Search Results (5,356)

Background/Objectives: Hyponatremia is a clinically important electrolyte disorder in older adults, yet early identification is hindered by complex, non-linear interactions between comorbidities and polypharmacy. This study aimed to develop and externally validate a machine learning (ML) prediction model for hyponatremia risk using nationwide claims data, focusing on medication patterns and clinical features. Methods: A retrospective cohort study was conducted using the South Korean Health Insurance Review and Assessment Service-Aged Patient Sample (HIRA-APS). Data from 2017 to 2018 were used for development, and 2019 data for temporal external validation (age ≥ 65). SHapley Additive exPlanations (SHAP)-based recursive feature elimination identified 33 high-impact predictors from 60 clinical features. Six ML algorithms, including LightGBM and CatBoost, were trained with 1:4 case–control matching and evaluated for discrimination and calibration. Results: The development and validation cohorts included 4810 and 648,586 patients, respectively. All models showed comparable discriminative performance (area under the receiver operating characteristic curve [AUROC] 0.741–0.746), with LightGBM achieving the highest (AUROC 0.746; 95% confidence interval (CI) 0.728–0.763). The models had very high negative predictive values (>0.999) for ruling out low-risk individuals. Tree-based ensemble matched linear models in discrimination but achieved better calibration. Conclusions: These validated, interpretable ML models can serve as clinical decision support tools that rule out low-risk patients and prioritize monitoring for high-risk individuals. Across sociodemographic subgroups, calibration was maintained after recalibration, whereas discrimination was lower in the oldest, most comorbid, frailest, highest-medication-burden, and lowest-socioeconomic groups—a gap to address before equitable deployment. Full article

Background/Objectives: Celiac disease (CD) is common, but its cancer-risk profile remains incompletely defined. Estimates vary because of referral patterns, diagnostic era, outcome definitions, and surveillance around diagnosis. We evaluated cancer-category-specific associations in a matched cohort of clinically recognized CD. Methods: We used longitudinal electronic health record (EHR) data from Clalit Health Services for a propensity-matched cohort. Adults with EHR-coded CD were matched to controls on demographic, socioeconomic, comorbidity, and inflammatory variables. Pre-index invasive malignancies and non-invasive neoplasms were excluded. Dated EHR-coded invasive oncology outcomes were analyzed using Cox models. A restricted dated-event cohort, lag analyses, competing-risk modeling, hemoglobin adjustment, and age-at-index strata assessed robustness. Results: The primary matched cohort included 8143 individuals: 1006 with CD and 7137 controls, contributing 49,330.5 person-years. CD was associated with increased hazard of an EHR-coded invasive oncology outcome (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.47–1.77; $p<0.001$). Strongest signals were hematological malignancy codes (HR 1.99), lymphoma codes (HR 1.90), and gastrointestinal (GI) cancer codes (HR 2.71). Associations persisted after one-year and two-year lags. In the dated-event sensitivity cohort (161 CD; 1610 controls), CD remained associated with invasive cancer (HR 1.68, 95% CI 1.31–2.14), with the strongest signals for lymphoma (HR 2.81) and GI cancer (HR 2.25). The association was essentially unchanged under competing-risk modeling (Fine–Gray subdistribution HR 1.69) and after hemoglobin adjustment (HR 1.61), and was present in both age strata. Neither breast nor lung cancer was associated. Lymphoma codes included peripheral T-cell lymphomas recorded at intra-abdominal and extranodal sites, the pattern most consistent with enteropathy-associated T-cell lymphoma (EATL). Conclusions: In clinically recognized CD, cancer hazard was elevated and category-specific, concentrated in hematological, lymphoid, and GI codes with a gut-oriented T-cell lymphoma signal. The findings support targeted clinical vigilance, not expanded screening, and describe relative associations that require registry-linked confirmation. Full article

This study addresses the limited nationwide examination of Mountain Villages as strategic targets for regional revitalization amid rapid depopulation and population aging. Focusing on Mountain Villages located within Depopulation Regions in the Republic of Korea, this study quantitatively assessed workation suitability at the Eup-Myeon-Dong level and identified priority areas and differentiated policy directions. A workation suitability index was calculated using the CRITIC (Criteria Importance Through Intercriteria Correlation) method, and spatial clustering and potential–demand characteristics were examined through LISA (Local Indicators of Spatial Association) and quadrant analysis. The results showed that transportation accessibility indicators, including travel time to expressway interchanges and railway stations, had high information content in differentiating workation suitability among Mountain Villages. Suitability was high in the border areas between Gyeonggi-do and Gangwon State and parts of the central inland region, whereas low suitability was observed in northern Gangwon State and northern Gyeongsangbuk-do. High–High clusters tended to overlap with high-potential and high-demand areas, while Low–Low clusters were mainly associated with low-potential areas. By integrating suitability, spatial clustering, and demand conditions, this study provides an empirical framework for spatial decision-making. The findings suggest that workation policies for Mountain Villages should distinguish priority implementation areas from foundation-building areas according to accessibility, infrastructure, and demand levels. Full article

Background/Objectives: Falls and upper limb injuries (ULI) are prevalent in older adults, yet whether ULI independently predisposes to subsequent falls remains poorly characterized. This nationwide cohort study evaluated the association between ULI and future fall risk using Taiwan’s National Health Insurance Research Database (2011–2019, follow-up through 2020). Methods: Adults aged ≥ 50 years with newly diagnosed ULI—defined as fractures (clavicle, scapula, humerus, radius, ulna, hand), sprains, strains, or open wounds of the shoulder, arm, elbow, forearm, wrist, or hand—were propensity score-matched 1:1 to controls by age, sex, and eight major comorbidities. Fall occurrence was identified by validated ICD codes, and Cox regression estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results: The cohort included 110,600 participants (mean follow-up 4.4 years). Fall incidence was 2.8 versus 1.6 per 1000 person-years in ULI versus control groups. Patients with ULI had 62% higher fall risk (adjusted HR 1.62, 95% CI: 1.43–1.84, p < 0.001), corresponding to 1.2 additional falls per 1000 person-years. Kaplan–Meier curves showed early divergence sustained throughout follow-up. Conclusions: ULI is independently associated with subsequent fall risk in older adults and may serve as a sentinel marker warranting fall-prevention strategies in clinical practice. Full article

Background: Hormone therapy (HT) is an effective treatment for relieving menopausal symptoms; however, its association with health-related quality of life (HRQoL) in Asian populations remains insufficiently characterized. Objective: The aim of this study was to examine the association between HT use and HRQoL dimensions in postmenopausal Korean women using nationally representative data from 2005, 2007, 2008, and 2009. Methods: In this cross-sectional study, we analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2005, 2007, 2008, and 2009. Postmenopausal women aged 40–65 years were included (n = 2460). HRQoL was assessed using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument. Survey-weighted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association between HT use and each EQ-5D dimension, adjusting for age. Results: Of the 2460 participants, 464 (18.9%) were HT users. HT use was significantly more common among women with higher education levels (p < 0.001) and higher household income (p < 0.001). The weighted mean EQ-5D index was significantly higher among HT users (0.911, 95% CI: 0.902–0.921) than non-users (0.894, 95% CI: 0.889–0.900; p < 0.05). In age-stratified analyses, significant differences were observed between women aged <55 years (p < 0.05) and those aged ≥60 years (p < 0.05). The EQ-5D index was positively associated with HT duration in women aged <55 and ≥60 years (p for trend < 0.05). In age-adjusted, dimension-specific analyses, HT use was associated with lower odds of reporting problems across all five EQ-5D dimensions (all p < 0.001), with the strongest association observed for usual activities (OR = 0.719, 95% CI: 0.715–0.722). Conclusions: In this nationally representative sample of postmenopausal Korean women, HT use was associated with more favorable HRQoL outcomes, particularly in the usual activities domain, with patterns varying by age and BMI subgroups. These findings support individualized menopausal counseling that incorporates quality-of-life considerations into clinical decision-making. Full article

Challenging work conditions and a predominantly male workforce have intensified concerns about worker well-being in the U.S. construction industry. Although these issues are increasingly acknowledged, empirical evidence on how management perceives and addresses employees’ psychological needs remains limited. This study seeks to fill that gap by examining managerial awareness and responsiveness to workplace mental health challenges, as well as the implementation of targeted well-being interventions across construction organizations. A mixed-methods approach was employed, integrating quantitative data from a nationwide survey of construction professionals with qualitative insights from open-ended responses. Results indicate that workers experience moderate levels of psychological strain, with notable differences across demographic and occupational groups. Women, non-white professionals, and site supervisors reported higher stress and lower overall well-being, emphasizing the need for more inclusive and tailored interventions. While both senior leaders and frontline supervisors demonstrated moderate awareness of these challenges, supervisors were perceived as less consistent in taking action to address them. Among existing workplace practices, transparent compensation structures and opportunities for skill diversification were identified as the most established supports for well-being. In contrast, mentoring programs, employee recognition, and open feedback mechanisms emerged as promising yet underutilized strategies. Overall, the study contributes by shifting attention from documenting construction-related mental health stressors to understanding how leadership recognition is translated into organizational response. Therefore, the findings provide practical guidance for construction leaders seeking to strengthen workers’ well-being and build a more resilient work environment. Full article

Adjuvant XELOX (capecitabine plus oxaliplatin) and TS-1 (S-1) monotherapy are both guideline-recommended following D2 gastrectomy for gastric cancer, yet head-to-head real-world data exclusively in stage III disease remain scarce. Using Taiwan’s National Health Insurance Research Database linked to the Taiwan Cancer Registry–Long Form, we identified stage III gastric cancer patients who underwent D2 gastrectomy (2010–2019) and received adjuvant XELOX or TS-1 for ≥3 months. Propensity score matching balanced chemotherapy and non-chemotherapy cohorts (1706/group). Overall survival (OS) was the primary endpoint; disease progression was defined as initiation of FOLFOX salvage chemotherapy (used as a pragmatic proxy for disease recurrence). A second propensity score matching was performed directly between XELOX (n = 533) and TS-1 (n = 893) groups, yielding 490 matched pairs with well-balanced baseline characteristics. Multivariable Cox regression was adjusted for sex, age, comorbidities, and Charlson Comorbidity Index. TS-1 was associated with significantly better OS (adjusted HR 0.73, 95% CI 0.61–0.86; p < 0.001) and lower progression (adjusted HR 0.38, 95% CI 0.23–0.62; p < 0.001) versus XELOX; the corresponding 3-year OS was approximately 65.4% for TS-1 versus 56.8% for XELOX, and extrapolated 5-year OS approximately 50.2% versus 41.7%, respectively (note: these 5-year estimates are Kaplan–Meier projections beyond the mean follow-up of ~2.6 years and carry substantial uncertainty; they should be interpreted with caution). Benefits were confined to stage IIIA (OS HR 0.64, 95% CI 0.45–0.89; p = 0.009; interaction p = 0.006; progression HR 0.29, 95% CI 0.11–0.76; p = 0.011), with comparable outcomes in IIIB and IIIC. Adjuvant TS-1 monotherapy was associated with superior OS and lower disease progression versus XELOX in stage III gastric cancer, particularly in stage IIIA; these findings are hypothesis-generating and warrant confirmation in prospective randomized trials, whereas in stage IIIB/IIIC outcomes were comparable between the two regimens. Full article

Background: Despite increasing opioid use in Brazil, the national epidemiological profile of opioid-related poisonings remains insufficiently characterized. Objective: To characterize opioid-notified poisonings reported in the Sistema de Informações sobre Agravos de Notificação (SINAN—Notifiable Diseases Information System), accessed through Departamento de Informática do Sistema Único de Saúde (DATASUS—Department of Informatics of the Unified Health System), between 2019 and 2025. Methods: This retrospective descriptive study used secondary national surveillance data from publicly accessible databases. Records of exogenous poisonings related to medications and drugs of abuse were screened, and notifications involving opioid analgesics were identified and standardized. Descriptive analyses were performed for demographic, clinical, and exposure-related variables. Bivariate analyses and multivariable logistic regression, regression models were conducted for selected outcomes. Incidence rates were estimated by year and federative unit, and temporal trends were assessed using generalized linear mixed models. Results: Between 2019 and 2025, 1,127,265 poisonings related to medications and drugs of abuse were reported in Brazil, of which 12,645 involved opioids. The opioids most frequently implicated in notifications were codeine (38.65%), tramadol (33.98%), and morphine (17.86%). Most cases occurred in women (70.3%), in individuals aged 26–50 years (47.8%), and in residences (85.6%). Digestive exposure predominated (92.3%), and suicide attempt was the main circumstance (73.5%). Most patients recovered without sequelae (75.1%), whereas 1.6% died due to exogenous intoxication. Co-exposure information was classifiable in 9573 records, most commonly involving opioids and medications. In multivariable analyses, suicide attempts were associated with female sex (aOR = 1.98; 95% CI: 1.68–2.34), residence-based exposure (aOR = 8.95; 95% CI: 6.29–12.72), and co-exposure (aOR = 2.17; 95% CI: 1.82–2.60). Hospitalization was less likely among females (aOR = 0.83; 95% CI: 0.75–0.91) and more likely with co-exposure (aOR = 1.14; 95% CI: 1.02–1.27). Serious outcomes were associated with older age (aOR = 1.017; 95% CI: 1.009–1.026), while residence-based exposure and suicide attempt showed lower odds. A significant increasing temporal trend was identified, with higher reported notification rates observed in the South and Southeast regions. Discussion: The predominance of suicide attempts and residential digestive exposures suggests that the notification profile captured by SINAN/DATASUS is predominantly shaped by intentional self-poisoning and household medication availability, while still representing a broader toxicovigilance scenario involving abuse, habitual use, adverse reactions, and other exposure contexts. The contrast between the most frequent notification profile and the profile associated with serious outcomes indicates that occurrence and severity may follow different epidemiological patterns. Therefore, these findings should be interpreted as a toxicovigilance signal reflecting multiple exposure contexts rather than as evidence of a single opioid-use pattern. Conclusions: Reported opioid-notified poisonings in Brazil increased over the study period and were predominantly associated with domestic exposure, suicide attempts, and co-exposure to other substances. These findings highlight the clinical and public health relevance of opioid-notified poisonings and support the need for strengthened surveillance, improved reporting quality, and preventive strategies addressing both opioid use and mental health. Limitations: Underreporting, missing data, regional reporting differences, and possible misclassification in SINAN/DATASUS records; therefore, associations, temporal increases, and projections should be interpreted as exploratory, and hypothesis generating. Full article

Background/Objectives: The management of dyslipidaemia in Slovakia has undergone significant changes in recent years, particularly through the relaxation of prescription restrictions for existing medications and the introduction of new innovative molecules. Achieving target levels of LDL cholesterol (LDL-C) plays a key role in preventing the onset and progression of atherosclerosis-related cardiovascular (CV) diseases. The aim of this study was to analyse how these changes have affected the effectiveness of reaching target LDL-C levels in patients at very high CV risk. Methods: This project was conducted as a retrospective analysis of anonymised LDL-C values from 2020 to 2023 using data from a collaborating nationwide laboratory. Patients included were those diagnosed with acute coronary syndrome (ACS), stroke, and, more generally, those with high and very high CV risk. Target LDL-C values were assessed based on the 2019 ESC/EAS guidelines. Results: A total of 363,020 LDL-C test records from 115,950 patients were evaluated over the four-year study period. Among patients diagnosed with ACS, 2.2–5% achieved target LDL-C levels in the respective years of observation 2020–2023. As many as 6.5–7.4% had LDL-C levels ≥ 4.9 mmol/L. For patients with stroke, only 4–6.6% reached target LDL-C levels, while 5.6–6.7% had levels ≥ 4.9 mmol/L. In the group with very high CV risk, only 1.7–3% achieved target levels, and 7.5–8.7% had extremely high LDL-C levels ≥ 4.9 mmol/L. Despite these modest improvements, over 93.4% of patients in the highest-performing subgroup failed to reach the absolute guideline target threshold in 2023. Conclusions: While the lifting of prescription constraints and the introduction of innovative treatments correlates with a doubling of absolute target attainment and a contraction of extreme hypercholesterolemia, overall control remains critically low in Slovakia. Systematic, protocol-driven combination regimens and intensive follow-up are urgently needed. Full article

Background: Fibromyalgia is a chronic pain syndrome associated with impaired psychosocial functioning, reduced quality of life, and substantial socioeconomic burden. Although nutritional approaches to fibromyalgia management are increasingly investigated, the relationships between dietary patterns, socioeconomic determinants, and quality of life remain unclear. This study aimed to assess associations between fibromyalgia severity, psychosocial functioning, dietary patterns (DPs), socioeconomic factors, and self-rated quality of life among Polish women with fibromyalgia. Methods: A cross-sectional online survey was conducted between March and April 2026 among members of nationwide Polish Facebook support groups for individuals with fibromyalgia. The final analysis included 201 women who self-reported a physician diagnosis of fibromyalgia. Fibromyalgia severity was assessed using the Modified Fibromyalgia Assessment Status (FAS), disease impact using the Revised Fibromyalgia Impact Questionnaire (FIQR), and quality of life using selected WHOQOL-BREF domains. Dietary patterns were identified using principal component analysis (PCA) based on the frequency of consumption of 33 food groups from the KomPAN questionnaire. Hierarchical linear regression models were applied to identify predictors of self-rated quality of life. Results: Four dietary patterns were identified: traditional, meat-and-fat, pro-healthy, and dairy-based. Participants reported low overall quality of life and moderate fibromyalgia severity. A better self-rated financial situation was associated with a higher quality of life only in the initial regression model (β = 0.325; p < 0.001). After adjustment for clinical and psychosocial variables, socioeconomic factors and dietary patterns were no longer significant predictors. Functional limitations (FIQR Functioning: β = −0.202; p = 0.022) and overall disease impact (FIQR Overall Impact: β = −0.189; p = 0.026) were negatively associated with quality of life, whereas psychological (β = 0.234; p < 0.001) and social functioning (β = 0.162; p = 0.023) were positive predictors. The final model explained 40.3% of the variance in quality of life. Conclusions: These findings support a comprehensive biopsychosocial model of fibromyalgia care. Full article

Electric vehicle (EV) transport by ship is expanding beyond industrial logistics centred on automobile production, trade, and pure car and truck carriers (PCTCs) into daily transportation for island tourism, commuting, and essential mobility. According to Korea Maritime Transportation Safety Authority (KOMSA) vessel status data as of March 2026, 104 of 146 domestic passenger ships were car-ferry passenger ships, accounting for 71.2% of the fleet and operating on 75 of 99 designated routes nationwide. Korea Shipping Association (KSA) operational records show that the EV transport rate on these routes increased from 0.76% in 2024 to 1.21% in 2025, with some routes exceeding 2.0–4.7%. Unlike enclosed multi-deck PCTC vehicle spaces, Korean coastal car-ferry passenger ships generally have single-tier open vehicle decks and bow ramp gates. Crosswinds on open decks may reduce smoke detector activation probability by 60–75%. Although Article 97 of the Standard for Ship Fire-Fighting Appliance newly requires dedicated EV fire-fighting equipment for car-ferry ships, it remains primarily equipment-prescriptive and does not yet provide open-deck-specific performance requirements for wind-resistant detection, fixed EV-zone cooling, EV-designated stowage arrangements, or passenger–operator safety management obligations. This study applies the five-step International Maritime Organization (IMO) Formal Safety Assessment (FSA) procedure to support improvements to EV fire-fighting equipment standards for coastal car-ferry passenger ships. Hazard identification (HAZID) was conducted with a 15-member advisory panel, and probability elicitation was performed through a Delphi survey with 10 core experts, showing strong consensus (Kendall’s W = 0.74, p < 0.01). Fault tree analysis (FTA) and event tree analysis (ETA) probabilities were derived from the Delphi results and the international literature. H-07, representing wind-induced smoke dilution, was identified as the dominant single-point vulnerability within the detection-failure branch. Monte Carlo-based FTA–ETA analysis (n = 10,000) estimated annual fire frequencies of 5.9 × 10⁻², 1.8 × 10⁻¹, and 2.9 × 10⁻¹ yr⁻¹ at EV loading ratios of 10%, 30%, and 50%, respectively, with 2.47 expected fatalities per fire. Risk entered the IMO ALARP band above a 30% EV loading ratio and exceeded the maximum tolerable crew risk above 50%. The combined application of risk control options (RCOs) 2, 3, and 4 reduced annual expected fatalities by 85.6%. Based on these results, six RCOs and institutional recommendations are proposed, including strengthened safety management obligations for passenger ship operators. Full article

Background/Objectives: Against the background of the rapid aging of the population, the symptoms of depression are a major health problem for middle-aged and older adults. This study analyzes the relationship between social participation and the trajectory of depressive symptoms and whether this association varies by gender. Methods: The data comes from five rounds of surveys conducted by the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, including a total of 5796 participants aged 45 or above. The depressive symptoms of each wave are measured using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Social participation was defined as the number of reported activities (0, 1, or ≥2). The development trajectory of depressive symptoms was analyzed through Group-Based Trajectory Modeling (GBTM), and their links with social participation level were subsequently quantified using multinomial logistic regression. Gender differences were assessed via interaction tests and stratified models. Results: GBTM identified four distinct depressive symptom trajectories: low (29.71%), moderate (42.72%), increasing (22.07%), and high (5.50%). Compared with no participation, engaging in one activity was linked to lower odds of falling into the moderate, increasing, and high trajectories; the association was stronger for ≥2 activities. Gender-stratified analyses revealed substantial heterogeneity (all interaction p < 0.01). Among women, single-activity participation was associated with lower odds across all three adverse trajectories. Among men, similar associations required ≥2 activities, with single-activity participation linked only to lower odds of the high trajectory. Conclusions: Higher levels of social participation have significantly reduced the depressive symptoms of middle-aged and older adults, and the gender differences are pronounced. Interventions should improve access to social participation for older women and promote activity diversity for older men. Full article

Background/Objectives: Important gaps remain in understanding the association between ultra-processed food (UPF) consumption and same-day energy intake. This study aimed to expand the understanding of how within-person variation in UPF consumption is associated with total energy intake. Methods: Nationwide, representative dietary survey data from 38,854 participants (≥10 years old) in the 2017–2018 Brazilian Household Budget Survey food intake module were analyzed. These cross-sectional repeated-measures data were used to estimate within-person differences in energy intake between two days of food consumption. Mixed models were applied to examine the associations between the presence and energy share of UPFs in the diet and total daily energy intake. Results: Among participants who consumed UPFs on only one of the two days (n = 8055), daily energy intake was higher on the day when UPFs were consumed than on the day when UPFs were not consumed (1699 kcal vs. 1530 kcal; p < 0.001). On average, among all participants (n = 38,854), a 10 percentage-point increase in UPF energy share on a given day was associated with an increase of 39 kcal in energy intake over the day. We found statistically significant effect modification by sex (p = 0.024) and age group (p < 0.001). Supplementary analyses suggest that the association between UPF energy share and total energy intake is consistent with partial replacement of non-UPF by UPF and is unlikely to reflect differences in food quantity or energy density. Conclusions: Among participants who consumed UPFs on only one of the two days, the day with UPF consumption was associated with higher total daily energy intake than the day without UPF consumption. A higher within-person UPF energy share was also associated with higher total daily energy intake. Understanding the association between UPF consumption and same-day energy intake can inform public health strategies aimed at reducing excessive energy intake. Full article

Background/Objectives: Prehospital advanced airway management significantly affects patient outcomes. The King Laryngeal Tube (King LT) has been a standard method for managing compromised airways in various emergency medical services (EMSs). However, in-depth analyses of first-attempt success and influencing factors are limited. This study explores the use of the King LT in Saudi Arabia to assess the first-attempt success rate and predictors of successful management. Methods: This retrospective cross-sectional study was conducted to analyze cases requiring the King LT in the main EMS provider in Saudi Arabia between October 2021 and September 2022. A descriptive analysis was employed for categorical data, and Chi-square test, Fisher’s exact test, and a regression analysis were applied to assess the significance of the association. Results: Of the 239 analyzed cases, adults (58.6%) and males (70.7%) were predominant. The highest proportions of cases were medical cases (36.8%) and indoor incidents (69.9%), with a significant association of indoor incidents with female and elderly patients (p = 0.001). The first-attempt success rate reached 82.4%, with significant success likelihood in afternoon incidents (adjusted odds ratio [OR] = 2.92, 95% confidence interval [CI] [0.53–3.57]; p = 0.03). Conclusions: This first nationwide study of King LT outlines advanced airway management characteristics in Saudi Arabia. The high use rates in adults, males, medical cases, and indoor incidents could suggest tailored training strategies. Noted temporal variations may provide insights for policy improvements. While first-attempt success rates are high, reflecting literature findings; performance could improve with further training. Full article

A massive number of early-constructed small-to-medium-span bridges are collectively entering an “aging” phase in China. Meanwhile, vast amounts of unstructured bottom-level inspection texts remain underutilized. To address them, this paper proposes a data governance method. Large Language Models were leveraged to process unstructured defect data from 18,238 real-world bridges nationwide. The data were structurally cleaned and mapped into discrete features, revealing multidimensional vulnerabilities. On this basis, the Stable Contrastive Pattern Risk (SCPR) intelligent decision-making model was developed. The results demonstrate that, following robust filtration, 6 nationwide common risk rules were extracted from 2064 initial candidate combinations. These rules converge into three core risk patterns: the heavy-duty aging pattern, the substructure-dominated pattern, and the over-water small-span low-seismic-design pattern. Guided by these robust rules and specific damage enrichment characteristics, risk stratification and differentiated management strategies were further formulated for Class III bridges. This research facilitates a paradigm shift in bridge maintenance. It moves from reactive, post-event symptom characterization toward data-driven, proactive early warnings. This shift provides a substantive scientific foundation for optimizing resource allocation and enabling precise investment decisions at the road network level. Full article