Search Results (1,743)

Background/Objectives: The objectives of this study were to compare emotional well-being, depressive symptoms, and psychiatric medication use between adults with and without diabetes in Spain and to identify sex-specific factors associated with these outcomes among individuals with diabetes. Methods: A population-based matched study was conducted using data from the 2023 Spanish National Health Survey (SNHS 2023). Adults aged ≥35 years with physician-diagnosed diabetes were individually matched (1:1) to controls without diabetes according to sex, exact age, and autonomous community of residence. Low emotional well-being (WHO-5 score < 50), clinically relevant depressive symptoms (PHQ-8 ≥ 10), and psychiatric medication use were assessed. Conditional logistic regression and sex-specific multivariable logistic regression models were fitted. Results: The study included 3710 participants (1855 with diabetes and 1855 matched controls without diabetes). The prevalence of low emotional well-being was significantly higher among participants with diabetes than among matched controls in both men (16.4% vs. 11.6%; p = 0.004) and women (28.8% vs. 21.6%; p < 0.001). Likewise, clinically relevant depressive symptoms were more frequent among individuals with diabetes (men: 32.7% vs. 24.9%, p < 0.001; women: 54.4% vs. 40.2%, p < 0.001), as was psychiatric medication use (men: 20.5% vs. 15.2%, p = 0.005; women: 39.5% vs. 30.2%, p < 0.001). After full adjustment, diabetes remained independently associated with low emotional well-being (men: aOR 1.48, 95% CI 1.03–2.13; women: aOR 1.43, 95% CI 1.14–1.78), depressive symptoms (men: aOR 1.31, 95% CI 1.02–1.69; women: aOR 1.38, 95% CI 1.08–1.77), and psychiatric medication use (men: aOR 1.34, 95% CI 1.02–1.75; women: aOR 1.35, 95% CI 1.06–1.73). Poor social support, physical inactivity, and several chronic comorbidities emerged as the factors most consistently associated with adverse mental health outcomes among individuals with diabetes. Conclusions: Adults with diabetes in Spain experience a substantially greater burden of adverse mental health than matched individuals without diabetes. Integrating routine mental health assessment and psychosocial support into diabetes care may help improve both psychological well-being and disease management. Full article

Research on intimate partner violence (IPV) has traditionally examined perpetration and victimization separately, limiting understanding of the relational processes that sustain violence. The present selective review builds on the dyadic model of partner violence by synthesizing meta-analytic evidence concerning risk markers for physical IPV. Eight peer-reviewed meta-analyses published between 2000 and 2024 formed the core synthesis. Studies were included if they reported quantitative effect sizes for variables associated with physical IPV perpetration or victimization. Extracted results were organized into three hierarchical levels: (a) background and dispositional risk markers, (b) relationship context, and (c) situational context. Across the reviewed meta-analyses, the most consistent risk markers of IPV clustered within the relationship-context level, particularly prior partner aggression, emotional abuse, and relationship dissatisfaction. Communication skills and empathy were inversely associated with IPV risk. Few studies examined same-sex couples, IPV victimization among men, or culturally diverse samples, highlighting major gaps in current evidence. This selective review provides an updated synthesis and conceptual organization of IPV risk markers and emphasizes the importance of dyadic frameworks for guiding future theory, prevention, and policy. Full article

Background: Community-dwelling individuals at high cardiovascular risk are clinically heterogeneous, but whether distinct clinical-metabolic phenotypes differ in carotid plaque burden remains unclear. Methods: From 4191 participants in a community-based screening project conducted in two communities in Guangzhou, 1015 individuals in the high-cardiovascular-risk stage with nonmissing high-plaque-burden status were included. All 1015 participants underwent exploratory clustering using 17 clinical, metabolic, lifestyle-related, and disease-history variables. High plaque burden was defined as bilateral carotid plaques, multiple plaques, or maximum plaque thickness at or above the 75th percentile among plaque-positive participants. Logistic regression examined associations between phenotypes and high plaque burden. Results: Among the 1015 participants included in the clustering analysis, 329 (32.4%) met the definition of high plaque burden. Four phenotypes were identified: relatively low metabolic burden, older age–ASCVD burden, smoking–low HDL-C, and blood pressure-loaded phenotypes. The corresponding prevalences of high plaque burden were 15.9%, 44.4%, 49.7%, and 33.2%. After adjustment for age and sex, all three non-reference phenotypes showed higher odds of high plaque burden. In sensitivity analysis excluding age and prior ASCVD from clustering, the blood pressure-loaded phenotype remained associated with high plaque burden. Conclusions: Four exploratory clinical-metabolic phenotypes showed different levels of carotid plaque burden among community-dwelling individuals at high cardiovascular risk. The blood pressure-loaded and smoking–low HDL-C phenotypes were associated with greater plaque burden and may provide an exploratory framework for describing heterogeneity within high-risk populations. Full article

HIV-related stigma constitutes a critical structural determinant that adversely affects mental health and treatment outcomes among people living with HIV (PLWH) in Tunisia. Rooted in cultural conservatism, legal criminalization, and institutional discrimination, this stigma engenders social exclusion, the systematic removal of individuals from community participation. It further fosters internalized shame, precipitating depression, anxiety, and treatment non-adherence. Evidence was synthesized from English- and French-language literature published between 2014 and 2026, identified through targeted searches of PubMed, Scopus, Web of Science, Google Scholar, and grey literature sources from UNAIDS, WHO, and Tunisian governmental authorities. This narrative review synthesizes recent epidemiological data indicating a 0.1% general population prevalence but 13% among men who have sex with men (MSM), with only 26% testing coverage. Situated within trauma-informed, social determinants of health, and public health frameworks, this analysis identifies specific vulnerabilities for women and older adults living with HIV. Integrated approaches combining healthcare-provider training, legal reform, and culturally tailored mental health services are essential to mitigate the harms of stigma and improve equitable health outcomes in Tunisia. Full article

Background: Healthy lifestyle guidance is an important component of outpatient preventive care, yet evidence is limited on whether outpatients receive satisfactory guidance across multiple lifestyle domains. This study examined receipt of satisfactory healthy lifestyle guidance and its associated factors among outpatients in China. Methods: This national multicenter cross-sectional study used data from the outpatient component of the fifth National Third-Party Evaluation of the Action Plan for Further Improving Healthcare Services. A total of 31,599 outpatients from 143 tertiary public hospitals across all 31 provincial-level administrative regions of mainland China were included. The primary outcome was receipt of satisfactory healthy lifestyle guidance, defined as receiving at least one type of guidance and reporting satisfaction or high satisfaction. Mixed-effects logistic regression models with hospital-level random intercepts were used to identify associated factors. Results: Dietary guidance was the most frequently reported domain, followed by physical activity, weight management, and smoking cessation and alcohol reduction guidance. Overall, most outpatients were classified as having received satisfactory healthy lifestyle guidance. In the fully adjusted model, male sex and hypertension were associated with higher odds of satisfactory guidance, whereas a greater number of chronic conditions and unclear physician type were associated with lower odds. Satisfaction with history taking and disease communication and perceived respect and comfort from healthcare professionals were strongly associated with satisfactory healthy lifestyle guidance. However, these contemporaneously measured patient-reported indicators may reflect overlapping dimensions of patients’ overall outpatient care experience. Sensitivity analyses yielded broadly consistent findings. Conclusions: Satisfactory healthy lifestyle guidance was common among outpatients in China’s tertiary public hospitals, but guidance was unevenly distributed across lifestyle domains. Patients’ evaluations of satisfactory healthy lifestyle guidance were closely associated with their broader communication and interpersonal care experiences. However, because these measures were self-reported and assessed contemporaneously, the observed associations should not be interpreted causally. Full article

Loneliness and social isolation are related but distinct experiences, and their relative contributions to mental health among men who have sex with men (MSM) remain insufficiently studied in Portugal. This cross-sectional online survey of 641 cisgender MSM (age 18–74 years; M = 38.51, SD = 12.83) examined associations among loneliness, objective connectivity, interpersonal belonging, LGBTQIA+ community belonging, social-network composition, negative affect, and psychological distress, using the UCLA Loneliness Scale, the Social Isolation Scale, the Depression Anxiety Stress Scales-21, and a short Portuguese Positive and Negative Affect Schedule. LGBTQIA+ community belonging and LGBTQIA+ network representation were assessed with single items. Correlations, multiple regressions, and two moderation models were estimated with heteroscedasticity-consistent standard errors and sensitivity analyses. Loneliness was the strongest independent correlate of psychological distress (β = 0.509, p < 0.001, R² = 0.353) and negative affect (β = 0.398, p < 0.001, R² = 0.193). Interpersonal belonging showed a small, borderline inverse association with distress (β = −0.10, p = 0.050) that did not survive covariate adjustment. Neither LGBTQIA+ community belonging nor LGBTQIA+ network representation moderated the loneliness–distress association. Subjective loneliness was more closely tied to distress than objective connectivity or broad community integration. These cross-sectional findings are consistent with the value of examining interventions that address the quality and reciprocity of close relationships alongside affirming community resources. Full article

Home-rearing environments are integral to early childhood development. However, it remains unclear whether their developmental significance has changed over time. This study aimed to examine the temporal changes in home-rearing environments and their longitudinal associations with child developmental atypicality in Japan, using baseline assessments from 1999 to 2023 and follow-up assessments through 2024. Data were obtained from the Japanese Childcare Cohort Study, a nationwide childcare-based developmental surveillance project. The analysis included 40,627 1-year observation pairs of 18,210 children enrolled in childcare centers. Home-rearing environments were assessed using the Index of Child Care Environment, and developmental atypicality was evaluated using the Child Development Scale across six domains. Logistic regression models were used to examine the associations between baseline home-rearing environments and developmental atypicality 1 year later, adjusting for baseline developmental status, sex, and age. Generalized additive models and rolling-window analyses were used to assess temporal trends and time-varying associations. Overall, the Index of Child Care Environment scores increased gradually throughout the study period, although social stimulation declined after the mid-2010s. Higher-quality home-rearing environments were generally associated with a lower risk of subsequent developmental atypicality. Protective associations strengthened over time, particularly in the social, communication, vocabulary, and intellectual domains. Home-rearing environments and their developmental implications changed over the 25-year observation period. These findings highlight the continued importance of promoting direct caregiver–child interactions, including shared activities and social engagement. Early childhood surveillance should be periodically re-evaluated to remain relevant to evolving caregiving practices and family contexts. Full article

Background/Objectives: Depression and anxiety disorders exhibit significant clinical heterogeneity, which complicates diagnosis and treatment. This study investigated whether tripartite interactions between biological sex, the serotonin transporter gene promoter region (5-HTTLPR), and brain-derived neurotrophic factor (BDNF) G196A polymorphisms explain specific symptom-level variations. Methods: A community sample of 271 Australian adults was genotyped for common 5-HTTLPR (short/long) and BDNF (G/A) variants. Participants completed self-reported measures of anxiety (SAS), depression subtypes (SDS; clinical content scales), and psychological resilience (CDRISC). Morning salivary cortisol, BMI, and substance use were assessed as potential confounds. Statistical analyses utilised a three-way factorial ANCOVA to test for interactions on raw scores, controlling for age. Significant omnibus interactions were decomposed via planned stratified ANCOVAs within each 5-HTTLPR stratum. Results: The BDNF GA genotype exerted opposite effects on anxiety and anhedonia depending on sex and 5-HTTLPR background. In females, GA was associated with increased symptoms on an ss background, whereas in males, GA was associated with increased symptoms on an ll background. These effects were highly specific to anxiety and anhedonic depression, while depressed mood, cognitive, and somatic subtypes remained unaffected. Findings were independent of cortisol, BMI, smoking, alcohol use, and psychological resilience. Conclusions: The findings reveal a complex, sex-dependent genetic interaction that selectively influences anhedonia and anxiety. They should be interpreted in the context of modest subgroup sizes following genotype stratification and require replication in larger independent cohorts. Nonetheless, this study highlights the value of considering sex-stratified genetic backgrounds and symptom specificity to advance personalised precision medicine in psychiatry. Full article

Bursicon, a heterodimeric neuropeptide composed of Burs-α and its binding subunit Partner of bursicon (Pburs), is primarily known to regulate insect cuticle tanning and also participates in wing expansion, reproduction and immunity. Pburs is highly expressed during pheromone gland (PG) maturation in female Helicoverpa armigera, a major agricultural pest, indicating its potential role in PG development and function. In this study, we cloned the full-length coding sequence of HaPburs and verified its high conservation across insects. qPCR revealed PG transcripts peaking at 48 h post-emergence in scotophase. RNAi-mediated knockdown reduced HaPburs transcript levels by 60.01%, resulting in abnormal PG morphology characterized by irregular melanized protrusions. Silencing HaPburs lowered the major sex pheromone component (Z)-11-hexadecenal by 42.66%, reduced male attraction and mating rates to 59.15% and 56.25% of controls, and markedly decreased cumulative fecundity. HaPburs-knockdown significantly downregulated the transcription of HaPKA and HaACC, two key genes involved in sex pheromone biosynthesis. These results suggest that HaPburs mediates PG morphogenesis and sex pheromone biosynthesis, further modulating sex pheromone-mediated reproductive communication in H. armigera. The study expands the known reproductive functions of bursicon and provides a promising molecular target for eco-friendly pest management. Full article

Background: The aim of this study was to examine the relationships between dietary intake and two key components of sarcopenia in older, sex- and age-matched men and women: muscle strength and physical performance. Methods: The study included 620 carefully selected community-dwelling adults aged 60 years and more (310 men and 310 women) matched by sex and age (±1 year; median age: 66 years). Body mass and body mass index were assessed. Dietary intake was evaluated using 24 h dietary recall questionnaire and analyzed with Dieta 5.0 software. Handgrip strength (HGS) was measured using a hydraulic hand dynamometer, while physical performance using the Timed Up and Go test (TUG). Results: In men, but not in women, higher intakes of multiple dietary components, especially proteins, were associated with greater HGS. TUG was inversely related to animal protein, some amino acids, folate and vitamin C in men, whereas in women to copper, magnesium, vitamins C and E, riboflavin, and PUFA intakes. After multivariable adjustment, no nutrient remained associated with HGS in both sexes. In women, vitamin C intake remained inversely associated with TUG. Age was the strongest predictor of HGS, while age, physical activity (PA) and chronic diseases were significant factors associated with TUG in both sexes. Conclusions: Our findings show multifactorial nature of muscle physiology, suggesting that in preventive strategies adequate dietary intake integrated with PA and effective management of chronic diseases is required, as nutrition alone appears insufficient to preserve muscle function. The sex-stratified associations suggest that personalized dietary recommendations may be beneficial. Full article

Background/Objectives: The use of weight-control medications (WCMs) has increased rapidly, yet little is known about the physical activity (PA) behaviours of users. Therefore, the present study aimed to identify factors associated with moderate-to-vigorous physical activity (MVPA) among Korean WCM users and to examine sex-specific differences. Methods: This cross-sectional study analysed data from the 2024 Korea Community Health Survey (KCHS). A total of 6604 adults (men: n = 1209; women: n = 5395) using WCMs for weight control were included. Multivariable logistic regression, accounting for complex survey design weights, was conducted separately for men and women. Results: The weighted prevalence of MVPA was higher in men (32.3%) than in women (20.9%). Among men, being unmarried/divorced/widowed (OR = 1.52, 95% CI 1.12–2.07) was positively associated with MVPA, whereas being aged ≥60 years (OR = 0.48, 95% CI 0.28–0.83) was associated with lower odds. Among women, being aged 50–59 years (OR = 1.38, 95% CI 1.07–1.78) was associated with higher MVPA participation, whereas poor self-rated health (OR = 0.60, 95% CI 0.47–0.76) was associated with lower odds. Conclusions: Factors associated with MVPA among WCM users differed between men and women, suggesting that sex-specific approaches may be beneficial when promoting PA in this population. This study is limited by its cross-sectional design and reliance on self-reported data, which preclude causal inference. Full article

Background/Objectives: Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), has been proposed as an indicator of cellular health, nutritional status, and physical function. This study aimed to investigate the association between PhA, physical function, and sarcopenia defined according to the Asian Working Group for Sarcopenia (AWGS) 2025 criteria in community-dwelling older adults. In addition, we explored a preliminary PhA cutoff for discriminating women with prevalent sarcopenia. Methods: This cross-sectional study included 317 participants (81 men, 236 women) aged ≥65 years who participated in functional assessments conducted in three locations of Fukushima Prefecture, Japan, in 2024. PhA at 50 kHz was measured using BIA. Assessments included body composition, grip strength, knee extension strength, maximum walking speed, Timed Up and Go (TUG), the Montreal Cognitive Assessment, Japanese version (MoCA-J), and the Kihon Checklist (KCL). Sarcopenia was defined according to the AWGS 2025 criteria. Group differences were examined using the Mann–Whitney U test, and associations were assessed using Spearman’s rank correlation coefficients. Age-adjusted logistic regression analysis was performed in women to examine the association between PhA and sarcopenia. Receiver operating characteristic (ROC) analysis was performed in women to explore a preliminary PhA cutoff because the limited number of men with sarcopenia precluded a stable sex-specific analysis. Results: Sex-specific Spearman’s rank correlation analyses showed that lower PhA values were associated with lower muscle strength (grip strength and knee extension strength) and poorer physical function (maximum walking speed and Timed Up and Go [TUG] performance) in both men and women. Lower PhA values were independently associated with prevalent sarcopenia in women after adjustment for age (odds ratio, 0.26; 95% CI, 0.09–0.80). ROC analysis identified an exploratory PhA cutoff of 4.48° for discriminating women with prevalent sarcopenia (AUC = 0.67; sensitivity = 0.65; specificity = 0.71), indicating modest discriminative performance. Conclusions: Lower PhA values were cross-sectionally associated with poorer physical function and prevalent sarcopenia among community-dwelling older women. An exploratory PhA cutoff of 4.48° was identified to discriminate prevalent sarcopenia in women. However, this cutoff should be considered hypothesis-generating rather than an established clinical threshold and requires validation in larger, independent cohorts and prospective longitudinal studies before clinical application. Full article

Background: Hospitalizations for heart failure are commonly considered an indirect indicator of outpatient care effectiveness and continuity between hospital and community services. In 2021, the Abruzzo Region introduced a Diagnostic-Therapeutic Care Pathway (PDTA) for chronic heart failure, aimed at improving integrated management and reducing avoidable exacerbations. This study analysed trends in heart failure hospitalizations among residents of the Abruzzo Region from 2018 to 2023. Methods: We conducted a retrospective population-based study using regional hospital discharge records. Hospitalizations were identified according to the ICD-9-CM codes. Only admissions among adults with heart failure recorded as the principal diagnosis were included. Annual crude and age- and sex-standardized hospitalization rates were calculated using the 2018 Abruzzo resident population as the standard population. Temporal trends were assessed using Joinpoint regression. Results: Overall, 27,247 hospitalizations for heart failure were included. Annual admissions decreased from 5654 in 2018 to 3791 in 2023, corresponding to an approximate 33% reduction. Standardized hospitalization rates declined from 4.38 per 1000 inhabitants in 2018 to 2.85 per 1000 in 2023. Joinpoint analysis showed a significant decreasing trend, with an average annual percentage change of −9.1% (95% CI: −15.3 to −2.5). Conclusions: Heart failure hospitalizations significantly decreased in Abruzzo between 2018 and 2023. These findings may reflect changes in hospital use, pandemic-related effects, and progressive improvements in territorial chronic care management. Full article

Background/Objectives: Posttraumatic infections are common in emergency hand surgery. Amputation is the worst outcome and can occur at admission or during the course of antibiotic treatment and iterative surgical debridement. We wondered if the prolongation of antibiotic treatment beyond the usual indication, and more surgical debridement besides its immediate benefit, could reveal additional preventive effect against amputation during or immediately after therapy. Methods: We investigate 166 risk association (variables) of community-acquired (traumatic) hand infection with overall treatment failure using a specifically designed retrospective single-center cohort between 1 November 2018 and 31 October 2020. Results: Among 600 patients (362 males; 71 (11.8%) with diabetes mellitus), 58 (9.7%) required initially unplanned amputation during the therapeutic ourse. Multivariate Cox regression analysis identified only inherent risks associated with “amputation”: male sex (hazard ratio [HR] 3.12, 95% confidence interval [CI] 1.28–7.69, p = 0.01), age (HR 1.03, 95% CI 1.01–1.04, p = 0.03), diabetes (HR 2.40, 95% CI 1.15–5.01, p = 0.02), whereas no interventional variables such as early flapping or antibiotic-related parameters (early empirical antibiotic use, total duration of antibiotics including its initial parenteral use, and choice of agent) altered outcomes. Conclusions: In severe (traumatic) hand infections among 600 patients, the outcomes were determined by the extent of trauma and underlying comorbidities. The outcomes do not seem to be effectively reduced by more surgery or initial antibiotic treatment. Full article

Environmental contamination by potentially toxic elements remains a public health concern in groundwater-dependent regions. This exploratory community-based cross-sectional study examined associations among a historical area-level arsenic screening classification, questionnaire-derived potential-exposure indicators, and self-reported symptom count in 275 adults from 37 standardized locality clusters in Satu Mare County, Romania. The arsenic Health Risk Index (HRI) screening classification was derived entirely from drinking-water measurements collected in a preceding regional study during 2022–2024; no water samples or exposure biomarkers were obtained in the present survey. The questionnaire-derived potential exposure index was calculated as the unweighted sum of seven binary indicators covering residential, drinking-water, occupational, dental, and dietary characteristics (theoretical range, 0–7; observed range, 0–6) and was analyzed continuously. Symptom count (theoretical range, 0–8) was analyzed primarily using negative binomial regression with locality-clustered standard errors and adjustment for age, sex, smoking, alcohol consumption, HRI classification, and self-reported comorbidity. Each one-point increase in the potential exposure index was associated with a modestly higher expected symptom count (adjusted incidence rate ratio = 1.106, 95% CI: 1.031–1.186; p = 0.005), whereas the area-level HRI classification was not statistically associated with symptom count (adjusted incidence rate ratio = 1.135, 95% CI: 0.829–1.554; p = 0.431). The association remained positive across alternative index specifications, although the drinking-water-focused estimate was smaller and less precise. These findings represent exploratory associations between reported potential-exposure characteristics and nonspecific self-reported symptoms; they do not establish individual arsenic exposure, contaminant-specific effects, or causality. Full article