Burrowing owl is a bird of prey frequently found in urban areas and is therefore highly susceptible to injuries caused by human activities and domestic animals. This study aimed to investigate the use of clinical and laboratory parameters as prognostic factors in burrowing owls with fractures. A 10-year retrospective study was conducted using clinical laboratory data from the medical records of burrowing owls with long bone fractures and the data were divided into two groups: discharged and deceased individuals. A total of 26 medical records of burrowing owls with fracture were evaluated. There were significant differences in the duration of hospitalisation (p = 0.0001), cloacal temperature (p = 0.0202), absolute lymphocyte count (p = 0.011), absolute band heterophil count (p = 0.037), heterophil-to-lymphocyte ratio (p = 0.039), monocyte-to-lymphocyte ratio (p = 0.013) and thrombocyte-to-lymphocyte ratio (p = 0.002). Logistic regression analysis revealed that longer duration of hospitalisation (odds ratio [OR] = 1.411; 95% confidence interval [CI] = 1.138‒2.204), relative lymphopenia (OR = 0.097; 95% CI = 0.005‒0.729), a lower monocyte-to-lymphocyte ratio (OR = 0.001; 95% CI = 0.000‒0.202) and less frequent of a high heterophil-to-lymphocyte ratio (OR = 0.071; 95% CI = 0.003‒0.595) were significantly associated with survival. The main limitation of this work lies in its retrospective nature and the inability to retrieve some information from the patients' medical records. Relative lymphopenia, elevated monocyte-to-lymphocyte ratio and heterophil-to-lymphocyte ratio may influence the survival of burrowing owls with long bone fractures.

African migrants constitute a significant proportion of the Australian population. While migration and resettlement offer opportunities, the associated stressors may adversely affect the mental health and well-being of African migrants. This study explored, for the first time, the prevalence of depression and psychological distress among African migrants in Australia and the relationship between coping mechanisms and mental health outcomes. A web-based cross-sectional survey of adult African migrants in Australia was conducted between February and May 2022. Participants (N = 167) who did not have a refugee status who resided in Australia for at least 12 months were recruited through community groups. An e-link of the survey created in Qualtrics was posted on online platforms (WhatsApp, LinkedIn, Twitter, and Facebook) and distributed via emails of community members. The Kessler Psychological Distress Scale (K10) and Patient Health Questionnaire (PHQ-9) assessed mental health outcomes and the Brief COPE assessed coping strategies. Descriptive and multivariate regression analyses were used to determine the association between demographic variables, language ability, and mental health outcomes. Most respondents (45.2%) were between 35 and 44 years of age and were proficient in English. Approximately one in three individuals reported higher levels of either depression or psychological distress, while 30.9% reported higher levels of both mental health outcomes. Age-specific rates revealed higher levels of depression and psychological distress among younger participants (18-24 years, 62.5%) compared to older age groups (55-59 years, 22.2%; p < 0.05, for both). Coping strategies, such as self-blame, self-distraction, and behavioural disengagement, were significant predictors of depression. Similar findings were observed for psychological distress, with self-blame, behavioural disengagement, and religious coping identified as significant predictors. Notably, language ability did not significantly differ between groups with varying levels of depression or distress. However, the distressed group was significantly younger than the non-distressed group (X² (n = 131) = -2.13, p = 0.03), while the higher depression group tended to be younger than the minimal depression group (X2 (n = 124) = -2.67, p = 0.08). These findings highlight the importance of addressing mental health issues and promoting effective coping strategies among African migrants in Australia, particularly targeting young individuals.

Mucosal melanoma (MM) is an aggressive and rare subtype of melanoma, and it is associated with poor prognosis. Surgical resection remains the mainstay of the treatment for localized disease, and different from cutaneous melanoma, the impact of adjuvant therapy has not been clearly established. We retrospectively analyzed patients with surgically resected MM from the MD Anderson Cancer Center melanoma database from January 2000 to December 2019. The univariate log-rank test and multivariate Cox regression model were used to analyze the impact of adjuvant therapy on overall survival (OS) and relapse-free survival. A total of 246 patients with localized or locally advanced MM who underwent surgical resection were included. The median OS for all patients was 4.8 years [95% confidence interval (CI), 3.6-6], with median OS for the 125 patients who received adjuvant systemic therapy was 5.7 years (95% CI, 4.0-10.2) and 4.0 years (95% CI, 2.8-6.6) for the 121 patients who had only surgery or surgery plus radiation in the subanalysis, chemotherapy was associated with a longer OS (7.3 years; 95% CI, 4.4-NA) compared to immunotherapy (5.5 years; 95% CI, 2.8-NA). Cox regression analysis demonstrated lymph node involvement, Breslow thickness, and use of adjuvant systemic therapy were considered independent factors for OS. Adjuvant systemic therapy was associated with a significant survival benefit in patients with resected MM (HR 0.53; 95% CI, 0.34-0.82; P = 0.004). However, due to the retrospective nature of the study, prospective clinical trials are warranted to determine the optimal adjuvant treatment strategy for this patient population.

Delays in emergency medical care (EMC) can increase sepsis mortality. Sepsis symptoms, however, are less known in the public compared with signs of stroke and myocardial infarction. Using case vignettes, we investigated the decision to seek EMC in sepsis-related compared with other emergencies. Cross-sectional survey. A representative nationwide survey was conducted in December 2023 among 1013 persons in Germany. None. A standardized questionnaire was administered via face-to-face interviews to assess perceived urgency, the tendency to seek EMC, sepsis knowledge, and barriers to EMC utilization. Multiple regression analyses were conducted to identify predictors for the perceived urgency and the tendency to seek EMC. Across ten case vignettes, the perceived urgency was lower for sepsis-related (mean = 3.93, sd = 0.64) than for nonsepsis-related emergencies (mean=4.15, sd = 0.67). In sepsis-related vignettes, the immediate EMC option ("Call emergency medical services or go to the emergency department [ED] immediately") was chosen by 18.3-43.2% of respondents, compared with 20.1-71.9% in nonsepsis-related vignettes. Even when situations were rated as very urgent, EMC use was less likely for sepsis-related emergencies (35%) than for nonsepsis-related emergencies (17%). In regression analyses, sepsis knowledge was the only predictor of perceived urgency, and perceived urgency was the strongest predictor of EMC use. The likelihood of EMC use in sepsis-related emergencies was 14.9 percentage points lower (p < 0.01) than in nonsepsis-related emergencies; "long waiting times in the ED" was the only significant barrier for EMC use. Compared with nonsepsis emergencies, sepsis-related emergencies are perceived as less urgent and less often lead to EMC use, even if the level of perceived urgency is the same. As the perceived urgency is associated with sepsis knowledge, this underlines the need to increase efforts to improve sepsis knowledge and the awareness that sepsis requires timely emergency care in the general public.

This study aimed to examine the domains of student accountability implications and the development of a community of teachers in public elementary schools in Boston District, Division of Davao Oriental. A non-experimental quantitative research design using the correlational method was employed. The study’s respondents consisted of 134 teachers, selected through universal sampling. The statistical tools used for data analysis included the mean, Pearson Product-Moment Correlation (r), and regression analysis. The results revealed that the level of student accountability implications in public elementary schools was moderate. Moreover, the level of building a community of teachers was also high. A significant relationship was found between student accountability implications and the development of a community of teachers in public elementary schools. Furthermore, the domains of student accountability implications were found to significantly influence the building of a teacher community. In light of these findings, the researcher formulated the following recommendation: the enhancement of student accountability implications and the development of a community of teachers may be achieved by focusing on areas that need improvement, particularly in ensuring that students receive integrated and coherent learning experiences that contribute to their personal, academic, and professional growth. Keywords: Student Accountability Implication, Building Community In The Classroom, Public Elementary School Teachers, Education, Philippines

Multimorbidity is a leading cause of functional health impairments in older adults, affecting Activities of Daily Living (ADL). Health-literacy enables individuals to access, process, and apply health-related information effectively, serving as a strategy to mitigate these effects. This study explores the moderating role of health literacy in the relationship between multimorbidity and functional health according to ADL. Data were derived from 3069 individuals aged 80 and older from the "Ageing in Germany (D80+)" survey. Multimorbidity was measured using a 22-item index, while health literacy was assessed via a two-item scale evaluating knowledge and compliance. Functional health was determined by ADL performance. Elastic Net regression and moderation analysis were employed to examine the relationships between multimorbidity, health literacy, and functional health, controlling for sociodemographic and mental covariates. Multimorbidity was significantly associated with functional health (b= -1.668, p < 0.001). Health literacy emerged as a significant moderator, attenuating the impact of multimorbidity on functional health (interaction term: b = 0.243, p = 0.023). Conditional effects analysis revealed that individuals with higher health literacy exhibited better functional health, with the adverse effect of multimorbidity on ADL substantially diminished in this group. This study highlights the critical role of health literacy in mitigating the impact of multimorbidity on functional health. Interventions aimed at enhancing health literacy offer a promising avenue for promoting independence and functional health in older adults. Future research should focus on longitudinal designs and objective measures to further elucidate the pathways linking multimorbidity, health literacy, and functional health. Fostering the ability to independently obtain, understand and implement health information should be a key goal of clinical practice and policy interventions.

Although hyperthyroidism is known to increase the risk of atrial fibrillation (AF), subclinical hypothyroidism (SH) is an often-underreported condition characterized by elevated thyroid-stimulating hormone (TSH) levels and normal fT3/fT4 levels. This study aimed to clarify the association between SH and AF and to identify potential direct electrophysiological effects of TSH. We retrospectively included 2311 patients diagnosed with SH between 2007 and 2020 who had an ECG within 7 days of diagnosis. Logistic regression analysis identified factors independently associated with AF in patients with SH. Effects of different TSH doses on ion channel mRNA and protein levels were analyzed in HL-1 and neonatal rat cardiomyocytes. Video analysis with MYOCYTER, patch-clamp, optical mapping, and computational modeling were used to study automaticity and action potential characteristics after TSH application. AF was documented more often with higher TSH levels (4-10 mU/L TSH: 32.1% versus >10 mU/L TSH: 44.6%; P<0.0001). Multivariable regression identified elevated TSH levels as an independent risk factor for AF. TSHR (TSH receptors) were confirmed in cardiomyocytes, and exposure to TSH led to changes in ion channel expression levels that promoted action potential prolongation. TSH also increased the beating rate in neonatal rat cardiomyocytes. We identified a TSHR-mediated cascade involving cAMP, PKA (protein kinase A), and CREBH (cAMP-responsive element-binding protein H) as a potential regulator of cardiomyocyte electrical remodeling leading to the proarrhythmic effects that promote the development of AF. Individuals with SH exhibit an increased prevalence of AF, which is likely in part due to a direct effect of TSH on ion channel expression in cardiomyocytes via the TSHR/cAMP/PKA pathway.

The effect of brand image on customer loyalty toward supplementary products market are a critical aspect of marketing strategy, particularly in the health and wellness industry. This study aims to investigate the relationship between brand image and customer loyalty specifically within the context of supplementary products. By analyzing survey data collected from a diverse sample of consumers, this study seeks to identify key drivers of brand image and loyalty in the supplementary product market. It will employ statistical techniques such as regression analysis to assess the strength and significance of relationships between variables. Through a comprehensive review of existing literature and empirical research, this study will explore how various elements of brand image, such as perceived quality, trustworthiness, and alignment with health goals, influence consumer loyalty toward Supplementary products. It will also examine the role of factors like brand reputation, packaging, marketing communication, and consumer perceptions of product efficacy in shaping brand image and subsequent loyalty. The findings of this study are expected to provide valuable insights for Supplementary products manufacturers and marketers seeking to enhance brand image and foster greater consumer loyalty. By understanding the factors that drive consumer perceptions and behaviors in this market segment, companies can develop more effective branding strategies, product formulations, and communication approaches to attract and retain loyal customers. Ultimately, the study aims to contribute to the body of knowledge on brand management and consumer behavior in the context of health-related products. Keywords: Customer Loyalty, Brand Image and Supplementary Products.

The Left Atrial-Ventricular Coupling Index (LACI), which quantifies the volumetric interaction between the left atrium and ventricle, has emerged as a promising prognostic marker for cardiovascular events. We applied three-dimensional echocardiography (3DE) and AI quantitative software to automatically obtain the new echocardiographic parameter LACI in 1084 coronary artery disease (CAD) patients at the Fourth Affiliated Hospital of China Medical University. LACI was defined as the ratio between the left atrial end-diastolic volume and the left ventricular end-diastolic volume. The primary endpoints were major adverse cardiovascular events (MACE), including unstable angina, myocardial reinfarction, heart failure (HF) and death. Over a median follow-up of 13 months, 216 MACE were recorded. LACI was significantly higher in patients with MACE than in those without (0.22 [IQR 0.17-0.28] vs. 0.20 [IQR 0.15-0.25], p < 0.001). ROC analysis indicated that LACI demonstrated higher predictive accuracy for MACE than traditional echocardiography parameters. Multivariable Cox regression analysis revealed that LACI was significantly correlated with MACE (HR: 1.68, 95% CI [1.25-2.27], p < 0.001), especially in patients with severe lesion subgroups according to the Gensini scores (HR 1.33, 95% CI [1.17-1.52], p < 0.002) and male (HR: 1.37, 95% CI [1.20-1.56], p < 0.002). Furthermore, LACI assessment enabled further risk stratification in high-risk patients with severe lesion (p < 0.001 on log-rank testing). Consistently, category-free NRI and IDI confirmed the improvement by LACI to stratify MACE risk in severe lesion patients (p < 0.05). Our findings demonstrated that AI-enhanced 3DE-derived LACI provided incremental prognostic value beyond conventional echocardiographic parameters in assessing the prognosis among CAD patients, especially in severe coronary lesion subgroups.

Colorectal cancer (CRC) is among the most prevalent malignancies, with an increasing incidence in China, posing increasing challenges to current screening strategies. This study aimed to evaluate the feasibility of a screening strategy based on the stool-based methylated Syndecan-2 gene (mSDC2) test for detecting advanced colorectal neoplasia in the Chinese population. In this multicenter randomized study, participants aged 45-80 years and identified through community screening were randomized to take either the mSDC2 test or a fecal immunochemical test (FIT), and those with positive results were referred for colonoscopy between 2020 and 2022. The primary outcome was the detection rate of advanced colorectal neoplasia, including advanced adenoma, advanced serrated polyps, and CRC. The secondary outcome was adherence to colonoscopy. Univariable and multivariable logistic regression analyses were conducted to evaluate colonoscopy adherence among participants with positive stool-based test results. A total of 44,475 eligible participants were enrolled from 189 communities (93 in the mSDC2 test group and 96 in the FIT group). In the mSDC2 test group (n = 21,854), the detection rate of advanced neoplasia was 0.53% (n = 115), including 93 (0.43%) advanced adenomas, 8 (0.04%) advanced serrated polyps, and 17 (0.08%) CRC cases. In the FIT group (n = 22,621), the detection rate of advanced neoplasia was 0.47% (n = 106), including 71 (0.31%) advanced adenomas, 9 (0.04%) advanced serrated polyps, and 29 (0.13%) CRC cases. In addition, adherence to colonoscopy was greater in the mSDC2 test group (35.6% vs. 26.4%; odds ratio: 1.59, 95% confidence interval: 1.36-1.87; P <0.001). This study revealed the effectiveness of the mSDC2 test and FIT in detecting advanced colorectal neoplasia in a large Chinese population in a real-world setting, and indicated a possible improvement in adherence to colonoscopy for the mSDC2 test. Further studies with improved comparability and longer follow-up are warranted to clarify its clinical utility. ClinicalTrials.gov, No. NCT04221854.

BackgroundTherapeutic inertia the failure to intensify treatment despite persistent hyperglycemia is a major barrier to optimal management of type 2 diabetes, particularly in low-resource settings.MethodsA hospital-based cross-sectional study was conducted from June 1, 2024, to August 30, 2024. A total of 299 systematically selected patients were included. Data were collected via structured questionnaires and patient medical records. Bivariable and multivariable binary logistic regression analyses were used to identify factors associated with therapeutic inertia. Variables with a p value < 0.25 in the bivariable analysis were included in the multivariable model, and those with a p value < 0.05 were considered statistically significant.ResultsOverall, 67.2% of patients experienced therapeutic inertia. Multivariable analysis identified four independent predictors: lack of health insurance reduced the likelihood of treatment intensification (AOR = 0.177; 95% CI: 0.054–0.576; p = 0.004); management by general practitioners doubled the odds of inertia compared with specialist care (AOR = 2.002; 95% CI: 1.017–3.939; p = 0.045); higher baseline fasting plasma glucose was associated with increased odds of inertia (AOR = 1.008; 95% CI: 1.003–1.013; p = 0.003); and limited availability of point-of-care HbA1c testing substantially increased the risk of inertia (AOR = 8.423; 95% CI: 1.889–37.561; p = 0.005).ConclusionTherapeutic inertia is highly prevalent, affecting 67.2% of ambulatory patients with type 2 diabetes at NEMMCSH. This study highlights critical barriers at patient, provider, and system levels. Interventions such as expanding insurance coverage, enhancing provider training and decision support, implementing prompts for elevated glycemia, and integrating point-of-care HbA1c testing are urgently needed to reduce therapeutic inertia and improve glycemic control in resource-constrained settings.

This study aimed to investigate the role of FAM172A in epithelial ovarian cancer (EOC), a highly lethal gynecological malignancy often diagnosed at late stages with limited treatment options. FAM172A expression was evaluated in EOC and normal ovarian tissues using western blotting and immunohistochemistry, and its association with patient prognosis, treatment response, and CA125 levels was assessed by multivariate regression analysis. Functional assays were performed to examine the effects of FAM172A on EOC cell proliferation, migration, and invasion. In vivo models were used to evaluate the influence of FAM172A on tumor growth, metastasis, and chemosensitivity. The underlying mechanism was explored by modulating the PI3K-Akt pathway with pharmacological inhibitors and activators. FAM172A was significantly upregulated in EOC tissues, and its elevated expression correlated with poor prognosis, chemotherapy resistance, and increased CA125 levels. Multivariate analysis identified FAM172A expression, platinum sensitivity, and CA125 as independent prognostic factors. In vitro, FAM172A promoted malignant behavior and conferred resistance to cisplatin. In vivo, knockdown of FAM172A suppressed tumor progression and enhanced the efficacy of cisplatin. Mechanistically, FAM172A exerted its effects through regulation of the PI3K-Akt pathway, and modulation of PI3K signaling rescued FAM172A-induced phenotypic changes. These findings highlight FAM172A as a critical promoter of EOC progression, associated with aggressive tumor characteristics and treatment failure. By activating the PI3K-Akt pathway, FAM172A represents a promising therapeutic target for EOC, potentially offering new strategies to improve patient outcomes, particularly in overcoming chemoresistance.

Background: Taste perception plays an important role in a person's food preferences. Promoting an interest in taste and developing taste perception are important factors for healthy eating habits. However, only a few studies have been conducted to investigate the association of taste perception with personal background factors, nutrition, and eating habits. Aim: To investigate the current status and associated factors of taste perception among primary school children in Japan through a cross-sectional study design. Methods: A total of 77 children aged 9-11 years participated in this study between July and August 2022. Taste perception was assessed using the validated "Taste Strips" test, and participants were classified as either having high taste perception if their total taste score was ≥9 or having low taste perception if their score was <9. Data on demographic characteristics, anthropometric measurements, eating habits, nutrient intake, and self-efficacy were collected through questionnaires and regular health checkups. Results: Among the participants, 20% were classified as having low taste perception. Multivariable logistic regression analysis showed that family commensality at dinner (adjusted odds ratio: 5.4, 95% confidence interval: 1.1-28.0) and having a positive attitude (adjusted odds ratio: 1.1, 95% confidence interval: 1.0-1.1) were significantly associated with children's taste perception. Conclusion: Our findings underscore the importance of nutrition education and the home environment in supporting the development of taste perception, potentially guiding interventions to promote healthy eating habits during children's critical formative period.

BackgroundTuberculosis (TB) remains one of the most globally impactful infectious diseases, with a recorded mortality of 1.6 million in 2022. In Romania and Ukraine, two high burden countries in the context of the WHO European region, treatment is geared towards cure; however, this path is paved with significant challenges, from morbidity to loss to follow-up.MethodsA retrospective study was performed for drug-susceptible TB patients hospitalised in three TB expertise centres in Romania and Ukraine using routinely collected data. Univariable and multivariable logistic regression analyses were used to assess predictors of three treatment outcomes: unfavourable outcomes, loss to follow-up, and death.ResultsA total of 838 patients diagnosed with drug-susceptible TB were included. Median hospitalisation was 39 days (IQR 25–67), and treatment duration was 7 months (IQR 6–8). Predictive variables differed by outcome. For unfavourable outcomes, the multivariable model included age > 65 years, chronic kidney disease, at least one cavity on chest X-ray, underweight status, and persistently abnormal laboratory parameters despite intervention. Independent predictors of loss to follow-up were alcohol use, COPD, TB infection within two years prior to admission, obesity, slow treatment response, and sputum microscopy ≥2 + . Predictors of death included age > 65 years, male sex, cirrhosis, chronic kidney disease, underweight status, persistently abnormal laboratory parameters, and slow treatment response.ConclusionContextualising factors influencing drug-susceptible TB treatment outcomes in different settings can support the development of tailored interventions that enable early identification of patients at higher risk, thereby avoiding unnecessary treatment effects.

ABSTRACT Objectives The objective of this study was to evaluate the content, reliability and quality of YouTube® videos related to dynamic balance exercise training. Methods ‘Dynamic balance exercises’ was searched on YouTube in English in August 2025, and a total of 91 videos were watched. The videos were categorized based on their content features and source of upload. The reliability of the information was assessed using the modified DISCERN (mDISCERN) tool, while video quality was evaluated through the Global Quality Scale (GQS) and the JAMA benchmark criteria. Two physiotherapists with expertise in sports rehabilitation independently reviewed each video. In cases of discrepancy, a third independent evaluator provided the final judgment to ensure objectivity. (ClinicalTrials.gov Identifier NCT07117734). Results The findings indicate that among the 91 exercise videos focusing on dynamic balance exercises, 69 (76%) were classified as useful, while 22 (24%) contained inaccurate information. mDISCERN, GQS and JAMA scores exhibited statistically significant differences based on the source of the video (p = 0.001, p = 0.001 and p = 0.001 respectively). It was observed that videos uploaded by healthcare providers demonstrated greater quality and reliability. Additionally, the linear regression analysis revealed no significant associations between the GQS, mDISCERN, and JAMA scores and the Video Power Index (VPI). Inter-rater reliability, assessed using Cohen’s kappa, showed moderate agreement for mDISCERN (0.503), GQS (0.549), and JAMA (0.528). Conclusion While the majority of videos were useful, a portion still contained misleading information. Commonly used metrics such as VPI and view ratio do not necessarily reflect content accuracy. Therefore, paying attention to the credentials or professional background of video creators may help users access higher-quality and more reliable content.

Examining the prevalence of incivility among faculty members in universities and higher education institutions, and exploring its associations with certain demographic, personal, and organizational variables, may contribute to a deeper understanding of the phenomenon and help prevent its occurrence and mitigate its potential negative impacts. To investigate the phenomenon of incivility among faculty members in higher education institutions. The study sample comprised 1230 faculty members from 48 universities across six Arab countries. The Negative Acts Questionnaire-Revised was used as the primary instrument to evaluate perceptions of workplace incivility. Faculty members reported mid-levels of overall incivility (M = 1.43), work-related bullying (M = 1.93), personal-related bullying (M = 1.36), and low levels of physically intimidating bullying (M = 0.44). Incivility levels varied by gender, college, years of experience, residency status, university legal affiliation, academic rank, and country. Regression analysis indicated that the included variables accounted for 40.2% of the variance in academic incivility, with the most significant predictor being the absence of anti-bullying policies. Included establishing internal regulations to address smart bullying, implementing a code of conduct, and providing safeguards against incivility through a response system to support victims.

The harmonized version of the ALS Functional Rating Scale - Revised (ALSFRS-R) is typically administered according to standard operating procedures (SOPs) to ensure procedural consistency. In contrast, obtaining the self-explanatory (SE) version of the ALSFRS-R does not include the use of SOPs. The aim of this study was to examine the level of agreement between the harmonized and the SE version of the ALSFRS-R in a cohort of ALS patients. In a prospective study, the harmonized ALSFRS-R was assessed in 107 ALS patients. In parallel, all patients independently completed the ALSFRS-R-SE, either on a printed form (n = 36) or remotely via the ALS App (n = 71). Agreement between methods was investigated using Spearman's correlation, Lin's concordance correlation coefficient (CCC), Deming regression, Bland-Altman plots and item-level statistics including Kendall's tau-b and the Stuart-Maxwell test. Total scores from ALSFRS-R and ALSFRS-R-SE showed high correlation (ρ = 0.91-0.95) and concordance (CCC > 0.9). Deming regression (intercept≈0; slope≈1) and Bland-Altman analysis (95% of values within limits of agreement [LoA]) revealed no systematic bias. Item-level agreement was high (76.6% on average), with some variability in items such as handwriting, walking, and dyspnea. ALS progression rates were consistent (differences ≤ 0.02). ALSFRS-R-SE remained robust across remote digital and paper-based assessments. The strong agreement between the harmonized and self-explanatory versions of the ALSFRS-R supports their interchangeable use. The SE format may facilitate remote digital assessment and reduce complexity of ALSFRS-R assessment in research and clinical practice. Further studies are warranted to validate the ALSFRS-R-SE across larger cohorts, multiple languages, and diverse rater groups.

Low-value care has been recognized as a pernicious phenomenon that increases health care costs and contributes to suboptimal care delivery. Low-value surgery may be less likely in systems that used salaried reimbursement as opposed to fee-for-service. To explore the association of reimbursement model with low-value surgery among a battery of elective procedures. This cohort study used TRICARE health care claims to compare rates of low-value surgery over fiscal years 2016 to 2023. Participants included patients aged 10 years and older who underwent acromioplasty, partial knee meniscectomy, shoulder rotator cuff repair, wrist arthroscopy, or ankle arthroscopy. Data were analyzed from January to May 2025. Direct vs private sector care. The primary outcome was the comparison of low-value care in patients in direct care vs private-sector care. An interaction between environment of care and year of surgery was retained in all models. Multivariable logistic regression analyses were used to adjust for case mix. Secondary analyses were limited to non-active-duty individuals to account for differences in low-value care for each surgical procedure. A total of 304 908 procedures were included. The mean (SD) patient age was 47.2 (12.9) years, with 189 648 (62%) male patients. Partial meniscectomy was the most common surgical procedure (128 363 procedures [42%]), followed by acromioplasty (87 721 procedures [29%]). The percentage of low-value surgery in direct care was 20%, compared with 35% in the private-sector (χ22,304 908 = 90007.01; P < .001). After adjusting for case mix, the private sector demonstrated significantly greater odds of low-value surgery (odds ratio [OR], 1.41; 95% CI, 1.38-1.45). Low-value surgery was significantly lower in each respective sector for 2020 to 2023 compared with 2016 to 2019 (direct care: OR, 0.78; 95% CI, 0.73-0.83; private sector: OR, 0.93; 95% CI, 0.91-0.96). In this cohort study of 304 908 surgical procedures, direct care evinced a significantly lower likelihood of low-value surgery in both 2016 to 2019 and 2020 to 2023. These findings support the contention that changing clinician reimbursement models from fee-for-service to salaried is associated with lower rates of low-value care.

PurposeSocioeconomic conditions and loneliness are emerging as important determinants of oral and general health. This study explores their impact on odontogenic infections (OIs) severe enough to require hospitalization.Materials and MethodsThis retrospective cohort study utilized data of patients with emergency visits to the oral and maxillofacial emergency unit from January 2012 to October 2020 at Helsinki University Hospital. The data were combined with Statistics Finland to analyze the association between socioeconomic factors and OIs. Bivariate comparisons and binomial logistic regression analysis were used to investigate the effect of selected sociodemographic and socioeconomic factors on OIs requiring hospitalization.ResultsThe study included 2838 patients, of which 709 (25.0%) were hospitalized. Patients with OIs resulting in hospitalization were statistically significantly more often single, divorced, or widowed, than married (p<0.001). Additionally, rental living (p=0.049), a lower level of education (p=0.018), and lower income level (p=0.002) were associated with hospitalization. After adjusting for age, sex, and living arrangement, a marital status of single, divorced, or widowed (odds ratio, OR=1.406, 95% CI 1.148–1.723, p=0.001) and lowest income level (ref. highest income level, OR=1.418, 95% CI 1.090–1.845, p=0.009) predicted hospitalization in logistic regression analysis.ConclusionOIs resulted more often in hospitalization if the patient was single, divorced, or widowed, or had a lower income level. These findings highlight the importance of implementing comprehensive public health strategies that tackle socioeconomic disparities to enhance oral health outcomes and reduce the impact of severe dental infections.

This study aims to analyze the factors that affect the prevalence of poverty in Southeast Sulawesi Province during the period 2014 to 2023. The independent variables studied include the Open Unemployment Rate (TPT), Human Development Index (HDI), and Total Population (JP), with poverty level as a dependent variable. The method used is multiple linear regression analysis using the Ordinary Least Squares (OLS) method processed with E-Views software. The results of the study show that simultaneously, TPT, HDI, and JP have a significant influence on the poverty rate in Southeast Sulawesi. However, when tested partially or individually, the findings showed different results. Only the Population (JP) variable has been proven to have a significant and meaningful impact on the poverty rate in the region. In contrast, the Open Unemployment Rate (TPT) and the Human Development Index (HDI) did not show a significant influence separately on the dependent variables. This research presents an important contribution in deconstructing the complexity of the relationship between key socio-economic factors and the determination of poverty rates in Southeast Sulawesi province, as well as underlining the importance of population control in poverty alleviation efforts in the region.