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BACKGROUND: A third of adults in Western countries have impaired sleep quality. A possible solution involves distributing sleep aids through smartphone apps, but most empirical studies are limited to small pilot trials in distinct populations (eg, soldiers) or individuals with clinical sleep disorders; therefore, general population data are required. Furthermore, recent research shows that sleep app users desire a personalized approach, offering an individually tailored choice of techniques. One such aid is Peak Sleep, a smartphone app based on scientifically validated principles for improving sleep quality, such as mindfulness meditation and cognitive behavioral therapy. OBJECTIVE: We aimed to test the impact of the smartphone app Peak Sleep on sleep quality and collect user experience data to allow for future app development. METHODS: This was a 2-arm pilot randomized controlled trial. Participants were general population adults in the United Kingdom (aged ≥18 years) who were interested in improving their sleep quality and were not undergoing clinical treatment for sleep disorder or using sleep medication ≥1 per week. Participants were individually randomized to receive the intervention (3 months of app use) versus a no-treatment control. The intervention involved free access to Peak Sleep, an app that offered a choice of behavioral techniques to support better sleep (mindfulness, cognitive behavioral therapy, and acceptance commitment therapy). The primary outcome was sleep quality assessed using the Insomnia Severity Index at baseline and 1-, 2-, and 3-month follow-ups. Assessments were remote using web-based questionnaires. Objective sleep data collection using the Oura Ring (Ōura Health Oy) was planned; however, because the COVID-19 pandemic lockdowns began just after recruitment started, this plan could not be realized. Participant engagement with the app was assessed using the Digital Behavior Change Intervention Engagement Scale and qualitative telephone interviews with a subsample. RESULTS: A total of 101 participants were enrolled in the trial, and 21 (21%) were qualitatively interviewed. Sleep quality improved in both groups over time, with Insomnia Severity Index scores of the intervention group improving by a mean of 2.5 and the control group by a mean of 1.6 (between-group mean difference 0.9, 95% CI -2.0 to 3.8), with was no significant effect of group (P=.91). App users engagement was mixed, with qualitative interviews supporting the view of a polarized sample who either strongly liked or disliked the app. CONCLUSIONS: In this trial, self-reported sleep improved over time in both intervention and control arms, with no impact by group, suggesting no effect of the sleep app. Qualitative data suggested polarized views on liking or not liking the app, features that people engaged with, and areas for improvement. Future work could involve developing the app features and then testing the app using objective measures of sleep in a larger sample. TRIAL REGISTRATION: ClinicalTrials.gov NCT04487483; https://www.clinicaltrials.gov/study/NCT04487483.

AbstractBackground and aimsMethodsResultsConclusionsThe enhanced liver fibrosis (ELF) test has good discrimination performance in detecting advanced liver fibrosis. The chronic liver disease (CLivD) risk score based on clinical data accurately predicts risk for future severe liver disease. Considering the ELF test as a surrogate marker for liver fibrosis, we analyzed predictors of elevated ELF (eELF) and its change.The study cohort consisted of Finnish general population-based health surveys Health2000 and a follow-up study 10 years later Health2011 with 6084 and 2937 individuals, respectively with phenotype and ELF data. eELF was defined as ELF ≥ 9.8, and clinically relevant fibrosis progression as an ELF change ≥0.6. CLivD risk score was calculated at baseline. Analyses were age-adjusted.Obesity measures and diabetes predicted eELF at baseline. Only waist-hip ratio (WHR) could predict clinically relevant fibrosis progression over the follow-up consistently among men and women (OR 1.35 and 1.41, respectively). High-risk alcohol use was a significant risk factor for eELF only among men (OR 1.72, p = 0.049), and it did not predict fibrosis progression in either sex. Although elevated transaminases were associated with eELF, in most individuals with eELF they were within reference limits. Increased CLivD scores correlated with baseline and the change of ELF values over the 10-year follow-up independent of baseline ELF (p < 0.001).Liver fibrosis progression is difficult to predict based on single risk factors or liver enzymes. ELF had limited value to predict fibrosis progression. The CLivD score, based on multiple risk factors, predicted both occurrence of baseline eELF and its progression over a 10-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Although the second booster dose of COVID-19 vaccines is available, vaccine hesitancy among the public may have peaked due to the surge in infections caused by the Omicron variant. To improve coverage of the second booster dose, it is crucial to investigate the prevalence of vaccine hesitancy among the general population during this period and explore the reasons for this phenomenon. Methods: A cross-sectional survey was conducted between January 5 to February 9, 2023. Variables including sociodemographics, mental health, COVID-19 infection status, COVID-19 vaccination status, and vaccine hesitancy were collected. Univariate and multivariate logistic regression analysis were performed to identify factors associated with the hesitancy of the second booster dose of COVID-19 vaccine among the general population. Results: Among the 10,623 participants, the uptake rate of the second booster dose was 4.3%. Among those who did not receive the second booster dose, 43.6% expressed vaccine hesitancy. The highest hesitancy rate was observed among participants who had not completed primary immunization (71.4%), followed by those with chronic diseases (48.6%) and those aged 60 and above (33.2%). The COVID-19 vaccine hesitancy was higher among females, participants with high incomes, those with a history of COVID-19 infection, those with depressive symptoms and post-traumatic stress disorder, and those with adverse events after COVID-19 vaccination. Conversely, lower hesitancy was observed among students, participants aged 60 and above, those from southern China, and those with higher level of perceived social support. Conclusions: COVID-19 vaccine hesitancy remains prevalent among the general population in China after the surge period of the pandemic. Crucial steps, such as raising public awareness of the benefits and potential side effects of regular COVID-19 vaccination, ensuring timely monitoring and disclosure of pandemic information, and implementing targeted measures to improve social support and mental health, should be taken. These efforts will be instrumental in reducing vaccine hesitancy, advancing vaccination campaigns, and effectively preparing for the potential future outbreaks. [ABSTRACT FROM AUTHOR]

Objective: As alcohol consumption generally occurs in interpersonal contexts, many studies have examined the psychosocial mechanisms underlying drinking habits. However, most have focused on young/student populations, and far less is known regarding how these psychosocial determinants evolve through adulthood. We thus compared the weight of psychosocial factors in problematic alcohol consumption among young, middle-aged and older people from the general population. Methods: A general population sample completed an online survey (N = 614, Mage = 34.44, Range= 18–85). We measured demographic variables, problematic alcohol consumption and alcohol-related psychosocial factors (i.e. expectations, motives, norms, social identity, anxiety and depression). We performed dominance analyses to rank the importance of these psychological factors in explaining problematic alcohol consumption across young (18–24, n = 252), middle-aged (25–40, n = 179), and older (>40, n = 183) individuals. Results: In young adults, enhancement motives were the most important determinant of problematic alcohol consumption, followed by social drinking identity, coping and social motives. In the middle-aged group, social identity had the highest contribution, followed by social and enhancement motives. Finally, problematic alcohol consumption among older adults was mainly related to coping motives and social identity. Discussion: We showed that the psychosocial determinants of problematic alcohol consumption differ with age. While social drinking identity has a significant influence throughout the age groups, we documented a progressive shift from positive (social/enhancement) to negative (coping) reinforcement between younger and older individuals. This study provides a better understanding of the profiles of consumers according to age, and offers guidelines to adapt prevention and interventions to the age group targeted. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo quantify treatment preferences for food allergy management options (oral immunotherapy, biologic therapy, and allergen avoidance), overall and by sociodemographic strata.A US general population (≥13 years) discrete choice experiment (DCE) was conducted, including the Intolerance of Uncertainty-12 Scale and clinical/demographic questions. Conditional logistic regression analyses were conducted overall and by sociodemographic factors. DCE results were presented as odds ratios (ORs) with 95% confidence intervals (CIs).Participants (n = 294) mean (standard deviation) age was 47 (19.7) years; 48.6% were male. A 1% reduction in risk of having an exposure resulting in a moderate-to-severe reaction was statistically significantly associated with treatment preference (OR: 1.10; CI:1.04–1.16; p < 0.01). Features significantly associated with reduced preference included: a 1% increase in risk of treatment-related, severe anaphylaxis (0.85; 0.74–0.97; p=0.02); a 1% increase in risk of gastrointestinal symptoms (0.99; 0.99–0.99; p < 0.01); daily treatment (vs. every 2–4 weeks; 0.81; 0.72–0.91; p < 0.01); in-clinic administration (vs. at-home; 0.76; 0.66–0.87; p < 0.01); subcutaneous administration (vs. oral; 0.69; 0.61–0.78; p < 0.01); three-hour post-treatment physical activity limitation (0.84; 0.77–0.93; p < 0.01); and one-year life expectancy reduction (0.87; 0.85–0.89; p < 0.01). Rural dwellers favoured at-home use and no activity limits; lower-income respondents preferred convenience (oral, less frequent, and at-home administration). Teens strongly preferred being bite-safe (vs. fully allergic; 2.75; 1.09–6.90; p = 0.03).When making food allergy management decisions, US general population respondents had strong preferences for features related to safety and convenience; however, the magnitude of preferences varied by sociodemographic factors. These findings may be pertinent for population-level health decision makers. [ABSTRACT FROM AUTHOR]

Objective: This study examined the psychometric properties of a newly developed scale for measuring subjective cognitive reserve (SCR) across multiple domains, including nutrition, physical condition, sleep, cognition, willingness to learn, socialization, general health, and life plan. Method: The relationship between SCR scores and other established measures of cognitive reserve and subjective cognitive decline was also explored. A sample of 402 healthy participants aged 18 to 79 years took part in the study. Results: The SCR scale demonstrated strong psychometric properties, including internal consistency and construct validity, supporting the theoretical model of perceived cognitive reserve. Convergent validity was confirmed through a positive correlation between SCR scores and resilience (BRCS) as well as with other cognitive reserve measures, indicating consistency in evaluating cognitive reserve across various instruments. Furthermore, discriminant validity was demonstrated by a significant negative correlation between SCR scores and subjective cognitive decline, suggesting that individuals with higher cognitive reserve experience lower levels of perceived cognitive decline. No significant relationship was found between SCR scores and chronological age, further supporting the construct validity of the scale by showing that cognitive reserve is influenced by dynamic factors beyond age. Conslusion: The findings highlight the potential of the SCR scale as a reliable and valid tool for assessing cognitive reserve and its protective role in cognitive health and well-being over time. [ABSTRACT FROM AUTHOR]

Background: eHealth literacy (eHL) is positively associated with health-related behaviors and outcomes. Previous eHL studies primarily collected data from online users and seldom focused on the general population in low- and middle-income countries (LMIC). Additionally, knowledge about factors that affect eHL is limited. Chronic lung disease (CLD) has brought a large burden in LMIC, making it a relevant example for studying eHL. This study aims to explore eHL and its associated factors within the general population of China, encompassing sociodemographic characteristics, CLD knowledge, digital access, eHealth use and attitudes towards eHealth. Method: Data were collected from November 2023 to January 2024 via online and hard-copy questionnaires among the general population in China. Descriptive analyses were performed to explore eHL, CLD knowledge, digital access, and attitudes towards eHealth at different sociodemographic levels. Univariable and multivariable regression analyses were performed to identify factors associated with eHL. Results: 439 valid questionnaires were collected. Participants demonstrated a mean eHL of 24.7 ± 8.2 and CLD knowledge of 5.9 ± 3.7, obtained a score of 6.9 ± 1.8 in attitudes towards eHealth. A notable percentage of participants (45/439, 10.3%) reported no digital access, especially those aged 66+, the unemployed, retired, those with a primary school or below degree and earning ≤ 1500 RMB monthly. Multivariable hierarchical regression analysis showed higher eHL was uniquely associated with younger age (b=-0.10, P <.001), higher educational level (b = 2.02, P <.001), higher income (b = 1.10, P <.001), having digital access (b = 6.35, P <.001), more frequent eHealth use (b = 1.14, P <.001), and more positive attitudes towards eHealth (b = 0.47, P =.003). Conclusion: Our sample from the general population in China had a relatively low eHL and CLD knowledge level, but held a positive attitudes towards eHealth. A digital divide was noticed between the elderly, low socioeconomic population and other groups. Younger age, higher educational and income level, having digital access, more frequent eHealth use and more positive attitudes towards eHealth were significantly associated with higher eHL. Efforts at both individual and systematic levels should be made to improve eHL, and promote CLD knowledge and digital access, especially in disadvantaged populations. Moreover, there is a pressing need to develop and refine national and international standards for eHL. [ABSTRACT FROM AUTHOR]

Background: Delayed prescription is a strategy used in various countries to reduce antibiotic overuse and contend the effects of antibiotic resistance; however this practice is not yet used in Switzerland. The present qualitative study was thus conducted to investigate Swiss patients' attitudes towards the possible implementation of delayed prescription. Method: Five focus groups with the general population based on a fixed script of questions to elicit opinions on delayed prescription. Results: A total of 29 participants were involved (M = 39,76 years of age, SD = 15,91; 19 females). Participants naturally polarized into two distinct groups: one expressing attitudes against delayed prescription and the other in favor of such practice. One driver for their opposing stance was their pre-existing negative attitudes about the use of antibiotics. Other relevant themes contributing to the formation of one's opinion on delayed prescription included the participants' perceived convenience of this prescribing practice and their desired level of autonomy during and after a medical encounter. Another theme that emerged was the potential impact of these stances on the interpersonal relationship between doctors and their patients. Conclusion: The present study highlights the existence of several barriers and facilitators perceived by patients. Should delayed prescription be implemented in Switzerland, these results will inform policymakers about patients' attitudes towards the practice. Doctors may also benefit from this study as it identifies the limitations to consider when discussing treatment options with patients. [ABSTRACT FROM AUTHOR]

Purpose: Misophonia is a new disorder, currently defined as significant emotional and physiological distress when exposed to certain sounds. Although there is a growing body of literature on the characteristics of the disorder, the prevalence in the general population is still relatively unknown. This study therefore aims at determining the prevalence and symptom severity of misophonia in a large and representative general population sample in Germany. Methods: To examine the prevalence of misophonic sounds, misophonic reactions and misophonia severity, a cross-sectional population representative survey in Germany has been conducted. Participants (N = 2.522) were questioned retrospectively about misophonic symptoms using the Amsterdam Misophonie Scale – Revised (AMISOS-R). Results: Overall 33.3% reported to be sensitive to at least one specific misophonic sound. Within the total sample, subthreshold symptoms were reported by 21.3%, mild symptoms were reported by 9.9%, moderate to severe symptoms were reported by 2.1%, and severe to extreme symptoms were reported in 0.1% of participants. Conclusion: Based on the diverging presentations and prevalence rates of misophonic sounds, reactions and symptoms according to the severity, it seems worthwhile to conceptualize misophonia as a rather continuous spectrum disorder (subthreshold, mild, moderate to severe), still taking into account that an additional categorical diagnostic approach might be necessary to derive a diagnosis in clinical practice. [ABSTRACT FROM AUTHOR]

Background: As the population ages, the demand for social and health systems grows, especially due to chronic diseases and dependency. Informal caregivers, particularly women, face significant burdens including physical, emotional, and financial strain. Current caregiving assessment tools focus on those already in caregiving roles or health professionals, with no tools for the general population without prior caregiving experience. Purpose: This study aimed to develop and validate the Spanish COMCAPCARE scale, which assesses the skills and abilities necessary to care for dependent individuals, including those nearing the end of life, among individuals without prior caregiving experience. Methods: A scale validation study was conducted. A Delphi panel of 13 experts developed an 18-item scale, which was administered to 253 participants over the age of 18 who had not previously served as primary caregivers. Main measurements were psychometric analyses, including principal components analysis (PCA) and reliability testing using Cronbach's alpha and intraclass correlation coefficient. Correlation with a single-item self-assessment of caregiving competence was verified through Spearman's rho. Results: A total of 253 participants (73.9% women) with a mean age of 33 years (SD 13.7) participated. The scale identified 3 factors: financial and work situation (4 items), adaptability (8 items), and care and communication (6 items). The total scale demonstrated high reliability (α = 0.84) and significant correlations between the scale's total score and a single-item self-assessment of caregiving competence (r = 0.693, P <.001). Conclusions: The Spanish COMCAPCARE scale provides a reliable and valid tool for assessing caregiving competencies in the general population without caregiving experience. [ABSTRACT FROM AUTHOR]

Background: Single-nucleotide polymorphisms (SNPs) of the NF-E2-related factor 2 (NRF2) gene might be associated with several diseases. In the animal models, NRF2 has been reported to be associated with the age-related hearing loss (ARHL). However, the effect of NRF2 SNPs on ARHL in the general population has not been reported. Objectives: This study aimed to evaluate the effect of NRF2 SNP-617 on ARHL in the general Japanese population. Methods: This study included participants from the Iwaki Health Promotion Project. The genotypes of NRF2 SNP-617 were determined via whole-genome sequencing, and the hearing level of the CC homozygote + CA heterozygote carrier group was compared with that of the AA homozygote carrier group. Results: Among the 306 CC+CA and 31 AA group male subjects, 22 (7.2%) and six (19.4%), respectively, had hearing loss, with a significant difference. Multiple logistic regression analysis showed that the risk of hearing loss in the male subjects was significantly higher in the AA group than that in the CC+CA group (p =.031, odds ratio = 3.437, 95% confidence interval = 1.116–10.580). Conclusion: The genotypes of NRF2 SNP-617 AA carriers were significantly associated with the development of ARHL among the males aged 30–59 years. [ABSTRACT FROM AUTHOR]

Background: Studies on wet work and hand eczema (HE) frequently rely solely on self‐reports regarding wet work. Objectives: To assess the association between wet work and moderate‐to‐very‐severe HE, within the Dutch general population, by using a (sex‐specific) job exposure matrix (JEM). Methods: Within the Lifelines Cohort Study, participants with self‐reported moderate‐to‐very‐severe HE at worst in the past year were linked to data from the Danish (sex‐specific) wet work JEM, a tool that links occupations with wet work indices (including duration and probability of glove use, wet hands and total wet work for at least 2 and 4 h/working day). Results: In total, 56 978 (41.9%) participants were included. The multivariate binary logistic regression analyses showed significant associations between all facets of wet work and moderate‐to‐very‐severe HE. When using the sex‐specific JEM, significant associations were found in females, but not in males. Conclusions: This study is the first to use a wet work‐specific JEM in a general population sample, and found positive associations between wet work and HE. The sex‐specific findings should be interpreted with caution, due to limitations inherent in using a JEM, and should be further explored with observational studies, with a focus on duration, frequency, and exposure type. [ABSTRACT FROM AUTHOR]

Rationale: Research suggests that respiratory and cardiovascular drugs can ameliorate the rate of lung function decline. Objectives: To investigate the impact of respiratory and cardiovascular pharmacotherapy on lung function trajectories in the general population. Methods: Repeated spirometry was performed in the Rotterdam Study, a population-based cohort of adults aged ⩾45 years. Exposure to long-acting β2-agonists (LABAs), long-acting muscarinic antagonists, inhaled corticosteroids (ICS), cardioselective β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and statins was quantified from pharmacy records to account for therapy adherence. Propensity score matching and multinomial logistic regression were performed to model medication effects on lung function trajectories, which were previously identified on the basis of forced expiratory volume in 1 second and forced vital capacity patterns. Models were also stratified by genetic variation in each drug target. Results: Among 3,783 individuals, 2,974 (78.6%) were classified as normal lung function decliners, 432 (11.4%) as rapid decliners, and 377 (10.0%) as improvers. Exposure to LABA (odds ratio [OR], 1.09 [95% confidence interval (CI), 1.03–1.16] per 10% increase in exposure), ICS (OR, 1.08 [95% CI, 1.02–1.14]), and statins (OR, 1.04 [95% CI, 1.02–1.06]) significantly increased the odds of being an improver compared with a normal decliner. β1-Blocker use was associated with higher odds of being a rapid decliner (OR, 1.04 [95% CI, 1.00–1.09]), which was driven by incident users. Pharmacogenetic analysis suggests that the effects of LABA, ICS, and β1-blockers are dependent on genetic variation in their drug targets. Conclusions: Our study suggests that LABA, ICS, and statins may favorably modulate lung function trajectories in adults, whereas initiation of β1-blockers was associated with rapid lung function decline. [ABSTRACT FROM AUTHOR]

Anemia and chronic kidney disease (CKD), which worsen bidirectionally, are associated with mortality in older adults. This study aimed to examine the association between CKD and the type of anemia and its impact on mortality in the general population. Data from a nationwide database of 203,280 individuals who participated in the annual "Specific Health Check and Guidance in Japan" evaluation between 2008 and 2011 were used. Over a follow-up period of 4 years, 2,819 all-cause, 1,595 cancer-related, 523 cardiovascular, and 128 infectious disease deaths were recorded. Macrocytic anemia was detected in 2.3% of participants. The prevalence of normocytic and macrocytic anemia increased with advancing CKD stage. Multivariate Cox proportional hazards regression analysis revealed significant associations between macrocytic anemia and the all-cause, cancer, and cardiovascular mortality rates. Including the anemia type improved the prediction accuracy for all-cause deaths. The participants were divided into eight groups based on the anemia type and CKD. Macrocytic anemia of CKD had the highest hazard ratio for all-cause mortality in the general population. A correlation was observed between macrocytic anemia and CKD. Macrocytic anemia predicted mortality in the general population, suggesting that it could serve as an early indicator of premature death in high-risk individuals. [ABSTRACT FROM AUTHOR]

Regular physical activity can prevent various physical and mental illnesses or improve their prognosis. However, only about half of the German population meets the WHO recommendations for physical activity. The aim of this study was to identify factors that influence engagement in regular exercise and could help increase physical activity levels in the general population. To this end, we conducted a cross-sectional study using questionnaire instruments and self-designed items. The research cohort comprised a sample of online-acquired data from 1,119 mentally healthy individuals. Higher regular exercise was associated with higher both intrinsic and extrinsic motivation, self-efficacy, resilience, internal locus of control, and risk-taking behaviour, as well as higher scores in the personality traits conscientiousness, extraversion, and agreeableness. Higher regular exercise was also linked to lower external locus of control. Whether participants exercised was also related to external circumstances, such as their financial situation, whether family members frequently exercised during childhood or the availability of sports facilities. Furthermore, participants' preferred exercise environment was found to be different from reality. Despite expressing a preference for outdoor and group exercise, most participants reported exercising alone and indoors. People who exercised regularly during childhood stated higher levels of intrinsic as well as extrinsic motivation and resilience. Based on our findings, we suggest that additional low-threshold, low-cost opportunities for physical exercise should be provided in public spaces that lack exercise facilities, as well as in childcare settings with a particular focus on disadvantaged social groups. [ABSTRACT FROM AUTHOR]

Objective: This study examined the psychometric properties of a newly developed scale for measuring subjective cognitive reserve (SCR) across multiple domains, including nutrition, physical condition, sleep, cognition, willingness to learn, socialization, general health, and life plan. Method: The relationship between SCR scores and other established measures of cognitive reserve and subjective cognitive decline was also explored. A sample of 402 healthy participants aged 18 to 79 years took part in the study. Results: The SCR scale demonstrated strong psychometric properties, including internal consistency and construct validity, supporting the theoretical model of perceived cognitive reserve. Convergent validity was confirmed through a positive correlation between SCR scores and resilience (BRCS) as well as with other cognitive reserve measures, indicating consistency in evaluating cognitive reserve across various instruments. Furthermore, discriminant validity was demonstrated by a significant negative correlation between SCR scores and subjective cognitive decline, suggesting that individuals with higher cognitive reserve experience lower levels of perceived cognitive decline. No significant relationship was found between SCR scores and chronological age, further supporting the construct validity of the scale by showing that cognitive reserve is influenced by dynamic factors beyond age. Conslusion: The findings highlight the potential of the SCR scale as a reliable and valid tool for assessing cognitive reserve and its protective role in cognitive health and well-being over time. [ABSTRACT FROM AUTHOR]

When using a differential evolution algorithm to solve the joint flood optimization scheduling problem of cascade reservoirs, a greedy random optimization strategy is prone to premature convergence. Therefore, a new, improved Elite Conservative Differential Evolution Algorithm (ECDE) was proposed in this study. This algorithm divides a population into elite and general populations. The elite population does not undergo differential mutation, whereas the general population uses an adaptive differential mutation strategy based on successful historical information to participate in differential mutation. This elite conservative strategy effectively improves the diversity of the population evolution process and enhances convergence accuracy and stability. In a numerical experiment involving 10 test functions, the proposed ECDE performed the best overall (seven functions had the best stable convergence solution, while the remaining three performed the best), while in the single-objective flood control optimization scheduling problem of cascade reservoirs in the middle reaches of the Gan River, some algorithms could not even stably converge to feasible solutions (taking the 1973 inflow as an example, the peak shaving rate of the ECDE calculation results was 3.4%, 13.72%, and 11.73% higher than those of SHADE, SaDE, and GA, respectively). The proposed ECDE algorithm outperformed the SHADE, SaDE, GA, PSO, and ABC algorithms in terms of both convergence accuracy and stability. Finally, ECDE was used to analyze the multi-objective flood control scheduling problem of cascade reservoirs in the middle reaches of the Gan River, and it was found that the weight setting in multi-objective optimization should follow an upstream priority program or equilibrium programs. Adopting a downstream priority program results in poor upstream flood control performance. The above analysis fully verifies the superiority of the proposed algorithm, which can be used to solve and analyze the joint optimization scheduling problem of cascade reservoirs. [ABSTRACT FROM AUTHOR]

Background: The triglyceride-glucose index (TyG index), calculated as the logarithmic product of fasting triglyceride and glucose concentrations, is recognized as a simple marker of insulin resistance. However, the association between the TyG index and future decline of renal function remains unclear in the general population. Objective: To investigate whether the TyG index was associated with future decline of renal function in the general population who had not progressed to chronic kidney disease stage G2. Design: Retrospective longitudinal observational cohort study. Participants: Individuals who received a population-based health checkup at JA Ehime Kouseiren Checkup Center from 2010 to 2019 (n = 134,007). Individuals without data of baseline fasting triglyceride or glucose levels, or baseline and follow-up data of estimated glomerular filtration rate (eGFR), or those with baseline eGFR < 60 mL/min/1.73 m2 were excluded. Main Measures: Future renal function decline, defined as a ≥ 25% decrease in eGFR from baseline. Key Results: Of 10,758 participants, 8,076 were classified into the low TyG index group (TyG index < 8.76, 1st to 3rd quartiles) and 2,682 into the high TyG index group (TyG index ≥ 8.76, 4th quartile). The mean follow-up period was 37.8 ± 23.6 months. The incidence rates of renal function decline were 0.31 and 0.69 per 100 person-years in the low and high TyG index groups, respectively. In multivariate Cox proportional hazard models, high TyG index was significantly associated with future renal function decline (hazard ratio 2.25, 95% CI 1.40–3.60). This association was consistent across subgroups stratified by age, sex, body mass index, baseline eGFR, and diagnosed hypertension, diabetes, or dyslipidemia. Conclusion: In the general population, high TyG index was associated with future renal function decline. The TyG index may be useful in identifying individuals at high risk for future renal function decline in the setting of health checkups. [ABSTRACT FROM AUTHOR]

Aim: The COVID‐19 pandemic has had negative physical and psychological impacts worldwide. However, there has been a lack of real‐world evidence concerning the predictors of severe psychological distress (SPD) among the general population in Japan during the COVID‐19 pandemic. The aim of this study was to examine predictors of SPD during the COVID‐19 pandemic. Methods: We investigated the predictors of new‐onset SPD in the general Japanese population using data from a large‐scale internet‐based cohort study. Results: We included 16 489 study participants (age range = 16–81, mean age = 52.7, percentage of male = 50%) in the analysis. Over the course of 1 year from baseline, the estimated proportion of participants who experienced SPD was 5.2% with inverse probability weighting. The predictors of SPD included younger age, being never married, being unemployed, having a higher education background, scoring higher on the Fear of Coronavirus‐19 Scale, experiencing more adverse childhood experiences, reporting poorer subjective health status, and COVID‐19 with oxygen therapy. Our internet‐based survey of the Japanese population may have selection bias, limiting the generalizability to other countries and cultures. Conclusion: This study revealed that being afflicted with COVID‐19 requiring oxygen therapy is the most significant predictor of SPD. In addition, we found that vulnerability to social isolation, such as never being unmarried, anxiety toward COVID‐19, and susceptibility to stress, are predictors of the emergence of SPD. Therefore, the implementation of online support systems and ensuring access to accurate information may protect against SPD during the COVID‐19 pandemic in Japan. [ABSTRACT FROM AUTHOR]

Background and Aims: Although the evidence is uncertain, existing estimates for hepatitis C virus (HCV) in sub‐Saharan Africa (SSA) indicate a high burden. We estimated HCV seroprevalence and viraemic prevalence among the general population in SSA. Methods: We searched Medline, Embase, Web of Science, APA PsycINFO, and World Health Organization Africa Index Medicus for community‐based studies. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool, and heterogeneity using the index of heterogeneity (I2). Two approaches were deployed. First, we used random‐effects meta‐analysis to pool prevalence. Second, to derive representative estimates, we weighted each country's HCV seroprevalence using 2021 United Nations country population sizes. Results: We synthesized 130 studies. Overall, SSA HCV seroprevalence from the random‐effects model was 4.17% (95% confidence interval [CI]: 3.71–4.66, I2 = 99.30%). There were no differences between males (4.31%) and females (4.03%). Seroprevalence was 2.25%, 3.31%, and 16.23% for ages ≤20, 21–64, and ≥65 years, respectively, and was higher in rural (6.63%) versus urban (2.93%). There was indication of decrement overtime from 5.74% to 4.35% to 3.03% in the years 1984–2000, 2001–2014, and 2015–2023, respectively. The weighted overall SSA HCV seroprevalence was estimated to be 2.30% (95% CI: 1.59–3.00) with regional variation: Africa‐Southern (.79%), Africa‐Central (1.47%), Africa‐Eastern (2.71%), and Africa‐Western (2.88%). HCV viremia among HCV seropositives was 54.77% (95% CI: 47.80–61.66). Conclusions: HCV seroprevalence in SSA remains high. Populations aged ≥65 years, rural communities, Africa‐Western, and some countries in Africa‐Central and Africa‐Eastern appear disproportionately affected. These results underline the need for governmental commitment to achieve the 2030 global HCV elimination targets. [ABSTRACT FROM AUTHOR]

Aim: The global prevalence of overweight/obesity has been rising, and this trend is apparent in US and European incident end‐stage kidney disease (ESKD) populations. We aimed to examine temporal trends in the prevalence of overweight/obesity and underweight among adult incident ESKD patients in Japan by year of dialysis initiation between 2006 and 2019 in comparison with those observed in the Japanese adult population during the same period. Methods: Using data from the Japanese Society of Dialysis Therapy Renal Data Registry and the National Health and Nutrition Survey, the sex‐specific prevalence of overweight/obesity and that of underweight (BMI ≥ 25 kg/m2 and <18.5 kg/m2, respectively) were calculated, adjusted for age according to the 2019 Population Census via the direct method. Average annual percentage changes (AAPCs) and corresponding 95% confidence intervals (CIs) were calculated to examine trends. Results: From 2006 to 2019, the age‐adjusted prevalence of overweight/obesity in the incident ESKD population increased for males (AAPC 3.36 [95% CI, 2.70 to 4.09]) and females (AAPC 2.86 [95% CI, 1.65 to 4.19]). The age‐adjusted prevalence of overweight/obesity in the general population increased for males (AAPC 0.87 [95% CI, 0.26 to 1.42]) but not for females (AAPC 0.01 [95% CI, −0.55 to 0.57]). The age‐adjusted prevalence of underweight in the incident ESKD population significantly decreased but was higher than that in the general population for both sexes. Conclusion: An increasing trend of overweight/obesity was observed in the incident ESKD population in Japan. There is a pressing need to address both underweight and overweight/obesity in the incident ESKD population. [ABSTRACT FROM AUTHOR]

Few national studies have examined the community prevalence of ICD-11 posttraumatic stress disorder (PTSD) and Complex PTSD (cPTSD) symptoms, and their relationship with functioning. A nationally representative Danish sample (n = 689) provided data on trauma exposure. Participants who had experienced at least one traumatic event (n = 470) further provided self-reported data on ICD-11 PTSD and cPTSD, personality, and psychosocial functioning. Mediation analyses and linear regression models investigated the impact of impaired personality functioning, and the severity of PTSD/cPTSD on psychosocial functioning. Despite two-thirds reporting trauma exposure, PTSD and cPTSD prevalence was low (4.7% and 1.9%). Higher severity correlated with lower psychosocial functioning. The influence of impaired personality functioning post-trauma was limited. Replication of findings in clinical samples is warranted. [ABSTRACT FROM AUTHOR]

Purpose This umbrella review aimed to review and synthesise the findings of published systematic reviews and meta-analyses analysing the effects of cupping therapy programs on musculoskeletal pain in athletes and the general population. Methods A search in PubMed, Web of Science, Scopus, MEDLINE, Cochrane Central, CINAHL, EMBASE, and PEDro was performed. The methodological quality of the included systematic reviews was evaluated using the 16 domains of the AMSTAR2 checklist. Based on the performance in these 16 domains of different weights, an overall rating was generated, and the quality was determined to be critically low (1–4), low (5–8), moderate (9–12), or high (13–16). The overall confidence in the results of the reviews was low. Among the critical items, all reviews failed to present a list of excluded trials, four reviews did not consider the risk of bias when presenting or discussing their results, three reviews did not use adequate methods for the meta-analysis, the impact of publication bias was not investigated in three reviews, and the absence of a planned protocol to guide the review was noted in two reviews. Most reviews included trials of low quality (i.e., high risk of bias). Results A total of 301 studies involving 27,960 participants were analysed in 21 systematic reviews. The review confirmed that cupping therapy is more effective than passive interventions such as heat therapy, usual care, conventional medications, and no treatment. However, its effectiveness is similar to acupuncture. There is not enough evidence to recommend cupping therapy for athletes, and there are associated risks such as hematoma, pain at the application site, increased pain, tingling sensations, and dizziness. Conclusions Considering the standards, this umbrella review showed that most systematic reviews and meta-analyses using cupping therapy for musculoskeletal pain present low methodological quality. Most of the systematic reviews in this umbrella revealed that cupping therapy is ineffective in improving musculoskeletal pain in the athletic and general populations.

Abstract Background Due to the overlapping endemic regions and the high burden of both infections, coinfection with Plasmodium falciparum and Schistosoma mansoni poses distinct public health concerns that require coordinated, multifaceted interventions. There are epidemiological studies on the coinfection of these two parasites in Ethiopia, and the results differ and are inconsistent from one region to another. Thus, the goal of this systematic review and meta-analysis was to ascertain Ethiopia’s pooled prevalence of P. falciparum and S. mansoni coinfection. Methods The preferred reporting item review and meta-analysis guidelines were followed in this study. PubMed, Google Scholar, Research4Life, Scopus, African-Wider, and EMBASE were the primary search databases. The final analysis included six studies in total. Stata software version 11 was used for analysis after Microsoft Excel was used to extract the data. The critical appraisal tool developed by the Joanna Briggs Institute was used to evaluate the methodological quality of the studies. Publication bias was checked via a funnel plot, Begg’s test, and Egger’s test. The pooled prevalence of P. falciparum and S. mansoni coinfection was estimated via a random effect model via the Der Simonian–Laird method. The heterogeneity of the studies was evaluated via I2 statistical tests. Results The pooled prevalence of P. falciparum and S. mansoni coinfections in Ethiopia was 10.496% (95% CI 6.134, 14.859). Subgroup analysis of geopolitical regions revealed that the highest and lowest pooled prevalence rates of coinfection were 11.808% (95% CI 0.304, 23.312) and 8.600% (95% CI 5.755, 11.445), respectively, in the Amhara and Benishangul Gumuz regions. Conclusions This study highlights the substantial prevalence of P. falciparum and S. mansoni coinfection in Ethiopia’s general population, with considerable geographical variation. Targeted and intensive public health interventions are necessary because it has the highest incidence in the Amhara region, and ongoing efforts are needed to address the relatively lower but still considerable prevalence in the Benishangul Gumuz region. These results direct future research, integrated control strategy design, and resource allocation to successfully manage Ethiopia’s combined burden of malaria and schistosomiasis.

Purpose: This 10-year longitudinal cohort study aimed to investigate the annual rate of development of radiographic knee osteoarthritis (drKOA) and its predictive symptoms in the general Japanese population. Methods: A total of 263 volunteers (154 women) from the Iwaki Health Promotion Project were followed up over 10 years. Standing anteroposterior knee radiographs were obtained and the Kellgren–Lawrence grade was evaluated. drKOA was defined as a change from grade 0 or 1 to ≥2 over 10 years. Knee symptoms were evaluated using the Knee injury and Osteoarthritis Outcome Score at baseline. Logistic regression analyses were performed to identify symptoms related to drKOA, and a predictive formula was created based on the associated symptoms. Results: The overall incidence of drKOA was 52.9% (annual rate, 4.34%). Regression analysis revealed that predictive symptoms for drKOA were stiffness [p ​= ​0.033; odds ratio (OR) ​= ​1.89], frequent pain (p ​= ​0.024; OR ​= ​1.38), difficulty in ascending stairs, jumping, twisting, and kneeling (p ​= ​0.009–0.046; OR ​= ​1.71–2.78), and poor knee-related quality of life (p ​

• Specific urinary PAH metabolites were positively associated with SUA and hyperuricemia in general population. • CRP mediate the association of urinary hydroxyphenanthrene with SUA and hyperuricemia. • Further researches are suggested to validate these findings and elucidate the potential mechanisms. The associations of polycyclic aromatic hydrocarbon (PAH) exposure with serum uric acid (SUA) or hyperuricemia have been rarely assessed. We aimed to investigate the relationships between urinary PAH metabolites and SUA or hyperuricemia among US adults and to explore the mediating role of systemic inflammation in the associations. A total of 10,307 US adults were conducted to assess the associations of seven urinary hydroxy‑PAH with SUA and hyperuricemia and evaluate the role of C-reactive protein (CRP), a biomarker of systemic inflammation, in such associations. Results showed that each 1-unit increase in ln-transformed 2-hydroxynaphthalene (2-OHNa), 1-hydroxyphenanthrene (1-OHPh), 2&3-hydroxyphenanthrene (2&3-OHPh) and total hydroxyphenanthrene (ΣOHPh) was associated with a 1.68 (95% confidence interval (CI): 0.19 to 3.17), 2.46 (0.78 to 4.13), 3.34 (1.59 to 5.09), and 2.99 (1.23 to 4.75) µmol/L increase in SUA, and a 8% (odds ratio (OR): 1.08, 1.02 to 1.15), 9% (OR: 1.09, 1.02 to 1.18), 13% (OR: 1.13, 1.05 to 1.22), and 12% (OR: 1.12, 95% CI: 1.03, 1.21) increase in hyperuricemia, respectively. Co-exposure of seven PAHs was positively associated with SUA and hyperuricemia, with 2&3-OHPh showing the highest weight (components weights: 0.83 and 0.78, respectively). The CRP mediated 11.47% and 10.44% of the associations of ΣOHPh and 2&3-OHPh with SUA and mediated 8.60% and 8.62% in associations of ΣOHPh and 2&3-OHPh with hyperuricemia, respectively. In conclusion, internal levels of PAH metabolites were associated with elevated SUA levels and the increased risk of hyperuricemia among US adults, and CRP played a mediating role in the associations. [Display omitted] [ABSTRACT FROM AUTHOR]

Internet Gaming Disorder (IGD) has emerged as a significant public health concern, yet not enough is known about its prevalence among the general population as well as its relationship to well-being, mental health, specifically depression and anxiety, and gaming genres. This study aimed to address these questions. The research was conducted on a representative sample of the Croatian general population including 4,994 participants, aged between 15 and 64 years (M = 40.75, SD = 15.49). The Ten-Item Internet Gaming Disorder Test, Mental Health Inventory-5, Personal Well-being Index, Gaming time and Game Genres Preferences were used. The prevalence of the IGD in the general population of Croatia, aged 15-64 years, was estimated at 0.48%, 95% CI [0.30%, 1%], and among video game players (N = 1,239) at 1.63%, 95% CI [1.11%, 3%]. The highest prevalence was observed among young males. IGD showed the strongest relationship with depression, and weaker relationships with anxiety and well-being. Among the individual criteria, negative consequences for significant relationships, deception and escape had the strongest, while tolerance, loss of control and withdrawal had the weakest relationship to depression, anxiety and wellbeing, in a relative sense. Sports games and casual games players had lower risk for IGD, while other genres did not differ in their risk for IGD. Online and offline games did not differ in their risk for IGD. This study has shown that IGD has a relatively low prevalence among the general population and video game players, and that not all IGD criteria are equally relevant. Future longitudinal studies and studies on clinical samples are needed. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer (CRC) has surged to prominence as the leading cancer affecting men and the second most common affecting women in Saudi Arabia. The need for preventative screening is underscored by the rising prevalence of precancerous polyps, early-stage colorectal cancer, and the fact that these conditions often manifest without symptoms. Methods: This study utilized a cross-sectional descriptive design and employed data from a sample of 425 residents of Qassim region in Saudi Arabia. The participants guaranteed their confidentiality when completing self-administered online questionnaires. Results: Nearly half, 209 (49.2%), of the participants indicated that there were increasing incidences of colon cancer in Saudi Arabia. A considerable number [122 (28.7%)] of respondents believed that family history was the risk factor for colorectal cancer. A total of 203 (47.8%) knew that CRC could develop without symptoms. Common symptoms of CRC were cited as bleeding per rectum 300 (70.6%) and abdominal pain 259 (60.9%). The majority, 384 (90.4%), of the respondents believed that CRC could be prevented and cured if detected early, 415 (97.6%). The results noted that more females knew that there were increasing incidences of CRC in KSA (P = 0.03). Older participants were more likely to understand the function of the colon and rectum (P < 0.001**), the risk factors (P < 0.001**), and the symptoms of CRC (P < 0.001**), as well as their willingness to choose colonoscopy to conduct colon follow-up screening even without symptoms (P < 0.001**). Married participants had a higher likelihood of knowing the ranking of CRC among the most common tumors in both sexes in KSA (P = 0.027*). Participants with a higher education level were more likely to know the ranking of CRC among the common tumors in the KSA (P = 0.004**), the functions of colon and rectum (0.003**), and the symptoms of CRC (P < 0.001**). Conclusion: The study revealed considerably below-average knowledge about the general public’s screening for CRC in the Qassim region of Saudi Arabia. Although a substantial proportion of participants demonstrated knowledge about the risk factors, symptoms, and prevention of CRC, there is limited knowledge about screening programs in the region. This underscores the need for public awareness campaigns and concerted efforts to eliminate the obstacles preventing more people from getting screened with colonoscopies for early detection and prevention of CRC.

Abstract Data from clinical and population studies demonstrating the value of a highly sensitive troponin I test in predicting cardiovascular disease in the general population and patients without signs of acute coronary syndrome/acute myocardial infarction are presented. New indications for using a highly sensitive troponin I test are discussed.

The Y chromosome contains a set of genes with testis-specific expression that are responsible for the development of testes and spermatogenesis, and it is the most important target in the search for genetic causes of male infertility. Most of these genes are located in the “azoospermia factor” AZF locus (regions AZFa, AZFb, and AZFc) on the long arm of the Y chromosome. Microdeletions of the Y chromosome, leading to the removal of the entire AZF locus as well as one or more regions (complete deletions), are one of the leading causes of spermatogenesis impairment and infertility. However, the role of partial AZFc deletions (gr/gr, b2/b3, b1/b3) in spermatogenesis failure is unclear, and their impact on spermatogenesis varies between populations. The aim of the present study was to assess the frequency of various types of AZFc microdeletions and to search for associations with spermatogenesis parameters in men of Slavic ethnicity from the general Russian population (n = 700, average age 25.8 years). To identify AZF microdeletions, the presence/ absence of 15 STS markers was analyzed using multiplex real-time polymerase chain reaction. Age, weight, height, and the volume, concentration, total count, proportion of motile and morphologically normal spermatozoa in the ejaculate were recorded for all participants. In the studied sample, 19.9 % (139/700) of men were found to have AZFc microdeletions, of which 16.7 % (117/700) were carriers of a partial b2/b3 deletion, 3.0 % (21/700) had a partial gr/gr deletion, and 0.14 % (1/700) had a complete b2/b4 deletion. Neither AZFa nor AZFb microdeletions nor other types of AZF deletions were detected. The overall frequency of all types of AZFc deletions, as well as each type of partial microdeletion, b2/b3 and gr/gr, did not differ in the groups of azoospermia, severe oligozoospermia (≤5.0 mill/ml), oligozoospermia (5.0

Abstract Background Parkinson’s disease (PD) is a progressive degenerative neurological disorder that negatively affects the quality of life of affected individuals as well as their care givers. There is limited information in both epidemiological data and awareness level on PD in the Middle East. Considering the increasing prevalence of PD, the lack of awareness and negative attitudes toward PD pose a barrier in the provision of appropriate care for individuals with PD. Objective This study aimed to validate scales to explore the knowledge and attitude towards PD among the general population in Lebanon and identify the associated factors related to the knowledge and attitude assessment. This study’s results would guide awareness strategies in the country including public health strategies, campaigns and education sessions for the general population as well as targeted people. Methodology An online cross-sectional study was conducted between July and September 2023 in Lebanon. Snowball sampling was used to recruit 400 Lebanese adults living in Lebanon. The validity and reliability of the knowledge and attitude scales were assessed, followed by a thorough statistical analysis to explore the factors associated with these scales. Results The knowledge and attitude scales generated by this study were valid and reliable; Cronbach’s alpha values for knowledge and attitude scales were 0.697 and 0.901, respectively. Using these scales, 91.8% demonstrated inappropriate knowledge and 93% showed positive attitude towards PD. Higher knowledge scores were significantly associated with female gender (Beta = 1.130), being a healthcare professional (Beta = 2.514), having heard about PD (Beta = 5.338), obtaining the source of information from electronic databases (Beta = 1.283), from pharmacist or physician (Beta = 1.212), from personal readings (Beta = 2.386), and having PD or knowing someone with PD; a friend or a family member (Beta = 1.179). However, being illiterate or having primary or secondary education (Beta = -0.874), having a higher household crowding index (Beta = -1.890), not knowing if contents from sources provide negative images about PD (Beta = − 1.908) and preferring not to say to which social class they belong (Beta = − 1.602) were significantly associated with lower knowledge scores. Believing that contents from sources provide negative images about PD (Beta = 8.246) was significantly associated with a higher attitude score, i.e., a more negative attitude towards PD. Conclusion This study showed low levels of knowledge and an overall positive attitude towards PD in Lebanon. Factors associated with higher knowledge and attitude scores, including gender, education level, profession, knowing someone with the disease, household crowding index, social class, source of information and contents of such sources, reflect the need to consider those when implementing targeted corrective actions. Future studies can focus on educational campaigns to improve public awareness, reduce misconceptions and limit barriers to the early diagnosis and provision of optimal care to the affected patients.

Abstract Background Mental health apps (MHA) have gained popularity in recent years. Most freely available apps are of low quality and lack evidence for effectiveness. Yet, download rates indicate high usage. MHA are potentially beneficial for individuals with no/low symptom severity as prevention, or as an option to reach underserviced populations. However, currently very little is known about the characteristics of MHA users in the general population, about the kind of MHA used, or the motivation behind MHA usage. Methods We collected survey-data from N = 1,247 individuals from the general population to investigate MHA usage. Results Descriptive statistics revealed that 41% had used MHA in the past 12 months; prescription app-use however was low (1.5% of MHA users). Mindfulness, moodtracking, and relaxation were the most popular categories of MHA. Perceived helpfulness, fun, and availability were the top reasons for MHA usage. Non-users reported distrust, lack of perceived need, and data security concerns as usage barriers. MHA users and non-users did not differ regarding sociodemographic variables. Multiple regression analyses revealed that sub-threshold symptoms of psychological disorders as well as higher levels of anxiety and stress were linked to higher probability of MHA usage. Higher levels of depression were associated with lower likelihood of MHA usage in general, but increased likelihood of usage of self-help apps specifically for depression. Conclusions It follows that MHA use is common in the general population independent of sociodemographic characteristics. MHA can reach people who might benefit, but more awareness and better structure of the market is needed to reduce distrust, increase usage of high-quality MHA, and improve the fit between app and user.

Abstract Background On October 7th, 2023, Hamas launched a surprise attack on Israel, triggering a conflict with Israel in the Gaza Strip. This ongoing war, now six months old, has also seen threats from Hezbollah in Lebanon, as well as from Yemen and Iran. The precarious security situation along Israel’s southern and northern borders led to extensive evacuations, with residents relocating within Israel under uncertain conditions concerning their return and property safety. This study compares resilience (societal, SR; community, CR; and individual, IR), hope, morale, distress symptoms (anxiety and depression symptoms), and perceived danger between general Hebrew-speaking adults and evacuee adults a few months post-conflict initiation. Methods Data was collected using structured self-reported questionnaires focusing on resilience and coping strategies, administered through two online panel companies. The general population data was collected from January 14–21, 2024 (N = 1,360), and the evacuees’ data from March 1–9, 2024 (N = 372; 133 from the north, 239 from the south). Results Evacuees reported lower SR and CR, hope, and morale, and higher distress symptoms and perceived danger compared to the general population. No differences in IR were found. Regression analyses identified different primary predictors of SR for each group: hope for the general population and governmental support for evacuees. Additionally, IR significantly predicted outcomes only among evacuees, whereas age, religiosity, and education were significant predictors solely in the general population. One notable similarity emerged: CR served as the second most influential predictor in both samples. Conclusions The entire population of Israel is affected by the ongoing war, yet evacuees endure a disproportionately severe impact, with potential for increased harm as the conflict persists. The adjustment to a new wartime emergency routine is more complex for evacuees than for the general population. It is crucial for policy and decision-makers to address the distinct differences between evacuees and the general populace to effectively meet their specific needs. Yet, it should be acknowledged that the evacuees represent a heterogenic group, necessitating a detailed subdivision into subgroups to accurately assess and address their unique challenges.

Introduction: Rabies, a deadly viral disease transmitted through animal bites, poses a significant public health challenge in many regions, including Puducherry. Effective prevention and control rely heavily on community awareness and perception. Understanding how the general population perceives rabies risk and prevention strategies is crucial for developing targeted public health interventions. Objectives: To describe the sociodemographic profile and to assess community perceptions of rabies prevention and control among the general population in Puducherry. Methods: A community-based cross-sectional study, conducted in the rural and urban Puducherry region from October 2023 to December 2023. A total of 200 individuals were chosen from rural and urban Puducherry regions using a systematic random sampling technique. Individuals over 18 years of age residing in both rural and urban areas of Puducherry were included in the study. Semi-structured questionnaire was used to collect the data and entered in MS Excel 2019. Chi-square test was applied to test the difference in knowledge between urban and rural. Results: The majority of the study participants belonged to the age group of 18-29 years (55%), 152 were males and 48 were females. Most of the participants (99%) heard about Rabies and their source of knowledge about Rabies was from Doctors (40.5%), Newspapers & Media (39.5%), and Friends (19.0%). Approximately 82.5% of participants were aware of how rabies is transmitted, while 78.5% understood the signs of the disease. Conclusion: Education plays a significant role in the awareness of rabies as most participants were educated at least up to the primary level in the current study. According to our findings, clear gaps exist in rural people's understanding and attitudes toward rabies prevention and control.