Public Health and Healthcare

Abstract: Background/Objectives: Paediatric oral health during primary school years profoundly impacts systemic development and psychosocial wellbeing, with parental health habits heavily dictating whether care follows a preventive or a reactive pathway. The aim of this study was to evaluate parent-reported oral health status, oral hygiene habits, and dietary patterns in primary schoolchildren, as well as parental awareness regarding the impact of oral health on children’s overall wellbeing across preventive and reactive care pathways. Methods: A cross-sectional study was conducted, administering an online questionnaire to 1889 parents of primary schoolchildren, which evaluated the parent’s knowledge, behaviors and attitudes regarding the oral health and diet of their children. Results: Parent-perceived child oral and gum health was overall favorable, with girls (p<0.01) and children of parents with higher educational background (p<0.001) receiving higher ratings. While toothbrushing with fluoridated toothpaste was widely reported, fluoride usage and dental flossing remained heavily stratified by socio-demographic factors (p<0.001). The consumption of fruits, sweet bakeries and cariogenic snacks was frequent and soft drink intake demonstrated an age-dependent increase (p=0.001). Dental pain was rarely reported; increased pain frequency was correlated with poorer parent-perceived oral health ratings and cariogenic diets (p<0.001). Child dental visits were predominantly low or reactive, with non-attendance and pain-triggered visits significantly linked to rural residence, lower parental academic attainment, poor brushing frequency and cariogenic diets, which affected the children’s quality of life (p<0.001). Conclusions: Schoolchildren’s oral healthcare remains largely reactive, with dental pain serving as the primary trigger for dental service utilization, despite generally favorable parental perceptions.

Abstract: Background: Early childhood caries (ECC) remains a major public health concern and is influenced by interactions among children, environmental, and dental care factors. Purpose: This study aimed to determine the prevalence of dental caries and identify factors associated with dental caries among preschool children in Nakhon Si Thammarat Province. Methods: A cross-sectional correlational study was conducted among 435 preschool children aged 3–5 years and their primary caregivers in Nakhon Si Thammarat Province, Thailand. Data were collected using oral health examinations and structured questionnaires completed by caregivers. The questionnaires assessed demographic characteristics, caregivers' oral health attitudes and practices, and access to and utilization of dental services. Data was analyzed using descriptive statistics, chi-square tests, and binary logistic regression. Results: The prevalence of dental caries was 52.6%, and 55.6% of children had poor oral hygiene. The factors associated with dental caries included bottle-feeding, frequency and duration of toothbrushing, having a toothbrushing assistant at home, caregiver education level, attitude, caregivers’ oral health care behaviors for children, and visiting the dentist for toothaches, check-ups, and fluoride application (p < 0.01). Binary logistic regression confirmed that caregivers' oral health care practices were most strongly associated with dental caries. Children whose caregivers had low-to-moderate oral health care practices were 7.11 times more likely to have dental caries than those whose caregivers had high oral health care practices (AOR = 7.11; 95% CI: 4.11-12.32; p<0.001). And factors associated with dental caries included caregiver education below a bachelor's degree (AOR = 2.64; 95% CI: 1.64-4.23; p < 0.001), toothbrushing once daily (AOR = 2.20; 95% CI: 1.07-4.52; p < 0.05), and never/sometimes visiting a dentist only when experiencing toothache (AOR = 2.26; 95% CI: 1.36-3.74; p < 0.01). Conclusions: Dental caries remains highly prevalent among preschool children in southern Thailand. Caregiver oral health care was a strong predictor of dental caries. Oral health promotion programs should strengthen caregivers' practical skills in oral health care and encourage regular preventive dental care by collaborating among families and primary healthcare providers.

Abstract: Background. Dyspareunia is persistent or recurrent pain or discomfort before, during, or after sexual intercourse. Most studies identify provoked localized vulvodynia (PLV) as a principal cause. In this prospective study, however, central introital dyspareunia (CID) was the most frequent cause of introital dyspareunia. Moreover, 70% of cases had multiple concomitant causes, indicating that appropriate management requires a thorough, systematic diagnostic evaluation. Methods. We conducted a descriptive analysis of the differential diagnoses among women presenting with painful intercourse over a 1-year period. All new patients presenting with dyspareunia between October 2019 and November 2020 to clinics for lower genital tract pathology at Femicare and the Regional Hospital of Tienen (Tienen, Belgium) or University Hospital Antwerp (Antwerp, Belgium) were invited to participate. For consenting patients, the physician completed a questionnaire covering demographic characteristics, obstetric history, and the type and severity of pain. A systematic clinical examination, including office microscopy of vaginal fluid, was performed and yielded one or more diagnoses. Six months after a tailored treatment was proposed, participants were invited to complete an online questionnaire about treatment satisfaction. Results. During the 1-year study period, 210 new patients presenting with dyspareunia were included. Participants were 15-73 years old (mean, 37.2 years) and had experienced dyspareunia for a mean of 3.2 years before referral (range, 1 month-20 years). Two-thirds (68.1%) had secondary dyspareunia. Pain was reported most frequently during initial penetration (89.3%), after sexual intercourse (e.g., during urination; 68.9%), or during coital movement (59.7%). Identified causes included severe lateral vulvodynia (29.5%), severe central pain (65.7%), increased pelvic floor muscle tone (37.6%), vulvovaginal infections (28.2%), vaginal atrophy (29.0%), dermatoses (9.5%), scar-related problems (4.3%), and less frequent conditions (rectocele, vaginal septum, or fecal soiling). A single disorder was identified in 24.8% of participants, whereas 70.0% had at least two contributing disorders. At 6 months after treatment, 67 of 78 women (85.9%) reported improved quality of life, and 15 of 78 (19.2%) reported complete resolution of dyspareunia. Conclusions. Dyspareunia is a common medical complaint. Although localized provoked vulvodynia is often presumed to be the principal cause, our findings indicate that central introital dyspareunia is more frequent, affecting approximately two-thirds of patients. Furthermore, the condition was multifactorial in up to 70% of cases. A comprehensive examination is therefore needed to identify the potentially diverse causes before treatment is proposed.

Abstract: Background and aims According to the World Health Organization chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and the seventh leading cause of poor health worldwide. Our aim was to evaluate the effectiveness of COPD screening strategy in Romanian primary care, comparing the diagnostic utility of the COPD Assessment Test (CAT) and the Modified Medical Research Council (mMRC) dyspnea scale and post-bronchodilator (post-BD) spirometry. Methods A cross-sectional screening study was conducted among 220 consecutive patients aged over 40 years. The study enrolled patients from the General Practitioner (GP) office. Demographics, clinical history, tobacco exposure, and validated screening questionnaires (CAT and mMRC) were recorded. All participants underwent diagnostic post-BD spirometry. Airflow limitation was defined as a post-BD FEV₁/FVC < 0.70. Results Spirometry confirmed a positive COPD diagnosis in 48.2% (n = 106) of the screened cohort. Severity staging revealed that 34.9% met criteria for GOLD 1, 49.1% for GOLD 2, 15.1% for GOLD 3, and 0.9% for GOLD 4. Smoking history (p < 0.001) was significantly higher in the COPD group. While the mMRC scale at a cut-off of ≥ 2 demonstrated excellent diagnostic specificity (82.5%) the CAT score ≥ 17 had 64.2% sensitivity and 74.8% specificity. Discussion The findings of this screening shows the clinical utility of primary care screening questionnaires. A comprehensive evaluation of symptoms—incorporating cough, sputum production, and sleep impact—provides a much more reliable clinical trigger for diagnostic spirometry than dyspnea alone. Conclusion A targeted screening protocol utilizing CAT score (≥ 17) has high diagnostic utility in Romanian primary care. Screening algorithms in primary care should be focused on individuals over 40 who present with a CAT score ≥ 17, or a tobacco history exceeding 20 pack-years.

Abstract: Evidence on how organizational and technological factors jointly influence patient safety performance in community health centers remains limited in emerging health systems. Studies of digital transformation in primary care often emphasize technology adoption while underestimating leadership, culture, and contextual constraints. A sequential mixed-methods study was conducted across all 18 community health centers in one Indonesian district. Healthcare professionals completed structured surveys, which were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to examine relationships among organizational technology preparedness, perceived clinical value of EMR, healthcare technology self-efficacy, innovation-supportive leadership, organizational culture-driven orientation, teamwork climate, and perceived patient safety performance. Follow-up interviews contextualized the quantitative findings. Innovation supportive leadership emerged as the strongest predictor of organizational culture and teamwork climate (p < 0.001). Organizational culture significantly influenced teamwork climate and patient safety performance, and teamwork climate positively affected safety outcomes. The perceived clinical value of EMR did not directly improve teamwork climate. Resource constraints weakened the effect of organizational culture on patient safety. Patient safety in community health centers is driven more by leadership and organizational culture than by perceived technological value alone, underscoring the need for integrated organizational and digital strategies in emerging primary care systems. Keywords: Digital health preparedness; electronic medical records; patient safety performance; community health centers; emerging health system.

Abstract: Background: Continuous glucose monitoring (CGM) has been increasingly adopted for the management of type 2 diabetes mellitus (T2DM); however, real‑world comparative evidence from the United Arab Emirates comparing CGM with self‑monitoring of blood glucose (SMBG) remains limited and inconclusive, making definitive conclusions difficult. Aim: To compare glycaemic control and quality-of-life outcomes between adults with T2DM using CGM and those using SMBG in Dibba Fujairah, UAE. Methods: A quantitative, comparative observational study was conducted using clinical records from 416 adults with T2DM (204 CGM users and 212 SMBG users). Glycaemic control was assessed using baseline and follow-up glycated hemoglobin (HbA1c) values, and quality of life was assessed using a single‑item, self‑reported scale ranging from 1 to 10, as recorded in patient medical records. Results: CGM users were significantly younger than SMBG users (M = 48.63 vs. 54.73 years; p < .001) and had a shorter duration of diabetes (M = 9.09 vs. 14.65 years; p <.001). Baseline HbA1c was significantly higher in the CGM group (M = 9.61% vs. 8.01%; t (334.9) = 5.21, p < .001, d = 0.52). No statistically significant between-group differences were observed in single-item quality-of-life scores at baseline (p = .142) or follow-up (p = .605). Multiple linear regression predicting baseline HbA1c was statistically significant (R² = .622), with CGM use, gender, and baseline quality of life emerging as significant predictors. Conclusion: CGM was associated with differential glycaemic profiles and superior statistical performance in glycaemic outcomes; however, quality-of-life advantages were not observed on the single-item measure. Evidence of Channeling bias, which is when patients are preferentially assigned to a regimen based on their characteristics rather than at random, which can skew real‑world comparisons between treatments. Underscores the importance of cautious interpretation when evaluating real-world CGM effectiveness.

Abstract: Population aging increases the demand for home-based dental care, but access remains limited for older adults who are homebound. Although teledentistry is a strategy for overcoming mobility barriers, its feasibility within the routine of Primary Health Care (PHC) requires further investigation. This pragmatic pilot trial evaluated a teledentistry protocol for monitoring homebound older adults. Six homebound older adults in the Brazilian PHC system were assigned to receive either weekly remote monitoring via a telehealth platform or conventional home visits over a three-week period. Feasibility was assessed using the Acceptability, Adequacy, and Feasibility measures of the intervention (scale 1 to 5), along with diagnostic instruments (OFI-8, OHIP-14, Kihon Checklist). Teledentistry demonstrated moderate adequacy (3.5) and feasibility (3.3). However, acceptability was lower (3.0) due to severe digital literacy barriers that required caregiver mediation. Remote data collection proved technically stable, and the OFI-8 effectively tracked functional decline. In contrast, the intervention group showed a worsening of OHIP-14 scores, reflecting a likely increase in awareness of unmet needs without immediate physical relief. In conclusion, although continuous remote monitoring is technically feasible and safe, the low digital literacy of the target population suggests that a hybrid model—combining teledentistry with targeted in-person visits—appears to be more equitable.

Abstract: Background/Objectives: Plain radiography is the first-line imaging modality for acute foot and ankle trauma; however, computed tomography (CT) may provide additional information in selected patients with persistent clinical suspicion, equivocal radiographic findings, or a need for detailed fracture characterization. We hypothesized that CT positivity would be higher among patients with suspicious radiographs than among those with normal radiographs and that CT would identify additional fractures in a clinically selected cohort. Methods: This retrospective single-center selected-cohort study included 1000 adult patients with isolated foot and/or ankle trauma who underwent both plain radiography and CT during the same clinical encounter. Plain radiographs were categorized as normal, suspicious for fracture, or definite fracture on the basis of original radiology reports and available imaging records. CT positivity was defined as the presence of an acute fracture on CT. Analyses focused primarily on CT positivity rates and conditional diagnostic yield within the selected CT cohort. Conditional apparent diagnostic performance was evaluated as a supplementary sensitivity analysis and was not intended to estimate population-level diagnostic accuracy. Results: Plain radiographs were categorized as normal in 628 patients, suspicious in 283, and definite fracture in 89. CT detected acute fractures in 386 patients (38.6%). CT positivity rates were 14.8% in the normal radiograph group, 72.1% in the suspicious radiograph group, and 100.0% in the definite fracture group. The proportion of patients without a definite fracture on plain radiography but with an acute fracture on CT was 29.7%. Fracture-pattern classification was unavailable in 85 of 386 CT-positive cases (22.0%); therefore, fracture-pattern analyses were considered exploratory. Conclusions: In this selected CT cohort, CT identified additional acute fractures in a subset of adult isolated foot and ankle trauma cases that could not be definitively classified as fractures on plain radiography. Because CT was not systematically performed in all trauma patients, the findings represent selected-cohort CT yield rather than true population-level diagnostic accuracy.

Abstract: In the last two decades, there have been remarkable advances in the diagnosis and treatment of lung cancer, resulting in improved quality of life and increased survival. Despite that, lung cancer remains the leading cause of cancer death worldwide. The diagnosis, staging and management of lung cancer are dictated by guidelines that constitute a clear path for patients. However, the emotional and psychological challenges faced by patients with lung cancer may be overlooked and can affect the well-being of these patients. This can also negatively impact the patient adherence to therapy and the ultimate patient outcomes. In this article, we address the emotional and psychological manifestations in patients who are diagnosed with lung cancer. We highlight the importance of recognizing these symptoms early to ensure they are managed alongside the stressful and challenging lung cancer therapy, with the goal of improving the patients’ quality of life and general outcome.

Abstract: Multiple Chemical Sensitivity (MCS) is a chronic condition characterized by adverse reactions on exposure to low-level environmental chemical exposures, often resulting in multisystem symptoms triggered by substances such as volatile organic compounds (VOCs) from fragranced personal and household products. The condition emerges as public health and accessibility issues, as people with MCS may face barriers to accessing workplaces, healthcare settings, educational institutions, and other public environments. This study aims to describe the chemical exposures associated with the onset of the condition (sensitization) and subsequent symptom provocation in MCS, and to characterize symptom patterns and links with known transient receptor potential (TRP) receptor sensitization models. A cross-sectional survey was administered to Canadian residents aged 18 years or older, living with MCS for at least 1 year, with 18 questions assessing exposure history and associations with onset of MCS and symptom provocation. A total of 119 participants completed the survey. Condition onset often occurred at home (35%) and/or in the workplace (55%), following ongoing exposures (61%). Scents, such as perfumes and/or essential oils, including scented air fresheners, cleaning products, construction materials, disinfectants, and laundry products, were associated with both onset and subsequent symptom triggering. Symptoms involved multiple organ systems, with nearly one-third of participants reporting 11 or more symptoms. Cognitive and respiratory symptoms were most prevalent. Third-hand exposure may represent an underrecognized exposure pathway.

Abstract: Objective To evaluate the real-world effectiveness and tolerability of Iron Hydroxide Adipate Tartrate (IHATTM) in women with iron deficiency across three common obstetric and gynecologic clinical settings: pregnancy, the postpartum period, and abnormal uterine bleeding. Methods This prospective multicenter observational real-world study included women with iron deficiency managed in routine clinical practice across Italy. Participating gynecologists collected data using standardized case report forms. Patients received IHATTM according to routine clinical practice and were followed for approximately three months. Baseline demographic and hematologic parameters were recorded, including hemoglobin and ferritin levels. The primary outcome was the change in hemoglobin between baseline and follow-up. Secondary outcomes included changes in ferritin levels, treatment adherence, and tolerability. Results A total of 517 women was included in the analysis. The study population included pregnant women (N=287, 55.5%), women with abnormal uterine bleeding (N=161, 31.1%), and women in the postpartum period (N=69, 13.3%). Improvements in hemoglobin were observed across all clinical settings with hemoglobin increasing from 10.35 g/dL at baseline to 11.63 g/dL at three months, corresponding to a mean increase of 1.28 g/dL. Mean ferritin levels increased from 22.50 ng/mL to 37.74 ng/mL in three months. Treatment adherence was high or moderate in 93.4% of patients. Gastrointestinal adverse events were infrequent, with constipation (9.7%) and nausea (4.8%) among the most reported. Conclusion In this prospective real-world multicenter study, treatment with IHATTM was associated with meaningful improvements in hemoglobin and iron stores in women with iron deficiency across pregnancy, postpartum, and abnormal uterine bleeding. The treatment showed good adherence and a favorable tolerability profile in routine clinical practice.

Abstract: Background: Table tennis is a fast interceptive sport that requires continuous visual information processing and precise visuomotor control. Wearable eye tracking may provide objective information about ocular behaviour during sport-specific performance, although evidence on blink behaviour and pupil diameter in elite players re-mains limited. Methods: This observational cross-sectional study analysed blink-related and pupil-related variables during a standardized table tennis stroke-performance test in 17 elite male players. Participants completed a 56-ball ro-bot-based protocol, consisting of six familiarization trials followed by 50 analysed forehand topspin strokes. Ocular variables included total blink count, blink frequency, mean pupil diameter, maximum pupil diameter, and minimum pupil diameter. Technical performance outcomes were stroke accuracy and ball velocity. Results: Blink frequency was positively associated with stroke accuracy score (Spearman’s ρ = 0.624, p = 0.010), while total blink count showed a similar but weaker tendency (ρ = 0.496, p = 0.051). No significant associations were observed between blink-related variables and ball velocity. Pupil diameter variables were not significantly associated with either stroke accuracy or ball velocity. Conclusions: Blink behaviour, particularly blink frequency, may provide complementary information about perceptual-cognitive regulation during technical performance in elite table tennis. Further studies are needed to confirm these exploratory findings and analyse blink timing during the stroke sequence.

Abstract: Background/ Objectives: We aimed to identify the clinical efficacy of comprehensive geriatric assessment (CGA) in patients undergoing maintenance hemodialysis. Methods: This retrospective observational study included 433 inpatients aged ≥65 years from October 2024 to September 2025. We categorized patients into dialysis (n = 328) and non-dialysis (n = 105) groups and compared patient characteristics, CGA variables (Tokyo Metropolitan Institute of Gerontology Index of Competence; [TMIG-IC], Hasegawa’s Dementia Scale-Revised; [HDS-R], vitality index, and Geriatric Depression Scale-15; [GDS-15]), and clinical outcomes including length of hospital stay, nursing home admission, and mortality between the two groups of patients. The association between CGA variables and 1-year mortality after discharge was evaluated in inpatients undergoing hemodialysis.Results: Functional decline, as assessed by CGA, was more prominent in patients undergoing hemodialysis than in those not undergoing hemodialysis. Psychological distress was also observed in this population. There were significant associations between mortality and sex, vitality index, and social role scores.Conclusions：CGA is useful for assessing vulnerability and predicting mortality among inpatients undergoing maintenance hemodialysis.

Abstract: Background/Objectives: Patterns or biases in food preferences are thought to influence eating behavior. However, their associations with obesity remain unclear. We aimed to identify obesity-related food preference characteristics in the general population. Methods: We analyzed a nationwide web-based survey of adults in Japan (7,971 men and 7,524 women). Preferences for carbohydrates, fat, protein, and dietary fiber were assessed using the Japan Food Preference Questionnaire (JFPQ). Associations between food preference scores and BMI were evaluated in individuals with a BMI ≥18.5 kg/m². Moreover, food preference scores were compared between individuals with normal weight (BMI 18.5 to <25.0 kg/m²) and those with obesity (BMI ≥25.0 kg/m²), stratified by time since the last meal (<3 vs. ≥3 h). Results: A higher BMI was associated with a greater preference for non-sweet fat and soft drinks and with a lower preference for dietary fiber, particularly vegetables, in both genders. Compared with individuals with normal weight, meal-timing-related differences in food preference scores were less apparent in individuals with obesity, accompanied by higher carbohydrate, fat, and protein preference scores at <3 h after the last meal. Conclusions: Obesity was associated with distinct self-reported food preference patterns that may influence food choices and weight gain. Food preference profiling could be useful for identifying individuals at risk of future obesity and for guiding nutritional counseling in weight management.

Abstract: Background/Objectives: The Mediterranean diet (MedDiet) is a protective nutritional model against cardiometabolic risk, but current sociodemographic changes have favoured the abandonment of this pattern in favour of sedentary behaviours and increasing digitalisation. Screen-related behavioral addictions represent an emerging challenge for public health and nutritional psychiatry. However, scientific evidence on how different digital dependence profiles influence young adults’ diets remains scarce. The aim of this study was to evaluate the relationship between adherence to the Mediterranean diet and various dimensions of problematic screen use (smartphone dependence, compulsive internet use, and problematic experiences with video games) in a sample of young adults. Methods: Observational, descriptive and cross-sectional study conducted in 496 young adults between 18 and 34 years of age enrolled in the EVA-Adic study. Adherence to the MedDiet was assessed using the 14-item MEDAS questionnaire. Digital addictions were determined using three continuously validated psychometric instruments: the EDAS-18 scale (smartphone), the CIUS questionnaire (internet) and the CERV questionnaire (video games), also generating a Global Digital Addiction index. Hierarchical multivariate linear regression models (adjusted for sociodemographic, anthropometric and lifestyle factors) and binary logistic regression models were performed to analyze each component of the MEDAS individually. Results: The mean age of the 496 subjects analyzed was 26.60 ± 4.41 years. 339 subjects had low-moderate adherence (< 9) and 157 high adherence (≥ 9). The mean values of the psychometric scales of digital addiction were: smartphone dependence: 40.87 ± 12.24 points, for compulsive use of the internet: 13.83 ± 9.89 points, for video game dependence: 3.54 ± 5.22 points, and the global digital addiction index: 58.25 ± 21.76 points. In the multivariate linear regression analysis in the total fit model, smartphone dependence (EDAS-18) was inversely associated with the MEDAS score (β = -0.021 {95% CI} [-0.041 -0.003]). Problematic internet use (CIUS) showed a positive association with dietary adherence (β = 0.025 {95% CI} [0.002, 0.049]). Problematic experiences with video games (CERV) and the global digital addiction index did not demonstrate an association. In the logistic regression analysis of each of the components of the MEDAS: each one-point increase on the EDAS-18 scale reduced the probability of meeting the fruit consumption criterion ≥3 pieces/day (OR = 0.980); the criterion of low consumption of sugary beverages or less than one per day (OR = 0.956) and was linked to a higher probability of meeting the criterion of using olive oil as the main cooking fat (OR = 1.026). Compulsive use of the Internet (CIUS): A higher score on the CIUS scale decreased the probability of registering a low consumption of sugary drinks (OR = 0.955); positive association with compliance with olive oil consumption ≥ 4 tablespoons/day (OR = 1.035) and with the consumption of sofrito ≥ 2 times/week (OR = 1.026). Conclusions: The results of this study suggest that digital addictive behaviors are differentially associated with the quality of the Mediterranean diet. Higher smartphone addiction risk was associated with lower adherence to the Mediterranean diet, which may reflect a less healthy behavioral pattern linked to problematic mobile phone use. In contrast, problematic internet use may represent a different profile in relation to dietary habits, possibly influenced by the type of digital use, the context of exposure, or the characteristics of the participants evaluated. These findings reinforce the need to analyze different forms of digital addiction separately, rather than treating them as a homogeneous phenomenon, and suggest that interventions aimed at improving adherence to healthy dietary patterns should include the assessment of digital behavior.

Abstract: Alzheimer’s disease (AD) care is increasingly communication-intensive, requiring sustained caregiver education, symptom monitoring, behavioral management, and coordination across fragmented clinical settings. Large language models (LLMs) can generate, summarize, and adapt natural language at scale, creating opportunities to support dementia care workflows, but they also introduce safety risks that are amplified in cognitively vulnerable populations. We provide a narrative synthesis of emerging applications of LLMs across the AD care continuum, highlight Alzheimer’s-specific safety challenges, and propose pragmatic implementation pathways for responsible clinical translation. LLM use cases cluster into caregiver-facing support, patient-facing conversational agents (high caution), clinician workflow augmentation (highest near-term feasibility), clinical text intelligence for risk prediction (early-stage), and research/education support. Key safety threats include hallucinations, omission of critical information, over-reliance, bias, privacy leakage, and prompt-injection vulnerabilities. Implementation is most defensible using grounded architectures (e.g., retrieval-augmented generation), tiered deployment, human-in-the-loop verification, continuous monitoring, and security testing.

Abstract: Background/Objectives: Ischemic heart disease (IHD) is the leading cause of cardio-vascular death worldwide, and the emergency medical service (EMS) is frequently the first point of contact for affected patients. In Kazakhstan, ambulance crews must de-cide at the scene whether an IHD patient requires emergency hospitalization or can safely be left at home, yet the clinical factors that drive this decision have rarely been quantified. We aimed to identify the demographic, clinical and comorbidity-related predictors of emergency hospitalization among EMS calls for IHD. Materials and Methods: We conducted a retrospective analysis of 9985 consecutive EMS calls for IHD (ICD-10 I20-I25) attended in Astana, Kazakhstan, over a five-year period. The outcome was emergency hospitalization versus being left at the scene. Group compar-isons used the Mann-Whitney U and Pearson chi-square tests, and independent asso-ciations were estimated with an explanatory multivariable logistic regression model reporting adjusted odds ratios (aOR) with 95% confidence intervals. Results: Overall, 2676 calls (26.8%) resulted in hospitalization. The strongest independent predictors were cardiogenic shock (aOR 15.06), acute/unstable IHD versus chronic I25 (aOR 8.52) and heart failure (aOR 2.46). Other arrhythmias (aOR 1.84), atrial fibrillation (aOR 1.60), male sex (aOR 1.65) and age <45 years (aOR 1.88) independently increased the odds of hospitalization, whereas age ≥75 years (aOR 0.61), specialized crews (aOR 0.84) and high dispatch urgency (categories 1–2; aOR 0.84) were associated with lower odds. Conclusions: Beyond clinical acuity, stable cardiac comorbidities independently shape the EMS hospitalization decision for IHD. With only moderate explanatory per-formance, the model is not a deployable prediction tool; rather, these routinely availa-ble variables are candidate inputs for future field risk-stratification work and for EMS resource planning in urban EMS systems.

Abstract: Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous patient group who need individualized blood glucose targets to avoid hypoglycemia. Since elderly presents with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other co-morbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a Patient and Function Centric Approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and allow for individualized glycemic targets, which improves overall diabetes control and mental well-being.

Abstract: Background/Objectives: Poor bone quality significantly increases the risk of mechanical complications after adult spinal deformity (ASD) surgery, including proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Although teriparatide enhances bone quality, its effectiveness in preventing junctional complications after extensive correction remains unclear. This study investigated whether preoperative teriparatide administration reduces the incidence of PJK and PJF in patients with compromised bone quality undergoing ASD surgery. Methods: This retrospective cohort study reviewed 292 patients (T-score < -1.0) who underwent ASD surgery between 2015 and 2023. Patients were divided into teriparatide (n = 59) and non-teriparatide (n = 233) groups. Propensity score matching (1:2 ratio) was performed using six covariates: age, preoperative pelvic incidence minus lumbar lordosis, preoperative T1 pelvic angle, upper instrumented vertebra (UIV) cementing, UIV screw angle, and fusion length, yielding 153 matched patients (52 teriparatide, 101 non-teriparatide). Results: After matching, all baseline characteristics were well-balanced. The incidence of PJK and PJF did not differ significantly between the teriparatide and non-teriparatide groups (44.2% vs. 52.5%, P = 0.426; 9.6% vs. 9.9%, P = 1.000), nor did PJK subtype distribution (bony vs. soft-tissue). Multivariate analysis identified older age (odds ratio [OR] = 1.058), higher American Society of Anesthesiologists score (OR = 2.603, P = 0.002), UIV at the thoracolumbar junction (OR = 2.786), and greater postoperative thoracic kyphosis (OR = 1.044) as independent risk factors for PJK. Teriparatide use was not an independent predictor (OR = 0.872). Conclusions: Preoperative teriparatide did not significantly reduce the incidence of PJK or PJF after long-segment fusion for ASD. These findings suggest that improving bone quality alone is insufficient to prevent junctional complications, which are driven by complex biomechanical and patient-related factors inherent to extensive deformity correction.

Abstract: The development of bio-based hygiene products offers a sustainable approach to managing infectious topical pathogens while reducing dependence on synthetic antimicrobials. This study evaluated the antibacterial efficacy of soap formulated with Jatropha multifida leaf ethanolic extract (25%, 50%, and 75% v/v) against Staphylococcus aureus and Escherichia coli. Antibacterial activity was determined using the Kirby-Bauer disk diffusion method alongside positive and negative controls. All extract-infused soap formulations exhibited distinct, measurable zones of inhibition (ZOI) ranging from 16.33 mm to 17.67 mm for S. aureus and 16.33 mm to 18.00 mm for E. coli, consistently achieving an "Active" qualitative classification. A one-way Analysis of Variance (ANOVA) demonstrated highly significant differences across the entire dataset (p < 0.001). However, Tukey’s Honestly Significant Difference (HSD) post-hoc test revealed no statistically significant differences in antibacterial performance among the 25%, 50%, and 75% concentrations (p > 0.05). This indicates a performance plateau caused by agar diffusion limits or micellar entrapment within the soap base. J. multifida maintains antibacterial integrity within a soap matrix, offering a viable plant-based antiseptic alternative against S. aureus and E. coli. Formulating at a 25% concentration represents the optimal commercial choice, maximizing antimicrobial performance while minimizing raw material costs.