Search Results (888)

Background/Objectives: Teachers in educational institutions are continuously exposed to high occupational demands, which may contribute to the development of increased adiposity and comparatively unfavorable health-related quality of life (HRQoL) scores. However, there is limited evidence regarding how years of professional experience is associated with these indicators in teachers. The objective of this study is to examine the association between years of professional experience, adiposity indicators, and HRQoL among teachers in educational institutions. Methods: An observational, relational, exploratory cross-sectional study was conducted in 175 teachers from educational institutions in the city of Temuco, Chile. Body mass index (BMI), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) were assessed as adiposity indicators, and health-related quality of life (HRQoL) was measured using the SF-12. Age, sex, and years of professional experience were recorded. Simple and multivariable linear regression models were used to analyze the association between years of experience and the study variables, adjusting for age and sex. Additionally, experience tertiles were compared using ANOVA and ANCOVA. Results: In the unadjusted analyses, greater years of professional experience were associated with higher adiposity indicators, including BMI (β = 0.071; 95% CI: 0.020 to 0.129). However, after adjustment for age and sex, these associations were attenuated and no longer statistically significant (adjusted BMI: β = −0.172; 95% CI: −0.434 to 0.053). Associations with PCS and MCS scores were also not statistically significant after adjustment. Conclusions: Teachers exhibited high levels of adiposity and HRQoL scores suggesting an unfavorable perceived health profile. The observed associations between years of professional experience and adiposity or HRQoL appear to be largely explained by age rather than by professional experience itself. Future longitudinal studies are needed to more precisely distinguish between the effects of aging and prolonged occupational exposure. However, the findings should be interpreted cautiously given the convenience sampling design and the inclusion of teachers from a single city. Full article

Background/Objectives: Breast cancer affects working-age women not only through treatment and survival but also through health-related quality of life (HRQoL), work capacity and informal caregiving needs. Evidence from Central and Eastern Europe remains limited. This study estimated the indirect societal burden of breast cancer among working-age women in Croatia and reported economic indirect costs separately from monetised HRQoL/welfare loss. Methods: A multicentre cross-sectional study conducted in 2024 included women aged 18–65 years receiving outpatient oncology care at two tertiary centres in Croatia. HRQoL was assessed with the EuroQol five-dimension five-level instrument (EQ-5D-5L) and compared with Croatian general-population norms. Utility decrements were annualised and monetised using a national willingness-to-pay threshold of €17,000 per quality-adjusted life year (QALY). Work productivity impairment was measured using the Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire and valued, together with informal care, using the human-capital approach. Deterministic sensitivity analyses and approximate 95% confidence intervals were used to show how the estimates changed under key assumptions. Results: A total of 271 women participated (mean age 51.3 years among age-eligible records). Mean EQ-5D-5L utility was 0.76 versus 0.91 in the general population, corresponding to an annual QALY loss of 0.15 and a monetised HRQoL/welfare loss of €2550 per patient-year (95% CI €2083–€3017). Among employed participants, mean overall work productivity loss was 43.9% (842.9 h/year), equivalent to €7333 annually (95% CI €6311–€8355). Informal caregiving was reported by 54.7% of participants, with mean annual costs of €1566 (95% CI €1269–€1863). Economic indirect costs were €8899 per patient-year (95% CI €7835–€9963). In an extended welfare-inclusive scenario, the estimated burden was €11,449 per patient-year (95% CI €10,287–€12,611), corresponding to an illustrative national estimate of €86 million (95% CI €77–€95 million; 0.11% of gross domestic product). Conclusions: Breast cancer in working-age women imposes a substantial societal burden in Croatia, driven by reduced HRQoL, productivity losses and informal caregiving needs. These findings support taking societal burden into account in public health planning, survivorship care and health policy decision-making. Full article

Background/Objectives: Mild cognitive impairment (MCI) may precede dementia, and safe nutritional strategies able to support cognitive function are of clinical interest. Dietary nucleotides may contribute to membrane phospholipid synthesis, synaptic function, and neuroprotective pathways; however, clinical evidence in older adults with MCI remains limited. This randomized placebo-controlled trial evaluated the efficacy and tolerability of nucleotide-rich yeast extracts from Kluyveromyces fragilis and Saccharomyces cerevisiae. Methods: Seventy-two participants (mean age 73.5 ± 7.7 years; range 60–85) were randomly assigned (1:1:1) to receive K. fragilis extract, S. cerevisiae extract, or placebo once daily for 180 days. Cognitive outcomes were assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) at baseline (T0), 90 days (T1), and 180 days (T2); quality of life was assessed using the SF-12 questionnaire at T0 and T2. Treatment effects were analyzed using linear mixed-effects models adjusted for age and sex. Results: After 180 days, MoCA scores increased by 4.42 points in the K. fragilis group and 3.92 points in the S. cerevisiae group, compared with 0.58 points in the placebo group (time × treatment p < 0.001; T0–T2 within-group p < 0.001 for both active groups and p = 0.14 for placebo). MMSE scores increased by 1.62 and 3.11 points in the K. fragilis and S. cerevisiae groups, respectively, compared with 0.25 points in the placebo group (time × treatment p < 0.001; T0–T2 within-group p < 0.001 for both active groups and p = 0.57 for placebo). The SF-12 mental component score increased by 7.50 and 9.16 points in the two active groups, respectively (time × treatment p = 0.022; T0–T2 p = 0.0013 and p < 0.001, respectively), while physical quality-of-life scores did not change significantly (PCS time × treatment p = 0.11). No adverse events were reported. Conclusions: Nucleotide-rich K. fragilis and S. cerevisiae yeast extracts were well tolerated and were associated with improved cognitive scores over six months in older adults with MCI. Larger multicenter trials are needed to confirm these findings. Full article

Executive functions (EFs) are key cognitive processes for behaviour. However, there is little information about interaction with the dimensions of health-related quality of life (HRQoL), therefore the objective of this study was to analyse the association between lifestyle habits (physical activity and screen time), sleep, HRQoL and EFs in children and adolescents. Specifically, this study aimed to identify the extent to which perceived well-being dimensions are associated with EFs and to determine the potential mediating role of HRQoL in the relationships between lifestyle habits and these cognitive domains, examining whether these direct and indirect pathways remain robust after adjusting for gender and age. A total of 943 children and adolescents (51.3% female) aged 10–17 years participated. Lifestyle parameters (PA Krece Plus, sleep duration and KIDSCREEN-10 questionnaire) and EFs (CogniFit neurocognitive assessment battery) were evaluated. The analysis of the individual KIDSCREEN-10 items revealed that perception of school performance presented the most consistent association with EFs, being positively related to attention (b = 16.39, p = 0.018), cognitive flexibility (b = 30.65, p = 0.005), inhibition (b = 24.66, p = 0.022), and working Memory (b = 42.33, p < 0.001). Furthermore, parental fairness reported a significant association for three out of four domains: attention (b = 13.89, p = 0.006), flexibility (b = 22.93, p = 0.003), and working Memory (b = 25.42, p < 0.001). Having enough time for self was also significantly related to attention performance (b = 12.60, p = 0.026). Regarding lifestyle habits, the composite lifestyle index (PA + ST) showed the most consistent positive association across all cognitive domains, while sleep duration was inversely associated with attention, cognitive flexibility, and working Memory. The mediation analysis revealed that global HRQoL significantly mediated the relationship between lifestyle habits and executive functions, accounting for 9.55% of the total effect on attention, 5.45% on cognitive flexibility, and 4.14% on working memory, whereas no mediation was observed for inhibition. In conclusion personal time, parental fairness, and school adjustment were positively associated with EFs. HRQoL and physical activity levels also showed consistent links with all EFs, whereas sleep duration was inversely related. Furthermore, mediation analysis revealed that global HRQoL acts as a critical indirect pathway, explaining a significant proportion of the lifestyle habits’ total effect on attention, cognitive flexibility, and working memory. Overall, these findings highlight the multifactorial and interrelated mechanisms shaping executive functioning in children and adolescents. Full article

Background: Systemic lupus erythematosus (SLE) is associated with an increased burden of cardiovascular disease (CVD), driven by dyslipidemia, hypertension, obesity, inflammation, and treatment. These factors can impact patient quality of life (QoL) by limiting physical activity. Objectives: To characterize lipid abnormalities as CVD risk factors in a Saudi SLE cohort and assess associations between lipid profile, SLE features, treatment, and patient-reported outcomes of physical activity. Methods: A cohort of adult SLE patients followed at King Saud University Medical City since 2021 was analyzed. Demographics, lipid profiles, blood pressure, BMI, SLEDAI-2K, SDI, disease duration, and treatment data were collected. Physical function and quality of life were assessed using the LupusQoL and PROMIS Physical Function T scores. Univariate and multivariate logistic regression analyses were conducted to identify associations between lipid abnormalities, SLE-related factors, and QoL physical activity measures. Results: A cohort of 169 patients (88.2% female, mean age 39.3 ± 12.4 years) was evaluated to assess the presence of dyslipidemia (23.7%), obesity (BMI ≥ 25, 66.3%), and hypertension (≥130/80 mmHg, 26.0%). Mean SLE duration was 9.2 ± 7.7 years and mean SLEDAI-2K was 11.0 ± 7.0. Among these patients, 52.7% used steroids, 88.2% used antimalarial drugs, and 53.8% used immunosuppressives. Dyslipidemia was associated with lower LupusQoL physical scores (adjusted OR 0.986; 95% CI 0.972–1.000; p = 0.0446). No significant associations were found between lipid levels and the PROMIS Physical Function T score. Conclusions: In this Saudi SLE cohort, dyslipidemia and other modifiable CVD risks were common. Dyslipidemia correlated with poorer LupusQoL-specific physical scores, which highlights the importance of lifestyle changes in patients with SLE. Full article

Background/Objectives: We describe a case series of two patients with non-specific chronic low back pain (CLBP) and measurable decreased quality of life, who showed improvements after a specific multi-modal conservative spine and postural therapy regimen. CLBP is the leading cause of years lived with disability and disability-adjusted life years. This case series adds observational data to the medical literature on conservative treatment of CLBP and potentially improves diagnostic and treatment understanding of how conservative therapies can benefit patients suffering with CLBP. Methods: Two patients (Patient A: 58-year-old female; Patient B: 43-year-old male) presented with severe CLBP who did not find relief with prior traditional chiropractic manipulation. The patients sought treatment at a spine rehabilitation facility closest to their remote locations in Wyoming, USA. The conservative rehabilitation treatment program consisted of multi-modal therapies to strengthen postural muscles, postural spinal manipulation, and specific Mirror Image^® traction. After 36 treatments over 12 weeks in office and home rehabilitation exercises, baseline tests and outcome measures were repeated. Results: Patient-reported objective outcomes, disability indices, and radiographic analysis demonstrated changes at the conclusion of treatment that were maintained at long-term follow-up re-examination. Lumbar lordosis initially changed from −21.8° L1–L5 lordosis to post-treatment −33.6° for patient A and from −22.6° to −42.4° for patient B. Long-term follow-up demonstrated continued resolution of initial symptoms and maintained spine alignment. Conclusions: In these two patients, the described multimodal conservative program was associated with sustained improvements in symptoms, function, and radiographic parameters. This case series adds to prior biomedical literature regarding potential conservative interventions for treating CLBP and abnormal posture. Larger randomized controlled studies are required to evaluate generalizability and relative effectiveness. Full article

Background: Congenital heart defects (CHD) are prevalent, affecting 1% of live births globally. Despite improved survival rates, adults with CHD face increased risks of psychological distress and neurocognitive deficits. The P-BAHn study (P-BAHn = “Psyche Bei Angeborenen Herzfehlern”, Psyche for congenital heart defects) evaluates the mental health status and psychosocial challenges of German children and adolescents with CHD, focusing on retrospectively assessed COVID-19-related burden and patient-/parent-rated experiences with psychological, psychotherapeutic, or psychiatric treatment (PST). Methods: A cross-sectional, online-based survey was conducted using the National Register for Congenital Heart Defects (NRCHD). The final dataset comprised 1567 respondent-level records from 1310 families, including 992 parent reports and 575 self-reports from children/adolescents aged 6 to <18 years. The survey assessed mental health, emotional well-being, psychosocial status, demographics, medical history, and psychological treatment. Data were analyzed descriptively using chi-square tests and t-tests for exploratory unadjusted group comparisons. In addition, exploratory multivariable logistic regression analyses were performed for selected key outcomes. Results: School-related stress was common in young CHD patients (45.3%) and was associated with older age and female sex (51.5% female vs. 35.6% male) in adjusted analyses. Overall, 17.0% of patients reported having a mental illness, most commonly anxiety (6.8%), eating disorders (5.6%), and depression (4.7%); neither sex nor CHD severity was significantly associated with self-reported mental illness in adjusted analyses. Less good/poor self-rated health was associated with older age and complex CHD in both patient and parent reports. Retrospectively assessed pandemic-related changes were perceived as quite or extremely stressful by 23.9% of patients. High COVID-19-related burden was associated with female sex, whereas CHD severity was not significant after adjustment. Among patients with previous or current PST, patient- and parent-rated treatment benefit varied by patient sex and CHD complexity. Previous/current PST was reported by 25.9% of patients and 23.8% of parents and was associated with older age in both respondent groups and with complex CHD in parent reports. Among patients with previous/current PST, 56.4% reported high perceived support. Conclusions: The P-BAHn study highlights the need for targeted psychosocial support for children and adolescents with CHD, including female patients, those with complex conditions, and patients reporting school- or crisis-related burden. Retrospectively reported pandemic-related burden underscores the importance of integrating crisis-sensitive strategies into psychosocial care frameworks. Longitudinal studies are essential to understand mental health trajectories and to evaluate the sustained patient- and parent-perceived benefit as well as clinical effectiveness of PST use. Enhancing support services and refining intervention models will improve the well-being and quality of life for young CHD patients. Full article

Total hip arthroplasty (THA) is among the most effective orthopedic interventions for osteoarthritis, yet post-operative rehabilitation is frequently delayed due to informational and organizational barriers. Geographic information system (GIS) technology offers a promising approach to improving rehabilitation access coordination, though its integration into patient-facing mobile platforms remains insufficiently studied. This two-arm, parallel-group, superiority randomized controlled trial enrolled 142 adult patients (≥18 years) within seven days of primary THA at the National Research Oncology Center LLC, Astana, Kazakhstan. Participants were randomized 1:1 to the GIS-integrated Health-GIS mobile coordination platform (experimental group) or standard general practitioner (GP)-mediated referral (control group). Key exclusion criteria included severe cognitive or visual impairment, absence of smartphone access or digital literacy, and medical contraindications to rehabilitation. The primary outcomes were time to second-stage rehabilitation initiation and health-related quality of life assessed by the SF-12 (Physical and Mental Component Summaries). Secondary outcomes included the Harris Hip Score (HHS), Visual Analogue Scale (VAS) for pain, System Usability Scale (SUS), and quality-adjusted life years (QALYs) over a 12-month follow-up. Of 142 randomized participants (61% male, 39% female), 131 completed follow-up and were included in the modified intention-to-treat analysis (experimental: n = 66; control: n = 65). The experimental group initiated second-stage rehabilitation significantly earlier (median 43 vs. 59 days; p = 0.021). At 12 months, the experimental group demonstrated superior SF-12 Physical Component Summary scores (48.21 vs. 42.84; p < 0.001), while Mental Component Summary scores did not differ significantly between groups (46.96 vs. 47.05; p = 0.669). Quality-adjusted life years were significantly higher in the experimental group (0.74 ± 0.04 vs. 0.72 ± 0.04; p = 0.008). Harris Hip Scores were significantly better in the experimental group at 6 weeks (p < 0.001) and 6 months (p = 0.009), converging by 12 months (p = 0.068). No statistically significant between-group differences in pain intensity (VAS) were observed at any time point (baseline: p = 0.814; 6 weeks: p = 0.336; 6 months: p = 0.066; 12 months: p = 0.105). Platform usability was rated as good-to-excellent by clinicians (SUS: 86.9 at 6 months) and acceptable by patients (mean SUS: 71.4). A GIS-integrated mobile coordination platform significantly reduced time to rehabilitation initiation and improved physical health-related quality of life and health utility following THA compared to standard referral practice. These findings support platform-based care coordination as an effective complement to surgical care, with important implications for rehabilitation access policy. Future multi-center studies and formal cost-effectiveness analyses are warranted to establish generalizability. Trial Registration: ClinicalTrials.gov, NCT07201116, registered 23 September 2025. Full article

Background/Objectives: Impaired quality of life (QoL) represents one of the most important clinical determinants in heart failure with preserved ejection fraction (HFpEF). This study aimed to evaluate the incremental explanatory value of functional performance and inflammatory biomarkers for QoL in a clinically stable HFpEF cohort. Methods: A single-center observational study enrolled 110 consecutive patients with stable HFpEF. Functional capacity was assessed using the six-minute walk test (6MWT), expressed mainly as percentage of predicted distance. Health-related QoL was measured using the EQ-5D-5L utility index (primary outcome). Circulating IL-6, CRP, and NT-proBNP were obtained from peripheral blood. Hierarchical multivariable linear regression was applied to quantify the incremental contribution of clinical variables, functional capacity, and biomarkers. Results: The median age was 72 years, and 52.7% of the participants were women. The median 6MWT distance was 340 m (75.9% of predicted), and the median EQ-5D index was 0.76. The baseline clinical regression model (age, sex, atrial fibrillation, and glomerular filtration rate) explained 23.5% of EQ-5D variance. The addition of functional capacity increased explained variance to 45.2% (ΔR² = +0.217). The inclusion of IL-6 and NT-proBNP provided a modest additional increase (R² = 0.468; ΔR² = +0.042 in addition to Model 2). In the fully adjusted model, functional capacity (β = 0.376, p < 0.001) and IL-6 (β = −0.185, p < 0.05) remained independent predictors, whereas NT-proBNP lost significance. Conclusions: In stable HFpEF, objective functional capacity represents the dominant determinant of QoL, while inflammatory activation provides an independent but smaller contribution. Functional assessment may therefore be central to patient-centered phenotyping and therapeutic targeting. Full article

Background: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory rheumatic diseases associated with impaired quality of life, persistent disease burden, and increased healthcare utilization. Treatment adherence and psychosocial factors may influence outcomes, but their longitudinal associations in real-world hospitalized populations remain insufficiently characterized. Methods: We conducted a single-center, retrospective, mid-term longitudinal observational study including 50 adults with RA or AS who experienced repeated hospitalizations over a four-year period. The final dataset comprised 196 hospitalization episodes analyzed as repeated observations nested within individual patients. Disease activity was assessed using DAS28 in RA and ASDAS and/or BASDAI in AS, according to data availability and routine clinical practice. Treatment adherence, quality of life, anxiety, social isolation, patient–provider communication, dietary support, inflammatory markers, and hospitalization-related outcomes were extracted from medical records and structured inpatient assessments. Linear mixed-effects models were used for continuous outcomes, and ordinal mixed-effects models were used for ordered categorical outcomes, with adjustment for age, sex, and time where appropriate. Results: In RA, higher treatment adherence was associated with lower disease activity over time. In AS, comparable associations were not detected, possibly reflecting disease-specific factors, limited variability in adherence, and reduced statistical power in the smaller AS subgroup. Better patient–provider communication was associated with higher adherence and lower anxiety, whereas greater social isolation was associated with poorer quality of life. More favorable dietary support was associated with better adherence, although the magnitude of this association should be interpreted cautiously because of sparse categories and wide confidence intervals. Lower inflammatory burden, particularly lower CRP over time, was associated with lower hospitalization-related costs. Conclusions: In this selected cohort of repeatedly hospitalized patients with RA or AS, treatment adherence, psychosocial factors, and supportive care indicators were associated with clinically relevant longitudinal outcomes. The findings support a multidisciplinary, patient-centered approach to inflammatory rheumatic disease care. However, because of the retrospective design, modest sample size, selected inpatient population, non-standardized assessment of several variables, and possible instability of some ordinal model estimates, the results should be interpreted as exploratory and confirmed in larger prospective cohorts. Full article

Background/Objectives: Immunoglobulin A nephropathy (IgAN) is a type of chronic kidney disease (CKD) and the most common cause of kidney failure in patients <40 years of age. Previous economic models in CKD have generally defined health states solely by the progression of CKD. This manuscript presents an alternative method which also considers the level of proteinuria in a CKD patient. Methods: A cohort-level state transition model was developed, comparing the health benefits of sparsentan, a dual endothelin angiotensin receptor antagonist, to irbesartan, an angiotensin receptor blocker, in IgAN. Within four UP/C (proteinuria) states, patients are assigned to three sub-health states according to CKD stage. Patients with end-stage renal disease are grouped together, irrespective of UP/C, and are stratified instead by renal replacement therapy modality. Transition matrices are derived from a combination of data from PROTECT, a clinical trial comparing sparsentan to irbesartan, and the UK RaDaR registry. Health-related quality of life data from a general CKD population is used as a proxy. Results: Patients with IgAN who were modelled to receive treatment with sparsentan had an estimated total undiscounted life years of 25.5 years, a gain of 0.9 years in comparison with irbesartan. Patients were also more likely to spend more time in earlier CKD stages while in pre-ESRD. This translated to significant quality-adjusted life year gains for patients treated with sparsentan in comparison with irbesartan. Conclusions: This study presents a new structure for health economic models in IgAN that more comprehensively captures the effect of proteinuria in combination with CKD progression. This new approach ultimately allows for the more robust implementation of clinical trial data in IgAN and estimates of the cost-effectiveness of new treatments. Full article

Background/Objective: Kinesiophobia is a major fear-avoidance concept in chronic low back pain (CLBP); however, its independent contribution to pain, disability, and health-related quality of life (HRQoL) beyond sociodemographic and clinical variables remains unclear. This study aimed to evaluate the associations between kinesiophobia and patient-reported outcomes in adults with chronic low back pain regarding (i) pain intensity, (ii) functional disability, and (iii) HRQoL. Methods: This cross-sectional study included 298 participants with CLBP (average age 38.7 ± 13.2 years; 58.0% female). Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (range, 17–68). Outcomes were pain intensity (Numerical Pain Rating Scale; 0–10), functional disability (Roland–Morris Disability Questionnaire; 0–24), and HRQoL (RAND-36; 0–100). Two multivariable linear regression models were used per outcome. Model 1 was adjusted for sex and age, and Model 2 was additionally adjusted for BMI, marital status, education, employment, smoking status, and chronic disease. Hierarchical regression analysis evaluated the incremental variance explained by kinesiophobia (ΔR²) when entered after all covariates. Effects were reported per 10-point increase in Tampa score, with 95% confidence intervals (CI). Results: In the fully adjusted models, higher kinesiophobia was associated with greater pain intensity (B = +1.17 points per 10 Tampa; 95% CI 0.55–1.79, p < 0.001), greater disability (B = +3.24 points; 95% CI 2.05–4.43; p < 0.001), and lower HRQoL (B = −7.98 points; 95% CI −11.1–−4.81; p < 0.001). Hierarchical regression analyses showed that kinesiophobia explained additional variance in pain (ΔR² = 0.11), disability (0.12), and HRQoL (0.11), all p < 0.001. Conclusions: In adults with CLBP, kinesiophobia was associated with greater pain intensity, functional disability, and lower HRQoL, accounting for 11–12% of variance in each outcome beyond demographic and clinical covariates. These findings support routine assessment of kinesiophobia and justify longitudinal and interventional studies to determine temporal relationships and treatment effects. Full article

Background: Breast cancer (BC) survivors frequently experience depression, which is associated with poorer quality of life (QoL), increased healthcare utilization, and worse prognosis. Although traditional Chinese medicine (TCM) is commonly used as an adjunctive therapy among Chinese populations for cancer-related symptom relief and supportive care, population-based evidence remains limited regarding whether integrated Chinese and Western medicine (ICWM) confers measurable benefits over Western medicine (WM) alone in terms of healthcare utilization and survival. Taiwan’s National Health Insurance (NHI) system offers a unique nationwide setting to address this gap because it reimburses patients for both WM and TCM services and captures care from a large number of TCM clinics across Taiwan, allowing evaluation of adjunctive TCM use in routine clinical practice at a scale rarely possible in prior studies. We used emergency department visits, hospitalization, and length of stay as pragmatic proxy indicators of patients’ daily functioning and disease burden. Leveraging a 10-year enrollment window (2004–2013) and up to 17 years of follow-up, we hypothesized that ICWM would be associated with a reduced risk of acute care events and lower healthcare expenditures compared with WM alone. This hypothesis was examined in a large cohort of breast cancer patients treated across nearly 4000 medical facilities nationwide, encompassing the entire Taiwanese population. Methods: A retrospective cohort study was performed to analyze Taiwan’s National Health Insurance Research Database and Cancer Registry. Women newly diagnosed with breast cancer between 2004 and 2013 who subsequently developed depression (≥3 outpatient diagnoses or 1 hospitalization) were followed until death or 31 December 2021. Patients receiving ≥30 cumulative days of TCM after diagnosis were classified as the ICWM group, whereas those receiving <30 days were classified as the WM group. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for all-cause mortality. Healthcare utilization, including emergency department visits, hospitalization, and medical expenditures, was analyzed on a per-person-year basis. Results: A total of 1193 patients were included, with 488 in the WM group and 705 in the ICWM group. Compared with WM users, ICWM users were younger, had lower body mass index, and were more likely to have stage 0–II disease. ICWM was associated with lower total, inpatient, and emergency healthcare expenditures per person-year, as well as fewer emergency visits per person-year, although outpatient and overall visits were higher. In stage-stratified multivariable analyses, ICWM was associated with lower all-cause mortality in both stage 0–II disease (aHR = 0.61, 95% CI: 0.39–0.94) and stage III–IV disease (aHR = 0.38, 95% CI: 0.21–0.67). Kaplan–Meier analyses likewise showed significantly better overall survival in the ICWM group in both early-stage and advanced-stage disease. Conclusions: In this nationwide retrospective cohort of breast cancer patients with depression, adjunctive ICWM was associated with better survival, lower acute care utilization, and lower healthcare expenditures compared with WM alone. However, because quality of life was not directly measured and the study was based on observational data, QoL-related interpretations should be made cautiously, with healthcare utilization outcomes viewed as indirect proxy indicators rather than direct evidence of improved daily QoL. Full article

Background: Vision difficulty (VD) in childhood and adolescence may affect learning, daily functioning, and quality of life. Although body roundness index (BRI) has emerged as an indicator of central adiposity and cardiometabolic risk, its association with reported VD in pediatric populations remains unclear. Methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) August 2021–August 2023. Participants aged 5–17 years with available data on VD, BRI, and covariates were included. VD was defined as self- or proxy-reported difficulty seeing even when wearing glasses or contact lenses. Survey-weighted logistic regression models were used to examine the association between BRI and VD, with progressive adjustment for demographic, socioeconomic, and lifestyle factors. BRI was analyzed as both a continuous variable and weighted quartiles. Restricted cubic spline (RCS) analysis was performed to assess the dose–response relationship. Results: A total of 1566 participants were included. In the fully adjusted model, each one-unit increase in BRI was associated with 12% higher odds of VD (odds ratio [OR] = 1.12, 95% confidence interval [CI]: 1.02–1.23, p = 0.029). Per 1 standard deviation increase in BRI, the OR for VD was 1.20 (95% CI: 1.03–1.40). Weighted quartile analysis showed imprecise fully adjusted estimates; descriptively, weighted VD prevalence was higher in the highest than in the lowest BRI quartile. RCS analysis showed a significant overall association (p-overall = 0.0297) without evidence of non-linearity (p-non-linearity = 0.861). Conclusions: Higher BRI was associated with greater odds of reported VD among U.S. children and adolescents. Given the cross-sectional design and questionnaire-based outcome, these findings should be interpreted as a population-level association rather than evidence of causality or clinical utility. Full article

Background: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased rapidly in pediatric populations. Evidence on the cost-effectiveness of pediatric MASLD screening strategies remains limited. Methods: A decision tree combined with a Markov state-transition model was developed to evaluate the cost-effectiveness of three WHtR-based two-stage screening strategies among children aged 6–14 years in Beijing, China: WHtR combined with ultrasound (S1), WHtR combined with FibroScan^® (S2), and WHtR combined with magnetic resonance imaging-proton density fat fraction (MRI-PDFF) (S3), compared with no screening (S4). All screening strategies were combined with lifestyle modification programs, including dietary and exercise management. Model inputs were derived from the published literature, national survey data, and expert consensus. Costs and quality-adjusted life years (QALYs) were estimated from a healthcare system perspective over a 10-year time horizon, with a 3% annual discount rate. Incremental cost–utility ratios (ICURs) were calculated, and extensive one-way, two-way, and probabilistic sensitivity analyses were performed. Results: Our model indicated that, at a willingness-to-pay (WTP) threshold of $30,584.0 per QALY, corresponding to three times the gross domestic product (GDP) per capita of China, S2 was identified as the optimal strategy. At a higher WTP threshold of $71,415.5 per QALY, based on the GDP per capita of Beijing, S3 became the most cost-effective option. All three screening strategies were more cost-effective than no screening across both thresholds. Sensitivity analyses demonstrated that utility values for fibrosis stages and the response rate of the lifestyle modification program were the most influential parameters, and probabilistic sensitivity analysis confirmed the robustness of the baseline findings. Conclusions: To the best of our knowledge, this is the first cost-effectiveness analysis for pediatric MASLD in China. Model-based estimates suggest that early screening for MASLD in children using WHtR-based screening strategies is cost-effective, with FibroScan^® preferred in settings with average economic development and MRI-PDFF preferred in more affluent regions. These findings underscore the importance of context-specific implementation of early MASLD screening strategies in pediatric populations to mitigate long-term disease burden. Full article