Tag: pubmed

J Voice. 2026 Mar 26:S0892-1997(26)00118-9. doi: 10.1016/j.jvoice.2026.03.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate a multiparametric acoustic model, based on fuzzy logic, to predict the degree of breathiness in dysphonic and nondysphonic voices of Brazilian Portuguese speakers.

METHOD: This is a cross-sectional, retrospective study that included vocal samples of the sustained vowel [a] and connected speech from 300 participants (235 women, 65 men; mean age 36.47 ± 12.07 years), including both dysphonic and nondysphonic individuals. Five speech-language pathologists specializing in voice performed auditory-perceptual judgment of grade of breathiness (GB) on a visual analog scale from 0 to 100 points, using the VoxMore APJ plug-in. Based on these judgments, a Fuzzy Visual Analog Scale (Fuzzy VAS) was developed, which integrated the experts’ scores, weighted by their reliability (intraclass correlation coefficient), and modeled perceptual uncertainty using fuzzy logic and a k-means algorithm. Subsequently, 47 acoustic measures were extracted from the vocal samples. A multiple linear regression model was constructed using stepwise variable selection, with the Fuzzy VAS as the dependent variable, to identify the acoustic predictors of GB. Model validation included the evaluation of statistical assumptions (normality, homoscedasticity, independence, and multicollinearity) and the calculation of the Mean Absolute Error (MAE) relative to Fuzzy VAS.

RESULTS: The developed acoustic model (Grade of Breathiness Index-GBI) demonstrated high predictive ability, explaining 80.49% of the variability in perceived GB. Four acoustic measures were identified as significant predictors: median smoothed cepstral peak prominence, jitterddp, GNE_{3000 Hz,} and Hfno_{6000 Hz}. The model presented an MAE of 8.04 points (on a scale of 0-100) between GBI predictions and Fuzzy VAS scores.

CONCLUSIONS: The GBI demonstrates robust predictive ability and high adherence to perceptual judgments of breathiness, with an adjusted R² of 80.49% and an MAE of 8.04 points. This index emerges as a reliable and objective tool for quantifying GB. It provides valuable insights into the underlying vocal physiology, aids in longitudinal monitoring, and serves as a teaching resource for training new clinicians in vocal assessment.

PMID:41896050 | DOI:10.1016/j.jvoice.2026.03.001

Am J Geriatr Psychiatry. 2026 Mar 6:S1064-7481(26)00095-3. doi: 10.1016/j.jagp.2026.02.015. Online ahead of print.

ABSTRACT

OBJECTIVE: Affective neuropsychiatric symptoms (NPS)-depression, anxiety, and apathy-are frequent in older adults. Understanding which clinical characteristics might be associated with which affective NPS may guide future treatment and prevention strategies.

DESIGN: The National Alzheimer’s Coordinating Center dataset, a large case series of more than 170,000 clinical visits.

SETTING: Multiple Alzheimer’s Disease Research Centers throughout the United States.

PARTICIPANTS: Adults 60 years and older with and without cognitive impairment.

MEASUREMENTS: The authors associated the odds of depression, anxiety, and apathy with clinical variables, including common and cardiovascular comorbidities, vital signs, medication classes, APOE status, race and ethnicity, and marital status across three cognitive groups: Cognitively Normal, Mild Cognitive Impairment, and Dementia.

RESULTS: Hearing loss and sleep abnormalities were robustly associated with all affective NPS at all cognitive stages. Cardiovascular diseases were not consistently associated with depression but were associated with greater apathy odds in cognitively normal participants. Nearly all odds ratios for all three affective NPS tended to attenuate to 1 as cognition worsened, potentially suggesting that neurodegeneration may drive affective NPS beyond other risk factors. Other associations with angina, osteoarthritis, blood pressure, heart rate, tobacco use, and race were noted.

CONCLUSIONS: Clinical associations often vary by NPS metric choice. Hearing and sleep deficits may be important therapeutic targets to increase quality of life by reducing affective NPS in older adults. Further research into the specific biological mechanisms whereby neurodegeneration can cause affective NPS presentation may be warranted, separate from other risk factors for affective NPS in older adults.

PMID:41896046 | DOI:10.1016/j.jagp.2026.02.015

Clin Lung Cancer. 2026 Mar 9:S1525-7304(26)00035-5. doi: 10.1016/j.cllc.2026.03.001. Online ahead of print.

ABSTRACT

BACKGROUND: Lung cancer survival rates are higher among women than men across many populations globally. We examined real-world data on prognostic factors for lung cancer in Australia and assessed their contribution to the sex survival disparity.

METHODS: This was a retrospective analysis of data from the Victorian Lung Cancer Registry. People diagnosed with lung cancer during 2016 to 2022 were included with follow-up to August 2023. One-year overall survival was estimated by sex and stratified by 4 domain prognostic factors. The contribution of 4 domains of factors (patients’ characteristics, smoking history, tumor-related and treatment-related factors) to sex-based survival differences (alone and jointly) was assessed with multiple Cox proportional hazard regressions.

RESULTS: A total of 5313 women and 6540 men were diagnosed with lung cancer, with median 1-year survival 76.5% and 69.4%, respectively. The unadjusted hazard of all-cause death was significantly higher for men than women 1-year post-diagnosis (HR = 1.38, 99% CI, 1.28-1.49, P < .0001). The survival disparity remained statistically significant when each domain of prognostic factors was evaluated individually. Multivariable analysis revealed that treatment-related factors explained about 77% of the overall survival difference, followed by smoking history and tumor-related factors (explaining 26% and 24% respectively). After adjusting for all 4 domains of prognostic factors together, the excess risk of death among men was reduced by about 82% (HR = 1.05, 99% CI, 1.00-1.11, P = .02).

CONCLUSION: The sex-related lung cancer survival disparity in Australia is largely accounted for by treatment disparities, indicating an opportunity to explore sex differences in treatment preferences, options, and access.

PMID:41896045 | DOI:10.1016/j.cllc.2026.03.001

J Laparoendosc Adv Surg Tech A. 2026 Mar 27:10926429261435976. doi: 10.1177/10926429261435976. Online ahead of print.

ABSTRACT

BACKGROUND: Rouviere’s sulcus (RS) is widely regarded as an important extra biliary landmark during laparoscopic cholecystectomy (LC), yet its visibility, anatomical variability, and true impact on operative safety remain debated. This study evaluates RS morphology, its incidence of absence, and its influence on operative metrics and complications in a 2-year cohort.

METHODS: A longitudinal observational study was conducted at a single public hospital in the United Arab Emirates, including all elective and emergency LC cases from 2024 to 2025. Electronic medical records and operative videos were reviewed to document RS type, presence or absence, critical view (CV) dissection time, total operative time, and perioperative complications. Statistical analyses included Kruskal-Wallis, Mann-Whitney U, χ²/Fisher’s exact tests, and Spearman correlation.

RESULTS: Among 130 LC cases, RS was identifiable in 85.4%, with 14.6% absence (95% CI: 9.56-21.70). RS morphology (open, slit, scar, and closed) showed no significant effect on CV dissection or operative time (P > .08). However, RS absence was associated with a significantly longer CV dissection time (median 20 versus 18 minutes; P = .030), while the increase in operative time did not reach significance. Demographic factors and comorbidities showed no association with RS type or visibility. Complications were infrequent (4.6%) and unrelated to RS presence. CV dissection time strongly correlated with total operative duration (ρ = 0.834).

CONCLUSIONS: RS was present in most patients, and its absence modestly prolonged CT dissection but did not significantly affect overall operative time or complication rates. While RS can aid orientation, it should complement rather than replace established safety strategies such as the Critical View of Safety and bailout techniques. Multicenter studies are warranted to further clarify the clinical utility of RS morphology.

PMID:41896023 | DOI:10.1177/10926429261435976

Asia Pac J Clin Nutr. 2026 Apr;35(2):360-368. doi: 10.6133/apjcn.202604_35(2).0014.

ABSTRACT

BACKGROUND AND OBJECTIVES: This study aimed to investigate risk factors of malnutrition and the relationship between malnutrition and other geriatric syndromes in patients presenting to a geriatric outpatient clinic in Turkey.

METHODS AND STUDY DESIGN: The data of patients aged ≥65 years seen in a university geriatric outpatient clinic between January 2024 and January 2025 were retrospectively analyzed. Demographic, clinical, and laboratory data and the results of a comprehensive geriatric assessment were noted. The presence of malnutrition in patients was defined according to the Mini Nutritional Assessment-Long Form.

RESULTS: A total of 723 patients (55.9% women) with a median age of 70 years (range, 65-90 years) were included. The prevalence of malnutrition was 14.5% (95% CI 12.1-17.3%) and that of malnutrition risk was 23.9% (95% CI 21.0-27.2%). Malnutrition was found to be associated with advanced age (p = 0.002), female gender (p <0.001), chronic heart failure (p = 0.001), coronary artery disease (p = 0.001), chronic lung disease (p = 0.035), osteoporosis (p = 0.001), and depression (p = 0.001). In geriatric assessment, patients with malnutrition had significantly lower scores for independence in basic and instrumental activities of daily living and cognitive function but higher comorbidity burden, number of drugs used, and depression, sarcopenia, and frailty scores (p <0.001 for all).

CONCLUSIONS: This study showed that malnutrition is highly prevalent in older adults and is associated with chronic diseases and geriatric syndromes such as depression, cognitive impairment, functional dependence, sarcopenia, frailty, and polypharmacy. Therefore, it is essential to provide early nutritional intervention to older individuals who are malnourished or at risk of malnutrition.

PMID:41895839 | DOI:10.6133/apjcn.202604_35(2).0014

Asia Pac J Clin Nutr. 2026 Apr;35(2):347-359. doi: 10.6133/apjcn.202604_35(2).0013.

ABSTRACT

BACKGROUND AND OBJECTIVES: Globally, efforts are underway to evaluate foods and meals by their nutritional value. In Japan, however, there is no comprehensive system for evaluating overall diet quality. The aim of this study is to use the Healthy Eating Index (HEI)-2020, which is based on the American Dietary Guidelines, to evaluate the diet quality of independent elderly Japanese people to consider appropriate methods for evaluating the Japanese diet.

METHODS AND STUDY DESIGN: The subjects were 71 individuals aged 60 years or older who participated in a health examination. HEI-2020 was used to evaluate diet quality, with 13 components scored based on intake per energy unit. Associations of HEI-2020 scores with nutrient intake, food group intake, and dietary reference intakes (DRIs) for Japanese were analysed using statistical methods.

RESULTS: The median HEI-2020 score was 52/100 points. Among the components, the median score was the maximum for Saturated Fats and Added Sugars, but zero for Whole Grains and Refined Grains. The high-score group had significantly lower intake of saturated fatty acids and higher intake of dietary fiber, vitamin K, potassium, and magnesium. In comparison to DRIs, the high-score group had a significantly higher “% meeting the reference value” for several nutrients, including dietary fiber, magnesium, and potassium.

CONCLUSIONS: This study shows that the HEI-2020 can identify nutrients such as dietary fiber and minerals that are lacking in the Japanese population. However, for more effective assessment, there is a need to adjust the reference values to match the intake of Japanese people.

PMID:41895838 | DOI:10.6133/apjcn.202604_35(2).0013

Asia Pac J Clin Nutr. 2026 Apr;35(2):328-336. doi: 10.6133/apjcn.202604_35(2).0011.

ABSTRACT

BACKGROUND AND OBJECTIVES: Diet quality is a key determinant of child growth, yet little is known about its role in stunting-prevalent regions of Indonesia. This study assessed diet quality of young children using a modified Healthy Eating Index (HEI) and examined its associations with growth status and household-maternal factors.

METHODS AND STUDY DESIGN: A cross-sectional study was conducted among 215 children aged 12-59 months in Kulon Progo District, Yogyakarta. Dietary intake was assessed using a semi-quantitative food frequency questionnaire and 24-h recall. The HEI was modified to align with Indonesian dietary guidelines and nutrient adequacy standards. Anthropometry, maternal knowledge, education, and household food security were also measured. Children were classified into tertiles of HEI scores (T1: ≤116, T2: 117-127, T3: ≥128). Associations were analyzed using chi-square, ANOVA/Kruskal-Wallis, and multi-nomial logistic regression.

RESULTS: The mean HEI score was 122 ± 13.3, with 35.8% of children in the low-est tertile. Low intakes of fruits, vegetables, and dairy were the main contributors to poor scores, while grains and fats/oils scored higher. Younger age was independently associated with higher HEI (aOR 0.93; 95%CI 0.88-0.99; p = 0.03). Maternal education, household food security, and maternal knowledge showed no sig-nificant associations.

CONCLUSIONS: Diet quality among children in stunting-prevalent areas remains suboptimal, especially for fruits, vegetables, and dairy. Younger children had better diet quality, underscoring the need for interventions beyond early complementary feeding. Strategies should improve access to diverse, nutrient-rich foods and reduce reliance on processed products.

PMID:41895836 | DOI:10.6133/apjcn.202604_35(2).0011

Asia Pac J Clin Nutr. 2026 Apr;35(2):281-327. doi: 10.6133/apjcn.202604_35(2).0010.

ABSTRACT

BACKGROUND AND OBJECTIVES: In Japan, there are no official dietary guidelines for young children and nutrients may be insufficient on weekends, compared to weekdays at nursery schools. To ensure adequate nutrition, an appropriate dietary evaluation method is required. This study used the Healthy Eating Index (HEI)-2020, which is based on the Dietary Guidelines for Americans, to evaluate the diet quality of Japanese children, examine its validity through associations with nutrient and food group intake, and compare dietary characteristics on weekdays and weekends.

METHODS AND STUDY DESIGN: The participants were 669 children aged 3 to 5 years attending nursery schools across Japan. Relationships of HEI-2020 scores with nutrient and food group intake, and comparisons between weekdays and weekends were evaluated.

RESULTS: The median HEI-2020 score was 50/100, with almost maximum scores for Total Protein Foods, Seafood and Plant Pro-teins, and Added Sugars, while Whole Grains and Refined Grains scored zero. Additionally, the largest score differences between weekdays and weekends were found in Dairy and Greens and Beans. Higher HEI-2020 scores correlated with lower saturated fatty acids intake and higher intakes of dietary fiber, vitamins, and minerals. Weekday scores were significantly higher and less varied than weekend scores.

CONCLUSIONS: HEI-2020 can identify nutrient intake challenges in Japanese children. Greater consumption of Dairy and Greens and Beans-components that showed large weekday-weekend differences-may improve diet quality.

PMID:41895835 | DOI:10.6133/apjcn.202604_35(2).0010

Asia Pac J Clin Nutr. 2026 Apr;35(2):219-230. doi: 10.6133/apjcn.202604_35(2).0005.

ABSTRACT

BACKGROUND AND OBJECTIVES: Weekly iron-folic acid (IFA) supplementation has been implemented in Indonesia to reduce the prevalence of anaemia in adolescent girls. This study aimed to assess the prevalence of anaemia and adherence to weekly IFA supplementation and their associated factors among adolescent girls in senior high schools in two high-stunting-prone areas of Ambon City, Indonesia.

METHODS AND STUDY DESIGN: This cross-sectional study was conducted in August-September 2023, involving 645 adolescent girls enrolled at five senior high schools in two high-stunting-prone areas of Ambon City, namely Poka-Rumah Tiga and Laha Village. The dependent variables were anaemia (i.e., haemoglobin level <12 g/dL) and adherence to weekly IFA supplementation (i.e., consumption of one IFA tablet per week). Factors associated with anaemia and adherence to weekly IFA supplementation were examined using logistic regression.

RESULTS: Of 645 ado-lescent girls surveyed, 19.7% had anaemia, and 19.5% consumed weekly IFA tablets. The likelihood of developing anaemia was associated with respondents with a high level of awareness of anaemia (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.16-2.57). Adherence to taking weekly IFA tablets increased in those with a high level of awareness of IFA supplementation (aOR = 3.88, 95%CI: 2.46-6.10).

CONCLUSIONS: Our study showed that anaemia among adolescent girls represents a moderate to high public health problem, accompanied by low adherence to weekly IFA supplementation among adolescent girls in these areas. Strengthening school-based supplementation, parental engagement, and supply monitoring could enhance programme effectiveness and inform local health policies in Ambon City and other similar settings in Indonesia.

PMID:41895830 | DOI:10.6133/apjcn.202604_35(2).0005

Asia Pac J Clin Nutr. 2026 Apr;35(2):207-218. doi: 10.6133/apjcn.202604_35(2).0004.

ABSTRACT

BACKGROUND AND OBJECTIVES: This cross-sectional study explored the association between dietary patterns and depressive symptoms in middle-aged and older individuals in China.

METHODS AND STUDY DESIGN: A total of 2,956 individuals aged 45-74 years were included in the current data analysis, based on a community-based cross-sectional study from Qingdao, China. Data for this study were derived from field surveys conducted from August 2009 to November 2010. Their mean age was 57.2 ± 8.46 years, and 62.4% were women. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (SQFFQ). Dietary patterns were derived using principal component analysis. Depressive symptoms were assessed using the validated Zung Self-Rating Depression Scale. Logistic regression and restricted cubic spline analyses were conducted to examine the association between dietary patterns and depressive symptoms.

RESULTS: Of the participants, 12.4% had depressive symptoms. These participants were younger, were more likely to be smokers, had a higher body mass index, and had lower income and education levels compared with individuals without depressive symptoms. Four dietary patterns were identified: Balanced, Animal-Pickled vegetables, High sugar-Alcohol, and Animal-Seafood-Egg dietary patterns. The Balanced (odds ratio = 0.53, p < 0.01) and Animal-Seafood-Egg (odds ratio = 0.74, p < 0.01) dietary patterns were negatively associated with depressive symptoms, whereas the Animal-Pickled vegetables dietary pattern was positively associated with depressive symptoms. No significant association was observed for the High sugar-Alcohol dietary pattern. Subgroup analysis revealed stronger inverse effects of Balanced and Animal-Seafood-Egg dietary patterns in women younger than 60 years, nonsmokers, and urban residents compared with in their counterparts. Sensitivity analysis confirmed stability across the continuous and quartile-based variables.

CONCLUSIONS: The Balanced and Animal-Seafood-Egg dietary patterns were associated with lower odds of depressive symptoms, whereas the Animal-Pickled vegetables dietary pattern was associated with higher odds of depressive symptoms.

PMID:41895829 | DOI:10.6133/apjcn.202604_35(2).0004