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In alkaline soils rich in residual phosphorus, phosphorus availability to plants depends not only on the existing reserve, but also on the redistribution of the extractable fraction within the root-explored zone. This study evaluated the effects of water regime, fertilizer treatment, and wheat presence on the distribution of ammonium lactate-extractable phosphorus (P-AL) within the 2–8 cm layer of an alkaline calcareous Chernozem with high initial P availability (P-AL = 178.1 mg kg⁻¹). The pot experiment compared plant-free soil (S0) and wheat-planted soil (SP), four water regimes (H0–H150; 0–150 L m⁻²), and four fertilization treatments: an unfertilized control (F0), a solid NPK fertilizer (FS), and a liquid NP fertilizer applied at low and high rates (FL1 and FL2). These treatments represented practical fertilization options and were not equivalent in P input, supplying 51.8, 13.9, and 27.9 mg P pot⁻¹ for FS, FL1, and FL2, respectively. Soil and plant samples were collected at BBCH 21–22, 20 days after fertilization. Water regime was a major factor shaping P-AL redistribution, significantly affecting P-AL at all three analyzed soil depths (p < 0.001), with its effect depending on vegetation condition and fertilization treatment. Wheat presence reduced P-AL relative to S0, and apparent P-AL depletion (ΔP-AL = S0 − SP) was greatest under H0, ranging from 83 to 99 mg kg⁻¹. FL2 produced the largest S0–SP contrasts under H0–H100, whereas under H150 the largest difference was associated with FS. Under high water input, the higher-input solid NPK treatment (FS), which supplied the largest P input and was the only treatment supplying K, was associated with the highest shoot biomass (16.7 g), root biomass (6.92 g), and root P accumulation (25.2 mg pot⁻¹). The results indicate that P fertilization in high-P alkaline soils should be adapted to water regime, fertilizer input and application method, without allowing for direct conclusions regarding phosphorus use efficiency, total plant P uptake, or leaching losses. Full article

(This article belongs to the Special Issue Phosphorus Dynamics: Towards Sustainable Phosphorus Nutrition)

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30 pages, 12208 KB

Open AccessArticle

Integrating Cyber Threat Intelligence into Email Gateway Architectures for Phishing and Ransomware Detection and Prevention

by Mustafa Kara, Hasan Burus and Hasan Hüseyin Balık

Electronics 2026, 15(17), 3792; https://doi.org/10.3390/electronics15173792 (registering DOI) - 24 Aug 2026

Abstract

Email remains a major Initial Access vector for phishing and ransomware attacks, requiring security mechanisms that can combine multiple sources of threat evidence before malicious content reaches end users. Modern commercial email gateways already incorporate antivirus, reputation-based filtering, email authentication, and vendor-provided threat-intelligence mechanisms. However, their correlation logic, scoring criteria, decision thresholds, and automated response workflows are often proprietary or insufficiently documented. Moreover, transparent evaluations of the incremental benefit provided by external CTI enrichment and unified Indicator of Compromise (IoC) and Indicator of Attack (IoA) correlation remain limited. To address this gap, this study presents and experimentally evaluates a transparent CTI-supported email gateway workflow that integrates external intelligence feeds, IoC/IoA correlation, contextual threat scoring, predefined decision thresholds, and automated response actions. The proposed configuration was compared with a commercial baseline using the same vendor-native security controls in an isolated VMware ESXi-based environment. The evaluation included 1000 emails comprising 500 benign emails, 200 emails containing ransomware attachments, and 300 emails containing phishing URLs. The CTI-supported configuration achieved an overall detection rate of 98.8%, compared with 64.2% for the commercial baseline. Phishing URL and ransomware attachment detection rates reached 99.3% and 98.0%, respectively, while the false positive rate decreased from 4.5% to 1.2%. In the evaluated scenarios, the CTI-supported architecture interrupted the modeled attack chain at the Initial Access stage, demonstrating the measurable benefit of external CTI enrichment and unified correlation beyond the gateway’s native controls. Full article

(This article belongs to the Section Networks)

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19 pages, 840 KB

Open AccessArticle

Two World Cups: Technical–Tactical, Physical, and Goal-Timing Patterns in the Group Stages of the FIFA World Cup 2022 and FIFA Club World Cup 2025

by Andreas Stafylidis, Athanasios Mandroukas, Yiannis Michailidis, Charalampos Stafylidis, Eleni Semaltianou and Thomas I. Metaxas

Appl. Sci. 2026, 16(17), 8419; https://doi.org/10.3390/app16178419 (registering DOI) - 24 Aug 2026

Abstract

The objective of this study was to compare technical–tactical, physical, and goal-timing indicators in the group stages of the FIFA World Cup 2022 and FIFA Club World Cup 2025 and to determine whether associations between performance indicators and match outcome differed between the tournaments. A retrospective observational analysis included 192 team-match observations from 96 group-stage matches. Goal distribution by match half was examined using a chi-square test, while 15 performance indicators were analysed using mixed-effects models with Tournament, Match Outcome, and Tournament × Match Outcome as fixed effects and random intercepts for Team ID and Match ID. Benjamini–Hochberg correction was applied separately to each effect family. Goal distribution by half differed between the tournaments, with a greater proportion of second-half goals in the FIFA World Cup 2022 and a more even distribution between halves in the FIFA Club World Cup 2025 (Cramér’s V = 0.135) After false discovery rate correction, significant Tournament effects were identified for final-third receptions, defensive pressures, and forced turnovers, while significant Tournament × Match Outcome interactions were observed for possession, total and completed passes, final-third receptions, and defensive pressures. Full-data negative binomial sensitivity analyses retained the three Tournament effects and all five interactions, although four Match Outcome classifications changed. Within the FIFA Club World Cup 2025, winners showed higher possession and passing volumes than losing teams, while final-third receptions and defensive pressures also differed according to tournament and match outcome context. These findings indicate that performance–outcome associations varied according to tournament context rather than reflecting a universal profile of success. Full article

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16 pages, 7395 KB

Open AccessArticle

Duality-Derived Electromagnetic Modeling of an On-Board Traction Transformer Under Power-Frequency Overexcitation

by Lujia Wang, Yongze Yang, Xinyi Chen, Hailong Zhang, Xiu Zhou and Tian Tian

Electronics 2026, 15(17), 3793; https://doi.org/10.3390/electronics15173793 (registering DOI) - 24 Aug 2026

Abstract

Power-frequency overexcitation increases the voltage-to-frequency ratio applied to a transformer core and may drive the core into saturation, resulting in substantial distortion of the no-load current. This paper presents a duality-derived electromagnetic model for an on-board traction transformer by combining a sixth-order Foster network identified through vector fitting with a Jiles–Atherton hysteresis operator. The proposed model preserves the physical correspondence between magnetic-flux paths and equivalent-circuit elements while accounting for history-dependent core hysteresis and frequency-dependent core impedance. The model is implemented and numerically evaluated in MATLAB/Simulink R2024a, and experimental validation is performed on a 250 kVA prototype under rated power-frequency excitation and power-frequency overexcitation. Under rated excitation, the RMS relative error and NRMSE of the no-load current are 0.09% and 0.96%, respectively, with a maximum relative error of 2.90%. Under power-frequency overexcitation, the NRMSE is 4.14% and the maximum relative error is 9.37%. The results show that the proposed model accurately reproduces the nonlinear no-load current response associated with core saturation and hysteresis within the investigated power-frequency excitation range. Full article

(This article belongs to the Section Power Electronics)

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20 pages, 3866 KB

Open AccessArticle

Optimization Design and Experiment of a Pulling–Cutting–Clamping End-Effector for Hang Pepper Harvesting

by Xingxiao Ma, Mingjie Li, Hongxuan Liang, Jianneng Chen and Xiong Zhao

Agriculture 2026, 16(17), 1812; https://doi.org/10.3390/agriculture16171812 (registering DOI) - 24 Aug 2026

Abstract

Existing studies on selective pepper harvesting commonly use the pedicel as the picking target. However, for Hang pepper, dense branches and leaves cause severe fruit stem occlusion, resulting in a low harvesting success rate. To address this limitation, an end-effector that uses the fruit body as the picking target was designed in this study. Physical property tests of Hang pepper were first conducted. In radial compression tests, a post-release deformation of less than 5% was used as the criterion for low-damage clamping. The maximum allowable clamping force was determined to be 3.5 N, under which the maximum fruit compression ratio was 10%. The maximum cutting force required to shear the pedicel was 15.03 N. Based on these results, a harvesting strategy consisting of fruit clamping, fruit pull-down, and pedicel cutting was proposed. A five-bar linkage was adopted as the main mechanism of the end-effector, and its kinematic and mechanical models were established. Taking the minimum driving torque as the optimization objective, a genetic algorithm was used to optimize the linkage dimensions. The optimized driving torque was 0.801 N m, and a calculation method relating the target fruit diameter to the servo rotation angle was established. Harvesting experiments under prescribed target diameters showed a harvesting success rate of 95%, and the single-fruit harvesting time was 5.1 s, demonstrating the excellent harvesting capability of the proposed end-effector. Full article

(This article belongs to the Section Agricultural Technology)

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36 pages, 4355 KB

Open AccessArticle

Atomization, Transport, and Numerical Wall-Trapping Characteristics of Drag-Reducing Agent Droplets in Hydrogen-Blended Natural Gas Pipeline Inlet Sections

by Kairui Zhu, Xiaoling Li and Yuguo Wu

Processes 2026, 14(17), 2694; https://doi.org/10.3390/pr14172694 (registering DOI) - 24 Aug 2026

Abstract

Research on atomized drag-reducing agent (DRA) delivery in hydrogen-blended natural gas (HBNG) pipelines is limited, although inlet-section droplet transport and wall interaction are of practical importance. A three-dimensional CFD–DPM model of a

15 m

straight pipe equipped with a pressure–swirl hollow-cone atomizer was [...] Read more.

15 m

straight pipe equipped with a pressure–swirl hollow-cone atomizer was developed to evaluate the effects of atomization pressure drop, injection mass flow rate, spray cone angle, nozzle orifice diameter, hydrogen blending ratio, and operating pressure. Numerical robustness was assessed through mesh and parcel-number independence tests, turbulence-model sensitivity analysis, representative simulations at

MPa

-level operating pressures, and qualitative comparison with published pressure–swirl spray experiments. Increasing atomization pressure drop from

0.5

5 MPa

reduced the Sauter mean diameter from

120.07

32.85 μ m

and the numerical wall-trapping ratio from 32.96% to 13.68%, with diminishing changes above approximately

2 MPa

. Higher injection mass flow rates increased droplet size and numerical wall trapping, whereas larger cone angles intensified radial migration and caused severe inlet-localized trapping at

80^{\circ}

. Nozzle orifice diameter and hydrogen blending ratio showed weaker effects. Increasing operating pressure from

101, 325 Pa

2 MPa

reduced the SMD from

54.60

9.91 μ m

and the numerical wall-trapping ratio from 15.88% to 5.96%. These model-dependent trends require high-pressure spray, flow-loop, or field validation before engineering application. Full article

(This article belongs to the Section Energy Systems)

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17 pages, 1947 KB

Open AccessSystematic Review

Effect of Applicator Brush Use on Color Change, Hydrogen Peroxide Penetration, and Gel Consumption in In-Office Bleaching: A Systematic Review and Meta-Analysis

by Samille Biasi Miranda, Rosalia Maux de Carvalho Rodrigues, Caroline de Farias Charamba Leal, Fernanda Campos, Hugo Rafael de Souza Cavalcante, Priscylla Gonçalves Correia Leite de Marcelos, Marcos Antonio Japiassú Resende Montes and Rodrigo Barros Esteves Lins

Dent. J. 2026, 14(9), 533; https://doi.org/10.3390/dj14090533 (registering DOI) - 24 Aug 2026

Abstract

Background: In-office dental bleaching is a common aesthetic procedure, and different application methods may influence laboratory and clinical outcomes. Objectives: This systematic review and meta-analysis evaluated the effects of applicator brush use compared with conventional application without a brush during in-office hydrogen peroxide bleaching. Methods: The review followed PRISMA guidelines and was registered in PROSPERO (CRD42023491451). Electronic searches were conducted in PubMed, Cochrane Library, LILACS, and OpenGrey for studies published until April 2026. Clinical and in vitro studies comparing bleaching gel application with and without an applicator brush were included. Outcomes included hydrogen peroxide concentration in the pulp chamber, bleaching gel consumption, color change, and tooth sensitivity. Risk of bias was assessed using RoB 2 for the randomized clinical trial and the Sarkis-Onofre tool for in vitro studies. Meta-analyses were performed using RevMan, and certainty of evidence was assessed using the GRADE approach. Results: Of 10,260 records identified, four studies met the eligibility criteria, including one randomized clinical trial and three in vitro studies. Quantitative synthesis was based exclusively on the three in vitro studies. The randomized clinical trial showed low risk of bias, whereas the in vitro studies presented methodological limitations. Meta-analyses showed no statistically significant differences between applicator brush and conventional application methods for hydrogen peroxide concentration in the pulp chamber or bleaching gel consumption, although pooled estimates showed a tendency toward lower values with applicator brush use. No significant differences were observed in color change outcomes assessed by ΔEab, ΔE00, or ΔWID (p > 0.05). Heterogeneity ranged from 0% to 99%, and the certainty of evidence for all outcomes was rated as very low. Conclusions: Based on predominantly laboratory evidence of very low certainty, applicator brush use may be associated with lower hydrogen peroxide concentration in the pulp chamber and reduced bleaching gel consumption; however, these findings should be interpreted cautiously, and the clinical relevance of this application method remains uncertain. Full article

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Graphical abstract

21 pages, 5537 KB

Open AccessArticle

Deep Learning and Large Language Models for Offline Recognition of Latin Handwritten Kazakh Text

by Assem Shormakova, Madina Mansurova, Beibitkhan Yerkegul and Marek Milosz

Computers 2026, 15(9), 552; https://doi.org/10.3390/computers15090552 (registering DOI) - 24 Aug 2026

Abstract

This article investigates offline recognition of handwritten Kazakh text in the Latin script using a convolutional recurrent neural network. The relevance of the study is determined by the transition of the Kazakh language to the Latin alphabet and the need to automate the processing of handwritten documents. The proposed model consists of a convolutional neural network feature extractor, two bidirectional long short-term memory layers, and a Connectionist Temporal Classification decoder. The convolutional layers extract visual features from word images, the bidirectional recurrent layers model the sequential relationships between characters, and CTC enables end-to-end training without explicit character-level segmentation. A specialized dataset named KazEsim, containing 20,000 handwritten Kazakh name images, was created and divided into writer-independent training, validation, and test subsets. Experimental results showed a character accuracy rate of 96.5% and a word accuracy rate of 92.3%. Compared with a conventional CNN baseline, the proposed CRNN model improved character accuracy by 6.1 percentage points and word accuracy by 9.2 percentage points. The proposed model also outperformed the fine-tuned TrOCR-small comparative baseline while requiring fewer parameters and lower inference latency. These findings demonstrate the effectiveness of CNN–BiLSTM–CTC sequence modeling for offline recognition of handwritten Kazakh words in the Latin script. Full article

(This article belongs to the Section AI-Driven Innovations)

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17 pages, 5667 KB

Open AccessArticle

One-Step Hydrothermal Synthesis of Ni₂P/MIL-53(Fe) and Its Catalytic Performance in the Selective Oxidation of Aromatic Alcohols

by Shuangyan Meng, Bin Liu, Jijie Zhao, Kaizhou He, Minglin Xie, Xiangqian Wang, Zhiwang Yang and Xiaoping Gao

Catalysts 2026, 16(9), 759; https://doi.org/10.3390/catal16090759 (registering DOI) - 24 Aug 2026

Abstract

Developing cost-effective photocatalysts with high activity remains a key challenge in photocatalysis. In this study, a low-cost nickel phosphide (Ni₂P) cocatalyst was combined with MIL-53(Fe) to fabricate Ni₂P/MIL-53(Fe) nanocomposites via a simple hydrothermal method. The as-prepared composites were systematically characterized by XRD, FT-IR, SEM, UV-vis DRS, PL, and EIS to evaluate their structural, morphological, optical, and electrochemical properties. The introduction of Ni₂P significantly promoted the separation of photogenerated electron–hole pairs on the MIL-53(Fe) surface, thereby enabling valence band holes (h⁺) to participate in alcohol oxidation, as confirmed by photoelectrochemical analysis. Under optimized conditions, the Ni₂P/MIL-53(Fe) nanocomposite achieved a significant photocatalytic alcohol conversion rate of 74%, which is 7.4-fold and 2.5-fold higher than those of pristine Ni₂P and MIL-53(Fe), respectively. Furthermore, mechanistic studies revealed that valence band holes are primarily responsible for the selective oxidation of aromatic alcohols. Full article

(This article belongs to the Section Photocatalysis)

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Graphical abstract

24 pages, 17731 KB

Open AccessArticle

Thermal Performance of a Prefabricated Wall System Based on Styroconcrete Incorporating Recycled Expanded Polystyrene: A Numerical Comparison with a Conventional Large-Panel Building System

by Bożena Orlik-Kożdoń, Barbara Ksit, Jakub Kieloch and Mateusz Kieloch

Energies 2026, 19(17), 3969; https://doi.org/10.3390/en19173969 (registering DOI) - 24 Aug 2026

Abstract

This article investigates the thermal performance of a conventional W-70 large-panel building system and a modern prefabricated wall system incorporating recycled expanded polystyrene (EPS) regranulate. The study aims to compare the thermal performance of two prefabricated wall systems representing different construction technologies and to evaluate the combined influence of their structural and material solutions on heat losses and thermal bridging. Numerical simulations were performed using THERM 7.6 based on the finite element method (FEM). Three representative structural junctions were analysed: the external corner, the external wall-to-internal wall junction, and the floor slab-to-external wall junction. The evaluation included thermal transmittance (U-value), heat flow rate, thermal coupling coefficient, linear thermal transmittance (Ψ), minimum internal surface temperature, and the internal surface temperature factor (f_Rsi). The results demonstrated that the analysed prefabricated wall system exhibited lower heat losses and improved thermal performance than the conventional W-70 large-panel system. The observed differences reflect the combined effect of the wall build-up, material properties, insulation thickness, and structural junction geometry. The incorporation of recycled EPS regranulate constitutes one of the design features of the analysed wall system and may contribute to more sustainable use of construction materials through the utilisation of recycled polymer waste. Full article

(This article belongs to the Special Issue Thermal Insulation Materials for Energy Conservation in Buildings)

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31 pages, 5248 KB

Open AccessReview

Wireless Power and Data Transfer over Inductive Links for Biomedical Applications: Recent Advances, Challenges, and Limitations

by Naqeeb Ullah, Adel Barakat and Haruichi Kanaya

Micromachines 2026, 17(9), 998; https://doi.org/10.3390/mi17090998 (registering DOI) - 24 Aug 2026

Abstract

Wireless power transfer (WPT) has emerged as a promising technology for modern implantable medical devices (IMDs), providing a reliable alternative to traditional batteries and reducing the need for repeat surgical procedures. WPT-based IMDs are extensively employed in biomedical applications such as deep brain stimulators, endoscopic capsules, pacemakers, and cardiac monitoring systems, which are being commercialized. As the IMD market is expected to grow with the aging population, extensive research efforts are proceeding to address key design and implementation challenges. A key challenge lies in simultaneously achieving high power-transfer efficiency (PTE), high data rates, low power consumption, and low circuit complexity. This review paper thoroughly examines recent developments, design trends, and current research problems in simultaneous power and bidirectional data transmission over a single inductive link, as well as the associated modulation and demodulation techniques. We reviewed various uplink and downlink modulation techniques, focusing on key characteristics such as data rate, power consumption, circuit complexity, and health and safety considerations. Finally, future research directions toward efficient, compact, and reliable simultaneous wireless power and data transfer (SWPDT) for the next generation of IMDs are discussed. This review paper will hopefully guide ongoing research into more efficient, scalable, and safe SWPDT systems. Full article

(This article belongs to the Special Issue Bioelectronics: Technology, Challenges and Applications)

25 pages, 1023 KB

Open AccessArticle

Integrated Environmental, Energy, and Economic Assessment of Electric Taxi Fleet Electrification: A Case Study of Denizli, Türkiye

by Dolunay Zengin, Mehmet Çakmak and Soner Haldenbilen

Sustainability 2026, 18(17), 8657; https://doi.org/10.3390/su18178657 (registering DOI) - 24 Aug 2026

Abstract

Taxi fleets operate intensively, accumulate high annual mileage, and contribute disproportionately to urban greenhouse gas emissions, making them attractive candidates for transport electrification. Despite growing interest in electric mobility, integrated evaluations of the environmental, energy, and economic implications of taxi fleet electrification remain limited, particularly for medium-sized cities in Türkiye. This research examines the replacement of the commercial taxi fleet operating in the central districts of Denizli with battery electric vehicles (BEVs) through a framework that integrates operational emission estimation, electricity demand, charging infrastructure, and life-cycle cost analysis (LCCA). Operational emissions were quantified using the IPCC Tier 1 fuel-based approach together with a distance-based consistency check. Under the adopted assumptions, electrification reduced annual operational CO₂ emissions by 4217.48 tCO₂ (57.9%). The electrified fleet required 18.36 MWh of electricity per day (6.70 GWh annually), while estimated peak charging demand varied between 1.22 MW and 5.57 MW, depending on the charging strategy. Economic evaluation showed a positive net present value (NPV) of 1.32 million TL per vehicle, an internal rate of return (IRR) of 80.86%, and a discounted payback period (DPP) of 1.37 years. Although profitability varied with energy prices, vehicle costs, and annual mileage, fleet electrification remained economically feasible across all scenarios considered. These results suggest that electrifying commercial taxi fleets can support urban decarbonization while remaining financially attractive when accompanied by appropriate charging infrastructure and coordinated transport planning. Full article

(This article belongs to the Topic Advanced Technology of Smart Battery and Energy Management System of Transportation Electrification)

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17 pages, 9763 KB

Open AccessArticle

ZnO Nanoparticles Enhance the Biocontrol Efficacy of Bacillus siamensis YZUS007 Against Sclerotinia Stem Rot of Brassica napus

by Jianchao Hu, Jianwei Jiang, Guanze Yang, Haodong Wang, Jialong Chen, Juan Gan, Jiayi Wang and Zhengxiang Sun

J. Fungi 2026, 12(9), 633; https://doi.org/10.3390/jof12090633 (registering DOI) - 24 Aug 2026

Abstract

Sclerotinia sclerotiorum causes destructive sclerotinia stem rot and severe yield losses in global rapeseed production. The Bacillus biocontrol strain YZUS007 serves as an eco-friendly alternative to synthetic fungicides, yet its control efficacy fluctuates under complex field conditions. This study aimed to investigate whether low-dose ZnO NPs could enhance the biocontrol efficacy of YZUS007 and to elucidate the underlying mechanisms. We isolated and identified the antagonistic strain Bacillus siamensis YZUS007 from the rhizosphere soil of healthy Brassica napus, which exhibited an in vitro pathogen inhibition rate of 78.4 ± 0.7%. Pot tests showed that YZUS007 (BC) achieved 60.79% control efficacy, whereas the YZUS007 + 20 μg/mL ZnO NPs group (BZ) reached 74.68%. Cell-free filtrate of YZUS007 (EC) had a 50.44% control efficacy, and filtrate with ZnO NPs (EZ) increased efficacy to 58.08%. LC-MS/MS identified four extracellular metabolites with increased relative abundances: cinnamic acid, sesamol, patchouli alcohol and 2-phenylbutyric acid. The combined treatment boosted defense enzyme activities and induced higher expression of the defense-related genes RBOH, PR1 and WRKY33. Collectively, low-concentration ZnO NPs significantly enhanced the biocontrol performance of YZUS007 by promoting antifungal metabolite accumulation, providing a low-dose, nanomaterial-assisted strategy for sustainable sclerotinia rot management. Full article

(This article belongs to the Section Fungi in Agriculture and Biotechnology)

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18 pages, 1173 KB

Open AccessArticle

Behavioral and Clinical Correlates of Poor Sleep and Anxiety Symptoms in Adults Aged 50 Years and Older: A Cross-Sectional Study

by Hammad S. Alhasan and Mansour Abdullah Alshehri

J. Clin. Med. 2026, 15(17), 6531; https://doi.org/10.3390/jcm15176531 (registering DOI) - 24 Aug 2026

Abstract

Background/Objectives: Sleep quality, anxiety symptoms, physical activity, musculoskeletal pain, and multimorbidity are interrelated health domains, but evidence examining these factors together among adults aged ≥50 years in Saudi Arabia remains limited. This study described their prevalence and assessed cross-sectional associations among these domains. Methods: A cross-sectional online survey using convenience sampling was conducted in Saudi Arabia between December 2024 and April 2025. Participants completed measures of musculoskeletal pain, self-reported morbidity, physical activity (Global Physical Activity Questionnaire), sleep quality (Brief Version of the Pittsburgh Sleep Quality Index), and anxiety symptoms (Generalized Anxiety Disorder-7). Associations were examined using Spearman rank correlations and logistic regression with core adjustment for age, sex, and BMI. The Benjamini–Hochberg false discovery rate correction was applied to eight focal comparisons; Firth penalized logistic regression was applied as a sensitivity analysis for models in which multimorbidity was the outcome. Results: The sample included 298 adults (mean age 58.2 +/− 6.3 years; 75.5% male). Musculoskeletal pain was reported by 73.8%, multimorbidity by 8.4%, poor sleep by 43.3%, and moderate-to-severe anxiety symptoms by 23.8%. Better sleep quality was moderately associated with lower anxiety severity (Spearman rho = −0.45, p < 0.001). Poor sleep was associated with higher odds of moderate-to-severe anxiety symptoms (OR 6.49, 95% CI 3.45–12.20), and low total physical activity was associated with higher odds of both moderate-to-severe anxiety symptoms (OR 7.87, 95% CI 2.68–23.08) and poor sleep (OR 5.09, 95% CI 2.40–10.83). These focal associations remained significant after FDR correction. In an exploratory sensitivity analysis, the poor sleep–multimorbidity association remained comparable when Firth regression was applied (OR 2.71, 95% CI 1.12–7.06; p = 0.027). Conclusions: In this online convenience sample of adults aged ≥50 years, sleep quality, anxiety symptoms, and total physical activity showed consistent cross-sectional associations. Findings involving multimorbidity were exploratory because of the limited number of events. These results require confirmation in representative longitudinal studies. Full article

(This article belongs to the Special Issue The Complex Interplay Between Physical Activity, Sleep, Diet, and Obesity: Clinical Insights for Treatment and Prevention)

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14 pages, 264 KB

Open AccessArticle

Menopausal Symptom Burden, Quality of Life, Healthcare-Seeking Behavior, and Treatment Satisfaction: A Cross-Sectional Study of Romanian Women

by Andrei Pescaru, Flavia Crișan, Radu Ioan Lala, Adrian Cosmin Ilie, Norbert Wellmann, Adelina Marițescu, Alaviana Monique Faur, Daian Ionel Popa and Roxana Folescu

Healthcare 2026, 14(17), 2693; https://doi.org/10.3390/healthcare14172693 (registering DOI) - 24 Aug 2026

Abstract

Background/Objectives: Menopausal symptoms can impair quality of life and influence healthcare use. This study examined symptom burden, menopause-specific quality of life, healthcare seeking, consultation delay, treatment satisfaction, and associated demographic and clinical factors among Romanian women. Methods: This cross-sectional study included 204 peri- and postmenopausal women. We assessed symptoms and quality of life using the Menopause Rating Scale (MRS) and the Menopause-Specific Quality of Life Questionnaire (MENQOL). We compared groups, ran Spearman correlations, and used multivariable linear regression to identify demographic and clinical factors associated with MENQOL. We excluded MRS from the regression because of construct overlap, and restricted delay analyses to care seekers. Results: Care seekers had higher MRS (18.0 vs. 14.5; p = 0.041) and MENQOL scores (3.95 vs. 3.26; p = 0.009). MRS and MENQOL were strongly correlated (ρ = 0.858; p < 0.001), but consultation delay was not associated with either outcome among care seekers. In the adjusted model, higher BMI, postmenopausal stage, greater comorbidity burden, and menopause-medication use were associated with poorer quality of life (adjusted R² = 0.138). Treatment-satisfaction correlations were inverse but exploratory. Conclusions: Menopause-specific quality of life varied according to body composition, reproductive stage, general health burden, and treatment context. Clinical assessment should integrate these factors and review persistent symptoms among treated women. The cross-sectional findings do not establish causality or treatment effectiveness. Full article

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