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A recent study demonstrated that subcutaneous fat tissue thickness (SFTT) at the L1-L2 level is predicting paraspinal muscle fatty infiltration. Given that fat distribution patterns differ between males and females, we calibrated the SFTT index to obtain a standardized subcutaneous fat index (SSFI). A total of 175 patients admitted between January 2023 and July 2024 were included in this study. Based on lumbar CT attenuation values, patients were classified into an osteoporosis group (HU ≤ 110) and a normal bone density group (HU > 110). Demographic characteristics and clinical variables, including age, BMI, sex, medical history, and the standardized subcutaneous fat index (SSFI), were compared between the two groups. Pearson correlation analysis was subsequently performed to evaluate the associations between SSFI1 and other variables. Multiple linear regression analyses were conducted to further assess the relationships between SSFI1 and multifidus fatty infiltration, erector spinae fatty infiltration, frailty index, and vertebral bone quality (VBQ). Finally, receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of SSFI1 to discriminate osteoporosis. Patients with osteoporosis were older than the control group, while no significant differences were observed in smoking, alcohol consumption, diabetes, or hypertension between the two groups. Compared with controls, patients with osteoporosis showed lower SSFI1 values, greater paraspinal muscle fatty infiltration, and higher frailty index and VBQ scores. Moreover, SSFI was lower in both male and female patients with osteoporosis. Pearson correlation analysis further demonstrated that SSFI1 was significantly associated with paraspinal muscle fatty infiltration, lumbar bone mineral density, femoral bone mineral density, frailty index, and VBQ. Multiple linear regression analysis revealed that SSFI1 was associated with VBQ. ROC curve analysis indicated that SSFI1 had potential value in distinguishing osteoporosis from non-osteoporotic individuals. When the cutoff value of SSFI1 was < 0.29, the area under the curve (AUC) was 0.642, with a sensitivity of 0.696 and a specificity of 0.921, suggesting that SSFI1 may serve as a potential imaging marker for osteoporosis. SSFI1 was significantly reduced in patients with osteoporosis and was closely associated with paraspinal muscle fatty infiltration, bone mineral density, frailty index, and VBQ. In addition, SSFI1 demonstrated potential value in distinguishing osteoporosis from non-osteoporotic individuals. These findings suggest that SSFI1 may serve as a simple and accessible imaging biomarker for evaluating bone quality and may provide a novel approach for the early identification and risk stratification of osteoporosis.
An increasing number of workers are facing various physical factors, such as heat stress due to the inevitable climate change. This study aimed to develop and validate an Outdoor Environmental Heat Index(OETI) without using measurement instruments, relying only on meteorological and geographical data and using structural equation modeling. This cross-sectional study was conducted on 201 men who worked outdoors in both hot and dry, as well as hot and humid environments. Alongside collecting personal information from the participants, tympanic temperature and heart rate were measured both at rest and 90 min after the start of work. Concurrently, the climatic conditions of the workplace were assessed using instruments, along with geographic information and data from meteorological databases. Additionally, the metabolic rate and insulation value of the individuals' clothing were estimated, and information related to other observed parameters was also recorded. The results revealed that the main factors, with a total coefficient of 0.8 had a significant direct effect on tympanic temperature. According to the results, the indirect effect coefficients of the most important variables were as follows: globe temperature (0.59), dry bulb temperature (0.55), relative humidity (0.53), work place (0.59) and heat source (0.55). The overall index score was divided into four categories based on established optimal cut-off points of 18.5, 20.02, and 21.46. Furthermore, the results showed that the OETI developed using device data and with meteorological data was able to justify 69% and 59% of the changes in tympanic temperature. OETI was developed based on a combination of observational, geographic, and meteorological data, making it a practical tool for assessing heat stress without need to measurement ins As a result, this index justifies 69% of the tympanic temperature (R2 =0.69).
The intracranial pressure (ICP) pulse waveform reflects intracranial compliance. The pulse shape index (PSI), an artificial intelligence (AI)-based metric ranging from 1 (normal) to 4 (disturbed), quantifies morphological waveform pathologies. Early findings in smaller cohorts indicate that elevated PSI is associated with mass lesions, aging, higher ICP, and worse outcome. This study examined how PSI relates to other markers of intracranial compliance, the risk of ICP crisis, and clinical outcome in a large traumatic brain injury (TBI) cohort. This retrospective study included 321 TBI patients with ≥ 12 h of ICP/PSI monitoring. PSI was analysed in relation to ICP, ICP pulse amplitude (AmpICP), the moving correlation coefficient between mean ICP and ICP amplitude (RAP index), and arterial blood pressure (ABP) using generalised additive models (GAMs). Linear mixed-effects models assessed whether PSI during preceding hours predicted later ICP elevations (e.g., ICP > 20/22 mmHg). The prognostic value of PSI was tested using univariable Mann-Whitney U test and multivariable (after adjustment for age, Glasgow Coma Scale, ICP, CPP, and PRx) logistic regression for mortality (Glasgow Outcome Scale = 1) and favourable outcome (Glasgow Outcome Scale = 4-5). PSI increased with higher ICP, AmpICP, RAP, and ABP. PSI during the preceding hour predicted increased ICP burden above 20 mmHg (marginal R2 ~30%). PSI was lower in survivors and in patients with favourable outcomes. However, in multivariable logistic regressions, PSI was not independently associated with mortality or favourable outcome. PSI was linked to established indicators of intracranial compliance and provided early warning of impending intracranial hypertension. While PSI showed univariable associations with outcome, these did not remain in multivariable models. Retrospectively, PSI does not appear to have independent prognostic value, but rather a complementary value. Prospectively, it may serve as a dynamic marker of deteriorating intracranial compliance and an early signal for future ICP crisis.
This study aimed to predict risk of cardiovascular disease (CVD) in participants unaware of their cardiovascular health using a convenient approach. Continuous 100-second photoplethysmography (PPG) signals were recorded from 144 participants. The subjects were subsequently categorized based on the presence or absence of CVD. The proportions of abnormal stiffness index (SI), the sine-waveform ratio (SIN ratio), a morphological index of PPG waveform regularity used as a marker for cardiovascular pathological aging, and total power (TP), derived from heart rate variability (HRV) frequency-domain analysis to reflect autonomic nervous system activity, were compared. A total of 144 participants were enrolled in this study (CVD group, n = 54; healthy control group, n = 90). CVD group had higher SIN ratio (37.4 ± 27.8% vs. 21 ± 23.9%) and lower TP (1587.0 ± 262.9 vs. 1804.7 ± 261.7ms²) compared to healthy controls (p < 0.001). CVD group had higher rates of abnormal SI (46% vs. 24%) and SIN ratio > 40% (42.6% vs. 23.5%), all p < 0.01. The combination of abnormal SI values, SIN ratio > 40%, and TP < 1500 ms² indicated a high likelihood of CVD (p < 0.001). PPG-derived SI, SIN ratio, and TP are valuable indicators that are potentially associated with cardiovascular health. Our results provided a convenient, inexpensive, and automated approach for preliminary assessment of the presence of CVD. Further large-scale studies are needed to validate these findings.
Cardiovascular-Kidney-Metabolic (CKM) syndrome is a newly recognized condition characterized by systemic inflammation, a process also implicated in depression. The Dietary Inflammatory Index (DII) quantifies the inflammatory potential of diet, yet its association with depression among individuals with CKM syndrome remains underexplored. Utilizing data from 11,847 adults with CKM syndrome stages 0-3 enrolled in seven NHANES cycles (2005-2018), we examined the relationship between DII and depression. The DII was computed using 24-hour dietary recall data. Weighted logistic regression and restricted cubic spline (RCS) analyses were applied to evaluate linear and nonlinear associations. Subgroup and sensitivity analyses were also conducted to assess consistency and robustness. Elevated DII values were consistently associated with a greater likelihood of depression across all models. Participants in the highest DII quartile (Q4) exhibited significantly higher odds of depression than those in the lowest quartile (Q1). RCS models revealed a positive, nonlinear dose-response relationship. Additionally, a significant interaction was observed between DII and diabetes mellitus status. A pro-inflammatory dietary profile, reflected by higher DII scores, is positively associated with depression among individuals with CKM stages 0-3. These findings highlight the potential benefits of adopting anti-inflammatory dietary interventions to mitigate depression risk in this population.
This study investigated whether the Dietary Index for Gut Microbiota (DI-GM), a measure of diet quality for gut health, is associated with IBS risk, and symptom severity, inflammation. A case-control study included 350 adults (175 IBS patients per Rome IV and 175 matched controls). Dietary intake was assessed using a validated food frequency questionnaire to calculate DI-GM scores. Irritable Bowel Syndrome severity and quality of life were measured via the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS), Irritable Bowel Syndrome Extended Symptom Severity Scale (IBS-EISSS), and Irritable Bowel Syndrome Quality of Life questionnaire (IBS-QOL). Serum inflammatory markers-including C-reactive protein (CRP), lipopolysaccharide (LPS), zonulin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and brain-derived neurotrophic factor (BDNF)-were quantified using ELISA. IBS patients had significantly lower DI-GM scores than controls (7.69 ± 3.12 vs. 12.15 ± 2.60; p < 0.001). Participants in the highest DI-GM tertile showed significantly lower zonulin (31.33 ± 0.58 vs. 56.01 ± 22.49 ng/mL; p < 0.001), LPS (1.03 ± 0.30 vs. 1.84 ± 0.47 EU/mL; p < 0.001), and CRP (3.10 ± 0.03 vs. 5.53 ± 1.41 mg/L; p < 0.001). Higher DI-GM scores were associated with lower psychological scores and IBS symptom severity (all p < 0.001). Importantly, IBS symptom severity showed strong positive correlations with inflammatory markers, suggesting that symptom severity may drive dietary modifications and inflammatory responses. Logistic regression indicated that individuals in the highest DI-GM tertile had substantially lower odds of IBS compared to the lowest tertile. Higher DI-GM scores were associated with lower IBS odds and favorable profiles. However, strong correlations between symptom severity and inflammation suggest reverse causality-symptoms may drive dietary changes rather than diet determining disease. Due to the cross-sectional design, causal inference is not permitted, and prospective studies are required.
Macrocytic anemia is frequently associated with liver dysfunction; however, reliable biomarkers for predicting chronic liver disease (CLD) in this population remain limited. This longitudinal study included 693 individuals with macrocytic anemia from the China Health and Retirement Longitudinal Study (CHARLS). Individuals with a mean corpuscular volume (MCV) > 100 fL were defined as having macrocytic anemia. C-reactive protein-triglyceride-glucose index (CTI) was calculated by the formula of CTI = 0.412×Ln(CRP [mg/L]) + Ln(TG [mg/dL] × FPG [mg/dL])/2. Then, the association between CTI and CLD was assessed using three sequentially adjusted Cox regression models, along with restricted cubic splines and subgroup analyses. Model 1 was unadjusted; Model 2 adjusted for demographic characteristics including age, gender, marital status, education, and BMI; Model 3 further adjusted for smoking, drinking, sleep night, and socioeconomic status (SES) based on the Model 2. Key predictors were selected by Least Absolute Shrinkage and Selection Operator (LASSO) to construct a clinical nomogram. We found that a higher CTI was linked to a greater chance of developing liver disease, which remained robust after sequential adjustment for confounders. In Model 3, the hazard ratio (HR) for CTI was 1.607 (95% confidence interval [CI]: 1.085-2.381; P = 0.018). Restricted cubic spline analysis confirmed a linear positive relationship between CTI and CLD risk. This link was consistent across different ages, genders, and lifestyles. When we built a prediction tool using CTI and other factors like age and marital status, it showed a fair ability to estimate a person's risk. CTI may serve as a simple and potentially useful indicator to identify individuals with macrocytic anemia who are at a higher risk of chronic liver disease, helping guide earlier prevention efforts.
The association of the Cardiometabolic Index for stroke risk remains insufficiently explored. This study aimed to examine the associations of the CMI with the prevalence of stroke, as well as all-cause and cardiovascular mortality. This prospective cohort study employed a multistage, stratified, and cluster random sampling method to recruit 147,897 participants aged 40 years or older from 2017 to 2023. Multivariable logistic regression, Cox regression analysis and restricted cubic splines (RCS) were utilized to examine the associations of CMI with prevalence of stroke, all-cause mortality, and CVD mortality. The prevalence of stroke was 5.4%, with ischemic stroke at 4.8% and hemorrhagic stroke at 0.7%. Over a median follow-up of 4.75 years, 7,150 all-cause deaths, 3,701 cardiovascular deaths, and 1,598 stroke-related deaths were recorded. Multivariable logistic regression analysis demonstrated that, compared to the lowest quartile (Q1), individuals in the highest CMI quartile (Q4) had significantly higher odds of overall stroke (OR 1.54, 95% CI 1.44-1.65), ischemic stroke (OR 1.59, 95% CI 1.47-1.71), and hemorrhagic stroke (OR 1.25, 95% CI 1.04-1.51). Similarly, multivariable Cox regression analysis showed that individuals in Q4, relative to those in Q1, had a 13% increased risk of all-cause mortality (HR 1.13, 95% CI 1.05-1.21), a 21% increased risk of CVD mortality (HR 1.21, 95% CI 1.10-1.34), and a 32% increased risk of stroke mortality (HR 1.32, 95% CI 1.14-1.53).Restricted cubic spline analyses confirmed significant overall and non-linear associations between CMI and both stroke prevalence and mortality (P-overall < 0.05, P-non-linear < 0.05). CMI was significantly associated with stroke prevalence, all-cause mortality, and cardiovascular as well as stroke-specific mortality. These findings indicate that CMI could serve as a useful tool for identifying high-risk individuals, potentially informing targeted preventive strategies.
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The Mediterranean diet is widely recognized for its cardiovascular benefits, but its specific effects on atherogenic indices remain unclear, particularly in individuals seeking a weight-loss dietary program, where excess fat mass may mitigate the diet's protective effects. To explore this relationship, a cross-sectional study was conducted involving 10,286 participants enrolled in a weight-loss dietary program. Anthropometric and biochemical data were collected, and adherence to the Mediterranean diet was assessed using the 14-item Mediterranean Diet Adherence Screener questionnaire. Lipid profiles, including total cholesterol, LDL-C, HDL-C, and triglycerides, were analyzed to calculate the following atherogenic indices: atherogenic index of plasma, Castelli risk indices I and II, lipoprotein combine index, atherogenic coefficient, and atherogenic combined index. Multivariate linear regression models, adjusted for sex, age, body mass index, smoking, physical activity, sociodemographic factors, and use of lipid-lowering medications, showed that each one-point increase in the Mediterranean diet adherence score was significantly associated with reductions in the atherogenic index of plasma (- 0.003, 95%CI: 0.006, - 0.000), the atherogenic coefficient (- 0.013, 95%CI: - 0.024, - 0.001), Castelli risk index I (- 0.013, 95%CI: - 0.024, - 0.001), and the atherogenic combined index (- 0.004, 95%CI: - 0.007, - 0.000), with a marginal association observed for Castelli risk index II (- 0.009, 95%CI: - 0.019, 0.000). Significant associations were also observed for total cholesterol (- 3.453 mg/dl, 95%CI: -5.911, -0.995), LDL (- 3.225 mg/dl, 95%CI: -5.402, -1.048), and HDL-C concentrations (+ 0.255 mg/dl, 95%CI: 0.098, 0.412). However, except for HDL, these associations lost statistical significance after adjusting for body fat percentage. Significant interactions between Mediterranean diet adherence score and body fat percentage were observed for several atherogenic indices, including the atherogenic coefficient, Castelli risk index I, Castelli risk index II, and the atherogenic combined index as well as for total cholesterol and LDL, suggesting that the protective effects of the Mediterranean diet diminish as fat mass increases. Although adherence to the Mediterranean diet is associated with more favorable lipid profiles and atherogenic indices, these benefits are modulated by body composition, particularly fat mass. These findings highlight the importance of integrated dietary strategies that combine nutritional quality with body fat reduction to support cardiovascular prevention.
Effective interdental cleaning is essential for maintaining periodontal health in patients with fixed orthodontic retainers. This study compared the efficacy of a water flosser and an interdental brush in improving periodontal health over six months. Seventy participants were randomized into water flosser (n = 35) and interdental brush (n = 35) groups. Periodontal indices including plaque index (PI), gingival index (GI), bleeding index (BI), calculus index (CI), clinical attachment level (CAL), probing depth (PD), and marginal recession (MR) were assessed at baseline (T0), three months (T1), and six months (T2). Mann-Whitney U tests compared groups at each time point. Repeated measures ANOVA evaluated time, group, and interaction effects. Generalized estimating equations (GEE) determined the influence of demographic and clinical variables on outcomes. At baseline, no significant differences were found between groups (p > 0.05). By T1 and T2, the water flosser group showed significantly lower PI, GI, CI (p < 0.001). Significant time × group interactions favored the water flosser for these parameters, while CAL and PD showed no significant between-group differences. Generalized estimating equation (GEE) revealed superior soft-tissue outcomes with water flossers and identified male gender and thin gingival biotype as predictors of poorer periodontal outcomes. Water flossers offer superior improvement in soft-tissue periodontal indices compared to interdental brushes in fixed retainer patients. Age did not influence periodontal outcomes, while male gender was associated with higher plaque and gingival inflammation scores. ClinicalTrial.Gov; Registration number: NCT07054203; June 25, 2025.
Obesity is linked to heart failure, particularly with preserved ejection fraction, but is associated with lower natriuretic peptide levels, potentially leading to underdiagnosis. To examine the association between adiposity measures-body mass index, waist circumference, and waist-to-height ratio-and N-terminal pro-B-type natriuretic peptide levels, and to determine if lower cut-offs should be used to rule out heart failure in individuals with obesity. PORTHOS is a 2023 population-based study in Portugal including adults aged 50 years or older. Participants underwent N-terminal pro-B-type natriuretic peptide screening, followed by clinical and echocardiographic assessment in those with levels >= 125 pg/mL, self-reported heart failure, or a 5% random sample with levels <125 pg/mL. Among 2498 participants, obesity prevalence range from 25% using body mass index ≥30 kg/m² to >70% using waist-to-height ratio ≥0.6. Body mass index showed a strong inverse association with N-terminal pro-B-type natriuretic peptide, with approximately 50 pg/mL lower levels per 5 kg/m² increase. Individuals with obesity and peptide levels < 125 pg/mL had higher odds of heart failure symptoms (odds ratio 1.97, 95% confidence interval 1.15-3.38) and echocardiographic abnormalities (odds ratio 3.63, 95% confidence interval 1.27-10.4) than lean participants with levels >= 125 pg/mL, despite being 9 years younger and having fourfold lower median peptide levels (59 vs 235 pg/mL). Obesity is associated with lower N-terminal pro-B-type natriuretic peptide levels despite a higher burden of symptoms and structural abnormalities. Fixed cut-offs do not reliably exclude heart failure in individuals with obesity.
To assess the prevalence of Staphylococcus aureus and antimicrobial resistance patterns, with particular emphasis on methicillin resistance, among isolates from street-vended tomato sauces in Dhaka, Bangladesh. Among 104 street-vended tomato sauce samples, 83 (79.8%; 95% Cl: 71.1-86.4%) were S. aureus isolates confirmed. Of these, 38 (45.8%) identified as methicillin-resistant Staphylococcus aureus, 5 (6.0%) vancomycin-resistant S. aureus, 55 (66.3%) multidrug resistance, and 2 (2.4%) extensively drug-resistant. The multiple antibiotic resistance (MAR) index ranged from 0.08 to 0.75 (mean ± SD = 0.38 ± 0.12), with 60 (72.3%) isolates exceeding the high-risk threshold (≥ 0.2). Methicillin-Resistant isolates showed significantly higher index values than susceptible isolates (p = 0.003). Co-resistance observed between oxacillin-cefoxitin (φ = 1.00) and meropenem-amikacin (φ = 0.96). Elevated resistance index values were more frequently observed among isolates from slum and transport-hub areas.
Osteoporosis is common in adults with spinal deformity (ASD) and may worsen baseline malalignment and disability. Because these conditions often coexist, understanding how osteoporosis and patients meeting criteria for high risk of osteoporosis affect deformity severity and quality of life is key to improving outcomes. Adults (≥ 18 years) undergoing ASD surgery with complete baseline and two-year follow-up data were stratified into osteoporosis, high-risk, and non-osteoporotic cohorts. Osteoporosis was defined by preexisting diagnosis; high-risk by American Association of Clinical Endocrinologists (AACE) criteria (female ≥ 65 years or risk factors: steroids, chronic kidney disease, alcohol use, vitamin D deficiency, limited mobility, diabetes). Non-osteoporotic patients had normal bone quality. Baseline alignment was evaluated using Global Alignment and Proportionality (GAP) and Sagittal Age-Adjusted Score (SAAS). Health-related quality of life (HRQoL) was analyzed using multivariable regression adjusted for age, BMI, Charlson Comorbidity Index (CCI), and modified Fragility Index (mFI). Among 899 patients (mean age 60.3 ± 15.0 years; 74% female; BMI 27.5 ± 5.8 kg/m2; CCI 1.7 ± 1.7), 165 (18.4%) were osteoporotic, 194 (21.6%) high-risk, and 540 (60.1%) non-osteoporotic. Notably, 54% meeting AACE criteria lacked a formal osteoporosis diagnosis. Osteoporotic patients were more often severely frail (24.8% vs. 11.7%). After adjusting for confounders, osteoporosis/high-risk patients were less likely SAAS-matched (OR 0.646) and GAP-proportioned (OR 0.485) at baseline. Adjusted for baseline alignment, they were also more likely to be severely disabled (Oswestry Disability Index > 60; OR 1.45). ASD patients with osteoporosis or high-risk features exhibit poorer quality of life and more severe deformity at baseline, as inadequate bone health remains independently associated with worse radiographic alignment and greater disability after adjustment for confounders.
Metabolite-based interventions represent a promising strategy to mitigate water deficit-induced damage in perennial fruit crops such as apple (Malus × domestica Borkh.). This study evaluated the efficacy of two plant-derived metabolites**, melatonin (MT) and myo-inositol (MI), ** in enhancing drought resilience across five apple rootstocks (MM 111, MM 106, Bud 118, MM 116 and M9) under controlled greenhouse conditions. A two-phase experimental framework was used. In Phase I, dose optimization was performed under 40% field capacity using Response Index (RI) and Comprehensive Response Index (CRI) to identify the most effective metabolite combination. Among six treatments, T3 (100 µM MT + 100 µM MI) had the lowest CRI values, indicating improved physiological performance under moisture deficit. In Phase II, optimized treatments were evaluated under drought (40% FC) and irrigated (100% FC) regimes. Drought stress significantly impaired plant physiological functioning, reducing relative water content, chlorophyll stability, and gas exchange parameters. However, the combined application of MT + MI (T8: 100 µM each) significantly alleviated these effects by enhancing water retention, maintaining membrane stability, and improving photosynthetic efficiency. The most pronounced positive responses were observed in Bud 118 and MM 111, showing a strong genotype × treatment interaction. Notably, MT + MI also improved physiological performance under irrigated conditions, suggesting broader benefits for overall plant health. Each treatment was evaluated using three replications across five rootstocks, ensuring statistical reliability. Collectively, these results demonstrate the synergistic role of melatonin and myo-inositol in reinforcing drought tolerance. While the findings are based on controlled greenhouse conditions, they provide a mechanistic basis for future field validation and development of metabolite-assisted strategies for drought resilience in apple.
Income inequalities in health are a major public health issue in modern societies. This study investigated an understudied topic by comparing trends in income inequalities in self-rated health (SRH) between parents and non-parents. We used data from eight surveys of the GEDA study series (2009-2023) and from the first survey of the RKI Panel (2024), including a total of 106,399 randomly sampled participants aged 25-59. Age-adjusted prevalence of good SRH was calculated for each cross-section stratified by income groups and parental status. Moderation analyses using Poisson regressions with three-way interactions between income, parental status and survey were conducted. Trends in income-related health inequality were analysed based on the Slope Index of Inequality and the Relative Index of Inequality stratified by parental status. In 2009, 75.7% of women and 77.7% of men reported good SRH. For the total sample, no significant changes in good SRH were observed until the onset of the COVID-19 pandemic, when a notable increase was recorded (women: 80.2%, men: 81.9%). In 2022, the prevalence returned to pre-pandemic levels and reached its lowest point in 2024 (women: 68.1%, men: 71.6%). Non-parents and those at risk of poverty were less likely to report good SRH. The moderation analysis revealed a decline in good SRH among those at risk of poverty, particularly in non-fathers (from 2014/15 onwards) and non-mothers (after 2014/15). A decline in good SRH was also observed among mothers at risk of poverty in 2023/24. These findings were confirmed by the results on absolute and relative income-related inequalities in SRH. Even before the pandemic, income-related health inequalities in Germany were increasing to the detriment of non-parents at risk of poverty. This could be due to the prolonged strain on this group caused by the ongoing polycrisis. Parenthood may buffer some of the stress associated with poverty, particularly in women. However, selection effects could also be at play, meaning that people in poor health are less likely to become parents or earn higher incomes. To identify health trends early on and promote targeted policy interventions to improve the health of people living in poverty, health inequalities should be regularly monitored for different population groups.
The effects of thyroid hormone replacement or suppression therapy in women with thyroid cancer on thyroid function during pregnancy and subsequent adverse fetal outcomes are still largely unknown. To compare thyroid function at 8 weeks of gestation and its changes during pregnancy between the survivors and controls, and to assess the association of these differences with adverse fetal outcomes. This was a retrospective cohort-based parallel control study. A total of 140 survivors and 280 controls delivery time-matched controls were extracted from 46,610 singleton pregnant women who received prenatal examinations in a second-level specialized hospital between January 2019 and March 2024. The primary outcomes were birth defects, small for gestational age (SGA, defined as birth weight < 10th percentile by gestational week), preterm birth (< 37 weeks), and neonatal asphyxia (defined as fetuses with a 1 min-Apgar score of < 7). Apgar scores at 1 and 5 min and umbilical arterial blood gas (ABG) indexes were surrogate indicators of neonatal asphyxia. Compared to the control group, FT3 was lower in the survivors, while FT4 was higher. Change of FT3 between 8 and 16 weeks of gestation in survivors was significantly smaller than that in the controls (-0.08 vs. -0.30, P < 0.005). The survivors had an insignificant association with SGA/preterm birth (adjusted OR 2.06, 0.68-6.23, P = 0.20), a slightly higher risk of fetal asphyxia (Peto OR, 6.49; 95% CI: 0.81-52.0; P = 0.078), and a lower 1 min Apgar score (β, -0.10; 95% CI: -0.16 to -0.03;P = 0.004). Change in FT3 between 8 and 16 weeks was associated with SGA/preterm birth (adjusted OR, 4.42, 95%CI: 1.32-14.84, P = 0.016). FT3 at 8 weeks of gestation and its changes between 16 and 32 weeks of gestation were negatively correlated with the umbilical ABG index, with both β of -0.02(p = 0.015 and 0.019, respectively). This study found differences in FT3 and FT4 levels and their changes during pregnancy between the survivors and controls. These differences, especially the changes in FT3 during pregnancy, might suggest a potential biological link, though further studies are needed to establish causality.
Artificial intelligence is increasingly used to design cultural and creative products, yet consumer acceptance varies considerably. Personality traits may play a key role in shaping these responses, but research has not examined how nostalgia proneness - an individual's dispositional tendency to long for the past - influences attitudes toward AI-designed cultural products. This study investigated whether nostalgia proneness predicts lower acceptance of such products through reduced perceived authenticity, and whether need for uniqueness moderates this indirect pathway A cross-sectional survey was conducted with 291 Chinese university students. Participants viewed images of museum cultural products explicitly labeled as AI-designed and completed measures of nostalgia proneness (Southampton Nostalgia Scale, 7 items), perceived authenticity (8 items), need for uniqueness (8 items), and acceptance of AI-designed cultural products (5 items). A moderated mediation model (PROCESS Model 14) was tested using bias-corrected bootstrap confidence intervals with 5,000 resamples. Nostalgia proneness negatively predicted acceptance of AI-designed cultural products (B = - 0.29, p < 0.001). Perceived authenticity partially mediated this relationship; the indirect effect was significant (ab = - 0.129, 95% CI [- 0.198, - 0.071]), accounting for 44.6% of the total effect. Need for uniqueness moderated the second stage of the mediation path: the positive effect of perceived authenticity on acceptance was stronger among individuals with low need for uniqueness (B = 0.50) than among those with high need for uniqueness (B = 0.22). The index of moderated mediation was significant (index = 0.061, 95% CI [0.013, 0.124]), confirming that the negative indirect effect was attenuated as need for uniqueness increased. Consumers higher in nostalgia proneness are less accepting of AI-designed cultural products, largely because they perceive such products as less authentic. However, this negative pathway is attenuated among consumers with a stronger need for uniqueness, who are less reliant on authenticity judgments when evaluating AI-designed offerings. These findings extend nostalgia psychology to the domain of AI acceptance and provide actionable insights for culturally sensitive AI product marketing strategies.
This study examined whether the relationship between impulsivity and Internet addiction (IA) levels among university students varies depending on the indirect pathway mediated by the meaning-seeking in life and whether this indirect pathway is dependent on self-esteem levels. The study was conducted using data collected from 500 university students in Türkiye via valid self-report measures, employing a cross-sectional, correlational design. Controlling for daily internet usage time, the assumed direct, indirect, and conditional associations were tested using Hayes' PROCESS macro (Model 14). Correlation analyses found that impulsivity was negatively related to meaning-seeking in life (r = -.120, p < .01) and positively related to IA (r = .261, p < .001). In the conditional process analysis, impulsivity was negatively associated with meaning-seeking in life (B = -0.180, p = .003) and positively associated with IA (B = 0.592, p < .001). The interaction between meaning-seeking in life and self-esteem was significantly associated IA (B = 0.180, p = .009) and contributed additional explanatory power to the model (ΔR2 = 0.0125, p < .01; total R2 = .117). The direct association between meaning-seeking in life and IA in the regression model was statistically significant (B = 0.214, p = .004); however, the indirect pathway through meaning-seeking in life was moderated by self-esteem. The moderated mediation index was significant (Index = -0.032, 95% CI [-0.076, -0.007]), and the findings indicate that the indirect component of the relationship between impulsivity and IA level, mediated by meaning-seeking in life, varies according to self-esteem level; the indirect association is more pronounced at lower self-esteem scores. These findings were interpreted within a cross-sectional design framework and suggest that impulsivity is related to IA levels and that the conditional indirect mechanism is present, although its magnitude appears modest.
Heart failure (HF) and acute myocardial infarction (AMI) may contribute to cancer development through shared and disease-related pathophysiological pathways. We investigated the mid-term risk of incident cancer in patients with HF or AMI using a large, real-world dataset. Adults with a first hospitalization for acute HF or AMI between October 2015 and October 2024 were included from the TriNetX Global Collaborative Research Network. Patients with prior or concurrent cancer were excluded. Each cohort was matched 1:1 with controls without HF or AMI using propensity score matching. The primary end-point was any new cancer diagnosis occurring during follow-up, starting 6 months after the index hospitalization. After matching, 120 783 patients with HF and 7896 patients with AMI were included. Over a median follow-up of 13 months in the HF cohort and 16 months in the AMI cohort (after the 6-month landmark), both groups showed an higher incidence of cancer compared with controls (HF: HR 2.80 [95% CI, 2.69; 2.91]; AMI: HR 2.02 [95% CI, 1.71; 2.39]; both P < .001). In both cohorts, the excess risk was more pronounced for haematologic than for solid malignancies (HF: HR: 6.78 vs 2.53; AMI: HR: 4.45 vs 1.77). HF with preserved ejection fraction was associated with a slightly higher cancer incidence than HF with reduced or mildly reduced ejection fraction (HR 1.10 [95% CI, 1.04; 1.17], P = .002), whereas no difference was observed between ST and non-ST segment elevation AMI. In this large, real-world cohort, both HF and AMI were associated with an increased incidence of cancer, particularly haematologic malignancies. HF was associated with a greater excess risk than AMI. These findings are hypothesis-generating and warrant further investigation.