Search Results (135)

Background: Persistent liver pathology despite a sustained virologic response (SVR) to hepatitis C virus (HCV) therapy is a major clinical concern. This is particularly relevant for people with HIV (PWH) with HCV coinfection, a population prone to accelerated liver disease progression. This study aimed to characterize the plasma miRNA profile in PWH with cirrhosis one year after successful completion of HCV therapy, and to explore their relationship with metabolite alterations. Methods: This cross-sectional study enrolled 47 PWH who achieved HCV clearance with antiviral therapy. Using plasma samples collected approximately one year after completion of HCV therapy, participants were stratified into two groups based on liver stiffness measurement (LSM): compensated cirrhosis (n = 32, LSM ≥ 12.5 kPa) and non-cirrhosis (n = 15, LSM < 12.5 kPa). Plasma miRNAs and metabolites were determined using small RNA sequencing and untargeted capillary electrophoresis-mass spectrometry (CE-MS), respectively. Significantly differentially expressed (SDE) miRNAs were identified using generalized linear models (GLM) with a negative binomial distribution, and their correlation with metabolite levels was quantified using Spearman’s correlation. Results: In the cirrhosis group (n = 32), we identified a distinct signature of 15 SDE miRNAs (9 upregulated, 6 downregulated) compared to the non-cirrhotic group (n = 15), showing hsa-miR-10401-3p, hsa-miR-548ak, hsa-miR-141-3p, and hsa-miR-3940-3p the largest expression changes. miRNA-gene interaction and pathway enrichment analysis suggested that these 15 SDE miRNAs potentially regulate multiple genes involved in immune response and amino acid metabolism. In addition, correlation analyses with our metabolomic data revealed significant associations between specific SDE miRNAs and amino acids and their derivatives. Specifically, the expression of upregulated miRNAs (e.g., hsa-miR-10401-3p and hsa-miR-16-5p) was positively correlated with plasma levels of L-methionine and its derivatives, while downregulated miRNAs (e.g., hsa-miR-625-5p) were inversely correlated with L-tryptophan. Conclusions: In cirrhotic PWH with history of HCV coinfection, a distinct plasma miRNA signature linked to dysregulated amino acid metabolism is found one year after completion of HCV therapy. This underscores that the HCV cure does not equate to complete hepatic recovery, highlighting the critical need for long-term monitoring in this high-risk population. Full article

Background/Objectives: Birth preparedness and complication readiness (BPCR) is a cornerstone of maternal health strategies designed to minimize the “three delays” in seeking, reaching, and receiving skilled care. In Ethiopia, uptake of BPCR remains insufficient, and little evidence exists on how individual- and community-level factors interact to shape preparedness. This study assessed the determinants of BPCR among women of reproductive age in Hawela Lida district, Sidama Region. Methods: A community-based cross-sectional study was conducted among 3540 women using a multistage sampling technique. Data were analyzed with multilevel mixed-effect negative binomial regression to account for clustering at the community level. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported to identify determinants of BPCR. Model fitness was assessed using Akaike’s Information Criterion (AIC), the Bayesian Information Criterion (BIC), and log-likelihood statistics. Results: At the individual level, women employed in government positions had over three times higher expected BPCR scores compared with farmers (AIRR = 3.11; 95% CI: 1.89–5.77). Women with planned pregnancies demonstrated higher BPCR preparedness (AIRR = 1.66; 95% CI: 1.15–3.22), as did those who participated in model family training (AIRR = 2.53; 95% CI: 1.76–4.99) and women exercising decision-making autonomy (AIRR = 2.34; 95% CI: 1.97–5.93). At the community level, residing in urban areas (AIRR = 2.78; 95% CI: 1.81–4.77) and in communities with higher women’s literacy (AIRR = 4.92; 95% CI: 2.32–8.48) was associated with higher expected BPCR scores. These findings indicate that both personal empowerment and supportive community contexts play pivotal roles in enhancing maternal birth preparedness and readiness for potential complications. Random-effects analysis showed that 19.4% of the variance in BPCR was attributable to kebele-level clustering (ICC = 0.194). The final multilevel model demonstrated superior fit (AIC = 2915.15, BIC = 3003.33, log-likelihood = −1402.44). Conclusions: Both individual- and community-level factors strongly influence BPCR practice in southern Ethiopia. Interventions should prioritize women’s empowerment and pregnancy planning, scale-up of model family training, and address structural barriers such as rural access and community literacy gaps. Targeted, multilevel strategies are essential to accelerate progress toward improving maternal preparedness and reducing maternal morbidity and mortality. Full article

Differential abundance analysis (DAA) is a critical task in microbiome research aimed at identifying microbial signatures that reliably characterize groups. Research suggests that microbiome systems are relatively stable and resilient, yet even small changes under certain conditions can trigger dysbiosis. The high dimensionality of microbiome datasets exacerbates the challenge of detecting such changes by posing a multiple comparison problem that requires hypothesis filtration. Standard filtration using multiple comparison correction procedures is designed for scenarios with a high number of true positives and is often too conservative for microbiome data, where the proportion of true signals can be very low. Therefore, there is a substantial need for hypothesis filtration methods tailored to microbiome data. Confidence intervals (CIs) for between-group differences offer a powerful alternative to p-value filtration, as their range simultaneously conveys information about the significance, potential magnitude, and direction of the effect, as well as the certainty of the estimate itself. Microbial data can be adequately modeled using a negative binomial (NB) distribution, and its location parameter can be robustly estimated with the Hodges–Lehmann estimator (HLE). Using synthetic and experimental data, we demonstrate that hypothesis filtration based on CIs for the two-sample HLE is a robust method for comparing microbial data. Our analysis demonstrates that the HLE-CI approach provides the same level of precision as filtration using multiple-adjustment methods while achieving significantly higher recall in microbiome DAA. The results of this study suggest that HLE-CI-based filtration can be an effective step in the search for microbiome biomarkers. Full article

Background/Objectives: Antimicrobial resistance (AMR) threatens global public health. This systematic review and meta-analysis, as part of the “ENVIRE” project (interventions to control the dynamics of antimicrobial resistance from chickens through the environment), assesses the prevalence of phenotypic and genotypic resistance, including extended-spectrum beta-lactamases (ESBLs), AmpC beta-lactamases, carbapenemases, colistin, and fluoroquinolone resistance, in broiler chickens and their environment. Methods: The analysis covers the years 2002–2022, focusing on Escherichia (E.) coli, Klebsiella spp., Enterobacter spp., and Citrobacter spp. in fecal, meat, environmental, and other-than-feces samples from observational studies published in PubMed and Web of Science. Quality assessment was performed using the Alberta Heritage Foundation criteria. Results: Data from 170 studies, conducted in Europe, North Africa, and North America, were included. The most frequently studied resistance was to beta-lactam, with focus on ESBL-producing and AmpC beta-lactamase isolates. The pooled prevalence of ESBL-resistant E. coli observed in meat samples at 41% and in fecal samples at 38% demonstrated significant heterogeneity between the studies. The negative binomial regression analysis of prevalence data revealed significantly higher ESBL-producing E. coli rates in European meat samples compared to North African samples. Conclusions: This systematic review revealed substantial variation in prevalence and emphasizes the need for standardized surveillance systems and robust study designs. Full article

This study develops an integrated quality inspection and production optimization framework for an imperfect production system, where system deterioration follows a zero-inflated non-homogeneous Poisson process (ZI-NHPP) characterized by a power-law intensity function. Parameters are estimated from historical data using the Expectation-Maximization (EM) algorithm, with a zero-inflation parameter π modeling scenario where the system remains defect-free. Operating in either an in-control or out-of-control state, the system produces products with Weibull hazard rates, exhibiting higher failure rates in the out-of-control state. The proposed model integrates system status, defect rates, employee efficiency, and market demand to jointly optimize the number of conforming items inspected and the production run length, thereby minimizing total costs—including production, inspection, correction, inventory, and warranty expenses. Numerical analyses, supported by sensitivity studies, validate the effectiveness of this integrated approach in achieving cost-efficient quality control. This framework enhances quality assurance and production management, offering practical insights for manufacturing across diverse industries. Full article

Background: Early childhood caries (ECC) remains a critical public health challenge, yet recent prevalence data and risk factors are scarce in rapidly urbanizing regions like Shenzhen City, China. Objectives: This study aimed to assess ECC prevalence and identify risk factors among 5-year-old children in Shenzhen City. Methods: This cross-sectional survey was conducted in Shenzhen City in 2024, recruiting 5-year-old children through multistage sampling from kindergartens. Self-administered parental questionnaires were distributed to collect data such as demographic characteristics, socioeconomic background and oral health-related behaviors. One trained dentist conducted the oral examination in kindergartens using ball-ended community periodontal index probes and disposable dental mirrors with an intra-oral light-emitting diode light attached. Dental caries was assessed using diagnosis criteria recommended by World Health Organization. The decayed, missing, and filled primary teeth (dmft) were recorded. Zero-inflated negative binomial regression was applied to identify associations between risk factors and ECC. Results: Among 1462 participants (86% response rate), ECC prevalence was 58% (mean dmft: 2.5 ± 3.4), with untreated decay (dt) accounting for 92% of cases. Socioeconomic factors, including low family income (p < 0.001), non-local residency (p < 0.001), and low caregiver education level (p = 0.012), were significantly associated with higher dmft scores. Behavioral factors such as frequent sugary drink consumption (p = 0.005), lack of parental brushing assistance (p = 0.027), and non-fluoride toothpaste use (p = 0.008) also contributed to the risk of ECC. Conclusions: Over half of Shenzhen City’s 5-year-olds suffered from ECC, predominantly untreated, driven by socioeconomic disparities and modifiable behavioral factors. Public health strategies must prioritize parental education, fluoride use and early preventive practices to reduce the burden of ECC. Full article

Datasets with many zero outcomes are common in real-world studies and often exhibit overdispersion and strong correlations among predictors, creating challenges for standard count models. Traditional approaches such as the Zero-Inflated Poisson (ZIP), Zero-Inflated Negative Binomial (ZINB), and Hurdle models can handle extra zeros and overdispersion but struggle when multicollinearity is present. This study introduces the Ridge-Hurdle Negative Binomial model, which incorporates L₂ regularization into the truncated count component of the hurdle framework to jointly address zero inflation, overdispersion, and multicollinearity. Monte Carlo simulations under varying sample sizes, predictor correlations, and levels of overdispersion and zero inflation show that Ridge-Hurdle NB consistently achieves the lowest mean squared error (MSE) compared to ZIP, ZINB, Hurdle Poisson, Hurdle Negative Binomial, Ridge ZIP, and Ridge ZINB models. Applications to the Wildlife Fish and Medical Care datasets further confirm its superior predictive performance, highlighting RHNB as a robust and efficient solution for complex count data modeling. Full article

Background: Despite guidelines recommending lower alcohol limits for individuals who flush, some still drink at unhealthy levels. This study investigates whether drinking motives are differentially associated with alcohol consumption based on self-reported flushing status among U.S. Asian young adults. Asian American youth report alcohol use at rates comparable to other high-risk groups, identifying the need to understand factors shaping these behaviors. Methods: The current analysis drew participants from a longitudinal multi-cohort study examining the emotional and behavioral health of college students. Freshmen were recruited, all aged 18 years and older, to complete a baseline survey and follow up surveys over a four-year period. The analytic sample (Mean age = 19.4; 70.5% female) included 244 students who self-identified as Asian. Participants self-reported whether they experience facial flush when consuming alcohol and rated their endorsement of various drinking motives. Negative binomial regression models tested main effects and interaction effects between flushing status (flushers, non-flushers) and drinking motives (coping, enhancement, conformity, social). Results: Facial flushing moderated enhancement, conformity, and social drinking motives, but not coping. Among flushers, enhancement and social motives were more strongly associated with greater alcohol consumption. Among non-flushers, conformity motives were stronger and associated with greater drinking, at a trend level. Overall, flushing or higher coping motives were associated with lower alcohol consumption. Peer drinking was associated with higher consumption in both flushing-status groups. Conclusions: The current study extends prior international research on drinking motives and flushing status to U.S. Asian young adults. Findings support the need for prevention strategies that address individual drinking motives and the modeling of alcohol use by peers. Reducing alcohol use among individuals who experience alcohol-induced flushing is a public health priority, given their heightened risk for alcohol-related cancers and other negative health outcomes. Full article

The European mink Mustela lutreola is one of the most threatened carnivores in Europe, having suffered dramatic range contractions and severe population fragmentation. Accurate knowledge of its genetic diversity is crucial for conservation planning, yet earlier studies based on partial mitochondrial markers offered limited resolution and often underestimated haplotype richness. In this study, complete mitochondrial genomes from four extant populations (Russia, n = 11; Romania, n = 16; Germany, n = 24; France–Spain, n = 15) were analysed using a suite of non-parametric and asymptotic estimators (Fisher’s α, ACE, Jackknife1, Bootstrap, Chao1-based iNEXT) together with negative binomial modelling. A total of 41 haplotypes were detected, but extrapolated estimates indicated substantially higher richness, particularly in populations dominated by singletons. Rarefaction and extrapolation analyses revealed that sample sizes of 70–130 individuals per population are needed to approach complete haplotype detection. The France–Spain and Romania populations harboured the highest predicted richness, whereas Germany and Russia, both represented by ex situ stocks, showed lower diversity. These results refine earlier assumptions of extreme homogeneity in the Western population and demonstrate that significant mitochondrial variation persists at the continental scale. The study provides quantitative benchmarks for sampling design and genetic management, supporting preservation of evolutionary potential in this critically endangered species. Full article

Clostridioides difficile is an obligate anaerobe and is primarily transmitted via the fecal–oral route. Data characterizing the microbiome changes accompanying transitions from non-colonized to C. difficile colonized subjects are currently lacking. In this retrospective cohort study, we examined 16S rRNA gene sequencing data in a total of 481 fecal samples belonging to 107 patients. Based on C. difficile status over time, patients were categorized as Negative-to-Positive, Negative Control, and Positive Control. A linear mixed effects model was fitted to investigate the changes in the Shannon α-diversity index over time. Zero-inflated negative binomial/Poisson mixed effects models or generalized linear mixed models with negative binomial/Poisson distribution were used to investigate the changes in taxon counts over time among different groups. A total of 107 patients were eligible for the study. The median number of stool samples per patient was 3 (IQR 2–4). A total of 42 patients transitioned from C. difficile negative to positive (Negative-to-Positive), 47 patients remained negative throughout their tests (Negative Control) and 18 were always C. difficile positive (Positive Control). A significant difference in microbiome composition between the last negative samples and the first positive samples were shown in Negative-to-Positive patients, ANOSIM p = 0.022. In Negative-to-Positive patients, the phylum Pseudomonadota and family Enterobacteriaceae increased significantly in the first positive samples compared to the last negative samples, p = 0.0075 and p = 0.0094, respectively. Within the first 21 days, Actinomycetota decreased significantly over time in the Positive Control group compared to the other two groups (p < 0.001) while Bacillota decreased in both the Negative-to-Positive group and Positive Control. These results demonstrate that the transition from C. difficile negative to C. difficile positive is associated with alterations in gut microbial communities and their compositional patterns over time. Moreover, these changes play an important role in both the emergence and intensification of the gut microbiome dysbiosis in patients who transitioned from C. difficile negative to positive and those who always tested positive. Full article

Background: Research exploring the context in which ASD and offending are associated is limited, despite stereotyped perceptions that individuals with ASD are more violent than their typically developing peers. To address this gap, this research explored the influence of ASD, mental health and behavioural presentation, adverse childhood experiences, and demographic characteristics on offending presentations in a forensic youth sample. Methods: This was a cross-sectional study of a retrospective cohort, utilising secondary data of 327 young people from a forensic London-based service (83% male, M_age = 14.9 years old, SD = 1.90). Results: One hundred forty-two of these young people presented with either confirmed or suspected ASD diagnoses (83.8% male, M_age = 14.8 years old, SD = 1.84). Five offending categories (violence, sexually harmful behaviour, drug possession/supply, gang involvement, theft) and 32 offending behaviours were analysed in total. Poisson and negative binomial regression analyses indicated that ASD traits only increased the rate ratio of violent offences (p = 0.036) and gang involvement (p = 0.002). The use of substances significantly increased the rate ratio of theft (p = 0.012), gang involvement (p = 0.004), and drug possession/supply (p = 0.012). Conclusions: Our findings suggest that ASD, in the context of substance use, may increase a young person’s risk for more variable violent offences or gang involvement. Findings are discussed in the context of current research and recommendations for clinical practice and future research are made. Full article

Introduction: Type 1 diabetes mellitus (DM1) can influence oral health, increasing susceptibility to various oral manifestations. Objectives: This study aimed to characterise oral health-related quality of life (OHRQoL), reported oral symptoms, and oral health behaviours in paediatric individuals with DM1, and compare them with those without DM1; as well as to identify factors associated with OHRQoL in both groups. Methods: A cross-sectional study was conducted using an online questionnaire completed by caregivers of Portuguese children with or without DM1. The questionnaire collected information on sociodemographic, oral health behaviours, perceived oral health, reported oral manifestations, and OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS). Descriptive statistics were calculated, along with chi-square tests and negative binomial regression analyses (α = 0.05). Results: The sample included 235 individuals (115 with DM1 and 120 without). No significant differences were observed in overall OHRQoL between the groups, although children with DM1 had slightly higher ECOHIS total scores (4.38 vs. 4.02). Oral health behaviours were comparable in both groups. Children with DM1 reported significantly more xerostomia (p < 0.001). Within the DM1 group, better OHRQoL was significantly related to the following variables: female sex, absence of caries, absence of gingivitis, and no taste changes. In contrast, in the non-DM1 group, OHRQoL was associated with different conditions: the caregiver perception, frequent sugar intake, recurrent aphthous stomatitis, burning mouth sensations, and age. Conclusion: Although OHRQoL levels and oral health behaviours were similar between children with and without DM1, the factors influencing these outcomes varied considerably, emphasising the need for targeted oral health strategies tailored to the specific context of this chronic condition. Full article

Background/Objectives: The prevalence of dental caries in Romania is significantly high, especially among children and adolescents. We aimed to assess the prevalence of dental caries and their associated factors among schoolchildren aged 6–11 years learning at urban and rural schools from Mureş County, Romania. Methods: This cross-sectional study included a sample of 1124 children, aged 6–8 years (n = 524), as well as aged 9–11 years (n = 600). Nine schools in Mureş County, Romania, were selected for screening, based on their location (4 schools from urban areas and 5 schools from rural areas). Data were collected based on children’s visual dental screenings and a self-administered questionnaire addressed to their parents to collect information about oral health behaviors, sugar consumption, and dental care history. Dental clinical examination was performed by specialists, and DMFT/dmft values were recorded. Binary logistic and negative binomial regression analyses were used to assess the factors associated with dental caries. Results: Among 6–8-year-olds, the prevalence of untreated decay was 76.5% and the prevalence of caries experience was 77.7% (mean dmft = 3.9). Among 9–11-year-olds, the prevalence of untreated decay was 43.5% and the prevalence of caries experience was 48.2% (mean DMFT = 1.9). Among the most significant factors associated with caries prevalence were school location (p = 0.04 for children aged 6–8 years, and p < 0.001 for 9–11 years); the employment status of mothers (p = 0.04 for 9–11 years); eating sweets ≥4 times/day (p = 0.04 for 6–8 years); brushing time ≥3 min (p = 0.03 for 9–11 years); as well as past dental restorative treatments or emergency (p < 0.001 for all the children examined). Conclusions: Preventive measures and innovative educational interventions are needed to mitigate the impact of dental caries prevalence on the health and education of schoolchildren. Full article

This cross-sectional study aimed to (a) determine the apparent prevalence of mastitis pathogens and (b) to identify risk factors for intramammary infections (IMIs) at the herd level in dairy herds in Bavaria, Germany. A stratified random sample of 305 herds was selected based on herd size, administrative district, and season. During the farm visits between July 2023 and July 2024, management data were recorded, quarter milk samples (QMSs) from 14,700 lactating cows were collected aseptically and analyzed, and the somatic cell count (SCC) at the quarter level was determined. Risk factors for the within-herd prevalence of Staphylococcus (S.) aureus, Streptococcus (Strep.) uberis, Strep. dysgalactiae, and non-aureus staphylococci (NAS) were analyzed by negative binomial regression, while risk factors for the presence of Escherichia (E.) coli and Strep. agalactiae IMIs on dairy farms were identified by logistic regression. The most frequently detected pathogens were NAS, found in 5.0% of all QMSs (n = 57,251), followed by Strep. uberis (1.9%) and S. aureus (1.8%), Strep. agalactiae (0.2%), and E. coli (0.1%). At the herd level, NAS, Strep. uberis, S. aureus, and Strep. dysgalactiae were found in 92%, 69%, 67%, and 57% of farms, respectively. Risk factors for increased within-herd prevalence included automated milking systems (NAS), organic production (Strep. uberis, S. aureus), straw bedding (Strep. uberis), and lack of bedding or mattress cubicles (Strep. dysgalactiae). The odds for a herd to be positive were increased with audible liner slips (E. coli) and the irregular cleaning of water troughs (Strep. agalactiae), and without a maintenance agreement for milking equipment (Strep. agalactiae). These results provide valuable insights into options for the targeted prevention of IMI. Full article

This study evaluates the performance of count regression models in the presence of zero inflation, outliers, and overdispersion using both simulated and real-world maternal mortality dataset. Traditional Poisson and negative binomial regression models often struggle to account for the complexities introduced by excess zeros and outliers. To address these limitations, this study compares the performance of robust zero-inflated (RZI) and robust hurdle (RH) models against conventional models using the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) to determine the best-fitting model. Results indicate that the robust zero-inflated Poisson (RZIP) model performs best overall. The simulation study considers various scenarios, including different levels of zero inflation (50%, 70%, and 80%), outlier proportions (0%, 5%, 10%, and 15%), dispersion values (1, 3, and 5), and sample sizes (50, 200, and 500). Based on AIC comparisons, the robust zero-inflated Poisson (RZIP) and robust hurdle Poisson (RHP) models demonstrate superior performance when outliers are absent or limited to 5%, particularly when dispersion is low (5). However, as outlier levels and dispersion increase, the robust zero-inflated negative binomial (RZINB) and robust hurdle negative binomial (RHNB) models outperform robust zero-inflated Poisson (RZIP) and robust hurdle Poisson (RHP) across all levels of zero inflation and sample sizes considered in the study. Full article