Search Results (288)

Background: Italy exhibits a socioeconomic divide between its northern and southern regions, which extends into healthcare delivery and biomedical research. Medical oncology is particularly affected by this structural imbalance. This paper examines geographic disparities in clinical trial scientific publication output, citation impact, research funding, and collaboration networks in medical oncology between northern and southern Italy. Methods: A narrative bibliometric analysis was conducted using data from PubMed and other institutional databases of Italian Scientific Institutes for Hospitalization and Care. Data from the Italian National Agency for the Evaluation of Universities and Research Institutes, the Alliance Against Cancer, and the Italian Association for Cancer Research were also reviewed. Regional output was compared across two macro-areas, namely north and south Italy. Results: Northern Italian institutions account for a disproportionate share of publications, high-impact citations, and funded research projects. Northern Italy produces an estimated four to six times more medical oncology papers than southern Italy, driven by a higher concentration of cancer institutes, better-funded university hospitals, and stronger multidisciplinary infrastructure than in the south. Clinical trial density is highest in the north compared to the south (0.53 versus 0.02 per 100,000 inhabitants). Conclusions: The north–south divide in Italian oncology research productivity is real, multi-factorial, and persistent. The analysis reveals a substantial gap in research productivity, institutional capacity, and access to clinical trials between the two macro-regions. Targeted policy interventions, including decentralized trial models, dedicated funding streams for southern institutions, and stronger infrastructure for inter-regional collaboration, are urgently needed to ensure representativeness in oncology evidence generation and equitable scientific progress. Full article

Background and Clinical significance: Potassium is one of the most frequently measured laboratory parameters used to assess a patient’s clinical status and is also one of the analytes most commonly affected by preanalytical errors. Case Presentation: A potassium test was ordered for a 63-year-old male patient. The result obtained was 6.4 mmol/L, indicating hyperkalemia, and a medical consultation was recommended in the laboratory report. As the potassium result was inconsistent with the patient’s clinical status, a new blood sample was analyzed the next day. This yielded a result that was 1.3 mmol/L (20%) lower. A detailed interview with the patient and the staff responsible for blood sample collection revealed that the spurious hyperkalemia was most likely caused by prolonged storage of the blood sample in a refrigerator implemented because of high ambient temperatures. Further analysis demonstrated that after storage of blood samples at low temperature, potassium concentration increased significantly on average by 5% and 20% at the 4 h and 8 h time points, respectively. Conclusions: Low temperature and prolonged blood sample storage before analysis significantly affect potassium results. Since even a slight alteration in potassium levels can have a severe impact on a patient’s health and may require immediate action, obtaining accurate potassium results requires ensuring appropriate conditions for sample storage and transport, and proper sample handling. This is particularly important in laboratories serving large geographical areas, where prolonged storage and transportation of blood samples can considerably extend the preanalytical phase. Full article

Background: Population ageing, increasing care demands, and rapid advances in artificial intelligence and robotics have intensified interest in care robots as potential tools to support independent living and complement human caregiving. However, the successful implementation of robotic technologies depends largely on public acceptance, which is influenced by functional, psychological, ethical, cultural, and generational factors. Objective: This study examined generational differences in the acceptance of care robots among Portuguese adults by integrating the Almere Model of technology acceptance with the Katz Index of Activities of Daily Living (ADL) and the Lawton–Brody Instrumental Activities of Daily Living (IADL) Scale. The research sought to determine whether acceptance varies according to generation and the type of caregiving activity performed by the robot. Methods: A cross-sectional quantitative study was conducted using an online questionnaire administered to a purposive sample of 235 adults residing primarily in the Lisbon Metropolitan Area, Portugal. The questionnaire combined constructs from the Almere Model with perceptions of robotic assistance for ADLs and IADLs. Principal Component Analysis, reliability analysis, descriptive statistics, and inferential analyses were performed to examine differences across generational groups. Results: Acceptance of care robots was strongly task-dependent. Participants expressed significantly greater acceptance of robots assisting with instrumental activities, including housekeeping, shopping, transportation, meal preparation, and medication management, than with intimate personal care activities such as bathing, dressing, toileting, feeding, and continence care. Contrary to common assumptions regarding digital natives, Generation Z reported higher levels of fear, discomfort, and perceived intimidation than Generation X and Baby Boomers. Older generations generally demonstrated more pragmatic acceptance of robotic assistance, particularly regarding future support needs associated with ageing. Across generations, respondents preferred robots with more human-like appearances; however, emotional trust remained substantially lower than perceived functional usefulness. Conclusions: The findings suggest that acceptance of care robots is conditional rather than universal and is shaped by the nature of the caregiving task, generational differences, and broader emotional and cultural perceptions of care. Integrating the Almere Model with established ADL and IADL frameworks provides a novel perspective by linking technology acceptance to specific functional domains of caregiving. The results support the view that care robots are more likely to be accepted as complementary tools that enhance human-centred care rather than as substitutes for professional or family caregivers. Given the purposive and geographically limited sample, the findings should be interpreted cautiously and not generalised to the wider Portuguese population. They nevertheless provide valuable implications for the design of socially assistive robots, healthcare practice, and public policy in ageing societies. Full article

Background/Objectives: Severe dengue and dengue–malaria coinfection represent major diagnostic and therapeutic challenges in tropical endemic settings, where overlapping clinical manifestations may delay recognition of deterioration. This study aimed to describe the clinical and epidemiological characteristics of patients with severe dengue, dengue with warning signs, and dengue–malaria coinfection treated at a referral hospital in Montería, Córdoba, Colombia. Methods: A retrospective case series was conducted by reviewing medical records of patients diagnosed with dengue between 2018 and 2023. Cases classified as dengue without warning signs were excluded. The final analysis included patients with dengue-warning signs, severe dengue, and dengue–malaria coinfection. Dengue classification followed the 2009 World Health Organization criteria, and malaria was confirmed by thick blood smear. Sociodemographic, clinical, laboratory, geographic, and outcome-related variables were collected. Descriptive analyses were performed, and selected categorical variables were compared using Fisher’s exact test. Results: Fifty-three patients were included: 25 (47.17%) with severe dengue, 14 (26.42%) with dengue with warning signs, and 14 (26.42%) with dengue–malaria coinfection. Severe dengue was more frequent among females, whereas dengue with warning signs and coinfection predominated in males. Children accounted for the highest proportion of severe dengue cases, while coinfected cases were mainly distributed between childhood and adolescence. Fever was documented in all patients. Edema, elevated hematocrit, severe plasma leakage, and hemodynamic compromise were more frequent among severe dengue cases, whereas myalgia differed significantly across clinical groups. Ten deaths were recorded, six occurring in coinfected patients. Conclusions: Severe dengue and dengue–malaria coinfection are clinically complex conditions with overlapping manifestations and potentially fatal outcomes, highlighting the need for early recognition, differential diagnosis, and close monitoring. Full article

Introduction: Improving adult pneumococcal vaccination is a public-health priority in Romania, and evidence regarding patient-level outcomes following different approaches to physician training remains limited. Materials and methods: This non-randomised, multicentre, quasi-experimental implementation study examined patient-level changes across three geographically distinct Romanian settings between August and November 2025. Physicians in Iași and Dolj counties received in-person training combining medical content with communication techniques based on motivational interviewing, whereas physicians in the webinar group received online medical training without a dedicated communication module. Eligible adult patients completed questionnaires before and after counselling and reported whether they had been vaccinated or had scheduled a vaccination appointment. Results: The analysis included 295 questionnaire pairs from patients nested within 29 physicians. Baseline attitudes differed markedly across settings (composite score of 5.64 in the webinar group, 5.29 in Dolj County, and 4.09 in Iași County; p < 0.001), as did strong baseline vaccination intention (75.6%, 48.1%, and 27.2%, respectively). Using a composite score comprising all seven attitude items, with item 7 reverse-coded and vaccination intention analysed separately, the cluster-robust group-by-time model indicated different mean changes between settings (global p = 0.001): +0.28 in the webinar group, +1.02 in Iași, and +0.60 in Dolj. Strong vaccination intention increased within each setting, but the magnitude of change did not differ between settings (group-by-time p = 0.929). The combined self-reported vaccination-or-scheduling outcome was observed in 81.5% of patients in the webinar group, 49.4% in Iași, and 73.3% in Dolj; after adjustment for baseline intention, there was no longer evidence of an overall group difference (p = 0.651). Discussion and conclusions: Because training approach, delivery modality, geographical setting, physician cohort, and patient population were not independently allocated, and because baseline levels differed markedly between settings, the findings should be interpreted as exploratory implementation patterns rather than causal comparative effects. Full article

Lethal foodborne illness outbreaks represent a critical intersection of public health surveillance, environmental health, and forensic toxicology. When acute gastrointestinal syndromes lead to sudden death, traditional postmortem investigation techniques are often hindered by tissue autolysis and the overgrowth of putrefactive microflora, which complicate conventional microbiological assays. This review establishes a comprehensive framework for chemical forensics by evaluating the utility of stable isotope analysis (SIA) as a supportive, probabilistic chemical proxy to complement traditional epidemiological investigations of postmortem food contamination sources. Following JBI scoping review guidelines and the PRISMA-ScR reporting framework, data from 42 peer-reviewed articles (2000–2026) were charted and synthesized to map natural isotopic variations (δ¹³C, δ¹⁵N, δ¹⁸O, δ²H and δ³⁴S) across both forensic decedents and environmental reservoirs. The findings outline a structured, multi-tissue diagnostic cascade governed by biological metabolic turnover rates: unabsorbed gastric chyme provides a direct chemical match to contaminated source food items within a hyper-acute 0–6 h window; high-turnover visceral matrices (liver, blood plasma) shift to reflect acute exposure profiles within 1–7 days; and continuously fixed keratinized matrices (hair, nails) archive multi-month dietary and transcontinental transit histories. Furthermore, compound-specific isotope analysis (CSIA) of individual amino acids offers unprecedented structural resolution, utilizing the carbon discrimination metric (Δ¹³C_glu-phe) to differentiate pristine agricultural signatures from endogenous metabolic distortions while biochemically verifying pre-mortem physiological stress and hyper-catabolic muscle wasting. Taphonomic thresholds were explicitly defined, establishing that bulk visceral soft tissues remain isotopically stable (±0.3‰) for up to 48 h at room temperature (~21 °C) before microbially induced nitrogen enrichment (δ¹⁵N > +2.8‰) alters native profiles, whereas hair and nail keratin maintain absolute isotopic stability for over 180 days postmortem. When pristine multi-isotope signatures are coupled with mandatory chloroform–methanol lipid extraction and processed through spatial Bayesian assignment models, geographic provenance tracking via environmental isoscapes achieves a predictive accuracy of 97%. This review introduces a standardized environmental health protocol designed to harmonize field environmental sampling with medical autopsies. This protocol provides a legally robust strategy for investigating unresolved lethal foodborne illness case-outbreaks, particularly those involving pediatric mortalities linked to the consumption of counterfeit or fraudulent food products in low- and middle-income countries. Furthermore, it aims to strengthen national and municipal legal frameworks and international biosecurity enforcement. Full article

Background/Objectives: Melioidosis is an environmentally acquired infection caused by Burkholderia pseudomallei (B. pseudomallei). Although historically framed as a tropical disease, evidence indicates that recognized risk can extend beyond classical endemic regions. This narrative review synthesized Digital Object Identifier (DOI)-verified evidence on environmental persistence, climate-sensitive risk, geographic emergence, and One Health preparedness. Methods: Structured narrative searches of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Europe PubMed Central (Europe PMC), Crossref, and publisher records were conducted for literature available up to 19 June 2026. Forty-four DOI-verified sources were retained. Evidence categories were derived inductively by inferential function during thematic synthesis and used as a qualitative interpretive framework, not as a validated quantitative risk score. Results: B. pseudomallei persists in soil and water, survives nutrient limitation, and clusters in environmental microfoci, but the interpretive value of detection depends on viability, exposure context, and diagnostic endpoint. Rainfall, humidity, flooding, and cyclones are associated with incidence, severity, or mobilization in several settings, supporting climate-sensitive risk rather than uniform geographic spread. Case-based evidence is strongest when it separates importation, local acquisition, environmental establishment, source attribution, and animal sentinel signals. Human risk depends on exposure route, host susceptibility, diagnostic recognition, and access to prolonged antimicrobial management, whereas animal evidence is best interpreted as sentinel or common-exposure evidence unless reservoir or direct-transmission data are available. Conclusions: Melioidosis beyond the tropics requires graded evidence interpretation because environmental detection, modeled suitability, animal signals, and human cases support different levels of geographic and One Health inference; this approach links early signals to surveillance while reserving higher-confidence claims for convergent evidence. Full article

Background/Objectives: Croatia is among the European countries with moderately high antibiotic consumption and correspondingly elevated antimicrobial resistance (AMR) rates. National-level surveillance, however, masks substantial county-level heterogeneity that is relevant for targeted stewardship. This study aimed to (i) quantify and statistically test temporal changes in total antibacterial consumption (J01), beta-lactam antibiotics (J01C), and macrolides/lincosamides/streptogramins (J01F) across all 21 Croatian counties between 2017 and 2024, spanning the pre-pandemic, pandemic, and post-pandemic periods, and (ii) characterize geographic disparities that could inform region-specific stewardship interventions. J01C and J01F were selected because they are, respectively, the most heavily consumed and the most steadily rising antibiotic subgroups in Croatia, and both carry direct relevance to the WHO Access, Watch, Reserve (AWaRe) stewardship framework. Methods: A retrospective, registry-based analysis of antibiotic consumption in all 21 Croatian counties was conducted using annual distribution data from the Croatian Agency for Medicinal Products and Medical Devices (HALMED), covering 1 January 2017 to 31 December 2024. Consumption was expressed as defined daily doses per 1000 inhabitants per day (DDD/TID). County-level values for 2017, 2020, 2021, and 2024 were compared using paired Student’s t-tests (confirmed with Wilcoxon signed-rank tests) and a Friedman test across all four time points; national annual means (2017–2024) were compared descriptively against European Union/European Economic Area (EU/EEA) surveillance benchmarks. Results: National J01 consumption declined from 21.16 to 16.96 DDD/TID between 2017 and 2021 (−19.8%) and rebounded to 22.75 DDD/TID by 2024 (+34.1%); the county-level decline and rebound were both statistically significant (paired t-tests, p < 0.001 for each comparison; Friedman χ² = 57.97, p < 0.001). J01C followed the same U-shaped pattern, temporally coincident with the COVID-19 pandemic period (12.59 → 5.13 → 9.05 DDD/TID; all comparisons p < 0.001), whereas J01F rose continuously throughout the study period, without a corresponding dip during that period (2.81 → 3.49 → 4.43 DDD/TID; p < 0.001 for every interval). Croatia’s 2024 mean county-level J01 consumption was significantly above the 2024 EU/EEA population-weighted mean of 18.8 DDD/TID (one-sample t-test, p = 0.016). The sharpest pandemic-era declines and post-pandemic rebounds were concentrated in Adriatic coastal counties (Primorje-Gorski Kotar, Zadar, Šibenik-Knin, and Istria). Conclusions: Total and beta-lactam antibiotic consumption in Croatia followed a U-shaped trajectory temporally coincident with the COVID-19 pandemic period, while macrolide, lincosamide, and streptogramin use rose steadily throughout 2017–2024, a pattern of stewardship concern given that this subgroup is predominantly classified as “Watch” under the WHO AWaRe framework. Coastal counties displayed disproportionate fluctuations, plausibly reflecting seasonal population dynamics not captured by resident-population denominators. AWaRe-stratified, tourism-adjusted, county-level surveillance is recommended to guide targeted stewardship. Full article

Background: ERβ is an estrogen receptor isoform expressed in the normal human colon and has been proposed to act as a tumor suppressor gene. The loss of ERβ expression has been associated with advanced stages of CRC. The aim was to investigate the relationship between ERβ expression and CRC progression, quantifying the difference between tumor tissues and normal controls, and early-stage versus late-stage tumors. Methods: English Medical literature searches were conducted using PubMed, Embase, and Google Scholar up to 31 December 2025 according to PRISMA. Case–control studies comparing ERβ expression in CRC biopsy specimens with that in healthy controls were included. A meta-analysis was performed using Comprehensive Meta-analysis (Version 4). Pooled ORs and 95% confidence intervals were calculated using a random-effects model. Heterogeneity was assessed using the Cochrane Q test and the I² statistic. Publication bias was evaluated. Results: Six studies, representing 13 sub-studies, were selected according to the inclusion criteria, involving 1183 patients and 1000 normal mucosa/tumor early-stage patients. The OR for ERβ expression was 0.211 (95%CI: 0.122–0.363), significantly lower in advanced tumor stages than in normal mucosa and early tumor stages (p < 0.0001). Positivity rates were 76.40% in controls and early-stage tumor patients versus 51.31% in tumor patients (all stages). Heterogeneity was high (I² = 78%), but sensitivity analysis confirmed the robustness of the results. Publication bias was not significant. The studies used different methods and positivity cut-off values, with high heterogeneity, and were from only five countries, indicating the possibility of variation in results across other geographical areas or ethnic groups. Conclusions: ERβ expression is significantly lower in CRC tissues than in healthy controls and progressively decreases as the disease progresses. This finding underscores ERβ’s potential role as a prognostic factor and highlights the viability of ERβ activation as a novel therapeutic strategy. Full article

Background/Objectives: Tinnitus is a significant global health concern with substantial geographic variation in prevalence. However, data on tinnitus epidemiology in southern Saudi Arabia remain limited, despite emerging evidence suggesting a relatively high regional burden. Therefore, this study aimed to estimate the prevalence of tinnitus and identify its epidemiological determinants among adults in southern Saudi Arabia. Methods: A community-based cross-sectional study was conducted among 501 adults from four regions in southern Saudi Arabia (Jazan, Aseer, Najran, and Al-Baha). Data were collected on sociodemographic characteristics, chronic medical conditions, noise exposure patterns, and clinical features of tinnitus. Multivariable logistic regression analysis was used to identify factors independently associated with tinnitus. Results: The overall tinnitus prevalence was 31.1% (156/501). The mean age of participants was 30 ± 11 years, and 61.7% were female. Bilateral tinnitus was the most common (47.4%). Symptom duration was reported as <3 months in 31.4% of cases and between 3 months and 1 year in another 31.4%. The mean severity score was 3.7 ± 1.9. Most affected individuals (76.9%) did not seek medical care. Primary exacerbating factors included sleep deprivation (41.7%), noise exposure (41.0%), and stress (39.1%). Multivariable analysis identified two significant independent predictors: weekly noise exposure exceeding 5 h (odds ratio [OR] = 2.14; 95% confidence interval [CI]: 1.34–3.42; p = 0.001) and higher body mass index (BMI) (OR = 1.06; 95% CI: 1.02–1.10; p = 0.005). The most commonly associated underlying conditions were ear infections (25.6%) and hearing loss (24.4%). Conclusions: Tinnitus prevalence in southern Saudi Arabia (31.1%) substantially exceeds global estimates. Noise exposure and elevated BMI are key modifiable factors associated with tinnitus. The substantial healthcare gap, with most affected individuals not seeking treatment, represents a critical public health challenge requiring targeted prevention programs, provider education, and improved access to evidence-based care. Full article

Background: Geographic peripherality in Israel is linked to poorer health outcomes and may disproportionately affect patients requiring chronic therapies such as hemodialysis (HD). Though malnutrition and inflammation are strong predictors of morbidity and mortality in HD patients, regional differences in nutritional status and dietary adherence are unclear. Objectives: To examine the association between peripherality and malnutrition risk, dietary intake, and adherence to nutrition guidelines among Jewish Israeli adults on HD. Methods: In this multi-center, cross-sectional study, 154 adult Jewish HD patients were recruited from the northern periphery (n = 66) and central regions of Israel (n = 88). Demographic, clinical, laboratory, and anthropometric data were obtained from medical records. Nutrient intake was assessed using the multi-pass 24 h dietary recall method. Malnutrition risk was classified using BMI and serum albumin; the C-reactive protein-to-albumin ratio (CAR) was also calculated. Adherence to International Society of Renal Nutrition and Metabolism (ISRNM) dietary guidelines was evaluated. Between-group comparisons and multivariable regression analyses were conducted. Results: Overall, participant characteristics were similar between groups; however, coronary heart disease prevalence and dialysis vintage were higher in the periphery. Participants from the periphery had lower serum albumin, blood urea nitrogen, hemoglobin, and blood pressure, but higher LDL cholesterol. Sodium intake was significantly higher and adherence to ISRNM sodium guidelines markedly lower in the periphery. In multivariable analysis, peripherality reduced the odds of meeting sodium recommendations by 92.8%. Adherence to energy and protein guidelines was low in both groups. Nearly half of participants had some level of elevated malnutrition risk using the categorized variable, and an overall difference in the categories of malnutrition risk was detected, driven by the increase in the moderate risk category in the periphery. The composite malnutrition risk variable (any increase in risk vs. no increase in risk) did not differ by peripherality. Peripherality was independently associated with higher percent ideal body weight (%IBW), but not with CAR. Conclusions: Peripherality among Jewish Israeli HD patients is associated with differences in nutrition biomarkers, cardiovascular burden, and dietary adherence, especially sodium intake. Interventions considering peripherality should be explored. Full article

Background: Chatbots are becoming increasingly valuable in clinical settings, offering rapid access to medical information, aiding documentation, and improving perioperative patient education. Their adaptability makes them promising tools for personalized perioperative risk stratification (PRS) and anesthesia planning, but their definitive role remains uncertain. We aimed to evaluate chatbot performance in PRS compared to standard clinical judgment and to assess the certainty of the evidence supporting their use. Methods: This systematic review (PROSPERO ID: CRD42025642357) followed PRISMA extended and PRISMA-S guidelines. The population was defined according to the PICO framework: we included adult surgical patients undergoing anesthesia assessment (P), evaluated with LLM-based chatbots for perioperative risk stratification and anesthesia planning (I), compared with traditional clinician assessment (C), and extracted performance metrics (O). Comprehensive searches of PubMed, MEDLINE, Scopus, Embase, Google Scholar, Open Gray, ClinicalTrials.gov, WHO ICTRP, and Cochrane Library Central were conducted through January 2026. Risk of bias and study quality were assessed using PROBAST-AI, RoB-2, and ROBINS-I. Certainty of the evidence was assessed using GRADE system. A random-effects meta-analysis of pooled chatbot accuracy was performed, with subgroup analyses by ASA status and perioperative risk stratification. A sensitivity analysis was performed with a leave-one-out exclusion test. Results: Eleven studies published between 2023 and January 2026 were included (N = 227,059 patients). Five prospective cohorts, two large retrospective cohorts, one randomized non-inferiority trial, and three non-clinical or mixed-methods studies were found. Meta-analysis showed that the pooled accuracy of LLM-based chatbots for AI–clinician concordance in perioperative risk stratification and ASA classification was 0.90 [95% CI: 0.42–0.99; 95% prediction interval 0.03–1.00]. Subgroup analyses indicated that the ASA status prediction subgroup reached a pooled accuracy of 0.91 (95% CI: 0.46 to 0.99), whereas the exploratory perioperative risk stratification subgroup showed an accuracy of 0.73 (95% CI: 0.10 to 0.98). Performance decreased with increasing patient complexity. Evidence is limited by small sample sizes, extreme sample size skew toward a single center, geographic bias, inconsistent outcome definitions and performance metrics, and incomplete reporting of adverse events. Most studies lacked prospective trial registration or robust control for confounding, and publication bias cannot be excluded. Conclusions: LLM-based chatbots show promising performance in routine perioperative risk stratification but remain unreliable in complex cases, with potential safety concerns. Given the overall very low GRADE certainty of evidence, these tools should be used as clinician-supervised decision support aids for routine ASA assessment, and should not be relied upon for autonomous use in complex cases or for general perioperative risk stratification. Other: This research received no external funding. PROSPERO ID: CRD42025642357. Full article

Background/Objectives: No study has investigated the effect of the catechol-O-methyltransferase (COMT) Val158Met rs4680 polymorphism in cognitive and executive performance in migraine. The current study investigated the potential influence of the Val158Met rs4680 polymorphism in cognitive performance/executive function in women with migraine. Methods: One hundred and forty women with migraine (70 chronic and 70 episodic) and 70 healthy controls completed the following neurocognitive tests (D2 Attention test and Rey–Osterrieth Complex Figure) and executive functions (subtest “Digits D/R/I” of the Wechsler Adult Intelligence Scale WAIS-IV battery for, the 5-Digit test, the Symbol Search for and the Zoo Test) for evaluating selective attention, visual perception, working memory, mental inhibition, processing speed and planning/decision making, respectively. Thus, three genotypes (Val/Val, Val/Met, and Met/Met) of the Val158Met polymorphism were identified by polymerase chain reaction. The effect of group and Val158Met genotype in neurocognitive tests and executive functions was evaluated with multivariate analysis of covariance (MANCOVA). Results: The MANCOVA revealed a significant Val158Met polymorphism* group interaction on neurocognitive performance (Wilk’s λ = 0.393, F [76,688] = 2.425, p < 0.001, n2p = 0.208, 1 − β = 0.999), not influenced by age (Wilk’s λ = 0.920, F [19,174] = 0.743, p = 0.734, n2p = 0.035, 1 − β = 0.120), educational level (Wilk’s λ = 0.875, F [19,174] = 1.024, p = 0.440, n2p = 0.047, 1 − β = 0.190) and prophylactic medication (Wilk’s λ = 0.855, F [19,174]= 1.000, p = 0.467, n2p= 0.145, 1 − β = 0.686). Post hoc analyses revealed that women with chronic migraine with the Met/Met genotype exhibited domain-specific better performance (i.e., higher selective attention, visuospatial memory) and executive functioning (i.e., working memory, planning/decision making) than those women with chronic migraine carrying Val/Val or Val/Met genotypes. Conclusions: We found an association of the Met/Met genotype with neurocognitive performance/executive functioning, particularly in women with chronic migraine since women with chronic migraine carrying the Met/Met genotype showed domain-specific better cognitive performance/executive functioning than those with the Val allele. Future studies including large sample sizes from different geographic locations are needed to better generalizability and validity of the current results. Full article

Background: Health accessibility is a key determinant of equitable cancer care. In many countries, specialized oncology services are concentrated in urban and socioeconomically advantaged regions, forcing many patients to travel long distances for treatment. Consequently, geographic and social characteristics may be impactful in determining cancer healthcare outcomes. Objective: The aim of this study was to evaluate the association between the municipal-level Social Progress Index (SPI) and geographic travel burden, stage at diagnosis, treatment, and survival in patients with pancreatic cancer in São Paulo state, Brazil. Methods: We conducted a population-based study using data from “Fundação Oncocentro” on adults with pancreatic adenocarcinoma (2005–2025). The SPI (0–100 scale), a composite measure of municipal social and environmental development, was the primary exposure. It is structured into 3 dimensions and 12 components: Basic Human Needs (nutrition, medical care, water and sanitation, housing, safety); Foundations of Well-being (education, information access, health, environmental quality); and Opportunity (rights, freedom of choice, social inclusion, higher education). Municipal residence and cancer center locations were geocoded, and travel distance (km) was estimated. Multivariable Cox, logistic, and linear regression models assessed associations between SPI and overall survival, stage IV at diagnosis, surgery, and travel distance. Results: A total of 13,478 patients were included (mean follow-up 15.1 ± 27.2 months; mean age 62.3 years; 50.4% male). Stage IV disease was frequent (46.3%), and surgery was performed in 33% of cases. Over half of patients (53.2%) traveled more than 10 km for treatment. Increasing SPI was strongly associated with shorter travel distance (β −62.6 km per SPI unit; p < 0.001) and higher odds of surgery (OR 1.04; p < 0.001) and remained independently associated with a higher likelihood of undergoing surgical treatment (adjusted OR 1.04; p < 0.001). The proportion of stage IV disease did not decrease with increasing SPI and was slightly higher in the highest quartile (49.3%). In survival analysis, SPI demonstrated a protective effect in univariate modeling (HR 0.987; p < 0.001), but lost significance in multivariable analysis (p = 0.125). Travel burden was not retained as an independent predictor of survival after adjustment. Conclusions: Municipal-level SPI was a strong determinant of healthcare access and the likelihood of receiving surgical treatment for pancreatic cancer. Social and geographic vulnerability directly influence care pathways, revealing structural inequities in access to treatment. SPI-based stratification may serve as a practical tool to identify priority regions for transport support and equitable allocation of oncology services. Full article

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions, and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified that selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias are amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25, respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus, oesophageal cancer, and self-harm, while females are more vulnerable to cerebrovascular and chronic obstructive pulmonary diseases. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts, and evidence on the impact of interventions to be made available widely. Full article