Search Results (3,225)

Population-based evidence on sleep quality in Kazakhstan remains limited. This study describes sleep quality as a multidimensional construct among adults in Kazakhstan using data collected during the first national survey wave after the adoption of a single national time zone. The survey was designed as a national post-transition baseline assessment and not as an evaluation of the causal impact of the time-zone reform. Associations with socio-demographic, behavioural, clinical, and regional factors were examined. We conducted a nationally representative cross-sectional survey of adults aged 18–69 years in Kazakhstan from May to October 2025 using a multistage stratified cluster design. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined as a global PSQI score > 5. Complete PSQI data were available for 5872 participants. Descriptive analyses examined the global PSQI score and the seven component scores. Survey-weighted multivariable logistic regression was used to identify factors independently associated with poor sleep quality. The weighted prevalence of poor sleep quality was 28.1%, and the weighted mean global PSQI score was 4.43. The greatest component burden was attributable to sleep latency (mean 0.87), subjective sleep quality (0.82), and sleep disturbances (0.80), whereas use of sleep medication contributed minimally (0.11). Poor sleep quality was more common among women, older adults, urban residents, and participants with diabetes, current smoking, heavy episodic drinking, and depressive symptoms. In the adjusted model, female sex (aOR 1.37, 95% CI 1.19–1.57), age 55 years or older versus 18–24 years (1.98, 1.53–2.55), diabetes (1.47, 1.22–1.78), current smoking (1.28, 1.10–1.50), heavy episodic drinking (1.43, 1.16–1.76), and depressive symptoms (4.26, 3.52–5.15) were independently associated with higher odds of poor sleep quality. Rural residence was inversely associated with the outcome (0.71, 0.61–0.84). Compared with the North, higher odds were observed in the Central region (2.00, 1.46–2.74), East (1.94, 1.48–2.53), West (1.48, 1.17–1.88), and Almaty city (2.18, 1.72–2.76). Poor sleep quality is common among adults in Kazakhstan and is characterized primarily by difficulties with sleep initiation, perceived sleep quality, and nocturnal disturbances. The findings provide national post-transition baseline evidence and suggest that sleep health surveillance in Kazakhstan should prioritize demographic, mental health, behavioural, and regional inequalities while avoiding causal interpretation of the time-zone reform itself. Full article

Background: Advanced chronic kidney disease (CKD) and cardiovascular comorbidities frequently coexist in patients with multiple myeloma and are particularly common among hospitalized patients. However, the relationship between common cardiovascular comorbidities and advanced CKD in routine clinical practice remains incompletely characterized. Methods: We conducted a retrospective single-center cohort study including 137 hospitalized patients diagnosed with multiple myeloma between January 2015 and February 2026. Demographic, clinical, and laboratory data were extracted from electronic medical records. Advanced CKD was defined as eGFR < 30 mL/min/1.73 m², calculated using the CKD-EPI 2021 equation. Patients with isolated acute kidney injury were excluded. Cross-sectional associations between cardiovascular comorbidities and advanced CKD were assessed using logistic regression models. Results: The median age was 69 years (IQR 63–77), and 56.9% of patients were women. Renal impairment was common, with a median creatinine level of 2.82 mg/dL and a median eGFR of 22.4 mL/min/1.73 m². Advanced CKD was identified in 55 of 116 patients (47.4%) with available CKD classification. Cardiovascular comorbidities were common, including hypertension (42/55, 76.4%), diabetes mellitus (18/55, 32.7%), myocardial ischemia (41/55, 74.5%), and heart failure (25/55, 45.5%). In univariate analysis, atrial fibrillation showed a significant cross-sectional association with advanced CKD (OR 4.43, 95% CI 1.30–15.07, p = 0.017), as was myocardial ischemia (OR 2.89, 95% CI 1.07–7.80, p = 0.039). In multivariable analysis, atrial fibrillation demonstrated a trend toward an association with advanced CKD but did not remain statistically significant after adjustment. Conclusions: Advanced CKD and cardiovascular comorbidities frequently coexist in hospitalized patients with multiple myeloma. Atrial fibrillation and myocardial ischemia were associated with advanced CKD in univariate analyses; however, these associations were attenuated after multivariable adjustment. Overall, these findings provide insight into the coexistence of advanced CKD and cardiovascular comorbidities in hospitalized patients with multiple myeloma. Full article

Background/Objectives: Acute respiratory failure (ARF) encompasses heterogeneous etiologies, and early bedside prognostication remains challenging. Cytokines and chemokines may capture underlying biological severity and identify high-risk patients. We evaluated whether admission cytokine/chemokine profiles add incremental prognostic value over clinical risk factors in unselected ARF patients. Methods: This prospective, single-center cohort study enrolled adult patients admitted to medical ICUs with ARF requiring high-intensity respiratory support. Plasma samples were collected within 24 h of ARF diagnosis, and 19 cytokines/chemokines were measured using multiplex immunoassays. The primary outcome was ICU mortality. Univariate and multivariable logistic regression models assessed associations between biomarkers and mortality, with discrimination evaluated by the area under the receiver operating characteristic curve (AUC). Results: Among 41 patients, 15 (37%) died in the ICU. Non-survivors had higher rates of immunosuppression (80% vs. 38%, p = 0.010) and hematologic malignancy (67% vs. 31%, p = 0.026). CXCL10 (IP-10), IL-18, and CCL2 (MCP-1) were significantly higher in non-survivors, and IL-1Ra showed a marked numerical increase with a significant univariable association with ICU mortality, despite comparable severity scores and oxygenation indices at admission. A clinical core model (SOFA, immunosuppression, hematologic malignancy) achieved an AUC of 0.74 (95% CI 0.58–0.90); adding cytokines improved discrimination modestly (AUC 0.76–0.80). In highest-quartile survival analyses, IL-1Ra (p = 0.002), CXCL10 (p = 0.005), and CCL2 (p = 0.009) demonstrated significant survival separation. Conclusions: At ICU admission, CXCL10 (IP-10), IL-18, CCL2 (MCP-1), and IL-1Ra showed exploratory associations with ICU mortality and were prioritized as candidate inflammatory biomarkers. These findings require validation in larger multicenter cohorts. Full article

Background: Heart failure (HF) remains a major complication of acyanotic congenital heart disease (CHD) in children. Evidence integrating clinical and echocardiographic variables for HF severity stratification in pediatric acyanotic CHD remains limited. This study aimed to identify factors associated with moderate HF and develop an exploratory internally validated prediction model. Methods: This retrospective single-center outpatient study included 219 children aged 0–16 years with acyanotic CHD, identified from medical records spanning January 2023 to December 2025. Moderate HF was defined as Ross score 7–9 (≤5 years) or NYHA class III (>5 years). Multivariable analysis was performed using Firth’s penalized logistic regression. Internal validation used bootstrap optimism correction and leave-one-out cross-validation (LOOCV). Model discrimination was assessed using area under the receiver operating characteristic curve (AUC). Results: Moderate HF was identified in 131 patients (59.8%). LV remodelling defined by LVIDD z-score > +2 (adjusted OR 3.70, 95% CI 1.22–11.24; p = 0.021) and higher mean pulmonary arterial pressure (MPAP) (adjusted OR 1.03 per mmHg, 95% CI 1.00–1.06; p = 0.049) were independently associated with moderate HF. Premature birth showed an inverse association with moderate HF (adjusted OR 0.25, 95% CI 0.13–0.48; p < 0.001). The exploratory five-variable model demonstrated acceptable discrimination (apparent AUC 0.780, 95% CI 0.728–0.849; bootstrap-corrected AUC 0.760; LOOCV AUC 0.749, 95% CI 0.681–0.811), with adequate calibration. An MPAP threshold of ≥26.4 mmHg yielded 78.6% sensitivity for moderate HF identification. Conclusions: LV remodelling and elevated MPAP were independently associated with moderate HF in children with acyanotic CHD. The exploratory internally validated model demonstrated acceptable discrimination using routinely available variables. This model is exploratory and not yet ready for clinical use; prospective multicenter external validation is required before any clinical implementation. Full article

Background/Objectives: Children of families facing unmet social needs experience higher rates of adverse outcomes compared to those not experiencing unmet social needs. This study aimed to identify factors associated with families’ unmet social needs as reported by parents or guardians at their children’s primary care visits. Methods: This cross-sectional study recruited English-speaking primary caregivers of children less than 18 years of age from the Southwestern Ohio Ambulatory Research Network (SOAR-Net) who were surveyed between January 2023 and August 2024. Surveys included the Maternal Social Support Index, Social Capital Scale, RAND Depression Screener, Children with Special Health Care Needs Screener, Medical Expenses of Children Survey, a 10-item social needs screener, and demographics. Data were analyzed with chi-square or Fisher’s exact tests, adjusted logistic regression, and ANOVA. Results: Among 1167 respondents (78% response rate), 1114 provided complete data. Primary caregivers were predominantly mothers (79.9%) or fathers (13.6%), White (72.0%) or Black (16.0%), and had an associate’s degree or less (65.1%). The mean (SD) index child’s age was 6.4 (5.3) years, and 52.4% were female. Underinsurance, positive depression screens, and poor child health were positively associated with unmet social needs. Higher scores for social support and social capital were associated with fewer social needs. Multinomial logistic regression revealed significant relationships with reporting two or more unmet social needs with the following variables: childhood underinsurance, household annual income < $50,000, positive depression screens, raising a child with a chronic health condition, and Black race/ethnicity. Conclusions: Several significant social factors were independently associated with a greater number of unmet social needs. These findings highlight the complex interplay among social factors in children’s healthcare. Future research should explore the putative longitudinal stability of these relationships. Full article

Background: The COVID-19 pandemic was associated with extensive empirical antibiotic exposure despite the predominantly viral etiology of the disease. Evaluating patterns of azithromycin use, prescribing determinants, and appropriateness provides insight into real-world antibiotic use under conditions of diagnostic uncertainty. Methods: We performed a retrospective cohort study including 3200 adult patients hospitalized with laboratory-confirmed COVID-19 at the General Hospital in Ferizaj between June 2020 and June 2022. Demographic characteristics, comorbidities, markers of disease severity, laboratory parameters, and antibiotic exposure were extracted from medical records. Azithromycin prescriptions were classified as appropriate, potentially appropriate, or inappropriate based on predefined clinical and laboratory indicators suggestive of bacterial co-infection. Drug utilization patterns, temporal trends, and independent determinants of inappropriate prescribing were assessed using descriptive analyses and multivariable logistic regression modeling. Results: Among 3200 hospitalized patients, 1968 (61.5%) received azithromycin. Of these prescriptions, 612 (31.1%) were classified as appropriate, 418 (21.3%) as potentially appropriate, and 938 (47.6%) as inappropriate. The proportion of inappropriate use decreased over time, from 52.4% in 2020–2021 to 38.7% in 2022 (p < 0.001). However, a substantial proportion of prescriptions remained inappropriate throughout the study period. In multivariable analysis, absence of laboratory markers suggestive of bacterial infection (OR 2.41; 95% CI 1.98–2.93), concomitant use of more than one antibiotic (OR 1.67; 95% CI 1.32–2.11), and lower clinical severity at admission (OR 1.54; 95% CI 1.21–1.95) were independently associated with inappropriate azithromycin prescribing. Conclusions: Azithromycin use was frequent among hospitalized adults with COVID-19, and a considerable proportion of prescriptions lacked clinical or laboratory justification. Although prescribing patterns changed over time, the persistence of inappropriate use highlights ongoing challenges in aligning antibiotic use with emerging evidence. These findings contribute to the understanding of antibiotic utilization patterns in acute care settings and underscore the importance of integrating objective diagnostic indicators into antimicrobial decision-making to strengthen stewardship practice. Full article

Background: Hypertension remains one of the leading modifiable risk factors for cardiovascular diseases globally, yet blood pressure control remains suboptimal in many low- and middle-income countries. Understanding the prevalence of uncontrolled hypertension and its associated factors is important for improving treatment outcomes, particularly in rural primary health care settings. Methods: A cross-sectional study was conducted among 103 hypertensive patients receiving follow-up care at a rural community health centre in the Eastern Cape Province of South Africa between August and October 2024. Sociodemographic, lifestyle, and clinical information were collected using a semi-structured questionnaire and medical record review. Medication adherence was assessed using the Hill–Bone Compliance to High Blood Pressure Therapy Scale. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Associations between explanatory variables and uncontrolled hypertension were analysed using chi-square tests and multivariable logistic regression. Results: The mean age of participants was 63 ± 13 years, and 65% were female. The prevalence of uncontrolled hypertension was 63.1% (65/103), while 36.9% (38/103) achieved blood pressure control. The median systolic blood pressure was 149 mmHg (IQR: 135–163) and the median diastolic blood pressure was 84 mmHg (IQR: 76–89). Low medication adherence was significantly associated with uncontrolled hypertension (OR = 4.20, 95% CI: 1.75–10.09, p = 0.001). Forgetfulness and non-use of reminders were common barriers to adherence. Conclusions: Uncontrolled hypertension remains highly prevalent among treated patients in this rural setting. Low medication adherence was significantly associated with uncontrolled hypertension, suggesting that adherence support strategies warrant further investigation in similar resource-limited primary health care settings. Full article

Background: Insomnia is common among people with mental health conditions and can exacerbate symptoms, impair functioning and negatively impact treatment outcomes. Community mental health services require practical data to quantify the burden of insomnia in routine care and to identify groups at a higher risk of experiencing clinically significant insomnia. Methods: We conducted a retrospective analysis of anonymized routinely collected clinical data from adult psychiatric outpatients attending the Community Mental Health Center in Bra (Department of Mental Health, Asl Cuneo 2, Italy). Consecutive patients were included over a three-month period (1 September to 30 November 2025). Insomnia severity was assessed using the Insomnia Severity Index (ISI). Diagnoses were established by psychiatrists using the Structured Clinical Interview for DSM-5 (SCID-5). Results: The sample included 506 patients (mean age: 45.1 ± 16.7 years; 265 women, 52.4%). The mean ISI total score was 12.18 ± 6.99. Clinically significant insomnia (ISI ≥ 15) was present in 205 out of 506 patients (40.5%), while severe insomnia (ISI ≥ 22) was present in 55 out of 506 patients (10.9%). The ISI score differed across diagnostic groups (ANOVA, F(8, 497) = 2.82, p = 0.0046, η² = 0.043). Post hoc comparisons revealed higher ISI scores in patients with depressive disorders than in those with anxiety disorders (Tukey, p = 0.0056). In a multivariable logistic regression model (outcome: ISI score of at least 15), adjusted for age, sex, education and the complexity of concurrent psychotropic medication (number of medication classes), depressive disorders were associated with clinically significant insomnia (OR: 1.99; 95% CI: 1.07–3.73). Attention deficit hyperactivity disorder (ADHD) also showed higher odds (OR: 3.64; 95% CI: 1.26–10.55). Medication complexity was also associated with an ISI score of at least 15 (OR: 1.43 per additional class; 95% CI: 1.16–1.77). In a sensitivity model additionally adjusting for benzodiazepine prescription (yes/no), benzodiazepine prescription was associated with ISI ≥ 15 (OR 1.82; 95% CI 1.13–2.95), while the estimate for medication complexity was attenuated using this association (OR 1.17; 95% CI 0.90–1.53). The eating disorders group was excluded from multivariable models due to the very small sample size (n = 4). Conclusions: Clinically significant insomnia was prevalent among this sample of psychiatric outpatients, with modest differences in insomnia severity across diagnostic groups. Sensitivity analyses suggested that the signal of medication complexity may be partly accounted for by benzodiazepine prescribing, supporting the cautious interpretation of medication-related correlates in routine cross-sectional data. These findings support routine insomnia screening in psychiatric outpatient care, while prospective studies are needed to clarify directionality and clinical implications. Full article

Background and Objective: Perioperative antibiotics are widely used in pediatric surgical practice; however, inappropriate selection and prolonged use may contribute to antimicrobial resistance and unnecessary exposure. Appropriate use of perioperative antibiotics is essential to prevent surgical site infections while minimizing antimicrobial resistance, adverse drug reactions, and unnecessary healthcare costs. Despite existing international recommendations, deviations from guideline-based practice remain frequent in pediatric surgical settings. This study aimed to describe patterns of perioperative antibiotic use and assess the appropriateness of prescribing practices in a tertiary care setting, and to identify factors associated with inappropriate antibiotic use. Methods: A retrospective pharmacoepidemiological study was conducted by reviewing medical records of pediatric patients admitted to a tertiary care hospital in Kosovo between January 2022 and December 2025 (data lock: December 2025). A total of 650 patients aged 0–18 years who underwent surgical interventions and received perioperative antibiotics for prophylaxis or empirical treatment (defined as antibiotic therapy initiated in the presence of suspected infection) were included. Data collected comprised demographic characteristics, surgical diagnoses, type of surgery, antibiotics prescribed, weight-adjusted dosing, route of administration, timing of initiation, and duration of therapy. Appropriateness of antibiotic use was evaluated based on available documentation and compliance with WHO (2018) and CDC (2017) guidelines regarding indication, antibiotic selection, dosage, timing, and duration. Statistical analyses included descriptive statistics, chi-square tests, and multivariable logistic regression to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs), with statistical significance set at p < 0.05. Results: Among the 650 patients, 378 (58.2%) were male and 272 (41.8%) were female, with a mean age of 6.8 ± 4.3 years. The most common types of surgery were abdominal (35.7%), otorhinolaryngological (29.4%), urological (19.1%), and orthopedic (15.8%). Perioperative antibiotics were administered predominantly for prophylaxis (91.5%), while 8.5% of patients received empirical treatment. The most frequently prescribed antibiotics were cefazolin (42.6%), ceftriaxone (34.8%), ampicillin/sulbactam (12.3%), and gentamicin (6.1%). Notably, ceftriaxone was frequently prescribed for prophylactic purposes despite international recommendations generally favoring narrow-spectrum first-line agents for perioperative prophylaxis. Intravenous administration was used in 87.9% of cases. Antibiotic duration was ≤24 h in 61.2% of patients, whereas 38.8% received antibiotics for more than 24 h. Overall, appropriate antibiotic use was identified in 62.9% of cases, while 37.1% were classified as inappropriate. Prolonged antibiotic use beyond 24 h (adjusted OR = 3.87; 95% CI: 2.68–5.58; p < 0.001) and ceftriaxone use (adjusted OR = 2.41; 95% CI: 1.63–3.55; p < 0.001), were independently associated with inappropriate antibiotic use. Conclusions: Perioperative antibiotic use in pediatric tertiary care is highly prevalent, with more than one-third of prescriptions not fully aligned with international recommendations. Prolonged antibiotic duration and the preferential use of broad-spectrum agents, particularly ceftriaxone, were the factors most strongly associated with inappropriate prescribing patterns. These findings highlight the need for improved adherence to guideline-based perioperative antibiotic protocols; however, causal inferences regarding stewardship interventions cannot be drawn from this retrospective study. The findings should be interpreted within the limitations inherent to retrospective observational studies. 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

Background: Systemic lupus erythematosus (SLE) is associated with an increased burden of cardiovascular disease (CVD), driven by dyslipidemia, hypertension, obesity, inflammation, and treatment. These factors can impact patient quality of life (QoL) by limiting physical activity. Objectives: To characterize lipid abnormalities as CVD risk factors in a Saudi SLE cohort and assess associations between lipid profile, SLE features, treatment, and patient-reported outcomes of physical activity. Methods: A cohort of adult SLE patients followed at King Saud University Medical City since 2021 was analyzed. Demographics, lipid profiles, blood pressure, BMI, SLEDAI-2K, SDI, disease duration, and treatment data were collected. Physical function and quality of life were assessed using the LupusQoL and PROMIS Physical Function T scores. Univariate and multivariate logistic regression analyses were conducted to identify associations between lipid abnormalities, SLE-related factors, and QoL physical activity measures. Results: A cohort of 169 patients (88.2% female, mean age 39.3 ± 12.4 years) was evaluated to assess the presence of dyslipidemia (23.7%), obesity (BMI ≥ 25, 66.3%), and hypertension (≥130/80 mmHg, 26.0%). Mean SLE duration was 9.2 ± 7.7 years and mean SLEDAI-2K was 11.0 ± 7.0. Among these patients, 52.7% used steroids, 88.2% used antimalarial drugs, and 53.8% used immunosuppressives. Dyslipidemia was associated with lower LupusQoL physical scores (adjusted OR 0.986; 95% CI 0.972–1.000; p = 0.0446). No significant associations were found between lipid levels and the PROMIS Physical Function T score. Conclusions: In this Saudi SLE cohort, dyslipidemia and other modifiable CVD risks were common. Dyslipidemia correlated with poorer LupusQoL-specific physical scores, which highlights the importance of lifestyle changes in patients with SLE. Full article

Background/Objectives: Effective communication between medical practices and community pharmacists is essential for safe and efficient outpatient care, yet quantitative evidence from the perspective of community pharmacies regarding the frequency, content, and efficiency of routine pharmacist–physician communication in Germany is limited. This study aimed to investigate, from the perspective of community pharmacies, the reasons for and outcomes of initiating contact with medical practices following the submission of patient prescriptions in routine outpatient care. Methods: In this observational study, 45 community pharmacies in Leipzig and the surrounding region (Germany) documented simultaneously all contacts with medical practices related to prescriptions over a 14-day period (November 2023) using a standardized documentation form. Data included reasons for contact, communication channels, number of contact attempts, outcomes, satisfaction ratings, and case duration. Multivariable linear regression was used to identify factors associated with satisfaction with contact outcomes, and ordinal regression to examine determinants of case duration. Results: In total, 498 documented contacts were analyzed. The most frequent reasons for contact were drug availability issues and formal or content-related prescription errors. Consultations related to drug interactions or contraindications were rare. Overall satisfaction with contact outcomes was high, but lower satisfaction was associated with repeated contact attempts, non-acceptance of pharmacists’ recommendations, and contacts related to formal prescription errors. Case resolution was faster when fewer contact attempts were required and when communicating with general practices rather than specialist practices. Conclusions: Pharmacy-initiated communication with medical practices in outpatient care is largely driven by administrative and logistical issues rather than clinical consultations. Improving prescription quality, enhancing transparency of drug availability, and strengthening efficient communication pathways may reduce workload and increase satisfaction. Full article

China’s low-altitude economy (LAE) is moving from policy experimentation to coordinated industrial deployment, yet existing assessments often treat the LAE as a homogeneous sector or equate aircraft capability with deployment readiness. This study develops a scenario-gated sustainability readiness framework for six representative LAE and urban air mobility (UAM) scenarios in China: emergency medical logistics and disaster response, infrastructure inspection and public-service monitoring, urban instant logistics, airport shuttle and intermodal passenger transfer, urban air taxi, and low-altitude tourism. The proposed framework consists of a scenario layer, an eight-dimensional readiness layer, and a decision layer integrating 0–4 ordinal scoring, evidence-confidence tagging, non-compensatory gate conditions, and readiness classification. The eight dimensions cover mission and demand fit; airspace and traffic controllability; infrastructure and site readiness; digital communication, navigation, surveillance, and data security; vehicle, energy, and environmental performance; weather and route-environment robustness; workforce and organizational readiness; and social acceptance and legal legitimacy. The illustrative application indicates that infrastructure inspection is the only routine scaling candidate; emergency medical logistics and urban instant logistics are suitable for bounded routine operation; airport shuttle and tourism should remain controlled pilot candidates; and open-network urban air taxi is still at the pre-pilot stage. The study contributes a scenario-based deployment logic for sustainable aviation and UAM governance. Full article

This study investigates data augmentation as a strategy for addressing dataset scarcity in Internet of Medical Things (IoMT) cybersecurity and improving intrusion-detection system performance. Four augmentation methods—Rule-Based, Tabular Variational Autoencoder (TVAE), Conditional Tabular Generative Adversarial Network (CTGAN), and Gaussian Copula—were applied to two publicly available IoMT datasets (ECU-IoHT and WUSTL-EHMS) to generate augmented training data with differing class distributions and feature characteristics. Eleven machine learning algorithms were evaluated using Matthews Correlation Coefficient (MCC), F1-score, accuracy, and error-based metrics. Results showed consistent performance improvements across all evaluated models relative to the baseline datasets. The Rule-Based method produced the strongest overall results, achieving the highest MCC (0.9757), F1-score (99.19%), and accuracy (99.18%) with LightGBM, alongside low false-positive and false-negative rates. Among the generative approaches, TVAE delivered the strongest overall practical performance (F1-score = 96.94%, accuracy = 96.92%), while CTGAN achieved a marginally higher MCC (0.9047) and also produced competitive results with balanced class representation. Gaussian Copula generated the weakest overall outcomes, primarily due to highly skewed class distributions. Traditional models, such as Logistic Regression and Naive Bayes, recorded the largest relative gains, indicating that augmentation can substantially improve simpler classifiers in data-scarce environments. Overall, the findings demonstrate that augmentation quality depends not only on dataset expansion, but also on preserving class balance, feature diversity, and realistic traffic relationships. These results provide practical guidance for strengthening IoMT intrusion-detection systems in healthcare environments. Full article

Background/Objectives: Insomnia is a prevalent sleep disorder with substantial public health implications, yet epidemiological data from Serbia remain limited. This study aimed to assess the prevalence of clinically significant insomnia symptoms in the adult population of Serbia and to examine associated sociodemographic, comorbidity, psychosocial, and lifestyle factors. Materials and methods: A cross-sectional study was conducted from September 2023 to September 2025, including 2577 adults aged 18–89 years across Serbia. Insomnia symptom severity was measured using the Insomnia Severity Index (ISI), with scores ≥ 15 indicating clinically significant insomnia symptoms. Sociodemographic, comorbidity, psychosocial, and lifestyle factors were assessed via self-reported questionnaires. Multivariable logistic regression with LASSO variable selection was used to identify factors independently associated with clinically significant insomnia symptoms. Results: The prevalence of clinically significant insomnia symptoms (ISI ≥ 15) was 10.9%. Independent factors associated with clinically significant insomnia symptoms included being single (OR = 1.54) or divorced (OR = 1.75), lower educational attainment (OR = 0.71 per level increase), being retired (OR = 1.83) or a student (OR = 1.66), dermatological comorbidities (OR = 2.99), use of anxiolytic medications (OR = 2.44), exposure to stressful life events (OR = 1.88), engagement in late-night activities (OR = 1.37), consumption of coffee/tea (OR = 2.22), energy drink consumption (OR = 1.52), and late-night eating habits (OR = 1.27). Conclusions: Clinically significant insomnia symptoms among adults in Serbia are influenced by a complex interplay of sociodemographic, comorbidity, psychosocial, and lifestyle factors. These findings underscore the need for integrated approaches that address both medical and modifiable behavioral determinants in the prevention and management of insomnia symptoms. Full article