Saved Queries

by Kyle S. J. Jamar, Adam Peszek, Catherine C. Alder, Trevor J. Wait, Caleb J. Wipf, Carson L. Keeter, Stephanie W. Mayer, Charles P. Ho and James W. Genuario

J. Imaging 2025, 11(8), 261; https://doi.org/10.3390/jimaging11080261 - 5 Aug 2025

Abstract

This study evaluates the relationship between preoperative cartilage quality, measured by T2 mapping, and patient-reported outcomes following labral tear treatment. We retrospectively reviewed patients aged 14–50 who underwent primary hip arthroscopy with either labral repair or reconstruction. Preoperative T2 values of femoral, acetabular, and labral tissue were assessed from MRI by blinded reviewers. International Hip Outcome Tool (iHOT-12) scores were collected preoperatively and up to two years postoperatively. Associations between T2 values and iHOT-12 scores were analyzed using univariate mixed linear models. Twenty-nine patients were included (mean age of 32.5 years, BMI 24 kg/m², 48.3% female, and 22 repairs). Across all patients, higher T2 values were associated with higher iHOT-12 scores at baseline and early postoperative timepoints (three months for cartilage and six months for labrum; p < 0.05). Lower T2 values were associated with higher 12- and 24-month iHOT-12 scores across all structures (p < 0.001). Similar trends were observed within the repair and reconstruction subgroups, with delayed negative associations correlating with worse tissue quality. T2 mapping showed time-dependent correlations with iHOT-12 scores, indicating that worse cartilage or labral quality predicts poorer long-term outcomes. These findings support the utility of T2 mapping as a preoperative tool for prognosis in hip preservation surgery. Full article

(This article belongs to the Special Issue New Developments in Musculoskeletal Imaging)

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21 pages, 546 KiB

Open AccessReview

The Inflammatory Bridge Between Type 2 Diabetes and Neurodegeneration: A Molecular Perspective

by Housem Kacem, Michele d’Angelo, Elvira Qosja, Skender Topi, Vanessa Castelli and Annamaria Cimini

Int. J. Mol. Sci. 2025, 26(15), 7566; https://doi.org/10.3390/ijms26157566 (registering DOI) - 5 Aug 2025

Abstract

Chronic low-grade inflammation is a hallmark of both metabolic and neurodegenerative diseases. In recent years, several studies have highlighted the pivotal role of systemic metabolic dysfunction, particularly insulin resistance, in shaping neuroinflammatory processes and contributing to impaired cognitive performance. Among metabolic disorders, type 2 diabetes mellitus has emerged as a major risk factor for the development of age-related neurodegenerative conditions, suggesting a complex and bidirectional crosstalk between peripheral metabolic imbalance and central nervous system function. This review aims to explore the cellular and molecular mechanisms underlying the interaction between metabolic dysregulation and brain inflammation. By integrating current findings from endocrinology, immunology, and neuroscience, this work provides a comprehensive overview of how chronic metabolic inflammation may contribute to the onset and progression of neurodegenerative conditions. This interdisciplinary approach could offer novel insights into potential therapeutic strategies targeting both metabolic and neuroinflammatory pathways. Full article

(This article belongs to the Collection Latest Review Papers in Endocrinology and Metabolism)

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21 pages, 435 KiB

Open AccessArticle

Violence in Healthcare Workers Is Associated with Disordered Eating

by Nicola Magnavita and Lucia Isolani

Int. J. Environ. Res. Public Health 2025, 22(8), 1221; https://doi.org/10.3390/ijerph22081221 - 5 Aug 2025

Abstract

Workplace violence (WV) is a ubiquitous risk in healthcare settings where it has been associated with physical and mental health problems. We aimed to investigate the relationship between the violence experienced by healthcare workers (HCWs) and the presence of eating disorders (EDs). During routine health surveillance, 1215 HCWs were questioned about their experience of WV and the short version of the Eating Disorder Examination Questionnaire (EDE-QS) was used to assess their eating behaviors. Sleep quality, stress, and the presence of common mental illnesses and metabolic disorders were also evaluated. HCWs who had experienced one or more assaults in the previous year had a significantly higher EDE score than their colleagues. In a multivariate model, WV doubled the risk of EDs (odds ratio 2.33, confidence intervals 95% 1.30; 4.18, p < 0.01). A very significant association was observed between common mental disorders and EDs (OR 1.13, CI 95% 1.04; 1.23, p < 0.01), while low sleep quality almost reached a significant level (OR 1.09, CI 95% 0.99; 1.20). The higher frequency of EDs among workers subjected to violence may result from maladaptive coping mechanisms used when stress and mental health problems caused by WV lead to compensatory overeating. However, reverse causation, where WV is induced by stigmatization, cannot be ruled out. Because of the considerable impact EDs have on physical and mental health, productivity, and patient care, healthcare organizations should adopt programs designed to prevent these disorders in HCWs. Full article

(This article belongs to the Special Issue Bullying and Psychological Distress in Workplace)

19 pages, 618 KiB

Open AccessArticle

Effect of a Nutritional Education Intervention on Sports Nutrition Knowledge, Dietary Intake, and Body Composition in Female Athletes: A Pilot Study

by Macarena Veloso-Pulgar and Andreu Farran-Codina

Nutrients 2025, 17(15), 2560; https://doi.org/10.3390/nu17152560 - 5 Aug 2025

Abstract

Background/Objectives: Studies have reported that female athletes often exhibit low levels of nutritional knowledge and inadequate dietary intake to meet their nutritional needs. The aim of this study was to evaluate the effect of a nutritional education intervention on nutrition knowledge, dietary intake, and body composition in female handball players (n = 45; age, 17.6 ± 2.1 years). Methods: A quasi-experimental intervention design was implemented, consisting of a 3-week educational program delivered through six in-person sessions led by a registered dietitian. Nutrition knowledge, dietary intake, adherence to the Mediterranean diet, and anthropometric and body composition measurements were assessed. Results: Nutrition knowledge levels were significantly higher both immediately post-intervention and three months later compared to baseline (p < 0.05, ES > 0.8). A total of 36 participants completed a 3-day dietary record at baseline and at follow-up. Initial assessments revealed insufficient energy (31 kcal/kg/day) and carbohydrate intake (3.0 g/kg/day) and a high intake of total fats (1.4 g/kg/day). During follow-up, a significant decrease in the consumption of foods rich in sugar was observed (p = 0.0272). A total of 82.2% of the players needed to improve their adherence to the Mediterranean diet. No significant changes were found in Mediterranean diet adherence or body composition following the intervention. Conclusions: The nutritional education intervention significantly improved athletes’ nutritional knowledge and significantly decreased their consumption of sugary foods; however, further studies are needed to evaluate its impact on dietary intake and body composition, considering the study’s limitations. Full article

(This article belongs to the Special Issue Food Habits, Nutritional Knowledge, and Nutrition Education)

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22 pages, 14608 KiB

Open AccessArticle

Temporal and Spatial Evolution of Gross Primary Productivity of Vegetation and Its Driving Factors on the Qinghai-Tibet Plateau Based on Geographical Detectors

by Liang Zhang, Cunlin Xin and Meiping Sun

Atmosphere 2025, 16(8), 940; https://doi.org/10.3390/atmos16080940 (registering DOI) - 5 Aug 2025

Abstract

To investigate the spatiotemporal evolution characteristics and primary driving factors of Gross Primary Productivity (GPP) on the Qinghai-Tibet Plateau, we employed an enhanced MODIS-PSN model. Utilizing the fifth-generation global climate reanalysis dataset (ECMWF ERA5), we generated GPP remote sensing products by integrating six natural factors. Through correlation analysis and geographical detector modeling, we quantitatively analyzed the spatiotemporal dynamics and key drivers of vegetation GPP across the Qinghai-Tibet Plateau from 2001 to 2022. The results demonstrate that GPP changes across the Qinghai-Tibet Plateau display pronounced spatial heterogeneity. The humid northeastern and southeastern regions exhibit significantly positive change rates, primarily distributed across wetland and forest ecosystems, with a maximum mean annual change rate of 12.40 gC/m²/year. In contrast, the central and southern regions display a decreasing trend, with the minimum change rate reaching −1.61 gC/m²/year, predominantly concentrated in alpine grasslands and desert areas. Vegetation GPP on the Qinghai-Tibet Plateau shows significant correlations with temperature, vapor pressure deficit (VPD), evapotranspiration (ET), leaf area index (LAI), precipitation, and radiation. Among the factors analyzed, LAI demonstrates the strongest explanatory power for spatial variations in vegetation GPP across the Qinghai-Tibet Plateau. The dominant factors influencing vegetation GPP on the Qinghai-Tibet Plateau are LAI, ET, and precipitation. The pairwise interactions between these factors exhibit linear enhancement effects, demonstrating synergistic multifactor interactions. This study systematically analyzed the response mechanisms and variations of vegetation GPP to multiple driving factors across the Qinghai-Tibet Plateau from a spatial heterogeneity perspective. The findings provide both a critical theoretical framework and practical insights for better understanding ecosystem response dynamics and drought conditions on the plateau. Full article

(This article belongs to the Special Issue Climate Change Over the Tibetan Plateau and Surroundings on Decadal to Sub-Orbital Timescales and Its Driving Mechanisms)

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16 pages, 532 KiB

Open AccessArticle

A Play-Responsive Approach to Teaching Mathematics in Preschool, with a Focus on Representations

by Maria Lundvin and Hanna Palmér

Educ. Sci. 2025, 15(8), 999; https://doi.org/10.3390/educsci15080999 (registering DOI) - 5 Aug 2025

Abstract

This article reports on a Swedish study investigating how children aged 2–3 years experience mathematical concepts through representations in play-responsive teaching. Drawing on the semiotic–cultural theory of learning, this study examines how representations, such as spoken language, bodily action, and artifacts, are mediated. Video-recorded teaching sessions are analyzed to identify semiotic means of objectification and semiotic nodes at which these representations converge. The analysis distinguishes between children encountering concepts expressed by others and expressing concepts themselves. The results indicate that play-responsive teaching creates varied opportunities for experiencing mathematical concepts, with distinct modes of sensuous cognition linked to whether a concept is encountered or expressed. This study underscores the role of teachers’ choices in shaping these experiences and highlights bodily action as a significant form of representation. These findings aim to inform the use of representations in teaching mathematics to the youngest children in preschool. Full article

(This article belongs to the Special Issue Early Mathematics Education with a Focus on the Teacher and the Teaching)

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26 pages, 746 KiB

Open AccessReview

Prospects and Challenges of Lung Cancer Vaccines

by Zhen Lin, Zegang Chen, Lijiao Pei, Yueyun Chen and Zhenyu Ding

Vaccines 2025, 13(8), 836; https://doi.org/10.3390/vaccines13080836 (registering DOI) - 5 Aug 2025

Abstract

Lung cancer remains one of the most prevalent and lethal malignancies worldwide. Although conventional treatments such as surgery, chemotherapy, and radiotherapy have modestly improved patient survival, their overall efficacy remains limited, and the prognosis is generally poor. In recent years, immunotherapy, particularly immune checkpoint inhibitors, has revolutionized cancer treatment. Nevertheless, the immunosuppressive tumor microenvironment, tumor heterogeneity, and immune escape mechanisms significantly restrict the clinical benefit, which falls short of expectations. Within this context, cancer vaccines have emerged as a promising immunotherapeutic strategy. By activating the host immune system to eliminate tumor cells, cancer vaccines offer high specificity, low toxicity, and the potential to induce long-lasting immune memory. These advantages have positioned them as a focal point in cancer immunotherapy research. This paper provides a comprehensive overview of recent clinical advances in lung cancer vaccines, discusses the major challenges impeding their clinical application, and explores potential strategies to overcome these barriers. Full article

(This article belongs to the Section Vaccination Against Cancer and Chronic Diseases)

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26 pages, 10877 KiB

Open AccessArticle

Analysis of Mechanical Properties of Crumb Rubber Tires Mixed with Silty Sand of Various Sizes and Percentages

by Sindambiwe Theogene, Jianxiu Sun, Yanzi Wang, Run Xu, Jie Sun, Yuchen Tao, Changyong Zhang, Qingshuo Sun, Jiandong Wu, Hongya Yue and Hongbo Zhang

Polymers 2025, 17(15), 2144; https://doi.org/10.3390/polym17152144 - 5 Aug 2025

Abstract

Every year, a billion tires are discarded worldwide, with only a small percentage being recycled. This leads to significant environmental hazards, such as fire risks and improper disposal. Silty sand also presents technical challenges due to its poor shear strength, susceptibility to erosion, and low permeability. This study explores the incorporation of crumb rubber derived from waste tires into silty sand to enhance its mechanical properties. Crumb rubber particles of varying sizes (3–6 mm, 5–10 mm, and 10–20 mm) were mixed with silty sand at 0%, 3%, 6%, and 9% percentages, respectively. Triaxial compression tests of unconsolidated and consolidated undrained tests with cell pressures of 100, 300, and 500 kPa were conducted. The deviatoric stress, shear stress, and stiffness modulus were investigated. The results revealed that the addition of crumb rubber significantly increased the deviatoric and shear stresses, especially at particle sizes of 5–10 mm, with contents of 3%, 6%, and 9%. Additionally, the stiffness modulus was notably reduced in the mixture containing 6% crumb rubber tire. These findings suggest that incorporating crumb rubber tires into silty sand not only improves silty sand performance but also offers an environmentally sustainable approach to tire waste recycling, making it a viable strategy for silty sand stabilization in construction and geotechnical engineering performance. Full article

(This article belongs to the Section Polymer Analysis and Characterization)

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36 pages, 1840 KiB

Open AccessReview

Enabling Intelligent Industrial Automation: A Review of Machine Learning Applications with Digital Twin and Edge AI Integration

by Mohammad Abidur Rahman, Md Farhan Shahrior, Kamran Iqbal and Ali A. Abushaiba

Automation 2025, 6(3), 37; https://doi.org/10.3390/automation6030037 - 5 Aug 2025

Abstract

The integration of machine learning (ML) into industrial automation is fundamentally reshaping how manufacturing systems are monitored, inspected, and optimized. By applying machine learning to real-time sensor data and operational histories, advanced models enable proactive fault prediction, intelligent inspection, and dynamic process control—directly enhancing system reliability, product quality, and efficiency. This review explores the transformative role of ML across three key domains: Predictive Maintenance (PdM), Quality Control (QC), and Process Optimization (PO). It also analyzes how Digital Twin (DT) and Edge AI technologies are expanding the practical impact of ML in these areas. Our analysis reveals a marked rise in deep learning, especially convolutional and recurrent architectures, with a growing shift toward real-time, edge-based deployment. The paper also catalogs the datasets used, the tools and sensors employed for data collection, and the industrial software platforms supporting ML deployment in practice. This review not only maps the current research terrain but also highlights emerging opportunities in self-learning systems, federated architectures, explainable AI, and themes such as self-adaptive control, collaborative intelligence, and autonomous defect diagnosis—indicating that ML is poised to become deeply embedded across the full spectrum of industrial operations in the coming years. Full article

(This article belongs to the Section Industrial Automation and Process Control)

10 pages, 220 KiB

Open AccessPerspective

Reframing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Biological Basis of Disease and Recommendations for Supporting Patients

by Priya Agarwal and Kenneth J. Friedman

Healthcare 2025, 13(15), 1917; https://doi.org/10.3390/healthcare13151917 - 5 Aug 2025

Abstract

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a worldwide challenge. There are an estimated 17–24 million patients worldwide, with an estimated 60 percent or more who have not been diagnosed. Without a known cure, no specific curative medication, disability lasting years to being life-long, and disagreement among healthcare providers as to how to most appropriately treat these patients, ME/CFS patients are in need of assistance. Appropriate healthcare provider education would increase the percentage of patients diagnosed and treated; however, in-school healthcare provider education is limited. To address the latter issue, the New Jersey Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Association (NJME/CFSA) has developed an independent, incentive-driven, learning program for students of the health professions. NJME/CFSA offers a yearly scholarship program in which applicants write a scholarly paper on an ME/CFS-related topic. The efficacy of the program is demonstrated by the 2024–2025 first place scholarship winner’s essay, which addresses the biological basis of ME/CFS and how the healthcare provider can improve the quality of life of ME/CFS patients. For the reader, the essay provides an update on what is known regarding the biological underpinnings of ME/CFS, as well as a medical student’s perspective as to how the clinician can provide care and support for ME/CFS patients. The original essay has been slightly modified to demonstrate that ME/CFS is a worldwide problem and for publication. Full article

(This article belongs to the Collection Why Some Patients Never Fully Recover: Post Active Phase of Infection Syndromes (PAPIS))

21 pages, 4762 KiB

Open AccessArticle

Directed Energy Deposition: A Scientometric Study and Its Practical Implications

by Mehran Ghasempour-Mouziraji, Daniel Afonso, Behrouz Nemati and Ricardo Alves de Sousa

Metrics 2025, 2(3), 14; https://doi.org/10.3390/metrics2030014 - 5 Aug 2025

Abstract

Directed Energy Deposition is an additive manufacturing subgroup that uses a laser beam to melt the wire or powder to create a melt pool. In the current study, a scientometric analysis has been carried out to analyze the contribution of countries, publication type analysis, distribution of publications over the years, keywords analysis, author analysis, cited journal, categories, institutes of publication, and report the practical implications. Firstly, the database was extracted from the Web of Science and then post-processed with CiteSpace 6.2.R4 and VOSviewer 1.6.20 software. Afterward, the associated results had been extracted and reported. It was found that China is the leader according to publication, followed by the USA and Germany, which mostly published their achievements in article and proceeding paper formats, which are increasing annually. According to the keywords, additive manufacturing, Laser Metal Deposition, and fabrication are the most commonly used. Based on the CiteSapce and VOSviewer results, Lin, Xin and Huang, Weidong are the authors with the highest publication rates. In addition, Additive Manufacturing, Materials & Design, and Materials Science and Engineering: A are the most cited journals, and regarding the categories, materials science, multidisciplinary, applied physics, and manufacturing engineering are the most commonly used DED processes. Northwestern Polytechnical University, Fraunhofer Gesellschaft, and the United States Department of Energy (DOE) have performed the most research in the field of DED. Full article

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12 pages, 245 KiB

Open AccessArticle

Examining the Relationship Between Increased Vegetable Consumption and Lifestyle Characteristics Among School-Aged Children: A Descriptive Study

by Konstantinos D. Tambalis, Dimitris Tampalis, Demosthenes B. Panagiotakos and Labros S. Sidossis

Appl. Sci. 2025, 15(15), 8665; https://doi.org/10.3390/app15158665 (registering DOI) - 5 Aug 2025

Abstract

The purpose of this study was to examine vegetable consumption and its relationship with lifestyle characteristics among children and adolescents. Data from a health survey administered to a representative sample of 177,091 schoolchildren between the ages of 8 and 17 were employed in this observational, cross-sectional investigation. Physical activity level, screen time, and sleeping patterns were assessed using self-completed questionnaires. Vegetable consumption and dietary habits were analyzed using the Mediterranean Diet Quality Index for Children and Adolescents. Participants consuming vegetables more than once daily were categorized as consumers vs. non-consumers. Physical education teachers measured anthropometric and physical fitness factors. Descriptive statistics and binary logistic regression analysis were conducted, and the odds ratio with the corresponding 95% confidence interval was calculated and adjusted for confounders. Vegetables were consumed once or more times a day by more females than males (25.5% vs. 24.0%, p < 0.001). In both sexes, vegetable consumers slept more, ate healthier, spent less time on screens, and had better anthropometric and aerobic fitness measurements than non-consumers. Healthy eating practices, such as regularly consuming fruits, legumes, nuts, and dairy products, were strongly correlated with vegetable intake. For every one-year increase in age, the odds of being a vegetable consumer decreased by 8% and 10% in boys and girls, respectively. Overweight/obese participants had lower odds of being a vegetable consumer by 20%. Increased screen time, inadequate physical activity, and insufficient sleeping hours decreased the odds of being a vegetable consumer by 22%, 30%, and 25%, respectively (all p-values < 0.001). Overall, a healthier lifestyle profile was associated with higher vegetable intake for both sexes among children and adolescents. Full article

(This article belongs to the Special Issue Potential Health Benefits of Fruits and Vegetables—4th Edition)

38 pages, 3649 KiB

Open AccessArticle

Towards Smart Wildfire Prevention: Development of a LoRa-Based IoT Node for Environmental Hazard Detection

by Luis Miguel Pires, Vitor Fialho, Tiago Pécurto and André Madeira

Designs 2025, 9(4), 91; https://doi.org/10.3390/designs9040091 (registering DOI) - 5 Aug 2025

Abstract

The increase in the number of wildfires in recent years in different parts of the world has caused growing concern among the population, since the consequences of these fires go beyond the destruction of the ecosystem. With the growing relevance of the Internet of Things (IoT) industry, developing solutions for the early detection of fires is of critical importance. This paper proposes a low-cost network based on Long-Range (LoRa) technology to autonomously assess the level of fire risk and the presence of a fire in rural areas. The system consists of several LoRa nodes with sensors to measure environmental variables such as temperature, humidity, carbon monoxide, air quality, and wind speed. The data collected is sent to a central gateway, where it is stored, processed, and later sent to a website for graphical visualization of the results. In this paper, a survey of the requirements of the devices and sensors that compose the system was made. After this survey, a market study of the available sensors was carried out, ending with a comparison between the sensors to determine which ones met the objectives. Using the chosen sensors, a study was made of possible power solutions for this prototype, considering the expected conditions of use. The system was tested in a real environment, and the results demonstrate that it is possible to cover a circular area with a radius of 2 km using a single gateway. Our system is prepared to trigger fire hazard alarms when, for example, the signals for relative humidity, ambient temperature, and wind speed are below or equal to 30%, above or equal to 30 °C, and above or equal to 30 m/s, respectively (commonly known as the 30-30-30 rule). Full article

14 pages, 2709 KiB

Open AccessArticle

Metagenomic Analysis of the Skin Microbiota of Brazilian Women: How to Develop Anti-Aging Cosmetics Based on This Knowledge?

by Raquel Allen Garcia Barbeto Siqueira, Ana Luiza Viana Pequeno, Yasmin Rosa Santos, Romualdo Morandi-Filho, Alexandra Lan, Edileia Bagatin, Vânia Rodrigues Leite-Silva, Newton Andreo-Filho and Patricia Santos Lopes

Cosmetics 2025, 12(4), 165; https://doi.org/10.3390/cosmetics12040165 - 5 Aug 2025

Abstract

Metagenomic studies have provided deeper insights into the complex interactions between the skin and its microbiota. However, limited research has been conducted on the skin microbiota of Brazilian women. Given that Brazil ranks as the fourth-largest consumer of cosmetics worldwide, the development of new tools to analyze skin microbiota is crucial for formulating cosmetic products that promote a healthy microbiome. Skin samples were analyzed using the Illumina platform. Biometrology assessments were applied. The results showed pH variations were more pronounced in the older age group, along with higher transepidermal water loss values. Metagenomic analysis showed a predominance of Actinobacteria (83%), followed by Proteobacteria (7%), Firmicutes (9%) and Bacteroidetes (1%). In the older group (36–45 years old), an increase in Actinobacteria (87%) was observed and a decrease in Proteobacteria (6%). Moreover, the results differ from the international literature, since an increase in proteobacteria (13.9%) and a decrease in actinobacteria (46.7%) were observe in aged skin. The most abundant genus identified was Propionibacterium (84%), being the dominant species. Interestingly, previous studies have suggested a decline in Cutibacterium abundance with aging; although there is no significant difference, it is possible to observe an increasing trend in this genus in older skin. These studies can clarify many points about the skin microbiota of Brazilian women, and these findings could lead to the development of new cosmetics based on knowledge of the skin microbiome. Full article

(This article belongs to the Special Issue Feature Papers in Cosmetics in 2025)

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Graphical abstract

17 pages, 590 KiB

Open AccessArticle

Regional Differences in Awareness of Oral Frailty and Associated Individual and Municipal Factors: A Cross-Sectional Study

by Nandin Uchral Altanbagana, Koichiro Irie, Wenqun Song, Shinya Fuchida, Jun Aida and Tatsuo Yamamoto

Healthcare 2025, 13(15), 1916; https://doi.org/10.3390/healthcare13151916 - 5 Aug 2025

Abstract

Background/Objectives: Despite growing interest in oral frailty as a public health issue, no nationwide study has assessed regional differences in oral frailty awareness, and the factors associated with such differences remain unclear. This study investigated regional differences in oral frailty awareness among older adults in Japan and identified the associated individual- and municipal-level factors, focusing on local policy measures and community-based oral health programs. Methods: A cross-sectional analysis was conducted using data from the 2022 wave of the Japan Gerontological Evaluation Study. The analytical sample comprised 20,330 community-dwelling adults aged ≥65 years from 66 municipalities. Awareness of oral frailty was assessed via self-administered questionnaires. Individual- and municipal-level variables were analyzed using multilevel Poisson regression models to calculate prevalence ratios (PRs). Results: Awareness of oral frailty varied widely across municipalities, ranging from 15.3% to 47.1%. Multilevel analysis showed that being male (PR: 1.10), having ≤9 years (PR: 1.10) or 10 to 12 years of education (PR: 1.04), having oral frailty (PR: 1.04), and lacking civic participation (PR: 1.06) were significantly associated with lack of awareness. No significant associations were found with municipal-level variables such as dental health ordinances, volunteer training programs, or population density. Conclusions: The study found substantial regional variation in oral frailty awareness. However, this variation was explained primarily by individual-level characteristics. Public health strategies should focus on enhancing awareness among socially vulnerable groups—especially men, individuals with low educational attainment, and those not engaged in civic activities—through targeted interventions and community-based initiatives. Full article

(This article belongs to the Special Issue Oral Health and Rehabilitation in the Elderly Population)

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