Search Results (1,165)

Background: Tuberculosis (TB) in adolescents is distinct from both childhood and adult TB, particularly in terms of risk factors; however, national-level data assessing these factors in adolescents remain limited despite growing attention to the issue. This study aims to identify factors associated with TB among individuals aged 10 to 18 years. Methods: This study leverages data from the National Family Health Survey (NFHS-5) conducted in India during the year 2019–2021. A total of 479,674 adolescents were included. We employ a generalized linear mixed-effects logistic regression model to examine the association between household, environmental, demographic and behavioral factors and self-reported TB status among adolescents. Results: A total of 363 adolescents reported having TB. The results show that adolescents who are male (aOR = 0.735, p < 0.001), living in a nuclear family (aOR = 0.782, p < 0.001), residing in a household without TB cases (aOR = 0.17, p < 0.001), using a traditional mud stove or chullah (aOR = 0.279, p < 0.001), do not have air conditioning or a cooler (aOR = 0.405, p < 0.001), do not use tobacco (aOR = 0.766, p < 0.001), and do not consume alcohol (aOR = 0.912, p < 0.001) have lower odds of TB. Conversely, older age (aOR = 1.136, p < 0.001), absence of a separate kitchen (aOR = 1.395, p < 0.001), belonging to poor (aOR = 2.787, p < 0.005) or middle-income households (aOR = 2.662, p < 0.001), and living in households without cattle (aOR = 1.489, p < 0.001) are associated with higher odds of TB. Conclusions: Using nationally representative NFHS data, this study identifies multiple household, socioeconomic, and behavioral factors associated with TB among adolescents in India. These findings highlight the need for targeted TB prevention strategies that address household conditions, socio-economic disparities, and adolescent health behaviors. Full article

Background/Objectives: Postprandial hyperglycemia and sleep quality can influence arterial stiffness; however, the interaction between sleep quality and postprandial hyperglycemia-induced changes in arterial stiffness remains poorly elucidated. Therefore, the purpose of this study was to investigate whether sleep quality modifies postprandial changes in blood glucose levels and arterial stiffness following a 75 g oral glucose tolerance test in healthy middle-aged and older adults. Methods: In this study on 104 healthy middle-aged and older adults (50–83 years old), arterial stiffness was assessed using carotid–femoral pulse wave velocity (cfPWV) and brachial–ankle pulse wave velocity (baPWV) before and 60 min after a 75 g oral glucose tolerance test (OGTT). Poor sleep quality was defined as a Pittsburgh Sleep Quality Index score > 5.5. Results: In the 51 participants with poor sleep quality, baPWV increased significantly from baseline to 60 min after the 75 g OGTT (p < 0.01), whereas no such change was observed in the 53 subjects with good sleep quality. baPWV was significantly higher in the poor-sleep-quality group than in the good-sleep-quality group 60 min after the 75 g OGTT (p < 0.01). Moreover, baPWV and blood glucose levels 60 min after the 75 g OGTT had a positive correlation (p < 0.01, r = 0.64). Conclusions: These findings suggest that a poor sleep quality may enhance postprandial hyperglycemia-induced arterial stiffness, whereas a good sleep quality may help protect vascular function. Full article

Background: Childhood obesity is a growing public health concern globally and is associated with a wide spectrum of comorbidities, including sleep-disordered breathing (SDB). SDB remains under-recognized in pediatric population with obesity, particularly in Middle Eastern settings, despite its significant impact on cognitive, behavioral, and metabolic health. Objectives: To assess the prevalence of SDB among children with obesity aged 6–12 years attending King Faisal University polyclinics in Saudi Arabia and to identify key demographic and anthropometric predictors, with particular emphasis on the mediating role of neck circumference. Methods: A cross-sectional study was conducted involving 130 children with obesity aged 6–12 years. Data collection included sociodemographic characteristics, anthropometric measurements (BMI percentile, neck and waist circumference), and screening for SDB using the validated Arabic version of the Pediatric Sleep Questionnaire Sleep-Related Breathing Disorder (PSQ-SRBD) scale. Logistic regression and mediation analyses were performed to examine associations and pathways between obesity parameters and SDB risk. Results: Of the 130 participants, 37.7% screened positive for SDB risk. SDB prevalence was higher among males and older children. Neck circumference and BMI percentile were independently associated with SDB risk, with neck circumference mediating the relationship between BMI and SDB. The mediation model indicated that increased BMI contributes to SDB risk both directly and indirectly through increased neck circumference. Conclusion: SDB is highly prevalent among obese Saudi children, and neck circumference is a significant mediator of risk. Incorporating SDB screening and neck circumference measurements into routine pediatric obesity care can facilitate early detection and management. These findings support the need for integrated, multidisciplinary approaches to improve pediatric health outcomes. Full article

Background: Low and middle-income countries (LMICs) such as Mexico are experiencing rapid population aging, accompanied by increasing levels of functional dependency and growing long-term care (LTC) needs. Objectives: We aimed to identify the factors associated with varying levels of functional dependency in order to assist population health planning and LTC policy in aging populations in Mexico. Methods: This cross-sectional study analyzed data from the 2021 wave of the Mexican Health and Aging Study (MHAS). Functional dependency was assessed through a modified Autonomie Gérontologie Groupes Iso-Ressources (AGGIR) scale, adapted to incorporate cognitive and physical assessments suitable for the Mexican context. Socioeconomic, health-related, and psychological variables were examined using ordinal logistic regression models. Results: Among 8049 participants included in the analysis, 87.08% were classified with non-to-mild dependency, 9.13% with moderate dependency, and 3.79% with severe dependency. More severe levels of functional dependency were associated with older age, lower educational attainment, not having a partner (being single, widowed, separated or divorced), and the presence of chronic conditions such as hypertension and cardiovascular disease. Conclusions: In contrast, higher educational attainment and regular physical activity were associated with less severe levels of dependency. These associations highlight the multifactorial nature of dependency in later life. The application of a graded, multidimensional dependency classification provides a more comprehensive and differentiated understanding of care needs than binary functional measures. This population-level perspective may support the prioritization of healthy aging strategies and long-term care planning in rapidly aging middle-income settings such as Mexico. Full article

The rapid expansion of the digital economy and advances in artificial intelligence have elevated digital governance to a pivotal role in promoting environmental sustainability. Using data from the China Family Panel Studies, this study constructs a household-level indicator of the digital divide and systematically investigates its effects on household carbon emissions through three key mechanisms: consumption hypersensitivity, green technology adoption, and environmental awareness. The empirical findings demonstrate that the digital divide significantly increases household carbon emissions. Specifically, a one-unit increase in the digital divide is associated with an average rise of approximately 38.6% in household carbon emissions. Importantly, this result remains robust across a range of robustness checks and endogeneity controls. Further mechanism analysis reveals that the digital divide amplifies households’ sensitivity to consumption, diminishes their likelihood of adopting green technologies, and weakens their environmental awareness, thereby leading to an increase in household carbon emissions. Heterogeneity analysis indicates that these negative effects are particularly pronounced in regions with underdeveloped digital inclusive finance, among households headed by middle-aged and older individuals, and within populations with lower educational attainment. Based on these findings, policy initiatives should focus on improving the accessibility and inclusiveness of digital infrastructure, developing tiered frameworks to support green behavioral transformation and capacity building, and strengthening green finance initiatives alongside offline support mechanisms for digitally disadvantaged groups. Together, these measures can help bridge the digital divide and foster a more equitable, inclusive, and sustainable transition toward a low-carbon society. Full article

Kidney aging is receiving growing attention in middle- to high-income societies due to increasing longevity in general population. Chronic Kidney Disease (CKD) has been widely accepted as a major non-communicable human disease affecting over 10% of the adult population in industrialized countries. CKD is mainly caused by metabolic and cardiovascular disorders such as diabetes mellitus and hypertension, disproportionally affecting older people, whereas natural kidney aging is driven by age-dependent systemic and renal low-grade inflammation. Interleukin-6 (IL-6) is the key cytokine mediating age-related inflammation. At the same time, IL-6 has been implicated in the pathophysiology of cardiovascular and renal disorders as a major pro-inflammatory cytokine. Thereby, IL-6 is placed at the intersection between natural and pathophysiological kidney aging, and the latter accelerates systemic aging and substantially limits life quality and expectancy. Growing clinical availability of IL-6 inhibitors for treatment of autoimmune and autoinflammatory disorders demands clarification of potential renal consequences as well. Available data suggests that IL-6 inhibition may be renoprotective in some kidney disorders, but the setting of kidney aging has received only minor attention. The present review focuses on the known effects of IL-6 associated with natural or pathophysiological renal aging. Full article

Background: Food insecurity may adversely affect cognitive function through pathways involving nutritional deficiencies, chronic stress, and comorbid health conditions, with potentially different effects across cognitive domains. Longitudinal evidence remains limited by time-varying confounding, and it is unclear whether Supplemental Food Assistance Program (SNAP) participation modifies these associations. Objectives: To examine the longitudinal association between food insecurity and cognitive function using marginal structural models (MSMs), and whether SNAP participation buffers these associations for overall cognition, episodic memory, and attention/mental processing. Methods: 30,641 adults aged ≥50 in the 1998–2020 Health and Retirement Study (HRS) contributed 156,066 person-year observations. MSMs with stabilized inverse probability of treatment weights were used to account for time-varying socioeconomic, health, and cognitive confounding affected by prior exposure. Weighted pooled linear regression models estimated marginal associations and interaction effects. Results: Moderate and high food insecurity were associated with lower overall cognition (b = −0.36 and −0.71, respectively; p < 0.001). Similar graded associations were observed for episodic memory (b = −0.22; −0.43) and attention/mental processing (b = −0.15; −0.28; all p < 0.001). SNAP participation significantly attenuated these associations across cognitive domains, with stronger buffering effects among non-Hispanic Black and Hispanic respondents. Effect sizes corresponded to differences equivalent to several years of cognitive aging. Conclusions: Food insecurity is associated with poorer cognitive function across multiple domains, while SNAP participation mitigates these associations. Despite limitations of observational data, these findings highlight the methodological value of MSMs and the potential role of food assistance programs in reducing cognitive health disparities in later life. Full article

Background: Hyaluronic acid (HA) injections have become a cornerstone of minimally invasive aesthetic medicine. While the demand for these procedures continues to grow globally, large-scale longitudinal analyses of patient demographics and specific injection site trends remain limited, particularly in Asian populations. Existing data in Japan are largely confined to aggregate procedure numbers. This study aimed to elucidate the transition in patient demographics and site-specific treatment trends using a nationwide big-data approach. Methods: This retrospective study analyzed 299,413 treatment sessions (417,590 injection sites) from patients who underwent facial HA injections at 110 clinics across Japan between October 2020 and December 2024. Data were analyzed by year, patient age, and injection site to evaluate demographic shifts and treatment patterns. Results: The annual number of treatment sessions increased steadily during the study period. A significant demographic shift was observed: while patients in their 20s were predominant in 2020–2022, the proportion of patients aged ≥ 40 years increased markedly from 2023 onward, accounting for more than half of all cases (63.7% in 2024). Treatment preferences varied distinctly by age; younger patients favored localized contouring (e.g., pretarsal fullness, chin), whereas older patients required multi-site rejuvenation. By 2024, the orbital rim became the most frequently treated site (22.6%). Statistical analysis confirmed that age was a significant predictor for multi-site treatments (p < 0.001). Conclusions: This large-scale analysis reveals a clear transition in the Japanese aesthetic market from contour enhancement in younger demographics to anatomy-based rejuvenation in middle-aged and older populations. Full article

Background: Prostate cancer in the Middle East and North Africa (MENA) region is shaped by a complex interplay of behavioral and environmental risk factors, yet comprehensive estimates of preventable cases remain scarce. To address this gap, we estimated population-attributable fractions (PAFs) for a range of modifiable exposures among men aged 50 years and older and assessed potential reductions in incidence under feasible intervention scenarios. Methods: Regional prevalence data were combined with relative risks from meta-analyses to compute closed-form PAFs for tobacco smoking, obesity, physical inactivity, high dairy and calcium intake, heavy alcohol use, drinking water nitrates, trihalomethanes, arsenic, lead, selenium status, ambient PM_2.5 and NO₂, and occupational diesel exhaust, covering an estimated 47 million men. Estimates were validated using a synthetic cohort simulation of 100,000 individuals, with uncertainty quantified through Monte Carlo sampling. Results: Results showed that drinking water nitrate exposure accounted for the largest single fraction (17.4%), followed by tobacco smoking (9.5%), physical inactivity (6.7%), and trihalomethane exposure (5.0%), while other exposures contributed smaller but meaningful shares. Joint elimination of all exposures projected a 45.5% reduction in incidence, and simultaneous feasible reductions in four targeted exposures yielded a combined potential impact fraction of 12.1%. Conclusions: These findings suggest that integrated water quality management, tobacco control, lifestyle interventions, and targeted environmental surveillance should be prioritized to reduce prostate cancer burden in the MENA region. However, estimates of drinking-water nitrate exposure rely on limited evidence from a single case–control study with a relatively small sample size, and should therefore be considered exploratory and primarily hypothesis-generating. Full article

Background and hypothesis: Per- and polyfluoroalkyl substances (PFAS) are highly persistent synthetic chemicals that can accumulate in renal tissue and potentially disrupt kidney function. Most prospective studies on PFAS–renal associations have focused on middle-aged or older adults, leaving uncertainty about whether similar patterns exist in younger populations. Methods: We investigated decade-long trajectories of plasma concentrations of 11 PFAS and their longitudinal associations with estimated glomerular filtration rate (eGFR) among 529 Taiwanese adolescents and young adults (aged 12–30 years) enrolled in the prospective YOung TAiwanese Cohort (YOTA), with measurements obtained in 2006–2008 and 2017–2019. Results: Nearly all plasma PFAS declined significantly over the 10-year period. Despite these reductions, higher baseline levels and greater annualized increases (Δln-PFAS/Δt) in linear perfluorooctanoic acid (PFOA), linear and branched perfluorooctane sulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were consistently associated with larger eGFR gains over time (β = 0.33–0.40, q < 0.05). In complementary models using follow-up eGFR as the outcome, both baseline and cumulative PFAS changes (Δln-PFAS) remained positively associated with higher eGFR (β = 1.71–3.84, q < 0.05). Polynomial analyses further indicated mild non-linear exposure–response patterns for several PFAS, suggesting that renal effects may deviate from linearity across exposure ranges. The composite PFAS exposure index (mean of standardized ln-PFAS concentrations) was robustly associated with higher eGFR across sensitivity analyses excluding participants with chronic conditions. These associations were more pronounced among individuals with greater metabolic or physiological vulnerability. Conclusions: Higher PFAS exposure was associated with elevated eGFR in young adults, which may be consistent with early glomerular hyperfiltration or other renal hemodynamic alterations. These findings raise the hypothesis of early renal stress in early life and underscore the need for ongoing biomonitoring and longitudinal follow-up with additional kidney injury markers to clarify long-term renal consequences. Full article

The increasing momentum of agricultural digital transformation and green development necessitates investigations into how farmers’ digital literacy influences their engagement in green production behaviours, which is critical for achieving the high-quality development of modern agriculture. Utilising primary survey data collected from farmers in rural areas of Guizhou Province, China, this study investigated how digital literacy affects farmers’ green production behaviours. The findings are as follows: (1) Digital literacy exerts a significant positive impact on farmers’ adoption of green production behaviours. Regarding the hierarchical effect, the order of influence is as follows: digital security awareness > basic digital skills > digital application and innovation. (2) The facilitating effect of digital literacy is primarily achieved through two pathways: the peer effect and the guidance effect. (3) Farmers with higher education levels are more impacted by digital literacy than farmers with lower education levels. (4) The impact of digital literacy is more positively significant for young and older farmers than for middle-aged groups. Based on these research findings, it is recommended that future policy formulation and technology extension efforts should prioritise support for specific regions and groups, such as mountainous areas, small-scale operations, low-education backgrounds, and the elderly. Such targeted approaches are crucial for encouraging wider adoption of green production behaviours among farmers. Full article

Background: Plasticisers with endocrine-disrupting potential are ubiquitous and associate with obesity and type-2 diabetes (T2D), with higher levels reported in the Middle East. However, no data exist on plasticiser exposure in Bahrain where T2D affects 15% of the national population. Methods: An observational exploratory study in T2D (n = 60) and controls (n = 96), analysed for 24 h urinary plasticiser levels (liquid chromatography tandem mass spectrometry (LC-MS/MS)). Correlation and generalised linear model (GLM) analyses were employed to examine associations. Results: T2D were older (p < 0.001), had higher body mass index (BMI) (p < 0.001), body weight (p < 0.001) and glycosylated haemoglobin A1c (HbA1c) (p < 0.001). Correlation analysis revealed differences in inter-plasticiser, and plasticiser and biomarker relationships, with loss or reversal in T2D compared to controls. Mono-n-butyl phthalate (MnBP) levels were higher in T2D (p = 0.04); however, regression analysis revealed significant association with age. The GLM analyses demonstrated marked differences in the levels of mono(3-carboxypropyl) phthalate (MCPP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), monoethyl phthalate (MEP) and bisphenol S (BPS), with lower levels in T2D versus controls (B = −3.41, p = 0.01; B = −5.28, p < 0.001; B = −8.94, p < 0.001; B = −6.09, p = 0.006, respectively); however, these contrasts appeared to be substantially confounded by BMI and/or age. Positive influence of age and negative influence of BMI when observed across the full dataset were generally reversed in T2D. Levels were complementary to those previously reported for the Middle East. Conclusions: The study indicates the phthalate levels in Bahrain are elevated though complementary to studies of phthalates in the Middle East; within those levels, the study indicates differential exposure–response relationships with plasticisers, influenced by age and BMI, in those with T2D compared to healthy controls. Full article

A correlation between the near-surface ozone concentration in the urban atmosphere and hospitalizations of community-acquired pneumonia patients has been analyzed based on a long-term (five years) series of observations in the warm season in Moscow, Russia. The study included hospitalization records for patients over 15 years old. One of the main goals was to reveal vulnerable groups of the urban population that react most strongly to increased ozone concentrations. It has been shown that increased near-surface ozone concentrations lead to increased hospitalizations. Older people (over 60 years old) are most sensitive to the negative impact of air pollution. Women in this age group are more sensitive to the effects of ozone air pollution than men. In the middle-aged group (31–60 years), the highest correlation between the number of community-acquired pneumonia cases and the ozone level in the atmospheric surface layer, conversely, was in men, but it was still lower than the rate in older people. The young people (15–30 years old) group turned out to be insensitive to the near-surface air pollution. Full article

Background: In recent years, electronic patient-reported outcome (ePRO) systems on electronic devices, such as smartphones, have been employed to collect patients’ self-assessments and symptom reports. However, these studies were limited to younger populations and patients with severe diseases. Objective: This study aimed to evaluate the ease of use and response continuity of an ePRO system used by healthy middle-aged and older adults. Methods: This prospective observational study included participants aged 40–74 years undergoing specific health checkups. The System Usability Scale (SUS) was used to assess ePRO usability. Response continuity was evaluated by assessing EuroQol 5-Dimensional 5-Level responses once a month for up to 3 months after the health checkup date. Results: Eleven participants, aged 47–73 years, participated in the study. The mean SUS on the screening date was 59.1 (95% CI: 50.0–68.1; a cut-off of 70 indicated “useful”). However, only one participant failed to complete the ePRO at one and two months post-examination, and responses were obtained from all participants at three months. Conclusions: Due to the small sample size, usability as measured by the SUS should be interpreted descriptively. While initial onboarding appeared to be a major implementation barrier, sustained monthly ePRO reporting over 3 months was achievable among participants who completed registration with support, suggesting the conditional feasibility of response continuity in this preventive health checkup setting. Full article

Background/Objectives: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders globally, significantly impacting quality of life across diverse populations. Despite its association with middle-aged and older populations, evidence indicates that LBP is increasingly prevalent among younger age groups. Health science students are considered a potential risk factor for LBP; however, longitudinal studies are scarce. This study aims to determine the risk factors for LBP among health science students over a 2-year follow-up. Methods: One hundred ninety-seven of the third-class health science students (Nursing, Physiotherapy, Medical laboratory science, and Emergency Medical services) were contacted in June 2024. A self-administered modified version of the Standardized Nordic Questionnaire, and data about sedentary and physical activity behavior, as well as 1-month LBP (lasting at least 12 h and numeric rating scale > 5) and stress scores, were recorded. Results: A total of 172/197 (87.3%) respondents completed the questionnaire at the end of the 2-year follow-up. The mean age was 25 ± 3.5 (years) and body mass index (BMI) value 23.5 ± 4.3 (kg/m²). About 49% (n = 84) and 20% (n = 34) of the participants had 1-month LBP and functional disability, respectively. No significant association was found between health science programs and the presence of 1-month LBP (χ² = 0.55, p > 0.05). The logistic regression analyses found that males (OR = 0.269, p = 0.005) and a history of pain frequency (OR = 3.377, p = 0.001) had a significant association with LBP over time. Conclusions: This prospective study shows a high prevalence of 1-month LBP (48.8%) among health science students at Zefat Academic College. LBP was significantly related to sex (female) and pain frequency, but not to health science students. We believe that implementing ergonomic and educational strategies is recommended for this population. Full article