Background Bone metastasis is the most common site of distant metastasis in breast cancer. Patients with bone metastasis have their quality of life and survival rate threatened. This study aims to develop a practical nomogram for predicting the risk of bone metastasis in breast cancer by integrating clinical data, assisting doctors in making more scientific clinical decisions. Methods We conducted a retrospective analysis of the data of newly diagnosed breast cancer patients from the database of the Affiliated Hospital of Qingdao University from January 2015 to December 2017. The cohort is divided into training set and validation set in a ratio of 7.5:2.5. Determine independent risk factors through Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis and logistic regression, and develop a nomogram prediction model. The model's performance and clinical utility were evaluated by Receiver Operating Characteristic (ROC) curve analysis, Area Under the Curve (AUC), calibration curves, and Decision Curve Analysis (DCA). Results During the 5-year follow-up period, bone metastases developed in 48 of 421 patients (11.40%). Ultimately, six independent risk factors were identified: neoadjuvant chemotherapy, family history of cancer, distant metastasis in other locations, axillary lymph node metastasis, marital status, and primary tumor site. The nomogram demonstrated excellent predictive performance, with AUC values of 0.89 and 0.86 in the training and validation cohorts, respectively. Conclusions This pioneering nomogram, incorporating baseline, tumor characteristics, and therapeutic parameters, provides visual guidance for breast surgeons to assess bone metastasis risk in breast cancer patients. It enables clinicians to prioritize high-risk patients through early identification, thereby optimizing surveillance protocols and therapeutic strategies to safeguard patients' quality of life.

This study was aimed at determining the prevalence of difficult-to-treat (D2T) axial spondyloarthritis (axSpA) and identifying main associated factors for D2T axSpA. This multicenter observational cross-sectional study included axSpA patients from the BioSTaR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) from February 1, 2019, to January 1, 2025. Data from 1800 axSpA patients who have previously used or are currently using at least one biologic/targeted synthetic disease-modifying antirheumatic drug were analyzed. Patient data included demographic characteristics, body mass index (BMI), marital status, smoking and alcohol use, family history of SpA, and presence of comorbidities. The parameters related to SpA such as disease duration, type of axSpA (radiographic/non-radiographic), HLA-B27 status, the presence of extra-musculoskeletal manifestations (uveitis, psoriasis, and inflammatory bowel disease), arthritis, enthesitis, and dactylitis were also recorded. Comorbidities including hypertension, cardiovascular disease, diabetes, obesity, and hyperlipidemia were recorded, and Charlson Index scores were evaluated. Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and disease activity in means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) were also recorded. All medication history and currently used medications for axSpA and other diseases were noted. D2T and non-D2T axSpA patients were classified according to the suggested extrapolated definition. Of the 1800 axSpA patients recorded in the BioSTaR database, 204 (11.3%) were classified as D2T axSpA. Data of these patients were compared to the data from 1596 non-D2T axSpA patients. Disease duration was longer in D2T patients (p = 0.025). The presence of radiographic disease was more frequent in the D2T group (p = 0.047). In means of MASES and ASDAS-CRP, higher scores were recorded in the D2T group (both p < 0.001). Enthesitis and psoriasis were more frequent in the D2T group (p = 0.002 and p = 0.006). Regarding comorbidities, hypertension and cardiovascular diseases were more frequent in the D2T group (p < 0.001 and p = 0.009). The risk of D2T axSpA increased 2.37-fold with the presence of r-axSpA (p = 0.018), 1.92-fold with the presence of hypertension (p = 0.006), 2.12-fold with the presence of obesity (p = 0.024), and 3.63-fold with the presence of psoriasis (p = 0.004). Every 1-point increase in MASES increased D2T risk 1.08-fold (p = 0.017), and every 1-point increase in ASDAS-CRP increased D2T risk 1.62-fold (p < 0.001). In conclusion, 11.3% of patients with axSpA met the proposed criteria for D2T axSpA. This subgroup was characterized by longer disease duration, higher frequency of r-axSpA, enthesitis, and psoriasis, as well as elevated MASES, CRP, ASDAS-CRP, and BASDAI scores. Hypertension and cardiovascular comorbidities were also significantly more prevalent among D2T patients. These parameters represent potential contributors to treatment complexity and should be carefully considered in therapeutic decision-making. In cases of suboptimal treatment response, reassessment and optimal management of comorbidities are essential, as comorbid conditions can increase disease burden and diminish therapeutic efficacy. Comprehensive care for axSpA should therefore include targeted management of accompanying comorbidities in parallel with disease-specific therapy. Monitoring blood pressure, optimizing body weight, and encouraging smoking cessation are particularly important. Additionally, concomitant rheumatic diseases such as psoriasis, uveitis, or inflammatory bowel disease should be actively evaluated and treated, given their association with more severe disease and reduced treatment response. Key Points • Prospectively collected data of 1800 axial spondyloarthritis patients were assessed for this cross-sectional study. • 11.3% of axial spondyloarthritis patients were identified as difficult-to-treat. • Longer disease duration and presence of radiographic axial spondyloarthritis, enthesitis, and psoriasis are more prevalent in difficult-to-treat axial spondyloarthritis patients. • Factors and comorbidities complicating axial spondyloarthritis treatment should be considered in treatment plans.

ABSTRACT Background Childhood anthropometric failure remains a global public health problem. In Rwanda, malnutrition is a leading cause of child illness and death. Yet, more than an assessment of undernutrition using a conventional index is needed to conclude the overall prevalence of undernutrition among children aged 6–59 months; therefore, this study aims to assess undernutrition using the Composite Index of Anthropometric Failure (CIAF) and its determinants on children under 5 years of age in Gicumbi District, Northern Province, Rwanda. Methods A community‐based cross‐sectional study was employed among 366 mother–child pairs selected using a cluster sampling technique, followed by a systematic random sampling technique to select study participants. A pretested structured questionnaire was used to collect data. WHO Anthro software was used to calculate height for age, weight for age, and weight for height. Both bivariable and multivariable binary logistic regressions were used to identify factors associated with undernutrition. Results The overall prevalence of anthropometric failure among children under 59 months was 37.2%, significantly associated with female children who were 49.4% less likely to experience anthropometric failure (AOR = 0.506, confidence interval [CI]: 0.288–0.891, p = 0.018). Children below two had an increased risk (AOR = 1.556, CI: 1.04–2.31, p = 0.03). No livestock increased failure odds by 2.5 times (AOR = 2.50, CI: 1.059–5.921, p = 0.037). One daily meal doubled the failure risk (AOR = 2.05, CI: 1.09–3.87, p = 0.025). Conclusion Anthropometric failure affected nearly one‐third of children under five. Age, sex, livestock ownership, marital status, and meal frequency were significantly associated with CIAF. Multi‐sectoral nutrition interventions and further research on unassessed factors are recommended.

ABSTRACT Drawing on theories or conceptualizations of relational selves, relationally interdependent self-construal (RISC) and self-determination, we present theory and research on relationship identification – the degree to which a person defines themselves in terms of a specific close relationship and integrates that relationship into their sense of self. Identification predicts relationship maintenance efforts independent of relationally interdependent self-construal, commitment, and satisfaction, especially in response to relationship threats (e.g. dissimilar values, partner transgressions, and/or the availability of attractive alternates). We review recent work demonstrating that feeling understood and viewing the world in the same way as one’s partner are critical underpinnings for relationship identification, operating distinctly from feeling accepted and cared for. We also consider new research comparing identification with the merging of identities (inclusion of other in self; IOS). Whereas IOS predicts revealing one’s relationship status in general, identification is more specifically sensitive to threatening situations, predicting the revealing of one’s relationship status to attractive alternatives but not people in general. We also explore potential dark sides of relationship identification and discuss future research directions. Overall, we demonstrate that integrating a relationship into one’s personal identity uniquely motivates relationship cognition and behavior.

Concern is growing about rising opioid use disorder (OUD) rates and limited knowledge of how socioeconomic status (SES) and health factors interact. We examined whether health status moderates the relationship between SES and OUD among individuals with nonmedical opioid use. We analyzed data from 10 984 adults aged ≥18 years in the 2015-2019 National Survey on Drug Use and Health. Logistic regression estimated odds of OUD using self-reported health (good/very good/excellent vs fair/poor) and SES indicators (education, income, employment, and marital status). Interaction terms tested whether health status modified SES-OUD associations. Fair/poor health increased OUD odds, whereas college graduation and employment were linked to lower odds. Interaction analyses showed that among those with fair/poor health, higher SES corresponded to increased OUD odds. Those with fair/poor health and a college degree had substantially higher odds of OUD (odds ratio [OR] = 3.35; P < .001) than less educated peers. Among those with fair/poor health, individuals with annual family incomes ≥$75 000 also had higher OUD odds (OR = 1.84; P = .03) than those with incomes <$20 000, and employment was associated with increased OUD odds (OR = 1.61; P = .008). Individuals who were widowed/divorced/separated (OR = 0.36; P < .001) and never married (OR = 0.48; P = .001) had lower OUD odds than married individuals. Health status significantly moderated SES-OUD associations. Among those in poor health, higher SES was linked to greater OUD odds. Prevention and treatment efforts should consider how SES and health jointly shape OUD vulnerability.

Background/Objectives: Nurses are susceptible to compassion fatigue due to the nature of their professional responsibilities. Factors contributing to this vulnerability include daily patient interactions and organizational elements within their work environment, as well as work-related stress and sociodemographic characteristics, including age, marital status, years of professional experience, and, notably, gender. This research investigates the relationship between compassion fatigue and the levels of anxiety and depression, as well as the professional quality of life among nurses providing care to dementia patients in Greece. Methods: A cross-sectional survey was carried out with 115 nurses working in dementia care centers in Greece. The Hospital Anxiety and Depression Scale (HADS), the Professional Quality of Life Scale (ProQOL-5), and the participants’ personal, demographic, and professional information were all included in an electronic questionnaire. Multiple regression analysis was used. Results: A total of 42.6% of nurses rated their working environment as favorable. Additionally, 23.5% of the sample exhibited high levels of compassion satisfaction, whereas 46.1% demonstrated low levels of burnout. Female gender (p = 0.022) and a higher family income (p = 0.046) was positively associated with compassion satisfaction. Regression analysis indicated that elevated symptoms of anxiety and depression were found to correlate with decreased compassion satisfaction, increased burnout, and heightened secondary post-traumatic stress. Conclusions: Engaging in the care of patients with dementia, particularly throughout the pandemic period, has underscored a pronounced susceptibility to compassion fatigue, physical fatigue, pain, psychological stress, and a reduced quality of life. These results highlight the importance for nursing management to adopt specific organizational measures, including proper staffing levels, balancing workloads, and conducting routine mental health assessments.

IntroductionWhile gender is a known prognostic factor for many cancers, its specific role in pancreatic neuroendocrine tumors (PanNETs) survival remains poorly characterized. This study aimed to investigate gender-based differences in PanNETs prognosis using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThis retrospective cohort study included patients diagnosed with PanNETs between the years 2000 and 2020, extracted from the SEER database. Propensity score matching (PSM) was applied to mitigate potential selection bias. Overall survival (OS) was evaluated using Kaplan-Meier analysis and multivariable Cox regression.ResultsAmong the 5155 patients included (2814 males, 2341 females), males showed significantly worse OS than females both before (hazard ratio [HR] 1.29, 95% CI 1.14-1.47, P < 0.001) and after (HR 1.19, 95% CI 1.02-1.38, P = 0.026) PSM. Subgroup analyses confirmed a consistent OS advantage for females across most categories. Multivariable analysis identified marital status, age, tumor grade, gender, year of diagnosis, N stage, M stage, and surgical intervention as independent predictors of OS. Similar predictors were found in males, whereas in females, marital status, age, grade, N stage, M stage, and surgery were specifically significant.ConclusionsFemale patients with PanNETs exhibit superior OS rates. Further research is needed to clarify the biological and clinical mechanisms underlying these gender-related disparities.

Due to the ongoing aging process in many societies, Successful Aging-SA is of paramount importance both individually and socially. The objective criteria for SA, as formulated by Rowe and Kahn, are the subject of critical debate. One criticism is the lack of a subjective assessment of SA by individuals. The aim was to examine SA and its determinants from the perspective of older adults. The study included 2,964 individuals aged 60-103years (mean 70.44;SD = 7.09) - 1,974 women (66.60%) and 990 men (33.40%). The study area was southern Poland. The research tool was a questionnaire consisting of a metric section and a proprietary tool - the Successful Aging Index-SAI. Additionally, the study utilized questionnaires assessing health-related quality of life - the SF-12, physical activity - the PAQE, and anxiety and depression - the HADS. SAI was higher in women than in men. There was no correlation between age and the domains or the overall SAI. Sociodemographic variables: education, size of residence, marital status, household management, presence of chronic disease, and having children differentiated SAI and its domains: p < 0.0001. Regression results showed that physical and mental health components, education level, and household size positively influenced SAI levels. A sense of physical and mental health has a key impact on SA. Important moderators of SA include individual agency, sociodemographic factors, and, in particular, education level and household type. Due to the difficulties in defining unambiguous quality criteria, SA should be treated as a linear variable.

Introduction With the rise of emotional-value-driven consumption, self-satisfied consumption has become a significant market trend. However, research on its underlying psychological mechanisms remains limited. This study focuses on its future-oriented aspect, investigating how future self-continuity and perceived economic mobility influence the intention for self-satisfied consumption. Methods A questionnaire-based study was conducted, collecting 388 valid responses nationwide. The concept of self-satisfied consumption was synthesized as healthy, rational, and autonomous consumption driven by self-development and personal pleasure. Data were analyzed using Hayes’ SPSS Process macro (Model 4) to test the proposed mediation model. Results (1) Both future self-continuity and perceived economic mobility positively predicted the intention for self-satisfied consumption. (2) Marital status was a significant demographic factor, with married individuals showing higher intention than unmarried ones. (3) Perceived economic mobility played a significant partial mediating role in the relationship between future self-continuity and consumption intention. Discussion The findings confirm that future-oriented psychological factors are key drivers of self-satisfied consumption, revealing a specific pathway through perceived economic mobility. This extends the theoretical understanding of the formation mechanisms of self-satisfied consumption and offers practical insights for consumer psychology and marketing strategies aimed at enhancing consumer well-being.

To explore baseline activities of daily living (ADL) profiles and their association with memory decline over time in cognitively healthy, community-dwelling older adults. Observational panel study. This study analysed data from Waves 7-10 of the English Longitudinal Study of Ageing (the search was performed on May 28, 2024), including 2925 older adults aged above 65 with no dementia or cognitive impairments at baseline (Wave 7, 2014-2015). To categorise participants by their daily functional abilities at baseline, latent class analysis was conducted to derive participants' activities of daily living profiles. A linear mixed model was used to explore whether these baseline activity profiles might predict different memory decline rates (trajectories) over time, accounting for baseline demographic factors (gender, age, ethnicity, education, marital status and chronic diseases). Social demographics (younger age, female gender, white ethnicity, higher education and being partnered) and ADL profiles outweigh health conditions in predicting participants' memory function. Different baseline profiles were linked to different memory decline trajectories. An impairment profile with grocery shopping capability was linked to slower memory decline. This study showed that ADL profiles had a substantial correlation with memory decline, accounting for the significant impact of sociodemographic factors. An impairment profile that preserved grocery shopping abilities appeared to offer protective benefits and potentially slow memory decline. Strengthening nursing strategies that support older adults in maintaining the ability to grocery shop, such as guiding caregivers to promote involvement rather than shopping for the older adults entirely, or accompanying older adults grocery shopping as part of community nursing care, might help delay age-related memory decline in this population. Patients or members of the public were not directly involved in the study's design, conduct, reporting, or dissemination plans.

ABSTRACT Objective To examine whether same‐gender relationship (SGR) status predicts intergenerational estrangement, operationalized as emotional closeness as well as physical contact to parents, in Germany. Background The relationship to the family of origin can be a source of support or stress. It is important to understand how this relationship differs depending on whether a person is in an SGR. This can help identify problematic patterns and develop interventions tailored to the needs of this population. Method Analyses were based on 11 annual waves of the nationally representative German Family Panel (“pairfam”). A total of N = 12,926 participants ( N = 122,036 observations) were included, with n = 237 participants reporting at least one SGR in their lifetime ( n = 174 at the time of the interviews). Hypotheses regarding between and within person effects were tested using multilevel multivariate models. Results Participants who reported being in an SGR at least once in their lifetime or in proportionally more waves were less close to their fathers. The closeness to mothers was not related to participants' SGR status. Conclusion Intergenerational relationships for people in SGRs are similar to those of the general German population. The differences that do exist mainly relate to a less close father‐child relationship whereas relationships of mothers with their children appear to be more robust.

Disparities in hepatocellular carcinoma (HCC) outcomes are shaped by intersecting social determinants of health (SDOH). We hypothesized that patients experience distinct combinations of socioeconomic barriers that cluster into social risk phenotypes associated with differences in diagnosis, treatment, and survival. We analyzed data from 4,877 adults diagnosed with HCC in the Indiana State Cancer Registry (2009-2020). Latent class analysis (LCA) was performed using sex, race, insurance, marital status, occupation, neighborhood Social Deprivation Index (SDI), and distances to screening and Indiana University Hospital. Outcomes included early-stage diagnosis, receipt of curative therapy, and two-year mortality. Among 4,877 patients, 15.8% were non-White and 24.7% were female. LCA identified six distinct risk classes: (1) Minimal Barriers; (2) Publicly Insured - Married Females; (3) Publicly Insured - Unpartnered Males; (4) Rural and Geographically Distant; (5) Structurally Marginalized; and (6) Unseen and Uninsured. Class 1 had the most favorable characteristics (83.7% private insurance, 16.8% professional occupation) and best outcomes: 55.4% early-stage diagnosis, 24.4% curative therapy, and 55.4% two-year mortality. All other classes had significantly worse outcomes. Compared to Class 1, patients in Class 6 had the lowest early-stage diagnosis (39.7%) and curative therapy (10.5%) and highest mortality (83.6%; OR 4.12, 95% CI 3.06-5.54, P <0.001). Classes 4 and 5, reflecting rural and racially marginalized groups, also had significantly lower odds of early diagnosis and treatment. Social risk phenotypes based on intersecting SDOH were strongly associated with HCC outcomes and may inform future risk-based intervention strategies.

Overtime has become a strong feature of modern work culture, especially in high-pressure sectors in Asia, such as manufacturing, logistics, and services. Although many studies have proven the link between long working hours and the deterioration of employee welfare, the mechanisms explaining how overtime causes an imbalance between work and personal life (Work-life Balance) have not yet been fully explored and pieced together. This narrative literature review aims to synthesize findings from key and recent studies published between 2000 and 2025. The goal is to form a conceptual framework of understanding how overtime can trigger burnout (emotional, mental, and physical exhaustion) and ultimately disrupt WLB. Based on four main theoretical foundations, namely Job Demands–Resources (JD-R), Conservation of Resources (COR), Effort Recovery Model, and Work–Home Resources Model, this review identifies three main pathway mechanisms: (1) Overtime increases job demands while simultaneously reducing opportunities for self-recovery. (2) Burnout, especially emotional exhaustion, acts as a psychological strain that mediates the effects of overtime. (3) The spillover effects of burnout trigger interference between work and home domain through time based conflicts and strain. Organizational support, job autonomy, family roles, marital status, gender and workload pressure are important moderators that can strengthen or weaken the relationship between each variable. While the theoretical contribution of this review lies in combining various perspectives into a conceptual model of the "overtime trap," its practical contribution lies in proposing implications for organizations, job redesign, fatigue management, and more adaptive work policies. Future research is expected to use longitudinal, mixed-method, and cross-cultural designs to validate, strengthen and expand this model.

Construction of a risk predictive model for cognitive frailty in middle-aged and older patients with ischemic stroke: a cross-sectional study.

Introduction Personal wellbeing is a multidimensional construct encompassing emotional, psychological, social, and spiritual aspects. To capture this complexity, we introduce the Personal Wellbeing Spectrum Theory, which organizes these dimensions into two higher-order domains: internal wellbeing (emotional and psychological) and external wellbeing (social and spiritual). The paper aimed to conceptualize this theory and to develop and validate the Personal Wellbeing Spectrum Questionnaire (PWBSQ), a tool designed to operationalize the model. Methods The structural validity of PWBSQ was examined in a large online sample ( n = 11,686) using confirmatory factor analysis, and the hierarchical model was tested in three additional independent samples. Reliability and measurement invariance across sociodemographic groups were assessed. Substantive validity was evaluated through associations with established measures, including the Positivity Scale, Diener Flourishing Scale, Huppert Flourishing Scale, Values in Action Inventory, Mental Health Test, and the PERMA model. Results The hierarchical model demonstrated good fit across multiple samples (RMSEA around 0.06, SRMR round 0.04, CFI and TLI around 0.95), with consistent reliability (α and ω &amp;gt; 0.79). Measurement invariance was supported across five sociodemographic variables. The questionnaire showed meaningful associations with subjective financial situation, gender, education, and family characteristics, while marital status and occupation had only minor effects. Discussion Findings confirm the Personal Wellbeing Spectrum Theory and support the PWBSQ as a reliable and valid instrument for assessing multidimensional wellbeing. This tool provides researchers and practitioners with a comprehensive measure of personal wellbeing that can be applied across diverse populations, facilitating both theoretical development and practical assessment in health and social sciences.

Overweight and obesity are rising globally, with Ghana experiencing significant increases among women over the past two decades, raising public health concerns. This study aimed to identify and quantify the key drivers of overweight and obesity among women of reproductive age in Ghana, analysing how these factors have contributed to prevalence changes over time. Data from the 2003, 2008, 2014, and 2022 Ghana Demographic and Health Surveys were analysed using binary logistic regression to assess associations with factors such as age, wealth, and education. Multivariate decomposition analysis quantified the contributions of these factors to the observed increases in overweight and obesity prevalence over time. Here we show overweight and obesity among Ghanaian women rise significantly, reaching 43% in 2022. Key drivers of change in overweight and obesity include wealth, education, urban residence, age, and region. Women in the wealthiest quintile have three times the odds of overweight (aOR: 3.07 [2.02-4.67]) and over six times the odds of obesity (aOR: 6.73 [3.80-11.91]) compared to the poorest quintile. Decomposition analysis shows that 22.5% of the increase in prevalence was due to changes in population characteristics, such as marital and educational status. Our findings reveal that socio-demographic changes in society, beyond individual behavioural factors, drive the rising overweight and obesity prevalence among Ghanaian women of childbearing age. These findings highlight the dynamic factors influencing weight outcomes and the need for tailored strategies addressing the diverse and evolving determinants of overweight and obesity in Ghanaian women.

Objective. A comprehensive analysis of the scientific production on family and marital status, as indexed in the Web of Science Core Collection from 2001 to 2024, was conducted. This analysis aimed to identify patterns of international and institutional collaboration, as well as the field’s predominant thematic structures. Design/Methodology/Approach. A bibliometric approach was applied to a dataset of 8,457 articles classified under the Family Studies category in the Web of Science Core Collection. To this end, directed networks of country collaboration, institutional collaboration, and keyword co-occurrence were constructed and analyzed using Gephi. The analysis focused on weighted degree, betweenness centrality, and harmonic closeness centrality, while thematic communities were identified through modularity analysis. Results/Discussion. The findings indicated a field characterized by extensive integration within a hierarchical structure. International and institutional collaboration networks exhibited a pronounced centralization around universities and countries in the Global North, particularly the United States. The thematic structure was organized around a stable relational and psychosocial core centered on family, parenting, marriage, and mental health, alongside specialized communities addressing family violence, inequality, gender and sexual diversity, professional intervention, and academic training. Conclusions. The study of family and marital status is a mature and multidimensional field. While the phenomenon of collaboration is becoming increasingly transnational, the distribution of scientific visibility and agenda-setting remains uneven.

ABSTRACTBackgroundSoft tissue sarcomas (STS) of the upper extremity (UE) are uncommon and may require complex surgical management. Socioeconomic disadvantage, race/ethnicity, sex, and marital status may influence presentation, surgical complexity, local recurrence (LR), and overall survival (OS).AimsThe aim of this work is to examine the influence of socioeconomic and demographic factors on the presentation and outcomes of upper extremity soft tissue sarcomas.Methods and ResultsWe identified patients treated surgically for primary UE STS (2012‐2022). Demographics, tumor characteristics, and outcomes were recorded. Associations between demographics and time to presentation, skin grafting, amputation, and LR were assessed using chi‐square and t‐tests. Competing risks regression analyzed 3‐ and 5‐year LR, and Kaplan‐Meier analysis assessed 5‐year OS. Among 181 patients, the mean time to presentation was 17.1 months (SD 34.3), mean tumor size was 7.8 cm (SD 5.7) while 56% required re‐excision, 15% underwent amputation, 15% required skin grafting, and 24% experienced LR. Hispanic/Latino patients presented with larger tumor sizes (9.17 ± 5.71 cm vs. 7.43 ± 5.61 cm, p = 0.037). Non‐married patients had higher odds of amputation (OR 3.15, p = 0.012), and female sex predicted greater LR risk (OR 2.17, p = 0.037). Twenty‐one patients (11.1%) died within five years. In multivariable analysis, increasing tumor size (OR = 1.08; p = 0.010) and high tumor grade (OR = 8.28; p = 0.038) significantly impacted 5‐year OS.ConclusionWhile disparities across patient demographics may exist for surgical outcomes for UE STS, racial disparities in overall survival may be mitigated with treatment at an urban, tertiary care sarcoma center.

BackgroundUrinary incontinence (UI) is a common complaint among middle-aged and older women, associated with many negative impacts in health. The aim of this study was to analyze whether an association exists between UI and sarcopenic obesity (SO) among middle-aged and older women living in northeastern Brazil. The association of UI with sarcopenia or obesity alone was also assessed.MethodsIn a cross-sectional, analytical study, 531 women living in Santa Cruz and Parnamirim, Rio Grande do Norte state (Brazil), aged between 40 and 80 years, were assessed for the presence of UI in the last 12 months by self-reporting. Waist circumference equal to or greater than 88 cm was considered to classify obesity, while skeletal muscle mass below 5.93 kg/m2, assessed by bioelectrical impedance, classified the presence of sarcopenia. Based on these measurements, the participants were classified into four profiles: neither condition, sarcopenia, obesity, and sarcopenic obesity. Binary logistic regression investigated the association of UI with sarcopenia, obesity, and SO, adjusted for the covariates age, schooling, family income, marital status, hypertension, diabetes, parity, and menopausal status, considering p < 0.05.ResultsA total of 10.7% had no sarcopenia or obesity, 10.7% had only sarcopenia, 69.7% had only obesity and 8.9% had SO. Obesity alone was associated with a higher odss of UI compared to the group with neither conditions (OR = 1.95; p = 0.025). The associations between UI and sarcopenia alone or combined with obesity were not significant.ConclusionObesity alone was associated with UI. The results highlight the need for screening UI symptoms among women with abdominal obesity for early detection and timely interventions.

Background Hip fractures are a major health concern in the older adults, severely impacting patients’ quality of life and straining healthcare systems. With China’s aging population, their incidence is projected to increase. Thus, developing effective prediction models to identify high-risk individuals is essential for prevention. Objective The aim of this study was to develop and validate a reliable and accurate machine learning-based predictive model for hip fracture incidence to improve the prediction of the risk of hip fracture in community residents. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), encompassing 21,095 individuals aged 45 years and older, of whom 616 reported hip fractures. Baseline data from these participants were utilized to examine 34 metrics, including demographic characteristics, lifestyle, health status, and mental health and cognitive functioning scores. Ten machine learning algorithms, including Random Forest (RF), Adaptive Boosting (AdaBoost), and Decision Tree (DT) machine learning techniques were used to analyze and determine the optimal model. The performance of the predictive models was evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity and F1 score. The SHapley Additive exPlanation (SHAP) interpretation was utilized in identifying the key influencing factors and individual heterogeneity was explained through instance level analysis. Results After addressing class imbalance using a class-weighting technique, we found that the Random Forest model performed the best, with an AUC of 0.93, with high sensitivity, specificity, and F1 score. Metabolic Equivalent of Task (MET), age, fall down, drinking, cognitive functioning scores, sleep duration of nap after lunch, residence, total sleep duration, and marital status were the key predictors. The model demonstrated favorable predictive performance in both the internal and external validation cohorts, indicating that the model is optimal. Conclusion The machine learning-based predictive model developed in this study demonstrated strong predictive performance for incident hip fractures over a 7-year period. By incorporating readily available, modifiable lifestyle factors, the model serves as a promising tool for identifying individuals at high risk. It provides a scientific basis for developing early intervention strategies, but requires further prospective validation before clinical implementation.