The aim of our study is to compare the markers and parameters obtained from complete blood count between patients diagnosed with missed abortion in the first trimester and a healthy pregnant control group. This descriptive, retrospective, case-control study included 166 patients diagnosed with missed abortion according to ultrasound criteria, and an equal number of healthy pregnant controls, who visited the Gynecology and Obstetrics Clinic at a Training and Research Hospital from January 1, 2018, to July 1, 2023. Participants, with 5 to 14 weeks of gestation, were selected using simple random sampling. Data on age, gravida, parity, gestational week, and hemogram results were retrieved from medical records and compared. Statistical significance was set at p < 0.05. No significant differences were observed between the case and control groups in terms of gravida, parity, age, or gestational week (p > 0.05). Likewise, comparisons of hemogram parameters and derived values, did not show statistically significant differences (p > 0.05). However, the multivariate logistic regression analysis revealed that each unit increase in lymphocyte count was linked to a 2.075 times higher risk of missed abortion (p = 0.040). Our study found no significant differences in complete blood count parameters between the missed abortion and healthy pregnant groups. Although lymphocyte count was significant in the multivariate model, this association should be interpreted with caution, as complete blood count values were obtained at the time of diagnosis. Therefore, it does not indicate predictive value, and prospective studies are needed to determine whether lymphocyte count may serve as a pre-diagnostic marker.
Complete arch intraoral scans for implant-supported prostheses may be affected by cumulative stitching distortion because of limited geometric continuity between scan bodies. Various splinting and auxiliary approaches have been proposed to improve scanning accuracy; however, many require resin fixation, implant-specific components, or additional framework fabrication. This article describes a technique for using a universal, non-calibrated auxiliary geometric device (ScanClamp), inspired by a dental dam clamp design, to augment intraoral scan bodies during complete arch scanning for implant-supported prostheses. The device is fabricated from polyetheretherketone (PEEK) and mechanically retained to individual scan bodies through elastic deformation. Adjustable wing extensions may be oriented to establish continuous surface geometry across the arch. The technique is intended to enhance surface continuity within standard intraoral scanning workflows while remaining modular and implant system-independent.
Elucidating the evolution and epidemiology of Mycobacterium tuberculosis requires comprehensive characterization of its genomic diversity; however, short-read sequencing fails to resolve part of this variation. Here, we assembled 216 complete genomes from clinical isolates in the Valencia Region, Spain, using long-read sequencing. This dataset, mostly encompassing Lineage 4, provides a refined map of M. tuberculosis genetic diversity across evolutionary scales. Complete genomes uncover a median of 312 (-1 to 792) additional SNPs per pairwise comparison, revealing an estimated evolutionary rate 1.44-fold higher than that inferred from short-read mapping. This diversity is concentrated in discrete hotspots, particularly within the pe/ppe gene family, where gene conversion is a major driver of nucleotide diversity. While most PE/PPE epitopes remain highly conserved, suggesting strong purifying selection, some involved in vaccine candidates are affected by gene conversion, with unknown consequences. At the epidemiological scale, additional resolution is gained from SNPs previously masked and newly resolved indels and structural variation, refining genetic transmission networks. Finally, at the within-host level, the use of patient-specific reference genomes allows us to capture genuine diversity during infection, showing that previous approaches led to false positive calls. Together, these findings delineate the landscape of M. tuberculosis genomic diversity and provide a framework for more accurate inference of pathogen evolution, host-pathogen interactions, and transmission dynamics.
In the UK, Sudden Unexpected Death in Infancy (SUDI) clusters among priority families (those experiencing multiple and complex problems) where universal infant sleep safety guidance is least effective and alternative multi-agency approaches are required. This project implemented and evaluated multi-agency Eyes on the Baby SUDI prevention in Northumberland, a large rural English county. A Steering Group comprising diverse organisations oversaw the programme. The multi-agency workforce was grouped by job roles into three training strands based on frequency and type of contact with priority families. Online training was accessed individually or in teams. Normalisation Process Theory (NPT) supported engagement and embedding SUDI prevention into practice. Pre- and post-training surveys assessed staff knowledge and confidence with SUDI prevention. Follow-up surveys captured staff feedback and engagement at 2, 4 and 12 months post-training. Staff in 187 roles across 25 services were recruited; 607 of the 1007 staff registered completed training. SUDI-prevention knowledge and confidence increased across all strands; knowledge remained high 2 and 4 months after completion. Commitment to SUDI prevention was sustained over time. SUDI-prevention champions helped embed learning into everyday practice. At 1 year, 95% of the 73 staff who responded to follow-up remained actively engaged in SUDI prevention. Staff with limited contact with priority families were the least likely to sustain engagement. At the project conclusion, Northumberland County Council adopted the programme for their pan-Northumberland training platform. Eyes on the Baby can train and sustain staff engagement in multi-agency SUDI prevention. Key stakeholders with diverse experiences of SUDI prevention oversaw the programme. A Steering Group-led implementation approach encouraged staff to accept SUDI prevention within their roles and was reinforced by team leaders. Early adopters rapidly identified their contribution and engaged enthusiastically as SUDI-prevention champions. One year after training, staff remained engaged, although some roles required additional support. In the UK, Sudden Unexpected Death in Infancy (known as SUDI) is more likely to happen in families needing extra support. We looked at whether staff from different organisations working in a wide range of jobs across Northumberland would engage with the Eyes on the Baby programme to learn how they could help these families keep their babies safe.Managers from different organisations oversaw the programme and divided workers into three training groups based on how often and in what ways they had contact with families needing support. Staff completed online training alone or in teams. We used a method called Normalisation Process Theory (NPT) to help get everyone involved in making SUDI prevention a routine part of their work. Surveys completed before and after the training checked staff knowledge about preventing SUDI and confidence in talking to families. Surveys at 2, 4 and 12 months after the training gathered staff feedback.Staff in 187 roles from 25 services took part. Of 1,007 staff who signed up, 607 finished the training. Their knowledge and confidence about SUDI improved in all areas, and their knowledge stayed high 2 and 4 months later. Their commitment was strong over time. One year later, 95% of staff responding to a follow-up survey were still actively using their training. However, staff who had less contact with high-risk families were less likely to stay engaged. At the end of the project, Northumberland County Council put the training on their county-wide staff training platform.The Eyes on the Baby programme helps train staff and keep them involved in working together to prevent SUDI. One year after training, staff were still engaged, although some job roles needed extra support to stay involved.
Ambulatory blood pressure monitoring (ABPM) is considered a reference standard for diagnosing hypertension and is recommended for out-of-office blood pressure assessment, yet internal medicine residents receive limited training in its interpretation. We conducted a needs assessment to identify gaps in hypertension and ABPM education and developed an asynchronous e-learning module to address these deficiencies. We then evaluated its impact on residents' self-reported confidence and preparedness in outpatient hypertension management. We conducted a single-center quality improvement study among internal medicine residents (PGY1-4) at the University of Toronto between July 2024 and January 2026. A baseline needs assessment evaluated prior exposure to ABPM, confidence in interpretation, and preparedness to diagnose hypertension. An e-learning module was developed, consisting of a structured "Five Steps of ABPM Interpretation" framework and case-based learning. A post-intervention survey assessed self-reported confidence, preparedness, and educational value. Descriptive statistics were used to summarize outcomes. Between-group comparisons of categorical outcomes were performed using chi-square tests. Sixty-two residents completed the baseline survey, and 26 completed the module and post-intervention survey [1]. At baseline, 56.5% (35/62) reported no prior exposure to ABPM interpretation. Only 22.6% (14/62) felt comfortable interpreting ABPM reports, and 32.3% (20/62) felt prepared to diagnose outpatient hypertension. Following the intervention, 84.6% (22/26) of residents reported feeling comfortable or very comfortable interpreting ABPM, and 92.3% (24/26) reported feeling prepared or very prepared to diagnose hypertension. Learner satisfaction was high, with over 90% of participants reporting that the module was educationally valuable, easy to use, and effective. An asynchronous, case-based e-learning module was feasible, well-received, and associated with higher self-reported confidence and preparedness in ABPM interpretation among internal medicine residents. The observational nature and potential for both response and selection bias limits generalizability of the study.
To address mechanical analysis challenges of multi-body incremental launching for complex curve bridges in urban reconstruction, traditional methods suffer from incomplete working condition coverage, geometric model distortion, and inadequate core component simulation. This study establishes a refined full-stage calculation system: proposes a mathematical expression of the launching process and automatic constraint state judgment method, develops a finite element strategy (rapid 1D linear modeling and accurate 3D spatial mapping), and designs a Python-based automated program for MIDAS MCT command stream generation. Validated by the Guangzhou-Shenzhen Expressway reconstruction project, it covers 771 working conditions, accurately extracts key mechanical responses (support reactions, ductile hinge shear forces, displacements, stresses), and quantifies the influence of linear curvature and torsion. The method mitigates the shortcomings of traditional approaches in terms of computational efficiency, completeness of working condition coverage, and geometric fidelity, establishing an efficient automated analysis process that covers the entire construction stage. It promotes the digital and intelligent evolution of incremental launching mechanical analysis, offering technical support for safe and precise bridge construction in complex environments.
Respiratory illness contributes to substantial global morbidity and mortality. In Madagascar, an island nation off the southeastern coast of the African continent, hospital-based public health surveillance for respiratory pathogens screens for common respiratory viruses. However, many cases remain undiagnosed. We conducted metagenomic Next Generation Sequencing (mNGS) to identify the pathogen profile of 102 undiagnosed febrile patients who presented to public hospitals with respiratory symptoms and screened negative on a 14-virus multiplex RT-qPCR. We analyzed the diversity of the respiratory microbiome of each patient from mNGS data and identified viral infections potentially linked to undiagnosed fever. We assembled whole genome consensus sequences of viruses with sufficient read depth and coverage, characterized each phylogenetically, and identified any discrepancies with the primers used in the multiplex RT-qPCR panel. Finally, we compared all whole genome sequences against publicly available global databases in a phylogenetic analysis. We identified evidence of infection by a wide range of known human viruses in approximately two thirds (64.7%) of study participants from nine different families of viruses and generated 30 complete or nearly complete consensus sequences of known respiratory viruses including orthopneumoviruses, metapneumoviruses, rhinoviruses, coronaviruses, parainfluenza virus, and bocaparvovirus. mNGS-attributed evidence of infection was predominantly due to orthopneumovirus (also called respiratory syncytial virus [RSV]; n = 24; n = 8 previously diagnosed) and rhinovirus (n = 18) detections, despite previous negative RT-qPCR results for the majority of these cases. Finally, phylogenetic analysis identified two distinct phylogenetic clusters of RSV subtype A, suggesting local transmission following distinct international introductions for this virus. mNGS provides a sensitive pan-pathogenic tool for virus detection. We demonstrate the diversity of viruses associated with undiagnosed respiratory fevers in Madagascar, emphasize the importance and relevance of the existing respiratory surveillance in the country, and highlight the interconnectedness of regional respiratory infection dynamics with global networks of respiratory pathogen transmission.
Pain may be linked to neuropsychiatric symptoms in dementia but the nature of these associations is unclear. The aims of this study were to examine the concurrent validity of pain scales and to investigate the relationship between pain and neuropsychiatric symptoms in community-dwelling people with dementia. This study recruited dyads of people with dementia and their caregivers. Questionnaires measuring pain (Numeric Rating Scale, Brief Pain Inventory Short Form, EQ5D3L) and cognition (Mini- Addenbrookes Cognition Examination) were completed by people with dementia. Dyad partners completed the Neuropsychiatric Inventory Questionnaire (NPI-Q). We examined the degree of agreement between different measures of pain and compared the NPI-Q score and items between people with dementia with and without troublesome pain (NRS ≥ 4, NRS < 4), and between those with single and multisite pain. The study recruited 35 individuals with dementia (49% female, mean age 80 with a range of 65-91 years, mean Mini-ACE 13.6/30) and 35 dyad partners. 66% of people with dementia had troublesome pain and compared to those without troublesome pain they were not significantly different in terms of age, sex, frailty, or other demographic variables, but were more likely to take regular paracetamol. Agreement between the NRS and EQ5D3L pain score was good (Cohen's kappa 0.70, p<0.001), as was agreement between the NRS and BPI-SF with a close to 0 mean difference between the scores on a Bland-Altman plot. The total NPI-Q score was not significantly associated with the presence of troublesome pain. Of all NPI-Q symptoms, only disinhibition showed associations with both painseverity and multisite pain (44% vs 0% and 38% vs 0% respectively, both p<0.05). Community-dwelling people living with dementia can self-report pain using a range of pain scales. Certain neuropsychiatric symptoms may be more common in the presence of pain but requires further study with larger cohorts.
Intra-hospital transfers (IHT) of hospitalized children are unavoidable practices often performed with emergency patients and postoperative patients. Standardizing IHT processes to minimize adverse events might improve children's outcomes. We developed an evidence-based clinical practice IHT guideline for hospitalized children. The aim of this study was to evaluate the implementation process and the effectiveness of the implementation of this guideline on patient outcomes, healthcare professionals' knowledge and behavior, and hospital organizational context. A type III hybrid effectiveness-implementation design was adopted, using a pre-post intervention trial (January-December 2024). Data of patient demographics, transport-related outcomes, and healthcare providers' knowledge and compliance were collected. We used the RE-AIM framework to assess effectiveness across four dimensions: Reach, Effectiveness, Adoption, and Implementation. Totally, 110 healthcare professionals conducted 213 IHTs of eligible children (109 children in the pre-intervention group and 104 in post-intervention group). The Reach outcomes demonstrated that participation among hospitalized children (n = 312) was suboptimal at 33% (104/312). No differences were observed between the pre- and post-intervention group regarding gender, disease distribution, or pediatric early warning scores. The implementation showed favorable outcomes in the dimensions Effectiveness, Adoption, and Implementation. Healthcare professionals engagement was 95%, with 86% (19/22) of the implementation strategies successfully completed. Healthcare professionals' knowledge in the pre-intervention group (n = 109) improved from median 40 (IQR 28;52) to median 76 (IQR 64;84) in the post-intervention group (n = 104; p < 0.001). Clinically, the new guideline reduced adverse events (12 vs 4; p = 0.047), reduced the median minutes of bedside handover time from 5 (IQR 3;7) to 4 (IQR 3;5; p < 0.001), and improved handover information completeness from median score of 5 (IQR 4;6) to 20 (IQR 12;23, p < 0.001). The total transport time increased from 14 to 19 minutes in the post-intervention group (p < 0.05), while no significant changes were observed in handover interruptions or post-transfer vital sign stability (p > 0.05). The RE-AIM-based evaluation confirmed that the implementation strategies effectively enhanced healthcare professionals' knowledge and compliance while reducing adverse events and optimizing handover efficiency. However, the limited patient participation rate and increased transport duration highlight areas requiring further refinement to maximize the guideline's impact. ClinicalTrials.gov, NCT06512805. Registered 27 June 2024.
This study examined whether habitual exercise timing and sex are associated with lower-limb injury prevalence and frequency in physically active young adults. A total of 454 recreationally active university students (48% males; age = 22.1 ± 2.4 years) completed a validated survey assessing training exposure, experience, and injury history. Habitual physical activity timing was classified into three defined categories: morning (08:00-11:00), midday/afternoon (11:00-17:00), and evening/night (17:00-24:00). Group differences were examined using chi-square and log-linear analyses. Zero-inflated Poisson (ZIP) and multivariable logistic regression models were used to identify factors associated with injury counts and occurrence, adjusting for age, fat mass index (FMI), training load, and experience. Injury prevalence was higher in males than females (p = 0.048). Injury frequency differed across time-of-day categories (p = 0.004), with the highest burden among participants exercising evening/night. In ZIP models, males, exercising evening/night, and higher FMI were associated with higher injury counts, whereas older age was associated with fewer injuries. Logistic regression showed similar associations for injury occurrence (AUC = 0.74, 95% CI: 0.69-0.79). Lower-limb injury risk in young, physically active adults is consistently associated with habitual exercise timing, sex, and adiposity. These findings highlight the importance of considering exercise scheduling patterns and FMI in injury-prevention strategies.
T cell receptors (TCR) orchestrate adaptive immunity, yet the complex, repetitive architecture of the TCR loci has impeded systematic characterization of human genetic variation in the genes encoding the TCR. Using public long-read sequencing data from the Human Pangenome Reference Consortium and All of Us consortia spanning 2719 donors, we build a near-complete map of common alleles in TCR V, D, and J genes, revealing amino acid variation at almost every position within V genes. We observe allele frequency differences between populations for many individual TCR genes. We present evidence of natural selection on TCR genes, including signals of balancing selection and positive selection in the alpha chain locus. We find TCR allelic polymorphism alters core functional properties of T cells, including thymic fate commitment and cell-surface receptor abundance. Collectively, these findings position inherited variation in TCR genes as a key axis of immunological diversity that may shape interindividual differences in immune responses.
The prevalence of diabetes in Belgium has steadily increased since 2001, reaching 6.9% in 2024, with type 2 diabetes (T2D) accounting for approximately 90% of cases. Diabetes-related healthcare expenditures were estimated at €2 billion in 2022. The European Care4Diabetes Joint Action aimed to transfer and adapt the evidence-based Dutch lifestyle program Reverse Diabetes2 Now to 12 European countries. This study evaluated the transferability and potential effectiveness of the Care4Diabetes lifestyle intervention on metabolic, behavioral, and subjective health outcomes among Belgian adults with T2D in primary care. This quasi-experimental implementation study was conducted in two primary care centers in Wallonia. Forty-three participants initiated the program and 37 completed the 12-month follow-up. The intervention included a 6-month intensive phase with five thematic group sessions and one individual check-up, followed by an additional check-up and a refresher session at Month 12. Primary outcomes were changes in HbA1c and T2D medication use. Secondary outcomes included anthropometric measures, lipid profile, behavioral outcomes, and subjective health indicators. Linear mixed models were used to assess changes over time, accounting for repeated measures. At Month 12, 46% of participants had no change in T2D medication, 43% underwent medication de-intensification, and 11% required intensification. After adjustment for T2D medication changes, HbA1c decreased significantly from baseline to Month 6 by 5.4 mmol/mol (0.49%; p = 0.002), but the reduction was attenuated at Month 12 to 2.8 mmol/mol (0.26%; p = 0.06). Sensitivity analyses restricted to participants without T2D medication changes showed significant decreases in HbA1c at Month 6 and Month 12. Body weight decreased significantly (- 3.6 kg at Month 12, p < 0.001). Improvements were also observed in dietary behaviors and perceived general health, and satisfaction among participants and healthcare providers was high. The Care4Diabetes program demonstrated good transferability and promising effectiveness in primary care in Wallonia. Larger studies across Belgium are needed to further assess clinical effectiveness and potential economic benefits.
Depression is common in healthcare students, severely affecting their academic performance and daily life. Problematic internet use and insomnia are related to depression, yet underlying mechanisms remain unclear in Macau, China. This study aims to explore associations among problematic internet use, insomnia, and depression, and to examine the mediating role of insomnia. This cross-sectional study was implemented during January and February 2025. Two hundred and sixty-four healthcare students in Macau completed self-report questionnaires on sociodemographic variables, problematic internet use, insomnia, and depression using an online platform. Model 4 of the PROCESS macro was applied to explore the mediating effect. In this study, 40.2%, 18.6%, 6.4% and 3.4% of Macau healthcare students sustained mild, moderate, moderately severe, and severe depression, respectively. Problematic internet use was positively correlated with insomnia (r = 0.363, p < 0.001) and depression (r = 0.484, p < 0.001). Insomnia and depression were positively correlated (r = 0.666, p < 0.001). Insomnia served as a partial mediator between problematic internet use and depression, accounting for 35.6% of the total effect (95% Boot CI: 0.027-0.082). Depression is prevalent among Macau healthcare students. Improving sleep quality may reduce depression in students with problematic internet use. Clinical focus should shift toward assessing and treating insomnia as a core component of care for students with problematic internet use.
Small differences between females and males in cognitive abilities have been consistently reported, but the factors underlying these sex differences remain unclear. Social and cultural factors are thought to play a key role, but studies on this topic have been inconclusive. Examination of genetic factors may shed some light on the mechanisms underlying cognitive sex differences. Using data from the Philadelphia Neurodevelopmental Cohort, a large, general population sample of individuals aged 8 to 21 years old (N = 4,694), we tested for sex differences in the genetic factors (i.e., Gene × Sex interactions) underlying cognitive ability. Participants completed the Penn Computerized Neurocognitive Battery, which consists of 14 tests designed to capture accuracy and speed in five domains: 1) executive function (abstraction and mental flexibility, attention, working memory), 2) episodic memory (verbal, facial, spatial), 3) complex cognition (verbal reasoning, nonverbal reasoning, spatial processing), 4) social cognition (emotion identification, emotion differentiation, age differentiation), and 5) speed (motor, sensorimotor). Composite domain scores were derived using confirmatory factor analysis, and general accuracy (g) and speed (gs) using principal component analysis. Small sex differences were observed on most cognitive measures (standardized mean difference (SMD) = 0.061-0.182). Males showed significantly higher genetic variance and lower environmental variance in executive (female σ2g = 0.301 v. male σ2g = 0.598, p = 0.001, female σ2e = 0.243 v. male σ2e = 0.024, p = 0.007), and complex (female σ2g = 0.291 v. male σ2g = 0.610, p = 0.001, female σ2e = 0.259 v. male σ2e = 0.023, p = 0.006) accuracy. Females showed significantly higher genetic and lower environmental variance on complex (female σ2g = 0.575 v. male σ2g = 0.135, p = 0.009, female σ2e = 0.222 v. male σ2e = 0.641, p = 0.012) and social (female σ2g = 0.589 v. male σ2g = 0.129, p = 0.009, female σ2e = 0.236 v. male σ2e = 0.672, p = 0.012) speed. Genetic correlations between females and males were not significantly different from 1 on any cognitive measure. Altogether, our results suggest that while the same genetic factors influence cognition in females and males, the magnitude of effect of these genetic factors differs. We observed small differences between females and males on most cognitive measures, as well as sex differences in heritability on some measures. Future studies are needed to delineate how environmental, genetic, and other biological factors jointly influence cognition. Small differences in cognition between females and males have been consistently reported across abilities, cultures, and decades. However, the factors underlying these cognitive sex differences remain unclear. Social and cultural factors are thought to play a key role, but there has been less examination of potential genetic factors. We tested for sex differences in the genetic factors underlying a range of cognitive abilities in a large, general population sample of individuals aged 8 to 21 years old. Small sex differences were observed across most cognitive domains, with female advantages in memory and social cognition, and male advantages in executive and complex cognition. Moreover, differences between females and males in the magnitude of genetic factors underlying cognition were observed for executive, complex, and social cognition, suggesting that some cognitive sex differences are partly driven by sex differences in underlying genetic factors. Most research on the underlying causes of sex differences in cognitive abilities has focused on social and cultural factors, but our findings highlight the importance of considering genetic factors, as well as how these genetic factors act jointly with social and cultural factors to impact cognition. Given the impact of cognition on social, emotional, and health outcomes, further work is needed to delineate the interplay between environmental and genetic factors that underlie cognitive sex differences.
Perspective-taking refers to one's ability to infer one's own and others' mental states. The existing perspective-taking tasks mainly focus on healthy individuals and overlook the potential confounding effect of prompt type. The current study developed a perspective-taking task for social anxiety research by including both ambiguous and unambiguous prompts and a social context. Analysing two community samples with either ambiguous (N = 69) or unambiguous (N = 89) prompts found that both prompts cued self-perspective-taking and other perspective-taking as required. However, while unambiguous prompts cue perspective switching, the ambiguous prompts failed to do so. Thirty-two participants of the two samples completed the tasks with both prompt types and showed no differences in perspective-taking. Findings suggest that the newly developed task measures self-perspective-taking and other perspective-taking as prompted, regardless of prompt type. Furthermore, the unambiguous prompts may be more sensitive and appropriate for measuring perspective switching and offer greater applicability in neural research.
Migraine can impair productivity, work performance, and daily functioning in working-age adults. While higher Central Sensitization Inventory (CSI) scores have been observed in migraine chronicity, work-related stress, and musculoskeletal pain are also common among desk-based workers and may play a role in exacerbating migraine symptoms. However, these factors have rarely been studied together in this population. This cross-sectional study aimed to compare central sensitization, work-related stress, and musculoskeletal pain symptoms in desk-based workers with and without migraine, to examine the relationships among them, and to identify the determinants of central sensitization in individuals with migraine. This cross-sectional study included 228 desk-based workers: a control group (CG) without migraine (n = 84), episodic migraine (EM) (n = 74), and chronic migraine (CM) (n = 70). Participants completed the CSI, General Work Stress Scale (GWSS), Nordic Musculoskeletal Questionnaire (NMQ), Migraine Disability Assessment (MIDAS), and Headache Impact Test-6 (HIT-6). Group comparisons were performed using ANOVA or Kruskal-Wallis tests. Spearman coefficients were used in correlation analyses. Multiple linear regression was applied to identify factors associated with CSI. Both migraine groups scored higher on the CSI compared to the CG (p < 0.001), with CM showing the highest CSI scores. This difference remained significant after adjusting for confounders. GWSS scores were also higher in both migraine groups than the CG (p < 0.001) and remained significant after adjustment. NMQ;3-items were significantly higher in the migraine groups compared to the CG (p ≤ 0.005), independent of confounders. In the migraine groups, higher CSI scores showed a positive correlation with GWSS, MIDAS, HIT-6, and NMQ. In multiple linear regression analysis, GWSS (β = 0.380), number of painful body regions during the past 12 months (β = 0.382), MIDAS (β = 0.230), and the number of headache days per month (β = 0.170) were identified as variables independently associated with CSI scores (all p < 0.05). Desk-based workers with migraine had higher central sensitization, greater work-related stress, and more widespread musculoskeletal pain symptoms compared to those without migraine. In desk-based workers with migraine, central sensitization was more pronounced in CM than EM, suggesting a potential role in migraine chronicity. These findings support multifaceted management strategies for desk-based workers with migraine, including headache-stress management, musculoskeletal rehabilitation, and Sustainable Development Goal-3, "to ensure healthy lives and promote well-being for all ages." NCT07554664 (registration date: 21.04.2026).
Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples. A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple's therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software. All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = -.314, P = .001), erectile function (r = -.361, P = .003), intercourse satisfaction (r = -.365, P = .003), and overall satisfaction (r = -.266, P = .031). Similar negative associations were observed for female age with overall ED (r = -.371, P = .002), erectile function (r = -.354, P = .004), intercourse satisfaction (r = -.344, P = .005), and overall satisfaction (r = -.246, P = .047). Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.
Although childhood HPV vaccination reduces adult cancer risk, national uptake remains suboptimal. This study examined associations between unmet social needs and HPV vaccine uptake in a metropolitan area. Parents (N = 412) with children aged 10-17 were recruited to complete a survey through Meta advertisements and at a health fair. Overall, 54.9% of children were fully vaccinated, 81.0% of parents had initiated vaccination, and 54% of parents reported > = 1 unmet social need. In an income-adjusted model, under-vaccinated children were more likely to be younger (OR = 1.96, 95% CI = 1.25, 3.07), and have parents who were non-white (OR = 1.74, 95% CI = 1.11, 2.71), non-Hispanic (OR = 1.96, 95% CI = 1.15, 3.35), and unvaccinated (OR = 3.53, 95% CI = 2.00, 6.22). The association between housing instability and childhood under-vaccination was overshadowed by the strong effect of parental vaccination status. In a healthcare access-, income-, and sex-adjusted model, parents were 25% more likely to be unvaccinated with each additional unmet social need experienced (OR = 1.25, 95% CI = 1.05, 1.49). Unvaccinated parents were more likely to have under-vaccinated children and reported more unmet social needs. Unmet social needs may help identify families experiencing structural vulnerabilities associated with HPV under-vaccination.
The air urban heat island (UHI) poses significant challenges to urban environments. While vegetation is a recognized mitigation strategy, the in-situ cooling effects of different vegetation types, such as forests and grasslands, across diverse climatic regions remain poorly quantified. This study addresses this gap using a station-pair regression approach to evaluate vegetation's cooling efficacy in three major Chinese cities: Beijing, Shanghai, and the Mega-city Cluster in the Pearl River Delta (MCPRD). We developed multiple linear regression models using summer data from 2016 to 2020. These models predict the air temperature difference between paired meteorological sites based on spatial differences in vegetation conditions, derived from high-resolution Sentinel-2 imagery, distance to large water body, wind speed, and elevation. The model performed well, achieving coefficient of determination of 0.71, 0.58 and 0.82 for Beijing, Shanghai and MCPRD, respectively. Crucially, our results show that compared to completely urbanized land, existing vegetation significantly lowers air temperature by 2.43 °C in Beijing, 0.58 °C in Shanghai, and 2.74 °C in the MCPRD. This research quantifies the variable cooling benefits of urban vegetation across different climate zones, providing an empirical basis for optimizing green infrastructure in urban planning to enhance thermal comfort.
Perineal reconstruction remains challenging due to complex anatomy, high bacterial load, and frequent postoperative complications. Extensive tissue defects after oncologic resection or severe infection commonly necessitate reconstructive procedures. Although myocutaneous flaps are widely used, perforator flaps offer advantages such as muscle preservation and reduced donor-site morbidity. Given the perineal region's critical role in defecation, urination, and sexual function, evaluating patients' quality of life (QoL) after reconstructive surgery is essential. This single-center cohort study evaluated postoperative complication rates and QoL after perineal reconstruction with perforator versus non-perforator flaps from 2013 to 2023. All participants were invited to complete a postoperative QoL survey. Of all the patients, 58 % received a perforator-based and 40 % a non-perforator-based reconstruction. One patient (2.3 %) underwent a combined approach. The primary indication for perineal reconstruction (68.9 %) was defect coverage after oncologic resection. Both groups had a 50 % complication rate. Donor-site morbidity was higher in the non-perforator flap group, with all complications classified as Clavien-Dindo grade III. Additional findings were exploratory: patient satisfaction was higher in the non-perforator flap group (100 % vs 66 %), although this group had a substantially longer follow-up period (4.14 vs 1.74 years). Conversely, numerically higher QoL scores were observed in the perforator flap group. Perforator flaps demonstrated a more favorable donor-site profile, representing the most robust finding of this cohort. Observed differences in complications and patient-reported outcome measures are exploratory, and QoL continues to be insufficiently addressed in oncologic perineal reconstruction, underscoring the need for enhanced interdisciplinary collaboration.