Search Results (26,909)

Background: Elderly individuals represent one of the populations most affected by COVID-19, exhibiting high vulnerability to malnutrition, sarcopenia, and poor clinical outcomes. The association between nutritional status and disease progression highlights the need for standardized assessment and targeted nutritional interventions. Methods: A systematic review was performed using PubMed, Cochrane Library, and Google Scholar, covering studies published between January 2020 and October 2025. The review followed PRISMA guidelines and included studies evaluating nutritional status, screening tools, and nutritional support strategies for the elderly population (≥65 years old) with COVID-19 across inpatient, outpatient, and institutional care settings. Results: A total of seven studies met the inclusion criteria. Reported malnutrition prevalence ranged from 25% to 65%, increasing with both age and COVID-19 severity. The most frequently applied tools were the Mini Nutritional Assessment–Short Form (MNA-SF), the Global Leadership Initiative on Malnutrition (GLIM) criteria, and the Geriatric Nutritional Risk Index (GNRI). New evidence supports early nutritional screening, high-protein supplementation, and individualized dietary strategies to reduce complications and improve recovery trajectories. Conclusions: Nutritional risk screening and timely intervention are essential in the management of elderly patients with COVID-19. Standardized assessment tools and multidisciplinary nutrition approaches enhance clinical outcomes, minimize disease burden, and should remain integral components of geriatric care in infectious and post-pandemic contexts. Full article

Hexavalent chromium [Cr(VI)] is the toxic form of chromium often used in industry for its hardness, bright colors, and anticorrosive properties. Cr(VI) is a known human lung carcinogen, making its inhalation an occupational hazard. Growing evidence emphasizes the neurotoxic potential of Cr(VI), though it is not linked to brain cancers. Few studies consider neurotoxicity in chromate workers, reporting impaired olfactory discrimination and an increased risk of death from mental health disorders. A major factor limiting translation of most rodent Cr(VI) studies to human populations has to do with vitamin C, which can reduce the toxic Cr(VI) to non-toxic Cr(III). Rats and mice synthesize vitamin C and are likely more resistant to Cr(VI) than humans. Here, we considered Cr(VI) neurotoxicity in guinea pigs (Cavia porcellus), which do not endogenously synthesize vitamin C. We exposed Hartley guinea pigs (both sexes) to occupationally relevant concentrations of Cr(VI) via oropharyngeal aspiration weekly for 90 days. We observed behavioral effects in the open field assay, elevated plus maze, Y-maze, and novel object recognition test during weeks 9–12 of exposure. After euthanasia, we assessed Cr accumulation and essential metal dyshomeostasis in the hippocampus. We observed significantly increased hippocampal Cr accumulation in females, while males exhibited essential metal dyshomeostasis. Full article

Background/Objectives: Older adults with type 2 diabetes frequently have cardiovascular or kidney disease, and current guidelines strongly recommend the use of SGLT2 inhibitors or GLP-1 receptor agonists in these high-risk populations. This study aimed to critically evaluate their real-world utilization in a tertiary care setting to identify gaps in prescribing and opportunities for improvement. Methods: A retrospective cross-sectional analysis was conducted using electronic medical records from a tertiary academic hospital in Saudi Arabia (June 2019–May 2023). Patients aged ≥65 years with type 2 diabetes and documented ASCVD, heart failure, or CKD were classified as guideline-eligible. Prescribing rates, trends, specialty variation, and associated factors were assessed. Results: Among 223 older high-risk patients with type 2 diabetes, 83.4% received an SGLT2 inhibitor or GLP-1 receptor agonist. However, only 1.6% (223 out of 14,146 older adults) were identified in the electronic medical record as having ASCVD, heart failure, or CKD, suggesting potential underdiagnosis or incomplete recognition of guideline-eligible comorbidities. Overall, just 7.4% of older adults with type 2 diabetes were prescribed either therapy. Notably, approximately one-quarter of prescriptions originated from specialties not routinely involved in cardiometabolic care, indicating variability in prescribing patterns. Multivariable analysis showed that older age, female sex, and unmarried status were associated with lower odds of receiving therapy, while patients seen in cardiology or internal medicine had higher odds than those seen in primary care. Conclusions: Prescribing of GLP-1 receptor agonists and SGLT2 inhibitors was aligned with guideline recommendations in documented high-risk patients. Nevertheless, overall utilization remained low, indicating gaps in the recognition of cardiometabolic comorbidities. Enhancing routine cardiovascular and kidney risk assessment may improve therapy optimization. Full article

Background/Objectives: Intestinal ultrasound (IUS) is increasingly used to monitor ulcerative colitis (UC), but its predictive value remains unclear. This systematic review evaluated the ability of IUS parameters and scores to predict short- and long-term treatment response, remission, and adverse outcomes in hospitalized and outpatient UC populations. Methods: A systematic review was conducted according to Cochrane and PRISMA guidelines. MEDLINE and Embase were searched for prospective studies assessing IUS as a predictor of clinical or endoscopic response, remission, relapse, or adverse outcomes in adult UC. Two reviewers independently performed screening, data extraction, and QUADAS-2 assessment. Results: Eighteen prospective studies were included: eleven outpatient studies and seven involving hospitalized patients treated with intravenous corticosteroids (IVCS). In hospitalized patients, bowel wall thickness (BWT) was the most consistent predictor of treatment failure, rescue therapy, colectomy, and clinical response. Baseline BWT showed variable performance, but once IVCS was initiated, early BWT change within 48–72 h was the strongest marker of disease trajectory. Non-responders had higher BWT and smaller reductions. A BWT ≥ 4 mm, absolute reduction ≤ 1 mm, or relative reduction ≤ 20% at 48 h reliably identified patients needing rescue therapy (area under the curve (AUC) values of 0.77 (95% confidence interval (CI) 0.71–0.74), 0.71 (95% CI 0.56–0.86), and 0.74 (95% CI 0.60–0.88)). Colectomy risk was similarly predicted: BWT < 3 mm at 48 h was associated with no colectomies, whereas BWT ≥ 4 mm or persistently elevated BWT at day 6 markedly increased risk (Odds ratio (OR) 9.5-fold (95% CI 1.4–64.0) and OR 8.3 (95% CI 1.7–40.0), respectively). Other sonographic features (loss of haustration, increased vascularity) added supplementary but less consistent value. In outpatients, BWT also demonstrated the strongest predictive accuracy. BWT ≤ 3.6 mm at 2 weeks and <3.0 mm at 6 weeks were associated with early endoscopic remission (area under the receiver operating characteristic (AUROC) of 0.87 (95% CI 0.71–1.00) and 0.82 (95% CI 0.63–1.00), respectively). Dynamic changes with ≥23–25% relative reduction predicted clinical or endoscopic response (AUROC of 0.81 (95% CI 0.61–1.00) and OR of 13.9 (95% CI 1.13–1986.85), respectively). Persistent BWT > 3.5 mm or minimal reduction (<20% or <1 mm) indicated a low likelihood of long-term remission. Composite vascularity-based indices, particularly the Milan Ultrasound Criteria (MUC), strengthened prediction: MUC ≤ 4.3 or ≥2-point reduction at 12 weeks predicted long-term remission (AUROC 0.88 (95% CI 0.750–0.952) and 0.82 (95% CI 0.68–0.91), respectively), while MUC ≥ 7.7 indicated high risk of treatment failure or colectomy (AUROC 0.77 (95% CI: 0.73–0.82)). Conclusions: Across clinical settings, BWT consistently emerged as the strongest IUS predictor of UC treatment outcomes. Early BWT change within 48–72 h in hospitalized patients and absolute BWT values at 2–6 weeks in outpatients showed high predictive accuracy for response, remission, and colectomy. Composite indices incorporating vascularity further improved prediction. These findings support the incorporation of IUS into early treatment-response algorithms and underscore the need for standardized cut-offs and multicenter validation. Full article

Dog overpopulation poses serious challenges to public health, animal welfare, and environmental sustainability. While surgical castration remains the most commonly used method for controlling reproduction in dogs, it carries risks and limitations, including surgical complications and long-term behavioral or physiological side effects. This review examines the potential of immunocastration—vaccination targeting gonadotropin-releasing hormone (GnRH)—as an alternative approach. Immunocastration has been shown to suppress reproductive hormones, reduce gonadal function, and decrease behaviors such as roaming, aggression, and sexual mounting in dogs. The review also includes evidence from other species (e.g., pigs, cattle, and horses) to contextualize effectiveness and welfare implications. While behavioral effects are more variable and less frequently studied than physiological outcomes, recent findings suggest immunocastration may have fewer negative emotional side effects (e.g., anxiety and stress-related behaviors) than surgical sterilization. The review highlights the mechanisms, applications, and behavioral outcomes of immunocastration, including its reversibility, cost-effectiveness, and suitability for mass implementation. Overall, immunocastration offers a promising addition to dog population management strategies, particularly in regions with limited surgical infrastructure. Future research should focus on standardizing vaccine protocols and assessing long-term behavioral and welfare outcomes in diverse dog populations. Full article

Background: Antipsychotic medication (APM) can cause weight gain, insulin resistance, dyslipidemias, and an increased risk of developing type-2 diabetes and cardiovascular disease among youth. The study sought to increase water consumption, reduce sugar-sweetened beverage (SSB) intake, and prevent unhealthy weight gain via a healthy lifestyle intervention among youth newly started on a second-generation APM for psychiatric treatment. Methods: This randomized controlled trial enrolled 148 Medicaid-insured youth (ages 8–17) recently starting APM. The treatment group received both a biweekly home-delivery of bottled water and parental phone support from a family navigator. In-home visits conducted at baseline, three months, and six months assessed the participants’ height/weight and dietary intake. All participants received basic healthy lifestyle education emphasizing increased water intake and decreased SSB consumption. Longitudinal linear mixed models were conducted to examine between-group and within-group changes in BMI z-scores, and water/SSB intake. Results: No significant between-group differences in BMI z-score were found at three (p = 0.908) and six months (p = 0.919). However, the within-group increase in BMI z-score in the control group was significant from baseline to three months (p = 0.029). A between-group comparison found the treatment group significantly increased their water intake at three (p = 0.006) and six months (p = 0.002). No between-group differences were identified at three and six months for the reduction in SSB, although the treatment group did demonstrate a decrease from baseline to three months (p = 0.004). Conclusions: Neither group experienced unhealthy increases (>0.5%) in BMI z-score over the six months. Providing a safe/free water supply showed a superior improvement in water consumption in the treatment group, and an initial decrease in SSB. Further studies are needed to identify feasible, effective, and sustainable lifestyle interventions tailored to this at-risk population. Full article

The impact of physical health conditions on coronavirus disease of 2019 (COVID-19) severity in World Trade Center disaster-exposed populations remains understudied. We examined the association of type, number and diagnosis time of pre-existing health conditions with COVID-19 severity, using the WTC Health Registry (WTCHR). We analyzed 3568 WTCHR enrollees with self-reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a 2021 follow-up survey. COVID-19 severity was measured by self-reported symptom duration (<2, 2–4, and >4 weeks) and hospitalization (hospitalized versus not). Pre-existing gastroesophageal reflux disease (GERD), respiratory conditions, cardiovascular conditions, and diabetes were self-reported and categorized into four groups (no diagnosis, post-9/11, pre-9/11, and undefinable). We used multinomial logistic regression and binary logistic regression to analyze the association of comorbidities with COVID-19 symptom duration and hospitalization, respectively, adjusting for post-traumatic stress disorder and demographic factors. Analysis was also conducted separately by enrollee type: rescue and recovery workers (RRW) vs. community members (non-RRW). Having all four health conditions post-9/11 was associated with longer symptom duration after SARS-CoV-2 infection (>4 weeks) among RRW (AOR: 2.66, 95% CI: 1.03–6.87). Reporting a post-9/11 respiratory condition was associated with an increased risk of being hospitalized among RRW and an increased risk of longer symptom duration (>4 weeks) among non-RRW. While post-9/11 diabetes was associated with an increased risk of longer symptom duration among RRW, post-9/11 GERD and pre-9/11 cardiovascular conditions were associated with an increased risk of longer symptom duration and being hospitalized among non-RRW, respectively. The impact of certain health conditions on COVID-19 severity varied across enrollee types and time of diagnosis. Given the lasting health impacts of 9/11-related exposures, targeted medical surveillance and proactive healthcare interventions are critical for mitigating the risk of severe COVID-19 illness in this population. Full article

The incidence of multiple myeloma is higher in males. The underlying mechanisms may be related to differences in immune system orchestration in males and females. LAG3 and CTLA4 are immune checkpoint proteins and inhibitory regulators of T cells. Here, we analyzed the prevalence of the common LAG3 gene variant rs870849 and the common CTLA4 gene variant rs231775 in myeloma patients eligible for autologous stem cell transplantation. CTLA4 rs231775 was prevalent at normal allele frequencies. In contrast, LAG3 rs870849 was prevalent at elevated allele frequencies in myeloma patients, with allele frequency 0.61 in male and 0.53 in female patients compared to 0.39 in the European population. The gene risk analysis of rs870849 indicated an odds ratio 6.8 in male and 3.6 in female patients. Moreover, treatment outcomes differed in the three genetic LAG3 subgroups with median progression-free survival of 2.6, 3.3 and 3.4 and median overall survival of 7, 15 and 18 years in the I455hom, I455Thet and T455hom subgroups, respectively. LAG3 rs870849 may affect survival and treatment outcome after autologous stem cell transplantation in myeloma patients with favorable outcomes in rs870849 carriers. Full article

Cardiovascular Disease (CVD) remains the leading cause of morbidity and mortality worldwide. Despite significant advances in diagnosis and treatment, the global burden of CVD remains high, underscoring the crucial need for more effective and comprehensive prevention strategies. This narrative overview aims to critically evaluate the current pillars of cardiovascular prevention, identify the gaps in approaches and outline promising future directions. Challenges and barriers in lifestyle adherence and pharmacological management are addressed, while the increasing role of non-traditional and emerging risk factors is discussed. Future directions include maximizing the value of digital health to improve patient engagement and adherence, adopting precision medicine to refine risk stratification and implementing public health policies for population-level interventions. The optimization of cardiovascular prevention requires a multi-level approach that integrates clinical strategies with personalized solutions and environmental policies to ultimately reduce the global impact of CVD. Full article

Understanding how urbanisation shapes species distributions and ecological interactions requires long-term, spatially structured data. Using an exceptionally rare 40-year dataset (1986–2025) from 150 habitat patches and 102 downtown grid cells in St. Petersburg, Russia, we examined patterns in birch (Betula pendula and B. pubescens) persistence, ground conditions, woody vegetation, and the occurrence of Eriocrania leaf-mining moths. Birch presence, birch abundance, and ground quality declined both toward the city centre and over time, whereas woody plant cover showed no clear spatial or temporal pattern. Eriocrania occurrence within birch-containing patches was influenced primarily by habitat type, artificial ground, and birch abundance, while distance to the city centre, year, and woody cover exerted no consistent effects. Habitat characteristics offered only moderate predictive power for local extinction risk in both birches and Eriocrania, indicating that multiple drivers interact to shape patch dynamics. Contrary to the widespread declines observed in many insect taxa, Eriocrania populations exhibited no directional density trend across four decades. This long-term stability highlights the resilience of specialised herbivores in heterogeneous urban landscapes and underscores the value of extended temporal datasets for detecting subtle or unexpected ecological responses to urbanisation. Full article

Background/Objectives: Adults with congenital heart disease (ACHD) are at increased risk for mental health problems, particularly depression and anxiety. Emerging evidence suggests that psychological rather than purely medical factors may play a decisive role in explaining individual differences in emotional adjustment. However, comprehensive models integrating multiple cognitive and emotional domains remain scarce. This study aimed to identify the psychological variables most strongly associated with depressive and anxiety symptoms in ACHD when considered simultaneously to inform priorities for psychosocial interventions. Methods: A total of 1136 ACHD (aged 18–85 years; 59.7% female) from the National Register for Congenital Heart Defects, Berlin, completed an online survey assessing depression, anxiety, emotion regulation, illness perceptions, and illness identity. Correlational and multiple regression analyses were conducted, controlling for sociodemographic characteristics, CHD severity, and secondary diseases. Significance level for regression models was set at p < 0.025 due to Bonferroni correction. Results: Rumination showed the strongest positive correlations with both depression and anxiety, whereas acceptance was most negatively correlated. In multiple regression analyses, rumination (highest unique variance explanation with semi-partial R² = 0.068 resp. 0.072) and illness engulfment emerged as the most strongly associated predictors of depressive and anxiety symptoms. Illness-related concerns were not significant predictors. Conclusions: The findings highlight the key role of repetitive negative thinking and an engulfed illness identity in the development of emotional distress among ACHD. Psychotherapeutic interventions targeting rumination, fostering psychological distance from illness identity, and promoting a multifaceted self-concept may be particularly beneficial in this population. Full article

This study assessed problematic mobile phone use in the Spanish population between 2014 and 2025 using the Mobile Phone Problematic Use Scale (MPPUS) and the Mobile Phone Addiction Craving Scale (MPACS). Two online surveys were conducted in 2018 (n = 1612) and 2024 (n = 2001) across Spain’s 17 autonomous communities, with analyses by gender, age, occupation, education level, and population size. Data were compared with a 2014 baseline study (n = 1126). The prevalence of problematic mobile phone use declined slightly from 5.1% in 2014 to 4.8% in 2018 and 3.2% in 2024. Users reporting difficulties controlling their phone use (problematic and at-risk users) also decreased from 20.5% in 2014 to 18.8% in 2024. However, the severity of problematic use increased over the decade, as reflected by rising MPACS scores among problematic users. Major factors associated with problematic use included hours of daily use, age (especially under 35 years), anxiety symptoms, and videogaming, while gender and alcohol consumption showed minor influence. Despite the slight reduction in prevalence, the growing intensity of problematic use highlights its persistence as a public health concern among young adults, underscoring the need for preventive and therapeutic interventions. Full article

The high penetration of distributed photovoltaics (PV) into distribution networks alters the system’s short-circuit current characteristics, posing risks of maloperation and failure-to-operate to conventional inverse-time overcurrent protection. Based on an equivalent model of distributed PV during faults, this paper analyzes its impact on the protection characteristics of traditional distribution networks. With protection selectivity and the physical constraints of protection devices as conditions, an optimization model for inverse-time overcurrent protection is established, aiming to minimize the total operation time. To enhance the solution capability for this complex optimization problem, the standard Osprey Optimization Algorithm (OOA) is improved through the incorporation of three strategies: arccosine chaotic mapping for population initialization, a nonlinear convergence factor to balance global and local search, and a dynamic spiral search strategy combining mechanisms from the Whale and Marine Predators algorithms. Based on this improved algorithm, an optimized protection scheme for distribution networks with distributed PV is proposed. Simulations conducted in PSCAD/EMTDC (V4.6.2) and MATLAB (R2023b) verify that the proposed method effectively prevents protection maloperation and failure-to-operate under both fault current contribution and extraction scenarios of PV, while also reducing the overall relay operation time. Full article

Background: Acute transverse myelitis (ATM) can closely mimic degenerative spinal disorders, often leading to diagnostic delay or inappropriate surgical decisions. However, its epidemiologic characteristics among patients undergoing spinal surgery remain unknown. This nationwide, population-based study investigated the incidence, perioperative diagnostic trends, and risk factors of ATM in patients treated surgically for degenerative spinal disease. Methods: Data were extracted from the Korean Health Insurance Review and Assessment Service database (2014–2018). Adults (>19 years) who underwent surgery for degenerative spinal disease were identified, and those with malignancy, infection, fracture, or prior myelitis were excluded. The two-year perioperative observation period (−360 to +360 days) was divided into 24 consecutive 30-day intervals. Patients were classified by ATM occurrence, and multivariable logistic regression with bootstrap validation was used to identify independent risk factors. Incidence rates were expressed per 100,000 person-years. Results: Among 201,769 eligible patients, 269 (0.13%) developed ATM, yielding an incidence of 67 (95% CI: 59–75) per 100,000 person-years—substantially higher than in the general population. Younger age, male sex, myocardial infarction, cerebrovascular disease, rheumatologic disease, and cervical or thoracic spinal lesions were independent predictors. Notably, 28.3% of ATM cases were diagnosed within 30 days before surgery, and 50.9% within the four-month window from three months preoperatively to one month postoperatively, indicating a marked temporal clustering around surgery. Conclusions: ATM occurred far more frequently among patients undergoing surgery for degenerative spinal disease than in the general population, with diagnoses peaking immediately before surgery. This pattern likely reflects diagnostic delay rather than true perioperative onset. Because ATM can clinically and radiologically resemble degenerative myelopathy, clinicians should maintain a high index of suspicion in patients presenting with atypical or rapidly progressive neurological deterioration. Early recognition may prevent unnecessary surgery and improve neurological outcomes. Full article

Demographic trends over the last decades and future projections clearly indicate a steady increase in the proportion of older adults (65+) relative to both the working-age (15–64) and child populations (0–15) across Europe. This demographic shift—driven by rising life expectancy and declining fertility—raises pressing challenges for intergenerational equity and questions the sustainability of the implicit formal and informal “social contract” that links generations through the distribution of rights, responsibilities, and resources. In particular, the two fundamental pillars of European post-industrial societies, namely an extensive welfare state and a liberal–democratic institutional framework, appear to be at risk. To address this issue, the notion of “intergenerational fairness”, recently adopted by social policies in both USA and Europe, appears flexible and fundamentally ambiguous. As a substantial variant of neoliberal austerity policies, it is simply used as a justification for further austerity measures, the withdrawal of entitlements to social and economic rights by citizens and the dismantling of welfare states. A second meaning of “intergenerational fairness” is possible starting from the concept of ambivalence used to describe the mix of conflict and solidarity that characterizes intergenerational relations in contemporary post-industrial societies. In this respect, the two concepts of “successful ageing” and “active ageing”, often considered as overlapping, actually involve very different perspectives: successful ageing adopts a substantially reductionist, individualistic, and static approach to the process of ageing, whereas active ageing is a more comprehensive and dynamic strategy that seeks to overcome all these limitations by a life-course perspective. This recognizes that a person’s path to old age is not predetermined but depends primarily on earlier life experiences and their influence: the ageing process affects people of all ages, not just the elderly. And since the subjectivization of ageing in contemporary societies has challenged the conventional notion of “natural life stages”, the new theoretical concept advanced in the article of “ageing styles” becomes central to understanding the ageing process today. Ageing styles are the outcome of the interplay between the objective and subjective dimensions of the life course, represented, respectively, by life chances (social structure) and life choices (agency). A theoretical framework is proposed for analyzing ageing styles that can be used from a life-course perspective to highlight their complex and dynamic nature. An evidence-based European political strategy aimed at promoting active ageing from a perspective of intergenerational fairness, based on the eight principles indicated, can be flexible enough to ensure that everyone can adopt their preferred ageing style without top-down imposition and contribute to the maintenance of the intergenerational social contract. Full article