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16 pages, 1676 KB  
Article
Multimodal Bone Fragility Profiling in People Living with HIV: Trabecular Bone Score, Calcaneal Quantitative Ultrasound, and Sarcopenia Screening
by David Vladut Razvan, Jenel Marian Patrascu, Ovidiu Rosca, Iulia Georgiana Bogdan, Livia Stanga, Adrian Vlad and Camelia Vidita Gurban
Medicina 2026, 62(3), 603; https://doi.org/10.3390/medicina62030603 (registering DOI) - 23 Mar 2026
Abstract
Background and Objectives: Bone fragility in people living with HIV (PLWH) reflects both reduced bone mineral density (BMD) and impaired microarchitecture, while functional decline may further amplify fracture vulnerability. This study evaluated whether adding a pragmatic sarcopenia screen improves bone fragility characterization beyond [...] Read more.
Background and Objectives: Bone fragility in people living with HIV (PLWH) reflects both reduced bone mineral density (BMD) and impaired microarchitecture, while functional decline may further amplify fracture vulnerability. This study evaluated whether adding a pragmatic sarcopenia screen improves bone fragility characterization beyond DXA-BMD, trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS), and biomarkers, and explored the relationship between tenofovir disoproxil fumarate (TDF) exposure and microarchitectural impairment. Materials and Methods: In this single-center cross-sectional study at Victor Babeș University of Medicine and Pharmacy Timișoara, 98 adults on stable ART underwent DXA (T-scores), lumbar TBS (reported as TBS × 100), calcaneal QUS (SOS/BUA), and bone turnover markers (CTX, P1NP, 25(OH)D). Sarcopenia screening used handgrip strength and 4 m gait speed. Associations were tested using group comparisons, correlations, and multivariable modeling for degraded TBS (TBS × 100 < 124.0). Results: Sarcopenia screen-positive participants (n = 28) had lower TBS (123.8 vs. 127.7, p = 0.02), lower lumbar T-score (−1.7 vs. −1.2, p = 0.014), lower SOS (1523.3 vs. 1548.8 m/s, p = 0.002), and higher CTX (0.6 vs. 0.4 ng/mL, p < 0.001), with less frequent viral suppression (60.7% vs. 85.7%, p = 0.006). With >5 years TDF exposure (n = 28), degraded TBS prevalence was 82.1% vs. 40.0% in never-exposed (p = 0.001), alongside lower TBS (123.1 vs. 129.8, p < 0.001) and higher CTX (0.6 vs. 0.4 ng/mL, p < 0.001). Viral suppression independently reduced odds of degraded TBS (aOR 0.3, 95% CI 0.1–0.9; p = 0.034). Conclusions: In PLWH, prolonged TDF exposure and functional impairment co-occur with worse densitometric and microarchitectural profiles; viral suppression shows an independent protective association with microarchitecture. Full article
(This article belongs to the Section Orthopedics)
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15 pages, 246 KB  
Article
The Prevalence and Comorbidities of Self-Reported Mental Health Disorders Among Primary Healthcare Attendees in Riyadh, Saudi Arabia: A Cross-Sectional Survey
by Noof Alwatban, Mamdouh M. Shubair, Mariam A. A. Elmetwally, Bashar Mahmoud, Badr F. Al-Khateeb, Khadijah Angawi, Abeer Almudaihim, Nada Kareem Alenazi, Sahar Fahad Binhowaimel and Ashraf El-Metwally
Healthcare 2026, 14(6), 817; https://doi.org/10.3390/healthcare14060817 (registering DOI) - 23 Mar 2026
Abstract
Background/Objectives: This study aimed to determine the prevalence of self-reported prior diagnosis of mental health disorders and identify their sociodemographic, behavioral, and comorbidity-related determinants among primary healthcare attendees in Riyadh, Saudi Arabia. Methods: A cross-sectional survey was conducted among 14,239 Saudi [...] Read more.
Background/Objectives: This study aimed to determine the prevalence of self-reported prior diagnosis of mental health disorders and identify their sociodemographic, behavioral, and comorbidity-related determinants among primary healthcare attendees in Riyadh, Saudi Arabia. Methods: A cross-sectional survey was conducted among 14,239 Saudi residents visiting primary healthcare centers in Riyadh. Univariate analysis (p-value < 0.25) and multivariable logistic regression (p-value < 0.05) were employed to identify independent predictors of self-reported prior diagnosis of mental health disorders. Results: The prevalence of self-reported prior diagnosis of mental health disorders was 2.5% (95% CI: 2.24–2.76%). Multivariable analysis revealed several significant independent predictors. Individuals aged less than 50 years (AOR = 1.47, 95% CI: 1.19–1.83, p < 0.001) and females (AOR = 1.98, 95% CI: 1.56–2.50, p < 0.001) had significantly higher odds of reporting a prior diagnosis of a mental health disorder. The presence of health insurance was also found to be associated with increased odds (AOR = 1.85, 95% CI: 1.48–2.30, p < 0.001). Most importantly, smoking (AOR = 4.45, 95% CI: 3.22–6.15, p <0.001), hypertension (AOR = 2.32, 95% CI: 1.61–3.34, p <0.001), obesity (AOR = 9.40, 95% CI: 6.96–12.70, p <0.001), hypercholesterolemia (AOR = 2.84, 95% CI: 1.98–4.07, p < 0.001) and heart disease (AOR = 12.74, 95% CI: 9.25–17.56, p < 0.001) all were strong independent predictors of a prior diagnosis of a mental health disorder. Conclusions: The study identifies a measurable burden of self-reported prior mental health diagnoses among primary healthcare attendees in Riyadh, with higher odds observed among younger individuals, women, smokers, and those with chronic physical conditions. These findings highlight the importance of integrating mental health screening and management into primary healthcare services in Saudi Arabia. Full article
19 pages, 4178 KB  
Article
Uneven Paths to Health: A Spatial Analysis of Sidewalk Conditions and Healthcare Access for Older Adults
by Nikolaos Stasinos, Kleomenis Kalogeropoulos, Andreas Tsatsaris and Marianna Mantzorou
ISPRS Int. J. Geo-Inf. 2026, 15(3), 137; https://doi.org/10.3390/ijgi15030137 (registering DOI) - 23 Mar 2026
Abstract
As urban populations age, the built environment becomes a vital determinant of health equity. This research evaluates the sidewalk infrastructure, surrounding the Health Center in Egaleo, Greece, in order to quantify its impact on healthcare accessibility for older adults. Using a GIS-based approach [...] Read more.
As urban populations age, the built environment becomes a vital determinant of health equity. This research evaluates the sidewalk infrastructure, surrounding the Health Center in Egaleo, Greece, in order to quantify its impact on healthcare accessibility for older adults. Using a GIS-based approach to simulate realistic navigation, a routing algorithm prioritized the “easiest” path over the shortest distance by transforming accessibility scores into traversal costs. The results revealed a significant disadvantage in healthcare access, with routes to the Health Center scoring lower than the average accessibility of the greater study area. In addition, the negative correlation (r = −0.20, p < 0.001) confirms the pattern of accessibility disparity, where neighborhoods with the highest older adult density consistently face the poorest infrastructure. Eventually, Global Moran’s I of 0.912 confirms strong spatial autocorrelation, Local Indicators of Spatial Association (LISA) identifies “Accessibility Deserts” which comprise a 92.5% absence of crosswalks and an 81.7% rate of obstructions. This study outlines that those who depend most on the sidewalk network are disproportionately affected by inadequate urban planning conditions. By underscoring the necessity to remediate these low-accessibility clusters, public health is improved, ensuring equitable healthcare access and supporting healthy aging. Full article
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13 pages, 269 KB  
Article
Study—International Multicentric Minimally Invasive Liver Resection (SIMMILR-5): A Comparison of Open, Conventional Laparoscopic and Tele-Robotic Laparoscopic Liver Resection for Hepatocellular Cancer
by Andrew A. Gumbs, Roland Croner, David Fuks, Hadrien Tranchart, Zacharias Heger Londono, Joseph Derienne, Albert Chomątowski, Amir Nour Mohammadi, Vincent Grasso, Soufyan el Adel, Gianfranco Donatelli, Karol Rawicz-Pruzynski, Mohammad Abu-Hilal and Ibrahim Dagher
Cancers 2026, 18(6), 1031; https://doi.org/10.3390/cancers18061031 (registering DOI) - 23 Mar 2026
Abstract
Background: The role of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC) remains controversial because of concerns regarding oncologic adequacy, particularly margin status. While robotic-assisted hepatectomy has gained adoption, its true perioperative advantages over conventional laparoscopy and open surgery remain unclear. SIMMILR-5 was [...] Read more.
Background: The role of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC) remains controversial because of concerns regarding oncologic adequacy, particularly margin status. While robotic-assisted hepatectomy has gained adoption, its true perioperative advantages over conventional laparoscopy and open surgery remain unclear. SIMMILR-5 was designed to evaluate the short-term outcomes of open, laparoscopic, and tele-robotic laparoscopic hepatectomy for HCC using rigorous adjustment for confounding. Methods: A retrospective international multicenter study was conducted including patients undergoing liver resection for HCC between June 2004 and November 2024 at five high-volume hepatobiliary centers. Surgical approaches included open (O), conventional laparoscopy (L), and tele-robotic laparoscopy (TRL). Propensity score matching was performed using demographic, clinical, and tumor-related variables. The primary endpoint was short-term mortality (30 and 90 days). Secondary outcomes included estimated blood loss (EBL), operative time, length of stay (LOS), R0 resection status, and major complications. Results: A total of 904 patients were identified (302 O, 568 L, 34 TRL). After matching, conventional laparoscopy was associated with significantly lower EBL, shorter operative time, and shorter LOS compared with open surgery (all p < 0.00001). Compared with open surgery, TRL was associated with lower EBL but no improvement in operative time or LOS. Compared with laparoscopy, TRL was associated with longer operative time and longer LOS. Short-term oncologic surrogates were comparable across approaches. ConclusionsMinimally invasive hepatectomy offers perioperative advantages over open surgery for selected patients with HCC, driven primarily by conventional laparoscopy. Tele-robotic hepatectomy is feasible and safe in experienced centers but does not demonstrate superiority over advanced laparoscopic techniques. Full article
(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery (2nd Edition))
11 pages, 484 KB  
Article
Patient-Specific Restoration of Constitutional Alignment Within Predefined Safety Boundaries Using Three-Dimensional Navigation in Primary Total Knee Arthroplasty: One-Year Clinical and Radiographic Outcomes
by Maximilian F. Kasparek, Tobias Scheidl, Oliver Haider, Gyula Kiss, Anna Jungwirth-Weinberger, Maximilian Muellner, Valerie Ladstaetter and Thomas Muellner
J. Clin. Med. 2026, 15(6), 2441; https://doi.org/10.3390/jcm15062441 (registering DOI) - 23 Mar 2026
Abstract
Background/Objectives: This study investigates a surgical concept that restores constitutional bony alignment within predefined safety boundaries in primary total knee arthroplasty (TKA) using modern 3D navigation. The technique combines a standard knee implant with advanced navigation technology to achieve patient-specific alignment and [...] Read more.
Background/Objectives: This study investigates a surgical concept that restores constitutional bony alignment within predefined safety boundaries in primary total knee arthroplasty (TKA) using modern 3D navigation. The technique combines a standard knee implant with advanced navigation technology to achieve patient-specific alignment and recreate native joint mechanics. One-year outcome was evaluated to assess first clinical results. Methods: In this retrospective study, a consecutive series of 185 TKAs (171 patients) was analyzed. All patients underwent patient-specific restoration of constitutional alignment within predefined safety boundaries using a 3D navigation system and a standard knee arthroplasty implant. The clinical outcomes were assessed using the 2011 Knee Society Score (KSS), the Forgotten Joint Score (FJS-12), the UCLA Activity Scale, and a five-step Likert scale to evaluate satisfaction. Results: In a total of 87.6% of cases, the patients reported being either satisfied or very satisfied with their TKA. No patients reported strong dissatisfaction. The KSS demonstrated significant improvements in all subcategories (all p < 0.001). The FJS-12 increased significantly from a preoperative average of 32.5 points to 79.3 points postoperatively (p < 0.001). The mean UCLA activity score rose from 4.9 preoperatively to 6.6 postoperatively (p < 0.001). In 97.7% and 90.2% of cases, the femoral mechanical angle (FMA) and tibial mechanical angle (TMA) bone cuts were within ± 1° of the planned angles. A strong correlation was observed between the planned and verified bone cuts for the FMA (ρ = 0.939) and the TMA (ρ = 0.875). Conclusions: Patient-specific restoration of constitutional alignment within predefined safety boundaries in primary TKA using modern 3D navigation is a promising strategy for personalized joint reconstruction using a standard knee arthroplasty implant. It combines precision and reproducibility with high patient satisfaction by respecting each patient’s constitutional alignment. Full article
(This article belongs to the Special Issue New Insights in Joint Arthroplasty—2nd Edition)
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14 pages, 937 KB  
Article
Identification of High-Risk Individuals for Osteoporosis and Fragility Fractures in Cushing’s Syndrome: A Promising Predictive Approach
by Enes Ucgul, Burak Menekse, Ogulcan Boz, Huseyin Demirci, Bekir Ucan, Erman Cakal, Takako Araki and Muhammed Kizilgul
J. Clin. Med. 2026, 15(6), 2442; https://doi.org/10.3390/jcm15062442 (registering DOI) - 23 Mar 2026
Abstract
Background: Cushing’s syndrome (CS) causes excessive cortisol exposure, leading to significant skeletal complications. However, there is no validated, CS-specific model to predict osteoporosis and fracture risk. This study aimed to identify independent predictors and develop a practical clinical scoring system. Methods: [...] Read more.
Background: Cushing’s syndrome (CS) causes excessive cortisol exposure, leading to significant skeletal complications. However, there is no validated, CS-specific model to predict osteoporosis and fracture risk. This study aimed to identify independent predictors and develop a practical clinical scoring system. Methods: A retrospective study was conducted on 139 patients with CS diagnosed between 2014 and 2025. Demographic, clinical, and biochemical data were analyzed. Osteoporosis was defined using dual-energy X-Ray absorptiometry criteria. Logistic regression analyses identified independent predictors, and the Cushing-Related Osteoporosis Risk Estimation (CORE) Score was constructed from normalized beta coefficients of significant variables. Results: Osteoporosis was present in 35.9% and fragility fractures in 13.4% of patients. Independent predictors included age ≥ 51 years, symptom duration ≥ 13.5 months, diabetes mellitus, late-night salivary cortisol ≥ 0.42 μg/dL, and midnight serum cortisol ≥ 10.25 μg/dL (all p < 0.05). The CORE Score (0–6 points) showed strong diagnostic performance for osteoporosis (AUC 0.827; sensitivity 88%, specificity 72%) and fractures (AUC 0.866; sensitivity 84%, specificity 78%). Each one-point increase in the CORE Score elevates the risk of osteoporotic fracture by 3.13 times (p < 0.001). Conclusions: The CORE Score represents a promising disease-specific tool for early identification of CS patients at increased risk of osteoporosis and fragility fractures, enabling more personalized management and follow-up strategies, such as prioritizing bone-protective interventions and closer skeletal monitoring. Early identification of high-risk individuals may also facilitate timely therapeutic interventions, potentially reducing future fracture risk. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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11 pages, 226 KB  
Article
Cardiorenal Biomarkers and Cerebrovascular Risk in Patients with Congenital Heart Disease
by Efrén Martínez-Quintana and Fayna Rodríguez-González
J. Clin. Med. 2026, 15(6), 2440; https://doi.org/10.3390/jcm15062440 (registering DOI) - 23 Mar 2026
Abstract
Background/Objectives: Adults with congenital heart disease (CHD) have a substantially higher risk of ischemic stroke than the general population. Circulating biomarkers such as N-terminal pro B-type natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and microalbuminuria have been associated with adverse cardiovascular outcomes [...] Read more.
Background/Objectives: Adults with congenital heart disease (CHD) have a substantially higher risk of ischemic stroke than the general population. Circulating biomarkers such as N-terminal pro B-type natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and microalbuminuria have been associated with adverse cardiovascular outcomes in CHD, but their role in predicting cerebrovascular events remains uncertain. Methods: Prospective cohort study including 372 adults with CHD [median age 34 years (IQR 23–42); 57.8% male] followed at a tertiary center between 2017 and 2022. Baseline assessments included demographic characteristics, CHD anatomical complexity, cardiovascular risk factors, NT-pro-BNP, hs-CRP, lipid profile, and 24-h urinary albumin excretion. The primary endpoint was incident ischemic stroke during a median follow-up of 6.3 years (IQR 3.9–8.3). Univariable Cox proportional hazards models were used to identify predictors of stroke. Results: During follow-up, 13 patients (3.5%) experienced ischemic stroke. Patients with stroke were significantly older [51 (46–64) vs. 30 (23–40) years; p < 0.001] and had a higher prevalence of dyslipidemia (61.5% vs. 15.0%; p < 0.001). NT-pro-BNP levels were markedly higher in patients with stroke [369 (218–604) vs. 64 (21–172) pg/mL; p < 0.001]. No significant differences were observed between groups in renal function parameters, hs-CRP, thyroid-stimulating hormone, or urinary albumin excretion rate. In Cox analyses, older age and dyslipidemia were the strongest predictors of stroke (p < 0.001). Arterial hypertension, diabetes mellitus, and higher NT-pro-BNP levels were also associated with increased stroke risk (p < 0.05), whereas CHD anatomical complexity, NYHA functional class, and cyanosis were not. Conclusions: In adults with CHD, ischemic stroke was mainly associated with traditional cardiovascular risk factors and elevated NT-pro-BNP levels rather than anatomical disease complexity or functional status. Full article
(This article belongs to the Special Issue Current Challenges in Adult Congenital Heart Diseases)
8 pages, 416 KB  
Article
Evaluation of the Effects of Different Orthognathic Surgery Approaches on Mandibular Bone Structure Using Fractal Analysis
by Ömer Faruk Sari, Elif Albayrak, Muhammed Hilmi Büyükçavuş, Yavuz Fındık and Burak Incebeyaz
Appl. Sci. 2026, 16(6), 3076; https://doi.org/10.3390/app16063076 (registering DOI) - 23 Mar 2026
Abstract
Background: In orthognathic surgery planning, two main approaches are commonly used: the conventional orthodontic–surgical (COS) approach and the surgery-first (SF) protocol. The aim of this study was to comparatively evaluate trabecular bone changes in the mandibular condylar, angular, and molar regions following [...] Read more.
Background: In orthognathic surgery planning, two main approaches are commonly used: the conventional orthodontic–surgical (COS) approach and the surgery-first (SF) protocol. The aim of this study was to comparatively evaluate trabecular bone changes in the mandibular condylar, angular, and molar regions following COS and SF protocols using fractal analysis (FA). Methods: A total of 40 individuals (21 females, 19 males) who underwent bilateral sagittal split ramus osteotomy and Le Fort I osteotomy were included in the study. Patients were divided into COS and SF groups. Trabecular changes in the mandibular osteotomy line, condylar, and angular regions were evaluated on panoramic radiographs using FA, and fractal dimension values were calculated using the box-counting method. Results: No statistically significant differences were found between the groups in terms of baseline and post-treatment FA values in the molar and angular regions (p > 0.05). In contrast, a statistically significant difference was observed between the groups in the condylar region (p ≤ 0.05). The total treatment duration was significantly shorter in the SF group (p < 0.05). Conclusions: FA findings reveal that COS and SF protocols show similar effects in terms of mandibular bone healing, but the surgery-first approach is preferable due to its clinical advantages. Full article
(This article belongs to the Section Applied Dentistry and Oral Sciences)
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22 pages, 2901 KB  
Article
Investigation of the Effect of Plasma Discharge on Harmful Microorganisms in Water
by Askar Abdykadyrov
Water 2026, 18(6), 747; https://doi.org/10.3390/w18060747 (registering DOI) - 23 Mar 2026
Abstract
Microbiological contamination of drinking water remains a significant public health concern worldwide, necessitating the development of efficient and environmentally friendly disinfection technologies. This study investigated the effectiveness and physicochemical mechanisms of water treatment using high-frequency electrical discharge plasma. Experimental research was conducted employing [...] Read more.
Microbiological contamination of drinking water remains a significant public health concern worldwide, necessitating the development of efficient and environmentally friendly disinfection technologies. This study investigated the effectiveness and physicochemical mechanisms of water treatment using high-frequency electrical discharge plasma. Experimental research was conducted employing a laboratory dielectric barrier discharge reactor operating at 10–30 kHz and 10–25 kV, with treatment durations ranging from 5 to 20 min. Plasma exposure resulted in pronounced physicochemical changes in the aqueous medium, including a decrease in pH from 7.1–7.3 to 5.4–6.0 and an increase in electrical conductivity from 280–340 µS/cm to 480–620 µS/cm. The formation of reactive oxygen species, including hydroxyl radicals, ozone, and hydrogen peroxide, was confirmed, with hydrogen peroxide concentrations varying between 0.35 and 1.20 mg/L. Microbiological analysis demonstrated a reduction in microbial concentration from approximately 105–106 CFU/mL to 102–103 CFU/mL, corresponding to 3–4 log inactivation. The results indicated that microbial reduction was strongly associated with the generation of reactive species and treatment duration. Energy density within the range of 0.3–1.2 kWh/m3 was found to support effective disinfection performance. The findings demonstrated that high-frequency plasma treatment established a strong oxidative environment leading to microbial membrane disruption and cellular damage. Overall, the study confirmed the potential of high-frequency electrical discharge plasma technology as a promising approach for drinking water disinfection and provided a basis for further optimization and scale-up investigations. Full article
(This article belongs to the Section Water and One Health)
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14 pages, 844 KB  
Article
Out-of-Hospital Cardiac Arrest in Southern Italy: A Retrospective Analysis of 11,653 Cases
by Luca Gregorio Giaccari, Pasquale Sansone, Nicola D’Angelo, Daniele Antonaci, Eva Epifani, Luciana Mascia, Maria Caterina Pace, Vincenzo Pota and Gaetano Tammaro
J. Cardiovasc. Dev. Dis. 2026, 13(3), 146; https://doi.org/10.3390/jcdd13030146 (registering DOI) - 23 Mar 2026
Abstract
(1) Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue, with survival largely determined by the initial rhythm and timeliness of resuscitation. Comprehensive population-based data are essential for guiding prevention, emergency medical services (EMS) planning, and improving outcomes. (2) Methods: We [...] Read more.
(1) Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue, with survival largely determined by the initial rhythm and timeliness of resuscitation. Comprehensive population-based data are essential for guiding prevention, emergency medical services (EMS) planning, and improving outcomes. (2) Methods: We performed a retrospective observational study of all adult OHCA cases managed by EMS in Lecce (Italy) between January 2013 and March 2025. Demographics, arrest circumstances, initial rhythm, time intervals, and return of spontaneous circulation (ROSC) were analyzed across age, sex, temporal, and pandemic-related strata. Rhythm classification followed European Resuscitation Council guidelines. (3) Results: A total of 11,653 cases were analyzed (mean age 76.8 ± 15.5 years, 56.6% male). Asystole (AS) was the predominant rhythm (88.7%), followed by ventricular fibrillation (VF, 7.6%), pulseless electrical activity (PEA, 1.3%), and pulseless ventricular tachycardia (pVT, 0.08%). VF was more common in younger and male patients, while AS increased with age. Hour-level analysis revealed circadian peaks: VF in late afternoon and AS in early morning. Pandemic analysis showed reduced VF and increased AS during COVID-19, with partial recovery post-pandemic. ROSC occurred in 3.47% overall, strongly associated with shockable rhythms. EMS response times were stable across day–night and pandemic phases. (4) Conclusions: AS dominates OHCA presentations, especially among the elderly, whereas VF remains the strongest predictor of ROSC. Circadian variation at the hourly level suggests potential for EMS optimization. Pandemic-related shifts in rhythm highlight the vulnerability of the chain of survival to societal disruptions. Strengthening bystander CPR, expanding AED availability, and tailoring EMS strategies remain key priorities for improving OHCA outcomes. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
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22 pages, 1037 KB  
Article
Risk Factors for Mortality in Critically Ill Patients with Diabetes Admitted to the ICU: A Single-Center Retrospective Observational Study
by Mădălina Diana Daina (Fehér), Codrin Dan Nicolae Ilea, Cosmin Mihai Vesa, Alina Cristiana Venter, Simona Daciana Birsan, Timea Claudia Ghitea, László Fehér and Cristian Marius Daina
J. Clin. Med. 2026, 15(6), 2439; https://doi.org/10.3390/jcm15062439 (registering DOI) - 23 Mar 2026
Abstract
Background and Objectives: Diabetes mellitus (DM) is a highly prevalent comorbidity among critically ill patients and may significantly influence intensive care unit (ICU) outcomes through metabolic, immune, and cardiovascular mechanisms. This study aimed to evaluate the impact of DM on clinical profile, [...] Read more.
Background and Objectives: Diabetes mellitus (DM) is a highly prevalent comorbidity among critically ill patients and may significantly influence intensive care unit (ICU) outcomes through metabolic, immune, and cardiovascular mechanisms. This study aimed to evaluate the impact of DM on clinical profile, comorbidities, complications, need for intensive support, and mortality in adult ICU patients. Materials and Methods: A retrospective observational study was conducted between January and December 2024 in a tertiary ICU, including 1344 adult patients. Among them, 435 (32.37%) had DM. Demographic data, admission diagnoses, laboratory parameters, comorbidities, complications, therapeutic interventions, and outcomes were analyzed. Comparative statistical analysis and multivariate logistic regression were performed to identify independent predictors of ICU mortality. Results: Patients with DM were significantly older than patients without diabetes mellitus (non-DM group) (69.62 ± 10.26 vs. 67.16 ± 14.26 years, p < 0.001) and more frequently female (57%, p = 0.0002). At admission, they presented higher glycemia (204.7 vs. 134.0 mg/dL, p < 0.00001), reduced glomerular filtration rate (47.2 vs. 59.5 mL/min/1.73 m2, p < 0.00001), and more pronounced lymphocytopenia (p = 0.025). Cardiovascular and renal comorbidities were significantly more prevalent in DM, including hypertension (76.3%), heart failure (32.4%), and chronic kidney disease (33.1%) (all p < 0.01). DM was associated with increased odds of sepsis (OR 1.56), acute kidney injury (OR 1.51), and obesity (OR 2.57). ICU mortality was significantly higher in patients with DM (54.9% vs. 46.3%, p = 0.004; RR 1.19). Independent predictors of death included mechanical ventilation (OR 36.48), inotropic therapy (OR 4.74), hemodialysis (OR 2.57), elevated lactate, neutrophilia, and reduced glomerular filtration rate (GFR). Conclusions: DM was associated with increased ICU mortality and a higher burden of cardio-renal comorbidities and complications; however, mortality in the multivariate model was primarily driven by markers of organ dysfunction and the need for advanced supportive therapies. Early risk stratification and individualized management strategies are essential to improve outcomes in critically ill patients with diabetes. Full article
(This article belongs to the Section Intensive Care)
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9 pages, 208 KB  
Article
Effect of Acute Caffeine Intake on Maximal Aerobic Speed in University Soccer Players Assessed by the 30–15 Intermittent Fitness Test
by Diego Camilo García-Chaves, Juan Pablo Fernandez Zapata, Tatiana Oyaga Álvarez, Nelson Ortiz Escobar, Alfonso Villegas Mazo and Luisa Fernanda Corredor-Serrano
Sports 2026, 14(3), 123; https://doi.org/10.3390/sports14030123 (registering DOI) - 23 Mar 2026
Abstract
The aim of this study was to analyze the effect of acute caffeine intake on maximal aerobic speed (MAS) assessed using the 30–15 Intermittent Fitness Test (IFT) in university soccer players. An experimental, randomized, double-blind, crossover design was employed, involving 26 male university [...] Read more.
The aim of this study was to analyze the effect of acute caffeine intake on maximal aerobic speed (MAS) assessed using the 30–15 Intermittent Fitness Test (IFT) in university soccer players. An experimental, randomized, double-blind, crossover design was employed, involving 26 male university team players (n = 26). Each participant completed the test under two conditions: caffeine supplementation (220 mg; 2.85 ± 0.27 mg/kg, range 2.60–3.16 mg/kg) and placebo, separated by a 72 h washout period. The final running speed achieved (VIFT) was used as an estimator of MAS. Statistical analysis included descriptive statistics, normality testing, and paired Student’s t-test, with a significance level set at p < 0.05. The results revealed a significant improvement in VIFT under the caffeine condition (19.94 ± 1.67 km/h) compared with placebo (18.72 ± 1.50 km/h), with a mean difference of 1.22 km/h (6.5%) and a large effect size (dz = 1.24; p < 0.001). It is concluded that acute caffeine intake was associated with a significant improvement in intermittent aerobic performance in university soccer players under the conditions of the present study, suggesting that caffeine may represent a potentially useful strategy in similar applied contexts. Full article
5 pages, 205 KB  
Editorial
Oxidative Stress Is a Double-Edged Sword for the Neonate
by Ru-Jeng Teng
Antioxidants 2026, 15(3), 400; https://doi.org/10.3390/antiox15030400 (registering DOI) - 23 Mar 2026
Abstract
Fetal oxygen tension is low, with an umbilical venous pO2 of 30–37 mm Hg in the third trimester, while arterial pO2 is around 20 mm Hg [...] Full article
(This article belongs to the Special Issue Oxidative Stress in the Newborn)
12 pages, 290 KB  
Article
Stress Levels Among Primary Health Care Workers in Almaty, Kazakhstan: A Cross-Sectional Study
by Ainur B. Qumar, Assylkhan Kuttybayev, Mukhtar Kulimbet, Anuarbek Ashikbayev, Akmaral Abikulova and Dimash Davletov
Int. J. Environ. Res. Public Health 2026, 23(3), 403; https://doi.org/10.3390/ijerph23030403 (registering DOI) - 23 Mar 2026
Abstract
Ongoing health system reforms in Kazakhstan have transformed the working environment of primary health care (PHC) staff and may increase workload and psychosocial stress. This study aimed to assess perceived stress among PHC workers in Almaty and its associations with socio-demographic characteristics and [...] Read more.
Ongoing health system reforms in Kazakhstan have transformed the working environment of primary health care (PHC) staff and may increase workload and psychosocial stress. This study aimed to assess perceived stress among PHC workers in Almaty and its associations with socio-demographic characteristics and health-related behaviors. A cross-sectional survey was conducted in October–November 2023 across all 36 state-funded PHC facilities in Almaty. General practitioners (GPs) and family nurses employed in these facilities were invited to participate. In total, 1484 respondents completed a standardized questionnaire in Kazakh or Russian administered electronically via Google Forms. Perceived stress was assessed using PSS-10, physical activity using IPAQ-SF, alcohol consumption using AUDIT-C, and tobacco use through items aligned with STEPS/GATS. Statistical analyses were performed using SAS. Associations between variables were evaluated using χ2 and Fisher’s exact tests, and multivariable logistic regression models were applied. Statistical significance was set at p < 0.05. Higher stress levels were more common among GPs than nurses (OR = 2.58; p < 0.0001) and less common in younger workers (18–29 vs. 50–59: OR = 0.504; p = 0.017) and alcohol abstainers (OR = 0.587; p = 0.0004). Kazakh ethnicity showed a borderline protective association (OR = 0.472; p = 0.057), while physical activity was not a significant predictor. Perceived stress is highly prevalent in Almaty PHC and disproportionately affects GPs; younger age and alcohol abstinence are protective. The findings support prioritizing organizational measures to reduce role-related burden and maladaptive coping behaviors. Full article
(This article belongs to the Section Behavioral and Mental Health)
24 pages, 2042 KB  
Article
Valuing Sustainable Housing for Urban Heat Mitigation: A Behavioral Perspective from Urban Households
by Ira Irawati, Datuk Ary A. Samsura and Erwin van der Krabben
Sustainability 2026, 18(6), 3125; https://doi.org/10.3390/su18063125 (registering DOI) - 23 Mar 2026
Abstract
Rapid housing expansion exacerbates the urban heat island (UHI) effect, yet the influence of household-level awareness on sustainable housing decisions remains underexplored, particularly in tropical contexts. This study integrates the Theory of Planned Behavior (TPB) into a moderated-mediation model to examine how UHI [...] Read more.
Rapid housing expansion exacerbates the urban heat island (UHI) effect, yet the influence of household-level awareness on sustainable housing decisions remains underexplored, particularly in tropical contexts. This study integrates the Theory of Planned Behavior (TPB) into a moderated-mediation model to examine how UHI awareness shapes the relationships among attitude, subjective norms, perceived behavioral control, socioeconomic factors, purchase intention, and willingness to pay (WTP) for heat-mitigating housing. Survey data from 441 homebuyers in Bandung City, Indonesia, were analyzed using partial least squares structural equation modeling (SEM). Results reveal that awareness fundamentally alters decision pathways: without awareness, subjective norms (β = 0.066, p-value = 0.007) and perceived behavioral control (β = 0.050, p-value = 0.005) significantly influence WTP via purchase intention; with high awareness, attitude becomes the sole significant predictor (β = 0.109, p-value = 0.035), while the effects of social pressure (β = −0.015, p-value = 0.130) and perceived control (β = −0.005, p-value = 0.376) diminish. The model explains 50.1% of the variance in purchase intention (R2 = 0.501) but only 14.7% of the variance in WTP (R2 = 0.147), reflecting the low-price premiums respondents are willing to pay (0–5%). These findings highlight that climate-specific awareness acts as a cognitive filter, guiding pro-environmental housing choices, and underscore the importance of awareness-driven interventions for promoting sustainable urban development in tropical cities. Full article
(This article belongs to the Section Psychology of Sustainability and Sustainable Development)
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