Agricultural machinery users face a high risk of incidents and injuries, making the correct interpretation of safety warnings on machinery critical. However, limited evidence is available on how well the operators comprehend safety pictograms, especially in Turkey, where farmers generally have insufficient knowledge of occupational health and safety, and workers receive minimal training in this area. A questionnaire, adapted from previous studies, was administered to 230 agricultural machinery operators to investigate how age, education, work experience, and familiarity with safety symbols affect comprehension of 12 ISO 11684:2023 pictograms related to common machinery hazards. The study's results revealed different levels of comprehension among participants, with five pictograms achieving a comprehension rate equal to or greater than the minimum rate (75%) required by the ISO reference standard. Education, prior experience with agricultural machinery, and familiarity with pictograms significantly increased participants' ability to correctly interpret the safety symbols. When compared with previous studies conducted in other countries, pictogram #4, referring to the risk of injury from rotating knives, and pictogram #11, depicting tractor rollover risk, were investigated in seven out of eight and in all previous studies, respectively, and yielded high levels of comprehension across countries. The findings emphasized the need to increase the familiarity of potential users with safety symbols through targeted training programs. Furthermore, the visibility and placement of pictograms should be systematically considered in safety communication strategies. Standardization bodies should also consider improving pictograms design through a user-centered approach to enhance their clarity and effectiveness in communicating crucial safety information in different national and operational contexts.
Crystal methamphetamine is an illicit substance known to be associated with psychological disorder, aggressive behavior, and a significantly increased crash risk. The primary aim of this study was to investigate the links between likely methamphetamine dependency, psychological dysfunctioning (i.e., thought disorganization, emotional impulsivity, psychopathology), aberrant beliefs (i.e., antisocial beliefs about anger, positive beliefs about driving under the influence of methamphetamines [DUIM]), and risky driving behaviors (i.e., DUIM, aggressive driving, dissociative driving). To achieve this aim, an online questionnaire was advertised on social media and open to adult Australian users of crystal methamphetamine (N = 184). A series of independent t-tests showed that participants who met the criteria for likely methamphetamine dependence reported significantly higher levels of psychological distress, disorganized thinking, impulsivity, anger symptomology, DUIM, aggressive driving, and dissociative driving. Further, those who DUIM in the past month reported significantly higher aberrant beliefs and more frequent aggressive driving behavior, compared to those who did not. Bivariate correlations and follow-up structural equation modeling showed that there were significant linear and hierarchical relationships between the variables. Of particular importance, likely methamphetamine dependence was shown to indirectly affect aggressive and dissociative driving behavior via the hierarchical effects it had towards psychological dysfunctioning, problematic attitudes, and DUIM frequency, which acted as mediators in this model. In addition, DUIM frequency was shown to indirectly affect dissociative driving behavior via the relationship it had with aggressive driving behavior. This study has highlighted potential factors that underlie problematic methamphetamine use and associated aberrant driving behaviors. The findings can inform future road safety strategies, over and above traditional enforcement initiatives.
Services for people who are high users of emergency departments (EDs) have developed in a piecemeal fashion, including those embedded within liaison mental health services, over the past decade. We conducted a national survey of all 171 National Health Service hospitals in England with an ED to identify high user services, alongside 20 interviews from exemplar services to characterise the interventions offered. We had a 100% response rate. Of the 171 hospitals, 76 (44%) had a high user service in the ED without designated staff and 71 (42%) offered services with some designated staff time; 10 (6%) had community services, either separate or with hospital outreach; and 14 (8%) had no service. Interviews revealed great variability among services on most parameters, including staffing levels, entry criteria, case-load and types of intervention. There is a need for clarity on entry criteria, case-load and types of intervention, to improve consistency and effectiveness of these services to guide decision-making.
This study examines how using a native versus a foreign language shapes users' perceptions of ChatGPT in terms of linguistic proficiency, cultural fluency, emotional connection, and perceived human likeness. Drawing on Media Equation Theory, the study explores how multilingual contexts influence human-AI interaction and users' interpretations of humanlike qualities in AI communication. Participants interacted with ChatGPT in both their native language (Turkish) and a foreign language (English). Following these interactions, semi-structured interviews lasting approximately 30-45 min were conducted, audio-recorded with participants' consent, and transcribed verbatim. The data were analyzed using Interpretative Phenomenological Analysis (IPA). Through an iterative coding process, three main themes and nine sub-themes were identified. Language plays a significant role in shaping perceptions of AI interaction. Participants with lower English proficiency attributed greater humanlike qualities to ChatGPT and reported a stronger emotional connection when interacting in Turkish. However, interactions in English were generally perceived as more efficient and intelligent. Participants also raised concerns regarding ChatGPT's cultural fluency, particularly when culturally specific expressions were not adequately reflected. Overall, the results suggest that multilingual users may experience a tension between emotional connection and perceived AI competence across languages. The study involved 33 bilingual participants, and the findings may not be generalizable beyond this particular context. Nevertheless, the results highlight the importance of linguistic and cultural context in shaping human-AI interaction and suggest that multilingual environments may influence how users evaluate AI systems. Findings suggested a linguistic-emotional trade-off among non-native English-speaking users: participants commonly described Turkish-language interactions as fostering greater emotional connection and relational closeness, whereas English-language interactions were more often perceived as more competent and intelligent. The findings indicate that improving linguistic accuracy and cultural responsiveness in AI systems may enhance inclusivity, perceived empathy, and user experience in multilingual contexts. This study contributes to the growing literature on human-AI interaction by examining how multilingual users perceive AI systems across languages and by demonstrating how linguistic background shapes emotional and social perceptions of AI communication.
Problematic cannabis use has been linked to cognitive impairment and psychopathology, which may adversely affect an individual's ability to regulate attention and drive safely. This study examined associations between likely cannabis dependency, cannabis-related psychological symptoms, subjective general driving efficacy, and general driving inattention. It also aimed to compare these factors between specific cohorts of active cannabis users and a comparative sample of low-frequency substance users. An online survey was disseminated to Australian residents aged 20-65 years, who drove at least one hour per week, and did not have a physical condition impairing driving. Active users (N = 271) had consumed cannabis within the past month, whereas the comparison group (N = 159) reported minimal substance use. MANOVAs showed that likely dependent cannabis (n = 114) users reported the greatest psychological symptoms and driving inattention, and the lowest subjective driving efficacy, followed by low-frequency substance users, and then likely non-dependent cannabis users (n = 157). However, no significant differences emerged between those who used medically prescribed compared to non-prescribed cannabis. Correlational analyses further revealed significant associations between likely cannabis dependency, psychological symptoms, subjective driving efficacy, and driving inattention. Finally, structural equation modeling showed that likely cannabis dependency was indirectly associated with subjective driving efficacy and driving inattention through its relationship with emotional and cognitive dysfunction. Overall, these findings suggest that problematic cannabis use is associated with poorer driving capabilities, likely linked to greater psychological dysfunction and cognitive-attentional deficits. In turn, the findings highlight the importance of integrating chronic cannabis-related risks into driving research, policy, and regulation.
Online health communities (OHCs) have emerged as critical platforms for patients with type 1 diabetes (T1D) to exchange informational and emotional support. However, how stakeholder roles and disease duration jointly shape support dynamics and influence formation remains underexplored. This study aimed to examine network-based social support mechanisms in a large T1D OHC, focusing on how stakeholder diversity and disease duration are associated with social support behaviors, subnetwork structures, and user influence. This retrospective observational study analyzed digital trace data from China's largest T1D online community (January 1-May 20, 2024), comprising 43,788 posts and 145,423 comments contributed by 1393 users. We manually annotated 2000 randomly sampled posts and fine-tuned a GPT-4o-mini (OpenAI) to classify support type (informational or emotional, and seeking or providing), yielding 20,384 support-related posts and 56,953 comments from 1224 users. We constructed weighted directed informational and emotional interaction networks and modeled predictors of a composite influence metric (Relative Centrality) using a gamma log-link generalized linear model (including demographics, identity, sentiment, disease duration, posting orientation, and cyclical activity time). Analyses were conducted in Python (version 3.11; Python Software Foundation). Statistical significance was set at P<.05. Support predominantly flowed from longer-duration members (≥ y) to those at earlier stages (≤5 y). Both subnetworks exhibited multicentered, star-like structures; the informational subnetwork had broader participation (density 0.031, diameter 7), while the emotional network was denser (density 0.039, diameter 6). In the influence model, peer supporters had substantially higher influence than patients (exp(β)=34.79, 95% CI 18.94-64.08; P<.001), professionals lower (exp(β)=0.41, 95% CI 0.17-0.99; P=.055), and women higher than men (exp(β)=1.65, 95% CI 1.23-2.23; P=.001). Positive sentiment was associated with higher influence (exp(β)=1.91, 95% CI 1.22-2.97; P=.005), and negative lower (exp(β)=0.54, 95% CI 0.37-0.79; P=.001). Influence followed an inverted U-shaped trajectory over disease duration, peaking at approximately the 116th month (95% CI 43.25-188.91). This study suggests that social support patterns and user influence in a T1D OHC vary by stakeholder role and disease duration. Users with shorter disease duration more often sought support, whereas longer-duration users more often provided support, and informational and emotional exchanges formed distinct interaction subnetworks. Peer supporters were the most influential users; influence was also associated with gender, sentiment, activity timing, and a nonlinear (inverted U-shaped) relationship with disease duration. These findings may inform peer-facilitated, stage-tailored community strategies, with professionals engaged in targeted, complementary roles. A patient-centered collaborative care approach integrating peer experience with multidisciplinary clinical input could be explored in future work.
The SUSTAIN-7 trial demonstrated greater HbA1c and bodyweight reductions with once-weekly semaglutide versus dulaglutide in type 2 diabetes, but strict eligibility criteria limit external validity. We evaluated the comparative real-world effectiveness and safety of these agents in UK primary care. Using the IQVIA Medical Research Data (IMRD) incorporating data from THIN, a Cegedim Database, we included adults with type 2 diabetes initiating semaglutide or dulaglutide between 01-Jan-2019 and 01-Dec-2022, followed through 30-Jun-2023. Co-primary outcomes were 1-year changes in HbA1c and bodyweight, estimated using a new-user, active-comparator cohort design with marginal structural models and inverse probability of treatment weighting. Treatment heterogeneity was assessed in the primary per-protocol analysis by SUSTAIN-7 trial-eligibility. Safety events were assessed while-on-treatment. Among 6616 new users, 4636 (70.1%) remained on-treatment and 1980 (29.9%) discontinued early. Semaglutide new users (n = 1901) achieved greater 1-year reductions than dulaglutide new users (n = 2735) in HbA1c (estimated treatment difference [ETD] -0.22 percentage points [95% CI -0.30, -0.15]) and bodyweight (ETD -1.92 kg [95% CI -2.91, -0.93]). While semaglutide's benefits were preserved across the 87.7% (n = 4064) not meeting SUSTAIN-7 trial-eligibility (HbA1c: ETD -0.23 percentage points [95% CI -0.31, -0.15]; bodyweight: ETD -2.01 kg [95% CI -3.07, -0.95]), reductions in HbA1c and bodyweight were greater among trial-eligible individuals (12.3%; n = 572) for both agents (trial-eligible [semaglutide/dulaglutide] versus non-eligible [semaglutide/dulaglutide] individuals, HbA1c: -1.10/-1.02 versus -0.83/-0.60 percentage points; bodyweight: -5.72/-4.18 versus -5.50/-3.49 kg). Early discontinuers showed attenuated treatment effects and higher gastrointestinal event rates than those remaining on-treatment (23.5-26.1 versus 10.6-13.8 per 100 person-years). New users of semaglutide achieved greater reductions in HbA1c and bodyweight than new users of dulaglutide with comparable safety, with benefits preserved across SUSTAIN-7 trial-eligible and non-eligible individuals, supporting preferential use of semaglutide in UK clinical practice. Swiss National Science Foundation.
While telehealth has potential to enhance patients' access to care, uneven implementation may limit its impact. My VA Images (MVAI), a clinician-gated, patient-facing asynchronous teledermatology application developed by the Department of Veterans Affairs (VA) was piloted at three VA facilities, and then sequentially offered to groups of seven facilities every 3 months for 1 year. We characterized patients who were exposed to and used MVAI and we identified associated characteristics. We used VA's mobile health and administrative databases to examine MVAI activity and dermatology patient demographics over a 17-month period during 2019 and 2020. At 11 VA facilities, 494 established dermatology patients were invited to a follow-up visit using MVAI. Invitees were more likely than Non-Invitees to be White and urban, have shorter drive times to specialty care, and have more outpatient and dermatology visits before and after MVAI use. Forty-eight percent of Invitees successfully used MVAI and were most likely to do so in the 8-30 day interval. Successful Users were more likely than Unsuccessful Users to be younger and have a dermatology visit 1 year after MVAI use. Patients requiring multiple attempts before successfully using MVAI were older than initially Successful Users, though younger than Unsuccessful Users. Not all patients benefited equally during the initial rollout of MVAI. Disparities in VA where other forms of patient-facing telehealth are already common illustrate challenges for health care organizations in equitably implementing direct-to-patient teledermatology. Specific groups may benefit from targeted outreach or support.
In recent decades, probiotic and prebiotic-rich foods and supplements have gained considerable attention for their health benefits, particularly the promotion of gut health. Despite the widespread publicity around these benefits, there is a lack of recognition of the effects of gender and age on attitudes and preferences regarding the intake of these foods and supplements. Therefore, this study aimed to assess gender and age differences in attitudes and preferences concerning probiotic and prebiotic-rich foods and supplements among adults in Saudi Arabia. A cross-sectional study was conducted between May and July 2023 among adults aged ≥18 years recruited from different regions of Saudi Arabia. An online valid questionnaire was used to assess attitudes and preferences regarding probiotic and prebiotic-rich foods and supplements. A total of 915 participants completed the survey. Probiotics and prebiotics ever users, and never users accounted for 62, and 38% of the participants, respectively. Among the ever users, the main reason for using probiotics and prebiotics was gastrointestinal problems (57%). Females were more likely than males to prefer online or international pharmacies as sources of probiotics and prebiotics (24% vs. 12%, p = 0.003). Younger participants were more likely to get probiotic and prebiotic supplements from online or international pharmacies compared to older participants (p = 0.001). Among the never users, males were more likely than females to use probiotics and prebiotics in the future if a health professional recommended them (60% vs. 40%, p = 0.002). Gender and age play a role in adults' attitudes and preferences concerning probiotic and prebiotic-rich foods and supplements, particularly in terms of preferred sources as well as the forms and duration of consumption. Further studies are required to examine more determinants of probiotic and prebiotic intake.
Expanding access to oral contraceptive pills (OCPs) through over-the-counter (OTC) reclassification may reduce barriers to contraception, but Australian consumer preferences for OTC OCP access remain poorly understood. We conducted a discrete choice experiment (DCE) to quantify women's preferences for OTC OCP access in Australia. The DCE incorporated five attributes: method of accessing OCPs, provider training, ability to discuss other health issues, consultation time, and out-of-pocket cost. A D-efficient design generated 12 choice sets. Data were collected through quota sampling from 878 women during November to December 2023, including 359 current OCP users and 519 non-OCP users. Preferences were analysed using mixed logit models. Women using less effective contraceptive methods or no contraception favoured OTC access, whereas current OCP users did not show the same preference. Across groups, online general practitioner consultations and pharmacist consultations without a private setting were strongly disliked. Predicted uptake of, and switching to, OTC options was highest when OCPs received a high level of government funding, pharmacists had additional training in contraceptive care, women could discuss other health issues, and consultations were brief. Current OCP users were more likely to switch to OTC OCPs if they faced GP co-payments. Support for OTC access was greater among younger women, high-income women, and those with greater household decision-making autonomy. OTC access to OCPs is likely to be acceptable to many Australian women, particularly if pharmacists have received additional training in contraceptive care and consultations are affordable, private, and sufficiently comprehensive. Careful policy design will be needed to ensure acceptability, support informed contraceptive choices, and maximise the potential public health benefits of OCP reclassification.
Purpose: Independent mobility is crucial to the daily lives of the growing population of people who are blind or visually impaired (PBVI). Despite the rapid growth of research on assistive approaches for PBVI mobility, the limitations and challenges identified through empirical evaluations have not yet been sufficiently synthesised. Materials and methods: This paper presents a scoping review of 50 studies to examine how assistive approaches supporting PBVI wayfinding and navigation have been empirically evaluated and to conduct a thematic analysis of the limitations and challenges reported in prior work. For the purposes of this review, we use wayfinding and navigation as analytic labels: wayfinding refers primarily to activities related to route planning and environmental understanding, whereas navigation refers primarily to activities related to real-time movement during travel. Results: The review identified four recurring themes concerning the physical appearance of devices, the performance of hardware and software, the quality of interaction with users, and integration into daily life. More specifically, we summarised critical questions that highlight the aspects in which existing assistive approaches fall short compared to the expectations of users. Based on the identified themes and implications across the reviewed studies, we further developed a practical checklist of considerations to support future design and evaluation. Conclusion: Our findings reveal important gaps in current evaluation practices and unmet user needs, while also providing actionable guidance for the future design and assessment of assistive approaches for PBVI mobility. Implications for rehabilitationAssistive approaches for PBVI mobility should be selected, introduced, and evaluated according to whether they support route planning and environmental learning, real-time movement, or both.Rehabilitation practice should move beyond whether an assistive approach improves task performance and consider whether it can be learned, trusted, personalized, combined with existing mobility aids, and integrated into users' everyday travel routines.
GLP-1 receptor agonists (GLP-1 RAs) are increasingly used for obesity and for weight management in individuals seeking aesthetic improvement. Their pharmacologic effects (delayed gastric emptying and reduced appetite) and the rapidity of weight loss may create perioperative and morphologic challenges for aesthetic and body contouring surgery. A targeted narrative review of perioperative safety considerations, body-composition studies, and aesthetic/body contouring literature relevant to GLP-1 RA users. Classical massive weight-loss (MWL) body contouring principles were integrated to develop a practical conceptual framework for surgeon-facing perioperative assessment and surgical planning. Emerging evidence in aesthetic/body contouring cohorts signals higher wound complication rates in GLP-1 RA users, including increased wound dehiscence in semaglutide users versus matched controls (5.19% vs 2.78%). Perioperative data from mixed surgical populations suggest that some GLP-1 RA users may have retained gastric contents despite standard fasting, supporting individualized risk assessment, symptom screening, and multidisciplinary planning. GLP-1-associated weight loss may also coincide with clinically relevant lean-mass reductions, potentially influencing tissue quality and contouring strategy. Aesthetic surgeons are encouraged to anticipate perioperative and morphologic implications of GLP-1 RAs, incorporate multidisciplinary, individualized perioperative planning in coordination with anesthesiology and institutional policies, and adapt timing and contouring strategies, while prospective aesthetic-specific data remain limited. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Large language models (LLMs) can generate structured educational content at scale, yet their role in postgraduate radiology training remains untested. This pilot study evaluated the feasibility of deploying LLM-generated radiology board preparation materials, the psychometric properties of adapted survey instruments, and exploratory effect-size estimates for sample-size planning of a future multicentre trial. We conducted a prospective observational pilot among 41 radiology residents preparing for the 2026 Korean Radiology Board Examination. A governed seven-stage LLM pipeline generated 6,000 Anki flashcards, 833 infographic summaries, and presentation slides. Materials were distributed freely, and 24 completers self-selected into users (n = 15) and non-users (n = 9). Outcomes included enrollment yield, retention rate, voluntary adoption rate, internal consistency (Cronbach's alpha) of adapted cognitive load and satisfaction scales, and change scores in extraneous cognitive load (ECL) and self-efficacy (SE), compared using Mann-Whitney U tests with Cohen's d and 95% confidence intervals. Of 114 registered candidates, 44 were recruited (38.6%); 41 were enrolled (yield 93.2%); retention was 58.5% (24 of 41), below the prespecified 80% threshold; and voluntary adoption was 62.5%. The ECL scale showed acceptable reliability (alpha = 0.87 baseline, 0.80 post-examination). After reverse-coding one reverse-worded item (E3), the corrected three-item trust-in-AI alpha was 0.583 (bootstrap 95% CI 0.151 to 0.746), below the conventional 0.70 threshold. Between-group differences were non-significant for ECL (d = - 0.28; 95% CI - 1.50 to 0.59) and SE (d = 0.26; - 0.62 to 1.24). Among users, educational quality was rated 3.33 of 5.00, and 86.7% reported encountering no factual inaccuracies. A medium-effect scenario (d = 0.50) would require 160 participants. Retention (58.5%), the trust-scale alpha of 0.583, and the - 40 Net Promoter Score together indicate that the data-collection protocol, the AI-trust instrumentation, and the user-experience design all require modification before an efficacy trial is justified. Operational deployment was feasible at the levels of enrollment yield and voluntary adoption, but not retention. Adapted cognitive load and satisfaction scales reached acceptable reliability; the trust-in-AI and single-item self-efficacy outcomes did not meet conventional thresholds. Exploratory between-group point estimates were small and unstable across sensitivity strata; they are reported as inputs for sample-size planning and should not be interpreted as evidence for or against educational benefit.
Methamphetamine intoxication can lead to medical complications in burn patients, including longer intensive care unit (ICU) stays, sepsis, and more burn debridement procedures. However, its impact on graft durability remains unexplored. We hypothesize that methamphetamine-positive burn patients have higher rates of graft loss. A single center retrospective cohort study of patients admitted to the burn service from 2021 to 2024 was performed at an American Burn Association (ABA)-verified burn center. Patients were age 18 years or over, had toxicology screening, and were excluded if not screened for methamphetamine. The primary outcome measured was graft loss requiring return to operating room for re-graft or flap repair. Patient demographics, burn etiology, and use of autograft, along with ICU days, ventilator days, and length of stay were recorded. 746 patients were included in this study with median age 48 years and median total burn surface area burned for the full cohort of 8.35%. 112 patients were methamphetamine-positive. Methamphetamine users had higher rates of autograft loss (p < 0.001), even on logistic regression analysis. Methamphetamine users had increased TBSA (p = 0.01), longer hospital stays (p = 0.03), and increased likelihood of undergoing endotracheal intubation (p = 0.01). Methamphetamine-positive patients presented primarily with flame burns (p < 0.001), while non-users presented primarily with scald burns (p < 0.001). Methamphetamine-positive burn patients were more likely to sustain flame burns, undergo autografting, and experience graft loss as a complication. Methamphetamine is a unique risk factor for burn patients that increases risk of failing graft management. Routine toxicology testing can promptly identify these patients and notify providers earlier to plan for more intensive burn management.
While research is emerging, there remains an inadequate focus upon the experiences of those delivering and receiving care specifically for service users with complex emotional needs (CEN) within Crisis Resolution and Home Treatment (CRHT) settings. This study therefore utilised hermeneutic phenomenology to examine the lived experience of both those providing and receiving care within CRHT settings. Data were gathered via semi-structured interviews with 14 participants (seven mental health nurses working within CRHT settings and seven service users with CEN who have received CRHT intervention). Transcripts were analysed using van Manen's hermeneutic phenomenological reflective method. A synthesis of participant accounts revealed several areas of convergence across the two groups, thus highlighting those 'core structures' of mental health crisis care as lived by participants in these encounters. Fears arising from structural vulnerabilities were illuminated as the eidos (or the 'essence') of the crisis encounter in CRHT settings, and at the heart of the crisis encounter, a central phenomenon of reciprocal insecurity is illuminated, whereby both parties' attempts to achieve a sense of personal safety inadvertently threatens that of the other. Findings highlight an urgent need for hermeneutic mediators; structures that provide the space and containment necessary for both parties to feel safe.
Although rollovers account for 3% of vehicle crashes, they result in approximately one-third of all occupant deaths. This study investigates the effects of human, vehicle, and environmental factors on the occurrence and severity of rollovers in single-vehicle crashes. We emphasize the importance of a safe system approach that incorporates safer speeds, safer vehicles, and equitable design to prevent and mitigate rollover crashes while addressing the diverse needs and challenges of all road users. Using data from NHTSA's Crash Report Sampling System and the New Car Assessment Program's Safety Ratings, we applied logit regression and XGBoost models to identify the significant predictors of rollover likelihood and injury severity. We estimated the Levels of Automation in vehicles and their impact on the occurrence and severity of rollovers. We also used SHAP analysis to interpret the XGBoost model predictions. Our findings reveal that younger drivers, impairments, and device-related distractions on high-speed limit roadways increase rollover risks, while higher vehicle automation levels and seatbelt usage reduce them. We also find that environmental factors, such as road alignments and surface conditions, have complex impacts on rollover occurrence and severity. Notably, NHTSA's rollover possibility value, with a significant positive coefficient of 1.54, indicates that rollovers are more likely to occur as the values rise. We highlight the potential of emerging vehicle technologies to reduce rollover vulnerability. Additionally, we emphasize the need for inclusive road safety measures that cater to the needs of all road users. These insights provide valuable guidance for future transportation safety strategies.
To investigate whether the association between exclusive breastfeeding and malocclusions in primary dentition is modified by pacifier use duration and intensity. Data from a birth cohort study conducted in southern Brazil were used (n = 3591). Poisson regression with robust error variance was used to assess the association between exclusive breastfeeding and malocclusion. The exposure to exclusive breastfeeding was collected through information about breastfeeding duration at 3 and 12 months follow ups. Malocclusion outcomes were assessed at 48 months of follow up using criteria of the World Health Organization. Effect measure modification (EMM) analysis was adopted to verify the association between exclusive breastfeeding and malocclusions, which vary according to pacifier use duration and intensity. EMM was assessed by means of the relative excess risk due to interaction (RERI), which corresponds to the additional risk that would be expected if the combination of exclusive breastfeeding and pacifier use intensity and duration was fully additive. Children who were not exclusively breastfed for 6 months and who used a pacifier throughout the first 4 years showed a prevalence of 7.82 higher than malocclusion (95% CI 4.70-12.92). Even among children who were exclusively breastfed, pacifier use during this period was also associated with a higher prevalence of malocclusion (PR 5.98; 95% CI 3.50-10.21). When occurrence of malocclusion by pacifier use intensity at 48 months was analysed, children full-time users and those children who were not exclusively breastfed presented a malocclusion prevalence of 4.87 (95% CI 3.43-6.93), and those children who were full-time users and who were exclusively breastfed showed a prevalence of 3.96 higher for malocclusion (95% CI 32.66-5.90). Positive RERI for both duration and intensity of pacifier use were observed, suggesting that the joint effect of breastfeeding and pacifier use on malocclusion is larger than the sum of their individual values. Pacifiers use duration and intensity in the first 4 years of life modify the protective effect of exclusive breastfeeding for the first 6 months of life on the malocclusion prevalence at 48 months of life. These findings reinforce the deleterious effects of pacifier use on occlusal development, even with the practice of exclusive breastfeeding.
Obesity contributes to chronic inflammation and estrogen dysregulation, mechanisms linked to increased breast cancer (BC) risk and recurrence, particularly in postmenopausal women. Bariatric surgery and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective weight-loss interventions, but their comparative impact on BC outcomes remains unclear. This study compared long-term overall survival (OS) and locoregional recurrence (LRR) among postmenopausal obese BC patients treated with GLP-1RAs, bariatric surgery, or both. Using the TriNetX Network, a real-world federated research database of de-identified electronic records from multiple healthcare organizations, we identified women aged ≥50 years with BMI ≥30 kg/m² and stage 0-III BC. Study 1 compared patients who initiated GLP-1RA therapy ≥6 months after BC diagnosis with those who underwent bariatric surgery during the same interval. Study 2 compared patients who received both bariatric surgery and GLP-1RA therapy with those who underwent surgery alone. Propensity score matching (1:1) was performed for age, BMI, tumor stage, receptor status, adjuvant therapy, other cancers, and comorbidities. Outcomes included OS and LRR, assessed from 30 days to 10 years after the index event (bariatric surgery or GLP-1RA initiation). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. In Study 1, 22,532 GLP-1RA users and 3,468 bariatric surgery patients were identified; 3,438 were matched in each cohort. 10-year OS was similar (87% vs. 83%), yet GLP-1RA users experienced significantly lower instantaneous mortality risk (HR 0.57, 95% CI 0.45-0.73), indicating fewer or delayed deaths over time. LRR occurred in 1.8% vs. 4.7% (HR 0.52, 95% CI 0.39-0.70), also favoring GLP-1RA therapy.In Study 2, 1,220 patients underwent both bariatric surgery and GLP-1RA therapy and 3,468 underwent surgery alone; 1,129 were matched per group. The combination group showed higher OS (91% vs. 80%; HR 0.44, 95% CI 0.29-0.67) and lower LRR (2.5% vs. 5.8%; HR 0.52, 95% CI 0.33-0.81). Among postmenopausal women with obesity and stage 0-III BC, GLP-1RA therapy was associated with improved OS and lower LRR compared to bariatric surgery alone. Combination therapy achieved the most favorable oncologic outcomes, suggesting a potential synergistic effect. The advantage observed with GLP-1RAs may reflect oncologic effects beyond weight loss, potentially through anti-inflammatory, insulin-modulating, or other metabolic pathways. These findings support further investigation into the underlying biologic mechanisms and potential role of GLP-1RAs in oncology.
Due to a rise in fatal crashes where cannabis use is detected, there is substantial need for objective measures of cannabis-induced impairment. Research has identified promising measures to detect recent cannabis use and impairment, but they are often considered in isolation. Our study aimed to jointly evaluate the predictive potential of various physiological and cognitive measures to determine which are most effective at detecting recent cannabis use and impairment. Adult participants (N = 125) were recruited for an observational study. Users were asked to consume inhaled cannabis products ad libitum over a 15-minute interval and non-users were used as controls. Participants were assessed pre and post smoking with: (1) a tablet-based psychomotor test battery, (2) handheld pupillometry, and (3) blood cannabinoids at baseline (pre-use), and at 40 and 100 minutes after the start of inhalation. These measures were used to predict recent cannabis inhalation and impairment (defined as change in standard deviation of lateral position >6 cm on a MiniSimTM driving simulator) via penalized logistic regression with the Minimax Concave Penalty (MCP). Separate models were fit using data collectable in different contexts (roadside and occupational settings). Models including covariates from each data source performed best at both timepoints. At 40 minutes post-use, recent inhalation and impairment models had areas under the curve (AUCs) of 0.996 and 0.886, sensitivities of 100% and 83%, and specificities of 99% and 82%, respectively. At 100 minutes post-use, models for recent use and impairment performed worse with AUCs of 0.988 and 0.866, sensitivities of 97.8% and 79.2%, and specificities of 96.7% and 82.3%. Including multiple sources of data can improve prediction of recent cannabis use and impairment, over single sources. Additionally, predictive performance was stronger for measures collected at 40 minutes relative to those collected at 100 minutes post-use.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and the dual GIP/GLP-1 receptor agonist tirzepatide are increasingly used for weight and cardiometabolic management, but real-world prescribing patterns in women with polycystic ovary syndrome (PCOS) remain poorly characterised. We performed a retrospective cohort study of 38 263 adult women with ICD-coded PCOS in the LUX MED network, Poland, using electronic health records data from July 2006 to April 2026. The primary analysis included women diagnosed with PCOS in 2018-2024 and evaluated prescription-recorded initiation of GLP-1 RA/GIP-GLP-1 RA therapy within 365 days after the index diagnosis. Temporal trends were assessed using logistic regression with unadjusted and multivariable-adjusted models. Overall, 4557 women (11.9%) had a recorded GLP-1 RA/GIP-GLP-1 RA prescription and 16 381 (42.8%) received metformin. Among incretin-based therapy users, 75.5% had metformin co-exposure, whereas only 11.5% had coded type 2 diabetes mellitus. Recorded BMI was higher among GLP-1 RA/GIP-GLP-1 RA users than among metformin-only or untreated women (median 31.2 vs. 26.3 and 22.1 kg/m2) and greater comorbidity burden (all p < 0.001). Initiation within 365 days rose from 0.14% in 2018 to 5.97% in 2024. Calendar year was strongly associated with initiation (unadjusted OR 1.52, 95% CI, 1.44-1.59; adjusted OR 1.64, 95% CI, 1.56-1.73; both p < 0.001), with consistent results after excluding women with diabetes. Incretin-based therapy use in PCOS increased markedly over time, suggesting expansion beyond classical glycaemic indications toward weight-focused and cardiometabolic management. Studies using dispensing, persistence, safety and outcome data are needed.