Search Results (2,380)

Background and Objectives: Recovering from COVID-19 does not always imply a full return to health and may lead to the development of post-COVID-19 syndrome. Post-COVID-19 manifestations include, among others, symptoms of depression and/or anxiety. The aim of the study was to assess the prevalence of anxiety and depressive disorders and to identify their exogenous and endogenous predictors in individuals with post-COVID-19 syndrome. Materials and Methods: The study included 200 participants (116 women and 84 men, aged 18–80) diagnosed with post-COVID-19 syndrome. Participants completed psychological assessments, including the Hospital Anxiety and Depression Scale (HADS), the Generalized Anxiety Disorder 7 (GAD-7), and the Beck Depression Inventory (BDI). Comorbidities were also evaluated. Results: Based on the HADS, anxiety was identified in 41.5% of respondents and depression in 39.5%. Generalized anxiety disorder was screened positive for 36.5% of respondents (GAD-7), while mild depression was observed in 37.0% (BDI). Among participants with post-COVID-19 syndrome and diabetes, the risk of developing depression was three times higher than in individuals without comorbidities. In smoking women with post-COVID-19 syndrome and diabetes, the risk of developing depressive disorders was estimated to exceed 90%. Conclusions: The risk of developing anxiety and depressive disorders in individuals with post-COVID-19 syndrome and multimorbidity is very high, highlighting the need for preventive psychological care, including targeted screening programs, for those at greatest risk. Full article

Background: Cardiovascular (CV) risk estimation is usually based on the assessment of classic risk factors and the extent of coronary artery stenosis. However, a substantial rate of acute coronary syndromes (ACS) and sudden cardiac deaths (SCD) is observed in patients with high-risk atherosclerotic plaques (HRP), even in the absence of significant stenosis. Therefore, this study aimed to evaluate the predictive value of traditional clinical risk factors for the presence of HRP in patients scheduled for coronary computed tomography (CCT). Methods: This single-center study included 123 patients undergoing CCT for suspected coronary artery disease (CAD). Atherosclerotic plaque morphology (HRP) and the degree of coronary artery stenosis (CAD-RADS categories) were assessed in all the patients. CV risk factors, including LDL serum levels and CT Calcium score (CS), were analyzed. Results: The study cohort was mostly males (54.5%), with an average age of 60.40 ± 12.45 years and typical risk factors: hypertension (70%), diabetes (22%), obesity (30%), and smoking (20%). Most patients (88%) were found to have coronary atherosclerosis with nonobstructive disease (CAD-RADS 1–2) in 39% of patients. HRP was confirmed in over one-fifth of the participants (22%), with half of the patients in the CAD-RADS 2 category. There were no differences in CV risk factors between patients with and without HRP in CCT. No significant clinical predictor of HRP in CCT was identified. Conclusions: CV risk factors do not predict HRP in CCT, which may underestimate the real risk of ACS and SCD. Full article

Background/Objectives: The “Land of Fires” (LF) in the Campania Region has attracted considerable attention due to massive environmental contamination deriving from decades of illegal disposal, burial, and burning of urban, industrial, and toxic waste. Cadmium (Cd) has been repeatedly proven to affect male reproductive function by a plethora of endocrine and non-endocrine mechanisms. The scientific literature is almost devoid of large studies addressing semen quality in this area, particularly by directly correlating seminal parameters to objectively measured pollutant burden in biological samples. Therefore, the aim of the current study was to comprehensively evaluate semen quality of males of reproductive age living in the LF, by correlating seminal parameters to cumulative local male reproductive tract Cd burden objectively quantified in whole semen samples. Methods: The current single-center, observational, cross-sectional study evaluated semen quality in 493 males aged 14–50 (29.07 ± 7.17) years living in three LF municipalities. Moreover, the association of semen quality with whole semen Cd (sCd) levels measured by inductively coupled plasma mass spectrometry (ICP-MS) was addressed in a subgroup of participants; semen samples suitable for semen Cd measurements were available from 383/493 (77.7%) participants of the total cohort, and all analyses involving semen Cd were performed within the measured subset. Results: In the total cohort, seminal parameters were as follows: semen pH 8.32 ± 0.3, semen volume 3.13 ± 1.67 mL, sperm concentration 37.58 ± 30.18 × 10⁶/mL, total count 111.2 ± 104 × 10⁶/ejaculate, total motility 56.83 ± 16.09%, progressive motility 50.22 ± 16.63%, in situ motility 6.72 ± 3.43%, immotile spermatozoa 43.07 ± 15.88%, normal morphology 7.97 ± 4.02%, and viability 64.75 ± 15.34%. Prevalence of normozoospermia and pathological seminal parameters was as follows: normozoospermia 66.5% (328/493), pathological seminal parameters 33.5% (165/493), specifically, oligozoospermia 14% (69/493), cryptozoospermia 0.8% (4/493), azoospermia 2.2% (11/493), asthenozoospermia 3% (15/493), teratozoospermia 0.6% (3/493), oligo-astheno-teratozoospermia 6.1% (30/493), necrozoospermia 5.7% (28/493), and different combined seminal parameters alterations 7.1% (35/493). Whole semen Cd was below (undetectable) or above (detectable) the limit of detection (LoD) (0.2 μg/L) in 66.6% (255/383) and 33.4% (128/383) whole semen samples, respectively. In samples with detectable sCd, sCd level was below or above the median value (0.76 μg/L; min–max 0.1–5.95 μg/L) in 23.4% (30/128) and 76.6% (98/128) whole semen samples, respectively. Participants with detectable sCd levels had a significantly reduced sperm total count (93.28 ± 84.88 × 10⁶/ejaculate vs. 113.2 ± 101.5 × 10⁶/ejaculate; p = 0.037), and normal morphology (7.29 ± 3.71% vs. 8.23 ± 3.91%; p = 0.034), and a significantly lower prevalence of normozoospermia (60.2% vs. 72.2%; p = 0.02) and significantly higher prevalence of pathological seminal parameters (39.8% vs. 27.8%; p = 0.02), specifically, a significantly higher prevalence of oligozoospermia (21.1% vs. 12.6%; p = 0.036) than those with undetectable sCd levels. Whole semen Cd levels were significantly higher in participants with pathological seminal parameters (1.08 ± 0.84 μg/L vs. 0.93 ± 0.74 μg/L; p = 0.037) than those with normozoospermia. Participants with sCd levels above the median value (N = 98) had a significantly reduced sperm concentration (29.12 ± 24.84 × 10⁶/mL vs. 43.62 ± 29.55 × 10⁶/mL; p = 0.015) and displayed a trend towards reduced sperm normal morphology (6.92 ± 3.38% vs. 8.55 ± 4.49%; p = 0.057) than those with sCd levels below the median value (N = 30). Moreover, participants with sCd levels above the median value (N = 98) had a significantly reduced sperm concentration (29.12 ± 24.84 × 10⁶/mL vs. 35.3 ± 26.29 × 10⁶/mL; p = 0.03), total count (85.77 ± 80.52 × 10⁶/ejaculate vs. 113.2 ± 101.5 × 10⁶/ejaculate; p = 0.008) and normal morphology (6.92 ± 3.38% vs. 8.23 ± 3.91%; p = 0.006), and a significantly lower prevalence of normozoospermia (57.1% vs. 72.2%; p = 0.008) and significantly higher prevalence of pathological seminal (42.9% vs. 27.8%; p = 0.008), specifically, a significantly higher prevalence of oligozoospermia (23.5% vs. 12.6%; p = 0.014) than those with undetectable sCd levels. Conclusions: The results of the current study demonstrate an association between the environmental Cd exposure and the impairment of seminal parameters, with a significantly poorer semen quality in participants with detectable sCd, and, more markedly, in those with sCd level above the median value, compared to participants with undetectable sCd, although subgroups comparisons highlighted a homogeneous profile in major confounders including age, BMI, and smoking habits among subgroups of participants with different sCd burden. Full article

Smoking and central obesity have both been linked to periodontitis, but their combined relationship with periodontal disease may be influenced by demographic and behavioral factors. This cross-sectional study analyzed records of 420 adult dental patients attending the College of Dentistry at the University of Baghdad. Data included demographic characteristics, smoking status, periodontal clinical findings, body mass index (BMI), and waist-to-height ratio (WHtR). Periodontitis was defined according to the 2018 classification framework, and logistic regression models were used to examine the associations of smoking and obesity-related indicators with periodontitis. The overall prevalence of periodontitis was 36.4%. Participants with periodontitis were significantly older than those without periodontitis (46.0 vs. 28.9 years; p < 0.0001). In the fully adjusted model, age remained the strongest factor associated with periodontitis (OR = 1.15 per year; 95% CI: 1.11–1.18; p < 0.001). The apparent association between smoking and periodontitis was substantially influenced by age, as current smoking was more common among younger participants in this sample. The association between smoking status and periodontitis appeared to differ according to WHtR category (interaction term p = 0.016); however, this finding should be interpreted cautiously because of the cross-sectional design and age imbalance across exposure groups. Overall, the findings suggest that age was the dominant factor associated with periodontitis in this dental patient sample, while the relationship between smoking, central obesity, and periodontitis requires further investigation in longitudinal studies with detailed smoking and metabolic data. Full article

Background/Objectives: Blood-based biomarkers may improve risk stratification of indeterminate pulmonary nodules detected on low-dose computed tomography (LDCT). We evaluated the diagnostic performance and independent predictive value of an aptamer-based blood assay, AptoDetect™-Lung, in a high-risk Korean screening population. Methods: This multicenter prospective cohort study enrolled adults with Lung Imaging Reporting and Data System (Lung-RADS) category 3 or 4 pulmonary nodules identified on LDCT across ten tertiary hospitals in South Korea between June 2023 and December 2024. Analyses focused on a predefined high-risk subgroup meeting Korean screening criteria (age 54–74 years and ≥30 pack-years of smoking). Baseline serum AptoDetect™-Lung scores were measured. Associations with lung cancer diagnosis were assessed using univariate and multivariable logistic regression, adjusting for clinical and radiologic variables. Diagnostic performance was evaluated using receiver operating characteristic analysis. Results: Among 1084 participants with histopathologic confirmation, 319 met high-risk criteria, of whom 260 (81.5%) were diagnosed with lung cancer. In this subgroup, the AptoDetect™-Lung score was independently associated with malignancy after adjustment (adjusted odds ratio of 1.14 per unit; 95% confidence interval of 1.02–1.27; p = 0.020). Discriminative performance was higher in the high-risk subgroup than in the overall cohort (area under the curve [AUC] of 0.639 vs. 0.570; p = 0.025). Performance was higher for squamous cell carcinoma and small-cell lung cancer than for adenocarcinoma. A multivariable model incorporating biomarker score, Lung-RADS category, age, and family history achieved an AUC of 0.710. Conclusions: An aptamer-based blood biomarker may provide modest adjunctive value for risk stratification in high-risk individuals. Full article

Background: Adolescent tobacco, e-cigarette, and alcohol use are important public health concerns in China. However, the associations of specific types and cumulative exposure to childhood family violence with different substance use outcomes remain insufficiently understood. This study examined these associations among Chinese adolescents. Methods: We analyzed data from a cross-sectional school-based survey of 41,146 students aged 10–19 years conducted from October 2022 to March 2023 in a mountainous city in western Guangdong Province, China. Childhood family violence was assessed using the validated Chinese Family Violence Questionnaire and a cumulative exposure index. Descriptive analyses and logistic regression models were conducted, with adjustment for demographic and environmental factors. Results: The mean age of participants was 14.8 years, and 51.7% were female. Overall, 25.1% of adolescents reported at least one type of childhood family violence. Verbal insults (18.6%) and emotional neglect (16.3%) were the most frequently reported types and were consistently associated with tobacco, e-cigarette, and alcohol use (adjusted odds ratios [ORs] = 1.4–1.5, p < 0.001). A cumulative exposure pattern was also observed. Compared with adolescents reporting no childhood family violence, those exposed to three or more types had higher odds of tobacco use (OR = 3.81; 95% CI: 3.42–4.23), e-cigarette use (OR = 3.90; 95% CI: 3.39–4.48), and alcohol use (OR = 3.95; 95% CI: 3.59–4.35). Peer smoking and access to tobacco products were also significantly associated with substance use. Conclusions: Childhood family violence, particularly verbal insults and emotional neglect, was associated with adolescent tobacco, e-cigarette, and alcohol use. The findings highlight the importance of considering emotional maltreatment, cumulative adversity, peer influences, and access to tobacco products in future prevention research and practice. Full article

Background: This study examined the associations of dietary animal (AP) and plant protein (PP) with all-cause mortality in an Italian population and assessed the potential effect modification by sex, smoking status, and overweight/obesity (defined as BMI ≥ 25 kg/m²). Methods: This longitudinal population-based study included 1350 adults (50.2% females), aged 40–74 years, recruited between 1991 and 1995, who were followed for all-cause mortality through the regional mortality registry until 2015. Dietary data were collected using a food frequency questionnaire, and protein composition was analysed within a compositional data analysis framework, modelling the balance of AP and PP within the overall macronutrient composition. The associations of protein balances with all-cause mortality were estimated using Cox proportional hazards models adjusted for potential confounders. Effect modification was evaluated through stratified analyses. Results: During follow-up, 405 deaths occurred. A greater AP relative to other macronutrients was associated with higher mortality overall (hazard ratio (HR): 1.37; 95% confidence interval (CI): 1.00–1.87) and in males (HR: 1.57; 95% CI: 1.05–2.33). In stratified analyses, these associations were restricted to ever smokers overall (HR 2.06, 95% CI 1.32–3.20), males (HR 1.90, 95% CI 1.18–3.06), females (HR 3.29, 95% CI 1.03–10.54), and to participants with normal weight (HR 1.91, 95% CI 1.07–3.41). No overall association was observed for PP. Among females, PP was associated with lower mortality in those with normal weight. Conclusions: The associations between AP and PP and mortality differed by sex, smoking status, and adiposity, supporting more tailored dietary recommendations. Full article

Background/Objectives: This prospective observational cohort study aimed to evaluate the influence of heated tobacco (HT) and electronic cigarettes (ECs) on bone remodeling markers such as receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), and periodontal status, at baseline and at 3 months after initial periodontal therapy. Methods: The sample comprised 236 participants (130 women, 106 men; mean age 38.96 ± 7.69 years), distributed across non-smokers (n = 72), heated tobacco/HT product users (n = 83), and electronic cigarette/EC users (n = 81). For each patient, the periodontal charting included periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL). Unstimulated saliva samples were analyzed for RANKL and OPG levels. All patients underwent nonsurgical periodontal therapy (scaling and root planing). Between-group comparisons were performed using the Kruskal–Wallis test followed by Bonferroni-adjusted pairwise comparisons, while within-group changes over time were assessed using the Wilcoxon signed-rank test. To complement the primary nonparametric analyses, two-way mixed-design ANOVA and ANCOVA models adjusted for baseline values and periodontitis stage were performed as sensitivity analyses. Statistical significance was set at p < 0.05. Results: At baseline, both product user groups exhibited significantly higher PPD (p = 0.005) and CAL (p = 0.001) compared with non-smokers, with no differences between HT and EC users. Salivary RANKL levels were significantly higher in HT and EC users than in non-smokers, and OPG levels did not differ significantly. Following non-surgical periodontal therapy, all parameters improved significantly across groups (p < 0.001). At the 3-month follow-up, both product user groups maintained higher PPD (p = 0.008), CAL (p = 0.001), and salivary RANKL levels, compared with non-smoking individuals (p < 0.001). The RANKL/OPG ratio remained significantly different only for EC users compared with non-smokers (p < 0.001). Conclusions: HT and EC use were associated with differences in periodontal parameters and higher RANKL levels, while differences in the RANKL/OPG ratio were observed in EC users compared with non-smokers. Non-surgical periodontal therapy improved clinical parameters and reduced the RANKL/OPG ratio, highlighting the importance of biofilm control. Full article

Objectives: To compare the adjunctive efficacy of a MicroRepair^® mouthwash containing an antibacterial complex (ABX), composed of cetylpyridinium chloride, magnolol, and honokiol, with 0.12% chlorhexidine (CHX) in the management of generalized plaque-induced gingivitis, assessing clinical periodontal parameters, salivary activated matrix metalloproteinase-8 (aMMP-8) levels, and patient-reported outcomes over 6 months. Methods: A randomized, controlled, parallel-group clinical trial included 40 systemically healthy adults with generalized gingivitis and was reported in accordance with CONSORT 2025 guidelines. Following professional oral hygiene according to the Guided Biofilm Therapy (GBT) protocol, participants were randomly allocated to ABX or 0.12% CHX, used twice daily for 14 days. Clinical parameters, including Full-Mouth Bleeding Score (FMBS, primary outcome), Full-Mouth Plaque Score (FMPS), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (REC), and Modified Lobene Stain Index (MLSI), were recorded at baseline, 2 weeks, 1, 3, and 6 months. Salivary aMMP-8 levels were assessed at baseline and 2 weeks. Heavy smokers were excluded, and smoking status was evaluated as a potential covariate. Non-parametric tests were applied (p < 0.05). Results: Both groups showed significant reductions in FMBS and FMPS over time (p < 0.05), with no intergroup differences for the primary outcome at any follow-up at the patient level. Patient-level analyses did not reveal consistent differences across secondary parameters. At the tooth level, lower FMPS values were observed in the trial group at 2 weeks and 1 month (p < 0.05), with earlier PPD reduction. CAL, and REC remained stable. Salivary aMMP-8 levels decreased significantly in both groups without intergroup differences. Patient-reported outcomes were comparable. Smoking status was balanced between groups and was not significantly associated with treatment allocation or the main clinical outcomes. Conclusions: No significant differences were observed between ABX and CHX for the main clinical and molecular outcomes, supporting its potential use as an adjunct in gingivitis management. Full article

Background: Gastric cancer is a major global health concern. Although sex- and gender-based differences have been described, they are not yet well established, and the available evidence is often inconsistent. This systematic review aims to explore these differences in the incidence, clinicopathological characteristics, risk factors, treatment, and survival of gastric cancer, thereby contributing to healthcare equity. Methods: A systematic search was conducted in the main medical bibliographic databases (PubMed, Embase and Web of Science) in February 2026 following the PRISMA 2020 guidelines. Studies on gastric cancer were selected based on predefined inclusion and exclusion criteria. The results were synthesized qualitatively according to incidence, clinicopathological characteristics, risk factors, treatment outcomes, and survival. Due to the heterogeneity and predominantly observational design of the included studies, no meta-analysis or formal risk-of-bias assessment was conducted. Results: A total of 38 studies, involving more than 500,000 participants, were included. Most reported a higher incidence of gastric cancer in men, with a predominance of intestinal and well-differentiated tumors, while diffuse and poorly differentiated tumors were more common in women. Men showed higher rates of smoking, alcohol consumption, and postoperative complications. Overall survival tended to be higher in women, especially in early stages, although some studies described worse outcomes among young women. Conclusions: This review highlights relevant sex- and gender-related differences in gastric cancer and underscores the need to systematically incorporate these variables into future research to advance towards more personalized medicine. The available evidence was limited by the predominance of retrospective observational studies and heterogeneity across study designs and reported outcomes. Full article

Background: While trefoil factor 3 (TFF3) has been linked to cardiovascular disease, its role in peripheral artery disease (PAD) remains largely unexplored. In this prospective study, we assessed three pre-selected circulating biomarkers and found that TFF3 demonstrated the strongest association with the presence of PAD. Building on this finding, we integrated plasma TFF3 concentrations with clinical characteristics to construct predictive models aimed at identifying individuals with PAD and estimating their risk of major adverse limb events (MALE) over a two-year follow-up period. Methods: A total of 476 individuals were prospectively recruited, including 312 patients with PAD and 164 controls without PAD. At study entry, circulating concentrations of TFF3, oncostatin M (OSM), and brain-derived neurotrophic factor (BDNF) were quantified, and all participants were subsequently monitored for a two-year period. The primary endpoint was the occurrence of MALE within two years, comprising acute limb ischemia, major amputation, or lower extremity revascularization by either open surgical or endovascular approaches. PAD diagnosis served as the secondary outcome and was established by an ankle–brachial index (ABI) ≤ 0.9 or toe–brachial index (TBI) ≤ 0.67 in the presence of reduced or absent pedal pulses. For predictive model development, the cohort was randomly divided into training (70%) and testing (30%) sets. A random forest algorithm incorporating clinical variables and plasma TFF3 levels was developed and optimized using 10-fold cross-validation. Model discrimination was quantified using the area under the receiver operating characteristic curve (AUROC). For prognostic evaluation, patients were classified into low- and high-risk groups based on the optimal ROC-derived probability threshold of 0.60, and MALE-free survival between groups was assessed using Cox proportional hazards regression. Results: Among the three candidate biomarkers evaluated, only TFF3 demonstrated a significant association with PAD. Patients with PAD exhibited higher circulating TFF3 concentrations than those without PAD (7.27 ± 3.36 vs. 5.89 ± 2.67 pg/mL; p < 0.001), whereas OSM and BDNF showed no significant differences between groups. Over the two-year follow-up period, MALE occurred in 28 patients (9%). Predictive models combining plasma TFF3 measurements with clinical variables achieved strong performance for both PAD detection and 2-year MALE risk estimation, yielding AUROCs of 0.79 and 0.85, respectively. Furthermore, patients classified as high risk by the model experienced a significantly increased hazard of MALE during follow-up (HR 1.12, 95% CI 1.10–1.19; p = 0.003). Variable importance analysis revealed that TFF3 was the most influential predictor of MALE, followed by age and smoking history. Conclusions: Combining plasma TFF3 levels with readily available clinical characteristics enabled the development of a predictive model with good discriminatory ability for both PAD diagnosis and estimation of 2-year MALE risk. Such an approach may enhance risk stratification by identifying patients at elevated risk earlier in their disease course, thereby informing decisions related to vascular testing, referral for specialist evaluation, and implementation of targeted treatment strategies. Full article

Background: The triglyceride–glucose (TyG) index is a simple surrogate marker of insulin resistance (IR) and has been associated with coronary artery disease (CAD). However, the association between the TyG index and coronary chronic total occlusion (CTO) remains limited. Methods: In this retrospective study, 1157 patients who underwent coronary angiography at Beijing Chaoyang Hospital from January 2024 to January 2026 were enrolled and classified into the CTO group (n = 317) and the non-CTO group (n = 840). Multivariable logistic regression analyses were performed to assess the association between the TyG index and CTO. Restricted cubic spline analysis was used to examine the linear dose–response relationship. Subgroup analyses were conducted according to age, sex, smoking status, hypertension, and diabetes mellitus. Results: Patients with CTO had a significantly higher TyG index than those without CTO (8.98 [8.46, 9.45] vs. 8.79 [8.41, 9.26], p = 0.003). In the multivariable logistic regression analysis, the TyG index was independently associated with the presence of CTO (OR = 1.377, 95% CI 1.082–1.752, p = 0.009). In a sensitivity analysis further adjusted for diabetes mellitus, the association remained significant (OR = 1.356, 95% CI 1.052–1.747, p = 0.018). Restricted cubic spline curve analysis showed a nonlinear dose–response relationship (p for nonlinear = 0.005) between the TyG index and CTO risk. In the subgroup analyses, the association was directionally consistent across subgroups. Nominally significant associations were observed in elderly participants (OR 1.68, 95% CI 1.20–2.37, p = 0.003), men (OR 1.40, 95% CI 1.06–1.86, p = 0.018), and patients with hypertension (OR 1.55, 95% CI 1.14–2.11, p = 0.005). Conclusions: An elevated TyG index was independently associated with the presence of CTO. The association was generally consistent across major clinical subgroups, with no significant interactions observed. Full article

Objective: Traumatic brain injury (TBI) is disproportionately prevalent in incarcerated populations, yet the potential impact on cognitive functioning remains underexplored. This study examined the relationship between TBI history and cognitive performance in a male prison population. Method: Sixty-three participants from Tongariro Prison completed a comprehensive neuropsychological assessment including measures of executive function, memory, processing speed, and perceptual reasoning, with embedded performance validity metrics. TBI history was assessed using the Ohio State University TBI Identification Method (OSU-TBI ID), premorbid function was assessed using the Speed and Capacity of Language Processing (SCOLP) Spot-the-Word task, mood was assessed using the Depression, Anxiety and Stress Scales (DASS-21), and alcohol and substance use were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Regression analyses explored the relationship between TBI history and cognitive functioning, controlling for premorbid function, mood, alcohol and substance use, and ethnicity. Results: Contrary to hypotheses, TBI frequency and severity were not associated with poorer cognitive performance in this population. However, a self-reported history of pervasive TBI—defined as repeated head impacts over a narrow time frame—was significantly associated with reduced performance on the Color–Word Interference Test (CWIT) inhibition task, indicating links to greater cognitive disinhibition. Conclusions: Findings suggest that experiencing at least one period of pervasive TBI may be associated with an impact on inhibition (but not other aspects of executive functioning) in men in prison. These results underscore the importance of nuanced TBI history assessment and highlight inhibition as a potential target for rehabilitation in incarcerated individuals exposed to repetitive head trauma. Full article

Population-based evidence on sleep quality in Kazakhstan remains limited. This study describes sleep quality as a multidimensional construct among adults in Kazakhstan using data collected during the first national survey wave after the adoption of a single national time zone. The survey was designed as a national post-transition baseline assessment and not as an evaluation of the causal impact of the time-zone reform. Associations with socio-demographic, behavioural, clinical, and regional factors were examined. We conducted a nationally representative cross-sectional survey of adults aged 18–69 years in Kazakhstan from May to October 2025 using a multistage stratified cluster design. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined as a global PSQI score > 5. Complete PSQI data were available for 5872 participants. Descriptive analyses examined the global PSQI score and the seven component scores. Survey-weighted multivariable logistic regression was used to identify factors independently associated with poor sleep quality. The weighted prevalence of poor sleep quality was 28.1%, and the weighted mean global PSQI score was 4.43. The greatest component burden was attributable to sleep latency (mean 0.87), subjective sleep quality (0.82), and sleep disturbances (0.80), whereas use of sleep medication contributed minimally (0.11). Poor sleep quality was more common among women, older adults, urban residents, and participants with diabetes, current smoking, heavy episodic drinking, and depressive symptoms. In the adjusted model, female sex (aOR 1.37, 95% CI 1.19–1.57), age 55 years or older versus 18–24 years (1.98, 1.53–2.55), diabetes (1.47, 1.22–1.78), current smoking (1.28, 1.10–1.50), heavy episodic drinking (1.43, 1.16–1.76), and depressive symptoms (4.26, 3.52–5.15) were independently associated with higher odds of poor sleep quality. Rural residence was inversely associated with the outcome (0.71, 0.61–0.84). Compared with the North, higher odds were observed in the Central region (2.00, 1.46–2.74), East (1.94, 1.48–2.53), West (1.48, 1.17–1.88), and Almaty city (2.18, 1.72–2.76). Poor sleep quality is common among adults in Kazakhstan and is characterized primarily by difficulties with sleep initiation, perceived sleep quality, and nocturnal disturbances. The findings provide national post-transition baseline evidence and suggest that sleep health surveillance in Kazakhstan should prioritize demographic, mental health, behavioural, and regional inequalities while avoiding causal interpretation of the time-zone reform itself. Full article

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease characterized by poor prognosis and accumulating evidence of systemic vascular involvement. Although cardiovascular comorbidities are recognized in IPF, the presence and extent of subclinical atherosclerosis are yet to be fully characterized. This study determined whether patients with IPF exhibit increased carotid intima–media thickness (CIMT) and altered atherogenic indices compared with healthy controls. Methods: This retrospective case–control study enrolled 117 patients with IPF diagnosed based on international guidelines and 104 age- and sex-matched healthy controls. All participants underwent comprehensive pulmonary function testing, the 6-min walk test (6MWT), laboratory evaluation (including lipid profiles), and bilateral carotid Doppler ultrasonography for CIMT measurement. Atherogenic indices, including the atherogenic coefficient, cholesterol ratio risk (CRR), and atherogenic index, were calculated. Dyspnea severity was evaluated using the visual analog scale (VAS). Results: Patients with IPF exhibited significantly higher CIMT (0.78 ± 0.12 mm vs. 0.68 ± 0.10 mm, p < 0.001) and CRR (4.12 ± 1.23 vs. 3.45 ± 0.98, p < 0.001) compared with controls. After adjustment for age, sex, cumulative smoking exposure expressed as pack-years, BMI, and controlled hypertension, IPF status remained independently associated with higher CIMT (adjusted β = 0.086 mm, 95% CI: 0.057–0.115; p < 0.001) and CRR (adjusted β = 0.482, 95% CI: 0.191–0.773; p = 0.001). Furthermore, patients with IPF had significantly lower HDL cholesterol levels and higher VLDL cholesterol levels. CIMT correlated negatively with 6MWT distance (r = −0.312, p = 0.001) and positively with VAS dyspnea scores (r = 0.287, p = 0.002). Conclusions: Patients with IPF showed higher CIMT and more unfavorable atherogenic profiles than healthy controls, and these associations persisted after adjustment for major vascular risk factors. The observed relationships between CIMT, functional capacity, and dyspnea severity suggest a potential association between IPF and subclinical cardiovascular involvement. Prospective studies are warranted to clarify the clinical relevance and prognostic implications of these findings. Full article