Introduction: Oral health in children is essential for their overall well-being, influencing nutrition, language development, and self-esteem. Dental caries represent one of the most prevalent chronic diseases in childhood. Objective: The objective of this study is to evaluate the association between parents’ self-perceived knowledge of oral health and the presence of dental caries in their children. Materials and Methods: A cross-sectional observational study was conducted with 1052 children aged 4 to 14 years and their parents in Quito, Ecuador. Parents completed validated questionnaires (OHIP-14, OIDP, CPQ, and OHQoL-UK) to assess their self-perceived oral health knowledge. Clinical examinations were performed to detect cavitated carious lesions. Statistical analysis included Chi-square tests and odds ratio (OR) calculations. Results: A significant association was found between lower parental knowledge and higher prevalence of dental caries in children (Chi-square = 16.245, p = 0.0062; OR = 18.18, 95% CI [1.80–183.75]). Most caries cases were found in children whose parents rated their knowledge as “good” or “very good,” suggesting a gap between perceived and actual knowledge. Conclusions: The findings highlight the need for targeted educational strategies that address both knowledge and behavioral practices in oral health, especially among parents with low self-perceived knowledge.

Background: Vascular access is a very important element for patients on chronic hemodialysis treatment, but it is also a major source of complications, often compromising patients’ quality of life. Arteriovenous fistulas (AVFs) are preferred for their durability, but complications such as edema, bruising, cannulation pain, and hygiene concerns can affect patient satisfaction. Aim: We aimed to evaluate patient satisfaction with vascular access and to identify the clinical and sociodemographic factors influencing this satisfaction. Methods: We conducted a multicenter cross-sectional study on 235 hemodialysis patients in Italy. Satisfaction was assessed using the Short Form Vascular Access Questionnaire (SF-VAQ). Clinical and sociodemographic data were collected and analyzed with descriptive statistics, correlations, and multivariate regression models. Results: Satisfaction was significantly influenced by local complications, perceived hygiene, and access duration. Lower satisfaction was reported by patients with swelling, bruising, or negative hygiene perceptions. Longer use of the access was also associated with declining satisfaction. Conclusions: Patient satisfaction involves both clinical outcomes and patient perceptions. The integration of patient-reported outcomes (PROs) into vascular access management can help clinicians identify early dissatisfaction and implement interventions that can improve treatment adherence and quality of life.

Background: Internists formulate diagnostic hypotheses and personalized treatment plans by integrating data from a comprehensive clinical interview, reviewing a patient’s medical history, physical examination and findings from complementary tests. The patient treatment life cycle generates a significant volume of data points that can offer valuable insights to improve patient care by guiding clinical decision-making. Artificial Intelligence (AI) and, in particular, Generative AI (GAI), are promising tools in this regard, particularly after the introduction of Large Language Models. The European Federation of Internal Medicine (EFIM) recognizes the transformative impact of AI in leveraging clinical data and advancing the field of internal medicine. This position paper from the EFIM explores how AI can be applied to achieve the goals of P6 Medicine principles in internal medicine. P6 Medicine is an advanced healthcare model that extends the concept of Personalized Medicine toward a holistic, predictive, patient-centered approach that also integrates psycho-cognitive and socially responsible dimensions. An additional concept introduced is that of Digital Therapies (DTx), software applications designed to prevent and manage diseases and disorders through AI, which are used in the clinical setting if validated by rigorous research studies. Methods: The literature examining the relationship between AI and Internal Medicine was investigated through a bibliometric analysis. The themes identified in the literature review were further examined through the Delphi method. Thirty international AI and Internal Medicine experts constituted the Delphi panel. Results: Delphi results were summarized in a SWOT Analysis. The evidence is that through extensive data analysis, diagnostic capacity, drug development and patient tracking are increased. Conclusions: The panel unanimously considered AI in Internal Medicine as an opportunity, achieving a complete consensus on the matter. AI-driven solutions, including clinical applications of GAI and DTx, hold the potential to strongly change internal medicine by streamlining workflows, enhancing patient care and generating valuable data.

Background: Burnout among healthcare professionals is increasingly recognized as a syndrome with biological correlations. Beyond psychosocial factors, circadian misalignment, sleep disturbances, and hormonal dysregulation—particularly involving melatonin and cortisol—are emerging as relevant mechanisms. Methods: We systematically reviewed studies published between 2015 and 2025 examining associations between burnout, melatonin, circadian disruption, sleep quality, and related biomarkers in healthcare workers. Results: Across 14 included studies, burnout was associated with suppressed melatonin secretion, cortisol dysregulation, and circadian misalignment, including social jet lag and poor sleep quality. Night-shift nurses consistently displayed greater circadian disruption and higher burnout scores than day-shift colleagues. Evidence also suggests that environmental and interventional approaches—such as optimizing daylight exposure and melatonin supplementation to improve sleep quality and cognitive performance—may mitigate circadian disruption and occupational fatigue. Conclusions: Burnout should be recognized as a biopsychosocial syndrome with measurable chronobiological correlates. Future research should integrate circadian biomarkers into occupational health assessments and evaluate preventive strategies aimed at preserving circadian health in healthcare professionals.

Background: The increasing incidence of spondylodiscitis and its potentially severe consequences when not promptly diagnosed highlight the need for further research to improve treatment guidelines, reduce mortality and morbidity and improve the quality of life in patients who suffer from persistent physical limitations. Methods: We collected data from 103 patients, with 8 patients lost to follow-up, who were diagnosed with vertebral osteomyelitis, disk infection or discitis between 2009 and 2018. The primary outcome was the 1-year mortality rate in patients treated with either conservative or surgical intervention, with both groups receiving antibiotic treatment. A standardized questionnaire was used to assess health-related quality of life after treatment by evaluating the European Quality of Life 5 Dimension 5 Level version (EQ-5D-5L) and the European Quality of Life Visual Analog Scale (EQ-VAS). In addition, we used the Oswestry Disability Index (ODI) and the Parker Mobility Score to identify backpain-related limitations after treatment. Results: The group receiving surgical treatment had a significantly lower 1-year mortality rate (22%) than did those who were treated conservatively, who had a 4-fold greater risk for death after a year following first diagnosis of SD and treatment. With respect to quality of life, 39 patients answered the standardized questionnaires during follow-up, and the questionnaire results revealed no significant difference in limitations in daily life or in health-related quality of life, with a median Parker Mobility Score of 9 for the conservatively treated patients compared with 7.5 for the surgically treated patients. This difference between the groups was not statistically significant, with a p value of 0.216 > α. A similar result was obtained in the evaluation of the ODI, with a medial index of 30% in the conservatively treated group compared with 24% in the surgical group, which was not statistically significant as indicated by a p value of 0.360 > α. Conclusions: The early surgical approach when treating spondylodiscitis is advantageous for identifying the underlying infection and initiating appropriate antibiotic therapy, therefore reducing mortality and resulting in a greater likelihood of full recovery than the conservative treatment does.

Background and objectives: Numerous studies and meta-analyses have established the efficacy of telemonitoring for blood pressure and other components of metabolic syndrome in improving disease management. Nevertheless, the adoption of telemonitoring technologies is often hindered by personal, technological, and systemic barriers. In Slovakia, where patient–physician contact rates are high, there is limited research on patients’ perspectives regarding telemedicine adoption for cardiovascular risk management. The objective of this study was to examine patients’ perspectives on and perceived obstacles to the use of telemonitoring for arterial hypertension and dyslipidemia in Slovakia. Methods: This cross-sectional, questionnaire-based survey targeted a cohort of 18,053 patients. The survey instrument was designed to gather data on several key areas: patient demographic characteristics, blood pressure measurement habits, the utilization of smart technologies, perceived benefits and barriers to telemonitoring, and patients’ knowledge of their lipid profiles and cardiovascular risk factors. Statistical analysis included chi-square tests, ANOVA, and effect size calculations with 95% confidence intervals (CI). Results: A total of 1787 patient responses (9.9%) were collected. Among the respondents, 67.4% (n = 1204) had arterial hypertension, while 7.9% (n = 95) were on non-pharmacological therapy. Only 21.2% (n = 255) of hypertensive patients measured their blood pressure daily, with a significantly higher proportion of men than women (28.6% vs. 12.7%, p = 0.011, Cohen’s d = 0.42). The most frequent users of blood pressure monitoring were in the 31–45 age group (p = 0.001, η2 = 0.08). A total of 19.4% (n = 347) of respondents used wearable devices, and 6.3% (n = 113) used blood pressure monitors connected to an application. Smart technology use was significantly more common in the 31–45 age group (p = 0.01, Cramer’s V = 0.15). Moderate interest in telemedicine was expressed by 69.8% (n = 1247) of respondents, though only 27.4% (n = 490) showed strong interest. The majority of patients (73.8%, n = 1319) did not know their LDL-C levels, and 45.7% (n = 817) of those who did had elevated levels. Conclusions: The findings suggest that while interest in telemedicine methods for the management of arterial hypertension and dyslipidemia exists among Slovak patients, it is more moderate than initially assumed. Importantly, expressed willingness to participate in a study should not be directly equated with readiness to adopt new technologies in daily practice. Successful integration of telemonitoring into the Slovak healthcare system will therefore require not only patient engagement but also active support from healthcare providers to overcome practical and motivational barriers. These findings highlight the need for targeted implementation strategies that address the specific barriers identified in the Central and Eastern European healthcare context.

We thank Haq and Khan for their thoughtful commentary [...]

We would like to thank Leivaditis et al [...]

Background/Objectives: Recently, epigenetic mechanisms have been recognized as crucial in atopic dermatitis development. The emphasis of this research was on expanding existing knowledge about the epigenetic aspects of atopic dermatitis, as well as identifying new molecules that could serve as disease biomarkers. Methods: The research was conducted as a cross-sectional study examining two groups: the group with atopic dermatitis (50 patients) and the control group (50 healthy adults). The serum levels of total immunoglobulin E (IgE) and eosinophil count (Eos%) were performed in routine laboratory analyses, and the detection of microRNAs from peripheral blood was performed using RT-PCR. Results: Analysis of selected miRNA expressions in patients with atopic dermatitis and controls revealed that only the expression and the relative expression of miRNA-146a were statistically significantly higher in patients with atopic dermatitis than in the control group (p = 0.042 and p = 0.021, respectively). There was a weak positive correlation between miRNA-146a expression and the eosinophilia/IgE level (r = 0.22 and r = 0.25, respectively). MiRNA-21, miRNA-29b, miRNA-143 and miRNA-223 were significantly upregulated in patients with higher SCORAD (p < 0.001, p < 0.001, p < 0.001 and p = 0.015, respectively). ROC curve analysis revealed the specificity of miRNA-146a as 82% and the sensitivity as 62%. The area under the ROC curve (AUC) was 0.7, indicating its diagnostic potential. Conclusions: Our findings imply that miRNA-146a might serve as a biomarker of atopic dermatitis, suggesting its relevance in the development of the disease, while miRNA-21, miRNA-29b, miRNA-143 and miRNA-223 may have an impact on disease progression. Our findings provide a preliminary basis that should precede validation through larger, multicentric studies and use in diagnostics, targeted personalized treatments and monitoring of treatment efficacy in atopic dermatitis.

Background: Achieving low-density lipoprotein cholesterol (LDL-C) goals is essential for secondary prevention after atherosclerotic ischemic stroke or transient ischemic attack (TIA). This study assessed the prevalence of LDL-C goal attainment and identified associated determinants post-ischemic stroke/TIA. Methods: A cohort of Thai patients discharged on statin therapy after admission with acute ischemic stroke or TIA was evaluated for LDL-C goal attainment within 12 months post-discharge. Logistic regression determines factors associated with LDL-C goal attainment, and the generalized linear model confirmed the association between covariates and LDL-C reduction. Results: Among 487 patients (85.8% with ischemic stroke), the prevalence of LDL-C goal attainment differed across LDL-C target levels: 9.9% for <55 mg/dL, 29.0% for <70 mg/dL, 70.4% for <100 mg/dL, and 17.5% for ≥50% reduction from baseline. Logistic regression identified high-intensity statins as a significant predictor of goal attainment at <70 mg/dL (OR 1.91, 95% CI 1.09–3.34), <100 mg/dL (OR 1.64, 95% CI 1.01–2.67), and ≥50% reduction (OR 2.32, 95% CI 1.14–4.73), but not <55 mg/dL (OR 1.65, 95% CI 0.72–3.79). In the generalized linear model, high-intensity statin and baseline LDL-C were significant determinants of LDL-C reduction. Conclusions: LDL-C target attainment after ischemic stroke/TIA is modest overall, and remains low for the more stringent targets (<55 mg/dL). High-intensity statins improve goal attainment and produce greater LDL-C reductions, supporting wider use of more aggressive lipid-lowering strategies in this high-risk population.