Search Results (178,480)

Designing fair and sustainable pricing mechanisms for health insurance requires accurate risk assessment and the formulation of incentive-compatible strategies among stakeholders. This study proposes a hybrid framework that integrates machine learning with game theory to determine optimal, risk-based premium rates. Using a comprehensive dataset of insured individuals, the XGBoost algorithm is employed to predict medical claim costs and calculate corresponding premiums. To enhance transparency and explainability, SHAP analysis is conducted across four risk-based groups, revealing key drivers, including healthcare utilization and demographic features. The strategic interactions among the insurer, insured, and employer are modeled as a repeated game. Using the Folk Theorem, the conditions under which long-term cooperation becomes a sustainable Nash equilibrium are explored. The results demonstrate that XGBoost achieves high predictive accuracy (R² ≈ 0.787) along with strong performance in error measures (RMSE ≈ 1.64 × 10⁷ IRR, MAE ≈ 1.08 × 10⁶ IRR), while SHAP analysis offers interpretable insights into the most influential predictors. Game-theoretic analysis further reveals that under appropriate discount rates, stable cooperation between stakeholders is achievable. These findings support the development of equitable, transparent, and data-driven health insurance systems that effectively align the incentives of all stakeholders. Full article

Coronavirus disease 2019 (COVID-19) emerged in late 2019 and was declared a pandemic from March 2020 to May 2023, profoundly affecting public health systems, economies, and daily life worldwide. University students were among the most impacted groups, facing abrupt transitions to remote learning, social isolation, and increased psychological distress due to academic and personal uncertainties. During the pandemic, few studies have been conducted with this population and so far, none have evaluated factors associated with COVID-19 infection in university students, so this study aimed to evaluate variables associated with COVID-19 infection among university students in southern Brazil. Data were collected from July to November 2020 through an online questionnaire addressing lifestyle and health, with participation from 1533 students. Among the variables analyzed, statistically significant associations with COVID-19 infection were identified for age, occupation, use of continuous medication, compliance with social distancing, and self-medication practices. Younger students (18–29 years) and those dedicated solely to studying exhibited higher infection rates. Additionally, participants who reported using continuous medication, not adhering to social distancing measures, or engaging in self-medication were significantly more likely to have contracted COVID-19. These results help outline risk profiles within the university student population and contribute to improved preparedness for future disease outbreaks. Furthermore, they underscore attitudes and behaviors that may increase vulnerability to infectious diseases, highlighting the importance of targeted health promotion and prevention strategies in this demographic. Full article

Background: While disparities in vaccine uptake have been well documented, few studies have evaluated the impact of local vaccine programs on COVID-19 outcomes, namely cases, hospitalizations, and deaths. Objectives: Evaluate the impact of COVID-19 vaccine doses coordinated by the Louisville Metro Department of Public Health and Wellness (LMPHW) on COVID-19 outcomes by race across ZIP codes from December 2020 to May 2022 in Jefferson County, Kentucky. Methods: Fixed-effects longitudinal models with ZIP codes as ecological time-series units were estimated to measure the association between COVID-19 vaccine doses and outcomes with time lags of one week, two weeks, three weeks, four weeks, and one month. Models were adjusted for time (week or month of the year) and its interaction with ZIP code. Results: In the one-week lag model, significant negative associations were observed between LMPHW-coordinated vaccine doses and COVID-19 outcomes, indicating reductions of 11.6 cases, 0.4 hospitalizations, and 0.3 deaths per 100 doses administered. Vaccine doses were consistently associated with fewer deaths among White residents across all lags, with an average reduction of 0.2 deaths per 100 doses. No significant associations were found for Black residents. Temporal trends also indicated declines in COVID-19 outcomes when LMPHW’s vaccine administration program peaked, between March and May 2021. Conclusions: Timely uptake of COVID-19 vaccines remains critical in avoiding severe outcomes, especially with emerging variants. Racial disparities in vaccine–outcome associations emphasize the potential need for equitable, community-driven vaccine campaigns to improve population health outcomes. Full article

Microbiome science has revolutionized modern biology, shifting the focus from pathogens to the essential roles of beneficial microbes in health, metabolism, and ecosystems. Advances in genomic technologies like metagenomics have rapidly expanded our understanding of microbial diversity and function. Despite this progress, global microbiome research remains concentrated in high-resource regions, limiting diverse perspectives and opportunities in places like the Caribbean. This communication discusses the establishment of the first Center for Microbiome Sciences in Puerto Rico, which addresses this gap by providing local researchers with access to advanced tools, training, and infrastructure through broader collaboration. Novelty, services, and ideas on the integration of activities among local centers for the scientific improvement of the region are addressed. Additionally, how the center is poised to contribute to improving public and environmental health is also highlighted. Full article

Background: Chronic pain is a major contributor to a reduced quality of life in the United States, with chronic shoulder pain comprising a sizeable portion of complaints. Multiple techniques are utilized in the treatment of chronic shoulder pain, but many patients report significant pain refractory to these modalities. For these patients, the suprascapular nerve’s radiofrequency ablation (RFA) offers a potential long-lasting solution. Methods: This retrospective analysis used data from UW Health HealthLink records of patients who received suprascapular RFA from June 2017 to May 2024. Data were collected across 31 procedures, covering demographics, RFA technique, procedure efficacy, duration of relief, adverse events, and relevant medical history. The data were analyzed using a paired t-test. Results: The average pre-RFA pain score was 6.08/10, and the average post-RFA pain score was 2.95/10. The average percentage improvement was 63.3%, with a mean duration of improvement of 3.12 months. Five procedures yielded no improvement in pain. Conclusions: This study demonstrated that RFA is an effective alternative therapy for chronic shoulder pain refractory to conventional pain management strategies, with a potential for long-term relief. Limitations of this study are due to the inherent challenges of retrospective analyses. Full article

Background: One’s dietary pattern throughout life is established during the perinatal period, especially in the intrauterine environment. This study aims to analyze whether maternal and birth characteristics are associated with food consumption in young adults using baseline data from the Nutritionists’ Health Study (NutriHS). Methods: We employed cross-sectional analysis of data from 386 undergraduate nutrition students and nutritionists. Current food consumption was evaluated as per the NOVA classification. The maternal and birth factors included maternal age, parity, type of childbirth, health problems during pregnancy, prematurity, and birth weight, and multiple correspondence analysis of these variables was performed to identify patterns in them. Results: The energy contribution of ultra-processed foods was positively associated with the pattern characterized by participants whose mothers were 19 years of age or younger, primiparous, and had a vaginal delivery (β = 0.48; 95% confidence interval = 0.02, 1.66). Conclusions: We concluded that maternal age at birth was associated with the dietary patterns of adult children. Participants whose mothers were 19 or younger at birth had significantly higher consumption of ultra-processed foods in adulthood compared to those whose mothers were older. Full article

Background: Burnout is a prevalent issue among mental health nurses. While various interventions have been implemented to address burnout, their effectiveness and sustainability remain unclear in specialised mental health settings. This systematic review aims to clearly evaluate the effectiveness of interventions specifically designed to reduce burnout among mental health nurses, focusing on intervention types, their impact, and the sustainability of results. Methods: A comprehensive search of databases (Embase, CINAHL, Medline, PubMed, Scopus, and Web of Science) identified studies on burnout reduction interventions for mental health nurses. Inclusion criteria focused on mental health nursing populations with pre- and post-intervention burnout measures. Methodological quality was assessed using JBI Critical Appraisal Tools. A narrative synthesis guideline was used to analyse data. Results: Among 2502 studies retrieved, only 4 met the inclusion criteria after a rigorous screening process. These studies explored specific intervention types, including a two-day burnout prevention workshop, an eight-week group-based psychoeducational programme, a twelve-week mindfulness-based psychoeducational intervention, and an eight-week guided self-help mindfulness programme delivered via a digital platform. Significant reductions in burnout were observed across these studies; however, the sustainability of these effects varied. Interventions of greater duration, such as the 12-week mindfulness-based programme and the 8-week group psychoeducational intervention, yielded more enduring improvements. In contrast, shorter interventions, like a two-day workshop, showed transient benefits that diminished over time. Conclusions: This review highlights a critical gap in research on burnout interventions for mental health nurses. While the reviewed interventions showed promise in reducing burnout, the findings underscore the need for sustainable, adaptable interventions and more robust research. Full article

Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs. Full article

This study was conducted to investigate the effects of a Chinese herbal medicine compound microecological agent (C-MEA) on the egg production performance, ovarian follicle development, ovary transcriptome, and cecal microbiota of caged laying ducks. A total of 108 black Muscovy ducks (150 days old) were randomly divided into three groups for 30 days in a formal feeding trial. Compared with the control basic diet (Group C) and 16 g/kg C-MEA dosage (Group B), the 8 g/kg C-MEA dosage (Group A) increased egg production (average laying rate 69.35%) and follicle development (5~7 Fs, 6~7 LYFs, 11~13 SYFs) mass (p < 0.05). According to RNA-Seq, the ovaries’ transcriptome among different dietary groups enriched six key pathways, including neuroactive ligand–receptor interaction, the PPAR signaling pathway, ECM–receptor interaction, focal adhesion, the adherens junction, and the FoxO signaling pathway, as well as 46 candidate key genes. According to 16S-Seq, the microbial diversity was significantly increased in Group A, and the genus abundances of Sphaerochaeta and UCG-004 were significantly changed among different dietary groups (p < 0.05). Supplementation with C-MEA may optimize the cecal microflora and the interactions between the intestinal microflora and the host. The results from combining RNA-Seq and 16S-Seq demonstrated that the relationship between Sphaerochaeta and the hub gene cluster (F2, KNG1, C5, PLG, F2RL1, FABP1, and GCG) is the most prominent. In conclusion, the egg performance of caged laying ducks can be modulated through the microbiota–gut–ovary axis. Our findings provide new insights for improving gut health and reproductive performance of caged laying ducks. Full article

Background/Objectives: Fungotherapy has long been recognized as a therapeutic approach for treating and preventing various diseases. As an important representative of the so-called functional mushrooms, Chaga plays a crucial role in this system. Since this species is of limited distribution in Bulgaria, we are interested in studying a related but different species, Inonotus nidus-pici Pilát, with potential benefits for human health. Methods: The phytochemical composition of phenolic compounds in the studied species was analyzed using spectrophotometric methods and high-performance liquid chromatography (HPLC). Additionally, antioxidant activity was assessed using various assays, and the gastroprotective effect was evaluated in experimental rat models with indomethacin-induced gastric damage. Results: The quantities of the main classes of phenolic compounds in the studied object were determined, and an enriched phenolic extract (EPE) was obtained. The amount of phenolic compounds, in decreasing order, is as follows: tannins (1.67 ± 0.02%), phenolic acids (1.50 ± 0.09%), and flavonoids (1.24 ± 0.04%). Quercetin was the most present flavonoid (15.95 ± 0.05 mg/g DWE), followed by (+)-catechin (9.86 ± 0.15 mg/g DWE) and kaempferol (1.67 ± 0.09 mg/g DWE) in the enriched phenolic extract. The quantity of other established compounds was significantly lower. Of all ten phenolic acids identified in the same extract, the highest concentration was found only for rosmarinic acid (6.41 ± 0.08 mg/g DWE) and somewhat for p-coumaric acid (2.13 ± 0.12 mg/g DWE). Among all the applied methods regarding antioxidant activity, the highest potential of the extract for reducing copper ions was the most pronounced (1506.93 μM TE/g DWE), and the ability of the extract to reduce iron ions was almost the same (1354.05 μM TE/g DWE). In the experimental indomethacin-induced gastric ulcer rat model, EPE (25 mg/kg and 10 mg/kg) demonstrated a dose-dependent gastroprotective effect. Conclusions: The results of the experiments confirm the potential of the wood fungus species as a source of valuable biologically active compounds with beneficial and pharmacological effects. However, further studies are needed to fully determine its chemical composition and the biological activities related to it. Full article

Background/Objectives: Oral health plays a crucial role in the physical, emotional, and social well-being of children. Data from 2019 indicate that oral diseases remain a major concern in the Italian paediatric population, affecting not only children’s health but also caregivers’ well-being. This study aimed to assess the importance attributed by Italian families to their children’s oral health and correlate parents’ perceptions with children’s actual oral health status. Methods: A total of 131 children aged 0–12 years, admitted to the IRCCS Giannina Gaslini Children’s Hospital (Genoa, Italy) for reasons other than dental problems, were enroled between January 1 and December 31, 2024. Parents completed validated questionnaires (ECOHIS or PCPQ + FIS) based on their child’s age, along with supplementary questions on socio-demographic background and dental history. Oral examination was performed to assess dmft/DMFT scores, the Index of Orthodontic Treatment Need (IOTN), and the Modified Gingival Index (MGI). Results: In younger children (0–5 years), oral health was generally good, but the presence of caries negatively impacted the family’s quality of life. Older children (6–12 years) showed higher rates of caries and gingival inflammation, affecting their daily functioning and emotional well-being. Poor oral health was more common among children of non-European backgrounds and those with lower parental education. Early dental visits, within the recommended 24 months of age, were rare. Conclusions: Despite clear international recommendations, early dental visits remain uncommon, and many children experience preventable oral health issues. These findings highlight the urgent need to improve caregiver education and public health strategies to promote early preventive dental care. Full article

Background/Objectives: This randomized controlled trial aimed to evaluate the effects of casein-enriched milk (CEM) consumption and its timing (presleep vs. during the day) in the early postoperative period on body composition, muscle strength, physical function, and biochemical parameters in individuals undergoing laparoscopic sleeve gastrectomy (SG). Methods: Forty-five adults (60% female, 40% male; mean age 35.1 ± 9.7 years; mean BMI 41.4 ± 4.9 kg/m²) undergoing SG were randomly assigned to three groups: (1) 15 g protein CEM (12 g casein) presleep, (2) the same CEM during the day, or (3) standard-protein diet without supplementation. The primary endpoint was change in fat-free mass (FFM) at 12 weeks; secondary endpoints included handgrip strength, 30 s sit-to-stand test, and serum total protein, albumin, and prealbumin. Assessments were performed preoperatively and at weeks 4, 8, and 12. Results: No significant differences were found between the groups in terms of body composition, muscle strength, or physical performance measurements (p > 0.05). However, a significant increase in handgrip strength was observed over time in Groups 1 and 2 (p < 0.05), which was not observed in Group 3. Prealbumin levels at week 12 were 0.3 ± 0.0 mg/dL in Group 1 and 0.2 ± 0.0 mg/dL in Group 2, both higher than 0.2 ± 0.0 mg/dL in Group 3 (p < 0.05). No significant differences were found in albumin and total protein levels (p > 0.05). Conclusions: Early postoperative CEM consumption following SG did not significantly affect body composition or physical performance; however, the higher prealbumin levels indicate that this marker may be more sensitive in detecting early protein response, highlighting its potential clinical relevance in monitoring nutritional status after bariatric surgery. Full article

Background: Chewing gum is a simple, accessible tool with high user compliance, traditionally associated with oral health benefits. Although its potential effects on different aspects of health and well-being, beyond its oral applications, have been explored, the area remains relatively under-researched. This mapping review and evidence gap map (EGM) aimed to evaluate the existing literature on the non-oral health applications of chewing gum and to identify gaps in the literature. Methods: A comprehensive search was conducted across five databases (Scopus, Embase, PubMed, PsycINFO, and CINAHL) using tailored search strategies. Abstracts were screened against predefined eligibility criteria using EPPI-Reviewer version 6, with full texts reviewed only when relevant information could not be drawn. The included studies were coded by gum type, outcome, and study design, and the EGM was constructed using EPPI-Mapper version 2.4.5. Results: Of the 2614 identified records, 1326 were screened after duplicate removal, and 260 studies were included in the final analysis. Three main areas of application emerged: for enhancing well-being and performance, as a medical aid and as a surgical/procedural aid. The EGM indicated that the most frequently studied uses of chewing gum were in sports performance, smoking cessation, and post-operative recovery. However, notable research gaps were found, particularly in paediatric and geriatric contexts. Conclusions: Chewing gum has been extensively studied as a surgical or procedural aid, particularly for post-operative gastrointestinal recovery, but its broader applications for well-being, performance, and its use in paediatric and elderly populations remain underexplored. Further high-quality research using standardised methodologies is needed to address these gaps. Full article

Refugee mothers are at heightened risk of developing negative family dynamics due to traumatic experiences and unstable living conditions, often impacting their children in lasting ways. This partially mixed, explanatory mixed-methods pilot study examines the potential of Drama Therapy as a psychosocial intervention to reduce harmful parenting behaviors and strengthen parent–child relationships. The study engaged 20 refugee mothers who participated in a three-session intervention based on Emunah’s five-phase model. Data collection included pre-intervention demographic information, two standardized psychological scales—The Child–Parent Relationship Scale and the Parent Anger Scale—and post-intervention focus group discussions. The findings indicate that the Drama Therapy Intervention (DTI) helped reduce parental anger and improve emotional regulation, leading to more positive interactions with children and decreased conflict within the family. Focus group insights revealed that the mothers’ ongoing and past traumas significantly shaped their emotional responses and parenting styles. This pilot study highlights the importance of addressing maternal mental health in post-displacement contexts. Although one cannot draw causal inferences of efficacy in the absence of a control group, the findings provide preliminary evidence that Drama Therapy can be an effective tool for reducing parental maltreatment and improving family relationships among refugee populations. Full article