Search Results (510)

Background and Aim: Long-term treatment with biologic therapy alongside immunomAfodulators in patients with inflammatory bowel disease (IBD) can be associated with severe side effects. The objective of this study was to determine whether discontinuing anti-TNF treatment after two years in patients who have achieved mucosal healing is associated with lower relapse rates. Materials and Methods: A total of 67 patients with IBD from a single tertiary IBD Center who had achieved mucosal healing were enrolled in this retrospective study. In this single-center retrospective study (January 2014–December 2022), we screened 67 IBD patients in deep remission (endoscopic mucosal healing after ≥2 years of anti-TNF therapy). After excluding three patients without histologic data, 64 patients (25 ulcerative colitis, 39 Crohn’s disease) were analyzed. Mayo endoscopic sub-score and SES-CD were used to evaluate endoscopic activity after two years of anti-TNF therapy. Histological activity was assessed using the GHAS (for CD) and Nancy index (for UC). Results: A total of 67 patients were screened, of whom 3 were excluded due to a lack of biopsies. Of the 64 included patients, 39.06% (25/64) had UC and 60.9% (39/64) had CD, with a mean disease duration of 11.6 ± 8.0 years. All patients were in endoscopic remission at the time of therapy de-escalation, and 60.9% (39/64) also achieved histological remission (“deep remission”). In the follow-up of 38.6 months (IQR 30–48) after biologic therapy was stopped, 57.8% (37/64) relapsed with a median time to relapse of 13.5 months (IQR 8–24) off anti-TNF—a total of 34 patients required a restarting of biologic therapy. Using Spearman’s correlation, a moderate connection was observed between histological activity at withdrawal and subsequent relapse (rho = 0.467, p < 0.001). The probability of relapsing within 4 years after anti-TNF cessation was significantly higher (OR 2.72) in patients with histologically active disease at the time of de-escalation. Conclusions: Achieving ‘deep remission’ (clinical, endoscopic, and histological healing) may be a suitable parameter for making decisions on when to de-escalate therapy; however, given that over half of patients in endoscopic remission relapse after discontinuation, any de-escalation should be approached with caution and individualized patient assessment. Full article

Background: HIV-associated neurocognitive disorders (HANDs) continue to be a significant concern, despite the advancements in prognosis achieved through Combination Antiretroviral Therapy (cART). Neuropsychological assessment, recommended by international guidelines for HANDs diagnosis, can be resource-intensive. Brief screening tools, like the International HIV Dementia Scale (IHDS) and the Montreal Cognitive Assessment (MoCA), are crucial in facilitating initial evaluations. This study aims to assess the Italian IHDS (IHDS-IT) and evaluate its sensitivity and specificity in detecting cognitive impairment in HIV patients. Methods: This cross-sectional study involved 294 patients aged ≥30 years, evaluated at the Immunology Unit of the University of Cagliari. Cognitive function was assessed using the MoCA and IHDS. Laboratory parameters, such as CD4 nadir, current CD4 count, and HIV-RNA levels, were also collected. Statistical analyses included Spearman’s correlation, Receiver Operating Characteristic analysis, and the Youden J statistic to identify the optimal IHDS-IT cut-off for cognitive impairment detection. Results: The IHDS and MoCA scores showed a moderate positive correlation (Spearman’s rho = 0.411, p < 0.0001). ROC analysis identified an IHDS-IT cut-off of ≤9, yielding an Area Under the Curve (AUC) of 0.76, sensitivity of 71.7%, and specificity of 67.2%. At this threshold, 73.1% of patients with MoCA scores below 23 also presented abnormal IHDS scores, highlighting the complementary utility of both cognitive assessment instruments. Conclusions: The IHDS-IT exhibited fair diagnostic accuracy for intercepting cognitive impairment, with a lower optimal cut-off than previously reported. The observed differences may reflect this study cohort’s demographic and clinical characteristics, including advanced age and long-lasting HIV infection. Further, longitudinal studies are necessary to validate these findings and to confirm the proposed IHDS cut-off over extended periods. Full article

Visual observation to record grass intake is time-consuming and labour-intensive. Technological methods, such as activity monitors, have been used but only record head position. This study aimed to evaluate sound recorders attached to headcollars to acoustically measure grass intake behaviour in horses as a low-cost alternative method. Pilot Study 1 assessed 6 × 11 min periods comparing bites/min and chews/min between video footage (VD) and sound recorders (SR). Grazing was identified audibly (SR_ear) and visually through soundwave pattern software (SR_wav). Chew rates (SR_ear: 47 ± 5 chews/min, VD: 43 ± 4 chews/min) were similar between methods. Pilot Study 2 compared hourly grass intake times between SR_wav and visual observation (VO) for two horses during a 3 h period. Results showed significant correlation between methods (rho = 0.99, p < 0.01, Spearman). The main study measured intake behaviour using SR_wav and VO methods for three free-ranging horses during 3 h observation periods over multiple days, adding up to 3 × 24 h in winter and in spring (n = 48). Mean differences per period between SR_wav and VO were 1.8% ± 3 s.d. Foraging duration per period measured with SR_wav closely matched VO (r² = 0.99, p < 0.001). Sound recorders accurately recorded grass intake time and chews in grazing horses during moderate weather conditions. Full article

Background/Objectives: Accurate dietary assessment is crucial for nutritional epidemiology, but tools like 24 h recalls (24HRs) face challenges with missing or implausible data. The Automated Self-Administered 24 h Dietary Assessment Tool (ASA24) facilitates large-scale data collection, but its lack of interviewer input may lead to implausible dietary recalls (IDRs), affecting data integrity. Multiple imputation (MI) is commonly used to handle missing data, but its effectiveness in high-variability dietary data is uncertain. This study aims to assess MI’s accuracy in estimating nutrient intake under varying levels of missing data. Methods: Data from 24HRs completed by 743 adolescents (ages 13–18) in Ontario, Canada, were used. Implausible recalls were excluded based on nutrient thresholds, creating a cleaned reference dataset. Missing data were simulated at 10%, 20%, and 40% deletion rates. MI via chained equations was applied, incorporating demographic and psychosocial variables as predictors. Imputed values were compared to actual values using Spearman’s correlation and accuracy within ±10% of true values. Results: Spearman’s rho values between the imputed and actual nutrient intakes were weak (mean ρ ≈ 0.24). Accuracy within ±10% was low for most nutrients (typically < 25%), with no clear trend by missingness level. Diet quality scores showed slightly higher accuracy, but values were still under 30%. Conclusions: MI performed poorly in estimating individual nutrient intake in this adolescent sample. While MI may preserve sample characteristics, it is unreliable for accurate nutrient estimates and should be used cautiously. Future studies should focus on improving data quality and exploring better imputation methods. Full article

The global rise in urban-related health issues poses significant challenges to public health, particularly in cities facing socio-economic crises. In Lebanon, 70% of the population is experiencing financial hardship, and healthcare costs have surged by 172%, exacerbating the strain on medical services. Given these conditions, improving the quality and accessibility of green spaces offers a promising avenue for alleviating mental health issues in urban areas. This study investigates the psychological impact of nine urban public spaces in Beirut through a comprehensive survey methodology, involving 297 participants (locals and tourists) who rated these spaces using Likert-scale measures. The findings reveal location-specific barriers, with Saanayeh Park rated highest in quality and Martyr’s Square rated lowest. The analysis identifies facility quality as the most significant factor influencing space quality, contributing 73.6% to the overall assessment, while activity factors have a lesser impact. The study further highlights a moderate positive association (Spearman’s rho = 0.30) between public space quality and mental well-being in Beirut. This study employs a hybrid methodology combining Research for Design (RfD) and Research Through Designing (RTD). Empirical data informed spatial strategies, while iterative design served as a tool for generating context-specific knowledge. Design enhancements—such as sensory plantings, shading systems, and social nodes—aim to improve well-being through better public space quality. The proposed interventions support mental health, life satisfaction, climate resilience, and urban inclusivity. The findings offer actionable insights for cities facing public health and spatial equity challenges in crisis contexts. Full article

Background/Objectives: Traditional dietary screeners face significant limitations: they rely on subjective self-reporting, average intake estimates, and are influenced by a participant’s awareness of being observed—each of which can distort results. These factors reduce both accuracy and reproducibility. The Guide Against Age-Related Disease (GARD) addresses these issues by applying Assembly Theory to objectively quantify food and food behavior (FFB) complexity. This study aims to validate the GARD as a structured, bias-resistant tool for dietary assessment in clinical and research settings. Methods: The GARD survey was administered in an internal medicine clinic within a suburban hospital system in the southeastern U.S. The tool assessed six daily eating windows, scoring high-complexity FFBs (e.g., fresh plants, social eating, fasting) as +1 and low-complexity FFBs (e.g., ultra-processed foods, refined ingredients, distracted eating) as –1. To minimize bias, patients were unaware of scoring criteria and reported only what they ate the previous day, avoiding broad averages. A computer algorithm then scored responses based on complexity, independent of dietary guidelines. Internal (face, convergent, and discriminant) validity was assessed using Spearman rho correlations. Results: Face validation showed high inter-rater agreement using predefined Assembly Index (A_i) and Copy Number (N_i) thresholds. Positive correlations were found between high-complexity diets and behaviors (rho = 0.533–0.565, p < 0.001), while opposing constructs showed moderate negative correlations (rho = –0.363 to −0.425, p < 0.05). GARD scores aligned with established diet patterns: Mediterranean diets averaged +22; Standard American Diet averaged −10. Full article

Background: Preparing patients for surgery considers assessing the patient’s somatic health, for example by the American Society of Anesthesiology (ASA) scale or the Revised Cardiac Risk Index (RCRI), known as the Lee index. This process usually ignores mental functioning (personality and anxiety), which is known to influence health. The purpose of this study is to analyze the existence of a relationship between personality traits (the Big Five model and trait-anxiety) and anesthesia scales (ASA scale, Lee index) used for the preoperative evaluation of patients. Methods: The study group comprised 102 patients (59 women, 43 men) scheduled for hip replacement surgery. Patients completed two psychological questionnaires: the NEO-FFI (NEO Five Factors Inventory) and the X-2 STAI (State-Trait Anxiety Inventory) sheet. Next, the presence and possible strength of the relationship between personality traits and demographic and medical variables were analyzed using Spearman’s rho rank correlation coefficient. Results: Patients with a high severity of trait anxiety are classified higher on the ASA scale (rs = 0.359; p < 0.001). Neuroticism, defined according to the Big Five model, significantly correlates with scales of preoperative patient assessment: the ASA classification (rs = 0.264; p < 0.001) and the Lee index (rs = 0.202; p = 0.044). A hierarchical regression model was created to test the possibility of predicting ASA scores based on personality. It explained more than 34% of the variance and was a good fit to the data (p < 0.05). The controlled variables of age and gender accounted for more than 23% of the variance. Personality indicators (trait anxiety, neuroticism) additionally accounted for slightly more than 11% of the variance. Trait anxiety (Beta = 0.293) proved to be a better predictor than neuroticism (Beta = 0.054). Conclusions: These results indicate that inclusion of personality screening in the preoperative patient evaluation might help to introduce a more individualized approach to patients, which could result in better surgical outcomes. Full article

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and hospital-related variables in patients with TBI across two tertiary care centers in Eastern Europe, a region that remains underrepresented in the literature. Methods: A retrospective observational study was conducted using data from 119 TBI patients admitted between March 2020 and June 2023 at Cluj County Emergency Hospital (Romania) and Saint Vincent Hospital (Poland). GCS scores were analyzed as both categorical and continuous variables. Statistical analyses included Wilcoxon and Kruskal–Wallis tests for group comparisons and Spearman correlations for continuous variables. Results: Most patients included suffered a mild TBI (GCS score between 13 and 15). There were significant associations between GCS scores and post-traumatic amnesia (p < 0.05), discharge status (p < 0.01), discharge destination (p < 0.01), and education level (p < 0.01). GCS scores at admission were linked to survival, absence of post-traumatic amnesia, higher education levels, and home discharge. No significant differences observed across sex, residence, employment status, injury type, cause, or mechanism of injury. A weak but significant negative correlation was observed between GCS and length of hospital stay (rho = −0.229, p > 0.05), while age showed a non-significant correlation. Conclusions: The GCS score at admission is significantly associated with various clinical and socio-demographic outcomes in TBI patients, supporting the utility of the GCS score as a prognostic tool. The predominance of mild cases and the absence of radiological data, such as cerebral contusions or epidural or subdural hematomas, limit the generalizability of the findings. Further studies with larger samples and comprehensive imaging data are necessary to validate these findings. Full article

CrAssphage, a bacteriophage that infects human gut-associated Bacteroides spp., has emerged as a potential anthropogenic fecal pollution indicator in environmental matrices. This study investigated the presence and concentration of crAssphages in bivalve mollusks (oysters and mussels) marketed in three cities in the state of Rio de Janeiro, Brazil, sampled from January to December 2022. CrAssphages were detected during the study period in 66.7% (48/72) of sampled oysters and 54.8% (34/62) of sampled mussels, at median concentrations of 1.9 × 10⁴ and 4.2 × 10⁴ genome copies (GC)/g, respectively. These levels were 1–2 log₁₀ higher than those observed for major human enteric viruses, including norovirus genogroups GI and GII, sapovirus, human mastadenovirus (HAdV), rotavirus A, human astrovirus (HAstV), and hepatitis A virus. CrAssphage specificity and sensitivity were calculated for all viruses. Moderate correlations between crAssphage (log₁₀ GC/g) and norovirus GI and GII, HAdV, SaV, and HAstV (Spearman’s rho = 0.581–0.464, p < 0.001) were observed in mussels. Altogether, the data support the use of crAssphage as a molecular indicator of human viral contamination in shellfish, with potential application in routine environmental and food safety monitoring in production areas. Full article

Background: Patients with chronic kidney disease (CKD) G5 treated with dialysis (G5D) often experience reduced physical activity levels and impaired health-related quality of life (HRQoL), which are associated with poor clinical outcomes. Understanding the factors that influence these outcomes is crucial for improving patient care. This study aimed to evaluate the levels of physical activity and HRQoL and investigate the influence of potential confounding factors on these outcomes in patients with CKD G5D. Methods: One hundred and twenty-five patients with CKD G5D and 129 healthy controls completed a template with their general demographic and clinical information, followed by the short version of the International Physical Activity Questionnaire (IPAQ). Moreover, for patients with CKD G5D, the kidney disease-targeted version (KDQOL-SF36) was employed, whereas the healthy controls completed the standard SF-36. Results: A total of 59.2% of patients with CKD G5D demonstrated low physical activity levels, with a mean IPAQ score of 1163.38 MET-min/week, which was significantly lower than that of healthy controls (p = 0.002). Spearman’s rho correlation analysis revealed significant associations between KDQOL subscales and variables including sex, age, Charlson Comorbidity Index (CCI), hemodialysis (HD) vintage, educational level, employment status, and IPAQ activity category (p-values < 0.05). In the regression analyses, physical component summary (PCS) scores were significantly predicted by sex (β = 0.180, p = 0.036), CCI (β = 0.239, p = 0.045), and IPAQ total score (β = 0.316, p < 0.001). IPAQ scores were predicted by age (β = –0.303, p = 0.003), HD vintage (β = 0.275, p = 0.012), and PCS (β = 0.343, p = 0.002). Conclusions: The findings demonstrated a statistically significant association between physical activity and HRQoL, underscoring the importance of promoting physical activity among patients with CKD G5D. Additionally, several underexplored sociodemographic and clinical confounders were identified as significant correlates of these outcome measures. Full article

Wild-growing edible mushrooms are known to bioaccumulate radionuclides from their environment, particularly the natural isotope potassium-40 (⁴⁰K) and anthropogenic cesium-137 (¹³⁷Cs). However, region-specific data for commercially relevant species in north-eastern Poland remain limited, despite the cultural and economic importance of mushroom foraging and export. This study aimed to assess the radiological safety of wild mushrooms intended for human consumption, with particular attention to regulatory compliance and potential exposure levels. In this study, 230 mushroom samples representing 19 wild edible species were analyzed using gamma spectrometry, alongside composite soil samples collected from corresponding foraging sites. The activity concentration of ¹³⁷Cs in mushrooms ranged from 0.94 to 159.0 Bq/kg fresh mass (f.m.), and that of ⁴⁰K from 64.4 to 150.2 Bq/kg f.m. None of the samples exceeded the regulatory limit of 1250 Bq/kg f.m. for ¹³⁷Cs. The highest estimated annual effective dose was 2.32 µSv from ¹³⁷Cs and 0.93 µSv from ⁴⁰K, with no exceedance of regulatory limits observed in any sample. A strong positive correlation was observed between ¹³⁷Cs activity in soil and mushroom dry mass (Spearman’s Rho = 0.81, p = 0.042), supporting predictable transfer patterns. Additionally, the implications of mushroom drying were assessed considering Council Regulation (Euratom) 2016/52, which mandates radionuclide levels in dried products be evaluated based on their reconstituted form. After such adjustment, even the most contaminated dried samples were found to comply with food safety limits. These findings confirm the radiological safety of wild mushrooms from north-eastern Poland and contribute novel data for a region with limited prior monitoring, in the context of current food safety regulations. Full article

Increasing drought conditions at the global level have created concerns about the decrease in water resources. This situation has made the correct planning of irrigation applications the most important situation. Irrigation management in future periods is possible with the correct determination of the reference evapotranspiration (ET₀) trend. In the current situation, the trend is usually determined using one or two methods. Failure to conduct a detailed trend analysis results in incorrect irrigation management. With the new approach presented in the research, all of the Mann–Kendall (MK), innovative trend analysis (ITA), Sen’s slope (SS) and Spearman’s rho (SR) tests were used, and the common results of the four tests, namely increase, decrease, and no trend, were taken into account. The ET₀ values calculated in different approaches were focused on temporal and spatial analysis for the future irrigation management of Türkiye with the Blaney–Criddle (BC), Turc (TR), and Coutagne (CT) methods. The future period forecast was made using four different trend analyses with geographical information system (GIS) based spatial applications using 12-month ET₀ data calculated from 59 years of data between 1965 and 2023. Statistical analysis was performed to reveal the relationship between ET₀ calculation methods. The findings showed that although there is a general increasing trend in ET₀ values in the region, this situation is more pronounced, especially in the provinces in the western and central regions. The research results improve the determination of plant water needs for future periods in terms of irrigation management. This new approach, which determines ET₀ trend analysis in the Black Sea region, can be used in regional, national, and international studies by supporting different calculations to be made in order to plan future water management correctly, to reduce the concern of decreasing water resources in drought conditions, and to obtain comprehensive data in order to provide appropriate irrigation. Full article

(1) Background: The Peruvian healthcare system is widely regarded as deficient, with ongoing improvements identified as a key area of need. This study sought to assess user satisfaction and the quality of care in two public hospitals in Trujillo. (2) Methods: A non-experimental, cross-sectional, and correlational study was carried out. A group of 384 people who used two public hospitals in the city of Trujillo was studied. The people in the study were chosen based on the researchers’ convenience sampling. Information was collected using a survey based on the SERVQUAL model. This survey was used to evaluate the quality of service. Descriptive and inferential analyses were performed, including Spearman’s correlation and multinomial logistic regression to assess associations and identify key predictors of perceived service quality. (3) Results: The results indicated that 97.66% of the users perceived a low quality of care and 100% expressed dissatisfaction with the services. The most critical dimensions were reliability and responsiveness, while tangible items obtained better results. A positive correlation (rho = 0.723) was identified between quality of care and user satisfaction, with empathy (rho = 0.559) and safety (rho = 0.543) emerging as the most influential dimensions. (4) Conclusions: Responsiveness and Security were identified as key predictors of the perceived service quality in two public hospitals in Trujillo, Peru. Despite high empathy correlations, only timely care and safety significantly influenced satisfaction. The findings align with SDG 3, calling for improved efficiency and humanized care in public health services. Full article

The absence of skin color information in skin cancer datasets poses a significant challenge for accurate diagnosis using artificial intelligence models, particularly for non-white populations. In this paper, based on the Monk Skin Tone (MST) scale, which is less biased than the Fitzpatrick scale, we propose MST-AI, a novel method for detecting skin color in images of large datasets, such as the International Skin Imaging Collaboration (ISIC) archive. The approach includes automatic frame, lesion removal, and lesion segmentation using convolutional neural networks, and modeling normal skin tones with a Variational Bayesian Gaussian Mixture Model (VB-GMM). The distribution of skin color predictions was compared with MST scale probability distribution functions (PDFs) using the Kullback-Leibler Divergence (KLD) metric. Validation against manual annotations and comparison with K-means clustering of image and skin mean RGBs demonstrated the superior performance of the MST-AI, with Kendall’s Tau, Spearman’s Rho, and Normalized Discounted Cumulative Gain (NDGC) of 0.68, 0.69, and 1.00, respectively. This research lays the groundwork for developing unbiased AI models for early skin cancer diagnosis by addressing skin color imbalances in large datasets. Full article

Background: The enzyme A Disintegrin and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS13) regulates hemostasis by cleaving von Willebrand factor (VWF) multimers. ADAMTS13–VWF axis dysregulation leads to different thrombotic conditions. This study investigated changes in ADAMTS13 activity during major cardiac procedures and their relationship to VWF changes and clinical complications. Methods: A total of 628 ADAMTS13 activity and inhibitor measurements were carried out in 168 patients who underwent cardiac surgery. ADAMTS13 activity was measured after the initiation of anesthesia and daily for up to 6 days postoperatively via Technozym chromogenic ELISA. The von Willebrand factor antigen (VWF:Ag) and collagen binding (VWF:CB) were also measured. Clinical complications and correlations with liver function biomarkers were also assessed. Results: ADAMTS13 activity significantly decreased during surgery, with mean values markedly decreasing from preoperative to postoperative measurements (p = 0.01). A clear inverse relationship between ADAMTS13 activity and the VWF:CB/VWF:AG ratio was observed, indicating that increased high-molecular-weight VWF multimers are associated with decreased ADAMTS13 activity. Correlation analyses (CHE, Spearman’s rho = 0.39) indicated that the reduction in ADAMTS13 activity was not attributable to impaired liver synthesis but likely resulted from peripheral consumption, potentially influenced by surgical stress. Conclusions: Perioperative reductions in ADAMTS13 activity are associated with an accumulation of high-molecular-weight VWF multimers and a higher incidence of postoperative complications. These results demonstrate that ADAMTS13 could be a useful perioperative risk biomarker for cardiac surgery patients. Full article