Search Results (33,028)

Phthalates are widely used chemicals with ubiquitous human exposure. Evidence indicated that phthalate exposure was associated with an increased risk of aging-related diseases. Klotho is a transmembrane protein with anti-aging functions, and its association with phthalates remains unknown. To find the association between phthalate exposure and serum α-Klotho, a cross-sectional study was performed in 4482 adults (40–79 years old) who completed the National Health and Nutrition Examination Survey (NHANES) (2007–2016). As shown in the results of multivariable linear regression analyses, mono(carboxynonyl) phthalate (MCNP) and mono-n-butyl phthalate (MBP) were inversely associated with α-Klotho, and the regression coefficients of MCNP and MBP were −1.14 (95% confidence interval (CI): −2.00, −0.27) and −0.08 (95% CI: −0.14, −0.02). Subgroup analyses based on the quartiles of each phthalate metabolite showed that both MCNP and MBP were only inversely associated with α-Klotho in the subgroups of the highest levels. For mono-isobutyl phthalate (MIBP), the inverse association with α-Klotho was only statistically significant in the subgroup of the lowest level, and the regression coefficient was −26.87 (95% CI: −52.53, −1.21). Our findings suggest that α-Klotho might be involved in the association of phthalate exposure with aging-related diseases. Future research investigating the causality between phthalates and α-Klotho and its underlying mechanisms is encouraged. Full article

Objective: Imaging biomarkers of bone, muscle, and fat by magnetic resonance imaging (MRI) may depict osteopenia, sarcopenia, and adiposity as the three different conditions of osteosarcopenic adiposity (OSA). Methods: Subjects from a prospective, population-based case–control study underwent a health assessment and 3 Tesla whole-body MRI scan. Imaging biomarkers of bone (bone marrow fat-fraction (BMFF)), skeletal muscle (skeletal muscle FF (SMFF)), and fat (total adipose tissue (TAT)) were determined. Participants were allocated to one phenotype according to the OSA complex. Results: Among 363 participants forming the study cohort, 81 (22.3%, 48.1% males, 62.4 ± 6.9 years) were allocated into the OSA subgroup. Participants with an OSA phenotype were significantly older compared to all remaining subjects and showed the highest grades of SMFF (all p < 0.005). Together with subjects from the osteopenic sarcopenia group, OSA subjects exhibited the highest amounts of BMFF and together with the three other adiposity-containing subgroups also exhibited the highest BMIs. The highest prevalence of an impaired glucose tolerance as well as significantly higher blood pressure, blood dyslipidemia, and hepatic steatosis was found in the OSA subgroup (all p < 0.005). Conclusions: MR biomarkers of bone, skeletal muscle and fat are feasible for body composition phenotyping and may allow for targeted risk stratification in suspected OSA syndrome. Full article

Over the last three decades, the receipt of formal sexuality education has declined, with half of adolescents nationwide receiving the minimum Healthy People standard of sexuality education from 2015 to 2019. Further, racial and geographic inequities in sexuality education remain, with Black women and girls more likely to receive abstinence-only-until-marriage instruction. We sought to describe Black women’s sexual education in two southern states, North Carolina and Georgia. We conducted a qualitative community-based participatory research study. We held focus-group discussions with forty-nine Black women in Georgia and North Carolina between May 2019 and January 2020. The research team, the reproductive justice organization, and the Research Board reviewed, discussed, and refined themes developed using deductive thematic analysis. Most participants were employed. The median age was twenty-seven. From the participants’ accounts, we observed the inadequacy of sexuality education and the resulting process of unlearning inaccurate, negative information and learning positive and accurate information about sexuality. Participants expressed a desire for accessible, high-quality sexual education for themselves and the next generation that addresses autonomy, pleasure, and consent. Our findings highlight the need for investment in existing community efforts and in creating high-quality, culturally responsive comprehensive sexuality education nationwide to effectively address structural barriers to accessing sexuality and relationship information and skills. Full article

Background/Objectives: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by progressive impairment of neuronal transmission due to focal demyelination. The most common form is RRMS (relapsing-remitting multiple sclerosis), which, under the influence of certain factors, can progress to SPMS (secondary progressive multiple sclerosis). Our study aimed to validate the criteria proposed by a working group of the Romanian Society of Neurology versus the criteria proposed by a group of experts from Spain, Karolinska, and Croatia concerning the progression from RRMS to SPMS. Methods: This was done by gathering epidemiological data (age, gender) and by applying clinical tests such as the 9HPT (9-hole peg test), 25FWT (25-foot walk test), and EDSS (expanded disability status scale) tests and the SDMT test (symbol digit modalities test). The present research is a cohort study that included a number of 120 patients diagnosed with MS according to the McDonald Diagnostic Criteria 2017. The study was carried out between January 2023 and April 2024, including patients hospitalized in the Neurology Clinic of the Clinical Rehabilitation Hospital from Iasi, Romania. The data were collected at baseline (T0) and at a 12-month interval (T1). Results: The statistical analysis was conducted using Kaiser–Meyer–Olkin analysis, which indicated a value of 0.683, thus validating the clinical tests used. The correlation matrix and the linear regression for all the tests showed highly significant statistical results. Furthermore, the ROC curve analysis of the criteria suggested by the working group of the Romanian Society of Neurology demonstrated that the EDSS, 9HPT, and 25FWT are highly sensitive in diagnosing SPMS, an opinion that is shared with the Spanish experts, but not with the Karolinska expert panel. Using the criteria given by the Croatian expert group in the ROC curve analysis showed that only the EDSS was strongly significant for the progression to the SPMS phase. Conclusions: In conclusion, all clinical methods used demonstrated that they are valid and can contribute to identifying patients with an increased risk of progression. The model proposed by the Romanian Society of Neurology working group is similar to other countries’ expert opinions and can be used to detect the risk of disease progression and establish a more tailored therapeutic management of SPMS. Full article

COSMOS-France is the French part of the COSMOS project, an international prospective cohort study that investigates whether the use of mobile phones and other wireless technologies is associated with health effects and symptoms (cancers, cardiovascular diseases, neurologic pathologies, tinnitus, headaches, or sleep and mood disturbances). Here, we provide the first descriptive results of COSMOS-France, a cohort nested in the general population-based cohort of adults named Constances. Methods: A total of 39,284 Constances volunteers were invited to participate in the COSMOS-France study during the pilot (2017) and main recruitment phase (2019). Participants were asked to complete detailed questionnaires on their mobile phone use, health conditions, and personal characteristics. We examined the association between mobile phone use, including usage for calls and Voice over Internet Protocol (VoIP), cordless phone use, and Wi-Fi usage with age, sex, education, smoking status, body mass index (BMI), and handedness. Results: The participation rate was 48.4%, resulting in 18,502 questionnaires in the analyzed dataset. Mobile phone use was reported by 96.1% (N = 17,782). Users reported typically calling 5–29 min per week (37.1%, N = 6600), making one to four calls per day (52.9%, N = 9408), using one phone (83.9%, N = 14,921) and not sharing it (80.4% N = 14,295), mostly using the phone on the side of the head of their dominant hand (59.1%, N = 10,300), not using loudspeakers or hands-free kits, and not using VoIP (84.9% N = 15,088). Individuals’ age and sex modified this picture, sometimes markedly. Education and smoking status were associated with ever use and call duration, but neither BMI nor handedness was. Cordless phone use was reported by 66.0% of the population, and Wi-Fi use was reported by 88.4%. Conclusion: In this cross-sectional presentation of contemporary mobile phone usage in France, age and sex were important determinants of use patterns. Full article

Background/Objective: We sought to understand healthcare utilization and barriers to care among youth with chronic illness who interact frequently with the healthcare system. Methods: This was a retrospective analysis of healthcare utilization for youth ≤25 years of age with chronic illness during one calendar year (1 January 2021–31 December 2021) in a single urban academic healthcare system. Inclusion criteria were (1) having at least one healthcare encounter in the calendar year of 2021 and (2) having at least six healthcare encounters over the preceding 3-year period or having a qualifying chronic illness. Demographic and clinical characteristics were collected along with self-reported and derived social determinants of health. Univariable and multivariable regression models were created to identify predictors of missed clinic visits, telehealth use, and activated patient portal accounts. Results: The cohort (N = 14,245) was demographically, clinically, and socioeconomically diverse. The youth had frequent clinic visits (median 9, IQR 4–18), multiple subspecialty care referrals (median 4, 1–8), were prescribed multiple medications (median 6, 3–10), and a high proportion received emergency department (18%) or inpatient treatment (15%). Race and public insurance were significant predictors of missed clinic visits and telehealth use. Primary language was a significant predictor of patient portal activation. Conclusions: Youth with chronic illness who are high users of the healthcare system face a high burden of clinic, emergency room, and hospital visits, referrals, and medications. Systematic efforts to lower the healthcare burden and improve care access should address existing racial and socioeconomic disparities affecting this patient population, who are likely to need frequent healthcare over their lifetime. Full article

Salmonellosis is the second-most commonly reported foodborne gastrointestinal infection in the European Union and a major contributor to foodborne outbreaks globally. Salmonella serotyping differentiates typhoidal strains requiring antibiotic therapy (e.g., serovars Typhi, Paratyphi A, Paratyphi B-d-tartrate negative, Paratyphi C) from typically self-limiting non-typhoidal Salmonella (NTS) strains, making precise identification essential for appropriate treatment and epidemiological tracking. At the same time, the ability to identify the serogroup of Salmonella, regardless of which of the above two groups it belongs to, provides an important initial epidemiological indication that is useful for case management by competent health authorities. This study evaluates the effectiveness of ATR-FTIR spectroscopy coupled with a machine learning algorithm to identify four key Salmonella enterica serogroups (B, C1, D1—including typhoidal strains such as S. Typhi—and E1) directly from solid monomicrobial cultures without sample pretreatment. The system was paired with I-dOne software v2.2 already able to detect Salmonella spp., possibly leading to the characterisation of both the species and serotype from one colony. The multivariate classification model was trained and validated with 248 strains, with an overall accuracy of >98% over 113 samples. This approach offers a potential rapid alternative for clinical labs without serotyping facilities. Full article

Background/Objectives: The importance of the social determinants of health (SODHs) in diabetic and nondiabetic neuropathy has recently gained more attention. This retrospective study examined the correlation of incident diabetic neuropathy and neuropathy of other etiologies with SODH in Romania. Methods: All cases with the primary or secondary discharge diagnosis codes of neuropathy reported across Romania in 2019 were analyzed. The crude incidence rate was calculated per 100,000 persons for the whole population resident in Romania on the 1 July 2019. As SODHs sex, gross domestic product (GDP) per capita, unemployment rate, and the number of physicians/1000 persons were evaluated. Results: In total, 207,026 hospitalizations with a discharge diagnosis of neuropathy were recorded. Of these, 80,480 had a discharge diagnosis of diabetic neuropathy, with an incidence rate of 414.97 cases/100,000 persons. The incidence rate of diabetic neuropathy by county was correlated with the corresponding GDP (p = 0.013) and unemployment rate (p = 0.001). By sex, the correlation with GDP remained significant only for women (p = 0.010), while the correlation with unemployment rate remained significant in both sexes. No correlation was observed with the number of physicians/1000 persons/county. The incidence rate of neuropathy of other etiology was 652.49 cases/100,000 persons. No correlation between the incidence rate of neuropathy of other etiology by county and the corresponding GDP, unemployment rate or number of physicians/1000 persons was observed neither in the total sample nor by sex. Conclusions: Lower socioeconomic status was correlated with a higher incidence rate of hospitalized diabetic neuropathy and not with neuropathies of other etiologies. Full article

(1) Background: Worldwide, refugees may have some difficulties in accessing healthcare services. However, little is known about the factors that may predict the level of accessibility to the public healthcare system in the host countries. (2) Aim: To examine the level of accessibility of Syrian refugees to the public healthcare system in Jordan and further to identify the prediction of socioeconomic factors and barriers to healthcare access. (3) Methods: A cross-sectional study was conducted with a convenient sample of 356 Syrian refugees residing outside camps (Irbid, Ajloun, and Jarash). Data were collected using the Access to Healthcare Services Scale instrument (adopted from the Canadian Community Health Survey), which is composed of 2 sections: the general access scale (8 items) and the difficulties scale (20 items). One-way ANOVA test and independent t-test were used to examine epidemiological correlations among variables, whereas a hierarchical linear regression model was used to examine the predictability of socioeconomic factors and barriers to overall access to the public healthcare system by exploring the incremental impact of additional predictors. (4) Results: the mean age of the 356 participants was 35.22 years old, 56.5% were female, 67.4% were married, most of them 46.1% have secondary education, and non-employed 69.9%. Significant associations were observed among participants with different marital status (p < 0.001), educational level (mean 11.85 vs. 19.85, p < 0.001), working status (15.47 vs. 17.93, p < 0.001), family household number (16.42 vs. 17.0, p < 0.001), and health insurance (none: 15.50 vs. governmental 24.50, p < 0.001). Multivariate analysis revealed that the most important factors that may predict the overall access to healthcare services were: family monthly income (beta −0.19, p < 0.001), household family number (beta 0.17, <0.001), health insurance (beta −0.09, p = 0.047), and barriers (beta −0.43, <0.001), even after adjusting for potential confounding effects: sex, age, educational level, and place of residence. (5) Conclusions: Our findings indicate that socioeconomic factors and barriers may considerably predict overall access to public healthcare in Jordan. It is crucially important, therefore, for the Jordanian government and international organizations to create and develop strategic plans and programs that enhance refugees’ access to health services, positively impacting their health and wellness. Full article

The rising prevalence of food intolerances and increased health and environmental consciousness has driven the demand for free-from (FF) and organic products. This study aims to analyze consumer needs, motivations, and challenges related to these products in Portugal through an online survey with 2268 eligible responses, with a median age of the participants of 41 years. The sample was predominantly female (76.9%), with male participants comprising 23.1% of the sample. The results show that 97.4% of the respondents were aware of FF products, with 60.0% being regular consumers, particularly of lactose-free milk and gluten-free bread and biscuits. Significant market gaps were identified in the variety of FF bread (62.8%), pastries (49.0%), and cookies (38.4%). The consumers identified high prices (84.9%) and excessive sugar/fat content (52.1%) as the main drawbacks of FF products currently on the market. The women showed greater knowledge and purchase levels compared to the men. The trust in organic certification was low (21.4%), with skepticism higher among the lower-income and male participants. Despite this, 78.1% believed in the health benefits of organic products, and 72.2% agreed that increased demand could lower prices. Overall, this study highlights the need for greater product variety, improved transparency, and consumer education to enhance market trust and accessibility. Full article

Escherichia coli is a commensal and opportunistic bacterium widely distributed around the world in different niches including intestinal of humans and animals, and its extraordinary genome plasticity led to the emergence of pathogenic strains causing a wide range of diseases. E. coli is one of the monitored species in maternity hospitals, being the main etiological agent of urogenital infections, endometriosis, puerperal sepsis, and neonatal diseases. This study presents a comprehensive analysis of E. coli isolates obtained from the maternal birth canal of healthy puerperant women 3–4 days after labor. According to whole genome sequencing data, 31 sequence types and six phylogenetic groups characterized the collection containing 53 isolates. The majority of the isolates belonged to the B2 phylogroup. The data also includes phenotypic and genotypic antibiotic resistance profiles, virulence factors, and plasmid replicons. Phenotypic and genotypic antibiotic resistance testing did not demonstrate extensive drug resistance traits except for two multidrug-resistant E. coli isolates. The pathogenic factors revealed in silico were assessed with respect to CRISPR-element patterns. Multiparametric and correlation analyses were conducted to study the interrelation of different pathoadaptability factors, including antimicrobial resistance and virulence genomic determinants carried by the isolates under investigation. The data presented will serve as a valuable addition to further scientific investigations in the field of bacterial pathoadaptability, especially in studying the role of CRISPR/Cas systems in the E. coli genome plasticity and evolution. Full article

(1) Background/Objectives: Two pneumococcal conjugate vaccines, 15-(PCV15) and 20-(PCV20) valent formulations, are routinely recommended for US children in a 3+1 schedule. The first three doses are administered during the first year of life at 2, 4, and 6 months, while a booster dose is given at 12 to 15 months. This study evaluated the health and economic effects of the PCV20 infant series within the first year of life compared to PCV15. (2) Methods: Using a decision-analytic model, we calculated the health and economic effects of introducing PCV15 or PCV20 for five subsequent birth cohorts. Epidemiological data were drawn from peer-reviewed studies and estimates for vaccine effectiveness were extrapolated from established PCV13 effectiveness and PCV7 efficacy studies. Direct medical costs related to the disease treatment were extracted from the literature and inflated to 2024 dollars. (3) Results: Over the course of five years, the implementation of PCV20 vaccination for newborns in the United States, compared to PCV15, is projected to prevent an additional 220 cases of invasive pneumococcal disease, 6542 cases of community-acquired pneumonia, and 112,095 cases of otitis media within the first year of life across five subsequent birth cohorts. This strategy could prevent 66 infant deaths linked to these illnesses and confer extra health gains, amounting to 5058 years of life and 5037 quality-adjusted life years. These prevented cases are estimated to save approximately USD 147 million over 5 years. (4) Conclusions: This study demonstrated that vaccinating with PCV20 during the first 12 months of life compared to PCV15 in the US would yield a substantially greater health and economic return due to the five additional serotypes covered by PCV20. Full article

Background/Objectives: Risk prediction models (RPMs) for colorectal cancer (CRC) could facilitate risk-based screening. Models incorporating biomarkers may improve the utility of current RPMs. We performed a systematic review of studies reporting RPMs for CRC that evaluated the impact of blood-based biomarkers on clinical outcome prediction at the time of screening colonoscopy in average-risk populations. Methods: We conducted a search of MEDLINE, Web of Science, and PubMed databases from inception through April 2024. Studies that developed or validated a model to predict risk of CRC or its precursors were included. Studies were limited to those including patients undergoing average-risk CRC screening. Results: Sixteen studies published between 2015 and 2024 were included. Outcomes included CRC (16 studies) and high-risk adenomas (1 study). Using a complete blood count was the most common biomarker and was able to achieve an AUC of 0.82 and a specificity of 0.88. Other blood-based biomarkers included were various serum proteins/metabolites/enzymes, plasma metabolites, insulin-related factors, and anemia markers. The highest-performing model, with an AUC of 0.99, involved the use of a plasma metabolite panel. Conclusions: The evidence base of RPMs for CRC screening is expanding and incorporating biomarkers, which remain a prominent aspect of model discovery. Most RPMs included a lack of internal/external validation or discussion as to how the model could be implemented clinically. As biomarkers improve the discriminatory potential of RPMs, more research is needed for the evaluation and implementation of RPMs within existing CRC screening frameworks. Full article

Background/Objectives: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are significant public health issues, with cardiovascular morbidity and mortality being the leading causes of death in hemodialysis patients. Osteopontin (OPN), a multifunctional glycoprotein, has emerged as a potential biomarker for vascular disease in CKD due to its role in inflammation, tissue remodeling, and calcification. Methods: This cohort study included 1124 hemodialysis patients from the PROGREDIRE study, a registry involving 35 dialysis units in Southern Italy. Serum osteopontin levels were measured using enzyme-linked immunosorbent assay (ELISA). The primary endpoints were all-cause and cardiovascular mortality. Multivariate Cox regression analyses were performed to assess the association between osteopontin levels and mortality, adjusting for traditional risk factors, biomarkers of inflammation, nutritional status, and ESKD-related factors. Results: During a mean follow-up of 2.8 years, 478 patients died, 271 from cardiovascular causes. Independent correlates of osteopontin included alkaline phosphatase and parathyroid hormone. Elevated osteopontin levels were significantly associated with increased all-cause mortality (HR 1.19, 95% CI 1.09–1.31, p < 0.001) and cardiovascular mortality (HR 1.22, 95% CI 1.08–1.38, p = 0.001) after adjusting for confounders. Conclusions: Elevated osteopontin levels are associated with increased all-cause and cardiovascular mortality in hemodialysis patients. These findings implicate osteopontin in the high risk for death and cardiovascular disease in the hemodialysis population. Intervention studies are needed to definitively test this hypothesis. Full article

Escherichia coli (E. coli) is a predominant pathogen of urinary tract infections (UTIs) in the United States. We analyzed resistance patterns by geographic location in Washington State to assess the need for regional antibiograms. The study included urinary E. coli antibiotic susceptibility tests performed by Quest Diagnostics on Washington outpatient isolates from 2013 to 2019. We conducted logistic regressions with robust standard errors for five antibiotics (ceftriaxone, ciprofloxacin, gentamicin, trimethoprim-sulfamethoxazole), with isolates classified as “susceptible” or “resistant” for each antibiotic tested. Analyses were adjusted for sex, year of isolate collection, and age group (0–18, 19–50, >50). The state’s nine Public Health Emergency Preparedness Regions (PHEPRs) were used as the geographic level for the analysis. The analysis included 40,217 isolates (93% from females, mean age 47 years). Compared to the Central PHEPR (containing Seattle), most other regions had significantly lower adjusted prevalence ratios (aPORs) of antimicrobial resistance (AMR), with aPORs as low as 0.20 (95% CI: 0.06–0.63) for ceftriaxone in the North Central region. Additionally, no regions had significantly higher aPOR of resistance for any antibiotic. Differences in resistance between the Central and other regions varied by antibiotic with the largest difference for ceftriaxone and smallest for ampicillin. The finding of regional variation of E. coli AMR calls for more specific community antibiograms to enable a precise approach to antibiotic prescribing and stewardship. Full article