Public Health and Healthcare

Abstract: Vocational integration (VI) services aim to support sustainable employment for persons with disabilities. However, in individuals with spinal cord injury (SCI), evidence on effective intervention targets and the evaluation of sustainable integration remains limited. The Work-Life Study aims to build an evidence base for supporting sustainable employment in Switzerland, by: (1) identifying typical work-life trajectories; (2) examining key work-life transitions and their predictors; (3) establishing a multi-state model for intervention targets; (4) exploring individual work-life narratives; and (5) developing guidelines for personalized VI practice. The study combines a mixed-methods design with a collaborative Integrated Knowledge Translation approach, actively involving VI professionals and individuals with SCI. Participants are recruited from the Swiss SCI Cohort Study (SwiSCI). Work-life history data are collected through a Biographical Survey and Biographical Interviews and analyzed alongside SwiSCI data. Guideline development includes a stakeholder meeting with representatives from the Swiss Paraplegic Group, SCI clinics, individuals with SCI, employers, and disability insurers. Of 2,041 eligible SwiSCI participants, 478 (23.4%) completed the Biographical Survey (median age 57.5 years; median time since SCI 19.1 years), with responders and non-responders showing comparable characteristics. Work-life data closely matched existing SwiSCI data (rho > 0.8), indicating good recall. The resulting guidelines will help VI providers coordinate rehabilitation services to optimally promote sustainable employment for individuals with SCI.

Abstract: Background/Objectives: Artificial intelligence reshapes clinical practice and its effect on physician-patient relationship requires reconsideration of frameworks that have shaped modern medical ethics. When physician delegate expertise to algorithms they cannot verify, it becomes unclear who bears clinical responsibility. Methods: This article applies theoretically grounded normative approach to explore ethical conditions under which artificial intelligence can be integrated into clinical practice without compromising the moral foundations of medicine. The analysis is primarily based on Pellegrino and Thomasma’s concept of internal morality of medicine and the physician’s act of profession. It further draws on Kantian ethics of human dignity, Levinasian relational ethics, virtue ethics, and Vallor’s concept of technomoral wisdom. Results: AI systems do not satisfy the conditions under which moral responsibility can be ascribed to them. Clinical moral agency lies in the capacity to bear three distinct responsibilities – epistemic, relational, and phronetic – none of which can be fulfilled by AI. The implementation of AI in healthcare, therefore, must occur strictly under the condition of Meaningful Human Control, rather technical function of human oversight over algorithmic outputs. To ensure that MHC can function as an effective and ethically grounded safeguard, we propose five normative requirements: primacy of clinical judgement, prohibition of forced automation, traceability and explainability, transparency towards patients, and clinical authority over diagnostic tools. A dialog between the physician and the patients should remain the foundation of clinical decision-making. Proposed normative requirements aim to preserve internal morality of medicine in a form that harmoniously combines both technological progress and established medical ethics.

Abstract: Background/Objectives: L-carnitine is a naturally occurring compound involved in energy metabolism, while Coenzyme Q10 (CoQ10) is primarily indicated for CoQ10 deficiency and as adjuvant therapy in chronic heart failure. Both are widely used off-label in sports to enhance performance, reduce fatigue, and improve recovery. Despite their popularity, their safety profiles are mainly derived from pre-marketing studies conducted in deficient or clinical populations, not in athletes. Given this limitation, the present study aimed to evaluate and compare the real-world safety profiles of L-carnitine and CoQ10 using spontaneous reports of adverse drug reactions (ADRs) from the EudraVigilance database. Methods: EudraVigilance, managed by the European Medicines Agency (EMA), collects spontaneous reports of suspected ADRs related to authorized medicines. ADRs associated with L-carnitine and CoQ10 were analyzed and compared at the System Organ Class (SOC) level using reporting odds ratio (ROR) and proportional reporting ratio (PRR). Results: For L-carnitine, the most frequently reported ADRs were gastrointestinal disorders, followed by skin and subcutaneous tissue disorders, general disorders, and nervous system disorders. For CoQ10, the most common ADRs were general disorders and administration site conditions, followed by nervous system disorders, investigations, and gastrointestinal disorders. Comparative analysis (ROR and PRR) showed that CoQ10 was associated with a higher probability of reporting certain ADR categories, particularly blood and lymphatic disorders, musculoskeletal and connective tissue disorders, and nervous system disorders. Conclusions: Although L-carnitine and CoQ10 are widely perceived as safe and commonly used by athletes, real-world data highlight the need for increased awareness of potential risks. Continuous monitoring and periodic reassessment of their benefit–risk profile are essential, especially considering their widespread off-label use.

Abstract: Background: In 2016, the World Bank Group estimated that health costs related to PM2.5 pollution totalled approximately $5.7 trillion worldwide. Information on the estimated health costs from the environmental burden of disease caused by ambient air pollutant PM2.5 in Malaysia is limited. Therefore, this study aimed to estimate the environmental health costs associated with PM2.5 for all-cause and respiratory mortality at the national level. Methods: The population-weighted exposure level (PWEL) of PM10 concentrations across all Malaysian states for 2000, 2008, and 2013 was calculated using publicly available remote sensing data, air quality data from the Department of Environment, and burden-of-disease mortality statistics from the Institute of Public Health. The PWEL was then converted to PM2.5 using the World Health Organization's ambient air conversion factors. The AirQ+ 2.2.4 software was used to calculate mortality proportions for all-cause mortality, chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) in children under five, based on the National Burden of Disease data from 2000, 2008, and 2013. Results: The cost per disability-adjusted life-year (DALY) ranged from one (low estimate) to three times the Gross Domestic Product (GDP) per capita (high estimate). These costs were projected for 2022 using a GDP deflator. The estimated PWEL for PM2.5 in 2000, 2008, and 2013 was 22µg/m³, 18µg/m³, and 24µg/m³, respectively. The mortality cost of all-cause deaths increased from MYR 3.3 billion in 2000 to MYR 5.1 billion in 2008, and then to MYR 12.8 billion in 2013, accounting for nearly 1% of Malaysia's 2013 GDP. Conclusions:This indicates a rise in disease burden and mortality costs due to ambient air PM2.5 levels. Therefore, policymakers should remain highly vigilant.

Abstract: Securing electronic health records (EHRs) is critical in the modern healthcare landscape, where digital transformation enhances connectivity and data-driven decision-making. This paper introduces a secure framework that integrates voice-based authentication, blockchain technology, and machine learning to protect EHRs, particularly in IoT-enabled, high-frequency wireless communication environments. The new distributed system utilizes blockchain technology to improve the security and integrity of medical records. User verification is achieved through voice authentication, which adds a biometric element as well. A working model was designed to show the system’s feasibility along with a case study on heart health monitoring. Simulated results demonstrated better block creation time, transaction latency, and validation accuracy.

Abstract: This study examines the retail food environment surrounding public schools in Michigan using a multiscale, multidimensional framework. A cross-sectional spatial analysis integrates relative healthfulness (modified Retail Food Environment Index, mRFEI), availability (outlet density), and accessibility (network-based walking time) across school districts, census tracts, block groups, and school-centered buffers. The analysis includes 3,530 public schools, 7,680 fast food restaurants, and 2,065 convenience stores. Results show pronounced spatial heterogeneity and clustering of unhealthful outlets (Nearest Neighbor Index = 0.284, p < 0.001), with many located near schools. Approximately 34% of schools are within a 10-minute walk of a fast food restaurant, increasing to 65% within 20 minutes. Urban schools face significantly higher exposure—2.27–2.80 times more fast food outlets and shorter walking times than rural schools (p ≤ 0.002)—with consistent gradients across city, suburban, town, and rural contexts. Overall, school neighborhood food environments are highly structured, obesogenic, and inequitable. By integrating multiple spatial scales and dimensions, this study advances food environment research and provides policy-relevant evidence for targeted, place-based interventions to improve access to healthier food around schools.

Abstract: The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Although parents should play a critical role in preventing GD, how parenting styles help prevent adolescent GD remains understudied. This study assessed the association of parenting styles with adolescent GD in junior high school boys in Tokyo, Japan. Data were collected in 2024 via web-based, self-administered questionnaires from 300 parents. Suspected adolescent GD was assessed using a validated parent report measure (i.e., the Gaming Disorder Scale for Parents). Parenting styles were measured using the Parenting Scale, comprising two dimensions: Overreactivity and Laxness. The mean factor scores of Overreactivity and Laxness were compared between the suspected and non-suspected GD groups by t-test. Logistic regression analysis assessed the association of Overreactivity and Laxness with suspected GD, controlling for covariates. The mean factor score of Overreactivity was significantly higher in the suspected GD than in the non-suspected group, whereas Laxness was not. Logistic regression analysis identified parental Overreactivity as an independent predictor of suspected GD (adjusted odds ratio: 1.75, 95% CI: 1.24 to 2.49). This study showed that overreactive parenting is independently and significantly associated with an increased risk of adolescent GD, suggesting the importance of psychological support for parents.

Abstract: The Omicron variant of SARS CoV-2 is associated with milder symptoms and lower hospitalization and mortality rates than Delta variants, although the impact of Omicron on immunocompromised patients, especially Solid Organ Transplant (SOT) recipients, is still unclear. This study compares the hospitalization rate and outcomes between immunocompromised, immunocompetent, and SOT patients during the Delta and Omicron periods. We included adult patients who tested positive for SARS-CoV-2 on PCR or nasopharyngeal antigen test between June 26, 2021 to September 8, 2022, at our institution. 12,401 COVID-19 patients were included, of which 11,055 were immunocompetent, and 1,346 were immuno-compromised (375 SOT recipients). Throughout the Delta and Omicron outbreaks, immunocompromised patients exhibited higher comorbidities and 30-day hospitalizations, but rates of mechanical ventilation and ICU-level care were like immunocompetent patients. During the Omicron wave, immunocompromised patients had higher unadjusted relative risk estimates (RR=2.37, 95% CI 1.96-2.87, p< 0.05) than Delta (RR=1.58, 95% CI 1.24-2.01, p< 0.05) with higher adjusted relative risk for hospitalization in Omicron (RR=1.50, 95% CI 1.10-2.03, p=0.01). Analyses show increased hospitalization risk in immunocompromised during the Omicron wave compared to the Delta wave with no significant difference in hospitalization outcomes. The relative risk of hospitalization for SOT patients was higher in both waves.

Abstract: Background Short-term exposure to PM2.5 has been associated with respiratory infections, yet evidence on the health effects of its chemical components remains limited. Moreover, as PM2.5 components coexist as complex mixtures, it is unclear whether differences in compositional profiles contribute additional influenza-like illness (ILI) risk beyond the independent effects of individual components. Methods We analyzed weekly ILI surveillance data from 111 sentinel hospitals in 17 cities of Hubei, China (2021-2024), together with weekly PM2.5 concentrations and chemical components (sulfate, nitrate, ammonium, organic matter, and black carbon) from the TAP dataset and meteorological variables from ERA5-Land. To evaluate the associations of individual PM2.5 components and overall compositional profiles with ILI, we applied K-means clustering to identify distinct PM2.5 profiles and fitted city-specific quasi-Poisson models, which were then pooled using DerSimonian-Laird method. Results Among 2,804,416 ILI cases, PM2.5 mass was positively associated with weekly ILI, with a pooled RR of 1.041 (95% CI: 1.028-1.054) per 10 µg/m3 increase. Positive associations were also observed for sulfate, nitrate, ammonium, OM, and BC. Three compositional profiles were identified (SID: secondary inorganic-dominated, MOD: mixed organic-dominated; ORM: Other-rich mixed). After adjustment for PM2.5 and its component concentrations, exposure to ORM was associated with an extra 19.6% higher ILI risk than SID (RR = 1.196, 95% CI: 1.096-1.305), while exposure to the MOD was associated with an 8.9% higher ILI risk (RR = 1.089, 95% CI: 1.008-1.176). Conclusions These findings suggest that PM2.5 related ILI risk may depends not only on overall mass concentration and individual components, but also on compositional profiles. Incorporating PM2.5 mixture heterogeneity may improve assessment of air pollution related respiratory health risks.

Abstract: Background: Healthcare systems are organized around traditional levels of care (primary, secondary, tertiary), activated only when a patient enters the formal system. Translational medicine typically moves from bench to bedside. Here we propose a reverse translational step: patient-led self-management as a pre-clinical level of care – LINE ZERO. Objective: To introduce and test LINE ZERO – self-management, prevention, and self-care – as an extension of the traditional care model. Methods: An 11-month longitudinal self-experiment (n=1) in a 55-65 year old man with adjustment disorder. Interventions included breathing exercises, light therapy, music therapy, gentle stretching, moderate dietary changes, and self-monitoring of blood pressure, deep sleep, and blood glucose. Results: Deep sleep increased 3-fold (p < 0.001). Blood pressure stabilized. Glycemic variability decreased after an acute stress-related peak. A subsequent work stress episode caused a 30% drop in deep sleep, followed by rapid recovery within 48 hours. Conclusion: LINE ZERO extends the traditional care model by adding a pre-clinical self-management space. It aligns with Future Medicine (predictive, preventive, personalized, participatory) and represents a reverse translational contribution – from patient observation to a conceptual framework applicable to health systems.

Abstract: Hope is presented as a key driver of psychiatric and psychotherapy outcomes, helping clients move beyond symptom relief toward meaning, resilience, and flourishing. The text integrates goal-based models with relational, narrative, and cultural dimensions. Drawing on the “standard account,” the author proposes hope as the interplay of wishing for a valued good, believing its attainment is possible (though difficult), and trusting in internal and external resources, including the therapeutic alliance. A vignette of Susanne, a young woman with partial dissociative identity disorder, illustrates how psychoeducation and small wins increase belief, while a consistent therapeutic alliance builds trust that extends to self-trust and internal as well as external cooperation. Clinicians play a central role as “hope carriers,” shaping realistic goals, reinforcing progress, and avoiding false hope.

Abstract: Healthcare professionals are characterized by high levels of stress and burnout, including those working in assisted reproduction, with embryologists showing the highest levels. The aim of this study is to identify both the stressors that contribute to burnout, and the potential prevention strategies. A qualitative study based on a semi-structured interview was conducted in a panel of 12 senior embryologists from eight countries in four continents. The interviews were recorded and analyzed using MAXQDA® software. Results identified three important areas (1) Stressors associated to burnout could be classified as those inherent to the embryologist profession, physical and organizational, and patient-related; (2) Preventive tools to prevent or mitigate burnout could be divided in physical, relational, organizational and psychological; finally, (3) Lack of professional recognition could be split in the following themes, general lack of recognition, lack of recognition as healthcare profession, disparity in recognition compared to clinicians and lack of social recognition. The identification of stressors, preventive strategies associated with burnout and the lack of recognition of the embryologist profession could be included in a worldwide survey to create a protocol to regulate the profession and provide tools to prevent burnout and control or lower the effect the stressors.

Abstract: Metabolic syndrome (MetS) is highly prevalent in people living with HIV (PLHIV), but whether their intestinal microbiota differs from that of HIV negative individuals with MetS remains unclear. We conducted a cross-sectional study including 30 virologically suppressed PLHIV with MetS and 30 HIV-negative individuals with MetS. Fecal microbiota composition was assessed by 16S rRNA gene sequencing, and predicted functional profiles were inferred using PICRUSt2 and MetaCyc. PLHIV with MetS exhibited markedly reduced alpha diversity and a clearly distinct beta diversity profile compared with HIV negative MetS, indicating a remodeled community structure. Differential abundance analysis showed enrichment in PLHIV + MetS of Prevotella, Selenomonas, Odoribacter, Christensenellaceae R-7 group, and uncultured Lachnospiraceae, whereas Subdoligranulum and the Ruminococcus gauvreauii group were relatively more abundant in HIV negative MetS. Functional predictions revealed higher representation in PLHIV + MetS of Gram-negative cell envelope and lipopolysaccharide-related pathways, amino acid degradation, and ppGpp biosynthesis, while HIV negative MetS showed comparatively greater saccharolytic potential. Carbohydrate related pathways correlated positively with adiposity and blood pressure, and Prevotella correlated positively with BMI only in PLHIV + MetS. These findings support MetS in chronic treated HIV as a distinct dysbiotic and metabolically adverse intestinal phenotype and highlight the intestinal microbiota as a potential target for microbiome-oriented interventions in this population.

Abstract: Background/Objectives: Household poverty is a known risk factor for early childhood development. However, the extent to which caregiver education can mitigate these risks remains underexplored in Southeast Asian contexts. This study investigates whether caregiver educational attainment buffers the negative impact of low household income on child-rearing environments and early developmental outcomes in Indonesia. Methods: This study utilized cross-sectional data from Indonesian caregivers. To maximize statistical power, analyses of the home environment (Index of Child Care Environment) full sample (N = 933). Analyses of developmental outcomes (Early Childhood Development Index) were restricted to the validated age cohort of 3- and 4-year-old children (N = 355). General Linear Models (GLM) were conducted, controlling for child age and sex. Results: For the home environment, both household income (p = .042) and caregiver education (p = .021) were independent, significant predictors, with no significant interaction. However, for actual developmental outcomes, a highly significant interaction between income and education emerged (p < .001). Conclusions: While education and income independently improve the home environment, caregiver education acts as a robust protective buffer for actual child development, mitigating the risks typically associated with low-income households. Interventions targeting socioeconomic disparities should prioritize parenting and caregiver education.

Abstract: Intimate partner violence-related brain injury is the most recent condition in a 150-year arc in which biological brain injury has been misattributed to psychological or moral causes before formal clinical recognition emerged. Earlier conditions in this pattern were each marked by decades of recognition lag before formal diagnostic frameworks emerged. In each prior case, that lag was driven by limits in available diagnostic technology. Intimate partner violence-related brain injury is the first condition in which diagnostic technology, including computed tomography, magnetic resonance imaging, diffusion tensor imaging, and neurocognitive assessment, has been continuously available throughout the recognition gap. The review identifies three structural barriers that sustain this recognition gap: a diagnostic barrier that leaves the injury without formal criteria, an administrative coding barrier that leaves it absent from ICD architecture, and a population surveillance barrier that leaves it indistinguishable from broader assault categories. Each barrier reinforces the others, limiting visibility, resource allocation, and access to care. Across these conditions, recognition lag has reflected an institutional imperative that has shaped which injured populations became clinically legible. Recent neuroimaging and cognitive studies make the biological imperative explicit. A cognitive entrapment framework reframes the reduced capacity to engage the cognitive and material resources leaving requires as injury-driven rather than as ambivalence or motivational deficit. The framework explains mechanistically why brain injury disrupts the multistep planning that leaving demands. Intimate partner violence-related brain injury is not only underdiagnosed but structurally underserved; correcting the mechanisms of recognition failure is necessary for access to treatment and rehabilitation.

Abstract: Objectives: This study investigated the interplay between pre- and post-match physiological responses and subsequent emotional changes in elite male water polo players, focusing on differences between official championship (competitive) and non-competitive (training) settings. Methods: Sixteen male Italian Serie C water polo players participated. Salivary biomarkers (cortisol, immunoglobulin A (IgA), and uric acid) were measured, alongside psychological assessments of cognitive anxiety, somatic anxiety, and self-confidence. Measurements were taken before and after both training and competition matches. Results: A significant anticipatory rise in salivary cortisol was observed before competition matches compared to training, highlighting the psychological stress associated with competitive events. Post-match, cortisol levels remained elevated to a greater extent after competition. Salivary IgA levels decreased significantly following both training and competition, with a more pronounced reduction after official matches, and exhibited a negative correlation with cortisol. Salivary uric acid, a marker of oxidative stress, increased post-exercise and was significantly higher after competition. Players reported higher somatic and cognitive anxiety and lower self-confidence before competition compared to training, and pre-competition cortisol levels were positively correlated with both anxiety measures and negatively correlated with self-confidence. Conclusions: These findings highlight the distinct physiological and psychological responses elicited by competitive versus non-competitive settings in water polo, emphasizing the importance of considering the emotional context when monitoring athletes' stress and recovery. The social meaning of competitive contexts may be embodied, impacting stress and immune responses.

Abstract: Background: Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children, but predictors of critical illness remain poorly defined. This study aimed to identify risk factors for critical RSV pneumonia and to develop a predictive model. Methods: A retrospective analysis of 12,035 hospitalized children with RSV infection (2019-2025) yielded 304 eligible patients after exclusions. Based on critical illness criteria, 30 critical cases and 90 randomly selected non critical controls from the remaining patients were enrolled. Clinical characteristics, laboratory parameters, and co-infection patterns were compared. Univariate, Lasso, and multivariable logistic regression analyses were performed to identify independent predictors, which were then incorporated into a nomogram. Model performance was assessed using ROC curve, calibration plot, and decision curve analysis. Results: Among the 304 eligible children, 30 (9.9%) had critical illness. Co infection with three or more pathogens was most common in the critical group (43.3%), whereas single RSV infection predominated in the non critical group (38.9%). Multivariable logistic regression identified four independent predictors of critical illness: interleukin 6 (IL 6), creatine kinase MB (CK MB), serum bilirubin excretion (SBE), and neutrophil percentage. The nomogram combining these factors exhibited excellent discriminative ability (AUC = 0.921, 95% CI: 0.868-0.974). The calibration curve agreed well with the 45° reference line (Hosmer-Lemeshow χ² = 3.233, p = 0.919), and decision curve analysis demonstrated clinical benefit across threshold probabilities ranging from 0.01 to 0.99. Conclusions: Elevated IL-6, CK-MB, neutrophil percentage, and SBE are independent predictors of critical RSV infection in children. The nomogram based on these readily available biomarkers provides a robust tool for early risk stratification and clinical decision-making.

Abstract: Background: Hospital-acquired infections (HAIs) represent a major source of morbidity, mortality, and increasing healthcare costs. In Europe, their impact stays significant, especially in high-risk settings such as cardiovascular surgery. Despite this, the economic burden of HAIs is still insufficiently characterized. Objective: This retrospective study aims to analyze HAIs’ costs in an Italian private cardiac surgery hospital between 2022 and 2024. Methods: Starting from the HAI reports of the Infection Prevention and Control (IPC) Committee, individual events were extracted and matched with costs obtained from the business management control system. The same process was applied to matched non-infected cases. A pseudonymized database was later created for analysis. Costs were assessed using a bottom-up approach and evaluated against reimbursements based on the Diagnosis Related Group (DRG) system, which provides standardized tariffs for acute hospital care. Results: With a mean HAI incidence of 7.3% and a prevalence of bloodstream ones, HAI patients had statistically significantly longer hospital stays, averaging 23.5 days compared to 10 days in non-HAI patients (p < 0.001). Economically, HAIs imposed a substantial burden. The average cost per infected patient was approximately 41.000€, nearly double the DRG reimbursement, resulting in a mean pecuniary loss of about 18.600€ per case. The incremental cost attributable to HAIs vs non-HAIs was 19.700€ per patient (p < 0.001), largely driven by ICU-related expenses (53%). Conclusion: These findings highlight a partial mismatch between resource consumption and DRG-based reimbursement in complex, high-intensity care, such as cardiac surgery and a significant economic burden of HAIs. Strengthening IPC strategies is essential to improve outcomes and resource allocation.

Abstract: Background/Objectives: Genitourinary Syndrome of Menopause (GSM) negatively affects quality of life in postmenopausal women, causing sexual dysfunction, vaginal atrophy, and pelvic discomfort. Non-hormonal therapies, such as laser treatments, have emerged as potential alternatives, but evidence comparing intravaginal and extravaginal K-Laser therapy remains limited. The objective is to evaluate the efficacy of intravaginal and extravaginal K-Laser therapy on the symptoms of Genitourinary Syndrome of Menopause (GSM) in postmenopausal women. Methods: In this single-center, randomized, single-blind, placebo-controlled trial, 57 postmenopausal women were randomly assigned to receive either intravaginal and extravaginal K-Laser Cube Plus 30 therapy (n=36) or a simulated control treatment (n=21). The primary outcome was sexual function, measured by the Female Sexual Function Index (FSFI). Secondary outcomes included vaginal pH and pelvic floor muscle function assessed via the PERFECT protocol. Assessments were performed at baseline and after the 6-week treatment period. Results: Fifty-seven women were enrolled, with ten lost to follow-up. After 6 weeks, the treatment group showed significant improvements over the control group in FSFI (mean difference = 6.38; p &lt; 0.001), PERFECT protocol scores (mean difference = 0.78; p = 0.004), CPPQ-Mohedo (mean difference = 5.44; p &lt; 0.001), and Menopause Rating Scale (mean difference = 6.50; p = 0.017). Significant reductions were also observed in vaginal dryness, vulvar dystrophy, and atrophy (p &lt; 0.001). Conclusions: Intravaginal and extravaginal K-Laser therapy is a safe and effective non-hormonal intervention for GSM, improving sexual function, pelvic floor function, and menopausal symptoms.

Abstract: Diabetes mellitus (DM) is increasing worldwide and places a substantial burden on health systems through its complications. Background/Objectives: To identify factors associated with DM-related complications in adults receiving primary care in Rio Branco, Acre, western Brazilian Amazon. Methods: Population-based cross-sectional study in 30 Family Health Strategy (FHS) units; 324 participants, weighted to represent 2,245 adults with DM. Five binary outcomes were analyzed: self-reported stroke, electrocardiographic (ECG) abnormalities, microangiopathy, chronic nephropathy, and any complication. Associations were estimated by Poisson regression with robust variance. Results: About 72% of participants had at least one complication. Any complication was independently associated with male sex (PR = 1.23), age ≥ 60 years (PR = 1.25), hypertension (PR = 1.34), illiteracy (PR = 1.18) and ≤ 3 medical appointments in the previous 12 months (PR = 1.46). Distinct factors emerged for each individual outcome. Conclusions: DM complications were highly prevalent and driven by multifactorial determinants, supporting risk stratification, early detection and targeted interventions in primary care.