Search Results (10,585)

Background and objectives: Musculoskeletal disorders (MSDs) account for more than 60% of compensated occupational diseases in Korea. Despite this burden, benchmarks of standardized ergonomic exposure and evidence on the combined effects of risk factors remain limited. This study aimed to construct a body part-specific ergonomic job exposure matrix (JEM) and evaluate the independent and interactive effects of ergonomic, demographic, and work-related factors. Materials and Methods: We analyzed the data of 210,500 workers from the 2nd–6th Korean Working Conditions Survey (2009–2020). A JEM for arms/neck, back, and legs was developed and validated (κ ≥ 0.79). Logistic regression models estimated adjusted odds ratios (aORs), and additive interactions were assessed using relative excess risk due to interaction (RERI), attributable proportion (AP), and the synergy index (SI). Results: High ergonomic exposure was strongly associated with MSDs across all body regions (aORs 2.3–2.5). Age > 45 years, long working hours (>52 h), and high job strain also increased risks (aORs 1.4–2.3). On the additive scale, ergonomic risk combined with older age showed consistent synergy (RERI up to 1.5; SI >1.5), whereas combinations with long working hours or job strain showed attenuation (RERI < 0; SI < 1). Women reported higher crude prevalence but lower adjusted odds (aOR ≈ 0.9). Conclusions: This nationally representative study demonstrates that ergonomic risk, age, long working hours, and job strain are major determinants of MSDs. The validated Korean JEM provides a standardized tool for surveillance and compensation. However, the cross-sectional design limits causal inference. Future longitudinal research with objective exposure measures is needed to strengthen causal inference and guide tailored prevention. Full article

Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in intensive care units (ICUs), particularly in low- and middle-income countries (LMICs). Evidence-based practice (EBP) bundles have shown effectiveness in reducing VAP; however, the implementation in Bangladesh remains limited. This study aimed to evaluate the effectiveness of EBP to reduce the incidence rate of VAP among adult ICU patients in Bangladesh. Methods: A quasi-experimental study with a historical control group was conducted among 347 eligible ICU patients from October 2024 to April 2025. The intervention included nurse training on VAP bundle practices with advanced equipment support. Data on VAP incidence as a primary endpoint and VAP-related patients’ outcomes were analyzed. Results: The clinically suspected VAP incidence was 30.1 and 51.1 per 1000 ventilator-days, and the prevalence decreased significantly in the intervention group compared to the control group (26.9% vs. 46.1%; p < 0.001), respectively. Logistic regression indicated VAP bundle implementation was associated with reduced VAP (Exp(B) = 0.417, 95% CI: 0.262–0.666), while ventilation ≥96 h was a significant risk factor (Exp(B) = 2.6, 95% CI: 1.385–4.881). Early-onset VAP was reduced (25.0% vs. 10.2%), though late-onset predominated in the intervention group (75.0% vs. 89.8%). Conclusion: Implementation of an EBP-based VAP bundle by trained nurses significantly reduced VAP incidence. However, increased overall ICU mortality highlights the need for broader critical care improvements, including advanced comorbidity management and comprehensive ICU services. This study underscores the feasibility and effectiveness of VAP bundle implementation in the ICU of an LMIC. Full article

Background/Objectives: Migrants are recognized as a vulnerable population for non-communicable diseases (NCDs) due to unique socio-cultural and environmental challenges associated with acculturation. Despite a growing migrant population, evidence on NCD risk among migrants in Japan is scarce. This study examined the prevalence, co-occurrence, and clustering of modifiable NCD risk factors among middle-aged foreign residents in Japan. Methods: A cross-sectional web-based survey was conducted among foreign residents aged 30–60 years (n = 384). Eight risk factors were assessed: tobacco use (including cigarettes, e-cigarettes, and chewable tobacco), harmful alcohol consumption, inadequate fruit and vegetable intake, frequent consumption of ultra-processed foods, insufficient physical activity (PA), poor sleep, high stress levels, and high BMI. Latent class analysis (LCA) was used to identify risk clusters, and associations with demographic and socioeconomic characteristics were examined. Results: The prevalence of risk behaviours was high, with 96% reporting inadequate fruit and vegetable intake, 55% poor sleep, and 50% insufficient PA. Risk factor co-occurrence was common: 32% reported three concurrent risks, 27.1% reported four, and 17.2% reported five or more. LCA identified two clusters. Cluster 1 (46.9% of participants) was characterized by tobacco and alcohol use, with inadequate diet and poor sleep. Cluster 2 (53.1% of participants) was defined by insufficient PA, inadequate diet, and poor sleep, but low tobacco and alcohol use. Cluster membership varied significantly by sex and employment. Conclusions: This study provides preliminary evidence of the high prevalence and clustering of modifiable NCD risk factors among middle-aged migrants in Japan. Findings highlight the need for comprehensive, multi-behavioral interventions tailored to migrant populations, while considering gender roles and occupational contexts. Full article

Dyslexia is a highly prevalent learning disability characterized by deficits in specific cognitive and linguistic skills which impair accurate and fluent reading of written words. Intensive, comprehensive, multicomponent interventions are effective in improving outcomes for students with dyslexia, but effective curriculum delivery has traditionally required an educator with substantial training. Many school systems lack sufficient staff with this level of expertise to successfully meet the needs of all their struggling readers. Towards this end, a technology-assisted dyslexia intervention was developed to provide teacher support through a virtual human avatar, resulting in significantly reduced training time while maintaining the comprehensive scope and structure of a traditional intervention model. This paper evaluates the comparative efficacy of the tech-assisted delivery model and the traditional model across two independent substudies. Results from quasi-experimental observational substudies in both laboratory school (n = 82) and public-school (n = 157) samples demonstrate non-inferiority, i.e., comparable student progress in reading and spelling, of the tech-assisted instruction compared to the traditional delivery model. Furthermore, despite differences in the educator training model, implementation fidelity was equivalently strong (>90%) in both groups. Findings provide encouraging evidence towards the scalability of effective dyslexia intervention by providing technology-based support at the level of the teacher. Implications for practice and questions for future research are discussed. Full article

Background/Objectives: Antibiotic resistance is a growing global health threat, requiring comprehensive investigations into the occurrence, distribution, and diversity of antibiotics across environmental systems. This study aimed to examine the distribution and prevalence of commonly used antibiotics in various wastewater sources across the United Arab Emirates (UAE), providing insights into potential environmental reservoirs contributing to antimicrobial resistance dissemination. Methods: Wastewater samples were collected from the outlets of three hospitals, three residential communities, and the influent and return activated sludge of two wastewater treatment plants. Samples were prepared using solid-phase extraction (SPE) and analyzed via liquid chromatography–mass spectrometry (LC–MS/MS) to quantify antibiotic concentrations and compare their distribution among sources. Results: Significant variations were observed in antibiotic concentrations across the different wastewater sources. Ciprofloxacin concentrations were highest in hospital wastewater, reaching up to 247.9 ng/mL, while cefuroxime and vancomycin ranged between 0.2 and 10.9 ng/mL across samples. Clindamycin was notably prevalent in wastewater treatment plant samples (up to 10.9 ng/mL), whereas vancomycin and cefuroxime were dominant in residential community samples, reflecting diverse antibiotic usage patterns and persistence in treatment systems. Conclusions: The findings reveal substantial antibiotic contamination in United Arab Emirates wastewater systems, underscoring the need for ongoing surveillance and regulatory measures. Continuous monitoring, coupled with effective wastewater treatment and antibiotic stewardship strategies, is critical to mitigating the environmental spread of antimicrobial resistance and safeguarding public and environmental health. Full article

Background: There have been no previous comprehensive reports on interstitial lung diseases (ILD) in Israeli population, that may have unique epidemiological features. We aimed to explore ILD in Israel, with an emphasis on disparities between different regions of the country. Methods: The study included consecutive patients with a multidisciplinary diagnosis of ILD, using data from registries of four tertiary medical centers (MC) located in Central and Northern Israel. Multivariate regression models were used to assess the region of residence (peripheral vs. central) as an independent predictor for ILD subtypes. Results: Included were 927 patients with ILD (mean age 67 ± 13, 40% females). Most patients (56–61%) reported working in at least one job that involved relevant inhalational exposures. Despite the geographic proximity of MCs (all within 100 km), significant variations in demographic and clinical characteristics were observed, including age, sex, exposures, and ILD diagnoses (p < 0.01). The most prevalent diagnoses were Idiopathic pulmonary fibrosis (IPF, range 13–58%) and autoimmune-related ILD (11–30%). In peripheral areas, the diagnosis of IPF was more frequent (53% vs. 24%, p < 0.01), while exposure-related ILD (5% vs. 16%, p < 0.01) and autoimmune-related ILD (16% vs. 25%, p < 0.01) were more frequent in central Israel. In multivariate analysis, peripheral residence remained an independent predictor for IPF (AOR 2.95, 95% CI 2.1–4.1) and central residence for exposure-related ILD (AOR 0.46, 95% CI 0.33–0.63). Conclusions: Variations in ILD characteristics were observed between centers in close geographic proximity, highlighting disparities between peripheral and central Israel, and the need for personalized assessment based on local frequencies and exposures. Full article

Contemporary issues of particular concern include the current state of the teaching profession, the lack of professional and social respect for teachers, the need for salary increases, the need to reduce the burden on teachers, and performance evaluation. In addition, the low number of young people entering the teaching profession and the low proportion of graduates choosing this career path are of fundamental concern. The present research seeks to explore the perceptions of first-year student teachers towards the profession of teaching through a case study approach. A metaphor method involving sentence completion was used to explore students’ conceptions of the ‘teacher image’. The students’ metaphors were analyzed to determine the prevalence of teacher-centeredness or learner-centeredness, knowledge transfer or knowledge acquisition, and cognition or emotion. The students’ essays on the question “Why do I want to be a lower primary teacher?” were analyzed to identify career motivating factors, positive attributes that enhance career motivation, and future aspirations. The main findings of the research are that trainees are mainly inspired by their primary school teachers, they are aware of their strengths to become good teachers, and they envision a career in teaching. The motivation and commitment of our first-year students to their careers is an excellent starting point, which should be built on in both theoretical and practical courses during university education. They should be enriched with real-life experiences, encouraged and supported within their practice, in order to increase the number of young people who choose a teaching career after graduating from university. Full article

Wastewater contamination of freshwater ecosystems is a major driver of the spread of antibiotic resistance (AR). This preliminary study investigated the impact of wastewater pollution on the AR profiles of bacterial communities in the Oued–Zénati waterway, Algeria, across a pollution gradient. From September 2017 to May 2018, water samples were collected from an upstream reference site (P1), a site downstream of urban and hospital discharges (P2), and a downstream recovery site (P3). Physicochemical and microbiological analyses revealed a critical pollution hotspot at P2, with fecal coliform concentrations reaching 9.5 × 10⁵ MPN/100 mL, nearly 40 times higher than at P1. From a representative subset of 33 bacterial isolates characterized in this study, susceptibility testing showed a high prevalence of resistance, with observed trends matching the pollution gradient. Specifically, 100% of isolates from the polluted sites (P2 and P3) were resistant to ampicillin, and 60% of isolates from the hotspot (P2) were resistant to amoxicillin/clavulanic acid. Conversely, all isolates remained susceptible to gentamicin. These initial findings suggest that direct wastewater discharge is creating a significant reservoir for AR, highlighting potential risks to public and environmental health and underscoring the urgent need for improved wastewater management infrastructure. Full article

Porcine epidemic diarrhea (PED), a severe and highly contagious disease induced by porcine epidemic diarrhea virus (PEDV), impacts pigs across all age groups but has a particularly high lethality in neonatal piglets, with mortality rates reaching 80 to 100%, leading to substantial economic losses in the swine industry. In this investigation, 128 intestinal samples obtained from 65 large-scale pig farms in eight prefectures of Guangdong Province were screened by RT-qPCR between 2022 and 2024. Of these, 50 samples (39.06%) tested positive for Porcine Epidemic Diarrhea Virus (PEDV). The complete S1 genes of 31 representative strains were sequenced. Phylogenetic analysis revealed G2c as the exclusive dominant lineage (29/31, 93.6%), with single representatives of G2a and G2d. Nucleotide identity among the local strains ranged from 88.9 to 100% and 88.1 to 93.5% to prototype CV777 and from 91.2 to 99.1% to vaccine strain AJ1102. The COE neutralizing epitope (aa 499–638) carried 26 substitutions versus AJ1102; T499I/S, A520S/L, F539L, K566N and F615L were most prevalent. The SS2 epitope was fully conserved, whereas SS6 showed three low-frequency changes (S766P, S769F, G770V). Six distinct N-glycosylation patterns were identified relative to AJ1102. The predominance of G2c, accompanied by marked epitope drift and altered glycosylation, indicates the need for further investigation into vaccine efficacy. Continuous surveillance and the careful evaluation of G2c-based vaccine candidates are warranted. Full article

Background: Depression, anxiety, and stress are increasingly prevalent among university students, raising concerns about the role of video gaming behaviors, social support, and academic factors in mental health. Internet Gaming Disorder (IGD), recognized in international classifications, has been linked to psychological distress but remains underexplored in Portuguese higher education students. Objective: This study aimed to examine the relationships between IGD, social support, academic performance, and mental health outcomes. Methods: A cross-sectional survey was conducted with Portuguese university students, collecting sociodemographic information, gaming habits, academic performance, social support, and mental health indicators. Data analyses included non-parametric tests, Spearman correlations, and multiple linear regression models to explore group differences, associations, and predictors of mental health outcomes. Results: No significant gender or age differences were observed in social support or mental health. Students living with parents, engaging in multiplayer gaming, and exercising regularly reported higher social support. Social support correlated negatively with depression, anxiety, and stress, whereas IGD correlated positively with these symptoms. Regression analyses identified academic performance, IGD, and intimacy as predictors of depression; family satisfaction as a predictor of anxiety; and family satisfaction and academic performance as protective factors against stress. Conclusions: Findings highlight the interplay of behavioral, social, and academic factors influencing students’ mental health. Effective interventions should reinforce family support and students’ academic self-efficacy, alongside fostering responsible gaming practices. Limitations include cross-sectional design and self-reported measures, indicating the need for longitudinal studies. Full article

Wastewater treatment plants (WWTPs) are recognized hotspots for the convergence and dissemination of antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs) into the environment. Among ARB, carbapenem-resistant Enterobacterales (CR-E) and extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-Ec/Kp) are of particular concern due to their clinical relevance. We characterized 30 CR-E and 176 ESBL-Ec/Kp isolates (two of them were both ESBL-producing and carbapenem-resistant) recovered from influent, intermediate, effluent, sludge, and downstream river samples collected from two WWTPs in northern Spain. Isolates were evaluated for resistance phenotypes against 12 antimicrobials, and β-lactamase-encoding genes were assessed by PCR and sequencing. Notably, among CR-E isolates, bla_KPC-2 was the most prevalent (93%), followed by bla_OXA-48-like, detected in two isolates from non-treated and pasteurized sludge; both isolates also carried bla_CTX-M-15, a finding not previously reported specifically in sludge samples. Among ESBL-Ec/Kp, a broad diversity of ESBL genes was identified, including bla_{CTX-M group 1} (variants 1, 3, 15, 32, 55), bla_{CTX-M group 9} (variants 14, 27, 65, 97), bla_SHV-12 and bla_TEM-169. The most prevalent ESBL gene was bla_CTX-M-15 (48.3%), followed by bla_CTX-M-14, bla_CTX-M-32, and bla_SHV-12, detected in 10.8%, 8.5%, and 6.8% of isolates, respectively. CR-E and ESBL-Ec/Kp were found in all sample types and were still detectable at terminal stages, indicating persistence throughout treatment. These findings support the need to improve and optimize current wastewater treatment methods and underscore the importance of integrating culture-based and molecular methods into routine WWTP monitoring for early detection of microbiological hazards, although further research is still needed. Full article

The COVID-19 pandemic exposed the fragility of global health systems, as physicians faced extremely challenging conditions including excessive workloads, infection risk, and high patient mortality. We conducted a cross-sectional survey that aimed to assess the post-pandemic prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in a sample of Greek physicians who worked on the frontline during the SARS-CoV-2 (COVID-19) pandemic. An online survey was conducted between 1 March and 31 July 2023, in which 200 Greek physicians were invited via e-mail to voluntarily answer a confidential online questionnaire, and 58 of them responded. The survey included two clinically validated tools: the Patient Health Questionnaire-4 (PHQ-4) and the Impact of Event Scale—Revised (IES-R). Univariate correlations of 26 exposure variables with anxiety, depression, combined anxiety/depression, and PTSD were performed. In total, 58 eligible physicians (46.6% female) participated in this study. The rates of anxiety, depression, combined anxiety/depression, and PTSD were 27.5% (95% CI: 16.7–40.9), 31.0% (19.5–44.5), 22.4% (12.5–35.3), and 24.1% (13.9–37.2), respectively. Notably none of the physicians working in a laboratory developed any mental health symptoms. The following factors were found to be associated with the development of higher mental health symptoms: age ≤ 30, employment in healthcare ≤ 10 years, working in COVID-19 wards, working in intensive care units or COVID-19 wards, a history of mental health symptoms, a history of physical conditions, shortages of materials and equipment for diagnosing or treating patients, development of a disease other than COVID-19, and the development of a new mental health condition during the pandemic (p < 0.05 for all associations). Our findings highlight the need to better prepare physicians with adequate materials, infrastructure, and psychological support such that, in a potential future health crisis, they will not be at such high risk of mental health problems. Full article

Background: Addressing Missed Opportunities for Vaccination (MOV) contributes to increased vaccination rates in children, reinforcing the need to investigate and intervene in the related factors. Objective: To analyze factors associated with missed opportunities for vaccination in children under one year of age in a Brazilian capital. Methods: This was a cross-sectional, analytical study conducted in seven Basic Health Units in Teresina, Piauí, Brazil. A previously validated questionnaire was applied to parents or guardians of a sample of 316 children. Data were collected from March to June 2025. Multivariable Logistic Regression was performed, and results were expressed as Odds Ratios. Results: Among the children, 53.5% had at least one MOV. The associated factors were: parents with two or more children (95% CI: 1.06–2.96), false contraindications (95% CI: 1.29–8.73), inadequate assessment of vaccination cards by health professionals (95% CI: 1.78–29.00), vaccine shortages in health units (95% CI: 1.57–18.28), and refusal to open multidose vaccine vials (95% CI: 1.81–19.31). Receiving information about vaccination in the previous month was a protective factor against MOV (95% CI: 0.25–0.77). The vaccines most frequently contributing to MOV were BCG (15.8%) and the COVID-19 vaccine, with 15.5% for the first dose and 14.9% for the second. Conclusions: The high prevalence of MOV found in this study indicates weaknesses in the immunization process and suggests the need for implementing measures to interrupt the chain of causes leading to MOV, thereby contributing to the achievement of the objectives of the Brazilian National Immunization Program. Full article

Background/Objectives: The most prevalent prolonged cardiac arrhythmia and a significant global health burden is atrial fibrillation (AF). Although its connection to AF is still unknown, lipoprotein(a) (Lp(a)), a genetically determined lipoprotein with pro-inflammatory and pro-atherogenic characteristics, has been linked to cardiovascular disease. The purpose of this study was to measure and assess the relationship between circulating Lp(a) levels and AF. Methods: In compliance with the PRISMA 2020 guidelines, a systematic review and meta-analysis were carried out using a protocol that was preregistered in PROSPERO (CRD420251153244). Comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, Scopus, the Cochrane Library, and Google Scholar up until September 2025 were used to find observational studies comparing circulating Lp(a) levels in adults with and without AF. Results: Circulating Lp(a) concentrations were significantly higher in AF patients than in controls across 10 studies (pooled MD = 2.81; 95%CI: 1.58–4.05; p < 0.0001). In the subgroup analysis by geographical setting, studies conducted in Asia and studies from Europe/USA exhibited a statistically significant effect. Despite the extreme heterogeneity (I² = 99%), sensitivity analyses verified that the overall effect was stable. Conclusions: Our pooled analysis revealed a statistically significant association between Lp(a) and AF; however, the certainty of the evidence was rated as very low according to the GRADE methodology. To elucidate causality, enhance risk stratification, and investigate whether Lp(a)-lowering tactics could alter AF risk, large, prospective, multi-ethnic studies with standardized biomarker assessment are needed. Full article

Study objective: Electronic vapor product (EVP) use remains prevalent among adolescents in the United States. EVP use may be associated with high-risk substance use behaviors. This study investigates the association between current EVP use and current opioid misuse in high school students. Methods: We conducted a secondary analysis of the 2021 Youth Risk Behavior Survey (YRBS) (n = 7471). We first examined the prevalence rates of current prescription opioid misuse between participants ages 14 to 19 who reported any EVP use compared to those who did not report any EVP use. We conducted an adjusted Poisson regression analysis to determine whether EVP use was associated with prescription opioid misuse after controlling for multiple variables, including age, biological sex, race, ethnicity, alcohol use, other tobacco use, marijuana use, and depressive symptoms. Results: Among participants, 17.2% (95% confidence interval (CI): 15.4–19.1%) reported current EVP use. The prevalence of current opioid misuse was higher in the group of students who use EVPs (13.3%) as compared to students who do not use EVPs (3.2%) (p < 0.0001). Compared to participants who did not use EVPs, those with EVP use had an 80% greater prevalence of opioid misuse, after adjusting in regression analyses (adjusted prevalence rate ratio: 1.8, 95% CI: 1.4–2.3, p < 0.0001). Conclusions: Our findings highlight the significantly increased prevalence of opioid misuse among this population and the need to educate adolescents about the additional risks associated with nicotine and EVP use. Longitudinal studies are needed to test causal relationships and better understand the biobehavioral mechanisms that connect EVP use and opioid misuse. Full article