Cardiovascular diseases (CVD) are rising rapidly among the postmenopausal woman but they are less likely to identify their risk by an appropriate risk assessment tool. This review evaluates available literature on cardiovascular risk assessment among postmenopausal women to provide a concise view of risk factors and disease burden among them, present risk assessment systems including their drawbacks, emergence of new risk factors and their role in risk prediction, and finally use of hormone replacement therapy during menopause. Results demonstrate that menopause is a transition point for developing CVD not due to physiological changes only but psychosocial factors like depression and marital stress are also responsible. Both conventional and emerging risk factors burden are high among postmenopausal women. Though data regarding CVD risk assessment among postmenopausal population is lacking but existing evidences claimed underestimation or overestimation of risk among women. Moreover application of different tools on same population has revealed significant variation in result. In this regard, recalibration of conventional tools with local data and new risk factors has showed improvement of risk prediction. Hormone replacement therapy during early menopause has reported beneficial to prevent CVD but in secondary prevention it has no role. All of these findings demand further studies on cardiovascular risk assessment, especially in developing countries where women after menopause are not in consideration of health strategy makers.

The number of green buildings has increased to address the global environmental crisis. However, green buildings face risks resulting from new materials and methods. In addition, these buildings are expected to perform at higher levels than traditional ones. The objectives of this study are to identify the possible risk factors for architects developing green building projects in South Korea and to assess risk mitigation measures. To attain this goal, fourteen risk factors and twelve mitigation measures were identified from a comprehensive literature review. A questionnaire survey was administered to architects practicing green building design. Findings revealed the ‘adoption of new technology and processes’ was the largest difference between green and traditional building projects. This study identified ‘financial risk,’ ‘design changes,’ and ‘client’s goal uncertainty’ as the top three risk factors in green building design. Additionally, the survey proposed the four most effective risk mitigation measures for green building projects: (1) ‘contract indicating each party’s roles, liabilities and limitations clearly’; (2) ‘utilizing integrated design process’; (3) ‘understanding client’s goal in green building projects’; and (4) ‘improving communication and coordination among stakeholders.’ There are a few studies focusing on the architects’ perceived risk concerning green building projects; however, this study expands the knowledge and fills the literature gap. Additionally, this study provides a comprehensive understanding of critical risks and mitigation measures that can benefit South Korea’s green building design practice through better risk management.

BACKGROUND AND AIMS: Cardiovascular disease and colorectal cancer (CRC) are significant health problems and share some risk factors. The aim of our study was to develop and validate a predictive score for advanced colorectal neoplasia (CRN) based on risk factors for cardiovascular disease and CRC. MATERIALS AND METHODS: A cross-sectional study comprising a derivation cohort and an external validation cohort of 1049 and 308 patients respectively. A prediction score for advanced CRN (CRNAS: Colorectal Neoplasia Advanced Score) was developed from a logistic regression model, comprising sex, age, first-degree family history for CRC, systolic and diastolic blood pressure, total cholesterol, HDL-cholesterol, body mass index, diabetes, smoking, and antihypertensive treatment. Other cardiovascular risk scores (Framingham-Wilson, REGICOR, SCORE and FRESCO) were also used to predict the risk of advanced CRN. The discriminatory capacity of each score was evaluated using the area under the curve (AUC). RESULTS: CRN were found in 379 subjects from the derivation cohort (36%) including 228 patients (22%) with an advanced CRN. Male sex, age, diabetes, and smoking were identified as independent risk factors for advanced CRN. The newly created score (CRNAS), showed an AUC of 0.68 (95% CI: 0.64-0.73) for advanced CRN, which was better than cardiovascular risk scores (p

We assessed the association between cirrhosis and severe COVID-19-related outcomes among people with laboratory-diagnosed COVID-19 infection in British Columbia, Canada. We used data from the British Columbia (BC) COVID-19 Cohort, a population-based cohort that integrates data on all individuals tested for COVID-19 with data on hospitalizations, medical visits, emergency room visits, prescription drugs, chronic conditions, and deaths in the Canadian province of BC. We included all individuals, aged ≥ 18 who tested positive for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction, from January 01, 2021, to December 31, 2021. Multivariable logistic regression models were used to assess the associations between cirrhosis status and COVID-19-related hospitalization and ICU admission. Of the 162,509 individuals who tested positive for SARS-CoV-2 and were included in the analysis, 768 (0.5%) had cirrhosis. In the multivariable models, cirrhosis was associated with increased odds of hospitalization (aOR=1.97, 95% CI: 1.58 – 2.47) and ICU admission (aOR=3.33, 95% CI: 2.56 – 4.35). In the analyses stratified by age, we found that the increased odds of ICU admission among people with cirrhosis were present in all the assessed age-groups. Cirrhosis is associated with increased odds of hospitalization and ICU admission among COVID-19 patients.

Neonatal mortality remains a public health concern and timely identification and prompt intervention in the delivery room could improve the outcome in neonatal morbidity and mortality. We performed a retrospective study to help us finding the profile of the high-risk newborn regarding the need for NICU admission, necessary to establish a protocol regarding the mobilization of human and material resources for the urgent management of these situations. All deliveries and neonates born in Maternity of Bihor County Emergency Clinical Hospital from Romania were reviewed, including relevant maternal, foetal and perinatal data to identify risk factors that result in birth of newborns needing resuscitation at birth between 2012-2019. The number of births showed a downward trend but around 90% of the births were on term. The incidence of neonatal emergencies is increasing, the most frequently were respiratory, sepsis and other infections, cardiovascular emergencies, and extreme prematurity. It is noted that in 2021 the incidence of these neurological emergencies increased by three times compared to previous years. The neonatal and maternal risk factors associated with admission to the NICU were mother's age over 35 years, low level of education, second/more gestation, weight under 2500 g, Apgar score under 7, premature rupture of membranes, macrosomia and mother's infectious pathology. Accurate identification of risk factors and anticipation at the birth of a high-risk neonate would result in adequate preparation and prompt resuscitation of neonates who need some level of intervention and thus, reducing neonatal morbidity and mortality.

Cerebrovascular diseases represent a significant mortality rate worldwide and constitute a major public health and economic challenge. Many African countries such as Cape Verde are going through an epidemiological transition from communicable to non-communicable diseases, demographic and socioeconomic changes and facing an increase in cerebrocardiovascular diseases associated with increased cardiovascular risk. The present study aimed to identify the prevalence of risk factors that predispose to cardiovascular diseases in adult individuals residing on the island of Santiago. Cross-sectional population-based study with individuals over 18 years of age, of both sexes. Data collection took place in October and November 2021, in all municipalities on the island of Santiago. Individuals with Cape Verdean nationality who stayed abroad for more than one year and who arrived on the island of Santiago less than 30 days ago and individuals with any type of disability that could prevent them from participating in the study were excluded from the study. The sample size was calculated based on the projection of the population of the island of Santiago for the year 2021, according to the appropriate epidemiological model. Sociodemographic data were obtained through the application of a questionnaire containing age, sex, race, weight, height, risk factors (presence of diabetes, dyslipidemia, heredity, physical activity, smoking habits, history of cerebrovascular events, control of weight and blood pressure). RESULTS: Study sample is predominantly female (54.8%), the age group with the largest number was 18-27 years (21%); 42.2% with BMI ≥ 25 kg/m2; 65.1% sedentary; Smoking 7.3% and alcoholism 14.4%; 6.5% with diagnosed heart disease; 19.9% with close family members with cardiac pathology; 2.7% had a stroke, 0.1% had a transient ischemic attack; 0.5% acute myocardial infarction; 23.5% had the periodic habit of assessing blood pressure; 32.6% hypertensive; 4.5% with diabetics. CONCLUSIONS: The study showed that there is a high prevalence of cerebrovascular risk factors on Santiago Island, especially in females. Smoking and alcoholism showed a relationship with males. BMI, physical inactivity, diabetes and dyslipidemia were shown to be related to sex. Hypertension and Diabetes revealed a significant relationship with age group. Alcoholism, smoking, hypercholesterolemia and hypertriglyceridemia maintained a significant relationship with the municipalities.

WHO estimates that around 600 million people suffer from high blood pressure which causes high costs for health systems and influences the economy of these countries. In this study, we investigate the sociodemographic characteristics and risk factors related to hypertension among individuals from Huambo, Angola. This cross-sectional study was conducted with 158 participants consulted in the Cardiology services at Hospital Geral do Huambo, between January and July 2023. A total of 67.1% of the studied patients were hypertensive. The mean age of the hypertensive (55.8±11.3) patients was higher than non-hypertensive (53.1±13.4) patients, although no significance was observed (p=0.199). Patients aged between 30 and 40 (OR=1.19, P=0493), male (OR=1.17, P=660), employees (OR=9.94, P=0935), patients consuming alcohol (OR=1.11, P=0.864), and practising physical activity (OR=1.12, P=0.742) presented a high chance of developing hypertension, while those living in urbanized areas (OR=0.78, P=0.59) and with a low educational level (OR=0.43, P=0.194), had a low chance to develop hypertension. There was no statistical significance between demographic or behavioural characteristics with hypertension (P>0.05). Regarding clinical characteristics, body mass index was statistically related to hypertension (p=0.011). Our findings show that hypertension is a major health problem for the young population of Huambo. There is an urgent need to create strategies to improve the prevention, diagnosis, and treatment of hypertension, not only in Huambo but throughout the country. Further studies to understand determinants related to hypertension should be carried out among the young population in Angola.

Objective: To describe the proportion of patients undergoing major abdominal surgery who develop postoperative hypothermia, and the variables associated with its occurrence. Material and Methods: We conducted a prospective cohort study in a tertiary care referral hospital in Mexico City to describe the incidence of perioperative hypothermia and factors associated with postoperative hypothermia. A repeated measures ANOVA model was used to compare preoperative, intraoperative, and postoperative temperatures. Potential variables associated with hypothermia were evaluated with a logistic regression analysis. Results: A total of 110 patients were included in the analysis. Of them, 61% (n=67) were women. The mean age was 56.7 years (SD: 16.3, range: 75). The most frequently involved organ on which surgery was performed was kidney or urinary tract (21.8%), followed by large bowel (14.5%) and exploratory laparotomy (14.5%). The incidence of postoperative hypothermia in patients undergoing major abdominal surgery was 57.3%, while preoperative and intraoperative hypothermia occurred in 55.5% and 79.1%, respectively. Age over 60 years was the only variable associated with postoperative hypothermia after multivariable adjustment for sex, age, and time surgery (OR=18.4, 95% CI:3.79-89.6, p<0.0001). Conclusion: Increasing age was the only variable associated with postoperative hypothermia in patients undergoing major abdominal surgery.

1. Background: Cardiovascular diseases (CVDs) are India’s leading cause of mortality. This study aimed to recalibrate the original Framingham Risk Score (FRS) equations among adults in Kerala state. 2. Methods: Baseline survey data from the Kerala Diabetes Prevention Program were analyzed: 921 males and 567 females for lipid-based FRS scores and 1042 males and 646 females for BMI-based FRS scores. Recalibration of the original FRS scores was performed using local data on CVD risk factors and CVD mortality. 3. Results: Among males, the median 10-year CVD risk with the recalibrated lipid-based FRS score was 7.34 (IQR 4.33-12.42), compared with the original score of 8.88 (5.23-14.87) (p<0.001). For BMI-based FRS scores, the median 10-year CVD risk was 7.40 (4.27-11.83) with the recalibrated score, compared to 9.32 (5.40-14.80) for the original score (p<0.001). In females, the median 10-year CVD risk was 4.83 (2.90-8.36) with the recalibrated score, compared to 2.85 (IQR 1.71-4.98) with the original score (p<0.001). Similarly, the median 10-year CVD risk was 4.66 (2.74-8.81) with the recalibrated BMI-based FRS score, compared to 2.95 (1.72-5.61) with the original score (p<0.001). 4. Conclusions: Recalibrated FRS scores estimated a significantly lower 10-year CVD risk in males and a higher risk in females than the original FRS scores.

This scoping study aims to explore the relationships between urban green spaces (UGSs) and cancer. We followed the PRISMA extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: 1) to be concerned with UGSs, 2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, 3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, 4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, CINAHL and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e. protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors, the role of mental health in recovering from cancer and health inequalities.

Microorganisms belonging to the Lactobacillus genus are naturally associated or deliberately added to fermented food products and are widely used in probiotic food additives and supplements. Moreover these bacteria normally colonize mouth, gastrointestinal (GI) tract and female genitourinary tract of humans. They exert multiple beneficial effects and are regarded as safe microorganisms. However, infections caused by lactobacilli, mainly endocarditis, bacteremia and pleuropneumonia occasionally occur. The relevance of Lactobacillus spp. as opportunistic pathogens in humans and related risk factors and predisposing conditions are illustrated in this review article with more emphasis on the species L. rhamnosus, that has been more often involved in infection cases. The methods used to identify this species in clinical samples, to distinguish strains and to evaluate traits that can be associated to pathogenicity, as well as future perspectives for improving the identification of potentially pathogenic strains are outlined.

Background: The practice of self-medication is common worldwide and is an important component of medical self-care. However, the practice can be dangerous and is linked to various risks for the patients and the entire community. This study aimed to estimate the prevalence and factors associated with self-medication among Bangladeshi adults. Methods: A cross-sectional survey was conducted between April and June 2021 among Bangladeshi adults (aged &gt;19 years) using convenient sampling. A total of 1320 data were collected through face-to-face interviews using a standardized questionnaire. Multivariable logistic regression analysis was used to identify factors associated with self-medication practice (SMP). Results: Overall, 41% of adults in our survey reported SMP. The most common illnesses that prompted SMP were common cold/flu (66.4%), gastric problems (65%), and headache (64.4%). The most frequent reasons for SMP were to get better services (30.59%), perceive SMP without side effects (23.28%), and save time with effectiveness (14.56%). Potential risk factors included 10 years (AOR = 1.91; 95% CI: 1.04 - 3.50) and &gt;12 years of schooling (AOR = 5.03; 95% CI: 2.27 - 11.15), being a businessman (AOR = 4.64; 95% CI: 1.74 - 12.37), having ≤6 family members (AOR = 2.13; 95% CI: 1.40 - 3.24), being a member of a social group (AOR = 1.53; 95% CI: 1.10 - 2.12), a health status check after every six months (AOR = 1.52; 95% CI: 1.08 - 2.13), and current ill-health (AOR = 1.41; 95% CI: 1.06 - 1.87). Protective factors identified included ≤30 years of age (AOR = 0.40; 95% CI: 0.17 - 0.93), and practice of modern (AOR = 0.39; 95% CI: 0.22- 0.69) and herbal (AOR = 0.45; 95% CI: 0.21- 0.97) healing types. Conclusion: More than one-third of the study participants reported practicing self-medication. Increasing the community’s awareness of the extreme consequences of SMP and not just the average experience might sway individuals away from SMP, and implementing strict jurisdiction could be a way to minimize the SMP.

The epidemiological patterns of Bovine Viral Diarrhea (BVD) in North Africa and Mediterranean Basin (MB) are endemic with highly socio-economic impacts. The objective of the study was conducted to investigate the level of sero-prevalence of BVDV in Libya and the associated risk factor. A total of 1599 serum samples were collected from herds of cattle which belonging to seven Libyan regions. All sera were assayed by using screening ELISA assay for detection of antibodies against BVDV. An overall seroprevalence of BVDV was estimated to be 48.6% (95% CI, 46.08%-50.98%). Considering the age group, a seroprevalence of 36.8% was detected in cattle &lt;1 year, 41.0% in cattle between 1 and 2 years of age and 48.6% in cattle aged more than 2 years. Statistically significant differences (p&lt;0.001) between age groups were reported. Seroprevalence of BVDV was significantly associated with geographical region (P=0.033). This is the first study on BVD in Libya and the results of this study would suggest that BVD is endemic in Libya.

The primary objective of this systematic review was to analyze the main physical agents representing risk factors for commercial aircrew, together with their consequences. The secondary objective was to identify the countries in which studies on the topic were conducted, as well as the quality of the publications available. Thirty-five articles, published between 1996 and 2020, were selected for the review, having met all inclusion criteria. The majority of studies were conducted in the United States, Germany and Finland and had moderate or low methodological quality of evidence. The main risk factors for aircrew identified in publications were exposure to abnormal air pressure, cosmic radiation, noise, and vibrations. Hypobaric pressure was explored in response to demands for studies on this agent, a factor which may lead to otic and ear barotraumas, as well as acceleration of atherosclerosis of the carotid artery. However, there is a dearth of research exploring this phenomenon.

The data for the study on the epidemiology of bovine mastitis were collected fromNovember 2015 to February 2016 to investigate the prevalence of mastitis in administrative towns of three selected districts of Arsi zone, Oromia Regional State, namely Iteya, Sagure, and Asella, Ethiopia; and to analyze the association between the risk factors and mastitis occurrence. Sample cows were selected and examined for clinical mastitis and at the same time, milk samples were evaluated both clinically and using the California Mastitis Test (CMT). Some parameters of the cows which have biological relation with this disease together with other potential risk factors were collected along with primary data collection. The analysis of the primary data showed that overall mastitis prevalence in the locations covered by the study was 28.6% of which 83.3% was subclinical, while 16.7% were clinical mastitis cases. Analysis related to the investigation of the existence of an association between risk factors and mastitis revealed that there was a significant association between the occurrence of mastitis and two of the risk factors evaluated, breed and age of the cow. The other risk factors investigated (i.e. parity, location, and lactation stage had no significant association with mastitis occurrence). Since mastitis is a complex disease that results from the interaction of different factors, it may be difficult to limit it to only some given factors. Environment and management factors and their combination may also have an additional impact on the epidemiology of the disease. A prevalence with the indicated magnitude together with the added effect of a lower level of awareness of the society about milk-associated zoonoses implies that this disease causes significant public health problems. In addition, mastitis may cause silent economic loss through unnoticed production loss along with reduced milk yield from subclinical and clinical (e.g. blind teats) cases. Due to a lack of awareness about mastitis and/or negligence, farmers in all corners of the country are suffering from economic and public health problems imposed by mastitis. This lack of awareness about mastitis-associated problems and/or negligence could be a possible reason for the use of raw milk which is a common scenario particularly in pastoral areas and the selling of adulterated milk which is becoming increasingly practiced in Ethiopia which is also true in these specific localities.

Abstract: The study aimed to determine the factors associated with the avoidance of dental preventive care in adolescents and their parents in the framework of The Youth and Parents Risk Factor Behavior Survey in Slovakia has been initiated during the years 2015/2016. The data were collected using two separate standardized questionnaires: (i) the questionnaire for adolescents (n=515) and (ii) the questionnaire for parents (n=681). The study group consisted of 57 adolescents (54.4% males) who did not visit the dentist for preventive care in the previous year. The control group consisted of 458 adolescents (35.8% males) who visited a dentist for preventive care at least once in the previous year. A significantly higher number of males (54.4%), older adolescents (21.4%) were not visiting dental preventive care regularly. Incomplete family (56.1%), stressful situations at home (17.5%), and feeling unwell were observed as the factors contributing to the avoidance of dental preventive care. More than 34.5% of adolescents were not visiting either dental preventive care but also pediatric preventive care (AOR=5.14; 95%CI=2.40, 10.99). Divorced mothers and mothers with household income lower than 900 € had significantly higher dental care avoidance in their children. A significantly higher percentage of fathers from the exposed group were not visiting dental preventive care regularly (47.8%; p&lt; .05). The results of the study can be used as an educational intervention steps focusing on the influence of parental and adolescent behavior in dental preventive care.

Severe early childhood caries remains the most common chronic disease affecting children. Its multifactorial etiology has established a controversy about which risk factors were more significant to its development. Therefore our study aimed through meticulous statistical analysis to arrange the “well agreed upon” common risk factors in order of significance, to aid the clinician in tailoring an adequate preventive program for this affected age group. The study reshuffled the risk factors contributing to severe early childhood caries and placed them in the order of their significance as follows: snacking of sugary food several times a day, increased number of siblings to 3 or more, night feeding, child self-employed brushing, mother caries experience, 2 siblings, on demand feeding, once/day sugary food, sharing utensils, 1 Sibling, male gender, father’s education, late first child dental visit, brushing time, mother’s education, no dental visit, decreased brushing frequency & no night brushing.

This study explores individual and contextual risk factors for the onset of work interfering with private life (WIL) and private life interfering with work (LIW) among self-employed men and women across European countries. It also studies the relationship between interference (LIW and WIL) and wellbeing among self-employed men and women and the effect of macro level risk factors. Data from the fifth round of European Working Conditions Survey was utilized and a sample of self-employed men and women with active businesses was extracted. Applying multilevel regressions, results show that though business characteristics are important for level of WIL, time demand is the most evident risk factor for WIL and LIW. There is a relationship between wellbeing and WIL and LIW respectively, and time demands is the most important factor in this relationship. Gender equality on the labor market did not relate to level of interference, nor did it mediate the relationship between interference and wellbeing. However, the main and most important risk factor for experiencing WIL and LIW and for how interference relate to wellbeing is gender relation processes in work and life, both on individual and contextual level.

Falls are the third-leading cause of disabilities among the elderly population worldwide. In Pakistan, the prevalence is 44%; out of them, 8% develop injuries, placing them at high risk for hospitalization or even premature death. Interestingly, fall is multifactorial, and fall risk depends on individual characteristics (intrinsic factors) and environmental features (extrinsic factors), which can be different from context to context. Therefore, regular assessment of fall risk factors is required to develop a strategy for fall prevention. This study aimed to identify intrinsic risk factors for falls in Pakistani elders living in the communities, and provide evidence for preventive strategies of falls in elderlies. Data were collected from 140 Muslim elders from two residential areas of Peshawar, Khyber Pakhtunkhwa, from July 2022 to August 25, 2022, after taking permission from Zhengzhou University Ethical Review Board (ZUIRB #202254), and District Health Department Office (DHO #14207).Participants were informed and concern was taken before collect data. Data were collected using the Time Up and Go Test (TUGT), the Mini-Mental Status Examination, and interviews regarding the prayer practice. Factors associated with falls were; age, gender, education, cognitive status, TUGT level, incorrect prayer postures, poor vision, and history of falls with a significance of (P.<0.05). Poor cognition, low vision, poor walking speed, and prayers without body movements have good membership with falls risk prediction as (P<0.005) in Omnibus, Lemeshow score (0.77). Hence, our study provides a road map for future risk assessment for falls by adding the four mentioned risk factors as offered in the proposed model to facilitate taking timely action to prevent fall-related ailments in Pakistani elders.

It is essential to consider the factors that affect early childhood development because doing so can help identify potential risks and window of opportunity for intervention to improve outcomes for children. However, identifying risk and protective factors in early childhood requires careful consideration of several challenges and an integrated approach that recognises the complex and dynamic nature of development. The purpose of this study was to identify and describe the prevalent psychosocial risk and protective factors in the early childhood development phase, using an ecological perspective. The study employed a quantitative cross-sectional study using a random sampling technique. The final sample consisted of 505 caregivers of children aged 5 years old and younger. This study revealed that the most prevalent protective factors include child self-regulation, parent-child warmth, family management and collective efficacy but more importantly social support. While risk factors may exist this is mitigated by social support as it moderates and buffers against the effects of risk factors, as indicated by the various research studies cited.

Framed in a context with an emerging economy and with a high percentage of school failure, this study aimed to identify the factors that turn students with socioeconomic disadvantages into resilient students. Two questions guided the research: Can resilience be supported in students in adverse socioeconomic situations? What factors influence building resilient students? A cross-sectional study was carried out from 2011 to 2015 in Chile, using a multilevel logistic regression model with three levels, considering the hierarchical data structure. The behavior of 63100 to 76400 sampled students was analyzed. Results show five relevant factors in building resilience: self-efficacy in language, minor aggressions and violence perceived by students, norms and values of the establishment, interest in study, and self-efficacy. Some risk factors identified were an atmosphere of less respect and trust, engagement in physical education activities and good performance in carrying them out. These results could orient educational leaders interested in supporting the educational community in order to improve the academic success of disadvantaged students.

This study examined the tail dependency structure of sovereign credit risk and three global risk factors in BRICS countries using copulas approach, which is known for its ability to provide the “true” tail correlation based on the correct marginal distribution. The empirical results show that global market risk sentiment comoves with sovereign CDS spreads across BRICS countries under extreme market events, with Brazil having the highest co-dependency followed by China, Russia, and South Africa. Furthermore, oil price volatility is the second biggest risk factor correlated with sovereign CDS spreads for Brazil and South Africa while exchange rate risk exhibits very small co-dependence with sovereign CDS spreads under extreme market conditions dominated by tail events. On the contrary, exchange rate risk is the second largest risk factor co-moving with China and Russia’s sovereign CDS spreads while oil price volatility exhibits the lowest co-dependence to CDS in these countries. Between oil price and currency risk, evidence of single risk factor dominance is found for Russia where exchange rate risk is largely dominant. These results suggest that BRICS policymakers might consider financial sector regulations that mitigate risks spill-over such as targeted capital controls when markets are distressed.

According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death among women worldwide, yet its magnitude is often underestimated. Biological and gender differences affect health, diagnosis, and healthcare in numerous ways. The lack of sex and gender awareness in health research and healthcare is an ongoing issue and affects not only research, but also treatment and outcomes. The importance of recognising the impact of both sex and gender on health and of knowing the differences between the two in healthcare is beginning to gain ground. There is more appreciation of the role that biological differences (sex) and sociocultural power structures (gender) have, and both sex and gender affect health behaviour, the development of diseases, their diagnosis, management, and long-term effects of an illness. An important issue is the knowledge and awareness of women about vascular diseases. The risk of cardiovascular events is drastically underestimated by women themselves, as well as by those around them. The purpose of this review is to draw attention to improving the medical care and treatment of women with vascular diseases.

Background: Maternal mortality remains dire in Nigeria, claiming 40,000 lives yearly due to pregnancy complications. Factors like limited healthcare access, poverty, and early marriage worsen the crisis. Despite efforts to improve skilled birth attendance, Nigeria struggles to meet MDG targets, underscoring the urgent need for more effective interventions. Objectives: The objective of the study is to assess and understand the knowledge of community members regarding the risk factors influencing maternal mortality in the Ede South Local Government Area of Osun State, Nigeria. Methodology: A descriptive cross-sectional study was conducted. The study methodology involves employing the Leslie Kish formula to select 185 participants from the Ede South Local Government Area in Osun State, Nigeria. The selection process involved the use of a systematic sampling technique to ensure a representative sample based on population demographics and characteristics, ensuring a balanced and accurate selection process. Quantitative data was collected through a self-administered questionnaire and analysed using SPSS version 21. Results: The study encompassed 185 participants. 64.9% females with a mean age of 27.3 + 8.3 years. Among them, 60.5% were single, 46.6% being students, 55.7% held a BSc degree, 64.9% were Yoruba and 61.1% identified as Christian. 91.4% were aware about maternal mortality, 74.6% recognized maternal deaths in reproductive-aged women. Participants identified that maternal deaths mostly occur during labour (91.4%). Direct causes, such as bleeding (88.1%), unsafe abortion (88.6%), infection (49.2%), and hypertension (64.9%), were recognized. Results indicated substantial awareness concerning specific risk factors: lack of education (98.9%), poverty (91.6%), poor health care services in facilities (94.0%), alcohol consumption (87.6%) and poor transportation (78.4%). Conclusion: Findings revealed good awareness of maternal deaths and critical factors such as ANC impact and direct causes of maternal mortality like bleeding and unsafe abortion. However, gaps persisted in SDG awareness, suggesting the need for targeted interventions to enhance overall understanding and address identified knowledge gaps.

Introduction. Congenital muscular torticollis (CMT) is an asymmetrical head positioning resulting from structural changes in the sternocleidomastoid muscle (SCM) that occurs early in a child’s development period or due to perinatal trauma. Children with CMT exhibit a marked imbalance in tension between the SCMs. When the clinical picture is typical, an ultrasound scan is performed to reveal characteristic lesions, such as tissue fibrosis or post-traumatic changes. Early diagnosis of CMT in newborns and implementation of treatment offer the chance of a complete cure. Torticollis treatment aims to rebuild the SCM's normal function by restoring its anatomical length, normal cervical spine mobility and muscle flexibility to enable regular head movements. Surgical treatment is performed when conservative methods fail to improve the patient’s condition. Indications for surgery include marked shortening of the SCM, persistent fibrosis in the muscle, constant head and facial asymmetry, and rotation or lateral flexion in the cervical spine restricted by > 15°. After hip dislocations and foot deformities, pediatric orthopedics addresses torticollis as the third most common congenital anomaly. Aim. This study was a retrospective analysis of 111 children diagnosed and treated due to CMT. Methods. The following were determined: the relationship between the side of CMT location and the type of delivery (cc vs. natural), between the body weight at birth and the side of CMT location, between the extent of SCM thickening and the type of delivery, and the incidence of CMT depending on the order of delivery. Results and conclusions. The analysis showed that CMT was more common in boys 61(54%) than in girls 51(46%), which may be related to the greater birth weight in boys. Of the pediatric patients with CMT, 76% were primiparous. More often, children born via natural delivery had left-sided torticollis with a more significant broadening of the SCM on ultrasound scans than right-sided torticollis. Theories of torticollis development pathophysiology should be deepened, systematized, and further researched.

The benefit of adjuvant radiotherapy (RT) after radical hysterectomy in patients with cervical cancer remains controversial. The aim of this study was to determine the impact on survival of adjuvant RT according to the Sedlis criteria. Patients with early-stage cervical cancer who underwent radical hysterectomy between 2005 and 2022 at a single tertiary institution were included. A multivariate analysis was performed to determinate if RT was an independent prognostic factor for recurrence or death. We also analyzed whether there was a statistically significant difference in overall survival (OS) between patients who met only one or two Sedlis criteria, depending on whether they received adjuvant RT or not. In this retrospective study 121 patients were included of whom 48(39.7%) received adjuvant RT due to the presence of unfavorable pathological findings. In multivariate analysis, RT was not found to be a statistically significant prognostic factor for OS (p=0.584) or disease-free survival (DFS) (p=0.559). When comparing patients who met one or two Sedlis criteria, there were no statistically significant differences in OS between RT and no adjuvant treatment in either group. Since the selection of patients with cervical cancer eligible for surgery is becoming more accurate, adjuvant RT might not be necessary for patients with intermediate-risk factors.

Small ruminant lentivirus (SRLV) are infected and transmitted among ovine and caprine species. This disease is a severe problem for small ruminant production, not only for animals’ wellbeing but also for the herd’s efficiency. The main aim of this research was to quantify the seroprevalence and associated risk factors for SRLV infection in the north region of Portugal. Collected samples from a total of 150 herds, of which 129 (86.0%; 95% CI: 80.67% - 91.33%) had at least one seropositive animal. Out of 2607 individual blood samples, 1074 (41.2%) were positive for SRLV. The risk factors associated with SRLV infection were: specie (caprine), age (&gt; 2 years old), herd size (&gt; 100 animals), production system (intensive), production aptitude (milk), type of activity (professional), participation in livestock competitions (yes), buy replacement young ewe (yes) and rearing (natural). This knowledge empowers the implementation of effective preventive measures. Overall, biosecurity measures should be promoted and implemented to aim reducing viral transmission, with the main goal of reducing the prevalence of this disease. Completely, we understand that government authorities should promote and audit voluntary control and eradication programs in small ruminant herds in the region studied.

Children from rural areas face numerous possibilities for neurodevelopmental conditions that may compromise their well-being and optimal development. Neuropsychology and electroencephalography (EEG) have shown strong agreement in detecting correlations between these two variables and suggest an association with specific environmental and social risk factors. The present meta-analysis aims to integrate the qualitative and quantitative EEG findings, their relationship with cognitive impairment in children living in vulnerable or rural environments, and the main risk factors influencing EEG abnormalities. The method for this purpose was based on a systematic string-based review from Ebscohost and Web of Science, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Qualitative and quantitative analyses were conducted from the outcomes that complied with the selected criteria. A total of 92 records were identified; however, only 20 were eligible, considering 11 for qualitative and 9 for quantitative analysis. The findings highlight a significant amount of literature on EEG and its relation with cognitive impairment from studies in children with epilepsy and malnutrition. In general, there is evidence about the advantages of implementing EEG diagnosis and research techniques in children living under risk conditions. Further research is needed to better describe and integrate the state of the art regarding EEG features extraction.

TB and HIV continue to increase and constitute major public health concerns worldwide, mainly in resource-limited countries, showing that we are not going to end HIV if we do not also end TB. Herein, we investigated the risk factors related to HIV infection among TB patients in Luanda, the capital city of Angola. This was a retrospective cohort study conducted on the medical records of 117 TB patients from January to September 2016. Overall, the HIV/TB co-infection rate was 12%. The mean age of coinfected patients was 37.7±10.1 years. No statistically significant relationship was observed between sociodemographic or clinical features with HIV/TB co-infection (p>0.05). TB patients aged 30 years or older (OR: 4.13, p=0.072), female (OR: 1.08, p=0.898), residing in urbanized areas (OR: 1.90, p=0.578), with a history of treatment abandonment (OR: 3.74, p=0.083), with polyresistance (OR: 1.62, p=0.603), and MDR-TB (OR: 2.00, p=0.454), were more likely to have HIV/TB co-infection, while latent TB infection (OR: 0.63, p=0.559) and treatment-susceptible TB patients (OR: 0.56, p=0.616), presented a lower chance of HIV/TB coinfection. Our finding showed a slightly high HIV/TB coinfected rate, which suggests that the dual HIV/TB epidemic keeps evolving and poses a huge concern to the public health in Angola. Further studies on features related to HIV/TB coinfection and its impact on disease progression and clinical outcome in adults from high-risk Angolan communities, should be carried out to intensify and strengthen collaborative activities between national TB and HIV programs in Angola.

Background: At altitudes beyond 2500 m the risk of developing high altitude pulmonary edema (HAPE) grows with the increases in pulmonary arterial pressure. HAPE is characterized by severe pulmonary hypertension, though the incidence and relevance of individual risk factors are not yet predictable. However, the systolic pulmonary pressure (SPAP) and peak in tricuspid regurgitation velocity (TVR) are crucial factors when diagnosing pulmonary hypertension by echocardiography. Methods: The SPAP and TVR of 27 trekkers aged 20-65 years en route in the Solu Khumbu region of Nepal was assessed. Echocardiograph measurements were performed at Lukla (2,860 m), Gorak Shep (5170 m), and the summit of Kala Patthar (5,675 m). The altitude profile and the participant’s characteristics were also compiled for correlation with the measured data. Results: The results showed a highly significant increase of SPAP and TVR after ascending Kala Patthar. The study revealed a lower increase of SPAP and TVR in the group of older participants, although the initial respective measurements in Gorak Shep were significantly higher for this group. A similar finding occurred in those using Diamox® as prophylaxis. There was an inverse relationship between TVR and SPAP, the peripheral capillary oxygen saturation and heart rate. Conclusions: The echocardiograph results indicate that older people are a risk group for developing a HAPE. The prophylactic use of acetazolamid led to higher initial SPAP values in Gorak Shep, and a lower increase of SPAP as well as TRV after ascending Kala Patthar. Arterial oxygen saturation measurements can provide an indicator for the self-assessment for the risk of developing HAPE and provide a rule of thumb for the altitude profile but does not replace a HAPE diagnosis. The collected data variables concerning backpack weight, sex, workload (actual ascent speed), and pre-existing diseases were not statistically significant factors related to SPAP and TVR (p=<0.05).

Screen viewing time is the total time spent by a child on any digital/electronic device. The objective of the present study was to determine the incidence and predictors of excessive screen viewing time in children in Ujjain, India. This cross-sectional, community-based study was conducted through house-to-house survey by using the three-stage cluster sampling method in 36 urban wards and 36 villages of Ujjain district, India. Excessive screen viewing time was defined as screen viewing for &gt; 2 h/day. The prevalence of excessive screen viewing time was 17.83%. Risk factors identified using the multivariate logistic regression model were: age (OR: 1.5, P &lt; 0.001); mobile phone use before bedtime (OR: 3.17, P = 0.008); parents’ perception about the child habituated to screen (OR: 14.03, P &lt; 0.001); television in bedroom (OR: 48.69, P &lt; 0.001); morning mobile screen viewing time (OR: 9.27, P &lt; 0.001); not reading books other than textbooks (OR: 9.71, P &lt; 0.001); and lack of outdoor play for &gt;2 h (OR: 4.20, P &lt; 0.001). Presence of eye pain was a protective factor for excessive screen viewing time (OR: 0.12, P = 0.011). The study identified multiple modifiable risk factors for excessive screen viewing time.

Aims: To assess the occurrence of Chemotherapy-induced nausea and vomiting (CINV) after standard antiemetic therapy in the acute (24 h post-chemotherapy) and delayed (2–5 days post-chemotherapy) phases, as well as to identify risk factors for CINV in the acute and delayed phases. Methods: This prospective longitudinal and observational study analyzed the data of 400 breast cancer patients scheduled for chemotherapy over two cycles in two hospitals. The self-report survey was developed to assess the occurrence of CINV and their associated factors. CINV was evaluated with a Multinational Association of Supportive Care in Cancer Antiemetic Tool (MAT) on days 2 and 6 of chemotherapy. The incidence of acute and delayed CINV were presented by frequency and percentage. Generalized equation estimates (GEE) was used to identify risk factors of acute and delayed CINV. Results: There were 400 evaluable patients with complete Round 1 data, 334 for Round 2 data. Among 400 patients, 29.8% and 23.5% experienced acute and delayed CINV, respectively. Risk factors associated with for acute CINV were pain/insomnia, history of CINV, history of motion sickness (MS), and highly emetogenic chemotherapy regimen, while history of MS, CINV history, number of completed chemotherapy cycle number < 3, and the incidence of acute CINV were risk factors of delayed CINV (all p < 0.05). Conclusions: The findings may help nurses working for Chinese population in identifying patients at risk for CINV and in planning effective program to reduce the occurrence of CINV.

Thoracic aortic calcium (TAC) appears to be a subclinical marker of cardiovascular disease (CVD) and to predict CV mortality. However, studies on TAC use tomographic scans obtained for coronary artery calcium (CAC) score, which does not include the aortic arch. This study evaluates TAC prevalence in aortic arch (AAC), ascending (ATAC) and descending thoracic aorta (DTAC) and verify whether they are associated with the same CV risk factors. Cross-sectional analysis, including 2,427 participants (mean age 55.6 ± 8.7; 54,1% women) of the ELSA-Brasil cohort. Nonenhanced ECG-gated tomographies were performed in 2015-2016. Multivariable logistic regression estimated the CV risk factors associated with calcium in each segment. Overall prevalence of ATAC, AAC and DTAC was, 23,1%, 62.1%, and 31.2%, respectively. About 90.4% of the individuals with TAC had AAC and only 19.5% had calcium in all segments. In the multivariable analysis, increasing age, lower levels of schooling, current smoking, higher body mass index, and hypertension remained associated with calcium in all segments. No sex or race/ethnicity differences were found in any aortic segment. Diabetes and Dyslipidemia were associated with ATAC and DTAC, but not with AAC, suggesting that AAC may reflect an overlap of mechanisms that impact vascular health, including atherosclerosis.

Introduction and objectives: a close association between metabolic syndrome among subjects with erectile dysfunction has been addressed, since mechanisms underlying metabolic syndrome compromise the blood flow to the penis in numerous ways. This study aims to analyze the relationship between erectile dysfunction and metabolic syndrome in a group of Mexican patients, to study the influence of other morbidity factors on erectile dysfunction, and to define the specific metabolic syndrome components most associated with erectile dysfunction severity. Methods: a descriptive and cross-sectional study was completed in a group of 86 adult Mexican patients with previous diagnosis of erectile dysfunction. Participants were classified as with or without metabolic syndrome. Erectile dysfunction severity, alcohol or tobacco consumption, and depressive behavior were identified through validated questionnaires and compared between both groups, as well as anthropometric, biochemical, and clinical parameters. Results: anthropometric measures, laboratory values, clinical characteristics and the Beck Depression Inventory score were significantly different among both groups. Additionally, more patients affected by severe and moderate erectile dysfunction were identified in the group with metabolic syndrome. Among the metabolic syndrome components, HbA1c >5.7% and fasting glucose >110 mg/dl were significantly associated to the development of erectile dysfunction (p = 0.004 and 0.04, respectively). Conclusions: metabolic syndrome components aggravate erectile dysfunction, particularly the lack of glycemic control manifested by Hb1Ac >5.7% and/or fasting glucose >110 mg/dL. The inclusion of fasting glucose and HbA1c as a complementary biochemical screening among patients with erectile dysfunction should be assessed.

Multiple births or twinning in equids are dangerous, undesirable situations that compromise the life of the dam and resulting offspring. However, embryo vitrification and freezing techniques take advantage of individuals whose multiple ovulations allow flushing more fertilised embryos from the oviduct to be collected, increasing the productivity and profitability of such techniques. Embryo preservation is especially important in highly endangered populations such as certain donkey (Equus asinus) breeds; for which conventional reproductive techniques have previously failed. For instance, becoming an effective alternative to artificial insemination with frozen semen to preserve the individuals’ genetic material. The objective of this study was to examine the historical foaling records of Andalusian donkeys to estimate genetic parameters for multiple births, assessing the historical foal number born per animal, maximum foal number per birth and multiple birth number per animal. We designed an Animal Model with single records considering the fixed effects of birthyear, birth season, sex, farm, and husbandry system, and age as a linear and quadratic covariate. Restricted maximum likelihood reported heritability estimates ranging from 0.18±0.01 to 0.24±0.01. Genetic and phenotypic correlations ranged from 0.01±0.01 to 0.83±0.01 and 0.12±0.01 and 0.53±0.01, respectively. These estimates enable the potential for selection against/for these traits, offering a new perspective for donkey breeding and conservation.

The aim of this study was a large-scale ecological analysis of nutritional and other environmental factors potentially associated with the incidence of cardiovascular diseases (CVDs) in the global context. Indicators of CVDs from 158 countries were compared with the statistics of mean intake (supply) of 60 food items between 1993 and 2011, obesity rates, health expenditure and life expectancy. This comparison shows that the relationship between CVD indicators (raised blood pressure, CVD mortality, raised blood glucose) and independent variables in the global context is influenced by various factors such as short life expectancy, religiously conditioned dietary customs, the imprecision of some statistics and undernutrition. However, regardless of the statistical method used, the results always show very similar trends and identify high carbohydrate consumption (mainly in the form of cereals and wheat in particular) as a dietary factor most consistently associated with the risk of CVDs. These findings are in line with the changing view of the causes of CVDs. Because only the statistics of raised blood glucose include people using medications and reflect true prevalence that is independent of healthcare, more objective data on the prevalence of CVDs are needed to confirm these observed trends.

Chikungunya virus (CHIKV) and Zika virus (ZIKV) have recently emerged as global infections with consequential disability adjusted life years (DALYs) and economic burden. This study aimed to explore the spatiotemporal heterogeneity in the occurrence of CHIKV and ZIKV outbreaks throughout Barranquilla, Colombia during 2014 and 2016 and explored the potential for clustering. Incidence data were fitted using multiple Bayesian Poisson models based on a suite of explanatory variables as potential risk factors and multiple options for random effects. A best fit model was used to analyse the case incidence risk for both epidemics to identify any risk factors during their epidemics. Neighbourhoods in the northern region of Barranquilla were hotspots for the outbreaks of both CHIKV and ZIKV. Additional hotspots occurred in the south-western and central regions of the CHIKV and ZIKV outbreaks, respectively. Multivariate conditional autoregressive models strongly identified higher socioeconomic strata (SES) and residing in detached houses as risk factors for ZIKV case incidences. These novel findings challenge the belief that these infections are driven by social vulnerability and merits further study both in Barranquilla and throughout the tropical and subtropical regions of the world.

Chikungunya virus (CHIKV) and Zika virus (ZIKV) have recently emerged as global infections with consequential disability adjusted life years (DALYs) and economic burden. This study aimed to explore the spatiotemporal heterogeneity in the occurrence of CHIKV and ZIKV outbreaks throughout Barranquilla, Colombia during 2014 and 2016 and explored the potential for clustering. Incidence data were fitted using multiple Bayesian Poisson models based on a suite of explanatory variables as potential risk factors and multiple options for random effects. A best fit model was used to analyse the case incidence risk for both epidemics to identify any risk factors during their epidemics. Neighbourhoods in the northern region of Barranquilla were hotspots for the outbreaks of both CHIKV and ZIKV. Additional hotspots occurred in the south-western and central regions of the CHIKV and ZIKV outbreaks, respectively. Multivariate conditional autoregressive models strongly identified higher socioeconomic strata (SES) and residing in detached houses as risk factors for ZIKV case incidences. These novel findings challenge the belief that these infections are driven by social vulnerability and merits further study both in Barranquilla and throughout the tropical and subtropical regions of the world.

Background: In Malaysia, the mortality from melioidosis infection was reported to be higher than in other infectious diseases. The research on melioidosis is still limited in Malaysia but slightly increasing. Objective: To give an overview of the study designs, statistical methods and comparison of research in identifying the predictors of melioidosis mortality in Malaysia between January 2010 to December 2021. This review articles were divided into two sections; Section 1: Review of literature and Section 2: Findings on predictors of melioidosis mortality in Malaysia. Data sources: Pubmed/Medline. Study Eligibility Criteria: Original English-language articles were abstracted. The articles that identified the predictors of melioidosis from mortality in Malaysia only included. Letters to the editor, editorials, reviews, systematic reviews, meta-analysis, case reports and any other ineligible articles were excluded. Results: A total of 7 studies were identified related to predictors of melioidosis mortality in Malaysia. From the selected articles, all of the data were retrospectively collected. Six out of 7 articles (85.7%) used the logistic regression in identifying the predictors of melioidosis mortality. Only 1 (14.3%) used advanced survival analysis methods of Cox regression analysis. Conclusion: Logistic regression methods remain the most common methods of analysis in publications on predictors of melioidosis mortality in Malaysia while retrospective research designs are favoured. There is a limitation of research in predictors of melioidosis mortality and the use of advanced statistical techniques reported using the melioidosis data in Malaysia. More published research on melioidosis will provide input to the clinicians on a more detailed understanding of how to improve the diagnosis of melioidosis and the prognosis factors of this disease.

The objectives of this study were to evaluate fixed risk factors associated with PWM and to estimate genetic parameters for PWM. A total of 927 birth records from a mixed population of purebred and crossbred Boer and Spanish goats born between 2016 and 2023 at the International Goat Research Center (IGRC) were used for this study. Four binary traits were studied: D0-3 (death within 3 days after birth), D4-60 (death between 4 and 60 days), D61-90 (death between 61 and 90 days), and D0-90 (death within 90 days). Logistic regression models were used to evaluate the risk factors associated with PWM traits. Bayesian threshold models and Gibbs sampling were used to estimate the genetic parameters. Birth weight, season, litter size, sex, dam age, breed, and heterosis were found to be significantly associated with at least one of the PWM traits. Heritability estimates were 0.263, 0.124, 0.080, and 0.207, for D0-3, D4-60, D61-90, and D0-90, respectively. The genetic correlations between the studied traits ranged from 0.892 (D0-3 and D0-90) to 0.999 (D0-3 and D61-90). These results suggest that PWM in goats is influenced by both non-genetic and genetic factors and can be reduced by management, genetic selection, and crossbreeding approaches.

Introduction: Cleft lip with or without cleft palate (CL/P) is the most common congenital face anomaly in the world of multifactorial etiology. Objective: To determine the prevalence and characteristics of cleft palate. To identify associated risk factors to guide prevention and/or prenatal detection for early intervention and better health outcomes. To assess the rehabilitation protocols after operations in cleft palate. Design: Retrospective descriptive and clinical study. Patients: One hundred and three children with cleft palate treated in the Department of Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury, were included in the study. Methods: Records evaluation was conducted regarding sex, cleft type, mother occupation, parents education, histories of cleft in any of parents. The data were analyzed using R (R core team 2021) and the ordinal logistic regression analyses. Results: Children of stressed mothers during pregnancy had 9.4 times higher odds of having bilateral cleft. While there was no evidence that children sex, order of birth, and body mass as well as risk of maternal toxicity at work or reporting infections or drugs toxicity had a significant effect on the dependent variable. Conclusions: Children of parents with cleft history and having low educated mothers had higher probability of bilateral cleft palate. Children of stressed mothers during pregnancy had higher odds of having bilateral cleft. In literature, there is a lack of reports about rehabilitation in different operations methods in children with cleft palates.

Aims. In a male Italian cohort (initially aged 40-59, n=1712) followed-up during 61 years and reaching practical extinction, the natural history of major CVD mortality categories including coronary heart disease (CHD), stroke and other Heart Diseases of Uncertain Etiology (HDUE, including congestive heart failure) were studied along with their risk factor relationships. Methods and Results. Cox models were run with 12 covariates measured at entry as possible predictors. About 93% of all CVD deaths were covered by the 3 major groups selected here (N=751): 37.4% of them were diagnosed as CHD, 30.6% as stroke and 28.5 % as HDUE. CHD declined in the last 20 years of follow-up, while a sharp increase of HDUE mortality was seen. Baseline mean levels of serum cholesterol were 209.6, 204.2 and 198.0 mg/dl respectively for CHD, stroke and HDUE deaths: the multivariable coefficients of serum cholesterol were positive and significant for CHD (p<0.0001) and stroke (p=0.0203) and not significant for HDUE (p=0.3467). In Fine-Gray models, the algebraic signs of cholesterol coefficients were opposite for CHD versus the other mortality categories (t=3.13). The predictive performances of remaining risk factors were varied whereas that of Cox models was not very good, probably due to the attrition phenomenon and possible competing risks. Conclusion. Large differences in natural history and risk factors were found comparing the 3 CVD conditions, potentially indicating different etiologies and pointing to the need of not mixing them up in a grouped CVD category.

Background Aspergillus spp. is a widely distributed filamentous fungus in the environment due to its high sporulation capacity. Currently, invasive aspergillosis (IA) is the most common invasive fungal infection in patients with hematologic malignancies with high rates of mortality and morbidity. The multifactorial nature of the disease requires appropriate risk stratification to allow the most appropriate preventive measures to be adapted and implemented according to the characteristics of the patient. In this sense, the present research aims to identify recent risk factors and environmental control measures against invasive aspergillosis to establish preventive actions to reduce the incidence of invasive aspergillosis in hospitals; (2) Methods: We conducted a qualitative systematic review of the scientific literature on environmental risk factors and preventive measures for invasive aspergillosis in patients with hematological malignancies. The Medline, Cochrane and Scopus databases were consulted, following the PRISMA and STROBE guidelines; (3) Results Adequate implementation of environmental control measures is presented as the most efficient intervention in terms of prevention to decrease the incidence of invasive aspergillosis in hospitals. We identify neutropenia, fungal contamination, lack of adequate environmental control measures in hospitals and patients´ homes, duration of hospitalization, and anemia as independent risk factors. We show that HEPA, LAF and Plasmair® systems are suitable methods to reduce the concentration of airborne fungal spores. Antifungal prophylaxis did not influence the reduction of IA significantly in our study; (4) Conclusions: Proper professional training and environmental control measures in hospitals are essential for the prevention of invasive aspergillosis. We should optimize risk stratification for patients with hematologic malignancies. Antifungal prophylaxis should be complementary to environmental control measures and should never be substituted for these last ones. Studies should also be done to evaluate the efficiency of environmental control measures against IA at patients' homes.

Background: Hospital-acquired infections (HAI) pose a significant danger to global public health, mainly because their numbers are growing exponentially each year. Additionally, the rise of bacterial strains resistant to current treatment options further exacerbates this threat. The study aimed to examine the occurrences of HAIs identified in public hospitals at the county level. Methods: We conducted a cross-sectional study utilizing data provided to the Mures Public Health Directorate from all the public hospitals within this county. We examined HAIs reported during the period spanning from 2017 to 2021, which amounted to a total of 4603 cases. Results: The medical departments reported the highest prevalence of HAIs at 48.25%. The most common infections in-cluded enterocolitis with Clostridioides difficile (32.61%), COVID-19 (19.83%), bronchopneumonia (16.90%), sepsis, surgical wound infections, and urinary tract infections. The five most frequently identified pathogens were Clostridioides difficile (32.61%), SARS-CoV-2 (19.83%), Acinetobacter baumannii (11.82%), Klebsiella pneumoniae (9.58%), and Pseudomonas aeruginosa (7.95%). Acinetobacter baumannii was the predominant agent causing bronchopneumonia, while Klebsiella pneumoniae was the leading cause of sepsis cases. Escherichia coli was the primary agent behind urinary tract infec-tions, and Staphylococcus aureus MRSA was identified as the main etiology for wound infections and central catheter infections. Throughout the study period, there was a significant rise in Clostridioides difficile cases, accounting for 40.36% of all reported HAIs in 2021. Conclusions: The study identifies Clostridioides difficile increase in HAI cases during COVID-19, highlighting the need for careful antibiotic use, and emphasizing the growing challenge of multi-resistant strains in post-pandemic state hospitals.

Cardiovascular diseases (CVD) are prevalent and lead to high morbidity and mortality globally. Physiotherapists regularly interact with patients with or at risk of CVDs (pwCVDs). This study aimed to assess the nature of existing evidence, interventional approaches used, and the population groups included in physiotherapy-led health promotion (PLHP) for pwCVDs. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Medline, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and PEDro databases were searched from inception until June 2023. Two reviewers independently screened the titles, abstracts, full text and conducted data extraction. All conflicts were resolved with a third reviewer. A total of 4992 records were identified, of which 20 full-text articles were included in the review. The studies had varied populations, including those with stroke, coronary artery diseases, peripheral artery diseases, hypertension, diabetes, and multiple CVD risk factors. The interventions ranged from exercise and physical activity programs, dietary interventions, education, and counselling sessions with various supplementary approaches. Most interventions were short-term, with less than 12 months of follow-up. Interventions were personalised and patientcentred to promote adherence and health behaviour change. Among the included studies, 60% employed experimental designs, with the remainder using quasi-experimental designs. Although a wide range of PLHP strategies have been used for pwCVDs, exercise and physical activity were employed in 85% of included studies. Other components of health promotion, such as sleep, smoking, and alcohol abuse, should be investigated within PLHP.

Background and Aim. Recently made analysis for anti-HBcor prevalence within Kazakhstan blood donors population concluded 17.2% rate. Considering these data are among the highest of infectivity results worldwide, an objective of this study was to define an association of positive Hepatitis B serology markers with risk and behavior factors. Methods. The blood donors’ samples were tested for anti-HBcore total (IgG/IgM) and anti-HBs, by CLIA on the Architect i2000SR platform (Abbott). Surrogate alanine transferase (ALT) markers for all blood donors were tested by kinetic method on the Biosystems A25 analyzer. A questionnaire was developed for socio-demographic characteristics, donors’ nutrition habits, cholesterol levels and history of smoking, alcohol consumption. Informed consent was obtained from all study participants. Statistics was calculated using the R software program (version 4.1.1, USA, 2021). Results. A group of 5709 blood donors participated in the study. Participants with positive anti-HBcore scores were on average older (41.8 vs 34.4 years, p<0.001), Kazakh (88.7% vs 83.0%, p<0.001), married (74.0% vs 55.6%, p<0.001), had a secondary education (70.1% vs. 59.4%, p=0.03), smoked (27.9% vs. 24.3%, p=0.05), had a longer smoking history (13.6±9.5 years vs. 9.8±8.5 years, p<0.001), and various hypercholestesterolaemia (6.2% vs 3.9%, p=0.02). Predominantly their main meal was dinner (17.0% vs 14.2%, p=0.03). Analysis for associations of socio-demographics characteristics, risk factors, nutrition with anti-HBs, showed that those who have secondary education level (70.1%) were more likely to be anti-HBs-positive (p=0.03). No other significant correlations for anti-HBs were observed. Conclusions. The risk factors and behavior analysis highlighted the blood donors’ overall health status. Positive Hepatitis B markers associated with statistically significant characteristics from socio-demography, nutrition habits or risk factors could support further pathogenesis studies looking for HBV treatment guides fulfilling the existing gaps.

The aim of this study was to determine the most common maternal and neonatal complications related to cesarean section at Sultan Qaboos University Hospital (SQUH) and to compare the outcomes between emergency and elective cesarean sections. A retrospective cohort study was conducted in the department of Obstetrics and Gynecology at SQUH from 1st January 2016 to 31st December 2016. This comparative study involved 300 women who underwent cesarean section, 150 in elective cesarean section group and 150 in emergency cesarean section group. Data was collected from the delivery ward maternity registry and Electronic Patient Records. SPSS software version 23 was used to analyze the data.The mean maternal age was 29.66 (± 4.96) and 33.22 (± 4.63) years in the elective and emergency cesarean section groups respectively (p=001). The main risk factor for both the groups was maternal diabetes and the most common indication for both was previous cesarean section. Hypotension related anesthetic complication was noted more in elective cesarean section (15.3%) than in emergency cesarean section group (4.0%) with p value=0.002. The most common major intraoperative complication in both groups was postpartum hemorrhage, 66.9% women in emergency group and 63.0% women in elective group. Post-partum fever was seen in 12.0% of women in emergency group as compared to 4% in elective group (p=0.019). Anemia was observed in 79.2% and 65.3% in emergency and elective groups respectively (p=0.011). Respiratory distress syndrome and transient tachypnea of the newborn were the main neonatal complications in both groups. There was no significant difference between emergency and elective cesarean section related maternal and neonatal complications except for transient intraoperative hypotension, maternal postoperative febrile morbidity and anemia. Future prospective studies including larger sample size and multiple centers is recommended.

Melioidosis, or Whitmore's disease, is an infectious disease initiated by a bacteria known as Burkholderia pseudomallei. This bacteria is commonly found in contaminated soil and water. In Malaysia, the mortality from melioidosis infection was reported to be higher than in other infectious diseases. The research on melioidosis is still limited in Malaysia but slightly increasing. The article's objective was to seek all the melioidosis research related to mortality in Malaysia. The information from the selected papers was then abstracted into two sections; Section 1: Review of literature and Section 2: Findings on mortality from melioidosis in Malaysia. In Section 1, the information on transmission and clinical features of melioidosis, demographic, severity of melioidosis, a clinical signs of melioidosis, diagnosis of melioidosis, management of melioidosis, the economic burden of melioidosis, and incidence of mortality from melioidosis were discussed in this paper. Meanwhile, in Section 2, the findings on mortality of melioidosis in Malaysia were discussed according to eight published articles. It is important to manage patients with melioidosis with appropriate treatment and management to reduce severe complications, high fatality rate, and relapse. More published research on melioidosis will provide input to the clinicians on a more detailed understanding of how to improve the diagnosis of melioidosis and the prognosis factors of this disease.

Canine leptospirosis is a zoonosis of epidemiological importance. Dogs are recognized as primary reservoirs of Leptospira interrogans serogroup Canicola and a source of infection to the environment through urine. This study aimed to determine the presence of antibodies against Leptospira in canines from 49 municipalities in the Department of Antioquia, Colombia. We performed a cross-sectional study of dogs included in a neutering control program. We collected 1335 sera samples, assayed by a microagglutination test (MAT), and performed PCR detection in 21 urine samples. We also surveyed 903 dog owners. We found a seroreactivity of 11.2% (150/1335) in Antioquia with titers 1:50. Municipalities with the highest number of cases were Belmira (46.1%), Turbo (34.5%), and Concepción (31.0%). L. santarosai was identified by phylogenetic analysis in one urine sample from the municipality of Granada. The most important factor associated with a positive result was the lack of vaccination against leptospirosis (PR 3.3, p < 0.014). Environmental factors such as water presence and bare soil around the household were also associated with Leptospira seroreactivity in the Department of Antioquia. We reviewed a national epidemiological surveillance database for human cases in those municipalities. We found a correlation between the high number of cases in canines and humans, especially in the Uraba. Serological and molecular results showed the circulation of Leptospira. Future public health efforts in the municipalities with the highest numbers of seroreactivity should be directed towards vaccination to prevent animal disease and decrease the probability of transmission of Leptospira. Dogs actively participate in the Leptospira cycle in Antioquia and encourage the implementation of vaccination protocols and coverage.

The association between obesity and the risk of gliomas remains unclear. We sought to evaluate the potential association between general and abdominal obesity and the risk of gliomas based on a nationwide population-based cohort study of Koreans. Using data from the Korean National Health Insurance System cohort, 6,833,744 people older than 20 years who underwent regular national health examination in both 2009 and 2011 were followed until the end of 2017. We documented 4,771 glioma cases based on an ICD-10 code of C71 during the median follow-up period of 7.30 years. Individuals with a body mass index (BMI) ≥ 25.0 kg/m2 were at significantly higher risk of gliomas than those with a BMI < 25.0 kg/m2 (HR 1.08 CI 1.02-1.15). Individuals with a waist circumference (WC) ≥ 90 cm (males)/85 cm (females) also had a significantly higher risk of gliomas than those with a WC < 90 cm (males)/85 cm (females) (HR 1.16 CI 1.09-1.24). In the group with a BMI ≥ 25.0 kg/m2, individuals with abdominal obesity were at significantly higher risk of gliomas (HR 1.18 CI 1.09-1.27) than those without abdominal obesity. The role of abdominal obesity in this association was stronger in women than in men. To our knowledge, this is the first demonstration that obese people may be at higher risk of gliomas, especially centrally obese people from an Asian population with a BMI ≥ 25.0 kg/m2. Loss of visceral fat in people with abdominal obesity may reduce their risk of gliomas.

Three decades ago, human arsenic (As) contamination has been recognized in Ron Phibun, a sub-district with tin mining activity in southern Thailand. Since then different government bodies have attempted to mitigate the As-contamination problem by providing safe water in households. The most recent study conducted during 2000-2002 reported only a small fraction of population still had high urinary As level. Less attention has been paid to this issue afterwards. The present study aimed to re-assess the current situation, including human As contamination, water use behavior as well as identify risk factors of elevated As concentration among residents of Ron Phibun. The survey of 560 participants living in Ron Phibun with urinary As assessment was conducted. The median urinary As concentration of study participants was higher than normal. Consumption of shallow well water, a source generally considered as As-contaminated, was higher than a previous survey. A significant association was observed between urinary As concentrations and water sources for drinking and cooking. Gender and educational level were found to be associated with urinary As concentration. Significant associations between urinary As concentration and certain diseases (respiratory diseases, dermatitis, and dyslipidemia) were observed. The findings suggested further investigation of all water sources in the area for As contamination.

Liver cirrhosis is a chronic disease that is characterized by the presence of fibrosis and regeneration of nodules in the liver whose consequences are the development of portal hypertension and liver failure. Cirrhosis arises from a wide variety of chronic diseases, which progresses slowly after years or decades. Liver cirrhosis is a public health problem. It is usually associated with viral hepatitis, consumption of alcohol, metabolic syndrome, autoimmune processes, storage diseases, toxic substances, and medications. Cirrhosis is the fourteenth most common cause of death in adults throughout the world, the fourth in Europe and the ninth in the United States. The prevalence of this disease is underestimated because it is symptomatic it is not diagnosed in initial stages, and it usually goes to the decompensated stage at a rate of 5 to 7% per year. We review here the epidemiology, pathophysiology, etiology, and diagnosis of liver cirrhosis.

The interrelatedness of social-structural aspects and psychological features with the vaccination intention provides the context to explore personal psychological fea-tures related to general decision-making and vaccine-related dispositions, and their contribution to the intention to vaccinate, within post-pandemic circumstances, after the imposed possibility of choosing a vaccine brand. The aim of our study was to map the function (promotive, protective, risk, vulnerability) of a set of psychological aspects in the intention to vaccinate, in people with different social roles regarding the vaccination. We surveyed three samples of people: healthcare providers (HPs), parents, and lay people, within the context of the after-pandemic. Negative vaccine attitudes lower intention to vaccinate in all regression models (all βs ranging from -.128 to -.983, all ps < .01). The main results indicate that, regardless of the sam-ple/social role, there is a shared attitudinal core for positive vaccination intention. This core consists of [high] trust in large corporations, government, and healthcare systems, as well as perceived consensus on vaccine safety/efficacy and experience of freedom (protective factors), and [low] vaccination conspiracy beliefs, trust in social media, and choice overload (risk and vulnerability factors, respectively). There are no common promotive factors of intention to vaccinate; for parents, perceived consensus on vaccines, and trust in corporations and the healthcare system play such roles, for HPs experience of freedom is obtained as a unique promotive factor. In contrast, for laypeople, no unique promotive factors were found. These results and guidelines for the promotion of positive vaccination behavior are further discussed.

This study aimed to assess the prevalence and identify risk factors for schistosomiasis among school-aged children in low- and middle-income communities. A retrospective cross-sectional study was conducted, involving the examination of 24 034 children for Schistosoma haematobium ova. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 27. Logistic regression was employed to determine the factors associated with schistosomiasis. The overall prevalence of schistosomiasis in the study population was 75%, with higher rates observed in rural-dominated areas, particularly Bushbuckridge (73%) and Nkomazi (51%). Age, a history of bilharzia, and the presence of blood in urine were significantly associated with schistosomiasis, while being a female child was found to be a protective factor. This study underscores the importance of implementing robust screening procedures and the necessity for health education to mitigate the high prevalence of schistosomiasis and prevent its further spread.

Parkinson's disease (PD) is a complex neurological condition characterized by bradykinesia, stiffness, tremors, and non-motor symptoms. Despite ongoing studies, the precise etiology of PD remains elusive, and treatment options are limited. This narrative review exhibits the effect of several factors, like chronic constipation, use of nonsteroidal anti-inflammatory drugs (NSAIDs), pesticide exposure, smoking, exposure to head trauma, hyperuricemia, gout, cholesterol level, use of statin medications, caffeine consumption, on the risk of developing Parkinson's disease, including up-to-date studies. Constipation emerges as a potential prodromal symptom of PD, with studies revealing a positive correlation between persistent constipation and an increased risk of developing PD. NSAIDs, present conflicting evidence regarding their role in PD prevention. Pesticide exposure, particularly long-term exposure, is associated with an elevated risk of PD, with varying outcomes for different types of pesticides. Surprisingly, cigarette smoking exhibits an inverse correlation with PD risk, suggesting a potential protective role. The relationship between repeated head trauma and PD remains uncertain, with conflicting evidence from epidemiological studies. Uric acid, known for its anti-pro-oxidant properties, shows gender-specific associations with PD risk. Cholesterol's impact on PD risk is multifaceted, with studies presenting contradictory findings. Statin medications, despite their role in managing cholesterol, yield inconclusive results regarding their association with PD risk. Caffeine consumption emerges as a potential protective factor for PD. The conflicting findings underscore the need for further studies to fully understand them. These observations are correlational, and causation remains uncertain. Individual risk factors will depend on a unique genetic and health profile.

Objective: To evaluate which risk factors contribute directly or indirectly to Toxoplasma gondii infection in patients with ocular toxoplasmosis. Methods: Between 2018-2020, a total of 306 patients were selected, and treated at the Retinology Outpatient Clinic of the Specialty Hospital of Sāo José do Rio Preto, in the state of São Paulo. After the fundoscopy test, the Enzyme Linked Fluorescent Assay (ELFA) was used to determine IgG and IgM class anti-Toxoplasma gondii antibodies. Results: The results showed that individuals aged 60 years or older, and women who had a previous pregnancy, (p=0.000, OR= 8.137 and 95 % CI = 2.562 – 25.844), (p=0.016, OR= 7.395 and CI 95 % = 1,449 – 37,725) respectively, were 48.6 % more likely to develop ocular toxoplasmosis. Conclusion: In this way, previous pregnancy is a risk factor for the reactivation of toxoplasma, as well as for the generation of retinochoroiditis in previously infected women.

Visceral leishmaniasis (VL) is a severe parasitic disease transmitted by phlebotomine sandflies. VL is endemic in West Pokot County, Kenya, where effective strategies to interrupt transmission are impeded by the limited understanding of VL risk factors. Therefore, this case-control study aimed to explore environmental, behavioral and household determinants of VL in West Pokot. From November 2022 to January 2023, a structured questionnaire was administered to 36 symptomatic primary VL cases attending the Kacheliba Sub-County Hospital and to 50 controls from local villages. The VL status of all participants was confirmed using an rK39 rapid diagnostic test. In an age-corrected univariate logistic regression analysis, significant associations were found between VL and housing characteristics, such as window presence and floor type. Furthermore, outdoor activities, including traveling outside the residence for more than 2 weeks, activities near termite mounds, and forest activities during the rainy season increased the risk of VL. VL cases more frequently reported the presence of cattle, dogs and sheep in their house yards at night. VL was also associated with cutting down trees in the house yard and house proximity to several Acacia tree species. To conclude, this work reports a number of previously undescribed risk factors for VL in the understudied West Pokot focus. Our findings warrant further research into sandfly ecology and potential zoonotic parasite reservoirs in West Pokot.

HIV diagnosis and poor HIV management have various detrimental impacts on the lives of people living with HIV (PLHIV). As part of a large qualitative study investigating HIV risk factors and impacts, with the suicide topic not being a focus, this paper describes factors contributing to suicidal ideation and attempts that arose naturally in the stories of women living with HIV (WLHIV) in Yogyakarta and Belu districts, Indonesia. The participants were recruited using the snowball sampling technique. Guided by a qualitative data analysis framework, the data were thematically analysed. Findings indicated participants experienced immense psychological challenges due to the infection, spousal transmission, fear of mother-to-child transmission, and losing a child due to AIDS, which triggered suicidal ideation and attempts. The women’s lack of awareness of HIV management strategies resulted in them feeling trapped and overwhelmed. Associated negative thoughts and the anticipation and experience of stigma relating to their HIV status were influencing factors for thoughts of suicide among participants. Lack of social support from family and friends during the early stage of HIV diagnosis, compounded with pre-existing financial difficulties, lack of income, unemployment, and feeling overburdened, also triggered the women’s thoughts of suicide. Other influencing factors for suicidal ideation and attempts among the women were family breakdown following HIV diagnosis and this was reflected in family disputes, husband-wife separation or divorce, mother-child separation by other family members, reported concern about future relationships, and fear of being rejected or abandoned by their partner due to their HIV positive status. The findings indicate the need for a nuanced approach to counselling within HIV care interventions for couples to support the acceptance of each other’s HIV status whilst maintaining psychological wellbeing. Additionally, the findings indicate the importance of HIV education and awareness among community members for the de-stigmatisation of HIV and to increase the acceptance of PLHIV within families and communities.

Background: Vitamin B12 is a water-soluble vitamin with important cellular functions and is an essential vitamin. The aim of this study is to determine the B12 levels of children in the period from the 6th month when they start taking additional foods to the age of 7 and the risk factors affecting them. Methods: One hundred pediatric patients aged 6-72 months who were diagnosed with vitamin B12 deficiency and their parents who agreed to participate in Istanbul Atlas University, Medical Faculty, “Medicine Hospital” Pediatric Clinic between September 2022 and June 2023 were prospectively included in this study. Results: B12 deficiency was significantly higher in the 6-11 (25%) month group than those in the 12-23 (5.8%) and 24-47 (2.8%) month groups. Homocysteine levels were highest in those with insufficient B12 levels compared to the other groups. There was no statistically significant difference in weekly dairy and meat consumption levels between age groups. B12 levels were lower in the 6-11-month group than in the other groups. Homocysteine levels were highest in those with insufficient B12 levels [<200 pg/mL (148 pmol/L)]. Folic acid levels were lower in the 24-47 month and 48-72 month groups than in the 6-11 month and 12-23 month groups. Conclusions: The results obtained in this study showed that low vitamin B12 and increased homocysteine levels seem to be important risk factors in children, especially from the 6th month when they start taking additional foods. The diagnosis of B12 deficiency can be confirmed by elevated serum total homocysteine levels, which are evidence of functional cobalamin deficiency.

Colorectal cancer is the second leading cause of cancer-related mortality worldwide. Numerous pathophysiological mechanisms, such as abnormal cell proliferation, cell differentiation, resistance to apoptosis, invasion of structures adjacent to colorectal tumor cells, and distant metastasis, are involved in colorectal carcinogenesis. These processes are initiated by the complex interaction of a number of genetic and environmental factors, including sedentary lifestyle, obesity, alcohol consumption, smoking or gut microbiota. Despite the significant progress achieved in the diagnostic and therapeutic management of patients with colorectal cancer, there has been recently a noteworthy increase in the incidence of colorectal cancer in individuals below the age of 50 years. Early-onset colorectal cancer has a different frequency of oncogenic mutations, a higher prevalence of mucinous histology, a distinct deoxyribonucleic acid (DNA) methylation profile, a more distal location, and lower survival rates. A significant improvement in the prognosis of these patients can be achieved through the detection and removal of modifiable risk factors, along with the implementation of personalized screening strategies for individuals at high risk for this malignancy. Furthermore, gaining comprehension of the pathophysiological mechanisms by which these risk factors contribute to the process of oncogenesis may facilitate the discovery of novel therapeutic targets.

The rapid development of the regional economy in China has led to the rise of local ecological risks. It is very important to provide enjoyable ecosystem services to residents while reducing ecological risks. In order to understand spatial relationships between ecosystem services and ecological risks, we took Chongqing as an example in this study to assess the spatial relationship between ecosystem services and ecological risks at the county scale based on the ES-DPSIR system. The main findings include: (1) significant variation in the spatial distribution of the comprehensive ecosystem service index, where the lowest ecosystem service index (0.013) was found in the main urban area of Chongqing and the scores gradually increased outward from this center, reaching 0.689 in the outermost areas, (2) the increase of the comprehensive ecological risk index from east to west, ranging from -0.134 to 0.333, (3) the spatial relationship between ecosystem services and ecological risks was prominent, with 52.63% of the districts and counties being imbalanced or mild imbalanced, and (4) the significant differences between development trends of ecosystem services-ecological risks, including 60.53% being imbalanced districts and 30.47% mildly balanced. Overall, it was necessary to improve the relationship between ecosystem services and ecological risks in Chongqing by reducing ecological risks., and these research results could provide effective approaches and technical support for improving regional ecological security and enhancing ecosystem service capabilities.

Background and Objectives: Since the beginning of COVID-19 pandemic, the infection primarily affected patients with following chronic conditions: cardiovascular disease, hypertension, chronic obstructive pulmonary disease, diabetes mellitus, obesity and cancer. The aim of this study was to explore clinical and epidemiological characteristics associated with COVID-19 outcomes in patients at the primary health care centre from March 2020 to September 2022. Materials and Methods: The study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed and registered as RT-PCR positive on COVID-19. Differences regarding the distributions of patients between groups were analysed using Pearson chi square test and Mantel-Haenszel chi square test for trends, while differences in mean values were compared using independent samples t test. Relationship between mortality and independent variables were examined using logistic regression. Results: Out of 40,692 COVID-19 positive patients, 7.76% were hospitalized. The average age of hospitalized patients was significantly higher than the age of non-hospitalized patients (64.2±16.1 vs. 45.4±18.7; p&lt;0.001). The average age of patients with lethal outcome was nearly twice higher compared to patients with non-lethal outcome (74.6±11.5 vs. 45.7±18.6; p&lt;0.001). Male patients had higher hospitalization and mortality rate, compared to females (9.8% vs. 5.9%, p&lt;0.001; 4.8% vs. 3%, p&lt;0.001, respectively). The highest hospitalization rate was in patients with chronic renal failure, diabetes and cardiovascular diseases, while the death rate was the highest among patients with CRF and hearth comorbidities. Fever, cough, fatigue, nausea and vomiting, chest pain, shortness of breath and appetite loss favoured hospitalization. Patients with fatigue and appetite loss had higher percentage of lethal outcome. Vaccinated patients had significantly lower rate of lethal outcome. Conclusions: Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in clinical outcomes of COVID-19.

Chronic diseases affect a disproportionate number of United States (U.S.) Veterans, causing significant long-term health issues and affecting entitlement spending. This longitudinal study examined the health status of U.S. Veterans as compared to non-Veterans pre- and post-COVID utilizing the annual Center for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey data. Age-adjusted descriptive point estimates were generated independently for 2003 through 2021, while complex weighted panel data were generated from 2011 and onward. General linear modeling revealed that the average U.S. Veteran reports a higher prevalence of disease conditions except for mental health disorders when compared to the non-Veteran. These findings were consistent with both pre- and post-COVID, however, both groups reported a higher prevalence of mental health issues during the pandemic years. The findings suggest that there have been no improvements in reducing Veteran comorbidities to non-Veteran levels and that COVID adversely affected the mental health of both populations.

Temporomandibular joint disorders (TMD) are characterized by their multifactorial etiology and pathogenesis. A 3-year prospective study was conducted in a Portuguese TMD department to study the prevalence of different TMD signs and symptoms and their association with risk factors and comorbidities. Five hundred ninety-five patients were included using an online database: EUROTMJ. Most patients were female (80.50 %), with a mean age of 38.20±15.73 years. The main complaints were temporomandibular joint (TMJ) clicking (13.26%), pain (12.49%), and masticatory muscle tension (12.15%). The main clinical findings were myalgia (74%), TMJ clicking (60-62%) and arthralgia (31-36%). Risk factors such as clenching (60%) and bruxism (30%) were positively associated with TMJ pain and myalgia. Orthodontic treatment (20%) and wisdom tooth removal (19%) were positively associated with TMJ clicking, while jaw trauma (6%) tracheal intubation (4%) and orthognathic surgery (1%) were positively associated with TMJ crepitus, limited man-dibular range of motion and TMJ pain, respectively. 42.88% of TMD patients had other associated chronic diseases, most of them were mental behavioral or neurodevelopmental disorders (33.76%), namely, anxiety (20%) and depression (13%). The authors also observed a positively association of mental disorders with the degree of TMJ pain and myalgia. Online database seems to be a relevant scientific instrument for healthcare providers who treat TMD. The authors expect that EUROTMJ database can serve as a milestone for other TMD departments.

The long-term laboratory aspects of the effects of COVID-19 on liver function are still not well understood. Therefore, this study aimed to evaluate the hepatic clinical-laboratory profile of patients with up to 20 months of long-term COVID-19. A total of 243 patients of both sexes aged 18 years or older hospitalised in the acute phase of COVID-19 were included in this study. Liver function analysis was performed. Changes were identified in the mean levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), and ferritin. Inflammatory markers such as ferritin > 300 U/L were observed in the group that presented more changes in liver function markers (ALT, AST, and GGT). Age ≥ 60 years, male sex, AST > 25 U/L, and GGT ≥ 50 or 32 U/L were associated with ALT > 29 U/L. There was a correlation between ALT and AST, LDH, GGT, and ferritin. Our findings suggest that ALT and AST levels may be elevated in patients with long-term COVID, especially in those hospitalised in the acute phase. In addition, ALT > 29 U/L was associated with other markers of liver injury, such as LDH, GGT, and ferritin.

Diabetes mellitus is a popular life-threatening disease and patients may gradually have started suffering from other diabetes-causing diseases such as heart attacks, stroke, hypertension, blurry vision, blindness, foot ulcer, amputation, kidney damage and other organ failures before diagnosis. Early detection can help reduce the fatality of this disease. Deep learning models have proven very useful in disease detection and computer-aided diagnosis. In this work, we proposed a deep unsupervised machine learning model for early detection of diabetes using voting ensemble feature selection and deep belief neural networks (DBN). Dataset was obtained from an online repository containing responses of prediagnosed patients to direct questionnaires administered in Sylhet Diabetes Hospital in Sylhet, Bangladesh. The dataset was preprocessed and preprocessed. Features were reduced using the ensemble feature selector. The DBN model was pretrained and tuned to obtain optimal performance. The model was also compared with other models with no multiple hidden layers. The DBN performed at its relative best with F1-measure, precision and recall of 1.00, 0.92 and 1.00 respectively. We conclude that DBN is a useful tool for an unsupervised early prediction of Type II diabetes mellitus.

The aim of the present study was to evaluate the association between television viewing/physical activity (TVV/PA) interactions and cardiometabolic risk in an adult European population. A total of 2,155 subjects (25-64 years) (45.2% males), a random population-based sample were evaluated in Brno, Czechia. TVV was classified as low (&lt;2hours/day), moderate (2-4), and high (≥4). PA was classified as insufficient, moderate, and high. To assess the independent association of TVV/PA categories with cardiometabolic variables, multiple linear regression was used. After adjustments, significant associations were: high TVV/insufficient PA with body mass index (BMI) (β=2.61,SE=0.63), waist circumference (WC) (β=7.52,SE=1.58), body fat percent (%BF) (β=6.24,SE=1.02), glucose (β=0.25,SE=0.12), triglycerides (β=0.18,SE=0.05), and HDL-C (β=-0.10,SE=0.04); high TVV/moderate PA with BMI (β=1.98,SE=0.45), WC (β=5.43,SE=1.12), %BF (β =5.15,SE=0.72), triglycerides (β =0.08,SE=0.04), total cholesterol (β=0.21,SE=0.10), LDL-c (β=0.19,SE=0.08), and HDL-c (β=-0.07,SE=0.03); and moderate TVV/insufficient PA with WC (β=2.68,SE=1.25), %BF (β=3.80,SE=0.81), LDL-c (β=0.18,SE=0.09), and HDL-c (β=-0.07,SE=0.03). Independent of PA levels, higher TVV was associated with higher amounts of adipose tissue. Higher blood glucose and triglycerides were present in subjects with high TVV and insufficient PA, but not in those with high PA alone. These results affirm the independent cardiometabolic risk of sedentary routines even in subjects with high-levels of PA.

Abstract – Objective: Ovarian cancer, although not possessing a high incidence, is still the most common cancer-related deaths among women diagnosed with a gynecologic malignancy. The present study aims to highlight the epidemiology, risk factors of this disease and the significance of development of improved early detection strategies. Materials and Methods: This study was conducted using current published English studies by searching PubMed and Google Scholar. The search strategy included the keywords “ovarian cancer”, “diagnosis”, “risk factors”, “screening”, “epidemiology”. Studies on incidence and mortality were also considered. Case reports were excluded.Results: The highest incidence and mortality rates are observed in Central and Eastern Europe, while rates are relatively low in Asia and Africa. These rates are highest among the white population (14.3 per 100,000) and lowest among blacks (10 per 100,000) and Asians (9.7 per 100,000). The risk factors for this disease includes a family history, hormonal factors, nutrition and diet and physical activity, with some of them playing protective roles in reducing risk of ovarian cancers. There are no reliable screening methods for ovarian cancers. The most common diagnosis methods include a transvaginal ultrasound and a blood test to detect CA125 markers.Conclusions: The mortality rate of ovarian cancer is gradually increasing; thus, preventative measures are required to reduce lifetime risk of ovarian cancers and improve mortality rate.

Several treatment guidelines for sporadic, nonmetastatic nonfunctioning neuroendocrine tumors of the pancreas (NF-pNETs) have recommended resection, however, tumors ≤ 2 cm do not necessarily need surgery. This study aimed to establish a surgical treatment plan for NF-pNETs ≤ 2 cm. From 2000 to 2017, 483 patients who underwent resection for NF-pNETs ≤ 2cm in 18 institutions from Korea and China were enrolled and their medical records were reviewed. Median age was 56 (range 16- 80) years. The 10-year overall survival rate (10Y-OS) and recurrence-free survival rate (10Y-RFS) were 89.8 and 93.1%, respectively. In multivariable analysis, tumor size (> 1.5cm; p = 0.001) and nodal metastasis (p = 0.013) were independent adverse prognostic factors for OS. Perineural invasion (p = 0.008) and high Ki-67 index (≥3%; p < 0.001) were independent prognostic factors for poor RFS. NF-pNETs ≤ 2 cm showed unfavorable prognosis after resection when the tumor was larger than 1.5cm, Ki-67 index ≥ 3%, or nodal metastasis was present. NF-pNET patients with tumors ≤ 1.5cm can be observed if the preoperative Ki-67 index is under 3%, and if nodal metastasis is not suspected in preoperative radiologic studies. These findings support the clinical use to make decision about small NF-pNETs.

In this study, we described the most critical risk factors for different malignancies including: breast, prostate, lung, and colorectal carcinoma among others, with an emphasis on modifiable risk factors. We revised the literature review about risk factors involved in the genesis of cancer in various databases, including articles indexed in PUBMED, SCOPUS, PMC, and Google Scholar. Awareness of risk factors enables conscious decisions to be made in an effort to combat malignancies. Knowing risk factors is a mode of fighting malignancy. Diet, lifestyle, practises, and laboratory/clinical interventions were among risk factors of diverse malignancy. Diet, lifestyle, laboratory/clinical interventions all contribute to the genesis and prognosis in a variety of malignancies. We concluded that abstaining from risk factors can prevent the development of many malignancies in a century where this conundrum is raising disproportionately. By informing the public about modifiable risk factors cancer mortality rates can be reduced. It is treated here is to make the public aware of the modifiable risks of cancers.

Objectives: A wealth of literature has established risk factors for social isolation among older people, however much of this research has focused on community-dwelling populations. Relatively little is known about how risk of social isolation is experienced among those living in long-term care (LTC) homes. We conducted a scoping review to identify possible risk factors for social isolation among older adults living in LTC homes. Methods: A systematic search of five online databases retrieved 1535 unique articles. Eight studies met the inclusion criteria. Results: Thematic analyses revealed that possible risk factors exist at three levels: individual (e.g., communication barriers), systems (e.g., location of LTC facility), and structural factors (e.g., discrimination). Discussion: Our review identified several risk factors for social isolation that have been previously documented in literature, in addition to several risks that may be unique to those living in LTC homes. Results highlight several scholarly and practical implications.

Today, rupture of the anterior cruciate ligament is the most common heavy injury in athletes, but it can also occur in sedentary subjects. Its treatment, always adapted to the lifestyle, age and will of the patient, often remains surgical. However, despite its frequency and universality, there are still walking disorders following the operation. These disorders sometimes persist for several months, or even several years after surgery. The present study is therefore interested in determining the risk factors linked to walking disorders following reconstruction of the anterior cruciate ligament. The objective of this study is to determine what risk factors associated with walking disorders are after reconstruction of the anterior cruciate ligament by hamstring graft. This study focused on factors that may exist at 3 and 6 months postoperatively. Two populations participated in this study, a healthy population and a population having benefited from reconstruction of the anterior cruciate ligament. The operated test group is divided into two subgroups, one with a postoperative period of 3 months and the second at 6 months. All subjects were subjected to the same protocol, their gait on the treadmill was analyzed and evaluated with an Optogait® analysis system. A univariate analysis was carried out first. Then, a multivariate analysis by adjustment method was carried out in order to eliminate the potential confounding factors. The comparison of the results between the populations in the univariate analysis shows an absence of significant results however there are trends. The statistical results of the multivariate analysis showed interactions in the two subgroups of the operated population.In fact, it turns out that at 3 months there is a tendency to worse gait disorders in subjects with a high BMI reflecting overweight, when an associated surgical procedure has taken place on the meniscus, in subjects over 35 years of age and males. On the other hand, at 6 months, the tendency to worsening is visible only in the strata represented by subjects with a BMI corresponding to overweight, as well as in subjects having benefited from a meniscal suture associated with ACL reconstruction. .The results of the present study show that there are certain factors which tend to increase the risk of these walking disorders after reconstruction of the anterior cruciate ligament by hamstring graft, these factors are different depending on the time postoperative.

Frailty is defined as a state of increased vulnerability to stressors, and it predicts the disability and mortality in the older population. This study aimed to investigate standardized prevalence and multidimensional risk factors associated with frailty among the Korean community-dwelling older adults. We analyzed the baseline data of 2,907 adults aged 70–84 years (mean age 75.8±3.9 years, 57.8% women) in the Korean Frailty and Aging Cohort Study. The Fried frailty phenotype was used to define frailty. Analyzed data included sociodemographic, physical, physical function, biological, lifestyle, health condition, medical condition, psychological, and social domains. Data were standardized using the national standard population composition ratio based on the Korean Population and Housing Census. The standardized prevalence of frailty and pre-frailty was 7.9% (95% confidence interval [CI] 6.8–8.9%) and 57.2% (95% CI 45.1–48.8%), respectively. The following 14 risk factors had a significant association with frailty: at risk of malnutrition, sarcopenia, severe mobility limitation, poor social capital, rural dwellers, depressive, poor self-perceived health, polypharmacy, elevated high-sensitivity C-reactive protein, elevated glycosylated hemoglobin, low 25-hydroxy vitamin D level, longer timed up and go, and low short physical performance battery score (p<0.05). Physico-nutritional, psychological, sociodemographic, and medical factors are strongly associated with frailty.

Objectives: The aim of the present study was to evaluate the association between psoriasis and osteoporosis using two different studies. Methods: Data from the Korean National Health Insurance Service-Health Screening Cohort of participants who were ≥ 40 years old were collected from 2002 to 2013. Psoriasis and osteoporosis were included using ICD-10 codes. In study I (a follow-up study), a total of 25,306 psoriasis participants were matched to 101,224 controls with respect to age group, sex, income group, and region of residence, and the occurrence of osteoporosis was analyzed. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. In study II (a nested case–control study), a total of 79,212 osteoporosis patients were matched to 79,212 controls, and a previous history of psoriasis was analyzed. Crude and adjusted odds ratios (ORs) were analyzed using a conditional logistic regression analysis. Subgroup analyses were conducted according to age group and sex. Results: The adjusted HR of osteoporosis was 1.11 (95% confidence interval [CI] = 1.07-1.15, P < 0.001) in study I. In the subgroup analysis according to age and sex, the results were consistent except for the ≥ 60-year-old women. The adjusted OR of psoriasis was 1.22 (95% CI = 1.16-1.28, P < 0.001) in study II. All subgroups demonstrated high adjusted ORs of osteoporosis for psoriasis. Conclusions: Psoriasis increased the risk of osteoporosis in the population of participants aged ≥ 40 years in Korea.

Diarrhoea contributes significantly in the under-five childhood morality and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having “some dehydration” and “dehydration” according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine output, and abnormal respiratory pattern. A questionnaire was administered to identify risk factors for severe dehydration, which was the primary outcome. Multivariate logistic regression modeling was used to detect independent risk factors for severe dehydration. The study included 332 children, with mean ± standard deviation age of 25.62 ± 31.85 months; out of which, 70%(95% confidence interval [CI] 65 to 75) were diagnosed to have severe dehydration. The independent risk factors for severe dehydration were: child not exclusive breast fed in the first six months of life (AOR 5.67, 95%CI 2.51 to 12.78; p<0.001), history of not receiving oral rehydration solution before hospitalization (AOR 1.34, 95%CI 1.01 to 1.78; p=0.038), history of not receiving oral zinc before hospitalization (AOR 2.66, 95%CI 1.68 to 4.21; p<0.001) and living in overcrowded conditions (AOR 5.52, 95%CI 2.19 to 13.93; p<0.001). The study identified many risk factors associated with severe childhood dehydration; many of them are modifiable though known and effective public health interventions.

Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, diabetes mellitus, Coronary Artery Disease and family history of AAA. Abdominal aortic aneurysm prevalence is higher in smokers and in males. It is important to underline that all countries, where AAA screening was set up, had high income level and the majority belong to Western Europe (United Kingdom, Sweden, Italy, Poland, Spain and Belgium). Abdominal aortic aneurysm screening is fundamental for public health. It would avoid deaths, ruptures, and emergency surgical interventions if abdominal aortic aneurysm was diagnosed early in the population target for screening.

Missense mutations in the LRRK2 gene were first identified as a pathogenic cause of Parkinson’s disease (PD) in 2004. Soon thereafter, a founder mutation in LRRK2, p.Gly2019Ser (rs34637584), was described, and it is now estimated that there are approximately 100,000 people worldwide that carry this risk variant. While the clinical presentation of LRRK2 parkinsonism has been largely indistinguishable from sporadic PD, disease penetrance and age at onset can be quite variable. In addition, its neuropathological features span a wide range from nigrostriatal loss with Lewy body pathology, lack thereof, or atypical neuropathology including a large proportion of cases with concomitant Alzheimer’s pathology, hailing LRRK2 parkinsonism as the "Rosetta stone" of parkinsonian disorders. These differences may result from interactions between LRRK2 mutant protein and other proteins or environmental factors that modify LRRK2 function, and thereby influence pathobiology. This review explores how potential genetic and biochemical modifiers of LRRK2 function may contribute to the onset and clinical presentation of LRRK2 parkinsonism. We review, which genetic modifiers of LRRK2 influence clinical symptoms, age at onset, and penetrance, what LRRK2 mutations are associated with pleomorphic LRRK2 neuropathology, and which environmental modifiers can augment LRRK2 mutant pathophysiology. Understanding how LRRK2 function is influenced and modulated by other interactors and environmental factors –either increasing toxicity or providing resilience- will inform targeted therapeutic development in the years to come. This will allow developing disease-modifying therapies for PD and LRRK2-related neurodegeneration.

Background: Long COVID, characterized by a persistent symptom spectrum following SARS-CoV-2 infection, poses significant health, social, and economic challenges. This review aims to consolidate knowledge on its epidemiology, clinical features, and underlying mechanisms to guide global responses; Methods: We conducted a systematic literature review, analyzing peer-reviewed articles and reports to gather comprehensive data on long COVID’s epidemiology, symptomatology, and management approaches; Results: Our analysis revealed a wide array of long COVID symptoms and risk factors, with notable demographic variability. The current understanding of its pathophysiology suggests a multifactorial origin yet remains partially understood. Emerging diagnostic criteria and potential therapeutic strategies were identified, highlighting advancements in long COVID management.; Conclusion: This review highlights the multifaceted nature of long COVID, revealing a broad spectrum of symptoms, diverse risk factors, and the complex interplay of physiological mechanisms underpinning the condition. Long COVID symptoms and disorders will continue to weigh on healthcare systems in years to come. Ad-dressing long COVID requires a holistic management strategy that integrates clinical care, social support, and policy initiatives. The findings underscore the need for increased international cooperation in research and health planning to address the complex challenges of long COVID. There is a call for continued refinement of diagnostic and treatment modalities, emphasizing a multidisciplinary approach to manage the ongoing and evolving impacts of the condition.

.Background: Clostridioides difficile infections (CDI) vary in severity from mild diarrhea to life-threatening conditions like pseudomembranous colitis or toxic megacolon, often leading to sepsis and death. The COVID-19 pandemic prompted changes in healthcare practices, potentially affecting CDI incidence, though reported data are inconclusive. We studied factors influencing CDI incidence and outcomes at a university hospital throughout the COVID-19 pandemic years. Methods: We conducted a retrospective study on all adult hospitalized CDI cases from January 1, 2020, to December 31, 2022. We collected demographic information, comorbid conditions, and concurrent infections. Results: While overall CDI and COVID-19 rates decreased in 2022, a nota-ble increase in CDI infections was observed among oncological patients and those undergoing some aggressive treatments, such as colon or gastroscopies. The prevalence of comorbidities remained unmodified, and there were declines in prior gastrointestinal surgeries and proton pump inhibitor prescriptions. Factors associated with patient fatality or prolonged hospitaliza-tion included older age, cancer, chronic kidney disease, higher Charlson and McCabe indices, elevated C-reactive protein, and low albumin concentrations. Conclusion: Our study shows the evolving landscape of CDI during the COVID-19 pandemic and emphasizes the impact of de-layed diagnoses and treatments exacerbated by telemedicine adoption. Identified risk factors for CDI-related mortality or prolonged hospital stays underscore the importance of targeted inter-ventions in high-risk populations.

Background: Despite their generally favorable prognosis, hepatic fibrosis remains a possible complication for hepatitis B virus (HBV) inactive carriers. This study aimed to estimate the prevalence of significant fibrosis and associated risk factors among Omani HBV inactive carriers. Methods: A retrospective study was conducted of 200 Omani HBV inactive carriers visiting a tertiary hospital in Muscat, Oman, between January 2017 and December 2018. Significant fibrosis (stage F2 or higher) was identified using two-dimensional shear-wave elastography. Baseline clinical, laboratory, and radiological data were analyzed to determine associations. Results: Of the total sample, 106 patients (53%) were male, and the mean age was 44.6 ± 9.3 years. The prevalence of significant fibrosis was 20% (n = 40). Male gender (p = 0.007), age ≥60 years (p = 0.024), and fatty changes in liver ultrasound (p = 0.044) were found to be independent factors for significant fibrosis. Conclusion: the prevalence of significant fibrosis was relatively high among a sample of Omani HBV inactive carriers, with several sociodemographic and clinical risk factors identified. Periodic assessment of liver function is needed for patients with these risk factors; moreover, routine biochemical parameters could be useful predictors of disease prognosis. Further research is recommended to substantiate these findings.

During the postpartum period, psychological disorders may emerge. Aims and objectives: 1 With the current study, we aim to raise awareness among healthcare professionals about postpartum depression (PPD) in women. To reach the aim we will perform the following tasks: (i) identify biological peripartum risk factors and calculate pooled prevalence of PPD for each of them; (ii) explore the strength of relationship between peripartum risk factors and PPD; (iii) rank the predictors by their prevalence and magnitude of association with PPD. The knowledge obtained will support the development and implementation of early diagnostic and preventive strategies. Methods and analysis: we will systematically go through peer-reviewed publications available in the PubMed search engine and online databases: Scopus, Web of Science, EMBASE. The scope of the review will include articles published any time in English, Arabic, or Polish. We will deduplicate literature sources with the Covidence software, evaluate heterogeneity between the study results, and critically assess credibility of selected articles with the Joanna Briggs Institute’s bias evaluation tool. The information to extract is incidence rate, prevalence, and odds ratio between each risk factor and PPD. A comprehensive analysis of the extracted data will allow us to achive the objectives. The study findings will contribute to risk stratification and more effective management of PPD in women.

This literature review was aimed to identifying the opportunistic bacterial pathogens that can be transmitted by contaminated food and represent a current threat for patients particularly suscep-tible to infections because of underlying conditions or predisposing factors. The analysis was focused on recent case or outbreak reports, and systematic reviews published in years 2019 - 2023 and resulted in sorting 24 bacterial groups comprising genera or species able to cause a variety of systemic or invasive infections if ingested with food or drinking water. These included both bacteria known to cause mild infections in immunocompetent persons and bacteria considered innocuous that are used in food fermentation or as probiotics. No recent cases from dietary routes were reported for bacteria of critical importance as nosocomial pathogens and widely occurring in food products, primarily, Acinetobacter baumanii and Klebsiella pneumoniae. However, the very first sources of their introduction in the clinical environment still need to be estab-lished. In many instances, risky dietary habits such as eating raw fish, seafood, raw meat, unpasteurized milk and derived products or the lack of control on fermentation processes led to the reported illnesses, pointing out to the necessity to improve the hygiene of production and consumer’s awareness of risks.

Background: Patients with chronic obstructive pulmonary disease (COPD) often suffer from acute exacerbations. Our objective was to describe recurrent exacerbations in a GP based Swiss COPD cohort, and develop a statistical model for predicting exacerbation. Methods: In a questionnaire-based COPD cohort, demographic and medical data were recorded for 24 months. Data set was split into training (75%) and validation (25%) datasets. A negative binomial regression model was developed using the training dataset to predict the exacerbation rate within 1 year. An exacerbation prediction model was developed, and the overall performance was validated. A nomogram was created to facilitate the clinical use of the model. Results: Of the 229 COPD patients analyzed, 77% of patients had no exacerbation during the follow-up. The best subset in the training dataset found that lower forced expiratory volume, high scores on the MRC dyspnoea scale, exacerbation history, being on combination therapy of LABA+ICS or LAMA+LABA at baseline were associated with a higher rate of exacerbation. When validated, the area-under-curve (AUC) was 0.75 for one or more exacerbations. Calibration was accurate (predicted 0.34 exacerbations vs observed 0.28 exacerbations). Conclusion: Nomograms built from these models can assist clinicians in the decision-making process of their COPD care.

Background: Myocardial infarction (MI) is a major cause of mortality worldwide. Its presentation as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) is influence by atherosclerosis risk factors. Aim: To assess the patterns of presentation and predicting risk factors of acute MI in Kosovo. Methods: This is a cross sectional study from the Clinic of Cardiology of the University Clinical Center of Kosovo, which included all patients hospitalized with acute MI over a period of 7 years (January 1st, 2014 to December 31st, 2020). Data was collected using a structured questionnaire and epidemiological patterns and risk factors were analyzed. Results: Among 7353 patients admitted with acute MI (age 63 ± 12 years, 29% female), 4366 (59.4%) patients had STEMI, and 2987 (40.6%) NSTEMI. Patients age was not different between the two groups (p=0.077). NSTEMI patients smoked less (48.3% vs. 54%, p<0.001), but were more diabetics (37.8% vs. 33.6%, p<0.001), more hypertensives (69.6% vs. 63%, p<0.001), frequently had family history for coronary artery disease (CAD) (40% vs 38%, p=0.009), and included more females compared to STEMI patients (32% vs 27%, p<0.001). The two groups of patients, did not differ in the prevalence of significant CAD on angiography (66.8% vs. 67.8%, p = 0.396), but NSTEMI patients underwent less primary percutaneous interventions compared with STEMI patients (43.6% vs. 55.2%, p < 0.001). Conclusion: In Kosovo, STEMI is commoner than NSTEMI, who were mostly males, more likely to have diabetes, hypertension and family history for CAD compared to those with NSTEMI. Smoking and arterial hypertension proved the strongest predictors of acute MI, in Kosovo, thus highlighting the urgent need for better atherosclerosis risk control and education strategy.

: Aim: The aim in this study was to conduct a prospective survey regarding the sociodemographics and lifestyle risk factors for cancer of a population of Caribbean immigrants living in the U.S. Materials and Methods: The data were processed and analysed using SPSS software 27 and Excel. Crosstabulations were performed. The chi-square test was used to evaluate different hypotheses. Statistical significance was defined as p &lt; 0.05. Results: Statistically significant differences in the country of birth of the Caribbean immigrants were found for sex (p = 0.038) and the cleanness of their neighbourhoods (p = 0.045). We found differences in occupations between men and women (p = 0.001). Men were less unemployed than women (p = 0.011). Sex also showed statistically significant differences in how easily the immigrants balanced their work and personal life (p = 0.044). Age groups depicted differences in the physical health of the immigrants (p = 0.001). The use of alcohol and tobacco was not an important risk factor among participants (p = 0.529). Conclusions: These findings suggest that the sociodemographics risk factors for cancer among a population of Caribbean immigrants were significantly different between the sexes. However, the use of tobacco and alcohol showed insignificant differences among the immigrants.

Sustainability is a characteristic manifested in the ability to maintain the necessary level of performance for construction companies when risk factors arise during the implementation of investment and construction projects. The risk factors that arise during the implementation of in-vestment and construction projects differ in nature, degree of influence, and other characteristics. Ignoring these factors and measures to manage them often leads to critical consequences in the form of disruptions in the timing of work. Risk is a combination of the probability and consequences of the occurrence of adverse events. The article considers the concept of risk as a potential possibility of occurrence of adverse situations and related consequences when exposed to these factors. Risk factors are characterized by surprise, discreteness of changes, the presence of threshold values, upon reaching which a transition to a different mode of operation is required. The article discusses the risk factors arising at the construction stage, their classification. A methodology has been developed that includes conducting a survey in the form of a questionnaire in order to collect information about risk factors that affect the implementation of investment and construction projects. Experts with experience in the construction sector were involved in the survey. The processing of the survey results made it possible to assess the significance of various risk factors in investment and construction projects. Thus, statistical and expert methods were used in the study. The results showed that financial, technical, legal, economic, managerial and natural factors have the greatest impact on investment and construction projects. It is recommended to pay special attention to the listed factors when developing measures aimed at preventing risks and their consequences. The methodology described in the study can be used by construction companies in strategic planning. The analysis of the stability of construction companies, depending on their use of various ways to counteract risk factors, allowed us to develop a number of practical recommendations to reduce the impact of the studied factors on achieving the goals of investment and construction projects.

BRICS-Plus (Brazil, Russia, India, China, South Africa, and 30 other countries) is a group of 35 countries with emerging economies making up more than half of the world’s population. We explored epidemiological trends of cardiovascular disease (CVD) mortality attributable to modifiable risk factors and its association with period and birth cohort effects and sociodemographic index (SDI) across BRICS-Plus by using joinpoint regression and age-period-cohort (APC) modeling from 1990 to 2019. Between 1990 and 2019, the all-ages CVD deaths increased by 85.2% (6.1 million to 11.3 million) across BRICS-Plus. The CVD ASMR attributable to dietary risks and smoking significantly decreased across BRIC-Plus countries, with some exceptions. However, four-fifth of BRIC-Plus countries observed a remarkable increasing trend of high body mass-index (BMI)-related CVD deaths in particular among younger adults (25-49 years). Early birth cohorts and individuals aged greater than 50 years showed a higher risk of CVD mortality. Both China-ASEAN FTA and Mercosur regions stand out for their successful sociodemographic transition, with a significant reduction in CVD mortality over the study period. Singapore and Brazil achieved great progress in CVD mortality reduction and the other BRICS-Plus countries should follow their lead in adopting public health policies and initiatives into practice.

We explored the trends and the diversity of the mortality and risk factors of age-standardized cardiovascular diseases (CVD) and cerebrovascular disease (CBD) from 2000 to 2020 in five advanced Asian countries, including China, Japan, Singapore, South Korea, and Taiwan. Data were obtained from the Global Burden of Disease (GBD) report. Overall, the CVD mortality rates decreased gradually in all five Asian countries. Singapore had the highest rates before 2011, but Taiwan replaced Singapore as the nation of the highest mortality rates after 2012. Additionally, South Korea had the highest CBD mortality rates before 2016, while Taiwan experienced a peak in 2011 and remained high thereafter. The absolute difference (AD) and relative difference (RD) for CVD mortality rates showed clear declining trends in all five countries, with South Korea and China displaying the highest reductions, respectively. It is noteworthy that overweight and obesity exhibited an increasing trend in all these five Asian countries, with China demonstrating the highest AD and RD. Except for Taiwan, where a negative association of r=-0.732 was observed, CVD mortality was positively associated with CBD, hypertension, and DM mortality in all other four countries, therefore, further investigation into these relationships are needed.

Background: Malaria remains a serious public health concern worldwide, particularly in tropical and subtropical regions, and the leading causes of mortality and morbidity in children especially among those aged under five in developing countries. Malaria can be fatal if not promptly and accurately diagnosed, especially in children.This study was carried out to determine the level of malaria infection and its associated risk factors among febrile children.Methods: Blood samples were collected and analyzed from two- hundred (200) systematically selected febrile children aged 1-10 years old. assay of samples collected were carried out using standard methods.data were collected using a pretested structured questionnaire. Results: Results obtained from study subjects shows that, of the eighty-seven (87) infected subjects, 34 (39.1%) were aged 1-5 years, while 52 (59.8%) were within the range of 6 years and above.severity of infection showed 48 (55.2%) with scanty parasitic infection while 25 (28.7%) showed moderate infection, and 13 (14.9%) showed heavy infection.The association of age and level of parasitemia showed that 34 (58.8% ) subjects below 5 years, recorded scanty malaria compared to 14.7% with severe malaria within the age range.Considering gender, of the 33 infected female subjects, 45.5% had scanty malaria, 36.4% showed moderate malaria, while 18.2% had severe malaria, compared to the males subjects.Conclusion: This study reveals the prevalence of malaria infection with some level of severity among children at our study location.The need for prompt diagnosis and improved access to all malaria interventions becomes relevant,with a special focus on the high risk group.

Since 2012, the northeast of Tunisia has been experiencing an emergence of dog rabies. Published data revealed that the disease is widespread in the north of Tunisia. Even with studies on rabies, lacking knowledge on the associated risk factors was highlighted. Therefore, we conducted a case-control study on dog rabies in northeast Tunisia to identify potential risk factors for dog rabies occurrence. The cases group (n=77) included positive dog rabies confirmed at the referral laboratory using Fluorescent Antibody Test (FAT) in 2014 and 2018. The controls group (n=77) involved all negative cases received at the laboratory and 15-days quarantine dogs that received a certificate of absence of rabies after the observation period. Univariate and multivariate logistic regression was conducted to explore the risk factors (age, sex, breed, confinement, vaccination status, presence of bites, owned or not and origin of dogs, sector, presence of rabies cases, and slaughterhouses, etc.…) related to the occurrence of rabies. The final logistic regression model revealed that unconfined dogs were almost twice as likely to be affected as confined dogs (OR=1.9; 95% CI: 1.17 to 3.27). The odds of rabies occurrence were 25 times higher in areas where rabies cases have been reported between 3 months and 1 year compared to the uninfected areas (25.7; 95% CI: 3.02-219.14). Similarly, the risk of rabies is significantly higher in dogs born in the home to the owner bitch (OR=2.41; 95% CI: 1.14-5.13). Living in areas with rabies cases in the last three months increases by 2.8 times the risk of getting rabies (2.8; 95% CI: 1.16-6.77). However, vaccination reduces by 1.6 times the risk of contracting rabies (0.6; 95% CI: 0.38-0.97). Our findings provide reliable data on dog rabies that will be very useful for decision-makers and could contribute to improving the ongoing national control program of rabies.

Human Adenovirus (HAdV) infection occurs in 14-16% of patients in the early months after pediatric hematopoietic cell transplantation (HCT) and this correlates with a higher risk to develop HAdV disease and overall 6-month mortality. The main risk factors for HAdV infection are T-cell depletion of the graft by ex vivo CD34+ selection or in vivo use of alemtuzumab or anti-thymocyte serum, the development of grade III-IV graft versus host disease (GVHD), the type of donor (unrelated donor, cord blood, haploidentical or HLA mismatched parent) and severe lymphopenia (< 0.2 x 109/L). The prevention of HAdV disease is based on early intervention with antivirals in the asymptomatic patient when the permitted viral load threshold on blood (> 102-3 copies/ml) and/or on the stool (109 copies/g stool) is exceeded. Cidofovir, a monophosphate nucleotide analog of cytosine, is the primary drug for preemptive therapy, used at 5 mg/kg/week for 2 weeks followed by 3-5 mg/kg every 2 weeks. The alternative schedule is 1 mg/kg every other day (three times/week). Enhancing virus-specific T-cell immunity in the first months post-HCT by donor-derived or third-party-derived virus-specific T cells represents an innovative and promising way of intervention applicable both in prevention and therapeutic setting.

In West Africa, research on the hepatitis E virus (HEV) is barely covered despite the recorded outbreaks. The still low level of access to safe water and adequate sanitation is one of the main factors of HEV spread in developing countries. HEV infection induces acute or sub-clinical liver diseases with a mortality rate ranging from 0.5 to 4%. The mortality rate is more alarming (15 to 25%) among pregnant women, especially in the last trimester of pregnancy. Here, we conducted a multicentric socio-demographic and seroepidemiological survey of HEV in Senegal among pregnant women. A total of 1,227 consenting participants attending antenatal clinics responded to our questionnaire. Plasma samples were collected and tested for anti-HEV IgM and IgG by using the WANTAI HEV-IgM and IgG ELISA assay. HEV global seroprevalence was 7.9% with 0.5% and 7.4% for HEV IgM and HEV IgG, respectively. One participant's sample was IgM/IgG positive, while four were declared indeterminate to anti-HEV IgM as per the manufacturer's instructions. From one locality to another, the seroprevalence of HEV antibodies varied from 0 to 1% for HEV IgM and from 1.5 to 10.5% for HEV IgG. The data also showed that seroprevalence varied significantly by marital status (p&lt;0.0001), by the regularity of income (p=0.0043) and by access to sanitation services (p=0.0006). These data could serve as a basis to setup national prevention strategies focused on socio-cultural, environmental and behavioral aspects for a better management of HEV infection in Senegal.

Cardiorespiratory fitness (CRF) is a strong independent predictor of morbidity and mortality. However, there is no recent information about the impact of CRF on cardiometabolic risk specifically in Central and Eastern Europe, which are characterized by different biological and social determinants of health. Normative CRF values were proposed and the association between CRF and cardiometabolic outcomes was evaluated in an adult Czechian population. In 2054 participants (54.6 % females, median 48 years), the CRF was predicted from a non-exercise equation. Multivariable-adjusted logistic regressions were carried out to determine the associations. Higher CRF quartiles were associated with lower prevalence of hypertension, type 2 diabetes (T2D) and dyslipidaemia. Comparing subjects within the lowest CRF, those within the highest CRF had decreased chances of hypertension (odds ratio [OR] = 0.36; 95% CI: 0.22-0.60); T2D (OR=0.16; 95% CI 0.05-0.47), low HDL-c (OR=0.32; 95% CI 0.17-0.60), high low-density lipoprotein (OR=0.33; 95% CI 0.21-0.53), high triglycerides (OR=0.13; 95 CI 0.07-0.81), and high cholesterol (OR=0.44; 95% CI 0.29-0.69). There was an inverse association between CRF and cardiometabolic outcomes, supporting the adoption of a non-exercise method to estimate CRF of the Czech population. Therefore, more accurate cardiometabolic studies can be performed incorporating the valuable CRF metric.

The COVID-19 pandemic affected the whole world, but not all countries were impacted equally. This opens the question of what factors can explain the initial faster spread in some countries compared to others. Many such factors are overshadowed by the effect of the countermeasures, so we studied the early phases of the infection when countermeasures have not yet taken place. We collected the most diverse dataset of potentially relevant factors and infection metrics to date for this task. Using it, we show the importance of different factors and factor categories as determined by both statistical methods and machine learning (ML) feature selection (FS) approaches. Factors related to culture (e.g., individualism, openness), development, and travel proved the most important. A more thorough factor analysis was then made using a novel rule discovery algorithm. We also show how interconnected these factors are and caution against relying on ML analysis in isolation. Importantly, we explore potential pitfalls found in the methodology of similar work and demonstrate their impact on COVID-19 data analysis. Our best models using the decision tree classifier can predict the infection class with roughly 80% accuracy.

The cause and prevention of recurrent aphthous stomatitis (also called aphthous ulcers or canker sores) are still unknown. This may be due in part to ignorance of the risk factors present in susceptible people. In this systematic review (PROSPERO record #CRD42019122214), we show that most of the risk factors for the disease are single nucleotide genetic polymorphisms in genes related to the functioning of immune system (TLR4, MMP9, E-selectin, IL-1 beta and TNF-alpha). Single nucleotide genetic polymorphisms do not constitute a modifiable risk. This indicates that, at least in part, susceptibility to recurrent aphthous stomatitis is hereditary, and that these factors cannot be modified.

Disease related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analyzed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical patients. In 59126 medical patients included between 2006-2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. Nutrition care processes increases slightly with presence of risk factors but never done in more than 50% of patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.

Nowadays, environmental circumstances and business rules of organizations are complicate, active and uncertain, so, they cannot assurance their long- term survival through some actions such as, structural changes and methods or relying on creativity of some people in organization. Companies and organizations should prepare conditions to institutionalize entrepreneurial culture in their organization. Corporate entrepreneurship can improve the value of the organization. The entrepreneurial oriented organizations are more responsive for environment and market changes. Opportunity recognition is the base of being successful. The research is applied and in terms of method is descriptive. Data were analyzed, using Linear Regression and Multiple Moderated Regression (MMR) and SPSS software. In this research the effects of organizational entrepreneurship (innovation, proactiveness and risk-taking) on performance of the centers influenced by environmental factors (government’s strategies, competitiveness and technology) as moderating variables, were studied. Furthermore, the study presents that there is a significant positive relationship between organizational entrepreneurship and performance. Although the study does not show any significant moderating effect of environmental factors (Government’s strategies, competitiveness and technology) on the relationship between organizational entrepreneurship and performance, however, the result of the study manifests direct relationship between environmental factors and performance of such centers.

The purpose of the present study was to determine the relationship between healthy lifestyle behaviors, physical fitness and coronary risk factors in university students. 320 male and female (n_m:171; n_f:149) students from a university participated in this study voluntarily. For the determination of body composition and Body Mass Indexes (BMI), subjects’ height, body weight, and skinfold thickness were taken and body fat percentage (%Fat) was determined. Healthy lifestyle behaviors were determined using the healthy lifestyle behaviors questionnaire. Indicators of physical fitness included flexibility (sit-up) (F), muscle strength and endurance (isometric knee (KS), back strength (BS) and a total of shuttle (TS), sprint performance, BMI, and body fat percentage (%fat). Coronary heart disease risk factors included mean arterial blood pressure (systolic (SBP) and diastolic (DBP)), fasting blood levels of triglycerides (TG), total cholesterol (TC), hematocrit (HT), and hemoglobin (HM). Results indicated subjects have normal body mass index, body fat percentage, SBP, DBP, TG, TCF, BS, KS. The results of the Pearson Product Moment Correlation Analysis, indicated that SBP, DBP, TG, TCF, BS, KS for male and female was significantly correlated with flexibility (sit-up) (F), muscle strength and endurance (isometric knee (KS), back strength (BS) and total of shuttle (TS)), sprint performance. (p<0.01; p<0.05), In conclusion, the findings of the present study indicated that physical fitness and healthy lifestyle behaviors play a determinant role in coronary heart disease risk factors for male and female students from a university.

This article offers a theoretical framework to contextualise the concept of "Safety Culture" in the field of public safety and Disaster Risk Reduction (DRR), with the aim of supporting its understanding and measurement in our communities and finally attaining more disaster resilient societies. The work discusses the role of cultural dimensions in risk management and DRR and highlights the relevance of building knowledge and practices based on the consideration of culture and cultural variability in all phases of the risk management process. After an overview of the Safety Culture concept, including its origins, developments and applications, the text explores the transferability of this concept to the context of public safety. Then, based on the existing Safety Culture models, metrics and indicators from other sectors, the paper proposes an original definition of Safety Culture for the DRR context, shaped on a series of elements and dimensions specifically outlined for this context. Finally, the expected benefits of the application of Safety Culture concepts and techniques for further advances in DRR is discussed.

Introduction. This retrospective study aimed to compare the risk factors for vascular calcification (VC) between pre-hemodialysis (HD) and prevalent HD adult patients while investigating associations with calcification biomarkers. Methods. Baseline data from 30 pre-HD and 85 HD patients were analyzed, including iPTH, vitamin D, FGF23, fetuinA, sclerostin, and VC scores (Adragao method). Multivariable linear regression identified VC predictors. Results: The prevalence of VC was similar in both groups, but HD patients had more pronounced VC scores ≥6. Pre-HD patients were older, with higher prevalence of Balkan endemic nephropathy, hypertension, and less frequent use of calcium phosphate binders. Both groups exhibited similar patterns of hyperphosphatemia, low vitamin D, and iPTH levels. In HD group normal phosphate was significantly common in patients with VC, whereas hyperphosphatemia was significantly common in patients without VC. Fetuin-A levels were higher in pre-HD patients, while FGF23 was elevated in HD patients. In pre-HD patients, male gender was associated with reduced VC risk, while in HD patients, malignancies and serum phosphate levels were negative VC predictors. Conclusion: Effective monitoring and tailored treatment of VC in CKD are still focused on phosphate regulation. Besides, mineral disturbances, hormones and biomarkers regulation, and patient-specific variables need to be considered.