloes) and pets (dogs and cats), aiming to provide an integrated perspective on animal reservoirs and their relevance for public health. Publications retrieved from the Web of Science Core Collection database were systematically screened, and country-specific results were extracted, emphasizing prevalence rates, genotype distributions, and zoonotic implications. Across Europe, cattle and pigs emerged as the most studied hosts, frequently harboring zoonotic group 1 genotypes such as I, J, BEB4, BEB6, and EbpA, while small ruminants, horses, and buffaloes remain comparatively undocumented. In pets, the dog-adapted genotype PtEb IX was predominant, but several zoonotic genotypes were also identified. Overall, the current evidence confirms the wide host range of E. bieneusi in Europe but also reveals significant data gaps compared to regions such as China, underlining the need for broader surveillance and harmonized molecular approaches within a One Health framework. Full article

Background: The digitization of health records was expected to improve data quality and accessibility, yet incompleteness remains a widespread challenge that undermines clinical care, interoperability, and downstream analytics. Problem: Evidence shows that missing and under-recorded elements in electronic health records (EHRs) are largely driven by process gaps across patients, providers, technology, and policy—not solely by technical limitations. Objective: This perspective integrates conceptual foundations of incompleteness, synthesizes cross-country evidence, and examines process-level drivers and consequences, with an emphasis on how missingness propagates bias in AI and machine learning systems. Contribution: We present a unifying taxonomy, highlight complementary approaches (e.g., Record Strength Score, distributional testing, and workflow studies), and we propose a pragmatic agenda for mitigation through technical, organizational, governance, and patient-centered levers. Conclusions: While EHR incompleteness cannot be fully eliminated, it can be systematically mitigated through standards, workflow redesign, patient engagement, and governance—essential steps toward building safe, equitable, and effective learning health systems. Full article