Search Results (4,673)

The COVID-19 pandemic highlighted substantial variability in public health information environments, yet the relationship between information source, perceived credibility, and behavioral response remains incompletely understood. This study evaluated how information sources influence COVID-19-related knowledge and behaviors and whether targeted educational interventions modify these relationships. We conducted a prospective survey-based study (July–December 2021) among adults recruited from outpatient clinics in Michigan (N = 209). Participants completed pre- and post-intervention surveys assessing information sources, perceived reliability, knowledge, and behaviors, and were randomized to receive either a video or infographic. Social media was the most frequently reported source (n = 95) but had lower perceived reliability (mean 2.97/5), whereas healthcare workers (HCWs) were rated most reliable (mean 4.26/5) despite lower utilization (n = 60). Use of HCWs, print media, and websites was associated with higher baseline knowledge, while television and radio were associated with lower knowledge of vaccine side effects (p = 0.011 and p = 0.003). Educational interventions improved knowledge and attitudes, with differential effects across source groups, while infographic-based interventions were more effective among social media users (p = 0.034). Information sources and perceived credibility significantly shape health knowledge and behavior, highlighting the need for communication strategies that integrate trusted messengers, high-reach platforms, and health literacy to improve public health outcomes. Full article

Objective: To study the prevalence and associated factors of digital eye strain among university students. Methodology: A cross-sectional survey and analytical study was conducted on 387 university students, ranging from 1st to 4th year, aged 18–23 years. The participants were digital device users who had not been medically diagnosed with any eye diseases affecting their use of digital devices. Statistical analyses were performed using the Descriptive Statistics, Chi-square test, and Fisher’s exact test. Results: The prevalence of digital eye strain among university students was found to be 80.40%. The most common symptoms were headache (80.62%), burning sensation in the eyes (75.19%), and eye pain (71.06%). The study found that 30.49% were male and 69.51% were female, with an average age of 20.07 ± 0.07 years. It was found that gender (p < 0.05, Phi = 0.14), vision problems (p < 0.05, Phi = 0.20), wearing light-filtering glasses (p < 0.05, Phi = 0.12), average daily smartphone screen time (p < 0.05, Phi = 0.19), avoiding digital devices before sleep (p < 0.05, Phi = 0.22), glare (p < 0.05, Phi = 0.19), wind exposure to the eyes (p < 0.05, Phi = 0.20), and ambient air conditions (p < 0.05, Phi = 0.15) were significantly associated with digital eye strain (p < 0.05); however, the strength of these associations was small (Phi = 0.12–0.22), indicating limited practical impact. Conclusions: Digital eye strain is highly prevalent among university students. Although several factors were statistically associated with digital eye strain, the small effect sizes suggest that each factor contributes only modestly. These findings highlight the multifactorial nature of digital eye strain and the importance of considering combined behavioral, environmental, and ergonomic influences. Full article

Background: The global aging population faces an increasing prevalence of type 2 diabetes mellitus (T2DM), often complicated by frailty, cognitive decline, and impaired manual dexterity. These factors make glucose self-monitoring particularly challenging. Minimally invasive glucose monitoring methods, particularly continuous glucose monitoring (CGM) as well as emerging non-invasive glucose monitoring technologies offer potential solutions, but remain insufficiently evaluated in older adults. Objective: To systematically review and synthesize available evidence on the advantages of continuous glucose monitoring (CGM) and non-invasive glucose monitoring methods in older adults aged ≥65 years, focusing on clinical efficacy, usability, adherence, and existing knowledge gaps. Methods: A systematic literature search was conducted across PubMed, Scopus, and Web of Science, including studies from 2020 to 2025. Eligible studies included participants aged ≥65 years and evaluated the clinical performance of CGM or other minimally invasive or non-invasive glucose monitoring technologies. The PRISMA framework guided screening and selection. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Due to substantial heterogeneity among study designs and reported outcomes, a narrative synthesis approach was adopted. Results: A total of 426 records were identified, of which 13 met the predefined eligibility criteria after full-text screening. After risk of bias assessment, one study was excluded, resulting in 12 studies included in the final synthesis. No eligible studies evaluating completely non-invasive glucose monitoring technologies were identified, highlighting a significant research gap in this area specifically for older adults. CGM was associated with improved glycemic control, reduced hypoglycemia, and increased time in range among older adults. Usability was generally high, particularly with newer, user-friendly devices. Conclusions: CGM is associated with improved glycemic outcomes and favorable usability in adults aged ≥65 years. However, a significant gap exists in research on non-invasive glucose monitoring technologies in this population. Future studies should address the accuracy, feasibility, and usability of non-invasive glucose monitoring devices, while accounting for the physiological and behavioral complexities associated with aging. Full article

Background: Food bank users experience food insecurity, a social determinant of health linked to poorer physical and mental health. However, evidence on the health-related quality of life (HRQoL) of food bank users in Spain is scarce. Objectives: This study sought to assess HRQoL among users of the Navarra Food Bank and identify associated sociodemographic factors. Methods: We performed a cross-sectional study of heads of household using the Navarra Food Bank. A simple random sample of 350 participants was selected from a population of 2749 families. HRQoL was assessed by telephone using the EQ-5D-5L. We described the prevalence of problems in the five EQ-5D-5L dimensions, calculated the EQ-5D-5L utility index using the Spanish value set, and analyzed EuroQol Visual Analogue Scale (EQ-VAS) scores. Associations with sociodemographic characteristics were examined using multivariable general linear models. Results: Mean EQ-VAS was 73.56 (95% CI: 71.62–75.50), and mean EQ-5D-5L utility index was 0.815 (95% CI: 0.800–0.831). The most frequently reported problems were anxiety/depression (62.9%) and pain/discomfort (55.7%), while mobility (25.5%), usual activities (19.7%), and self-care (8.7%) were less commonly affected. Older age was significantly associated with both EQ-VAS and EQ-5D-5L utility index. Employment status and nationality were significantly associated with EQ-VAS, whereas sex was significantly associated with the EQ-5D-5L utility index. Conclusions: HRQoL was impaired among users of the Navarra Food Bank, with the greatest burden observed in the anxiety/depression and pain/discomfort dimensions. Older age and selected sociodemographic characteristics were associated with poorer HRQoL. Given the cross-sectional design, the findings should be interpreted as associative rather than causal. Full article

The realization of the value of health big data relies on the coordinated cooperation among patients, the government, and data users. Enhancing the symmetry and balance between patient participation and the compliant use of data by data users is a critical link. This paper constructs a tripartite evolutionary game model and employs MATLAB R2023a simulation to analyze the impact of factors such as initial willingness, compliance costs, and penalties for violations on the strategic choices of the game players and the evolution of the system. The findings reveal that: (1) Patient participation is a key condition for achieving an ideal equilibrium in the system. (2) The data service income from participating in data provision and the costs associated with privacy breaches are critical factors influencing patients’ strategic choices. (3) Penalties for violations are a crucial factor in ensuring that data users choose compliant utilization; however, when compliance costs are high, their constraining effect may be somewhat diminished. (4) Enhancing regulatory efficiency is the future direction for government departments. Based on these findings, countermeasures and suggestions are proposed, including trust building, technological innovation and differentiated supervision, and constructing trusted data spaces, to provide references for health big data governance. Full article

We evaluated the interplay between systemic total antioxidant capacity (TAC), oxidative stress (OS) (lipid hydroperoxides), inflammation, iron status, and oral contraception (OC) use in 182 healthy 23-year-old women (76 OC-users, and 106 non-OC-users). In all women, blood TAC (FORD units) values were significantly inversely associated with OS (FORT units), high-sensitivity C-reactive protein (hsCRP), and transferrin; and positively associated with transferrin saturation (TfS%). No significant associations were observed for hemoglobin, hematocrit, red blood cells, serum iron, soluble transferrin receptor (sTfR), sTfR/log(ferritin) ratio (sTfR-F index), ferritin, folate, uric acid, or creatinine. OS hydroperoxides were positively associated with hsCRP and transferrin, and inversely associated with TfS%. sTfR was positively correlated with hydroperoxides in non-OC-users and with folate in all women and non-OC-users, but was not associated with hsCRP in any group. The combined abnormal condition of low TAC and elevated OS (n = 71) was significantly more frequent among OC-users (OR = 39.0), women with hsCRP ≥ 3 mg L⁻¹ (OR = 10.1), transferrin ≥ 330 mg dL⁻¹ (OR = 6.58), and smokers (OR = 3.76). OC use modulated the TAC/OS balance and inflammation. Low TAC and elevated OS may impact health status. Enhanced TAC/OS knowledge may increase awareness of effects of OC use among fertile-age women. Ferritin was independent of TAC/OS status and OC use, supporting its reliability as an iron biomarker. Full article

Multi-window map interfaces are widely used in geospatial monitoring systems and map-based analytical environments, where users must rapidly locate task-relevant information across multiple spatial displays. Designing visual cues and display conditions that effectively support visual search in such environments remains an important challenge for map interface design. This study examines how luminance contrast and highlighting influence visual search performance in multi-window map interfaces. A within-subject eye-tracking experiment was conducted using five highlighting conditions (No Highlighting as the control condition, Outer Border Highlighting, Text Highlighting, Title-Bar Highlighting, and Background Highlighting) and three luminance-contrast levels (low, medium, and high). Behavioral performance (accuracy and reaction time) and eye-movement measures (total viewing duration, fixation count, saccade count, and time to first fixation) were analyzed to evaluate how perceptual visibility and visual cue structures affect spatial information search. Results show that higher luminance contrast improved accuracy and reduced reaction time, although differences between medium and high contrast were small, suggesting that performance stabilized once a sufficient visibility threshold was reached. All highlighting conditions facilitated search relative to the control condition, with background and title-bar highlighting producing the most efficient gaze behavior and earlier target acquisition. A significant interaction between luminance contrast and highlighting was also observed, indicating that structured highlighting mitigates the performance costs associated with low contrast. Eye-movement evidence further indicates that region-based cues guide attention at the level of spatial interface regions rather than simply increasing local salience. These findings provide empirical guidance for improving spatial information retrieval efficiency in multi-window geospatial interfaces. Full article

Background/Objectives: Beyond glycemic control, oral antidiabetic drugs (OADs) may exert class-specific effects on muscle mass and hematologic parameters. However, real-world evidence comparing these effects across OAD classes remains limited. This study aimed to evaluate the differential effects of commonly prescribed OADs on skeletal muscle mass (SMM) and hemoglobin (Hb) levels in adults with type 2 diabetes mellitus (T2DM). Methods: In this prospective observational cohort study, 60 adults with newly initiated OAD therapy were followed for six months at a tertiary care center in Türkiye. Patients were classified according to the OAD class newly added to their regimen (metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, pioglitazone, or sodium–glucose cotransporter-2 inhibitors [SGLT2-i]). Multi-frequency bioelectrical impedance analysis was used to evaluate body composition, and hematologic parameters including Hb were obtained at both time points. To account for potential confounders—including age, sex, BMI, baseline Hb, and eGFR—binary logistic regression analyses were performed. Results: Patients initiated on pioglitazone (n = 11) demonstrated a borderline within-group increase in SMM in unadjusted analysis (median delta +0.17 kg, IQR −0.55 to +0.50; p = 0.050); however, this association was attenuated and no longer statistically significant after multivariable adjustment (OR 2.16, 95% CI 0.60–7.83; p = 0.240). In contrast, SGLT2-i users (n = 28) showed a significant increase in Hb (median delta +0.10 g/dL, IQR −0.30 to +0.50; p = 0.022), which remained significant after adjustment (OR 4.22, 95% CI 1.32–13.44; p = 0.015). Other OAD classes were not associated with meaningful changes in SMM or Hb. Conclusions: In this real-world prospective cohort, pioglitazone showed a trend toward increased SMM in unadjusted analysis that did not reach significance after adjustment, suggesting a hypothesis-generating signal warranting further investigation. SGLT2 inhibitors were independently associated with increased Hb levels, though the observed median increment was modest in absolute terms. These findings highlight potentially clinically relevant, non-glycemic effects of OAD classes and may inform individualized treatment selection, particularly in patients at risk of sarcopenia or anemia. Adequately powered, prospective studies are needed to validate and extend these preliminary observations. Full article

Fully decoupled radio access networks (FD-RANs) achieve spectral efficiency and coverage flexibility for 6G via independent uplink (UL) and downlink (DL) base station operation, yet dynamic user mobility brings critical challenges to joint user association and resource allocation. Asymmetric interference and heterogeneous base station capacities cause persistent network unfairness, while uncoordinated mobility management triggers ping-pong handovers and heavy handover overheads. To resolve these intertwined problems, we propose a fully decoupled, mobility-resilient and fairness-guaranteed framework, which integrates short-term congestion pricing with the long-term Jain fairness index for equitable resource distribution and introduces a composite handover penalty with a strict physical hysteresis margin to block invalid handovers. We formulate the optimization problem as a novel Sliding-Window Hysteresis-Integrated Fairness Two-Layer Multi-Armed Bandit (SHIFT-MAB) model, embedding an exponentially weighted moving average (EWMA) sliding-window mechanism to track real-time channel fluctuations efficiently. Theoretical analysis confirms the model’s decoupling optimality, sublinear regret bound and fairness convergence. Extensive simulations show that SHIFT-MAB effectively suppresses invalid handovers, ensures high network fairness, optimizes system utility and achieves a superior handover–throughput trade-off. Full article

Despite extensive research on sustainable urban mobility, non-designated crossings remain underexplored, particularly in low- and middle-income countries where they are highly prevalent. This study applies agent-based simulation to analyze pedestrian crossing behavior in commercial streets. We adopted a mixed-methods approach, combining video recordings, field observations, and structured questionnaires to capture physical conditions and user perceptions in a case in Cairo. The collected data were spatially analyzed using a Geographic Information System (GIS) to identify key spatial and behavioral variables influencing crossing decisions. These variables were then incorporated into an Agent-Based Model developed using the GAMA platform to simulate pedestrian–vehicle interactions. The simulation assessed pedestrian flow, non-designated crossing rates, average vehicle speed, and traffic volume. Results indicate strong relationships between pedestrian flow and non-designated crossings, and moderate associations between increased pedestrian activity and reduced vehicle speeds, while traffic volume shows weak correlations with pedestrian-related indicators. The model reveals distinct patterns of pedestrian crossing behavior, shaped by street configuration and traffic dynamics, and highlights critical risk points in commercial streets. Based on these findings, the study proposes seven actionable strategies to enhance pedestrian safety while supporting a more sustainable urban mobility. Full article

Drawing on 964 field observations from typical community parks in Changsha, this study utilizes the System for Observing Play and Recreation in Communities (SOPARC) alongside Kernel Density Estimation (KDE) to quantitatively dissect the intrinsic associations between older adults’ outdoor activity patterns and micro-spatial characteristics. The findings reveal a pronounced demographic differentiation in spatial utilization. Specifically, female-dominated collective activities, such as square dancing, exhibit a profound reliance on central plazas with unobstructed sightlines to cultivate a sense of social security. Conversely, male users demonstrate a distinct preference for static social interactions, including playing chess or cards, within semi-enclosed and shaded spaces beneath a tree canopy. Beyond gender distinctions, age-related spatial anchoring is also evident. Intergenerational caregiving activities among the younger old cohort (aged 55 to 74) are exclusively concentrated around children’s playgrounds, whereas older old individuals and those with impaired mobility rely heavily on densely distributed micro-scale resting amenities. Driven by these empirical insights, this research contends that age-friendly park design must transcend generic accessibility standards, advocating instead for a “categorized spatial provision” strategy. By meticulously balancing open exhibition plazas, semi-private shaded units, and composite caregiving zones within a single park ecosystem, this approach can effectively accommodate the multifaceted health and social requirements of various older adult subgroups. Full article

Urban mobility is increasingly conceptualized as a multidimensional, user-centered domain of transport system evaluation with potential implications for population health. This study examined the association between user-reported urban mobility experiences and perceived stress among adults using a high-intensity corridor in Nogales, Sonora, Mexico. A quantitative cross-sectional analytical study was conducted with 423 participants using the Urban Mobility Experiences Scale (UMES) and the Perceived Stress Scale (PSS-14). Spearman’s correlation analyses showed inverse associations between perceived stress and several mobility dimensions, although only Sustainability and Urban Environment remained statistically significant after Bonferroni correction (ρ = −0.266; p < 0.001). In multivariate analysis, Sustainability and Urban Environment, Accessibility and Connectivity, and Travel Time and Efficiency were retained as significant predictors, jointly explaining 14.1% of the variance in perceived stress (R² = 0.141; f² = 0.152). These findings suggest that multidimensional urban mobility experiences, particularly environmental and accessibility conditions, are associated with perceived stress beyond traditional operational indicators in high-intensity urban corridors. Full article

Background/Objectives: Type 2 diabetes mellitus (DM) commonly coexists with heart failure (HF) and is associated with increased cardiovascular (CV) morbidity and mortality. Although dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used for glycemic control, their CV safety in patients with established HF, particularly across HF phenotypes, remains uncertain. To evaluate the association between DPP-4 inhibitor use and 6-month CV mortality in patients with DM and HF, and to assess whether this association differs across HF phenotypes: HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), HF with reduced ejection fraction (HFrEF). Methods: We conducted a retrospective cohort study at King Abdulaziz Medical City from January 2017 to December 2024 that included adults with DM and echocardiographically confirmed HF. Patients receiving DPP-4 inhibitors were compared with non-users. The primary outcome was 6-month CV mortality. Propensity score overlap weighting targeting the average treatment effect in the overlap population was applied to balance baseline characteristics. Weighted logistic regression with interaction terms was used to assess effect modification by HF phenotype. Results: Among 3435 patients (median age 69 years; 51.3% female), 1921 (55.9%) received a DPP-4 inhibitor, predominantly sitagliptin. In unadjusted analyses, CV mortality was numerically lower among DPP-4 inhibitor users across HF phenotypes. However, after overlap weighting, CV mortality was similar between users and non-users within HFpEF (7.1% vs. 8.0%; OR 0.88, 95% CI 0.51–1.52; p = 0.646), HFmrEF (2.6% vs. 5.0%; OR 0.50, 95% CI 0.09–2.86; p = 0.436), and HFrEF (6.4% vs. 6.4%; OR 1.00, 95% CI 0.48–2.07; p = 0.992). No significant interaction was observed between DPP-4 inhibitor use and HF phenotype (interaction p > 0.05). Conclusions: In this large real-world cohort of patients with DM and established HF, DPP-4 inhibitor use was not associated with increased or reduced 6-month CV mortality after robust adjustment. The neutral association was consistent across HF phenotypes, supporting the CV safety of DPP-4 inhibitors, predominantly sitagliptin, in contemporary HF management. Full article

Background/Objectives: Childhood hearing loss (HL) affects auditory, linguistic, and social development. Alongside conventional rehabilitation, music-based interventions have gained increasing attention for their potential to support both auditory and non-auditory domains. This narrative review aims to summarize current evidence on the use of music-based interventions in children with HL. Methods: A narrative review of the literature was conducted, examining studies involving pediatric cochlear implant or hearing aid users. Publications were categorized into three main areas: musical auditory perception, musical training, and music therapy. Results: Studies on musical auditory perception demonstrate persistent limitations in pitch and timbre perception in children with HL, while rhythmic abilities appear relatively preserved. Musical training interventions, particularly those targeting rhythm, have been associated with improvements in auditory perception, linguistic processing, and selected cognitive skills, although parental involvement and long-term designs remain limited. Existing literature on music therapy is scarce but suggests potential benefits extending beyond auditory skills to emotional regulation, social interaction, and quality of life. Conclusions: Music-based interventions represent a promising complementary approach in pediatric hearing rehabilitation. While musical training is more widely studied, music therapy is still underrepresented despite its holistic focus. Further structured studies are needed to define standardized protocols and outcome measures for music therapy in children with HL. Full article

Background: The elderly are vulnerable to chronic diseases and altered lipid metabolism, leading to poor outcomes, including mortality. We investigated the association between Korean Medicine (KM) utilization, blood lipid levels, and health outcomes using the National Health Insurance Service Sample Cohort (NHIS-NSC) database. Methods: This retrospective cohort study included elderly participants who underwent health examinations (2009–2010). Participants were divided into KM and non-KM groups and matched 1:1 using propensity score matching (PSM) for age, sex, income, and comorbidities. Primary outcomes were mortality and disease diagnosis; secondary outcomes included medical spending and utilization. Results: After PSM, 13,044 subjects were analyzed. KM utilization was associated with a significantly lower risk of all-cause mortality (HR 0.93; 95% CI 0.87–1.00; p = 0.048). However, the hypolipidemia subgroup showed no significant differences in all-cause mortality and medical expenses compared to other lipid status subgroups. While the KM group showed a higher incidence of disease diagnosis (HR 1.09; 95% CI 1.04–1.14; p < 0.001), this may reflect increased healthcare engagement and proactive health-seeking behavior. Subgroup analysis revealed that statin users in the KM group had a significantly reduced mortality risk (HR 0.91; 95% CI 0.84–0.99; p = 0.022). Medical expenses and utilization were higher in the KM group. Being underweight or aged over 85 was associated with higher mortality. Conclusions: KM utilization is associated with reduced all-cause mortality after propensity score matching, particularly among statin users. Although KM users had a higher cumulative incidence of disease diagnosis, this potentially reflects increased diagnostic opportunities from prolonged survival. Hypolipidemia, underweight, and late-elderly status remain significant risk factors associated with frailty. KM may support improved survival in the elderly, warranting further prospective studies. Full article