Search Results (847)

Background: Metabolic syndrome is a major public health concern because of its association with cardiovascular disease and type 2 diabetes. Tobacco exposure, including combustible cigarette smoking and electronic cigarette use, has increasingly been linked to cardiometabolic dysfunction; however, evidence in occupational populations remains limited. Objectives: This study evaluated the association of combustible cigarette smoking, electronic cigarette use, and dual use with metabolic syndrome in a working population from southwestern Colombia. Methods: We conducted a cross-sectional study of 822 workers from formal companies. Tobacco exposure was self-reported and categorized as exclusive electronic cigarette use, exclusive combustible cigarette smoking, dual use, or non-use. Sociodemographic, anthropometric, and metabolic variables were collected using standardized procedures. Logistic regression models were fitted to estimate crude and adjusted odds ratios with 95% confidence intervals. Results: Metabolic syndrome was identified in 39.8% of participants. It was more frequent in men, who also exhibited a greater accumulation of metabolic abnormalities. Hypertriglyceridemia and low high-density lipoprotein cholesterol were the components most strongly associated with metabolic syndrome. Compared with non-use, the odds of metabolic syndrome were higher across all tobacco-exposed groups, with odds ratios of 3.02 for exclusive electronic cigarette use, 7.29 for exclusive combustible cigarette smoking, and 4.75 for dual use. The strongest association was observed for exclusive combustible cigarette smoking. Conclusions: Metabolic syndrome was prevalent in this occupational population, and tobacco-related exposures were associated with a less favorable cardiometabolic profile. These findings support integrated workplace prevention strategies that combine smoking control with early detection of metabolic risk. Full article

Particles exhibiting fluorescence after Nile Red staining have been increasingly investigated in human biological samples in the context of microplastic exposure, but their clinical relevance remains unclear. In this study, Nile Red-positive microparticles were quantified in whole blood from chronic users of different nicotine-delivery systems and non-user controls. The study included 73 nicotine users, including conventional cigarette smokers, e-cigarette users, and heated tobacco product users, as well as an age- and sex-matched control group. Only participants without diagnosed chronic somatic disease were enrolled. Microparticles were quantified by flow cytometry after Nile Red staining. Associations with age, nicotine dependence assessed with the FTND and FTQ, motivation to quit smoking assessed with the Schneider Motivation Test, and selected hematological and biochemical parameters were also analyzed. In the overall analysis, the mean number of microparticles was higher in nicotine users than in controls, but the difference was not statistically significant (p = 0.38). In subgroup analyses, higher particle counts were observed in conventional cigarette smokers and heated tobacco product users compared with controls. No significant difference was found for e-cigarette users. Higher particle counts were also observed in older participants and in participants with greater nicotine dependence. Participants with higher particle counts more often showed stronger nicotine dependence and lower motivation to quit smoking. These results suggest that circulating Nile Red-positive microparticle counts may differ according to the type of nicotine product used and selected behavioral characteristics. However, the subgroup findings should be interpreted with caution due to the exploratory design and limited statistical power. Full article

Background: Generative artificial intelligence (GenAI) is diffusing among consumers at exceptional speed, yet little is known about how its adoption relates to households’ prior engagement with digital financial services, or about the barriers associated with non-adoption. Methods: Using individual microdata from the 2025 Spanish Survey on ICT Equipment and Use in Households (INE; 14,642 internet users aged 16 and older), we estimate survey-weighted logistic regressions of GenAI adoption on financial digital engagement, digital skills and sociodemographics, with autonomous community fixed effects and cluster-robust standard errors, complemented by average marginal effects, alternative variance estimators, and an analysis of all stated reasons for non-use. Results: GenAI adoption is 37.3% among internet users. Online banking users have 73% higher adjusted odds of adopting GenAI (OR = 1.73; 95% CI 1.53–1.97), and adoption rises monotonically from 18% to 79% across a 0–4 financial digital engagement index, although this gradient is driven mainly by the online banking (extensive) margin. A steep age gradient is present, but the financial digital advantage does not significantly widen with age. Among non-adopters, the most frequently stated reason for non-use is a lack of perceived need (67%); privacy or security concerns are also prominent (43%) and are cited disproportionately by online banking users, women, and older individuals. Conclusions: Prior financial digital engagement is a strong correlate, rather than a demonstrated cause, of consumer GenAI adoption, consistent with experience and facilitating condition constructs in UTAUT2. Among capable non-adopters, for whom access and skills are not the obstacle, privacy- and security-related concerns, rather than a broader deficit of trust in AI, emerge as the most salient barriers to adoption, underscoring these concerns as priorities for consumer-facing AI in financial services. Full article

Background/Objectives: Although psychopharmacotherapy and physical activity may benefit children with mental disorders, the association of psychotropic medications with physical activity remains unclear. The study evaluated the association between exposure to antidepressants or central nervous system (CNS) stimulants and the likelihood of meeting the Centers for Disease Control and Prevention (CDC) physical activity guidelines (≥60 min of moderate-to-vigorous physical activity daily) among U.S. children. Methods: We used data from the 2017–March 2020 National Health and Nutrition Examination Survey (NHANES) to quantify medication use and physical activity duration. The exposure to antidepressants and CNS stimulants in children and their level of physical activity were captured via interviews with pediatric participants and their adult proxies. The proportion of children meeting the CDC-recommended physical activity level was compared between propensity-score-matched antidepressant users vs. non-users, as well as matched CNS-stimulant users and non-users, using Rao–Scott chi-square tests. Results: Among 3835 NHANES participants aged 2–17 years, representing approximately 59.4 million U.S. children, 0.89% used antidepressants, and 2.40% used CNS stimulants. After accounting for age, sex, race/ethnicity, body mass index (BMI), and family income, a smaller proportion of CNS stimulant users met physical activity guidelines compared with non-users (22.06% vs. 37.02%; p = 0.0075). Antidepressant use was not significantly associated with physical activity level (12.06% vs. 15.52%; p = 0.6342). Conclusions: These findings highlight the importance of monitoring activity patterns among youth prescribed CNS stimulants and antidepressants, particularly integrating physical activity promotion into public health strategies. Full article

Purpose: This study aimed to assess the association between electronic cigarette use and sleep quality among young adults aged 18 to 25 years. Methods: This cross-sectional study was conducted in the Jazan region using a structured, self-administered questionnaire. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with global scores >5 indicating poor sleep quality. Smoking behaviors, including electronic and combustible cigarette use, along with demographic, socioeconomic, and clinical variables, were collected. Multivariable generalized linear modeling was used to identify factors independently associated with PSQI global scores. Results: Among 423 participants (median [IQR] age, 21.0 [20.0–24.0] years), 51.3% were classified as having poor sleep quality (PSQI > 5). In univariate analysis, male, electronic cigarette use, and presence of comorbidity were significantly associated with poor sleep quality. Electronic cigarette users had a higher prevalence of poor sleep compared with nonusers (64.0% vs. 46.6%; p = 0.01). In multivariable logistic regression, electronic cigarette use remained independently associated with increased odds of poor sleep (odds ratio [OR], 2.86; 95% CI, 1.31–6.24; p = 0.008), whereas combustible cigarette use was not significant. Conclusions: In this study of young adults in Jazan, poor sleep quality was common and was associated with electronic cigarette use and comorbidity burden, whereas combustible cigarette use was not associated after adjustment. These findings suggest that vaping may be an important correlate of sleep health in this population. Further longitudinal studies are needed to clarify the temporal relationship between electronic cigarette use and sleep outcomes. Full article

Background/Objective: The psychosexual burden of human papillomavirus (HPV)-induced genital warts (GWs) in men remains underexplored. This study aimed to determine the prevalence of sexual dysfunction in men with GWs and to evaluate the effects of disease duration and condom use on the sexual cycle using the International Index of Erectile Function (IIEF-15). Methods: This single-center, cross-sectional study was conducted in the dermatology outpatient clinic of Kayseri City Education and Research Hospital between May and June 2026 and enrolled 150 sexually active male patients with clinically diagnosed, currently present genital wart lesions. To minimize reading comprehension and social desirability biases, a two-stage protocol was implemented. First, a clinician explained each IIEF-15 item face-to-face. Patients then completed the questionnaire independently and submitted it in a sealed envelope. Associations were analyzed using Spearman’s rank correlation, and group comparisons used the Mann–Whitney U and Kruskal–Wallis tests. Results: The median age was 30.0 years (IQR 25.0–36.0) and the median disease duration was 18.0 months (IQR 8.0–35.8). Erectile dysfunction (ED) of varying severity was detected in 84.7% (n = 127) of patients. In unadjusted analysis, longer disease duration was associated with lower sexual function scores; however, these associations did not remain significant after adjustment for age. As ED severity increased, all other sexual function domains declined concurrently and strongly (Spearman rho ranging from −0.679 to −0.821; p < 0.0001). Condom users exhibited higher total sexual function scores than non-users (median 55.5, IQR 43.2–61.0 vs. median 49.5, IQR 37.0–60.0); however, this difference did not reach statistical significance (p = 0.076). Conclusions: Genital warts in men constitute a major psychosexual condition that disrupts multiple phases of the sexual response cycle, not merely a dermatological lesion. Our cross-sectional findings suggest that lesion-directed treatment alone may not fully address this psychosexual burden: whether the proactive integration of multidisciplinary sexual counseling improves outcomes should be tested in controlled, longitudinal studies. Full article

The ultimate goal of integrating artificial intelligence into education is to ensure the long-term stability, quality, and sustainability of the educational process, turning it into a tool that consistently improves teaching and learning. Yet its sustainable and responsible integration depends largely on a positive mindset and the pedagogical willingness of future teachers. This study examines the attitudes and readiness of pre-service teachers, specializing in preschool, primary, and subject-specific science education, toward AI integration, with a specific focus on sustainable science education and Green Lab concepts. A mixed-methods study was conducted on a sample of 251 students from the University of Split. Data were analyzed using exploratory factor analysis, standard and Welch ANOVA with Tukey’s HSD and Games–Howell post hoc tests, and multiple linear regression in IBM SPSS 20, and qualitative content analysis. The findings reveal perceived usefulness as a primary driver of AI acceptance across all groups. Science students demonstrated the highest levels of ethical and critical sensitivity but provided the lowest ratings for AI’s practical application in sustainable science education, expressing cautious attitudes and distinct concerns about system reliability. However, no significant difference was found between students with and without a science background in regard to AI’s potential to facilitate sustainable scientific concepts. Furthermore, behavioral analysis demonstrated that even initial, occasional exposure to AI tools significantly boosted students’ perceptions of its utility and sustainable application compared to non-users, whereas increasing the frequency of use resulted in no additional gains. The transition toward sustainable science education requires moving beyond technical literacy toward a comprehensive framework that integrates pedagogical usefulness with ethical responsibility and sustainable scientific application. Future studies should explore potential models that combine the methodological creativity of pre-service educators and teachers with the analytical rigor of science students. Ultimately, this research underscores that an educational policy must integrate digital advancements while strictly maintaining ethical standards and the essential role of human supervision. Full article

Background/Objectives: Frailty is a clinically significant syndrome in older patients with ischemic heart disease, associated with adverse outcomes including hospitalization, disability, and mortality. This study aimed to evaluate the association of potentially inappropriate medication (PIM) and the Geriatric Nutrition Risk Index (GNRI) with the incidence of frailty among elderly patients with ischemic heart disease (IHD). Methods: This retrospective cohort study enrolled elderly patients with IHD between January 2018 and March 2024. Patients were grouped by PIM use and GNRI levels (<92 vs. ≥92). Cox proportional hazards models assessed the associations of PIM and GNRI with the incidence of frailty. Subgroup and sensitivity analyses evaluated the consistency and robustness of these findings. Results: PIM use was associated with a significantly higher risk of frailty (HR = 3.01, 95% CI = 2.48–3.65) than non-use. Similarly, lower GNRI increased the risk of frailty compared to higher GNRI (HR = 1.31, 95% CI = 1.12–1.54). Patients with both PIM and lower GNRI may have a higher risk of frailty, with an adjusted aHR of 4.09. Subgroup analyses showed significant interactions between GNRI and hypertension. Sensitivity analyses indicated that PIM (aHR = 2.65) and lower GNRI (aHR = 1.14) remained significantly associated with frailty, even after including those with pre-existing frailty. Conclusions: For elderly patients with IHD, both PIM and lower GNRI were significantly associated with the incidence of frailty. These findings suggest that PIM exposure and low GNRI may serve as clinically accessible markers for identifying older IHD patients at elevated risk of frailty. Full article

Objective: Thyroid hormone treatment is the standard therapy for hypothyroidism, particularly in women. Concerns have been raised that exogenous thyroid hormone use may increase breast cancer risk, but evidence remains inconclusive. This study aimed to systematically review and synthesize observational evidence on the association between thyroid hormone treatment and breast cancer risk in women. Design: We conducted a systematic review and meta-analysis of observational studies. Methods: MEDLINE, EMBASE, and Web of Science were searched from January 1976 to February 2025. Eligible studies assessed breast cancer incidence in adult women receiving thyroid hormone treatment versus non-users. Pooled ORs were calculated. Findings from cohort studies reporting hazard ratios were synthesized qualitatively. Heterogeneity, publication bias, and certainty of evidence were assessed. PROSPERO ID: CRD42022348966. Results: Four case–control studies including 221,254 women receiving thyroid hormone treatment and 4,385,666 controls were included in the prespecified primary OR-based meta-analysis. In the primary random-effects meta-analysis, thyroid hormone treatment showed a possible epidemiological signal with breast cancer risk (OR 1.43, 95% CI: 0.90–2.28; I² = 94.3%), although the confidence interval crossed unity and heterogeneity was substantial. Formal assessment of publication bias was performed but should be interpreted cautiously given the small number of included studies. The certainty of evidence was rated as low due to heterogeneity, serious inconsistency and imprecision. Conclusions: Thyroid hormone treatment was associated with a possible epidemiological signal for breast cancer in observational studies; however, the primary pooled estimate was not statistically significant and should be interpreted as hypothesis-generating because of substantial heterogeneity and residual confounding. Further well-designed prospective studies are required before causal or clinical inferences can be made. Full article

Background: Statins have pleiotropic anti-inflammatory, antifibrotic, and potential antineoplastic effects. Although several studies have linked statin exposure to lower hepatocellular carcinoma (HCC) incidence, their effect on survival after HCC diagnosis remains uncertain. We evaluated whether statin therapy before HCC diagnosis was associated with overall survival in a real-world cohort. Methods: We performed a retrospective single-center cohort study of consecutive patients with HCC managed at a tertiary referral center between January 2000 and January 2025. Demographic, clinical, laboratory, tumor-related, and treatment variables were collected at diagnosis and during follow-up. Patients were classified according to statin use before HCC diagnosis. Overall survival (OS) was assessed using Kaplan–Meier analysis and Cox proportional hazards regression. Results: Overall, 190 patients were included; 172 (90.5%) were male, 136 (71.6%) had cirrhosis, and 42 (22.1%) received statins. Statin users more frequently had diabetes mellitus, elevated body mass index and arterial hypertension, but baseline liver function, alpha-fetoprotein levels, tumor burden, and treatment allocation were broadly comparable between groups. Among 159 patients with available survival data, statin users had longer OS than non-users (mean 82.5 vs. 41.7 months; median 57 vs. 31 months; log-rank p < 0.001). In univariate Cox analysis, statin therapy was associated with reduced mortality risk (HR 0.45, 95% CI 0.28–0.70, p < 0.001). This association remained significant across multivariable models adjusting for baseline liver function, tumor stage, vascular invasion, and diagnostic era. Conclusions: Pre-diagnostic statin therapy was independently associated with improved OS in patients with HCC. These hypothesis-generating findings warrant prospective multicenter validation and careful assessment of confounding by indication. Full article

Variants in the glucocerebrosidase gene (GBA1) are the predominant genetic risk factor for Parkinson’s disease (PD), often accelerating disease progression. While biological sex modulates PD progression, the longitudinal association between rasagiline (a monoamine oxidase-B [MAO-B] inhibitor) and motor outcomes in GBA1-associated Parkinson’s disease (GBA1-PD) remains unclear. This retrospective cohort study (2019–2026) analyzed 259 patients with PD (106 females, 153 males) with a median follow-up of 1.56 years to evaluate the association between rasagiline use and motor decline, emphasizing sex-stratified outcomes. Motor progression was evaluated using the Movement Disorder Society—Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS-III). Rates of change were calculated using sex-stratified Generalized Estimating Equations models, with adjustment for age at diagnosis to evaluate treatment effects and sex-specific associations. Among 259 patients, rasagiline use was associated with a significantly slower annual rate of motor decline (Slope Difference: −0.95; p = 0.03). In the GBA1-PD subgroup, females using rasagiline exhibited a clinically relevant slower rate of progression (approximately 1 point/year on the MDS-UPDRS-III) compared with non-users, although not statistically significant (p = 0.08); no association was observed in males. These findings suggest a potential sex-specific association of rasagiline with motor progression in GBA1-PD. Results highlight the importance of sex-stratified analyses to support personalized therapeutic approaches for PD genetic variants. Full article

Background: Benzodiazepines are widely prescribed to older adults in primary care despite concerns regarding their potential cognitive adverse outcomes. Evidence on the association between benzodiazepine use and cognitive impairment remains inconsistent and is limited in middle-income countries, particularly in routine primary care settings. Objectives: To evaluate the association between benzodiazepine use and cognitive impairment among older adults in a primary care hospital in Mexico and to explore clinical factors associated with benzodiazepine prescribing patterns. Methods: A cross-sectional analytical study was conducted using non-probabilistic convenience consecutive sampling in a sample of 228 in adults aged ≥60 years attending a primary care hospital in Irapuato, Mexico, during 2025. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) and classified as normal cognition, mild/moderate cognitive impairment, or major cognitive impairment. Benzodiazepine exposure was identified through pharmacy records and categorized by duration of exposure (<3 years, 3–6 years, and >6 years). Sociodemographic variables were collected. Associations were evaluated using chi-square tests, and crude logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). An additional exploratory analysis assessed clinical factors associated with benzodiazepine type using a dichotomized outcome to ensure model stability. Results: A total of 228 older adults with documented benzodiazepine use were included. The sample represents the complete population of eligible benzodiazepine users during the study period. Cognitive impairment was identified in 61.8% of participants. Longer duration of benzodiazepine use was significantly associated with worse cognitive status (χ² = 25.81; p < 0.001), with the highest proportion of major impairment observed in individuals with more than six years of use. In exploratory analyses, benzodiazepine prescribing patterns were significantly associated with sleep disorders (χ² = 11.56; p = 0.009), polypharmacy (χ² = 10.28; p = 0.016), and MMSE category (χ² = 13.87; p = 0.031). In adjusted models, polypharmacy was associated with increased odds of receiving the most frequently prescribed benzodiazepine (OR 2.37; 95% CI 1.27–4.41; p = 0.007), while sleep disorders (OR 2.10; 95% CI 1.10–3.90; p = 0.009) and cognitive status (OR 1.85; 95% CI 1.05–3.20; p = 0.031) also showed significant associations. No comparisons with non-users were performed due to lack of comparable cognitive assessment; however, this comparison should be interpreted cautiously due to differences in assessment methods between groups. Conclusions: Among benzodiazepine users in primary care, longer duration of exposure was associated with worse cognitive status. Additionally, prescribing patterns were influenced by clinical factors such as polypharmacy, sleep disorders, and cognitive status, suggesting a predominantly clinically driven approach. These findings highlight benzodiazepine use as an important marker of cognitive vulnerability and underscore the need for careful prescribing, regular medication review, and deprescribing strategies in older adults. Full article

Introduction: Cochlear implantation is a well-established treatment for adults with bilateral postlingual deafness. In recent years, increasing research attention has focused on its use in patients with single-sided deafness (SSD) with or without tinnitus. Restoration of binaural auditory input through cochlear implantation may partially reestablish binaural processing. Methods: We conducted a narrative review of the literature focusing on studies examining the basic mechanisms associated with hearing impairment in SSD, as well as cochlear implantation outcomes in this population, including hearing performance, tinnitus suppression, and quality of life (QoL). We also reviewed comparative studies between cochlear implants (CIs) and alternative hearing devices, along with current candidacy criteria and the challenges associated with cochlear implantation in this patient group. Results: Current evidence suggests that CIs can provide significant benefits in this population, including tinnitus reduction or suppression, improved speech perception in both quiet and noise, enhanced sound localization, and better disease-specific and overall QoL. Furthermore, numerous studies—despite some variability in outcomes—indicate that CIs may offer superior performance compared with alternative options, such as contralateral routing of signals hearing aids (CROS-HAs) and bone-conduction devices, particularly in terms of speech perception, localization, tinnitus control, and aspects of QoL. Nevertheless, appropriate candidacy criteria and key challenges—most notably device non-use—should be carefully considered when evaluating cochlear implantation in this patient population. Conclusions: Further research is required to address these challenges and to advance a more personalized approach to cochlear implantation in individuals with SSD, with the aim of optimizing outcomes and reducing cochlear implant non-use. Full article

Personal Protective Equipment (PPE) compliance is critical in powerline and renewable energy construction projects, yet non-adherence remains common and difficult to monitor manually. This paper presents an automated PPE detection system using an Artificial Intelligence based object detection model applied to actual site overhead drone imagery. The aim was to identify key non-compliance categories such as the non-use of hardhats, reflective vests, long pants, T-shirts and long sleeve shirts. A custom dataset was developed from aerial and ground footage and enhanced through standard annotation and augmentation techniques. Model performance was evaluated using mAP, precision, recall, and confidence-based metrics, demonstrating reliable detection across most PPE classes despite environmental and distance-related challenges. The study shows the potential of AI-assisted, drone-based monitoring to enhance safety oversight on powerline and renewable energy construction sites. It further outlines future work to improve dataset diversity, resolution, and real-time deployment. 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