Objectives: Twin pregnancy implies a higher risk of preterm birth and, consequently, higher neonatal morbidity and mortality. In singleton pregnancies, infections of the lower genital tract (LGTIs) and bacterial vaginosis are associated with preterm labor, and their early detection has been proven effective in reducing complications like the preterm premature rupture of membranes (pPROM) and preterm delivery. The same evidence, however, is lacking for twin pregnancies. This study aimed to evaluate whether the early identification and treatment of LGTIs or bacterial vaginosis in asymptomatic women with twin pregnancy could reduce the rate of miscarriages, pPROM, and preterm birth. Methods: This study performed a retrospective comparison of 285 women with a multiple pregnancy submitted for a cervico-vaginal swab only at 20–22 weeks (Single Test Group, STG), and 199 women who underwent the swab at 12–14 and again at 20–22 weeks (Double Test Group, DTG). All women included in the study had a twin pregnancy and were followed up at Sant’Anna Hospital, Turin (Italy), between September 2012 and February 2021. Results: In STG, 21.7% of patients had a positive swab; in DTG, 19.9% had an early positive swab that was immediately treated by targeted antibiotics; and 16.7% had a mid-pregnancy positive swab. The DTG showed a significantly lower incidence of pPROM in univariate analysis (14.4% vs. 23.1%, p = 0.021), which was confirmed by multivariate analysis (OR 0.55, CI 0.33–0.93, p = 0.025). Conclusions: Our study suggests that, in asymptomatic women with twin pregnancy, the early screening of LGTIs and bacterial vaginosis by a cervico-vaginal swab at 12–14 weeks of gestational age is effective in reducing the risk of pPROM. Full article

Fibrosis is a ubiquitous pathology, and prior studies have indicated that various artemisinin (ART) derivatives (including artesunate (AS), artemether (AM), and dihydroartemisinin (DHA)) can reduce fibrosis in vitro and in vivo. The medicinal plant Artemisia annua L. is the natural source of ART and is widely used, especially in underdeveloped countries, to treat a variety of diseases including malaria. A. afra contains no ART but is also antimalarial. Using human dermal fibroblasts (CRL-2097), we compared the effects of A. annua and A. afra tea infusions, ART, AS, AM, DHA, and a liver metabolite of ART, deoxyART (dART), on fibroblast viability and expression of key fibrotic marker genes after 1 and 4 days of treatment. AS, DHA, and Artemisia teas reduced fibroblast viability 4 d post-treatment in up to 80% of their respective controls. After 4 d of treatment, AS DHA and Artemisia teas downregulated ACTA2 up to 10 fold while ART had no significant effect, and AM increased viability by 10%. MMP1 and MMP3 were upregulated by AS, 17.5 and 32.6 fold, respectively, and by DHA, 8 and 51.8 fold, respectively. ART had no effect, but A. annua and A. afra teas increased MMP3 5 and 16-fold, respectively. Although A. afra tea increased COL3A1 5 fold, MMP1 decreased >7 fold with no change in either transcript by A. annua tea. Although A. annua contains ART, it had a significantly greater anti-fibrotic effect than ART alone but was less effective than A. afra. Immunofluorescent staining for smooth-muscle α-actin (α-SMA) correlated well with the transcriptional responses of drug-treated fibroblasts. Together, proliferation, qPCR, and immunofluorescence results show that treatment with ART, AS, DHA, and the two Artemisia teas yield differing responses, including those related to fibrosis, in human dermal fibroblasts, with evidence also of remodeling of fibrotic ECM. Full article

Cardiovascular diseases (CVDs) represent the leading cause of death globally. Romania recorded the highest mortality rate due to CVDs in the EU in 2022, with 162,984 deaths, while the number of registered patients with CVDs surpassed 4 million. This study aims to measure the population’s potential spatial accessibility to cardiovascular hospitals in Romania, as timely access to such healthcare facilities is crucial to minimise avoidable mortality due to CVDs. Although distance is an essential parameter of spatial accessibility, time-based analysis is more reflective of real-world scenarios due to the unpredictability of travel. The potential spatial accessibility was measured using the Application Program Interface (API) offered through the Google Maps platform and a personal car as the transportation mode. The country’s cardiovascular hospital network comprises 161 units, of which 84 can provide complex care. Because all of them are located in urban areas, three different time slots were considered to distinguish between high and low traffic congestion situations. We created hierarchies of ten-minute and five km intervals for travel time and distance, respectively, to emphasize the population percentages with better or low potential spatial accessibility. Results showed that only 15% of the population can reach the nearest cardiovascular hospital in less than 20 min, and 23% must travel for over 60 min, while 45.7% live farther than 20 km from a cardiovascular hospital. Inhabitants living in remote areas, especially rural ones, are the most vulnerable, having to travel for the longest time and distance. Actions like improving the existing transport infrastructure and upgrading healthcare facilities and equipment are needed to ensure better medical care and an adequate response to population needs. This study can support local authorities in optimising spatial accessibility to cardiovascular care by identifying the most burdened hospitals in the context of low medical specialised staff and large catchment areas. Full article

Despite the high prevalence of mental health difficulties during the period of emerging adulthood and the availability of mental health resources, young adults are reluctant to seek professional psychological help. A significant contributor to this treatment gap is the inadequate levels of mental health literacy (MHL). The present study aimed to investigate the association between MHL with attitudes toward mental illness and the self-stigma of seeking psychological treatment among university students. The sample consisted of 485 university students (24.5% males, 75.5% females) with a mean age of 19.54 years (SD = 1.45) drawn from a regional university in Greece. MHL, attitudes towards severe mental illness, and self-stigma of help-seeking were assessed using the Mental Health Literacy Scale (MHLS), the Attitudes towards Severe Mental Illness (ASMI), and the Self-Stigma of Seeking Help Scale (SSOSH), respectively. MHLS was positively correlated with three out of four subscales of ASMI, namely stereotyping, optimism, and coping, and negatively related to SSOSH. Multivariate linear regression analysis adjusting for various confounders showed that students with higher MHL were more likely to report non-stigmatizing attitudes towards mental illness and lower self-stigma of help-seeking from mental health professionals. According to our findings, higher MHL was related to more positive views regarding mental illness and lower self-stigma of help-seeking. To lessen the self-stigma of seeking professional help, MHL must be addressed as an important component of psychoeducational interventions at universities aiming to support students’ help-seeking intentions and practices. Full article

The incorporation of distributed generation with photovoltaic systems entails a drawback associated with intermittency in the generation capacity due to variations in the solar resource. In general, this aspect limits the level of penetration that this resource can have without producing an appreciable impact on the quality of the electrical supply. With the intention of reducing its intermittency, this paper presents the characterization of a methodology for maximizing grid-connected PV system operation under low-solar-radiation conditions. A new concept of a hybrid system based on a constant current source and capable of integrating different sources into a conventional grid-connected PV system is presented. Results of an experimental characterization of a low-voltage grid–PV system connection with a DC/DC converter for constant-current source application are shown in zero and non-zero radiation conditions. The results obtained demonstrate that the proposed integration method works efficiently without causing appreciable effects on the parameters that define the quality of the electrical supply. In this way, it is possible to efficiently incorporate another source of energy, taking advantage of the characteristics of the GCPVS without further interventions in the system. It is expected that this topology could help to integrate other generation and/or storage technologies into already existing PV systems, opening a wide field of research in the PV systems area. Full article

Judges have long wrestled with the gigantean task of defining religion, with some describing the task as being ‘called upon to ponder the imponderable’, an impossible task, and even misguided. Despite these sentiments, and comments in almost every legal definition expressing the impossibility of the task, judges have, in fact, been able to come up with numerous legal definitions for religion. These have been applied in myriad circumstances to define the outer limits of the rights and responsibilities of states, religious communities, organisations, and individuals. By contrast, the term secular has rarely been judicially defined. However, it is no-less important in defining the rights and responsibilities of states and their citizens and residents, particularly in light of the number of states that claim, implicitly or explicitly, to be secular. This paper, therefore, (re)examines the definition of the secular as it pertains to the concept of the secular state. It considers the need for a legal definition of the secular with particular reference to constitutional and other legal instruments that include the term. It then examines the difference between the terms secular, secularisation and secularism, noting the often erroneous conflation as well as the inevitable interaction and overlap between these key concepts. Finally, drawing on existing classifications of legal definitions of religion, the paper classifies definitions of the secular into three overarching classifications, namely ‘historical’, ‘substantive’ and ‘characteristic’. Full article

Breast cancer is one of the most common cancers worldwide, at the same time being one of the most prevalent causes of women’s death. Many factors such as alcohol, weight fluctuations, or hormonal replacement therapy can potentially contribute to breast cancer development and progression. Another important factor in breast cancer onset includes micronutrient status. In this narrative review, we analyzed 23 micronutrients and their possible influence on breast cancer onset and progression. Further, the aim of this study was to investigate the impact of micronutrient status on the prevention of breast cancer and its possible influence on various therapeutic pathways. We researched meta-analyses, systemic and narrative reviews, retrospective studies, as well as original studies on human and animal models. The results of these studies indicate a possible correlation between the different levels of micronutrients and a decreased risk of breast cancer as well as a better survival rate. However, further studies are necessary to establish adequate doses of supplementation of the chosen micronutrients and the exact mechanisms of micronutrient impact on breast cancer therapy. Full article

During the operation of space gravitational wave detectors, the constellation configuration formed by three satellites gradually deviates from the ideal 60° angle due to the periodic variations in orbits. To ensure the stability of inter-satellite laser links, active compensation of the breathing angle variation within the constellation plane is achieved by rotating the optical subassembly through the telescope pointing mechanism. This paper proposes a high-performance robust composite control method designed to enhance the robust stability, disturbance rejection, and tracking performance of the telescope pointing system. Specifically, based on the dynamic model of the telescope pointing mechanism and the disturbance noise model, an H_∞ controller has been designed to ensure system stability and disturbance rejection capabilities. Meanwhile, employing the method of an H_∞ norm optimized disturbance observer (HODOB) enhances the nonlinear friction rejection ability of the telescope pointing system. The simulation results indicate that, compared to the traditional disturbance observer (DOB) design, utilizing the HODOB method can enhance the tracking accuracy and pointing stability of the telescope pointing system by an order of magnitude. Furthermore, the proposed composite control method improves the overall system performance, ensuring that the stability of the telescope pointing system meets the 10 nrad/Hz^1/2 @0.1 mHz~1 Hz requirement specified for the TianQin mission. Full article

Bronchial asthma is characterized by airway inflammation, airway hyperresponsiveness, and reversible airway obstruction. Eosinophils contribute to the pathogenesis of airway disease mainly by releasing eosinophil-specific granules, lipid mediators, superoxide anions, and their DNA. Type-2 cytokines such as interleukin (IL)-4 and IL-13 also play roles in the development of bronchial asthma. Among these cytokines, IL-4 is involved in T-cell differentiation, B-cell activation, B-cell differentiation into plasma cells, and the production of immunoglobulin E. Although IL-13 has similar effects to IL-4, IL-13 mainly affects structural cells, such as epithelial cells, smooth muscle cells, and fibroblasts. IL-13 induces the differentiation of goblet cells that produce mucus and induces the airway remodeling, including smooth muscle hypertrophy. IL-4 and IL-13 do not directly activate the effector functions of eosinophils; however, they can induce eosinophilic airway inflammation by upregulating the expression of vascular cell adhesion molecule-1 (for adhesion) and CC chemokine receptor 3 ligands (for migration). Dupilumab, a human anti-IL-4 receptor α monoclonal antibody that inhibits IL-4 and IL-13 signaling, decreases asthma exacerbations and mucus plugs and increases lung function in moderate to severe asthma. In addition, dupilumab is effective for chronic rhinosinusitis with nasal polyps and for atopic dermatitis, and IL-4/IL-13 blocking is expected to suppress allergen sensitization, including transcutaneous sensitization and atopic march. Full article

Freeze–thaw (FT) erosion intensity may exhibit a future increasing trend with climate warming, humidification, and permafrost degradation in the Qinghai–Tibet Plateau (QTP). The present study provides a reference for the prevention and control of FT erosion in the QTP, as well as for the protection and restoration of the regional ecological environment. FT erosion is the third major type of soil erosion after water and wind erosion. Although FT erosion is one of the major soil erosion types in cold regions, it has been studied relatively little in the past because of the complexity of several influencing factors and the involvement of shallow surface layers at certain depths. The QTP is an important ecological barrier area in China. However, this area is characterized by harsh climatic and fragile environmental conditions, as well as by frequent FT erosion events, making it necessary to conduct research on FT erosion. In this paper, a total of 11 meteorological, vegetation, topographic, geomorphological, and geological factors were selected and assigned analytic hierarchy process (AHP)-based weights to evaluate the FT erosion intensity in the QTP using a comprehensive evaluation index method. In addition, the single effects of the selected influencing factors on the FT erosion intensity were further evaluated in this study. According to the obtained results, the total FT erosion area covered 1.61 × 10⁶ km², accounting for 61.33% of the total area of the QTP. The moderate and strong FT erosion intensity classes covered 6.19 × 10⁵ km², accounting for 38.37% of the total FT erosion area in the QTP. The results revealed substantial variations in the spatial distribution of the FT erosion intensity in the QTP. Indeed, the moderate and strong erosion areas were mainly located in the high mountain areas and the hilly part of the Hoh Xil frozen soil region. Full article

Sentiment Analysis in text, especially text containing scientific citations, is an emerging research field with important applications in the research community. This review explores the field of sentiment analysis by focusing on the interpretation of citations, presenting a detailed description of techniques and methods ranging from lexicon-based approaches to Machine and Deep Learning models. The importance of understanding both the emotion and the intention behind citations is emphasized, reflecting their critical role in scientific communication. In addition, this study presents the challenges faced by researchers (such as complex scientific terminology, multilingualism, and the abstract nature of scientific discourse), highlighting the need for specialized language processing techniques. Finally, future research directions include improving the quality of datasets as well as exploring architectures and models to improve the accuracy of sentiment detection. Full article

This study investigates the interaction between static and fatigue strength and the rheological properties of acrylonitrile–butadiene–styrene (ABS) polymer reinforced with graphene nanoplatelets (GNPs) in both filament and 3D-printed forms. Specifically focusing on the effects of 1.0 wt.% GNPs, the study examines their influence on static/fatigue responses. The rheological behaviour of pure ABS polymer and ABS/GNPs nanocomposite samples, fabricated through material extrusion, is evaluated. The results indicated that the addition of 1.0 wt.% GNPs to the ABS matrix improved the elastic modulus of the nanocomposite filaments by up to about 34%, while reducing their ductility by approximately 60%. Observations revealed that the static and fatigue responses of the composite filament materials and 3D-printed parts were not solely attributed to differences in mechanical properties, but were also influenced by extrusion-related process parameters. The shark-skin effect, directly related to the material’s rheological properties, had a major impact on static strength and fatigue life. The proposed method involved adjusting the temperature of the heating zones of the extruder during filament production to enhance the static response of the filament and using a higher nozzle temperature (270 °C) to improve the fatigue life of the 3D-printed samples. The findings reveal that the proposed parameter optimisation led to filaments with minimised shark-skin effects, resulting in an improvement in ultimate tensile strength compared to pure ABS. Moreover, the 3D-printed samples produced with a higher nozzle temperature exhibited increased fatigue lives compared to those manufactured under identical conditions as pure ABS. Full article

Sepsis is one of the major causes of morbidity and mortality in hospitals, especially in low- and middle-income countries, and represents a challenge to health care providers to carry out early detection, and accurate diagnosis and prognosis with cost-effective diagnostic tools. An observational prospective study was conducted from December 2021 to December 2022 to investigate the extended inflammatory parameters (EIPs) for sepsis management and analyze the survival of septic patients in the emergency unit, intensive care unit (ICU) and inpatient ward. Patients suspected of having sepsis underwent a sequential organ failure assessment (SOFA) evaluation and had blood drawn for complete blood counts (CBCs). Significant changes were observed in various CBC parameters and EIPs, and the sepsis group was followed up with for 30-day mortality. The study highlighted a significant difference yet strong discriminatory power to differentiate sepsis with an AUC of 0.924 against the non-sepsis group and an AUC of 0.991 against the healthy control group using combination of white blood cells and EIPs. Furthermore, the study showed good predictive ability for 30-day mortality with a hazard ratio of 2.311. In summary, this study provides evidence that the utilization of EIPs may be valuable in diagnosing and predicting patient outcomes, and thus will be beneficial for sepsis management in the hospital. Full article

Vegetation coverage is a crucial parameter in agriculture, as it offers essential insight into crop growth and health conditions. The spatial resolution of spaceborne sensors is limited, hindering the precise measurement of vegetation coverage. Consequently, fine-resolution ground observation data are indispensable for establishing correlations between remotely sensed reflectance and plant coverage. We estimated rice plant coverage per pixel using time-series Sentinel-2 Multispectral Instrument (MSI) data, enabling the monitoring of rice growth conditions over a wide area. Coverage was calculated using unmanned aerial vehicle (UAV) data with a spatial resolution of 3 cm with the spectral unmixing method. Coverage maps were generated every 2–3 weeks throughout the rice-growing season. Subsequently, crop growth was estimated at 10 m resolution through multiple linear regression utilizing Sentinel-2 MSI reflectance data and coverage maps. In this process, a geometric registration of MSI and UAV data was conducted to improve their spatial agreement. The coefficients of determination (R²) of the multiple linear regression models were 0.92 and 0.94 for the Level-1C and Level-2A products of Sentinel-2 MSI, respectively. The root mean square errors of estimated rice plant coverage were 10.77% and 9.34%, respectively. This study highlights the promise of satellite time-series models for accurate estimation of rice plant coverage. Full article

Background: Common bile duct (CBD) stones may pass spontaneously without any intervention. Assessment of the predictors of spontaneous passage can contribute to avoiding unnecessary endoscopic retrograde cholangiopancreatography (ERCP) implementation. This study aimed to investigate the factors related to spontaneous passage of CBD stones. Methods: From January 2021 to August 2023, patients with naïve papilla who had undergone biliary ERCP and with CBD stones detected by MRCP before the procedure were analyzed retrospectively. Subjects were divided into two groups on the basis of the presence of stones during the ERCP procedure: the spontaneous passage group and the non-passage group. Groups were compared in terms of demographic, laboratory, and radiological data. Results: A total of 236 patients, including 26 in the spontaneous passage group and 210 in the non-passage group, were involved. Multivariate logistic regression analyses revealed that only stone size was significantly associated with spontaneous passage. From ROC curve analysis, stone size with a cut-off value of 4.3 mm predicted spontaneous passage with 58% sensitivity and 85% specificity. Conclusions: Stones with a size of less than 4.3 mm are more likely to pass spontaneously without endoscopic intervention. Paying attention to the stone diameter before ERCP procedures can contribute to avoiding unnecessary ERCP implementation. Full article

This work aimed to develop gluten-free snacks such as crispbread based on beetroot pomace (Beta vulgaris L.) and golden linseed (Lini semen). Beetroot is attracting more and more consumer attention because of its nutritional and health properties. The use of beet pomace contributes to waste management. Linseed, known as a superfood with many health-promoting properties, was used to produce crispbreads as an alternative to cereals, which are allergens. Beetroot pomace and whole or ground linseed were used in different proportions to produce crispbread snacks. Chemical and physical analyses were performed including water activity, dry matter, betalains, and polyphenols content, as well as Fourier transform infrared spectroscopy (FTIR). A sensory evaluation and microstructure observations were also performed. The obtained snacks were characterized by low water activity (0.290–0.395) and a high dry matter content (93.43–97.53%), which ensures their microbiological stability and enables longer storage. Beetroot pomace provided betalains—red (14.59–51.44 mg betanin/100 g d.m.) and yellow dyes (50.02–171.12 mg betanin/100 g d.m.)—while using linseed enriched the product with polyphenols (730–948 mg chlorogenic acid/100 g d.m.). FTIR analysis showed the presence of functional groups such as the following: -OH, -C-O, -COOH, and -NH. The most desired overall consumer acceptability was achieved for snacks containing 50% beetroot pomace and 50% linseed seeds. The obtained results confirmed that beetroot pomace combined with linseed can be used in the production of vegetable crispbread snacks. Full article

This study investigates the prevalence of resistance and virulence genes in Klebsiella isolates from surface waters in Northern Portugal, within the broader context of freshwater quality challenges in Southern Europe. The aim of this research is to explain how Klebsiella dynamics, antibiotic resistance, and biofilm formation interact in surface waters. Antimicrobial susceptibility was examined using the Kirby–Bauer disk diffusion method against 11 antibiotics and screening for Extended-Spectrum Beta-Lactamase (ESBL) production using the double-disk synergy. PCR was employed to detect resistance and virulence genes, while biofilm production was assessed using the microplate method. Out of 77 water isolates, 33 Klebsiella (14 Klebsiella spp. and 19 K. pneumoniae strains) were isolated. ESBL production was observed in 36.8% of K. pneumoniae and 28.6% of Klebsiella spp. High resistance rates to bla_CTX-U were observed in both. The papC gene was prevalent, signifying potential environmental risks. Biofilm production averaged 81.3% for K. pneumoniae and 86.9% for Klebsiella spp. These findings underscore the intricate interplay between Klebsiella’s dynamics and freshwater quality, with ESBL’s prevalence raising concerns about waterborne dissemination and public health implications. This work supports the need for vigilance of Klebsiella in surface waters in Southern Europe. Full article

Background: Diabetes mellitus (DM) and osteoporosis are two of the most widespread metabolic diseases in the world. The aim of this study is to investigate the prevalence of DM among patients affected by osteoporosis and fragility fractures, and to search for differences in clinical characteristics. Methods: This is a single-center retrospective, case–controlled study. A total of 589 patients attending CTO Bone Unit between 2 January 2010 and 31 May 2023, due to osteoporosis and fragility fractures, were divided into two groups, according to the diagnosis of DM. The clinical and bone characteristics of patients were compared. Results: Prevalence of DM was 12.7%. Compared to patients without DM, the median age at the time of first fracture was similar: 72 years ± 13.5 interquartile range (IQR) vs. 71 years ± 12 IQR; prevalence of combination of vertebral and hip fractures was higher (p = 0.008), as well as prevalence of males (p = 0.016). Bone mineral density (BMD) at all sites was higher in DM group; trabecular bone score (TBS), instead, was significantly lower (p < 0.001). Conclusions: Patients with fragility fractures and DM more frequently show combination of major fractures with higher BMD levels. In these patients, TBS could be a better indicator of bone health than BMD and, therefore, might be used as a diagnostic tool in clinical practice. Full article

Fatsia japonica plays an important role as a commonly used plant in urban landscaping. From 2022 to 2023, a root rot infestation was observed that caused extensive wilting of Fatsia japonica without leaf shedding and eventual death of the plant, severely reducing the ornamental qualities of the plant as well as the vigor of its growth. Fusarium species were isolated from the roots of the affected plants, exhibiting abundant and dense yellow mycelial colonies that proliferated radially from the center of the Petri dishes. Morphological examinations revealed the presence of falciform macro- and microconidia consistent with Fusarium, as well as chlamydospores characterized by their thick walls. For further identification, the amplification and sequencing of the ITS, TEF1 alpha, and RPB2 alpha genes were performed. Finally, healthy Fatsia japonica plants were inoculated with a spore suspension of the pathogen, to confirm that the disease symptoms were compatible with naturally occurring infection. Fusarium vanettenii was identified as the causative agent of Fatsia japonica root rot. To the best of our knowledge, this is the first report of F. vanettenii causing root rot of Fatsia japonica in China. Full article

Wildland fires cause economic and ecological damage with devastating consequences, including loss of life. To reduce these risks, numerous fire detection and recognition systems using deep learning techniques have been developed. However, the limited availability of annotated datasets has decelerated the development of reliable deep learning techniques for detecting and monitoring fires. For such, a novel dataset, namely, SWIFT, is presented in this paper for detecting and recognizing wildland smoke and fires. SWIFT includes a large number of synthetic images and videos of smoke and wildfire with their corresponding annotations, as well as environmental data, including temperature, humidity, wind direction, and speed. It represents various wildland fire scenarios collected from multiple viewpoints, covering forest interior views, views near active fires, ground views, and aerial views. In addition, three deep learning models, namely, BoucaNet, DC-Fire, and CT-Fire, are adopted to recognize forest fires and address their related challenges. These models are trained using the SWIFT dataset and tested using real fire images. BoucaNet performed well in recognizing wildland fires and overcoming challenging limitations, including the complexity of the background, the variation in smoke and wildfire features, and the detection of small wildland fire areas. This shows the potential of sim-to-real deep learning in wildland fires. Full article

Statement of problem: Urbanization has brought significant advancements in human well-being; however, it poses challenges to urban green spaces (UGSs), affecting environmental quality and public health. Research gap: Previous studies have established the importance of UGSs for urban well-being but have not sufficiently explored how the naturalness of these spaces—ranging from untouched natural areas to human-designed landscapes—affects mental health outcomes in the context of developing countries, particularly Brazil. Purpose: This study aimed to bridge the research gap by investigating the relationship between the degree of naturalness in UGSs and mental health among residents of Brazilian metropolitan areas. Method: Data were collected through an online survey involving 2136 respondents from various Brazilian urban regions. The study used Welch’s ANOVA and Games–Howell post hoc tests to analyze the impact of UGS naturalness on mental health, considering depression, anxiety, and stress levels. Results and conclusions: The findings revealed that higher degrees of naturalness in UGSs significantly correlate with lower levels of mental distress. These results underscore the necessity of integrating natural elements into urban planning to enhance public health. Practical implications: Urban planners and policymakers are encouraged to prioritize the preservation and creation of naturalistic UGSs in urban environments to improve mental health outcomes. Future directions: Further research should explore the specific attributes of naturalness that most contribute to well-being and examine the scalability of these findings across different cultural and environmental contexts. Full article

This study aims to describe the epidemiological and clinical characteristics and trends of these admissions in Spain. This retrospective study drew data from the Hospital Discharge Records Database of the Spanish National Health System. We used the diagnostic codes for leprosy from the International Classification of Diseases, ninth and tenth revisions, to retrieve leprosy admissions from 1997 to 2021. There were 1387 hospitalizations for leprosy The number of annual cases decreased gradually, from 341 cases in 1997–2001 to 232 in 2017–2021 (p < 0.001). Patients’ median age increased, from 65 years in 1997–2001 to 76 years in 2017–2021 (p < 0.001), as did the prevalence of some comorbidities, such as hypertension (15% in 1997–2001 to 27.6% in 2017–2021; p < 0.001). The mortality rate (6%) and the frequency of leprosy complications remained stable. After Spain (79.1%), the most common country of origin was Paraguay (4.4%). Admissions decreased significantly in Andalusia, from 42% in 1997–2001 to 10.8% in 2017–2021 (p < 0.001), and in the Canary Islands, from 7.9% in 1997–2001 to 2.6% in 2017–2021 (p = 0.001), whereas they increased in Madrid, from 5.9% in 1997–2001 to 12.1% in 2017–2021 (p = 0.005). Overall, leprosy admissions in Spain have declined, even in the regions with the highest prevalence. Patients admitted for leprosy have become older and sicker. Full article